Lacy's BAT results were high...need some advice

[MyFairLacy]

Lacy is a 4 1/2 year old 8lb Yorkie who has always been really healthy. She's very lean..always been on the thin side. She's eaten Nature's Variety raw medallions for over 2 1/2 years and has always done very well on it. She's not a picky eater and normally scarfs down her food. Over the past few months she started having a day once a week or so where she would refuse eat all day and would usually vomit at some point. Some of those days she would have diarrhea, but vomitting was more common. Sometimes we'd go a week in between these days..sometimes two..sometimes as much as three weeks. Last week she was sick Monday and Wednesday...wouldn't eat and vomitted.

So we went to the vet Saturday morning for a checkup. She had an exam, a heartworm check, a full blood panel w/ CBC, and a Bile Acid Test.

Her last meal was 9:30pm Friday night and her first blood sample was drawn around 9:00am Saturday morning. None of my pets or myself ate Saturday morning before the vet appointment as I had heard that sometimes even the smell of food can cause the pre- blood draw to be off.

anyway, her blood panel results were all normal. Got her BAT results today and Pre was 44.5 and Post was 53.5.

Her vet made us another appointment for tomorrow afternoon. She would like to do a urinalysis to check for crystals and wants to do x-rays to check her liver size. She also suggested an ultrasound to check to see if there is a shunt.

So here's where I need advice...I know some of you have gone through liver shunt and MVD with your yorkies and I want to make sure I go about the best route of diagnosis. I don't want to do a lot of unneccessary tests that don't tell us much so I would like some suggestions on where to go from here to best diagnose what is going on. The vet seems to really want to rule out an aquired shunt first....I am more so suspecting MVD.

[stedmansmommy]

Michele I am so sorry to hear about little Lacy You know I have no advice to offer you girl, since I'm usually the one who comes to YOU for advice...but I just wanted to say that I am praying for her and that I hope she will be ok. Please keep us posted

[kalina82]

sorry to hear her BAT results were high. Her results are actually lower then Morgan's and Morgan is just fine.

An x-ray isn't going to show anything really. The ultrasound will be better. Others here will give you lots of information about what tests they think are best and what've they've done.

Since Lacey has been eating raw for a couple years i wouldn't jump to conclusions just yet. it may be something else besides MVD.

I'd have her bile acids retested again in 3 months. And maybe take her off the raw to see if it makes a difference with the vomiting.

I have morgan mainly on wellness core and small breed, with NV raw every now and then. she also gets no supplements for her liver. she is asymptomatic.

[MyFairLacy]

I'm definitely going to keep the appointment and do at least a urinalysis tomorrow as I think it will be a good idea to know if there are crystals or not. But was a little iffy about xrays as I'd never really heard of anyone saying they'd done that with high bile acids before

[kalina82]

Originally Posted by MyFairLacy

I'm definitely going to keep the appointment and do at least a urinalysis tomorrow as I think it will be a good idea to know if there are crystals or not. But was a little iffy about xrays as I'd never really heard of anyone saying they'd done that with high bile acids before

yeah you really can't judge anything about the liver on an x-ray. ultrasounds are much better. you can see the size, and texture of the liver. plus they should look at the gall bladder and see if there is any sludge.

[MyFairLacy]

Originally Posted by kalina82

yeah you really can't judge anything about the liver on an x-ray. ultrasounds are much better. you can see the size, and texture of the liver. plus they should look at the gall bladder and see if there is any sludge.

so would you suggest doing an ultrasound next then? I read that it would need to be a doppler ultrasound to detect a shunt...although I would suspect MVD over a shunt..but i guess you never know.

Did you do anything else with Morgan once her Bile Acids were high? Or did you change her diet or anything?

[kalina82]

Originally Posted by MyFairLacy

so would you suggest doing an ultrasound next then? I read that it would need to be a doppler ultrasound to detect a shunt...although I would suspect MVD over a shunt..but i guess you never know.

