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Hello,

I am a first time poster out of desperation. I have no where to turn to and no one has any answers for me. I have a 9 year old Keeshond. About 2 weeks ago she started urinating on the floor in one particular place. Thinking she may be suffering from a bladder infection, we contacted our vet. He prescribed a course of antibiotics. For 6 days, all was well. She stopped urinating in the house, but all of a sudden she began vomiting bile. We immediately took her to the vets. They stated that a virus was going around, especially with older dogs, and he would take blood work as a precaution. The blood work came back stating that her liver levels were slightly elevated. Her ALT was roughly 383. He put her on metronitizole as well as antibiotics and sent us on our way. That was Tuesday the 19th.

Just two days later, we returned to the vets office because Hope had not eaten since Monday night before her last doctors appointment. We were extremely concerned because she was refusing everything and vomiting her pills back up. The doctor took a chest X-Ray and looked for any type of blockage. The results came back normal. We took her home and started her on SubQ fluids, Panacur, Pepcid and an anti-nausea. This was Thursday the 21st.

On Sunday we were administering her SubQ's when we noticed her skin was jaundice. Immediately we rushed her to the closest emergency veterinarian. He stated that we should keep her on the SubQ fluids until the next day and then return to our normal vet. This was Sunday the 24th. Still hasnt eaten anything, by the way.

Monday morning came and we got the very first appointment in the morning. Our regular vet decided to run another chem report. This time, he found her liver levels were literally off the charts. Her ALT=1572, ALP >2000, GGT=81, Total Bilirubin=20.7, Cholesterol=520. How is it possible that in less than one week her liver levels became so high?

We rushed her to a specialists hospital featuring 20 different doctors, 24/7 veterinary care, a chemotherapy and radiation clinic, and orthopedic surgeon, dentist, ophthalmologist...etc..etc. She was admitted for an ultrasound, IV fluids, a liver aspiration for testing, and testing for Leptospirosis. Monday the 25th.

On Tuesday the 26th we were told that her cytology report stated that she most likely did not have cancer or pancreatitis. However, she was (obviously) experiencing liver failure, but the doctor stated that she was very optimistic. They started her on a variety of medications which I will list:

Ampicillin/sulbactam (Unasyn) 150mg/ml
Famotidine (Pepcid in IV form)
Normosol-R 1000ml
Metoclopramide (Reglan) 5mg/ml injection
Potassium Chloride injection

Which brings us to today, Wednesday the 27th. Hope still hasn't eaten. Her liver levels were retested. All of a sudden the doctors optimism has gone south. She stated that maybe its possible she could have cancer after all--we'd have to have a biopsy done. Shes hoping her liver levels will change during tomorrows chem work-up. She stated if no change takes place, then we are in serious trouble and then started talking about euthing her. I work at the humane society and have seen many owners bring their animals in who are on their last leg-- Hope is NOT acting that way. She is cheerful and happy to see us visit. She wags her fluffy butt and enjoys going outside for a quick walk. This is not a dog thats ready to go.

Here are her current levels:

Total Protien-4.3
Albumin-2.4
AST-240
ALT-1246 (normal is 12-118
ALK Phos-3941 (normal is 5-131)
GGTP- 158
Bilirubin- 19.7
Cholesterol- 805

We already invested over $6,000 dollars in just the 4 nights shes been in the current hospital shes in. We are no closer to answers than when we first arrived on Monday. Please, if you have any ideas or suggestions I would be more than happy to hear them. I have been searching for answers, talking to other Keeshond owners, reading articles-- Im stumped!

Please help!
 

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Have the doctors considered a shunt? The only one I know of is called a portosystemic shunt. This.can be intra- or extrahepatic which means internal or external respectively. Intrahepatic shunts are more difficult to deal with because.it's inside the liver. Basically , a shunt prevents the liver from doing its functions like filtering toxins and metabolizing proteins amongst many others. Is she acting disoriented or out of the ordinary at all? Treating liver problems is complicated but I hope the doctors.figure out something soon!
 

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Discussion Starter · #3 ·
Other than refusing to eat and being a bit sleepy, she is completely normal--the happy little girl we've always known. I'm not sure if they doctors have considered a shunt or not, but I will be researching that in just a moment so I can bring it up to them. I just cant fathom how her levels could have gotten so high so quickly. Is a shunt visible on an ultrasound? Honestly, we've seen so many doctors who have all tossed around so many possible diagnoses and yet known of them seem to actually follow up on those potential ideas. For instance, one doctor suggested hepatitis. Since that time, Ive never heard another word mentioned about it and when I asked if this was possible, I was quickly dismissed.
 

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Ask your vet about Adenosyl 225, I think it's called. It's the only med that actually aids regenerating the liver. I had a Cocker that one morning vomited coffee-ground looking blood. Her liver values were awful, and vet talked about cancer/biopsy. He put her on the A-225, Metronitizole, flagyl, and something else. She also was in the hosp for about 3 days on IV's. Then she came home w/a prescript diet, and meds. My vet said not to do a biopsy because at her age, if it was cancer, there wasn't much to do. If it wasn't, he'd have her on the meds he'd already prescribed. Plus a biopsy has risks of uncontrolled bleeding, infection, etc.
One month later her bloodwork was perfect.

Dogs can get Hepatitis. Some meds can cause liver damage. The liver is one of the few organs that can actually regenerate itself, though. Has the dog possibly gotten into anything like ibuprophen? Any toxic plants, garlic, rat poison, horse dewormers, blue skinks?
 

