Weird/elevated Alt Levels?

[MalteseLuna]

My 1 year old Maltese got de-sexed roughly 5 months ago and at that time we discovered that she had abnormal ALT levels (they were at about 120) - I got a big scare and the vet wanted to do ultrasounds/biopsy's for a liver shunt - but since she didn't have any symptoms we helt off and instead started doing monthly blood tests to monitor her liver enzymes - they rose to about 140 and then started to fall to 110 (still abnormal). They were steady at 110 and she still seemed fine so we decided to retest at her yearly exam (which is next week). I don't think she has a shunt but rather asymptomatic MVD - which I have read about in some Maltese forums - unfortunately the only un-invasive test for shunt/mvd is only avaliable in America (it's called a Protein C test). If she still has abnormal ALT levels then we will likely have an ultrasound or I will get a bile acids test done (though the vet thinks this is useless )

Anyway when I first got her until about 4 months ago I gave her Heartguard 30 for heartworm protection and I noticed that after having a tablet she would have loose stools and not act normally (i.e. she would be drowsy) so I changed to interceptor - my question is has anyone else had a similar experience with heartguard 30? Is ivermectin dangerous to liver compromised dogs? Could her weird reaction indicate that she does have a liver problem? Could the weird ALT levels be a result of ivermectin? My vet thinks I am over-reacting and said that heartguard was perfectly safe and she had never heard of a dog having a weird reaction to it

Thanks for any advice/tips in advance

Kylie

Edited October 5, 2008 by MalteseLuna

[Rappie]

Running bile acids wouldn't be particularly useful - as a breed, Maltese often return abnormal bile acid results without any detectable liver disease. A normal results rules out a PSS, but an abnormal results does not confirm disease. An ammonia tolerance test may be more useful for investigating a shunt.

[MalteseLuna]

Thanks for the reply Rappie I am aware that bile acid tests often give an abnormal result for Maltese - I will have to see if my vet does ammonia tolerance tests

Do you of an association between bad reactions to ivermectin and liver abnormalities?

[WoofnHoof]

When I was researching liver shunts there was a lot about them being more common in maltese than other breeds, it might be worth just getting an ultrasound done it's probably cheaper than monthly blood tests. From memory the blood tests I had to do were about $150 and the ultrasound was $500.

Never heard of a link between ivermectin and liver problems though.

[MalteseLuna]

Her ALT levels on Friday were 127 so still elevated and this time higher than 4 months ago (they were 113 last time we tested).

Has anyone heard of allergies (particularly food) affecting ALT levels?

I don't know if I should bother with an ultrasound given that she shows no symptoms of a shunt and I've heard they aren't very good at diagnosing shunts anyway. I am leaning towards doing a bile acids or ammonia tolerance test and fiddling with her diet - I've heard that asymptomatic MVD is common in Maltese and shows up as elevated ALT and bile acid levels does anyone have first hand knowledge about this? My vet doesn't know what asymptomatic MVD is

[Rappie]

If there is true hepatocellular damage then any drug with a high degree of hepatic metabolism could potentially cause side effects. The dose of ivermectin in heartgard however is very low and side effects in 'normal' animals are uncommon - it also possible that it is coincidental. If you feel that it the heartgard is related then speak to your vet about a different plan.

Bile acids or ammonia tolerance tests reflect the liver function, ultrasound can show abnormalities in appearance and structure so they are both indicated for different purposes.

Keep in mind that 'MVD' is commonly used to refer to mitral valve dysplasia (heart disease) so at first glance asymptomatic MVD may not seem to be a significant or related problem. Asymptomatic microvascular dysplasia is a different condition entirely

Edited October 5, 2008 by Rappie

[WoofnHoof]

Her ALT levels on Friday were 127 so still elevated and this time higher than 4 months ago (they were 113 last time we tested).

Has anyone heard of allergies (particularly food) affecting ALT levels?

I don't know if I should bother with an ultrasound given that she shows no symptoms of a shunt and I've heard they aren't very good at diagnosing shunts anyway. I am leaning towards doing a bile acids or ammonia tolerance test and fiddling with her diet - I've heard that asymptomatic MVD is common in Maltese and shows up as elevated ALT and bile acid levels does anyone have first hand knowledge about this? My vet doesn't know what asymptomatic MVD is

I don't know anything about MVD sorry. The ultrasound we got was really good and showed the shunt really clearly (even I could see it lol), they did an even more specific one at the Sydney Uni Vet centre I don't know if you are near there but if you are going to get one done that is the place to do it they are the best .

I have heard about dogs living with shunts for ages and not being detected so don't let lack of symptoms be the only reason for not checking it.

[MalteseLuna]

I am getting mixed up - there is an MVD associated with hearts and another with livers ...

Within the liver, the portal vein branches into smaller and smaller vessels so that the blood can percolate throughout the tissues to each liver cell. When these microscopic vessels are abnormal on liver biopsy, the condition is called “hepatic microvascular dysplasia (HMD or MVD)” or “portal atresia”. When the microscopic vessels within the liver are underdeveloped or absent, the liver becomes small (“atrophied”) and the animal can no longer process toxins or make proteins necessary for growth and normal function.

Taken from YorkiePatrol

I have noticed that her coat is very fragile - could this be related to liver disease?

I think I am going to get an ammonia tolerance test done at Sydney Uni and see where that takes us. I really want to avoid having to put her under for a biopsy or ultrasound. If it is HVD/MVD then an ultrasound won't be able to make a diagnosis.

Kylie

Edited October 5, 2008 by MalteseLuna

[WoofnHoof]

My dog wasn't put right out for his ultrasound, just sedated heavily, the vets are much more cautious with drugs if liver disease is suspected. An ultrasound should detect a smaller than normal liver but not sure about the other stuff, I think they use a dye to illuminate the blood vessels, I know the vessels showed up as a different colour on the ultrasound here in brissy but I wasn't there for the one they did in sydney. If your girl has that condition I would think that it would produce similar symptoms anyway? I'm not sure, does she change her behaviour after a high protein meal or slow to recover from anaesthetic? Hard to say without the full run of tests. Do the ALT levels coincide with the levels of protien in her diet? When my dog got sick at 6 months he had been put onto a very high protein (23%) food and that is what really showed up the symptoms, the other symptoms he had were in hindsight classic shunt but at the time were just passed off as sensitive tummy issues.

If you go to Sydney Uni try to get Geraldine Hunt she is the expert on these things, I found them all to be really great though

Hope they get some answers for you and your girl, hope it's easily managed too, I wouldn't wish a shunt on anyone that's for sure!

ETA sorry I missed your coat question, my sibes coat was quite sparse as a puppy, the healthier he got the better and thicker his coat got, now it's everywhere lol!

Edited October 6, 2008 by tkay