Any Ideas? Raised liver enzymes

[Erin]

Will try and keep this as brief and to the point as I can!

1st blood test on 22/09/11:
Elevated liver enzymes,
Liver function normal.
White blood cells abnormal (should be 70/30, Reena was 50/50)
Had a 3 week course of ABs (norodine) and started on a liver supplement (Legaphyton)

2nd blood test 24/10/11:
2 enzymes back to normal, other 2 greatly reduced.
White blood cells ok.

Finished liver supp a week later.

3rd blood test 21/11/11:
Liver enzymes back up.
Vet talked to specialist (Tim Brazil) and decide on biopsy.

Liver Biopsy 1/12/11:
Liver normal size, couldn't find anything specific but ruled out the really bad stuff (tumors, ragwort poisoning)
Small amount of Bilary Hyperplasia and thickening of the bile ducts.
No permanent damage.

Plan of action was: make sure iron & protein levels in diet are low (always have been) give her a Vit B supplement (TRM Multiplex, 3 week course) Put her back on the Legaphyton and a 4 week course of steriods (Prednidale)

4th blood test 13/1/12:
Liver enzymes still high and white blood cells changed (although still within normal range)
Vet has spoken to TB again, could be that the toxic insult has now gone but is progessive, or that she's still being exposed to it.
She has spent most of the last 4/5 months on box rest so we are pretty sure its not anything in the grazing.

First thing we are trying is cutting out all supplements other than her vit & min one (as recently moved to a new one, so we know its not that) and cleaning/sterilising all buckets every day. So we are trying that for 2 weeks (vet is going on holiday) and then will blood test again. (The supplements we are cutting out are Agnus Castus, Brewers Yeast, Milk Thistle & MSM - I dont think it is these though - she's been on the AC & MSM for over 18mnths and the BY & MT started after the 1st blood test)

We are also going to do a worm count (worming is all upto date, so this is just to rule it out)

Other things that may or may not be relevant:
She has been suffering with itchy skin - she is generally and itchy horse, but its normally just in the heat not this time of year. TB says he doesn't think this is related to liver.
She is craving salt. She was having 1tsp a day in her feed and was occasionally using her salt lick. I stopped adding it to her feed week ago to see if it was needed and she's got through a lot of her salt lick in the last few days. (She is drinking a normal & consitant amount).
She is suffering from a bit of thrush, could well be due to the box rest, but she's never had it before (and has had a few bits of box rest, but nothing as long)
All other horses on yard are fine - a few have had bloods done for other reasons and all normal.

Despite all of this she is fine! Lovely shiny coat, good feet, good weight (has lost weight - but is on a diet as was too fat, she could do with losing a little bit more) She's bright and alert and seems to be her normal self.

We are a bit stumped!

 

[be positive]

Have you tried a detox, vets are not so likely to recommend as it would be "alternative" but it can help support the liver function and also stop itching. I have used both global herbs and naf with good results.

 

[Box_Of_Frogs]

How old is she? Liver enzymes up and down + weight loss (+ a dozen more symptoms but not all horses get all symptoms) is something that is common in Cushings. Worth doing an ACTH test x

 

[little_critter]

You are about a month ahead of me - my mare had a liver biopsy yesterday with TB.
No idea at the moment what's causing her raised liver enzymes, results back next week.
My mare is lacking energy but other than that appears fine (good appetite, weight, coat, feet etc)
What vit / min supplement do you feed? Tim said to avoid iron so I need to find a vit / min supplement that doesn't have iron in it.
Depending on what the vet says I might switch hay because her sluggishness started around the same time we switched hay suppliers.
Frustrating isn't it?

 

[Erin]

Equimins Advance Complete Meta Balance - you need to phone and ask for it (the advance Complete on the website has iron in it, but the MB doesn't)

Be positive - i have thought about a liver detox, but i want to find out what's causing it so it doesn't happen again.

Box of frogs - interesting thought but where does the toxic insult come from? That's what the vets are pretty sure causing the problem.

 

[GreedyGuts]

You may already have done this, and I may have missed it in your post by reading too quickly, but has she been treated for liver fluke? I'd consider treating with Fasinex (Triclabendazole) to exclude this possibility.

 

[lizzy22]

I'm watching this post with interest as my horse has raised livery enzymes after having a cough which laid him really low at the end of November and our vet suggested a blood test.

3rd blood test has just come back with the enzymes lower but still not level and he still lacks a lot of energy, but he has always been laid back and he is 21 . He had just finished his course of Legaphyton when the last blood test was done, so I will be interested in the next one which is due in a couple of weeks time.

The vet did comment on his lethargy in the stable.

I have always fed him an iron supplement, so perhaps I should stop this? He also has garlic, MSM and Farrier4Feet daily.

