BAT - Surgeon question

[Lolasmom1211]

My 13 month old baby girl, Lola has gotten her BAT results back and they were not good. Pre meal was 43 - Post 237. I have been on the Yahoo Liver support web site which has been very helpful, but I wanted to see if anyone here had an opinion on Gulf Coast Veterinary Associates in Houston. My vet wants me to see a surgeon at Gulf Coast to have the surgery done, but it certainly seems as though the experts are at University on Tennessee. Does anyone know anything about Gulf Coast? Thank you.

[Ellie May]

What are her symptoms and what diagnostic imaging tests have been done?

I don't know about any of the surgeons for this in Texas but I am in Michigan and they do it at Michigan State University and at least one other hospital here. That said, if Ellie would've been diagnosed with a shunt, we were going to Tennessee. Even with travel, you may pay about that same because Tenn. is very cheap. They have the most experience with this surgery in Yorkies, so I agree with you. It is the place to go.

[Lolasmom1211]

She has no symptoms at all except that she is a picky eater. My vet consulted with the lab and the surgeon at Gulf Coast, and with her BAT results they feel it is pretty conclusive that she has a liver shunt. I don't want to put her through a bunch of unnecessary tests if they do the scintography at Tenn the day before surgery. I had not heard anything about shunt surgery at Gulf Coast...I've heard wonderful, life saving stories about other problems there, but nothing about the shunts.

[Ellie May]

Hmmm, while a shunt is probable, it is not for sure. Dogs with MVD can have bile acids in the 200's. Unless they are going to do a liver biopsy if no shunt is found (which is usually not recommended), there is no reason to open her up without a diagnosis. I would personally do scintography before they go in for surgery. I think they do it at UT before most of their LS surgeries.

[Ladymom]

She definitely needs to have a Protein C test before you even consider surgery. That will tell you if you are dealing with a shunt or MVD.

Here is information on the test to show your vet if he is unfamiliar with it.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

[Lolasmom1211]

That is correct. I have been told that they will do that at TN the day before surgery. It just sounds like they do so many of these on the smaller dogs at TN. That is definitely where I am leaning towards.

[manolos mom]

You know (MY FAIR LACY) mom just went thru this. I think A&M might be closer for you. You may want to PM her. I have gone thru all the test but Im in the Dallas FTW area. I know Tenn Dr Tobia is the best and it is cheeper. Depends on if you can travel. Just some info...

[Ladymom]

Originally Posted by Lolasmom1211

That is correct. I have been told that they will do that at TN the day before surgery. It just sounds like they do so many of these on the smaller dogs at TN. That is definitely where I am leaning towards.

The Protein C test can so easily be done by your vet, why travel all the way to Tennessee until you get the results? If it's not a shunt, they'll just send you home because she won't need surgery.

[Ellie May]

Originally Posted by Ladymom

The Protein C test can so easily be done by your vet, why travel all the way to Tennessee until you get the results? If it's not a shunt, they'll just send you home because she won't need surgery.

I agree.
It is easy to do in Texas.

But then it comes down to, I see a huge trend right now. Vets are learning about the Protein C test, getting the results back and still doing more testing...
So it almost seems pointless now.

I think if it comes back normal and MVD is suspected, they will stil want to do a biopsy (unstandably so because normal Protein C doesn't always mean MVD but is the biopsy really worth the risk...probably not).

[Ladymom]

Originally Posted by Ellie May

I agree.
It is easy to do in Texas.

But then it comes down to, I see a huge trend right now. Vets are learning about the Protein C test, getting the results back and still doing more testing...
So it almost seems pointless now.

I think if it comes back normal and MVD is suspected, they will stil want to do a biopsy (unstandably so because normal Protein C doesn't always mean MVD but is the biopsy really worth the risk...probably not).

I'd get the Protein C test done locally, but go to U of Tenn if any other tests like scintigraphy are indicated.

One of the main reasons for getting bile acids tested when a puppy is young according to Dr. Center is to avoid over testing and invasive testing like biopsies later on.

This is from page 22 of Dr. Center's seminar handout. Based on her research, she has changed the recommended age from four months to five months:

2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography.

[MyFairLacy]

with yorkies we always want to assume a shunt or mvd because in many cases it is. However bile acid results can be elevated with any type of liver disease. There are many other liver diseases too. When lacys bile acids were high (pre 44.5 and post 53.5) everyone assumed mvd but after her biopsy Tuesday the clinician I spoke with said she doubted lacy had mvd. I guess we will find out for sure when the results are in, but they are leaning toward some other cause of liver disease for her.

