Typically an increase in gamma-glutamyltransferase with other parameters being normal may indicate a bile duct obstruction or other bile duct issue; by itself it is not very useful diagnostically. Slight elevations are usually not much to be concerned about, but should be monitored over the medium to long term. Regards Dr Callum Turner DVM

Thank you for your email. I"m sorry that Pearl is having those problems, that is distressing and hard on her, I'm sure. Your veterinarian seems to be doing a very thorough job taking care of her, and it would be best to continue to follow up with them. If they feel that she needs to be on those doses of Prednisone, you may just need to be patient and follow those instructions, as that seemed to be what made a difference for her the last time that this happened. I hope that she continues to recover well.

Thank you for your email. It sounds like you are taking great care of Lwee. Without knowing details of the rest of his labwork and ultrasound results, I can't comment on additional liver protectants, but Milk Thistle is an efffective medication. Vitamin E and Ursodiol are sometimes presribed as well for liver disease, and you can talk to your veterinarian about those medications, and if they would be appropriate with what is going on with Lwee. i hope that everything goes well.

Regina, thank you for contacting us about Riley - I'm sorry that he is having so many problems. I'm not sure of your question, but will give you my thoughts if they help. It would be very unusual for Phenobarbitol to cause IMHA - there are always the possibilities of drug reactions that we don't expect, but a short term therapy doesn't tend to cause that disease. For his platelets to be that low, I suspect that it was happening and that may have been the cause of the seizure, especially if he had never seizured before? That could be possible if he had some sort of vascular event. The drug dosages that he was put on seem appropriate for suspected IMHA. I'm not sure which liver enzymes were elevated, as there are quite a few that we use to judge liver function, but it is quite common for the Alkaline Phosphatase to increase very dramatically with both Phenobarbitol and Prednisone, so that wouldn't surprise me, and putting him on something like Denamarin is fairly standard to protect his liver from any effects of these other medications - that rise doesn't necessarily mean that he is having liver dysfunction, just that we need to protect it. If other liver enzymes are elevated, that is typically more serious, but again, I'm not sure which enzymes are high, or what levels they are. It seems at this point that you may want to either have a conversation with his veterinarian to see what they think might be going on, as he doesn't seem to be following a normal course of recovery for seizures, although it does sound like both his seizures and his IMHA are under control, and you are weaning him off of his steroids as expected. Both seizures and IMHA can be difficult diseases to treat and manage, and it sounds like there may be more going on with him that caused all this to begin with, as they seem to have been treating his signs appropriately so far. If you aren't comfortable talking with your veterinarian about what is going on with Riley, there is never harm in seeking a second opinion. Sometimes one veterinarian will think of something that another might not, or may have had different experiences. Another option would be to ask your veterinarian for a referral to a specialist, as sometimes we need to use these professionals when animals don't respond the way that we plan them to, and he doesn't seem to be getting better. I hope that Riley gets better and returns to his normal happy self.