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Liver issues-Shiela

 
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grannydi



Joined: 13 Jun 2006
Posts: 21
Location: Fountain hills, AZ

PostPosted: Sun Jul 02, 2006 3:46 am    Post subject: Liver issues-Shiela Reply with quote

Hi Shiela,

My little guy is having some slight elevations in his liver numbers. They aren't dangerously high but on the high end of normal to slightly above that. My vet thinks the numbers are elevated due to a reaction to Rimadyl that he was taking just before we put him back on fluconazole, and that they are trending downwards. But EEK I am a little paranoid because we removed one toxin (the rimadyl) and replaced it with another (fluconazole-at a pretty high dose).

I don't want to just ignore the issue and hope she's right about the rimadyl and that they're trending downwards, because she's only guessing too. His numbers were good a few weeks ago, but then he had a horrible reaction to rimadyl (he became extremely lethargic, stumbled and wobbled when he walked, couldn't get up by himself, and had bloody diaharrea) and those symptoms all reversed themselves within 24 hours after stopping the rimadyl. Based on those reactions, she's presuming that his liver took a bit of a hit too, but who knows?

At any rate, I'm repeating his bloodwork every two weeks for now to keep a close check on it, (also reduced his fluconazole dose a little for now, since he's on a high enough dose to play with it a little) but am wondering if there's anything else I can do to boost his liver function. I am giving him milk thistle now, at 1/4 the adult dose, and I believe you said I could double that, but is it really beneficial or just overkill? It was suggested by someone working at the healthfood store that I add SAMe, but she didn't seem all that knowledgeable, so here I am back to our herbal expert for your advice. What do you think about adding the SAMe? Increasing the milk thistle? Do you have any other recommendations? Thanks in advance. My vet won't even touch the issue of supplements. She's not against them, but says she doesn't know enough to make recommendations either.

Remember, he's only 12 pounds. (Well, 13 pounds now. LOL He's gained a little from all that yummy chicken stew I've been feeding him to get him eating again.)

Diana
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Sheila



Joined: 29 Dec 2004
Posts: 240
Location: Reno, NV

PostPosted: Sun Jul 02, 2006 5:03 pm    Post subject: Reply with quote

Hi Diana. You know Rimadyl is horrible stuff. I would like to vote for your vet being correct that it was the Rimadyl and the trend is downwards. On the cautionary note I would add NAC. Yes, SamE is also a good supplement for the liver, but NAC is also for detox and respiratory. Here is a link you might find of interest:
http://www.wellvet.com/nac.html

As long as his numbers are just above norm and you will test in another 2 weeks, don't go crazy! You did the right thing by lowering his fluc, double his milk thistle for 5 days and get some NAC. The WellVet capsule is 600 mg and they are recommending 1/4 cap opened into food for under 20 lbs. That would be 150mg once per day (same for a kitty).

I will be interested to know how his numbers work out. Did you find a new vet? Yes, I read pcvf. If you found one you like in AZ you might post their name on this forum for any who come by here too. Let us know what you decide to do.
Sheila
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grannydi



Joined: 13 Jun 2006
Posts: 21
Location: Fountain hills, AZ

PostPosted: Sun Jul 02, 2006 6:56 pm    Post subject: Reply with quote

Shiela,

Yep, I'm convinced about the Rimadyl now. He'd taken it once before though, with no problem, so I didn't expect such a terrible reaction. What it did to him this time around was pretty awful, and none of my dogs will ever take it again. That's for sure.

At this point, I am still with the same vet. I had made an appointment with a different vet for a 2nd opinion, and when they called my vet to get Scooby's records faxed over, she called me right away. We talked for quite some time, and the result was that she was able to get Scooby a same day appointment with Dr. Razor, an internal medicine specialist, at ARECA. ARECA is a top notch specialty referral clinic here (a MAYO clinic for pets) and about the best that this area has to offer, so I couldn't not jump on it. Scooby had a full workup there, and evaluations with internal medicine, neurology and orthopedic. Basically I wanted them to either confirm or rule out the VF diagnosis, but unfortunately they couldn't do either.

The only thing pointing to a relapse is that he got that 1:4 titer early in June. They said that the increase was pretty insignificant in that there is room for technician error in the testing procedure because it is speculative based on a color change. The antibodies could have been left over from his initial infection and who knows if the reading was really 1:2 or 1:4? On the other hand, to ignore it would be to take a huge gamble with Scooby's life. They couldn't find anything else pointing to a relapse. No elevations in WBC's or globulins, they couldn't isolate a lesion through exray, and nothing remarkable showed up neurologically. He's not showing any signs...no cough, limp, fever, etc.

