I agree with this. I would be asking BOTH the Vet and Specialist WHY they want to do a Biospy??? What are they to gain? (beside more money for this invasive surgery :eek:). Because if they both come back and say, well to confirm MVD, then I would advise you to think long and hard about that. And then I would say, ok, if you did the biopsy, and MVD was confirmed, than what???? They would say Diet and Supplement....So you have to figure out if it is worth it or not :confused:

:thumbup::thumbup::thumbup:

Also, Liver Biopsy can be risky even on a healthy liver, risk of bleeding, infection, etc. If I remember correctly, the liver is one of the worst areas, if not the worst area to biopsy from, more danger of complications than any other biopsy procedure. You will have to weigh the benefits of info gained from the biopsy against the risks involved. And you don't have enough information to make that decision at this time, without speaking to your vet and/or the specialist.

My little one has liver issues too, but controlling with L/D food and she's doing so much better - only good thoughts and prayers for you!!! :animal36

Hate to keep bugging you, but

If you're like an A type personality, if you have an insatiable 'need to know' thing going on, that can be a problem for you. That was my problem. I was ready to see this thing through to the end... definitive diagnosis and treatment and/or surgery... whatever it takes. Sit back ...run all those tests and give me answers and fix my baby!

I have a good vet who likes to not spend my money unneccessarily. We did go 'round a bit till he got through my hardheadedness, and I accepted the fact that basically all liver disease is treated the same way. If it's inoperable (MVD), you use diet and medication, regardless of what it is. If it's operable, you operate and go from there. Now, if there's a shunt and they operate, at that point it would be helpful to know if the pup has MVD also, but even then, follow up bloodwork will tell you that.

Hope this was helpful to you, if not, then maybe someone following this thread can benefit... and the very Best of Luck to you... Liver Disease Sucks!

Ok, BUT, did you have the scintography (sp) to rule out a shunt? That's my big question too. Lucy's numbers are not over 100 - so certainly not a definitive shunt.

Suppose we re-test and they are the same - in the 50's.

Is Scintography my next step? Or just diet management?

I think you need read about the Scintography test, as it is pretty intense too. Personally, I have not gone that route with Roxy. Her post numbers IMO are not high enough to indicate shunt (60 to 100), plus she doesn't show any of the 'major' symptoms of LS, so I decided to medically manage, and she is doing fine.

Well that's very helpful. My vet is saying scintography after the next test and I'm wondering if that is necessary as well.

If her numbers indicate - we should just assume she has MVD and proceed accordingly. It seems simple and clear-cut and people have good results on the right foods with the right supplements.

A Scintigraphy is very accurate in finding a shunt, so if a shunt is truly suspected, than I say go for it, especially if surgery to repair the shunt is the next step. However, you can not repair or fix MVD. You can only Medically Manage MVD. It really depends on wether you need a 100% Answer that YES it is MVD. I was ok (so is my Vet and Specialist) with basing Roxy having MVD from her "numerous" high BATs, Protein C test, and the barely visible symptoms that she displays. I didn't need that "true" confirmation of MVD, because how we proceeded with her life long after care was going to be the exact same regardless. But that's me :p

Well that sounds quite reasonable to me. In fact, that's going to be my plan depending on the outcome of her next tests in 2 weeks. Hopefully, my Vet will be on board. Lucy has no real symptoms either - other than 1 isolated incident - and an elevated BAT.

I was using Animal Medical Center on the Upper East Side in Manhattan... I was seeing Dr. Cook but they have a number of specialists there, it is a very large hospital... they have a website you can poke around a little if your interested.

I have also heard good things about Veterinary Specialists in the Hells Kitchen Area of NYC... I used their emergency service once with another dog and they were very nice but I have no experience with their specialists although I have heard when compared to AMC they are more expensive. AMC basically trained all their doctors though, so either way you are getting great doctors.

Okay, well I just got back to this thread... and hadnt had a chance to reply... I am not doing surgery on my dog for my own wellbeing... I am doing everything that is best for her. My vet is very good too... your not the only one with a good vet... my vet is not trying to get money out of me... she is not set on doing this biopsy, she has provided me with the options, she has consulted with specialists and she is telling me what she thinks is best.

