my friend just had drug-induced hepatitis, and she had to GO OFF all supplements. Why give the liver more work to do digesting supplements when it is not functioning well already? Just a thought...

Unless it's prescribed by the vet I think the only supplement I would use is SAM-e. I don't recall what the actual ingredient is but it's also used in veterinary medicine by another name so you may already be using it. I known to a degree the liver can regenerate but with this much damage I'm not sure about your particular case. Hope your pup does well for a long time.

Lisa

I am not a vet but I would get another opinion. A friend just lost their dog because they left him in the hands of a vet they had trusted and used for decades. During one weekend they started to realize certain things didn't make sense to them and planned to take the dog to another vet come monday. Unfortunately by that time it was too late. The mistake had become lethal. If it doesn't make sense to you, then have another vet look at your dog.

Gayle, has your nutritionist put him on milk thistle? If not, ask her about it and do some research on it yourself. It seems to have regenerative qualities where the liver is concerned.

Vet's do not always know what's best. That's why you have to be a good patient (or patient companion). Their knowledge is limited like anyone's, but hopefully if you find a good one, they will be open to what you have researched and want to try for your friend.

Rather than say things like "vets don't always know best", I think a more accurate statement is "vets can make mistakes."

Thank you all for taking the time to answer.

Nancy, that's interesting. I would have never thought about it being more work for the liver to process the supplements. I will check on this further.

Lisa, I seem to remember her saying something about SAM-e, maybe that something we have him on is the same but I'll have to ask to be sure. Thank you for your concern.

Quirky, I have been thinking about getting a second opinion from another Vet. Ours admits that he doesn't know everything and prescribing the Deramaxx confirms that. He also tried to get me to use Science Diet but I have always cooked for the poodles. I had been giving the cat SD until recently I read the ingredients and wasn't impressed and changed.

Quasi, I will ask about the milk thistle. I did some limited research today but didn't find anything pertaining to animals. Thanks for the suggestion.

I'm still hoping the Vets will see this and respond.

There are companies that make prescrition diets other than Science Diet. You may look at one of those. Even tho they ingredients are not not up to par with what you would normally feed some of them do a great job of restricting nutrients that some pets really need in some cases. Also search yahoo and see if there is a group there where you can get help in formulating a diet for him.

Lisa

Here's a nice, short article.

Here is a link that might be useful: Milk thistle in dogs

Hepatitis isn't that helpful of a description of what is going on. It just means that his liver is inflamed but it doesn't say why. He could have any number of different problems, and they may be all treated differently and carry different prognoses.

As far as 30% liver function, there is no way to know this. There is no test that gives a quantitative measure of liver function, so I don't know where the vet came up with this number. Probably made it up out of thin air.

The liver is extremely regenerative. When there is a problem with the liver, over time it can heal itself, up to a point. The key is to stop whatever is causing the problem in the first place, when possible. There are certain liver conditions that are irreversible, such as fibrosis, but simple inflammation can be treated as long as the underlying cause is eliminated.

Dogs can get an idiopathic hepatitis, where there is liver inflammation for no known cause. However it takes quite a few diagnostic tests to rule out known causes. Without knowing what tests have been run and the results, it is impossible for us to say what is going on with your dog.

There are 2 major tests that will help determine what is really going on with your dog. He may have had them, but you didn't mention it so I'll briefly discuss them here. The first is the bile acids tolerance test. The dog is fasted for 12 hours and a blood sample is taken. Then you give a fatty meal, and redraw blood in 2 hours. You measure bile acids concentration in both samples. The liver is responsible for clearing bile acids from the blood, so if there is an elevation in the second sample (usually greater than 20 is the cutoff) then you can say that liver function is impaired. It doesn't tell you how bad liver function is, and there is little correlation between the degree of elevation in bile acids and liver function. In other words, a sky-high post-prandial bile acids doesn't always indicate a totally trashed liver. And again, it doesn't indicate the cause of liver disease or the prognosis. For example, dogs with portosystemic shunts can have post-prandial bile acids over 100, but if the shunt is surgically repaired they can live perfectly normal lives. On the other hand, an older dog with significant liver fibrosis may have a post-prandial bile acids of 25 and die of liver disease quickly.

