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I am learning all about canine liver disease especially in the doberman.. i have an ultra sound appointment set up for dec 1.. my hubby keeps asking me to ask you all if the ultra sound would make a difference in treating liver disease... heres the problem.. very very very..strung out dobie in the car.. at the vets ... i mean so bad that we really feel so sorry for how emotional she becomes.. i believe it is the away from home syndrome.. because she is obsessed with me.. if i am outside she cries and stands by the door for me to let her out with me.. but when we are in the truck or in an new location it does not matter that i am with her.. she goes into a frenzy... i have not been able to break her of this no matter how i try..She will jump into the truck like she is eagar to go and as soon as you pull out of the driveway.. she cries and bellows so loudly ... breaks your heart.. okay so getting back to the ultra sound.. it is an hour and a half away... i know she won't lay there and let anyone run the wand over her side.. not until she is totally traumitized and exhausted... i know if it is cancer.. tumors.. we will not get her operated on..if it is liver disease we will continue to feed and give her medicine the way we have been... is there something else i am missing here.. can they possibly see something i need to know about... Should i proceed with this test regardless of how much hell i will do to her.. or are there some dogs that you just shouldn't do this to... i just do not know what to do.. it is not the money.. we spent $5000 trying to save a horse ...she had so many feet of intestines removed because of sand colic... she died anyway in recovery.. we took our rusty dobie for cancer treaments.... i cannot tell you how much we have spent on recovery of pets..i just do not want to stress this girl that she gets worse.... she is so good in every other way..but nervous nelly is putting it mildly... thanks for all your help
 

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Have you had bloodwork done to show high liver values and that is why you are getting the ultrasound?

What are the possible outcomes of the ultrasound test and do you have a plan for each one.

If the majority of your plans are to continue supporting the liver and not perform the surgery for cancer, shunt, biopsy etc, then why are you doing the ultrasound?

Why not just continue with the milk thistle and SAMe and maybe 5mg cortisone EOD? Several small meals a day and limit the amount of fat etc. High quality protein with oats and yams and probiotics.

I have a dog that is so fed up to "here" with getting blood taken, that I have vowed no more bloodwork, we will simply support his liver and ease his path when it is his time. I will not try for heroics anymore.

Good luck - but I wouldn't be doing it without a very, very good reason.
 

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Discussion Starter · #3 ·
we have had the blood work done.. she has no sign of disease but she was getting thin.. so we took her stool in thinking it was a possible parasite problem..that was negative.. so we brought her in... all hell broke out on the way... and then once she was in there my husband picked her up to put her on the table as the vet insisted.. the dobies head hit my hubbys head.. she flung herself backwards..this was with two benedryl in her.. i helped maintain her on the table and poor girl urinated and looked like she collapsed for the moment as the vet took her blood.. i am so fortunate she is built like an athelete because she recovered quickly but cried her heart out again.. the blood came back with liver enzymes elevated.. so we started her on the diet and medicine right away.. she takes danmarin an hour before she eats anything.. she has gained weight.. and yes following a good diet of low protein and low fat.. etc.. what i want to know is .. if i continue to treat liver... is there any special thing i need to know in the ultra sound about the liver.. or is this treatment for all liver problems.. one way or the other.. because i definitly have decided if it is cancer i will not have her have any operations.. and i will not have her have a biopsy to see if it is cancer. the vet himself said that would be a risk.. is this the normal proceedure to treat all liver disease.. or by actually seeing the liver is there something they will learn or could learn to make the treatment different... i just do not want to jeopardize her chances... thanks so much for your response.. you have been through this too???
 

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The main thing you will find out is this: if it is cancer that they will treat her for cancer with extra meds and provide as estimate of life quality for you. I recently lost my old boy in June to lung cancer and we got 3 good months for him after the dx by using 20mg cortisone BID and draining the fluid that accumulated in his thoracic cavity. We did that with xrays though. I refused any biopsies.

With the one that has liver issues, we treat him with milk thistle, SAMe, VitE, Fish Oil, 5 meals/day, low fat but not low protein - just small amounts spread throughout the day (5 meals). He also gets cooked rice, oats, yams, yogurt, egg, various meats. Because his liver is not functioning right, he needs the smaller meals to make the glucose he needs to be active. He also gets 5mg Cortisone every other day (EOD) because he appears to have an autoimmune disease of some sort and it is not worthwhile working out which one because it won't help with the treatment.

