BILE SALTS IN DOG WITH LIVER FAILURE

[Megan136]

Have a 12.5 year old springer with liver failure. We're managing quite well apart from the obvious problems with food i.e. low fat, low easily digestible protein. Until recently tho would eat for a couple of days then be "unwell" for a day or so and vomit bile then start eating again.  Vet said that this was due to bile salts. Since last visit to vets approx 11 days ago, we changed diet to pasta and fish and no vomiting until today, and even then not a lot. Have looked up bile salts on i/net but unsure whether it is a LACK of bile salts or EXCESS bile salts causing the vomiting?  Not due back at vets for 10 days or so. Dog on Vit E, Milkthistle compound and Biostrath from us and antiobiotics and liver supplment from vets. Generally quite happy in himself apart from his "off" days when he vomits and is very sorry for himself!.  Any ideas from anybody would be appreciated!  I've looked up so much stuff on i/net I'm googled out!   Thanks to anybody who has any suggestions.

[jj999103]

hi my dog and I moved home to the uk two years ago, seemed strange he stopped wanting his walkies, i thought it was th change in climate as he had only lived in the med, he started to put on weight and became even less enthusiastic about walkies, hes a west highland whaite terrier , sorry forgot to mention. Well here i am two years later and he has become fat and stiff so i took him to the vets as i thought he had arthritis, the vet took bloods and said he suspected Cushings disease, within days he was being sick crying in pain couldn,t settle to sit anywhere, so i went back to the vet who took bloods and said he has liver problems  could be disease or tumour , he hospitalised him for 2 day on a drip with water and anti-biotics, he seemed to make a good recovery and was allowed home with antibiotics, days later his now refusing to eat, although his not in pain he looks so sad like his given up, he barely moves, i am cooking sausages as we speak as he has become tired of the chicken and rice, i lay with him talking and stroking but he seems so distant now, i am suppose to return to the vets in six day time with him, i do not see him being here then, any help please, desperate to save my boy.

[Megan136]

Apologies for the second posting on the liver problems.  This was initially meant to go to the Vet and I can't get rid of it!  Told you I wasn't used to these forums!

[Megan136]

Thanks for all the replies.  Very encouraging!  I'm glad I found this site 'cos as I said previously, I'm just about "googled" out, and some of the info you get on the sites is very contradictory!   I'm watching him for ascites/water retention and I also know about watching the colour of his stools as this can mean major internal changes! (Hi Guys - I'm the one who not only picks up the poop but examines it as well!!!)  We've tried him on the specialised dog foods - he won't even try the Liver Diet one but we had limited success on the Renal Diet one - but again only for a short time. With regards to the weight loss - we went on holiday in October for 3 weeks. Prior to going he weighed 23kilos. When we returned, he weighed 18.  We've been back up to 19 and then down to 17 but we're hoping with the last bout of eating he's put a little back on.  We've also tried the carbohydrates i.e. toast, rice, mashed potato, plain biscuits etc. but again, will eat for a couple of days (if that) and then refuse.  It seems that he wants/needs a change of diet every couple of days.  Babyfood is a good idea though - we'll try that one, although he can't digest chicken.Sometimes, just sometimes, I wonder if he is "trying it on" as he's always been totally spoilt and has "attitude" but I don't want to take the risk that he's NOT being a total b*****, and its purely down to his illness.  Will also try the lactulose - saw that initially on a website but Vet said no need.  However, Vet although aware that we are giving Milk Thistle Compound, Vit E and Biostrath (herbal supplement to increase appetite) doesn't seem to have much faith in these. As I said, I think the lactulose is now a must try. We've also had metrodizanole for 2 weeks but unfortunately I queried this with Vet as I saw on website that it could be toxic in liver failure and he now refuses to give, even though he did explain that only possibly toxic if given intravenously and I'm quite happy with that.  Despite the above, we do have a lot of faith in our Vet, he has seen us through pancreatis and removal of anal glands etc. etc. I think he believes we are slightly mad though! I'm going to go through all the bits and pieces on your posts again later and list them.  Oh - forgot to say, pills no problem!  My partner gives them so he's the "nasty" one!  I just give the cuddles!   Thanks again everyone.  