 

[Erin]

You may already have done this, and I may have missed it in your post by reading too quickly, but has she been treated for liver fluke? I'd consider treating with Fasinex (Triclabendazole) to exclude this possibility.

I will mention to vet, but we are not in a 'flukey' area, no standing water etc

I have always fed him an iron supplement, so perhaps I should stop this?

I would! I was told to make sure all her feed was low/no iron.

I emailed the people at forage plus, who have suggested that perhaps my hay is high in iron which could be cause, so I am going to organise getting the hay analysed and see if that sheds any light.

I have also sent of a hair sample to be analysed and should have the results of that very soon.

 

[oscarwild]

I too read this post with interest as to things that can cause this. My horse had bloods done in July which gave us raised liver enzymes. She had lethargy and had a dull coat but otherwise was fine. She also had a liver biopsy done in Nov as her enzymes went down a bit then back up. Came back ok so it could be allergies that are causing the issue but we have no idea what so ever. she had a allergy test done when all this kicked off as she had a swelling in her throat which only came up grazing in certain fields. We are still none the wiser and are still having health issues with her.

Hope to get to the bottom of this as I would love to know why her enzymes are raised and that. Hope you get answers to your horses issues soon.

 

[Box_Of_Frogs]

Toxic insult is that Cushings makes the production of cortisol run riot. So the horse's body is full of the flight or fight hormone 24/7. The body's response to a sudden surge of cortisol is to temporarily shut down those bodily functions that aren't essential whilst the horse either runs for his life or turns to fight for it. Normally, the cortisol production would return to normal after a scare but with Cushings it's non stop. Eventually, this "turning off" of non-essential bodily systems has some pretty terrible effects. Be aware that at least 80% of horses over 21 will have Cushings. And 20% of those aged 15 and over will. The youngest horse I've ever heard of with Cushings was 8. It really is worth doing the ACTH test. Costs about £15 if you go onto talkaboutcushings.com and register your horse - you can then print off a voucher to give to your vet for £15 off the lab costs for the test.

 

[Alec Swan]

I will mention to vet, but we are not in a 'flukey' area, no standing water etc
.......

Liver Fluke is present nationwide and is no longer resident exclusively in the previously found wetlands. As you will probably know, the Fluke needs the Mud Snail, a minuscule mollusc, as a secondary host and so that it can continue its reproductive cycle, and that snail is now found on land where it's never been known before.

Do you, or have you had, high concentrations of sheep or deer where you keep your horses? Without previously high levels of ruminants, I'd be very surprised to here that Fluke is the problem.

Fasinex contains an additional white wormer, and Fasimec also contains an Ivermectin. It works very well on sheep, and having just read G_G's comments, I've googled it, and it seems on horses too!!

The Liver Fluke, in low concentrations is a relatively benign parasite, and doesn't set out to kill its host. It's only in heavy infestations that there is serious risk, and in ruminants, severe anaemia is the first sign.

None of the above is intended to frighten you, and I apologise if it has!! If you were to contact Novartis, the manufacturers of Fasimec, they have research vets on hand, who will readily talk you through the life of the Liver Fluke.

Alec.

 

[little_critter]

When my mare had her biopsy on Thursday I quizzed the vet about the fact that there seems to be a lot of unexplained liver issues around and did he have any ideas what could be causing it.
He said that in a lot of cases it appears to be due to mycotoxins.
From what I understand (I may be wrong) these are moulds growing on grass / hay / feed etc which can be toxic to livestock.
If you google them the websites have some pretty scary stuff on them but they tend to be American, perhaps there are milder versions too.
What you do about it I'm not sure - removing the source seems the best idea but if it's in your grazing then what?

 

[Erin]

Toxic insult is that Cushings makes the production of cortisol run riot.

Thanks, will ask vet about testing

Do you, or have you had, high concentrations of sheep or deer where you keep your horses? Without previously high levels of ruminants, I'd be very surprised to here that Fluke is the problem.

The yard we're on at the moment (been her for almost 3yrs) has been a livery yard for as long as I can remember (at least 15yrs) and no cows/sheep in the immediate area.
The yard she was on for the 2 1/2 yrs before had also been just horses for a long time, but had cows in the adjacent fields.

He said that in a lot of cases it appears to be due to mycotoxins.

I have googled mycotoxins, but all the horses on the yard eat the same hay, and no one else seems to have any problems.

 

[oscarwild]

I too have since googled mycotoxins and the none of the horses eating the same as my mare or in sale fields have had any issues. But I have wondered if it is mycotoxins could it be that my mare has something else going on (allergy or something) which has run her system down which has allowed this to develop?

