# Liver Problems



## MelodyoftheForest (Sep 11, 2015)

So, Gobo was supposed to get a dental to remove a retained puppy canine yesterday. Pre-anesthetic bloodwork was not part of the original estimate they sent me, so I called and made sure they knew I wanted it to be done. I dropped him off yesterday morning and got a call from my bet much earlier than I expected. Turns out he had an elevated liver enzyme, so I agreed that they could do the bile acid test with him instead of the dental. The vet called this evening to say that, too, came back as abnormal. She knows I am an attentive and educated dog owner, so she asked what I knew before she suggested what to do next. The most likely explanation is, of course, a liver shunt, so she recommends imaging to look for one. She emailed the local internal medicine specialist vet to see what she recommends. I will either go to her, or she will suggest going to Tufts, which is a couple hours away.

I remember a similar thing happened to SinisterKisses when Finley went for his neuter, so I am very glad I had the bloodwork done. I don't look forward to the process ahead, either surgery or medical management depending on the specific issue. We have had a hellish couple of weeks here already. I did't need this!


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## susan davis (Mar 25, 2011)

Reta, I'm so sorry this has happened. Does Gobo have any symptoms? How old is Gobo? If he is a puppy, maybe this will resolve by itself I have a chi that is 9 yrs old and has been on phenobarbital for years, and has a very abnormal liver enzyme. Just one out of the several liver enzyme tests. She shows no symptoms, and the vet is just watching it. I know that this abnormal test is due to the phenobarbital, so there isn't much I can do about it. She also has an abnormal bile acid test. If you feel comfortable waiting it out, for a couple of months, then I'd wait. Up to you, obviously.


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## MelodyoftheForest (Sep 11, 2015)

Gobo doesn't really have any symptoms. He is at least a 18 months old, but not sure as he was a rescue. I have fed him three kinds of kibble since I had to stop doing raw. His stools are the worst on the one he is eating now, and it has the highest fat, but not the highest protein, of the three formulas. The food with the middle amount of fat but lower protein than the other two was also difficult for him to acclimate to. I wonder if that is because his liver can't process the fat well. If I wait, maybe I will look for a lower fat food in the meantime just to see if it helps his stools.


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## Ari1405 (Apr 18, 2017)

I'm sorry to hear about Gobo. 
I honestly don't know much about this topic 
But I think you should try changing his food to see if it helps his stools. How many different kibbles has he went through? Maybe their is one he'd do better on, as you said being lower in fat. 
The ultimate decision is yours of course but if he really isn't showing any signs perhaps you could wait it out. 
Please keep us updated.


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## SinisterKisses (Sep 20, 2015)

Ahh I'm sorry to hear this - yes, we had the exact same issue when Fin went for his neuter! Blood work done prior to the procedure showed he has micro-vascular dysplasia. This is why I ALWAYS insist on blood work being done beforehand, you just never know and it's always better TO know.

Gobo isn't showing any symptoms at all? That's good! He'll probably be totally fine then. Finley was diagnosed at 6 months old and same thing, was a complete surprise as he hadn't shown anything even remotely close to a symptom. Finley has now celebrated his 2nd birthday this past June, and his condition has never once affected him in ANY way to date. From the extensive conversations we had with our vet at the time, she/we don't expect that he will likely ever REALLY have an issue given that he's not symptomatic at all. She expects that he will live a full, regular lifetime and it likely won't affect him much at all - perhaps in the future if another issue comes up, it may affect what medication he is able to have and that sort of thing. When he gets into his later senior years, into the teens she figured, he MIGHT need some sort of regular liver medication at that point, but he may not. 

