Protein C Test Results: where do we do from here?
 

Here's an update if you haven't heard Lacy's story so far. She turned three in February, and last year was sort of unofficially diagnosed with a liver shunt and possible MVD due to elevated bile acids. We never knew if it was both or just MVD, but a veterinary internist advised us not to seek surgery due to Lacy's tiny four-pound stature. For a year we have managed her dietarily, and she has never once displayed any symptoms. She has been perfectly happy and healthy. Recently, we took her in for her checkup, and a new vet wanted to get some more information. They did a urinalysis and did find a moderate level of crystals. It got us thinking about all this stuff from last year all over again, and got us worried and pondering the surgery we had rejected because we could lose Lacy on the table, when she is living a perfectly happy and healthy life as far as she knows.

I also suggested a Protein C test, which just came back this morning. Lacy got a 55% capacity, and the normal range is 75 to 135%. Our local vets have been so kind to us, but they're a little baffled as to what they should be comparing the numbers. Lacy is in the shunt range, but is a really "low" number in the fifties, or the tens? How bad is she? I guess we'll have to look into getting the scintigraphy done next to see if surgery is an option. Anybody else know any specifics about Protein C testing and how accurate it is? I don't even know if the vet did the test right, but that's probably just wishful thinking.

Im not even going to attempt to tell you I know about the numbers but did you say your vet did the Protein C Test? Did they send it to Cornell Uni. because I do know that is where the test should be sent and they do the results not your vet. Scintigraphy should be the next step and thats were they inject dye into the spean watching it flow thru the liver and can tell if there is a shunt. This is not very invasive and not that expensive. My Manolo was under about 10 min and his liver functioned well but was diagnosed with MVD. I know others will answer the Protein C test question in more detail. Wishing you well..

If that is an accurate Protein C % result ~ than YES 55% is in Liver Shunt range.

I would go onto the Scintigraphy.

4 lbs is not too small for LS surgery BTW ~ if that is what she needs :(

Have you joined the LS group yet?
DogLiverDisease : Dog Liver Disease

Protein C test can not give you a *real* difference between Healthy and MVD ~ BUT I do believe it is a Good indicator of Liver Shunt.

My Roxy's Protein C was 165% ~ mild MVD what was I was told :(

Keep us posted.

That is shunt territory and yes, the next step is a scintography.
Even if it is just asymptomatic MVD (not likely because of the Protein C number), while not necessary, SAMe could definitely be given and can only help things. Omegas, vitamin e and milk thistle can be given also.

I suppose the question is, if she has a shunt, are you going to correct it?
If not then the scint. would be pointless.

There is a baby here that had a Protein C test and I *think* the results were 78% (approx. right around that %) and YES he had a shunt, he was about 8 months old and about 3 lbs ~ He is doing well now after he had surgery. Him too, no real symptoms, just abnormal pre-neuter bloodwork. And I think he had stones too :(

My baby girl Lola had liver shunt surgery in March of this year. We did not do the Protein C test. Her bile acid test numbers came back so high that I took her straight to Dr. Tobias at University of TN where they specialize in doing this surgery on these tiny babies. They did the Scintigraphy there and it showed a large shunt. Lola was in the hospitsl there for 2 nights and she is doing super now - no complications whatsoever. They have special, heated beds that sort of "inflate" around these little ones so they don't get chilled during surgery and their aftercare is excellent. The have grants and gifts that make the scintigraphy and surgery very affordable. I can't say enough wonderful things about out experience there. Lola is like a different dog today - so full of energy. She had no other symptoms either - only a picky eater and she was very small. Please ask questions - someone out there or on Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support
knows the answer. Good luck - sending Yorkie hugs your way!

are you in beverly hills , california?

yes join this group immediately and i would not let anyone do this surgery but dr tobias PERIOD especially if you are in california -- i would fly to tennessee and have dr tobias do all the testing and surgery

is your dog having symptoms - seizures, head pressing, spaced out after eating, vomitting, picky eater? If not having any symptoms then my belief is treat the dog not the blood work. If having symptoms then pursue further

if you are in california in los angeles and tustin dr broome does the scintigraphy - below is his website but i would not do this test unless my dog was having symptoms as i live in california and my girl had post biles of 73, 54 and 26 on low protein diet and they wanted me to do this test and i said no way as she has no symptoms and she is below 100 on post biles so i put her on low protein diet and she is still doing fine

AVMI- Portal Scintigraphy

Sorry, no we're actually in Maryland, not CA. I meant to change that a while ago, someone else set up the account for me who just picked a random city. We're about an 8 hour drive out of Tennessee, so it's do-able. I asked our vet to call Dr. Tobias, but haven't heard back from her. I think I'd also like to have them do another BAT, because they only did one in her history, and that was more than a year ago. We asked if they wanted to do another one the last time she was there and they just shrugged us off and said the numbers would be high anyway, so it wouldn't matter. Should have said something. :mad: The numbers were astronomical when they did it a year ago, however--I think 150 and 220 pre and post-prandial. I don't even see how those kinds of numbers are possible: Lacy is totally asymptomatic. We've never seen a single behavior associated with a liver shunt in her, EVER.

How good is Dr. Tobias at getting back to vets who contact her, and how long can we expect to wait for the surgery? Also, I should probably start another group for this, but does anyone know how much just the surgery costs? Lacy has already been spayed and had her baby teeth removed, so she should need just the surgery. That's another thing--when she was little, before we knew about this, she went through anesthesia just fine. The vets said she was totally normal.

U of Tenn is an EXCELLENT idea. I advise you to do what ever you need to do the get this moving with your Vet and Dr. Tobias this week.

From reading other stories here about U of Tenn, surgery can happen rather quickly. U of Tenn will do ALL the required testing, etc....and surgery. Don't quote me, but I think it would be around $1300 - $1500 ~ which is way better than quotes I have seen from Specialty Hospitals. Plus you will be getting one of the BEST surgeons!

I've sent you a PM. Please don't hesitate to contact me with any other questions! Good luck ~~~ Valerie, "Lola & Harley"

100% agree dr tobias is where i would fly from anywhere to have her do the surgery - she is the best surgeon on liver shunt and dr center at cornell university is best internal medicine specialist for this disease

wait no symptoms of liver shunt ? The bile acids could be high due to gall bladder contraction during blood work. If my dog were not having any symptoms at all i would not push for surgery if it were me -- i would just lower protein to 22% - my dog is mvd -usually shunt is indicative in numbers post bile over 100 but not always - maybe do protein c test but i would not rush to surgery on a dog that is not seizing, not picky eater, not head pressing, not spaced out after eating JMHO

Have you joined Liver_Shunt_And_MVD_Support@yahoogroups.com this group will enlighten you alot they did for me

also did they do bile acids after or before spay if before why did they not biopsy liver to see if mvd?

my vet recommended scintigraphy for my dd as well - i opted against it since dd was not having any symptoms and never has for 5 years and she is on temaril p for allergies which is processed through liver so honestly again only if symptoms would i pursue further testing.

My motto - Treat the dog not the blood work as there can be many variables that affect the blood work

AVMI- Portal Scintigraphy

I hate to say it, but it does sound like she has a shunt. Her post bile acids are over 200. Her protein C test was 55% :( :(

I think she needs to see Dr. Tobias :thumbup:

I agree to see her and have tests run but i surely would not do scintigraphy or any surgery on a dog not having any symptoms - sounds to me the tests were not done accurately as they sound baffled ???? how are you baffled if you are confident in what you are doing. Sounds to me they do not and may have not done tests accurately so agree with getting accurate info but i would never put my dog through a surgery unless they were having the symptoms and i would not do scintigraphy either as that is an all day thing with radioactive dye - no way not unless symptoms

My Lola had no symptoms except being a picky eater. My vet did not want to BAT her because she had no symptoms and was "gaining weight" - although very little. She had NO other symptoms. I insisted that we do the BAT since Liver Shunt is so prevalent in Yorkies. Her numbers were: pre meal 43, post 237 - which definitely pointed towards a shunt. I went directly to Dr. Tobias, from Houston, did the scintigraphy which showed a large, repairable shunt - and had Dr. Tobias do the surgery the next day. Lola is like a different dog. She runs and twirls and plays like she did when we first brought her home...her energy level has increased dramatically and she has gained almost a pound, which for her is about 25 - 30% of her body weight!
Each baby is different, but I feel the surgery has saved Lola's life!

