High Alt Levels In Asymptomatic Young Dog

[Guest LittleMissOdie]

Hi all,

I know there are previous threads already discussing liver enzyme levels, but I wanted to start a new thread because I could not find any topics discussing ALT levels in a younger dog. Apologies if this is long but I am a bit distressed at the moment.

I have an 10 month old Frenchie girl Odie. 4 months ago, we booked her in for her spay and they did some preliminary blood tests and the vet found her liver enzyme levels to be very high - above 1000. She mentioned this was alarming as normal levels range from 10 to 100. She immediately booked our pup in for a bile acid test. This came back a little bit abnormal as well (high levels before she was fed, with levels stabilizing after she was fed a meal... excuse my lack of medical terminology). The vet suspected a liver shunt. Odie was then booked in for an ultrasound where, to our relief, the specialist found a normal looking liver and noted that all of her other organs looked normal, everything was a great size etc. The vet chalked this up to a possible infection, gave us a round of antibiotics, and told us to come back in a month or two.

Due to a sudden house move and Odie coming into heat shortly afterwards, we could not book her in for another spay until last Friday. The vet ran her bloods again - her liver enzymes were still elevated, slightly more than last time.

At this point the vet told us this was beyond her expertise and has referred us to a specialist.

This has hit us out of nowhere because presently Odie is asymptomatic - she is at a healthy weight for a Frenchie pup (11.7 kilos), she has grown and thrived beautifully, great muscular development, no neurological symptoms whatsoever, bathroom habits are great, her stools look good, and she is playful, alert and VERY active. My MIL calls her the energizer bunny. Her appetite is also excellent - she loves food and never turns her nose up at anything.

Obviously this has left us baffled and really petrified something bad is going to happen to her.

The only thing I can think of that could possibly indicate a problem was that when we fed her kibble as a pup, she would sometimes regurgitate it if she ate and then proceeded to run around, or drink water. But I chalked this up to a bulldog quirk, especially because she acted totally normal afterwards and her appetite never waned. Sure enough once I switched her over to a balanced home cooked diet and fed kibble in smaller quantities the regurgitation stopped immediately and she's had no problems since.

I am at a complete loss as to what to do. The vet has mentioned our options are a CT scan, a liver biopsy during her spay (she did not recommended this as she thinks anesthetic at this point would be very risky), ANOTHER ultrasound (I don't understand the point of another ultrasound if it did not lead to anything the last time?). The most drastic option she mentioned was exploratory surgery to find a possible shunt.

I am at a really, really difficult position here because I want to do what's best for my dog, but I do NOT want to pull out every invasive procedure in the book, especially because she is seemingly so healthy. Even the vets we have been to have commented on how healthy she looks, how shiny her coat looks etc.

I am asking if anyone has had similar experiences with a young dog and what they came to find. Money is not the issue, I will pay what I have to in order to give her the best chance possible. It's just such a strange situation and the vet has not told us anything helpful at all apart from "there's something wrong with her liver enzymes". I understand that problems may manifest over time, and that it is quite an urgent matter because liver enzymes over 1000 are not the norm. Perhaps I am in denial, I just love her so much and can't bear the thought of her being sick

If anyone can shed some insight or advice on where to go from here, it would be greatly appreciated.

[JulesP]

My dog was just under 1yo when she was diagnosed with a shunt. Woofs boy was about 10 months I think.

The high ALT plus bile would suggest that something was going on. Apart from my girl being a fussy eater she really didn't have any obvious symptoms, no vomiting etc, until she got really sick.

When I went to the specialist and was told my options for investigating what was wrong they told me that a ultrasound may not pick up what was wrong. Luckily it did as I was a bit baffled what option to pick next. What does your specialist want to do?

[Guest LittleMissOdie]

My dog was just under 1yo when she was diagnosed with a shunt. Woofs boy was about 10 months I think.

The high ALT plus bile would suggest that something was going on. Apart from my girl being a fussy eater she really didn't have any obvious symptoms, no vomiting etc, until she got really sick.

When I went to the specialist and was told my options for investigating what was wrong they told me that a ultrasound may not pick up what was wrong. Luckily it did as I was a bit baffled what option to pick next. What does your specialist want to do?

