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

[sadiesamie]

Samie had a bile acid test done on 12/19/07.
pre: 15.0
post 25.0.

the vet presribed antibiotic and also a 30 day supply of Denamarin (which i researched this to be a liver supplement)

we did her follow up bile acid test this past saturday to and got a call today to find that now:
pre: 3
post: 79

Vet now says to do a collagulation test 48 hrs before and wants to do a untrasound and biopsy. she did the trial and error thing with my other Yorkie and 3000.00 later we discovered the problem. she is a very good vet but fresh out of school maybe 5 yrs so i am worried she is getting test happy now with our little one samie. She told my husband that it could be cancer, hepatitis or infection. of course i am worried out of my mind and we are very concerned. My husband does not want to do anything more until we research.

could this denamarin through off her numbers? i am worried sick! I don't understand how her post number could go up so high after just one month. Also none of this blood work was done until we had a collapsing trachea episode a month ago. dog shows no signs of anything wrong at all. If anything she has been doing extremely well. I don't get it? I appreciate any help or advice

I have given new treats and also more canned food than usual- (wellness venison and sweet potato and also wellness duck and sweet potato)

could adding more of the wellness canned food cause her numbers to be higher?

[Ellie May]

Originally Posted by sadiesamie

Samie had a bile acid test done on 12/19/07.
pre: 15.0
post 25.0.

the vet presribed antibiotic and also a 30 day supply of Denamarin (which i researched this to be a liver supplement)

we did her follow up bile acid test this past saturday to and got a call today to find that now:
pre: 3
post: 79

Vet now says to do a collagulation test 48 hrs before and wants to do a untrasound and biopsy. she did the trial and error thing with my other Yorkie and 3000.00 later we discovered the problem. she is a very good vet but fresh out of school maybe 5 yrs so i am worried she is getting test happy now with our little one samie. She told my husband that it could be cancer, hepatitis or infection. of course i am worried out of my mind and we are very concerned. My husband does not want to do anything more until we research.

could this denamarin through off her numbers? i am worried sick! I don't understand how her post number could go up so high after just one month. Also none of this blood work was done until we had a collapsing trachea episode a month ago. dog shows no signs of anything wrong at all. If anything she has been doing extremely well. I don't get it? I appreciate any help or advice

I have given new treats and also more canned food than usual- (wellness venison and sweet potato and also wellness duck and sweet potato)

could adding more of the wellness canned food cause her numbers to be higher?

I'm not sure I would want to do a biopsy so soon. Ellie's bile acids are way too high and she had a biopsy (she was being spayed anyway) and it came back fine. Other tests are fine, so she probably doesn't have liver shunt or MVD but she does have high bile acids. So it isn't always that. Maybe do a Protein C test to help rule out shunt and go from there? It does sound a bit like MVD in this case. What are her symptoms?

[BLEU BOY BARBER]

Praying For You And If You Want The Best Service For Your Baby We Only Deal With Texas A&m They Are Wonderul You Are Here In Texas And They Are Reasonable And Yes They Have Real Vets With Vet Students... What I Like Is They Talk To You About Everything Before Doing Anything The Daily Charge To Be Seen Non Emergency Is Only $78.00 They Rule Out One Test At A Time But Always Keep Your Money In Mind As It Is Not Their Sole Income... Sorry Jmo But Some Vets Can Run Those Tests Up Pretty Darn Quick Been There Done That And 1 Grand Later Still Did Not Know A Thing Ill Be More Than Willing To Help You If I Can There Are Others Here That Just Use A&m Yes You Are Suppose To Have A Referral But Ive Been Told Sometimes You Can Work Around That Ill Say A Prayer For Your Little One And Especially You Cause I Know It Is Heart Breaking To Not Know What To Expect Next.... Stick Around On This Site Because As The Morning Progresses People Can Help Give You More Ideas And Advice Welcome And Be Patient On Yt You Will Get Your Answer I Did And Will Be On This Site For As Long As It Is Up!

Hugs
Bleus Mommy

[Ladymom]

It's too soon to do a biopsy. The next step would be a Protein C test, then, if needed, a scintigraphy according to Dr. Center. An invasive surgery like a biopsy should only be done as a last resort.

