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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Buster's ALK PHOS test
| I finally got a copy of Buster's last blood work and it looks great except for is liver test. I am very worried about his ALK Phos. test. His numbers for this are 1083 and the normal should be from 20 - 150. My local vet seemed a concerned about this number so he called U of I. They were happy with his numbers. Should I be concerned? Is this number fairly normal for this stage? I am worried about permanent liver damage. |
| Ronda Illinois |
| Rhonda, This is a liver enzyme value that reflects the large load that prednisone is putting on it. Each time it must process prednisone, some liver cells are destroyed. This value reflects this. It is unavoidable and not something you can stop until the dose of prednisone is reduced. That said, the liver is regenerative. It can recover from insults like this by making new cells. And unless there was any kind of liver issues prior to this illness, it will most likely return to normal or near normal values once the prednisone is decreased. To give you some reference, my dog Chance's alkaline phosphatase was over 8600 at one point with the high value from his lab at 212. That is an obscene number. And it caused him discomfort. This is just one of the reasons that other drugs are added to a protocol, and the prednisone reduced gradually, to spare the liver this insult. But it is very important in the early days to use high dose prednisone. No other drug has the immediate action that this does. It is truly a life saver, but not good in the long term. You can take some important steps to assist the liver right now. Dr. Dodds has a "liver sparing diet" that consists of some type of white fish, some sort of carbohydrate like potatoes or rice and the addition of easy to digest vegetables like steamed green beans. Someone on this forum will post a link to the diet, I am time pressed today. In addition ask you vet to prescribe Denamarin, a veterinary supplement made by Nutramax Labs. It will assist the liver to recover. It is not a drug, but a supplement and is safely dosed by weight. It is pretty expensive, but I know from experience how important that is with this high alk phos value. http://www.nutramaxlabs.com/vet/products/Denamarin.aspx my best patrice |
| Patrice NYS |
| Ronda, here's the link to the liver diet (by Dr. Dodds). www.canine-epilepsy-guardian-angels.com/liver_diet.htm I've used this diet (slightly modified) since almost the beginning with Tessy as well as Milk Thistle and her liver numbers have only been up a couple times...and only just slightly. It's also a really good idea to give the pred with food at ALL times. Have you been using milk thistle at all? I'm with Patrice with regards to using denamarin. IF money is an issue you can look into adding SAMe. I'm not sure the price difference here so you'd have to look into it. If you decide to use SAMe due to cost then you should also use milk thistle with it. If using denamarin then there's really no need to use milk thistle. Oh, and smaller more frequent meals are a good idea also. Are you in the position to lower the prednisone dosage yet? My thoughts and prayers are with you both. Johnny & Tessy |
| Johnny |
| Buster is taking 30mg of prednisone a day. This is down from a high of 60mg a day. His ALK numbers are still going up. We lowered his cyclosporine from 200mg a day to 100mg a day and have lowered his azothiaprine from 20mg every other day to once every third day. Could some of these other drugs be messing with his liver also? I am glad to hear that this is probably a temporary problem. Thanks for the diet information. |
| Ronda |
| Rhonda, 30 mg is still in the category of "immunosuppressive" dose. It is flooding the body with cortisol, this is similar to the same cortisol that the body produces by the adrenal glands. These secrete cortisol hormones into the bloodstream and help the body respond to stress. They have an important role in many body functions like controlling blood sugar levels, fat metabolism, muscles, kidneys, nervous and cardiovascular systems, and immune responses. The goal of all this excess cortisol in this case is to suppress or shut off the immune system. Does this make sense to you? When you put more cortisol into the body than the adrenal glands normally would, it causes issues with all these other functions because they don't need that much. This is referred to as Iatrogenic Cushing's Disease, or caused by the excessive use of glucocorticoids. The adrenal glands respond to this oversupply by shrinking and not producing cortisol. Remove the prednisone too quickly and the adrenal glands will not be awake enough to respond immediately. Thus, decreasing the dose of prednisone slowly, according to a specific schedule, helps wake them up properly. Every doctor and vet knows how to do this. Other drugs that also impact any of these systems will exacerbate the situation. So yes, they can contribute to the problem, but cortisol in excessive amounts is the real culprit here. Reduce that and the problem diminishes. Once the dosage reaches what is called a "sub-clinical" dose, or lower than the amount the body normally produces on its own, then the adrenal glands will take over. Some dogs need small doses of pred the rest of their lives, in the range of 1-5 mg per day, per every other day, per every 3 days. It varies. Only a qualified vet can determine this proper dosage at this point. I know how worried you are. It's hard when you don't understand everything and you want to make the best decisions. When a medical professional expresses concern over something, you are now on alert, wondering what to do. This is a time for focusing on the important issue which is to make sure that Buster's immune system stop attacking the red blood cells. If that wasn't stopped with prednisone, you would not be looking at the results of a good blood test. You have saved his life and that is significant. No one else did the hard work; you administered the meds on the right schedule, kept him fed properly, made sure that he saw the vet at the appropriate times and all the other hundreds of little things that go along with caring for a sick dog. His blood work shows success. Try to relax a little at this point and enjoy your success too. I can't say positively that the liver values will go down, but I have a pretty good feeling they will. my best patrice |
| Patrice NYS |
| Patrice, Sometimes the fear just overwhelms me. I need a good calming down talk every now and then. Thank you, Thank you, Thank you!!!! |
| Ronda |
| Ronda, if it makes you feel any better I get worried even when Tessy sneezes!!! Also gotta remember just how regenerative the liver is. It's an amazing organ for healing itself! Plus, none of the other liver enzymes are up so take comfort in that also. Imagine how worried you'd be if they were all high! Just take comfort in knowing you're taking care of what has to be done. You're doing your homework on this issue and most would just listen to the vet and not worry. That's what makes you a great doggy mom! We can only do what we can. Kudos to you! HUGS, Johnny & Tessy |
| Johnny |
This thread was discussed on 29/06/2010
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