Our vet didn't suggest any changes to what his diet was at the time, which is what it is now - he gets Orijen Six Fish kibble with a smidge of wet food mixed in for breakfast and lunch. It's definitely a higher-fat food of course, but he's never had any dietary issues in two years. Which food are you feeding Gobo now? I had asked our vet at the time if we needed to make any dietary changes and she said to leave it be as long as he was doing well on it, so perhaps the issues Gobo is having on his food isn't a result of the liver issue but something else? Either way, if he's not doing well on what he has, certainly couldn't hurt to see if there is something else out there that agrees with him better.

Please keep me updated on what you learn from the internal medical specialist if you go to see her - obviously I have a great interested in this as well! Best of luck to you and Gobo!


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## MelodyoftheForest (Sep 11, 2015)

Thank you for responding. When my vet mentioned MVD, I thought that is what Fin was diagnosed with. What kinds of diagnostics did you do? Gobo doesn't have any of the symptoms my vet listed of more advanced disease, though he did take longer than expected to recover from the coccidia he had when I rescued him. He was underweight then, too, despite a good appetite. Of course, he was eating lower-quality food too. He is on Nature's Variety Instinct salmon, the original formula without freeze-dried raw pieces. Of the three formulas I have tried, he did the best on the Merrick grain free Lil Plates beef. He did just OK with Fromm 5 star pork and peas. Merrick was 15% fat, Fromm was 17%, and the Instinct is 20%. I will look for something with lower fat but still plenty of protein.

I will absolutely keep you all updated. My vet was really glad I have this community to learn from and share with, and I am too!


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## susan davis (Mar 25, 2011)

I think you are on the right track with the lower fat content, if his stools are not as 'good' as a higher fat content. Sounds as if Merrick is the winner! Keep us informed, as we all care.


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## SinisterKisses (Sep 20, 2015)

Fin's diagnosis was fairly "easy". As soon as the abnormality came up in his pre-neuter blood work, our vet had her suspicions right away due to the fact that Finley's half brother belongs to one of the girls who works at our vet and also has the condition. When we had started bringing Gizmo to the vet as a puppy, one of the receptionist fell absolutely in love with him and asked for the information on where we got him. She ended up getting a Gizmo-brother from the next litter (Tait) - same mom and dad. Finley has a different mom, but the same dad as Gizmo and Tait. Apparently Tait was diagnosed with MVD when HE was neutered as well, which we didn't know until it came up with Finley (Tait is about a year, year and a half older than Finley). Because our vet knew they had the same dad, she was pretty sure what the issue was when the blood work showed an issue. As such, we did a bile acid profile next, and after that we did a protein culture. I know there was one or two other things we could have done at that point to completely 100% absolutely positively define that he has MVD, but our vet was sure already so we didn't bother paying for procedures that wouldn't really give us any more information.


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## MelodyoftheForest (Sep 11, 2015)

I am glad it went easily for you. Did you and she alert the breeder that the stud seemed to be passing this on?

I got a message from my vet today while I was watching the eclipse with my family. She is sending me to the local specialist clinic to get an ultrasound on Gobo. Given his history is unknown, we are starting with the most likely possibility, a shunt or shunts. The specialty clinic also has talented surgeons and the latest technology if that is the direction we need to go. I will call for an appointment tomorrow.


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## SinisterKisses (Sep 20, 2015)

Oh yes, I let the breeder know immediately. Apparently, though, she is not the caring, knowledgeable, more-about-the-dogs-than-the-money breeder I thought she was once upon a time. She flat out denied that it came from her stud, refused to even think about the idea, blamed everything else under the sun, and a year and a half later has continued to breed him more times than I'd like to count. Now if I happen to come across someone else who has one of her pups, I make sure NOT to say how great she is, and instead tell them how TERRIBLE she is and to have their pups tested. Obviously, I will be looking for a new breeder whenever the time comes for our next pup.

Fingers crossed for the best possible outcome for Gobo!


