Question:
here:

I am writing for help to determine what in the world is wrong with our 4-year old Pomeranian, Ietsje ("Eat 'cha") --and if there is anything we can do to correct it. I know that my vet would also welcome any suggestions --as he is as stymied as we are!

In a nutshell, her bloodtests are showing ALT (liver) readings that are rising at an alarming rate. Yet her other readings generally appear to be quiet normal. I will paste below a table of the results he has accrued so far:

Code:

+-------+------------++------+------+------+
| Test  |Normal Range|| JUN  | NOV  | FEB  |
#=======#============##======#======#======#
|*ALT*  |   10-100   || 154! | 576! |1417! |
+-------+------------++------+------+------+
|ALB    | 2.70-3.80  || 3.60 |      | 3.15 |
+-------+------------++------+------+------+
|ALKP   |   23-212   ||  82  |  85  |  94  |
+-------+------------++------+------+------+
|AMYL   |  500-1500  || 552  |      | 262  |
+-------+------------++------+------+------+
|BUN    |  7.0-27.0  || 18.3 | 18.2 | 21.1 |
+-------+------------++------+------+------+
|Ca     | 7.90-12.00 ||10.15 | 9.40 | 9.94 |
+-------+------------++------+------+------+
|CHOL   |110.0-320.0 ||167.2 | 172  |199.9 |
+-------+------------++------+------+------+
|CREA   | 0.50-1.80  || 0.76 |      | 0.79 |
+-------+------------++------+------+------+
|GLU    | 77.0-125.0 ||107.3 | 118  |110.5 |
+-------+------------++------+------+------+
|PHOS   | 2.50-6.80  || 4.45 | 3.30 | 3.29 |
+-------+------------++------+------+------+
|TBIL   | 0.00-0.90  || 0.40 |      | 0.21 |
+-------+------------++------+------+------+
|TP     | 5.20-8.20  || 6.58 |      | 6.27 |
+-------+------------++------+------+------+
|GLOB   | 2.50-4.50  || 2.98 |      | 3.12 |
+-------+------------++------+------+------+
|Na     |144.0-160.0 ||154.9 |154.6 |154.9 |
+-------+------------++------+------+------+
|K      | 3.50-5.80  || 4.66 | 4.55 | 4.59 |
+-------+------------++------+------+------+
|Cl     |109.0-122.0 ||120.1 |120.0 |120.5 |
+-------+------------++------+------+------+
|HCT    | 37.0-55.0  || 45.9 |  49  | 46.1 |
+-------+------------++------+------+------+
|HGB    | 12.0-18.0  || 16.8 | 17.0 | 15.9 |
+-------+------------++------+------+------+
|MCHC   | 30.0-36.9  || 36.6 |      | 34.5 |
+-------+------------++------+------+------+
|WBC    |  6.0-16.9  || 4.3  | 4.1  | 6.0  |
+-------+------------++------+------+------+
|GRANS  |  1.1-6.3   || 1.2  |      | 4.6  |
+-------+------------++------+------+------+
| %GRANS|            || 72%  |      | 77%  |
+-------+------------++------+------+------+
|L/M    |  1.1-6.3   || 1.2  |      | 1.4  |
+-------+------------++------+------+------+
| %L/M  |            || 28%  |      | 23%  |
+-------+------------++------+------+------+
|PLT    |  175-500   || 180  |      | 387  |
+-------+------------++------+------+------+
|Retics |            || 0.9% |      | 0.5% |
+-------+------------++------+------+------+

Let me provide some additional information --in case it helps.

DIET.
-------
She regularly eats cooked beef (stew meat, steak, hamburger) and chicken (breasts), mixed with some Gerber chicken baby-food and a quarter to a half of a Petab supplement. In the past we also added some glucosamine and bone meal, but stopped giving those to her when the ALT readings started rising. She gets dry Eukanuba as "treats" when we take walks, and she likes peeled grapes, oranges, tomatoes. Since the problem began, we have given her only bottled water --to know avail.

SYMPTOMS
-------------
This is what has us perplexed. She doesn't seem to exhibit any truly disturbing symptoms. Occasionally she seems a little lethargic after an active day "out and about," but more often than not she is a typical, happy-go-lucky, even frisky Pom.

I have noticed that her bowels seem rather runny about one-fourth of the time. She seems to "clear her throat" a bit after eating, but I think that Poms are known to have small tracheas that cause them to "cough" once in a while.

MEDICATIONS
-----------------
We put Revolution 3 (for heart worm and ticks/fleas) on her once a month.

OTHER PROBLEMS
----------------------
She does not have good teeth (notorious in small dogs), even though I brush them daily (as best I can, as she only begrudgingly allows it). She has never been a chewer; I can only get her to really use her teeth to gnaw on a bone. Consequently, the vet has had to pull five of her teeth so far and I take her in to have them cleaned every six months.

