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Liver Problems in 9 Year Old Fennec Fox

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Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Mon Apr 25, 2016 3:07 am

My question is at the end, but first some background:

I have a fennec fox who has been health for the past 9 years. But suddenly last week, he became verysick. He would eat the vegetables I would supplement his diet with, but refused to eat his kibble (which has about 100mg of taurine per half cup). He only wanted to eat carbs, fruit and vegetables, but no protein. He also started running a fever and started developing a discharge in his eyes by the second night. I took him to the vet Saturday morning and the blood work showed that he had severely elevated liver enzymes, but his bilirubin was normal, which is a good sign that we are catching this early enough to reverse the damage.

The vet gave me a prescription to support his liver's function and a 1000ml bag filled with B-Complex admixed into a lactated ringer, which I am dosing him with daily, subcutaneously. He was also given a 14 day antibiotic injection. After the first dose of B-Complex, he started started perking up within the first hour. Now that he's had his second dose, he's feeling a lot better. He's sleeping a lot more than normal, but when he's awake, he's running around squealing with happiness and begging for attention. He's also started eating his kibble again, though not very much. The vet will be calling back in the morning to check on my fennec's progress. I'll also have to bring him back in to see how his liver is doing at some point.

I have a medical background and neither I nor my vet are sure what's going on. Onset of this illness was sudden. Just two weeks ago, he was feeling great, being very playful. He has had no contact with any animals other then the dogs I have, as he stays indoors 100% of the time, and the dogs are quite healthy.

Is it possible that their is something missing in my fennec's diet, even though what he's been eating has done well for him for the past 9 years? When fennecs age, do they need more of any particular nutrients more than others? Obviously, he's deficient in one or more B-vitamins, but why? And is this deficiency related to his liver functions being out of whack? This is apparently what my vet thinks, but I'm unclear as to how he knows.

Doing some googling, it sounds to me like my fox has CCHS: http://www.petmd.com/dog/conditions/end ... s_syndrome

It sounds very similar to what he has. If his liver and bile ducts are inflamed, it is likely inflaming his pancreas, too, which would also explain his elevated blood sugar. A stressed pancreas can't release enough intrinsic factor to absorb b-12, nor can it release insulin like it needs to.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Mon Apr 25, 2016 3:09 am

This is him just a week ago: https://www.youtube.com/watch?v=oH3DfGXuFMY
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Mon Apr 25, 2016 5:05 am

Do you have a copy of the blood work? I could get a better idea seeing it. GGT is a good indicator for liver inflammation especially bile duct obstruction.

Were his actual pancreatic enzymes elevated at all? Pancreatitis can come on suddenly and harsh and it's inflammation can irritate the liver and make those levels go up too. The aversion to fats and more rich protein foods is also a common sign with that. Fatty food can be a trigger but often the cause is not known. Sometimes it's viral. It's common in Chihuahuas and I've dealt with it plenty. This spring Pua got it and looked real bad but perked right up with some care then Hyzzie got it after and it hit her old butt hard, then Beaker got it.

B vitamins especially b-12 do become less absorbed as an animal ages. But b-12 is great to give to perk any sickly animal up and help them get eating as most illnesses can effect the levels.

How high was the blood sugar? That's a bit more concerning but being ill can sometimes be enough to get higher levels. Hopefully that is back down after a retest.

On the other hand liver disease is common in fennecs and in a past dog that had liver and kidney disease(both looked like swish cheese on ultrasound) she was fine when we found the issue from a pre-dental blood test but then over time would have bouts/crashes then with some support bounce back but not all the way back, like a slow stair stepping down.

Good foods for liver include cottage cheese and eggs and something for soluble fiber(helps ease the work load of the liver).

Curcumin is a valuable supplement great for the liver and pancreas. Studies have shown it helps pets with pancreatitis bounce back faster and it helps the liver heal and bring liver levels down. Some squash like sweet potato or pumpkin will help with fiber and provide more zinc.

Excess vitamin A will stress the liver as well. What kind of kibble is it? Cat food has too much for fennecs.

Rabbit is a good meat still as it's low in uric acid ad vitamin A. High levels of uric acid are seen in liver disease.

Cutting back on or avoiding organ meats as well.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Tue Apr 26, 2016 4:21 am

His random blood glucose is 164. Normal range is 71 to 159.
BUN and CREA are both below normal, which means his kidneys are functioning superbly.
GGT is normal. If fennecs are anything like humans, this usually only goes up when they have ingested toxic levels of alcohol.
Lipids are normal; bilirubin is normal; electrolytes are normal; pancreatic enzymes are normal. Total protein and albumin (which can reflect liver health) are in the normal range, but on the low end of normal.

His other liver enzymes are more alarming. ALT >1000; AST 246.
He also has an elevated AlkP 249, which implies skeletal muscle damage.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Tue Apr 26, 2016 2:37 pm

Whoa problem, it seems your vet isn't comparing his test to fennec values. This is important to do.

