sounds like you have a great vet who wants to learn and do the right thing - they cannot possibly know everything about everything so it is great she is open to learn and do what is best and deal with specialists and no ego about it all that is great. Alot of times it is a narrowing down process - i really think in this case with no symptoms it is the food :( but could be wrong so always good to check it out further just in case---

I think food due to age of her as i think you would have seen bladder stones or symptoms by now at her age

Repeat ALT result
 

Brought Chipper home from vet at noon. He had bloodwork done for BAT which will be sent off and results on Monday....hopefully. She redid the ALT and the number had dropped from 1863 to 659 and the BUN was in normal range. Vet is cautiously optimistic. Thinks it may have been the infected anal gland causing the gallbladder to act up and affect the liver or the high protein food. He will remain on the k/d for the time being until the BAT is in. Then we will rethink. Thanks for all the responses. It's wait and see right now. Will let you know on Monday/whenever what the BAT results are. ~Joanne~

great news glad the alt is down :)

Oh I'm so glad to hear this, I wondered if the infection could skew tests results. This is such a hard time, and it's great to have calm minds that will help you think, we're here for you Joanne, and I can't offer any information on this, but know that I'm praying for you. Big hug to you!

I'm attempting to get that information for you, I've just e-mailed another YTCA member.

But, I think I posted the number for Dr. Hawthorne...if your vet wants to call him in the morning, he will have Dr. Center's contact information.

Hope Chipper is feeling better...

Here's a link to evaluating liver enzymes... may or may not be helpful...

The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine=

Some excerpts:

Although elevated serum hepatobiliary enzyme activities are frequently identified, they do not necessarily indicate clinically important hepatic disease.

Alanine aminotransferase
Increases in serum ALT activity are considered liver-specific in dogs. ALT activity can increase with severe muscle necrosis, but simultaneous evaluation of serum creatine kinase activity can rule out a muscle source.3,4 ALT is a cytosolic enzyme, and leakage occurs with damage to hepatobiliary membranes. The magnitude of serum ALT activity elevation is roughly proportional to the number of injured hepatocytes.3 Serum ALT activity may also increase because of induction of enzyme synthesis by corticosteroid use and, possibly to a lesser extent, by phenobarbital therapy.3,5 Serum ALT half-life is 2.5 days.6
Increases in serum ALT activity have the highest sensitivity (80% to 100%) for hepatic inflammation and necrosis, vacuolar hepatopathy, and primary neoplasia (hepatocellular carcinoma, cholangiocarcinoma) but have less sensitivity (50% to 60%) in cases of hepatic congestion, metastatic neoplasia, and portosystemic vascular anomalies.3

Increases in serum liver enzyme activities are sensitive indicators of hepatobiliary disease, but these activities can be elevated secondary to various endocrinopathies, gastrointestinal disease, pancreatic disease, systemic disease, and enzyme induction. In asymptomatic patients, a systematic approach is required to obtain a definitive diagnosis. A careful review of the patient's history is essential to uncover vague clinical signs that the owner may have missed and to identify any potential exposure to hepatotoxic agents. A complete minimum database, including a complete blood count and urinalysis, is required to rule out an underlying extrahepatic disease. In some cases, sequential monitoring may be elected; however, persistent elevation, marked elevations, concurrent increases in serum bilirubin concentrations, or concurrent decreases in albumin concentrations warrant further investigation, including diagnostic imaging and, in many cases, hepatic biopsy.

I just had my yorkie at U of T for LS surgery in January so please pm me if you have any questions. Dr. Tobias was on an extended leave then as she was taking care of her husband, but the doctors there were absolutely wonderful. I have a 1 year old yorkie who at Christmas time just felt like something was wrong but he really didn't have any symptoms. Well small ones like not eating as well and not as energetic as he should have been for a puppy. My vet thought he was fine but I took him to run a complete bloodwork to rule out LS and anything else that could come up. His bile acids came back high, he never had to do the fasting one since we already knew something was wrong with that test. I called U of T and scheduled him for 2 weeks later. I drove 11 hours by myself to take him to the best possible care. As for a referral, you print out the form online and just have your vet fill it out and fax it. As far as cost, I didn't care because I had insurance but everything (neutered with only one testicle descended, baby teeth pulled, all the testing and the surgery) came out to $1800. My vet said the testing alone here would have been more than that. (I'm in Maryland). Anyway if you have any questions please ask or pm me. By the way it is now 3 months later and Ozzie is a chubby bundle of energy. Oh and I absolutely fell in love with Tennessee.
Ginger

that is so great - so happy your baby is doing well - yeah dr tobias' hubby just passed away very sad :(

results
 

I don't have specific numbers but they will be coming in the mail. My vet called and said that the BAT was 44. If I understand it right it shouldn't be any higher than in the low 20s. She wants Chipper to stay on the k/d food for another 3 wks. and then she wants to rerun the BAT and the ALT. If it continues to be higher than it should be, we will start out at K-State with tests before she sends us to U of T. Just wanted to let you know that Chipper hasn't been vomiting anymore although he had the trembles on Sunday. Turned out I hadn't given him his Metacam that I was supposed to. She said that it is painful for the doggie to have the gallbladder dump so much fat. Don't really understand that all, but the meds helped. I was panicking for a moment. Thank you, again, for all the information. ~Joanne~