[arachnaphob]

Hi,  I was wondering if you know why your dogs liver is failing.  If it is secondary to pancreatitis, then maybe a long long course of metronidazole may help.

My dog had pancreatitis, liver failure and a liver tumour. I was told she had less than 48 hours to live.  That was early in 2008.  She is fine now. No liver failure, no pancreatitis and liver tumour is gone.

I used to work with people who had liver failure and were waiting for transplant.  I applied some of that knowledge to caring for my little girl.

Low protein, low fat diet.Add a lot of complex carbohydrates
As long as the abdomen isn't swollen (ascitis) then encourage lots of fluids to wash the bile out of the blood.(via the kidneys)
Lactulose to encourage at least 3 to 5 bowel motions a day, this is to prevent a build up of ammonia which can cause mental changes, lethargy and coma.
Antibiotics to prevent SBP (subacute bacterial peritonitis, which is common in liver failure)
Salt can be a problem. Sometimes it needs to be restricted because it can cause fluid retention and an increase in ascitis and peripheral oedema (swelling of the limbs) but on the other hand, sometimes the salt is low and this can cause mental confusion and lethargy etc.
I was giving her metoclopramide for nausea, but found that it caused behavioural changes, anything from extreme lethargy to hyperactivity almost bordering on seizure like symptoms.

And lastly I kept her on metronidazole for about 4-5 months to ensure that the pancreatitis was completely gone.

I don't know if she would have recovered any way but all I know, this is what I did and she is still alive, well and happy.

I wish everyone could have this type of happy outcome.

Chirley

[Me967]

I totally agree with Jaybay on everything she said.  My dogs are great at spitting pills back up after you put them down so as listed above that method works great.  I also found that wrapping them all in a piece of bread tightly and putting them all down at once works great!  My "Lady" gets 5 in the morning, one mid day and 5 in the evening feeding.  It works great!  
I also figured out with my Lady that giving the pills either before a meal that I know she likes with ALOT of praise it makes her food like a reward.  If she's being picky with eating (especially with pills that require food...example amoxicillon) then I give a good 15 minutes to 1/2 hour later after she eats and then a small treat after.  
Pretty much it's just watching what works best.  Trial and error.  Sometimes it can be very frustrating but with the love you have and the help from your vet you will know what's best.  I know how very hard and frustrating it can be though like many others on here.  
There is alot of very special people on this site though that can help you threw no matter what the outcome is.   It's been 6 months now for Lady and she seems to be doing fine for ~17 years old.  God bless them and you too along with this forum and all who is in it.

[Jaybay]

I think you're doing everything you possibly can do regarding diet.  At some point, the weight loss and malnutrition get to the point that ANYTHING you can get your dog to eat is a victory - even if it's on the "do not eat" list.  That's what happened to our dog in kidney failure.  Even with vitamin supplements, she was so malnourished in the last 2 weeks that her hair fell out by the handful.  

We lost our first dog to pancreatitis and associated liver failure.  He was an inpatient the last 2.5 weeks of his life with TPN nutrition and hydration given through a port in his neck.  His pancreas got so hugely swollen that the pressure on the bile duct caused the bile to back up into his gallbladder and liver.  There was just nothing else to be done so we had to put him to sleep.  I completely embarrassed myself at that time, my husband, the vet, the vet tech and likely scared the cr*p out of everyone in ear shot.  It seemed to come out of nowhere, but there it is.

It doesn't sound like your dog has anything for nausea, so ask your vet about something to cover that angle.  It really can make a big difference in getting a sick dog to eat more.  And get your pilling technique refined so you can just pop that pill down his throat before he even notices.  If you get it past where the back of the tongue rises against the roof of the mouth, it won't come back up.  I can pill my dogs in less than one second by now.  They never know exactly what just happened.  LOL!

