Liver Values For Spencer

[greyhead]

Spencer's liver values are very high, though lower than last week. Anybody have any experience with numbers like these? (I'm waiting to hear from his internist but won't for 4+ hours. I hope she'll call back today because she doesn't work again until Monday.) Regular vet wrote: "The primary liver value ALT is relatively unchanged. There is a decrease in ALP and GGT is back to normal." (ALP was in the 600's a week ago.)

 

In anticipation of questions, his diet is entirely venison, 2/3 raw at this point and 1/3 Natural Balance kibble and Wellness canned. He has tended to be dehydrated, and we gave him 1000 mL of fluids sub-q over the weekend. (So even after that the sample was hemolyzed Monday!) He's also losing weight slowly but surely, down to 73 lbs, which is close to where he was after his 20-lb SIBO and IBD weight loss. We had gotten him back up to 80 lbs. His teeth could use a dental, which he can't have with these numbers. I'm thinking of requesting dental x-rays anyhow; can they be obtained without anesthesia? Many thanks for any and all thoughts/experiences.

 

ETA: He's on a lowered budesonide dose of 1 mg every other day. Maybe we can eliminate it entirely, since he's doing okay with the IBD even after we discontinued the Flagyl and the Tylan three weeks ago.

 

 

Test Requested Results Reference Range Units

 

Superchem

 

Total Protein 5.9 5.0-7.4 g/dL

 

Albumin 3.2 2.7-4.4 g/dL

 

Globulin 2.7 1.6-3.6 g/dL

 

A/G Ratio 1.2 0.8-2.0

 

AST (SGOT) 69 (HIGH) 15-66 IU/L

 

ALT (SGPT) 281 (HIGH) 12-118 IU/L

 

Alk Phosphatase 469 (HIGH) 5-131 IU/L

 

GGT 10 1-12 IU/L

 

Total Bilirubin 0.2 0.1-0.3 mg/dL

 

BUN 16 6-31 mg/dL

 

Creatinine 1.3 0.5-1.6 mg/dL

 

BUN/Creatinine Ratio 12 4-27

 

Phosphorus 4.9 2.5-6.0 mg/dL

 

Glucose 100 70-138 mg/dL

 

Calcium 9.5 8.9-11.4 mg/dL

 

Corrected Calcium 9.8

 

Magnesium 1.7 1.5-2.5 mEq/L

 

Sodium 151 139-154 mEq/L

 

Potassium 4.3 3.6-5.5 mEq/L

 

Na/K Ratio 35 27-38

 

Chloride 114 102-120 mEq/L

 

Cholesterol 139 92-324 mg/dL

 

Triglyceride 62 29-291 mg/dL

 

Amylase 892 290-1125 IU/L

 

Lipase 176 77-695 IU/L

 

CPK 245 59-895 IU/L

 

Comment

 

Hemolysis 1+, the following results may be affected by this degree of

 

hemolysis:

 

-INCREASE-

 

ALT may be increased by 15-20%

 

AST may be increased up to 10%

 

LDH may be increased up to 20%

 

-DECREASED-

 

Direct Bilirubin may be decreased up to 80%

Edited May 27, 2011 by greyhead

[Guest BiancasMom]

Hemolysis is caused by the blood draw, technician's fault. Sounds like his numbers are all improved. That's gotta be good, right?

[greyhead]

Hemolysis is caused by the blood draw, technician's fault. Sounds like his numbers are all improved. That's gotta be good, right?

Well, in fairness to the techs, he has been very dehydrated, and his PCV was 74 on his last draw. Plus, he had eaten (a little) four hours before this draw because you just can't fast a dog this skinny! If I'm not mistaken, blood that thick tends to hemolyze.

 

But, yes, there has been a mild improvement in a couple values since last time. I'm clutching that thought for dear life!

