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Vacuolar hepatopathy.

Species: Dog
Breed: Jackapoo
Age: 5-8 years
Hi Dr. Marie

I am following up with you regarding Oreo's elevated bile acid tests, elevated liver enzymes and his liver biopsy he had done at the University of Wisconsin-Madison last week.

The biopsy went just fine, although excruciating for mama dog! Took him about 36 hours to bounce back to his adorable little personality. He had two small incisions and those are doing well, no signs of infection and the sutures will come out next week.

So I got home from work tonight and had a message on my answering machine with the biopsy results from the vet internist. It was highly suspected he had MVD but she told me no, he doesnt. No evidence at all of it. The report came back as "mild vacuolar hepatopathy" but she didnt explain to me what that was! She just kept saying "good news, good news". The preliminary cultures were in for bile in the liver and that was negative. She said they were still waiting on reports from metal concentrations in the liver... does that sound right I tried to write down everything as accurately as I could from my answering machine.

While she didnt tell me what vacuolar hepatopathy was she did tell me it can be caused by 1) Prednisone 2) Overactive adrenal or a 3) non specific finding. She said it was nothing to treat.

I had this biopsy done to go full circle in the attempt to find out why his bile acid tests continued to rise over a 3 month period and why his ALKP continues to rise too. While there, they checked the ALKP again and in a months time, it had gone from 457 to 675! This is just unbelivable to me as it has continued to rise since November. This vet/internist told me it was still not extreme and she was not worried when I talked to her about it last week.

Oreo is still taking Denamarin and I am not sure he is suppose to continue on that. I will have to touch base with her later this week after all reports come in.

So what is vacuolar hepatopathy and how does it differ from MVD? Is Oreo still considered a liver dog? If he doesnt have MVD why do all this bile acid test results and ALKP suggest he does? He was seen by 5 vets for opinions and they were all certain he had that.

I am seeking peace on this and while I am glad he doesn't have MVD, I am still confused. Hoping you can help me out! Hoping perhaps today or tomorrow I might have more to report back to you on the metal concentrations. By the way, does that test for copper storage disease?

Thank you!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

This really does sound like good news.

Vacuolar hepatopathy is not really a disease on its own, but rather it is a way to describe how the liver cells look. What it means is that there is more glycogen than normal being stored in liver cells. So, what does that mean?

Really, it doesn't mean much! I know that is a little frustrating to hear, but the point I am getting at is that the results of this biopsy show us that there really shouldn't be anything to worry about here.

To answer your question about MVD, dogs with microvascular dysplasia will have changes in how their liver blood vessels look on biopsy. It doesn't sound like this was seen on Oreo's biopsy.

There are several possible reasons for vacuolar hepatopathy. If a dog is on steroids (such as prednisone) then this can cause these changes to be seen in the liver biopsy. Another possibility is if a dog has cushing's disease. My theory is that a lot of dogs who have high ALKP, but no obvious reason for it will go on to get Cushing's disease later on in life. Now, don't let that get you worried! Many many dogs have very mild cushing's disease that doesn't need treatment.

Then, there are dogs who have what is called "idiopathic vacuolar hepatopathy". "Idiopathic" means "we don't know the cause." If a dog has a high ALKP but we can't find a reason for it, in many cases the cause is idiopathic vacuolar hepatopathy. Although it's frustrating to not know the cause, the good news is that there is no evidence (that I am aware of) that dogs with this condition get sick or are any more prone to liver diseases or cancers. It is really an "on-paper" disease in the sense that the lab values could get you worried, but the dog is actually quite healthy.

I know 675 sounds high for ALKP, but I can tell you that this is a very common occurrence. I'm guessing I have about 50 dogs in my practice right now who have high ALKP but because there are no other issues we are simply monitoring them.

Regarding the bile acids, if I remember right, Oreo's bile acids were a little elevated, but not high enough to make anyone worried.

From what I have read, Denamarin (sam-E) is not usually needed for dogs with vacuolar hepatopathy so your vet may decide to stop this.

Regarding the metal concentrations, they are likely testing for copper and for iron. It is unlikely that either of these come up positive. If they do, let me know and I'll go into further detail. There's no point getting worried about those conditions right now.

So, as I see it, we have reason to celebrate! Vacuolar Hepatopathy is a relatively common change in the liver of dogs and rarely is anything to worry about. It sounds like you are in good hands and I would definitely continue to take the advice of the doctors who are treating Oreo.

I know this is hard, but at this point, as long as Oreo is happy and eating well, I would advise that you totally ignore his lab values for a while. I'm guessing that his ALKP will continue to rise, but I don't think that means anything to him.

Hope that helps!