WHAT HAS BEEN DONE
----------------------------
In fact, this is how we noticed the problem. When she was to have her teeth cleaned in November the vet didn't want to put her under the gas because of the rising ALT. He sent out for more extensive analysis from a dedicated lab, and the results were within parameters, with the exception of GGT (normal is 1-12; hers was 13) and BUN/Creatinine Ratio (normal is 4-27; hers was 29). I could post all those results here if it would help (there are two pages worth).

He then put her on S-Adenosyl-100 to see if that would help. Obviously it did not have any effect, given her last results.

Because those results were higher than ever, he did an ultrasound to look at her internal organs --and couldn't find anything. Indeed, her liver, gall bladder, etc., seemed completely clear and healthy.

He just doesn't know what to think at this point, as he can't find any cause for the rising ALT readings. And he hesitates to put her on stronger medication if she isn't showing symptoms, for those types of drugs can prove more harmful than the condition. In the meantime, the plaque keeps accumulating on her teeth...!

Next week he wants to do another blood test, then feed her some sort of "marker" food, and repeat the blood test.

We are, of course, worried about her. What could be causing such rising liver enzymes? It is almost as if she were constantly exposed to some kind of toxic substance, but we can't imagine how, when, or where that is happening.

Does she simply have some kind of congenital defect that doesn't show up on an ultrasound? Have any of you run across this type of problem before? What will happen if her ALT continues to rise like this? Is there anything we can do? Are there some suggestions that we should pass along to our vet?

Any advice would be highly appreciated! She is our "little girl," the love of our life, and we would be emotionally devasted to lose her.

Many thanks!

"Markintosh"

Answer:
In my recollection high ALT levels usually means some form of a liver disease or damage to the liver. Has she sustained any injuries/falls that you can remember?

Since your dog is having liver troubles I would change the diet and exclude any fatty substances whatsoever so that means getting rid of the hamburger. Go with boiled chicken and boiled potato or turkey. Keep off the beef. Beef fat, hamburger can cause pancreatitis. So I'd get this baby on a strict diet, no doggie treats just the meals at this time and feed in smaller portions more often to give the body less stress in the digestion and detoxification.

Since Pancreatitis can cause liver damage I would suggest an IMMEDIATE change of diet!! Has your vet not suggested this?
I am so surprised!

If your dog has some type of oral bacterial / fungal / viral infection because of it's tooth/gum decay this can spread to the blood stream and cause problems in many organs including the liver. Trouble is, adding antiviral/antibiotics makes the liver work harder to detox from these harmful drugs.

If this were my dog, aside from doing the strict diet like I told you about I would start giving her things to combat infection. I'm a big believer in homeopathic medicine and things that can help fight infection naturally are things like oil of oregano (which I boast about constantly) Get it at a health food store and add a drop or two to your dogs food. Also, you want to increase healthy bacteria so buy some live bacterial culture ie: acidophilous from the health food store.

Once you have your dog on this strict diet for a couple of weeks, you can slowly start to add other veggies to it, like greens and things ie: turnip, peas, carrot but NO onions. HOWEVER right now just stick to potato and chicken.

You can also help the body flush toxins by using natural cranberry. PURE cranberry juice (not crap from Welch's) is a bit pricey but has NO additives to it.... get some, dilute it 1 part cranberry juice to 10 parts room temperature water. Your dog may NOT drink this because it is bitter/sour. OR she may like the taste.

Give her a couple of tablespoons before each meal. If she doesn't take it put it in an eye dropper and slowly feed it to her a couple of drops at a time.

After she is done let her have her meal but SMALL portions!! AND it should be room temperature, never cold/hot.

GRAPES can be very TOXIC to dogs!!

Since dogs cannot digest/break down raw veggies they should be atleast steamed. Esp if your dog is having troubles.

I hope some of what I tell you helps, I'm not an expert but just going from personal experience here!

Please keep informed and if you have any questions we're all here to help.

You may want to seek out a homeopathic vet!!! Take copies of ALL test results with you.
__________________________________________________
I did a little searching and found some sites that may be useful to you:

http://www.canine-epilepsy-guardian-...Laboratory.htm

This enzyme is considered to be liver specific in the dog. Increased levels of ALT are an indicator of damage to liver cells, as this enzyme is contained within the liver cell itself. When the cell is injured, the enzyme is released into the bloodstream and the increased level can be measured.


http://www.lbah.com/liversummary.htm


http://www.vetinfo.com/dliver.html

) There are several possible problems.

