# Liver Enzyme Levels are elevated-- but Liver Biopsy is Normal. Help!



## LamborghiniGirl (Apr 16, 2009)

Hi everyone,

This is somewhat of an extension to my other thread about the whole process before, during and after Misto was spayed. I was encouraged to start another thread specific to the new issue at hand :wub:

So here is the history. Right before Misto was going to be spayed, they checked her blood and found her Liver enzymes were slightly elevated. We decided to have the surgeon do a liver biopsy while she was already under anesthesia, so she wouldn't have to go under again in the future. 

After the surgery, the surgeon said her liver has 'mild cell vaculation', but otherwise the liver looks very healthy, and all the tests they did on her liver for serious problems came back negative.

They asked us to come back in a couple months to check Misto's liver enzyme level again, and see if they were slightly elevated still or normal.

So, a couple weeks ago we went back and it turns out Misto's liver enzymes are actually even higher than before. Still, the level wasn't super high, and the surgeon said that some dogs just naturally are elevated.

But I don't want to just wait for something bad to happen-- I want to find out what is causing the elevated enzymes and get to the root of the problem.

They prescribed her an antioxidant for her liver, but I haven't gone to pick up the script yet. 

*Does anyone have an opinion on what else could be causing the elevated liver enzymes, if the liver biopsy came back normal?*


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## edelweiss (Apr 23, 2010)

Maybe her food is too high in protein. You could reduce that w/a lower protein food & start her on milk thistle to bring down the levels, re-test in 4-6 weeks and see if they come down?


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## Snowbody (Jan 3, 2009)

I have no suggestions, though Sandi's sound right, but do hope that darling Misto will be fine. She's fully recovered since the spay right? Boy we were all on the edges of our seats with it.


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## pammy4501 (Aug 8, 2007)

Could be MVD. Pretty common in some tiny dogs. Is the med he ordered called Denamarin? If it is, it will help. Looking into feeding a liver friendly diet is something to consider. mVD dogs can live perfectly great lives with a little extra care.


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## jmm (Nov 23, 2004)

I would have your vet call and get the pathology slides sent to them. I would then send them to Dr. Sharon Center at Cornell. If it is MVD (sounds like it), she will give you a definitive diagnosis. Many MVD dogs have elevated liver enzymes but live long, normal lives.


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## LamborghiniGirl (Apr 16, 2009)

Thank you all for the suggestion! I have put in a call for my vet to call me back. Other than MVD, is there anything else it could be I should investigate?


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## allheart (Oct 3, 2008)

Praying for your precious baby, and hope those numbers stay down.


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## *Missy* (Oct 7, 2011)

Oh sweet Misto! I hope it is nothing to cause something bad in the future  everyone sounds pretty knowledgable so I would definately talk to your vet about this and I'll pray that it is nothing that won't heal itself or with some easy meds


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## LamborghiniGirl (Apr 16, 2009)

I just spoke with my surgeon-- who is also the head of neurology-- hence why have been referred. Misto and I have an appointment with the head of internal medicine tomorrow. We are going to discuss how to proceed, because they already specifically analyzed her for MVD, and just didn't mention it to me since they found nothing to suggest it is MVD. After consulting with several other specialists they all concluded she absolutely doesn't have MVD. So I guess that is good news-- I am just worried what else it could be.

After tomorrows appointment I am still going to request Misto's liver readings per JMM's suggestion to send to the Cornell specialist, just to have another opinion.


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## mss (Mar 1, 2006)

Which enzymes?
I've been doing some googling about why just one enzyme (ALT) is elevated and I've found articles that say it can indicate damage to muscles or other organs, not just liver. You might find this article interesting. http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00128.htm


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## LamborghiniGirl (Apr 16, 2009)

mss, Thank you so much for sharing that article! Tomorrow at the appointment I am going to ask for all the specifics and copies of all the medical records pertaining to this. Maybe then I can look at that link and figure it out. I will definitely keep everyone posted!!


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## girlie girl (May 28, 2006)

Hi there girle my maltese had an elevated alt dont know if that is that same as what ur saying but she has been on denosyl for numerous years. there is also a product called denamarin for that. also she eats science diet id formula. hope all goes well

jan


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## SammieMom (Nov 13, 2010)

My only exper with liver tests was with My Maltese. He tested slightly elevated for the bile testing for liver. I dont know if that is same Test your talking about here. They told me same thing that it can be common with small breeds. And will retest later. Then I was told by a friend that there was really no point in retesting him unless he had issues. Prob depends on numbers 
Keep us posted.


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## suzimalteselover (Mar 27, 2006)

I'm so glad Mistro was confirmed not to have MVD. This is a shot in the dark...but, worth a shot....by chance, has Mistro taken Angel Eyes? (It's a supplement taken for tear staining.) Angel Eyes causes elevated liver enzymes. Once the Angel Eyes dosage is stopped, the liver enzyme resumes a normal reading.


