While I wait...info on LS
 

Nancy said I needed to post this. Chipper threw up yesterday at noon and then again at 2:00. Decided to take him to the vet. He had an anal gland that she described as "very hot and full." I mentioned that I am always so scared of LS because he is from a byb. She decided to run a blood test. Everything was normal except the ALT was 1,863 and the BUN was 35. Decided to do a sonogram. Couldn't find the liver. Took an x-ray and said she thought the liver looked small. None of these are good signs.:( She wants to do a fasting test on Friday. Been thinking that maybe I should just head off to the U of Tenn. that specializes in LS. My question is....since he is asymptomatic what is my time limit? Tomorrow, a week, a month? My vet also put Chipper on k/d canned food. Thought l/d was what was recommended. He has not thrown up since yesterday afternoon and is as feisty as ever.

Now this is why I am hoping there is a mistake. She ran tons of tests on Cocoa and said she had Cushings. Turned out to be EPI. Just don't know how the ALT # can be so high and he doesn't have any other symptom. Yes, yes.....I know I am grasping at straws. We are just so devastated because he is my only normal Yorkie. The two senior girls are both so traumatized by their past.

Nancy gave me a link that makes me think that we are headed for the LS diagnosis. I am so sad.:( ~Joanne~

I am so sorry your Chipper is not feeling well and will say a prayer for him and also for you.

There are lots of people here who can give you good information. In the meantime, try not to get too worked up until you know for sure what you are dealing with.

I believe she put him on K/D because of the BUN being elevated. That should also be low in protein. But...ask your vet anyway! I always question the whys of what my vet prescribes so that I know ...I don't like to leave there with questions because then I worry more.

My suggestion would be to take your baby to Dr. Tobias.

With Dr Center's protocol on running bile acids, it is unnecessary to do a fast. In order to get an accurate Bile Acid Test...it's in the process on how the blood is drawn and tubes used. Dr. Tobias is very familiar with Dr Center's protocol. However, Dr. Center's has made herself available to any vet requiring assistance and instruction.

Again it is unnecessary to run a fasting...I'm attempting to find The Yorkie Gazette where it has her protocol printed....I'm looking all over this house for it.

As far as time limit.....Better now while he's asymptomatic.

Does that mean I need to get on the phone tomorrow and make an appointment? Do I need my vet to call? Thanks for info.

You can call directly....At least I would....I'm not sure how the whole situation is handled....But, I do know that the sooner the better.....

I'm still looking for that particular issue of Yorkie Express......I'm turning this house upside down...and it's buried somewhere.

Oh by the way. I do know that Dr Tobia's Husband just passed away.

If you dog is currently not symptomatic; then you probably have a little time to plan and decide what is best.

Sounds like your next step is the BAT - which you may decide to do locally or to visit Dr. Tobias if that is possible for you. My Vet does the testing locally - but sends away for the results. It stil only took a couple of days to get the numbers back. Those numbers are going to help you decide where to go from there.

I wouldn't wait indefinitely - but don't think you have to go tomorrow or next week either.

Best of Luck and keep us posted on your little one.

I am so appreciative of the information that is being given to me. I just sent an e-mail to my vet with a link to Dr. Tobias. That's too bad about her husband. Guess all we can do is call and see when she'll be back. Dr. Centers was mentioned. Does she have a site? Would like to give that to my vet. My vet has been terrific working with Cocoa who has EPI and I expect her to be the same with this issue. I do, though, want to have the best care for Chipper if it comes to that.

One other thing.....is there any chance that kibble could affect the numbers? I just recently changed Chipper over to Orejin. I did hear a little blip about that. Thanks again. ~Joanne~

Dr Center is out of Cornell University. Since I can't find my Yorkie Gazette, I'd PM Dwerten for the contact information.

I've heard at times that kibbles can skew the numbers. But, don't jump to any conclusions at this point, wait until all the tests are in. I really think your first thought of seeing Dr Tobias...is the best route....but, there is no harm for a back-up plan.

