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Jess K
Jess K, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 1290
Experience:  Licensed Veterinarian
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My vet just called this morning and says my daschounds ALT

Customer Question

My vet just called this morning and says my daschounds ALT liver enzymes have gone from 535 to 741 in 3 months. She is thinking cushings I am a little concerned because my dog has none of the symtoms. She gets extremely nervous when I take her to the vet. Could this be the reason her cortisol levls are so high??
Submitted: 9 months ago.
Category: Dog Veterinary
Expert:  Jess K replied 9 months ago.

Hello, this is Dr. Jess. I am sorry to hear about your dog. Was it definitely the ALT that is elevated, and not the ALK Phos? Does she have other values that are elevated on her bloodwork?

Cushings disease is one of the diseases we worry about with elevated liver values, but we also worry about pri***** *****ver disease as well.

Stress from a vet visit wouldn't be enough to cause changes in her liver values like this. Changes in the liver values would be the result of chronic elevated cortisol levels, not just a temporary elevation due to a stressful day every so often.

Customer: replied 9 months ago.
My vet told me it was only the ALT level that was high. Could her liver be failing and she not have any other symptoms?
Expert:  Jess K replied 9 months ago.

There can be damage going on to the liver for some time before a pet begins acting ill. Even a level of 535 would be concerning to me (unless they are using a different reference range, normal is usually only up to 70 or so), so the fact that it was so high and is continuing to climb is concerning. I would be concerned about a chronic hepatitis or a tumor. I would probably recommend an x-ray followed by an ultrasound. HAve they had her on any liver supplements or anything yet?

Customer: replied 9 months ago.
She has been on a liver support medication for about 3 months. I don't want to make the wrong decision with what I decide to do. The vet keeps telling me whatever we do won't prolong her life it will just give her a good quality of life. My dog is 14 years old. She has a great quality of life right now. I did some research on the medicine for cushings and it sounds like the meds are actually worse than the disease. I am just not sure what to do at this point. Any advise would be greatly appreciated.
Expert:  Jess K replied 9 months ago.

Has your vet done any testing for Cushings? Does your dog have increased thirst and urination? Does she have a thin haircoat or a pot-bellied appearance?

Customer: replied 9 months ago.
She has not done any testing yet. I am weighing my options right now. Frankie has none of the symptoms you just asked about. She is on metacam for arthritis. Could this raise her liver enzyme level?
Expert:  Jess K replied 9 months ago.

Metacam and any other NSAID can cause liver changes- has she been on this for a long time? Did your vet talk about stopping it and trying a different medication?

Customer: replied 9 months ago.
She has been on it for about 3 years. We haven't talked about taking her off of it yet.
Expert:  Jess K replied 9 months ago.

Hmmm... I would talk to your vet about whether or not they think the metacam would be a concern. If it was my patient, I would be concerned about the NSAID and would consider stopping it and trying a different drug such as Tramadol as well as a joint supplement instead. I would also ask your vet about doing a urine cortisol creatinine ratio to screen for cushings. This test is less expensive than the ACTH stimulation test that is the confirmatory test for Cushings. The urine test is nice because it is not as pricey, and if it is negative you know your dog doesn't have Cushings. If it is positive it doesn't mean your dog does have Cushings, but it is a possiblity and further testing may be indicated. If the test is negative, then the next step I would recommend would be an ultrasound of the liver.

Expert:  Jess K replied 9 months ago.

Just checking to see if you had any other questions about your dog,or if there was anything I didn't answer?