Slightly Elevated ALT, Your Thoughts? - Doberman Forum : Doberman Breed Dog Forums
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post #1 of 24 (permalink) Old 11-06-2018, 12:07 PM Thread Starter
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Slightly Elevated ALT, Your Thoughts?

Mocha has always had slightly elevated ALT levels (I think I put up a thread about this a while back). 1 year ago, while doing a jr. wellness blood panel, her ALT was 187. 6 months later, it was 230 so our vet advised we start her on Denamarin to see if that helped. Now, 6 months later, her ALT is 208 so although it hasn't gone up any further, it also didn't drop a lot considering she's on the medicine.

All her other levels (bilirubin, AST, etc.) are perfectly normal and our vet says she's isn't too worried with Mocha's ALT being at 208. She said we could have her referred to the internal specialist for a biopsy if we wanted, but with the ALT only being 208, and not going up, and Mocha acting perfectly healthy, a biopsy isn't something she would push at this point. She recommends continuing the Denamarin and doing bloodwork on a regular basis to monitor the levels and asked what I thought, and for now, I agree with her but...wanted to come here to ask the experts.

Mocha doesn't drink excessive amounts of water, she has high energy, has a good appetite, stools are normal (yippee ); she is on Proin for the spay incontinence and gets the Rx rabbit and potato food.

Any thoughts? Thanks!



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post #2 of 24 (permalink) Old 11-06-2018, 01:34 PM
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We used to call it SGPT. There are lots of liver tests--I always have to stop and remember which is which.

Just looked up some causes for slight elevation...one thing you didn't mention was whether or not she drinks (alcohol). Well?

But one thing I noticed when I looked stuff up is that hypothyroidism can cause an elevated ALT. Do you know if her thyroid function tests are normal? Some folks consider even low normal tests to be a sign of hypothyroid in dobes because they are so prone to it. It might be worth checking into that with a full thyroid panel...ask your vet. Vets don't always know about different breeds' specific tendencies; he may not be considering whether or not she could be having thyroid problems??

Anyway, I don't have any first-hand advice here. But I imagine other folks will chime in.

Last edited by melbrod; 11-06-2018 at 02:18 PM.
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post #3 of 24 (permalink) Old 11-06-2018, 03:45 PM
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I personally would let it ride - in the big picture, that 208 is not a big deal IMHO. My Jezebel is at almost 800 as of August - she was diagnosed with copper storage disease by biopsy at age 3 - and her ALT was high when I did her first bloodworkup at age 2. At age 6 3/4, she still has no symptoms of the disease. I never expected her to make it past the age of 6.... but knock on wood, she is doing fine. She takes Denamarin every day, and I keep her on a low copper kibble (Annamaet Aqualuk) and feed her 1/2 fresh foods - egg based (4 eggs a day) with yogurt, cottage cheese, fresh fruits and veggies.
You can put your girl on the RX liver diet, but the ingredients are pretty crappy. There are other options out there, and you might want to look up the "liver cleansing diet"
Without a biopsy, you can't know if she has liver disease, and what kind. So if her numbers continue to go up, I would recommend a biopsy. An ultrasound now can tell you if her liver is enlarged.
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post #4 of 24 (permalink) Old 11-06-2018, 04:56 PM Thread Starter
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Quote:
Originally Posted by Fitzmar Dobermans View Post
I personally would let it ride - in the big picture, that 208 is not a big deal IMHO.
That's pretty much what my vet said too; she said it's not something we want to ignore, but she also didn't think it was worth having Mocha sedated and having the biopsy done (plus the cost). She said we can do bloodwork every 3 months if I want, I think she said they can do a simple check right there at the vet's office for just the ALT so it wouldn't cost me as much as a full blood panel.
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post #5 of 24 (permalink) Old 11-06-2018, 05:24 PM
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Kelly is 6 y/o and ongoing soft stools / indicating a possible Liver problem.
- last week blood tests / her ALT level was 158 (max. limit 118)
- months ago she was fed Orijen (meat protein 38-44% and no plant protein)
- she is now switched over to Royal Canin® Veterinary Diet Canine GASTROINTESTINAL LOW FAT dry dog food
^ Min. protein 20%
- our senior vet said Kelly suffered from too high a kibble protein
- and she needed a Low Protein / High Carb, diet Dr. Vern said, 24% max. protein
- stools have been absolutely perfect, lately

