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Old 11-15-2009, 09:03 AM   #1
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Animal Smiley 036 Bile Acid test 94.500 - Above Normal (Range 0 to 20)

Our 6 month old Morkie, Lexie was scheduled to be spay on October 15th and routine blood work showed her blood count was high: ALT=136 (Range 8 to 75), so the spay was postponed 2 weeks. They sent us home with Metronidazole 250mg, Amoxicillin Drops and Hivite Drops 30ml with plans to follow up in weeks.

We returned 2 weeks later to recheck and if ok then perform the spay. A Bile Acid test came back: Preprandial 94.500 (normal is 0 to 20) and Postprandial 65.700 (range 15 to 25). We were sent home with Adenosyl 100mg and suggested to get an ultra sound done (they don't do them there). Doctor says she is demostrating signs of hepatic disease (suspect hepatic microvascualr dysplasia).

Returned 2 weeks later for follow up however, Lexie was having diareha for several days (waking three times in the middle of the night to go out). Took her in and a Giardia test came back fine as well as the intestinal parasite exam. Sent us home with Amoxicillin 100mg, Ampicillin Trihydrate and Panacur 100mg. Our vet (Banfield @ Pet Smart) wants us to get an ultra sound (they don't do there) so currently in search of finding one. Having problems financially so searching for the least costly one which so far is $450.

My poor little one. I have never ever ever ever loved a dog as much as I do Lexie. {SIGH} On a good note, or I think, she has sooooooooo much energy and eats perfectly.

Thanks for listening (reading) and I look forward to reading others posts.
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Old 11-15-2009, 09:34 AM   #2
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Could be MVD or could be a shunt. Ultra sounds are only about 60% accurate and the person doing it has to be very skilled at reading a U/S.
Also, a U/S will NOT show MVD, rather a Liver Biopsy done during spay can be taken and tested for MVD. A shunt can be seen on a U/S or it can not, as it is only about 60% accurate in seeing a shunt.

Since you are in FL, I would consider looking into the U of Tenn, as they are the BEST in shunt/MVD care.

Also, if it is MVD, it can only be maintained thru diet and supplements.

I am not a fan of Banfield and I would suggest looking for a different Vet, only that has experience with Small Breeds and Liver Shunts/MVD.
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Old 11-15-2009, 09:35 AM   #3
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What food and treats are you feeding her?
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Old 11-15-2009, 09:45 AM   #4
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As TLC said, ultrasounds aren't very reliable. The next step would be a Protein C test. Many vets have never heard of it so here a link. It has to be submitted to Cornell.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

TLC is right. University of Tennessee is the place to go if you are in the Southeast.

Portosystemic Shunts FAQ
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Old 11-15-2009, 10:12 AM   #5
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Thanks Ladymom and TLC.

Someone had also suggested that an ultra-sound would not produce 100% results and that I should request a Doppler-Sound??? I too am not thrilled with Banfield Vet, but we are committed to a one year puppy care package with them. It expires next July (UGH) and will make a switch then.

As far as food...... we feed Lexie Eukanuba Puppy Small Bites. Rare we give her any snacks but 2 months ago we would give her a raw baby carrot to chomp on. I am so anal about upsetting her stomach and creating loose bowels that I haven't tried anything else but always opened to discussions. She is not a big eater, but the FortiFlora powder the vet gave me (to add goo bacteria to her body from the bout with loose bowls last week) she loves! It smells like beef and she devours her food when it is sprinkled on (cat tried to get it too). However, there is only one dose remaining.......
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Old 11-15-2009, 10:55 AM   #6
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As far as imaging goes, scintigraphy is preferred over ultrasound for diagnosing shunts, but you don't have to jump into either right now. As I said, a Protein C test would your next step. Can you speak to the vets at Banfield and see if they can collect the sample to send to Cornell?

Here is a little more information for you on the differnet diagnostics:

Hepatic Vascular Disorders - WSAVA 2006 Congress

BTW, Dr. Sharon Center at Cornell and Dr. Karen Tobias at UT are considered the top experts on liver disease. Dr. Center is currently working on trying to find a genetic marker for shunts with a grant from the AKC.
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Old 11-15-2009, 11:07 AM   #7
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Have you checked with the breeder? As far as Banfield is concerned, I have had nothing but bad experiences with them. If there was something out of the ordinary, I would have to take my furbabies to a different vet because they could not handle the problem. As soon as the contracts expired (even though they tried to automatically renew them) I would not renew and take them to another vet. For these tiny furbabies, they gave way too many shots. You should let the breeder know what is going on, as this may be a genetic problem.
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Old 11-16-2009, 02:47 PM   #8
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Quote:
Originally Posted by Lexie Loo View Post
Our 6 month old Morkie, Lexie was scheduled to be spay on October 15th and routine blood work showed her blood count was high: ALT=136 (Range 8 to 75), so the spay was postponed 2 weeks. They sent us home with Metronidazole 250mg, Amoxicillin Drops and Hivite Drops 30ml with plans to follow up in weeks.

We returned 2 weeks later to recheck and if ok then perform the spay. A Bile Acid test came back: Preprandial 94.500 (normal is 0 to 20) and Postprandial 65.700 (range 15 to 25). We were sent home with Adenosyl 100mg and suggested to get an ultra sound done (they don't do them there). Doctor says she is demostrating signs of hepatic disease (suspect hepatic microvascualr dysplasia).

Returned 2 weeks later for follow up however, Lexie was having diareha for several days (waking three times in the middle of the night to go out). Took her in and a Giardia test came back fine as well as the intestinal parasite exam. Sent us home with Amoxicillin 100mg, Ampicillin Trihydrate and Panacur 100mg. Our vet (Banfield @ Pet Smart) wants us to get an ultra sound (they don't do there) so currently in search of finding one. Having problems financially so searching for the least costly one which so far is $450.

My poor little one. I have never ever ever ever loved a dog as much as I do Lexie. {SIGH} On a good note, or I think, she has sooooooooo much energy and eats perfectly.

Thanks for listening (reading) and I look forward to reading others posts.
I agree with posts recommending Dr Tobias or Dr Center or a Doctor in your area that specializes. I am curious as to why the POST prandial is lower than the PRE, usually it is the other way around... Sometimes only an radiologic exam with flouroscopy (the dye) can tell if it is a shunt, or a particularly small shunt, or in a less obvious location. I would also be wary of drugs being given that they don't know why to give them. Some drugs have hepato toxicity (they can cause liver damage over time or in hi doses). These guys are small.
I am looking for a link to vet specialists by state...
Maybe someone else here has it handy...
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