Bile Acid Test- vet want to now do biopsy. I am so worried

[sadiesamie]

Originally Posted by Yorkieluv

Don't cry!! It will be okay...First, let's find out if there's even anything wrong with her liver...My first piece of advice is to re-do the bile acid test in a couple of weeks...make sure she has not received any heartworm or flea meds within this time frame, as I believe this can throw the test off...

If the pH is too acidic, your dog can form calcium oxalate stones..If it's too alkaline, your dog can form struvite stones. That's what I meant by off...I think the target pH is more in the 7-range.

As far as food goes, if you homecook and give the right kinds of food (no high oxalate and very little to no medium oxalate), then in theory, she should not need the potassium citrate...BUT you would have to talk to your vet about this.

Can you remind me what is in this wellness food?

so now we figured out that the ursodiol is going to throw off her bat and may mask somthing. My husband wants me to stop the Ursodiol and get in to see the specialist next week. I would rather retest her w/o it too. since we changed her diet and stopped the wellness canned. but i dont fully understand why the canned food could be hard on her liver unless there was a liver problem.

The only thing i added was the omega 3 this past week. do you think that this could impact her numbers in any way? I have read that it can help her liver.

also- my husband asks: Is there anything about denamarin that could possibly raise her numbers on the bat. I told him that you said it is a supplement so it's supposed to help in getting those numbers down. he wants to know how we can be so sure? he says one month she is only doing denamarin as a precaution bc the levels were only a tiny bit over the normal range...now within a month they went up while being on the denamarin???? i don't understand it all too well myself. Something with the milk thistle it supposed to help her but I don't know for sure how it works.

[sadiesamie]

Originally Posted by sadiesamie

so now we figured out that the ursodiol is going to throw off her bat and may mask something. My husband wants me to stop the Ursodiol and get in to see the specialist next week. I would rather retest her w/o it too. since we stopped the wellness canned. but i dont fully understand why the canned food could be hard on her liver unless there was a liver problem.

The only thing i added was the omega 3 this past week. do you think that this could impact her numbers in any way? I have read that it can help her liver.

also- my husband asks: Is there anything about denamarin that could possibly raise her numbers on the bat. I told him that you said it is a supplement so it's supposed to help in getting those numbers down. he wants to know how we can be so sure? he says one month she is only doing denamarin as a precaution bc the levels were only a tiny bit over the normal range...now within a month they went up while being on the denamarin???? i don't understand it all too well myself. Something with the milk thistle it supposed to help her but I don't know for sure how it works.

.......

[Ellie May]

What type of omega 3 are you giving? Fish oil? How much?

The vet may not have a clue what VetriDMG is. Ellie's specialist never had heard of it.

I would be suspicious of her amylase being so high. That signals a problem with the pancreas. Ellie's pancreas is in question right now and she has high bile acids. The Actigall could be a good choice for this kind of thing but I would want a diagnosis first in your case (to make sure it's not a shunt). I'm not sure the pancreas can make the bile acids go up, but it seems possible in Ellie's case.

[sadiesamie]

Originally Posted by Ellie May

What type of omega 3 are you giving? Fish oil? How much?

The vet may not have a clue what VetriDMG is. Ellie's specialist never had heard of it.

I would be suspicious of her amylase being so high. That signals a problem with the pancreas. Ellie's pancreas is in question right now and she has high bile acids. The Actigall could be a good choice for this kind of thing but I would want a diagnosis first in your case (to make sure it's not a shunt). I'm not sure the pancreas can make the bile acids go up, but it seems possible in Ellie's case.

the Omega 3 that i am giving is: EicosaDerm that i got from someone on YT. I think it was Yorkieluv. I need to keep better track with my notes of who tells me things LOL... but i give 1/2 a pump for both dogs. I have seen amazing results with Sadie who had been iching really bad. and on her sides where the hair was coarse and her skin was red and rough feeling is now much softer too. Sadie has been on it for about 2 wks. after i read somewhere that omega 3 is good for liver comp dogs i started giving it to samie also. It comes in the form of a pump and is very easy to use. SADIE also isn't losing protein like she was in totally outrageous amounts so she no longer smells bad 2 days after a bath and her hair feels nice and soft again.