I live in a very small town with few choices in veterinary care, and the vet that I'm currently using is the best our little town has to offer. (Which isn't saying a whole lot) but the next closest vet is a good 25 mile drive. Not a big deal to drive that far for a good vet, but on the other hand, in an emergency it could be life threatening. So I am trying to work with her, and as long as she is willing to let the internal medicine doctor diirect the treatment, it makes sense to stick with her and try to make it work.

We're stuck treating him now, at least for a period of time, simply because I opted to start treating him as soon as he got that 1:4 titer. If he hadn't been on fluconazole for three weeks, we could have repeated the titer with the same lab that intially did his titers years ago, and they may have read it as the same 1:2. Now that he's been on fluconazole, a retest wouldn't have any impact because the titer could have dropped from the treatment. At any rate, I would rather risk treating him than risk not treating him, if that makes sense.

Yes, the liver numbers are just slightly elevated. Like a dummy, I left the test results on my desk at work friday or I could tell you exactly what they were, but one was at the high end of normal, and the other was slightly above the high end of normal. So even though they aren't that high, they are still significantly increased from before he started on the rimadyl and the fluconazole. I'm not panicking, but I don't want to ignore it and hope things improve on their own either. My poor little guy already had the crummy luck of the draw getting Valley Fever, and now possibly having it again. I just want to do whatever I can to get him through the tough times. : )

Thanks for the advice. I wonder if the NAC is something I could find locally, or will I have to order it? I hate to have to order and wait. : ) And I will let you know what happens with the bloodwork. I am having it rechecked on the 12th. Send some white light our way that the cause turns out to be the Rimadyl. That would sure make these next months easier since he's stuck on the fluconazole for a while.

Diana
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Sheila



Joined: 29 Dec 2004
Posts: 240
Location: Reno, NV

PostPosted: Sun Jul 02, 2006 8:40 pm    Post subject: Reply with quote

Diana I have a couple of comments. First, my Motley, who never had any meds, has had a 1:4 titer for the past 1 1/2 years. He has no symptoms (anymore) and receives no meds. But he has a 1:4 titer. I understand he may have this titer forever, as an indication of past infection. 1:4 is about as gray an area as you can get. I don't see 1:2 as much different. I know about dogs that have died with negative titers and dogs with higher titers, like 1:8 that do just fine. It's a controversial area with nothing definitive really.

In the beginning I recall you started the treatment because (of the titers) and the limp. The limp went away, yes? No real dx, no known cause. Crummy Rimadyl may have helped it even with the reaction. So what I'm getting at is the reason he is on a (high?) dose of fluc is his 1:4 titer? I do understand your fear of not treating as opposed to treating. Do you think the tests will be different so soon, on the 12th? Would you keep him on meds forever with a 1:4 titer?

When I put Jennie on keto last year we also were very aggressive at the beginning. Her titers were 1:128 so you can understand why. But within the first 30 days her liver enzymes had elevated to where Scoob's are now. I cut her keto dose in half and doubled her milk thistle and 30 days later her numbers were perfect. I stayed at the lower dose and went back to once per day on the milk thistle and all has been fine and her numbers continually go down, last at 1:8. But I will face the same problem with the meds. She's doing so well. I will test them both in a week and see. I will continue treating her at 1:4, but then Motley was never treated and has been fine at 1:4. It's a hard decision and you have go with your gut.

You should be able to get NAC at any good health food store. The lady who told you about SamE should have it. I understand your problem with the distance. I live outside of the city limits here and my vf vet is a 45 minute drive. I have to use closer ones for my regular emergencies! Why is it so hard to find a good one? Just like regular doctors. I have heard mention of ARECA before.

Healing white light coming your way.
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grannydi



Joined: 13 Jun 2006
Posts: 21
Location: Fountain hills, AZ

PostPosted: Sun Jul 02, 2006 9:56 pm    Post subject: Reply with quote

Shiela,

I understand all about the titers. I have a dog that nearly died of VF with a negative titer. After a year of treatment, he finally had his first sort of positive titer of 1:2, and that's the highest it got. Until he popped that 1:4 in June.

He was on such aggressive treatment for three reasons. First, because what we now believe was a rimadyl reaction was first thought to be VF progression. From the time the blood was drawn for the titer (and also the day he started the rimadyl) he declined very rapidly Neither my vet nor I suspected the rimadyl because he'd been on it before without any negative reaction. I first took him to the vet for a very slight limp, and he had leaped off the patio and had a hard landing the day before, so I figured he was limping from that.

