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Old 05-31-2013, 09:53 AM   #1
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Default Liver Shunt diagnostic testing thread

Are there any thoughts on whether all Yorkie puppies should receive diagnostic testing for liver shunt, and if so, which tests are the best ones? I was reading that Yorkies are 36 times more likely to develop liver shunts than other breeds of dogs, but even so, only about 2% of Yorkies are affected by liver shunts. Should we get them tested only if they start displaying the classic symptoms, or should we be more proactive? Here are a few links (taken from other threads) to start off the discussion:

The University of Tennessee College of Veterinary Medicine - Liver Shunt Research

LIVER SHUNT

http://livershuntandmvd.com/PSS-PVH-MVDBrochure.pdf

Liver Shunt
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Old 05-31-2013, 10:32 AM   #2
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Thanks for starting this thread. It will be a great place to share thoughts and info about Liver Shunts and other Liver issues.

It will take me a while to check out the links you posted.

But, as an intro I will tell you that my 5 yr. old Yorkie Tiki is suspected of having mild MVD. At 7 months, during a pre-spay blood panel her ALT was elevated, which led to BATS that were a little high, then an ultrasound that did not detect a shunt, and not wanting to open her up for a biopsy, the vet said she most likely has MVD. I have managed it and kept her mostly symptom free by feeding a lower protein/fat food, and avoiding fatty treats & people food, and avoiding toxins and vaccinating very conservatively. I used liver support supplements for a year, but discontinued as it seemed to ruin her appetite.

She is thriving, and sometimes I wonder if she even has MVD, until somebody comes along and gives her a little bacon or cheeseburger bite. Arrg. Sick for a week. Flea prevention meds react badly with her too, and luckily I no longer have to use them

At the time we were testing her in 2008, YT members were recommending a Protein C test in diagnosing LS. I haven't heard of it so much lately. I'm wondering if it is currently used in the top LS Vet Schools?

Also, back then, several members advised joining the Yahoo Liver Support groups (2 of them), and I wonder if anyone here is still participating in them. There was good info and support there however I found the Yahoo format hard to follow.

Again, I am happy to have this thread to share info and ideas and update what I have previously been told and practiced in dealing with liver issues.
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Old 05-31-2013, 10:44 AM   #3
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The internal med specialists where I go say that testing all is not necessary. One of mine had a shunt recently and he is around 8 years of age...I had him for 7 years before this and his labs never showed anything, nor did he have any typical signs.

Even so, I will not be testing all of my pups. The odds are just not that high in my mind to justify it. Besides that, BATs are not totally reliable...and I sure as heck would not be doing any other tests for it.
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Old 05-31-2013, 10:49 AM   #4
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Quote:
Originally Posted by MauiGirl View Post
Thanks for starting this thread. It will be a great place to share thoughts and info about Liver Shunts and other Liver issues.

It will take me a while to check out the links you posted.

But, as an intro I will tell you that my 5 yr. old Yorkie Tiki is suspected of having mild MVD. At 7 months, during a pre-spay blood panel her ALT was elevated, which led to BATS that were a little high, then an ultrasound that did not detect a shunt, and not wanting to open her up for a biopsy, the vet said she most likely has MVD. I have managed it and kept her mostly symptom free by feeding a lower protein/fat food, and avoiding fatty treats & people food, and avoiding toxins and vaccinating very conservatively. I used liver support supplements for a year, but discontinued as it seemed to ruin her appetite.

She is thriving, and sometimes I wonder if she even has MVD, until somebody comes along and gives her a little bacon or cheeseburger bite. Arrg. Sick for a week. Flea prevention meds react badly with her too, and luckily I no longer have to use them

At the time we were testing her in 2008, YT members were recommending a Protein C test in diagnosing LS. I haven't heard of it so much lately. I'm wondering if it is currently used in the top LS Vet Schools?

Also, back then, several members advised joining the Yahoo Liver Support groups (2 of them), and I wonder if anyone here is still participating in them. There was good info and support there however I found the Yahoo format hard to follow.

Again, I am happy to have this thread to share info and ideas and update what I have previously been told and practiced in dealing with liver issues.
It looks like Protein C tests are still in use. From an article posted at Cornell (link below):

"How can I use the Protein C assay to diagnose dogs with portosystemic shunts?

Protein C deficiency is a marker of portosystemic shunting. While clinical signs, breeds at risk, and bile acid elevation are common to portosystemic shunting and microvascular dysplasia, Protein C deficiency develops primarily in dogs with congenital portosystemic shunts. Including Protein C in the diagnostic workup helps identify patients for imaging studies and ultimately shunt repair."


Animal Health Diagnostic Center
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Old 05-31-2013, 10:57 AM   #5
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My Tibbe was a little around 4 years or so when he began having mild symptoms of occasionally spitting up bile, anorexia for most of the day and lethargy, worse once he turned 5. He was symptomatic 2 - 4 x monthly or more since last fall.

When he had pneumonia last year, his amylase was 400 but all his other liver and other tests were normal and have always been normal x2 yearly when he has his comprehensive exam and labs and yet his occasional symptoms continued. He had a pretty bad prolonged GI upset May/June of 2012 and a CPL Snap test for pancreatitis at that time was normal. He was started on Hill's I/D GI.

Recently, he had another onset of symptoms and one diarrhea stool and back to the vet we went. All testing in December 2012 and again in April 2013 was entirely normal. Crystal/Ellie May said some liver tests are normal and still there is a problem in some dogs so she suggested having the BAT and others chimed in so I asked for a BAT. Tibbe had it and the levels were 102 and 60 pre- & post-prandial, the post being lower, which is rare. Off we went to have nuclear scintigraphy & an abdominal sonogram which showed no liver shunt but MicroVascular Dysplasia (MVD) could not be ruled out w/out a liver biopsy, which the radiologist and none of Tibbe's vets recommend at this time. His liver and all other organs were normal except he had some bilateral kidney stones, which the radiologist and his other two vets said is not that abnormal. They aren't blocking any ducts, etc., so they said not to sweat those unless he has symptoms - they are a fairly common finding in Yorkies(!). Tibbe was put on Metronidazole for a week or 10 days to help him over his gastroenteritis and a hepatic diet, Hill's I/D Hepatic and I'm very slowly transitioning from his Hill's I/D GI to that, to be sure he's not going to have a wild allergic itching bout or something. We're almost to 1/2 and 1/2 of each now and he's doing very, very well.

I would suggest that any little Yorkie who is spitting up bile with some frequency, vomiting and/or having diarrhea in any recurring fashion go ahead and get the Bile Acids Test and probably the CPL Snap test and go from there. Since he started his new diet, Tibbe's only had one lethargic day that first Sunday, has not once vomited, spit up bile or had diarrhea and is back to his old self ruling the world now, anything but lethargic or nauseated!!! Get them tested and start treatment if your babies are having symptoms not otherwise explained would be my recommendation.
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Old 05-31-2013, 11:33 AM   #6
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I believe in bile acid testing before certain drugs and anesthetics are given. Perfect bile acuds in a diseased dog is highly unlikely. Liver disease in a dog with normal enzymes is common. Doggies do die under anesthesia And liver disease does increase risk. Ican't thinkof anyreason to skip testing.
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Old 05-31-2013, 12:00 PM   #7
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A vet I know told me that if you have a concern, an ammonia level is the test to do. I don't know..but I do know I am not going to BAT every pup I take for an anesthetic procedure. Just seems a bit much to me.

My Teddy Bear had anesthesia every year that I have had him and he is fine...not saying it was the best thing now that I know he had a shunt....but I simply did not know. He did have labs done...just not BATs.

My pups all get dentals done pretty much each year (as needed) and I am not going to test them for a shunt. I just don't feel it is common enough for me to get that concerned.
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Old 05-31-2013, 12:13 PM   #8
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Well, we each need to do what we feel is safest for our pups. I am happy that I tested Ellie on a whim. Her drug protocols are different because of it. It simply is not worth the risk to me over a $75 test. Now if I cohld not test I would just ask the vet to use a protocol suitable for liver compromised dogs.

If it wasn't for drugs and anesthesia I'd wait til symptoms appeared.
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Old 05-31-2013, 12:14 PM   #9
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So here is the rub. Just exactly how common is it? Here on this board and at the link I provided it seems pretty common.

That link states that someone around 1000x combined against other breeds Yorkies are more likely to be at risk for liver shunt.

As a breeder I would never,ever mate a dog to another without Bile Acid testing being done.

And I would not let puppies go without the same. And btw it is proven as a genetic disease in Irish Wolfounds...lol... 1000x the weight of a Yorkie, but the markers would appear to be different... God knows why.

And yes Liver Shunts of various natures can be acquired as a result of other disease processes. And yes some dogs can test normal with an extrahepatic shunt for years, but that is the outliers.

Linda you are not a breeder but a rescuer. I am not saying that every rescued dog at 1-5 yrs old should be tested. What I am saying as a pro-active owner of a puppy YOrkie, it would be a good idea to test for the same.

That way early identification of MVD if it is MVD can be handled and the appropriate medicines and diet could be followed. If a liver shunt is indicated and further tests (which btw) need to be done, then they can be done.
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Old 05-31-2013, 12:32 PM   #10
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I am not against it...merely saying that I won't be doing it for mine. You all know I don't balk at spending money on my pups. This has nothing to do with money..and nothing to do with how I care for my pups.
It's my choice after speaking with my vet and a few of the specialists that I use. They are all boarded and don't see the need. *shrug*
It is fine for those who wish to do it. To me it is similar to looking for a needle in a hay stack.
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Old 05-31-2013, 12:43 PM   #11
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You know, it is hard enough to get people to do routine blood work on their pups...there are probably not many who would do BATs.

