Possible liver shunt

[drabinowitz43]

My puppy Joey saw the vet today to follow up on his abnormal (74) liver bile acid test. They were going to run more bloodwork, but my vet says there is no doubt his liver is compromised and sent me to Oradell Animal Hospital in NJ for a sonogram and to see a surgeon there. I live very close to NYC and could go elsewhere like Cornell. However, my vet thinks Oradell is a great facility and the sonographer specializes in diagnosing liver disease. It is a very reputable and well known 24 hour day emergency hospital and and an upper tier facility (not the run of the mill place). I can't get an appt until March 5th. Joey is asymptomatic right now. Feedback please, anyone hear of Oradell for this, okay to wait, can he have a seizure or develop symptoms at any time? Should I switch his food from California Natural Lamb/Rice small bites. The lamb formula is the only one this company makes in small bites. I switched off the puppy food because I also have a one year old Yorkie. Thanks everyone.

[MyFairLacy]

I would still want to do a Bile Acid test first to get a paired sample around a meal before just jumping into more diagnostics. I also recommend a urinalysis.

So far as which place to be referred to, that's up to you. I dont know anything about the place your vet wants you to go to, but Cornell is one of the top vet schools in the country, and Dr. Sharon Centers who developed the bile acid test and researches liver shunts and MVD is at Cornell.

[TLC]

I am just a little confused...

Did Joey have just Pre-op Blood Work the day of his neuter?
OR did he have an actual Bile Acid Test done?

The reason I ask is b/c when a BAT is done, the dog has to be fasted. They draw blood, then feed him something and he has to sit for 2 hours and then they draw blood again. The results give you a Post # and a Pre #

So I am confused, b/c if he was going in for a neuter, I don't think they would do an actual Bile Acid Test, b/c if he was going under Anesthesia they wouldn't feed him

Here is what I posted on your other post:
I have to be honest that he is rushing and freaking you out
Try to calm down. Pre-op blood work will indicate things that are off with the liver. But the next step is to have a Bile Acid Test done. Those results will give you more info onto whether there are liver issues.

Usually if the Post# from the BAT is OVER 100 - they will lean more towards a Liver Shunt. If the Post # is below 100 - they will lean more towards MVD.

MVD is tiny microscopic shunts thru-out the liver and NOTHING can be done. MVD is managed thru a special diet and supplements.

I would really suggest having a BAT done BEFORE you consider an Ultra-Sound. The U/S is only about 60% accurate, and the person reading the U/S has to be extremely skilled at reading a U/S. Plus the U/S costs about $300 to $500
-Nicole

[MyFairLacy]

Originally Posted by TLC

I am just a little confused...

Did Joey have just Pre-op Blood Work the day of his neuter?
OR did he have an actual Bile Acid Test done?

The reason I ask is b/c when a BAT is done, the dog has to be fasted. They draw blood, then feed him something and he has to sit for 2 hours and then they draw blood again. The results give you a Post # and a Pre #

So I am confused, b/c if he was going in for a neuter, I don't think they would do an actual Bile Acid Test, b/c if he was going under Anesthesia they wouldn't feed him

It sounds like he was fasted for surgery and a blood panel and bile acid test was taken on that morning his surgery was to take place. So I think he just had a single fasted bile acid test.

The OP was originally taking him back to the vet today to have a paired bile acid test taken so they could get a post result as well.

[Ellie May]

Originally Posted by MyFairLacy

I would still want to do a Bile Acid test first to get a paired sample around a meal before just jumping into more diagnostics. I also recommend a urinalysis.

So far as which place to be referred to, that's up to you. I dont know anything about the place your vet wants you to go to, but Cornell is one of the top vet schools in the country, and Dr. Sharon Centers who developed the bile acid test and researches liver shunts and MVD is at Cornell.

With high bile acids, if I lived close to Cornell, that is where I would go without a doubt because they may not pressure you to do an ultrasound (since they aren't entirely accurate...). He needs a bile acids test...paired samples around a meal.

If he is asymptomatic, the food choice is really yours but if you switch it, be ready to switch it again after diagnosis. At the very least, I would switch to a puppy food with chicken instead of red meat. Before switching a young pup to a vegetarian/adult food, I would talk to a specialist.

[Ellie May]

Originally Posted by TLC

I am just a little confused...

Did Joey have just Pre-op Blood Work the day of his neuter?
OR did he have an actual Bile Acid Test done?

The reason I ask is b/c when a BAT is done, the dog has to be fasted. They draw blood, then feed him something and he has to sit for 2 hours and then they draw blood again. The results give you a Post # and a Pre #

So I am confused, b/c if he was going in for a neuter, I don't think they would do an actual Bile Acid Test, b/c if he was going under Anesthesia they wouldn't feed him

Here is what I posted on your other post:
I have to be honest that he is rushing and freaking you out
Try to calm down. Pre-op blood work will indicate things that are off with the liver. But the next step is to have a Bile Acid Test done. Those results will give you more info onto whether there are liver issues.

Usually if the Post# from the BAT is OVER 100 - they will lean more towards a Liver Shunt. If the Post # is below 100 - they will lean more towards MVD.

