Is There Hope for Healing Canine Liver Disease?

Chances are, if you're reading this page, your dog has been diagnosed with liver disease. Is there hope for healing canine liver disease? This page documents some of what I did to help my dog improve his liver function. Hopefully you will find some useful tidbits here that will help your dog too.

DISCLAIMER: I'm not a vet and I have no veterinary or medical background whatsoever. This information on liver disease in dogs is not meant as a substitute or replacement for veterinary advice. It's meant for educational and informational purposes only, as a starting point for discussing the diagnosis and treatment of canine liver disease with a qualified vet.

Background: My dog had been diagnosed as a Cushings Dog. The symptoms of Cushings Disease in dogs are easily mistaken for the natural progression of old age... we were fortunate to catch it, and, not long after I started my dog on maintenance therapy for Cushings, I started seeing subtle signs of something not right. Back to the vet he went. After more testing, I got the devastating diagnosis that he had "significant liver damage".

The vet estimated he would feel okay for 2 or 3 weeks and then start a decline. Surgery wasn't an option; my dog's liver was covered in multiple lesions. Supportive care was what I decided on, and at the time of writing this web page, it's been 9 months and my ancient "pup" is still going strong and feeling great.

The main issues were getting him to take his medications (several types of supplements and pills), and getting him to eat. We all need food for energy to help our bodies heal when we're ill, and it was no different for him. It took about a month before he really started turning around. At 2 months, he was perhaps 75% of normal, and at 3 months he was pretty much himself again (his lab values, though, took a couple months more to return to near-normal).

SUPPORTIVE THERAPY FOR CANINE LIVER DISEASE

It is critical that you find a vet you trust, and one who will give you a straight-forward answer to your questions. Preferably, you can find a vet who is experienced with liver disease - an Internal Medicine Specialist (also called an IMS or an internist) is often the best person for this job.

My vet suggested several things to give my dog a chance to heal, if possible, and to help him feel his best. The first was a couple of types of antibiotics - I'm not going to name them here, because that's something that's best determined by your vet. The vet also suggested using Pepcid to help calm my dog's nausea. This helped to some degree. And finally, there were a couple of supplements called Zentonil and Marin, both of which contain ingredients that help the liver. Ask your vet for more information and to make sure these are safe for your dog.

Fair warning though, that the costs of all these pills add up and it can be very expensive. Ordering online is often cheaper (I order ours through Amazon.com).

OTHER USEFUL WEBSITES/RESOURCES:

LACK OF APPETITE - TIPS ON GETTING YOUR DOG TO EAT

One of the biggest and most stressful issues was inappetence: my dog simply did not want to eat. The liver disease was making him nauseous, and even taking a Pepcid tablet twice a day did not give him significant relief from the nausea.

I know that some vets will recommend that you feed a prescription diet that has been specially formulated for dogs with liver disease... the problem with this is, if a dog won't even eat many of his favorite foods, then why would he want to eat this new diet? (For the record, I tried offering my dog several brands of prescription dog food meant specifically for dogs with liver disease -- he consistently refused all of them)

Our vet told us to take our dog home and feed him anything he wanted to eat. I think this was good advice. I strongly felt that it was better that he ate something, anything at all, then insist he try a prescription diet, or a low-protein diet, and instead have him eat nothing at all. A body needs food for energy to help itself heal.

If your dog isn't getting enough calories or nutrients, try a high-quality nutritional supplement like Nutrical. This is a gel you can rub onto your dog's gums. For us, it turned out that Nutrical worked as a minor appetite stimulant as well - right after giving my dog the gel, he would usually eat something. It wasn't much - usually only a couple of teaspoons worth of food - but it was something.
OTHER USEFUL WEBSITES/RESOURCES:

