Last Friday we ran the blood work again.
The ALT remains unchanged. It didn't get higher, it didn't get back down to normal. Cookie remains to look happy and healthy. So now what?
Because of the prior elevation, they included a liver profile in addition to comprehensive blood work to check liver function.
Other than the ALT everything else looks normal.
- It is possible that this is normal level for Cookie
- It is possible that it is caused by something outside the liver, such as low grade duodenal or pancreatic inflammation (Cookie did have pancreatitis a bit over a year ago)
- It could be portal vein hypoplasia (PHV) which means that the blood vessels in the liver are reduced in number, resulting in reduced blood flow to the liver
- It could be primary low grade hepatitis, which is inflammation of the liver. If that was the case we'd have to figure out why.
- Liver ultrasound with biopsy to observe vasculature (PVH) and rule out primary hepatitis
- Treating empirically with 4 weeks metronidazole and retest
- GI function test (cobalamin, cPLI, folate)
- Monitoring and retesting annually (which is something we do anyway)
Because the liver could be affected by something such as low-grade chronic pancreatitis, testing the GI function makes sense to me to either discover the culprit or rule it out.
We also had Jasmine's vet review the results.
He feels that unless there are any signs of illness that at this level of the ALT he would not explore further other than regular re-tests. He also feels that it is possible that this level is normal for Cookie. No other values point to an unhappy liver.
A side note:
The earlier blood work also showed elevated eosinophils, a type of white blood cells. Both Cookie and JD had the same elevation. The primary suspect were parasites, even though none showed in the stool. We treated with Panacur and Cookie's eosinophils are back to normal.
There is a possibility that this is behind the ALT elevation and didn't have time to resolve.
I have to say that I don't like it when the blood work shows an abnormality.
Though it is not all that unusual that on a full blood panel a test value might end up outside the normal range. It happened on Jasmine's blood work a number of times that one value or another was off.
But that's just it. In Jasmine's case, it was a different value every time. This one popped up twice consistently.
I think that testing the GI function makes sense to me.
Ultrasound, while non-invasive, requires shaving of the belly. In the temperatures we've been having, running around with a bare belly doesn't sound like a good plan. And putting a sweater on Cookie? The way she runs through the bush it would probably last five minutes if that long.
Putting Cookie through invasive diagnostics while she doesn't seem to be sick at all doesn't make much sense. Or does it?
What would you do?
Related articles:
Incontinence? Cookie's Mysterious Leaks
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot?
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide
Taming Of The Wild Beast: Cookie's Transition To Civilization
Staying On Top Of The Ears: Cookie Is Not Impressed
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy
The Threat Of The Bulge Is Always Lurking
Today Is Cookie's Three-Months Adoptoversary
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment
Why Examine Your Dog's Vomit?
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely?
The Project That Is Cookie: Pancreatitis Up Close And Personal
Pancreatitis: Cookie’s Blood Work
Another Belly Upset: Pancreatitis Again Or Not?
Happy Birthday, Cookie
Who's Training Whom? Stick And Treat
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps
Cookie's Mysterious Bumps Update
One Vomit, No Vomit
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update
Don't Panic, Don't Panic: Know What Your Job Is
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated
Cookie's Plantar Paw Pad Injury
Your story can help others, maybe even save a life!
What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?
Email me, I'll be happy to hear from you!