He had the blood drawn on a friday, and I thought the vet was nuts for wanting to run the titer. He seemed a little sore, but he was still jumping around, still eating, still happy. By monday when we got the results back, he had declined so much that I was not at all surprised he tested positive. The decline continued all week, and by thursday night when I gave him that last rimadyl, he could no longer get himself to a standing position. I only had a week's rimadyl anyway, so I was out of it and I still didn't suspect the rimadyl until friday night, 24 hours after his last dose. The change in him was so remarkable that I couldn't believe it. He was eating, begging for treats, jumping up on the furniture again, and chasing birds in the backyard. A complete 180 in 24 hours. He continued to improve by leaps and bounds over the weekend and by monday he was pretty much back to his normal baseline.

The vets, of course, are hesitant to blame the rimadyl, because it is their miracle drug. @@ They say, there is the possibility that it WAS progression from the VF, and the fluconazole suddenly and miraculously kicked in (in that same 24 hour period that he also... concidentally... stopped taking the rimadyl) and is responsible for him suddenly being able to walk again. Hmmm....that would be quite the coincidence. The vet went as far as to say that she had never seen or heard of a reaction like that to rimadyl, but there are pages and pages on the internet that describe those exact same symptoms, with the wobbling, stumbling, unable to stand, bloody diaharrea, anorexia etc etc etc. All rimadyl reactions. And I know you can't believe everything you read on the internet but on the other hand there are so many stories with very similar reactions and often the reactions were apparent after only a few doses of the rimadyl. It would be hard for me to believe that there is no truth at all to it. Now the vet has pretty much changed her stance anyway, and is in agreement that he likely did react to the rimadyl. (I think she did some research.)

The second reason for the aggressive treatment is his past history of not titering with his initial infection. His titer then was no indication of the severity of disease in his body, so it might not be now.

And third, after all the testing at ARECA, the vets there were not able to isolate any sign of fungus. Clear lungs, no lesions. If we go on the premise that he does have VF, and I guess that's what we're doing because we're treating him, and because a week ago he couldn't walk (and we don't believe in coincidence so it couldn't have been the rimadyl) then where's the fungus? Could it be in his CNS? If so, well then the aggressive treatment is the correct protocol. And if not, better safe than sorry. (Can you tell I'm frustrated?)

Truthfully it's hard for me to believe he's relapsed, and not only both of my vets but also Dr. Shubitz in an email agrees that the chances of relapse after so long are pretty slim. He looks and acts like the picture of health. In the evaluation summary I got in the mail from ARECA, Dr Razor wrote a little note on the side that said, "Scooby looks happy, healthy and full of energy. I would be very surprised if he has in fact relapsed." Still, she recommends continuing the treatment. So what do you do?

Oh, and it's the bloodwork for the liver function that I'm repeating on the 12th. There's not much point in doing another titer for at least a few more months. Both vets are in agreement that even if the titer dropped back to 1:2, they couldn't say for sure whether it was 1:2 all along, or if it dropped because of the fluconazole. Dr. Razor wants him on the meds for a minimum of 4 months, no matter what. So I might as well save that $80 since it wouldn't change anything.

Diana
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Sheila



Joined: 29 Dec 2004
Posts: 240
Location: Reno, NV

PostPosted: Mon Jul 03, 2006 7:22 am    Post subject: Reply with quote

Good morning Diana and Scoobster! I have good feelings about this whole thing today. OK. 4 months of treatment and regular liver function tests sounds like a good protocol for now. If his liver was in trouble you would see lethargy. I don't think you will. I also feel that he will handle the meds just fine. Sometimes these azoles do kick in right away. When I finally put Jennie on the keto the change in her energy was noticeable almost immediately. Yes, very frustrating, not really knowing.

Rimadyl horror stories are true, just like NSAIDS horror stories for people. Some do tolerate the stuff and it's all they have. I have used it also, unhappily and very briefly. But I have used it. All things considered, with his decline I think you have chosen the right thing for now. I would be scared also if I saw Jennie limping again. She went through that so much, we did so many xrays, we never found anything. Which also doesn't necessarily mean anything. Oh, so frustrating.

Will you start him on NAC? I like that stuff, use it myself at 1200 mg per day. Bathe him in the light, give him a little massage down his spine and keep us posted. Smile
Sheila
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