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Discussion Starter · #1 ·
Good evening everyone:) I could really use an ear and some advice with for dealing with the Tobester (or maybe you need to just talk me off this cliff?) So if anyone has time to read my novel, and let me know what they think, I'd be so grateful.

My Dober-boy is 8.5yo, and he's been moving towards hypothyroid since the spring I think (hindsight is always 20/20.) When I look back at his spring vet records I see that his thyroid was at the low end of normal, and his cholesterol and triglycerides were creeping high. All good indicators that maybe I could have started him on meds then, but... I didn't look that close at his test results. Bad mom.

About six weeks ago, he needed minor surgery and that is when it all started going awry. First he had a reaction to the sedation. Then he had a reaction to the antibiotics, and his ALT shot up to 500+. He was vomiting and miserable, and the vet switched him to Hill's ID, which he has been tolerating fine since. But as we starting switching back to his regular food (Wellness Core), he stopped acting like himself, and started losing weight. He's always been a "hard keeper" and a really heavy drinker (which the vet has not been concerned about before, but has been watching).

So a week into food switch (yesterday), we retested everything, and did abdominal X-rays, which were clean. The radiologist thinks that everything looks normal. His T4 is only 0.7, I'm still waiting on the Free T4 test results. ALT is back to normal at 47. Cholesterol and triglycerides are still high, Amylase and CPK are low end of normal. The vet thinks that this is *likely* just hypothyroidism, and that the liver involvement is due to the low thyroid levels. I'm worried that there may be another issue here that I shouldn't be too eager to write off.

So enough rambling background, on to my questions. The vet wants to start him on thyroid meds ASAP, which I'm going to do. Do I give the thyroid meds 6 weeks and see if any of the liver symptoms resolve or do I continue to try and hunt down a cause for this intermittent liver distress? Should I ask if we can start a supplement like Denamarin? I'd really like to avoid feeding the Hill's ID, and the vet is recommending that I feed something with less protein and fat and more fiber in it than the Wellness Core. Does anybody have any recommendations of similar quality to the Wellness that I can run past the vet for approval? Until then, he's back on the ID.
 

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Good evening everyone:) I could really use an ear and some advice with for dealing with the Tobester (or maybe you need to just talk me off this cliff?) So if anyone has time to read my novel, and let me know what they think, I'd be so grateful.

My Dober-boy is 8.5yo, and he's been moving towards hypothyroid since the spring I think (hindsight is always 20/20.) When I look back at his spring vet records I see that his thyroid was at the low end of normal, and his cholesterol and triglycerides were creeping high. All good indicators that maybe I could have started him on meds then, but... I didn't look that close at his test results. Bad mom.

About six weeks ago, he needed minor surgery and that is when it all started going awry. First he had a reaction to the sedation. Then he had a reaction to the antibiotics, and his ALT shot up to 500+. He was vomiting and miserable, and the vet switched him to Hill's ID, which he has been tolerating fine since. But as we starting switching back to his regular food (Wellness Core), he stopped acting like himself, and started losing weight. He's always been a "hard keeper" and a really heavy drinker (which the vet has not been concerned about before, but has been watching).

So a week into food switch (yesterday), we retested everything, and did abdominal X-rays, which were clean. The radiologist thinks that everything looks normal. His T4 is only 0.7, I'm still waiting on the Free T4 test results. ALT is back to normal at 47. Cholesterol and triglycerides are still high, Amylase and CPK are low end of normal. The vet thinks that this is *likely* just hypothyroidism, and that the liver involvement is due to the low thyroid levels. I'm worried that there may be another issue here that I shouldn't be too eager to write off.

So enough rambling background, on to my questions. The vet wants to start him on thyroid meds ASAP, which I'm going to do. Do I give the thyroid meds 6 weeks and see if any of the liver symptoms resolve or do I continue to try and hunt down a cause for this intermittent liver distress? Should I ask if we can start a supplement like Denamarin? I'd really like to avoid feeding the Hill's ID, and the vet is recommending that I feed something with less protein and fat and more fiber in it than the Wellness Core. Does anybody have any recommendations of similar quality to the Wellness that I can run past the vet for approval? Until then, he's back on the ID.
You said ALT is back to 47 - so what liver issues are you wanting to see resolved? Cholesterol is linked to low thyroid. Why does the vet want you to feed more fiber and less protein? My internist wanted me to feed 5 meals a day each with high quality protein or oatmeal (for 1 meal) and no raw meats. My alternative vet told me to remove all dairy (cottage cheese and yogurt) since it is not very good for liver issues. But again, what liver issue are you looking at addressing? What are the other enzyme levels at?