PS - the Vet Prescription id HILLS Science diet kibble, made Kelly vomit...3x in 2 days...garbage brand IMPO.
- given the diet change above, Kelly will have blood work checked again...in 2 months time
- so far / so good

https://www.royalcanin.ca/products/c...og-food/223025

------------Kelly & (Amy - RIP @ 11.7 y/o)

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post #6 of 24 (permalink) Old 11-06-2018, 05:53 PM Thread Starter
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Mocha is on Royal Canin Rabbit & Potato; I just got this from their website

Crude Protein (min) 19.5%
Crude Fat (min) 10.5%
Crude Fiber (max) 3.7%



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post #7 of 24 (permalink) Old 11-06-2018, 07:18 PM
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Quote:
Originally Posted by TNfisher View Post
Mocha is on Royal Canin Rabbit & Potato; I just got this from their website

Crude Protein (min) 19.5%
Crude Fat (min) 10.5%
Crude Fiber (max) 3.7%
Looks real good TNfisher - what was Mocha earlier food & protein % ?
- just curious here

Our Vet has been practicing for 40 years, knows his Dobermans and also sought our by Race Horse owners & breeders, across our province.

An earlier young Vet said Kelly needed probiotics, every time we took her in BS / and 2 weeks later, diarrhea again.
- Dr. Vern is now 1/2 retired, so we waited for his time slot, and glad we did.
- Some dobes, just can't handle rich Protein levels, and it over-taxes their Liver.

Dr. Vern also saved former Amy's life, in an emergency-extended surgery / she lived another 2.5 happy years and passed of old age, 23% over breed life-expectancy.
- so we have utmost faith & trust, in his prognosis / he has a gift, of being right
- a gifted surgeon, and also practices acupuncture, chiropractor & Chinese medicine

Often - fixing a dobes heath, is finding the right Vet....and we learned, some need a Low Protein / High Carb diet.
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------------Kelly & (Amy - RIP @ 11.7 y/o)

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post #8 of 24 (permalink) Old 11-09-2018, 10:14 AM
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Quote:
Originally Posted by TNfisher View Post
Mocha is on Royal Canin Rabbit & Potato; I just got this from their website

Crude Protein (min) 19.5%
Crude Fat (min) 10.5%
Crude Fiber (max) 3.7%
Since you don't know what exactly she might have, I would call Royal Canin (or email) and ask what the copper content is. Copper is never listed in the ingredients & is sometimes very high. If she has copper storage disease, you will want to keep the copper very low.
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post #9 of 24 (permalink) Old 11-09-2018, 11:26 AM
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It will be listed - 99.9 percent of the time as Copper Sulfate - We have cut out all copper sulfate for Ali - for the same reasons as Fritzie

One other thing - Ali can not have high protein food either -
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post #10 of 24 (permalink) Old 11-10-2018, 11:17 AM Thread Starter
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Well, look at that



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post #11 of 24 (permalink) Old 11-10-2018, 11:25 AM
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I asked why do they even have to add Copper sulfate to the food - The answer was to call the food a complete diet - it has to be in there -

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post #12 of 24 (permalink) Old 11-10-2018, 12:12 PM Thread Starter
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Now the question is; are there any decent non-Rx foods out there without copper content?



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She will be yours, faithful and true, to the last beat of her heart. You owe it to her to be worthy of such devotion.
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post #13 of 24 (permalink) Old 11-10-2018, 03:11 PM
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I don't think there's any such thing as a NO copper dog food. However, there is a HUGE range of copper contents in dog foods. This listing is kind of old, but it's a good starting place to look at the listings.

I know one reason way back that I changed away from feeding Orijen years ago was the high copper content in the food (among MANY other reasons). One of the reasons I like Fromm is it's a fairly low copper content. Certainly these should be checked because, like I said, it's an older list, but...decent place to start.

Copper Content in Dog Foods


DSC_0133
by Shanoa Delta, on Flickr

Richter & Sypha
Glengate's Mountain Fortress CAA ORT L1E L1C NW2 L2V L2I ACT1 RATI SOG WAC
& Sirai's Golden Masquerade ORT L1V L1E L2C L2I NW2 RATI SOG DOG TKN WAC
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post #14 of 24 (permalink) Old 11-11-2018, 07:53 AM
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My Jossie will be 10 this month and was diagnosed with copper storage disease at 3 1/2. My suggestion for you is to keep a close eye on those liver panel levels for trends towards elevation and that if you see it going up, take her to an internal medicine vet.

Chronic liver disease in dobermans is either of metabolic origin (copper storage) or autoimmune. The treatment is very different depending on the type of disease.

