Sophie Lab results - ALT/ALP elevated

[Nathalie]

On Monday, my little Sophie had dental work done under IM anesthetic. She is 7.5 years old and has not had a vacc since the approximate age of 9 mon. Maybe 3 half applications of Advantage her entire life. Raw fed since the age of 9 mon.
We also did a complete blood panel and everything looks fine except for elevated ALT and ALP levels.

ALP: 154 (24-141)
ALT: 109 (5-95)

It’s not a big elevation but I just was not expecting this and with everything that has been going on with Phillip I am bit more paranoid and what is mind boggling to me is that Phillip’s ALT is 35 while having cushings and taking a huge amount of Lyso and Sophie’s is 109.:confused:

Are there any other tests on the panel that I should look at that might be ‘borderline’ to figure out what is going on or do you guy’s think this is really nothing to be concerned about?
Something must be causing these numbers but I just can’t think of anything I have been giving her or in the environment.

I have changed her protean to chicken and fish instead of beef. Will start giving Milk Thistle and B-Complex 250 mg.

The name of the game with Sophie is prevention because she needs to be anesthetized for anything such as a blood draw. If she where to get cushings I would not be able to treat her as she could not handle the stress of it all.

Nathalie

[Harley PoMMom]

Hi Nathalie,

So sorry your Sophie's liver enzymes are alittle off, and I do hope that this is nothing to worry about.

This is from Broadway Veterinary Hospital:


The ALT, or Alanine Transferase, is slightly elevated. The significance of this finding is unclear at this time. This is an enzyme that is primarily found in liver cells, although small numbers of red blood cells and striated muscle cells also contain this enzyme. Elevations of ALT occur when any of these cells are even slightly damaged. Extreme exercise, hemolysis of red blood cells, and any liver problem will result in a high ALT.

http://www.broadwayvh.com/site/view/83223_AssessmentDescriptions.pml

As far as the liver, what is her AST and the Total Bilirubin numbers?

Is there anything else marked on there abnormal?

Love and hugs,
Lori

[Nathalie]

As far as the liver, what is her AST and the Total Bilirubin numbers?

Is there anything else marked on there abnormal?



Hi Lori,

Good question ... I can't locate a Total Bilirubin nor AST. :confused:
We have a Total Protean :o

Platelets are increased 669 (165-550) but vet said this is due to the anasthetic and apparently nothing to worry about.

Nathalie

[Harley PoMMom]

Sophie and I are back from the vet and overall it went very well! :D

She got a good scaling and polish and one lower incisor removed – just in time as the infection started to effect the adjacent teeth who had become a bit loose but should firm up now since the culprit is gone. Nails are short, anal gland empty and a little growth removed. We decided to not touch the lipoma as it is not interfering with anything – and the removal is not worth the risk of a reaction to the sutures (which she had before) or other complications so no general anesthetic was needed. Nathalie

Just maybe the infection from the tooth, the little growth you did have removed and lipoma that is still there, is what's making the liver enzymes higher than normal. What do you think?

Love and hugs,
Lori

[Harley PoMMom]

Nathalie,

Was her blood drawn before or after anesthesia? The reason I'm asking is because when Harley had his Chemistry profile done 2 weeks after his teeth extractions w/anesthesia, his ALP/ALT went higher and it was due to the anesthesia.

[Nathalie]

Just maybe the infection from the tooth, the little growth you did have removed and lipoma that is still there, is what's making the liver enzymes higher than normal. What do you think?


Ok - how could I not have thought about her teeth - duh :o:o:o
She has pretty bad periodontitis and it has spread to the adjacent incisors - the remaining 3 incisors are quite mobile but things should firm up since the culprid is gone. The lipoma ... yep good point too plus add to this beef as the main protean I think that could explain things.
I tell you - when it comes to my own guy's I tend to worry too much too quickly (I was not always like this - it all started with Phillip's rocky road for a diagnosis etc.) and then logic thinking somehow goes right down the drain :o:o:o
Thanks once again Lori,

Nathalie

We drew the blood while she was under anesthetic, about 20 min after injection.

[Harley PoMMom]

Oh my dear friend, I know exactly what you mean...our pups! :eek::eek::eek::confused::confused::confused:;):D They do like to keep us on our toes! Glad I could be of some help.

Love and hugs,
Lori

[Harley PoMMom]

Then I really do believe it is a combination of them all (anesthesia, infection, lipoma, and the growth you had removed). If it would put your mind at ease, run the panel again in a few months and see where the numbers are then.

Love and hugs,
Lori

[AlisonandMia]

I guess all you can do is have her liver enzymes looked at again once the anesthetic and its effects are well and truly out of her system. (Although I can understand you thinking twice or three times or more about that because of her vet stress.:eek:) I don't know how long that would take - I gather the enzymes (in humans) will peak about 1 week after the anesthetic and Lori mentioned elevated enzymes 3 weeks later. And then there is the effect of the cruddy teeth as well...

You'd think that 20 mins into the anesthesia would have been too early for any anesthetic effect to show up in the liver - but who knows?

Has she ever had her liver enzymes looked at before?

I know some dogs do just have idiosyncratically elevated ALT (although that may have been AST?) and it can be normal for that dog.

Looking back over Mia's records I noticed that, over the years (long before Cushing's) her ALT was always mildly elevated (ALP was normal then). No vet had ever commented on it. When she developed Cushings her ALT rose further, along with ALP - her ALT probably actually rose proportionately more than the ALP. She was treated with Lysodren and I gave her Milk Thistle too. Her ALP returned to right in the middle of the reference range and her ALT was, for the first time, nicely within normal range too - go figure! I can only think it was the Milk Thistle. Apart from the Cushing's Mia never had any "internal medicine" issues and was outwardly very healthy and robust.

Alison

[Nathalie]

Hello my Friends,

Nope – retesting is not going to happen. :eek: This was the first time any vet laid hands on her since her last vacc at around 9 months – so it had been almost 7 years.
Getting her anesthetized without pushing her over the edge was very difficult doing it a second time will be close to impossible unless I do it myself and surprise her. If it was one of the boy’s I would retest – no problem.
She is completely asymptomatic so I am going to approach this from a dietary angle and go into sweet denial unless she starts showing symptoms. Just the thought of her getting cushings gives me that yucky feeling in the stomach – it would be a death sentence for her – she just would not be able to cope.

“Has she ever had her liver enzymes looked at before?”

Yes, when she was around 8-9 month and remember one or both where slightly elevated not that the vet had mentioned anything at the time and back then – let’s just say I was not on the ball about these things. :o:o

On a lighter note – there has been a change in her demeanor – she seems to be happier – I think her teeth must have bothered her. So in retrospect it was a good thing that she hurt her nail which made me go through with this.
I bought her some raw organic Chicken with veggies yesterday – until I figure out exactly what her diet is going to be.

Cheers, :)
Nathalie

[AlisonandMia]

ALP will be elevated in a young growing dog because the bones are growing. ALP is also produced by bones and screening tests don't tell you the source of the ALP. You need to do further testing to discriminate, I believe - not that you ever would with a young healthy dog. That was probably the source of the elevations you remember seeing and why the vet wasn't at all concerned.

Alison

[Nathalie]

Thanks Alison!

"ALP will be elevated in a young growing dog because the bones are growing.'

I have never heard or read this anywhere. That's very good to know because I was thinking along the line that she may have been born with an issue and this has been going on all these years. Glad you took the time to let me know.

I have been focusing so much on the Phillip for quite some time - now I am going to focuse a little more on the other 2 dogs - its just that this whole cushing ordeal kind of took over everything.

Tonight we rough-housed a bit and she actually got a good hold of my hand - she has not done that in a long time - now I know it was because of her loose tooth.

Nathalie

[Harley PoMMom]

Hi Nathalie,

The Broadway Veterinary Hospital link I pasted to you has some really good info. This is what they say about mildly elevated ALP:



The Alkaline Phosphatase is mildly elevated. This is a liver and bone enzyme that is elevated when there is inflammation of these tissues. Even a slight affect on the liver from system disease or medication can cause this enzyme to be elevated. This mild of an elevation may be significant enough to pursue, but should be monitored. Some common reasons for this elevation include pancreatitis, gastrointestinal disease, liver disease (gall bladder obstruction, cholangiohepatitis, cirrhosis, cancer, toxicity or infection of the liver), Cushings Disease (an adrenal hormonal disease), right sided heart disease, and arthritis or other bone lesion. Some of the medications that can cause this elevation are corticosteroids, some anti-seizure medications, estrogen, non-steroidal anti-inflammatory drugs (like Aspirin, Rimadyl®, Deramaxx®, or Metacam®) and barbiturates. Also, this enzyme is commonly elevated in dogs under 8 months or age due to their bone growth.

Love and hugs,
Lori

[Nathalie]

Thanks Lori,:)
I think for now I am going to sit with this and make the changes to her diet as well as add the Milk Thistle and the Vitamin B Complex.
Phillip will need to go in for a stim in 3 months - at that point I am going talk to the vet about little Sophie again.

Nathalie

[Nathalie]

Lori, I just reread through this thread and everybody must think ‘now she has lost it’ :D… the info was right there in your link from Broadway Veterinary Hospital …. :o:o:o

“Also, this enzyme is commonly elevated in dogs under 8 months or age due to their bone growth.”

I am terrible for ‘scanning’ and not truly reading – I spend about 9-10h on the computer (work and then whatever I have to do after work) and I have gotten into the habit of just ‘flying’ through emails and ‘scanning’ for keywords.
Anyhow, just wanted to let you know that I finally caught on.;)

I been pondering about this off and on – denial technique is not working as well as I hoped.
Are you guy’s saying/thinking that not having the liver values rechecked would be neglectful and taking into consideration Sophie needs to be anesthetized again (oral sedation won’t do it) so the blood sample would be taken under the same condition it would be worth the stress on her etc. to recheck eg. 6 mon?:confused:

I just need to bounce this off you guy’s – I am really torn now.

Nathalie

[Harley PoMMom]

Hi Nathalie,

If it were me ;):rolleyes: and I had a pup like Sophie that was so fearful that the only way I could get a retest was thru anesthesia again, then my answer would be no...poor Sophie.

You KNOW your pups so well, Nathalie, and you'll know when she is not feeling well, thus then you'll know when it is time to do a retest, but I don't think you have to do a retest so soon. This is JMO, of course.

Love and hugs,
Lori

[AlisonandMia]

I too think I'd be reluctant to retest - very reluctant. I just hate stressing any animal out that much - anxiety is one thing but full-on wild-animal panic mode is completely another.
If I was that worried that I wanted to retest you know I'd think about getting an ultrasound done while the dog was knocked out - just in case something did come back weird on the second test. I'm thinking particularly of looking for a gallbladder issue. And seeing a perfectly normal liver (and everything else) could be very reassuring too - as you know! I think I'm coming to the conclusion that every middle aged dog deserves at least on ultrasound - if possible. Don't know if I'd go down that route and I'm certainly not saying that you should - but it is one course of action I'd consider.

What is Sophie's breeding? Some breeds are more prone to certain problems (such as gallbladder issues) which help guide decision making.

It is a difficult one....

Wish someone would get a move on and invent that crystal ball thingy! I want one for Christmas this year!

[AlisonandMia]

I see Sophie is a Chihuahua (looked at your pictures!:p:o). I don't think Chi's are noted for gallbladder issues - the breeds usually mentioned are Shetland Sheepdogs, Mini-Schnauzers and (I see when I look it up) Cocker Spaniels. Of course doesn't mean she couldn't have a problem in that area but if she was, say, a Shetland Sheepdog mix or something it would be something to very definitely worry about.

Did they look at her blood lipids at all?

Bring on the crystal ball thingy, I say.

[Nathalie]

Thanks Lori and Allison – I truly value your opinions.

I don’t like seeing the elevation but I am not overly worried – just need a ‘reality check’ as I am VERY protective of little Sophie and I wanted to make sure that this did not cloud my decision making.

The thing is other then her phobia from having anything done to her body and zero pain tolerance she is very well adjusted. I can take her anywhere, park, stores, other peoples home, great social skills with other dogs of all sizes and she is a very quick learner and a great problem solver. I worked hard on building up her confidence when she was little and she even did well in agility until she discovered that people drop little pieces of treats and from then on hovering the floor become more important then jumping over a hurdle which put an end to her short agility ‘carrier’. :D

She is just too much of a ‘thinker’ – where Phillip only thinks about a treat when I ask him to do something Sophie will assess, evaluate the why’s, how’s and possible consequences and she NEVER forgets – so forget trying to trick her into anything. So at the end of the day, she may not be perfect but she is my dog and I love her quirks and all.

You know, one of my friends always says there is a reason we end up with certain dogs and I think this is true. Sophie could have been easily turned into a nervous fear biter in the wrong home, then there is Phillip with everything that is going on and Matthew would have probably ended up being on daily steroids due to his immune system issues if he made it out alive of the pound.

No – lipids was not checked – I thought it was understood that because this our only chance to get a blood sample the they would request a more comprehensive blood panel –sigh.

A crystal ball thingy sure would be nice to have.

My gut tells me that another blood test is not worth the ordeal on Sophie.

An U/S certainly is something to keep in mind for down the road if need be.

Anyhow – we are off to the park soon – it supposed to be going up to +8 today and the sun is shining.