Whenever a vet suggests tests, I always ask what it will show - diagnoses that are possible. Then I ask what can be done for each of these dx. Sometimes, I get that they will end up using the same treatment or standard surgeries or treatments aren't possible for different reasons. I have had this several times lately, so I have decided not to pursue further testing of his blood and or further testing of issues because it won't make any difference to what we are currently doing. When my vet has told me "we are out of options" I know it is time to stop looking and start evaluating quality of life. That's where I am now. My boy started off being the most agreeable to all treatments. 40-some blood draws later he isn't cooperative anymore and that causes its own problems. No more, I have drawn the line for him.

You have make your own choices. How high are the liver enzymes? What are the actual results?
 

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Discussion Starter · #6 ·
The main thing you will find out is this: if it is cancer that they will treat her for cancer with extra meds and provide as estimate of life quality for you. I recently lost my old boy in June to lung cancer and we got 3 good months for him after the dx by using 20mg cortisone BID and draining the fluid that accumulated in his thoracic cavity. We did that with xrays though. I refused any biopsies.

With the one that has liver issues, we treat him with milk thistle, SAMe, VitE, Fish Oil, 5 meals/day, low fat but not low protein - just small amounts spread throughout the day (5 meals). He also gets cooked rice, oats, yams, yogurt, egg, various meats. Because his liver is not functioning right, he needs the smaller meals to make the glucose he needs to be active. He also gets 5mg Cortisone every other day (EOD) because he appears to have an autoimmune disease of some sort and it is not worthwhile working out which one because it won't help with the treatment.

Whenever a vet suggests tests, I always ask what it will show - diagnoses that are possible. Then I ask what can be done for each of these dx. Sometimes, I get that they will end up using the same treatment or standard surgeries or treatments aren't possible for different reasons. I have had this several times lately, so I have decided not to pursue further testing of his blood and or further testing of issues because it won't make any difference to what we are currently doing. When my vet has told me "we are out of options" I know it is time to stop looking and start evaluating quality of life. That's where I am now. My boy started off being the most agreeable to all treatments. 40-some blood draws later he isn't cooperative anymore and that causes its own problems. No more, I have drawn the line for him.

You have make your own choices. How high are the liver enzymes? What are the actual results?
i just read all you wrote to my hubby... i started to get choked when i read that your poor guy has had 40 blood tests.. thats just mind boggling.. and what a guy to finally tell you enough.. i appreciate your solid advice so much.. my husband just said..if we go for ultra sound and we get the worst news possible .. and we refuse any operation or biopsy i quess it would not change anything that we are doing now. for the liver.. . If it were cancer i quess we would know that sooner or later.. and take it from there.. i cannot give you the results of the test because i did not get a copy of the actual readings.. i remember he said all three tests related to the liver were elevated..because i asked him if we could repeat the test and he said the three tests would not be wrong.. i know dogs can live for a long time with a diseased liver.. and diet really makes a difference .. i appreciate all the ingredients you mentioned.. is your dog on the prescribtion food from vet or do you do this your self. Or do you add it to a special good kibble thats on the market.. I have fed her Innova all these years.. i am buying some lower fat innova ..merrick and evo and some others in the can to supplement her Id can food from the vet.. two or three tablespoons per each meal for added taste.. yams .. eggs and yogurt.. and now oatmeal.. that ID is sooooo bla.. she wouldn't eat it without adding the other can food... hope this is okay.. thanks so much... you have been a great help to me.. i have just made my decision.. i will wait one month..take her back for another blood test and see how it reads.. if still high ..go for ultra sound then...
 

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i just read all you wrote to my hubby... i started to get choked when i read that your poor guy has had 40 blood tests.. thats just mind boggling.. and what a guy to finally tell you enough.. i appreciate your solid advice so much.. my husband just said..if we go for ultra sound and we get the worst news possible .. and we refuse any operation or biopsy i quess it would not change anything that we are doing now. for the liver.. . If it were cancer i quess we would know that sooner or later.. and take it from there.. i cannot give you the results of the test because i did not get a copy of the actual readings.. i remember he said all three tests related to the liver were elevated..because i asked him if we could repeat the test and he said the three tests would not be wrong.. i know dogs can live for a long time with a diseased liver.. and diet really makes a difference .. i appreciate all the ingredients you mentioned.. is your dog on the prescribtion food from vet or do you do this your self. Or do you add it to a special good kibble thats on the market.. I have fed her Innova all these years.. i am buying some lower fat innova ..merrick and evo and some others in the can to supplement her Id can food from the vet.. two or three tablespoons per each meal for added taste.. yams .. eggs and yogurt.. and now oatmeal.. that ID is sooooo bla.. she wouldn't eat it without adding the other can food... hope this is okay.. thanks so much... you have been a great help to me.. i have just made my decision.. i will wait one month..take her back for another blood test and see how it reads.. if still high ..go for ultra sound then...
I do a naughty thing and feed raw - except for the chicken which we grind (necks) and cook. He gets veal, pork, lamb, beef, fish, chicken, eggs, yogurt. He used to get cottage cheese as one of his protein inputs each day but one vet wanted us to drop all dairy and when that made no difference we added the yogurt back in but didn't bother with the cottage cheese since I had substituted something else there.

