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Originally Posted by dwerten  she does not have the pancreatitis issue it is dexter who had the pancreatitis. The vet never even mentioned it and his friend is the guy who does the scintigraphy in so cal and the first vet out of 3 that mentioned bats on her and he has a phd from ucdavis. I know some have posted high protein meal but have not seen high fatty meal before as it is the protein that triggers the test so confused is this from dr centers about the high fatty meal prior?
also dr dodds never said anything about diet change for test as two were done with vet and one with dr dodds now my curiosity is peaked lolll |
Sorry about the mix up with your pups.
Then, if first tests were done on dd's regular diet, and Dr Dodds was trying to repeat the result, the same conditions should be followed, to rule out error in testing method.
http://www.vet.utk.edu/clinical/sacs/shunt/diagnosis.php
Serum bile acids are synthesized in the liver from cholesterol. ...If the animal is sensitive to high protein meals, a low protein diet mixed with a few milliliters of corn oil can be used to stimulate gastrointestinal motility and cholecystokinin activity. ...
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Originally Posted by dwerten no if they have mvd it will always be over 25 so no need to keep testing. The only reason i did it is I wanted dr jean dodds to do it as i was still questioning it as she had no symptoms. The only reason we did second one with vet is because i had no clue about all this stuff back then and he did not do pre the first test and had me so freaked out wanting me to take her down for a scintigraphy immediately but after doing all my research and joining liver shunt group i learned it was not necessary and so glad i did my homework as 3 years later she is still the same no symptoms eats like a pig, no seizures, no head pressing nothing. |
I think the fact that Chipper has other issues (anal gland infection, high ALT) going on, and that the BAT is not astronomically high, retesting the BAT when the infection resolves wouldn't hurt anything, just to see if these issues did skew the result any.
I've seen a few LS/MVD cases on here where the vets want to continue testing after elevated but <100 BAT results. Some will spend your money if you let them.
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Originally Posted by Ellie May Just to throw yet another opinion into the mix (sorry  ): (no problem... always interested in your opinions...)
I agree about the Metacam. NSAIDs (including this one) are not recommended for dogs with probable MVD or LS. I have no idea why the vet thought it was okay, but there are better options for pain management in thi case. These drugs can mess up even a healthy dog's liver. Ellie had a post BAT of 47 and then 15. She was spayed and had a liver biopsy shortly after. NSAIDs weren't really even in her vet's thinking process for this.
Bile acids in Yorkies that are over 100 (post) are very often LS, but can still be MVD (or both) or something entirely different. Bile acids below 100 are very often MVD (but in rare cases...LS). It can also be sometihng else.
The ALT being that high would be of concern. Good that it's coming down, but I just think it was too high to not keep rechecking. We were slightly concerned when Ellie's was 118, sooooo a jump like that can't be taken lightly in a young dog. If the ALT does not go back down to normal range, then I personally would err on the side of caution and go further. I'm not necessarily saying that a biopsy needs to be done nor a scintography. I just think having a specialist deal with the high ALT may be good (if it stays where it is or goes back up). It means liver cell death probably occurred and there are some things you can do to help protect the liver from further damage (i.e. (SAMe, possibly milk thistle). |
Well said and I agree, but
, from
The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine=
Although elevated serum hepatobiliary enzyme activities are frequently identified, they do not necessarily indicate clinically important hepatic disease. There are several reasons for this discordance. First, increased serum hepatobiliary enzyme activity can originate from nonhepatic tissues. Second, the liver's dual blood supply and large blood flow make it uniquely sensitive to injury due to systemic disorders and diseases in organ systems drained by the portal circulation, particularly the gastrointestinal tract and the pancreas. Finally, drugs can induce excess hepatobiliary enzyme production in the absence of liver damage.
Alanine aminotransferase
Increases in serum ALT activity are considered liver-specific in dogs. ALT activity can increase with severe muscle necrosis, but simultaneous evaluation of serum creatine kinase activity can rule out a muscle source.3,4 ALT is a cytosolic enzyme, and leakage occurs with damage to hepatobiliary membranes. The magnitude of serum ALT activity elevation is roughly proportional to the number of injured hepatocytes.3 Serum ALT activity may also increase because of induction of enzyme synthesis by corticosteroid use and, possibly to a lesser extent, by phenobarbital therapy.3,5
Serum ALT half-life is 2.5 days.6
Increases in serum ALT activity have the highest sensitivity (80% to 100%) for hepatic inflammation and necrosis, vacuolar hepatopathy, and primary neoplasia (hepatocellular carcinoma, cholangiocarcinoma) but
have less sensitivity (50% to 60%) in cases of hepatic congestion, metastatic neoplasia, and portosystemic vascular anomalies.3
I have read too that on high ALT result, many times the exact cause of this elevation is never determined. And normally two or more liver enzymes would be increased in LS/MVD, and BUN is normal or decreased, not normally elevated.
http://www.vet.utk.edu/clinical/sacs/shunt/diagnosis.php DIET & MANAGEMENT -- Care and Feeding
In most cases, proper diet, consisting of very low protein and medication will postpone the urgency of the surgery.
This information, such as KD Prescription Diet or LD Prescription Diet, and appropriate medications, if necessary, should be discussed with your veterinarian.
And, Joanne, feeding him the high protein didn't cause this. It may have caused some symptoms and test results, but he already had an underlying liver problem to begin with, just not bad enough to be evident.