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## LamborghiniGirl (Apr 16, 2009)

Thank you everyone for your input, I feel like I am being a detective lol! Like I said, tomorrow hopefully we will have a plan from the vet of how to get to the bottom of this.

Misto's bile acid test was normal, no shunts at all, liver size is very healthy, no MVD, and she has never taken angel eyes.  

She has a very delicate stomach that has completely rejected all foods except for Weruva and Kong-brand peanut butter (go figure!). I am very worried about changing her food-- obviously if it is the cure I will do it, but every other food we've tried, Misto immediately throws up. Including science diet i/d. we haven't tried their formula specific for the liver though. She can have one tiny treat each day-- but if i give her more than one, she throws them both up. 

All the cans of Weruva say there is 8% protein-- is that particularly high?


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## Maidto2Maltese (Oct 19, 2004)

I'm not much help but want to say that Quincy's blood panels are all but perfect except for some elevation in ALT. ( Not horrible but elevated) The vet said we'd keep eye on it but isn't really concerned since everything else is normal. In reading the article posted I see it can be caused by GI issues which he does indeed have.

Another possible>> At our pets with diabetes group there were a couple of dogs that had elevated liver enzymes, found when doing pre-testing for dentals. The first was a Schnauzer owned by our administrator. The second was another pooch who followed the same pattern. At first dentals were postponed to seek cause for the elevations. When none were found, the dentals were done. Come to find after the dentals were done, the liver enzymes went down.

Praying with little Misto that is nothing of any concern and likely so since so much has already been investigated, but totally understand your wanting to rule out any possible issues for the future!


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## kodie (Aug 24, 2004)

As for food recommendations... have you tried any of the veterinarian sold dog foods? I have had my little boy on Royal Canin duck and potato Veterinary Diet Canine... i'm not saying to try just that one... but they have other options from that brand as well... and it has worked really well for us... my babies have sensitive stomachs, plus my little boy has allergies with his skin and MVD. You can purchase the food online (i think) but i purchase it at any vet office. I also use the treats made by them... or i give them cheerios. I dont buy any of the treats from petsmart or anything... there seems to be alot of weird things in them.


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## harrysmom (Sep 28, 2007)

I'm sorry that you're upset about Misto's liver enzyme levels. My Harry has liver issues and we saw the vets at Cornell and consulted with Sharon Center about his issues. Harry's issues are severe and there were symptoms... fluid in his abdomen, strange behavior. In my opinion, if Misto is not having any symptoms and the numbers are just slightly elevated, I would just monitor him at this point. I don't think there would be any harm in trying different foods and adding Denamarin is a good idea, but other than that I wouldn't do anything. With Harry, right now, we treat the symptoms as they occur. For example, I have lasix on hand and if I notice fluid retention I give him some for a few days until the problem is resolved. I spoke with Dr. Canter a few months ago and she told me that's the right way to go... and I was glad to hear it, since that's what I was doing all along anyway...lol. Harry will be 5 soon and, thank God, he is doing great! 

MaryH knows a lot about liver issues, and she helped me with Harry. Maybe she'll see this thread, or you could PM her. I wish you a lot of luck with Misto. Please keep us updated.



Hugs.
Debbie


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## LamborghiniGirl (Apr 16, 2009)

We just got back from the vet. The doctor took another blood sample to analyze for 3 other diseases/problems it could be in her intestinal tract/stomach. I guess the fact Misto has so much trouble with food (such a picky tummy) may actually be because she is allergic to something in her food (chicken or beef). I guess if there is a problem/disease in the intestine, since it all filters through the liver, that can spike the liver enzyme level? so first we are going to wait for the results of the 3 tests and then try changing her food to venison.

Honestly, I am not too excited about changing to Royal Canin venison, which is what they suggested. I really like Weruva and the whole concept behind it (grain free, organic, the cans themselves are safe, 100% meat and veggies).

I am not sure what else to investigate for!


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## Lacie's Mom (Oct 11, 2006)

Jacquelyn -- if they feel it might be a food allergy, I would encourage you to look at this thread:

http://spoiledmaltese.com/forum/52-...-dodds-nutriscan-test-food-sensitivities.html

I kept it posted as a "Sticky" because so many of our little ones have had food allergy issues. You might want to pm April about her experience with this test.

Sending hugs to you and lots of hugs and kisses to our sweet little Misto. I am glad that she doesn't seem to be feeling bad, though.


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## Ladysmom (Oct 19, 2004)

Lacie's Mom said:


> Jacquelyn -- if they feel it might be a food allergy, I would encourage you to look at this thread:
> 
> http://spoiledmaltese.com/forum/52-...-dodds-nutriscan-test-food-sensitivities.html
> 
> ...