[Guest JillinMichigan]

Birch had 2 liver enzymes that were high over a year ago (I can't remember which 2 now). I had an ultrasound done, and they could not see anything abnormal. He was put on Sam-E (S-Adenosyl 225 mg) once a day. After a couple of months it made the 2 enzymes get back into the normal range. He then developed soft tissue sarcoma that we discovered a couple of months ago during his dental, and his tumor was removed successfully about a month ago. My vet increased the Sam-E from once a day to twice a day because of the anaesthesia and the DeraMaxx and Tramadol pain medicine he was on for about 6 weeks until about a week ago. Even though he is not on pain meds currently, I am still giving him Sam-E twice a day just to "flush" his system, I guess. I am going to have his liver enzymes tested again in a couple of months to see how he is doing (since the vet recommended he be tested every 6 months at least). I could tell he was more energetic and playful after starting the Sam-E, and the tumor on his right rear leg actually did not slow him down, except after it was removed "aggressively" the second time he had to heal and not do anything for 3 weeks because of the stitches. The first time it was just removed during his dental and sent out for testing, but the margins were not 3 cm all around, so he went back a month later to have more tissue removed, and the margins were good this time. I have asked my vet for the bloodwork/lab results so I can put more details in when I get them for you.

Edited May 18, 2011 by JillinMichigan

[greyhead]

Thanks so much, Jill, for your reply. I'm so glad things worked out well for Birch! My heart is in my throat, frankly. It's one of those times when if I had my way, the world would just stop and take care of Spencer! Can't even believe I'm keeping my eye-exam appointment this afternoon! I really appreciate that you're willing to look up those numbers!

[GeorgeofNE]

Are you giving him any supplements?

 

My vet had suggested Valerian Root for George's anxiety, and within weeks his ALT was out of control.

 

Stopped the stuff, and they went back to normal within a month.

[tbhounds]

Keep in mind that GH's ALT and AST run higher than non- GH breeds. Many times when you see a spike in these numbers you can blame medications or toxins. Corticosteroids will increase liver values greatly (budesonide). Another reason to have elavated ALP values would be from some conditions like Cushings disease. I would get your boy on Dernamarin-- it's not cheap but, IMO it's the best available to help support the liver while it heals. Also, you might want to ask your vet about running a bile acid test but, I'm not sure if budesonide to alter the results.

Honestly, I feel the rest of the blood work looks good.

The hemolysis was most likely from the draw itself or the way the blood was placed into to blood tube-- it's not an uncommon event. Hemolysis has nothing to fo with feeding-- it's the draw.

Sorry in advance for typos-- I'm on my phone-- can hardly see what I'm typing!! Na- don't need those glasses!

[packmom]

When Leeanna was 11 she suddenly got sick and her liver values were 100 times higher than they should be. A cause could not be determined. Of course, she was hospitalized but one of the drugs she was given was Denamarin. She recovered fully.

[greyhead]

Thank you, everyone!

 

The internist just called, and she wants the bile acids run. If that comes back normal, she wants to go ahead and have the dental done. She said we can lower the budesonide more, but she didn't say how much. Since he's getting 1 mg every other day, I'm thinking every thrid day. (The capsules are so small, they're about impossible to open, so I'd have to order more of the .5 mg size, which will take a while.)

 

The regular vet says she has the right anesthesia for dogs with iffy liver values. But she's worried about his weight loss and seems to think his GI status is not great. (I think it's pretty good myself, and I think she's just not focused on how little medicine he's on!) She's afraid that doing a dental could put Spencer into some kind of stress-colitis crisis.

 

So the internist is trying to call the vet. When they figure it out, we'll have a plan. But I'm not as scared as I was a few hours ago. Leeanna's story is especially heartening!

 

I've been giving Spencer 200 mg. sam-e per day. (400 seems to give him diarrhea.) Could I also give milk thistle too and have it more or less add up to Denamarin for the time being? (I'm not sure where to get Denamarin; does it need a prescription?)

 

Thanks again. You guys are the best!

[tbhounds]

Don't need a script for the denamarin. The benefit of using denamarin vs other is the dosage is standarized (it's made by nutramax). It is reccomened to be given on an empty stomach-- preferably in the a.m. after an overnight fast. It's sold in blister packs-- only open one tablet as needed- very unstable once it's introduced to air.

I was able to give my Poots 1mg of budesonide every 3 days-- he stayed stable on that dose for quite a while. He never had hair loss like Spencer so, prehsps Spencer is more senitive to corticosteroids ? His blood protein values look great-- I would bet he will do well with that freqency.