As an example I noticed GGT on the test when they didn't used to have it. I failed to see it on the tamandua values and so compared it to human and she was high, really high. I talked to a human DR friend of mine about GGT before and there's a number of reasons it could go up, bile ducts being blocked was one of the main ones. Later my vet pointed out it was on the tamandua values but I missed it as they write out the whole words, and it was within the ranges listed so at least normal for a captive tamandua.

Only issue is the zoo values are averages from all zoo animals tested, some may have been ill or stressed at the time. They list Mean max and min values. So use the mean as your guide but if they're over the max that's bad for sure. So using my GGT example it could be all captive tamandua livers are stressed or maybe they really do run higher than other animals for some reason, unfortunately we don't have wild tamandua values. It's still better than comparing to the wrong species though.

I wouldn't worry about the glucose at all then. It's fairly common for it to go up when stressed or ill and that's not out of the tested fennecs range. Fennec glucose info is Mean 126 and max was 261 in zoo animals tested, there is no minimum value listed for some reason.

ALT mean is 112 max was 755, so yeah the tested vale is still super high.
AST is 69 max was 340
AlkP 38 max 382
So Both AST and ALkP are under the max from the zoo collection of values but as I pointed out we can't assume the max is "normal max", though my vet keeps tending to, because they did not ensure all values were form apparently healthy animals, they just compiled all tests done no matter why the tests were done. So I would say those are still elevated but probably not alarming high.

Normal bun is 22 max was 60.
CREA 0.7 max 1.5

Other important values may be off since you were not comparing to fennecs. PM me your email and I'll send you the fennec blood values and you and your vet can compare and figure things out a bit better.

SO ALT is the main number as it is VERY elevated. AST and ALKP might be elevated over healthy normal but are within tested ranges so not as alarming. Elevated ALT is most commonly acute hepatitis and/or infection though can also be from exposure to toxins. A less common cause would be some issue inhibiting blood flow to the liver. With it being sudden seems most likely infection or toxins. Milk thistle and curcumin can help the liver the heal it's self.

But here also is a short list of some values from a healthy male when he was neutered at one year, from Japan though and they don't list how the numbers are read like are they all mg/dl or whatever I've on occasion seen this listed differently from average but anything similar to the zoo values we can assume is listed the same. So again the current glucose value is a total nonissue really.
WBC 44
 RBC 846
 Hb 15.7
 PCV 50
 MCV 59.1
 MCHC 31.4
  Plat 40.2
  ALB 3.3
  GLU 145
  BUN 27.6
 CRE 0.4
 GPT 115
 GOT 39
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Tue Apr 26, 2016 4:22 pm

Added the zoo blood results to the end of my care sheet https://docs.google.com/document/d/1-ID ... mQNkR0/pub
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Wed Apr 27, 2016 5:58 am

Cody's GGT level was ZERO.

Could you get me a citation for which publication you derived your normal ranges? This seems like something that should be found in a peer review journal. My vet would likely not accept ranges that were pulled from the Internet without a journal publication or text book of some kind. If you could get me an exact citation, that would be really helpful.

Also, if these ranges were derived from statistics that include unhealthy animals, then this would be very bad science. In order to establish a normal range, it must be based on statistics from known healthy animals only. The only value unhealthy animals have in statistical analysis is to develop laboratory result profiles for specific disease. And if you want to get really fancy, you can use longitudinal studies to see what lab results predict future disease, narrowing the range of what is considered "normal". Additionally, you can even divide up ranges based on sex and age, and even by continent, since fennec foxes have different pet populations in Japan, China and Europe. It may be that the US population is more prone to high liver enzymes because they have bad genes, while the other populations do not have these problems.

This is how its done in actual hospitals, since human medicine demands far greater precision than veterinary medicine. Veterinary medicine is very "quick and dirty", which is why it costs so much less, incidentally. I've been a medical technologist since 2003, so I'm well experienced in these things. Many laboratory ranges in human medicine, once thought to be perfectly healthy, have been narrowed significantly. For example, a fasting glucose used to be considered normal if it was below 120, but now anything above 100 to 110 (depending on the lab) is considered pre-diabetic.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ash » Wed Apr 27, 2016 1:00 pm

She said she'd send it to your email. ;) It's zoo averages, and as a result, most people do not and are not allowed to have access to them.
3 red fox, 4 iguanas, nile monitor, BW tegu, sailfin dragon, leachie gecko, 6 snakes, 2 salamanders, tarantula
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Wed Apr 27, 2016 2:13 pm

I know that's how it should be done and is with domestics but we do not have that option with most exotics.

They are the ISIS(international Species Information System" blood values. The fact we don't have actual norms established for exotics is the point though. Even thought they did not ensue some unhealthy animals didn't make it in it still is better than comparing to the wrong species values. GGT was just an example of how things can vary significantly by species. There wasn't a single 0 result for anteaters with that and they were all high numbers but we don't really know why at this point but if you went ant tried to treat an anteater based on a high GGT you could hurt them due to high GGT being apparently normal for them.