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## susan davis (Mar 25, 2011)

I have run into this too. I sought out a good breeder, found one in Indiana, and talked with her. She gave me a phone number, saying 'she has pups on the ground'. Well it turned out that the breeder was in Oregon! (I am in Joliet IL) She said she would fly the pup to Indiana, as they did breedings with their dogs. After picking out little Bonnie, it took her 17 weeks to finally fly this dog to Indiana. I met the Indiana breeder half way. Bonnie is really tiny. She was barely 1.5 pounds at that age. It turned out that she is extremely shy, is not registered, has a dental problem with teeth growing down instead of up, and cannot eat and breathe at the same time! Poor thing is scared out of her wits and spends most of her time in her pen. She willl not come to me, unless she is really sick, or I just pick her up. The minute I let go, she runs back to the pen. I tried socializing her, took her to puppy school, took her to a dog camp in Vermont. All of which she tolerated, but never came out of the 'shell'. The breeder quit answering my questions, and a month after I got her, she blew me off! I don't know what I'll do for the next pup---probably a rescue.


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## lulu'smom (Jan 4, 2012)

So very sorry to read about Gobo! Absolutely smart of you to do bloodworm before the dental, but being a long-time dog owner as you said you knew that. Lulu had hepatitis a few years ago which elevated her liver enzymes--I know no comparison to possible liver shunt or what you're going through, but my vet gave me a homemade diet that Jean Dodd has patients with liver issues follow that I used at the time. I'd be happy to pull my file and share if you're interested. Also, I have a chart of foods that are good, bad and neutral for liver issues if your interested. I think it could only help.


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## MelodyoftheForest (Sep 11, 2015)

It sucks that so many breeders are so good at lying to puppy buyers. Lulu's Mom, I would be glad to look at what you have found as far as feeding dogs with liver issues. I spent some time finding some foods I want to try with Gobo that still have high (at least 27%) protein and lower (under 11%) fat. I want to see if that works for him before we get a diagnosis.

He has an appointment to see the specialist Sept. 1. I think it is a consult, so I don't know if we would do the ultrasound then.


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## lulu'smom (Jan 4, 2012)

I would love to help! When I pulled my info I remembered I focused on low purine foods, but I'm sorry I can't remember why (all this happened in 2013). The diet is a formula of 2 cups of any low fat white fish such as cod or pollack, which I would poach, and 1 1/2 cup white potatoes, 1 1/2 cup sweet potatoes, 1 1/2 cup zucchini, and 1 1/2 cup of string beans or summer squash. Cook the potatoes as you see fit. Some people don't like to boil because they don't want to lose nutrients into the water. Some people don't like to microwave because it destroys nutrients. I leave that up to your decision. Cut up the string beans or squash and zucchini and either steam or boil--also up to you. Once all ingredients are cooked, stir them all together. Feed as you feel is best for Gobo. My paperwork does say though with liver disease 3-4 small meals a day is best. Personally I would add No Salt to maintain potassium--not alot, just a touch. It also recommends supplementation with an infants liquid multi vitamin. I used Poly Vi Sol. Also give Milk Thistle for help with liver healing. For dogs under 5 lbs use 10% of adult dose. 5-10 lbs--15%. You can get Milk Thistle at a health food store. If you want to see the copy of my diet I used, it's on Canine epilepsy and diseases that cause seizures in dogs even though Lulu doesn't have epilepsy. I also liked the website Canine Nutritionist Service | Customized Diets for Dogs | Homemade Dog Food. 
Foods low in Purines: eggs, cheese, cottage cheese, yogurt, carrots, potato summer squash, sweet potato, cucumber, asparagus, apple, blueberry, orange, strawberry, rice-white, wheat flour.
Moderate Purines: beef muscle, chicken muscle, lamb muscle and liver, rabbit, turkey and venison, cod, haddock, halibut, whitefish, pumpkin, kale, green beans
High Purines: beef liver, heart and kidney, chicken liver and heart, lamb heart, salmon, sardines, tuna, broccoli, brussels sprouts, cauliflower, corn, banana, oats, rye
That is not a complete list of Purine foods but many of them. I wish I could send you copies of this stuff, but I'm not great with a computer.

