Prednisolone

[Rappie]

Prednisolone is the only thing like prednisolone, and it is probably the most flexible as far as control over the dosing. For all it's downsides, a very lose dose, given intermittently (say every 2-4 days) probably has less of an impact on the liver than daily antihistamines, or other medications for atopic allergies such as cyclosporin. That is at least the case in a dog with a 'compromised' liver - I'd normally recommend an antihistamine trial etc first, but in your case I would aim for the least treatment in general, with the least impact. Add as many supportive treatments as are possible and effective, such as moisturising treatments, omega oils, medicated shampoos where required etc to limit systemic medications in general.

If the bile acids went down after introducing the diet and supplements that is great :) They probably wont ever return to normal because the liver is not normal, but the ALT will typically increase gradually over time.

Edit to add: If she has any blood tests while on prednisolone, there will probably be an increase in the level of ALP - which is steroid induced but doesn't reflect damage as such. It will stay up for about 3 weeks or so after the meds are finished.

Edited November 14, 2013 by Rappie

[sas]

My allergic dog lived on it for 5 years and no problems with his liver that were detectable. He died from unrelated causes.

Work with a Vet who will manage the dosage i.e. use only what is needed > overuse is not your friend.

Edited November 14, 2013 by sas

[Guest hankodie]

Thanks for the advice Rappie, I appreciate it :)

The ears seem to be getting better though she still has a bad bout of the runs and kept us up all night poor thing off to the vet's this morning with a stool sample

[Rappie]

No problem :) It's welcome (and relevant :laugh:) distraction.

[JulesP]

My liver specialist vets in consultant with the skin specialist vets said not to give antihistamines to Amber. They suggested a couple of lotions, which wouldn't be useful for ears. Luckily Amber's skin issues cleared up when I got her liver condition stableish.

I would probably just use the ear drops and not the pills personally. The less going through the liver the better.

[Florise]

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Edited November 17, 2013 by Florise

[Guest hankodie]

My liver specialist vets in consultant with the skin specialist vets said not to give antihistamines to Amber. They suggested a couple of lotions, which wouldn't be useful for ears. Luckily Amber's skin issues cleared up when I got her liver condition stableish.

I would probably just use the ear drops and not the pills personally. The less going through the liver the better.

Thanks JulesP. if I recall correctly Amber has multiple acquired shunts?

I held off on giving her the prednisolone after the first dose because I wanted to double check with my regular vet but the ears seem to be clearing up with the just the drops. we went to the vet today because she's been having some tummy troubles on top of everything else and he said to stop the prednisolone anyway as he had to give her some metrogyl.

Unfortunately her liver isn't the only health issue that we're battling with so often we have to weigh up the pros of giving her certain medication with the effect it may have on her liver.

[JulesP]

My liver specialist vets in consultant with the skin specialist vets said not to give antihistamines to Amber. They suggested a couple of lotions, which wouldn't be useful for ears. Luckily Amber's skin issues cleared up when I got her liver condition stableish.

I would probably just use the ear drops and not the pills personally. The less going through the liver the better.

Thanks JulesP. if I recall correctly Amber has multiple acquired shunts?

I held off on giving her the prednisolone after the first dose because I wanted to double check with my regular vet but the ears seem to be clearing up with the just the drops. we went to the vet today because she's been having some tummy troubles on top of everything else and he said to stop the prednisolone anyway as he had to give her some metrogyl.

Unfortunately her liver isn't the only health issue that we're battling with so often we have to weigh up the pros of giving her certain medication with the effect it may have on her liver.

The vet thought that Amber has the same thing as your dog. Her vessels didn't grow in her liver so the shunts developed. We didn't do a biopsy as the treatment was the same. She was strange from a little puppy.

Amber has metrogyl daily.

[Guest hankodie]

Thanks for your reply JulesP. Out of curiosity did you opt to do digital imaging with Amber or did you conclude she had liver issues from the blood tests alone? Sorry for the questions - I very rarely get to speak with other owners who are dealing with the same issues :)

[JulesP]

I was lucky in that the specialist vet could see the shunting on their heavy duty ultrasound. If she hadn't been able to do that I had the choice of a MRI or to open her up.

Her blood and bile tests were not that scarily abnormal. But we already knew her liver was odd before the blood test as the original vet had seen that it was half the size it should be on an ultrasound when we were checking out her heart. She had a build up of fluid and the vet thought it was a heart problem. As he moved over the liver he noticed it was abnormal.

How is your dog going? Amber was given 6 months and that was over 2 years ago now.

[Guest hankodie]

So glad to hear Amber is doing well after her prognosis JulesP, you must be looking after her very well :)

Odie is doing well, I'm currently managing her liver issues through a home cooked diet and supplements. The vet wants to hold off putting her on hills l/d as she's never had a HE episode to speak of. I am cooking her a diet formulated by specialists in the states, it's mainly just chicken and rice.

We also opted to do an ultrasound but the specialist couldn't find a shunt and her liver looked normal. We also faced the same options as you did - she needed to be desexed so we opted for a liver biopsy at the same time. Looking back on it now I wish we had gone with an MRI first. The liver biopsy showed she does indeed have MVD as well as moderate portal fibrosis, which isn't good news at all (I think it's caused by pressure on her liver?)

