Here is some more input for you.
I had heard thru the grape vine of liver issues with a couple other pups from my Roxy's parents, so off we went for a BAT. Which came back at pre 43 and post 100.9
My Vet said it is in shunt range, but he doesn't do any further, so he sent me to a Internal Medicine Specialist for an U/S. I knew going into that they are only about 60% accurate in seeing a shunt, but it was a Doppler u/s and I was assured that their is only one Dr. there that does the u/s (she is the only one skilled enough).
Her U/S showed a normal sized liver, normal shape. No shunt was seen, however, no one could tell me 100% there wasn't a shunt. We did more blood work, clotting tests, urine analysis, and a repeat BAT. All came back normal, except elevated BAT results.
We tried Lactulose and Metro for 10 day and I had already switched Roxy to a low, but quality homecooked diet (created by a Vet-Nutritionist), and I was to watch her behavior to see if the Lactulose and Metro was making any difference.
After 10 days, my report was that I honestly did see any "better" behavior in Roxy, so my Internal Med. Special said Roxy didn't need the Lactulose and Metro. And based on Roxy really have no major HE symptoms (other than she can be docile and has poor muscle tone), both the IMS and my Vet believe she has MVD.
Oh, we also did a Protein C which came back at 165%
If I were you, and going to U of Tenn isn't that big of a deal, that's where I would go for a consult
Roxy is still on her special home cooked diet and she gets liver support (Vetri DMG and Hepato Support both from homevet.com)
Please keep us posted