Did you do anything else with Morgan once her Bile Acids were high? Or did you change her diet or anything?

i honestly have no idea about which ultrasound machine to use but i suspect my hospital has the best one LOL and that's what they used on morgan. She probably has MVD which can't be confirmed with an ultrasound. so the U/S is to check all her organs.

With morgan i first did a CBC/Chem, then a bile acid test. when i received her elevated results we did an ultrasound. Nothing crazy to report with the ultrasound so we left it at that since she isn't showing signs.

Morgan was eating Raw at the time of her first bile acid test. after the results i freaked for a little bit and decided to put her on a low protein diet because that's what one of the internal medicine docs said most people do. So i went out and bought Canidae Senior, which was the best i could find with low protein. after a week or two of this i rehashed what was going on. talked to the other internal med doctor, a holistic vet, and the owner of a holistic pet store. The 2nd internal med vet said i didn't have to change her diet since she was asymmtomatic so they low protein diet wasn't necessary right now. the holistic vet and the pet store owner said to put her back on raw.

the hoslic vet and the pet store owner said that raw was best because dogs are carnivores and digest simple meat proteins better then processed dog food. a lot of people here who have dogs with MVD say not to do this and have their dogs on special homemade diets or vegetarian diets. i personally don't believe that is the right diet.

Anyway, morgan is eatting NV raw, wellness core, and wellness small bred right now. She can basically eat whatever i want to feed her (besides Innova Evo because that is the only high protein food that makes her vomit)


YOU, need to do your own research, and not just on YT. Read as much as you can, and not just from dr centers or whoever it is that is recommended here. you go to a great school and i'm sure you can find lots of great information there about liver issues. form your own opinion on what is best for your dog. you know her best.

[Ellie May]

I would keep the appt. and do the urinalysis.
I wouldn't be in a hurry to do an xray.
If you are doing to do a u/s anyway, xray just seems like a waste of money.

U/S is great to see the size of the liver, etc. and the other organs but don't expect them to find a shunt. You may get away with just doing a Protein C test.

Diet is so hard because opinions are so varied. I honestly don't care too much about what vets or nutritionists say about it because they aren't the ones who own the dogs and they aren't with them all the time. I do agree with the findings that vegetarian, fish or egg protein is best because there is an explanation for why this is. It is the toxins (most notably ammnonia) in meat that the liver has a hard time processing. Because liver compromised dogs are more prone to a compromised immune system, I would not do raw at all. At the same time I don't think a dog that is mostly asymptomatic needs to go on a 16% prescription diet kibble. I think there is a happy medium somewhere.

You may be able to stop the NV for a month, go to a lower protein food with a better protein source for liver issues then retest but because the pre was hgih, I wouldn't be too happy waiting that long. With her having a couple symptoms, I would consider not waiting and going ahead with testing or at least SAMe.

Were any drugs given within a week before the BAT?

[MyFairLacy]

Originally Posted by kalina82

i honestly have no idea about which ultrasound machine to use but i suspect my hospital has the best one LOL and that's what they used on morgan. She probably has MVD which can't be confirmed with an ultrasound. so the U/S is to check all her organs.

With morgan i first did a CBC/Chem, then a bile acid test. when i received her elevated results we did an ultrasound. Nothing crazy to report with the ultrasound so we left it at that since she isn't showing signs.

Morgan was eating Raw at the time of her first bile acid test. after the results i freaked for a little bit and decided to put her on a low protein diet because that's what one of the internal medicine docs said most people do. So i went out and bought Canidae Senior, which was the best i could find with low protein. after a week or two of this i rehashed what was going on. talked to the other internal med doctor, a holistic vet, and the owner of a holistic pet store. The 2nd internal med vet said i didn't have to change her diet since she was asymmtomatic so they low protein diet wasn't necessary right now. the holistic vet and the pet store owner said to put her back on raw.

the hoslic vet and the pet store owner said that raw was best because dogs are carnivores and digest simple meat proteins better then processed dog food. a lot of people here who have dogs with MVD say not to do this and have their dogs on special homemade diets or vegetarian diets. i personally don't believe that is the right diet.

