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My 10 year old 18 lbs female dog has been diagnosed with…

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My 10 year old...

My 10 year old 18 lbs female dog has been diagnosed with liver disease. Elevate liver enzymes as well as lymphocytes. Biopsy ruled out cancer or tumors. was put on Atopica treating as an auto immune disease. It helped a lot for the 1st few weeks, enzymes and lymphocytes going down in the right direction. unfortunately she became really lethargic and her blood panel revealed her bilirubin had risen 4 x normal so at 4.0. She is not eating and continues to be lethargic. Vet put her on metronidazole yesterday. Still lethargic and not eating. Any thing you can think of we aren't doing. She has been on denamarin for a year.

Veterinarian's Assistant: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about the dog?

That's about it.

Submitted: 11 months ago.Category: Dog Veterinary
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Customer reply replied 11 months ago
Oh, is there anything like an antacid or omeprazole that would improve her appetite??
Answered in 55 minutes by:
9/15/2017
Dog Veterinarian: Scott Perry, Dog Veterinarian replied 11 months ago
Scott Perry
Scott Perry, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 3,583
Experience: DVM
Verified
Hello. My name is***** and I am a veterinarian that can answer your question. I understand your dog has liver disease, but despite treatment, the bilirubin is climbing and she is lethargic. Otherwise, there is no vomiting or diarrhea. She is being treated with Atopica, metronidazole, and Denamarin. I have a couple follow up questions to help you with treatment of this condition. First, did the veterinarian have a histopathology performed on the biopsies - if so, what was the diagnosis? Idiopathic hepatitis is a somewhat common diagnosis of liver disease in dogs, but a culture of the sample should ideally be performed to make sure there is no infection and a copper/lead test to measure if there is a metal accumulation. Assuming there is no infection and metals are within normal limits, the treatment for idiopathic hepatitis includes liver protectants like Denamarin, a medication to move gall bladder fluid (i.e. Ursodiol), anti-nausea medication, and pain medication as needed. There is limited evidence that this form of hepatitis is an autoimmune disease, so Atopica is more experimental in its use. What is more highly recommended is to prevent fibrosis (i.e. scarring) in the liver to help recovery. A steroid is better for this purpose. Another medication called Colchicine can help prevent fibrosis. Cerenia is a prescription anti-nausea and is one of the better options available. You could use human Pepcid as an over-the-counter option, but it's affect is weaker comparatively. A lower protein food is also recommended, which is really only achievable with a prescription brand. You will want to add a little more protein than what comes in the prescription, so 1 tablespoon of cottage cheese to each feeding is recommended. Pain medications can be used as needed, but Cerenia offers that as well.
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Dog Veterinarian: Scott Perry, Dog Veterinarian replied 11 months ago
Please let me know if you have any other questions. I am here to help. If you have no other questions, I would appreciate a positive review. You may select up to 5 stars for your rating. This helps connect Experts with other customers, so your input is highly appreciated. Thank you.
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Dog Veterinarian: Scott Perry, Dog Veterinarian replied 11 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Scott Perry
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