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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 25639
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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Matt, My mom has a pit who is almost 13 years old. She was

Customer Question

Hi Dr. Matt,
JA: I'm sure Dr. Matt feels you are doing your best. What is the matter with Dr. Matt?
Customer: My mom has a pit bull who is almost 13 years old. She was put on rimadyl for 13 days and now has elevated liver values. We are giving her milk thistle and denamarin. What are the chances of the liver values going back to normal like they were before rimadyl was given? How long should this take to see improvements? Also she has pain in her leg. How safe is Tramadol 50 mg to give her with elevated liver counts? ***@******.***. Thanks
JA: Have you looked to see if there is a wound on their foot?
Customer: No wound
JA: Is there anything else the veterinarian should be aware of about Dr. Matt?
Customer: No that's it
Submitted: 3 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 3 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 3 months ago.

There's every reason to believe that her liver enzymes will return to normal (if they weren't elevated prior to Rimadyl adminstration) because we don't believe that the liver is irreversibly damaged by that drug; instead, it's postulated that an immunological reaction occurs on hepatocytes (liver parenchymal cells) secondary to the formation of certain metabolites of Rimadyl. A blood test called serum bile acids should be considered in addition to liver enzyme assessment. Serum bile acids assesses liver function. Liver enzyme values don't tell us how well the liver is functioning. The time for return to normal liver enzyme values is variable but I would expect progressive liver enzyme value decreases when assessed at 1, 3, and 6 month intervals.

Elevated liver enzymes don't represent a contraindication for tramadol administration. Impaired liver function, however, might necessitate a dosage alteration because the liver metabolizes this drug (to O-desmethyltramadol). 90% of this narcotic is excreted through the kidneys. Please respond with further questions or concerns if you wish.

Customer: replied 3 months ago.
Here are her numbers as of 11/18/16:
BUN 51
PHOS 6.9
ALT 480
ALKT 364
K 6.1With these numbers do you think it would be ok to give her Tramadol 50 mg to help her with the pain she is in currently without doing further damage to the liver? That's my mom's main concern.
Expert:  Dr. Michael Salkin replied 3 months ago.

Can you upload a copy of all of of her test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

The elevated BUN needs to be evaluated along with the creatinine and SDMA and the results in a complete urinalysis. If the creatinine and SDMA are elevated indicating that the kidneys might not be able to clear tramadol efficiently and because both the ALT and ALKT are significantly elevated and could indicate hepatic insufficiency, care must be taken when administering tramadol. It's likely to be safe but I would dose it at its lowest recommended dose of 2 mg/lb of body weight thrice daily. Please continue our conversation if you wish.

Customer: replied 3 months ago.
Thanks, ***** *****'t have a copy of her labs. I just called the vet to get these numbers. She's about 55 lbs. I'm thinking maybe 1 pill a day for the pain might be ok? would you think it would be?
Expert:  Dr. Michael Salkin replied 3 months ago.

It might be enough. In general, the lowest effective dose is the correct dose. I'll watch for your next post. I can be more informative once I see all of her test results.

Customer: replied 3 months ago.
Thank you!
Expert:  Dr. Michael Salkin replied 3 months ago.

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.