Dear Dr. John,
My 13-year-old Chihuahua has had a heart murmur for several years and has taken appropriate cardiac drugs to manage her situation. She went in recently for her cardiology evaluation and bloodwork was performed. This showed markedly elevated liver values for which it was suggested I get an abdominal ultrasound for her. The ALT was 800 and the AST was 216, and the GGT was 21. The ALT four months ago was 81. The ultrasound showed everything was normal, especially the liver, but the report stated that she had mild mucinous hyperplasia of the gall bladder with moderate intraluminal sediment. The specialists suggested I speak with my vet about two medications, Denamarin and Ursodiol. My vet was not convinced to use those yet but suggested rechecking the liver values soon. My dog is otherwise acting quite normally and healthy. C.C.
Dear C.C.,
I cannot help but wonder if your dog possibly got into some toxin or medication that spiked the number from 81 to 800 especially given the fact that she is acting normally and not jaundiced, something that would be seen in liver failure. Normal ALT, which is the only liver specific enzyme, is 22-74 with the lab that I use. The other two values are also more than double normal. I would concur with your veterinarian to wait 2-3 weeks and then retest the bloodwork to see if the values come down. If not, then either or both the Denamarin and Ursodiol might be useful to give.
Technically, Denamarin is a supplement that helps to promote proper liver function. Once started, it typically takes 2-4 weeks to have an effect on liver function. Ursodiol is a drug that specifically increases the flow of bile and would address the sediment or sludge, which can be precursors to gallstones, found in the gallbladder by dissolving it. It also reduces liver enzymes, and it usually works in just a few days. Moving forward, your dog will need to balance the cardiac issues and medication with the liver and gallbladder. Proper management can go a long way in keeping things well. Good luck.
Dr. John de Jong owns and operates the Boston Mobile Veterinary Clinic. He can be reached at 781-899-9994.
