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

[sadiesamie]

Originally Posted by Yorkieluv

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

You are a GODSEND for telling me about the yahoo site!
xxxxxxxxxxxxx!!!

[Ellie May]

Originally Posted by sadiesamie

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.

Yes, I am a member of the liver shunt group. They really can't tell me what is wrong with Ellie because she isn't even near clinical. There are a zillion reasons why the bile acids could be doing this, so nobody really knows... They are a wonderful group of people though and I highly recommend that people join if they have a liver compromised dog.

[Yorkieluv]

Originally Posted by sadiesamie

You are a GODSEND for telling me about the yahoo site!
xxxxxxxxxxxxx!!!

You are welcome!! The group's members are amazing and have helped soooo many dogs...

[Ellie May]

How did the specialist trip go?

[sadiesamie]

Well took Samie to the Internal Med Specialist today…His recommendation was to stop everything. The Flovent inhaler, Soloxine, Potassium Citrate granules, and the Denamarin liver supplement. We will go see him in 6 wks for a new baseline blood and urinalysis. He also indicated that based on the x-rays Samie does not have CT but- may have something called Laryngeal Paralysis. This would explain why Samie would occasionally turn blue. It has to do with the breathing inward and it can stop air flow and be very serious. Samie did well at the vet. At first she was very excited but she calmed down after we were there.

He also recommended that we send over my other dogs labs for him to review and also recommended that we stop the Soloxine with her. Apparently my girls may not be hypothyroid. 2 of their readings showed other low thyroid values, but the TSH in general was within range.
Overall he was not convinced that there is a thyroid problem.

He was concerned with Samie’s ph being at 8.0 and her urine being now on the alkaline side. So he said no more Potassium citrate. They do a urinalysis to check for crystals “in house” so the urine is tested immediately. The urine taken at the reg vet gets sent out to the lab and by the time they get to testing it, crystals can form in the urine causing inaccurate results.

Her liver size was slightly larger than normal, but he didn’t think anything looked abnormal about it. He specifically said that she does not have a liver shunt. In 6 wks Samie will have a BAT and she will stay at the clinic. They said they are going to feed her regular food and also add a higher fat food to challenge her liver. They will do a full blood panel and urinalysis also. He did say that the Flovent could be contributing to this easily and there was only one way to find out.

It appears to be that my girls have been over medicated making it impossible to determine “what” is wrong- if anything.

So- with that, for the next 6 wks, I am going to relax and feel more at ease.
He said if we notice anything unusual to call him immediately.

I am still reeling this all in, as I was sure that we were going to get bad news today. I was so overwhelmed I could not help but just start crying when we left the place. If you all knew the whole story as to how we were treated at the regular vet! From being rushed into tests, never getting a detailed explanation on results, the money we have spent this past 6 months on a lot of unnecessary tests… AND an incident that took place a few months ago when the office manager called me to tell me how all calls will go through her since we take up valuable time with the vet. And that because of the fact that i talked to her on the phone for 15 minutes and kept her from seeing very sick patients that I will now be charged 25.00 for phone calls if I didn’t handle everything with her. I have a write up saved that i did one night on this experience but have not had the time to read through it all first. Just something I wanted to share with you all. I haven't decided it I am going to post it just yet.
WOW it was such a learning experience they put us through.

So anyway- AFTER today's visit with the specialist... I am so overwhelmed.

You can be sure that we will not be going back to the regular vet any longer.

I will continue to check back and continue to update. I won't go 6 wks without checking in with you all who have been here to support me and help me through this.

It has been 6 mos of sheer madness for me.

[Ellie May]

Originally Posted by sadiesamie

Well took Samie to the Internal Med Specialist today…His recommendation was to stop everything. The Flovent inhaler, Soloxine, Potassium Citrate granules, and the Denamarin liver supplement. We will go see him in 6 wks for a new baseline blood and urinalysis. He also indicated that based on the x-rays Samie does not have CT but- may have something called Laryngeal Paralysis. This would explain why Samie would occasionally turn blue. It has to do with the breathing inward and it can stop air flow and be very serious. Samie did well at the vet. At first she was very excited but she calmed down after we were there.

He also recommended that we send over my other dogs labs for him to review and also recommended that we stop the Soloxine with her. Apparently my girls may not be hypothyroid. 2 of their readings showed other low thyroid values, but the TSH in general was within range.
Overall he was not convinced that there is a thyroid problem.

He was concerned with Samie’s ph being at 8.0 and her urine being now on the alkaline side. So he said no more Potassium citrate. They do a urinalysis to check for crystals “in house” so the urine is tested immediately. The urine taken at the reg vet gets sent out to the lab and by the time they get to testing it, crystals can form in the urine causing inaccurate results.

Her liver size was slightly larger than normal, but he didn’t think anything looked abnormal about it. He specifically said that she does not have a liver shunt. In 6 wks Samie will have a BAT and she will stay at the clinic. They said they are going to feed her regular food and also add a higher fat food to challenge her liver. They will do a full blood panel and urinalysis also. He did say that the Flovent could be contributing to this easily and there was only one way to find out.