Thanks for the reply. I have not spoken with the specialist yet, we have an appointment later this week but in the meanwhile we're going to see another vet who seems to be a little more helpful. If you don't mind my asking, what breed is your dog, and what kind of shunt was it? The vet I've been speaking to mentioned that it was strange that nothing was picked up in the first ultrasound because small dogs usually have extrahepatic shunts which are outside of the liver and should have been picked up by the ultrasound. Interhepatic shunts, as I understand, are much harder to see & diagnose

[JulesP]

My dog was just under 1yo when she was diagnosed with a shunt. Woofs boy was about 10 months I think.

The high ALT plus bile would suggest that something was going on. Apart from my girl being a fussy eater she really didn't have any obvious symptoms, no vomiting etc, until she got really sick.

When I went to the specialist and was told my options for investigating what was wrong they told me that a ultrasound may not pick up what was wrong. Luckily it did as I was a bit baffled what option to pick next. What does your specialist want to do?

Thanks for the reply. I have not spoken with the specialist yet, we have an appointment later this week but in the meanwhile we're going to see another vet who seems to be a little more helpful. If you don't mind my asking, what breed is your dog, and what kind of shunt was it? The vet I've been speaking to mentioned that it was strange that nothing was picked up in the first ultrasound because small dogs usually have extrahepatic shunts which are outside of the liver and should have been picked up by the ultrasound. Interhepatic shunts, as I understand, are much harder to see & diagnose

My dog is a border collie. She has multiple extrahepatic shunts. My normal vet could not see the shunts when he did his ultrasound.

My specialist said that in a lot of cases they don't pick up the shunt via the ultrasound. It was by far the cheapest option which is one reason we went with it. Plus the others involved generals and my dog was pretty sick and that was a risk.

[Rappie]

I would follow up with the specialist and consider a biopsy. As opposed to a macroscopic liver shunt, it may be something like microvascular dysplasia. The cases of this I have seen have been identified in younger, asymptomatic small breed dogs and for the most part have not required specific management. There is a limit to what the blood test can tell us, and the next step after that is to get an idea of the structure of the organ itself. The bile acid results tell us that the function of the liver is 'abnormal' but this does not necessarily imply that there is disease that will cause clinical signs.

[Guest LittleMissOdie]

I would follow up with the specialist and consider a biopsy. As opposed to a macroscopic liver shunt, it may be something like microvascular dysplasia. The cases of this I have seen have been identified in younger, asymptomatic small breed dogs and for the most part have not required specific management. There is a limit to what the blood test can tell us, and the next step after that is to get an idea of the structure of the organ itself. The bile acid results tell us that the function of the liver is 'abnormal' but this does not necessarily imply that there is disease that will cause clinical signs.

Thank you so much for your reply. I have read up on microvascular dysplasia and considered that it could be something like that but obviously I am not a professional.

If you don't mind me asking, is there a great risk putting her under anesthesia for a biopsy and spay with her liver enzymes so high? Especially because she is a brachycephalic dog, I know that extra measures have to be put into place for normal brachy dogs so I'm afraid the elevated enzymes would be an added risk.

Thanks again for your response.

[Rappie]

The risk with liver disease is not so much with the anaesthesia (as in going to and staying asleep) but with the drug choices before, during and after the procedure. The main consideration in these cases is either eliminating or reducing the dose of drugs that are metabolised mainly by the liver, as they have the potential to have either a more profound effect than expected, or potentially interact with other drugs due to prolonged clearance times. The main drugs of concern are those used for premedication (so using reduced doses of opiod drugs and avoiding others like medetomidine) and and post operative pain relief (using opiod drugs as opposed to NSAID drugs which are the most common choices). Maintenance of anaesthesia is typically with isoflurane gas only so the premedication will affect the level of gas flow required during the GA but the depth of anaesthesia can be changed quite quickly.

The brachycephalic component does require extra management and it is a good idea to ask your vet how they will approach that, they should be happy to discuss it with you.

[Guest LittleMissOdie]

The risk with liver disease is not so much with the anaesthesia (as in going to and staying asleep) but with the drug choices before, during and after the procedure. The main consideration in these cases is either eliminating or reducing the dose of drugs that are metabolised mainly by the liver, as they have the potential to have either a more profound effect than expected, or potentially interact with other drugs due to prolonged clearance times. The main drugs of concern are those used for premedication (so using reduced doses of opiod drugs and avoiding others like medetomidine) and and post operative pain relief (using opiod drugs as opposed to NSAID drugs which are the most common choices). Maintenance of anaesthesia is typically with isoflurane gas only so the premedication will affect the level of gas flow required during the GA but the depth of anaesthesia can be changed quite quickly.

