Caring for a Three Legged Dog or Cat
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My 12 year old chocolate lab, Marley, is scheduled for amputation of her left hind leg on Monday due to a tumor found in her hip. (suspected osteosarcoma) I just got a call from the surgeon who was concerned about elevated liver levels found from her blood work. Alkaline Phosphatase is 1800 and ALT is 450. She does have a history of this - back in May her Alkaline Phosphatase was 291, ALT was 234. She had a liver ultrasound, then biopsy which found some hepatitis - I believe my vet described her liver as somewhat enlarged and an odd shape - biopsy showed some inflammation, but I remember it was not a huge concern. We had her on 10 mg of prednisone 2x a day for about a month (sept), then had to reduce to 5 mg every other day since she was so anxious/not herself/panting, etc. She was on 5 mg every other day oct til 3 weeks ago when we found the tumor. When I explained all of this to the surgeon she said the fact that she was on prednisone would explain the high Alkaline Phosphatase, that it can take a while to come down… she then asked if she's on Rimadyl - I said yes, she has been on 75 mg 2x/day for the past 2 weeks. she said that would cause her ALT to be elevated and to stop giving it to her. I asked if she had any concerns re: surgery on Monday and she said no....
I'm just looking for confirmation of this. I feel like we get different answers from different people - i.e. another surgeon felt her right knee (what will be her remaining hind leg) and said she most likely had a previous ligament injury which healed, but the scar tissue would break apart if we amputate her left leg and blow out her good knee. We saw this surgeon for a 2nd opinion - she did not agree - said both of her knees felt the same and showed on xray that if she had a previous injury she would be able to see *something* relating to an injury which she could not. just a little inflammation (most likely from limping on and off the past few months).
I am so nervous about Monday!! I just can't bear to lose her on the operating table. I know if we don't do the surgery we'll lose her within 2-4 months....
please help me sleep better and ease my worries on this! thanks so much...
Holly, Kevin and Marley
I think you are describing chronic hepatitis which is very common in Labradors. My dog Tazzie has this and she takes milk thistle and vitamin E (Marin) as well as SAM-E (denamarin ) which keeps her ALT and ALKphos normal. Without the drugs her ALT used to run about 334. The biopsy showed inflammation so your vet has her on pred which is okay but I would be very careful using prednisone with Rimadyl, since together they can upset the stomach. Any NSAID like Rimadyl has the potential to damage the liver and Rimadyl is the worst offender (especially in Labs) so you might want to choose another one like Metacam or Deramaxx.
Tazzie's liver flared up post-op despite her meds and her ALT was greater than 2000 and Alkphos greater than 3000 plus she became jaundiced. Turned out that she had a liver infection (Pseudomonas) that was only sensitive to Baytril, not the standard drug Cefazolin that is used for orthopedic surgeries. Once I changed her antibiotic she did great and after 6 weeks of meds her values are normal again. There is also a test you should run before surgery called a bile acids panel that will tell you if the liver is functioning okay. At the minimum I would recheck liver enzymes prior to starting chemo. Carboplatin is very safe for the liver and Tazzie did well with it.
This is a pretty technical disease so you can send me a PM if needed!
Pam and Tazzie
Hi Pam,
Thanks so much for your reply. Yes! My Vet refers to it as hepatitis. Do you think we should have any concerns about her making it through the surgery because of it? I am so nervous about this whole thing I can't even tell you!
She is no longer on prednisone - we stopped it so that we could start on the Rimadyl. (which we are now stopping due to the ALT!) I'm concerned that she will start limping again - assuming it is the combo of Oxycodone and Rimadyl that are keeping her pain free. Also, she had a fever a few weeks ago - 104, my vet said probably due to the cancer. I'm worried about that coming back. (she would pant inside, go out, then shiver... then shiver when she came back in!) I'll call him if it does and get her on something else I guess. I will also call to ask about doing a bile acids panel before the surgery. So you think other than that we should be ok for Monday? Were Tazzie's levels elevated when she went into surgery? How long ago did she have her surgery?
thanks so much for your help!!!
Holly
One more thing... her stomach has been gurgling on and off the past week. Moreso today and she won't eat her breakfast - homemade steak, sausage, chicken, brown rice "stew" my husband has been making for her and she normally chows down... What causes the stomach gurgling? It's very loud...
LASTLY! Marley has had very few bowel movements lately - only every few days.... I checked her stool from last night today and it was black. I remember my vet saying that could mean blood in her stool so I just dropped it off to be tested. I then searched online for Rimadyl side effects. I am horrified! It must be the Rimadyl. (which we have stopped - she was on it for 16 days....) There are so many postings of dogs (looks like it especially effects labs) dying from Rimadyl! how horrible! Is there anything I can do at this point to make sure she's ok?
She also has been "scooching" rubbing her rear end along the ground and having small drips of loose stool and her back end at times seems very sensitive - I go to pet her and her back legs collapse like her bum is bothering her. At one point the other day it seems she was having an issue with her anal glands... again, scooching and that anal gland smell...
I think that all of your dog's symptoms could be due to Rimadyl (I also posted under your Rimadyl topic). Labs do seem to have more issues with this drug so I don't use it on them much since there are other options now, but I know many Labs who have taken it without a single problem.
If the bile acids test is normal that means that your dog's liver is functioning normally no matter how high the ALT is. Tazzie's ALT was about 225 before surgery but rising (I thought it was due to the Deramaxx I was giving her for pain). Her bile acids was only slightly elevated so I proceded with surgery. That was 8/26/08 and now her liver is back to normal even with the chemo. I have checked her enzymes a few times over the past 2 weeks because I have started metronomic chemotherapy plus some holistic stuff and her enzymes and bile acids have remained normal.
Chronic hepatitis can be fatal in its later stages but osteosarcoma is very aggressive and can be fatal in its early stages so I opted for surgery ASAP despite her slightly elevated values. If your dog is feeling okay and is over her GI upset and the bile acids test is not that high then I would procede ASAP!!!!
Pam and Tazzie
My vet said the bile acid test was not necessary....? wasn't sure if I should push it? She seemed to convince me that it would be fine, I can't remember exactly what she said though. I could call again tomorrow and request it again? she said based on her numbers she's fine for surgery. The surgeon said the same thing. so hopefully we're ok?
She did give Famotidine, Sucralfate and Flagyl for her stomach upset. No more gurgling and she's eating fine today. Hopefully we are on the mend.
Thank you so much for your help with this!!! I was telling Marley's acupuncturist about Tazzie today - She was amazed that she's a tripawd at 175 pounds! She was so impressed!
Now I remember... I think she said since her ALT level in early Jan was only 197 the fact that it is 450 is clearly from the Rimadyl. And since she was on prednisone up until 3 weeks ago that accounts for the high Alkaline Phosphatase. so we don't have to both with a bile acid test....? my brain is such mush! my husband was traveling last night and I was so stressed about the Rimadyl issue I could barely sleep last night!
The bile acids test is just another piece of info to tell how your dog's liver is doing. I did it for Tazzie because she is so big and I really wanted to put all of the pieces together before surgery. Her heart enzyme test was also slightly elevated but she was just feeling so good so we went ahead with the surgery and I am so glad that we didn't waste any more time. If both your vet and the surgeon think it is okay then I would procede. You can always check the liver values after surgery and after the Rimadyl is out of her system.
I'm glad that she is feeling better on her stomach meds!
Pam and Tazzie
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