Hi,

I posted earlier in the week because we were thinking that our 10 month
old had a blockage of some description due to lethargy and
regurgitation of water occasionally and vomiting every few days.
Multiple X-rays were carried out, and no foreign body was found.
However, the spleen/liver/pancreas looked slightly enlarged which at
the time the vet put down to medication (as she had been treated for
food poisoning).

I asked for a blood panel to be carried out, as we still had not found
the cause of the lethargy (our dog now simply lies in her bed and
doesn't want to play or walk).

The blood panel showed elevated levels of the Liver Enzymes : ALT= 987
(norm 10-100) and ALKP= 465 (norm 23-212). On closer inspection with
guided X-rays, the liver does appear to be slightly enlarged. They have
no ultrasound available here.

They do not think that this liver problem is a secondary problem. The
reading for the Pancreas (Amylase) appears normal/lower than normal =
292 (norm 500-1500) and this they said ruled out Pancreatitis, which we
were thinking was a possibility. They think she is too young for
Addison's.

So, the vet is presuming it is a type of Chronic Active Hepatitis and
treating with prednisone steroid, and two types of antibiotic, as well
as L/D Hills prescription diet. She plans to review in 10 days time and
carry out another blood test.

Now I get to where you may be able to help:

1. Has anyone had a young dog have Chronic Active Hepatitis? What was
the cause? Outlook?

2. She had been given a vetalog steroid injection and Metronidazole
antibiotics before the lethargy came on- has anyone had experiences
where these drugs have caused problems with the liver?

3. Any recommendations on diet supplements? Also, we live on an island,
and we will run out of the Hills Prescription L/D food soon- I have
read that K/D may be a good alternative (they do have that left), or
any pointers on a home made diet?

4. Has anyone followed through with a needle aspiration or invasive
surgery, for a liver biopsy? I feel these may be warranted in 10 days
time if things do not improve, but I am concerned about her having to
be opened up (she took longer than average to recover from her spay
operation when she was fit and healthy). A needle aspiration is less
invasive but is it likely to be good enough?

Thank you for listening!

2. She had been given a vetalog steroid injection and Metronidazole
antibiotics before the lethargy came on- has anyone had experiences
where these drugs have caused problems with the liver?

Metronidazone is contraindicated in dogs with liver abnormalities. At the
time she was given this, the liver issue was unknown, though. This may be
makng the existing problem worse.

"Sharon" wrote in message
...
2. She had been given a vetalog steroid injection and Metronidazole
antibiotics before the lethargy came on- has anyone had experiences
where these drugs have caused problems with the liver?

Metronidazone is contraindicated in dogs with liver abnormalities. At the
time she was given this, the liver issue was unknown, though. This may be
makng the existing problem worse.


......and steroids can cause pancreatitis in breeds that are prone to this
problem.

..........To the OP - has this dog been tested for tick diseases or
Leptospirosis? The only way to definitively diagnosis CAH in dogs is with a
liver biopsy, so you don't necessarily have a diagnosis yet.

buglady
take out the dog before replying

buglady wrote:


.........To the OP - has this dog been tested for tick diseases or
Leptospirosis? The only way to definitively diagnosis CAH in dogs is with a
liver biopsy, so you don't necessarily have a diagnosis yet.


The first step to diagnosing CAH is getting two separate liver panels
2-3 weeks apart. A moderately elevated ALT on both tests (and 900 is
moderate) will indicate a biopsy is needed. Needle biopsies are not
always accurate, laproscopic biopsies where they can get a decent chunk
and also view the liver are best.

I haven't been following this thread and don't know if this is a male or
female mix, but CAH is almost unknown in male dobermans, totally unknown
in intact male dobes. It seems to be a disease of bitches and a few
neutered males. When I had Jasper in the CAH study at the University of
Missouri, he was the only male dog in the study--neutered.

Thank you for your reply. She is currently on 500 mg of Metronidazole
twice a day, as well as 500 mg Amoxicillin twice a day. She is a 50 lb
female mixed breed (part Doberman).

