Newly diagnosed CAH - abnormal immune response.

[agilitylori]

My dog was recently diagnosed with CAH following a liver biopsy.  Although her copper concentration is high (778), the most serious problem is severe inflammation so my vet believes that the chronic hepatitis is due to an abnormal immune response against her own liver cells and  that the copper build up is secondary.  Does anyone else's dog in the group have a similar diagnosis?  I've consulted with a couple vets and they have given me completely different treatment plan options:  (1) Stay on the Denamarin and Vitamin E and add Ursodiol, Metronidazole, and Hills L/D diet; (2) dog needs Prednisone NOW!  Plus possibly zinc supplements.  I DON'T KNOW WHO TO LISTEN TO AND I'M AFRAID I'M GOING TO LOSE MY BABY!  Anyone been down this road?  Thanks.  - Lori

[Arwyn Todd]

Hi Lori,

So sorry to hear about your diagnosis. We had a similar conversation with our vet when our boy was first diagnosed. His biopsy showed a lot of scarring in his liver as well as the copper deposits. The vet told us it looked like an autoimmune response, that the liver was seeing the scar tissue as a foreign object and was attacking it, creating more and more scar tissue, that could eventually take over his liver. Whether the damage was caused by the copper concentration or the damage allowed the copper to accumulate is hard to tell, and honestly didn't change how we would treat the CAH.

To slow down the autoimmune scarring process we started him on a fairly high dose of prednisone, but he didn't tolerate it very well, so we lowered the dose until he wasn't reacting to it any more. That seems to have helped, though we have not done another biopsy. He is also on all the usual liver support meds for the CAH - denamarin, ursodiol, zinc acetate (to prevent copper accumulation from food - he was originally on penicillamine to try to get the copper out of his liver), vitamin E, and salmon oil. We just recently started a low dose of metronidozole, though not for the liver (it can be helpful with infections in the liver, but high doses can be hard on the liver), and a new liver med called hepato support that has additional milk thistle properties denamarin doesn't.

I'm definitely not a vet, but it sounds like combining the advice from both vets is what we've done with our boy, and what I believe a lot of people in this group do with their pups.

Hopefully that helps. Good luck!

Arwyn