# Kelly's liver biopsy report



## arycrest (Feb 28, 2006)

First the good news, he DOESN'T have cancer which is a big relief.








But, he definitely has a problem though they don't feel it's life threatening. I'm gong to copy the DIAGNOSIS and COMMENTS parts of the report. I may have made typos since there are so many technical words I wouldn't recognize as being right/wrong!

*"DIAGNOSIS: Liver biopsies: Cytoplasmic swelling and vacuolar change in hepatocytes, diffuse, moderate to marked, with multifocal overt vacuolar degeneration, and multiple small lipogranulomes comprised by hemosiderin laden macrophages/Kupffer cells. Inflamination is not a prominent feature. Hepatocytes are swollen so that sinusoids are collapsed. They have fine to medium granular eosinophilic foamy cytoplasm with multifocal overt vacuolar degeneration. Fibrosis is not a feature.

COMMENT: The most common cause of vacuolar degeneration of canine hepatocytes is hypercortisolism, either endogenous or exogenous. Alkaline phosphate is usually markedly elevated in that case. Some other drugs (for example, Rimadyl, phenobarbital) and some environmental hepatic toxins cause a similar but often less dramatic change." *

He's having a test for Cushings Disease Monday - BUT his bloodwork does not give any indications of a problem with his adrenal glands.

I'm going to have to check out what alkaline phosphate can include and then try to remember if he's had any contact with them - the vet said exposure to toxins is a real possibility. He may have had Rimadyl after he had the bloat surgery in September 2005, but I don't know if he had enough to do serious liver damage. He's never had phenobarbital. I'll also have to check out the environmental hepatic toxins.

He's currently taking: Ursodiol, Denamarin and just finished a course of Tetracycline. He's had some Tramado AFTER the biopsy. He didn't start taking the Ursodiol and Denamarin until he flunked his recent bloodwork with high ALT values. He's been off and on Tetracycline for about 19 months.

I haven't had any insect spray in the house in over 7 years. I get my yard sprayed maybe once a year or longer for ticks and fleas with malathion and an IGR. The last time I had it sprayed was probably in the Spring of 2006.

Any thoughts, suggestions, ideas will be greatly appreciated.









THANKS!!!


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## JeanKBBMMMAAN (May 11, 2005)

Though I have no idea what the rest of it means! 

My vet said they had a dog from there that was biopsied and the bloodwork was not showing anything Cushing's like but the biopsy results did. He DID have Cushing's but it was good because it was like they caught it really early. I think that's how it went-we talk all this liver stuff and I try to keep it straight! SO, good luck with the Cushing's test!


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## arycrest (Feb 28, 2006)

I didn't talk to my regular vet since she's on vacation, but that's what the vet on duty said yesterday - that it could be Cushings Disease and if it is, it was caught early before it affected bloodwork results. She said that would be good!!!








I know, when I was typing the report, it was like a foreign language to me.

I guess it's good that my old guys get physicals every six months, to pick up stuff like this. It's upsetting, but I'm sure I'd be more upset if Kel got super sick with some liver problem.


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## Elaine (Sep 10, 2006)

I don't remember if you are a kibble or a raw feeder, but after finding out what is really wrong with your dog, I would suggest switching to a liver friendly home prepared diet. It can really help the liver along with whatever treatment your vet suggests.


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## arycrest (Feb 28, 2006)

Thanks for the suggestion Elaine, I never thought about his liver being affected by his diet.

With Kelly, I'm between the devil and the deep. Kelly has SIBO and has been eating Eukanuba Low Residue for the past 19 months or so. I may be lucky and be able to wean him onto another diet. He's been on a program to help him gain weight. He started off with a McD's double cheeseburger without the bun for lunch and did pretty good on it until he was diagnosed with a gall bladder problem. Now he has 1/2 cup of yogurt or cottage cheese for lunch and so far, no problems.

I'll definitely talk to his vet once we know what's going on with him and see if we can come up with a diet that can tightrope between the liver and SIBO problems.


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## Elaine (Sep 10, 2006)

If the prescription diets are working for you, great, don't change anything, but when you start to have more than one medical problem, they are kind of limiting in scope. Home prepared diets are much more flexible and can help in situations like yours, but can be time consuming and a pain in the butt. If you are considering it, I would highly suggest you pay for a consult with Monica who will work closely with you, your vet, and your dog, to get the best results possible. She is well worth the money.


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## Jen Williams (Aug 14, 2007)

> Originally Posted By: Arycrest
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IME, EVERYTHING is affected by diet. If it were my dog, I'd go underground (meaning not tell the vet unless they're gonna be supportive) and feed raw, carefully. All these issues you're mentioning are essentially auto-immune problems (esp.Cushing's) and can be all but eliminated with the proper diet. I wouldn't feed any dog with problems any grain whatsoever. It's the liver that gets the great job of trying to detox the body...and you don't want to know what's in dog food. I would get that dog off Eukanuba immediately, and try raw. If you're scared, cook it for a while. Whatever you choose, grain-laden commercial dog food is NOT helping this poor dog.