While Denamarin is widely prescribed for liver issues, in my personal experience it doesn't have a big effect on liver enzymes.

Jossie was under 1 when we started seeing the liver values towards the top of normal ranges. We kept the close eye on them and at 3 1/2 the biopsy confirmed accumulation of copper in the liver tissue. She was on penicillamine for 2 years to clear the copper. We maintained her levels normal with diet alone (prescription hepatic Royal Canin + added cooked chicken breast) for 6+ years. Liver values started escalating again this year. She recently was in surgery (foreign body) so we took another biopsy of the liver and it showed copper accumulation so she's back on the meds to clear it.

My other doberman with liver issues did not live past 4. I personally believe that being more proactive this time with Jossie is what has made her live this long.

People say that the prescription hepatic diets are crap, to me these diets have been a godsend. We tried to find a different diet for Jossie by consulting with the Cornell veterinary nutrition service. They designed a home cooked diet for her that included some very expensive specialized supplements. When we tried to transition her into it, we found out that she's very sensitive to rice and her poops were awful. They advised us to put her back on the prescription diet and add the chicken so that she would have more protein. It was an expensive lesson learned.
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post #15 of 24 (permalink) Old 11-11-2018, 09:04 AM
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Dobe_Mom --- Great advice ! It sounds about like what we went threw with Ali -- As you said - The internal Vet is a must - After we got her on the road to recovery - Our general Vet admitted - he did not much knowledge on copper storage - it damn near cost her - her life - and we were pretty proactive with her - they go down hill very fast .


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post #16 of 24 (permalink) Old 07-17-2020, 01:24 PM
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Helo Agathon is dealing with high ALT right now. Back in April it was 600 non-fasting, repeated 2 weeks later fasting was 257, then in May repeat fast back up to 573 so my vet sent us to an internist. He performed a bile acid test, abdominal ultrasound and repeat blood work. All completely normal; ALT was 118 ref range 18-121 for IDEXX labs. The internist was scratching his head. Meanwhile, I found an FDA report from 2018 on NexGard listing high ALT as one of the complaints. Well, Helo was on NexGard for 6 months to control some localized mange and he had been off it for almost 2 months prior to the visit with the internist. He has not had any NexGard since.

So, he just had repeat blood work this week and unfortunately, his ALT is up again to 191. Not as high as before but enough to have the internist recommend a liver biopsy which is scheduled for end of this month. It's the only way I guess we will know what is going on.

I have been researching copper content in foods. Most companies will tell you if you ask. Helo eats Annamaet Extra chicken which has a copper content of 12 ppm. I was thinking of switching to Annamaet option which is salmon (Helo doesn't like the chicken right now). It has a copper content of 13.4 ppm. Purina Pro Plan shredded salmon is 17.6 ppm but the lowest I found is Nature's Logic distinction sardine at 7 ppm copper which is almost as low as the prescription diets. I've also been feeding Helo cottage cheese and yogurt recommended by Fitzmar thanks

I'll wait to see what the biopsy results are and discuss with his internist.

Elaine


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post #17 of 24 (permalink) Old 07-17-2020, 01:53 PM
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Mav had an elevated ALT of 204 about 2 years ago, my vet takes a more holistic approach to things and suggested milk thistle. I gave him 1000mg of milk thistle a day for 6mo. and it brought him down to 125. I haven't tested him in about a year but I'm hoping it will be even lower. I talked to Sharon Marinelli of Sharjet about it and she highly recommends trying milk thistle, not just for dogs but even for people who have elevated numbers.

I'm def. not an expert on liver enzymes but this worked for us.
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post #18 of 24 (permalink) Old 07-17-2020, 02:01 PM
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Thanks! I knew about the milk thistle but they want to confirm what the exact cause is before treatment. They mentioned copper storage, however, he is only 16 months old so it could be something else.
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post #19 of 24 (permalink) Old 07-17-2020, 02:11 PM
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Quote:
Originally Posted by Beaumont67 View Post
Kelly is 6 y/o and ongoing soft stools / indicating a possible Liver problem.
- last week blood tests / her ALT level was 158 (max. limit 118)
- months ago she was fed Orijen (meat protein 38-44% and no plant protein)
- she is now switched over to Royal Canin® Veterinary Diet Canine GASTROINTESTINAL LOW FAT dry dog food
^ Min. protein 20%
- our senior vet said Kelly suffered from too high a kibble protein
- and she needed a Low Protein / High Carb, diet Dr. Vern said, 24% max. protein
- stools have been absolutely perfect, lately

PS - the Vet Prescription id HILLS Science diet kibble, made Kelly vomit...3x in 2 days...garbage brand IMPO.
- given the diet change above, Kelly will have blood work checked again...in 2 months time
- so far / so good

https://www.royalcanin.ca/products/c...og-food/223025
Hey Beau,

Not all prescription diets agree with all dogs but I got to wondering why Kelly was on Hills ID? at all. If there was a question about liver and your vet wanted to prescribe a Hills product why didn't he prescribe LD--designed specifically for dogs with liver issues.

