Elevated bile test

[terrymccown]

Hey everyone....looking for some advise and/or help. I have the most precious little girl in the world. She is 14 weeks old and currently 1.9 pounds. She is growing right on the growth chart, great appetite, lots of energy, runs, plays, attentive to every movement in the house. She has gained 5 ounces in 2 weeks. She got her 2nd set of shots in mid March. This week she work up from nap (morning) and very lethargic, stubbling, etc.. I gave her some syrup for hypoglycemia and no better so I took her to the vet. They did a liver test, CBC, and bile test. Her liver enzymes were elevated, CBC normal and post (only) bile test was 68. My vet immediately told me he thought it was liver shunt and referred me to an Animal Clinic in NC. My heart sank and I went into shock. Came home and began my research. Have started her on a low protein diet by Hills LD. Small frequent feedings, antibiotic, lactulose and dem?? meds. She is still doing great. Very energentic. She just does not appear to be sick. Have not seen any of the typical symptoms of LS. I have read about C Protein test. Suppose to have her third set of vaccines in am. Just wondering what information is out there for me. My funds are really limited, I want the best for her, but do not have $5000.00 for surgery and related expenses. I am just wondering if my vet is jumping too fast. Do I need a second opinion and would you advise to get the last dose of vaccines this week. I also applied flea/tick control Revolution when she got her second set of shots. One interesting think on the report states the blood was hemolyized. Also she tee-tees on white training pads and her urine is yellow, not orange colored. Should we get urine samples to look for crytsals? Sorry to be so long winded but I so want some answers. My breeder has offered a refund or another puppy but I already lover my baby girl so much...just dont know what to do??

[Ladymom]

If the blood was hemolyzed, the test needs to be repeated:

This is from Dr. Center, the developer of the bile acids test:

Results can be falsely abnormal if the bile acid samples are lipemic (lots of fat IF the fat is not adequately removed by the laboratory analyzing the sample) or if hemolysis (burst red blood cells, makes the plasma red) occurs. The red color interferes with the color of the end point dye in the bile acid test. A clinician can tell if the sample is hemolyzed when they centrifuge the sample to separate the red blood cells from the plasma. If it is hemolyzed they should collect another sample.

PSVA and MVD Research Summary

I would try not to panic at this point. Since she's due for vaccines tomorrow, I'd wait another 30 days to retest her.

[terrymccown]

thank you...it is soooo hard not to panic....I already love her so much!! I really was surprised that my vet did not want to repeat the test. I am just scared to get her shots incase that made her levels go up or that one episode was realated to vaccinations and/or flea tick medication.

[terrymccown]

Does anyone know the correct dosage of Amoxicillin for yorkies. Tadum weighs 1.9 pounds. Thanks again...Sorry for all the questions.

[RONLYNN]

You should also really join this group. Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

They are a wonderful group with lots and lots of answers. My Teddi had a liver shunt and someone on here told me to go there and they helped me A LOT. I thought I was going to have to spend thousands and thousands of dollars too but ended up going to University of Tennessee and it cost only $1,200 for her surgery. The vet here in California told me it was going to cost between $4,500 and $6,500. You can go here to read about my Teddi's story.
Liver Shunt Stories

[ladyjane]

Originally Posted by RONLYNN

You should also really join this group. Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

They are a wonderful group with lots and lots of answers. My Teddi had a liver shunt and someone on here told me to go there and they helped me A LOT. I thought I was going to have to spend thousands and thousands of dollars too but ended up going to University of Tennessee and it cost only $1,200 for her surgery. The vet here in California told me it was going to cost between $4,500 and $6,500. You can go here to read about my Teddi's story.
Liver Shunt Stories

Your little Teddi is a doll! What a beautiful story!

[MyTrixie143]

I would definitely retest before you start worrying. And do get a second opinion!! I can't believe a vet would be willing to put her through all that without further testing!!

I have heard that recent shots given can effect the results.

My little one had a post of 70 when I got him tested for breeding purposes. He had absolutely no signs. I panicked and took him to OSU for further testing. He did not have a shunt, I made them do a scintigraphy to make sure. They also bile acid tested him themselves and his numbers were alright. They told me I should have had a second bat done as sometimes the test gets messed or the vet isn't doing in properly. An expensive lesson for me but I am glad for it as it gave me peace of mind.

