Sago Palm Poisoning

Question
QUESTION: Hi, JoAnn,
My 5.5 lb Maltese ate a Sago Palm seed on 17th of Aug. I didn't get her to a vet until 8 days later because she was just under the weather-no vomiting etc. I didn't know it was a Sago or that they were poisonous. When she started to vomit-and continued not to have an appetite, I Googled it and realized what had happened 8 days prev. I immed took her to vet. Vet kept her overnite giving her IV fluids. I'm a nurse, so vet gave me equipment to give her bolus fluids each day under skin of nape of neck. She also gave me same-E, milk thistle, Reglan for her appetite and stomach. In addition I'm giving digestive enzymes and pet flora for her gut.
She's better now on Sept 11th. My question is should she be better than she is by now? She still isn't eating unless I give her Lil Cesars by hand at least to start. How long does it take to get better? Because she's better, does that mean she's out of the woods? Can she relapse and die?
I haven't asked the vet because until today, I couldn't even face that option of losing her. Did your doggie die after getting better, or was it a downhill spiral?
Is there something else I could be giving her?
I'm very worried about her.
Thanks,
Catharine

ANSWER: Hi Catherine,

I am SO sorry to hear this.  I was just at a Home Depot Store and see that they STILL have no warnings attached to the sago palms they're selling and that is just negligent in my opinion.  Just a year ago I had a vet tell me that eating a palm plant of any kind shouldn't be a problem.  You'd think vets would be WELL aware of the HORRENDOUS toxicity of these plants.

First off, I'd like to know what her liver enzymes were and what they are now and I'd like to know if they did a Bile Acid Response Test and, if so, what the results were.

The inappetence is a very common problem with dogs that have liver dysfunction. You should have her on a liver friendly diet and I'm afraid that wouldn't be Little Ceasar's. This website will have a liver cleansing diet on it (created by Dr. Jean Dodd's who is VERY familiar with liver dysfunction) and possibly some other information that you may be interested in:  http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm  Highly digestible forms of protein are the best so that the liver doesn't have to work as hard. This would include things like white fish, chicken, eggs and cottage cheese (low fat and low salt). Red meats produce more ammonia which can be a problem for liver dogs.

I haven't had a dog that had sago palm toxicity, but have had a dog with a liver shunt and I'm well acquainted with individuals who have experienced sago poisoning with their dogs and who now have dogs with severe liver damage.  It takes time for the liver to repair and how well it repairs most likely depends on the type of assault to the liver and how bad the damage is/was. To get an idea of how well she's doing, you'd need to take a look at the CBC they originally did and you should have had a repeat CBC by now to compare with it.  Repeating the Bile Acid Response test at regular intervals is also important in my opinion.  You want to make sure to do both the preprandial and postprandial portions of the test.  The BAT tells you how well the liver is functioning.

Catherine, my heart goes out to you...and I mean that sincerely.  Get back to me with the blood test results and lets talk about this more, including the supplements that are commonly used (which do include the milk thistle you're currently giving her) under these circumstances. Who recommended the digestive enzymes and the gut flora that you're using?  Are you talking about probiotics?  I'm just wondering WHY they would be recommended at this point? I am committed to giving this warning to ALL who write me about health problems (so, this is NOT directed specifically to you): Do be extremely careful of using supplements sold by individuals over the internet that serve no more purpose than making them a commission - people like that generally have NO idea about the health problems of your dog and can cause even more harm. Since the liver clears most medications and supplements put into the body, we have to be VERY sure of the efficacy and safety of what we use when dealing with liver dysfunction.

I look forward to hearing back from you, Catherine.  I'm sure you already know that you can call your vet and ask for a copy of all test results.

Jo Ann



---------- FOLLOW-UP ----------


Wolfie & Spunky (on L)   QUESTION: Hi,
Thanks for all your great info, Jo Ann.
I'm feeding her Lil Cesars only because it's the only thing she'll eat besides a few choice treats. And even then I have to start her eating by tucking tiny bites into her mouth and waiting until she swallows. We do that for a few minutes and then she'll hesitantly eat a little more in her bowl. I keep thinking after these 3 weeks of doing this her appetite will come back on it's own. I was cooking lots early on-chicken, rice, Telapia fish w carrots, sweet potatoes with lots of nice broth, and she wouldn't have any of it so I quit. I'll try cooking again, and mixing the lil cesars into it in smaller and smaller portions. It's horribly discouraging to keep trying all these things and her not wanting it. I normally feed both my Malteses fresh frozen green tripe I have shipped in. Normally, they both love it. Now she won't even have any broth of it. She will eat it dried, and likes that, so I'm giving that to her. Dehydration is a real problem too because she doesn't want to drink anything. So with lil cesars, I add 1/4 c or so of water and she'll take that.
Vet hasn't done a BAT. Liver enzymes are:
8/25
AlkP-74
Alt-114
Albumin (not liver enzyme)-4.3

9/3
AlkP-68
Alt-103
Albumin-4.0

CBCs both times were normal

Her test results aren't real bad. I just don't know why she's not feeling better. Will get the vet to run a BAT.
I'm also going to increase her milk thistle according to the website you provided.
Digest enzymes were suggested by vet to help digest the lil cesars and take a load off her liver and pancreas. I'm giving Pet Flora as as support for flora in her bowel. Apparently with liver damage, the bacterial load goes way up. It's a probiotic.
Thanks again for your support and advice.
Catharine

Answer
Hi Catharine...

I apologize for being a bit late with my reply.  Her liver enzymes are quite good.  Her ALT was up a bit and then came back down on 9/3, so that's good.  That's great that you'll have the BAT run and if you haven't checked her bilirubin with a urinalysis, that would be good, too.

Often times when a dog has liver dysfunction they will become inappetant because the type of food that they're eating makes them feel bad.  Red meat isn't highly digestible and causes ammonia which effects the brain and causes a neurological dysfunction called hepatic encephalopathy (HE).  Liver friendly proteins like chicken, cod, eggs, yogurt, low fat & low or no sodium cottage cheese are all good (which I think you're already aware of). I think your idea to mix the cesars food into a new diet and then decrease the amount gradually is a good one.  That's good that she will take water with the lil cesars food. Do you think that she would be more apt to adjust to a more liver-friendly diet if you blended the food to a baby food consistency and added the lil cesars to that?  Many people with inappetant, liver compromised dogs will syringe blended food into the dog's mouth to "jump start" them to eat again.

Yogurt would most probably serve the same purpose as the Pet Flora.  I should mention that it's also important that she be fed several small meals per day vs. one or two large ones.

There's a Yahoo group for dogs with liver dysfunction that you might be interested in.  If you think you want to join, write me back and mark your correspondence as "private" and I'll send you the information.  If nothing else, you can peruse the files and archives and look for information from others who have experienced sago poisoning.

I'm thinking of you and sincerely hoping for a full recovery for your little Maltese.

Jo Ann