My 2-year-old German Shepherd's liver meds aren't working. What now?

If the liver mass grows slowly then with medication Blue may continue to do well. The pills won't stop working but the liver disease and mass may continue to progress causing Blue's condition to decline. Since you've had improvement on the medication there is a good chance that Blue will continue to do well for some time. Remember to enjoy every day with Blue. Thanks for using Petco Pet Education Center, formerly Petcoach to help you get answers to your veterinary questions.

Hello, and thanks for using Petco Pet Education Center, formerly Petcoach. When you get Rocky I would have your own primary vet repeat the bloodwork to get an updated baseline, and because the units measured and normal range can differ from one lab machine to another. If decreased liver function is suspected, you should plan to run a fasted bile acids (liver function blood test). The next diagnostic step would then likely be an ultrasound with a liver biopsy, if your vet thinks that’s necessary. Of course, I would defer to the vet who’s actually examining the dog, as there may be clues in the exam to justify going a different direction with diagnostics. But this is what I’d be anticipating. Hope this helps.

Hi there and thank you for using pet coach to address your concern. I am sorry to hear that Lio is suffering from liver and kidney disease at such a young age. The most helpful treatment Lio could receive right now would be IV fluids for hydration. This will also help diurese him to flush out any potential toxins from his blood. With his age I would be concerned that the cause is a toxicity from him eating something possibly. Denamarin is a good liver supplemw t and getting him to eat a critical care formula food such as Hills A/D is good. If an abdominal ultrasound has not yet been performed, I would consider having that done for more information. I hope this helps and that Lio improves soon. Please let me know if you have any other questions or concerns. I am also available via consultation if needed.

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. Elevated liver enzymes and abnormal liver appearance on ultrasound scan does not necessary mean liver tumour or liver failure. Older dogs often have abnormal liver appearance, which is not related to any serious underlying problem. Liver enzymes level is a measure of 'damage' to liver cells but it is not directly related to prognosis. Again, older dogs often have mild elevation of liver enzymes I would think that the specialist will perform full abdominal scan and possibly take liver samples through a needle - this is commonly performed procedure in dogs with signs of liver disease. Based on the findings of the aspirate, the doctor will recommend further testing or prescribe treatment for Mars.

This is a very valid question and it is important to consider his overall wellbeing and comfort above and beyond prolonging the length of his life. If he is mobile, greeting family members as he normally would and eating enough (a specialised liver diet and supplements can help to reduce some of the symptoms of poor liver function by reducing the amount of toxins the liver needs to excrete. As long as his appetite is sufficient to prevent significant weight loss then it is likely he is feeling ok in himself. The following link can be very helpful for all family members to sit down together and discuss and can help in the medium term decision making https://vet.osu.edu/vmc/sites/default/files/import/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. I don't think that the cough is related to the liver problems or the medications Scoundrel is taking at present. I suspect the cough is related to airways infection (kennel cough, bronchitis etc) but it also may be caused by heart problems. Please,take Scoundrel back to your vets as he will need full clinical examination and potentially further investigation (for example an x-ray) to make the diagnosis and to start treatment for him.

I assume when you say liver enzymes you mean ALT? There a few enzymes we look at and elevation in 1 value makes us consider different causes then elevation in another. ALT elevation is caused make liver cell injury and leakage of enzymes in to the bloodstream. As the liver sees all the blood of the body it can be quite a reactive organ. So the question is whether the liver enzyme is up because of something wrong with the liver/vessels to liver themselves (such as an infectious or inflammatory cause (hepatitis) or a shunt (more common in younger dogs)) or something the liver is responding too (toxicity, disease of over organs). Unfortunately all parts of sago palm are toxic to dogs with the seeds (nuts) being most toxic. And it can be quite challenging to know if this is the cause. If it is sago it depends on the degree of ingestion as to how severe the case is. Unfortunately the treatment for this is supportive as you have been doing. The values may continue to increase or hopefully may plateau off and remain mildly elevated or decrease again. Ultrasound will help to rule out other things going on in the abdomen, assess the liver for changes in texture (although a liver can appear normal on an ultrasound and not be functionally normal), and sometimes identify a portosystemic shunt. After the ultrasound then sampling either first by fine needle aspirate or with a biopsy (needed for many cases of hepatitis, some other issues) can be performed. Checking platelets and clotting times should be performed prior to liver sampling in patients whose livers are not normal to decrease the risk of bleeding from sampling. As shunts are more common in younger animals , if this is suspected, additional imaging may be recommended prior to sampling as ultrasound will not identify all shunts. There is also a disorder called microvascular dysplasia that can be found in the liver. This is best diagnosed by liver biopsy and the sample sent to a pathologist who specializes in liver pathology. I hope this has helped and not confused you more. It sounds like your vet has taken the appropriate steps thus far and has recommended the next best steps to try to rule out some other causes. Thank you for using Petco Pet Education Center, formerly Petcoach!