The second important test is a liver biopsy. This is usually done with ultrasound guidance so the specific lesions can be sampled. Without ultrasound guidance it is possible to get a sample of normal liver, which isn't very helpful. The other way to get a liver biopsy is surgically, but that is very invasive and usually reserved for animals whose problem may be corrected surgically, such as liver masses.

Besides prescribing liver-damaging drugs, what has your vet done for your dog?

My own B'Elanna had what was called at the time chronic active hepatitis, now called canine idiopathic hepatitis. When she was diagnosed we had an ultrasound of her liver which showed nodular regeneration. She was placed on metronidazole to help eliminate certain infections which can cause hepatitis, prednisolone to reduce the inflammation, SAM-e for liver function support, a liver diet (homemade), vitamin B, vitamin E, and milk thistle. Her liver biopsy confirmed that she had idiopathic hepatitis. B'Elanna completely recovered in 9 months. Another dog was diagnosed at the same time with the same disease, but he still needs prednisolone to control the inflammation, which is more common from what the specialists at school tell me. But he's still living very well on low dose pred and it's been 3 years since he was diagnosed. Oh, and he's a standard poodle.

Hepatitis is not a death sentence. You just have to work on finding the underlying cause and eliminating it if possible, control the inflammtion, protect the liver with a proper diet and avoidance of liver-toxic drugs (such as all NSAIDs), and management of clinical signs. The liver has remarkable regerative ability, so sometimes the tincture of time is also helpful.

Since your current vet is apparently not familiar with treating liver disease, I would find another. You may even consider a specialist if possible, because a liver ultrasound and biopsy are best performed by experienced veterinarians.

I hope you can find the help you need to get your dog through this. It IS possible, depending on the cause and the damage already done, to get a dog through hepatitis, but you'll need a vet who knows what s/he is doing to make that possible. Good luck.

Not the OP but thanks for the explanation Meghane. Very informative.

Lisa

Meghane, thank you so much for taking the time to help me. I know you must have a busy schedule and your expertise is certainly valued. At one point he listed lipidosis for the diagnosis and at this year's exam it was chronic active hepatitis. I googled lipidosis and everything I found pertained only to felines. I have copies of some earlier lab results and it appears to me that the alkaline phosphatase is the main thing we should be concerned about. In March '04 it was 1303, March '05 - 1441, March '06 - 3060, April '06 - 3360. I don't have the report for this year but I think it's back down @ 1400. This is the only year I remember giving the fatty meal and redrawing blood. Some other things are in the high range. Is there anything else that is pertinent for this problem? There has not been a liver biopsy. He is taking Denamarin, Colchicine .6MG, and URSO 250MG. We have always cooked for him but his diet primarily consisted of chicken breast & liver with all fat removed and ground beef. Just recently I put him on a more varied diet with the addition of ground pork, ground turkey, canned rabbit, fish, 2 eggs/wk and Dr. Harvey's Canine Health food (organic grains, vegetables, herbs, vitamins & minerals. Also give him Nupro, fish oil, vitamin E, Liver Support tabs & ground egg shells. Instead of the Deramaxx he was on for arthritic joints I now give him Yukka. Please tell me if I should not be giving him any of this and if there is anything I need to add. Would the SAM-e be the same as the Liver Support I'm giving him? Should I add the milk thistle? Does he need vitamin B in addition to the multi-vitamin in the Canine Health? Again, thank you so very much. This little guy needs all the help he can get. He is 8 years old and I'm hoping for several more years with him.

Quasi, thank you for the link for the milk thistle. I found it interesting.

Lisa, thank you too. I will continue searching for still better ways to feed him.

First of all, I think you are doing a great job giving appropriate supplements for a suspected unhealthy liver. The only thing I would add is glucosamine HCL 1500mg with chondroitin sulfate 1200mg for joint health support. I am a little concerned that your vet may not be doing such a great job in getting to the bottom of your dog's elevated liver enzyme.