You make the choices you think are best for your dog and I will make the choices I think are best for mine... go play psychiatrist with someone else.

wow did not know this as always thought liver was most forgiving organ as it can regenerate itself - good to know

if no symptoms and posts below 100 I would not put my dog through scintigraphy it is radioactive dye so i would only do if my dog was over 100

100% agree

i always thought scintigraphy was 100% accurate until Ginger as scintigraphy at dr tobias showed shunt they opened her up no shunt :( although i feel it is more accurate than ultrasound and protein c test I was shocked on Ginger that it showed yes and then nothing when they operated so that really bummed me out :(

what isolated incident ? What was pre and post bat? was it a seizure?

No, I did not have the scintography to rule out a shunt because her BAT was high enough (post=145) to indicate there is a shunt. U of T has run so many of these tests they basically know from the results of the BAT when a shunt is present or not. The BATS that come in close to 100, either over or under are the ones that are questionable, and may need repeated. With Lucy's results being in the 50's, it is okay to assume she has MVD and can be managed with diet and/or medication. If, in the future, she begins to show symptoms that diet and/or medication cannot control, that would warrant retesting her BAT, and probably further testing depending again on her latest BAT results. Many pups with MVD are managed solely on diet alone and do fine.

Incident - well meaning neighbor gave me a can of Alpo. Put a little on her food for 2 days. On day 3- strange symptoms - flopping around; could not get comfortable; shaking and twitching. Went to Vet - Vet said sounds like gas - dogs try to 'run away from it'. Day 4 - standing in corners, walking up against wall; hiding under furniture; lethergy; no interaction with family. Return to Vet - he does not know. Possibly stomach pains; virus; not sure. Decided to BAT.

BAT numbers: pre - 51 and post 41. Since the BAT - everything fine with normal behavior; energy, etc. Lucy has a bundle of energy; then sleeps; energy then sleeps.

Plan: Keep everything as is and re-test in 2 weeks. (2/15).

Sorry, tried to condense. Normal liver enzyme test when she was first brought home so Vet was surprised by the BAT numbers. Sister PTS by breeder for LS (different mother same father)

...ok that's says it all...

sounds like MVD to me. what food are you feeding now?

Well. My vet did not want to change her food yet because,according to him, she is a puppy and needs the protein. I had been weaning her off her Purina Puppy Chow (sent by breeder) onto TOTW. After incident, checked ingredients and removed TOTW - VERY HIGH PROTEIN food.

Now, just Purina (yes its crap) until we re-test 2 weeks.

Bought some limited ingredient Wellness for my Westie and saw that it had only 20% protein (less than the Puppy Chow at 27%). So have been adding a few Wellness kibbles to her food to try and transition.

She is doing well - no other symptoms - other than I would say a very docile dog. Of course, my Westie is the Alpha and she usually pesters him a good bit and loves to get him to play - but rarely barks, etc. Everyone says the best behaved dog. Wonder if some of that is liver symptoms when we think she is just being sweet and quiet??

Must get back to work for a few. I do think you are right. MVD and feed and supplement accordingly. That's what my gut says. We'll see after re-test. Problem will be convincing my vet who wants to send her somewhere for scintography before he spays. Now he's very nervous about the spay. Holding off on that.

Thanks!

agree mine is only on diet no supplements and does fine and she is on temaril p and soloxine which both are processed through liver and no symptoms - i do not supplement as she already gets alot and not easy to give her supplements but if she ever has symptoms or high alt i will supplement to repair liver but for now i just go with low protein diet only and her numbers went from 73 then 54 then 26 post on last one 6 mos on low protein diet

my dog did not have symptoms and i fed her raw for 6 mos and holistic vet had her on cod liver oil supplement which is a HUGE NO NO for liver dogs as it has alot of vitamin A in it and no symptoms. Other than that due to allergies has always been on fish diets until we went to hydrolized soy diet for my ibd dog and her since mvd diagnosis. It has 18% protein and 8% fat. She was spay no problem and she also had dental this year and did great under anesthesia. Make sure they use propofol and isoflurine though.

The only concern is you saw some symptoms so see how the next bat goes and i can understand concern with low protein and puppy but if any symptoms i would get to 18% protein - these little ones do not need a lot of protein they are not as active as bigger active dogs so do not buy into the high protein content.

I really think your dog just has mvd as well but is symptomatic which i would do lower protein myself

if your vet has concerns about spay have him consult dr centers at cornell university to ease his mind about mvd and anesthesia or maybe get a vet more comfortable as that would make me nervous if my vet was nervous lol :)

I believe there are a few good Vegetarian Kibbles (Natural Balance and one other that I can't think of right now) out there, that are probably best for her, especially since she had that episode from the Alpo.

