I think you need to go back and read Terry's post. Her puppy's BAT was 68.

yeah i saw that and why i said to treat as mvd below in my posts

have you heard about dr centers not going to surgery on liver shunt dogs ? I think it was Jackie that was telling me that and she knows her stuff and i was surprised as i always thought a liver shunt dog should have corrective surgery to live a long life. I know some cannot have surgery if they have more than one shunt so you have to medically manage but always thought if one shunt you should have corrected so they do not get more than one ?

here is my response to this particular dog saying to treat as mvd

Did I say ONE person told me? No. A few people have. I would trust Dr. Tobias more with information than any other liver disease expert. Here is waht Dr. Tobias says about Protein C tests:

Protein C Test
by
Dr. Karen Tobias



Question: How good is the Protein C test?

Answer: We're re-evaluating the Protein C test here at UT. In the original Cornell paper, normal dogs had Protein C activity between about 70% and 130%; 95% of dogs with MVD/CPH (microvascular dysplasia secondary to congenital portal hypoplasia) had protein C's in that range; and 88% of dogs with shunts dogs had Protein C's below 70%. Most dogs with liver failure had low numbers. Dogs with other liver diseases fell in the normal or abnormal range. So, the test is not completely accurate and should be coupled with other tests to be sure there's a shunt. Currently our dogs with MVD/CPH have very low Protein Cs and we don't know if it is the way we are running our test or whether we are seeing dogs with MVD/CPH that are much more severely affected.

*Angel Fund Update 4/2009


We have been using the Angel Fund for several things: clinical research, cost reduction (for all shunt patients), and extra support for a few shunt patients that have special needs. Most recently, our special needs patients included a Yorkie with a shunt that had complications (the bill exceeded the owner's budget; supplement with the Angel Fund allowed us to provide life saving treatment instead of Euthanasia), a shunt dog with a stomach ulcer and pneumonia that needed extra care, and a rescued Golden retriever with an intrahepatic shunt that needed a CT to confirm the diagnosis.
Our current research project is on the Protein C test. The previous study on Protein C (from Cornell) showed that Protein C activity overlaps in dogs that have a variety of liver conditions. When only comparing shunt dogs and dogs with MVD (microvascular dysplasia secondary to congenital portal hypoplasia), then any dog with a value below 70% had a shunt. In our current study, we are finding more overlap in our groups; in fact, our dogs with other congenital defects like PDAs (heart defects) had low Protein Cs. So, we are revisiting the accuracy of the Protein C test, which should be very helpful to our Yorkie owners. That project is being partially funded by the Angel Fund and is expected to be completed by the end of the summer.
*

You should join the Liver Shunt and MVD group on yahoo. I personally had a bad experience with that group BUT they are helpful and give great advice. I would recommend you do the BAT again in about a month. From what I know, anything under 100 pre/post is most likely MVD, which, like Dwerten said, can be treated. She has MVD babies so I'm sure she could give you great advice.

thanks for posting this as i have not read that so it is very helpful and that is great they are doing another study on it as well - this disease is so complex and so sad how much it runs in the yorkie and maltese breed :( and there is no real genetic marker so hopefully they will figure that one out as well. I am so glad you are doing all your homework on this - i am very impressed at your hard work to help your baby :)

scintigraphy

That is where the info is.....also of interest is this article that says there is no real way to know if there are multiple shunts so I would assume that the case you mentioned was just one of those...and not the fault of the Protein C test.

She still does say in the other article pasted above without a link, that many tests need to be done including Protein C.

the one i listed below the scintigraphy said shunt and there was no shunt :( and dr tobias did this surgery

the protein c test i posted about the protein c test said no shunt and there were 4 shunts and dr tobias opened him up as well :(

If you pay for scintigraphy and it shows up you will go to surgery and if you pay for protein c test and it says positive you will still have to go to scintigraphy anyway so to me a waste of money just like i think the ultrasound is a waste of money just like i feel a liver biopsy is a waste of money and too stressful on a dog with mvd as whether they do it or not the dog is still treated the same so why put a dog through that :(

I had an ultrasound done when Sasha first became sick and there was no sight of a shunt but she does have one so those aren't very accurate either.

yeah it is very hard to see a shunt in a toy breed so i agree waste of money and those are $400 where i live for an ultrasound as I paid for 3 of them when dex had pancreatitis :( was not happy about that as really did not help much as blood work showed pancreatitis :(

I think the major and most accurate ways in finding MVD/liver shunt is doing a bile acids test, and if high, do a scintigraphy.

I agree and even a full blood panel sometimes does not show it as dee dee has had normal blood work no high alt ever and her bats were high but less than 100- were sasha's alt numbers high?

I was merely remarking about what Dr. Tobias said about doing different tests. I don\'t voice my opinion about what tests should or should not be done.

I think it completely depends on the dog. There is a time and a place for u/s, biopsy, and maybe even Protein C testing. That doesn\'t mean that they are the best tests available, but they may give the information that is needed. In a dog with HE symptoms and high bile aids, I would go to scintography. However, I\'d also have concerns about bladder stones, so I\'d probably go with a u/s too if the $$$ was available and we would get added info about the liver. That\'s not a bad thing. In general, yes I agree, not great at diagnosing shunts, but they have their place. The same goes for biopsy. The assumption is made that if a Yorkie has high bile acids and no shunt, it\'s probably MVD. But that doesn\'t mean it couldn\'t be something else and the treatment could be different. So there is a place for biopsy also. I would not do it in every case that MVD is suspected, but I also can\'t say it is never worth it.