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Old 01-29-2012, 03:32 PM   #1
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Animal Smiley 019 Urgent! Help! Don't understand test results!

Hi everyone,

We were supposed to Spay Rosie on 1/26/12 but when they did the blood test, the vet said that her ALT was 111 which was high and should be concern about that. Therefore she insisted on getting a bile acid test done. So we did that and she said that it will take two days for the results to come back. She prescribed 2 pills and 1 antibiotic for her to take for a month to help lower the ALT. Then the vet emails me saying that she called me on 01/28/12 and it went to voicemail. (I never got a call from her and there was no voicemail) Apart from that, she wrote this in an email which I don't quite understand:

I tried to call you today but only got your answering machine. Rosie's bile acids test came in. Although her baseline is normal (it was 8, normal being below 10), however the post prandial (after eating) challenge part of the test was abnormal (the post result was 60, with normal less than 20).

What does it mean? Is she really sick? Is it genetics? Does anyone have any experience with this? I am so nervous. She is my first furbaby and i am so devastated that this is turning out the way it is.. thanks for your time
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Old 01-30-2012, 09:19 AM   #2
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Hopefully Crystal will come on here. But speaking from experience in having a bile acid test done to my baby, there are two tests one before food and one after (I'm sure you got this explanation as well).
If it was high after eating, then it may (key word may) be an indication that that liver is not functioning 100%
My advice would be to talk to your vet and have her/him explain everything to you. I always ask my vet to "dummy it down".
When Gizmo got his done, his post bloodwork was 27 which was above 20. However, my doctor believed that it was simply and upset tummy that spiked the liver count. I'm not saying this is the case with Rosie but it's something to go over with your vet.
I don't know how much you were told, but a bile acid test is done for a dog with suspision of a liver shunt. There are many postings on this forum about it. And many success stories from Yorkie parents after their little one has had the liver shunt taken care of surgically.
But that's getting way too fard ahead. My first step would be contacting the vet and having them explain everything.

Good luck, and keep us posted.
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Originally Posted by mzwenc View Post
Hi everyone,

We were supposed to Spay Rosie on 1/26/12 but when they did the blood test, the vet said that her ALT was 111 which was high and should be concern about that. Therefore she insisted on getting a bile acid test done. So we did that and she said that it will take two days for the results to come back. She prescribed 2 pills and 1 antibiotic for her to take for a month to help lower the ALT. Then the vet emails me saying that she called me on 01/28/12 and it went to voicemail. (I never got a call from her and there was no voicemail) Apart from that, she wrote this in an email which I don't quite understand:

I tried to call you today but only got your answering machine. Rosie's bile acids test came in. Although her baseline is normal (it was 8, normal being below 10), however the post prandial (after eating) challenge part of the test was abnormal (the post result was 60, with normal less than 20).

What does it mean? Is she really sick? Is it genetics? Does anyone have any experience with this? I am so nervous. She is my first furbaby and i am so devastated that this is turning out the way it is.. thanks for your time
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Old 01-30-2012, 10:44 AM   #3
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I'm sorry in advance for typos.

It sounds like you have a good vet. Preop blood work indicated that her liver may be under stress. Bile acid testing gives more information about how the liver is functioning. Your girl's result is high, but nothing crazy.

There is a long list of things that can cause liver function issues. Somewhat commonly in yorkies is liver shunt which you could google. As a general rule though, post prandial bile acids are higher than your girl's when LS is present. I wouldn't worry too much that this is the problem. Micro vascular dysplasia (mvd) is also common. This is a sort of microscopic shunting in the liver. The bile acids often fall in this number range when mvd is present. This would be medically managed.

First thing to do is talk to the vet about the next step. The best option is probably a consult with an internal medicine specialist to try and get a diagnosis.

Sometimes drugs and such can make the bike aids go up also. Our vet may just want to retest in a month. Different vets' protocols vary. It may be a big problem but most likely it's not a huge deal. Try to relax until you talk to the vet. My dog's bike acids have been almost double that and she does fine.

Common scenario..although certainly not the only one..is a yorkietalk that has post bile acids in the 40-90ish range being diagnosed with mvd after specialist consult (a biopsy is needed for absolutely diagnosis but skipped a lot of times). They are managed for life on supplements and certain foods and particular attention is paid to drugs prescribed because they can be hard on the liver. They live long and happy lives.

So talk to your vet and don't focus on worst case scenario because that is likely not the case.

That ALT is a very low high. It is something to keep an eye on but no reason to panic.

I'm sorry that was a big ramble.
If I just confused you more or if you want something else explained, just pm me
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Old 01-30-2012, 04:53 PM   #4
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Thanks for the information. I spoke with the receptionist because apparently the vet was too busy. She told me that Rosie has a mild MVD and she is ok to spay tomorrow. They will use liquids to flush the anesthesia out so it doesnt affect her liver much. They highly recommend a biopsy. I asked if it was curable and they told me no. The biopsy will only verify that she does have a MVD. If we do the biopsy, the risks we are taking would be loss of blood, using a bigger tube, longer in anesthesia and other things she mentioned. Therefore I decided to not do the biopsy, I do not want Rosie to go through that. I figure that we will change her diet and monitor very closely. Do you think I am making the right decision? I want the best for her but if we are going to leave her open on the table for longer to confirm that it is a MVD and there is no cure I think we should just do changes on her lifestyle. Besides, the vet is charging me $320+ for her spaying and with the biopsy would be $600+. Is that how much it is supposed to be? I know that her health comes before money but I just don't want to get rip off. When we did her bile acid test they charged me for little things here and there.. even for her staying there while they examine her. I read a lot of posts regarding MVD and its scary but manageable. I hope everything goes well tomorrow
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Old 01-30-2012, 05:34 PM   #5
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Well that is a hard one to advise on. It sounds like your vet is reasonably on top of LS issues, but I'm assuming this vet is no specialist. Ohio State University Hospital has a very good vet school and hospital ... it is where I would take my pup too, for a definitive diagnosis of MVD.

It sounds like you feel comfortable with your decision to not do the biopsy at this point. Let me ask you; is she staying in overnight - and if a problem were to occur at the vet clinic what are their resources there to deal with it? If she is staying overnight will someone be present 24/7 to monitor her?
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Old 01-30-2012, 05:44 PM   #6
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Thank you for your concern Gemy She will be staying over night and the vet said that there is someone that stays there til a certain time. I wish I could be there with her but I am in a few hundred miles away and she is staying with my brother who is taking care of her. We decided to take her there because the vet actually cares and the ones where we live at just worry about the money. If anything happens (God forbid), they immediately transfer her to the Central Pennsylvania Veterinary Emergency Treatment Services. The vet told me that she has a lot of experience in spaying and that there should be no problems since they are going to be really cautious. It still makes me so nervous that I'm deciding not to do the biopsy and it scares me that I will regret in the future
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Old 01-30-2012, 05:57 PM   #7
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I'm not sure that there is a right or wrong answer. I did elect to have my girl biopsied during spay, because it was a good chance to do it. There IS more risk to a spay this way. It IS more expensive. Some vets and internists will tell you it isn't necessary.

After consulting with your vet (not the staff), you should do what you and they think is best. It is generally assumed that Yorkies with bile acids in range indicate MVD. That might be okay. However, it isn't always true. There is at least one disease (rare but possible in dogs) that can raise the bile acids, but it has a different treatment plan than MVD to a certain extent (hepatic lipidosis).

Personally, with an asymptomatic dog, I wouldn't be too excited to be cutting into a liver. The other side to that is the fact that they will already be right there. I think this is only something your vet (or a specialist) can advise you on.

If there is a staff member there only until a certain time, then your pup will be left alone for part of the night. Because of the anesthesia wearing off, new pain meds being used, risk of the incision opening, possible breakthrough pain that needs to be managed, and problems related to dogs being unattended when an IV is placed, I would not leave her overnight.
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Old 01-30-2012, 06:15 PM   #8
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Thanks for your reply Ellie May. I think you are right, I don't want to leave her overnight but the vet insisted we do last time we were there. I will speak with her about it. My boyfriend wants to take her home after her spaying since he will be able to take care of her in case anything happens. Rosie is also not interested in her food since I bought her new bag of Iams puppy food. I asked the vet if we should change her diet to maybe for a low protein one and she insisted that we dont. I researched that Iams is not a good dog food but yet the vet recommended. I definitely want to change her diet when she gets back home. Currently she is on medication: amoxidropzentonil plus and metronidazole. Would medication such as heartgard/frontline affect blood tests or bile acid tests? Just curious
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Old 01-30-2012, 06:23 PM   #9
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I would not leave my pup overnight in a facility where no one is there at night, especially after surgery. I know a lot of people do it, but it is not for me.

I hope that you can find a vet closer to you. There has to be a good vet in your area. Maybe if you ask around on YT you might find someone in the Pittsburgh area who has a vet they can recommend. You really need to have a vet close by that you can count on.

Hope that all goes well tomorrow. I agree that you and the vet need to discuss this at length. Good luck. I will keep Rosie in my thoughts and prayers.
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Old 01-30-2012, 08:24 PM   #10
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My Cali has mild MVD. Her bile acids were 0/84 and 0/50 ish if I remember correctly. I did the ultrasound and had a liver biopsy done when she was spayed. She was spayed at a Specialty clinic because they thought she may have a blockage and she needed the liver biopsy. The biopsy confirmed she had very mild MVD and needed no treatment. The cost for her surgery was over 2,000.00. But it was a board certified surgeon who did it and I felt very confident with her. In the end it probably made no difference that I had the biopsy, but it did confirm she had very mild MVD. I would not leave my babies where there is no vet on duty overnight. I'd rather take them home and watch them myself. Fortunately, I live 5 minutes from the ER specialty clinic. I hope everything works out for Rosie. It can be overwhelming to go through this. We are all here for you.
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Old 02-01-2012, 10:39 AM   #11
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I just want to thank everyone who provided me with useful information and helped me through this tough time. It is going to be a challenge going forward, however at least now I know what we are dealing with. We just picked up Rosie from the vet this morning and they said she was doing great. She barely ate while being there but she didn't need a cone to prevent her from licking her incision. We are going to switch her from Iams (she refuses to eat it unless she is starving) to Blue Buffalo. We mixed it so she would get used to it but she picks at it and only eats the BB and not Iams. As far as the vet informed me, she will need to be on medication and will need annual bile acid tests. Thank you for those wonderful thoughts and advise. I really appreciate it. I think I was freaking out way more than she was. I'm just glad she is ok for now.
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Old 02-01-2012, 11:19 AM   #12
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Glad to know you're little one is doing better. Remember, it's your right as a dog owner to have a vet explain things, and explain them until you understand it.

Prayers that your baby feels better and has a speedy recovery.
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