You're doing a great job.  No matter what happens, never forget that.  :-)

[Me967]

Hi my dog also has liver failure.  I was pulling my hair out as I watched our 17 year old border collie drop 21 pounds.  Thank goodness she was really fat before this started.  lol.  
Anyhow being serious here, she would go maybe 3 days and eat fine and then be sick or totally refuse to eat.  The vet specialist phoned in a Rx. for Lactulose for her to regulate her stool and help to move things along and also Reglan for any upset stomach issues as needed.  I was happy and it seemed to help a lot.  

This has been going on since ~ July with her diet but her it goes concerning diet.  
She flatly refused the Rx food (l/d) after a few weeks.
So next we done chicken, mashed potatoes, rice, children's single grain rice for baby's and that worked great for a while.  
Then she changed again.  For the last two weeks we have been buying baby food for kids #3 stage, example turkey dinner, chicken dinner, etc. as a last resort where she gets a (lg. size jar) different jar 3 times a day and nutra-cal once every other day.  So far so good.  

I hope that helps you a little with diet ideas.  I would talk to your vet. or specialist though before you change her diet.  For us it was starting to be a question and quality vs. quantity.  As of now she loves the baby food as long as she doesn't get the same kind twice in a row and is back to running around out in the yard again.  Best of wishes to you.  I hope this might help you and your vet a little in diet ideas.

O forgot to add she stopped getting zinc daily.  The specialist we take her to say's that the SAMe and Zinc sometimes will mess with them.

Take care and best of wishes for your fur baby.  

[Megan136]

Thanks for your post.  It's nice to find a site where there are people willing to give their advice/experience!   He doesn't seem to have encountered any problems drinking (as yet) but sometimes we try and limit it as he'll try and gorge a whole bowl at once and then sicks up bile!  His eyes show his jaundice but last time at vets we were told it wasn't as bad as before.   Have you any tips on diet?  We know low protein, low fat, and very easily digestible.  He can't digest chicken, but can digest turkey mince (recommended by Vet). Fish he's OK on and pasta but at present time he is refusing to eat rice. Occasionally when he's off food (generally after having an "off" day) we can get him to eat either porridge or weetabix with a little skimmed milk. He eats these best if we are eating them as well!!  I've just been given an article from newspaper stating that probiotic yoghurts are good for treating liver failure in humans so we'll try him on some of that tomorrow as he likes yoghurt (and as long as it doesn't make him worse, may even help to alleviate some of his tummy problems).Vet recommended Marmite for B vitamins which is quite salty, but he's flatly refused that, even mixed with food/spread on toast or smeared on gums.I can't stand it either, so would probably do the same!   Any recommendations for foods that you gave your dog during his/her illness gratefully received.   I'm so glad your dog recovered!  We know ours isn't going to, but that doesn't mean that you just have to sit and watch them die, does it?  Anything that helps maintain their quality of life is better than just giving up, even if you know their quantity isn't going to be that long.  Again, thanks for responding, as I said to Jaybay its reassuring to know that people have other ideas and recommendations which they are willing to share/pass on in order to help.  

[Megan136]

Thanks for responding so quickly.  Interesting comments - but he only seems to vomit bile after he has been eating for a couple of days. Not a vast amount either - we can usually tell that he's going to be sick as he has a good long drink of water and then whoops! there you go!   He doesn't have diarhhea and his stools seem relatively normal, if only slightly looser and lighter than usual.  As we've got him on a (hopefully) easily digestible diet of either white fish/rice/pasta or turkey mince(recommended by Vet) and also (hopefully) fairly low in protein and fats, he seems to be managing - as I said we've just done 11 days with an enormous appetite, back to bouncy self and only punctuated by one barfing up bile episode!  He's starting to eat again now (usually does after a day or so) and encouragingly this started only a few hours after he vomited.  We're just trying to control it all by diet, hence the do we need to give him more stuff for bile salts or less!  You've suggested in your post that it might be lack of bile salts due to gall bladder etc. - I think you've hit the nail on the head - he also started off with pancreatis and gall bladder problems so your explanation fits the scenario.    Don't want to give too many tablets too soon - apart from odd days when he is obviously off colour, when we just pamper & comfort him, he really isn't that bad - we're not hiding our heads in the sand, but are trying to the best of our ability and limited knowledge to provide comfort and palliative care to him.  Do you have any ideas re diet?  We know that everything probably tastes of cardboard due to the jaundice associated with liver failure (which last time at vets we were told was receding!) but we're not sure whether he's trying it on sometimes with food i.e. holding out for something better and tastier!  Never previously a fussy eater, but now is extremely fussy - will eat something one day and refuse it the next! and we do know what they say about "they'll eat it when they're hungry". Well he won't and in his current state of health, I'm not willing to risk waiting anyway!    Thanks again for your post - it was very positive and informative!  