Drugs Used to Stimulate Appetite (discuss with your vet)
Try warming up the food to room temperature, or slightly warmer. Heating up food can help enhance its scent. This may be enough to persuade your dog to at least try the food.
Try serving the food cold. If your dog is feeling nauseous, strong scents may turn him off completely. So try serving chilled food instead. Offer a small bite-sized morsel first to try and entice him to eat. My dog accepted cold food far more often than warmed food.
Bake canned dog food. Invert a can of dog food until the food comes out in one piece. Then slice the food as thin as you can and place them on a cookie sheet. Bake at low temperatures until the slices are completely dry.
Cook - and grocery shop. I tried scrambled eggs (sometimes with ham or cheese), fried eggs, hard-boiled egg yolks, ground chicken / turkey / beef simmered with rice; roast beef; roast chicken and flavored chicken wings from the grocery store; chicken pot pie; oatmeal; pretty much anything (note: many, many times my dog refused the food I had prepared, so it became my lunch or dinner).
Offer very small quantities. When my dog was feeling nauseous, a larger amount of food made it worse. Sometimes he would eat if I offered a teensy scarce 1/2 teaspoon of food at a time (at times, he would eat 1/4 cup or more of food in this way!).
Offer food throughout the day. It's hard to know when your dog will be feeling inclined to eat... so if it's possible, offer him food whenever you can. You never know when he's going to accept.
Be creative in how you offer food. Sometimes we offered it on a fork, on a spoon, or offered fingerfuls of food. My dog would occasionally eat kibble off the floor, if I didn't put down more than 3 or 4 kibble at a time. And sometimes he'd eat if I put a small amount of food beside him (not in front of him), so that he could easily turn his head and eat it when he wanted.
Don't force him to eat -- it might make him turn away in the future. If he's not eating, he might still be feeling too nauseous to eat. You don't want him to associate the food with feeling bad.
Be wary of hiding pills in food. Hiding pills in food is the easiest way to administer them -- if you don't get caught! With my dog, he would sometimes roll the food in his mouth before eating it... and a couple of times he ended up tasting the pill. That was the end of that food - he wouldn't ever touch it again... and that's the last thing you want when liver disease is making your dog so nauseous he hardly wants to eat anything at all.
Ask your vet to show you how to properly "pill" your dog. What we found helpful were "Pill Pockets" -- you hide your pills inside this "treat" and some dogs will willingly eat them. Mine wouldn't. But they were still helpful because I could package up several pills at a time, so I only needed to pill him once (rather than having to give him a whole series of pills, one by one).
Be watchful for any 'quirks' that may help your dog eat. For example, my dog didn't want me to look at him while he ate, so I spent a lot of time pretending to gaze at the wall or ceiling, while surreptitiously watching him from my peripheral vision.

HYDRATION - IS YOUR DOG DRINKING ENOUGH?

The nausea caused by my dog's liver disease made him even reluctant to drink, at times. I experimented with what would entice him to drink: huge, deep bowls of cold, fresh water... room temperature water... shallow bowls... water bowls all over the house... ice cubes... water flavored with a bit of chicken or vegetable broth... even just the (low-sodium) broth itself would help to hydrate him.

Someone had suggested to us that we try unflavored Pedialyte, which is a hydration drink for children. I gave it to my dog a few times, but he hated it so much that I stopped. Instead, I added water to his food whenever he would accept it (for example, mixed with a bit of tasty canned food).

If your dog gets dehydrated, the other thing your vet can do is give your dog subcutaneous fluids.

You can check your dog for dehydration by:

Grab the skin between his shoulders and gently pull it up. Let it go. It should immediately rebound back into place. It it's slow to settle back into place, your dog might be dehydrated.
Check your dog's gums. They should feel slippery and look 'shiny'. Then take a finger and gently press the gums until they turn white. Release. The gums should return to their usual pinkness almost right away. If your dog's gums are sticky and dull-looking, or if the gums don't return to their regular pink color after being pressed, your dog might be dehydrated.

OUR RESULTS

I never could persuade my dog to eat a low-protein diet, as dogs with liver disease are supposed to do. He was always thrilled and happy when it came time for his walk (oddly, his energy level never flagged, even though he wasn't eating much) - but when it came to food, it had to be extra-delicious for him to even consider it. For him, extra-delicious = protein.

It took about 5 months from the time of diagnosis to get my dog's liver values and function back to near-normal levels. But much earlier than that, he was back to eating well. Now -- 9 months after diagnosis, at the time I'm writing this -- his liver appears to be stable. But that doesn't mean it's all okay. Since he has a history of liver problems now, he continues to get his nutritional and supportive supplements. We stay away from drugs whenever possible, and use complementary/alternative therapies instead. For example, instead of using the heavy-duty drugs Rimadyl or Metacam to relieve his arthritis, he gets Zeel and goes for acupuncture treatments. So far it seems to be working. If or when it stops working, then I will give him whatever drugs needed to keep him comfortable and maintain his quality of life.

IS THERE HOPE FOR DOGS WITH LIVER DISEASE?

The liver is an amazing organ. Liver calls can regenerate, and dogs can regain good liver function even when there has been significant liver damage. It happened with us. That's not to say that it will happen for every dog... sometimes the damage is simply too great and we need to make the difficult decision to let our friend go when life isn't any fun anymore. Early detection can provide more options and more time to try to reverse the damage - be sure you know the symptoms of liver problems in dogs, and talk to your vet to figure out a course of action. There is hope for healing canine liver disease.

OTHER ARTICLES ABOUT LIVER DISEASE IN DOGS:

Symptoms of Liver Problems in Dogs

Canine Liver Disease - Prognosis

Liver Damage in Dogs - Dog Vomiting Bile

Hepatic Encephalopathy in Dogs

*Hope for Healing Canine Liver Disease