I was also told that a protein C test wasn't reliable. As studies have not been done to show why some dogs with no liver problems test high as well. These vets were very knowledgeable and some had graduated from the University of Tennessee and had worked with Dr. Tobias.

Try not to worry too much right now about your baby. Her numbers are low enough that they don't suggest liver shunt, mvd maybe though.
Good luck with her!!

[Ellie May]

I thing I'd be most concerned with right now is giving more vaccines.
You're kind of in a spot because your pup needs to finish them, but it would be nice to figure out what is going on first.
On the other side of that, it sounds like while your vet is knowledgeable, they are moving way too fast.

The bile acids test isn't as accurate as we like to see until >20 weeks. And even then there are so many variables. The thing we do know about bile acids testing is that there is so much to learn about the test. Any drug can potentially make them go up, so a vaccine could have falsely elevated it.

[terrymccown]

Thank you all, just an update for everyone. Tadum is 15 weeks today and she continues to do well. I have her on Hill's LD canned dog good, have order the Royal Canine LD 14 nibbles but it has not come in yet. She gets a little apple and watermelon a day. She is on Amoxicillin 1.2 ml twice a day, She gets Lactalose 1 ml three times per day and two liver supplements-- (Liquid Hepato) 2 drops per day Vetri Liquid DMG- 1/2 syringe daily. I am planning on taking her back to vet after her 20 week birthday and get her bile tests done(pre and post).

Last night finally got to work on her hair. I have worked with her almost daily on brushing, working with her nails, feet, ears, eyes, etc...but she is SUCH a biter. I do not think I have very much skin left on my hands (she thinks they are chew toys) I have ordered some of that Bio Groom Conditioner and a new brush, but last night tired I found I walmart...Just For Me (2-1 Conditioning Detangler) It made her hair much softer, was able to brush it well. Still have to do some touch up work around the bottom area...but it did go well.

Finally---I thought...oh no...last night around 10 pm she started running around acting like she had something caught in her throat. I called my son and we held her and opened her mouth..she had ? small stick stuck sideways. My son tried to pull it out while I held her and it broke and Tadum swallowed it. She was fine after that and ate and drank. Well, around 4 am, she vomited and appeared that she was in pain when I touched her stomach...I panicked...it has been a long morning, but she is now up & active --has had two bowel movements and urinated. She urinated on the floor which is her first accident in almost 2 weeks. So hope all continues good today.

I have to leave her on Thursday for the weekend. I am going out of town with husband and friends and the place that we are staying is not pet friendly..Can you believe that? My mom and step dad are going to take care of her, but I am stressing.

Thanks again for everyone caring...It truly means alot

[dwerten]

Originally Posted by Ladymom

If the blood was hemolyzed, the test needs to be repeated:

This is from Dr. Center, the developer of the bile acids test:

Results can be falsely abnormal if the bile acid samples are lipemic (lots of fat IF the fat is not adequately removed by the laboratory analyzing the sample) or if hemolysis (burst red blood cells, makes the plasma red) occurs. The red color interferes with the color of the end point dye in the bile acid test. A clinician can tell if the sample is hemolyzed when they centrifuge the sample to separate the red blood cells from the plasma. If it is hemolyzed they should collect another sample.

PSVA and MVD Research Summary

I would try not to panic at this point. Since she's due for vaccines tomorrow, I'd wait another 30 days to retest her.

yep i agree i would not panic unless those numbers were over 100 as my dog was post 73 the first time did what you are doing and she is fine on low protein diet but she did not have the symptoms you describe though but i still think low protein diet will help

join these groups and read the files, links, etc and they know a ton on this stuff.

DogLiverDisease : Dog Liver Disease

Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

I personally am not a fan of protein c test nor liver biopsy myself after all the reading i have done on this-- and not a fan of ultrasound for this either as too hard to see and waste of money

if the numbers were well over 100 on a retest then i would go straight to scintigraphy

are you close to university of tennessee?