I just found information that Dr. Tobias requires a referral so that she knows that there is a vet who can help when the doggie goes home. I have been sending some of the links about Dr. Tobias to my vet.

If you can get in touch with Dr. Center so she can instruct your vet on the correct method for the Bile Acid test.........

Okay, I found Dr. Centers e-mail and telephone number. Forwarded it to my vet. Also noticed that Texas A&M works with liver shunts. Any thoughts? That would be closer, I think.

Dr. Center is one of the experts in the field, she actually developed the Bile Acid Test....

I'm not sure about Texas A&M. But, my vet out of Texas who sits on the board with Dr. Center may be able to assist you. Dr. Robert Hawthorne -214-328-3255. He'd be able to give you more info on Texas A&M

We had a LS pup a couple of years ago that went to A&M and she did fine. I do think they are more expensive than UT. I also have heard so many positive things about Dr. Tobias that I am not sure if I would go to A&M for LS.

Just want to thank everyone for information, thoughts, and opinions. They are greatly appreciated. Good night everyone. Have a great Thursday. ~Joanne~

Hi. Sorry to hear this news.

First thing your vet can do is the Bile Acid Test. I think the fasting/non-fasting issue has to do with the involuntary release of bile that many dogs do in the middle of the night, which will throw off the prepandial (first) result (may be high).

The postprandial (after meal) needs to be drawn exactly 2 hours after the meal.

I don't think anything can be done before you get these results, and this test can be done by your regular vet. The U of Tenn. is willing to talk to any vet seeking info/protocols for treating any suspect LS dogs.

Usually dogs with LS will present with more than one high liver enzyme. ALT, AST, ALKP run high, and the BUN will be low. Also, normally with a high ALT, the AST runs close to parallel (should be increased also).

The High ALT means that there is cell death in the liver. (The liver can regenerate itself to an extent).

Many times a UTI will be going on also, crystals may be present.

Could he have gotten into something toxic?

Another YT member went to Texas A&M for diagnostics, and basically it was a total farce. Stick with U of T.

I have to go, but I'll be back in 1 hour, if I can be of further assistance.

Kathy

Thank you for all the information. This is what my vet sent me this morning:

Hi. How is chipper feeling? I read thru the site. Good points. I think one thing forgotten about the fasting is that it reduces the problem with lipemia. It can be frustrating to set up a test and find out that the day is wasted because the sample is too lipemic. I think that feeding him 8 pm the night before let us draw blood first thing in the morning then feed him right away won't take him too far off routine.

Any thoughts on what she said?

~Joanne~

With just a high ALT, I wouldn't go to UT too quickly. It is likely LS or MVD, but there is a long list of things that can cause the ALT to rise. Just wouldn't want to see you go all the way there without more proof. Bile acids testing should be done and any vet should be able to understand how to do it when given insructions. All vet hospitals and schools come after UT and Cornell when dealing with LS (IMO). I'd make the trip to UT if one is suspected (after BAT). Although I might also consider scintography around home too just to make sure.

A slightly elevated BUN can be caused by high protein food. The same could be said for ALT, but keeping in mind that the reference range for Idexx is 18-100, this is over 18 times the highest it should be. So, IMO, the protein could not be responsible for such an increase.

I was also thinking about toxicity. There are so many possibilities. If you aren't confident with your vet right now, you could go to your vet school, have them do the bile acids test and whatever else, and then transfer to UT. I'm sure UT would be willing to do testing even if it isn't for LS, but that just seems so far away from you.

Do you have the ultrasound report? What was found? Or did you say vet didn't see the liver at all? Not quite sure why a general DVM was attempting an LS U/S. Even the most skilled with this disease can have trouble with it.

You are right about the K/D. It's low protein, but it isn't the right type. L/D canned is safer.

