Question: My dog Murphy is 8 years old 1/2 mix of Aussie and Golden, he recently went in for his yearly teeth cleaning under anesthesia and they couldn’t do it because his liver enzynes were too high 298, he has been on Denamarin for a month and they have dropped to 228 so we are keeping him on it. I wanted a second opinion on if you feel it would be safe to now go in and do the dental cleaning since the number has dropped, she seems to think so but it worries me. Also the vet suggests sometime still doing an ultra sound to see if they can find anything in the liver but I understand liver problems are difficult to diagnose and costly so if his numbers are dropping with the Denamarin do you feel this is necessary? Thank you! P.S He has no symptons other than drinking more water than usual. Cristina Abdala
Dr. Stacey Wallach: First of all, I want to commend you on understanding the importance of dental care in your pet. This is a condition that is overlooked by so many. Unfortunately, without knowing
which liver enzyme is elevated I won’t be able to fully answer your question. There are multiple liver enzymes that we test which tell us different things about the cells of the liver and liver function. I do think it is very important to try to find out what is the underlying cause of the elevated liver enzymes before doing anesthesia on your pet. These tests could include performing bile acids, which will tell you whether the liver is functioning or not, an abdominal ultrasound to look for any masses or nodules, and then possibly a liver biopsy. Elevated liver enzymes do not necessarily mean your animal cannot undergo anesthesia. Anytime we do anesthesia, it is important to determine the risks versus benefits. If your pet is in pain or has significant periodontal disease, I would probably still recommend the dental cleaning and examination but I may change my anesthetic protocol to use drugs that are less metabolized by the liver and make sure your pet is on fluid therapy before, during, and after the procedure. I would also continue on the Denamarin as this product is great for liver health and seems to be improving the liver values. I do want to make sure you understand that numbers decreasing on liver enzymes are not always a good thing. For example, ALT is a liver enzyme that elevates when there is liver cell death and as more and more cells of the liver die this enzyme will elevate in the blood. However, once the liver is in failure and there are no functioning liver cells remaining, this value will decrease back to normal. So even though the value is normal the liver has completely failed. That’s why the bile acid (liver function) test is so important. Of course, animals in liver failure usually have some sort of clinical signs that you would be observing at home. For instance, you may see yellowing of the skin, anorexia, vomiting and weight loss, which is not present in your dog.
If the liver enzyme that is elevated is ALKP then this may not have much to do with the liver and more to do with an endocrine disease called Cushings. One of the clinical signs of this disease is a dog that is drinking more water which is consistent with your dog. This disease would require a completely different workup before pursuing a dental cleaning and examination. So all in all, I think it is important to find out which enzyme is affected and then determine what the underlying cause is. Once we have a better idea of what we are dealing with, the risk versus benefits can be discussed further and a better decision can be made for the health of your pet.
Please keep us posted on Murphy!
Stacey Wallach, DVM
Town & Country Veterinary Hospital