MVD is tiny microscopic shunts thru-out the liver and NOTHING can be done. MVD is managed thru a special diet and supplements.

I would really suggest having a BAT done BEFORE you consider an Ultra-Sound. The U/S is only about 60% accurate, and the person reading the U/S has to be extremely skilled at reading a U/S. Plus the U/S costs about $300 to $500
-Nicole

I was confused about this too but this was two days prior to surgery I think. It sounds like just one reading was taken though.

[drabinowitz43]

To clarify, Joey was just having a routine pre-op panel done prior to neutering. The vet just decided to do bile acid test at that time (2 days before surgery, not fasting, late in the day) as a screening measure because he is so little. That test came back with a 74. No paired screening was done and no urine. He is saying because it is so high, he has no doubt that the dog has something wrong with his liver.

[TLC]

Originally Posted by drabinowitz43

To clarify, Joey was just having a routine pre-op panel done prior to neutering. The vet just decided to do bile acid test at that time (2 days before surgery, not fasting, late in the day) as a screening measure because he is so little. That test came back with a 74. No paired screening was done and no urine. He is saying because it is so high, he has no doubt that the dog has something wrong with his liver.

Ok...now I understand.

If I were you and I were able to go to Cornell University - that is where I would go - with the experience and skill they have, you will NOT get the run around, you will NOT have to do any unnecessary testing and you will most likely save money

[Ellie May]

Originally Posted by drabinowitz43

To clarify, Joey was just having a routine pre-op panel done prior to neutering. The vet just decided to do bile acid test at that time (2 days before surgery, not fasting, late in the day) as a screening measure because he is so little. That test came back with a 74. No paired screening was done and no urine. He is saying because it is so high, he has no doubt that the dog has something wrong with his liver.

I agree with the vet (except paired samples should've been taken to begin with), but might opt to redue the bile acids test to have a good pre and post reading. However, with a number like 74, I would consider a specialist. One of Ellie's numbers was 47 and her vet talked to an internist and offered a referral. We treated it for a month under her regular vet but the understanding was, if Ellie got sick at all during this time, it was straight to the internist.. I see no problem going straight to the specialist if that is what your vet wants to do. Just be careful about them talking you into unnecessary testing.

[drabinowitz43]

I just want to report that I faxed my vet a copy of the Cornell article about the Protein C bloodtest that i think MyFair Lacy sent me and he was very impressed. He totally agreed we should do it and apologized for not thinking of it, he doesn't see this often. Joey is having the bloodtest on Monday am and they will send it to Cornell. He thinks I am such a brilliant researcher (lol). Thank you all so much, I feel better when I have a protocol to follow. You guys are all amazing and so smart.

[Ladymom]

Originally Posted by drabinowitz43

I just want to report that I faxed my vet a copy of the Cornell article about the Protein C bloodtest that i think MyFair Lacy sent me and he was very impressed. He totally agreed we should do it and apologized for not thinking of it, he doesn't see this often. Joey is having the bloodtest on Monday am and they will send it to Cornell. He thinks I am such a brilliant researcher (lol). Thank you all so much, I feel better when I have a protocol to follow. You guys are all amazing and so smart.

I'm the one who sent you the information on the Protein C test.

I would get the BAT and Protein C done through Oradell if it is closer, but beyond that I would go to Cornell for further testing if a shunt is suspected.

Just to clarify the misinformation that still seems to be out there, fasting is not required for bile acids testing.

This is taken from page 5 of Dr. Center's seminar handout several years ago:


7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial).

Dr. Center also states that in her more recent research summary article:

PSVA and MVD Research Summary

[drabinowitz43]

Thank you so much. That information was very helpful. If nothing else, this has been quite a learning experience. If it is a shunt, I hope Joey makes a good recovery, and I think I should notify the breeder who may not realize this is in the bloodline. I was going to wait until all the results are in, but maybe I shouldn't wait.

[Ladymom]

Originally Posted by drabinowitz43

Thank you so much. That information was very helpful. If nothing else, this has been quite a learning experience. If it is a shunt, I hope Joey makes a good recovery, and I think I should notify the breeder who may not realize this is in the bloodline. I was going to wait until all the results are in, but maybe I shouldn't wait.

Definitely let the breeder know if it does turn out that Joey has a shunt or MVD, but I'd wait until you get the results of his tests first.

Do you know if his breeder routinely bile acids test her adults? All Yorkies should have a BAT once they are 20 weeks old according to Dr. Center, but especially Yorkies who are being bred. Two dogs with normal BATS can still produce a puppy with a shunt, but until Dr. Center finds the genetic marker for shunts, the best preventative is bile acids testing and careful genetic screening.

[drabinowitz43]

I don't think she does. He was the only one in the litter to survive. One was stillborn and two others died within weeks. I don't know if this has anything to do with it, but now I wonder.

[Ladymom]

Originally Posted by drabinowitz43

I don't think she does. He was the only one in the litter to survive. One was stillborn and two others died within weeks. I don't know if this has anything to do with it, but now I wonder.

Oh, dear. She doesn't sound like a responsible breeder.