I've heard some good things about gulf coast but aren't that familiar with them. I'm right here at A&m and we were referred to dr Willard and dr cook, both internal medicine specialists. She had an xray and urinalysis done before we went to A&m and then did ultrasound and a blood ammonia test. With a shunt blood ammonia will be high and many times the liver will be smaller then normal. The person that did the ultrasound is supposed to be really good at finding shunts. Ultrasound is only as accurate as the person doing it. It was less invasive then jumping right to a scintigraphy. They would have done that next if a shunt wasn't found on ultrasound but blood ammonia was high. But with her results we were confident there was no shunt. They found abnormal areas on her liver so we then did a biopsy a d are now waiting results.

UT is supposed to be the best and cheapest for shunt repairs. I know a lot of people travel there.

[Ellie May]

Originally Posted by MyFairLacy

with yorkies we always want to assume a shunt or mvd because in many cases it is. However bile acid results can be elevated with any type of liver disease. There are many other liver diseases too. When lacys bile acids were high (pre 44.5 and post 53.5) everyone assumed mvd but after her biopsy Tuesday the clinician I spoke with said she doubted lacy had mvd. I guess we will find out for sure when the results are in, but they are leaning toward some other cause of liver disease for her.

I've heard some good things about gulf coast but aren't that familiar with them. I'm right here at A&m and we were referred to dr Willard and dr cook, both internal medicine specialists. She had an xray and urinalysis done before we went to A&m and then did ultrasound and a blood ammonia test. With a shunt blood ammonia will be high and many times the liver will be smaller then normal. The person that did the ultrasound is supposed to be really good at finding shunts. Ultrasound is only as accurate as the person doing it. It was less invasive then jumping right to a scintigraphy. They would have done that next if a shunt wasn't found on ultrasound but blood ammonia was high. But with her results we were confident there was no shunt. They found abnormal areas on her liver so we then did a biopsy a d are now waiting results.

UT is supposed to be the best and cheapest for shunt repairs. I know a lot of people travel there.

This is what I don't like about the current protocol (BAT, Protein C then Scint. if necessary). A normal Protein C and high bile acids is not always MVD and with no biopsy, we can't be sure. Then again, biopsy is kind of risky. I just don't get the high BAT, normal Protein C always meaning call it MVD in Yorkies. Then again, Dr. Center is really the expert.

And I really don't see how doing a BAT at 20 weeks then following the same protocol prevents overdiagnosis because a dog can have other types of liver disease at that age and high BA unless I'm missing something.

All I know is UT does more LS surgeries on Yorkies than anyone else could hope to it appears. They have a good anesthetic protocol and, in my opinion, they seem to have the best safety record and less complications.

[Lolasmom1211]

I really appreciate everyone's help, advice and opinions. It's funny that I don't get much feedback on Gulf Coast...I guess that in itself answers my question!!!

[MyFairLacy]

Originally Posted by Ellie May

This is what I don't like about the current protocol (BAT, Protein C then Scint. if necessary). A normal Protein C and high bile acids is not always MVD and with no biopsy, we can't be sure. Then again, biopsy is kind of risky. I just don't get the high BAT, normal Protein C always meaning call it MVD in Yorkies. Then again, Dr. Center is really the expert.

And I really don't see how doing a BAT at 20 weeks then following the same protocol prevents overdiagnosis because a dog can have other types of liver disease at that age and high BA unless I'm missing something.

All I know is UT does more LS surgeries on Yorkies than anyone else could hope to it appears. They have a good anesthetic protocol and, in my opinion, they seem to have the best safety record and less complications.

I know...liver disease can be so difficult to diagnose. A lot of times it IS a shunt or MVD with yorkies..but then there are so many other liver diseases too such as damage from a toxin, infection (from several different viruses, bacteria and parasites), cancer, fatty liver, etc. etc.

I will always test any puppy I get from now on to make sure I'm not buying a puppy with a congenital shunt or MVD...but then there is always the possiblity that an older dog can develop and aquired shunt, MVD, or any number of other liver diseases.

[MyFairLacy]

Originally Posted by Lolasmom1211

I really appreciate everyone's help, advice and opinions. It's funny that I don't get much feedback on Gulf Coast...I guess that in itself answers my question!!!

Probably the only people that would be referred to Gulf Coast would be those in Houston or surrounding areas. That could be why you aren't getting as much feedback on them too. A lot of people get referred to vet schools, like A&M and University of Tennessee. You could always talk to the surgeon at Gulf Coast and see what their experience is with diagnosing liver disease and doing shunt surgery and then decide.