[arachnaphob]

Hi,
When my dog had liver failure (resolved spontaneously), she turned bright yellow because of the high bile level.  The vet kept her in hospital for a long time on a drip to help excrete the bile through the urine.  When she came home, I almost forced her to drink a lot so that she still had the high urine output and hence the increased bile excretion via the kidneys. I gave her any fluid she wanted including lactose free milk, goats milk as well as her usual water. I was lucky (??) because she also had a disease that required giving her a lot of salt as well.  This increased her thirst and made it easier to get her to drink.  I don't know if that is an option for you.  You would need to ask a vet before giving extra salt because sometimes in liver failure it's better to have low salt due to retaining fluid in the abdomen and tissues.  

I hope things go well for you.  I had a miracle in my house and my dogs liver tumour disappeared. My vet doesn't know how the tumour went away because we didn't give her any anti cancer treatment.

Chirley

[Jaybay]

I think your vet was talking about the dog vomiting actual bile.  When there is no food on the stomach, an animal (or human!) will often vomit bile because it's the only thing there to come back up.  That in itself is not something to worry about other than being a symptom of something else going on.  

Bile is produced in the liver and aids in digesting fats.  Normally, it travels down the bile duct and some of it gets stored in the gallbladder to be ready to dispense in the sudden presence of a fatty meal.  If too much bile gets dumped into the small intestine - as in people or dogs who have had their gallbladders removed - explosive diarrhea can result.

Bile is also what gives feces its brown color.  If a dog's stool is light tan, that means bile is not getting into the small intestine.  Same thing goes for humans.  In the case of liver failure, I imagine there is a lack of bile available to aid in digestion; hence the nausea and vomiting.

Has your vet prescribed a specific nausea medication to help keep your dog more comfortable?  The cheapest one available is reglan (metoclopromadine) and it works by increasing peristalsis to move food and digestive enzymes through the tract faster.  If the dog can't keep it down long enough to do any good, you can inject it at home.  We had much better results with injections last year with our dog who was dying of kidney failure.  Sometimes bypassing the GI tract altogether produces a better result with things.

I take phenergan every day for my own medical issues, and learned from my vet that dogs can also take phenergan.  When nothing else works, one 25 mg phenergan gets rid of my dog's occasional nausea, extreme bowel noises and vomiting.  He's just got one of those touchy tummys and gets the barfs if he manages to sneak something he shouldn't have.  You could even try plain Tums tablets - the ones that are calcium only with no other additives.  Dramamine (the OTC motion sickness med) is another over-the-counter anti-emetic that dogs can take.  Of course, check with your vet on any of these meds first so they don't interact with his other meds, and also for correct dosing amounts.

Dealing with any kind of organ failure finally becomes a matter of treating the symptoms to keep your pet comfortable until the end.  Keep after your vet for these kinds of palliative measures.  And never be afraid to ask him ANY kind of question.  If you aren't getting an understandable explanation of what is happening to your dog, keep asking questions until it's clear.  Those kinds of conversations can be invaluable and lead to "What if we do XYZ?" questions that might trigger your vet into trying something he wouldn't have thought of otherwise.