Liver Shunt Testing

[MyFairLacy]

Originally Posted by Ladymom

The bile acid test was developed at Cornell by Dr. Center. They wrote the initial protocol and have since updated it.

This is taken from Page 5 of the handout Dr. Center gives out at her seminars:

7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial)." (all emphasis was added by Dr. Center)

This is from Page 22:

2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. How old dogs should be at he time of initial testing has not been established. Typically, abnormal bile acids DO NOT normalize as a dog ages ..... " (all emphasis added by Dr. Center)

Since Yorkies are thirty-six times more likely to have a liver shunt than all other breeds combined, I can't imagine why a breeder would not have a BAT done or a buyer insist that it be done before the puppy goes home. 12 hour fasting is no longer required and the test is so inexpensive.

Sadly, just because the parents are clear doesn't mean they won't produce a puppy with liver disease. We have two puppies on our Maltese forum from reputable show breeders whose parents were clear, had a CBC done before they came home with normal ALT's who have both been diagnosed with liver disease since - one with a shunt, one with MVD.

how old were they when they were diagnosed? I need to do more research on Liver Shunt. Are dogs more commonly diagnosed very young (4 months and under), young age (4months to a year) or older (over a year)? Is it worth doing a bile acid test somewhere between 12-16 weeks and then again at 6-7 months before a dog is commonly spayed/neutered?

[Ellie May]

Originally Posted by Ladymom

The bile acid test was developed at Cornell by Dr. Center. They wrote the initial protocol and have since updated it.

This is taken from Page 5 of the handout Dr. Center gives out at her seminars:

7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial)." (all emphasis was added by Dr. Center)

This is from Page 22:

2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. How old dogs should be at he time of initial testing has not been established. Typically, abnormal bile acids DO NOT normalize as a dog ages ..... " (all emphasis added by Dr. Center)

Since Yorkies are thirty-six times more likely to have a liver shunt than all other breeds combined, I can't imagine why a breeder would not have a BAT done or a buyer insist that it be done before the puppy goes home. 12 hour fasting is no longer required and the test is so inexpensive.

Sadly, just because the parents are clear doesn't mean they won't produce a puppy with liver disease. We have two puppies on our Maltese forum from reputable show breeders whose parents were clear, had a CBC done before they came home with normal ALT's who have both been diagnosed with liver disease since - one with a shunt, one with MVD.

Interesting. I think it is funny how vets are so slow to change protocol (still requiring 12 hour fasts) when the inventor of the test says it isn't necessary.

[jencar98]

Originally Posted by Ladymom

Sadly, just because the parents are clear doesn't mean they won't produce a puppy with liver disease. We have two puppies on our Maltese forum from reputable show breeders whose parents were clear, had a CBC done before they came home with normal ALT's who have both been diagnosed with liver disease since - one with a shunt, one with MVD.

I was wondering about this very thing, the possiblity of parents testing okay and still producing an LS puppy. I did wonder if the disease could skip a generation. Now that I know, I wouldn't accept a puppy just because the parents were cleared, I would insist the puppy be tested too.

[Ellie May]

Originally Posted by MyFairLacy

how old were they when they were diagnosed? I need to do more research on Liver Shunt. Are dogs more commonly diagnosed very young (4 months and under), young age (4months to a year) or older (over a year)? Is it worth doing a bile acid test somewhere between 12-16 weeks and then again at 6-7 months before a dog is commonly spayed/neutered?

I think four months to a year is most common. There was atleast one dog diagnosed at age 8 and MVD is sometimes asymptomatic so it can be diagnosed commonly after age 5 or 6.

You might be interested in this:
http://clubs.akc.org/astc/health/astchlth/astcshnt/

[MyFairLacy]

Originally Posted by jencar98

I was wondering about this very thing, the possiblity of parents testing okay and still producing an LS puppy. I did wonder if the disease could skip a generation. Now that I know, I wouldn't accept a puppy just because the parents were cleared, I would insist the puppy be tested too.

That's why it's important for your breeder to know their lines & be positive that there are no known dogs in their pedigrees that have had LS. If adults are tested & there is no known history of a shunt in the pedigree, there is a lot less chance of getting a puppy with a shunt than if you bought from a byb that doesn't know their dogs' histories or do any health testing. Even with screening, there is still a possibility of getting a puppy with LS, but you can lower your chances if you go with a good breeder over a bad one.

[MyFairLacy]

Originally Posted by Ellie May

I think four months to a year is most common. There was atleast one dog diagnosed at age 8 and MVD is sometimes asymptomatic so it can be diagnosed commonly after age 5 or 6.

You might be interested in this:
http://clubs.akc.org/astc/health/astchlth/astcshnt/

Thanks. When I buy my next puppy she'll most likely be spayed between 4 and 6 months (depending on her size) so i'm wondering if it would be best to do a bile acid test at that point? Most puppies leave around 12 weeks so would it be almost pointless to test at 12 weeks if most don't show signs until they are older? And would it be "overkill" to test only 1-3 months apart?

