rexysjourney

[rexysjourney]

Rex enjoying a stick January 16th 2018

[rexysjourney]

Abnormal ALT liver enzymes in my dog and our journey.

If you’ve ended up here it’s likely you’ve discovered your dog has abnormal liver enzymes, particularly ALT. The purpose of this blog post is not to freak you out but to describe our long journey to find out what was actually wrong with Rex. Early in January 2018 I took Rex for a general check up as he was off his food. Sometimes he wouldn’t eat anything, sometimes he would eat half his food, sometimes he would have it all. January in Australia is usually very hot and Rex is a dog that has always been affected by the heat so I wasn’t too worried at the time, thinking it could just be the heat. All through his life he’s had the same lack of appetite during summer however because he is getting older (11years) I decided to take him for a check up. Everything about him seemed normal on the general check up, we also ran a full blood test and the only thing that came back was some elevated ALT levels. I won’t go into too much detail about what elevated ALT enzymes mean here as there’s plenty of pages that do that but suffice to say it means that something is not right and that’s something that’s worthy of further exploration. I was concerned obviously because anything out of the ordinary would concern me but we needed to narrow down exactly what was causing the levels to be elevated and that would prove time consuming. First of all we started on a holistic liver support product called Demarin which I had high hopes for. If given the chance I would always prefer natural options as I hate the thought of chemicals and drugs flowing around my dogs body. We tried it for a month and went back for another blood test. To my horror the ALT values had gone up! I was so disappointed and a bit scared. We started Rex on 2 weeks of antibiotics followed by another blood test. This time the ALT values had dropped a little and I was really hopeful that whatever the problem was we were on the right track. We started him on another 2 weeks on antibiotics followed by another blood test. This blood test showed that the ALT values had shot right up! Again, I was so confused and disappointed. I was so worried I started crying and as the vet could see how distressed and stressed I was by it all they offered to do an X-ray and an ultrasound. The X-ray showed nothing obviously abnormal and the ultrasound looked quite even, meaning that if there was anything wrong with the liver it was likely diffuse and all through it rather than just in one spot. The fact that the ALT values had gone down on the antibiotics initially had given me hope but now that they had jumped so much I was really scared about what this meant. I was asked by the vet about whether Rex had been in contact with any toxins lately (things like decaying animals or roundup and poisons). While we do use roundup in the garden I had not seen Rex eat any treated grass any time in the last few months. I was racking my brain trying to think of what could be causing it. I researched everything I could online. Finding that contaminated foods as well as medications can cause elevated ALT values. Rex is having good quality foods (Ivory Coat brand dry food and cooked chicken) so I didn’t believe that a food contamination was likely to be the culprit however it certainly opened up my eyes to what actually goes in our dogs mouths. Everything from their toys rolling around in potentially contaminated soil to the food we feed them potentially being contaminated at point of farming with insecticides or perhaps even having too much copper in it. I scrutinised everything. I wouldn’t let Rex have treats. I brought him bottled water to try for 2 weeks before our next blood test in case it was a contamination in our water tank (something like a dead possum in the tank that we might not know about). When we went back for the next blood test we found the ALT values had dropped a bit but were still high. We started talking about biopsy and decided that a referral to a specialist would be in order as they could make a smaller incision which would mean a shorted recovery time for Rex. Throughout this whole time since January Rex had been his normal, active self. We were walking anywhere from 6-11kms a day and he took it in his stride. I was scared at the prospect of my darling boy having a surgery but decided that going ahead with the biopsy was the best idea as we wanted to know what was going on with his body. We had to wait a few weeks for the surgeon to be available so during this time I brought the things back into Rex’s life that I had removed for trial and error, his treats, his toys, the tank water. During these few weeks Rex started doing something peculiar, he started licking his bottom! I would tell him to stop and he would but I would see him doing it again later in the day or the next. The fact was, clearly it was irritating him. Again, I did some research online and found that it’s not uncommon for dogs to need their anal glands expressed when there is a build up. This build up can cause them discomfort and cause them to lick their bottom. I was hoping this was all it was but sent off an email to the vet describing the problem just incase. We knew that we would be back in a couple of weeks for another blood test anyway. Rex continued on licking his bottom periodically and on our next blood test appointment the vet expressed one gland getting a lot of gross stuff out, however she was unable to express the other one describing a “pea sized” lump that she didn’t want to squeeze too hard. The vet had seen innocent lumps here before so didn’t automatically jump to worst case scenario but by now as we had our appointment for Rex’s liver biopsy we requested that a ultrasound also be done of his anal glands to find out what the small mass might be. When we went