Coughing and liver problems.

Dr. Marie replied:

Hi and thanks for your question.

First of all, I'm so sorry about the delay in getting back to you. I had a baby 11 days ago and am not completely on top of my game! Thank you for sending the email to remind me about your question.

I'm so sorry to hear that Mazzy is not feeling well. Cases like this are difficult as often it can be hard to know exactly what is going on. I'll give you my thoughts though.

There are not many things that can make a dog cough. I do tend to get concerned though when an older dog coughs. Something like Kennel cough is always a possibility, but kennel cough is something that should not come and go like this...it should get better within a few days or at least be dramatically improved by now.

A heart condition can cause a cough, but this is not that common in a larger dog. Plus, xrays really should have shown if there was heart enlargement (which usually goes along with a cough.)

Some type of asthma (such as COPD) is definitely a possibility. This type of problem is usually treated quite well with steroids. However, asthma or COPD should not cause weight loss. Neither should steroids.

The liver enzymes are moderately elevated. This can sometimes be hard to figure out a cause for. Yes, steroids can cause an elevation in ALP, but they should not cause an elevation in ALT and GGT. I am concerned that there is something more serious going on. Unfortunately, with the liver, it is often very difficult to get a diagnosis. A good next step would be to talk to your vet about getting an ultrasound done of Mazzy's liver. The point of the ultrasound would be to look for signs of cancer. Some liver diseases, however, don't show up on ultrasound. A liver biopsy can often be more helpful but this will increase the expense of her diagnosis.

If this were my case I would likely be suggesting the ultrasound. I would also want to repeat her chest xrays. Unfortunately I am concerned about the possibility of cancer. Sometimes, cancer that is in the chest will not be super obvious on xrays. I have had some cases where we took xrays and could not see anything significant, but when we repeated xrays a few days to a week later we could see that there was cancer in the chest.

Any time I see an older lab with some type of breathing issues I wonder about a condition called laryngeal paralysis. However, this condition doesn't really cause a cough...it is more like just labored and loud breathing. It also wouldn't cause the weight loss.

I'm not sure that a low fat diet is a good thing right now...if she is fighting illness she may need some extra fat in her diet. If this were my dog I wouldn't be making any dietary changes at this point. The only exception would be if the vet wanted to put her on a reduced protein diet which we often do for dogs with liver disease.

I wish I could give you more answers. I am concerned about what you have written. I think it is a good idea to repeat her bloodwork and see if things are changing dramatically. And, if your vet suggests extra tests such as repeat xrays or ultrasound I think that is a good idea.

Please let me know if you have more questions.

Dr. Marie


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Dr. Marie replied:

I think the plan is a good one.

Often in cases like this I still do recommend an ultrasound because it can help with decision making. If we find out that there is cancer present in the liver then we may decide not to be too aggressive with medications but rather keep her as comfortable as possible until it is time for euthanasia. But, your vet is right - at this point the liver ultrasound is not likely to change anything in regards to how Mazzy is feeling.

It's really hard to know how to proceed because the symptoms she has could belong to a great number of issues - some serious and some not so serious. I think the plan to repeat bloodwork shortly is good. Most likely if there is something really serious then you will see that the liver values have increased despite the supplements.

I really hope you get some answers (and hopefully good ones) soon!

Dr. Marie.

Dr. Marie replied:

There are many things that can cause diarrhea and often it's hard to know what the cause is!

I am concerned about the cough though. You may want to consider another xray to see if there are now signs of something more serious like cancer.