While I wait...info on LS

[dwerten]

Originally Posted by kjc

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!

i agree

the only thing is dd had bats done on the diet she was on which was dd salmon and potato and then when we switched to purina ha after 6 mos i had jean dodds redo bats and they were lower but we did not feed a fatty meal we just fed her the diet she was on

[kjc]

Originally Posted by dwerten

i agree

the only thing is dd had bats done on the diet she was on which was dd salmon and potato and then when we switched to purina ha after 6 mos i had jean dodds redo bats and they were lower but we did not feed a fatty meal we just fed her the diet she was on

Probably safer for her bc of her allergies and predisposition to attacks of pancreatitis?

[4doggiemama]

Originally Posted by kjc

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!

Awwwww, I can understand this. Makes sense. Yes, it is the BATs that my vet wants to re-do in 3 wks. considering the anal gland infection and the extremely high protein food that I was feeding. Thank you for this information. I thought that any number above the norm was devastating. I am learning. ~Joanne~

[dwerten]

Originally Posted by kjc

Probably safer for her bc of her allergies and predisposition to attacks of pancreatitis?

she does not have the pancreatitis issue it is dexter who had the pancreatitis. The vet never even mentioned it and his friend is the guy who does the scintigraphy in so cal and the first vet out of 3 that mentioned bats on her and he has a phd from ucdavis. I know some have posted high protein meal but have not seen high fatty meal before as it is the protein that triggers the test so confused is this from dr centers about the high fatty meal prior?

also dr dodds never said anything about diet change for test as two were done with vet and one with dr dodds now my curiosity is peaked lolll

[dwerten]

Originally Posted by 4doggiemama

Awwwww, I can understand this. Makes sense. Yes, it is the BATs that my vet wants to re-do in 3 wks. considering the anal gland infection and the extremely high protein food that I was feeding. Thank you for this information. I thought that any number above the norm was devastating. I am learning. ~Joanne~

no if they have mvd it will always be over 25 so no need to keep testing. The only reason i did it is I wanted dr jean dodds to do it as i was still questioning it as she had no symptoms. The only reason we did second one with vet is because i had no clue about all this stuff back then and he did not do pre the first test and had me so freaked out wanting me to take her down for a scintigraphy immediately but after doing all my research and joining liver shunt group i learned it was not necessary and so glad i did my homework as 3 years later she is still the same no symptoms eats like a pig, no seizures, no head pressing nothing.

[Ellie May]

Just to throw yet another opinion into the mix (sorry ):

I agree about the Metacam. NSAIDs (including this one) are not recommended for dogs with probable MVD or LS. I have no idea why the vet thought it was okay, but there are better options for pain management in thi case. These drugs can mess up even a healthy dog's liver. Ellie had a post BAT of 47 and then 15. She was spayed and had a liver biopsy shortly after. NSAIDs weren't really even in her vet's thinking process for this.

Bile acids in Yorkies that are over 100 (post) are very often LS, but can still be MVD (or both) or something entirely different. Bile acids below 100 are very often MVD (but in rare cases...LS). It can also be sometihng else.

The ALT being that high would be of concern. Good that it's coming down, but I just think it was too high to not keep rechecking. We were slightly concerned when Ellie's was 118, sooooo a jump like that can't be taken lightly in a young dog. If the ALT does not go back down to normal range, then I personally would err on the side of caution and go further. I'm not necessarily saying that a biopsy needs to be done nor a scintography. I just think having a specialist deal with the high ALT may be good (if it stays where it is or goes back up). It means liver cell death probably occurred and there are some things you can do to help protect the liver from further damage (i.e. (SAMe, possibly milk thistle).

[dwerten]

Originally Posted by Ellie May

Just to throw yet another opinion into the mix (sorry ):

I agree about the Metacam. NSAIDs (including this one) are not recommended for dogs with probable MVD or LS. I have no idea why the vet thought it was okay, but there are better options for pain management in thi case. These drugs can mess up even a healthy dog's liver. Ellie had a post BAT of 47 and then 15. She was spayed and had a liver biopsy shortly after. NSAIDs weren't really even in her vet's thinking process for this.

Bile acids in Yorkies that are over 100 (post) are very often LS, but can still be MVD (or both) or something entirely different. Bile acids below 100 are very often MVD (but in rare cases...LS). It can also be sometihng else.

The ALT being that high would be of concern. Good that it's coming down, but I just think it was too high to not keep rechecking. We were slightly concerned when Ellie's was 118, sooooo a jump like that can't be taken lightly in a young dog. If the ALT does not go back down to normal range, then I personally would err on the side of caution and go further. I'm not necessarily saying that a biopsy needs to be done nor a scintography. I just think having a specialist deal with the high ALT may be good (if it stays where it is or goes back up). It means liver cell death probably occurred and there are some things you can do to help protect the liver from further damage (i.e. (SAMe, possibly milk thistle).

you can also juice zucchini and celery together put pulp and juice on food as zucchini cleanses the liver and celery cleanses the urinary tract - my friends bull mastiff got into a toxic plant and alt was through the roof and she did the zucchini and celery and did the milk thistle and his numbers were way down. He then ended up having addisons after that whole incident.