Anyway, morgan is eatting NV raw, wellness core, and wellness small bred right now. She can basically eat whatever i want to feed her (besides Innova Evo because that is the only high protein food that makes her vomit)


YOU, need to do your own research, and not just on YT. Read as much as you can, and not just from dr centers or whoever it is that is recommended here. you go to a great school and i'm sure you can find lots of great information there about liver issues. form your own opinion on what is best for your dog. you know her best.

I also posted on a great Yahoo MVD/livershunt group that I had joined over a month ago just to learn....I'm just not 100% confident in the vet we're seeing so far as this issue goes I guess and so I wanted some advice from some of you who have gone through this with your dogs to see what you all have done. The vet I saw did mention someone at the vet school that was great with ultrasound so we may just do that next after a urinalysis. I just haven't had enough classes yet to know indepthly about liver diseases yet...and I do know that some info is great online and some not.

The diet thing is a difficult one. I will not put her on prescription diets....I would want to go to homecooked if we no longer could do the raw. On the Yahoo liver group they have a receipe from Dr. Dodd that is homecooked with cod fish as a protein source so I'd probably try that. I just want to do what's best for her to keep her healthy, as I want to with all my pets. Low protein diets are so opposite of what I feed now so it would be a big change....especially with figuring out treats because ever treat I have in my pantry is a grain-free, meat treat...

Originally Posted by Ellie May

I would keep the appt. and do the urinalysis.
I wouldn't be in a hurry to do an xray.
If you are doing to do a u/s anyway, xray just seems like a waste of money.

U/S is great to see the size of the liver, etc. and the other organs but don't expect them to find a shunt. You may get away with just doing a Protein C test.

Diet is so hard because opinions are so varied. I honestly don't care too much about what vets or nutritionists say about it because they aren't the ones who own the dogs and they aren't with them all the time. I do agree with the findings that vegetarian, fish or egg protein is best because there is an explanation for why this is. It is the toxins (most notably ammnonia) in meat that the liver has a hard time processing. Because liver compromised dogs are more prone to a compromised immune system, I would not do raw at all. At the same time I don't think a dog that is mostly asymptomatic needs to go on a 16% prescription diet kibble. I think there is a happy medium somewhere.

You may be able to stop the NV for a month, go to a lower protein food with a better protein source for liver issues then retest but because the pre was hgih, I wouldn't be too happy waiting that long. With her having a couple symptoms, I would consider not waiting and going ahead with testing or at least SAMe.

Were any drugs given within a week before the BAT?

the high pre value really confuses me....any info on that?? Especially since she was fasted almost 12 hours just doesn't make a lot of sense to me.

So what tests are you suggesting? Doing the urinalysis and then an ultrasound?

I know a liver biopsy is the only way to 100% diagnose MVD...but would you just jump to that or would you only do that with major symptoms?

[Ellie May]

Originally Posted by MyFairLacy

I also posted on a great Yahoo MVD/livershunt group that I had joined over a month ago just to learn....I'm just not 100% confident in the vet we're seeing so far as this issue goes I guess and so I wanted some advice from some of you who have gone through this with your dogs to see what you all have done. The vet I saw did mention someone at the vet school that was great with ultrasound so we may just do that next after a urinalysis. I just haven't had enough classes yet to know indepthly about liver diseases yet...and I do know that some info is great online and some not.

The diet thing is a difficult one. I will not put her on prescription diets....I would want to go to homecooked if we no longer could do the raw. On the Yahoo liver group they have a receipe from Dr. Dodd that is homecooked with cod fish as a protein source so I'd probably try that. I just want to do what's best for her to keep her healthy, as I want to with all my pets. Low protein diets are so opposite of what I feed now so it would be a big change....especially with figuring out treats because ever treat I have in my pantry is a grain-free, meat treat...



the high pre value really confuses me....any info on that?? Especially since she was fasted almost 12 hours just doesn't make a lot of sense to me.

So what tests are you suggesting? Doing the urinalysis and then an ultrasound?

