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**Update - she's home ** Educate me on liver failure in dogs

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  • **Update - she's home ** Educate me on liver failure in dogs

    My 13yr old Boston has just been diagnosed with liver failure this morning and of course my way of coping is going into research mode

    I'm trying to dig through articles on the internet but was hoping someone on COTH with experience with this could give me the Cliff Notes version now.

    It seems that diet needs to be a big concern at this point to make sure she's getting the nutrients she needs in the most efficient way possible for her body. I'm currently feeding Taste of the Wild. One article I've already read mentioned that they needed higher carb diets with high quality, easily digestible proteins (but that lots of meat released ammonia during digestion = bad). Do you think there's a better food choice for her that would be easier on her liver?

    We're starting her on Denamarin to help support her liver. What kind of results can I expect? Her blood results showed that her liver levels were very high (forgive me for not remembering the exact tests). I'm just wondering how much of an effect this drug can have and how much time it can buy us.

    All other info is appreciated. I just want to do what I can to help her live out her life as comfortably as possible, while also keeping her around as long as possible!
    Last edited by SkipHiLad4me; Apr. 3, 2012, 11:24 AM.
    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!

  • #2
    This may or may not be of any help to you, but I had a Cocker that ended up vomitting what looked like coffee grounds, and walking in circles, and vet diagnosed with liver failure/disease. Opted not to biopsy, because he said if it was cancer, then she wouldn't get better, and if it wasn't, then treatment might help. Her bloodwork was horrendous, in regards to her liver.
    Vet put her on IV's for 2 days, and started her on Metrozinole (sp?), Flagyl, and Adenosyl 223. Apparently the Adenosyl 223 at the time was the only drug proven to help the liver regenerate quicker. (this was about 6 yrs ago). Brought dog home after a few days, and dog was eating and no longer throwing up but numbers still looked awful (worse, than before). Kept her on meds for a month and brought her back, and bloodwork was perfect. Dog lived for another couple of yrs, eventually needing to be put down for heart failure combined with liver issues...couldn't give heart meds, due to liver...couldn't give liver stuff, due to heart.

    Don't know if any of that helps, but I'd definitely talk to your vet about Adenosyl 223. (there may be something even better now, but it seemed to definitely help).

    Did your vet test for Lyme disease? It can cause liver problems. Treating the Lyme disease, can help the liver.


    • #3
      Liver values can be elevated for a host of reasons, so I guess if I was in your shoes I would want to investigate further. Usually if the ALT/ALKP are elevated on a routine screen, the next steps would be ACTH stim test (to check for cushings), pre/post bile acids (checks liver function), abdominal radiographs and an abdominal ultrasound (+/- biopsy).
      I guess I, personally would base what I wanted to do diagnostically on how high the elevations on the screen were and if there were clinical symptoms and of course what my vet recommends.

      Denmarin helps to support the liver and thereby slow the disease process. But getting a diagnosis and treating appropriately will help the most overall.

      Hope that helps a bit.


      • #4
        I dealt with this last year.

        10 year old male Corgi was to have minor surgery and I had bloodwork drawn. Came back with high liver values. Life interfered with medical needs of other dogs so did not follow up for a period of time. Drew more blood, liver values were worse. We did yet more bloodwork that needed to be sent out, diagnosed with liver disease. Over the course of the next 2-3 months we changed meds and some helped, some did not. Dog was having a tremendous amount of paw discomfort and began to show lesions around testicles and corners of mouth and eyes.

        I lost him May of 2010. I did not do a necropsy (and regret not doing it).

        I wish I had better news for you.


        • #5
          So sorry your dog is not feeling well.

          What is your dog doing clinically? Does he/she have fluid in her abdomen? Do you have the lab work available? Liver failure and disease are two different things (as far as management) and the lab work can help differentiate. In addition some liver diseases are very treatable even if values are very elevated. For example copper storage disease can cause liver failure but is very treatable with proper work up and management. Even some dogs with lymphoplasmacytic hepatitis can have marked improvement or resolution with proper management. There are, of course, some dogs that do not respond well to therapy. If you have the lab work available I am happy to provide my opinion ( for what it is worth )

          If she is in liver failure you would really want to feed a low protein diet. The denamarin alone will probably not help much. It is most useful for toxin exposure (such as xylitol), but it will certainly not hurt. The denamarin has adenosylmethionine in the product. Treatment varies widely depending on how advanced the disesae is and the underlying cause.