And, what's next? Xrays, MRIs and spinal taps to rule out AAI and GMe? Of course you will say those tests are expensive...yes, they are...but in my thinking, we see a lot of those things...so why not?

I just think sometimes we can worry too much.

Sure we see sick pups here on YT but that is often why people come to YT...they have a sick pup and they have been googling. I don't think YT is representative of all of the yorkies that are owned.
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Old 05-31-2013, 12:48 PM   #12
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I am not against it...merely saying that I won't be doing it for mine. You all know I don't balk at spending money on my pups. This has nothing to do with money..and nothing to do with how I care for my pups.
It's my choice after speaking with my vet and a few of the specialists that I use. They are all boarded and don't see the need. *shrug*
It is fine for those who wish to do it. To me it is similar to looking for a needle in a hay stack.
Not exactly in my mind Linda. Even the YTCA recommends BATS prior to breeding; as less than perfect this measurement is. Many many tests are less than perfect. Doesn't mean they should not be done.

BATs even at an 80% effectiveness as a pre breeding test is worthwhile to be done, and in the puppies as well.

Always it is the owners choice, as it is the breeders choice to do or not to do a certain test.

I elect as a breeder and an owner of dogs, to do the most complete breed specific testing / screening I can. For example I do not do BATS on my BRT\s because as of this moment in time it is NOT an issue in our breed. How ever HD and ED are. And coming up in the forefront are thyroid problems. Does that mean I should not screen my breeding dogs for those things? Or educate my future puppy owners on those things?

I do not separate vaccinations for my BRT;'s but I do for my Yorkie. Based on research on vaccinosis and adhoc reporting of same for the toy breeds.
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Old 05-31-2013, 12:52 PM   #13
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Not exactly in my mind Linda. Even the YTCA recommends BATS prior to breeding; as less than perfect this measurement is. Many many tests are less than perfect. Doesn't mean they should not be done.

BATs even at an 80% effectiveness as a pre breeding test is worthwhile to be done, and in the puppies as well.

Always it is the owners choice, as it is the breeders choice to do or not to do a certain test.

I elect as a breeder and an owner of dogs, to do the most complete breed specific testing / screening I can. For example I do not do BATS on my BRTs because as of this moment in time it is NOT an issue in our breed. How ever HD and ED are. And coming up in the forefront are thyroid problems. Does that mean I should not screen my breeding dogs for those things? Or educate my future puppy owners on those things?

I do not separate vaccinations for my BRT;'s but I do for my Yorkie. Based on research on vaccinosis and adhoc reporting of same for the toy breeds.
The YTCA recommends it to breeders for their breeding stock, so I should do it for my yorkies?

Nope..not convinced. Again, I have consulted with specialists and I am fine with my decision for my personal pups. I DID ask that question of them when Teddy came up with his shunt.

Like I said, to each his own. I think someone should start a little voting thread...have each person do BATs on their pup and come back and let us all know the results. Might be interesting.
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Old 05-31-2013, 12:57 PM   #14
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You know, it is hard enough to get people to do routine blood work on their pups...there are probably not many who would do BATs.

And, what's next? Xrays, MRIs and spinal taps to rule out AAI and GMe? Of course you will say those tests are expensive...yes, they are...but in my thinking, we see a lot of those things...so why not?

I just think sometimes we can worry too much.

Sure we see sick pups here on YT but that is often why people come to YT...they have a sick pup and they have been googling. I don't think YT is representative of all of the yorkies that are owned.
Linda I am not talking about AAi or GME, but LS is an increasing concern in this breed.

And yes I do think that Xrays and OFFA of hips on the Yorkies should be done. This is from a concern over several breeders here in Canada at our meetings for the Yorkies. The adhoc reported incidence rate appears to be rising in this breed.

Again we struggle with less, far less than complete reporting of health problems in any one breed. It is a crying shame we can't get more complete recording/reporting across all vet offices, health hospitals etc.

Again Linda you are at one end of the spectrum the rescuer. NOt the breeder who is trying to breed to insure all of the above is clear in their breeding pair, and in their puppies..

The test of BATS is an inexpensive one, that can give pet owners a direction forward and inform their vet and themselves on how to feed and nuture this pup over their lifetime. Not to mention for the breeder to understand that at 6mths old so many of this litter tested clear.
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Old 05-31-2013, 01:02 PM   #15
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whoa! I'm already lost...

What happened to Basic Liver Shunt 101?

What would even lead someone to first think their dog may have liver shunt? Does it only affect tiny yorkies?
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