I know a liver biopsy is the only way to 100% diagnose MVD...but would you just jump to that or would you only do that with major symptoms?

I would not open up a dog with suspected MVD for a biopsy alone.
It may be a good thing to do if the dog is being spayed (varying opinions).
Of course that isn't the case here.

Urinalysis is a good idea.
You could go to the Protein C test or ultrasound.
While Dr. Center's protocol is BAT, then Protein C then scintography if that is elevated, the assumption then is all Yorkies who have high bile acids and normal Protein C have MVD I guess. That obviously can't be right but I'm not sure how often that is the case and I'm not sure when she does recommend other testing. If you want to see the size of the liver and look at everything going on, the u/s is fine. If you are looking for a shunt diagnoses, it is as low as 60% accurate for that. We did a u/s and all we got out of it was a pancreatitis diagnosis. We did a biopsy and all we got out of that was mild bile stasis.

Remember if you get everything under control and she is "completely" asymptomatic, you can start increasing her protein as long as that protein is the right type. There is really no reason to leave an asymptomatic dog on 20 or so % in my opinion. That doesn't mean you would go to 40-50% either though. Too little protein isn't a good thing. While she is having symptoms and since it may be her liver, I would drop the protein % and get her on a better type as soon as possible.

I typically look at the post number. Haven't read too much on the pre but 95% of dogs with shunts have elevated pre. Most shunt dogs have a post over 100 though.

[Ellie May]

Originally Posted by Ellie May

I would not open up a dog with suspected MVD for a biopsy alone.
It may be a good thing to do if the dog is being spayed (varying opinions).
Of course that isn't the case here.

Urinalysis is a good idea.
You could go to the Protein C test or ultrasound.
While Dr. Center's protocol is BAT, then Protein C then scintography if that is elevated, the assumption then is all Yorkies who have high bile acids and normal Protein C have MVD I guess. That obviously can't be right but I'm not sure how often that is the case and I'm not sure when she does recommend other testing. If you want to see the size of the liver and look at everything going on, the u/s is fine. If you are looking for a shunt diagnoses, it is as low as 60% accurate for that. We did a u/s and all we got out of it was a pancreatitis diagnosis. We did a biopsy and all we got out of that was mild bile stasis.

Remember if you get everything under control and she is "completely" asymptomatic, you can start increasing her protein as long as that protein is the right type. There is really no reason to leave an asymptomatic dog on 20 or so % in my opinion. That doesn't mean you would go to 40-50% either though. Too little protein isn't a good thing. While she is having symptoms and since it may be her liver, I would drop the protein % and get her on a better type as soon as possible.

I typically look at the post number. Haven't read too much on the pre but 95% of dogs with shunts have elevated pre. Most shunt dogs have a post over 100 though.

And if you want to just get it over with and really rule out a shunt, consider doing scintography right away.

[MyFairLacy]

Originally Posted by Ellie May

I would not open up a dog with suspected MVD for a biopsy alone.
It may be a good thing to do if the dog is being spayed (varying opinions).
Of course that isn't the case here.

Urinalysis is a good idea.
You could go to the Protein C test or ultrasound.
While Dr. Center's protocol is BAT, then Protein C then scintography if that is elevated, the assumption then is all Yorkies who have high bile acids and normal Protein C have MVD I guess. That obviously can't be right but I'm not sure how often that is the case and I'm not sure when she does recommend other testing. If you want to see the size of the liver and look at everything going on, the u/s is fine. If you are looking for a shunt diagnoses, it is as low as 60% accurate for that. We did a u/s and all we got out of it was a pancreatitis diagnosis. We did a biopsy and all we got out of that was mild bile stasis.

Remember if you get everything under control and she is "completely" asymptomatic, you can start increasing her protein as long as that protein is the right type. There is really no reason to leave an asymptomatic dog on 20 or so % in my opinion. That doesn't mean you would go to 40-50% either though. Too little protein isn't a good thing. While she is having symptoms and since it may be her liver, I would drop the protein % and get her on a better type as soon as possible.

