Lyme disease and liver problems

[turtle]

I recently had my old dog at the vets and they found she has Lyme disease and that her liver is not functioning properly.

She was on Doxycycline 100 mg tabs 2x a day for the Lyme for 28 days, which sounds about right. Poor old dog was limping badly but seems better now.

Anyone have experience with Lyme in dogs? Is it cured by the antibiotics?


But the liver problem worries me much more. The vet really does not seem to know what is wrong with her liver. They said the problems could be caused by toxicidity, cancer, or by an infection. They did a general blood panel and then a specific test for liver function.

Her liver numbers on the blood test were 10 times higher than they should be. I had one more test done but it showed nothing except that her liver is not functioning properly.

I have been reading the articles on this site –

http://www.dogaware.com/health/liver.html

The vet prescribed Denosyl (SAMe) for her. That is supposed to help liver function and she has had 22 of the pills so far. She is about 11 years old, and in good health otherwise, except for her liver and the Lyme disease.

Here is a link about the SAMe and how it works –

http://www.peteducation.com/article.cfm ... 3&aid=3062

Her ALT is 1843 now, and normal range is 12 to 118, a year ago her ALT was 200, which was still high but not 10 times normal range like it is now.

Her ALB is 505 now and normal range is 5 to 131, and last year it was 53. So her liver numbers are way off. Vet asked if she was eating ok and she is, but she sleeps a lot.

If anyone has input or medical advice for her, please post. I am quite worried about all of this.
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[pblove]

join some of the lists that are on dogaware asap
http://www.dogaware.com/health/liver.html#links
feel better Fremiet

[Misskiwi67]

That is a REALLY high ALT. She should have x-rays and an abdominal ultrasound as soon as you can get her scheduled.

If her bile acids were elevated as well, her liver function is not good. The Sam-E is a good medication, but there's something more serious going on, and a supplement to liver function is only going to do so much. If her ALT were 400 I would still recommend an ultrasound, her numbers right now are off the chart, and should be addressed immediately.

What was her total bilirubin?

Lyme disease can do whatever it wants, it causes generalized inflammation, but the medication almost always results in improvement in 48-72 hours. Sometimes they will re-infect, but if the treatment was recent I would expect the lyme is a completely separate issue from the liver.

[turtle]

Thanks for the responses!

Yes, I am worried about her high ALT numbers.

Her Total Bilirubin was 0.3000 with normal range 0.1-0.3 mg/dL, so that number seems to be in the high normal range.

The vet also did a Liver Chemistry test and a Bile Acid test. I will copy the high numbers off of the test papers.

The Liver Chemistry test showed these numbers --

AST at 370, with normal range 25-66 U/L
ALT at 1956, with normal range 12-118
Alk Phosphatase was 567 with normal range 5-131 U/L
GGTP was 22 with normal range 1-12 U/L

The other numbers on that test were in the normal range.

The Bile Acid test showed these numbers –

Bile Acid, Resting (pre meal bile acids) 19.8 with normal range 10.0
Bile Acids, Post (post meal bile acids) 59.5 with normal range 20.0

These tests were done a month ago exactly, we all went on a trip right after this so now I am back home and looking to try to get to the bottom of what is wrong.

An X-ray and ultrasound was recommended and I have a call in to learn more about those and see about having them done. Is one preferred over the other one? I had a rough quote of over $500 for the ultrasound which seems pretty high to me but I have no experience with it.

She has finished the course of antibiotics for the Lyme and she does seem to feel better. I agree that the Lyme is a separate issue and hopefully is cured as much as it can be. Her liver numbers have been high in the past but never this high. But she eats well and does not act sick at all.

Thank you for any help and suggestions!
.

[Misskiwi67]

Thanks for the responses!

Yes, I am worried about her high ALT numbers.

Her Total Bilirubin was 0.3000 with normal range 0.1-0.3 mg/dL, so that number seems to be in the high normal range.

The vet also did a Liver Chemistry test and a Bile Acid test. I will copy the high numbers off of the test papers.

The Liver Chemistry test showed these numbers --

AST at 370, with normal range 25-66 U/L
ALT at 1956, with normal range 12-118
Alk Phosphatase was 567 with normal range 5-131 U/L
GGTP was 22 with normal range 1-12 U/L

The other numbers on that test were in the normal range.

The Bile Acid test showed these numbers –

Bile Acid, Resting (pre meal bile acids) 19.8 with normal range 10.0
Bile Acids, Post (post meal bile acids) 59.5 with normal range 20.0

These tests were done a month ago exactly, we all went on a trip right after this so now I am back home and looking to try to get to the bottom of what is wrong.

An X-ray and ultrasound was recommended and I have a call in to learn more about those and see about having them done. Is one preferred over the other one? I had a rough quote of over $500 for the ultrasound which seems pretty high to me but I have no experience with it.