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## arycrest (Feb 28, 2006)

Thanks for the suggestion!!!









I never go "underground" with my vet, I sometimes do things she might not agree with, but she always knows about it. I want her to have all the pieces of the puzzle when dealing with any of the Hooligan's problems, IMHO, it's in their best interest to have all the cards on the table. 

I fed a frozen, complete raw diet around 2002 & 03 (my vet didn't have any problem with it). It was costing me over $500 a month and I stopped feeding it because of the cost after JR and Too went to the Bridge. I'm too ignorant to feed them a raw diet because I don't feel qualified to ensure they're receiving all the proper nutrients - that's why I fed the complete raw diet. The Hooligans loved it.


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## 3K9Mom (Jun 12, 2006)

Gayle, I had a dog with nearly the identical biopsy results. Everything I do is organic in my yard. I rarely use chemicals in my house, other than the occasional household bleach in laundry. My closest neighbor also gardens organically. There's almost no way my dog could have been repeatedly exposed to toxins or heavy metals in the last however many years.

We ran the cushings test on Grover not once, not twice but three times over a period of about five or so years. Her liver was what the radiologist and internist called "a classic cushings liver." The first test came back borderline/inconclusive. The second, borderline. The third about a year ago finally came back negative. Grovie had an extremely high alkaline phosphate level for the last 1/3 of her life. 

The treatment for cushings is dangerous. I balked at treating her with it. We started down this path initially because she seemed to feel bad, was lethargic and something was clearly wrong. I'm not sure how, but it seemed to get better on its own. 

Grover was a stray for about 6 months when she was 1-1 1/2 years old. I don't know what happened to her during that time. Perhaps this played a role? I joked that she had liver disease because she was a beer drinker (she used to love to sneak a few sips from my old bf's beers when he wasn't looking.) I joked because it kept me from crying. 

The thing is, it IS possible to live with a high Alkaline phosphate level. I recall that you said that Kelly seemed to be feeling fine. I think this is one of those cases where vets want to fix what's wrong when they're not even sure what IS wrong. I spent a lot of time "discussing" (ok, arguing) with my vet what WAS wrong with Grover? And if we weren't sure, why was he suggesting that we treat her with a strong medicine just because senior dogs 'tend to' get Cushings disease? 

We started down this path in 11/2001. Grovie passed away in 12/2006...her heart gave out at age 12. During that time, we evaluated very carefully every single medicine she needed -- did she need it badly enough to put extra work on her liver? (And kidneys. The two are so interrelated). Heart medicine, yes. Other medicines, no. Or perhaps yes, but at half strength. It was an excruciating balancing act. 

My advice? Follow your instincts. All I had was my gut that told me that a high liver enzyme didn't mean what I was told it meant. Of course, there have been times when I have been certain that my dogs have been sicker than their blood tests have indicated. Like I tell new dog owners -- we know our dogs better than anyone else. 

I wish I had really concrete advice for you. But maybe this helps in some tiny way? 

Bless you and your seniors.


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## LisaT (Feb 7, 2005)

That was a great post Lori.

Arycrest, somewhere I have the chapter from Strombeck's book on liver disease as a Word file. I don't know if you know much about Strombeck -- he's retired now, but was one of the foremost K9 GI doctors. I forgot all about it until I read the post above. If you ever want it, pm me your email address and I will try to hunt it down -- I have no idea which computer it's on (home, work or laptop!!!).....I really need to get organized.


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## arycrest (Feb 28, 2006)

Thanks Lori,

I'm sure I'll be having quesions for you from time to time.

Just curious, but what is the treatment for Cushing's Disease. I guess I'm more familiar with Addison's Disease.

Kelly's 11-1/2 and the elevated ALT level that started all this investigative testing first showed up during his physical in June.


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## arycrest (Feb 28, 2006)

LisaT - please check your PM!!!


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## JeanKBBMMMAAN (May 11, 2005)

http://www.kateconnick.com/library/cushingsdisease.html 
Don't know who Kate Connick is but there are a lot of links to check out.


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## 3K9Mom (Jun 12, 2006)

I tossed much of Grovie's medical records after died, at least all of the Cushings stuff. But the medicine that the vet wanted to put her on was Lysodren. (This is the same medicine that humans with Cushings take.) The problem with this medicine is that it has a low therapeutic/toxicity level. One day, it's therapeutic, limiting the ACTH production as it should be. The next, there can be too much in the dog's system, so it starts to be toxic and the dog can crash. 

The first step is to do an ACTH test. If it comes back with clear and convincing results of Cushings, then you may want to treat for a while. But I would retest in a few months to see if there's a way I can back off the medicine. I had a situation where the results weren't clear and convincing, so I didn't even go the medicine route. 