It appears to be that my girls have been over medicated making it impossible to determine “what” is wrong- if anything.

So- with that, for the next 6 wks, I am going to relax and feel more at ease.
He said if we notice anything unusual to call him immediately.

I am still reeling this all in, as I was sure that we were going to get bad news today. I was so overwhelmed I could not help but just start crying when we left the place. If you all knew the whole story as to how we were treated at the regular vet! From being rushed into tests, never getting a detailed explanation on results, the money we have spent this past 6 months on a lot of unnecessary tests… AND an incident that took place a few months ago when the office manager called me to tell me how all calls will go through her since we take up valuable time with the vet. And that because of the fact that i talked to her on the phone for 15 minutes and kept her from seeing very sick patients that I will now be charged 25.00 for phone calls if I didn’t handle everything with her. I have a write up saved that i did one night on this experience but have not had the time to read through it all first. Just something I wanted to share with you all. I haven't decided it I am going to post it just yet.
WOW it was such a learning experience they put us through.

So anyway- AFTER today's visit with the specialist... I am so overwhelmed.

You can be sure that we will not be going back to the regular vet any longer.

I will continue to check back and continue to update. I won't go 6 wks without checking in with you all who have been here to support me and help me through this.

It has been 6 mos of sheer madness for me.

Wow, what an interesting day for you.
I am so glad you're done with that vet. You deserve better. All calls go through the office manager...LOL...yeah sure. If the vet doesn't want to talk to her clients then why is she a vet to begin with? And $25 for a phone call?

Just about any meds could elevate bile acids, so those being elevated wouldn't be my first concern (just recheck like the specialist said). I would be very unhappy if my dogs were medicated for more than one disease all this tim for no reason. I think your "old" vet has a lot of explaining to do.

[sadiesamie]

Ok- I am feeling nervous. Not only has my daily "med giving routine" totally changed. This is day 5 and Samie is without: Flovent, Soloxine, Potassium Citrate or Denamarin... I don't know if the specialist wasn't able to figure anything out bc of Samie being on so many meds? Or if something is going to change. We go back for a revamp of everything - blood work and urinalysis.

Samie is doing very well. It's nice to not have her running away from me. She hated getting the mask for the flovent.

They are still on the Wellness for now but they have such a ravenous appetite when it is feeding time. I think there may be a lot of fillers in this food. For as bad as I want to switch- (it's time for a new bag) I have to be patient. I need to know what the labs show in 6 wks before we persue talking with a nutritionist. I know my girls love their food wet... so maybe the appetite comes from that. ??

I was relieved at first when we saw the specialist but now that we are not giving "any" meds. I am nervous. He said I don't believe Samie has a liver shunt? Maybe mvd? only one way to tell- take her off of all of this meds. He didn't want to come out and say it but several times he would refer to his saying "UM...Not sure how to say this???" I think he pretty much was saying that the vet messed up. He did tell us that if for whatever reason Samie started to not feel good- vomiting or diarrhea... to call him immediately.

So far- so good. yet I am a worry wart so... The specialist knows his stuff and he is a specialist for a reason. He has years and years 30+ experience so I am going to trust him and go with it.

[sadiesamie]

Also, I posted a follow up on the yahoo liver group, but I can't seem to locate it. I did it twice and it said my reply was sent. I still can't locate it..
and I never heard anything back from anyone. I can't help but think no replies are a good sign. Bc maybe they feel my situation isn't as serious as we thought? not sure- i keep checking for responses to my follow up and nothing... ??

[Yorkieluv]

I haven't seen any posts from you since the original post??

I don't think they are going through...Make sure you are sending it to the entire group...Could it be that you are sending it to only one person's email...

The yahoo group always responds.

[Yorkieluv]

It really sounds like your specialist knows what's going on!! What a relief it must be to have them in this vet's care I am so happy to hear that they are doing so well without all those meds. Your vet is right, if they have been given these meds unnecessarily that definitely could be a big problem right there...

I hope to see your post on the yahoo group soon!

[sadiesamie]

Originally Posted by sadiesamie

Ok- I am feeling nervous. Not only has my daily "med giving routine" totally changed. This is day 5 and Samie is without: Flovent, Soloxine, Potassium Citrate or Denamarin... I don't know if the specialist wasn't able to figure anything out bc of Samie being on so many meds? Or if something is going to change. We go back for a revamp of everything - blood work and urinalysis.

Samie is doing very well. It's nice to not have her running away from me. She hated getting the mask for the flovent.

They are still on the Wellness for now but they have such a ravenous appetite when it is feeding time. I think there may be a lot of fillers in this food. For as bad as I want to switch- (it's time for a new bag) I have to be patient. I need to know what the labs show in 6 wks before we persue talking with a nutritionist. I know my girls love their food wet... so maybe the appetite comes from that. ??