A portosystemic shunt could be present. In this condition, blood bypasses the liver because a
connection between the venous blood supply and the arterial blood supply develops (or is present
congenitally). This decreases the functional capacity of the liver significantly. in most cases, signs of
this disorder show up before dogs are a year of age, but sometimes clinical signs wait until later in life
to show up. Dogs with this condition tend to have problems after eating. Surgical correction of the
shunt is usually considered to be the best option for dealing with this problem, when it is present.

Microvascular dysplasia is another problem in which the blood supply is not properly routed, but in
this case the shunting occurs at the cellular level. Dogs with microvascular dysplasia may be normal in
appearance most of the time but have intermittent problems when the liver just can't react to an
increased demand on it. Other times, the disorder is evident almost all the time. This problem is
usually dealt with through dietary changes (lowering protein levels) and the use of lactulose and/or
metronidazole or neomycin antibiotics. All of these treatments aim to lower the serum ammonia
levels, which cause the clinical signs associated with the condition. Microvascular dysplasia can be
subtle enough that clinical signs are not noticed until a dog is a young adult or may even be mild
enough that they are never seen.

Chronic immune mediated hepatitis or chronic active hepatitis (probably different names for the same
condition) may also be present. This disorder is most common in middle aged female dogs but can
show up earlier than middle age. The only really good way to diagnose this condition is a liver biopsy
and it is a good idea to check for copper accumulation in the biopsy sample, because copper may
not be excreted properly when this disorder is present and can accumulate in the liver. This happens
most commonly in dobermans. I do not know exactly how much correlation there is in problems
between dobermans and miniature pinschers, if any, though.

Sometimes inflammatory bowel disease, pancreatitis, intestinal obstruction, gallstones, liver infection,
blood clots or other problems lead to bile duct blockage or a sudden onset of hepatitis and these
problems can occur in any age dog.

2) If you are worried about Callie and don't mind the possibility of having to pay for the ultrasound
examination and/or liver biopsy twice, there is no reason not to go ahead and have the ultrasound
done prior to the time it is possible to go to NC State. If it is suggestive of one of the above
problems you may still need to go to the college for scintigraphy or other testing that is usually done
mostly at universities.

3) I know of no connection between deafness and liver problems, except that liver disease can cause
central nervous system disorders if they get severe. I haven't really heard of deafness from this
problem, though.

4) The liver problems fall into two categories -- chronic conditions for which a couple of weeks of
waiting isn't going to matter and acute conditions that will probably get better, with your usual vet's
help, before you even get to the university. So that is probably why the tech feels that a routine visit is
reasonable in this circumstance. If you feel otherwise, NC State seems reasonable about seeing
patients on an emergency basis, based on our experiences with the school.

Answer:
Luba:

Many thanks for responding. No, she hasn't received any injuries that we are aware of: she has been with us 24 hours per day for nearly a year.

Our vet didn't think that her diet was a problem (in fact, he thought she was eating better than most dogs), but we can certainly try your suggestions.

Although the beef she gets isn't very fatty, I'm sure she'd be just as happy with only chicken and turkey. She isn't a big fan of potatoes, but will eat them, especially when cooked in the chicken's juices or broth.

I am surprised that peeled grapes would be so toxic. They always seemed like such a mild fruit to me, and she really likes them. But if that is the case... no more! She doesn't seem to mind cranberry juice, although I can tell that she is a little surprised by its tart taste. Anything is worth a try.

I guess we can also try the oregano, if you strongly recommend it. I have no idea how she'll react. I actually do believe in homeopathic treatments within reasonable limits. This is why we do not feed her "dog food." After all, her ancestors were not chasing down bags of kibbles on the tundra: dogs evolved primarily as meat eaters, so I assume that their bodies thrive best on those types of food.

Sometimes I think that her ALT is simply skyrocketing out of stress when we go to the vet. She is a shy, almost timid dog, and starts shaking like a leaf whenever we cross the vet's threshold (obviously remembering past traumas of shots, teeth cleaning, blood tests, etc.). Could a surge of adreneline be the culprit?

One reason I suspect this is because the second more extensive lab test last November was done with a blood sample taken after the first one --after she had calmed down a bit. The vet's ALT results were 576; the lab's were 549, i.e., it had dropped by 27 after only a half-hour...? Or, maybe, results from two different tests commonly show such a variance, and I am letting my imagination run wild out of concern.

Again, many thanks for your suggestions. Hopefully we'll pin down the cause behind her rising ALT results soon.

"Markintosh"

Answer:
You are most welcome.

I do not think that stress can make the levels change that drastically myself. If there is troubles, the enzymes will show it for certain.

Try the diet change, no hamburger or beef for now and if you do end up giving her beef later on cut out the hamburger it's not good IMHO can cause pancreatitis.

To me, I'm thinking perhaps your dog had an attack of pancreatitis and you didnt' know it and it left the liver enzymes elevated.