Have a great weekend everyone,:)
Nathalie

[Nathalie]

Well Leslie, to tell you the honest truth I am scared and I don’t know what is what anymore.
You know about her luxating patella diagnosis. The joint supplements seem to be helping quite a bit as her gait has quite improved. Back when she had her dental done I also posted about her elevated liver enzymes.
What I am seeing in comparison to last year is decreased tolerance of exercise even so we walk now a fraction of the distance we used to walk. Panting at temperatures she did not pant before.
Hind end weakness/muscle loss, reluctance to jump on furniture, lack of overall energy/sleeps too much that I first noticed last year.

I would like to blame all this on her knee issues but I can’t help thinking cushings and then I just go back into denial.
Free T4 was smack in the middle so I don’t think its thyroid. I talked to Phillip’s vet because I thought I might just put her on 0.1 soloxine for 2 months to see if we see any improvements. I would have done that already if she would have tested borderline … it’s still an option … will have to see.

Just thinking about cushings being a possibility makes me cry. If we could do any blood work on my mouse without sedation I would have a thyroid panel done and then an LDDS right now because I am worried sick of what is going to happen to her. There is no way I get urine from her either otherwise we could have least tried to rule out cushings.:(:(:(

Anyhow, there is really nothing that can be done unless someone can send me a crystal ball.

Hope you and the puppers doing well – I think I remember you said you now live in the country. I would love to swap city for country living anytime – my neighbor seems to be having a midlife crises he is listening to AC/DC right now.:)
Nathalie

[Harley PoMMom]

How are her appetite and thirst? Have they increased too?

[Nathalie]

I don't think her thirst has increased.
Appetite - this is really hard to say because I had to slim her down a bit to help with the knee issue so I am feeding a bit less now.
So yes, appetite is up - but this could also be due to that I am feeding her now a bit less.
I know - this is not really helpful at all.

[Harley PoMMom]

Help me here because my mind is feeble, now, was is it that you can't get a urine sample from her for a UC:CR test?

[Bichonluver3]

That is just the SWEETEST face!! Have you tried giving her something to calm her before she goes to the vet? I can't remember the name, but, when I first got Chloe and she was such an emotional mess, I was told about a liquid that I got at the health food store and it worked well. I added it to her drinking water and it mellowed her out!
Carrol

[Nathalie]

Oh Lori, I am sitting here crying and you made me laugh - thank you:o

If I where to get even within an arms length at her butt with a container she would scurry away - remember, Sophie has a phobia of having anything done to her body and that includes her assuming that something is going to be done.
Plus she is a Chihuahua, she is so low to the ground, by the time I would get down there and position that container she already would have figured that something is up and high tailed it.

I know - there is just nothing easy with this girl.

Let me give you an examplet of what I see ..
I am gone for 6.5 h at work - they sleep, I know that for sure, I come home she is excited, I get them dressed and in the Van to get to the park and she is nodding off on the drive to the park ....
That is not normal for a healthy 8 Year old Chihuahua - at 8 years of age she is still a spring chicken. If I let her, she would sleep more then Phillip.
She has been on liquid vitamin B Complex for 2 month now - she should be feeling happy.
She has short bursts of energy but no stamina, and she used to walk 5.5 Km with us no problem.
Today we where out ther for 1h - walking really slowly - on the way back I had to pick her up because she was lagging behind and panting so much.

[Harley PoMMom]

Oh Gosh, Nathalie...I remember now...poor Sophie :( Does she have one special pee spot outside, one place she usually always squats down to urinate outside?

[Nathalie]

Not really. Are you thinking something along the line of having her pee on a tarp or some plastic sheet? I don't know if she would go for this if that is what you are thinking about.

[lulusmom]

Hi Nathalie,

I noticed from at least one of the pictures you have posted that Sophie is overweight. With the exception of the loss of muscle mass, all of the other symptoms you mentioned are all common in obese dogs. My Buster was a real porker and the heavier he got, the more inert he became and the more he panted. Like you, I was terrified that he was cushingoid and our old gp vet even said that his physical appearance looked cushingoid. He had every symptom Sophie has and also like Sophie, his water intake was normal and his ALT was elevated on bloodwork done before bladder stone surgery. His appetite has always been healthy which makes it difficult to tell if it's on the rise. Incredibly, all of those scarey symptoms faded away as the excess weight came off. Buster is 8 years old, svelte, alert and he plays like a puppy.

The muscle wasting is the only thing that doesn't make sense with obesity, unless you are equating muscle wasting with Sophie's inability to jump up on things or her intolerance to exercise. I would think that if a dog has cushing's advanced enough to see the loss of muscle mass, I think you'd be seeing at least one of the really common symptoms like a pendulous abdomen, PU/PD and a voracious appetite. Muscle wasting, increased appetite and pot belly are very much connected in that all three are caused in part or entirely by the catabolic effect of excess cortisol on protein. Sophie's elevated liver enzymes a few months back are mild, plus ALT being higher than the ALP is not the usual pattern in cushing's so it stands to reason that it was more likely Sophies dental issues and/or stress. Severe emotional or physical stress can definitely elevate ALT and ALKP and if that was going to happen to any dog, Sophie would definitely fit the profile. Anything that interferes with a dog getting sufficient oxygen to the blood is going to impact the liver.