I was relieved at first when we saw the specialist but now that we are not giving "any" meds. I am nervous. He said I don't believe Samie has a liver shunt? Maybe mvd? He is not really sure anything is wrong with her liver at all... He said dogs with liver issues are very skinny and samie is not. He said her bat was not that high. But the only one way to tell- take her off of all of this meds. He didn't want to come out and say it but several times he would refer to his saying "UM...Not sure how to say this???" I think he pretty much was saying that the vet messed up. He did tell us that if for whatever reason Samie started to not feel good- vomiting or diarrhea... to call him immediately.

So far- so good. yet I am a worry wart so... The specialist knows his stuff and he is a specialist for a reason. He has years and years 30+ experience so I am going to trust him and go with it.

revised...

[Ellie May]

I would be very happy that the specialist pulled the meds for now. It could be MVD but even more likely is the bile acids are up from all the medication she is on. Those are bound to effect the liver somehow.

[sadiesamie]

Originally Posted by Yorkieluv

It really sounds like your specialist knows what's going on!! What a relief it must be to have them in this vet's care I am so happy to hear that they are doing so well without all those meds. Your vet is right, if they have been given these meds unnecessarily that definitely could be a big problem right there...

I hope to see your post on the yahoo group soon!

Ok- I think it worked this time. I don't know what I was doing wrong but I saw what i posted. It is good to see that specialist. I think if there was something major going on here he wouldn't say to stop the meds... but still it makes me a nervous wreck. He knows these lab results... he has to. He knows what to look for??? I have got to trust him and I am in such denial. I thought for sure he was going to say- ultrasound... ??? more tests... we left there literally dumbfounded!

One thing I am noticing is Samie has a little irritation by her private area. she did a little scooting last week and i think she took off some skin. ALSO- her hair around her privates was WAYYYY too long - maybe the urine irritated her also.

I cleaned her anal glands again the other day. I knew I got it all this time, (her glands are so tiny and so hard to find) my other dog's are easy- but samie's are hard to find. Still she was still scooting a little- I need to shave her private area but for now I just used scissors.

I checked her front area. just a tiny little irritation. Like one little spot. I don't want her to go to long with this. bc i worry she might have another uti. she had 2 in the last 6 mos. ???

i think i am really................. just driving myself crazy. I will continue to put the Entederm ointment on her the rest of this week. I am off next Monday if still not better -then I will have it looked at. don't want to wait six wks to see him.

[sadiesamie]

Originally Posted by Ellie May

I would be very happy that the specialist pulled the meds for now. It could be MVD but even more likely is the bile acids are up from all the medication she is on. Those are bound to effect the liver somehow.

I just keep saying to myself- it something was going on he knows how to read those labs he would have said differently. but to stop all meds? I just can't believe that. I just can't believe my little dog was on so many things (373.00 a month in meds!) we figure if she lives 5 more years or so on all of this it will be like 25,000.00 to keep her alive - a little dog who shows no signs of anything wrong. I am just in awww.... I might want to go our and buy a new car now! :-) geez i tell ya...

He is the same specialist that saw my other dog for high bp (265) and he said stop the claritin he knew it was that immediately raising her bp. instead- our reg vet prescribed something to lower her bp. (AMlodipine) is she crazy???? how did she not know that the Claritin was raising it in the first place. It's like she was telling me to give her something for her itching - she had high bp and then also prescribing somthing else to lower it at the same time. How did she not realize it was the claritin raising it??? It just doesn't make sense to me. my husband and i keep asking ourselves... why did the reg vet not take into consideration all of the meds samie was on? she immediately wanted to do a biopsy? wow.

[Ellie May]

Originally Posted by sadiesamie

Ok- I think it worked this time. I don't know what I was doing wrong but I saw what i posted. It is good to see that specialist. I think if there was something major going on here he wouldn't say to stop the meds... but still it makes me a nervous wreck. He knows these lab results... he has to. He knows what to look for??? I have got to trust him and I am in such denial. I thought for sure he was going to say- ultrasound... ??? more tests... we left there literally dumbfounded!

One thing I am noticing is Samie has a little irritation by her private area. she did a little scooting last week and i think she took off some skin. ALSO- her hair around her privates was WAYYYY too long - maybe the urine irritated her also.

I cleaned her anal glands again the other day. I knew I got it all this time, (her glands are so tiny and so hard to find) my other dog's are easy- but samie's are hard to find. Still she was still scooting a little- I need to shave her private area but for now I just used scissors.

I checked her front area. just a tiny little irritation. Like one little spot. I don't want her to go to long with this. bc i worry she might have another uti. she had 2 in the last 6 mos. ???

i think i am really................. just driving myself crazy. I will continue to put the Entederm ointment on her the rest of this week. I am off next Monday if still not better -then I will have it looked at. don't want to wait six wks to see him.

I don't think the specialist is going to put her life in danger. Try to relax.
Ellie's anal glands have never been and hopefully will never be emptied. Once you start it can lead to problems.
Ellie has one red bump by her privates and it is going away. I think the girls just get irritated sometimes. She has long hair down there.
When she was diagnosed with those UTIs, was the urine sample taken by cysocentesis or free catch?