I don't use kibble except for Evo - I used to use that as one of the protein inputs too except a different vet wanted us to drop all protein for an elimination diet - and that didn't work. Breakfast is yogurt (make my own from Greek Yogurt and VitD milk since there are 3-4 dogs that get it daily), egg, Nzymes and cooked ground chicken. Lunch is boiled rice with fish or veal or beef. Dinner is a small raw meaty bone with extra meat. Supper#1 is cooked old fashioned oatmeal with cooked yams added after. Supper#2 is a bowl of veal meat (no fat).

I would make sure you give the milk thistle and the SAMe since those really do make a difference. Make sure you feed many small meals so the liver doesn't have to work very hard at one time. Get a copy of the bloodwork from your vet - you may be entitled to in your state but regardless, you paid for the test, get a copy of the results - I have every single copy of everything for every dog and I plot bloodwork on a spreadsheet with the ranges for every test ever taken for each dog. Just because the enzymes are elevated doesn't mean you have liver disease (as has been said). Usually a vet will put your dog on a course of antibiotics (Simplicef) to eliminate the cost of too many tests and possibly fix the problem. DobermansRule has had this twice with Quincy. This is often a first knee-jerk reaction from a vet and (IMO) a good one. It is cheap and often addresses the issue. The liver is the sewer system of the body and if any part anywhere gets an infection, the liver can start shedding enzymes. Trouble is trying to find where the problem is - cheaper to run a course of ab. Of course that is not a great way to treat most things but for the liver, it is a general practice. Then you re-test at the end of the course of ab. Here is a site to check out what different blood tests mean:

Broadway Veterinary Hospital / Laboratory Assessment Descriptions

You can also just call your vet and ask for the name of the enzyme, the reference range and the value in the test. Ask for all 3 common enzymes (Alkaline Phosphatase, ALT, and AST) plus GGT (Gamma-Glutamyl Transpeptidase).

Again, if was my dog with those issues, I agree with Murreydobe, if you won't be doing a biopsy, then don't do the ultrasound.
 

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Discussion Starter · #8 ·
thanks again for sooooooo much info.. you are like a vet... i quess after all you have been through.. you have done all your homework.. i give you great respect and regards... when Lady had her blood work he did every test imaginable.. i don't think anything was missing .. it came back that her white blood cells where normal... indicating there was no infection.. could there still have been an infection even though this was negative.. should he have put her on an antibiotic just as a precaution in case there was an infection.. i will get all the stats tommorrow from the vet.. then let you know what it said and check it to this.. i have had this vet for 30 years.. horses and my dogs.. he only does small animals now.. he is great so i do trust him.. but does not mean that there are not other more modern things available.. thanks so much again.. infact i want you to know truly appreciate your explanations and help.. i am learning and you made it easier.. talk to you tommorrow ... when i know more..
 

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Discussion Starter · #9 · (Edited)
what kind of milk thistle do you get.. do you get it from mail order..or drug store.. is it for humans or dog formula.. i definitly want to get some..and also the SAMe..is that available for humans or dogs.. what multi vitamin do you reccommend.. just about to order some... thanks..
 