BTW, Ellie has had three BAT and has been fasted for all of them with no raise in preprandial. I'd do what your vet is comfortable with. Most will still insist on the fast because that's what they have been taught.

Okay, I'm back.

If the postprandial result is under 100, it is indicative of MVD, which is a disorder that presents identically to LS, except there is no shunt. It is inoperable, but successfully managed with diet alone, or diet and Lactulose if necessary.

If the result is over 100, it is indicative of LS, and if a single shunt is present, is operable. (98% success rate at U of Tenn. considerably less at other animal hospitals/clinics) Multiple shunts cannot be repaired, but are managed with diet and meds.

So if the postprandial result is less than 100 = low protein diet

If over 100 = low protein diet, Lactulose and Denamarin (liver support)
and further testing (at U of Tenn) scintigraphy most likely, to determine if there is one or more shunts.

That sounds appropriate to me. How old is Chipper?

Chipper is 3 yrs. old. He's a wonderful bouncy, energetic little boy. He lives up to his name. His only downfall is that he likes to lick material. Spray Bitter Apple and he stops. Thank you, once again, for all the replies. I'm getting a grip on thing. ~Joanne~

My Tinkerbell was diagnosed at 2.5 years old. She's asymptomatic also, full of energy (too much if you ask me!). She's on L/D, Lactulose and Denamarin. Her BAT was 44 pre, 126 post. Gallbladder disease can also skew the BAT results.

One thing to consider: U of Tenn gave me an estimate for scintigraphy, and any other necessary diagnostic tests, Shunt repair surgery, all medications, and 3-4 days aftercare = $1400.00 - $2000.00. (They prefer to do their own testing after the BAT results are in, as if done elsewhere, they may need to be repeated.) ) Other hospitals are charging twice that for the surgery alone. So you could take a mini-vacation in Tennessee while your pup has surgery and still save money. On their website, they give a list of pet-friendly hotels that give a discount if you are staying bc your pet needs surgery. Plus they have the highest sucess rate bc they are the most experienced in doing shunt surgery.

Also, check the Uof T website, there is so much info on LS... they explain everything...

I can tell you that they will give your Chip the best of care at UT, I was there with Micah who has( MVD,small liver,luxatting patella & he only had 1 testicle) in dec 09 he was given the best care and i was treated so nice and i appreciated that so much that you are not rushed and they answer any questions.

Micah was put on Hill's LD wet/dry he takes adenosylmethionine & milk thistle each 1time aday

why K/D that is for kidney and that bun is not that high but kidney diet is low protein low sodium as well but L/D or the royal canine are better for liver issues

if asymptomatic you have time. Do the pre and post bile acid here then see what the numbers are then go straight to ut if the numbers are well over 100 and have scintigraphy done. Ultrasound is waste and protein c waste in my opinion. That Alt is high :(

i personally always do fasting blood work on mine as i do not want any interference of food for pre and post is how liver is handling food after introduced so that is just my personal opinion

yep if high in protein it can definitely affect those numbers is the protein count way over 22% ?

here is her info just call main number

Cornell University Hospital for Animals

i have heard they are so awesome and it is horrible dr tobias' hubby just died i think of cancer :( just heart breaking

dd had 3 bats as well and first time no pre only post and second two she had the same pre post 3 and post were higher 73, 54 and 26 but her alt was never elevated and she has mvd. We always did fasting

what she is saying is there may be too much protein and fat in the blood to get a good reading if not done on fasting - i tend to agree with her - we as humans fast to get a good blood work up so i do the same with my dogs- some tinies cannot fast that long and where the problem begins i think and why centers may not deem necessary for those guys and she probably weighs more heavily on post numbers after food is introduced anyway as that is how you can tell if the liver is not processing proteins and toxins and it is bypassing the liver.

i would only have tobias do the surgery if my dog had liver shunt. Centers is internal medicine specialist and tobias is a surgeon - they are the experts in the field for this