I am concerned about giving her the Metronidazole, though the vet has
prescribed these medications since the liver issue was found (as well
as previously). The vets change here every two weeks (as we are on an
island and they fly in from the States). She seems a competent vet from
Wisconsin and mentioned her mother's dog have liver problems but making
a full recovery (presumably with her help). Now I am torn. I have read
about this contraindiction as well, and have also found advice on
prescribing Metronidazole at much lower levels because of this- what
would amount to 160 mg. My gut says to reduce the amount. Any one else
with thoughts on this?

Hi,

Thank you for your comments. The vet has mentioned that Pancreatitis is
pretty much ruled out, as she is not vomiting as much as
'regurgitating', and not as often as normally seen with pancreatitis.
Also, her Amylase test was low (292 rather than 500-1500) which would
indicate no problem with the Pancreas. Having said that, I do feel that
the combination of the Vetalog (such a strong one off injection) and
the Metronidazole, made the liver problem progress much quicker, if it
they did not cause it. I am not sure if we will ever know whether they
caused it or made it worse, but she was regurgitating and vomiting
before taking them.

She has been tested for the tick diseases (Lyme and Ehrlichia) and
Heartworm which they have here. She came negative on all three (though
the vet had suspected these strongly at the time).

She hasn't been tested for Leptospirosis - I am not sure if that is on
this island, or if it is everywhere. I will look in to it. Thank you
for that angle.

Robin wrote:

The first step to diagnosing CAH is getting two separate liver panels
2-3 weeks apart. A moderately elevated ALT on both tests (and 900 is
moderate) will indicate a biopsy is needed. Needle biopsies are not
always accurate, laproscopic biopsies where they can get a decent chunk
and also view the liver are best. '

Thank you for this information. We will carry out another liver panel
in 10 days time (which will be 2 weeks apart) to see if anything has
changed, and I will post here. Then we will move towards the biopsy if
things haven't improved. At the moment, I am concerned about giving her
the antibiotics and steroids when we do not really know what is going
on, and I am resting with the judgement of the vet in the most part,
but am considering reducing the metronidazole dosage at least.

I haven't been following this thread and don't know if this is a male or
female mix, but CAH is almost unknown in male dobermans, totally unknown
in intact male dobes. It seems to be a disease of bitches and a few
neutered males. When I had Jasper in the CAH study at the University of
Missouri, he was the only male dog in the study--neutered.

Bonnie is a spayed female 10 month old mixed breed. We are only
presuming she is part Doberman, and likely that one of her parents was
possibly purebred Doberman. She looks very similar to the Dobermans we
have seen on the island as pets, and it is likely that one of them went
with a stray dog on the island, and produced a litter including Bonnie.
I am not sure how likely it is that she has the inherited problems of
some purebred Dobermans, but I have a feeling that it has at least made
her more susceptible. Any thoughts or knowledge on Doberman mixes in
the study?

wrote in message
oups.com...
Thank you for your comments. The vet has mentioned that Pancreatitis is
pretty much ruled out, as she is not vomiting as much as
'regurgitating', and not as often as normally seen with pancreatitis.
Also, her Amylase test was low (292 rather than 500-1500) which would
indicate no problem with the Pancreas.
.........Amylase level is not a definitive marker for pancreatitis. It may
be elevated, but not always. If it is NOT elevated, it can't necessarily be
ruled out.

Having said that, I do feel that
the combination of the Vetalog (such a strong one off injection) and
the Metronidazole, made the liver problem progress much quicker, if it
they did not cause it. I am not sure if we will ever know whether they
caused it or made it worse, but she was regurgitating and vomiting
before taking them.

She has been tested for the tick diseases (Lyme and Ehrlichia) and
Heartworm which they have here. She came negative on all three (though
the vet had suspected these strongly at the time).

........well, that's good, because I think steroids are contraindicated with
Erlichia IIRC.

.........how about Babesia? What island is this - tropical?

She hasn't been tested for Leptospirosis - I am not sure if that is on
this island, or if it is everywhere. I will look in to it. Thank you
for that angle.

.......lepto can affect either the liver or the kidneys. It would take 2
weeks to get a test result.

..........And I wouldn't necessarily rule out Addison's either. The only way
to rule it out is an ACTH stimulation test.
........I went back and reread your original post. What was the deal with
the food poisoning? You know for sure what she ate?

buglady
ta eout the dog before replying