I should have asked right off the bat, what problems is your dog having because of the liver disease? Does he have a poor appetite, or vomiting, or jaundice, or anything? Is he drinking excessively or experiencing a thinning haircoat? Does he have repeated infections of any kind?

Second, was he on any medications last year when the ALKP was higher? I'm thinking specifically things like steroids, NSAIDs, phenobarbitol, certain antibiotics, and some other drugs.

Let me know and I'll give you some more specific thoughts. Although the spike into the 3000s is a bit concerning, honestly without any clinical signs an ALKP in an older dog isn't something I'd jump up and down about (to borrow a phrase from my wheelchair-confined boss). I know many older dogs who live with an ALKP in that range and have no evidence of liver disease, and they do just fine.

Meg, I feel so much better now that I have your opinion of this. I've seen your advice to other people on here and it's pretty obvious that you know your stuff.

As to the problems he's having, actually very little. We've never had to take him to the vet other than for his annual exam and the lab work. He has no vomiting, no jaundice, he eats an amazing amount and has always been a little overweight, his hair is fine, he has no infections. He drinks a good bit but not so much that I'm concerned. He is not active but has never been. Even as a puppy he didn't play ~ it just didn't interest him, he prefers to eat.

The only medications he has taken are the above mentioned ones for the hepatitis and the Deramaxx that he took for pain but he wasn't taking much of it until recently. He's never taken steroids, phenobarb or antibiotics. Does the vet have to prescribe the glucosamine/condroition?

His ALT has gone from 189 in '04 & 139 in '05 to 328 in '06 (ref. range 12-118). I don't have the report for this year.

I talked with the nutritionist today about the milk thistle, SAM-e and the vitamin B and she said this was in the Nupro I'm giving him.

I'm looking forward to your further advice on this and I appreciate it so much. Gayle

Glucosamine/chondroitin is an OTC joint supplement. You can get it at a human drug store. I personally go to Costco for their Kirklands brand, which is the most economical choice since my husband, myself, and all 4 dogs take it daily. $21/200 tablets.

Hmm, I wouldn't think of hepatitic lipidosis OR hepatitis without any kind of clinical signs. I don't think I've ever seen a hepatitic lipidosis animal that was eating (anorexia is usually the cause of their problem, and it's not common in dogs anyway) or that wasn't jaundiced. And usually dogs with hepatitis have decreased appetite (not all though; my B'Elanna ate well throughout her hepatitis too), increased drinking/urination, sometimes other more serious problems such as hepatitic encephalopathy, hypoproteinemia, and others. My B'Elanna was a little lethargic, but she was also VERY yellow, which is why we knew to look for liver disease.

Personally I would have an ultrasound and liver biopsy done. Between those tests, you'd get a ton of information, such as are there liver masses or nodules, is there steroid hepatopathy (like with Cushing's disease which is common in poodles), you can do special stains for copper accumulation, etc. The ALT is a little more concerning because that is more liver specific and indicates liver cell damage. But that could be secondary to other things such as Cushings, nodular regeneration, etc.

OTOH, my Aleksander lived the last several years of his life with an ALKP in the 1200s and he did not have any disease that would cause that elevation. He eventually died of stomach cancer, but that wouldn't cause elevated ALKP and in fact his ALKP was lower when he got sick. Again I know many dogs who just have a higher ALKP. If we can't find a cause for it after a good workup and the dog seems fine, we just kinda say OK, it's normal for that dog and continue to monitor it once every 6-12 months as long as dog stays healthy. I'd do bloodwork every 6 months on any dog over 8 years old anyway; now your guy has an even better reason than just routine senior care.

Anyway, since he's feeling fine, I wouldn't rush into anything, but I would get the ultrasound and biopsy done. You may do a bunch of other tests and find nothing. If you have results of other bloodwork, I'd love to see them. In the meantime, keep up what you're doing because your dog seems to be doing well with it.