Remember with the cranberry juice that is has to be PURE cranberry. The other store bought ones contain too much sugar and other juices.

I do recommend the oregano oil, it will help fight off any infections/virus's including bacterial and fungal. If she has anything like that the oregano oil will target it. On the other hand if she doesn't, it will boost the immune system and help ward off and prevent infections.

Bad teeth, can cause all kinds of troubles.

I'm glad to hear you are a responsible and dedicated individual.



Get some chicken breasts, skin removed and boil them in some water with a couple garlic cloves and add the potato's in the water. She will gobble it all up!!!

Answer:
Luba:

Yes, we'll try the chicken, potatoes, garlic cloves, oregano oil, etc. and hope that the change in diet makes a difference.

I am also wondering if she has some kind of hepatitis, but wouldn't that have shown up in her blood tests...? I'm going to ask the vet if he can test for that specifically, as it seems to be one of the most repeated diagnoses I have found on the web for elevated ALT results.

One question I had: you stated "buy some live bacterial culture ie: acidophilous from the health food store." We will do so when we get the oregano oil, but... how much do we give her? I doubt the homeopath would know the dose for a 6.4 lb. Pomeranian, as the health food stores primarily cater to home sapiens!

I really appreciate your recommendations. By the way, if you'd like to see some photos of Ietsje, I have posted one on my university pages:

http://www.usu.edu/spanish/larsen/dibujos/ietsje.JPG

And you can see another one that I recently uploaded to a Pom-Forum:

http://www.pom-mart.com/pomeranian/f...php?pic_id=120

Forgive my urge to share. As you can likely tell, we absolutely adore our "li'l girl."

"Markintosh"

Answer:
Now tell me who couldn't love a face like that!!


She is absolutely ADORABLE!!!!!!


Well, I would be safe and start of small dosages with the acidophilous and such, there are usually three or four bacterial cultures in the one capsul/drink.

I would get her the capsul form, as the other contains dairy and we may not want to add dairy to her diet at this time.

So, get the capsuls and I'd open the capsul and give her only 1/2 of a capsul a day. You can shake a little on each of her meals.

Mash it in with the potato so she doesn't notice too much

The oregano oil is VERY concentrated, dilute it...actually put it in the cranberry juice and that will do the trick. Two drops a day for her should be enough!! BUT make sure it's diluted.

If she won't take it in the juice, put it in the potato.

It can tingle/burn a little bit at first but that goes away rather quickly. I say only 1 drop of oregano oil because she is so small.

Answer:
Luba:

Yup, I don't know how anyone could resist her face. I'm probably biased, but I don't think I've seen a cuter Pom anywhere (and they're all adorable).

Okay: we'll get the acidophilous capsules, the oregano oil, and the pure cranberry juice today, and we'll be sure to give her only the very small amounts you recommend with boiled chicken and potatoes.

Let's keep our fingers (paws) crossed; I'll be sure to let you know how it is going.

Many thanks!

"Markintosh"

Answer:
Although not a dog, I can share my experience with my cat that suffered from elevated liver enzymes. It may help.

She got quite sick (we suspect from overheating - it was a very hot day in Vancouver and the condo I was living in at the time did not have airconditioning and I could not leave all the windows open since she could jump out them and it was the 28th floor - I did leave the ones open that I could (ie no couch access to them, etc., the sliding glass door to the balcony open, closed blinds, left on a fan, etc.) and I immediately rushed her to her vet. After they put her on IV and got her fluids back, they did the whole work up. She was 100% except for her liver enzymes were at 1800.

We did x-rays as a first step to determine if any tumours could be seen easily. Nothing was noted. The next step, once we had her rehydrated and stable, was an ultrasound to make sure there was no cancer - a cause of elevated liver enzymes. After that I was given the option of a biopsy (which carries high risks of injury) or to try to start her with the liver disease medication (sorry, for the life of me I cannot remember what it was called). The vet suspected that it would be a lot of trial and error given the nature of liver enzyme elevations and liver disease.

Amazingly, after two months on the liver disease meds she was cured (enzymes down to 18 from 1800)!!! Although I screen for it, her enzymes have never gone back up. I was very lucky!!!

All in all, the diagnosis and treatment (including the extended vet stay to stabilize her) cost me around $1500.00. In my view money well spent but I do realize that not everyone is able to spend that amount on a cat in the span of a couple of months. Would I do it again? Absolutely!

In any event, Nadia (said cat) and I wish you the best of luck with your dog. Definitely have all the necessary testing done to determine whether or not it is cancer so you know what beast it is that you are tackling. If it is not cancer, you may want to try the meds for your beloved pooch in conjucntion with some of Luba's homeopathic recommendations.

Our thoughts are with you!

Michelle

Answer: