Please help very worried!

[vinnysmom]

I brought my yorkie in to be neutered on Monday. The vet called to say they weren't going to neuter him because his ALT was high (84). They did a bile acid test pre-3 and post 62. When I brought my puppy in he was completely fine. When we got home he was starved and drank a ton of water. He then peed about 15 times and was not himself.

I took him to another vet today and they said he looked great! We can do a protein c test or wait and retest bile and liver in 3 weeks. I chose to retest in 3 weeks. Now I wake up in the middle of the night to my puppy peeing in the bed and throwing up a yellow substance. Now he has an odd odor to him.

I took him to another vet because the first one upset me with how they handled him and because he was completely fine when I brought him and now he's not doing so good.

He is 3.2 pounds, gaining weight, eating well. I'm scared! He is 22 weeks old. I don't know what to do for him. Should I have the protein c test done or wait to retest bile acid?

Thanks for listening! Any help would be appreciated!

[Ellie May]

Either way is fine. There are some questions about the Protein C test right now, so I'd personally redo the bile acids instead. It's very possibly a problem common in Yorkies and may not turn out to be anything serious.

The increased drinking doesn't sound right though. I'd say if it was right when he got home, it could have been the food they gave him, but it does sound odd. A few things come to mind. If it continues, a vet should be willing to figure out what is causing it. The yellow bile he just threw up, did he eat before you went to bed or does he have an empty stomach?

[vinnysmom]

He ate before bed. I'm concerned because he was completely fine before dropping him off at the vet monday. Since then he has gotten worse. I'm worried they did something to him. They told me he would be ready for pick up in 2 hours and he ended up not being ready for 4 hours. When I called to check up on him they said they were still doing a "few" things with him. They never gave me a clear answer on what those "few" things were. This is all so stressful.

Since he threw up he has been sleeping all curled up in a ball.

Thank you for responding!

[kjc]

So he was fasted the night prior to his surgery? Then they drew blood for the Bile Acid Test, and fed him a meal. After two hours, they draw blood again.

Depending on what time they did the blood draws, and what time you picked him up, how long was he actually fasted?

When you took him home, food and water should be offered in small quantities. Did they tell you that? He was probably very thirsty but should only have been given small amounts at a time. If you didn't pick him up till late afternoon, they should have fed and watered him at the hospital.

If late when you picked him up, he probably hadn't gotten enough to eat throughout the day. At home he drank and drank... so at night he still had fluid to get rid of. His glucose was probably a mess, and a bunch of water just diluted everything. His body is way off track.

This morning, start by offering him small amounts of food and water, every two hours or so. See if that doesn't level him out some. He vomited yellow bile bc his stomach was empty. By 2 pm, offer him a bit more food and water, but don't let him have as much as he can eat or drink, still ration it out. ease up to his regular amount and offer him rationed water until he walks away without drinking the whole bowl.

I'd wait two months to repeat the Bile Acid Test. I wouldn't feed him any super high protein food, maybe 20% - 25% protein tops, till the BATS are repeated.

How's he doing this morning?

[vinnysmom]

Well I just wrote a huge post that didn't go through for some reason. So i'll try it with less detail.
monday 7 am dropped off. hadn't eaten since 7:30 sunday.
9:30 call ALT high doing bile test be ready in 2 hours.
12:30 I call vet because I hadn't heard anything. Told finishing up a few things. Should be ready in a few minutes. Someone will call me.
1:00 Still no call, I call back. Told he'll be ready at 2. Not acceptable so they say ok 1:30.

I get there at 1:30. By the time we get him it"s almost 2. Get in with him at 2:30 and give him food and water. Seems ok but tired. A couple hours later I gave more food and water. Finished everything and wanted more water. Then about 30 minutes later he peed a few times. He then went to sleep on the couch. When he woke up he peed on the couch. Never did this before. Then he kept going all over like he couldn't control it.

Talked to the vet the next day and vinny had only been given 2 teaspoons of food for the test and a wet towel to lick. Poor little guy.

He seems to be great this morning. Very active playing with my kids. Very spunky again!

[kjc]

Check your receipt from the vet. What were the charges for?

It sounds like he went a bit too long without food and water. It harder for the little ones to go that long. Is he able to hold his urine now... and is he going apropriately? If so, he sounds like he's okay. He may have had a hard time recovering from the fasting and the blood draws. I would ask them why that happened.... and maybe find a vet that is more geared to treating smaller dogs, as they do need special consideration due to their small size.

Has he ever had a hypoglycemic (low-sugar) episode at home?

Usually with the little dogs, bc their metabolism is higher than the larger dogs, it's okay to give them a later meal the night before a surgery, but nothing after midnight. Check this with the vet next time.

Glad he's doing better...

PS: If you do a long post, divide it into a few smaller posts so you don't lose it. Long posts don't always make it.

[kjc]

I believe that pups need to be 8 months old for an accurate Bile Acid Test.

Just the ALT result High, or was it the AST? You can ask them for a copy of the bloodwork. I would need to see the normal values for the tests to be sure.... my lab shows normals for ALT 12-118, from Antech Diagnostics. So, depending on where it was done, actually probably in-house... I'd have that repeated too at another vet, or have them do it a few days before the BAT is repeated... If the ALT is/was high, that could mean he ate something toxic enough to throw the ALT up, but not enough to make him really sick. I would have that chem panel (pre-op) run again now (at new vet) and in a month to see if there's any changes, but hold off on the BAT till he's 8 months old. You can wait to have him neutered too.

Does he have any symptoms after eating... any odd behavior you may have noticed? Anything he may have ingested that he shouldn't have? What was the odor you smelled? Was it like amonia? Has it gone away?

[vinnysmom]

He is completely back to normal today! He's eating really well, going to the "bathroom" normal, and playing like he always did.

With your labs guidelines my little boy was well within normal. Our labs normal range is 8-75 and Vinny's was 84. Yes it was all done in house. The BATS I believe were sent out. I have a feeling they weren't very accurate in their blood draw. I don't see an AST result.

I brought him to a new vet the following day and she said she would like to retest his ALT, Globulin (it was 1.8 and range is 2.3-3.8) and redo the BAT. The original already wanted to send him to a specialist and get an ultrasound done.

I don't know if I will have him neutered now. He didn't eat anything that he wasn't suppose to as far as I know. As for the smell I think it was the bile from when he threw up. I don't think I cleaned his face well enough that night. I washed him yesterday and it's gone. He slept great last night. Held his urine all night like he used to and like I said seems back to normal. As for behavior after he eats nothing strange. He usually ends up playing a little and then takes a nap.

Thank you for all your help! I hope his next set of tests come out normal. Trying not to think too much about possible LS or MVD. Thanks again!

[vinnysmom]

Vinny is doing great! Back to normal. I don't have an AST result on the lab report. At your lab his ALT was within normal. Our labs range is 8-75 and Vinny's was 84. I have already had him to a new vet and that is who want s to repeat the tests. She wants to redo the ALT, Globulin (Vinny was at 1.8 and range is 2.3-3.8).

He slept through the night and held his urine just like he always did. This morning he ate very well and is very playful. He doesn't act any different after eating. He plays for a little bit and then usually takes a nap.

As far as I know he didin't eat anything he shouldn't have. As for the odor I think it was the bile. I don't think I cleaned it off his face well enough that night. I washed him in the morning and the smell is gone.

Thank you for all your help! Hoping repeated tests come back normal and trying not to think about the possibility that he may have LS or MVD. Thanks again!

P.S. Your little one is adorable!

[kjc]

Ha! Thanks! That's just one of four!

I was thinking too that since they did inhouse, and the result wasn't too far off, that maybe their machine wasn't calibrated properly, which sometimes happens. I'm glad your new vet is going to retest him. Who knows, maybe all will come back normal. I also read in another thread that the new Bile Acids Protocol is to have puppies tested at 16 weeks, so I was wrong about it not being accurate until 8 months. I would question about the fasting part though, before you have it scheduled again.

Very glad he's back to normal.... scary situation!

And you're very Welcome!

[vinnysmom]

Vinny was retested and his ALT is normal but BAT still high post. It's now 90. He's doing great. New vet is wonderful. She gave me lots of different options on further testing but said no rush. He's gaining weight and seems very healthy. Her office is going to call tomorrow with quotes for all the different testing options and then it's up to us as to what direction we want to go.

[kjc]

What food is he eating? What is the protein content (%) on the package? How old is Vinny now?

[kjc]

General info: If the Post Bat is less than 100, more than likely will be MVD and can be managed with diet, or diet and meds. If Post BAT is over 100, more than likely will be a Liver Shunt, but not always. High BAT results can occur with problems other than Liver Shunts, but symptoms usually occur with higher results if not LS. Liver Shunts can also be managed with diet and medications, but surgery to repair the shunt is highly recommended. Some dogs with LS also have MVD and need to stay on a protein restricted diet for life.

Symptoms of LS: picky eater, slow growth rate, poor coat condition, skinny in appearance, recurring Urinary tract infections, head-pressing (into walls or furnitue), circling, drunken gait, seizures (can occur within 30 minutes after eating), lethargy, pacing...and others. On X-Ray the liver will appear small. Not all symptoms show all the time, may only see one or two.

Many times further testing after a low BAT (under 100) is not done if dog has no symptoms. Many owners opt to get their pups on a low protein diet and retest BAT in 3-6 months. The only way to difinitively diagnose MVD is through a Liver biopsy, which is an extremely invasive surgery, the outcome of which will not change the treatment (BAT 26-100=low protein diet).