The brachycephalic component does require extra management and it is a good idea to ask your vet how they will approach that, they should be happy to discuss it with you.

Thanks very much, the responses in this thread have been very helpful! I will be sure to discuss the drug choices in depth before we go ahead with the biopsy/spay. The vet has mentioned that brachy breeds need an extra tube to facilitate breathing during surgery, and this is only removed once the dog is waking up and chewing it back up

[julesluvscavs]

Sorry to hear your dog is having liver issues also.. I seem to be reading more about it now in different dogs of different ages

Just letting you know our Cavs are brachy breeds and both have had ops over the years for different things including desexing and dental work, and both have never had any major problem with being put under. Our 10 year old Cav recently had an op and they had no trouble with her at all. As Rappie said just discuss any concerns with your vet beforehand.

All the best with it ! , we are fighting a liver issue atm too with our 10 year old cav..

[Guest LittleMissOdie]

Sorry to hear your dog is having liver issues also.. I seem to be reading more about it now in different dogs of different ages

Just letting you know our Cavs are brachy breeds and both have had ops over the years for different things including desexing and dental work, and both have never had any major problem with being put under. Our 10 year old Cav recently had an op and they had no trouble with her at all. As Rappie said just discuss any concerns with your vet beforehand.

All the best with it ! , we are fighting a liver issue atm too with our 10 year old cav..

Thank you, glad to hear you have not had any issues with putting your pups under, our Odie is a good breather (for a Frenchie) she doesn't snuffle as much as some of the ones I've met, apart from her snoring which I've grown quite fond of :laugh:

Best of luck to your Cav girl, they are wonderful little dogs with the sweetest temperaments!

[julesluvscavs]

Thank you LittleMissOdie, Renae's a tough girl, Im sure she will give it her best go at dealing with it. Im trying to remain positive about it all, especially around her :)

[MalteseLuna]

I have an asymptomatic dog whom had high ALT levels, discovered during/at her spay. We monitored her ALT levels, I decided that I did not want to do ultrasound (most tech's aren't good enough to pick anything up on a toy dog... so I was told) and no biopsy until talking to a specialist.

Who are you seeing in regards to the specialist - I would recommend the guy from USyd.

Luna is now 4 years old and going strong - she has no symptoms and remains healthy. We still monitor ALT levels occasionally. The specialist gave us some medications and her ALT levels decreased slightly but are/were still elevated. He deemed that this might just be her "norm".

I would take her to the specialist and see what he/she says rather than going to other vets etc. Best save your money incase you have to do surgery and in all likelihood the specialist will know best :)

PS. My dog is a toy breed - Maltese

[Guest LittleMissOdie]

I have an asymptomatic dog whom had high ALT levels, discovered during/at her spay. We monitored her ALT levels, I decided that I did not want to do ultrasound (most tech's aren't good enough to pick anything up on a toy dog... so I was told) and no biopsy until talking to a specialist.

Who are you seeing in regards to the specialist - I would recommend the guy from USyd.

Luna is now 4 years old and going strong - she has no symptoms and remains healthy. We still monitor ALT levels occasionally. The specialist gave us some medications and her ALT levels decreased slightly but are/were still elevated. He deemed that this might just be her "norm".

I would take her to the specialist and see what he/she says rather than going to other vets etc. Best save your money incase you have to do surgery and in all likelihood the specialist will know best :)

PS. My dog is a toy breed - Maltese

Thank you for the rec! would you be able to PM me his name? :) so glad to hear Luna is going strong after 4 years. I think I read that the Maltese breed in particular sometimes do have elevated ALT levels and they are indeed the norm sometimes.

We have not discussed making a specialist appt yet with the new vet - he thought odie's bile acid results seemed strange last time, they were 111 before a meal and went within the normal range after eating (47 if I remember correctly) he said if anything they should be the other way around to indicate a possible problem with her liver. So she was retested this morning and we get the results tomorrow. I guess our next move will be seeing a specialist depending on how they turn out. I have been worried sick about her, looking out for anything that may indicate a problem and over analyzing everything!!

