Novice Yorkie Mom/ Possible Liver Disease..Please Help.

[MyLola]

Hello,

Lola and I are new to the forums and would appreciate some guidance. I am a complete novice to Yorkies and have been reading everything I can get my eyes on about this breed. The information on this forum has been priceless! Lola is one of eight (Yes,eight!) and the smallest of the litter. She is 5 months now and weighs 3lbs, has a funny walk and shakes. All her siblings weigh between 7 and 10lbs at this point. I noticed these problems upon first seeing Lola and was a large part of why I adopted her. I wanted to make sure she received the care she requires.

I schedule Lola the first available appt. with my vet.

She immediately suspects a liver shunt and proceeds with testing.

X-rays revealed a healthy liver with slight calcification.

Her BUN/Creatinine Ratio was high 48
(lab says normal is 4-27)

BAP
Pre-meal 17
(lab says 10 is normal)
Post-meal 85.4
(lab says 20 is normal)

Urinealysis showed her WBC high 4-10 (
lab says normal should be 0-3)

We have a consult scheduled for Tues with a specialist and having an ultrasound done.

As a precaution, I have been feeding her a home cooked low protein diet.

Am I missing anything or doing anything wrong? I would appreciate any suggestions or advice at this point. I want to make sure this little angel is happy and healthy.

[Yorkieluv]

Did the urinalysis show any crystals?
Did they do regular bloodwork? If so, what was the ALT?
What kind of low protein diet are you feeding? What are the ingredients?

Meat, poultry protein is difficult for them to metabolize and they produce the most amount of ammonia which is not filtered properly in a liver compromised dog...Therefore, the ammonia enters the bloodstream and causes neurological symptoms.

The internist might want to do an ultrasound to get a better look at the liver and to check for stones in the bladder.

The next step after this might be a Protein C test. This helps decide if it's a liver shunt or MVD.

Have you joined the liver shunt and MVD group on yahoo groups yet?

[MyLola]

Thank you for your help.

They did check for crystals. No crystals, protein, casts or cells found in her UA.

Complete bloodwork was performed.

ALT(SGPT) was 53 (lab says normal is 12-118)

I have been giving her lowfat cottage cheese, yogurt, carrots, yams, oatmeal, string beans, egg whites, boiled chicken breasts.

I am currently researching suppliments...

Do you know how successful the US is with helping confirm diagnosis? Should I have her do the Protein C test first?

Yes I joined the Yahoo Group but still learning how to navigate my way through the site.

[saphire]

As I don't have these problems with my two, I can't be of any assistance, but there are so many on here who can help you.

I just want to welcome you to YT, and let you know I will be praying and thinking of you and your baby.

Sheilagh.

[Yorkieluv]

The ultrasound is only as good as the person reading it, so it is typically inconclusive in determining if there is actually a shunt. It will show the size of the liver and if there are stones in the bladder b/c the types of stones/crystals associated with liver disease do NOT show up on x-rays.
The Protein C would be a good next step and is affordable. You can find info on that in the liver shunt and mvd group.
Be careful with chicken because as I mentioned meat protein produces high amounts of ammonia which a compromised liver cannot filter and therefore will cause neurological symptoms like the shaking.
Typically a dog with symptoms needs to eat between 2g and 2.5 grams of protein per kg of body weight per day, but considering that she's a puppy, she needs a little bit more. She should eat around 2.7 to 4 grams of protein per day at her weight... Nutrition facts, calories in food, labels, nutritional information and analysis – NutritionData.com can show you how much protein is in the different foods.
It's also important that you feed frequent and small meals. 4-6 meals per day is optimal. This helps increase her protein amount tolerance and also keeps her glucose levels stable. It's important that you don't overload your furbaby on protein at each meal..
Just one egg white contains 3.5 grams of protein, so that means that she should only eat one egg white split up into 4 meals throughout the day along with a bunch of veggies like the ones you are feeding.
Vegetable, dairy, and egg white proteins are the best for liver compromised dogs.

[Ladymom]

As Yorkie said, ultrasounds are very unreliable - best case 80% according to Dr. Center. Don't waste your money.

The next step would be a Protein C test. If further testing is needed, scintography would be the next step.

I've posted some helpful links for you from the two top authorities on liver disease, Dr. Center and Dr. Tobias.