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I agree with asking about Adenosyl (AKA Sam E, Denysol), Marin, and milk thistle into her. They will all help aid liver function. My dog had off the chart liver enzymes as well, a combination of putting her on a carefully balanced raw diet, and those 3 supplements (I find that keeping the Denosyl and the Marin separate instead of the drug that combines them together). The good news is it sounds like this is an acute VS a chronic problem, and as someone else mentioned, the liver can regenerate itself, so with proper treatment she should be fine - All these supplements are OTC, you don't need a prescription to get them but I've seen them time and time again make a VERY dramatic difference in liver health! I believe these supplements have saved the lives of 2 of my dogs!
 

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Other than refusing to eat and being a bit sleepy, she is completely normal--the happy little girl we've always known. I'm not sure if they doctors have considered a shunt or not, but I will be researching that in just a moment so I can bring it up to them. I just cant fathom how her levels could have gotten so high so quickly. Is a shunt visible on an ultrasound? Honestly, we've seen so many doctors who have all tossed around so many possible diagnoses and yet known of them seem to actually follow up on those potential ideas. For instance, one doctor suggested hepatitis. Since that time, Ive never heard another word mentioned about it and when I asked if this was possible, I was quickly dismissed.
Unfortunately, an ultrasound, even if viewed by an internist, will not be able to confirm a shunt. Even a biopsy. Nevertheless, the ultrasound will show if the blood vessels going in and out of your dog's liver and see if they are visible. If they are not, then the blood (thus, oxygen and other vital elements) are not getting through. The biopsy can show if there is inflammation of the liver. Shunts are difficult to diagnose unfortunately. But seeing as she has symptoms, then that is why I thought of a shunt.

What is her BUN (Blood Urea Nitrogen)? Has your vet done a fasting bile acids test? If the concentration is high, then it is likely PSS (portosystemic shunt). Bile acids has something to do with gallbladder contraction and gastric emptying and intestinal absorption - they do a blood test before and after eating. A high bile acids does not confirm PSS - some dogs have microvascular dysplasia which means that the vessels in the liver are small so vital elements cannot be transported into and out of the liver. Dogs with MVD are usually asymptomatic and I've read that it occurs mostly in some breeds like Maltese. But seeing as your dog's ALT and ALB are very high, this is more indicative of a shunt. I asked about your dog's BUN because urea is created in the liver....your liver metabolizes protein and thus creates waste products as a result. One of these waste products is urea so if it is low, then your dog's liver is not working properly. I'm going to try and attach a document about PSS - hopefully, it will clarify some things. Ask your vet about doing a protein C test (mine cost around $92 with a discount and it's sent to Cornell) - there is research that if it is lower than 70%, then it is more likely that it is PSS rather than a congenital condition like Microvascular Dysplasia (MVD). One way to diagnose PSS is scintigraphy. I'm not sure what this involves but the result is some kind of fraction that can be calculated and determine whether it is a shunt or not.

Regardless, my vet says liver conditions are treated the same way. That is, denosyl, adenosyl, Zentonil, and/or milk thistle. Another vet told me my dog's elevated ALT could be intoxication by some bacteria (possibly by feeding her raw) so he suggested giving her antioxidants. I've been giving her vitamin E and her ALT has reduced. But my dog most likely has MVD.

I don't want to say it's a shunt but it won't hurt to ask your vet. Hopefully, the attachment will...well...be attached. Let me know if they don't.
 

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Oh no, I went through this with my cat. His ALT was 1200+ and Bilirubin was 14.5 so I can sympathize with you. My cat made it, he is 100% today (a yr later) but it was alot of work to keep him alive while his liver regenerated. He wouldn't eat/drink for about 5 months. But he didn't act like he was dying either, like you said about your dog.

The meds he was on were: metro, pepcid, pred, amox, milk thistle, denosyl, ursodial.

We never got a real diagnosis, it was a very odd case and my vet didn't think Bear would make it. It took a long time for the levels to go down, I guess it took the liver a while to heal. The closest thing we got to a diagnosis was chlorhepatitis, you might want to look it up. We did an ultrasound too, it didn't show anything for bear. Just inflamed liver/panc/intestines, no tumors.

We had to do SubQ fluids @ home every day (then every other day as he was getting better) and I had to force fed him for those 5 months. He acted normal and happy, the only difference was that he slept more. Our I would have pts, I really struggled with that.

I will pray for you & her. Def ask for Denosyl and ask the vet if he thinks Ursodial would help. Mine didn't know what it was, but he looked it up and have me an rx anyways. It's supposed to help the bile flow through the liver better, apparently it can get so thick that it causes issues.

(((hugs)))
 

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In July of 2011, Remmy had a seizure while at an Agility trial. About six weeks later he had another so I had a blood test done and they did a fasting bile test and his liver numbers were out of kilter. He was put on a month of antibiotics and another fluid (can't remember the name right now). At the end of that his liver was back to normal. I had him tested again in Feb. 2012 and everything was good. In all this time, he has been acting perfectly normal, eating, drinking, going to Agility trials.

On Saturday, he had another seizure. It only lasted a couple of minutes, then he was right back to normal. I am taking him into the Vet on Thursday to get tested. They never really discovered what was wrong with him but hepatitis was mentioned.
 

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This thread is from 2011, and the OP has not been active since. You're unlikely to get an answer. Please feel free to start your own thread about this topic or participate in current discussions, but I'm closing this one to further replies.
 
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