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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - HIgh liver enzymes and possible dental work.
| Wylie is now 13 years old and has been med free a year now. Last year she had her teeth cleaned and had no problems. her ALK was around 100 and the ALT was in the 200 range. She has been now been consistantly in the 400 range ALK and 450-550 in the ALT. She has reently been spitting out her dry kibble whe she eats, she also does this with her dog treats. She does not do it with soft food. The vet suspects a tooth problem but wanted me to monitor her and the ore I see her the more I think its a tootrh problem. Soo what kind of problem for dental work with these liver numbers? I know when she had her spleen out her ALT was 600 and he was concerned about surgery. He thinks because of her age and everything she has gone thru its chronic liver problem and there is nothing that can be done. Any thoughts?? Thanks Laurie |
| Laurie CA |
| Laurie, I'm not entirely sure what to say or recommend with regards to these liver values and sedation. I can't see it being a problem cause I know that sometimes they'll sedate a dog to do ultrasounds and liver biopsies when values are higher than these. I *think* it's important to have the bile acid tests done pre surgery/pre sedation when these values are high isn't it? Might be worth asking the vet. If I were you i'd also consider having them do an ultrasound AND maybe even a biopsy of the liver while under...that way they can treat more specifically. If money isn't a huge issue. I'd also take into consideration the clinical signs Wylie shows. If he's acting normal and everything is good except the kibble issue then that certainly helps. What has the vet said specifically about this? Johnny & Tessy |
| Johnny |
| Laurie, I don't have anything to add or suggest but I wanted to let you know I am thinking and praying for you and your dear girl. Penny |
| Penny Lytle Creek Calif |
| Laurie: I don't have any good advice for you about the liver values and dental work. What I can tell you is that we did have Sheba sedated for X-rays and dental work while she was still on Atopica back in the fall of 2008. My husband was not happy about it but I felt we really needed to know why she was having problems walking and I figured as long as she was out we'd have her teeth cleaned, too. I can't remember what her liver values were at the time but I'm sure they weren't normal. Sorry I can't be or more help than that! You might try emailing Dr. Dodds and asking her opinion. BTW - how is Wylie's paw? It must be doing better? Sheba fell down the steps 3 weeks ago and fractured a toe on her right front paw. Not fun - especially since our vet had just left for a 2 week vacation. The gal who was subbing was nice enough but put a full splint on Sheba. Poor thing could hardly get around with her bad rear end. After a week we had the vet who does her acupuncture shorten it up for us and we left it on another week. Finally took it off last weekend and have been letting her go without. She's doing okay but not happy about having to be carried down stairs. (Hates it!) Keep us posted and we will keep you in our thoughts! Rita, Mike and Sheba |
| Rita IA |
| Laurie, This is a bit tricky and I don't think there is one simple answer. In the end this would be the choice of the attending vet and the policy of the clinic. It is entirely possible that these numbers are elevated DUE to the problem with the teeth and removal of that tooth/teeth would cause the numbers to drop. These values can increase and decrease rapidly from week to week and so therefore don't always indicate liver problems that need treatment. However, if they are consistently elevated, then the vet needs to exam further why that is the case. Talk it over with your vet. Decide if they think it is a good idea to some dental exploration under gas anesthesia. I would highly suggest a pre-op blood test for this. When you do this, you will have a good idea of what is going on. There may be other values on the test out of the norm that would indicate caution going forward. Or if these numbers are the only numbers elevated, and they seem to be consistently elevated, then perhaps a liver biopsy is called for. Here is one website I sometime reference. This vet answers questions and some of the ones on this page relate to dental work and elevated ALT. You will see as you read that there are so many variables it might often be difficult for a layperson to decide what to do. http://www.vetinfo.com/dalkphos.html In addition, this is an excellent round-table discussion by several vets on how they approach diagnostics with animals that present with elevated liver values. Try to read through it. You may not understand all of it, but at least print it and show your vet that you tried to read it, could they help you understand their take on it? http://www.idexx.de/tiergesundheit/praxisanalysegerate/snapreader/lr0905final.pdf Here is an excerpt that might be of interest to you: "Twedt: ALT is a sensitive indicator of liver disease but not necessarily specific for a primary disease that we have to treat. We have to keep that in mind. In addition to assessing the enzyme values, we need to evaluate the entire patient for systemic disease and always determine the animal’s drug history. Various medications can cause liver changes and increased enzyme activity. We must always perform a physical examination to identify whether the animal has other obvious problems, such as neoplasia. The enzyme values alone don’t specify the liver as the problem. Steiner: I use a twofold and fivefold rule. With a twofold to fivefold ALT elevation in an otherwise normal animal presented for an elective procedure, I watch that patient and recheck it. I may postpone the procedure, but if it’s medically indicated for example, a dental cleaning in a patient that eats poorly because of its dental disease I do not postpone. With a persistent twofold elevation that is reproducible over two or three months, I get more aggressive diagnostically. If the ALT is initially higher than a fivefold elevation, I pursue additional diagnostics immediately." If this won't open from this link copy this into google and it will put it at the top of the search list: Diagnosing Liver Disease A roundtable discussion my best patrice |
| Patrice NYS |
| Patrice, thank you for all of that information, it really helps. We had her teeth cleaned for first time last year, when her ALT was about 300 and Alk normal, the vet thought a tooth problem could be causing that high ALT but nothing was found. All of her other CBC# are normal, she is eating fine now so I wonder if she was sick, After I brought her home from thet vet I found 3 throw up spots like probably right after she ate. LOL, Trying to figure out what dog it is since her and Jake eat similar things. But the strange thing is she wanted to eat. She is now eating good again and only spitted out food a few times. and Ihave not seen anymore throw up. Rita, your post from when I asked before about getting Wylies teeth cleaned encouraged me to move forward to do it and she did just fine. Its just he older she gets I worry and since she also also just had that episode with low platelets. Wylies paw finally healed, she's got a bad scar from it, I really think it was a spider bite. I am so so sorry to hear Sheba fractured her toe. Wylie went thru that and had to wear a cast longer than her leg for 6 weeks! That was eight years ago and so funny to see her running around on 3 legs with this bright red cast up in the air. You should ask the vet to just wrap it to stabilize it. I can't imagine how Sheba could get around in a cast. Big hugs to Sheba. How is the accupuncture working on her back legs? Jake my 13 year old lab is now having a lot of difficulty and I want to see if he can get some relief. |
| Laurie CA |
| Laurie: Glad to hear Wylie's paw is better now and that she is eating well again. Sheba limped for a few days after we took the splint off but is doing fine now. We only let her do stairs with supervision right now and won't take her in for grooming for another two weeks or so to be sure it's healed. She seems to be self-limiting her activity so that's good. The acupuncture is working great! The vet uses a laser - not needles - which is good as Sheba is bad about standing still for the process. He also does chiropractic on her spine. If you can find someone nearby who is qualified, I would try it for Jake. It has made a huge difference for her. There for awhile we were thinking we would have to make some hard choices because we couldn't see how we would get through the winter. Now we are picturing Christmas celebrations and spending time next spring smelling all the pretty flowers. (Sheba loves to smell the flowers - it's fun to watch!) We hope Wylie continues to improve and if you try acupuncture for Jake we hope he responds to it. Keep us posted! Rita, Mike and Sheba |
| Rita IA |
This thread was discussed between 01/07/2010 and 08/07/2010
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