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HappyHunch2011

High Liver Enzyme Levels (Update And Milk Thistle Question)

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My horse presented with 4 swollen legs- thinking it was tick related my vet drew blood. Everything came back normal except his GGT count (being in the 400 range when normal is 1-35), as well as another liver count that I don't know what it's called or the number his was.

He was put on banamine for 2 days and tricloramethazide for 5 days (he will be through with that this Sunday) to get the swelling down. The swelling is now completely gone in the front and just very minor in the back legs now. Had more blood taken to send out to Cornell. Vet did an ultrasound on him and the liver looks fine. Got the blood results this morning- same as the first set. Everything normal but has high GGT and the other was high as well. He was put on SMZs and will get more tests done when he is almost done the bottle of SMZs. Also will be getting a fecal done to rule out worms.

Other than the swollen legs, he is completely normal- eating, drinking, etc., no fever.

Has anyone had this happen with there horse? Kinda at a loss with what is going on with him since overall he looks like he is in picture health.

My horse presented with 4 swollen legs- thinking it was tick related my vet drew blood. Everything came back normal except his GGT count (being in the 400 range when normal is 1-35), as well as another liver count that I don't know what it's called or the number his was.

He was put on banamine for 2 days and tricloramethazide for 5 days (he will be through with that this Sunday) to get the swelling down. The swelling is now completely gone in the front and just very minor in the back legs now. Had more blood taken to send out to Cornell. Vet did an ultrasound on him and the liver looks fine. Got the blood results this morning- same as the first set. Everything normal but has high GGT and the other was high as well. He was put on SMZs and will get more tests done when he is almost done the bottle of SMZs. Also will be getting a fecal done to rule out worms.

Other than the swollen legs, he is completely normal- eating, drinking, etc., no fever.

Has anyone had this happen with there horse? Kinda at a loss with what is going on with him since overall he looks like he is in picture health.

Edited by HappyHunch2011

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Had this happen once with an older stallion who had been on straight alfalfa hay (TB). As soon as he was switched over to grass hay, the swelling went away. He was never sick either.

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we start the puzzle. for what has he been inoculated and in what intervals.

horses that work regularly and the don't work for two days (plows) on Monday's have swollen legs (edema). what is the horse getting to eat, and what is he doing daily (work).?

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He gets 3 qts of safe choice performance am and pm. Calfmanna, soaked alfalfa cubes and a hoof supplement at night. And grass hay 3-4 times a day.

He is an eventer- so dressage work (3-4 days a week), jumping (1-2 days a week), and trail riding (when possible at least 1 trail ride a week). He is ridden 5-6 days a week.

He was inoculated I believe in September. I have the records at home and I am on the road.

Edited by HappyHunch2011

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I would take samples of his feed and hay for analysis as well. Some horses (and people) don't react well to pesticides.

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Not necessarily. As with people, some are affected by things that don't bother others. I get breathless and wheezy standing next to someone with too much cologne, others aren't bothered.

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High liver enzymes indicate some liver problem, as more liver specific enzymes are released,as liver cells are damaged.

Fluid retention is one of the signs of liver damage

From link that follows:

'

Hepatic disease is common in large animals. Increases in serum hepatic enzymes and total bile acid concentration may indicate hepatic dysfunction, insult, disease, or failure. Although liver disease is especially common in horses and foals, 'progression to liver failure is not.'

http://www.merckvetmanual.com/mvm/digestive_system/hepatic_disease_in_large_animals/overview_of_hepatic_disease_in_large_animals.html

Another link, with some of the sypmtoms that might accompany liver disease, including excess fluid (edema )

The most common clinical signs are weight loss, hepatic encephalopathy, icterus and colic. Less common signs are hepatogenic photosensitization, diarrhea, bilateral laryngeal paralysis, hemorrhage and fever. Rarely reported clinical signs of hepatic insufficiency in horses are ascites, dependent abdominal edema, endotoxic shock and hemolysis.

http://veterinarynews.dvm360.com/liver-disease-horse-clinical-signs-and-diagnostic-aids?rel=canonical

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Laboratory findings of hepatic insufficiency

Because massive hepatic disease must be present before alterations are seen with some laboratory tests, and because different liver functions are variably altered by disease, the laboratory diagnosis of hepatic disease can be challenging.

The most useful diagnostic tests for evaluation of hepatic disease in horses are quantitation of sorbitol dehydrogenase (SDH) and gamma-glutamyl transpeptidase or -transferase (GGT) activity and serum bile acids concentration (SBA).

In the face of clinically significant liver disease, at least one of the three former serum tests typically is abnormal. Although increases in SDH, GGT and SBA are highly specific for liver disease, they are not specific for the type of disease.

(from second link )

In other words, the edema is secondary, and those elevated liver enzymes indicate some liver insult, which can have several causes

viral

toxic, either viral, bacterial or chemical

I would worry as to what has caused those elevated liver enzymes, and not so much on the edema, as it is jsut part of what is going on in that liver

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I can't remember the specifics but we had one similar which was a protein related reaction - swellings presented, etc.

Does/did he seem swollen around his head/eyes at all?

Perhaps add milk thistle supplement to his diet to help the liver in the meantime.

Edited by NaughtyNeigh2

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Also, with the raised liver count....have you had blood drawn before I presume to realise it is high? Or is there a possibility that the liver count could be a more long term issue that just wasn't known till the bloods were drawn for his legs?

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Another separate horse also had an extremely high liver count to the point the vet said chronic liver damage - this horse was a picture of health and it was only picked up 6 months after having him when a buyer had bloods done on a getting and we found out. He was worm counted and was negative and eventually the diagnosis was damage from ingesting a toxic plant like ragwort or similar as a youngster/previously. He luckily came back right after 6 months plus on milk thistle and special diet. His liver count was pretty dire yet he still looked absolutely fine and was in full work, bit of competing the whole time etc. If we hadn't gone to sell him, we'd never had even known till much later when symptoms digressed I would imagine.