          • Original Poster

            I thought I had a copy of her blood test results but I don't. I will have to ask my vet for another copy to let you know exactly what was tested and what the levels were. I really didn't ask the questions I should have because I was having a hard time even holding it together. We lost our other senior dog this past summer and I couldn't help but think OMG I'm going to have to put another one of my dogs down I plan to call back tomorrow so I can speak to the vet again. I have no idea what to expect with this which makes it that much more stressful for me and I want to make sure I'm doing everything I possibly can to help her.

            Her symptoms started out a few days ago when she started having trouble getting around, which isn't unheard of because she has arthritis in her back and hind legs. But then yesterday she couldn't keep her food down and was just really lethargic so I knew something was up. I do think that she might have some fluid retention in her abdomen also but the vet didn't mention it. We had an xray done and there were no signs of tumors/growths that might point to cancer. There is an ultrasound specialist that comes to the office twice a month so we're on the schedule to see him next week to see if he can determine more about what's going on.

            I finally got her to eat some cottage cheese mixed with a handful of dog food and she was the most excited about eating as she's been in a couple of days so I'm hoping this is a good sign. She's also been drinking more water today, which she wouldn't do much of yesterday. So hopefully this will help her regain some strength.

            I'm pretty sure my dog food is on the high end of the protein scale so I need to find out what else is available to me that might be a better choice.

            Thank you so much for the info and suggestions thus far! It's very much appreciated.
            "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

            Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!


            • #7
              This was years ago, so it may not apply today.
              Our toy poodle was healthy until at 12 years old she was diagnosed with liver failure and, once stabilized, put on special dog food.
              Her symptoms left and she had some good 1 1/2 years, when her liver just didn't support her any more, she was in terminal liver failure and our vet euthanized her.

              Now, this many years later and each case different, you and your vet will have to play this by ear.

              Hoping your dog comes out of it this time and you have some more good times to come.


              • #8
                Different species, but fwiw - my elderly horse had a liver infection 2 years ago. We treated it with antibiotics then put him on a "liver failure" type of diet, low in protein and fat and high in carbs. He has done amazingly well - bloodwork is back within normal limits and he's gained weight and looks great. Here's hoping you can come up with a similarly effective plan for your dog.


                • #9
                  It depends WHY the liver is failing. There are thousands of reasons.
                  Some are reversible, some are managable and some come with a very poor prognosis.

                  Great vet for recommending an ultrasound - this can give you a LOT of information.

                  About 5 years ago we did biopsies on a husky (he was 10), had a HUGE liver mass with high ALT (normal AlkPhos). Biopsy came back as hyperplasia. As the mass was huge, it was causing him discomfort, gall bladder obstruction and overall making him very ill. He did go through surgery, and has returned yearly for checkups - at 15 years old, he's looking great.

                  Other types of liver disease can be medically managed well (ie. vacuolar hepatopathy, steroid hepatopathy, hepatic lipadosis), some managed for short to medium term (ie.lymphoma), and some types just dont respond (end stage liver). Its best to know exactly what you are dealing with (if you are prepared for that) IF you plan to treat it. If you dont plan to treat, and just let nature take its course than of course there is no need to biopsy.

                  Non-invasive biopsies called fine needle aspirates are easy to obtain, are a quick 5 minute in and out procedure and can sometimes give you a vast amount of information. Usually these can be obtained with a mild sedative. Core biopsies done ultrasound guided are also less invasive than surgical biopsies. These are usually obtained with a 16g biopsy needle and analgesed sedation or short general anesthetics are used.

                  Best of luck with treating your pup!!!


                  • Original Poster

                    Just wanted to update... I called the vet's office this morning and was able to speak with our regular vet (who is the BEST). She reviewed Cindy's file from yesterday's visit with a different vet and was definitely able to shed some light on the issue that the other vet didn't share. We were scheduled for an ultrasound NEXT Friday (that's when the ultrasound specialist was coming). Our regular vet said that based on what she saw that she would NOT wait until then and that now was the time to act if we were going to do it. She called in a referral to the NCSU CVM for us around 10am and we dropped everything and were in the car on our way to Raleigh by 11am. It's been such a stressful day!

