Spencer Has Higher Liver Values - Biopsy Result At Post 82

[greyhead]

No, Alicia, not yet. But thanks for the suggestion. I shouldn't think this problem, whatever it is, would be very greyhound specific. Telling his internist is probably the first next logical step, and she'll probably want bile acids. I have to say that other than the stuff I mentioned before, his demeanor is fabulous. Today I even think the circles under his eyes have diminished. (They come and go, usually lasting a couple weeks when they're around. Have no idea what it means, but just like with people, it never looks like he feels good then.)

[JJNg]

Like Batmom, I don't think the high USG necessarily rules out Cushings. And I don't think kidney values are relevant to Cushing's, so I'm not sure I understand using that to rule it out. Almost every dog I've diagnosed with Cushings has had normal kidney values.

 

I think asking the internist's advice is a good idea. If you want to keep your vet in the loop and not 'go behind her back', maybe you can talk to your vet, and let her know you're really concerned about the rising liver enzymes. Then depending on your previous interactions or what kind of response you get, either ask your vet if she'll consult with the internist, or just let your vet know you'd like to talk to the internist about it. If your internist is involved with managing Spencer's IBD, she'll need to know you stopped the Tylan too.

 

Personally, I'd probably have the abdominal ultrasound done before proceeding with Cushing's testing. At a minimum, if you decide to wait on further testing for the moment, I'd at least recheck his liver values in 2-3 weeks to see if the upward trend is continuing. This more conservative approach would be ok as long as he continues to feel good and not have any problems.

[greyhead]

Like Batmom, I don't think the high USG necessarily rules out Cushings. And I don't think kidney values are relevant to Cushing's, so I'm not sure I understand using that to rule it out. Almost every dog I've diagnosed with Cushings has had normal kidney values.

 

Thanks for weighing in, Jennifer. The vet's position is that low USG despite normal kidney values is what she has seen in all/most of her Cushing's cases, so it's the combo that's interesting. I'm just wary of always/never statements, especially with relatively indirect measures like these. The UCCR test would have been more targeted to the issue, I'd think, as Batmom mentioned.

 

I probably will just tell the vet that I'm feeling queasy and request that she report Spencer's blood work and USG results to the internist, if she hasn't already. But I'm probably going to hold off for a couple more days' observation at home unless he deteriorates in some way. It's just so easy, I've found, for docs/people to dismiss problems as age-related when in fact they could be rectified with a little effort if taken more seriously.

 

Thanks to all of you for your ideas and support.

[Guest BleuDog]

 

Wishing that Handsome Laddie of yours 'THE BEST'!!!!!

 

Keeping you guys in my thoughts and prayers.....andi

[Charlies_Dad]

No advice, just good thoughts for Spencer and you.

[EllenEveBaz]

Adding more good wishes.

[greyhead]

Thanks so much, Andi, Kyle and Ellen -- and everyone else!

 

By way of minor update, I needed more Denamarin -- dear me, is that stuff $$$! -- and contacted his internist, emailing her his bloodwork. She okayed getting more Denamarin from our vet but didn't say anything else. So I've emailed her back, asking if there's anything else we could/should be doing. That was on Friday late in the day, so we'll see what she comes up with next week. He's basically doing well, though. The biggest visible problem is his LSS, which he has had for years. Now I notice that his back end tends to sink if he tries to walk backward. Happily, he seems to have caught on that he needs instead to circle around to change direction, which will work fine until sometime he gets excited and forgets to do it that way. He sees his acupuncturist/chiropractor on Tuesday, so we'll see what she has to say about both problems. I'll let you know if anything else happens.

 

Thanks SO much for the support.

[tbhounds]

You can get Denamarin w/o script online :-)

[GreyTzu]

You can get Denamarin w/o script online :-)

 

 

Yup, Denamarin is OTC and you can find it on eBay, among other places.

[a_daerr]

By way of minor update, I needed more Denamarin -- dear me, is that stuff $$$! --

 

I know! The best deal I found was on Amazon... $70 a month.

[greyhead]

Thanks, yes, I can get it on Amazon. But I was short of time, and the tech at the vet quoted me a much lower price than Amazon, so... Turns out the tech was wrong. Next time.

[greyhead]

We waited 6 weeks for the retest, per the internist. Here are the results:

 

Wellness Chemistries

Total Protein 6.8 5.0-7.4 g/dL

Albumin 4.0 2.7-4.4 g/dL

Globulin 2.8 1.6-3.6 g/dL

A/G Ratio 1.4 0.8-2.0

ALT (SGPT) 622 12-118 IU/L HIGH

Alk Phos 1720 5-131 IU/L HIGH

BUN 17 6-31 mg/dL

Creatinine 1.3 0.5-1.6 mg/dL

BUN/Creat Ratio 13 4-27

Glucose 99 70-138 mg/dL

Potassium 4.4 3.6-5.5 mEq/L

 

Comment

Hemolysis 2+ No significant interference.

 

CBC

 

WBC 5.2 4.0-15.5 103/μL

RBC 8.4 4.8-9.3 106/μL

HGB 20.7 12.1-20.3 g/dL HIGH

HCT 60 36-60 %

MCV 71 58-79 fL

MCH 24.8 19-28 pg

MCHC 35 30-38 g/dL

Platelet Count 169 170-400 103/μL LOW

Platelet count reflects the minimum number due to platelet clumping.

