Improved liver function for Hannah

Hannah progress report week of 7/7

Hannah is in a good mood and she is doing down the steps the the backyard and up the steps to the office with increasing frequency. A few weeks ago she would hesitate to do these everyday activities that she had done so effortlessly in the past. For the past few days, that hesitation is gone.

This week we had some very good news regarding Hannah's liver function. Both her Alkaline Phosphatase and her ALT (SGPT) values were closer to normal. This is encouraging news.

After her blood work on June 18, Actigall was added to the Denamarin that she was already taking for liver support. That combination has led to a marked improvement in her liver values.

	Alkaline Phosphatase (5-131)	ALT (SGPT) (12-118)
June 3	2821	1901
June 4	3107	1932
June 18	2108	505
July 8	476	173

Unfortunately, her kidney function is still and issue. Our vet feels that this is an age related decline. She mentioned that Hannah has about 25% kidney function now. According to the IRIS kidney staging, Hannah's plasma creatinine would put her right in the Stage 2-3 borderline area which means keep a close eye on things.

	BUN (6-25)	creatinine (0.5-1.6)
June 3	29	1.0
June	25	2.0
June 18	38	2.1
July 8	45	1.8

Hannah continues to not want to eat much per meal. If we are going to cook for her at home our vet suggests 1 part meat (lean meat or eggs) to 3 parts starch (mashed potatoes, rice) and a children's or pet multivitamin. In terms of quantity it would be about 1 cup per 10 pounds of dog. Dr. S. stressed that this would not be a balanced diet for 14 years or anything but that it is good for trying to get them to eat.

Finally, our vet suggested that we might want to treat Hananh's Cushing's (hyperadrenocorticism) more as an atypcial Cushings than a primary adrenal type Cushings. In other words, she suggested that melatonin and Omega-3/Linolenic Acid might be a reasonable approach.

Hannah is to continue on the Actigall and Denamarin. She is doing well and we are reluctant to do anything that would make her feel less well for even a few weeks. For that reason, I think that we are leaning towards the melatonin treatment. Dr. S. is not recommending testing by the University of Tennessee at this time.

Options:

• surgery to remove enlarged adrenal gland - Hannah is not a good candidate
• Lysodren - not a cure
• melatonin - not a cure. The melatonin and the lignans somehow have a reaction with the secondary sex hormones in the adrenal glands that are elevated
• keep Hannah comfy - tramadol only

Update: After discussing it with DH tonight, I think that we are going to try the melatonin route. I will talk to Dr. S. about this again tomorrow. I have a call in to Dr. S. now confirming that the goal of this treatment is to better manage Hannah's hormones/endocrine system and that we are treating this as if it were atypical Cushing's.

Update 2: Dr. S. suggested that we treat for atypical at this point in an effort to improve the quality and dignity of Hannah's life. At some point in the future we will probably want to do the University of Tennessee panel but she feels comfortable treating Hannah this way now. If we do not see results or future testing indicates otherwise, we may need to revisit other options. Hannah is somewhat fragile at this point and this is a very safe treatment. We are starting with 3mg melatonin 2x daily (may increase to 6mg in the future) and omega-3 fatty acids with lignans.

Hannah's current medications: osteoarthritis (Tramadol 50 mg (3x daily), Zubrin 200mg), urinary tract infection (Amoxicillin 500mg, FortiFlora probiotic), Denamarin 425 mg, Actigall 300mg, Famotidine (10mg, 3x daily); melatonin (3mg, 2x daily); Purina Veterinary Diets EN GastroENteric Canine Formula dog food