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Coughing and liver problems.

Species: Dog
Breed: lab mix
Age: 11-15 years
Hi there!

We are hoping that you can lend us some advice with our baby. Our almost 12 year old (mostly healthy besides arthritis) lab mix started a hacking cough out of no where about a month ago. Our vet treated her with Temaril-P and a 500mg of cephalexin. She was also treated for an ear infection. The cough stopped for about a few days. Our vet then thought it could be COPD or an asthma or some kind. Since her cough returned after the round of meds the vet wanted us to use prednisone for a few days. We started with a 10mg dose 2x a day, then after 3 days bummed it down to 5mg 2x a day. The cough again stopped.

About a week ago we noticed her getting thin rather quickly and lossing a lot of muscle mass. I knew something wasn't right. So we returned to our vet today for more tests. She has lost about 3 pounds in one week and not sure how much muscle mass, but she is much thinner than she was 2 weeks ago when the vet saw her.

Her levels were rather high and gave us reason for concern. Her are her results:

High results:

ALT: 512
ALKP: 1521
GGT: 85
RDW: 20.6%

Low results:
PLT: 113
HCT: 36.9%

She is showing no other symptoms besides the weight & muscle loss. She is eating like normal. She is drinking a bit more, but we thought that was because of the steriods.

The vet gave us Liver Support with mile thistle to give her once a day. She also gave us Theyophylline 100mg twice a day.

My questions is, could this be cancer of some kind? Are these levels dangerously high to the case that we could lose her soon? Could this turn around for the better and just be a side effect of the steriods? I feel like the cough and our new findings could be related. Is there anything we can do to make her more comfortable. Now that her couch can't be treated we are more concerned. She is also being taken of trammadol for her arthritic pain. Needless to say, we are very concerned.

I think we left the vet in such a shock that I didn't think everything through very clearly. Now left with tons of questions. The vet was concerned that such a low dose of steroids could cause this large of a level increase. Last blood test last year had no abnormalties.

We are retesting blood work next week and hoping these meds will bring her levels down a bit. I am switching her food to honest kitchen zeal formula. I figured a more raw diet with less fat % would be best for her right now. She is currently on Nutro natural choice for seniors.

Thank you for you help, we are hoping you will have some insight on our situation.

Online vet, Dr. Marie

Dr. Marie replied:

Hi and thanks for your question.

First of all, I'm so sorry about the delay in getting back to you. I had a baby 11 days ago and am not completely on top of my game! Thank you for sending the email to remind me about your question.

I'm so sorry to hear that Mazzy is not feeling well. Cases like this are difficult as often it can be hard to know exactly what is going on. I'll give you my thoughts though.

There are not many things that can make a dog cough. I do tend to get concerned though when an older dog coughs. Something like Kennel cough is always a possibility, but kennel cough is something that should not come and go like should get better within a few days or at least be dramatically improved by now.

A heart condition can cause a cough, but this is not that common in a larger dog. Plus, xrays really should have shown if there was heart enlargement (which usually goes along with a cough.)

Some type of asthma (such as COPD) is definitely a possibility. This type of problem is usually treated quite well with steroids. However, asthma or COPD should not cause weight loss. Neither should steroids.

The liver enzymes are moderately elevated. This can sometimes be hard to figure out a cause for. Yes, steroids can cause an elevation in ALP, but they should not cause an elevation in ALT and GGT. I am concerned that there is something more serious going on. Unfortunately, with the liver, it is often very difficult to get a diagnosis. A good next step would be to talk to your vet about getting an ultrasound done of Mazzy's liver. The point of the ultrasound would be to look for signs of cancer. Some liver diseases, however, don't show up on ultrasound. A liver biopsy can often be more helpful but this will increase the expense of her diagnosis.

If this were my case I would likely be suggesting the ultrasound. I would also want to repeat her chest xrays. Unfortunately I am concerned about the possibility of cancer. Sometimes, cancer that is in the chest will not be super obvious on xrays. I have had some cases where we took xrays and could not see anything significant, but when we repeated xrays a few days to a week later we could see that there was cancer in the chest.