[Ladymom]

Originally Posted by MyFairLacy

how old were they when they were diagnosed? I need to do more research on Liver Shunt. Are dogs more commonly diagnosed very young (4 months and under), young age (4months to a year) or older (over a year)? Is it worth doing a bile acid test somewhere between 12-16 weeks and then again at 6-7 months before a dog is commonly spayed/neutered?

Both were diagnosed when they went in for their neuter and had routine pre op bloodwork, about six months old.

As Dr. Center says in her handout, the importance of having a BAT done at about four months (or before the puppy goes home) is that it can avoid confusion and invasive tests like liver biopsies later on in MVD dogs.

For those of you who breed and have vets who are not aware that the protocol eliminating the 12 hour fasting has changed, have them contact Dr. Center herself for a consultation. Apparently she is very willing to advise both vets and pet owners.

[Ellie May]

Originally Posted by Ladymom

Both were diagnosed when they went in for their neuter and had routine pre op bloodwork, about six months old.

As Dr. Center says in her handout, the importance of having a BAT done at about four months (or before the puppy goes home) is that it can avoid confusion and invasive tests like liver biopsies later on in MVD dogs.

For those of you who breed and have vets who are not aware that the protocol eliminating the 12 hour fasting has changed, have them contact Dr. Center herself for a consultation. Apparently she is very willing to advise both vets and pet owners.

Ladymom, do you know if Dr. Center would talk to me personally? Not my vet... I don't know if I want to but may need to have some good answers soon.

[kalina82]

here are a few things i've learned so far from working where i do about liver problems. The Bile Acid Test is preformed with a pre and post feeding blood draw, NOT one blood draw after a 12 hour fast. It is important to do the pre and post testing to get the most accurate information. Also a ultrasound of the abdomen will help to see if there is anything going on with the liver. The dogs that turn out to have full blown shunts are usually under 2 years old when diagnosed and have surgery.

At one point i was worried about Morgan. She has never had a BAT done. One day when she was sick (vomiting) i just had this crazy notion that she had liver problems so i brought her to work with me. I was told that if she did have liver problems they would have become very apparent when she was spayed because she would have had a difficult time with the anesthesia (not waking up, taking a long time to recover, dying on the spot). She has gone under anesthesia twice with no problems.

[Ladymom]

Originally Posted by Ellie May

Ladymom, do you know if Dr. Center would talk to me personally? Not my vet... I don't know if I want to but may need to have some good answers soon.

I would try it. I know of at least one member of the Maltese forum offhand who has personally spoken to Dr. Center after going through a lot of tests with no conclusive answers. I'm pretty sure there was another one, too. Both these were pretty recent, too, within the past few months.

[Yorkieluv]

Most definitely.....The pre-meal test is not enough.. There have to be two samples, one before, one after...

[Ellie May]

Originally Posted by kalina82

here are a few things i've learned so far from working where i do about liver problems. The Bile Acid Test is preformed with a pre and post feeding blood draw, NOT one blood draw after a 12 hour fast. It is important to do the pre and post testing to get the most accurate information. Also a ultrasound of the abdomen will help to see if there is anything going on with the liver. The dogs that turn out to have full blown shunts are usually under 2 years old when diagnosed and have surgery.

At one point i was worried about Morgan. She has never had a BAT done. One day when she was sick (vomiting) i just had this crazy notion that she had liver problems so i brought her to work with me. I was told that if she did have liver problems they would have become very apparent when she was spayed because she would have had a difficult time with the anesthesia (not waking up, taking a long time to recover, dying on the spot). She has gone under anesthesia twice with no problems.

Liver compromised dogs go under anesthesia and quite a few do fine. Some have reactions. Ellie does fine with it and her postprandial is 106. I would do a bile acid test if you're concerned. There is also a possibility of asymptomatic MVD.

[Ellie May]

Originally Posted by Ladymom

I would try it. I know of at least one member of the Maltese forum offhand who has personally spoken to Dr. Center after going through a lot of tests with no conclusive answers. I'm pretty sure there was another one, too. Both these were pretty recent, too, within the past few months.

Hmmm, maybe if the specialist doesn't have any answers I will try it.

[kalina82]

Originally Posted by Ellie May

Liver compromised dogs go under anesthesia and quite a few do fine. Some have reactions. Ellie does fine with it and her postprandial is 106. I would do a bile acid test if you're concerned. There is also a possibility of asymptomatic MVD.

If you know your dog is liver compromised then the precautions are taken beforehand to assure that they will get through the surgery ok.

When i brought up my dog, i used it as an example to say that the chance of her having a liver shunt after going under anesthesia twice with flying colors is very minimal. If there was a problem it would have been discovered during her spay (1st anesthesia) and her dental (2nd anesthesia) would never have been performed (at least at a general practice because they just cannot handle it).

i am no longer concerned about my dog.

[mojo]

After having health issues with both my yorkies I have now (different breeders) I did ask the breeder I am getting a little girl from to do the test. I think mostly it is just for my own peace of mind, cannot go through having another sick baby.