My Roxy was a very well behaved and docile dog when she was young. she had her spay at 7 months old (no blood work), she had her teeth cleaned at 14 months (no blood work), she had bi-lateral luxating patella surgery at 2.5 yr (nothing odd on the blood work). She had a repeat LP surgery at 3 yr (nothing odd on the blood work). And at 38 months old, one more surgery to remove the pin in her knee. Everything went well. When she was 3 1/2 yr old, upon hearing about liver issues in other pups from Roxy's parents, we decided to do the BAT. And it was pre: 43 and post: 100.9 :eek:

The best thing to do is research, and talk with your Vet and Specialist, bc knowing that her littermate had a LS would make me believe your pup has liver issues too (not necessarily LS though)

See post about Hill's L/D, University of Tenn highly recommends this diet.

Sorry, I really didn't intend to offend you... but if you make these decisions with a 'need to know' mentality, the surgery will be for your own wellbeing...not in the best interests of your dog.

I believe your vet is very good from what I've read, and I never said she wasn't good.

I never said that your vet is trying to get money out of you, that was someone else... I said my vet was good because he won't spend my money unneccessarily...ie: on tests that I already have the answers or solutions to.

And you said the specialist was pushing for the biopsy, and you weren't sure about what to do, so you posted questions and I posted suggestions, along with two or three others telling you basically the same thing.

Again my apologies, good luck with your pup
Kathy

Did she eventually have diarrhea from the Alpo?
These are symptoms of Hepatic Encephalopathy, basically a build up of toxins in the blood that go to the brain. You would do well to get a script for Lactulose to keep on hand as Lactulose can stop these symptoms almost immediately. It will most likely reoccur from time to time. If these symptoms are allowed to progress, they will be followed by a seizure, coma and death. (sorry to be so blunt, I don't know how else to say it).

And Yes, lethargy is a symptom of liver malfunction. My pup has good days and bad days. On her good days, I half expect her to run up the walls and across the ceiling. On her bad days, she gets in her crate and sleeps alot... she is not crate trained and barks incessantly if I put her in it.? Other things you can do to help her liver: Feed 3-4 small meals per day. Easier on the liver to process smaller amounts at a time. Use only stainless steel or safe ceramic bowls for food and water, plastics can leach chemicals into the food and water. Use filtered water, if possible.

Ok, thanks. I think I will end up going to a specialist because though my Vet is wonderful; I don't think he's up on all this. Otherwise, why would he not be changing her diet and adding the lactulose . . .

And he IS nervous about the spay so maybe he'll refer me to a specialist anyway and I'll get some of the prescription food (he didn't want to give me any) and some of the other things she might need.

OR - best case - we restest and her numbers are clear! Wouldn't that be so wonderful! In the meantime, I'll be armed with questions for him.

I know! Me too!

Oh my gosh; little Roxy has been through it! Good thing you found out when you did. Did you have the surgery? I think you said maybe that you are medically managing it.

Again JMHO: There's no reason to change vets or to see a specialist at this point in time. I think your vet wants to repeat the BAT bc the pre number is higher than the post number. I haven't seen this to date, so it is appropriate to retest in 2 weeks with no changes made as to diet or meds. Some pups will throw a higher than normal pre test due to the involuntary release of bile into the stomach in the middle of the night. Can happen often. The post number indicates a mild MVD, waiting two weeks to retest shouldn't put her in any danger. The Alpo episode is weird, I'm thinking the fasting from the BAT may have helped clear her system of the toxins, or it may have been a weird reaction to a preservative in the food, if not H.E. As has been said prior, mild MVD can successfully managed by feeding low protein quality food. This is usually the first step in beginning treatment, food change, no meds. If your pup should then start to show symptoms, the next step would be to add medications. This is rarely needed in cases of mild MVD, but your vet wouldn't prescribe them until your pup shows symptoms. If it were my dog, I would still ask for the Lactulose to have on hand, it is a laxative and also removes toxins in the bowel preventing them from reaching the liver, kind of easing the load on the liver.

The U of Tenn has a very informative site. They explain all the tests, medications and symptoms concerning Liver shunt and MVD. Here's a link: Portosystemic Shunts FAQ They would also discuss your case with your vet to get your pup on a treatment plan, if your vet needs any assistance. They also have a clinical section on their site for vets to access. They would probably have a procedure/recommendation for doing a spay and could discuss with him.
And the Yahoo MVD/LS group is a great resource too.

Not trying to tell you what to do, but just stating my opinion resulting from my experiences with my own LS dog.

Wishing you the best...
Kathy

Oh and Nature's Recipe also makes a vegetarian diet, 20-22% protein (I think).