My nine year old dog had an abdominal ultrasound because her liver values were in the 200s (ALT and ALP). The ultrasound revealed some stones in her bladder which, I was told, is a normal occurrence in dogs her age. There was also a bit of sludge in her gallbladder. The specialist in internal medicine didn’t seem alarmed at all and told us there was nothing abnormal.

Baby had already started taking a prescription medication with SAMe and silybin/phospholipids (milk thistle) but I wonder now if it’s worth it to continue with this since her issues are normal for her age? Can the medication still help by prevention of more stones? I would like to know why or why not this should be continued. I am very happy it’s all natural, at least! Also, the vet has said that Baby should be taking the drug Ursodiol because of the sludge in the gallbladder.

I have read that, unlike the SAMe and milk thistle, this medication can have some harmful side effects and even cause cancer. Is there a more natural way to deal with gallbladder sludge and is it really important to treat this? We have recently changed Baby’s diet from a holistic commercial to a specially balanced homemade diet with salmon and lots of fresh vegetables, fruits, oils, etc. (slightly cooked because she won’t eat raw). Will this in itself help the issue or is more needed?

~ Lisa

Dr Jeff FeinmanHi Lisa,

What a greet thing you are doing for Baby by feeding her a fresh food diet and investigating the cause of her elevated serum alkaline phosphatase (SAP or ALP) and alanine aminotransferase (ALT). In my experience and clinical experience, feeding fresh (and yes, even raw!) foods are one of the best ways to manage most chronic dis-orders. Especially when they are gastrointestinal (stomach, intestines, liver, pancreas, etc.) in origin. It is fantastic that you had her diet’s composition analyzed and balanced. Only by doing so, can any diet safely be fed every day for long periods of time. I find that the more common method for achieving balance is by feeding a wide variety of fresh foods in moderation. Similar to how we eat.

Normal urine crystals may accumulate and form “sand” in the bladder. In some dogs, these tiny crystal coalesce and form a larger stone. Unlike Baby, these dogs have clinical signs of cystitis (bladder inflammation). Frequent, difficult urination is a very common symptom in these patients. As Baby’s internist said, minute and sub-clinical bladder stones are indeed an occasional incidental finding seen on abdominal ultrasound in some older dogs. A good ultrasonographer with sensitive ultrasound equipment can diagnosis stones below .25 cm. These minute stones are below the size that can be seen on x-rays and may never cause a problem. Certain breeds are genetically predisposed to forming stones like Bichons, Lhasa Apsos and Miniature Schnauzers.

Regarding supplementation, I agree that continuing the SAMe and milk thistle supplements would be beneficial to continue. It is wonderful to watch biochemical abnormalities return to normal under any kind of treatment. Especially when those treatments are virtually free from the toxic problems that plague drug treatment. In general, ursodiol is safe to use, but can still have serious side-effects. I hear from many pet owners who are seeing fantastic clinical and biochemical improvement from supplements that help optimize liver function. Hepato Support from Rx Vitamins is a commonly used and widely available supplement that provides great liver support with milk thistle, alpha lipoid acid, methionine, choline. SAMe and DMG are both also very useful in helping support Baby’s liver function. I consulted with veterinary herbalist Dr. Cynthia Lankenau to learn more about medicinal herbs that can further help thin the bile. Gentiana (not gentian violent) has a long history of successful use and has well documented effeicacy: Others include dandelion root, chamomile and yellow dock.

It is important to know however that even when natural methods like vitamins, supplements, herbs, acupuncture, etc. are used, this manipulation of symptoms is pharmacological. This will lead to their palliation and not their permanent resolution. Even if Baby’s liver blood values and urine results return to “normal”, she is not free of the underlying dis-ease that is causing problems with her liver and bladder/kidneys. Covering up symptoms (palliation and suppression) is commonly practiced but should not be the goal of treatment in my opinion.

Curative resolution of Baby’s elevated liver enzymes, thick bile, etc. can only occur if the underlying problem is addressed. Although there are many triggers that lead to imbalance, there is only one primary energetic imbalance that causes all secondary physiologic abnormalities. It results in most symptoms like arthritis, skin and ear problems, behavior and emotional issues, etc. The body can become imbalanced many ways. Inherited problems, environmental toxins, inadequate diet and repeated vaccination are among the most common.

Energetic homeopathic treatment needs to be guided by Baby’s specific symptoms. In general though, there are certain homeopathic medicines that have affinity for different organs and parts of the body. A professional homeopath can analyze Baby’s history, review her medical records and diagnostic tests to help determine which would be most effective in her specific situation. Homeopathic medicines will stimulate the natural healing of her body. In addition to improvement of specific symptoms, one of the wonderful benefits of curative (vs. palliative or suppressive) homeopathic treatment is a higher level of health. This may mean that during treatment of her liver problems Baby becomes less fearful of thunder, wants to again interact and play nicely with other dogs, has a better appetite, stops leaking urine, etc.

Baby reminds me of a patient I originally saw in 2004. In late winter of 2011 Molly had started acting a bit strangely. She was eating leaves, rocks. A few years earlier she had an episode of severe autoimmune hemolytic anemia which she had survived. Because of this previous problem, during her exam she had a quick in-clinic red cell count that was normal. The blood tests sent out to the lab however were another story. At that time, her lab values were even worse than Baby’s. Her ALT was found to be over 400 and her ALP was over 600.

On the first day of Spring of 2011 I referred her to an internist to help obtain a definitive diagnosis. Abdominal ultrasound revealed a very inflamed gall bladder that looked like it was about to rupture, gall stones, and bile sludge. At that time the owners elected to have her gall bladder removed as advised by the specialist.

Being more holistically-minded and having treated Molly with homeopathy in the past, her guardians chose to bring her back to me before she had surgery. As in all cases with structural pathology, I warned them that the healing ability of Molly’s body when stimulated by homeopathic medicines could not be fully determined in advance of therapy. Regardless, they chose to start treating Molly with homeopathy.

Within 10 days, Molly was feeling better. Her energy was higher, she was in a better mood and acting more like herself in many ways. On her 3 week blood recheck, her SAP was about ~30% improved but her ALT was 10% worse. During her recheck, I pointed out that with homeopathic treatment we commonly see internal improvement reflected in improved mood and energy prior to improvement of blood tests.

No need for me to go further into this case except to say that Molly’s liver problem fully resolved soon thereafter. 1 ½ years later another ultrasound was performed for a different problem. In it her inflamed gallbladder, bile sludge and gall stones had all resolved. The body had healed itself under homeopathic guidance. As nature intended.

It is most beneficial to continue supporting and working with Baby’s body to optimize her well-being and longevity.

Best of luck on your holistic and homeopathic journey with Baby.

Dr. Jeff

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