Any time I see an older lab with some type of breathing issues I wonder about a condition called laryngeal paralysis. However, this condition doesn't really cause a is more like just labored and loud breathing. It also wouldn't cause the weight loss.

I'm not sure that a low fat diet is a good thing right now...if she is fighting illness she may need some extra fat in her diet. If this were my dog I wouldn't be making any dietary changes at this point. The only exception would be if the vet wanted to put her on a reduced protein diet which we often do for dogs with liver disease.

I wish I could give you more answers. I am concerned about what you have written. I think it is a good idea to repeat her bloodwork and see if things are changing dramatically. And, if your vet suggests extra tests such as repeat xrays or ultrasound I think that is a good idea.

Please let me know if you have more questions.

Dr. Marie

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Customer reply:

Dr. Marie,

Thank you for your time and advice. We hope you are not working too hard with that new baby :) enjoy the moments!

Just wanted to clarify that we have only done blood tests on our girl. The cough was believed to not be related per our vet. The reason we returned last week was due to her weight & muscle loss.

That is when we saw her elevated levels. Our vet suggested retesting in 7-10 days for bloodw work. She is hoping to lower her levels by being off steroids and a liver boozer.

She gave her theophylline 100mg 2x a day for her cough. The liver booster is to help her levels, ideally.

Our vet said we could do an ultrasound. She did suggest that if we would likely not operate due to he age, the. To hold off on ultrasound. She said it would be the same path either way in medications.

We did switch her diet to honest kitchen (zeal) due to lower fat content: I believe that was due to the liver. I wanted to try the dehydrated raw diet oppose to kibble so it's easier on her system. We are still adding in her kibble though for transition.

She showed signs of loose stool today. Our vet is out of town so another one called us back. She seems to think he gallbladder is more he issue with her levels. She prescribed her 2 medications. One for the cough and another an antibiotic.

The tough part is knowing if cough & levels are related or not. Needless to say we just wan her comfortable. They suggested holding off on her trammadol for now. But, her hips are bothering he with arthritis.

So, do you think we should retest next week and go from there? We kind of ruled out the ultrasound as we don't think with any finding that we would put her through surgery. An X-ray was suggested but they said its very hard to get a clear reading of her chest. We lost a pup to bone cancer and it only showed upon her lungs on an X-ray near the end.

Just wanted to clarify that we have not done X-ray or ultrasound. Just blood test. Wasn't sure if that would make a difference in your response.

Thank you!!!!

Online vet, Dr. Marie

Dr. Marie replied:

I think the plan is a good one.

Often in cases like this I still do recommend an ultrasound because it can help with decision making. If we find out that there is cancer present in the liver then we may decide not to be too aggressive with medications but rather keep her as comfortable as possible until it is time for euthanasia. But, your vet is right - at this point the liver ultrasound is not likely to change anything in regards to how Mazzy is feeling.

It's really hard to know how to proceed because the symptoms she has could belong to a great number of issues - some serious and some not so serious. I think the plan to repeat bloodwork shortly is good. Most likely if there is something really serious then you will see that the liver values have increased despite the supplements.

I really hope you get some answers (and hopefully good ones) soon!

Dr. Marie.

Customer reply:

Dr. Marie,

Thank you again for your help! We are happy to have found you! I am a little confused at this point.

On Friday, our girl started showing signs of diarrhea. I called our clinic, but our vet was out of town. Another vet called me back and thinks this is all galbladder, but liver at all. She wanted to start her on antibiotics thinking there is an infections somewhere. We declined, because I really trust our vet and wanted to stick with her path right now.

Good news is the stool is back to normal! Bad news is the cough is causing her to gag and throw up at times. Are these signs of liver failure?

I can't help but think that there is cancer in her lungs and its getting worse. I know this is a bold statement with little proof. We have lost a dog to cancer before so I think seeing her get worse each day just leds me my thoughts.

Online vet, Dr. Marie

Dr. Marie replied:

There are many things that can cause diarrhea and often it's hard to know what the cause is!

I am concerned about the cough though. You may want to consider another xray to see if there are now signs of something more serious like cancer.

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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.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.