Elevated Liver Enzymes and Lyme Disease

by Mike
(New York City)

Reader Question: Is This A Dog Lyme Disease Effects?

Our dog, a 6 year old American Eskimo, tested positive for Lyme Disease yesterday. The vet, who we were meeting for the first time, took some X-rays to look at his leg because he was limping. The x-ray turned up nothing so the issue is presumably related to joint pain related to the Lyme. She also did some blood work and prescribed an antibiotic for the next 30 days.

Today the vet called and said that the blood work showed elevated liver enzymes. She recommended that we do an ultrasound and possibly (depending on the results) a biopsy. She said, in the alternative, we would just treat it with antibiotics and re-test again later. In hindsight, it's now unclear to me if the antibiotics would be additional to the ones already prescribed to treat the Lyme. She also said "I don't know what would be causing this, whether it's inflammation, an infection, or something else."
I'm writing because after doing a bit of reading, it seems that a lot of information out there suggests that the elevated liver enzymes are often associated with acute Lyme Disease. If that's the case, I'm wondering if it is really prudent to do an ultrasound when we have already started the antibiotics for Lyme. I guess my premise being "if we expected to see them because of the Lyme, why do we need to do further testing?"

I have to admit, my questioning comes from a bit of skepticism. I live in Manhattan in NYC, a very expensive place for a vet to practice. My office visit yesterday (including x-rays and blood work) cost me $600. I would expect the ultrasound to cost hundreds more and I'm wondering if it's necessary or just a way to "upcharge" a new patient.

I'd greatly appreciate your thoughts!! I do won't to provide great care to our beloved dog, but I don't want my obvious concern to be taken advantage of by a new vet I don't have a relationship with.

Veterinarian Responds To Reader Question Regarding Lyme Disease Effects and Treatment

Hi,

As long as your dog weren’t showing clinical signs associated with liver disease (e.g., vomiting, diarrhea, increased thirst and urination, a yellowing of the mucous membranes, a fluid-filled abdomen, etc.) and her liver enzyme numbers weren’t terrifically high, I would be comfortable taking a “wait and see” approach if she were my patient.

My recommendation would be to recheck her liver values a couple of weeks after stopping the antibiotics (antibiotic therapy can sometimes cause elevations in liver enzymes so I wouldn’t recheck them immediately after stopping). If they were back to normal or nearly so, I’d forgo the work-up and just recheck them six months to a year later. If the problem persists, the ultrasound is certainly called for.

The nutritional supplement s-adenosylmethionine (SAMe) can be helpful in cases like these. It helps the liver heal and protect itself against continuing insults.

Best of luck,

Jennifer Coates, DVM