Also, the vet we saw prior to the one now charged us a bomb for testing and general consults (it was a supposedly "high end" Sydney vet), did not answer many of our questions and basically pushed us out the door. The local one we are seeing now (we have just moved an hour outside sydney) has been wonderful - answered all of my questions, is very thorough and has provided ongoing support to us in just a matter of days, including gathering 2nd and 3rd opinions from his sources. Just goes to show that paying more $$$ doesn't necessarily buy quality service, at least in this case.

[MalteseLuna]

I have an asymptomatic dog whom had high ALT levels, discovered during/at her spay. We monitored her ALT levels, I decided that I did not want to do ultrasound (most tech's aren't good enough to pick anything up on a toy dog... so I was told) and no biopsy until talking to a specialist.

Who are you seeing in regards to the specialist - I would recommend the guy from USyd.

Luna is now 4 years old and going strong - she has no symptoms and remains healthy. We still monitor ALT levels occasionally. The specialist gave us some medications and her ALT levels decreased slightly but are/were still elevated. He deemed that this might just be her "norm".

I would take her to the specialist and see what he/she says rather than going to other vets etc. Best save your money incase you have to do surgery and in all likelihood the specialist will know best :)

PS. My dog is a toy breed - Maltese

Thank you for the rec! would you be able to PM me his name? :) so glad to hear Luna is going strong after 4 years. I think I read that the Maltese breed in particular sometimes do have elevated ALT levels and they are indeed the norm sometimes.

We have not discussed making a specialist appt yet with the new vet - he thought odie's bile acid results seemed strange last time, they were 111 before a meal and went within the normal range after eating (47 if I remember correctly) he said if anything they should be the other way around to indicate a possible problem with her liver. So she was retested this morning and we get the results tomorrow. I guess our next move will be seeing a specialist depending on how they turn out. I have been worried sick about her, looking out for anything that may indicate a problem and over analyzing everything!!

Also, the vet we saw prior to the one now charged us a bomb for testing and general consults (it was a supposedly "high end" Sydney vet), did not answer many of our questions and basically pushed us out the door. The local one we are seeing now (we have just moved an hour outside sydney) has been wonderful - answered all of my questions, is very thorough and has provided ongoing support to us in just a matter of days, including gathering 2nd and 3rd opinions from his sources. Just goes to show that paying more $$$ doesn't necessarily buy quality service, at least in this case.

Mmmmm I can't remember his name - but certainly Sydney University Vet Hospital is great and they have a vast number of staff (and specialists). Luna was referred there by my local vet, I would just ask your current vet for a referral to Sydney University Vet. The correct specialist there will be assigned to it.

The local vet sounds great, the fact that he is looking for different opinions and researching is a GREAT sign!

Try not to get too worried, she is asymptomatic. I remember at that time during Luna's life I was constantly worried, researching online to find anything and over analysing as well. But in all likelihood if she doesn't have symptoms and remains healthy (no weight loss, continues eating, no tremors etc) then she will be fine and have a long healthy life. Most dogs with shunts or serious liver issues have symptoms. If it is a shunt there are treatments, as with most other issues.

Has her ALT level increased since she was last tested? Or is it stable?

Did they say the normal ranges for the bile acids - those don't seem very odd/high.

There is another disease called MVD (microvascular dysplasia), which is also referred to as hepatic microvascular dysplasia (HMD) or portal atresia. Maltese have it and quite a few other small dogs. Many dogs are asymptomatic and most dogs live a full normal life (with no/little lifestyle changes needed). Most common change needed is a lower protein diet. There was a lab in the USA researching it, and they also developed a special test to distinguish it from shunts. Called a Protein C test.

Most maltese/dogs that I've heard of having MVD had no symptoms or issues.

Here is a website about it - HVD website.

It could be related to exposure to chemicals or toxins in the environment - you mentioned moving recently... was that before or after the ALT levels were noticed?

[julesluvscavs]

Has the vet mentioned about giving these tablets yet Ursodiol? we have just started Renae on it for her liver toxin issues .. She will have another blood test in 6 weeks time to see if they are helping or not..

[Xyz]

All i can say is Thank Dog you had the preanaesthetic blood testing!! That is why it is offered/recommended.! While 95% show nothing, this is great it was picked up so early!!

Hope you get some answers soon!