 

[GreedyGuts]

To be honest, these days almost all areas of GB are affected by fluke to some degree or another, so I wouldn't rule it out on that basis. The area I work in is considered particularly 'flukey', and we routinely recommend treatment with a flukicide for horses with vague symptoms of illthrift/malaise and it seems to do the trick. We have farmer clients who will treat horses grazing with ruminants routinely; triclabendazole is a very safe drug (although not licensed for horses).

Horses are less prone to infection than ruminants, and show fewer symptoms when infected partly because they have more fibrous livers, but a proportion will show clinical signs. It is definitely something I'd be thinking about in horses with chronic elevation of the enzymes associated with cholestasis (Alkaline phosphatase, GGT and bilirubin) because the adult fluke worms sit inside the bile duct impairing their emptying, as opposed to those associated with damage to liver cells (AST and GLDH).

Your local Veterinary Investigation Centre would probably test a faecal sample or blood sample, for you but may just say that the test hasn't been validated for horses. I'd consider just treating if it were my horse after having a chat to your vet about it obviously.

 

[BuzyLizzie]

Thank you Box of Frogs and Alex Swan! I have a similar scenario with an 18yr old pony, i only had him blood tested in Nov after the vet confirmed he was not lethargic due to any lameness issues/arthritis. He is looking very well but i thought i had done a super job controlling his weight over the summer but the liver damage may have helped!

He has had a course of AB's Noromectin for 3 weeks with 3 tube of the B vits and 4 weeks of Hepatosyl. Next test showed 2/3rds improvement so continued with 3 weeks of Hepatosyl. Next test showed increased AST and something else (bio something?) but Gamma GT fine. I get a bit lost with all the terminology!!! We are now doing another course of AB's and 3 tubes of B Vits, but as the cost is getting serious i have dropped the Hepatosyl and have got some NAF Hepafyte Gold which is £20 for a 1l and will last a month for a pony, and has milk thistle extract in it. Sadly the pony has had LOU and therefore not insureable for vets fees!

We have sheep and have done for many years and i did suggest fluke as we had problems about 2 yrs ago with ewes with swollen jaws which was cured with a shot of flukicide. The vet and lab wrote the idea off, but if i do not get improvement this next test i will push this issue.

However, last week my other pony had colic and a different vet, new to the practice, came out and whilst we were waiting for the pain killers to kick in i was telling her about the other pony's liver problem. She told me that at her previous practice there was a lot of it about, and that it is thought we may be looking at a virus or some sort of infection like that, and that a veterinary body is doing some research into it.

I'm glad i am not the only going through this, as it does seem to be a bit of a mystery that is testing lots of vets.

 

[gem1979]

Another mystery liver problem sufferer here! Glad to say that my boy appears to be on the mend but never got to the bottom of the issue which started in May last year with lethargy and lacking stamina. He was confirmed as having hydatid cysts after a scan but these could be completely incidental.

On the subject of mycotoxins I read up quite a bit about these. As a possible issue I decided to try a toxin binder. I've used Mycosorb. Smelt quite strong (marmitey) and took a couple of days for my boy to get used to it but he eats it happily now. It may or may not have helped at all but all I can say is he's definitely feeling much better and enzyme levels are back to normal. Might be worth a try for anyone else wondering about toxins. I'm told liver problems can wax and wane so fingers crossed he doesn't get worse again. There does seem to be a high number of un-diagnosed liver problems about though.

 

[nikkirip]

Hi all. I read with interest the above as mine too has had mildly elevated liver enzymes and bile acid. He has had a tape worm infestation which could have caused and awaiting another test to see how things are going. Done tests too and not insulin resistant, thank fully. But what is fluke?
Nikki

 

[little_critter]

Another mystery liver problem sufferer here! Glad to say that my boy appears to be on the mend but never got to the bottom of the issue which started in May last year with lethargy and lacking stamina. He was confirmed as having hydatid cysts after a scan but these could be completely incidental.

On the subject of mycotoxins I read up quite a bit about these. As a possible issue I decided to try a toxin binder. I've used Mycosorb. Smelt quite strong (marmitey) and took a couple of days for my boy to get used to it but he eats it happily now. It may or may not have helped at all but all I can say is he's definitely feeling much better and enzyme levels are back to normal. Might be worth a try for anyone else wondering about toxins. I'm told liver problems can wax and wane so fingers crossed he doesn't get worse again. There does seem to be a high number of un-diagnosed liver problems about though.

I was reading up on Mycosorb the other day - where do you get it from?

 

[BuzyLizzie]

But what is fluke?
Nikki

Nikki, liver fluke is a parasite found in cattle and sheep that graze wet /low lying pastures.

 

[nikkirip]

Thanks buzylizzy. An interesting idea to research. Can they get liver fluke from being in the vicinity of cattle but not sharing the same grazing?

 

[Alec Swan]

Hi all. I read with interest the above as mine too has had mildly elevated liver enzymes and bile acid........