Also, have you checked into Sojo food? It's a commercial raw I fed Lulu for a while when I worried about her liver. It was the closest commercial raw I could find that fit into those categories of protein/fat you gave and I searched exhaustively!

Hope this helps!!


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## MelodyoftheForest (Sep 11, 2015)

I just wanted to give you all a quick update. Gobo saw the internal medicine team today and had an ultrasound. There was no evidence of a shunt or anything on the ultrasound, so that is good. We are watching for now. I will get new bloodwork from my regular vet in two weeks to see if the elevated enzyme goes down, stays the same, or goes up. The enzyme does not suggest liver failure, but does suggest some kind of trauma to the liver, like a night of binge drinking would do to a human liver. If the labs don't change or the value goes up more, we will try a course of antibiotics (metro-something, don't feel like looking it up) to see if there is an infection that can be knocked down.

The specialist said sometimes these tiny dogs just have really tiny livers, so they have trouble keeping up. In the meantime, I greatly reduced his fat intake, and that has improved the quality of his stools.


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## susan davis (Mar 25, 2011)

Is Gobo on any medications? Emmie, my 9yr old, has ONE very elevated liver enzyme. The vet says it is because of phenobarbital. It shows inflammation of the first layer of the liver. As long as the other enzymes are normal not to worry. The liver works fine, just this one outer layer shows inflammation. Very impressive elevation too.


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## MelodyoftheForest (Sep 11, 2015)

No, he is not on any medication. Maybe the high fat food was just too much? We shall see what happens!


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## lulu'smom (Jan 4, 2012)

I'm hoping it's simply the high fat food. That's why I stopped feeding only Ziwi Peak. Lulu had a couple of elevated liver enzyme blood works. No one gave an official diagnosis of the food, but when I deciding to stick with the lower fat raw foods on a regular basis she hasn't had any more. I only started feeding some S & C and ZP trying to get her to eat something/anything now with CHF, but I'm worried it will cause me to deal with other issues. If it's not one thing it's another.


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## MelodyoftheForest (Sep 11, 2015)

So Gobo and I went back to the vet today to get blood drawn again and we talked about probable courses of action. It seems like the probability is that he has microvascular dysplasia (MVD) like SinisterKisses' youngest. Assuming his liver value is still elevated, which my vet anticipates they will be, she wants to do a liver biopsy to look for MVD. I will probably have her do it when he finally gets his dental done. She said the treatment is generally long-term Flagyl and diet changes. I seem to have gone the wrong direction with the low fat. He will likely need low protein to prevent the build-up of nitrogen. He isn't doing great on the high-protein, low-fat anymore anyway. At least, his poops are getting worse again. Apparently plant protein can be better for dogs like Gobo, so I am curious to try a vegan food. I will add fat to it so the fat isn't too low.


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## susan davis (Mar 25, 2011)

Good luck on the blood tests. I wonder what Flagyl does for the liver? I was a medical assistant with family practice, and that wasn't what flagyl was used for. More for gynelogical problems! Maybe ask the vet about vegan dog food? I know they exist, but you'd have to google them?


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## SinisterKisses (Sep 20, 2015)

Hmm I'll be interested to see how it turns out for poor Gobo - like I said, we haven't done any treatments or changes for Finley since he was diagnosed, and he's doing perfectly fine. Perhaps Gobo has a higher/worse stage of the condition? But good news about no shunt!


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## MelodyoftheForest (Sep 11, 2015)

susan davis said:


> Good luck on the blood tests. I wonder what Flagyl does for the liver? I was a medical assistant with family practice, and that wasn't what flagyl was used for. More for gynelogical problems! Maybe ask the vet about vegan dog food? I know they exist, but you'd have to google them?