[Guest LittleMissOdie]

Mmmmm I can't remember his name - but certainly Sydney University Vet Hospital is great and they have a vast number of staff (and specialists). Luna was referred there by my local vet, I would just ask your current vet for a referral to Sydney University Vet. The correct specialist there will be assigned to it.

The local vet sounds great, the fact that he is looking for different opinions and researching is a GREAT sign!

Try not to get too worried, she is asymptomatic. I remember at that time during Luna's life I was constantly worried, researching online to find anything and over analysing as well. But in all likelihood if she doesn't have symptoms and remains healthy (no weight loss, continues eating, no tremors etc) then she will be fine and have a long healthy life. Most dogs with shunts or serious liver issues have symptoms. If it is a shunt there are treatments, as with most other issues.

Has her ALT level increased since she was last tested? Or is it stable?

Did they say the normal ranges for the bile acids - those don't seem very odd/high.

There is another disease called MVD (microvascular dysplasia), which is also referred to as hepatic microvascular dysplasia (HMD) or portal atresia. Maltese have it and quite a few other small dogs. Many dogs are asymptomatic and most dogs live a full normal life (with no/little lifestyle changes needed). Most common change needed is a lower protein diet. There was a lab in the USA researching it, and they also developed a special test to distinguish it from shunts. Called a Protein C test.

Most maltese/dogs that I've heard of having MVD had no symptoms or issues.

Here is a website about it - HVD website.

It could be related to exposure to chemicals or toxins in the environment - you mentioned moving recently... was that before or after the ALT levels were noticed?

Very very helpful links, thank you! As for Odie's ALT levels, they have increased only slightly but everything else (UREA, CREA) was within the normal range. We also sent off for a full blood panel today, so we should get a better idea of numbers since those only came from the vet's office.

I think we are ruling out any toxins and diet allergies, as she was tested prior to moving and I've changed her diet within that time as well I did consider that as a possibility... Honestly, the things I've seen her try to eat! :laugh:

I'm trying not to fret, but at the same time I've read cases where dogs have been asymptomatic in the first few years, before falling very ill... In some cases it was too late to save them absolutely heartbreaking. I guess I have to stay positive and be thankful we caught this early. Also thankful she's got a huge appetite, not sure if it's the bulldog in her but she is an absolute garbage guts!! She was giving me the sad eyes today as I'm trying to control what I'm feeding her while we sort this out, so no sneaky treats... She flopped dramatically across my feet when I was cooking dinner in protest! :laugh:

Your story of Luna has certainly given me hope, thanks again for the info!

[Guest LittleMissOdie]

Has the vet mentioned about giving these tablets yet Ursodiol? we have just started Renae on it for her liver toxin issues .. She will have another blood test in 6 weeks time to see if they are helping or not..

Thanks Jules, no discussion of meds yet until we get the latest blood work but I have written the name down and will ask on my next visit.... The vet must love me.... Every time I see him I'm grilling him with questions :laugh:

Thanks to you and everyone else who has been so helpful in providing information. I will update once we hear more news

[Guest LittleMissOdie]

All i can say is Thank Dog you had the preanaesthetic blood testing!! That is why it is offered/recommended.! While 95% show nothing, this is great it was picked up so early!!

Hope you get some answers soon!

Thank you! Yes I'm so thankful, the vet nurse looked at me in surprise when we insisted on one, she was almost convincing us there was no need.... Thankfully we did, hate to think of what could've happened had they put her under

[Guest LittleMissOdie]

Hi all, thought I would provide an update on Odie in case anyone has some insight or shared experiences.

She went back for a re-test of her bile acids, and unfortunately the results came back the same - higher levels prior to feeding, however this time around her 'post' results did not drop down to the normal level:

Bile Acids (Pre) 81 umol/L (< 21)

Bile Acids (Post) 37 umol/L (< 21)

The vet says that it's very strange that the bile acids are actually higher prior to feeding than after. The other strange thing is, we got her full blood panel results back and all other indicators of liver function (urea, albumin and cholesterol) are all normal. So at this point, we have no idea what we are looking for, could be anything from her gall bladder or vet mentioned it could be a vascular disorder and we still have not ruled out a shunt

In the meanwhile her appetite and overall health is still excellent. I've never seen a dog love food so much. Behavior after eating is very normal too, she's still happy and playful.

The vet is going to speak to the pathologist but our next step is definitely to go see a specialist. This is all terribly confusing!