A better example may be glucose though. A tamandua with a glucose of 33 is the low in the zoo data and the mean was 72 and high was 175. My vet compared to cats and said 250 was okay and just showed a rise from stress. Now lets pretend Pua is an alien and for some reason she came to you as a DR since she's sentient and wouldn't go to a vet. She only has the info like above from tests done on her people(why no real norms I don't know lets pretend they're stupid aliens). So she tests normal high for people but she's tons higher than the highest tested for her people ever and since it could include some ill people some may have even had sugar issues themselves. Do you tell her she's fine and go home because she's normal for humans and her info is not good enough or do you come up with a plan to try and help lower her glucose? I'd hope you'd help her lower as she is also peeing more and it's sticky ;)

That is how these results help. The mean gives an idea of normal and anything outside the high or low number is going to obviously be bad. Though if it's just a bit out like the glucose on your guy I'd not be real concerned, though that's some what dependent on what it is.

It would be great if we had real norms for fennecs but unless you want to fund and run the study that just isn't an option. Comparing to the averages is the best we got but averages for the species is still better than comparing to norms of the wrong species. Trust me your vet will be happy to have the info.

Actually ISIS does still have them up but you have to download the WHOLE file of ALL zoo species and try to wade through it and the tables are bad compared to the old files. The copy I have is off their info when you had to buy discs from them to get it but they have no new info it's just in a worse formate and yeah I think you had to be a member too back then. Someone was just nice enough to share. I copied the whole thing and put it in my sheet. It has the citation attached. ISIS and they compiled data from member zoos who submitted info so that is the citation. The one I posted in the thread is "just off the net" since from an owner but it helps show his healthy range was in the range of the ISIS values. The ISIS values are in my care sheet. At the end. This version(I can't yet edit the one on the sight here, only Pat): https://docs.google.com/document/d/1-ID ... mQNkR0/pub
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Wed Apr 27, 2016 2:19 pm

Oh a little PS. I recently found a new study on tamandua where they only included apparently healthy animals. Unfortunately it was only blood count and not chemistry but the results did line up with the ISIS info so it's not really all that bad. My main point in being up front about it not being true norms is so you might not see something at the high number and automatically assume that's a high normal(my vet keeps doing that). Something there [i]might[\i] be a bit more concerning because it might have come from an ill animal though it might not. That sucks but has to be considered when making decisions.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Wed Apr 27, 2016 10:50 pm

What I was specifically looking for was something along the lines of a "materials and methods" section of a scientific journal article. These sections explain how data was obtained, where it was obtained, what methods were used, who performed those methods, and what statistical techniques were employed. This is important to know because it can be used to 1) recreate the experiment, and 2) given an idea of how trustworthy the data and conclusions are.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby TamanduaGirl » Wed Apr 27, 2016 10:56 pm

http://www2.isis.org/support/MEDARKS/Pa ... anges.aspx

Otherwise I really don't know what to say. Sorry. It's still the best info there is right now and all owners, zoos, and vets who deal with exotics regularly use them.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby pat » Thu Apr 28, 2016 11:37 am

Ranger,

I am so sorry to hear of the health problem with your fox icon-sad

on the liver issue, did they rule out liver cancer?

my oldest raccoon went to the vet for a routine checkup, the vet examined him, did blood work and i think an ultrasound. sadly, it turned out he had liver cancer. the vet told me to give him sam-e and milk thistle. the vet gave me a script for it, but it was pill form. later I found both in liquid form, which was easier to give to him with an eye dropper. the day the vet told me about the cancer, he said, larry would only live maybe another 3 months. but, he died about 10 months later. the vet was even surprised he made it that long.

larry had good days and bad days, until the last week of his life. I had to put him down icon-sad

I am not saying that is what your fox has, but, thought I would mention it, hopefully, the cancer is ruled out.

on the blood levels, mary is correct, many vet compared the blood levels to dogs or cats. mary found the correct blood levels for one of my raccoons. I passed it on to my vet.

again, so sorry to hear about your fox. I know how hard it is when our pets are sick, and we are not sure why and what to do.
I truly hope your fox makes a full recovery. please keep us updated....
Pat (Sybil and Benny's Mom)

http://sybilsden.com Sybils Den
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby Ranger » Thu Apr 28, 2016 2:01 pm

We aren't thinking cancer at the moment. Cancer of the liver usually causes a blockage of the bile duct, in which case his stool would turn grey. He never developed a grey stool. Since he's begun treatment, he has responded very well, bouncing back as if nothing had ever happened to him at all! All I'm doing is giving him B-vitamins every other day and one fourth of a Denamarin pill daily. Actually, he seems to have energy levels that he hasn't had in years! In fact, after his injections, he turns into a little bullet! Not as fast as a year old fennec, but certainly not elderly, either.
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Re: Liver Problems in 9 Year Old Fennec Fox

Postby hecate » Thu Apr 28, 2016 5:25 pm

It appears the physiologic data can be ordered by non-members on CD for $75:

http://www2.isis.org/membership/Documen ... ldlife.pdf

If it prevented even one misdiagnosis it would have paid for itself.

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