                    The good news is that the CVM vets are cautiously optimistic that this is not true liver failure and that we could possibly be dealing with a liver infection. Her chest xray was clear. The ultrasound showed no major issues except for a slightly enlarged liver. No obvious signs of pancreitis (sp??). They have sent her liver aspirate sample off for culture and are awaiting the results. Her liver enzyme levels were actually slightly lower than originally thought when retested with the CVM's equipment but still quite elevated (ALT was 622 and AST? was 1800). We were at the outer range of our local vet's testing so the results were skewed. They will retest the CBC tomorrow morning and hopefully have results from the culture. They have her on broad spectrum antibiotics, fluids, pain meds, and anti-nausea meds. She was comfortably sleeping off her sedation when the vet called. We will know more about her condition in the morning. Jingles and well wishes are appreciated. I *heart* the CVM and I'm so glad to have access to such a great facility. I know she's in good hands and this is the best shot we can give her but it was SO hard leaving her there this afternoon
                    Last edited by SkipHiLad4me; Mar. 29, 2012, 09:20 PM.
                    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

                    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!


                    • #11
                      Yes, that leaving them there is just about impossible to live with, is it.
                      I say, they need to have rooms where you can stay with your dog overnight, for those that can.

                      Sounds like they have things under control there, does it.


                      • #12
                        Yay!! Good for you for working her up. Sounds like she is hopefully well on her way to a good recovery!


                        • Original Poster

                          Bluey - It was terrible!! I cried all the way to the parking lot and couldn't get the picture out of my head of that little face saying "Mom you can't leave me here!!" I would sleep in that kennel with her tonight if I could.
                          "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

                          Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!


                          • #14
                            So glad that you got the referral. Hoping for good news for you and your pup!


                            • #15
                              Jingling for you and your girl.
                              "Kindness is free" ~ Eurofoal
                              The CoTH CYA - please consult w/your veterinarian under any and all circumstances.


                              • #16
                                I sure feel for you. Last July my 11 year old Boston girl (who was my soulmate dog, my best friend) started showing signs of illness (vomitting ect). We took her in and her bloodwork showed that she had either Hepatitis or cancer of the liver and that a surgical biopsy would have to be performed. I didn't want to put her through sugery but there was a chance that if it was Hep that we could control it and she could have a few more years, so we went ahead with it. It was horrible leaving her there...I just wish they could understand.

                                Crossing my fingers for your little Bostie girl. Sounds like she is in great hands and that is otherwise quite healthy. You are a good mom

                                "Simple: Breeding,Training, Riding". Wolfram Wittig.


                                • #17
                                  More jingles for Cindy!!
                                  The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


                                  • Original Poster

                                    Saturday update

                                    Wanted to give you guys another update... my pup is still at the vet hospital on IV antibiotics, fluids, and pain meds. She finally ate breakfast for the vet staff this morning which is great news!! They also seemed to think she was more alert and responsive this morning. I hope this means we're heading in the right direction.

                                    They pulled blood yesterday and her liver enzymes had dropped slightly. They will pull blood again tomorrow AM to take another look. At this point, after all of the testing, they still don't have a definitive answer as to what this is and what has caused it. They're still treating it as an infection in the liver. They were concerned about cancer but so far we haven't found any signs of it anywhere (thankfully!). There have been a few other wonky things to show up on bloodwork that they can't quite pinpoint but can't prove that they're related to her current condition. We're hoping this is a one time event of unknown cause and that she can overcome it with the antibiotics and supportive therapy. DH and I are making the trip to Raleigh tomorrow morning to visit her and see how she's doing. We're hoping that she continues to improve today and tomorrow and can possibly come home in the next couple of days. We're still trying not to get overly optimistic - you just never know what can happen at this point. They've pretty much done all they can do for her at this point without going into further and more invasive testing (which still might not provide us with a feasible option for alternative treatment). She's own her own now to get better! I've sort of come to terms with the fact that if she can't recover from this that the best thing we can do for her is to let her go. She IS 14yrs old now and has lived a wonderful healthy life up to this point. I'm really hoping and praying though that her little body can fight back and beat this We'll know more in the next day or two.
                                    "Farming looks mighty easy when your plow is a pencil, and you're a thousand miles from the corn field." --Dwight D Eisenhower

                                    Boston Terrier Rescue of NC - www.btrnc.org - Adopt for Life!


                                    • #19
                                      Thank you for the update.
                                      Maybe she will rally and be ok after this go round.
                                      Our toy poodle did, was fine for two more years after the first go round with liver failure, but yes, once they don't, it is time to let them go.

                                      Jingles for a rally.


                                      • #20
                                        Do ask your vet about Adenosyl 223.