Thanks again for your reply, Meg. I need to first find out if the Nupro I have him on is the joint support which has glucosamine/condroitin in it or just the supplement. She gave me some in a baggy and I didn't know to ask. I will check on getting an ultrasound done. Would they have to sedate him to do it? The vet told us he couldn't put him to sleep because he probably wouldn't wake up. He actually found the problem when he was doing the lab before cleaning his teeth. Before this he suspected he might have Cushing's but decided not. Honestly I'm starting to question his expertise. I think if he was real up on things we could have been doing a lot more for him. I will be taking the other one for her exam sometime this month and will get the rest of his lab results and let you know what it shows. I appreciate your help. Gayle

He wouldn't need sedation for the ultrasound, but if you were going to get a liver biopsy at the same time (and I would) then he'd need it for that. Of course, the vet is the one to say whether or not he is OK for sedation (which is not the same as general anesthesia, as required for a dental) since he's the one doing the physical exam and seeing all the lab work.

I really dislike it when vets say things like "if I put him under, he may never wake up." Anesthetic death is ALWAYS a risk, even in perfectly healthy animals (and people)! In order to make a good decision, you need to know what the risk is. Is it 50% likely your dog will die? 10%? 0.5%? 100%? Makes a BIG difference! Sorry, that's a pet peeve of mine. Wild tangent over.

Anyway, a liver aspirate may be able to be done with sedation- how much depends on the dog. You don't want him to be moving around when the vet has a pretty big sized needle stuck in his liver. The liver aspirate lasts about 10 seconds, so the duration of sedation is very short, which also reduces the risk of problems. For the animals I've seen, we have more questions about their ability to form clots than about the sedation. The liver makes many clotting factors, and animals with liver disease may not be able to make those factors well. So you run a clotting profile first and make sure that's OK. It's all about managing risks....

He may have already run a test to rule out Cushings. That's a weird disease to diagnose, usually easier to say an animal does NOT have it vs trying to say it does. But an otherwise feeling fine poodle with high ALKP, gotta at least have it on the list.

I'm still curious about the 30% function thing...

Glad your doggie feels fine through all of this. I hope he gets plenty of treats with all his supplements! Mine get their pills in peanut butter- best part of their morning.

Gayle, is there a canine internist in the area that you can consult with?

We are in a somewhat similar situation (One of our dogs is being tested for Cushings, after an elevated ALKP was detected before her teeth cleaning.)

Anyway, our vet consulted by phone with an veterinary internal medicine specialist. Our previous vet (before we moved), also checked with an internal medicine specialist when she wanted to confirm a diagnosis or treatment. To me, that is one of the hallmarks of a superior vet.
Good luck, and please let us know how he is doing

Meg, thanks again and sorry to be so late getting back to you. I got sidetracked with some other things and didn't have much board time. I'm definitely going to check on the ultrasound/biopsy. I'm pretty sure he tested to rule out Cushings because he was concerned about him having it and then told me he doesn't. Later this month when I take the other one in I will get his latest lab results. When I take him for further testing I will let you know how he's doing now that he's on a better diet and supplements. He sure is an expensive little guy but definitely worth it. I got his Urso from the drugstore yesterday ~ $72 for 30 pills. I appreciate your concern and help.

Lynn, I have not heard of an internist here. We're not in a real large city. Our vet has 3 partners and he does talk with them about what to do. I think at least one of them has more experience than he does. I sure hope yours doesn't have Cushings. The vet says that is a bad thing to have. Thank you and I will let you know how he is doing. Let me know about yours too.

I'm curious how much of the liver supplement info would apply to cats as well as dogs? My cat has liver "issues" and is on SamE, but I see there are other things such as milk thistle for the liver and glucosomine, for his elder joints. I used that with our old spaniel but it didn't occur to me to give to the cat. Any reason these supplements shouldn't be given?

Tauphidelt, milk thistle and glucosamine/chondroitin are good for kitties too. It is always good to ask though, because as we all know, cats are not small dogs!

Gayle, glad that your dog doesn't have Cushings. It is a very difficult disease to treat, and it's a lifetime management issue- you can never cure it. I hope you can get the ultrasound and biopsy done. I really think it will help clear up the diagnosis. I spent a lot of time worrying about my older guy with the elevated ALKP, but found out that it can be OK for some dogs. I hope that is the case with your guy too. Keep us posted on him. I'll be thinking about you and your puppers.