Elevated Liver Enzymes

HOLY SMACK! That is huge-when I was researching ALT stuff I found some as high as 9000 I believe (not sure what the reference range was-but know it wasn't anywhere near that).

You know, now this makes me think that pre-HW treatment bloodwork needs to be done as a matter of procedure to
A. have a reference range
B. to determine if the dog has any health issues that will impact tx

Regardless-do you think she is having a reaction to the Ivermectin?

Do you have access to (if she's well enough) an ultrasound? I've gone to Dr. Homko, who is out of Ithaca, but comes to Rochester on Thursdays and she's really good.

In the meantime have any x-rays been done?

She's not eating Nutro is she? (I know-but...)

Rimadyl?

Also, was this what they were seeing with the aflatoxin thing?

And there is jaundice? Or...???

I mean, I look at those combos of numbers and have no idea. It has to make sense to someone, somewhere.

If my vet had no idea, I'd say let's you call Cornell in case it's some sort of new something that hasn't been confirmed yet.

Crap-when Kramer had a giant liver tumor his ALP was normal and his ALT was 540 I think (something in that range). SO would that possibly mean that this is an acute reaction and not a chronic thing like a tumor? I have no idea if that is an OF COURSE IT IS! question or not.

That is just-yikes. The good news is that the liver bounces back. Kramer's values are normal in all liver functions except just a little step high in the ALT-but have been going down since January-so it's regenerating. Let's hope that it will here.

Is she eating? Dr. Dodd's has a fish based liver cleansing diet that while it might not fix things, would help her liver work less perhaps? As long as you don't use fish from China. I have a link somewhere.

Can you get some Denamarin from work? http://www.nutramaxlabs.com/products/animal/denamarin/denamarin_faq.asp

Prayers on the way.

First of course we are still a shelter, though we have come far on what we treat. We do lots of heartworm treatments. This girl really didn't have anything prior to starting her treatment that gave us any indication that we should have sent bloodwork out first. We've had some in the past that haven't been in the greatest shape and we have sent pre-bloodwork out before starting their treatments. It would be nice if we could make it a normal thing with all heartworm tx's yes! (But with the number we sometimes have and cost/funding...)

No Ivermectin given yet, just one immiticide injection.

We don't have ultrasound but we have some vet clinics we work with (or know vets at) that have them and I will bring that up to vet Monday to see what his thoughts are (or all 3 of them as we have 3 vets but only one was working today and he's our head vet whom I trust with my own animals).

Chest xrays done prior to treating for heartworm, all was normal no xrays of liver yet.

No not eating Nutro, I have her on vet A/D right now as she has been eating on and off not the greatest but still eating. (was eating good when on Pred but...)

Yellowing she has in the whites of her eyes made us think yes she has jaundice. Her skin is ok though, and gums and skin in ears.

We have contacts at Cornell and I do believe that will be our next call Monday if fluids haven't seemed to help any. Right now biggest thing trying to do is flush her system out. (2 liters a day IV) Slowly so to not fluid overload but needs to get one bag in over 12 hours next over next 12 hours.

I'm hoping it's something that came on acute that we caught early enough that we can reverse it and turn her around and get her better. She's a sweetie.

Will have to check on the Denamarin too.

I'm always up for new thoughts to bring up to the vets. And I know they are always working to expand our clinical treatment range as shelter vets/clinic.

Thanks!

Sending out some prayers to your girl


Have you ruled out Pancreatitis? Does your dog have loose, black, clay-colored (grayish) feces (my dog had this)

Info from "The Dog Care Book - not to scare you, but to try and pin anything down.


Info on the Liver - makes the proteins that provide strength to your dog. Manufactures the clotting agents that stop th bleeding of cuts, and is very important in fat and sugar metabolism. The liver is the great detoxifier - purifying toxins and drugs in your dog's system. it recycles the bodies of dead red blood cells. Some of its products are used to make new red blood cells, others are used to make bile, the green digestive juice stored in the gall bladder that, at mealtime, is released to the intestine through the bile duct to help break large fat molecules into smaller ones. Liver disease or the rapid destruction of red blood cells will release large amounts of bile into the bloodstream, producing jaundice and staining the eyes, gums and skin yellow.


Has your dog be able to eat any sugar free gum, cakes or candy? Grapes? These can cause liver damage. Or any lawn treatments she might have gotten into?

Good luck and hope your sweet girl will be fine.

Yeah-for the bloodwork-I was thinking of that in my little standard policies and procedures list I have in my brain! (as if it matters!)

I just looked up the immiticide and it sounds like it's safer for the liver-that is weird. But anyone can react to anything right?

Does anyone ever react to doxycyclene?

Is her white cell count normal?

Maybe cook for her to get any dog food out of her system? I have no idea. Just tossing easy to do stuff out. Here is one version of the Dr. Dodds diet: http://www.monicasegal.com/aboutus/yahoo017.php and another version (just find out where the fish is farmed! they were showing green water in China today!)
http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm

Bile acids test?

(don't you think my vet earns every penny I spend there-can you imagine dealing with me!)

Re: Elevated Liver Enzymes UPDATE

It's been a week since all this has happened with my foster. She's still hanging in there, not worse, but not much better. We did a liver panel blood re test this past week and her levels are all down, still above normal range by 1500 and so, but not at 4500 as before.

We have a lepto test being done at Cornell, we have a coagulation test being done at a vet lab. Should have results tomorrow.

She went for an ultrasound today, liver is a bit small but otherwise very healthy. She has Pancreatitis. Her Kidneys- the pelvis in both is dilated. This could be due to her fluids or it could be kidney disease. Another urinalysis was run and her specific gravity is very low, yet another sign of kidney disease/failure. The vet thinks that the liver enzymes was a rare infection somewhere in her body.

We repeated her chest rad today and her lungs are not in great shape. They were 100 percent clear prior to starting her heartworm treatment and now they are cloudy and granuloma all over, possibly from heartworm dying or rare chance she has cancer. Films are being sent to Cornell tomorrow. Going to do a bile acid test as well. (bilirubin very high in urine and blood)

My vet is doing lots of research and talking with some other vets to get a plan for her. Keeping her on the IV fluids for pancreatitis.

Hopefully we will get more answers soon! Feel free to chime in if you have thoughts!