It is really uncanny how much Buster and Sophie have in common so if I were you, Nat, I'd put all the worry about cushing's on the back burner and concentrate on getting Sophie down to a healthy weight. If you do that and none of her symptoms improve, then you can put your worry hat on and go at it.

[Bichonluver3]

Hi Natalie!
Thanks for the picture comment! Chloe will also pee on pee pads as well as outside. To get a urine sample, I just turn the pad over and she pees on the plastic side!
Carrol

[Nathalie]

Hi Carrol,
Pee Pads, I never would have thought about this. Maybe that was what Lori was getting at.
I was thinking cut up garbage bags or heavy duty tarps that make noise when you step on it.

We never done Pee Pads here but Sophie will pee on cue - if push comes to shove I probably could teach her to pee on a pad - at least I think we could do this.
Good idea - thanks for sharing Carrol.
Nathlie

[Nathalie]

Thanks for your feedback Glynda.

Yes, I agree she was overweight ;) but she is very chesty and muscular in the front end because she does not use her hind end enough because of her knee issue and the lipoma on her rip cage makes her appear chubbier too.
Those pictures are bit older and she has slimmed down quite a bit in the past few months due to portion control so I would have expected an increase in energy.
The muscle loss could be very well explained by her not using her hind legs as much/less exercise and compensating for it in the front.
She does not have the cushings/hypo-t look – I think she is close to ideal weight now.
I am going to try to take a few pictures and post them.

Or perhaps her knee is giving her discomfort even so her gait has improved.
Even so I hate doing this, I could try putting her back on meloxicam for a week and see how she does. If she perks up, I know her not wanting to move is pain related and the combined having to compensate for her knee could make walking potentially way more strenuous which could increase the panting/heat intolerance....

Ok, I think this is what I am going to do, put her on meloxicam and see what happens. If no improvement then I could try to collect urine via turned over pee pad – ok, its working, I am starting to feel better. I think I have a plan of action.:o:)

Thanks again for the feedback,
Nathalie

[Harley PoMMom]

Just love those pee pads! Have those for Harley, altho he hasn't had to use them in quite a while...Alex the bad cat hides underneath them or scatters them all over the place! That cat!

Keep us posted Nathalie, please! Sending warm thoughts, positive energy and well wishes to your house for all your precious furbabies.

Love and (((hugs)))
Lori

[Nathalie]

That is just the SWEETEST face!! Have you tried giving her something to calm her before she goes to the vet? I can't remember the name, but, when I first got Chloe and she was such an emotional mess, I was told about a liquid that I got at the health food store and it worked well. I added it to her drinking water and it mellowed her out!
Carrol

Sorry Carrol, I did not mean to ignore your question.
You might be referring to Rescue Remedy ..
Little Sophie is my heart dog. Unfortunatly this is a real phobia - we are talking seizure potential so nothing oral will sedate her mind enough to not go into panic mode.
The name of the game with this mouse is prevention and management.

[AlisonandMia]

If she pees on command maybe you could somehow get her to pee on some plastic wrap?

Or (and it would take time to shape the behavior) you could get her to pee on a plastic lid of some kind.

I never had to get a urine sample from Mia - which is a good thing because she was so small and low to the ground that it would have been quite an operation. And she didn't have any "issues" either.

Alison

[frijole]

My vet gave me this plastic rectangular clear plastic urine catcher to use. Pretty slick. Looks like a butter dish only bigger. Plastic - Haley never saw me slide it underneath her.

[Bichonluver3]

I think the pee pads work because they have a scent that the dog is drawn to.

[Bichonluver3]

Hi, again, Nathalie!
Yup, Rescue Remedy is what I was thinking about. It's too bad we can't hypnotize dogs!
Carrol

[Nathalie]

As promised - I took a few pictures (http://www.k9cushings.com/forum/album.php?albumid=216) of Sophie this morning.
Not the gratest but it shows her body quite well.

Some people expect Chihuahuas all to be 5 lbs or less - she is a big girl, not in weight but in frame as you can see by the group picture.

She looks nicely muscular in the front but you may notice in the picture where she is standing that her hind end does not match the front.

Anyhow, one way or another I will figure this out just as I did with my Phillip.

Hope everybody is having a good day. :)
Nathalie