Keep us posted! Again, sorry for the typos :-)

Edited May 19, 2011 by tbhounds

[greyhead]

Don't need a script for the denamarin. The benefit of using denamarin vs other is the dosage is standarized (it's made by nutramax). It is reccomened to be given on an empty stomach-- preferably in the a.m. after an overnight fast. It's sold in blister packs-- only open one tablet as needed- very unstable once it's introduced to air.

I was able to give my Poots 1mg of budesonide every 3 days-- he stayed stable on that dose for quite a while. He never had hair loss like Spencer so, prehsps Spencer is more senitive to corticosteroids ? His blood protein values look great-- I would bet he will do well with that freqency.

Keep us posted! Again, sorry for the typos :-)

What typos?!

I'll bet my neighborhood pharmacy will have Denamarin. (They're small and have a specialty with supplements and holistic things.) I'll check in the morning.

You remember about his hair loss, bless your heart. Actually, it started growing back after we lowered his dose to 1 mg and then to .5. You can really tell on his chest! Was Poots on anything else at the same time as the budesonide? I wonder if having two antibiotics in addition to the budesonide was unhelpful from the perspective of liver toxity. Tonight his poop was awful -- too dark, smelly, and runny. So I wonder if that means we'll have to start at least the Tylan again.

 

Thanks much, Tracy!

Edited May 19, 2011 by greyhead

[GreyTzu]

Denamarin at a good price.

 

I also have Denamarin and other stuff left over from Donner. I am interesting in selling the whole package of stuff for like $120.00. Contains about 50 Denamarin, Marin and two new bottles of Standard Process supplements, along with part open bottles of each.

[JJNg]

Mary, were the elevated liver enzymes initially found on routine screening bloodwork, or was the bloodwork done because he's developed new problems? I don't know Spencer's full history and what kinds of medications and supplements he's currently on (anything besides the budesonide?). But those numbers really don't look that bad to me. ALT tends to be the one that concerns me more as it is specific to damage to liver cells. I'd consider an ALT level that is about 2-3 times the high end of normal to be a fairly mild elevation. With more severe problems, ALT can get into the thousands. As tbhounds mentioned, ALP is often elevated due to steroids, and it can also be elevated in older dogs just from benign, age-related changes in the liver.

 

As the organ that processes most of the medications, toxins, and other 'bad things' that we are exposed to on a daily basis, the liver is always subject insults. Any of these day-to-day insults can cause temporary increases in liver enzymes, and then they go back down as the toxin is cleared and liver cells regenerate. It typically takes liver enzymes about 3-4 weeks go return to normal after a transient elevation in response to dealing with toxins. So when I find elevated liver values on routine screening bloodwork in a dog who isn't showing any clinical signs, I usually just recheck after that time to see if the values have returned to normal, remained stable, or have increased further.

 

Obviously if the dog is ill, a more aggressive workup needs to be done more quickly. And your vets may be more cautious with Spencer because of his IBD. The recheck liver values after 3-4 weeks often determines how concerned we need to be about the numbers. If they are all back to normal, I chalk it up to temporary toxin exposure (such as eating something mildly poisonous, or something moldy and decaying in the yard, or even bacteria in raw food). If the values are still high, especially if there's an increase, then the next steps are usually bile acids and abdominal ultrasound to determine what's going on inside the liver. Liver enzymes like ALT and ALP only show damage to liver cells. Bile acids give an indication of overall liver function.

 

Keep in mind that GH's ALT and AST run higher than non- GH breeds.

Do you have a reference for this? In everything I've come across about greyhound blood values, I don't remember anything about liver enzymes being different. Would be interested in more info. Thanks!

 

Denamarin is combination of SAMe and the active ingredient in milk thistle, silybin. Here's the Nutramax page on Denamarin for more info. It's a veterinary product, so you local pharmacy probably won't carry it. You'd probably have to get it from your vet or online.

