Hepatocutaneous syndrome, email to and from Dr. Jean Dodds

Dear Jamie: Hello ! Your special companion seems to be doing very well as far as the liver function is concerned at this time, so I would keep her on the liver cleansing herbs and liver cleansing diet. Her alkaline phosphatase (ALK P) remains high but that level is normally slightly elevated in geriatric dogs (up to 250 IU/L would be normal at her age]. The ALK P is a “dump” enzyme that reflects the excretion of enzymic activity emanating from the metabolic activity of the liver and adrenal glands. So it goes up when the liver metabolism is working harder. The ALT, by contrast, reflects her liver cell-specific function and is basically normal (that’s good). Do you know if they measured bile acids or GGT ? Either of these tests would measure bile flow through the liver as a measure of liver function.

One more thing, are you giving the Soloxine at least an hour before or three hours after foods or treats that contain calcium or soy — to ensure its complete absorption (these foods bind thyroxine and impair or delay its absorption). Best wishes, Jean

—–Original Message—–
From: Jamie Goff [mailto:jamie@jamiegoff.com]
Sent: Tuesday, November 13, 2012 10:02 PM
To: hemopet@hotmail.com
Subject: Consult needed from Dr. Dodds

I have a 13 y/o female lab diagnosed with hepatocutaneous syndrome. I have started her on milk thistle, the liver cleansing diet and she has received 2 amino acid infusions (650 mg aminosyn iv over 12 hrs)

She was diagnosed on 10/25 and treatment was begun immediately

She is also hypothyroid on Soloxone 0.5 bid (total T4 was 0.9 on 10/5/12) She is epileptic, controlled with phenobarb and k bromide over the last 6 years. Upon diagnosis, we did rapid phenobarb withdrawal and she was placed on keppra 500 mg q 8 hr and has had no seizures during transition period (weaned her off phenobarb in 1 week)

I can send all her lab work, but liver enzymes are slightly elevated:

11/7/12: 10/5/12

Alk phosphatase: 516. 506
ALT: 117. 143
AST: 41. 52
Cl: 125. 133
Anion gap: 9.3
Serum iron: 62
Albumin: 2.5. 2.8
Hct: 32.4. 35.8

Clinically, the margins of her mouth have lesions, as do pads of all 4 paws and she either hurts or they itch, as she wants to lick them constantly.

Her meds:
Tobramycin eye drops for right eye infection Prion 1/4 tab q day K bromide 400 mg/3cc bid Soloxone 0.5 mg bid Oral amino acid supplements Zinpro biscuits 6-8/ day Tramadol 50mg prn (mostly gets during amino acid infusions) Cefoodoxime 200mg qd for bacterial infection of paws Miconazole into ear canals q day

We want to make her comfortable and do not want to prolong her suffering, if none of this is going to improve. Please advise how to go about getting consult from Dr. Dodds, as we want to make sure we are doing all we can for our “baby”! (Also, want to find out how long before diet changes might actually help)

I can send labs results and clinical notes from Auburn College of Veterinary Medicine where Zoë has been diagnosed and treated.

Thank you so much!

Jamie

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