She has finished the course of antibiotics for the Lyme and she does seem to feel better. I agree that the Lyme is a separate issue and hopefully is cured as much as it can be. Her liver numbers have been high in the past but never this high. But she eats well and does not act sick at all.

Thank you for any help and suggestions!
.

The ALT is scary high. I recommend advanced testing when the level is around 300-400. The bile acids and bilirubin are not as bad as expected, so liver function is probably acceptable for now. The ALT is a liver enzyme that is released when liver cells are dying, so there is some sort of major trauma going on to your pets liver. Luckily, the liver is one of the organs that can regenerate, which is probably why the function tests are only moderately elevated. Even so, I wouldn't wait to pursue more testing if you are considering it.

The x-ray and ultrasound complement each other, so both are recommended. The x-ray is very good at showing overall size of organs, and gives good quality images of fat, gas, and surrounding tissue. The x-ray will not show lesions within organs or changes to the internal structure of organs, and it is not good at picking up changes in fluid status (such as gallbladder obstruction). The ultrasound is less effective at showing size, and is unable to see through air in the lungs, stomach, intestines etc. The ultrasound is the least expensive non-invasive test that will give you an idea of internal structure of organs .

$500 for an ultrasound and x-rays is decent. I'm in the midwest and radiographs are $135 and ultrasound is $300. Keep in mind that ultrasound requires a LOT of advanced training. This is not something we learn to do in veterinary school, and it takes a lot of time and practice to learn to do it. I'm in the process of learning now. I've got 20 hours of formal classroom training, and it cost me $3,000 to get that training. I am only able to do basic ultrasounds, mostly on an emergency basis only. I'm about 25% of the way through what I expect will be required for me to perform ultrasound on a referral basis. The machine to perform an ultrasound costs anywhere from 20K-100K. The probes alone tend to run 5-10K.

[turtle]

The ALT is scary high. I recommend advanced testing when the level is around 300-400. The bile acids and bilirubin are not as bad as expected, so liver function is probably acceptable for now. The ALT is a liver enzyme that is released when liver cells are dying, so there is some sort of major trauma going on to your pets liver. Luckily, the liver is one of the organs that can regenerate, which is probably why the function tests are only moderately elevated. Even so, I wouldn't wait to pursue more testing if you are considering it.

The x-ray and ultrasound complement each other, so both are recommended. The x-ray is very good at showing overall size of organs, and gives good quality images of fat, gas, and surrounding tissue. The x-ray will not show lesions within organs or changes to the internal structure of organs, and it is not good at picking up changes in fluid status (such as gallbladder obstruction). The ultrasound is less effective at showing size, and is unable to see through air in the lungs, stomach, intestines etc. The ultrasound is the least expensive non-invasive test that will give you an idea of internal structure of organs .

$500 for an ultrasound and x-rays is decent. I'm in the midwest and radiographs are $135 and ultrasound is $300. Keep in mind that ultrasound requires a LOT of advanced training. This is not something we learn to do in veterinary school, and it takes a lot of time and practice to learn to do it. I'm in the process of learning now. I've got 20 hours of formal classroom training, and it cost me $3,000 to get that training. I am only able to do basic ultrasounds, mostly on an emergency basis only. I'm about 25% of the way through what I expect will be required for me to perform ultrasound on a referral basis. The machine to perform an ultrasound costs anywhere from 20K-100K. The probes alone tend to run 5-10K.

MissKiwi, thank you very much for your detailed response!

You explained this much better than my vet did. The quote was only for the ultrasound not including the xrays. I have found another vet that does ultrasounds so I am looking at getting this done as soon as possible.

She is on the Denosyl now and from what I have read, it should help her. Would it be better for her to be on Denamarin instead? Or should I just add Milk Thistle to her food?

Thanks for your help!
.

[Misskiwi67]

She is on the Denosyl now and from what I have read, it should help her. Would it be better for her to be on Denamarin instead? Or should I just add Milk Thistle to her food?

Thanks for your help!
.

Whatever is easiest for you to administer. I've had plenty of people use the human products and have the same effects.

[turtle]

My vet wants to do a CBC blood panel to check her liver enzymes to see if anything has changed. I am hoping for lower numbers! She wants me to stay with the Denosyl for now so I will just add some Milk Thistle to her food.

I also talked to the clinic that does the ultra sound, they sound pretty knowlegeable. They quoted $135 for the consultation and $259 for the ultra sound so that is not too bad. My vet wanted to check the numbers then have the ultra sound, and later maybe the x-rays.

So I am hopeful we can find out what is going on with her liver. Thanks again for the replies!

[Misskiwi67]

My vet wants to do a CBC blood panel to check her liver enzymes to see if anything has changed. I am hoping for lower numbers! She wants me to stay with the Denosyl for now so I will just add some Milk Thistle to her food.