I think with the lowered protein your little one will be ok

what was the protein count on the food you were feeding as dogs with symptoms should be on 18% and no symptoms but high numbers 22% so if you were feeding 30-40% protein diet this could have caused those symptoms

dr tobias and dr centers are the experts on this disease and dr tobias assistant is on that second group above

[dwerten]

Originally Posted by terrymccown

thank you...it is soooo hard not to panic....I already love her so much!! I really was surprised that my vet did not want to repeat the test. I am just scared to get her shots incase that made her levels go up or that one episode was realated to vaccinations and/or flea tick medication.

don't be surprised many vets have no clue about this disease and panic people. Our vet has a phd from ucdavis and he had me panicked too wanting me to run her down for scintigraphy immediately with a post of 73 then we re did and was pre 3 and post 54 so i was like hold on sparky let me do some research here and joined those groups and with no symptoms did not put my dog through that unnecessary test for her. Now if she was way over 100 and having symptoms i would have had it done immediately

[dwerten]

Originally Posted by MyTrixie143

I would definitely retest before you start worrying. And do get a second opinion!! I can't believe a vet would be willing to put her through all that without further testing!!

I have heard that recent shots given can effect the results.

My little one had a post of 70 when I got him tested for breeding purposes. He had absolutely no signs. I panicked and took him to OSU for further testing. He did not have a shunt, I made them do a scintigraphy to make sure. They also bile acid tested him themselves and his numbers were alright. They told me I should have had a second bat done as sometimes the test gets messed or the vet isn't doing in properly. An expensive lesson for me but I am glad for it as it gave me peace of mind.

I see the vaccine was done mid march and then she had symptom around 4/8 - vaccines can cause reactions up to 30 days after vaccine for some dogs

I was also told that a protein C test wasn't reliable. As studies have not been done to show why some dogs with no liver problems test high as well. These vets were very knowledgeable and some had graduated from the University of Tennessee and had worked with Dr. Tobias.

Try not to worry too much right now about your baby. Her numbers are low enough that they don't suggest liver shunt, mvd maybe though.
Good luck with her!!

i agree with this as i helped a dog on here that had 4 shunts and protein c test said no shunts after that i question that test

the gall bladder can contract thus throwing off the test

any vaccines, flea prevention,etc can throw off test as everything gets processed through the liver

was the bat done after doing flea and tick prevention and did she have these symptoms after flea and tick prevention as that can be the cause of her reaction as well - think back to 12-24 hrs after her acting this way as usually a reaction will happen to something done in that time frame if not immediately

[dwerten]

Originally Posted by terrymccown

Thank you all, just an update for everyone. Tadum is 15 weeks today and she continues to do well. I have her on Hill's LD canned dog good, have order the Royal Canine LD 14 nibbles but it has not come in yet. She gets a little apple and watermelon a day. She is on Amoxicillin 1.2 ml twice a day, She gets Lactalose 1 ml three times per day and two liver supplements-- (Liquid Hepato) 2 drops per day Vetri Liquid DMG- 1/2 syringe daily. I am planning on taking her back to vet after her 20 week birthday and get her bile tests done(pre and post).

Last night finally got to work on her hair. I have worked with her almost daily on brushing, working with her nails, feet, ears, eyes, etc...but she is SUCH a biter. I do not think I have very much skin left on my hands (she thinks they are chew toys) I have ordered some of that Bio Groom Conditioner and a new brush, but last night tired I found I walmart...Just For Me (2-1 Conditioning Detangler) It made her hair much softer, was able to brush it well. Still have to do some touch up work around the bottom area...but it did go well.

Finally---I thought...oh no...last night around 10 pm she started running around acting like she had something caught in her throat. I called my son and we held her and opened her mouth..she had ? small stick stuck sideways. My son tried to pull it out while I held her and it broke and Tadum swallowed it. She was fine after that and ate and drank. Well, around 4 am, she vomited and appeared that she was in pain when I touched her stomach...I panicked...it has been a long morning, but she is now up & active --has had two bowel movements and urinated. She urinated on the floor which is her first accident in almost 2 weeks. So hope all continues good today.

I have to leave her on Thursday for the weekend. I am going out of town with husband and friends and the place that we are staying is not pet friendly..Can you believe that? My mom and step dad are going to take care of her, but I am stressing.

Thanks again for everyone caring...It truly means alot

what kind of stick as these can splinter - i think i would have her checked out if she is vomitting - was there blood in the vomit ? I would have her checked before you leave town

you may want to start a new thread for this and get others take that have dealt with this as vomitting after something like this scares me

did the stick come out in her bowel movement did you see? This is something i really would not mess with and would have an xray done as this has me concerned but do another thread and see if others can give you advice that have gone through it - i would title it swallowed a stick or twig