[Ellie May]

I definitely agree with option 3 but it looks hopeful that it's MVD.
They must have sent it out to a lab because the postprandial was above 30.
Ninety-five percent of dogs with a shunt have elevated preprandial bile acids, so it looks hopeful to me.

I would wait and talk to the internists about the spay but it really isn't terribly risky if done right.