The Royal Canin GI low fat diet is one that takes care of a number of non-specific problems but thought it was interesting that your vet chose that one rather than than the LD.

It isn't just curious minds who want to know all of us nosey folk also want to know.

ABTLH
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post #20 of 24 (permalink) Old 07-17-2020, 03:06 PM
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They mentioned copper storage ??? Ali was around 7 or so when she got it . I have whole book on her eeg if you need any info .
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post #21 of 24 (permalink) Old 07-17-2020, 03:24 PM
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They mentioned copper storage ??? Ali was around 7 or so when she got it . I have whole book on her eeg if you need any info .
Thank you! Fitzmar has given me info as well.

I know, he is so young for copper storage which is why they really want to do the biopsy. I hate to put him through it but I need to know so we can treat whatever it is. I have racked my brain and can't think of anything he would be exposed to. His diet is good, he is off the NexGard (I'm using a natural spray) and I don't use any chemicals on my yard. The only supplements he gets is an Omega cap and Nature's Farmacy Complete which is low in copper. I even tested my water and it's very low in copper. He is on Interceptor for HW preventative but he takes it every month so that wouldn't explain the fluctuations in his ALT. His other liver enzymes are normal.
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post #22 of 24 (permalink) Old 07-17-2020, 05:46 PM
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My Jossie's copper storage started when she was under 1. Levels increased over time, leading us to decide to do the biopsy to confirm the diagnosis. She was 2 1/2-3 when we started the treatment.

Coincidentally, my new program that I am leading at work is on Wilson's Disease, which is copper storage liver disease in humans. So lately I have been reading more literature on the disease, which may or not be related to how the disease happens in dog breeds.

Accumulation of copper in the liver is the definitive clinical observation, this accumulation is because the patients lack the ability to metabolize copper.

Dog foods do contain varying levels of copper and lower copper foods are better for dogs with copper storage disease, however the disease is not caused by ingesting high copper levels. It is the accumulation in the tissues over time that starts affecting liver function.

I am not convinced that milk thistle/ denamarin is an efficient way to manage this disease long term. The best way is to use a copper chelator like penicillamine to lower the copper levels well ahead of observing reduced liver function and maintain by feeding the dog a low copper diet while monitoring the disease.

My Jossie will be 12 in November, her liver values have increased with age and have required one repeated treatment with penicillamine since the original one upon diagnosis. She has been seeing the same internal medicine vet all these years. The liver values are just over normal and the disease is under control. Last year she developed DCM and is on meds for that as well. She's starting to have mobility issues, but overall she's a happy dog. All considering she is doing well for a near 12 year old doberman.
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post #23 of 24 (permalink) Old 07-17-2020, 08:54 PM
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My Jezebel was diagnosed with liver disease at age 2 when a standard baseline bloodwork showed an ALT level of around 600. A liver biopsy verified that it was copper storage. I was never impressed with the quality of the RX kibbles, and talked to Annamaet about their copper levels - they are very low compared to most kibbles. I've maintained her for over 6 years on Denamarin and diet and while her ALT levels have not gone down, they have not really gone up either. Half of her diet is eggs, yogurt, cottage cheese, fruit, and veggies. She also has a low thyroid, and recently is having a lot of issues with incontinence (proin didn't help and we are trying DES right now - but have an appointment with UPenn vet school in a couple of weeks)
The Denamarin is not cheap, but I have managed to keep the cost reasonable in managing her liver disease. There was another med when she was first diagnosed that was going to cost $170/month - just for that one. It just wasn't feasible to spend that much. The diet has really worked to keep her pretty healthy for over 6 years - I'm pretty happy about it.
I'm hoping that Helo will have as much success with diet as my Jezebel.

Mary Jo Ansel
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post #24 of 24 (permalink) Old 07-18-2020, 05:44 PM
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I like the Annamaet too Mary Jo. I’ve been feeding eggs, cottage cheese and yogurt too like you suggested. Hoping I will have an answer soon!

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