The way my vet explained the meds is that it keeps down the load of anaerobic bacteria. With blood not going through the liver correctly, bacteria is not always cleaned out of the blood, which can clearly cause issues. I actually was doing some research on foods yesterday, and there is an organic vegan food that has protein on par with the prescription diets (PetGuard Organic Adult Vegetarian) that I am curious to try. I would add some oil to up the fat content.



SinisterKisses said:


> Hmm I'll be interested to see how it turns out for poor Gobo - like I said, we haven't done any treatments or changes for Finley since he was diagnosed, and he's doing perfectly fine. Perhaps Gobo has a higher/worse stage of the condition? But good news about no shunt!


Gobo is not symptomatic now, other than the fact I haven't found a food that he has great poops on long-term. I want to keep ahead of it, though. Maybe the biopsy would tell us more about the severity and how heavy we need to go on prevention.

Edit: the PetGuard food does have a little egg in it, but egg is a good protein for this condition, if I remember correctly.


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## susan davis (Mar 25, 2011)

I wonder if Gobo would do as well as Finley with your doing nothing? He is not having any symptoms. Medication always has pros and cons, and if he could get along with none, it would be great!JMO


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## MelodyoftheForest (Sep 11, 2015)

Yes, I have thought that too. I need to talk with my vet more. I have been curious about trying a vegetarian diet for Gobo regardless, so I will likely do that, if not put him on Flagyl. 


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## lulu'smom (Jan 4, 2012)

I'm so sorry the low fat diet didn't work for Gobo. It's frustrating that you have to try things that don't work to get to what does. I googled it, and there are several brands of kibble that advertise vegan. Also, I saw several homemade vegan recipes that looked pretty easy to do. The problem there to me would be if you fed homemade he may not want to eat the kibble if you wanted a break from doing it yourself. Would he stay on the Flagyl constantly or off and on? Also, would he need a probiotic with the Flagyl? Just wondering.


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## susan davis (Mar 25, 2011)

Do you know the specific liver enzyme that was elevated? The reason I ask is that the alkaline phosphotase is a liver enzyme that targets the outside of the liver, and is very sensitive. My chi Emmie has an alkaline phosphotase of 8000mg! The rest of the liver panel is fine. Normal is about 150mg. She has been on phenobarbital for epilepsy for years. See if you can find out----maybe helpful in deciding what to do. (I am a retired medical assistant---thus the questions!)


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## MelodyoftheForest (Sep 11, 2015)

Lulu's Mom, I have my own health issues that make kibble the best choice for us now, and I use it in his Treat & Train machine. I have cooked for dogs in the past and enjoyed it, though. Thankfully, Gobo is not picky at all, so switching around doesn't concern me. I think the Flagyl would be all the time, but it is very gentle and spares the good gut bacteria.

Susan, I do not know the name of the elevated enzyme. It is apparently the same one that would be elevated in a person after a night of heavy drinking, if that helps.


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## MelodyoftheForest (Sep 11, 2015)

So I just talked to my vet, and the one enzyme is still elevated, but not as much as before. She said it is ALT. The Chem 25 was all good! Since he is not showing clinical signs, I won't do the biopsy. It seems MVD is the assumed diagnosis, so that also makes it seem not worthwhile. We are going to keep an eye on him and re-test his values in a year or two to see if things have changed. Since I have struggled to find a kibble that is just right for Gobo, I asked the vet about what direction I might want to look in for something that might be easier on his liver and perhaps prevent or delay the onset of clinical signs of disease. She is going to do some research and consult with the specialist and another vet in my local practice who is apparently a walking dog food encyclopedia and get back to me. I feel confident this is the right path for now, and that is a good feeling!


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## susan davis (Mar 25, 2011)

This is great news! Hooray!!! Lets hope Gobo does as well as Finley!


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## lulu'smom (Jan 4, 2012)

Wonderful! If we must go through these issues with our dogs, it's comforting to feel good about the direction/care we're getting and giving.


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## SinisterKisses (Sep 20, 2015)

Good news!


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