Depending on what the Protein C test results are, make sure your vet does a scintigraphy, not an ultrasound. According to studies done at the University of Tennessee, ultrasounds are only 80% effective in detecting a shunt. Dr. center estimates that number could be as low as 60%. A scintigraphy is about $400, but is much more accurate.

Have your vet call Dr. Center for a consultation if he is not sure how to proceed. She is very accessible and helpful.

Sharon A. Center, DVM, DiplACVIM
Professor
Department of Clinical Sciences, College of Veterinary Medicine
Cornell University, Ithaca, NY 14853
Phone: 607-253-3060 (hospital, on page), ext. 3114 - biochemistry laboratory, audex recording)

[TLC]

I agree - too early to do a Liver Biopsy.

Roxy's first BAT was pre:43 and post: 100.9 - I was referred to a Internal Medicine Specialist. This is what we did:
Superchem/CBC
Urinalysis
Cystocentesis
Coagulation Prof 3 PT/PTT/PL
Ultrasound - Abdominal

The u/s showed no visible shunt, a normal sized liver and normal shape. Once the test results came back, everything was normal. I was given Metronidazole and Lactulose to give for 10 days, during that time, I was to watch to see if Roxy's behavior was more upbeat, etc. I honestly told the Dr. that I didn't notice any changes in Roxy while taking the meds, so the Dr. said that Roxy doesn't need to take them then.

We did a second BAT a few weeks later - Pre: 10 and Post: 64
We did a third BAT just a couple of weeks ago - Pre: 10.3 and Post:60.8

At this point we are treating Roxy with a Special Diet and Supplements, as if she has MVD. I won't know for sure, unless we do a biopsy, but I don't want to put her through that and the hospital here quoted about $3000 for it.

My advice, change her diet to low, quality protein. Add supplements to aid her liver.
I would do more tests:
Superchem/CBC
Urinalysis
Cystocentesis
Coagulation Prof 3 PT/PTT/PL

And I would retest the BAT in a month. Then compare all the tests and go from there. I wouldn't waste your $ on a U/S - and it's too early for a Biopsy. But that's just IMO

[Yorkieluv]

Excellent advice, Ladymom and TLC!!

Good luck, sadiesamie...Keep us updated on what you decide.

[Ellie May]

Originally Posted by TLC

I agree - too early to do a Liver Biopsy.

Roxy's first BAT was pre:43 and post: 100.9 - I was referred to a Internal Medicine Specialist. This is what we did:
Superchem/CBC
Urinalysis
Cystocentesis
Coagulation Prof 3 PT/PTT/PL
Ultrasound - Abdominal

The u/s showed no visible shunt, a normal sized liver and normal shape. Once the test results came back, everything was normal. I was given Metronidazole and Lactulose to give for 10 days, during that time, I was to watch to see if Roxy's behavior was more upbeat, etc. I honestly told the Dr. that I didn't notice any changes in Roxy while taking the meds, so the Dr. said that Roxy doesn't need to take them then.

We did a second BAT a few weeks later - Pre: 10 and Post: 64
We did a third BAT just a couple of weeks ago - Pre: 10.3 and Post:60.8

At this point we are treating Roxy with a Special Diet and Supplements, as if she has MVD. I won't know for sure, unless we do a biopsy, but I don't want to put her through that and the hospital here quoted about $3000 for it.

My advice, change her diet to low, quality protein. Add supplements to aid her liver.
I would do more tests:
Superchem/CBC
Urinalysis
Cystocentesis
Coagulation Prof 3 PT/PTT/PL

And I would retest the BAT in a month. Then compare all the tests and go from there. I wouldn't waste your $ on a U/S - and it's too early for a Biopsy. But that's just IMO

Wow Nicole, that is WAAAY too much for a liver biopsy even in New York. Ellie's was $255 because she was already under anesthesia and already had preop blood work. I wouldn't expect to pay more than $500 (maybe $1000 in NY). We do go to a pricey vet too.

[TLC]

Originally Posted by Ellie May

Wow Nicole, that is WAAAY too much for a liver biopsy even in New York. Ellie's was $255 because she was already under anesthesia and already had preop blood work. I wouldn't expect to pay more than $500 (maybe $1000 in NY). We do go to a pricey vet too.