Dr. Marie



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Customer reply:

Hi Dr. Marie

Thank you for explaining what vacuolar hepatopathy is! You are right, it is frustrating and confusing for me. I am thankful the biopsy showed no signs of MVD but wondering then is Oreo not considered a liver disease dog then? I did do a little googling on it but your explanation was much easier to comprehend. What I did read when I googled, left me with the impression that it is still a form of liver disease. No?

I know I am going to have to touch base with the university vet later this week when I have a day off and I am still awaiting word on the metal concentration results.

I am wondering if the Denamarin is causing his ALKP to continue to rise? Before the Denamarin was started, his ALKP was never that high and it has just continued to elevate. I cant help but think there might be some correlation? If the vet takes him off of the Denamarin, which I am going to ask to do, do I have to wean him off of it or gradually cut down?

And yes to your recalling that his bile acids were only slightly elevated. But again, they continued to climb in 3 months being on Denamarin. Before he was on that, they were barely abnormal.

For over a month now, I have noticed Oreo will lick his stuffed toys alot. And often he sits on my lap and just licks his lips alot. When I mentioned this to the vet last week, she said Denamarin does have zinc in it and she wondered if maybe he was tasting that. We havent talked about that since though.

I will deffinately let you know the outcome of the cultures. Thanks again Dr. Marie!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

I would not call vacuolar hepatopathy a liver disease. Rather, I would say that Oreo's liver just looks different than other dogs. We don't know why dogs with vacuolar hepatopathy have high ALKP but we're pretty certain that it has nothing to do with a problem with the liver.

The Denamarin won't be causing the ALKP rise. The vet will give you instructions on what they would like you to do with the medication. My guess is that they will stop it, but I can't say for certain.

Hope that helps!



Customer reply:

Interesting indeed Dr. Marie about how the liver looks different. Well, I am still waiting word on the metal concentrations. Ugh, how long does this take I wonder?

Regarding the Denamarin, it was the only thing I could think of that he has been on since the ALKP has risen. Ok so scratch that idea then about that being the cause. When I was there last week, I bought a 2 month supply too. If they have him stop taking it, not to waste it, do you think it would hurt to just use up what I bought?

Last week before I contacted you, I was reading how sometimes elevated ALKP can be caused by Osteosarcoma. I know, I know I shouldnt even go there! lol If he had that would blood work be really off? His white and red blood count as of a month ago were right in norm range.

Well, hoping I find out results this week of metal concentrations then and will let you know how this all ends.

Thanks Dr. Marie!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

Sorry, I'm not sure how long the metal readings will take.

Regarding the Denamarin, really only your vet can advise you on what's best to do there.

Don't even start thinking of osteosarcoma...it's not even remotely likely!



Customer reply:

Hello again!

Just as I was going out the door today, the phone rings and it was the vet with the results. Metals were normal. So that is good news. But it all leaves me scratching my head. All opinions I went for, (4), said they were pretty certain it was MVD. But I'm not complaining it just shocked me as I was braced for the probability that it was. She told me I could stop the Denamarin but since I have a 60 day supply left, I wont throw it out, so she said to just use it up then.

I have more questions to ask her so she is going to call me Friday sometime.

Sorry to bring up the Osteosarcoma, it was just something I had read about when googling high ALKP.

So had I not had this biopsy done, we would have gone through the rest of Oreo's life thinking he had liver issues, so glad we did it. The vet we saw back in December, she told me not to put him through it so I called her partner, explained things to her about my wanting some peace of mind and she was all for it.

I was advised to perhaps recheck his biles in 3 months. However if he isnt a liver disease dog, why is that necessary?

So a happy and very surprising outcome!! :-)

Thank you Dr. Marie!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

Good news on the metal!

I guess the idea of checking the bile acids again is just to be sure nothing is developing. Now that we have the biopsy we can say that we are almost certain that the increase in ALKP is because of the vacuolar hepatopathy and that we don't have anything to worry about. With that being said, we can't say 100% for sure. The wise thing to do would be to occasionally check the bile acids to make sure that the liver is functioning well.

Now, don't take this as a license to worry about Oreo's liver. The chances that anything bad is there are extremely small.



Customer reply:

Hey Dr. Marie

I'm working on getting a grip on this and am getting better about it but you know, he's my baby, my only family, and it's worriesome. BUT you have helped me alot! I am still waiting for a return phone call from the vet at the vet school. It's easier communicating with you actually. :-) I really like he alot but I sense she is not big on phone calls and questions, lol.

For sure I will monitor him and when I find myself worrying, I will tell myself I have gone full circle in seeking an answer. Alot of people wouldnt have gone as far as I have.

I'm thinking I might keep him on Denamarin for life as it does support good liver health. The vet told me to take him off of it and I hope she doesn't mind if I go against her word on that.

Thanks again Dr. Marie, you are awesome!

Suzie



Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome and thanks so much for the bonus!



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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