??? metacam - was that given before the bats? If so that will skew the test and those numbers were not high at all and no need for further testing it is clearly mvd if not over 100 on bats and if your pup had any medication prior to doing bats that will elevate the bats as well. I need to refresh my memory and will go back and re-read but curious why metacam as that affects the liver and kidneys

she gave the dog metacam bc the gall bladder was dumping fat ??? Ok this does not sound right to me at all

how long was your dog eating the new food before bats were done? I think the alt was high due to infection from anal glands and probably had some toxins in his system which affected the alt numbers as the bats are a better measurement of the liver and those are not bad. If this were my pup i would do no further testing and feed a low protein diet. Also i would not be using metacam as metacam should not be used in a dog with liver and kidney not functioning at a 100% and your dog probably has mvd - also the food at 40% protein was too high so probably upped the numbers as well

is the anal gland infection cleared up ?

was your dog shaking before ? Is it cold there? Was it after eating as liver shunt/mvd dogs are in pain after eating usually as the food is what triggers the toxins and pain

that number is lower than my mvd dog and my mvd has no symptoms

Joanne,


Here's a link posted on the YTCA.org website. If you go to YTCA.org the website will come up. Hit the area that says with frames, it'll take you to the next page. On the left side you'll see Health, click on that and there is all kinds of information you can browse through, there is also a question and answer page taken from the Seminar Dr. Center's held at the Roving Specialty in Memphis.
http://www.ytca.org/health_biletestproced.doc-1.pdf

Deb is correct any kind of medication and or changes can skew the test results.

The Metacam was for after the BAT. The amount was .2 ml/day pre-measured in a syringe. I didn't give it on Saturday. On Sunday morning he was trembling and looking miserable with his curled tail hanging down. It wasn't cold....maybe chilly, but not cold. I gave my vet a call. She asked if I had given him the Metacam because the high fat food can cause pain. I hadn't, so I gave it and he has done much better....his normal 'chipper' self. Three days earlier when he originally had his ALT and wasn't feeling good she gave him something that knocked him out....think it was for nausea. He has also been on antibiotics since then, which would be 5 days as of today. About the gallbladder causing the pain after the high fat food....maybe I misunderstood that. I have read, though, that the gallbladder, liver, and kidneys are entwined. Again, I may not understand. I am trying to learn about this so I have to ask questions. Dwerten, why would you recommend not re-testing if there is any chance that the numbers are messed up because of the anal infection or the high protein food? Then these numbers wouldn't really be true. Is it too rough on the doggie? I so want to do what is best for Chipper. He is so sweet I want to keep him around for as long as I can. Also, Mardelin, thank you for the link. Will be reading it and hoping that I understand. I had to learn about Cocoa's EPI, so somehow I will do this, too. Dwerten, what food do you feed? Thank you. ~Joanne~

i feed purina ha a hydrolized soy diet at 18% protein and 8% fat. If they have mvd the numbers will always be over 25 which is normal but as long as it is not over 100 as that is when it is more indicative of shunt.

Were the antibiotics given before the bats were done? If so that would throw the numbers off as well. A high alt can be from toxins as well and due to the infection and the fact that the alt went down to 600 range I think that was the issue and blood work will always be skewed if a dog is sick or on any medications - DD has always had normal ALT but her bats were high but less than 100

I am just concerned about the shaking but think that may be due to anal glands as i do not think it is due to the mvd - I think you have the answer that there is no shunt and mvd is treated with low protein diet when no symptoms

What antibiotics are you giving and what has he had 12 to 24 hrs prior to shaking? My dd got the shakes on clindamyacin is why i am asking and that can be a side effect of antibiotics

when you say metacam for after bat i am confused why ? Was the metacam for ? anal glands? Metacam is used for pain and anti-inflammatory and bats do not cause that

The vet has to feed a fatty meal 2 hours before the blood draw for the BAT. Also, this was done after a fast, so I imagine he may have experienced some cramping, as this meal passes through his system.

If the Post (after meal) result is under 100, the dog has MVD. We know this because thousands of dogs have been tested to date and when the results are less than 100, there has never (or almost never) been a shunt. When the results come in over 100, there is more than likely a shunt, and further testing would be warranted..

So, with result less than 100, no further testing is required, unless to repeat the BAT, or if the dog has new symptoms. Just get him on a reduced protein diet to help his liver to function the best it can, without overloading it on protein.

This is a type of illness where you don't need to get definite answers. A liver biopsy can be done to absolutely confirm the MVD, but this is very stressful on the dog ,and very invasive, and all surgeries come with risks. I personnally feel comfortable with the BAT result being the main diagnostic test for this disease. If the result was over 100, then a scintigraphy would be done to determine the location and number of shunts, then if a single shunt, surgery to repair, multiples are inoperative, just treated with low protein diet and medications.

So you can relax, he got a good test result. Not the best, but second best. Considering what he''s been through, if anything the repeat BAT will be lower, as Gallbladder issues, infection, etc. can skew the BAT results (makes them elevated). All you need to do now is get him on the appropriate diet, and hug him alot!:D