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Heart enlargement?

Species: Dog
Breed: Terrier
Age: 8-11 years
Hi I have a female terrier dog, Fido and she is 9 years old. Couple of months ago my dog had a facial problem and it came out as facial paralysis due to idiopathic reasons. Her brain MR scans were perfect everything was fine. she had the problem oh her right side, she could not blink, close her right eye lid. After other more tests her Prof. vet decided to put her on cortisone treatment (Prednol 1 in first 2 - 3 weeks, then half pill ) and eye drops to create fake eye drops and prevent from dryness and bacteria. after 2 to 2.5 months her issue improved %90-95 as they check with a machine with needles going through under her facial skin. Her vet saw that her nerves are responding amazing and now she is fine. But due to cortisone treatmen her liver rates (ALT) went upto 400 which was horrifying. Thus they put her on another treatmen including vetri-same treats 1 a day and also Denamarin liver pills. after a while her levels dropped down to 90 and we were so happy that she was improving. At the end of August we had her spayed because my mum was so late to get her spayed. I wanted it when she was 1 yrs old but no one listened to me. After her operation her levels were stll fine. After 3.5 weeks later today, they took my dog to vet faculty in Istanbul (I am living in London due to my studies) because she was shaking her head and they found some irritation in her ears. They said its ok and they gave some ear drops. I asked my mum that one they are there, I wanted them to make a check up on Fido to see her liver levels and heart. Because like 2 years ago we have been told that she has a heart enlargement and I wrote on this site again with her x ray and result, one of the vet said she doe not have they are wrong it was normal for that breed. Another vet in London said the online vet was right so it was a release. But today i again asked them to do an ECG heart test too. And they said her liver rates went up to 150 again and she has a heart enlargement. We didn't give her Demarin the last 3-4 weeks because we have been told to give a brake. So my questions are, I am attaching her first(2 years ago) and latest heart x ray and would you mind to tell are they right and what can be done? - The vet said the effect of cortisone disappears in a long term period. But once it was nicely dropping down how did it go up again when we gave a brake? Do we have to use this all the time, isn;t it dangerous? Or would it be ok if we use it again for a while only? Because they told my mum to use it again. I am sending all her food from London and she is Hills L/D food and she loves it. Also she is on Lilly's organic food every 2 days too to feed her with something different and thinking about buying Hills H/D too for her heart...I am so devastated today because every month i fly to istanbul to be with my dog and i want her to be healthy when she is getting older. Regards. Erdem

Optional Information:
Type of Animal: Terrier
Gender: Male
Age: 9
Name of Dog: Fido

Already Tried:
For her heart, after showing her 1st x ray to other vets, they said there was nothing wrong so we did not do anything for the heart - for her facial paralysis she was on prednol cortisone treatment for 2 months vitamin pills and tear drops. Then once she was cured and the liver levels were high, she was on Demarin and vetri-same dog treats one a day

I am sending additional photos via email regards Erdem

Online vet, Dr. Marie

Dr. Marie replied:

This is a complicated question. I'll see what I can do to help, but really your vets that you are seeing in person will likely be able to give you better information than I can.

Let's start with the ALT level of 400. Yes, this is a higher than normal level, but normally I wouldn't be too concerned about a high ALT on a single reading. I would want to have other signs of liver problems before getting worried. For example, if there were also really high levels of ALKP, GGT or bilirubin I would be more concerned. Lots of things can cause a high ALT and they don't always mean that the liver is having trouble functioning. In fact, the only test that I trust to tell me about liver function is to do something called a pre and post prandial bile acids test. Now, if this test is showing really high levels, then I get worried. Otherwise, I likely would have just retested the ALT level every few months to keep an eye on things.

I had a look at your xrays and there is nothing there that I can see that would make me super worried about heart enlargement. It is possible that on the second xray the heart looks a tiny bit enlarged, but if it is, it is not obvious to me. However, it's obviously not as accurate for me to look at a photo of an xray as having a vet look at one in person.

An ALT level of 150 is not a level that I would be at all worried about. If I had a patient who needed cortisone and was benefitting from the drug and the patient had an ALT level of 150 I would not be worried. I would likely be rechecking the ALT from time to time. If it started to rise significantly I might do some liver function tests such as the pre and post prandial bile acids.

But really, from what you have told me in this post I would not be too worried.

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:

Dear Dr Marie thank you for your reply, you would not know how much i appreciate it as i am away from my little doggy. Today also they have checked her ALP levels because one of my british vet friend told me the same thing you wrote to me. He said ALT is not that concerning especially after cortisone treatment which means it is not due to an illness. But he said he would like to see the ALP and today Fido had her test done again and the results show her ALP level is 74. Is this a normal result or should i have concerns dear Dr? I am sending these latest test images via mail if you dont mind please and you will see ALT includin ALP on top.

Regards Erdem

Online vet, Dr. Marie

Dr. Marie replied:

This ALP level sounds perfectly normal. That's great news. :)

Dr. Marie.

Customer reply:

Dear Dr you made my day believe me :)
Thank you for your online great help
Regards from London

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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.