Introduction:
Chronic active hepatitis (CAH), Doberman hepatitits
(DH) is a yet relatively unknown liver disease with dramatical consequences
for the Dobermann. The disease was first discovered by us in Finland at the
end of the 70s. Articles in medical journals began appearing in the beginning
of the 80s in the USA. As there is too much copper in the liver, the condition
has been also called copper toxicosis. Other names used for DH are chronic
hepatitis and doberman hepatitis. The symptoms are so typical of DH patients
that they caught the eyes of the Finnish Dobermann breeders in the 80s. This
led to the beginning of an erradication program. This disease is recognized
worldwide as data has been published at least in USA, Finland, Holland, Sweden,
Germany, England, Australia. Signs The disease is most likely to affect a
female aged four to six years. Males develop DH more seldomly. The initial
symptom, though often neglected, is polydipsia (heavy drinking). The dog may
eat a lot of snow during the winter and tends to seek some other sources of
water, besides its own cup. Heavy drinking may only be temporary or intermittant.
When the condition progresses further, a poor apetite vomiting and weight
loss soon follow. As the disease advances, the mucous membranes start to turn
yellowish. This is most apparent in the eyeballs (sclera), the gums and on
the skin in areas where hair is scarce such as the ears and the inguinal region.
This stage is called icterus and is typical of any liver condition.because
bilirubins (bile pigments) accumulate in the blood stream and tissues due
to the liver dysfunction. Weight loss becomes accelerated and the dog develops
free fluids in the abdomen, often so much that it looks like a puppy that
has just eaten a huge dinner. The only differences in the appearance are the
pronounced ribs and spine. The dog is tired and lethargic, although not entirely
incapable of running and playing if required, as Dobermanns always like to
do.
History:
The Finnnish Kennel Club supported the start of a wide based collection of
blood samples from healhy Dobermann females in 1987. We anticipated to find
changes in liver enzymes like ALT (s-ALT) from normal dogs before the onset
of clinical signs. The suspicions proved to be valid. The serum ALT values
were clearly elevated for a long time before the individual itself showed
any signs of the disease. As a matter of fact, as the project has continued
we have noticed that some dogs with elevated liver enzyme values may develop
the clinical signs quite late. Only the elevated liver enzymes indicate the
presence of problems in the function of the liver. The right nutrition among
other yet unknown reasons is believed to play an important role in keeping
the individual from developing symptoms. This is not surprising considering
the responsibility the liver takes in metabolism; it becomes over loaded with
the wrong nutritions.
Erradication program:
In Finland, we want to discover the sick animals long before the problems
show up. During the years we have collected blood samples from dogs that do
not present any signs of the disease. A majority of the test are normal of
course continuously. The ideal procedure is to start investigations at the
age of two to three years and continue yearly or every two years up to the
age of about seven years. Nowadays DH testings are official and obligatory
for Dobermanns which are used for breeding. To get puppies registered, both
parents must have results no more than ten months old at the time of the mating.
Every now and then we discover individuals with abnormal values. Many of them
are just innocent, once in a life time jumps, but few of those elevated values
remain high. These are the dogs that should be to followed by blood tests.
The definitive diagnosis of DH is made only by biopsies taken from the liver.
That is recommended for individuals with high ALT values for two to three
consecutive tests or several high peaks during one year. We are able to detect
any deterioration at their health condition by following the test values.
Those Dobermanns with ALT values over the normal laboratory range (VETLAB,
Tampere; the normal range is 24 - 136 U/I ) more than once, are also controlled
for SAP, bilirubin, bile acids, and if needed, other blood parameters to get
more information about the situation and to know more about the prognosis.
Different laboratories have different normal ranges for ALT. In order to obtain
reliable and compareble results, qualified lab is needed. In Finland, we approve
only one lab for official tests by Finnish Dobermann Club / Finnish Kennel
Club.
Treatment:
The treatment should be started as early as possible, before the clinical
signs. What if the dog gets the clinical signs? Then the situation is worse.
Blood tests may show s-ALT to be five to ten times over the normal. Other
blood parameters are often not good either. At the moment we do not know the
cause of the disease and it is very difficult to try to cure DH with specific
treatment. We have to try the medicines which relieve the symptoms. Initially,
drugs which chelated the copper (D-penicillamine) were used. This didn't seem
very encouraging. The most valuable medicine is still corticosteroids. On
the other hand, steroids and the Dobermann is not a good combination and the
use of this medicine can result in some problems. It seems that the breed
is sensitive to its use. Corticosteroids often results in side effects which
we would prefer to avoid. The treatment of clinically ill dogs demands a lot
of precision and caution. With the proper treatment, it is possible to ease
the progress of DH and prolong the inevitable a little further. The difference
between the beginning of the symptoms and the start of the treatment makes
a great difference in survival time. According to our statistics, the survival
time can be from some weeks to several years. New medicines to treat patients
with DH are continuously being researched, but until this day we do not have
many promising alternatives. We prefer a strict diet based on home-made food
low in copper and abandoning all comercial preparations. The food regiment
is the same for dogs with no clinical symptoms.
Discussion:
Just by controlling all breeding stock, the number of DH cases seems to be
decreasing. We had great difficulties in the 80s just before our quarantine
system for dogs was abandoned. Most individuals were related to some heavy
used carriers of DH. In 1988 and onwards we were able to import many new dobermann
lines. It seemed to help a lot. Or perhaps the problem is just hidden? Anyway
it is almost impossible to breed with individuals with high ALT results nowadays
in Finland. Not because it is not allowed (because it is, only test has to
be made), but mostly because the results are public. Public opinion is important
in selling the puppies. We are not free from DH. Our first recognized cases
to Finland came with the imported animals from Germany. We have still found
many individuals with DH to have direct ancestors of imports or are imported
themselves. So it is not possible to stand against DH alone. It is sad that
we are dependent on European breeding stock, which is totally out of control
with DH. That is of course mainly because breeders and veterinarians are not
aware of the problem called DH. The problem can come more common again in
Finland, but also elsewhere due to two reasons. We sometime use some males
heavily all over Europe not knowing their health state and population number
can drop quickly in the near future because of the ear and tail cropping legislations,
leading to serious genetical problems.