I think had this dog not had an infection, not been on antibiotics then yes but since it dropped so drastically as dog was getting better from anal gland infection I would still tend to think blood work was off due to that -jmo Especially in a dog with no symptoms at all

BUT the shaking thing still has me concerned so need more info on that

also the protein of 40% could have very well done that as well

[kjc]

Originally Posted by dwerten

she does not have the pancreatitis issue it is dexter who had the pancreatitis. The vet never even mentioned it and his friend is the guy who does the scintigraphy in so cal and the first vet out of 3 that mentioned bats on her and he has a phd from ucdavis. I know some have posted high protein meal but have not seen high fatty meal before as it is the protein that triggers the test so confused is this from dr centers about the high fatty meal prior?

also dr dodds never said anything about diet change for test as two were done with vet and one with dr dodds now my curiosity is peaked lolll

Sorry about the mix up with your pups. Then, if first tests were done on dd's regular diet, and Dr Dodds was trying to repeat the result, the same conditions should be followed, to rule out error in testing method.

http://www.vet.utk.edu/clinical/sacs/shunt/diagnosis.php

Serum bile acids are synthesized in the liver from cholesterol. ...If the animal is sensitive to high protein meals, a low protein diet mixed with a few milliliters of corn oil can be used to stimulate gastrointestinal motility and cholecystokinin activity. ...

Originally Posted by dwerten

no if they have mvd it will always be over 25 so no need to keep testing. The only reason i did it is I wanted dr jean dodds to do it as i was still questioning it as she had no symptoms. The only reason we did second one with vet is because i had no clue about all this stuff back then and he did not do pre the first test and had me so freaked out wanting me to take her down for a scintigraphy immediately but after doing all my research and joining liver shunt group i learned it was not necessary and so glad i did my homework as 3 years later she is still the same no symptoms eats like a pig, no seizures, no head pressing nothing.

I think the fact that Chipper has other issues (anal gland infection, high ALT) going on, and that the BAT is not astronomically high, retesting the BAT when the infection resolves wouldn't hurt anything, just to see if these issues did skew the result any.

I've seen a few LS/MVD cases on here where the vets want to continue testing after elevated but <100 BAT results. Some will spend your money if you let them.

Originally Posted by Ellie May

Just to throw yet another opinion into the mix (sorry ): (no problem... always interested in your opinions...)

I agree about the Metacam. NSAIDs (including this one) are not recommended for dogs with probable MVD or LS. I have no idea why the vet thought it was okay, but there are better options for pain management in thi case. These drugs can mess up even a healthy dog's liver. Ellie had a post BAT of 47 and then 15. She was spayed and had a liver biopsy shortly after. NSAIDs weren't really even in her vet's thinking process for this.

Bile acids in Yorkies that are over 100 (post) are very often LS, but can still be MVD (or both) or something entirely different. Bile acids below 100 are very often MVD (but in rare cases...LS). It can also be sometihng else.

The ALT being that high would be of concern. Good that it's coming down, but I just think it was too high to not keep rechecking. We were slightly concerned when Ellie's was 118, sooooo a jump like that can't be taken lightly in a young dog. If the ALT does not go back down to normal range, then I personally would err on the side of caution and go further. I'm not necessarily saying that a biopsy needs to be done nor a scintography. I just think having a specialist deal with the high ALT may be good (if it stays where it is or goes back up). It means liver cell death probably occurred and there are some things you can do to help protect the liver from further damage (i.e. (SAMe, possibly milk thistle).

Well said and I agree, but, from The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine=

Although elevated serum hepatobiliary enzyme activities are frequently identified, they do not necessarily indicate clinically important hepatic disease. There are several reasons for this discordance. First, increased serum hepatobiliary enzyme activity can originate from nonhepatic tissues. Second, the liver's dual blood supply and large blood flow make it uniquely sensitive to injury due to systemic disorders and diseases in organ systems drained by the portal circulation, particularly the gastrointestinal tract and the pancreas. Finally, drugs can induce excess hepatobiliary enzyme production in the absence of liver damage.

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

I have read too that on high ALT result, many times the exact cause of this elevation is never determined. And normally two or more liver enzymes would be increased in LS/MVD, and BUN is normal or decreased, not normally elevated.


http://www.vet.utk.edu/clinical/sacs/shunt/diagnosis.php

DIET & MANAGEMENT -- Care and Feeding
In most cases, proper diet, consisting of very low protein and medication will postpone the urgency of the surgery.
This information, such as KD Prescription Diet or LD Prescription Diet, and appropriate medications, if necessary, should be discussed with your veterinarian.

And, Joanne, feeding him the high protein didn't cause this. It may have caused some symptoms and test results, but he already had an underlying liver problem to begin with, just not bad enough to be evident.

[kjc]

Does the Orejin you were feeding contain any fish meal or fish ingredients?

