LIVER DISEASE, SYMPTOMS AND DIAGNOSIS

Written by Guardian Angel Paula and Little Guy

One of my favorite topics....The Liver. As quoted from Dr. Fleming, (Sherwood Animal Clinic) "If you asked 10 people on the street what they knew about Liver the most consistent answer you would get is that it tastes really bad unless the cook really knows his stuff".

Thankfully with the guidance of Dr. William Thomas, a board certified neurologist, and Dr. W. Jean Dodds, we epi parents have learned quite a lot in dealing with liver disease and have been able to save many pups from untimely deaths. The liver can be up to 70% dysfunctional and still heal completely with proper care.

As stated by Dr. Fleming, the liver processes raw materials, manufactures the building blocks of the body, recycles the old to make new, and detoxifies the industrial waste of the body. In short the liver is involved in most processes required to run the body. As a result, liver disease can effect just about any part of the body. The liver can perform its duties with up to 70-80% of its mass effected by disease. While its a benefit that the liver can keep us alive despite an overwhelming infection or mass it also means that by the time most symptoms are noticed they are well advanced, "end stage disease" and possibly untreatable. We all know that any disease is most easily cured when caught early and the liver is one organ in the body that can completely regenerate if caught in the early stages of disease.

Common Presenting Symptoms...

(All, some or only one of these signs may be present. Some of these symptoms are "end stage" liver disease).

  • Loss of appetite

  • Vomiting

  • Diarrhea

  • Constipation

  • Increased water consumption and urination

  • Intermittent recurrent abdominal or gastrointestinal upsets

  • Progressive depression or lethargy...doesn't want to play anymore or refuses to go for walks

  • Swollen belly with a "fluid filled" look. This is also known as ascites and is actually fluid accumulation in the belly due to circulation alterations in the abdomen.

  • Pale gray feces. Bile pigments are what gives poop its characteristic brown color. If the liver isn't processing bile properly, the feces will not get its color.

  • Orange Urine. The improper processing of bile results in the excretion of bilirubin in the urine in high amounts, thus orange urine.

  • Jaundice, also known as icterus. Any pale or white skin or visible tissue takes on a yellow hue. Biliry pigments are accumulating in the body because the liver is not processing them.

  • Rare: bleeding problems. Many of the proteins required for proper blood clotting are created in the liver...remove these proteins and blood clotting decreases.

  • Hepatic encephalopathy, or severe neurological signs, behavioral changes, seizures, aimless pacing or circling, head pressing. May be associated with meal time.

  • Pain associated with the abdomen. This is due to the stretching of the liver capsule. May be noted when dog is picked up around belly or when probed (palpates) the abdomen

  • Chronic weight loss or wasting. The liver processes all the building blocks. If it fails to process, the body fails to maintain itself.

How do we go about diagnosing liver disease (hopefully before symptoms arise)?

Checking liver enzymes in a chemistry panel (GGT, ALT and  Alkaline Phosphatase) AND regular pre and post bile acid testing every 6  months is the key to a long and healthy life for our pups on Pb.

I cannot stress enough how important it is to have chemistry panels with liver enzymes done regularly for pups who are taking Pb to control seizures. I was very fortunate with my Angel Alex to have done so. She was on Pb and thru the Guardian Angels I learned of chemistry panel and bile acid testing and was diligent to have this done. She did have elevated test results and we were able to wean her off Pb and unto Kbr, start homecooking and heal her liver. We would have lost her years before we didn't have bile acids done every 4 months without fail. Pre and post bile acids are the most accurate tests of how the liver is functioning.

For a dog whose liver is compromised already, if you should decide on a biopsy, you should have a needle biopsy opposed to a biopsy during exploratory surgery. Most neurologists can do the needle biopsy, where a regular vet is not likely to have the equipment.

The safest and most reliable way to go is to have a pre and post bile acid test done. This will give you an accurate reading of the condition of the liver. You need to fast your dog for 12 hours and then have blood drawn. This will give you a pre bile acid reading. Then you feed a high calorie food like a 1/2 can of dog food. You then have blood drawn again 2 hours later. This will give you a post bile acid reading. Comparing the two will tell exactly what kind of liver damage (if any) you are dealing with.

My pup was diagnosed with liver disease---Now what?