Tell me about it. Her LP surgery cost $3000
To tell you the truth, I am not 100% sure that the Dr. was accurate with that quote. It was over the phone, and at that time, she was brand new at this Hospital, so she may not have gotten it right

[Ellie May]

Originally Posted by TLC

Tell me about it. Her LP surgery cost $3000
To tell you the truth, I am not 100% sure that the Dr. was accurate with that quote. It was over the phone, and at that time, she was brand new at this Hospital, so she may not have gotten it right

Yeah, the LP surgery sounds more accurate. For that price you might you get the liver shunt surgery itself done twice at UT>

[TLC]

Originally Posted by Ellie May

Yeah, the LP surgery sounds more accurate. For that price you might you get the liver shunt surgery itself done twice at UT>

Seriously. I could go to U of Tenn or up to Cornell for the surgery and even stay at a really nice hotel for a week and eat 3 meals out each day, maybe go to the spa and get my hair and nails done....sorry...day dreaming

[Ellie May]

TLC, please check your PMs.

[sadiesamie]

First of all i want to thank eveyone for their reponses. This is a long one- but i guess i have lots to say LOL i want to make sure you have all the details. :-) here goes...

Ok so today my husband talks to the vet. He tells her that we aren’t ready to do a liver biopsy and at this point we may just want to be referred to the specialist. (we saw a specialist that treated my other dog Sadie with her protein issues a couple months back and we really liked him) If we had we seen him a few months ago… we would have saved a lot of money from unnessessary tests –imo- that were done on Sadie.

So the vet says she has no problem referring us if that’s what we want to do. My husband just told her that he thought it was too soon to do a biopsy and that we not only did not have the money BUT we also wanted to do more research.

After finding out the venison was not good for her – there was no way that I could give it to her anymore- not even just a tiny amount of it for giving her meds.
So-I go to the pet store today in hopes of finding a low protein canned food ONLY so I have something to use to give meds with and that’s it.
And there really aren’t any. A guy that works there was helping me and he told me that a small can of Wellness contains 40% or more protein. He also seemed to think that this could throw off liver values/bat.
I decide to get the lowest protein in canned that I could find (Innova Senior with 4.5% protein) The Wellness has 8.0%.

Again- we decide that we are ONLY going to use a super, super small amount used to give meds with ONLY. I am going to try to use the dry food (that I wet) for the meds but just in case I wanted to have something on hand in case it didn’t work out. Well-I did use the dry food that I wet first to give the pills and it worked out good so I very well may not need to use the canned food after all.

My husband told the vet that since Samie’s last test we had been giving her the Wellness canned and we think that may have something to do with her values coming back higher. She said if we wanted to modify her diet and eliminate the canned food and keep her on the Denamarin and then retest she was ok with that. (Just yesterday she was in a hurry to biopsy) ???? go figure.

I do have to say that I was so impressed with the ingredients with the Wellness dry (we had just switched to this) so I decided to change the canned food that I was currently using (Innova Senior formula) to the Wellness brand. I do know that most Innova foods contain high amounts of protein) too high for our little dogs to eat it I think. But this was the senior formula, and it is 4.5% protein. I am really uneducated also on the way the breakdown works on the canned food. I don’t understand when the ingredients are listed as 8% fat when it is actually more than that. (again- I don’t understand it but I know that can is not only 8% fat)

And with us just recently switching to the Wellness. I was so impressed with the food and it’s ingredients- I decided to get the Wellness canned (instead of the Innova I had been giving them). I started giving more of the canned wellness (venison and also duck) more often. Not as main source of feeding, but I would put maybe a tablespoon or so on Samie’s food. And then again I would use it to give her med 2 times a day. And ALSO as a treat maybe 2 times more for the night.

With Sadies allerergies this seemed to help her so I was using the canned food as treats. SO maybe 5 times total for the day I would give the canned food. say a ½ - 1 teas for samie each time. and then a good tablespoon with her breakfast and dinner. Then I went out and bought the Wellness “wellbites” to give those as treats too since they have such great ingredients. Never more than ½ a square a day.
Well come to find out treats and canned contain large amounts of protein. Which as we know are not good for Samie now.