Platelet Est Adequate

Differential Absolute %

Neutrophils 3536 68 2060-10600 /μL

Lymphocytes 1144 22 690-4500 /μL

Monocytes 520 10 0-840 /μL

Eosinophils 0 0 0-1200 /μL

 

The livers continue to climb despite the Denamarin, though he's acting fine, for his age and conditions. We recently added amantadine to his tramadol and gabapentin regimen for his disk problems and LSS, and it has made him a much happier dog in less pain. The only thing I think we might be able to discontinue is his tylosin, as his poops are championship quality! A copy of these values has been sent, late today, to his internist, and we'll see if she has anything to recommend. Meanwhile, any thoughts from GTers? Could his liver have been damaged by all the meds he has taken the last four years or so? How have others dealt with liver issues? Many thanks for considering this. I don't like those numbers or the trend!

 

ETA: Per JJNG's prior post, it's probably not the meds. He passed the liver function test, but that was 18 months ago. I wonder if we should repeat it or just consider going straight to ultrasound.

Edited March 26, 2013 by greyhead

[tbhounds]

With this persist high liver values I would want an abdominal ultrasound done--I would be curious to see what the gall bladder looked like at this point.

[JJNg]

I agree with tbhounds. With persistent elevation and an upward trend in the liver enzymes, I'd go straight to abdominal ultrasound.

[greyhead]

Many thanks, Tracy and Jennifer! I emailed the internist late yesterday and am giving her some time to mull it over (and see other patients). If I don't hear from her by this afternoon, I'll call the office. Will let you know what transpires.

[greyhead]

The internist emailed me, suggesting an ultrasound. We've scheduled it for Thursday a.m., and she's blocking off the whole morning so she can get him in and out expeditiously. That's good because he hates going there and he won't like his 12-hour fast much either! Wish us luck, that we find something and it's fixable. Thanks for all your support so far!

[tbhounds]

Keep us posted!

[greyhead]

This ultrasound may turn into a biopsy procedure if it appears to be necessary, the tech informed me yesterday, so he has to fast for 12 hours. After my initial relief at the idea of *doing* something to get answers, I find that I'm more than a bit nervous. (Part of the reason is that I've found the internist to be more casual than I am at the prospect of doing invasive investigation of my skinny old man. She thought it strange that I declined a full-thickness biopsy for his IBD four years ago, after he'd been so sick and lost so much weight.) To her credit, she worked with us anyhow, without the biopsy. But I'm still nervous, so please hold good thoughts for Spencer tomorrow. Thanks.

[carronstar]

Holding good thoughts for Spencer.

[TheFullHouse]

Lots of good thoughts for Spencer.

[greyhead]

With this persist high liver values I would want an abdominal ultrasound done--I would be curious to see what the gall bladder looked like at this point.

 

 

I agree with tbhounds. With persistent elevation and an upward trend in the liver enzymes, I'd go straight to abdominal ultrasound.

 

Belatedly it occurs to me to ask, how bad could a liver biopsy or other biopsy be on a dog like Spencer? (To review: age 12, history of hookworm, SIBO, intestinal lymphangiectasia, malabsorption, mod to severe IBD, LSS, and disk issues.) Aside from tongue swelling for unknown reason, and husky breathing when excited, he has been doing really well. I'd hate to do something that would mess him up worse. The reason I'm asking now is because I can foresee being asked during the ultrasound to give sudden permission for a biopsy, maybe even sign permission papers before I leave him there, without having time to think about it. It's better to give these things a little thought ahead of time; at least, that's my preference.

 

Anybody have any idea?

[tbhounds]

Honestly, I wouldn't hesitate to run the biopsy-assuming he has had recent bloodwork (chemistry and a CBC) AND they are equipped to run a co-ag panel that morning. If the biopsy is determined safe to perform then, they will give him a form of sedation-at our clinic we would use ket/val. The biopsy site is very small. The things they need to watch for is bleeding (hence the co-ag). We recommend doing these types of procedures early in the day so, we may watch them for a while post procedure. Often, just to be careful we'll check a PCV or just pop the ultrasound proper on them just for a quick looksie to make sure there's no free fluid in the abdomen.

Now, that I scared you, honestly, I have to tell you I find ultrasound guided biopsies rather safe if performed by a qualified clinician.

Edited to add cause I always forget something-another reason to have him fasted is you really need an empty tummy/GI tract to get a full view/assessment of the abdomen. Essentially food obscures the view.

Edited March 28, 2013 by tbhounds

[greyhead]

We have his bloods from last Friday, and his HCT (PCV) is 60 (30-60), so that's good enough for an older grey, no? I'll be sure and ask about the co-ag panel. Thanks for talking me down, Tracy. I feel much better because of what you just said.

[JJNg]

Completely agree with Tracy. Ultrasound-guided liver biopsy is a pretty routine procedure, with the main concern being bleeding afterward. I wouldn't hesitate to do it if the internist feels it will help provide a diagnosis.

[tydyelady]

I am just getting back to this, and I want to say we will be thinking of Spencer, and praying that everything goes well, and turns out well.