I have always treated any liver problems with at least 21 days of AB's. Diagnosis to me is more important. Shotgun therapy with Pred and AB's usually bring the dog back to health, but what should you expect then? I really try to stress diagnosis even though it is $$. Autoimmune disease needs to be uncovered for future prognostic reasons.

2. As to the dog you mentioned, I am sure this isn't the only response you will get from veterinarians on the list who are concerned at the choice of treatment and lack of diagnostic testing for this dog.

The dog sounds like it is icteric or jaundiced, which only tells the vet that there is biliruben in the bloodstream. Bilirubin can be high due to liver disease, but it can also be elevated in certain circumstances by hemolysis (red blood cell breakage in the bloodstream, allowing hemoglobin to be released and processed by the liver to biliruben).

At this point diagnostic testing is the only way to know what is going on in that dog's body. Starting with a complete blood count, and blood chemistry, but more than likely to include specific tests for liver function, as well as possibly imaging (X-rays or ultrasound to see the liver). Liver diagnosis is difficult and often requires a biopsy. I don't know what the financial situation is, and all this costs money, of course. If the owners were part of the reason no diagnostic testing was done, I can see using antibiotics (though nothing actually pointed to infection, unless a cbc was run and evidence to support infection was found), as they probably would do no harm. Prednisone or prednisolone might be indicated if it was a hemolytic disease, but if it is a liver disease, especially an infection, they would be contraindicated, and may actually harm the dog.

As to the diet, a low protein diet may actually be indicated (or not), but getting him to eat is important until you know what is actually causing the problem. The pred is almost certainly causing the urine accidents.

He could have a liver tumor, a liver inflammation, a liver infection, a toxicity reaction to something, autoimmune hemolytic anemia, bile duct blockage, or a host of other diseases. The appropriate treatment to each of these problems varies widely, so he needs a DIAGNOSIS to guide rational treatment.

Other useful responses:

1. I'm thinking in human terms, but you'd be surprised how similar dogs are! It sounds like the dog is in liver failure. They usually stop eating and have a huge increase in thrist. Thus the additional water amy not necessarily be from the steroid (more later). Look at the eyes, the white will be yellow. Look at the urine. It will appear darkish brown like tea. Look from the side at the stomach. There may be swelling (ascites). The liver's circulatory system is a bit different from the rest of the body so an increase in venous pressure causes fluid to build up and that's what causes the swelling. It's not a true inflammation (hence steroids won't work). If things are advanced, there may be blood in the stool or urine, also you may see bruises on the gums and soft tissues. The dog will want excessive amounts of water just from the liver disease. As it progresses it can lead to seizures, coma and death. This is not something to mess around with!

You really need to try to find a cause. it could be things like chemicals--especially lawn chemicals, insecticides, lead, copper, phosphorous iron, selenium or arsenic. Check his diet, surroundings, water etc. It can also be rom viruses or cancer. In dogs heartworm, gallstones and flukes have been reported. Certain breeds are more susceptible to copper toxicosis. If that is the case the copper needs to be chelated from the system. Certain antibiotics and also steroids can make the situation worse. That is why you need to know what you are dealing with.

You said the dog is drinking more water, that is a side effect of the steroid and it may be a warning the dog is a steroid responder.

2. I don't know about "liver infections', I do know about liver shunts & undersized livers. There's a fairly easy test, not too expensive (about $60 here) called the "Bile Acid test". The dog in question is brought in first thing in the morning, without having been fed (sorry, I know there's a term for that, but I haven't had my coffee yet & can't think of it). Blood is drawn, then the dog is fed a small, high protein meal. Two hours later blood is drawn again. Bile acid levels are measured in both samples. The first sample should show a level below 20 & the second should show below 25. If the dog is affected, it is manageable with diet, environment and weight control.

Our dog has an undersized liver with shunts. She is on k/d, with only fruits & veges for the occasional snack. We make sure she doesn't get much stress & don't introduce any unnecessary chemicals in her system. She doesn't get Frontline, or any of those products & luckily we don't live in an area with lots of heartworm. So, although she gets checked each year,she doesn't get the heartworm preventative medicine like our others. We haven't even had the front yard sprayed for ants. She is mostly an indoor, couch potato. She's pretty much asymptomatic. The most noticeable thing is that she doesn't have the extended energy level you'd expect in a 2 year old (NOT necessarily a bad thing *g*). She is loved & spoiled and the only Dal in my house not to have had formal obedience work. She has 'house manners' & walks nicely on a lead, but not much more than that. Our vet says she probably won't live as long as she would without this problem, but doesn't know how long. We caught it early, so her body didn't have to try to deal with so many toxins in the blood. That's what happens when the liver's too small & shunts by-pass the liver. Some of the blood doesn't get filtered & cleaned and returns to the system carrying those toxins that would have been removed. The longer an affected dog goes without the proper diet, the longer the body is exposed to those elevated toxins that can do all sorts of internal damage.

3. I am hoping against hope that this is the problem, however this description triggered an idea. I lost my 10-year-old Dal bitch in March to liver failure which was secondary to a spleenic tumor. We had no inkling there was a problem until she collapsed one day when the tumor ruptured. A splenectomy was performed, successfully, but it quickly became apparent that she had other problems. She wasn't obviously icteric (yellow) but had a clotting deficiency. Within 36 hours, she began to become icteric and, unfortunately, we were forced to make the decision. As you can imagine, it was horrible.

Short answer - were this my dog, I'd take it in quickly and VERY CAREFULLY to have an x-ray done. (If it is indeed a spleenic tumor, those things are terribly fragile. My vets wouldn't even palpate her - they only x-rayed her. The tumor ruptured again just as the vet was removing it from her abdomen - I was there and saw it.) Hope this isn't it. Hope it's something simple and imminently curable.

4. ___ has a Dal with a very serious liver problem. Some of the symptoms you have described sound familiar. At about 2 1/2 years began consuming large amounts of water and having accidents in the house. Owner assumed that he had some type of urinary infection and could not believe the diagnosis from her vet. She took him to her vet and they performed a liver biopsy. His liver is abnormally small and the vessels in and out of the liver are constricted. Little they can do for him. They could perform surgery and insert shunts to help with the blood flow, but there are no guarantees and success rate is slim. He is on a special diet, and I believe she gives him herbs to help cleanse what the liver isn't. To see the dog he does not necessarily look unhealthy. He is somewhat bloated all the time, but is still very active. In fact, she must limit his activity. If he plays too hard - he will pay for it later. She has indicated that he often brings his food back up shortly after eating. He continues to have accidents - he is not marking...poor fellow, these accidents are in his crate and in front of the door. And, he often has "tremors" - not exactly seizures. I'll check with her regarding the exact diagnosis she was given.

5. Sue, I'm going to have to query my parents (never a FUN phone call) but their old patched male (now this decade gone to the Rainbow Bridge) did have liver disease of some sort. This dog was fat as a pig -- something I carped at my father about constantly. But the vet told them he needed to "diet or die," and they got the weight off. The liver improved, and Hank lived to be maybe 12 years old. I think his liver was as full of fat as a Strasbourg Goose being fattened up to make pate. These folks may say the dog is "slightly" overweight. MY dad said Hank was "a FINE figure of a dog! SUBSTANTIAL!" He was, of course, obese.