down to the referral hospital on August 7th we met the specialists and conferred that it would be best for Rex to have a fine needle aspirate of his liver to try and find the reason for his elevated ALT enzymes and they would also do the ultrasound on his anal glands. We picked rexy up after these small procedures and brought him home, awaiting nervously the results. A few days later we revived a call to advise that unfortunately the fine needle aspirate had not shown what the problem was and therefore a full biopsy would be needed. At the same time they suggested removing the anal glands and the mass as often these could be cancerous but occasionally they could be innocent too. They also suggested doing a CT scan as it was much more detailed and they could see if there was any cancer or spread and I was happy to do this. Being that Rex is my whole life there was never any hesitation is doing all that we could do for him. If this was cancer I wanted it out of him ASAP. I was hopeful by the “pea sized” mass too that whatever this was we had caught it early. Even the specialists commented they believed we had got it early. Rex went down for his big surgery day on August 14th and I was nervous the whole time, praying that I didn’t get a phone call to say there had been some complications. Being that he’s an older dog there’s always some concern in putting them under anaesthetic as well as going through the surgery itself. But, I worried for nothing as we got the call to say everything had gone well. A piece of his liver was taken for biopsy and both anal glands had been removed and the mass send to pathology. It was so hard having him stay in hospital over night as I missed him so much but I knew it was best incase there were any complications they could look after him right away. We lived 30 mins from the nearest vet and over 2 hours from the referral hospital. We went down the next day to pick him up and in true rexy fashion he was so happy to see us he went to jump up as he normally would and instantly you could see on his face how much it had hurt. He was his normal happy barky self and it was so good to see him. He was discharged to us with plenty of painkillers and I positioned myself on the backseat of the car with him for the 2 hour trip home but less than 10 minutes into the journey I noticed some watery blood drops on the bedding and we made the decision to go back to the hospital as we were worried this was not normal. As we got out of the car and back inside poor rexy was dripping his watery blood everywhere and it was determined he had possibly torn a stitch open in jumping up to hug us (my heart broke!) and we decided it would be best for him to stay another day and night incase anything went wrong, as again, we were so far from help if he needed it. I’m so thankful that we got to see him and the trip was worth it just for that but I was certainly sad to be going home without him! The next night after work I made the trip down to pick him up after he had had no more complications and had been assessed as fine to go home. I’ve never been so happy in my life as I was so see rexy that night. I drove the smoothest I could knowing how much pain he was likely in with his 30cm scar on his abdomen and his stitched up bottom. And now we played the waiting game for the results. I remember it so clearly, I was on my daily walk and it had been 7 days, August 21st. The hospital had advised to call in 7 days for results if they hadn’t called me so I made the call nervous as anything. I spoke to the surgeon who went through the results and unfortunatley the results were among the worst we had been expecting. This thing that had been dragging on since January, some mere elevated ALT enzymes in an otherwise healthy, happy dog that I wouldn’t have taken to the vet other than as a precaution, was cancer. An anal sac adenocarcinoma, a malicious, malignant, fast growing cancer. And worse still, the pea size of it meant nothing because it had metastasised to the liver which was the cause of the elevated ALT. This indicates that the cancer had been in Rex for months to years and yet it was only 3 weeks before his scheduled biopsy surgery that he showed any signs of problems with his anal glands by licking them. I racked my brain to think of instances where he had done ribbony stools (another potential sign) and I could think of a few occasions but they were sporadic and because of this I didn’t think they were an issue. The CT scan was the thing that saved us. I could have had the anal glands removed and the biopsy done at my local vet but they don’t have a CT scanner. An X-ray and ultrasound both missed the masses in Rex’s liver because of their location but the CT scan picked them up. While under for surgery they had been able to remove one of the masses in his liver but unable to remove another, smaller one. This scared me so much. Chemotherapy was suggested and we thought about it over Rex’s 2 week recovery from surgery period. If he wasn’t the otherwise healthy happy dog that he is I probably wouldn’t have put him through chemotherapy. But this dog loves life so much and means so much to me that although I was terrified of what I was about to put my dog through, I felt strongly I wanted to do it. Rex started Carboplatin chemotherapy on Wednesday 29th August 2018, with the intention of 5 rounds at 3 weekly intervals. We found that his body was slow in building his white cells back up so after his second treatment we decided to do the next 3 treatments at 4 week intervals. So far Rex has handled chemotherapy really well, and everything I’ve read on the matter is that dogs handle it much better than humans. I’m glad that we decided to go through with it, I don’t know how much time it will give us - I was quoted anything from 2 months to 2 years - but I’ll take any time with Rex that I can. And here is the journey from here on: