Thank you all for this thread. I know it's a couple years past--but, hoping you may share the results and hopefully happy outcome. My dog has been 8 months on pencillamine and his liver enzyme levels are still increasing! Also, he is given Denamarin, and Zinc (but oddly, the vet said nothing about B6--and I don't know where to buy it--since pet vitamins have more than just B6--and I fear that other stuff like Niacin may contraindicate. So, anymore info you can share is appreciated. Someone also mentioned an alternative therapy on this thread PhosCal (?) What is that. Thanks in advance.

I'm very sorry about what your dog has gone through. Kudos to you for doing so much research, and for sharing your findings with the rest of us.

I have a young girl whose breeder told me that the dam was sensitive to copper, and to be careful about copper levels in her food. Which food have you found to be the lowest in copper levels?

Hi Kate,
Sorry for the multiple posts but I am interested in the PhosChol and how to obtain it. I am in the Stow area and can have my vets talk to your vets. If this is something I can give to my girls to help with the scarring and fibrosis, that would be great.

Thanks

Cindy

Hi Cindy,
I get my Phoschol from Amazon but you can also get it from the manufacturer, Nutrasal. The vet hospital I go to in Red Bank, NJ is very large and advanced. When they did Theo's biopsy they sent results/samples to Dr. Sharon Center at Cornell. Dr. Center is a veterinary liver specialist and my vets are following the protocol that she developed. Dr Center seems to be ahead of the curve when it comes to liver disease and copper toxicosis.This is how we learned about Phoschol as an anti-fibrotic and vitamin B6 in conjunction with d-penicillamine. I would strongly suggest that your vets consult with Dr. Center at Cornell. I am eternally grateful to my vets for consulting with her. It does not matter where you live... My vets did it all via phone, fax and email. Where is Stow?

Hi Cindy,
I get my Phoschol from Amazon but you can also get it from the manufacturer, Nutrasal. The vet hospital I go to in Red Bank, NJ is very large and advanced. When they did Theo's biopsy they sent results/samples to Dr. Sharon Center at Cornell. Dr. Center is a veterinary liver specialist and my vets are following the protocol that she developed. Dr Center seems to be ahead of the curve when it comes to liver disease and copper toxicosis.This is how we learned about Phoschol as an anti-fibrotic and vitamin B6 in conjunction with d-penicillamine. I would strongly suggest that your vets consult with Dr. Center at Cornell. I am eternally grateful to my vets for consulting with her. It does not matter where you live... My vets did it all via phone, fax and email. Where is Stow?

Nancy

The dosing on Phoschol is one 900mg capsule a day.

Nancy

Hi Nancy,

My vet is in Stow, Ohio but our biopsy was done by a specialist at a clinic in Copley, Ohio. Bloodwork was sent to Texas A & M. I will pass on the info you provided to my local vet. They have been great. Since we were able to catch Folly's liver disease fairly early, I am hoping we can slow things down.

Thanks

Cindy

Because most dogs are not diagnosed until late in the disease, you have a wonderful opportunity to improve her liver function! If she has copper toxicosis, I urge you to consult Dr. Center as Nancy has suggested.

Let us know if we can help in other ways. Kate

I have been following these threads on copper tox for a few months.

While I was able to rule out copper issues my girl was diagnosed with CAH which is a broad spectrum diagnosis.

I went with the milk thistle and SAMe like some others posted and want to mentioned that I learned that when giving the SAMe it should be given away from meals and with a B-50 complex for better uptake by the body.

It took me a year and a half but I got my girls liver levels in normal range and she has been good since 12-2009 and will be 12 next month.

I did and have continued to give the B-50 complex, vitamin E at 100 -200 iu and alfalfa tablets to support her liver.

I read that giving milk thistle once liver is in normal range can be detrimental so I stopped that (and the SAMe)

I have a blog on what I did in hopes it will help some of you. However I think the link is registering spam on this site and will not let me post so please email me privately if you want to see my blog and what I did to get my girl back in normal range and keep her there for the past 8 years. (please put liver disease in the subject line)

I also fed Origen thru most of her episode (champion pet foods as Donna Forte posted) have since switched to Acana by the same company and my girl is still in normal range

trying the link again to my blog:

http://www.heartypet.com/blog/?p=78

I also noticed Dr. Twedt from Colorado U mentioned in this thread and want to say he was a world of info for me years ago and very quick to respond to emails.

He is a liver specialist so don't hesitate to email him with questions.

Patty, Glad your girl is doing well. You certainly learned a great deal in the process. Thanks for sharing it. Kate

Thanks to a friend in the Midwest, I learned about another dog food option for those who want to feed a good quality food with low-ish copper content.
Nutrasource Large Breed made with Lamb and Rice has a copper content of 9 mg/kg.
Nutrasource was once an "economy" food but in the last several years has switched to become a premier dog food and is receiving high marks from www.dogfoodadvisor.com.

Avo Derm Lamb Meal and Brown Rice Formula has 7.5 mg/kg of copper (the oven baked formula has 8 mg/kg)

Thanks so much, Laurel. I missed that fact. Very clever of the company to hide the actual amount in the ingredient list, rather than the guaranteed analysis section where others put the amount. Good grief, I am now wondering if other dog food companies are being equally tricky.

Also I note that Tuffy Pet Products, which manufactures Nutrisource, had a recall of another of its brands in February 2013.

Avo Derm Lamb and Rice was recalled in 2012 and 2013 due to salmonella. They may have fixed this problem, but it worries me. Salmonella is a very serious reason for recall.

My lab Scout died suddenly (within 5 days) this past March due to Hepatitis/Copper storage disease. We had every test done possible and he was in ICU at CSU, but it was too late. We had an autopsy performed because we still have his sister/littermate Lily. Lily was seen by Dr. Twedt at CSU just this week. Although she has liver inflammation and high ALTs, she is not symptomatic and a biopsy is only recommended at this time, as well as diet change/monitoring lab work regularly. After Scout died and I learned about Copper storage disease in Labs, we started adding liquid zinc to her food. It is tasteless, so works great. Milk Thistle is horrible tasting. I am also looking into low copper content food (which is how I found this forum). Hills l/d has only 4.9mg/kg and 4mg/kg is what was recommended to us by CSU. It is VERY expensive, so I am doing some more research. I am also going to add Vitamin E to whichever food we decide on. We have used Merrick in the past and our current food doesn't provide an amount, so am desperately researching. I appreciate all of the information on these posts and wish everyone luck.

If you are only feeding one dog, I strongly suggest you consider a homemade diet. You can get appropriate diets and a supplement to balance the nutrition from www.balanceit.com

Good luck with your girl and let us know how the biopsy turns out. This is the first case about which I have heard that involved more than one littermate. I urge you to contact the breeder of your dogs.

At this point my girl is doing wonderfully. She is playful and happy with her homemade diet. She is tolerating half the recommended dose of d-penicillamine and we are slowly increasing the amount.

She also takes

Denamarin 650 mg
PhosChol 900 mg
Vitamin E 400 mg
Omega3 325 mg
B6 50 mg

The Denamarin, PhosChol, Vit E, and Omega 3 are to improve liver function.

B6 compensates for the effects of d-penicillamine (which interferes with B6 and causes taste aversions).

My girl continues to improve in mood and activity. Occasionally, I see a stool that seems too light (indicating problems with bile acids), but within a day the stools improve. We have not retested her liver function, but we will at the end of summer.

Her current daily regime is:

Denamarin 650 mg
PhosChol 900 mg
B6 25 mg
Vitamine E 400 mg
Omega 3 325 mg
D-Penicillamine 400 mg

She continues on a copper-free homemade diet supplemented by Balance It for copper-free diets.

Kate,
I'm glad your girl is doing well. We (after almost two months) are still waiting on one last test for our young toller to confirm copper storage disease (long story..wrong test...had to rerun the test etc.) The unofficial diagnosis is chronic inflammatory hepatitis. After 7 weeks on a prednisone, ursodial, and vitamin E drug therapy, her liver enzymes (with the exception of one) are coming back down to the normal range. The one enzyme (reflects how bile moves through the liver) continues to increase. I am wondering if this is prednisone related? She is 50 pounds and started out at 30 mg of pred. a day. We are currently at 10 mg/day. She did not do well on high pred. dose.

She is currently eating Hills Science Liver Formula (copper restricted) and loves it- but it is very high in fat. In fact, she is trying to eat anything in site. I am still trying to find some other options for treats/snacks.

I discussed Phoscol with my regular vet and they are cautious to add any additional supplements until we find out for sure about the copper. I am frustrated as I know her liver is inflamed and she has many nodules.

If tests come back definitive for copper storage, I will be working with the specialists. Are you familiar with the drug Trientine? It is supposed to be better tolerated although doesn't seem to have some of the benefits of penicillamine. I have also read about prednisolone as an alternative to prednisone.

Thanks for any help.

Cindy

Gosh, Cindy, 30 mg of pred was the dose we had our 70 lb girl taking. But it sent her liver enzymes skyrocketing. But she did not have immune-mediated hepatitis. We had simply fallen victim to our vet's desire to do everything possible--not always a good choice. And no dog or human really does well with high doses of steroids of any kind. Sometimes necessary but always has significant bad side-effects over time.

I can't see how PhosChol would be a problem unless the vet fears that it might increase an immune response. PhosChol is given to people whose alcohol use has caused liver scarring to the extent that they have little liver function left; so PhosChol must be pretty safe.

Trientine is hard to get and expensive and not as effective as d-penicillamine. Our girl is tolerating the d-pen quite well now that she is getting 25 mg of B6 to counteract the B6 deficiency and taste aversions caused by the d-pen.

Boy, I would be unhappy if my dog had to have a second biopsy. Hope you get your results soon. Kaate

About 2 weeks ago I brought Theo, my 10 year old boy into the vet for his follow up. His results were great. All of his liver scores were comfortably in the normal range. His Alt is now 49!!!!! It was 2084 when he was first diagnosed. My vet has started to reduce his d-penicillamine in anticapation of stopping it entirely. Instead of taking the d-penicillamine BID he is now taking it only once a day. He goes back for his next check up in about 4 weeks. He started the d-penicillamine in mid/late February. His copper levels were at 2000 at that point. With copper at that level (1500 is considered toxic) Dr. Center recommended 6 months of chelation therapy.

Cindy, my lab was initially diagnosed with hepatitis until they got the copper results. When he first presented with high liver scores but before his liver biopsy and diagnosis the vet placed him on Denamarin (milk thistle and SAM-e) and vitamin E (400IU). As soon as the copper results were known they added in the D-Penicillamine (500mg BID), B6 (25mg) and Phoschol (900mg). They also changed his food to Royal Canin Hepatic diet.

We have been very lucky. My guy tolerated all the meds, loved the food and now 5 months later we are weaning him from the D-penicillamine. His scores as I noted above are great. It is my understanding he will remain on the other meds for his liver

I agree with Kate about all the meds. My vets consulted with Dr Sharon center at Cornell. She is really an expert in this area. Maybe you can get your guys to send her lab results. Good luck!

Thanks Kate and Nancy. Thankfully, with Folly's initial biopsy, they took about 20 samples as the said she had a "nodular liver." I'm not sure if this is typical with copper storage issues. They ran the wrong test for copper quantification at the lab but had enough sample material that the test could be run again. The specialists are leaning towards copper issues. And the results should be available any day now. But they wanted to get her liver enzymes under control so started the high dose of pred. to crash her immune system.

Folly is also on Denamarin (chewables) and as I mentioned the ursodial and Vitamin E. All of her enzymes with the exception of the GGT are back in the normal range. From what I have read, prednisone can affect both ALT and GGT levels. The high pred dose was very hard on Folly. She went from a normal dog zooming around an agility course to being weak, lethargic, and even appeared to have cognitive issues and she was starving. Now at 10 mg she is still not up to her normal physical activity but is becoming more alert and chipper. She will chase squirrels and Frisbees so that is a blessing.

I discussed Dr. Center's protocol with my own vet. They were very aware of her but as the copper issue was not yet conclusive...were not ready to go down that road yet. If copper is a definite, I will most likely be working with the specialists and will certainly suggest the information presented here including the addition of the vitamin B and phoschol (I actually purchased a bottle to have it on hand.)

It is just so frustrating as (thankfully) this disease is not often seen...my vet has only had one other case.

Thanks Again!

Cindy

Our toller Folly (5 1/2) has finally been diagnosed with Copper Storage Disease. We got the final word today. Her values for copper were 2476 and we were told this was very high.

Our vet discussed a similar protocol to what has been presented here (Kate/Nancy) and the vet has suggested I look around for the best value for the penicillamine. I have seen some posts where the generic is being used. I have looked on-line and have seen prices all over the board. Is there a reliable source for this medication that someone can recommend? Our vet will contact the Pharmacy with the prescription. He also recommended the same site as Kate for home cooked meals. Folly has some complications with the fibrosis that is occurring so we are hoping to get things under control and get the treatment started as soon as possible.

Thanks for the help.

Cindy

Hi Cindy, I am sorry Folly has copper storage disease but now that you have a diagnosis you can start her on the road to recovery.

I get my penicillamine from Wedgewood Pharmacy, 405 Heron Drive, Swedesboro, NJ 08085. Their number is 800-331-8272. Wedgewood was recommended by the Cornell vet as well as my own. Theo's original administration directions were to give 1 capsule (my guy gets 500mg) by mouth twice a day 30 minutes prior to a meal. As I mentioned earlier, theo's dose was recently reduced to once a day as he will be completing treatment soon. Be sure you also give the B6.

I have been pleased with Wedgewood. They are very responsive and helpful. I don't remember what it costs-- it was not cheap but it wasn't outrageous. They ship it to me FedEx (ground I think) and have been very reliable. Wedgewood compounds this so it takes a few days to get it. I think start to finish from ordering it to delivery was about 3-5 days. I probably could get overnight delivery if I requested.

The diagnosis was a shock but my vet told me that with the appropriate treatment theo's life expectancy should not be affected! That is the light at the end of this tunnel.

Hi Cindy, We get our penicillamine from Diamondback Pharmacy in Arizona. Your vet can fax them a prescription, and Diamondback will send the prescription to you. Diamondback is a pharmacy for veterinary products and provides medications to all manner of animals, including zoos. I have heard that they have an excellent reputation, and my interactions with them have been positive. Their prices are competitive.

Because my girl had trouble tolerating the penicillamine before we started the B6, we are slowing working back to her full dose, which would be 400 mg twice a day. At the moment we are at 400 mg once a day.

Dr. Twedt at Colorado State told me that he seldom uses prednisone for copper toxicosis. Given the long-term negative side-effects of prednisone, I would ask your vet if you can taper her off.

My girl really likes the recipes from BalanceIt. We primarily use couscous and cottage cheese, and we buy the couscous online 10 lbs. at a time from Amazon.

Denamarin, PhosChol, Vitamin E and Omega 3 all help with the fibrous from too much copper in the liver.

Good luck. The outlook is positive with appropriate treatment. Keep us posted. Kate

Thanks Kate

We are waiting to hear back from the vet as I still have so many questions. With the prevalence of copper in the tissue samples and the high elevation 2476...I am trying to find out if this is the primary cause of her liver issues or a secondary reaction to the hepatitis. Also, I was told that the PhosChol is incorporated into Denamarin in combination with the silibyn but it does not look like the dosage is very high and certainly not the 900 mg many of you are taking. And the vet seems determined to keep Folly on Prednisone or Prednisolone. I don't know if it is because her liver has been so damaged or if they are just not familiar with the treatment.

It is very frustrating. I am hoping we can get the meds ordered soon so we can start the treatments to rid the copper from her system.

Cindy

Just catching up on this thread and glad to hear of the dogs doing well and so sorry for those diagnosed with copper issues.

Just want to mention that my vet told me steroids (pred) can be detrimental to a dog with liver disease (I believe that is basic CAH or copper). I had another issue and had no choice but to do pred for a period of time but thankfully bloodwork showed no effect Just wanted to put it out there to discuss this with your vets that are prescribing Pred for dogs with liver disease.

Certain topicals for fleas. etc. are also not good for liver issues (sorry can't remember which one now since it was about 3-4 years ago I had to deal with fleas). but something to ask your vets.

Praying for all of your babies and success with the treatments.

My dog's copper quantification came back as 1,912 ug/gm, and that was four months ago. At that time, her post-prandial bile acid was 48 (normal is <15). After four months of treatment, that's now down inside the normal range already (14.2), so her liver function has improved dramatically. Her ALT dropped from 410 to 130-160. I'm impressed with the changes after such a short time. We're going to continue treatment for 5 more months and then repeat the biopsy.

I paid the nutritionist at Cornell to work up a custom homemade diet for her that minimizes her copper intake. She only gets .44 mg of copper per day with the homemade diet, which is less than the alternative of Hill's L/D. There are a LOT of supplements to balance it, in addition to all the meds, but it's manageable. Dr. Center has her taking Penicillamine, B6, Denamarin, Vit E, and Ursodiol.

I haven't noticed anyone referencing these two sites, so I'll throw them out there:

Nutritional Analysis Tool 2.0: http://www.myfoodrecord.com/mainnat.html

USDA Food Tables: http://ndb.nal.usda.gov/ndb/nutrients/index

Those two sites are very helpful in determining the copper in various foods.

Someone asked about what to use for training treats...the nutritionist said cheese (mozzarella sticks) were an excellent choice because the copper is almost non-existent in cheese. I use a lot of it for training and to get the pills into her.

Lee Baragona and Teagan

Glad your dogs are doing well!!! Kate

Does the source of copper matter? I feed Acana, which has 20 mg/kg of copper, which seems high. However, the copper is derived solely from the food - there is no added copper sulfate, etc.

Ingredients: Boneless salmon, salmon meal, herring meal, whitefish meal*, green peas, red lentils, boneless herring, boneless flounder, herring oil, field beans, canola oil, sun-cured alfalfa, pea fibre, natural fish flavour, whole apples, whole pears, pumpkin, butternut squash, parsnips, carrots, spinach greens, cranberries, blueberries, kelp, chicory root, juniper berries, angelica root, marigold flowers, sweet fennel, peppermint leaf, lavender, rosemary

I have one dog on Pinnacle Salmon and Potato, which has 11mg/kg of copper, which is lower, but the copper sources are from Copper Sulfate and Copper Amino Acid Chelate.

Does the source of copper matter if there is an intolerance issue? The dogs love the Acana but I am a little concerned about the levels of copper in the food.

I fed my two tollers Nature's Variety Instinct Grain Free (with raw boost) for many years and switched to Acana grain-free regionals (great plains) about two years ago. Both dogs seemed to thrive on these high quality foods but my younger toller (5 1/2 yrs) has copper toxicity with values through the roof. I was told by my vet that the high quality foods have copper added in such a way that it is more easily assimilated. But if a dog has issues passing copper through their system, then this probably doesn't help them. I was also told that all animal protein sources contain copper. Folly was put on a copper restricted prescription diet (Hills) with primarily plant and egg based protein. I believe it contains roughly 4 mg/kg of protein. We are also making some of our own foods with vet approved recipes (the Balance It site was mentioned by Kate in this forum). The protein sources in these recipes are eggs and cottage cheese.

I am happy to say that Folly has been on the penicillamine for two weeks now and is still eating like a goat. She loves the prescription food and the homemade diets. She is also a big fan of squash, zucchini and cucumber snacks. She is still on a maintenance dose of prednisone (10 mg every other day) which I am sure is stimulating her appetite. We recently took her down to the Ohio State University Vet school as we are still trying to figure out the whole copper toxicity and CAH... It's sort of like the chicken and the egg. Is the copper a by-product of the CAH or is the copper driving the CAH. The Drs. down there will be consulting with Dr. Center at Cornell. Folly's most recent blood work at OSU shows nearly all enzyme in the normal range. One was just slightly elevated. She seems much more active and alert with the lower prednisone dosage.

My 8 year toller Jazz recently had a wellness check. She is a half sister to Folly (same mother different father) All of her blood work came back in the normal range. I still switched her to Wellness Simple as it appears to be one of the commercial foods with lower copper levels.

This forum has been a wonderful source of information.

Humans who have Wilson's Disease must eat copper-restricted diets. It does not matter what the source of the copper is. They eat as little copper as possible.

20 mg of copper is many times the normal daily requirement.

Lee Baragona I was wondering how you get stared with a nutritionist at Cornell? I would like to do that. Please let me know. Thanks!!

http://www.vet.cornell.edu/hospital/Services/Companion/Nutrition/

I just went to this page for Cornell's nutrition folks and filled out the client form and submitted it. They emailed me back and we got started. If you want to use commercial food like Hill's L/D, it's pretty cheap, but if you want a customized homemade diet like I did, it was around $275. You get free follow-ups for a few months, to customize the diet as needed.

Lee

I was wondering if you had looked at the Balance It site recipes to see how they compared to the diets provided by the Cornell Nutrition folks. The website recipes are pretty easy to follow but the amount of supplements can be overwhelming. I am wondering if this is the case with any homemade diet.

Cindy

I have but I have an extremely rare case. My cat actually has copper storage disease with sclerosing CCHS and since its rare we are using meds that treat dogs but as for diet cats have a difference balanced diet =(

Since it requires vet referral to see the diets, I haven't viewed the full Balance It homemade diets. I can tell you that the primary ingredients are not the same as the custom ones that the nutritionist worked up for me. Dr. Center also wanted me to feed higher than normal protein levels, so that was customized for my dog. The nutritionist said I could use either a human pre-natal multi-vitamin (which has no copper in it) or I could do individual supplements. Since Dr. Center also said NOT to supplement zinc, and the multi-vitamin had extra zinc, I chose to go with the individual supplements. Makes for a lot of pills, but luckily my dog will take them willingly in cheez whiz. BTW, the Walmart Great Value Cheddar Cheese Sauce has ZERO copper in it, which is a godsend for giving pills.

The BalanceIt supplement contains 0.3 mg of copper per teaspoon. Dr. Center's paper “Emerging Syndrome of Copper-Related Hepatotoxicity” recommends a daily limit of 0.4 mg of copper for a medium sized dog (Bedlington Terrier), so the BalanceIt is too high in copper to be useful. The homemade diet plus all the supplements came to a daily copper intake of 0.46 mg, which was as close as we could get, but better than commercial diets.

Lee

Thanks Lee.... We were initially placed on the Hills Science Diet dog food after the biopsy showed Chronic Active Hepatitis. My vets were concerned about high protein levels and the CAH going on with our toller. Once we got the copper quanitification results 2476 ug/mg, we started the chelation process and have been on a quest for better alternatives than the commercial diet. We recently took our toller to Ohio State for follow recommendations. The Drs. here will be contacting Dr. Center. I am hoping to get some guidance on future medication (like prednisone) and some alternatives for our girl who was thriving on her high protein ACANA that was also loaded with copper. We go back to OSU in late Sept. and hopefully we will have some info and updates.

Thanks for the Cheez-whiz tip. Nancy also mentioned mozzarella cheese sticks which our dog loves!

Cindy

Lee, I'm not sure where you are getting the information about the Balance It supplement for copper sensitivity diets, which is different from the regular supplement. BalanceIt-Cu has .0006 mg per teaspoon. For the home-made recipes that we feed, this amounts to less than .0048 mg a day, which is about 1/10th of what you are feeding.

The amount of zinc is necessary to complete a balanced diet and would not count as a "supplement" to a regular diet. Dogs do need zinc in a balanced diet and the BalanceIt homemade diet has practically none.

The amount of protein in the diets runs about 24-25%, which is a relatively high protein level.

All of the diets I use are specially designed for a dog who has copper storage disease--and are not the regular diets on the website. Bedlington Terriers are the prototype for this kind of diet.

Balance is a lot less expensive than a private nutritionist--and much more convenient. The vet who runs it is a nutritionist himself.

Yup, my bad, I didn't scroll far enough down to find the copper-specific product. Basically no copper so that's great, but it does have 265 mg of zinc. The nutritionist has me giving my dog 25 mg and that meets her daily requirement. If I am understanding Dr Center's reasoning correctly, all the extra zinc will bind with the chelator, which reduces the effectiveness of the Penicillamine.

Actually the Balance It recipe for my 47 pound toller calls for about 30 mg of zinc gluconate a day if you are using human supplements. I purchased the Cu restricted diet supplement mix that the website offers and it contains about 5.3 mg of zinc per tsp. The recipes that I downloaded call for 5-7 tsp of the supplement powder per day.... so again about 25 to 30 mg of zinc. Most of the protein sources that I was approved for are egg or cottage cheese based. They are easy to make but the human supplements can be a little difficult (at least for me) to track down.

Currently, I am feeding both the homemade diet and the commercial prescription food. Folly isn't picky and at least for now, will eat anything that I give her. My hometown vet is suggesting the homemade meals as they are natural, good and wholesome and I can control the ingredient sources. Ironically, the vets at the specialty clinic that did our biopsy and OSU seem fine with the prescription foods.

Cindy

Don't understand where you are getting the zinc amounts in BalanceIt Cu. The bottle says 5.3 mg per teaspoon, which works out to be less than 42 mg per day in most recipes.

Again, dog do need zinc in their diet. The amount in BalanceIt-Cu seems entirely appropriate to me because the chelator will bind some of it (not all). Zinc itself has sometimes been used as a chelator for copper, though it is not nearly as effective as d-penicillamine. After chelation is finished, some dogs continue on a higher level of zinc to chelate the copper in their diet.

I get the same low figures for zinc Kate...and actually my human supplement recipe calls for half a tab (not a whole tab as I mentioned earlier) of the zinc gluconate which is only 15 mg a day. I bought the CU restricted diet supplement as I was beginning to feel like a chemist and it seemed easier. Though as I become more familiar with the recipes and can source out the human supplements, I may start to use those instead.

Cindy

I was looking at the breakdown on the website rather than on the label, and I made the mistake of assuming it was "per serving" like other vitamin supplements, or per teaspoon, but for some reason they listed it per 100 grams, so that's why it reads 265 mg. You gotta divide everything by 50 to get one teaspoon's value. That makes it much more reasonable!

The nutritionist at Cornell and Dr. Center had differing opinions on the zinc. The nutritionist thought it should be supplemented in order to bind with the copper, while Dr. Center was adamant that zinc would impair the penicillamine and that it was not an effective method for removing copper. I opted to follow Dr. Center's instructions and the nutritionist reduced her zinc accordingly, so she only receives the daily minimal requirement until we are finished with chelation.

So much is theoretical in this treatment that I find it hard to figure out who has actual facts to support opinions. The cutting is sure a dangerous place to live.

I don't have a dog with this disease but I wanted to share a few thoughts.

Organ meat is high is copper. Most dog foods contain a great deal of organ meat because it's a readily available by-product and cheap. I think the amounts of by-products in most kibble is too high to be fed daily, it's disproportionate to what would be found in any prey.

There's no proof that chelated minerals are better, they are taken up and metabolized better but in the case of copper toxicosis this might not be a good thing, or any of the added chelated minerals for that matter. Nobody knows how much chelated minerals are actually needed for a dog, we are all a part of this experiment. Most of these things were developed to optimize growth in animals used for food. for most living beings less is usually better. It's rare for an animal to die from a vitamin deficiency whereas hypervitaminosis is much more likely.

Canada does not have an agency like AAFCO that regulates dog food. Years ago I sent a couple of samples of Canadian food off for nutrient analysis and some of the results were quite different than what they claimed. Orijen has great marketing and make it sound like the food contains fresh caught whole fish but the truth is it's mostly by-products. A high amount of by-products could cause a high amount of copper without them adding it. Copper amounts (like ash content) might be useful as a tool for determining dog food quality.

I hate that commercial dog food is so crappy. I'm sorry that your dogs are going through this.

Thanks for your perspective. I greatly appreciate it.

In this very dangerous situation with my sick dog, I certainly did not feel safe using commercially produced foods OF ANY KIND. With BalanceIt, I am able to provide a very high quality, homemade food that has the appropriate supplementation for my dog's health. I've never actually figured out how much it costs me to feed this diet (not just "human-grade"; it is actually HUMAN FOOD). I suspect that my homemade diet might be somewhat less expensive that the Royal Canin food for copper toxicosis, which actually contains 7 mg of copper whereas my home-made diet contains nearly no copper.

Even though I've always fed a high-quality food, I have moved my other dogs to an even higher (and even more expensive) quality food that has the lowest copper content I can find in a commercial food.

I agree that chelation provides no protection. Chelation is a great sell job by the commercial dog food establishment though. The absolute levels of copper are simply too high. The high level of copper is not health motivated but motivated to preserve food, decrease recalls, and maintain profit. The commercial dog food industry would dearly love to see you on the idea that copper toxicosis is only a genetic problem in certain breeds. Caveat emptor if you believe an industry that wants to sell their product.

Hi Kate,
I am struggling to find a commercial food that is low in copper for my older toller who at t his point has normal liver functions and enzyme levels. She is a half sister to Folly who has the copper toxicity problem. After doing research, I am finding that the actual content is higher than I originally thought and the forms of copper are not very desirable. We recently switched to wellness simple but found that it contains copper sulfate. Do you have any suggestions?

Thanks

Cindy

Cindy, I finally settled on Flint River Ranch Grain-free Salmon, which has 11 mg/kg. FRR original recipe has 10.6, but it contains wheat and one of mine can't eat wheat. The form of copper is copper sulfate, but I have come to believe that the form matters much less than the absolute amount of copper in the food. Increased bioavailability of the other forms of copper may actually be a deficit.

I fed FRR long ago because my dogs liked the taste so much and became a distributor to get it. But I stopped for a few years ago and fed California Natural because of cost and distribution. The dogs loved FRR.

I found it easy to go back to FRR; they even gave me a website and my old distributor number back. They deliver my orders by UPS in a very timely fashion. Shipping is free.

FRR is, however, the most expensive food that I have fed. But the quality is exceptionally good, the food exceedingly fresh, and they have had no recalls--ever. They are a small family owned company, and I can actually speak to the son-in-law of Jim Flint who now runs the company.

Kate,
Thanks for the tip. I have been looking at their lamb, rice and millet formula along with the California Natural and the Wellness Simple. I am a fan of the dog food advisor website and noticed that the Flint River formula you are using is rated well.

I hope your girl is continuing to improve. The vets at OSU are still trying to get in contact with Dr. Center to see if there will be any changes with Folly's treatment. I think they are concerned with the cirrhosis and feel that the pred is needed to keep it in check. I am hoping she will have other suggestions.

Thanks again.

Cindy

Cindy, both PhosChol and Denamarin help with cirrhosis. PhosChol has been used when alcohol dependent people have cirrhosis and has been found to increase life span as much as 2 years before a liver transplant is required.

Steroids caused more problems for my girl than they cured. Kate

Got back my girl's bloodwork today. Nearly all of her liver values were smack dap in the middle of normal. Only her Total Protein and Albumin were slightly lower than normal, but they were both improved from her testing three months ago and greatly improved from January when she was diagnosed. I feel as if I won the lottery!!!

Kate,
I am so happy for you and your gal! This gives me much encouragement. My Folly was just diagnosed with a UTI and I am even more determined to get her completely of the prednisone. We go back to OSU for bloodwork next Thursday!

Thanks for sharing the good news!

Cindy

Cindy, My girl also got a UTI when she was on pred. Took a long time to cure. Haven't had another one since she has been off pred. I guess pred is a blessing and a curse. Kate

I read your post regarding adding B6. My doberman was diagnosed with copper storage hepatitis in June. He is currently taking Denamarin and d-penicillamine twice a day; Uridisol; and Vitamin E. Although his ALT levels are still high, they have gone down some. He was on Royal Canin Hepetatic, but no longer will eat it. In fact, he doesn't seem interested in any dog food. Food he liked last week, he won't eat this week. However, he will eat any dog treat, cheese, meat scraps, basically anything "people". I'm wondering if his fickleness is related to a B6 deficiency. How much would I give him? He weighs 70 lbs. Thank you.

From Dr. Center's papers on CuAH: "Because d-penicillamine imparts an anti-pyridoxine (vitamin B6 inactivation) effect in man, pyridoxine supplementation is advised (25 mg pyridoxine/day)."

If that doesn't help the anorexia, you could try ask your vet to let you try mirtazapine. It's a pretty good appetite stimulant. You want to avoid all those human foods/treats and get him back on his Hill's in order to minimize his copper intake. As a last resort, a very low dose of pred can get them eating again, but of course that needs to be discussed with your vet and your internal specialist.

Lisa, You are describing how my girl reacted to d-pen. Lowering the dose helped some, but the effect of B6 was remarkable. A deficiency in B6 effects how foods taste. We give 25 mg of B6 daily, and she loves the same food she would not eat before we added the B6.

Overall, I can't recommend the Hills Diet because it still has considerably more copper than my home made diet with a special supplement to balance the nutritional needs without copper. My homemade diet and special supplement came from www.balanceit.com. A prescription for the diet and supplement from your vet is necessary to order the supplement.

We have also added 625 mg of Denamarin and 900 mg of PhosChol to repair and improve liver function. I highly recommend both. My girl's liver enzymes have returned to normal since June when they were still off the charts.

Hi Lisa, my 10 year old lab was diagnosed in January. He also takes the 25mg B6. My guy has done extremely well. In July his twice daily regimen of 500mg of d-penicillamine was reduced to once daily. Last week he went in for a follow up and the vet further reduced the d-penicillamine regimen to one 500mg capsule every other day. The vet said I could also reduce the B6 to every other day but I have kept it on a daily schedule. In July Theo's ALT was 41, (down from 2084 at diagnosis). Last week his ALT was 39. All other blood test results continue to be in the normal range. His next trip back to the vet will be at year end. You will be surprised and pleased with the effect of the B6.

I just saw a FB post from Lisa G. Shaffer from Paw Print Genetics. It was a couple weeks old. It said, PPG is "seeking samples from Labrador retrievers with a diagnosis of Copper Storage Disease. Samples submitted must be from a dog confirmed with the disease through liver biopsy. We understand that many of these dogs can be deceased and can accept any stored material such as DNA, blood or semen. Would also like to collect samples from obligate carrier parents." The FB post said to contact Lisa G. Shaffer of PPG with any questions.

Theo's breeder contacted PPG some months ago and started the ball rolling on this and our samples have all been submitted. It would be great to have a genetic test for CSD. Please spread the word.

Nancy, Very interesting and exciting. Sassy definitely had copper in her liver by biopsy but no one ever gave her the diagnosis "copper storage disease." Kate

I'm so glad I've found this post!
My girl Ginn was diagnosed early June with hepatitis and we already suspected copper-storage since we know that in her ancestors there was copper storage (hope my English isn't too clumsy, I'm from the Netherlands ;) ) A few weeks into treatment, we learned that she has Addison's disease also (and it was probably thanks to the pred she got for the hepatitis that she didn't go into crisis...). With medication her Addison is stable now and after a biopsy we started D-penicillamine 3,5 weeks ago. Two weeks ago, she started vomiting, what could be Addison- or D-penicillamine-related. Addison was ruled out then, but she also started eating again so we picked up the penicillamine-treatment and she seemed ok.

Last week, she had an osteopathic treatment (because she also has two bad knees, for which she had surgery in January but are still not ok...) and after that, she started vomiting on Friday. Saturday was fine, Sunday she didn't want to eat her kibble (Royal Canin Hepatic). And after that it was on and of, one day she ate, the other day she didn't. We stopped with penicillamine on Tuesday. Yesterday she ate, this morning too but she's definitely not feeling well.

We're going to see the vet this afternoon to do some bloodwork. We were supposed to go next Tuesday, since she was 4 weeks on D-penicillamine then, but will do it now to see if we can get a clue what's going on.
And then, I read your post about the B6 Kate! I will definitely get her some of that. She also gets Milk Thistle, alpha lipoid acid and, SamE. But I think a few days ago the SamE together with tramadol (for her knee) and metoclopramidehydro-chloride (it's called Emeprid but don't know what it's called in other countries?) caused her a slight serotonins-problem.. So will stop with the SamE...

I can't wait to see what her liver-enzymes are now... Because I desperately want to get her off the pred (37,5 mg, she weighs about 70 lbs/38 kg) but every vet I talk to says she needs it for her liver.....

Monique, 37.5 mg is a large dose of prednisone for her size dog. 30 mg was as high as my girl of a similar size took. And my girl had many side-effects from the steroid--including dramatically elevated liver enzymes. My rheumatology friend said that 30 mg would be a lot for a human with liver disease. And Dr. Twedt who is a canine liver expert said that he does not usually use prednisone for copper storage disease and would not give more than 30 mg if he did.

Find another vet or get a consultation from a vet such as Dr. Center in the US. Keep us posted.

I am also struggling with the prednisone issue. We are working with three different vets including the Ohio State University and all of them want to keep our toller on a maintenance dose of 10 mg every other day. They are trying to connect with Dr. Center at my request. But to date have not heard back from her. We go back to OSU today for more blood work and hopefully some treatment updates. Her last blood work showed all enzyme levels back to normal except for one which was slightly elevated. Hoping all are back to normal today.

Fortunately we have had no issues with the Penicillamine. We are also giving the B-6. We are in our 7th week of treatment and Folly wants to eat anything and everything in sight. We had to cut back all of the hostas (highly toxic) in our yard as she was trying to nibble on those the other night. We are back to doing one or two therapy dog visits a month. I also put Folly back in her agility class (low or no contacts and low jumps) for exercise and fun. With her increased appetite, we are trying to keep the excess weight off.

As to the genetic samples. After reading this forum, I contacted one of my toller breeder friends and was put in touch with a breeder in California who is also a professor at UC Davis (I think she was a student of Dr. Center's)and has a genetics lab where "all things toller" are kept. I'm not aware of any other toller with the CSD diagnosis so I forwarded blood samples and Folly's health records to her lab. I am hoping that it proves useful to them.

Thanks for all of the info and advice!

Cindy

We got our latest test results from the Ohio State and after 7 weeks on Penicillamine, our toller's liver enzymes are all in the normal range. She is much more animated, playing with toys and acting like her old self. Our vet ordered our next 3 month supply of the Pen along with another year scrip as her copper values were so high, I am guessing will need more than the usual 6 month treatment. They are encouraging another biopsy early next year. I am worried about another surgery and anesthesia with a diseased liver. Thoughts?

Because of a recent UTI, we are weaning off the prednisone. She is now on 5 mg every other day and within another week, will go off completely.

We will retest after a month, and if things are stable, hopefully she can just continue the chelation process and liver support drugs (Vitamin E, Denamarim, ursodial and PhosChol.

Keeping our fingers crossed that things remain stable...

Cindy

My 10 year old lab started on d-pen (500 mg twice a day) in February of this year. In July we started the weaning process and he went to 500mg once a day. In September his dose was further reduced to one 500mg capsule once every other day. His next visit will be at the end of the year. At that point he will have been on the d-pen for 11 months.

His copper level was above 2000 when first diagnosed (1500 is considered toxic). His liver enzymes were very high initially (ALT 2084) but started to drop as soon as he started all of the "liver friendly" meds--even before the chelation started. In fact, by the time he had his liver biopsy and subsequently started the d-pen most of his scores were back in or close to the normal range (due to the liver meds)... But at that point his liver was still full of toxic levels of copper. The only way to see if the copper is gone is to do a liver biopsy. That said, my vet told me that most people don't do it. The procedure is very expensive and comes with all the risks associated with anesthesia and surgery. My guy will turn 11 next April so I doubt that I will do another biopsy but he is and will continue to be followed closely by his GP vet and his Internal Medicine specialist. Plus I scrutinize his every movement and have him in to the vet if see ANYTHING!

There is a big part of me that wants to know the exact level of copper in his liver when he is finished with chelation but the surgical/anesthesia risks for a dog his age are high. With the exception of the d-pen and B6 he will be staying on the rest of his liver drugs forever and he will be monitored closely.

Hi Nancy,
I have the same concerns about another biopsy as anesthesia is not kind to dogs with diseased livers. Folly will be 6 in January...so she is still very young. I think that is why they want to see her copper levels. Her level was also high..2470....

She too will remain on liver support meds for the rest of her life...The vet was also suggesting prednisone but the jury is still out and hopefully we can avoid the steroids.

Hi all, I was wondering where everyone purchases there B6 and how you administer it.

I buy B6 25-mg tablets off Amazon. You can get them anywhere really.

I also get my B6 on Amazon. My vet recommended 25mg of Jarrow brand B6.

The 25 mg version of B6 was not carried by any of my local pharmacies, but my favorite pharmacist orders it for me. It's the least expensive of all the medications my girl is taking by far.

Does anyone give Vitamin E? We use to use TwinLabs but they dont make it anymore. I found a new one and wanted to see if anyones ever used it. Aqua-E Water-Soluble Vitamin E; Tocopherols & Tocotrienols; 8 fl oz (237 ml) Glass Bottle

I give a water soluble vitamin E...200 IU ...one gel tab a day. My vet just had me purchase from a local pharmacy. I got mine in a health food store.

Our most recent bloodwork showed all enzyme levels back to normal so we are not taking the pred. Just the chelation meds and liver support meds.

We go back in a month for more blood work and are hoping things remain stable.

Our toller got into her denamarin last night and ate about 12 chewable tablets! She is eating everything in sight! From what I read, there should be no ill effects.

Cindy

I give a water soluble vitamin E...200 IU ...one gel tab a day. My vet just had me purchase from a local pharmacy. I got mine in a health food store.

Our most recent bloodwork showed all enzyme levels back to normal so we are not taking the pred. Just the chelation meds and liver support meds.

We go back in a month for more blood work and are hoping things remain stable.

Our toller got into her denamarin last night and ate about 12 chewable tablets! She is eating everything in sight! From what I read, there should be no ill affects.

Cindy

Question. I was wondering if any of you also have a secondary diagnosis of lymphocytic cholangiohepatitis and or sclerosing or destructive cholangitis along with the copper storage disease? We are currently on all the following meds and have been since April and it doesn't seem like the liver values are going down =(

Penicillamine 55mg

Ursodiol ¼ tablet (250mg)

Prednisolone 1 tablet 5mg

1/8 teaspoon Phosphatidylcholine

Liqui-E 1.5cc/ml

Denamarin 90mg

Chlorambucil 1.9mg every other day

Penicillamine 55mg

My 9 year old lab was recently diagnosed with Chronic Hepatitis...and the liver biopsy results came back with a high level of copper (700). In doing my research, I came across this forum...and thank you for sharing what you have learned!

River had no symptoms of liver disease, until a round of Rimidyl...and we hit a storm. ALT numbers over 2000. She spent two days in the hospital, IV fluids, antibiotics and anti-nausea drugs. She has since then been on Uracil and Denomarin. Her ALT numbers have drastically decreased, to around 500.

I am still sorting all this out (which came first the Copper Storage issue or the Chronic Hepatitis?). However, she has not had any further symptoms of Hepatitis...no ascites, yellowing of her eyes, aneroxia etc. I plan to get a second opinion on course of treatment, likely with Cornell as you suggested.

I am researching liver diet dog foods...and I am NOT impressed. One wants to feed them trees (cellulose) the other corn, both are extremely low in protein and available calories. My dogs are currently on Fromm's, and I love this company and their food, but from their website...the copper is 20 mg/kg.

I am interested in Flint River for my River, what formula did you find to have the lowest copper amounts? what is the Crude Protein and protein source? I don't believe she needs to be on a strict protein reduction...as her liver is processing proteins just fine.

Thank you for your input!
Tracy Harper & 'River'

I use the grain-free fish diet, and it has 10.6 mg copper. I think the regular formula is slightly less copper. But you can call the company.

Nearly a year after my girl became so ill both of my vets thought she was going to die, she is celebrating her first year anniversary by running, playing and eating. It's been a steep learning curve, but I now have some confidence she will enjoy the pleasures of living another year. Many thanks to those who accompanied us on this journey that I hope no one else has to take.

Last week when filling Sassy's pill box. I omitted the B6 by accident. 4 days later she started vomiting and refusing the food she loves. At that point I realized my B6 mistake and popped one immediately in her mouth. She got another one with her morning meal, which she ate reluctantly. But by evening she was no longer nauseated and ate vigorously.

B6 supplementation is essential to d-penicillamine chelation because the d-pen causes a deficit of B6, which causes nausea and taste aversions.

We were fortunate to have found this forum and started using the B6 from the beginning and have not had any issues with eating or nausea.

We are nearing the end of the 6 months treatment period for our toller although the vets from OSU have ordered up another years worth of penicillamine.

We are concerned about doing another biopsy as surgery can be hard on the liver. What are your thoughts about a second biopsy after treatment?

Folly's copper levels were extremely high.

Currently, she has lots of energy...is doing agility classes and continuing with her therapy dog work once a week. She has put some weight on and we are working to
get that under control.

Thanks

Cindy

We were fortunate to have found this forum and started using the B6 from the beginning and have not had any issues with eating or nausea.

We are nearing the end of the 6 months treatment period for our toller although the vets from OSU have ordered up another years worth of penicillamine.

We are concerned about doing another biopsy as surgery can be hard on the liver. What are your thoughts about a second biopsy after treatment?

Folly's copper levels were extremely high.

Currently, she has lots of energy...is doing agility classes and continuing with her therapy dog work once a week. She has put some weight on and we are working to
get that under control.

Thanks

Cindy

Right before Christmas Theo saw his internist. It was almost a year from when this journey started. He got a clean bill of health and all of his liver scores and other blood scores were normal. The vet had been weaning Theo from the penicillamine for some time and I was looking forward to the day when Theo would no longer need penicillamine. But that is not to be. My internist vet is following the protocol provided to her by Dr. Center. Per the protocol, Theo will stay on a low dose of penicillamine (and B6) for the rest of his life.

Dr. Center's protocol got us to where we are today so I have no complaints. Plus it does provide some peace of mind. Theo is taking classes to become a certified therapy dog. He has his CGC and at the end of this course he will be therapy certified and have his CGCA. The exercise for the "leave it" command is a challenge for Theo. After performing it correctly a few times, he made a dive for the treat-- a turkey brownie! At that point I was glad he is still on the penicillamine. Poor Theo, he got tired of Craisins and animal crackers as training treats!

During the weaning process Theo first transitioned from 1 capsule twice a day to one capsule once a day. After several months he then transitioned to 1 capsule every other day. After 3 or 4 more months and good blood tests he transitioned to his maintenance dose which is 1 capsule twice a week. So for the rest of his days Theo will be taking his penicillamine--1 capsule every Monday and Thursday--- always accompanied by his B6. The other meds he will always take are: Phoschol, milk thistle, SAMMe and vitamin e. Theo will turn 11 years old in April. God bless all of the wonderful, knowledgable vets who saved him.

The gold standard is a second biopsy to evaluate the efficacy of the treatment; however, most owners don't do it. In that event, Dr. Center has a standard protocol based on the copper quantification from the first biopsy, the extent of liver injury from the pathology, and looking at the liver enzymes, which should return to normal.

Mine is having her second biopsy middle of February, after 10 months of chelation. Her ALT only returned to the normal range in December.

Kate,

"From another Lab breeder I have learned that Dr. Twedt at Colorado State is now trying to avoid the use of d-pen and use zinc, which also has side effects. Partly this change is due to the fact that a shortage of d-pen raw ingredients has occurred. The research on zinc efficacy for this kind of chelation is much less favorable than d-pen. "

Do you know how Dr. Twedt is using zinc instead of d-pen? how girl is not tolerating the d-pen very well even with the B6.

Charity,

Have you tried adding Cerenia? Khalil had horrible side effects from D-pen (mainly vomiting and low appetite) As soon as we added Cerenia he is doing much better.

Our vet just recommended it but didn't give me directions on when is the best time to give it. This is only her second case of Copper Toxicosis. Did you give it at the same time as the D-pen or at another time? Also, her Cerenia is quite expensive life $40 for just two doses. Any suggestions?

Charity, what dose B6 are you using?

Charity at first we gave Cerenia everyday an hour and a half before D-pen. Then over a couple months now give it every other day an hour and a half before D-pen. We actually take a 16mg pill and split it into fours. Khalil only weighs 11 pounds though. Also We actually started at a really low dose of D-pen and over the months titrated up

Nancy,

We are giving B6 50mg because we feel like she already has a pretty large deficiency in it, split in morning and night.

My guy weighs about 100. He was getting 25mg of B6 with each dose of d-penicillamine. So initially when he was taking d-pen twice a day he was getting 50mg a day. Now he only gets B6 twice a week when he gets the d-pen. Even though he is only taking the D-pen twice a week now his dosage is still 500mg. Sorry that it isn't helping your girl.

When I first started chelation, I had to use a lot of Zofran to deal with nausea and vomiting. I think the nausea and vomiting was more due to her liver disease than the chelation. Over time as her liver healed, I was able to drop the Zofran and only use B6.

Hope this helps. Kate

Hi,

In last December one of my dogs was diagnosed with chronic hepatitis and as I was feeding them with Orijen, I was searching the net for a possible relation, that's why I found this forum. I decided to share my experience, maybe it will be useful for others too...

I have 3 dogs, all of them are mixed breeds and I can only guess about their origins, but probably my above mentioned dog have labrador retriever (or golden retriever) blood in his veins. I started feeding my dogs with Orijen 6 Fish and Orijen Red around Ferbruary, 2012 and on the regular yearly blood screen check (21st of September, 2013) he was detected with elevated ALT enzymes (214). The vet recommended to take a human medication called Silegon, which is based on a thistle extract. I gave that to my dog for a month, but on the next check, his ALT value was a bit higher (225).

Then (in November, 2013) I took him for a biliary stress test, which came up with a negative result, but the new vet, who performed this test, recommended to take Samyling dust and Glutamax tablets for a month. After that treatment the ALT value dropped to 172.

After a few months of waiting, in April 2014, the next blood screen check came up with a shocking result of ALT level 366, so our next way was for an ultrasound check, which came up with a negative result too. That vet also performed an ammonia test, which was also negative.

From May, 2014 we started the earlier Samylin/Glutamax treatment once again, but this time I had to switch the food for this dog from Orijen to Royal Canin Hepatic. After a month ALT dropped to 254, so I continued to feed my dog with the Royal Canin food. After a few months of waiting, in August the next blood screen check showed ALT level of 158, which was a bit relaxing news.

While continuing to feed with the Royal Canin Hepatic food, in November I made another blood check and the ALT level was 195.

In April 2015 (still on Royal Canin), the next check showed ALT level of 191 and the advice of my vet, I stopped feeding with the hepatic food and switched back to Orijen (that was not my vet's advice, just my idea).

At the end of the year we went to the regular blood screen test with my dogs and I got completely devastated by the result. The above mentioned dog had an ALT level of 515 and the AST level (which was still within normal limits until now) of 105. As we basically tried everything already, the vet recommened a laparoscopic liver biopsy and I accepted that. From the sample they made a bacterial test (which came uo negative), a copper test (also negative) and a histology test, which diagnosed an early stage of chronic hepatitis.

I have to make a small detour here and mention two of my other dogs. One of them is a possibly german shepherd and husky/malamute mix, the other was a still yong (1 year old) foxhound mix. The former dog was eating the same Orijen food for more than 3 years and her liver values were completely normal all the time. However the foxhound had a blood check in April, where the results were completely normal and around that time I switched to feed her with Orijen too. When the next check came in December her ALT and AST values were above the limit (ALT went from 42 to 94, AST went from 51 to 81 in 8 months).

After the liver biopsy I decided to stop feeding my dogs with Orijen immediately and switched to Dogchow, which was just a quick cheap / lighter in protein choice. After a month the foxhound's liver values went back to normal (ALT from 94 to 63, AST from 81 to 44).

Back to my first dog... After the histology diagnosis, my vet told me that I have two choices, either I start a steroid treatment or we try Cyclosporin, which, as he told, is a lighter medicament with less side effects and as we are in an early stage, he would recommend that. As it was my dog's life at stake, I decided to get at least two other vet's opinion before making a decision.

Next I went to the university of veterinary science and spoke with a professor, who was expert in liver diseases. She checked the dog, the earlied blood values, the result of the biopsy and told me that we should forget Cyclosporin, we have to treat the dog with Prednisolone for 6 weeks. She also said, that with the steroid we might catch the inflamation, but as the cause is unknown, it is possible that it will reoccur again. She was so confident that even while I was heavily against using steroids for the liver problem, I started to accept it, that we don't have any other choice.

However I already had a time reservation at a homeopathic vet, who was recommended by some friends, telling that sometimes he can make miracles. I am not a big believer of homeopathy, but as I already had a reservation, I decided that we can't loose anything with the extra check.

I told everything to him, with all the results, opinions, etc. and told him that I have to choose between the two treatment and came for an advice about which one to choose. After checking my dog and the lab results, he said that his opinion won't help with my decision, because he don't recommend any of those two treatments. His opinion was that the condition of my dog was the result of the feeding with dry food and I have to switch to raw feeding. He also prescribed the following as a treatment:

- Carduus Marianus D6 (probably vitamine D6)
- Xiao Yao Wan (a chinese herbal mix that stimulate the liver and looks like lead balls)
- Em-bio (I think this is a bacterial culture for supporting the switch between digesting raw meat instead of the dry food)

As this treatment seemed to be the most promising with the least side effects, I decided to give it a shot and try it for 1-2 months, if it is not effective I can still try using steroids...

The medicaments lasted for about 3-4 weeks, after that I was still feeding my dog with raw food. After one and half month, I went to the local vet to check the liver values to see which direction they went. I told the vet all the previous history including the last ALT/AST values (515/103). She seemed to be scepticist when I told about the current treatment but was quite surprised whenshe called me with the results. The ALT value went to 125 and the AST value dropped to 62!

I was very happy hearing those results, but I try to be careful about it as it might be an error with the blood check or only a temporary success, but we will do another big blood screen test in May and if that remains the same or better, I might believe in the raw feeding/homeopathy... :)

If I have more news, I will post an update, but if anybody need details, feel free to contact me...

Regards,

Csaba

I have found that Avoderm Lamb and Rice has only 7.5 mg copper, which is only slightly more than the therapeutic low-copper diet for liver disease provided by Royal Canin. Lots less expensive too. Better food.

I have switched all my dogs to AvoDerm original Lamb & Brown Rice. It is costing me about $1.70 per pound of dog food so it is not either the most expensive nor the least expensive dog food available. The dogs seem to like it. And gastrointestinal products look OK. The copper content is 7.5 mg/kg, which is just slightly above the 7 mg/kg therapeutic diet produced by Royal Canin for liver disease.

Two flies in the ointment are that I must special order it from my local retail store or buy online and that Breeder's Choice who produce Avoderm had a recall in 2012 for salmonella.

Another possible food was Honest Kitchen but this is a dehydrated food that needs to be reconstituted with water before serving and is incredibly expensive.

Months of searching. Hope it helps someone else. Kate

I have a 10lb chiweenie who is struggling hard with liver disease. I am curious about PhosChol , and what a dosage would be like for her. My vet doesn't know about it, and I talked to another that said dosage for such a small dog is hard - and to not do it. YET, I'm afraid because H.E is getting bad.