Anyway the vet who did the biopsy couldn't find a shunt when he opened her up either but I've read that they can be hidden behind other organs. I've ummmed and ahhed over whether or not we should put her through an MRI in case there is a shunt and its operable, but with the state of her liver and her other health issues I don't think we're going to go down this route. We're taking a "if it aint broke don't fix it" approach and if there is a shunt it could very well be the reason she's so stable right now

Anyway, the vet I spoke to this week wasn't hopeful when I told him about Odie's diagnosis but my regular vet says as long as she's happy and not suffering just keep doing what we're doing and who knows how long she'll be around.

It's hard isn't it?

[JulesP]

It is hard. Amber is very thin. I was feeling really bad about it last night but today I have just been watching her bouncing around the garden with my other dog and you would not know there was anything wrong with her.

Amber is on the L/D as she had a few HE episodes. One was really bad.

The main problem I face is her fluid retention in her stomach. That is a constant juggling act with medication.

[Guest hankodie]

Sorry to hear Jules, does Amber get lactulose with her meals? There is a good support group on Yahoo for dogs with liver issues. They have lots of information and files dealing with all sorts of liver related things including advice on ascites/fluid retention. If you google "liver shunt and MVD" I think it's the first link.

I have lots of trouble keeping weight on Odie too. She was doing very well and had gained almost a kilo but her recent tummy troubles have brought her weight back down again.

And Odie is the same - she does the fastest zoomies I've ever seen a dog do and gets up to so much mischief every day! Lots of people are surprised when I tell them about her health issues. She does get mistaken for a puppy quite often though people usually think she's only 8 months old.

[JulesP]

I was on a liver group support page. They did help a lot but they also gave me the shits a bit because they are mainly Americans and kept trying to tell me to buy Royal Canin. Was very frustrating having to constantly say we couldn't get it.

Amber doesn't need lactulose. The L/D gives her nice soft poos. The poos should look like soft serve icecream btw. Disgusting to clean up but it means things are moving at a decent rate through the dog.

Amber looks like a puppy too.

[Rappie]

If there is a histology diagnosis of microvascular dysplasia, that is probably your 'shunt' - there may not be a visible / identifiable abnormal vessel.

[Guest hankodie]

I was on a liver group support page. They did help a lot but they also gave me the shits a bit because they are mainly Americans and kept trying to tell me to buy Royal Canin. Was very frustrating having to constantly say we couldn't get it.

Amber doesn't need lactulose. The L/D gives her nice soft poos. The poos should look like soft serve icecream btw. Disgusting to clean up but it means things are moving at a decent rate through the dog.

Yeah they are a bit crazy with their "liver protocol" too and tend to give inaccurate advice. But their files have lots of articles/info written by specialists in the states.

Haha Odie also has soft serve poo and tends to go a few times a day. I rarely have to give her lactulose. It's not so bad picking it up in the yard but it's a little gross trying to pick it up during a walk!

If there is a histology diagnosis of microvascular dysplasia, that is probably your 'shunt' - there may not be a visible / identifiable abnormal vessel.

Rappie - I have read of some dogs having both (that is tiny abnormal vessels as well as one or two large ones) though would you say this is more of an unlikely occurrence given it didn't show up in the biopsy results?

This thread sparked my curiosity so I dug up her old biopsy report - the sample they took showed:

1. A moderate portal fibrosis

2. Additionally there was a mismatching of the arterial and venous microvascular tributaries in most portal tracts in that there were too many branches of the arteriolar channels.

3. Most portal tracts also had swollen lymphatic channels

Apparently the moderate portal fibrosis is not a good sign. But like I said despite the state of her liver she has never had an HE episode yet (she's almost 2).

[JulesP]

My official diagnosis is Multiple acquired portosystemic shunts secondary to congenital portal vein hypoplasia.

The HE episodes can be very mild and almost not noticeable. Can be as simple as rubbing the head along the wall. A lot of the symptoms of a serious liver condition are so vague that they do get missed. One of the things Amber did as a puppy was run into things. You could easily just write that off as being clumsy. It is a symptom though. Another weird thing she does is stand and flick her tongue in and out. During the really bad episode she lay on the ground and twitched and was then walking with a really weird gait. I did think I was going to lose her that day.

She was always super fussy with her food but some dogs are fussy. She did totally stop eating at one stage but the vet couldn't find anything wrong then, liver was never suggested. She never vomited or had runny poos then. It wasn't until her tummy totally swelled up over night that the vet found her tiny liver via the first ultrasound. She was about 11 months then.

[Guest hankodie]

Amber sounds like a real trooper. How old is she now Jules, about 3?

Odie has never had a fussy appetite, she scarfs down her food. We came across her MVD almost by accident - we booked her in to get desexed around 6 months, the vet nurse asked if I wanted to run a blood test prior to putting her under and I said sure, why not. A couple of hours later they rang and said they couldn't do the surgery because her liver enzymes were through the roof. If that hadn't of happened I don't think we would've discovered it for quite a while.

I've never noticed any neurological symptoms, though she does deal with a lot of gastro issues. She also has unexplained vomiting/regurgitation episodes, sometimes they are quite frequent. The vet has chalked it up to acid reflux, she goes on medication for it for a while and then it can disappear for months and months before it happens again. It's very strange.

Though it's interesting what you said about the tongue flicking, I have noticed her doing this once or twice but always after she licks crumbs off the floor, I will have to pay closer attention next time.

[JulesP]

Yes Amber is 3 now.

The vomiting is a symptom of MVD but it is interesting that she eats ok. Amber was terrible at eating, she used to look at me like I was poisoning her. I love watching her scoff her food now.

Amber has a sort of vague look in her eyes when she does the tongue flick thing.

Edited November 18, 2013 by JulesP