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what kind of milk thistle do you get.. do you get it from mail order..or drug store.. is it for humans or dog formula.. i definitly want to get some..and also the SAMe..is that available for humans or dogs.. what multi vitamin do you reccommend.. just about to order some... thanks..
As MaryandDobes said - you are giving him Milk Thistle and SAMe in the Denamarin. My problem with it was my dog weighed more than the single tablet dose (over 65lb) and the cost of 2 tablets was double (of course) so I looked at getting it separately. I even found that getting Marin and SAMe from Puritan's Pride was cheaper than Denamarin. Now I have dropped getting Marin and since he also getting VitE separately, I am just getting Milk Thistle from them as well. He gets 600mg of SAMe SID and 1 milk thistle 250mg SID 1 hour before the 1st meal of the day. I don't use a multi-vitamin - just the extra VitE and Fish Oil that my internist told me to get. He gets 2000mg Salmon Oil bid, and 550 IU VitE bid. [sid = once a day, bid = twice a day, eod = every other day]. My vet had told me to give the SAMe bid but the internist told me to combine it into a single dose sid.

Marin is a higher quality milk thistle (supposedly) than regular human grade milk thistle. This is a judgment call on which to get - cost became my main driver, cost without sacrificing quality.
 

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An Ultrasound isn't a treatment...just a diagnostic tool. It's benefits would be giving the vet a visual indication of the condition of the surface of the liver (which could give some indication of how progressed any disease is), whether there are any tumours or shunts. It's possible to get a rough idea of disease progression through bloodwork and the dog's condition/behaviour...but it's a lot of guesswork and uncertainties.

Given that your girl gets so distressed going to the vet...and that you don't intend any invasive work...it's not going to be the end of the world if you don't get it done...if at her next bloodtest day she is calmer...perhaps it can be done then, as it can provide information that is helpful to tailor her treatment in the most effective direction.
 

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Discussion Starter · #13 ·
An Ultrasound isn't a treatment...just a diagnostic tool. It's benefits would be giving the vet a visual indication of the condition of the surface of the liver (which could give some indication of how progressed any disease is), whether there are any tumours or shunts. It's possible to get a rough idea of disease progression through bloodwork and the dog's condition/behaviour...but it's a lot of guesswork and uncertainties.

Given that your girl gets so distressed going to the vet...and that you don't intend any invasive work...it's not going to be the end of the world if you don't get it done...if at her next bloodtest day she is calmer...perhaps it can be done then, as it can provide information that is helpful to tailor her treatment in the most effective direction.
This is exactly what i am thinking... get the ultra sound later if the next blood test does not show improvement.. the vet for blood work is about 1/2 hour away..the ultra sound is 1.5 hours away.. if my vet had the ultra sound eguipment.. i would not even be disscussing the issue.. but he doesn't .. and the techs in the other place probably never had to handle a dog like my Lady.. she is certainly different and a whopping handful.. not at home.. not in the yard..but out in public... she just falls apart and nothing you can do to get her to think rational except maybe the drugs which i have not tried as yet.. and really i don't want too.. but i have not made a decision on it yet.. i may try it one day before next blood work just to see.. i just hate upsetting her mind.. at home she is so happy and content.. i can leave and come back and she will greet me.. but go right back to her bed to snooze.. or on the couch with me.. her legs in the air and snoring... those are the times she is at peace... very sad to deal with a dog that is nervous and so gratifying to see her when she is content..thanks everyone for all the support and understanding.. and especially the great info.. you all are such a world of information... thank you for passing it on.
 

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As MaryandDobes said - you are giving him Milk Thistle and SAMe in the Denamarin. My problem with it was my dog weighed more than the single tablet dose (over 65lb) and the cost of 2 tablets was double (of course) so I looked at getting it separately. I even found that getting Marin and SAMe from Puritan's Pride was cheaper than Denamarin.

Denamarin is expensive, no question. I recently tried the same thing. I was in the US where SamE is available over the counter (it's not in Canada, I don't think) so I bought some Nature's Bounty SamE at Meijer on a buy one, get one free sale and I picked up a bottle of milk thistle. (BTW, the dog I'm treating for copper associated hepatopathy was on milk thistle for several years as a preventative, which obviously didn't keep him safe.)

So, I started kind of alternating Denamarin one day, and giving SamE / milk thistle the next or maybe a couple of days of one, a couple of days of the other, etc. No major rhyme or reason. The SamE dose was 50 mg less than he'd receive on Denamarin. I came as close as I could.

His blood work last week showed a little more elevation in the liver enzymes, so my vet is concerned with the trial I was doing with the SamE vs the Denamarin and wants me to go back to Denamarin only. She always stresses that the supplement business is not very regulated and always says you can never be sure you're getting the mg they say you are of whatever product it is you're using. I don't know if that's true.
 

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To cut down on some of the costs, I give Marin, rather than Denamarin. Then I give SamE separately, buying the SamE online through Swanson Vitamins.