that is great but she was having the symptoms picky eating so i agree for further testing - our vet tests every maltese and yorkie required in his practice for bile acids before he does any meds is how i found out about dd mvd. DD is a pig she eats so fast like she is starving, never head presses, never spaced out, no seizures and he wanted her to have scintigrapy and i said no after joing liver shunt group. she was pre 3 post 73, then 54 then 26 on low protein diet. Now had she had one symptom then yes i would have done further

sounds like energy level on yours was low as well which is probably after eating as well

agree each dog is so different but there has to be at least one symptom in my eyes as i do not believe in putting a dog through a bunch of unnecessary testing as it is very stressful on them and they do not understand :( so why i believe in doing your homework first and educating yourself as sadly i have experienced some not so great vets out there that just want to test like crazy. I did this stayed up all night reading everything about liver shunt and joined all the groups and went with what i felt was best as i knew my dog better than any vet who saw her for 15 minutes and looked at her blood work. If i felt any idea she had this from everything i read i would have done further testing and flown to tobias for surgery as i would do anything for my babies and they will only get the best care and why i usually deal with specialists such as dr dodds who does all of our titers and blood work

I am in total agreement with you. Unfortunately, I had a vet that did not want to test and felt my baby was OK. Her BAT numbers definitely pointed towards a shunt and that is the reason I went to Dr Tobias. The specialist here in Houston wanted to run alot of other tests that I felt would have been inconclusive anyway, so I wanted to take her to what we felt like was the best...so off we went to TN. I have had a very hard time finding anyone locally who knows much about liver compromised babies - you have to be so careful. Even though this is becoming more and more of a problem in these small breeds, these vets seem to know so little about how to manage it. It does take a great deal of homework on our part to make sure our babies are taken care of! By the way, I feel the Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support is a great site, too. They have helped me and Lola so much. Good luck with your babies!!! Give them hugs and belly rubs from all of us!!!
~~~Valerie, "Lola & Harley"

that is the group that taught me a ton about it and yes you are so right you have to do your homework and why i joined the groups as not real impressed with vet profession so i go to specialists with anything serious such as orthopedics, opthamologist,dermatologist dentist, internist, and dr dodds who specializes in blood work and titers. Nothing but the best for my kids. I am about 20k in vet bills with my 3 so i have learned the hard way and why i try to help so many others with theirs now. I joined 64 dog groups on yahoo, 4 yorkie and maltese panels and educate myself daily to keep mine healthy as i have lost faith in vets and still needing a good local vet -- I think they are fine for basic stuff like spay, neuter, ear infection but when it gets more serious i get mine to a specialist as you will end up there any way so why not get the answer upfront less costly in the long run

this little one also has crystals in her urine.

yes another reason to test if crystal's in urine - any symptoms i would further test

Thank you all for your helpful responses! I left a message with Lacy's vet, and will call again tomorrow about contacting Dr. Tobias--or just do it myself. The reason we didn't rush out to get surgery for Lacy a year ago when we found out about this is the same thing I keep saying: Lacy has NO symptoms. She has as much energy as she did when we brought her home as a puppy, and is a totally happy and healthy dog on the outside. She eats sparingly some days, and seems pretty hungry on others. She runs around and plays constantly, and follows us around the house the rest of the time. The vets say she is a good weight for her stature. She is completely sweet and devoted, and you would not know she is sick without the blood tests. That's why we've put this off, and it's why we're so baffled. I'm hearing mixed things on here about whether we should pursue this further and go see Dr. Tobias, or just continue with our homemade food and medicine. Is it worth going through the stress of more surgery and tests when we have an otherwise healthy dog? Will we be in trouble if we wait and she suddenly gets worse? The tests point to a pretty serious shunt, but how is that possible if Lacy seems fine?