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Elevated Liver Values, Biopsy Question


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Hi all -

 

Our lovely 11 year old hound, Penny, recently started refusing breakfast. Since this was so out of character for her, we took her in for a senior panel, which revealed that all of her liver values were elevated, as well as her cholesterol. Yesterday she had an abdominal ultrasound and liver biopsy, and we're waiting to hear more on that. In the meanwhile, I'm curious if anyone has had an similar experience.

 

The vet said that her liver looked "mostly good" on ultrasound, but that there were two areas that looked, for lack of a better word, "mushy." They sampled both areas, and the samples contained congealed looking tissue that essentially fell apart. Instead of being able to submit a "core sample," if you will, the vet had to prepare smears which he sent for cytology. Basically, he's unsure what this is. It didn't immediately scream "tumor" to him, and he and the other vet in the practice were speculating about toxin exposure, some kind of inflammatory process, or something else that would cause necrosis. The gall bladder, spleen, etc. all looked normal.

 

Any thoughts from the armchair vets out there? Does this ring any bells for anyone? We are really scared for our special girl. It's likely we'll have to have other testing done, unless the cytology comes back with a clear answer. Thanks for your help.

 

Sweet Penelope:

 

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Wait for the biopsies to come back before looking for other opinions. Sometimes too much "maybe its this" can make things very confusing. I await the results along with you and hope that it's nothing serious. BTW - Penny has that beautifully silvered and totally delicious face of a well loved and cherished senior girl . I know she must be an absolute joy to you and your family. Seniors ARE the BEST! I have, however, learned that for our hounds, just like humans, that getting old is not for sissies!

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The more I see of man, the more I like dogs. ~Mme. de Staël
Missing my Bridge Angels Ryce, Bo, Jim, Miss Millie, Miss Rose, Gustopher P Jones (Pimpmaster G), Miss Isabella and Miss Star

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No advice or ideas, but hope this is nothing too serious. You might ask your vet about a liver support supplement in the meantime. I have seen liver values recover significantly just from the addition of a supplement containing Milk thistle and sam-E like Denamarin. You can get these OTC btw. Denamarin is sold on Amazon.

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Jen, CPDT-KA with Zuri, lab in a greyhound suit, Violet, formerly known as Faith, Skye, the permanent puppy, Cisco, resident cat, and my baby girl Neyla, forever in my heart

"The great thing about science is that you're free to disagree with it, but you'll be wrong."

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Guest LazyBlaze

Yes, SAM-e and milk thistle had fantastic results with our old terrier boy, brought his elevated values right back down to normal.

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Thanks all - I have emailed my vet asking about liver support supplements.

 

The reason for looking for other opinions now, is that I've been told that the results from cytology will likely come back inconclusive, and I want to get a plan of action going right away. I lost my first dog to a hemangiosarcoma that ruptured and destroyed his liver. He was fine in the morning, lethargic in the evening and dead the next day. It was horrible.

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She's beautiful <3. I too rec starting Denamarin. Remember Denamarin is poorly absorbed so it needs to be given on an empty tummy-ideally one hour before breakfast after an overnight fast. Thankfully, the liver can rebuild so hopefully, this will be the case with your girl. One red flag went off when you mentioned the high cholesterol-not the problem of the day but, I would check her thyroid -and run a T4/cTSH at some point.

All the best for her-keep us posted <3

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The pathology came back not particularly helpful. The vet says there are basically two hypotheses at this point: either Penny has suffered a trauma to her liver, and it will repair, OR she has hemangiosarcoma in which case "we cannot save her." She says that one lobe of her liver is basically a hematoma. Her best advice was to "just take care of her." So, we wait and watch. We try to get her to eat. We medicate her and hope it makes a difference. We try to be sure she has good days.

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I think that sounds a bit odd that they are saying it may be hemangiosarcoma without a positive path report. HSA is hard to miss esp with a biopsy optioned via an explore. Also, not to have any splenic involvement? How is her liver enzymes and the rest of her blood work? Did they suggest running a bile acids test? Sorry-another question-did they feel that perhaps she had a a clot in one of her vessels feeding the liver?

Too much not adding up-perhaps you should ask Dr Couto his opinion.

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tbhounds -

 

it's hard for me to explain exactly what happened with the needle biopsy. I don't want to get too graphic, but the samples they got simply fell apart. The vet described it as being like blood pudding. Neither of my vets recommend a surgical biopsy/exploratory surgery at her age, given the situation.

 

She is not eating, and today vomited up what little I was able to coax into her so I could medicate her. She goes back for repeat blood work tomorrow. Her ALT, AST, ALP, and GGT were all high, her bilirubin and cholesterol were high and her albumin was low on 5/13. Her hematocrit was normal, but much lower than any other time we've tested her. They do not suspect a clot anywhere and there doesn't appear to be any bile duct blockage. I hope to know more tomorrow.

 

The dog I lost was completely asymptomatic until the tumor ruptured and he did not have any splenic involvement either, as far as they could tell when they attempted surgery.

 

This past week, in addition to Penny's issues, my favorite horse was diagnosed with Cushing's disease. At least I know how to manage that. But a bad week nonetheless.

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I'm sorry. :( Have you started Denamarin? There's really no harm and I've seen it bring outrageous liver values back into normal range.

gallery_12662_3351_862.jpg

Jen, CPDT-KA with Zuri, lab in a greyhound suit, Violet, formerly known as Faith, Skye, the permanent puppy, Cisco, resident cat, and my baby girl Neyla, forever in my heart

"The great thing about science is that you're free to disagree with it, but you'll be wrong."

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Oh-gotcha-thought she had an explore. She had a core biopsy--often called worms (because of the shape) With all of those liver values high and her albumin low (although keep in mind ghs run on the lower side of norm) I would run a bile acids test-which im sure will be crazy high. Get her ultrasounded if you haven't already. Poor girl-she must feel horrible.

Sorry about your horse-I too had a horse with Cushings-she did really well. Lost her at 35yrs of age-osteosarcoma of all things. Broke a leg walking in from the pasture :-(

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