You need to help the liver work as little as possible. You need to start removing all toxic agents. Identify and remove (or at a minimum reduce) any drug which may potentially hurt the liver. Toxins include many common drugs such as acetaminophen, ASA, anabolic steroids, chemotherapy drugs, some antibiotics, glucocorticoids, anesthetics, parasite control drugs and phenylbutazone. Anti-convulsant therapy drugs such as Phenobarbital, primidone or phentoin may cause liver disease in dogs. **Please do not take your pup off seizure meds "cold turkey." Do not try and reduce Pb without the help of your vet and Dr. W. Jean Dodds. We will have another post to help in the reduction of medication in the very near future. The idea is if your vet suggests reducing seizure meds (a common method is 10% reduction in meds every 2 weeks but your vet might advise an alternate plan) to get your pups weaned off entirely of Pb or to get the medicine under the limits of toxifying the liver. Some dogs do not have good seizure control without just a tad bid of Pb in their systems. Others do quite well.

Other hepatotoxins your vet might ask to be removed (a hepatotoxin is anything processed by the liver) are heartworm meds, flea and tick control meds along with any antibiotics your pet may be taking or pain medications, etc.

**a side note...if your vet asks to remove heartworm medications please have your dog tested every 3 month for heartworm. By testing every 3 month if a test comes back positive one dose of interceptor will kill the microfelia that is the beginning of the heartworm stages. You must be diligent and test every 3 month. Again ask your vet first because you may be in a very high risk area for heartworm.

Extremely important is dietary management. The liver aids in digestion and processes fat. When the liver is dysfunctional, it cannot process fat like it should and thus it has to work harder. You want to avoid fatty foods, processed foods, and undercooked foods (bacteria in undercooked meats in processed through the liver and another good reason we do not indorse the raw diet for our epi pups). When I went thru liver dysfunction with Alex one of the biggest helps in turning her liver around was the help I got from Dr. W. Jean Dodds and the liver cleansing diet. An excerpt from UC Davis Book of Dogs states that the Liver is able to heal if the patient is provided with a diet that supports an optimal return to normal function. The liver cannot heal if the patient does not eat, thus, it is important to ensure an adequate food intake.

The liver cleansing diet consists of white fish, potatoes and vegetables. Since Vitamin A can be toxic to the liver, any amount added to the diet should be very minimal. Vitamin E. is protective of the diseased liver and can be added in greater than usual quantities. You will find the liver cleansing diet on our website:

Liver Cleansing Diet

And lastly...another key element in helping to heal Alex liver was Milk Thistle. Milk thistle helps increase bile flow. When purchasing Milk Thistle make sure it reads in the back "milk thistle extract".

From "Milk Thistle (Silymarin) by R.M. Clemmons, DVM, PhD, Associate Professor of Neurology and Neurosurgery":

"There is no evidence that Milk Thistle has any adverse effects. It increases bile flow and bile content of cholesterol, but does not appear to decrease bile formation from the studies I have read. Most of this work has been done in rats, but their livers function basically the same as the dog. There is probably no reason for a normal dog to take milk thistle, unless there is exposure to potential hepatotoxins. Phenobarbital is a hepatotoxin, therefore, epileptics probably need it."

As regards dosages, here is information on Milk Thistle Dosage from the newsletter "Healthy Pets - Naturally":

Dog's size Dose as % of adult human dose
5 lbs 10%
5-10 lbs 15%
11-20 lbs 20%
21-40 lbs 30%
41-70 lbs 50%
71-100 lbs 75%
100 lbs 100%

Liver dysfunction is a very serious issue & one to approach with a sense of urgency. Milk thistle plays an important role in that approach.

I would urge you and your vet to contact Dr. W. Jean Dodds, one of the advisors to our list, and have your vet consult with her regarding pre and post bile acid testing and liver dysfunction. Dr. Dodds is an internationally recognized expert on thyroid and other autoimmune disorders and can test your pup with pre and post bile acids and liver damage. She has served as a guide to many of us epi moms and dads regarding Pb induced liver toxicity and our dealing with liver disease in dogs. There is no charge for her consultation and she will be able to help you and your vet take that next step in dealing with your pups liver dysfunction. Dr. Dodds was invaluable to me when Angel Alex had liver disease.

References:

Dr. W.B. Thomas DVM University of Tennessee
Dr. Fleming, Sherwood Animal Clinic Regina, Saskatchewan, Canada
Dr. W. Jean Dodds, DVM
Newsletter, "Healthy Pets--Naturally"
Milk Thistle (Silymarin) by R.M. Clemmons, DVM, PhD, Associate Professor of Neurology and Neurosurgery"