I also talked to the clinic that does the ultra sound, they sound pretty knowlegeable. They quoted $135 for the consultation and $259 for the ultra sound so that is not too bad. My vet wanted to check the numbers then have the ultra sound, and later maybe the x-rays.

So I am hopeful we can find out what is going on with her liver. Thanks again for the replies!

It does make sense to recheck the numbers, so this is a good idea, I'm just not expecting much for results as Denosyl is for management of chronic disease, it doesn't treat any underlying disease. Unless the numbers are normal, do the ultrasound. Even if they come down by half (common with Denosyl, its amazing), they are still very high. An ALT over 200 is concerning, anything over 400 requires a full workup.

I would do the x-rays at the same time. The two tests really do complement each other, and we generally will not do ultrasound without them (If there's a giant tumor, why spend $260 on ultrasound?). I'm quite surprised your vet hasn't pushed harder for them, it makes me wonder if they have an older machine and maybe the x-rays should also be done by the specialist.

[Leslie H]

No liver experience, just Lyme's. It tends to have a second flare up 1-2 months after treatment. Not always, just another thing to watch.

[turtle]

No liver experience, just Lyme's. It tends to have a second flare up 1-2 months after treatment. Not always, just another thing to watch.

Thanks for that info! I can tell she is feeling better but good to know the Lyme can pop back up. Do you know if it should be treated a second time if it flares up?

[turtle]

It does make sense to recheck the numbers, so this is a good idea, I'm just not expecting much for results as Denosyl is for management of chronic disease, it doesn't treat any underlying disease. Unless the numbers are normal, do the ultrasound. Even if they come down by half (common with Denosyl, its amazing), they are still very high. An ALT over 200 is concerning, anything over 400 requires a full workup.

I would do the x-rays at the same time. The two tests really do complement each other, and we generally will not do ultrasound without them (If there's a giant tumor, why spend $260 on ultrasound?). I'm quite surprised your vet hasn't pushed harder for them, it makes me wonder if they have an older machine and maybe the x-rays should also be done by the specialist.

I had another blood panel done on her and then the recommended ultra sound. The vet wanted to do the ultra sound and see and then maybe the x-ray, I am not sure why she did not want to have both done at the same time.

Her liver numbers have improved but they are still very high compared to what they should be.

The most recent CBC panel showed these numbers –

ALT is 1325, was 1956, with normal range 12-118
Alk Phosphatase is 325, was 567 with normal range 5-131 U/L

So those numbers have come down some from the last test done in a month ago in August.

The ultra sound showed that her liver is a bit smaller than normal and it is darker in color, they also said her adrenal glands were “a bit plump”, but no other abnormalities were found.

The vet suggested she might have Chronic Active Hepatitis (CAH) or lymphoma, but more likely she has the Chronic Active Hepatitis. They gave me a prescription for antibiotics in case she has an infection in her liver too.

She is on the Denosyl 425 mg to help her liver function and Marin was also recommended. I was cautioned about using over the counter Milk Thistle because the Marin is formulated for dogs and has just the silymarin, plus many dogs are allergic to the straight Milk Thistle.

From doing some reading, the Chronic Active Hepatitis is not curable but can be managed with antibiotics, supplements like the SAMe (Denosyl) and a low protein diet. Copper levels in foods are something that is to be considered too as copper makes the liver problems worse.

I am trying to learn more about these diets for Chronic Active Hepatitis, and found this link –

http://phoenixdogphotography.com/2009/0 ... hepatitis/

There are many more links on this condition in dogs so I have a lot more to read.

Does anyone here have experience with this condition and with diets that will help it?
.

[Murfins]

Sending lots of healthy thoughts.

[suzanne]

I don't know about the CAH but we just had a dog with hepatitis we were treating... Her values were well into the thousands as well. Our doc put her on metronidazole, actigal, and pred. She also got a cerenia injection because she was urpy and not eating.

Come to think of it my cousin had a dog go into some kind of liver failure and they used the Denosyl and Pred to treat it. Has your vet mentioned using steroids at all??

the Denosyl 425 mg to help her liver function and Marin was also recommended. I was cautioned about using over the counter Milk Thistle because the Marin is formulated for dogs and has just the silymarin, plus many dogs are allergic to the straight Milk Thistle.

They make a product called Denamarin, same company that makes the Marin and Denosyl... would it be cheaper to buy the combined drug?

[Leslie H]

Another round of doxycycline if there's a flare up. My friend's agility apbt just went through this. Her first bout was atypical, included weird skin outbreaks, and a very high fever. The second bout was much more typical, sudden onset lameness and pain, which quickly subsided with the doxy.
Sending healthy thoughts your way.