Is there a chance of it being unrelated to the swellings and being a prior history issue? (like ours being exposed to a toxic plant etc)

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NaughtyNeigh- he does not have any swelling around his head/eyes. How did you come to find out it was protein related? We have never had his blood taken other than for the coggins test- so it is definitely possible that this has been going on longer term than we know. I contacted his previous owner- just wondering if they have ever had his blood drawn other than for coggins and have not heard back from her.

My vet was back out today and took more blood to see if the counts have gotten lower, stayed the same or higher. She also took blood to rule out lepto. Still not sure what has caused the higher count- but he has stayed completely normal throughout this whole thing.

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I can't remember for the life of me regarding the protein I'm afraid, perhaps have a google - but it isn't that uncommon over here. A lot of horses have reactions to haylage etc over here too, my friends horse swells up on haylage or any high protein/sugar feeds or seasonal grass changes etc. I only mentioned facial swellings as a lot which are reacting to that over here, get facial swellings too (mainly above eyes and glands in jowel).

Milk thistle would defo be a good idea for liver issues though.

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I can see the problem with haylage, but high protein in itself does not cause liver disease. Excess protein is excreted, and is only a problem if the horse has impaired kidney function

Liver damage itself, has to be pretty extensive, before the horse is actually clinically affected

Point being, specific enzyme tests are used all the time to assess/diagnose different organ problems. When there is cellular damage in any organ, be it heart, liver, , prostate, ect, a higher than normal amount of that enzyme is released, as those cells are destroyed.

If liver enzymes are up, the leg stocking up is just secondary to a liver problem, and not the primary concern

Many things can cause liver damage, including toxic plants, exposure to toxic substances in the environment , viral disease, ect.

Any chance his hay was contaminated with something?

I would think that the anecdotal association with high protein and liver damage, has another true cause, as in hay contamination , There is no documentation to my knowledge, that high protein levels cause any liver damage, although there are plenty of 'old wives tales, far a protein level, that have been debunked by equine nutritionists, like Dr Lorrie Warren

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The first horse with protein problems had melanomas so whether that contributed to the abnormal liver results - I don't know as I didn't own him and was a long time ago.

The friends horse with protein swellings has no liver problems associated only swellings.

The pony with liver damage was from a previous point in history not with us and was only picked up when bloods were done routinely on a purchase vetting.

My point being whether the two ailments are linked or not. If it's toxicity from a previous time then it could just be coincidentally timed with stocked up legs (for whatever reason that is).

The point being finding out if there's two separate problems, or one with secondary symptoms. :)

Edited by NaughtyNeigh2

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Yes, I think we agree on the stocking part, just being a symptom of the true problem-some live insult

Far as melanoma, it can be very likely that the horse had liver metastases, and many cancers themselves, produce abnormal proteins. If The horse was treated systemically for melanoma, that therapy could well have a side effect pf liver damage.

Being a lab tech, high liver specific enzymes are diagnostic of some liver disease/insult, and then that stocking up is just part of that entire picture, and not a separate entity

Fluid build up is very common in people with liver failure.

Horses and people can be surprising asymtomatic , until a large portion of the liver has been compromised. The liver also has a great potencial to heal, providing there is some healthy liver left, and insult/trigger is removed

So, the horse with melanoma, had a high blood protein, as opposed to a high protein diet? That makes sense, as abnormal blood protein levels are a part of tumors, failing organs, ect

This from a human medical source, but abnormally high protein levels are used to screen for liver disease

Total protein measurements of your blood can reflect nutritional status and are used to screen for and help diagnose liver and kidney diseases, as well as other health conditions. Sometimes an abnormal level of protein in your blood is detected well before symptoms of liver or kidney disease begin to appear. If total protein levels are abnormal, further testing is done to identify which specific protein is too low or too high so that an accurate diagnosis can be made. - See more at: http://www.livestrong.com/article/531533-what-causes-high-protein-in-liver/#sthash.RyJYcaVq.dpuf

Edited by Smilie

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I've owned him for a little over 3 years. My mom and I have discussed contacting his previous vet but have not done so to my knowledge. (We used the same vet they did when I lived in Maryland).

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Update: We took him to Mid Atlantic and after an ultrasound and biopsy he was diagnosed with subacute hepatitis with multi focal single cell necrosis. Still don't have a cause for why this happened but he stayed at the hospital for a week and a half. Still has high enzyme levels (higher than before- when we took him in his GGT level was in the 800 range). He was on IV baytril, IV penicillin and IV DMSO for the first week there. Than was switched to Baytril, Dexamethasone and DMSO (all IV) when the biopsy came back and his numbers did not go down.

He has stayed completely normal the entire time- eating, no fever, pooping/peeing, just plan normal. To keep the costs from going up and eating through the major medical we asked if we could bring him home and continue the meds, etc at home.

He's been on Dexamethasone and Baytril since being home. He ends the Dex on Monday and is switching to Prednisolone for a couple weeks. The last blood test we did after he came home did not show much of a difference in the levels. Taking blood again next week to see where the levels are and will go from there.

There is a chance he could go back down for laparoscopic surgery to get a better look at the liver with a camera if the levels don't go down.

We are going to put him on milk thistle seed- I read that the whole seed is hard for them to completely digest. I've seen it in powder and bruised form as well. Which would be the best to get (powdered or bruised)?

He also has a acupuncture/Chiro appointment next week, and we are looking into other things as well to help support the liver.

I am working in close contact with my vet and the vet from Mid Atlantic!

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