....... But what is fluke?
Nikki

In short, Google it. It's a worm-parasite, which when part grown, and attached to blades of grass, will be ingested by mammals (that's you and I, too!!) and when swallowed, it will migrate through the stomach wall and find it's way to the liver. Once there, and living in the bile duct, it will reproduce, and the eggs, as a sort of larvae, will then work their way back into the gut, and be passed out through the bowel.

This is where it gets interesting. In a larvae form, the Fluke needs to source a very small snail, known as the mud snail (L truncatula) (and I hope that you're impressed!!) anyway, when it's lived within its secondary host, for a while, it leaves, climbs up a stem of grass, and is re-ingested, by a mammal.

That's about it. It's a fiendishly clever, damaging and revolting little parasite.

Alec.

 

[Alec Swan]

Nikki, liver fluke is a parasite found in cattle and sheep that graze wet /low lying pastures.

The Liver Fluke can and does infect and affect any living creature which has a liver. Those humans who act as hosts, generally manage to get it form water cress.

I wouldn't worry too much, mostly we survive it.

Alec.

 

[BuzyLizzie]

The Liver Fluke can and does infect and affect any living creature which has a liver. Those humans who act as hosts, generally manage to get it form water cress.

I wouldn't worry too much, mostly we survive it.

Alec.

Thank you for clarifying that for me/us, i've never been a big fan of watercress so i think i'll be ok! On a more serious note I am going to express my concern to my vet about the Fluke possibility. Obviously I don't want to give him any sort of wormer or drugs that will challenge the liver unless they are essential to his recovery.

 

[little_critter]

Got my biopsy results today so update as promised...
The biopsy showed some change to the liver which is reversable. Also a little scarring (not much at all).
On a scale of 1-14 (1 being normal horse, 14 being about to drop dead) her liver is a 2 so the smallest amount of change detectable.
There were no signs of ragwort damage.
The likely cause is some sort of dietry influence on the liver - possibly mycotoxins.
The likely sources are hay and pasture so see if we can move field and switch hay to see if this causes an improvement.
The vet suggested a months course of prednisolone to see if this kick starts some repair (it may be able to repair some of the scarring)
We will keep doing blood tests to see if the swapping and changing of forage has worked.
I asked if Mycosorb would be worth using (is supposed to bind the mycotoxins and prevent them getting into the horses system) The vet hadn't heard if it but will investigate and let me know if there's any science behind the claim or just quackery.
I celebrated by bringing my mare back into work and having a gentle hack (not sure she was too keen on the 'gentle')

 

[yellowdun]

We went through this with a 7 year old last year. Similar blood results and symptons. Tests showed it was pasture and hay related. I did stop the supplements and just fed what they vet gave me in a small amount of A&P Fast Fibre. I had to move areas to test the pasture theory. We also tried anti histimine powders from the vet and steroids for a time.

 

[gem1979]

I was reading up on Mycosorb the other day - where do you get it from?

The first lot I ordered from Barefoot Basics which hadn't shown after 2 weeks. Had emailed them and got no response so ordered some from www.haysteamers.co.uk which came the next day. The Barefoot Basics stuff turned up a few days later.

This link has some more info about mycotoxins.
http://www.knowmycotoxins.com/horse.htm

 

[thundersprite]

my mare also had liver problems and it was touch and go for a while , she underwent 3 liver biopsys but the cause was never found she also had a belly tap
her symptoms were
weight loss
dull cat hairy course coat
eyes would go like she had been sedated
she was explode and run and once collapse
very stressy
colics
would start eating feed then leave it and colic
started cow kicking
and would sit on her quaters if rollered like she was cold backed but she wasnt
she had a 30 day course of antiboitics but bloods showed they didnt change any thing
she was then on 90 tablets of 5mg per tablet prednisolone but they never heped her either
then the last thing we tried was

hepatosyl 4 tablets a day
and enalapril maleate 22 tablets a day which is a human blood pressure tablet
and she started improving

shes still got 1 liver function raised but that going to be the norm for her

she was put on v-sorbin as high b supplement by tim brazil and my vet to
she also had yea-sac, milk thistle and a low dose of mag ox

she had a thread at the time on another forum
http://ihdg.proboards.com/index.cgi?board=help&action=display&thread=100990&page=1

 

[nikkirip]

Thanks Alex re Liver fluke. I'll definitely keep my grass and water cress eating to a minimum!

Nikki

 

[Erin]

Just an update for anyone interested.

We had the hay analysed and it came back as being very high in iron.
We also tested the iron levels in the blood. The top end of the 'average' is 35 and Reena's was 48.

So although it probably wasn't the hay that caused the initial problem/toxic insult, this seems to be the reason it has been dragging on for so long.