I have her on: cerenia, prednisone (1mg day), ursodial, zinc, vitamin e, milk thistle, samE (I use to have her on denamin, but didn't seem to be doing much so I switched samE), tumeric, missing link supplement (gonna switch to Balance CU)...

I also give her low/no fat yogurt with manuka honey for snacks, but her appetite is good. I give her sweet pototates/white potatoes/ground turkey, sometimes egg whites/ white rice....

But I feel like I do not have things dialed in, she is getting worse -- though she just stopped metronizadole for 3 weeks.. though I don't think that it helped much after the first week. (previously, it worked well, this time, seemed to make her HE worse).

any ideas/thoughts?

Thanks for the food info, Kate. My lab, Lincoln and I are just starting down the Copper Storage Disease path and everyone's comments here make me feel much better. Lincoln flatly refused to eat the Royal Canin hepatic(perhaps this just shows his basic good sense) although he has never refused to eat anything ever before. Anyway, with our vet's approval we are going to try the AvoDerm Lamb meal and brown rice. I noticed that their red meat and potato formula also has 7.5 mg/kg of copper. Your information saved me hours of searching and I really appreciate it.

I just came across your post in a search for low copper dog food recipes. Our Black Forest Hound was also just diagnosed with Copper Storage Disease. Everything I have read so far points to genetics, but his breed is not known to be genetically predisposed, and we are in touch with his breeder and there have been no reported cases in his blood line. Could it be that his dog food has poisoned him due to the excessive copper content? Even the prescription food we have order in exceeds the amounts of copper that I have been able to find as the recommended maximums with Copper Storage Disease (the references I have found state < 5mg/kg of body weight, and the prescription food contains 7mg/kg of body weight). I was thinking about giving him some prescription food and supplementing with other low copper foods (I am a Registered Dietitian, and have worked with humans with Wilson's Disease, so feel comfortable with doing this, however, I am not that knowledgable about canine nutritional requirements, and don't want to cause micronutrient deficiencies by not giving him the right amounts of food). Any suggestions on low copper home-made meal recipes that would meet his nutritional requirements?

I hope that you read this entire thread because it addresses many of the issues that your posts has. I feed a copper-free diet that is made from recipes I got from Balance It. They provide a nutritional supplement so that the recipes contain what a dog needs without copper. The recipes and supplements are designed by a veterinary nutritionist who started Balance It. I highly recommend it.

I feed all my other dogs Avoderm Lamb & Rice which contains 7.5 mg/kg, the lowest food I have been able to find.

Kate

My lab has this condition. He is taking, and tolerating well, Pencillimine, which he has been on for 4 months. His enzyme levels are improving slowly. He also has epilepsy, which we are managing well, although he had to change from Phenobarbital to Keppra because of his liver condition. Otherwise he is in good health, unfortunately he doesn't like the prescription dog foods. He refuses to eat Hills, wet or dried, and is now going off Royal Canine. Does anyone have any suggestions? He's not a fussy eater otherwise, happy to eat the bits of cheese, egg white and chicken I use to get him to eat the quantity of pills he has to take.

Avoderm Lamb and Rice has only slightly more copper than the prescription diets.

Honest Kitchen.

Homemade recipes from BalanceIt.

Good luck with your boy. Kate

Thank you so much for your forum and for all the work you've done researching this condition. I'm definitely going to check out AvoDerm and run it past my vet. Nelson loves lamb so he should be pleased.

My 4 year old lab had copper storage disease confirmed this summer. His surgeon did find scarring during his liver biopsy. We have been treating him with penicillamine for four months. He was also taking cyclosporine but we had to discontinue that because he kept getting infections. I'm writing to see if anyone else has had issues with the blood protein levels (albumin) being slow to come back up to normal. Bandit's are still low, even though his other levels are now in a normal range (they were off the charts when we first discovered his condition this summer). Also, I read that some of you are continuing penicillamine treatments at low doses for life. Is that correct? I just want him to have the best chance possible. We love our boy and want him to keep getting better. I'm open to all suggestions (medicine, diet, etc) that have worked for you guys.

It will be 2 years this January that my now 11 and a half year old lab was diagnosed and began treatment. Theo takes his penicillamine and B6 twice a week. The vet said he will always stay on a low dose penicillamine. He is also taking his Phoschol, SAMe, vitamin e and milk thistle. He has a great quality of life and got certified as a therapy dog earlier this year. Theo's blood tests haven't shown any issues with albumin. His issue recently has been very slightly elevated creatinine levels. I hope your lab does well. Eventually all of "this" becomes your new normal. My vet said Theo's life expectancy will not be affected by copper storage disease. Best wishes!

Welcome, Deborah, to the thread no one ever wants to join. I'm so sorry for your boy, but I am glad that you are getting help.

My girl Sassy was first diagnosed about two years ago when I started this journey and this thread. She had great difficulty tolerating the d-penn so she was taking a reduced amount until April of this year when she began to have intermittent bouts of vomiting and diarrhea.

I took her off the d-penn because it appeared to be causing her GI distress. We could not figure out the whole picture and her weight dropped from 65 lbs to 47 lbs. We began treating her as if she had inflammatory bowel disease using steroids and many small meals a day. For the last two months we have decreased the steroids and slowly increased her food through small meals. She is gaining weight and is off the steroids for the last couple of weeks.

I doubt that I will ever risk putting her back on the d-penn because she nearly died from the GI problems. So for now she is taking only Vitamin E, PhosChol, and Omega 3. When she gets back up to a normal weight, I will add back the Denamarin.

She will be 11 in February, but at diagnosis she was not expected to live. So I think we are doing well managing her liver disease.

About the albumin levels, she is normal. Kate

Hi Kate and all,
I have a Duck Tolling Retriever, Folly, who was diagnosed with CAH almost two years ago in March. Later that spring, we found she had crazy high copper levels and began our journey trying to control this issue. I found this thread to be extremely helpful as I educated my own vet through this process.

As her liver showed much scaring and damage, we started Folly out with steroid treatments that are typical with chronic active hepatitis but Folly did not do well with the pred. We stopped the steroids after several months.

She currently takes D-Penn, vitamin E, Vitamin B-6, Ursodial, and Denamarin (with Phoscol thrown in from time to time) She is on a liver diet.

My dilema...Folly has been on her full dose of D-Penn for 16 months now. She seems to tolerate it well...in fact the vets at Ohio State want her to lose a few pounds. I am concerned about long term D-Penn usage but have not been able to find out anything about this topic.

Folly's liver enzymes tend to fluctuate somewhat from normal to a slight elevations in ALT. We do bloodwork quarterly. We don't know why the fluctuations occur.

Her energy level is good...she does agility and is a therapy dog.

I know a second liver biopsy is recommended but we just lost our other toller to cancer and I dread the thought of putting Folly through a second surgery.

Any thoughts on long term D-Penn usage. Folly will only be 7 in January. When diagnosed almost two years ago, she was given a guarded prognosis.

Thanks

Cindy

Cindy, about 20-30% of people being treated for Wilson's disease discontinue treatment with d-penn because of side effects, especially GI side effects but also kidney problems. In one study nearly half of the participants had to stop taking the d-penn. Kate

Kate,
Thanks for the info. Maybe that explains why my vet also does a urinalysis when they do the quarterly bloodwork on Folly? We will be doing more bloodwork this month. I am hoping everything is back in the normal range.

Cindy

Your vet should get a creatinine and/or BUN level to assess kidney function. Ask for it. These may be part of the blood work that your vet plans, but I would ask to be sure because some vets don't know that d-penn can affect kidney function. Good luck and keep us posted. I think we all learn from these experiences. Kate

Great...Thanks again Kate. I will ask about these other tests. As always, you and this site have been a wealth of information.


Cindy and Folly

What is the dosage and brand of B6 vitamin supplements that you give while dog is undergoing 400mg 2/x per day of D-penacillimine treatment. Thnx!

From the earliest days when he was taking d-penicillamine twice a day, 7 days a week until now (2 years later) when he takes 1 capsule only 2 days a week the B6 dose has remained steady at 25mg.

The brand I use is Solgar. I buy this on Amazon because local shops didn't carry the 25mg dosage.