Sadie had a bout with pancreatitis in December and the spec just said to avoid greasy food and no people food. we told him that we don't feed table scraps at all. that's when he said to feed a good quality protein and low fat.

now those values i listed for SAMIE were taken from July 07. I am going to get her December copy tomorrow and then i will post her values again. It was my fault that i didn't get a copy. i only got a copy of the bat from December... but as a rule-I am good about keeping a 3 ring binder that is (believe it or not...about full already) but i keep all of their labs on file and also any info that i want to keep on all of their issues we have been dealing with. At the back of the binder i keep all of the invoices and it's almost 1/2 inch thick. so many of them it's crazy!!!

i know when the specialist saw SADIE for her protein loss he wasn't concerned with her amylase or lipase values bc sadie had no blood in her stool or no diarrhea. and SADIE'S amylase was 2045! and her lipase was 1047. We thought for sure she would have to spend the 3 days in the hosp on fluids and the whole 9 yards but no- he didn't spend but 1 or 2 min talking with about her pancreatitis. he went right for the protein loss.

My husband told me last night ( and trust me he was ALL ears now) because he is realizing why i keep telling him things i am learning about this all. He is so upset with our vet for not telling him that the Ursodiol could maybe skew her next bat. So we are going to schedule with the specialist this week. we are not waiting for samie's next bat in a few weeks. The only thing that makes me nervous is that samie can't be there long. we can't sit in the waiting room for 15 min and then in the waiting room for another 15 min. it's just too much for samie. And i don't want to see her have really bad breathing problems and turn very blue. we have almost lost her 2 times-both times was bc we had tried switching vets and even though i prepared them it still didn't help. i guess they thought i was exaggerating. so i need to talk with the specialist and let them know that if they cannot see us w/o samie then we will have to be super quick with her there. Just thinking about getting her to the specialist this week already has my stomach upset and in knots.

[Ellie May]

Okay, I asked because not just any fish oil will work for what you are trying to accomplish. There has to be a certain minimum of EPA and DHA and appears that there is in this one.

I would still really wonder why those numbers are up and if it is at all connected with the high bile acids. Just a thought.

I wouldn't be happy either if I wasn't warned about the med changing the bile acids but at the same time the vet saying I have to recheck them. That makes very little sense. She did give the med for a reason though and I would not advise taking her off of it unless it is under a vet's supervision/with their knowledge.

[sadiesamie]

It was after these labs that were taken in December that led to the vet wanting to run a BAT. And i am so worried now after seeing these. I am only listing the high values... SUCH a HUGE difference from JULY TO DECEMBER IN HER "ALT VALUE"!!! I KNOW THIS IS A BIG ONE TO LOOK AT SINCE I HAVE BEEN RESEARCHING BUT I DON'T KNOW WHAT 'ALT" IS?
I JUST SEE EVERYONE ASKING OR LISTING ALT VALUES...

FIRST I AM LISTING HER JULY 07 LABS AND THEN HER 12/07 LABS:


7/14/07 LABS:
ALT: 25 (RANGE: 5-107)
AMALYASE: 1443 (RANGE: 450-1240)


12/11/07 LABS:
ALT: 162!!!
AMALYASE: 1707

Now i will say this... Since July... when Samie's ALT was 25... we have introduced SOLOXINE AND FLOVENT. I WONDER IF THESE MED'S COULD HAVE MESSED WITH THESE VALUES??? BECAUSE HER VALUES EASILY COULD HAVE CHANGED WITH STARTING HER ON THESE MED'S I THINK. IT WAS IN THE JULY LABS THAT SHE WAS DIAGNOSED WITH HYPOTHYROIDISM AND WE STARTED THE SOLOXINE JULY 20TH ... AND THEN SHORTLY AFTER THAT WE ADDED THE FLOVENT 8/14/07.

REGARDLESS- WE HAVE OUR APPT SET FOR 8AM THIS WEDNESDAY WITH THE SPECIALIST.

I AM NOT MESSING AROUND WITH THIS.

[sadiesamie]

My Yorkie Samie (9 yrs) had a bile acid test done 12/11/07.

