Dog with spot in her mouth

[KarlaL]

Hi, @Dr. Jeff, @Dr. Sara, @Dr. Christina,
Cricket is a 13 yr 9 months old Teddy Bear ( Maltese and Shih Tzu mix) spayed female and weighs 13lbs.
BEAM? I would say 8. During storms or traveling in a car, it goes down to 3-4.
Cricket's diet has been Darwin's Natural Pet Food for the last 5 years. I slightly cook it because it grosses me out!
She had vaccinations from the breeder before we bought her at 10 weeks and has only had rabies since then.

I took her to the vet because she won't let me brush the right side of her mouth and I thought the white spot above her tooth might be an abscess on her gum.
It wasn't and I didn't want her sedated so they could take a biopsy. We did blood work instead.
Her Platelets and Total Proteins are high but her ALT is crazy. Is it possible to bring these down or is her liver pretty much destroyed?
Cricket acts the same as she did 3 years ago. I'm stressed, she is not. Can you help?

 

[Dr. Sara]

Dear Karla,
Breathe, and snuggle your Cricket!
There are two liver enzymes reported here, ALT and alk phos (ALP). I prefer the more comprehensive profile with ALT and AST (the two liver cellular enzymes) and GGT and ALP (the two liver bile stasis enzymes). It is better to have all four because the ALT stays up for up to 2 weeks after liver cellular damage stops. AST does not stay elevated as long, so it is a better indicator if there is an ongoing problem with the liver. When the ALT is three or more times the normal level, it does indicate that the enzyme has leaked out of the liver cells. It does not indicate definite liver disease, nor does the magnitude of the elevation mean that the dog is going to do poorly. It simply means the liver cells leaked the enzyme. This can occur for many reasons related to the liver, as well as unrelated causes. Elderly dogs often have elevated liver enzymes, sometimes from primary liver disease, sometimes from other causes such as sepsis (bacteria in the blood), heart disease, or inflammation elsewhere in the body. This could even be from a problem in the past, as we don't know Cricket's AST. Do you have previous blood work for comparison?

Cricket's total protein is high, which makes me think either her hydration is not optimal (albumin increases when dogs are dehydrated), or she is having an immune response, as indicated by elevated globulin. There could be an infected tooth root, which would not be obvious from an exam, only from dental x-rays. Both albumin and globulin are at the top of the normal range, so either poor hydration or immune stimulation could be true. Many elderly dogs run a little toward the dehydrated range, and a first morning urine would be good to more fully evaluate the kidneys. The BUN and creatinine (two of the kidney waste products) are normal, which is good. Unfortunately this profile did not include phosphorus, the third waste product.

The platelets increase when animals are excited. As Cricket does not like to ride in the car, this is not a worrisome increase.

You are concerned about the spot on the gum, and I assume you are worried that this increased liver enzyme is in some way connected, perhaps indicating a cancerous process. That is unlikely, though not impossible. It is rare to have any indication of cancer on a routine blood panel, because most cancer does not affect blood results until the patient is in dire condition.

I have no idea what the white spot on the gum is, as it could be exposed bone, a depigmented area of skin, or a tumour. As you feel the spot is bothering Cricket, since she doesn't want the area handled, I would have it examined more closely. Does she need a dentistry? If so, you could have dental x-rays taken to see if there is a problem that is not visible on the surface, and the spot could be evaluated while she is sedated. She is a cute little thing, but I'm betting that they had difficulty getting a good look at it while she was awake!

I hope this helps!
Dr. Sara

 

[Dr. Jeff]

Thanks for making your first post Karla.

Let's see if I can help unravel Cricket's elevated ALT and gum spot.

Dr. Sara gave you important context with physiologic facts about what's going on in Cricket's body. Test results reflect physiological function of cells and organs throughout the body. Like liver and gums.

Blood test results can give your vet clues about other informative diagnostic tests, like liver ultrasound, that can be run.

However, the same test results in different individuals may be from different dis-eases and does not necessarily lead to effective treatment.

So one pet with an elevated ALT may be treated differently than another with the same elevation.

That's because all diagnostic tests only reflect physiologic function.

However, there's also a flow of energy and information that helps maintain normal function which may not be reflected by the test results.

When smooth flow is disrupted, symptoms (like a high ALT and white spot) appear. Things like environemental toxins and viruses can disrupt smooth flow and thereby cause symptoms.

Most doctors and scientists focus on the physical mechanisms of cellular and organ function.

However, there are others, such as all of the vets of HA!, who are vitalists and believe that the physiologic changes are only part of the picture. To vitalists, these changes are secondary to fluctuations of a life force.

What this means, is that we think an important underlying cause for the liver cell and ALT abnormality is an imbalance of energy.

In my 25+ years of practice focusing on building cellular energy has shown that doing so promotes healing and helps maintain a high BEAM.

Your focusing on BEAM, happiness and quality of life will help Cricket "flow" and should also speed her healing.