Hepatic Vascular Disorders - WSAVA 2006 Congress

The Univ. of TN College of Veterinary Medicine - Portosystemic Shunts

[linda44]

I cant give you any answers but I sure can send best wishes and prayers.

[Patti]

My Cali has a very mild MVD (internal shunts) and her BAT were 0/94 and 0/43 if I recall correctly. We did the ultrasound which showed nothing, then we did a liver biopsy when she was spayed which showed a very mild MVD with no treatment necessary. The specialist said that in her experience when the BAT's are under 100 it can be an internal shunt and real high numbers (300) would be more likely to be external shunt. Hopefully your baby will not have this but in most cases it is treatable. keep up posted.
Welcome!!!

[yorkiesmiles]

welcome to YT - I will pray for your little one

[DolcesMom]

Since her levels are a bit off, did the Dr. reccomend putting her on Lactulose? It's a sugury solution that helps eliminate the toxins through her poop.

My Dolce had LS, diagnoised at 6 1/2 months. She did the shunt surgery and is doing great now.

I also fed Dolce a high fiber content diet to help eliminate toxins (oatmeal, sweet pot, yams, lentils, quinox). Also give her bits of watermelon, that helps too, but I forgot how. Eggs, cottage cheese were a great staple in her diet to provide the right protien. No Bully sticks if you give her those. They're high in protien too. I'll look up recipes to send you.

Also if you're going to put her on a prescription diet, give her the brand Royal Canin and not Hills. Hills contains an additive (it's starts with an "E", sorry I forgot the name, but the Yahoo group has articles in the archives about it) that is proven to be bad for LS.

Sorry your little one and you have to go through all this.

[DolcesMom]

Here's the letter a member of the yahoo group sent hills to ask about the preservative (Ethoxyquin) that's harmful...

Dear Sir/Madam: I'm writing on behalf of myself and a support group of
some 116 members for liver compromised dogs that I own and run. We have a
collective question about the Hill's L/D and K/D dry lines
specifically. Typically, these two foods are the most recommended and prescribed for liver-compromised dogs due to the low protein content. However, many of us are concerned as to why Hill's would still be using Ethoxyquin in
their dry food formulations of the L/D and K/D at all as this is an hepatotoxic substance and is not good for ingestion even in healthy pets. Would
Hill's PLEASE provide us with the reasoning behind this ingredient being used
when there are other alternative preservatives available for formulation
that would be much healthier and safer for our liver-compromised dogs such
as mixed tocopherols? To further our inquiry, Ethoxyquin is listed and
> identified as a hazardous chemical under the criteria of the OSHA
Hazard Communication Standard (29 CFR 1910, 1220). The Chemical Toxicology of
Commercial Products says that ethoxyquin has a toxic rating of 3 (on a
scale of 1 to 6, with 6 being super toxic requiring less than 7 drops to
produce death). At that level it can slowly develop depression, convulsions,
coma and death; skin irritation and liver damage. Naturally, we are
concerned about the use, cumulative or otherwise, of this ingredient being used
in a product that has been formulated for pets with special health
considerations and dietary needs. We would appreciate your input and look forward to your response. Thank you.

[MyLola]

Thank you all so much for your help. The information provided here and the Yahoo Group has been amazing!

I am off with Lola to see the specialist this morning. I am armed with so many questions for her.

We had a rough night
Lola did not want to eat and has the runs. Please send some positive thoughts for m baby girl!!

[Ladymom]

I would not feed any of my pets Hills.

Lady is diabetic and when she was diagnosed six years ago my vet wanted to put her on Hills W/D. Now, why would I want to put a dog with a compromised immune system on a food that was full of peanut hulls/floor sweepings and Ethoxyquin?

Ethoxyquin:

Many pet food manufacturers use ethoxyquin because of it's excellent anti-oxidant qualities, high stability and reputed safety. However, an ongoing controversy surrounds issues related to its safety when repeatedly fed at permitted amounts in dog foods, particularly when fed to genetically susceptible breeds of inbred or closely linebred dogs. Toy breeds may be particularly at risk because they ingest proportionately more food and preservative for their size in order to sustain their energy needs.

For human consumption, ethoxyquin is permitted in certain spices to prevent loss of color. Ethoxyquin is permitted in pet foods, fats and oils at levels not exceeding 0.915% in the finished product (e.g. 0.015% as fed basis). It is readily absorbed, metabolized and excreted in urine and feces, with residual levels in liver, gastrointestinal tract and adipose liver.