Pre: 7 and post 15. The vet suggested starting Samie on Demamarin

and to re-test BAT 30 days later.

retest 30 days later: BAT pre: 3 post: 79

Vet suggests liver biopsy (light sedation, small needle, etc.) we do
some research and do not want to do biopsy as we felt it was too
soon. and no other tests had been done. (no xray's or anything)

So opting out of having the biopsy she says she understands people
cannot affort testing and she now says continue Denamarin and lets
add Ursodiol. I start the Ursodiol as she had directed, but now
after further researching YT and on line. I discover that giving
Samie the Urosodiol may skew her BAT retest in 30 days. so with that
we discontined the Ursodiol because I don't want to be "masking"
something here such as Shunt or MVD (as I had researched)

I also read that "anything" can throw off a BAT.

Here is some backround:

Samie had blood work done July 07-
We discover that she is Hypothroid. We did notice that Samie was
less playful, mopey, and she had put on weight (2 lbs)
BUT- Since adding the Soloxine she is a totally new dog. Yappy,
playful and back to her normal self. And we have even got her to
lose 1 lb!

Her Collapsing Trachea had progressed. Samie was on an allergy med
called Chlorphenarimine. Samie's breathing and coughing progressed
and we had to start giving her Hydromet. Sometimes every day. So
the vet says we can also try putting her on Flovent. In the meantime
we decided to STOP the Chlorphenarimine. I realized hat it was
making her pant more. and with more panting...came more breathing CT
issues.

Samie made a complete turn around once we
stopped the Chloraphenarimine. We still have her on the FLOVENT. I
believe the FLovent also causes excitability because Samie would pant
very very fast in her sleep. As soon as I backed off of the Flovent
and only gave it 1 x a day instead of 2 x a day. She no longer pants
heavily in her sleep.

Samie had been producing Calcium Oxalate crystals in her urine we
discovered that in July also I believe. The vet Prescribed
Pottassium citrate granule in her food 1 x a day.
SAmie's ph is holding at 8 (now on the high side IMO) But she is no
longer producing crystals.

So now- Samie has a CT fainting episode on 12/11/07- We are almost
positive this was a fainting episode because I have another Yorkie
and I had heard them quarreling over their food dishes. When i got
into the kitchen, I found Sadie in Samie's food dish and found Samie
flat on her back, I picked her up and she fainted in my arms. (I
thought she had passed away actually :-( Samie awakes- pushing out
her paws and crossing them. I didn't know if it was a seizure or
what? Vet says no she doesn't think so. ??? so ok we decide to run
some blood work on her.

Just want to remind you that Samie presents no symptoms of not
feeling well before this fainting episode. She has been feeling
great!


What I am questioning here is...

Labs done 7/14/07... we discover she is Hypothyroid.
we added SOLOXINE 7/20/07
With CT progressing- we added FLOVENT on 8/14/07.

Samie does still have CT episodes- The Chorepharimine just made her
so much worse. Samie does not go for walks and vet visits have to be
quick. Sometimes after a bath when she is excited and I am drying
her she will even turn blue (tongue)

For the crystals- we start adding Potassium Citrate granules to her food 1 x
day.

Fainting episode in December triggers BLOOD WORK. After December
Labs- the vet realizes something may be off so she suggests BAT.
After reviewing the labs i see that the ALT is HIGHer than it was in
July. So we do a BAT.

Something MAJOR that i noticed when comparing July labs and December
labs:
ALT in July was 25 Now ALT in December was 162!

This is what i am wondering all day long...
Could these med's be impacting Samie's liver values hency throwing
off her BAT?

We are seeing a specialist this Wednesday. I am just wondering if
anyone has any imput on this?

[sadiesamie]

I started looking back on all of our invoices...
One thing that that may have impacted Samie's bat and ALT readings is the FLOVENT inhaler.

During Samie's first set of bloodwork and BAT she was not on the flovent every single day. In fact, there was a period where i stopped it for a couple weeks because it was making her pant very heavily in her sleep.

I started her back up on the Flovent bc the vet prescribed it- i though it was best that we give it to her. Samie has been on the flovent every day since her last bat.

I am currently researching if FLovent has an impact on the liver. if anyone finds something please post or pm me.

I know this is wishful thinking- but all w/end and today i keep trying to figure out why such an increase in her bat this past 30 days and also what changed between her labs in July and December.