I think it's a good thing to use Marin (which contains a refined form of one of the active ingredients in milk thistle, rather than regular milk thistle, as many dogs are allergic to it in it's unrefined state. This allergry manifests itself through elevated liver enzymes, the very thing you're giving milk thistle to treat. Marin also contains zinc and vit. E, so you don't need to supplement either of them separately.
 

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Discussion Starter · #16 ·
To cut down on some of the costs, I give Marin, rather than Denamarin. Then I give SamE separately, buying the SamE online through Swanson Vitamins.

I think it's a good thing to use Marin (which contains a refined form of one of the active ingredients in milk thistle, rather than regular milk thistle, as many dogs are allergic to it in it's unrefined state. This allergry manifests itself through elevated liver enzymes, the very thing you're giving milk thistle to treat. Marin also contains zinc and vit. E, so you don't need to supplement either of them separately.
wow...thanks for letting us understand...
 

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wow...thanks for letting us understand...
You don't need zinc unless you are concerned about copper storage. The amount of VitE in Marin still had me supplementing with VitE. Yes, I read all the comparisons between Marin and regular Milk Thistle and I don't believe he has any issues with regular Milk Thistle - we did tha6t for the first year and brought his enzymes down to the top of normal or a little above and the internist called that good. A misdiagnosis of Addisons caused the cortisone to be added which dropped the enzyme levels to the bottom of the normal range. So we eaned him off the pred to 5mg EOD because the side effect was a positive and it keeps him in the normal range - pred, SAMe, Milk thistle and the vitE and Salmon Oil. I switched from Fish Oil to Salmon Oil because the Fish Oil I was getting from Costco contained soy.
 
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Discussion Starter · #18 ·
You don't need zinc unless you are concerned about copper storage. The amount of VitE in Marin still had me supplementing with VitE. Yes, I read all the comparisons between Marin and regular Milk Thistle and I don't believe he has any issues with regular Milk Thistle - we did tha6t for the first year and brought his enzymes down to the top of normal or a little above and the internist called that good. A misdiagnosis of Addisons caused the cortisone to be added which dropped the enzyme levels to the bottom of the normal range. So we eaned him off the pred to 5mg EOD because the side effect was a positive and it keeps him in the normal range - pred, SAMe, Milk thistle and the vitE and Salmon Oil. I switched from Fish Oil to Salmon Oil because the Fish Oil I was getting from Costco contained soy.
That is very good results.. so i quess it is only some that should be concerned with allergys.. you are doing very well with these results.. i can only hope now that her readings come down.. i will get the report of past blood work on monday.. i forgot today was sat.. is soy a problem.. i will switch to salmon as well.. what about adding salmon to diet too.. from can.. is that okay.. and tuna??
 

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I gave SAMe and Marin until my dog refused the Marin and it meant shoving it down her throat every day. I went back to large dog Denamarin and found it to be comparable in price to purchasing the two other products and easier to dose. In addition to the Denamarin I give fish oil, vitamin B6, vitamin E, zinc carnosine and thisilyn with Optagest as a top dressing digestive aid. So far her liver enzymes have remained well within normal range.

If you are not doing the biopsy, the ultrasound may help show liver condition, size and any irregularities and is less costly than the biopsy. It is something you must decide for your particular situation. Good luck!
 

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Discussion Starter · #20 ·
I gave SAMe and Marin until my dog refused the Marin and it meant shoving it down her throat every day. I went back to large dog Denamarin and found it to be comparable in price to purchasing the two other products and easier to dose. In addition to the Denamarin I give fish oil, vitamin B6, vitamin E, zinc carnosine and thisilyn with Optagest as a top dressing digestive aid. So far her liver enzymes have remained well within normal range.

If you are not doing the biopsy, the ultrasound may help show liver condition, size and any irregularities and is less costly than the biopsy. It is something you must decide for your particular situation. Good luck!
thats wonderful that your dog is in the normal liver enzyme range.. good job!!! i hope i can accomplish this ... do you give these vitamins in a multiply vitamin...excluding the fish oil.. i give her fish oil caps two a day.. she loves them.. can you suggest a good vitamin chewable supplement.. if the ultra sound shows any of the different things you mentioned that could be wrong with the liver would her treatment be any different then i am doing now.. this is really the question i had when i posted this thread.. is there different treatments to an ailing liver.. or no matter what is wrong with liver is this the standard treatment..??? thanks for info..
 
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