I ask this because all fish is preserved with ethoxyquin on the boats at the time they are caught. This is a toxic preservative and can make dogs and cats extremely sick, and deaths have been reported in animals fed this for any length of time.

Dog food makers don't have to list it as an ingredient bc they are not the ones adding it to the fish. They buy the fish from another company and add the fish to their food. Supposedly, the ethoxyquin is burned off in the cooking process, but tests are not done to ensure a complete removal of the ethoxyquin.

How long had he been eating the Orejin? I'm thinking this may have been the cause of his increased ALT.

[dwerten]

Originally Posted by kjc

Does the Orejin you were feeding contain any fish meal or fish ingredients?

I ask this because all fish is preserved with ethoxyquin on the boats at the time they are caught. This is a toxic preservative and can make dogs and cats extremely sick, and deaths have been reported in animals fed this for any length of time.

Dog food makers don't have to list it as an ingredient bc they are not the ones adding it to the fish. They buy the fish from another company and add the fish to their food. Supposedly, the ethoxyquin is burned off in the cooking process, but tests are not done to ensure a complete removal of the ethoxyquin.

How long had he been eating the Orejin? I'm thinking this may have been the cause of his increased ALT.

great as i am feeding dee dee cod to pill her so is this something i need to be concerned with as she throws up white potato now after metacam nightmare

i also noticed the wild cod is from CHINA at sam's club so next time we will buy from costco as their wild cod is not from CHINA - wth is anything from US anymore ?

wild as i read alot on bats an no where ever read adding fat to it nor did jean mention it or our vet - not sure it would make a huge difference and the risk of pancreatitis in this breed i would not recommend it and would just feed normal diet do the bats as if it is there it will show up and i would want to know what they were without playing with their diet they are currently on.

very interesting about the toxins though as toxins will affect the alt

yeah i have read if bats are not normal they will never be normal so no need to keep redoing them over and over

[kjc]

Originally Posted by dwerten

great as i am feeding dee dee cod to pill her so is this something i need to be concerned with as she throws up white potato now after metacam nightmare

I'm sorry, it is not used in Human food

Originally Posted by dwerten

i also noticed the wild cod is from CHINA at sam's club so next time we will buy from costco as their wild cod is not from CHINA - wth is anything from US anymore ?

wild as i read alot on bats an no where ever read adding fat to it nor did jean mention it or our vet - not sure it would make a huge difference and the risk of pancreatitis in this breed i would not recommend it and would just feed normal diet do the bats as if it is there it will show up and i would want to know what they were without playing with their diet they are currently on.

You would think...

I copied the info from the U of Tenn. Also, since my dog was diagnosed last April, I study that site quite a bit.
Also, my Tink is on L/D, and that's 20% pork fat (kibble) I refused to give it to her till I spoke with the vet again! Another YTer warned about feeding pork, and that's about the highest percentage of fat I've seen in any food. Tink loves it though and it is helping to keep a bit of weight on he.r

Originally Posted by dwerten

very interesting about the toxins though as toxins will affect the alt

yeah i have read if bats are not normal they will never be normal so no need to keep redoing them over and over

Yeah, that's the only thing that stood out to me.
And with BATS I read alot of pups are retested between 3-6 months of starting a liver diet. I guess to make sure things are improving. Many report BATs improved. IDK!

[dwerten]

Originally Posted by kjc

I'm sorry, it is not used in Human food



You would think...

I copied the info from the U of Tenn. Also, since my dog was diagnosed last April, I study that site quite a bit.
Also, my Tink is on L/D, and that's 20% pork fat (kibble) I refused to give it to her till I spoke with the vet again! Another YTer warned about feeding pork, and that's about the highest percentage of fat I've seen in any food. Tink loves it though and it is helping to keep a bit of weight on he.r




Yeah, that's the only thing that stood out to me.
And with BATS I read alot of pups are retested between 3-6 months of starting a liver diet. I guess to make sure things are improving. Many report BATs improved. IDK!

yep dd was retested by jean 6 months after being on purina ha which is 18% protein and 8% fat so it works for both dex and dee dee and she went from 73 and 54 down to 26 so it definitely helped

yeah you are probably more current than me on the U of T as have not read on it in a while and not real active on the yahoogroup anymore just going by posts on sm and here and what i read back a few years ago with dee dee as i wanted to be sure to know everything i could before she got radioactive dye in her body and so glad i did as no way was i doing that unless she was well over 100 or having serious symptoms below 100

whew good to know on the fish as i am having the hardest time with pilling her with stuff - i just did not like the cod being from CHINA WTH is up with that so we will not be buying that anymore and the one from whole foods is hard to pill her with it is too thinly cut

[kjc]

How's he doing on the new diet?

I just wanted to add that before my dog went on L/D, I asked my vet to talk to someone at U of T, bc her ALT had shot up to 599 (after ingesting rancid grease), just so we would be on the same page with a treatment plan for her. My vet was most impressed with the treatment she got over the phone... she says they are all so nice and so helpful. A Vet there did tell my vet that getting her on L/D was absolutely the best thing to do, as they have seen the most improvement in so many dogs after just switching to the L/D diet.