[Ellie May]

I'm glad you got an appt. with the specialist.
They should be able to help you.
Ellie's ALT was 118 (normal is 100 or lower) and it went right back down to 43 with the next blood test. Samie's might go right back down. 162 isn't good but it isn't terrible high.

[sadiesamie]

Originally Posted by Ellie May

I'm glad you got an appt. with the specialist.
They should be able to help you.
Ellie's ALT was 118 (normal is 100 or lower) and it went right back down to 43 with the next blood test. Samie's might go right back down. 162 isn't good but it isn't terrible high.

what is ALT?

[sadiesamie]

I believe this high ALT is what made her do a bat. Did you ever find out why Ellie's increased? Was it her diet that you changed to make it come down? Bc we are talking with a nutrionist next.

[Yorkieluv]

High ALT levels point to liver inflammation or damage. This can be caused by many, many factors...

[Ellie May]

Originally Posted by Yorkieluv

High ALT levels point to liver inflammation or damage. This can be caused by many, many factors...

There is your answer and it stands for alanine aminotransferase if that is what you wanted to know...

[Ellie May]

Originally Posted by sadiesamie

I believe this high ALT is what made her do a bat. Did you ever find out why Ellie's increased? Was it her diet that you changed to make it come down? Bc we are talking with a nutrionist next.

Ellie's bile acids were post: 47.
This is when her ALT was elevated.
She went on Denosyl, vitamin E and low protein diet (started with Royal Canin...made her itchy so we switched to Dr. Dodds liver cleansing diet with egg instead of fish).
Retested bile acids one month later.
This time the post bile acids were 15 and the ALT was down to 43.
She stayed on the Denosyl and this diet for awhile.
She was spayed and her liver biopsy came back okay.
She came off the Denosyl around this time and her protein intake increased. I talked to a nutritionist and was now using a homemade diet with 24% protein (chicken). This started in early November sometime.
We were pretty happy that the bile acids came back down and the biopsy was good but the bile acids still needed to be rechecked to make sure everything was okay.
They were rechecked in mid January and Ellie's post was 106.
Her ALT hasn't been checked since it was 43.
We are going to start Denosyl again and go from there since the specialist doesn't have an answer........

[sadiesamie]

Originally Posted by Ellie May

Ellie's bile acids were post: 47.
This is when her ALT was elevated.
She went on Denosyl, vitamin E and low protein diet (started with Royal Canin...made her itchy so we switched to Dr. Dodds liver cleansing diet with egg instead of fish).
Retested bile acids one month later.
This time the post bile acids were 15 and the ALT was down to 43.
She stayed on the Denosyl and this diet for awhile.
She was spayed and her liver biopsy came back okay.
She came off the Denosyl around this time and her protein intake increased. I talked to a nutritionist and was now using a homemade diet with 24% protein (chicken). This started in early November sometime.
We were pretty happy that the bile acids came back down and the biopsy was good but the bile acids still needed to be rechecked to make sure everything was okay.
They were rechecked in mid January and Ellie's post was 106.
Her ALT hasn't been checked since it was 43.
We are going to start Denosyl again and go from there since the specialist doesn't have an answer........

Have you been on the yahoo liver support group site yet? There are so many people with the best advice. I posted and I could not believe the abundance of info. I am soooooooo thankful that Yorkieluv told me about this site. I wanted to let everyone know that our appt is tomorrow morning at 8am with the specialist. It was originally for today but something came up with my husband at work and we needed to move it to Thurs. I am anticipating our visit. I think she will do ok.

Since we discontinued the Chlorphenaramine she hardly ever pants anymore. And our last long Vet visit was last December. She did ok for about 20 minutes. She gets so excited there. I can't tell you how fearful I am going to a place where no one knows how she can get. they said that they would be ready for us right when we get there. I told them 3 different times that I spoke to them and we even typed up a summary to fax to the specialist. They faxed me all forms too -so I have everything completed and ready to go.

It's amazing the fear we feel for our little ones.
My stomach is in knots!!! but my heart and soul is FULL of hope - all at the the same time. :-) If this is from the Flovent we are done with this vet. All she has done is over medicate my girls and cause us problems.