I would start on thyroid meds. I would recommend soloxine instead of thyroxine (the generic). If you want a good 2nd opinion, you can send copies of your blood tests to Dr. Jean Dodds and pay a minimal fee for an analysis/opinion. Here is her website with the form to use - I personally have the vet draw the blood and spin it up following her instructions then I send it to her by priority mail:

Consultation Only form:
http://www.hemopet.org/files/TEST_REQUEST_FORMandTESTING_DETAILS.pdf

Website home page:
Dr. Jean Dodds - Canine Thyroid Testing | Hemopet.org
 

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Discussion Starter · #3 · (Edited)
Thanks Vivienne, I guess what worries me about the liver is the fact that is keeps cropping up. I feel like the test numbers aren't telling the whole story, since they are so easily inflamed?

The vet has prescribed 0.6 mg levothyroxine twice a day, which I'm picking up on my lunch break tomorrow. The form that she's giving me is the chewable, because that's what she has in his dose right now, but once we get his dose confirmed I can asks her to order another form/brand if its preferred.

I'm not sure I understand the low protein diet either, I think its just because he isn't tolerating his old food which is 34%, and she thinks it might be because of his liver?

ETA: thanks for the recommendation for the second opinion, I'm definitely going to hop on over to her website and look into this right now!
 

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Discussion Starter · #4 ·
Yesterday's blood work:
AST 19
ALT 47
Alk Phos 90
GGT 3
Cholesterol 342
Triglycerides 510
Amylase 310
Lipase 465
CPK 96
(I have the rest of the CBC, but for brevity's sake...)
 

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Thanks Vivienne, I guess what worries me about the liver is the fact that is keeps cropping up. I feel like the test numbers aren't telling the whole story, since they are so easily inflamed?

The vet has prescribed 0.6 mg levothyroxine twice a day, which I'm picking up on my lunch break tomorrow. The form that she's giving me is the chewable, because that's what she has in his dose right now, but once we get his dose confirmed I can asks her to order another form/brand if its preferred.

I'm not sure I understand the low protein diet either, I think its just because he isn't tolerating his old food which is 34%, and she thinks it might be because of his liver?

ETA: thanks for the recommendation for the second opinion, I'm definitely going to hop on over to her website and look into this right now!
Well 34% is quite high so yes, maybe dropping down to a more normal level would be better but you also mentioned she wanted to lower fat content and that's a good thing too - but not too low. I see no reason to 2nd guess the advice your vet has given - I of course would prefer a homecooked diet in this case if you are concerned about her liver. Also for sick livers, many small meals is a better plan - puts less stress on the liver.

You may be trying different dose of thyroid meds, but once you agree on one, get yourself a stock bottle of soloxine by having your vet supply a script for an on-line pharmacy - I use KVVet since they had the best price for .6mg Soloxine at the time. Different dosages will have different suppliers giving the best price at any one point in time. Someone else on here said that Foster & Smith had the best price for them. A stock bottle contains 1000 tablets and that will last you 500 days or less than 2 years - they have a 2 year shelf life. It really is a bargain deal to get a bottle.

But get Dr. Dodds' 2nd opinion if you are worried at all - for $45 it offers good peace of mind. Make sure you include a long description of everything that is going on with her liver and how often etc etc. I mean really give her the full story in writing.
 

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Discussion Starter · #6 ·
Well, to update, Toby's Free T4 by equilibrium dialysis came back totally normal at 28.2, so the vet thinks now that he has "sick thyroid" and that the totaly T4 is low due to some other cause that we haven't pinned down.

Monday we're going to draw blood for the hemopet panel, just to be sure. I'm also trying to get in to see the veterinary nutritionist at the U of M clinic, because the other options that we have now are: IBD or some kind chronic, low grade liver disorder. He's not a good candidate for surgical biopsy due to age and health right now, so managing with diet has got to be the first step. Lymphoma was on the radar screen, but his CBC is completely normal.

Oh Tobes, momma loffs you. Please feel better soon!
 

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I hope you get some good help at the U. They have some great vets on staff. Toby is lucky to have you!
 
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Discussion Starter · #8 ·
Thanks Meadowcat :)

I got a couple kibble recommendations on a phone consult to start transitioning him onto, we're going to add fiber and watch his blood work carefully. I brought up the smaller meals too, and she thought that was a super idea. we have a plan! Yay!

Now lets hope it works.

On the plus side, Toby has been acting great since yesterday. Up at five, wants to go for his morning run, wagging his little stub all over the place... makes me a happy me mom!
 
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