[greyhead]

Jennifer, I always love to hear from you! Spencer did have routine blood work done three weeks ago at his regular, periodic internist exam. She noted that his left lymph node was slightly swollen in his neck and thought it might be due to needing a dental. (His regular vet kind of resists doing dentals on him more than once a year, but he has always had bad teeth, and he may have an infection.) Internist drew the blood and sent him home with 10 days' worth of cephalexin (500 mg). But when the bloodwork results came in the next day, it showed the elevated liver values: ALP = 641 (10-84), ALT = 216 (5-65), GGT 18 (0-10). Metronidazole and tylosin for his IBD were to be discontinued while taking the cephalexin anyhow, but after these results she reduced his budesonide from 1.5 mg/day to 1 mg every other day. The dental was scheduled to occur a week after the cephalexin was stopped, and pre-anesthesia blood work was going to be done on the day of the dental.

 

Uncomfortable with waiting that long to see what the liver was doing, I took Spencer to his vet last Thursday to check his liver values in house. But he was dehydrated enough that his blood was too thick for their equipment to run the sample. I informed the internist, who said give him 500 mg sub-q fluids. We did that Friday and gave him 250 more on Sunday. (For some reason, Spencer isn't drinking as much as he should. Like when he returns from a walk, he doesn't always head for the water bowl the way he usually would.) They took this latest sample on Tuesday and sent it out to a lab. Results came back today, and here we are. The vet wants the internist to "reevaluate" him.

 

The only supplement he has been getting is SAM-e, 200 mg every 1-2 days. I've been afraid to add milk thistle until a vet says it's okay, just because IBD dogs can even react to toothpaste! (He was taking 1000 mg L-glutamine before, but I stopped it when he went on the cephalexin and the liver values showed up wonky.) I doubt he got into anything bad outdoors or in, btw, because he's watched too closely for that.

 

He had a bad poop on his walk with my husband. (He hasn't been eating as much as normal, and I guess that could be either from the mouth or the liver status.) Now I'm worried that he needs to go back on his tylosin and/or metronidazole, but that can be toxic too. (He's been on all these IBD-related meds for about two years.)

 

QUESTIONS: Might the dehydration relate to the liver? What makes a dog not want to drink even after a walk?! Might the not eating relate to the liver? Can he get by with those liver values long-term, as he might have to if he has to keep taking the meds for his IBD? If the bile acids are good, will it be reasonably safe to do the dental? (The vet thinks her anesthesia will allow work to proceed with his liver values.)

 

Hearing that these liver values aren't all that bad is helpful! But I always come back to the thought that Spencer is not only 10, he's an old 10. [He's had a truly terrible case of hookworm, lumbosacral stenosis, intestinal malabsorption, SIBO (Clostridium perfringens), and moderate-to-severe IBD.] Doing a dental is always a risk, this one will be riskier, and not doing one may be the riskiest thing of all! So when I tell you and others that I appreciate your input now, I REALLY mean it! I know he won't last forever, but I don't want to lose him over this, after all he has toughed his way through.

[greyhead]

Denamarin at a good price.

 

I also have Denamarin and other stuff left over from Donner. I am interesting in selling the whole package of stuff for like $120.00. Contains about 50 Denamarin, Marin and two new bottles of Standard Process supplements, along with part open bottles of each.

Holy Shoot, I checked that link and now know what "pricey" means in relation to Denamarin! I doubt I could take the whole package with the supplements too, but thanks very much for the offer!

[GreyTzu]

No problem, it's a lot of stuff for the price. And worth it. I would have to count again to be more accurate. The bottles of Standard Process are $20.00 each and the Marin is like $25.00 or so. VetMarket has the best prices on Denamarin that I have seen.

[JJNg]

QUESTIONS: Might the dehydration relate to the liver? What makes a dog not want to drink even after a walk?!

Probably not, although I'm not sure why he's just not drinking enough. What about adding water to his food?

 

Might the not eating relate to the liver? Can he get by with those liver values long-term, as he might have to if he has to keep taking the meds for his IBD?

The decreased appetite might be related to the liver, but it might also be related to his IBD, especially if he's had some abnormal stools lately too. The liver values on the chemistry panel really don't tell you much about underlying cause or prognosis. I had a patient (dachshund) whose ALT and ALP were both over 1000, and both levels gradually increased over a period of a year to where they were over 3000 or 4000. The dog was very old, and the owner did not want to find out what was causing it, so we just put him on Denosyl, and he did well for over 2 years. My suspicion in that case was either liver cancer or a chronic inflammatory process. I've had a couple other similar cases of dogs with severely elevated liver values who were never diagnosed and were fine for quite some time.

