I'm thinking he must have some sort of pancreas disfunction.

And we're SO careful with what he eats, and he's not overweight at all! All the risk factors he should be fine. I guess sometimes it doesn't help.

The vet doesn't think his hypoglycemia is a factor but I'm suspicious of blood sugar disregulation in all this, since diabetes is linked.

Jennifer,

I had a dog with serious liver disease (cirrhosis and hepatic lymphoma) a few years ago. JMHO, but that elevated bile acid number would have me asking the vet for a liver panel now, not in another month. There is a lot you can do to successfully manage chronic canine liver disease, but getting a diagnosis and starting while it's still in early stages greatly improves the outlook. Problem is that it really is specialist territory beyond most general vets - I didn't get anywhere until we got the dog to an internist. Have any of your vets suggested a fine-needle liver biopsy? Ultrasound?

There is useful basic info on liver disease in dogs at http://www.canine-epilepsy.com/liverdisease.htm. Reducing dietary fat is a good precaution (especially if chronic pancreatitis hasn't been ruled out) but a low protein diet is not necessary unless you see symptoms of hepatic encephalopathy (dog acts really strange an hour or so after eating as the damaged liver cannot process the protein and ammonia builds up in the system). The liver has considerable capacity to regenerate, but severely restricted dietary protein can actually impede this. My dog had about 20% functional liver capacity left by the time we got a diagnosis, and he did fine on a reduced fat raw diet with a lot of supplements. Don't let anyone sell you Hills L/D or similar "special" kibbles for dogs with liver disease - they are awful (and expensive).

My suggestion would be to get his liver enzymes checked again right away. You might also consider starting him on milk thistle and SAMe (S-adenosyl methionine) - they won't do any harm if he doesn't have liver disease, but they can make a big difference if he does.

Just some suggestions. I'm not a veterinary professional, but I have been through the works with a liver dog.

Thanks very much Sarah.

I think the vet wants to wait a bit to do the test to see if food changes make a difference.

Tonight he's getting a home cooked meal with some of his TOTW.

The vet did mention an ultrasound - so it is good to know that a fine needle biopsy is an option to.

I think we'll talk to them tomorrow about waiting a week or so and then re-testing. I'm thinking that should be enough time to let him get onto a new diet, whatever we settle on, and then test.

Everything you do flows from the correct diagnosis, and then you can be confident that you are taking the correct steps, instead of hoping. If your vet is not up to the job try to find a group who can really help you. You'll be money ahead, and you'll have peace of mind.

So does it not make sense to move him to a new diet (I'm thinking the reduced fat Wellness Core) and wait for a week before retesting, to let it take some effect?

Or just start doing tests now?

 Quote: jennifer mullen

So does it not make sense to move him to a new diet (I'm thinking the reduced fat Wellness Core) and wait for a week before retesting, to let it take some effect?

Or just start doing tests now?

"I think the vet wants to wait a bit to do the test to see if food changes make a difference. " Not good enough for me!

Also, I would want the test results in my hand, printed out in full.

Sarah gave a pile of right-on info, as did Dr. Betty, including, from Sarah:

"Reducing dietary fat is a good precaution (especially if chronic pancreatitis hasn't been ruled out), but a low protein diet is not necessary unless you see symptoms of hepatic encephalopathy."

You aren't getting all the info you need from the vet, sounds like. Just MHO.


And the low protein diet ... there's a lot more to it than that, even with a diagnosis, and you have no diagnosis!

"Restricting proteins can complicate a patient's condition, impairing tissue regeneration and recovery from disease .... malnutrition can develop when protein-restricted diets are inappropriately recommended" (from the Journal Of Nutrition).

Straight "low protein" recommendations are decades out of date.

JMO!

I'll hunt up a Journal Of Nutrition article or two.


eta

" Problem is that it really is specialist territory beyond most general vets - I didn't get anywhere until we got the dog to an internist. "

My opinion too.

PS

 Quote: sarah ward

... You might also consider starting him on milk thistle and SAMe (S-adenosyl methionine) ...

All JMO:

Milk thistle and Sam-e are not unproven "out there" recommendations, despite their OTC status.

Sam-e is an emerging therapy with an extremely good track record for both efficacy and lack of side effects. Its effects on depression and arthritis have turned out to be a little less promising than expected, but even these studies mostly concluded that higher dosages than recommended on the package were needed for the benefits described.

Its liver benefit (on patients with cirrhosis), OTOH, has proven to be very good.

Of course I don't mean that Sam-e is a substitute for appropriate diet and vet care, but it is something to research and ask the internist about. (Its use with dogs is far newer than its use with humans, but an internist will be familiar with it. It gets a lot of print.)
JMO!

Journal of Nutrition:

http://jn.nutrition.org/content/128/12/2733S.full#sec-2

" ... recommendations for animals have been derived empirically from studies completed in humans, most work having been done in patients with end stage cirrhosis or liver failure complicated by hepatic encephalopathy. This is problematic because most veterinary patients with liver disease are not in hepatic failure and do not suffer from hepatic encephalopathy. Iatrogenic malnutrition can develop in patients when protein-restricted diets are inappropriately recommended."

Thank you all so much.

For whatever reason, while I'm usually pretty good about vet stuff (I ran the feral program for a cat rescue) this has me confused and floundering. It freaks me out so much, and I don't know why.

And the vet had been happy his results were going 'in the right direction' and I feel like if I had been more on top of this we would've figured it out sooner.

He acts COMPLETELY normal. Which is good, but weirds me out too. I'm glad of it though.

I think I am going to ask for the fine needle biopsy. I'm hoping it will be more affordable and from what I've read will be more definitive. A specialist sounds like something to investigate as well.

It's not just the vet we have now - the vets at the emerg had no idea what was going on either. I'm not used to vets not having real opinions, or at least it doesn't feel like they do.

We're definitely not going the low-protein route, not at this time. The reduced fat core has 9% fat but 33% protein - so still decent.

I'm curious about the sam-e reccomendation. I can't take anything like that because it makes me freak out. Sleepless, manic... craziness.

Could it potentialy have the same side effect on an animal?

Sorry to go off topic, just curious and not sure the question warrants a whole new thread.