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