 

However, if the values remain elevated and you want to do everything possible to address the problem, the best thing to do would be to get a diagnosis. This can often be done with an abdominal ultrasound and ultrasound-guided aspirate or biopsy of the liver.

 

If the bile acids are good, will it be reasonably safe to do the dental? (The vet thinks her anesthesia will allow work to proceed with his liver values.)

Yes, if bile acids are normal, that means liver function is normal. The elevated liver enzymes just mean that some liver cells have been damaged, but the liver as a whole may be functioning just fine. I hope everything comes back normal, and that it's nothing serious!

Edited May 20, 2011 by jjng

[greyhead]

We do the bile acids test on Friday. Many thanks for the info and good wishes!

[Guest Stripeyfan]

Only just seeing this as I've been away! I have no advice about the liver or dental stuff, but is there any chance the weight loss etc could be from stopping the flagyl? When Kelly had his UTI back in Jan, we had to switch his oxytetracycline for amoxycillin for a week. Even in that short time, his stools got soft again and he lost weight noticeably, simply because without the oxytetracycline, his malabsorption problem (which it seems to keep at bay) returned.

 

When I need Kelly to drink (he is a reluctant drinker, especially if I have to fast him when he has a flare-up), I find flaking some of his food into a small amount of warm water does the trick – he's so desperate for the food he slurps the water right up.

 

As always, sending lots of good thoughts over the pond to Spencer (and you)!

[greyhead]

Thanks to you all for the information and support. The bile acids test came back entirely normal.

 

The problem now is that the internist insists on a dental and doesn't want to wait for me to try to fatten him up. But it's not until June 7, so I'll do what I can. Please hold a good thought for my skinny old boy (and his nervous mom).

[MP_the4pack]

Can handsome Mr. Spencer handle Ensure Plus? If so, add that in sometime during the day in addition to his other meals. Maybe even two. It's meant to add weight. It kept weight on my little old lady, but I used it when she decided not to eat her regular dinner.

[TheFullHouse]

Thanks to you all for the information and support. The bile acids test came back entirely normal.

 

The problem now is that the internist insists on a dental and doesn't want to wait for me to try to fatten him up. But it's not until June 7, so I'll do what I can. Please hold a good thought for my skinny old boy (and his nervous mom).

 

You know I was terrified of Gee having her dental. She had stopped eating and was losing weight and at the age of 11 I was afraid for her but she came through with flying colors. She lost 6 teeth and I can't even describe the difference in her now. She's fattened up and is a chow hound galore!

 

Lots of good thoughts for your boy!

[greyhead]

Mary Pat, Spencer does handle Ensure, a half-bottle at a time, very well. The Ensure-Plus can be too rich for him, it seems. Thanks for the suggestion!

 

Thanks for the encouragement, Judy. I have a feeling Spencer is going to loose some teeth this time around. The vet is worried that the whole experience of the dental/anesthesia will throw him into a "stress colitis." I guess we'll just have to handle that if and when it happens. The internist was concerned that bacteria, if enough to swell a lymph gland, could also be affecting his liver. I understand why we have to do it, but for some reason I have this feeling of dread. (Maybe it's because the vet blamed Shane's "incontinence" on me for not giving him Proin, and I kept asking for more antibiotics since the C&S kept showing E. coli, and it turned out in the end it was that infection all along. But she hasn't apologized for all she put Shane and I through for the better part of a year, and she at some point became chilly and distant toward me. I don't think she'll hurt Spencer on purpose, but I worry that her feelings about me will affect her choices in some way.) And I just don't think it's prudent to take Spencer a long distance to a vet who knows nothing about him. But thanks again for the reassurance because it really does help!

[TheFullHouse]

I will keep you and Spencer in my prayers.

[tbhounds]

Glad the bile acids came back well. Forgive me-- I'm getting old---do you have your boy on Denamarin?