I am really hoping that the Wellness canned venison & sweet potato and the Duck & sweet potato was too much protein for her and if we eliminate it and continue the Denamarin her numbers will come down. The vet said that she will research food options with a Hills specialist- I don’t want to hear that bc she knows how I feel about their food and what goes into it. But she said we could monitor her again if we’d like. This time around though we are going to eliminate the canned food and treats. I got some sweet potato fries today that have 6 gr protein to give as a treat. I am praying that by eliminating the canned food her numbers will improve.

But she is doing really good on the Wellness Weight Mgt dry food- it is 17 % protein and 6 % fat. She is losing weight on this food. Do they make a food lower than that in protein? In the mean time we decided to start her back up on the Denamarin (her last pill was last Thursday and her retest was this past Saturday) I know that Denmarin is a supplement and not sure how it really works? I had been feeding Samie at 6:30am and 6:30 pm and then waiting until 10:30-11:00pm before bed to give her the Denmarin. Apparently this isn’t supposed to be given with other meds and you have to wait a few hours after eating to give it to her.
I don’t even know if this is the best time to give it to her. I work Mon-Friday both my husband and I so I don’t know what else to do. Does anyone think she is getting the full benefits of this Denamarin at the time I am giving it? Or should I think about trying to figure out a different time to give it to her? I get up at 6:00 and feed them right then. Then I have to leave the house within the hour.

We asked the vet also about Denosyl? But my husband spoke with one of the receptionists at the vet and she said she would check with the vet and call us back. Well when the vet tech called my husband back she said that she could have the Denamarin ready for me to pick up tonight and also she called in Ursodiol 35 mg for Samie too. I have no idea what this is? It is a med? It is a supplement? and once again- we don’t get enough info. But this is why my husband talks to the vet in the first place. She is always so quick to explain and I could never absorb it all enough to relay what she said back to my husband. So I decided to let him take over. We didn’t get a chance to ask her about the Hepato support. But I want to know more about that.
My friend works at an emergency vet and says they deal with this vet a lot and she has reassured me that we are going to a very good place- she said the best of the best so….. I trust her. And there are very good- just sometimes test happy. They are very pricey too. But when it comes to our pets. I want the best for them and I will pay what I have to.
Below is a section I copied from a MVD link I researched…
Nutriceuticals- compounds that are not considered “drugs”- can also improve liver function. Milk thistle (“silymarin”) can help improve liver function and regeneration. Because the government does not regulate over-the-counter compounds, purchase of specially formulated veterinary supplements is recommended. Two veterinary companies that sell milk thistle include Nutrimax (“Marin”) and RxVitamins (“Hepatosupport”). Veterinarians may also prescribe Denosyl (SAM-e) to improve liver function.
My questions:
1. Can someone tell me why Hepatosupport is better than Denamarin? If I have to I will order it?
2. Has anyone ever heard of URSODOIL? It’s a beef flavored liquid is all I know. I need to research it more before I give it to her.
3. What are the best times do you think to give the liver supplements? I am currently giving 4 hours after dinner.
4. are we safe to wait this out another 30 days. (no symptoms of any kind that we notice) if anything she is doing really really well.

Sorry this is so long- and sorry for not posting sooner- I had it all typed up and ready to post and the darn site timed out on me. I guess I was taking too long LOL 
I will check back. I am not giving the Ursodiol until i have more info on it. I also need more info on the Hepatosupport - is this something that can only be purchased on line or would the vet have it?

[Ellie May]

http://www.marvistavet.com/html/body_ursodiol.html
I'm a little bit confused why the vet didn't try Denosyl first.
I'm not saying it is wrong though.
Ellie's specialist said we could try it and I declined because Denosyl seemed to really help her on its own.

[TLC]

Here is where I buy the stuff. No you don't need a Vet to buy it.

http://www.homevet.com/osc/product_i...cb47e841f2f3dd


http://www.homevet.com/osc/product_i...?products_id=9

[sadiesamie]

Originally Posted by TLC

Here is where I buy the stuff. No you don't need a Vet to buy it.

http://www.homevet.com/osc/product_i...cb47e841f2f3dd


http://www.homevet.com/osc/product_i...?products_id=9

And you think it works better than the Denamarin? The Denamarin is 60.00 for 30 days supply. But i don't care about spending the money and it not working. I will get the hepato support.