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High liver enzymes.

Species: Dog
Breed: Sheltie
Age: 8-11 years
After vomiting, we took him to the vet, thinking it was a sinus or allergy issue.
His liver enzymes were elevated, so we took him off rimadyl, started giving him Denamarin, waited 30 days and tested again, they were down just a bit. Then tested him for adrenal issues and thyroid issues,both negative, because he wants to eat all the time and is drinking a lot of water (sugar levels are fine) He has not been sick since, walks twice a day but tires easily. Now they want him to take metronidazole, I am not comfortable with this after reading about it.
Could the rimadyl(he was on it for several years0 have caused the high enzyme count? should we just keep him on the denamarin and wait and see, what do you suggest, I don't want to give him a ultra sound or biospy because they will have to sedate him to get him on his back and I worry about sedation at his age with a high enzyme count. the counts aren't extremly high, but enough to be concerned about, the only other issue is his colesteral is a bit high, he eats fromm dry food with boiled chicken,.
I just need another opinion, I am going nuts researching all this.
Thanks so much,

Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that your dog is dealing with these frustrating issues. It don't doubt that you are going crazy trying to research what high liver enzymes can mean because there is rarely a straightforward and obvious reason for this type of thing.

Rimadyl gets a bad rap when it comes to the liver because there can be the odd dog that can get serious liver complications within a short time of starting Rimadyl. It is quite rare. In 14 years of practice I can recall seeing one dog who had a serious liver related reaction to Rimadyl. Chronic Rimadyl use is *probably* not the problem with the liver right now. However, because Rimadyl is processed through the liver, it is wise to stop it for now.

You mentioned that the vet tested him for adrenal issues. I'm assuming you are referring to testing for Cushing's disease which is the condition that happens when the adrenal glands produce too much cortisol. He really has a lot of the potential symptoms of Cushings including an increase in thirst and appetite. Dogs with Cushing's will usually have a significant increase in alkaline phosphatase (ALP) as well. As ALP is associated with the liver, I'm assuming this may be the case for your dog as well. However, Cushing's doesn't usually cause vomiting. But then again, it sounds like the vomiting could have been something unrelated to the current problem.

In a case like this where we have elevated liver enzymes and some mild non specific symptoms like lethargy and increased thirst and urination then I'd usually be giving my clients a few options. The first would be to keep on the Denamarin and recheck the liver enzymes in a few more weeks.

The more aggressive option would be to do more tests. The problem is though that we can often do more tests and still not have an answer. The test that probably is best to do next is a liver ultrasound, but often there is no obvious diagnosis just by looking at the ultrasound and a biopsy is needed. In most cases, I would feel comfortable with the sedation needed for a liver biopsy but I would want to be doing some tests to make sure that his blood clots properly. As such, doing the tests, the sedation, the ultrasound and the biopsy can be quite pricey and there is still no guarantee of a diagnosis. BUT...sometimes we do get a diagnosis so I think it still should be considered.

If your vet feels that metronidazole is warranted here then I would not hesitate to use it. Metronidazole can often be good to take care of infections in the liver or even some parasites that can affect the liver. If it was going to be used long term then I'd probably be prescribing a lower dose than normal. But, if your vet is saying it is a good idea to prescribe it then I wouldn't be afraid to do so.

One other thing to consider is the possibility that this is early Cushing's disease that is still not able to be diagnosed with bloodwork yet. I have had a few cases where everything in my gut said the dog had Cushing's and the test was normal. But, we tested again a few months later and the test showed that Cushing's was there. This could be the case here.

It really does sound like your vet is doing all of the same things I would. I know liver problems can be frustrating and often we don't have immediate answers.

I hope things look up soon!

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

thanks so much for your response!
The test they gave him was a low dose dexamethasine suppression test, would that have detected Cushings?
The only numbers that I have on the receipt of his enzymes levels are ALt 399 and alkp 478, abdomen appears normal, all other systems were normal except stage II tartar build up. He has taken heart guard forever, and was all clear on th heartworm test, so considering everything I have read suggest that they have decreased appetite with liver disease, of which he has not, he eats like he has always, too much!! The fact that he walks twice a day, will take out after a squirrel in a flash, I think he gets tired because he is off the rimadyl and his hips and joints hurt as he is 10 years old. He does not have a fever or has not shown any symptoms of illness since the initial throwing up, except for drinking more water, so am I in denial here?
Could this just be old age, the fact that he is overweight (although he is just a big frame sheltie, like a female collie size)Could the tarter build up cause this?
Could they not prescribe a antibiotic with less side effects or just give him a shot if they feel it might be a low grade infection, instead of the 500 mg of metronidazole?
My vet is a very sweet caring person but she seems to look at me to decide what to do next, like I suggested to check his thyroid, she said good idea, let me see if the lab has enough blood to check, which they did and it was negative, I guess that is why I am second guessing everything at this point. My dog is not acting sick, just drinking more water than usual, could that be due to the denamarin or the fish oil that he is taking? Should I take a wait and see approach? Also is there anything he could take to help his hips and joints that would not effect the liver enzymes?
Sorry, I have so many questions, I am just worried and at a loss, any additional light you can shed on this would be greatly appreciated, Thanks so much,

Online vet, Dr. Marie

Dr. Marie replied:

The low dose dex test is the most commonly used one to detect Cushings. However, I have had some dogs that have tested normal on it and then a few months later, have shown signs of Cushing's disease.

The liver enzymes that you gave me are not extremely high. Sure, they're higher than normal but I wouldn't be too concerned.

I think that if your vet is wanting to prescribe a course of metronidazole I would have no problems with that. Don't be worried about what you read about side effects. In my experience it is very safe especially if it is just used for a short course.

The reason why there is no definitive path on what to do next is that really there is no obvious path to take. It's not wrong to do an ultrasound and even a biopsy but you still might not have an answer.

It sounds to me like the best course of action is to try the metrodnidazole and keep an eye on things for now. It really does sound like your vet is doing the same things I would.

Hope things are more clear soon!

Dr. Marie

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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.