Interestingly, the tumors CAN be seen via MRI. If you have doubts, that is one option if you don't trust the ACTH stim test. Since Grovie's initial symptoms went away and she never developed other symptoms (except the pot belly. She had a cute little rounded tummy, not from being overweight either), I saw no reason to MRI her. 

PM me at any time.


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## arycrest (Feb 28, 2006)

Thanks Lori. 

I'll post the results of his test and let you all know if they're going to pursue any treatment. When I spoke to the vet Friday, I was under the impression that they're not expecting him to have Cushings, they're really trying to eliminate it since none of his bloodwork supports a diagnosis of Cushings. Hopefully I won't have to make any decisions about using that medication.








What I know about liver problems can be put on the head of a pin with lots of room left over.


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## 3K9Mom (Jun 12, 2006)

I'm now a teeny-tiny mini expert on everything liver, kidneys, heart and lungs. Didn't know about ANY of this until Grovie had problems with each of these organs. Then I crammed til my head nearly exploded. 

We learn as we go, eh? 

And fortunately, we have friends along the way to help us out. (My bf is a surgeon. She'd call her cardiologist friend back east when I had cardiopulmonary questions she didn't know the answers to...) 

Yep, we help each other out...


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## arycrest (Feb 28, 2006)

I got the results of Kelly's Cushing's Disease test back and it is NEGATIVE!!!!








Now, what's the next step??? Do I pursue it further or just play it by ear - if his ALT values don't go back up (low 300's), his other values remain the same and he seems to be feeling good, do I just wait and see??? Gosh, I like everything in black/white - I hate knowing he has some type of problem but not knowing what it is.

3K9Mom - Thanks so much for sharing Grover's experiences with me. I'm so ignorant about liver problems I don't even have any instincts.


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## LisaT (Feb 7, 2005)

That's great news that there is no Cushing's.

As for your next step, I guess I would have a few questions -- 

Are you pretty confident that he isn't fighting an infection....and of course I'm always thinking tick disease.....

If he is maintaining, I think that's a major accomplishment and I would suspect there are a number of dog folks that would give anything to be able to say that.

If you're a tinkerer, you may end up playing with your supplements or new ones after awhile,

For now, my guess is that you might hold until your instincts tell you to move in one direction or another. If you get that gut instinct, follow it. I guess you'll have to decide on how often you want to monitor the blood levels too.

I understand having to live with "not knowing". Indy, with her "immune complex disease' from vaccine damage has a fancy name, but that's about it. No real disease to fight, and it just makes the water murky when other problems do arise. You sorta have to go through an internal process to be okay to live with that. Much like Jean and Kramer too, I suspect.


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## JeanKBBMMMAAN (May 11, 2005)

Wow, it was like reading my own post! I wish you had something in black and white too. 

I wonder if the liver has a setpoint type thing where it gets used to a certain elevation that might not be healthy in another liver, but is what has been re-set in that dog as manageable. Probably not, but I am going to go with that idea. 

You would think they would have more effective, statin like drugs for the liver. What do we do with people with this problem? 

I like Lisa's advice.


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## 3K9Mom (Jun 12, 2006)

Yep. What Lisa and Jean said. And good job Kelly for not having nasty old Cushings. Give him a kiss on the nose for me! 

With the liver, I'm not inclined to tinker too much. (and I LOVE to tinker. I hate doing nothing) The problem with the liver is that everything we give goes through the liver (well, except the few water soluble vitamins). Some supplements like milk thistle are supposed to help detoxify the liver. But how effective are they versus the workload that they put on this critical organ? I don't know. And while I trust holistics a fair amount and I love to mess with them on my own body, when it comes to my kids, I tend to get pretty conservative 1. if I think there's any chance they can do harm or 2. unless it's a last-ditch effort. 

So I can't advise you on supplements and such because for me, years ago, a friend gave me some brilliant advice that I think applies in situations like this: Don't do something, Just stand there!

Jean, we don't do much for humans with liver disease. We tell them to eat healthy, drink fluids, stay away from drugs, booze and exposure to certain illness (Hepatitis A, B, C) , exercise, and we keep them as comfortable as we can with pain medicine if it gets too bad. Oh, and transplants. 

I trust that Kelly is eating well, maintaining a regular exercise regime, not running with the wrong crowd...and well, as far as we know, his liver may have quite a few good years left in it, more than he may need it, in fact. 

Grover's heart gave out after 12 good years. When my internist ran all sorts of tests just two days before she died, including ultrasounds and blood tests, her liver enzymes were almost exactly where they were a few years earlier. (There was no evidence of serious heart trouble at that time either.) I don't know what any of it means, except that organs like the liver and heart are hard to understand. If Kelly's feeling good, I think I would ignore that screaming voice inside me that says DO SOMETHING! Instead I would wait and see. 

The poet John Milton said: "They serve who also stand and wait." I try to remember that sometimes the best way I can serve my dogs' health best is by standing by and waiting. 

Even if it kills me!


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## JeanKBBMMMAAN (May 11, 2005)

bumping for Dave


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