I agree with pm'ing April or just searching for her recent posts about Lily's digestive issues. A grain free, high protein food was the culprit. 

Bailey's breeder recommends a moderate (24%) protein food. I feed Bailey Fromm per her suggestion. There really are lots of high excellent quality foods out there that have a lower protein content. Royal Canin would not be my choice either.


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## LamborghiniGirl (Apr 16, 2009)

The Weruva has 8%... so that must not be high?

Also I forgot to mention earlier, I found out 3 of her liver enzymes were high, but the main one, her ALT level was in the 300's when she was spayed, and 550 a week ago.


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## LamborghiniGirl (Apr 16, 2009)

p.s. do you think they want me to try her on this special prescription royal canin venison formula because it is simply venison and not chicken or beef... or because there is something else special about it?

if that is the case, and lets say it works-- and she shouldn't be on chicken or beef anymore, i'd much rather have her back on an organic, grain-free venison food. not royal canin. we've had such nightmares with royal canin already-- granted, not the same formula, but a different royal canin made misto particularly sick.

and i don't mean to offend anyone who has had success with royal canin! i am just nervous. i hate when misto starts throwing up again, she deteriorates so quickly.


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## Ladysmom (Oct 19, 2004)

LamborghiniGirl said:


> The Weruva has 8%... so that must not be high?
> 
> Also I forgot to mention earlier, I found out 3 of her liver enzymes were high, but the main one, her ALT level was in the 300's when she was spayed, and 550 a week ago.


I checked the Weruva website and the analysis is different than most pet foods who use 100% value. Looks like they use a 10% value which means their canned food is 80% plus pure meat/protein. The reminder is primarily fat.

Weruva - People Food for Pets - Dog Cuisine - Human Style

I am not veterinary nutritionist, but if Misto were mine, I'd suspect her food might be the culprit.


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## maggieh (Dec 16, 2007)

Jacquelyn - DVP Natural Balance makes a venison and sweet potato. It's a pretty good food as well.


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## LamborghiniGirl (Apr 16, 2009)

wow-- so maybe the super high protein is the culprit-- thank you for sharing that with me. i am just nervous about switching. the 10 types we tried before weruva made her throw up almost instantly after eating-- i have no idea how to choose another one.


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## Ladysmom (Oct 19, 2004)

LamborghiniGirl said:


> wow-- so maybe the super high protein is the culprit-- thank you for sharing that with me. i am just nervous about switching. the 10 types we tried before weruva made her throw up almost instantly after eating-- i have no idea how to choose another one.


Misto obviously has serious digestive issues so I would follow your vet's advice. I just wanted to give you a heads up on the actual nutritional content of Weruva.


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## girlie girl (May 28, 2006)

Hi again something for nausea *metoclopramide* girlie just starting taking it recently and it seems to help dose is twice a day either 1/4 or 1/8 of a tablet

jan


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## SammieMom (Nov 13, 2010)

LamborghiniGirl said:


> We just got back from the vet. The doctor took another blood sample to analyze for 3 other diseases/problems it could be in her intestinal tract/stomach. I guess the fact Misto has so much trouble with food (such a picky tummy) may actually be because she is allergic to something in her food (chicken or beef). I guess if there is a problem/disease in the intestine, since it all filters through the liver, that can spike the liver enzyme level? so first we are going to wait for the results of the 3 tests and then try changing her food to venison.
> 
> Honestly, I am not too excited about changing to Royal Canin venison, which is what they suggested. I really like Weruva and the whole concept behind it (grain free, organic, the cans themselves are safe, 100% meat and veggies).
> 
> I am not sure what else to investigate for!


Poor little Misto, nothing worse than a belly ache. She is a doll. You gotta post some more pics of her. I don't believe I have ever seen a doggie that small. I feed NB Venison and sweet potato, but mine has NO stomach issues, just itching. I went to grain free for that reason, but like Marj said that may not work with elevated proteins. Good luck. Hoping you get some answers soon. This is so stressful I know and I did not have near the issues you have to work through.


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## jmm (Nov 23, 2004)

I just want to stress again having the slides reviewed by Dr. Center. Just because the lab your vet used says one thing doesn't mean one of the foremost experts in the field won't have a better answer for you.


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## LamborghiniGirl (Apr 16, 2009)

jmm said:


> I just want to stress again having the slides reviewed by Dr. Center. Just because the lab your vet used says one thing doesn't mean one of the foremost experts in the field won't have a better answer for you.



Thank you-- I will definitely do this. What exactly should I request from my vet? If I say I need Misto's "slides" will I get everything I need?


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## Rocky's Mom (Apr 10, 2010)

Oh what a scare...hoping sweet Misto is just fine!


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## jmm (Nov 23, 2004)

You should. You will be charged for the recut and shipping (usually around $35).


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