Ethoxyquin is assigned a toxicity rating of 3 or "moderately toxic", indicating the probable oral lethal human dose is 0.5-5 g/kg, 3- to 33-times the maximum allowed in pet foods. This toxicity rating is slightly greater than ratings for tetracycline and penicillin, lower than for aspirin and caffeine. Susceptibility of laboratory animals to anti-oxidant toxicity increases with the nutritional stress of variable dietary constituents. Increased dietary fat, for example, increases susceptibility to toxicity of ethoxyquin fed to chickens and BHT (as well as DDT) fed to rats. The response in chickens to increased dietary fat appeared to be due to the resultant lowered protein. Chickens fed 17 vs. 23% protein showed increased susceptibility to ethoxyquin toxicity. Ethoxquin levels fed to chickens were, however, almost 17 times the maximum allowable level for pet foods.

In laboratory animals, ethoxquin increased hepatic vitamin A levels 2 to 5 fold, and at levels 3 times that found in pet foods, increased blood vitamin E levels 2 fold. These data suggest that ethoxyquin assumes some in vivo anti-oxidant activities and thus spares natural anti-oxidants such as vitamin E.

Since the late 1980's, the incidence of chronic disorders in purebred dogs appears to have increased. These disorders include dysfunction of liver, kidney and thyroid, reproductive problems, autoimmune diseases and other immune dysfunction, birth defects in pups, increased stillbirths and neonatal mortalities, neoplasia, allergies and problems with skin and coat condition. Most concerns have focused on inbred or closely linebred dog families.

Suspicions about the safety of ethoxyquin and any association with these disorders would be difficult to corroborate because the affected animals may have received drugs or other medications to treat their symptoms and other diseases may be present. Furthermore, ethoxyquin has been used in some animal feeds since 1959, some years before the controversy arose. Nevertheless, the additive or cumulative effects of several environmental insults, could explain the increasing frequency of debilitating illnesses in these dogs. Cumulative effects of metabolites and their interactions may place inbred or closely linebred dogs exposed to other inducing agents at significantly increased risk. The Food and Drug Administration of the USA Center for Veterinary Medicine states, however, that there is insufficient scientific evidence to show that ethoxyquin is unsafe when used at approved levels or to warrant action against its use in pet foods. Future studies incorporating modern toxicological techniques, appropriate medical and epidemiological assessment of cases and consideration of multifactorial interactions in inbred or closely linebred dogs, should help to clarify the issue. Indeed, for the majority of dogs, health risks from the ingestion of inadequately preserved rancid fats might be more harmful than risks from the potential adverse effects of ethoxyquin.

Ethoxyquin and other Anti-oxidants

[Yorkieluv]

I agree...Do not feed DRY varieties of Hill's prescription foods because they contain ethoxyquin. CANNED L/D though does not contain ethoxyquin, so it is safe.

[MyLola]

Thank you once again for all your help.

I drove and hour and fourty minutes to see this specialist ..only to leave fustrated an in tears.

I arrive, am greeted by a vet tech and she proceeds to take Lola's history. The tech then informs me that she will be taking Lola in the back for an ultrasound.

I declined and insisted that I wanted to meet with the Dr first. She seemed a little surprised and annoyed. The Dr comes in, I review Lola's history and inform her of my concerns about doing the Ultrasound. She agreed that I should not do the ultrasound and go straight for a biopsy. I proceed to ask her about the Protein C test...she dismissed it without even knowing what it is. I pulled out the printouts I had with me about the test and held them out until she took them. Her attitude changed immediately when she saw Dr Center's name! She asked if she could keep the literature and would research it further.

I am terrified to have Lola put under anesthesia in the shape she is in. My thought process is to have her on a controlled diet and suppliments until she gains a little more weight and builds up her strength. The Dr does not want to go this route and wants to go straight for spaying her...and performing the biopsy at this time.

My regular vet was not in the office today. I will follow up with her first thing in the morning.

I definately want a second opinion. I wonder if anyone would know of a great vet that specializes in Liver Diseases in the Northern Jersey area?

Alos, She also prescribed Lola Ranitidine. She says it is an antiacid. Does anyone know if there are side-affects with taking this med?


Tremendous thanks from Lola and I!!!