I typically look at the post number. Haven't read too much on the pre but 95% of dogs with shunts have elevated pre. Most shunt dogs have a post over 100 though.

Originally Posted by Ellie May

And if you want to just get it over with and really rule out a shunt, consider doing scintography right away.

I realized I didn't answer your question above about drugs. No, she hasn't been on any medication. She hasn't had topical flea treatment put on since September. She does take Heartguard once a month but it had been a month since her dose..she took one the day after her appointment on Feb. 1. Other than that...she eats her NV medallions, gets fish oil almost every day (Eicosaderm) and usually gets Juice Plus for Dogs (a supplement) once a day too...and she gets treats such as Wellness Pure Rewards, Ziwi Peak, dried liver, etc.

I seem to be getting a general consensus that a liver biopsy should only be done if she's open anyway...

I guess we'll either be doing a doppler ultrasound or a schintography...supposedly one of the clinicians at Texas A&M is supposed to be really good at finding shunts with ultrasound, and I've read that with ultrasound the accuracy really depends on how good the operator is. I've heard of the schintography of course, but I really don't know much about it...I'm not sure if they do that at A&M or not.

I think I've definitely decided to nix the x-rays..everyone seems to think it's a waste of money and won't tell me anything. So we'll do the urinalysis tomorrow and I guess I'll see about doing an ultrasound or schintography.

She's only showing mild symptoms and isn't really sick but I definitely don't want her to get sicker..so I really want a to have a better idea of a diagnosis.

[Yorkieluv]

Sorry to read about Lacy's elevated bile acid test results...I agree that urinalysis should be done to check the pH and to check for crystals.
If you do u/s, doppler is best if looking for a shunt. Make sure they check all of the organs including the bladder for stones. Scintigraphy is more expensive, but much more accurate at diagnosing shunt.
Dr. Dodds diet as written is really not "low" protein. Just 3 oz of cod contains 20 g of protein...
Even though her symptoms seem mild, she does have some symptoms, and like you said, it's important to get a good idea of what's going on with her so that you can help her...The symptoms you described are typical of dogs that I've seen with MVD/liver issues.
Prayers for Lacy!!

[MyFairLacy]

Originally Posted by Yorkieluv

Sorry to read about Lacy's elevated bile acid test results...I agree that urinalysis should be done to check the pH and to check for crystals.
If you do u/s, doppler is best if looking for a shunt. Make sure they check all of the organs including the bladder for stones. Scintigraphy is more expensive, but much more accurate at diagnosing shunt.
Dr. Dodds diet as written is really not "low" protein. Just 3 oz of cod contains 20 g of protein...
Even though her symptoms seem mild, she does have some symptoms, and like you said, it's important to get a good idea of what's going on with her so that you can help her...The symptoms you described are typical of dogs that I've seen with MVD/liver issues.
Prayers for Lacy!!

thanks I think my plan for now is to go do the urinalysis tomorrow afternoon, and I'll talk to the vet about doppler ultrasounds and schintigraphies and then decide where to go from there.

[AmyChristine]

My vet didn't know very much about shunt/mvd. I asked her if she could consult with someone else... Not sure which vet she contacted but after bile acids, blood pannel, urinalysis tests we then did the protein C then she wanted to do an ultrasound, after reading on here I opted for scintigraphy instead. I am so sorry to hear about Lacy not feeling well, It gets better once you know for sure.

also the Ziwi peak is a really great treat but so high in purines, this is the treat we were feeding when Copper started having neurological problems.
Cop has now been diagnosed with MVD, we home cook, and he loves his "new" food.

I have learned that it is not so much the amount of protein but the kind, you already know that to little protein is bad for the liver, we feed proteins that are low in purines white fish is great, eggs, plain full fat yogurt, cottage cheese... There are also dog foods that are designed to rehydrate and then add in raw, when I dont have time to cook or puree I use this and then add a low purine protein and suppliments.
Sending warm wishes to you and Lacy, I hope that you get answers soon.