Please help!!!
 

Sorry if this is long. My girl has been sick just for a couple of days last weeks after 3 days she is herself again. Anyways, she has a complete bloodwork which all came back normal. My vet didn't know what could be wrong with her (she has a fever also) So he sent me home with some antibiotics to give to her. I posted before here and some members here told me to get a bile test done on her. So I called the vet and requested that I wanted her to have a bile test. She didn't eat for 12 hrs. to prep for the test etc. Well that was friday. The vet called today and said her test was high 96. He said it wasn't really high but still abnormal. So he wants us to take her to Virginia University hospital for an ultrasound to see if they can see a shunt. My question is, does an ultrasound show a shunt or am I just wasting money, should she be having some other test done to find a shunt? Can anyone recommend me anyone to go to? And what kind of test would show a shunt? Please, Please if anyone can give me any kind of advice or anything please let me know. I really appreicate it. I want to take her somewhere that is experienced with shunts and know what they are doing. I dont' want to put her through any kind of worthless tests. Please help!

I don't know that much about shunts, I just wanted to let you know I will say a prayer for your little one. I have read about Dr. Tobias at UT which is near me in East Tennessee, from what I have read she is the best. I hope some of the more knowledgeable members will pop in soon to give you some good advice. I know there are a lot of them who are experts in this area. I hope your little girl is better soon.

What symptoms was she having?

96 is very high for bile acids considering the normal reference range.
Ultrasound is good for some things (size of liver, bladder stones, etc.), but they aren't great for locating shunts. Scintography may be a better option. How far are you from Knoxville? University of Tennessee is preferred in this case.

That is what's puzzling me? She has no symptoms of liver shunt. I have been reading all about it and the symptoms, but she has none of the symptom. She was not feeling well for just 3 days last week and now she is back to normal playing and running around like nothing is wrong with her. My vet told me that 96 wasn't that high? Is he wrong? What is normal and high? Thanks for any information you can give me. I live in WV. But going to Tennessee is no problem if she is better off going there to be seen.

Reference range is 15 or 20 and below post meal. 25 is sometimes considered normal. 96 is pretty far up there... That doesn't mean it is uncommon in Yorkies, but yes, it is high.

The three day illness may not have been related at all unless she was having neurological symptoms.

Bile acids under 100 usually indicate microvascular dysplasia (MVD) in Yorkies (small shunting throoughout the liver....inoperable). Over 100 usually indicates a shunt that can probably be repaired. There are many exceptions to the rule and sometimes they don't show symptoms till later in life. Some dogs, esp. with MVD, can be completely asymptomatic. So if she does have MVD you may not have to do anything at all. Best option (imo) is to see an internist and go from there. If they want to go further with testing and they give you the choice of u/s vs. scintography, really consider the scintography since it's much better at locating a shunt.

Try not to worry too much in the meantime though because asymptomatic MVD is possible and you may not need to do a thing or just give supplements and/or a diet change depending on what you and vet or internist decide.

Does that make sense?

My girl's bile acids were post 106 at last check. Liver biopsy didn't show anything serious and u/s didn't show liver problems really. I just give supplements, watch her protein intake, and we are very careful with the drugs that she receives.

Thank you so much for the info. I am expecting a call from Virginia University to take her there for an ultra sound , but I believe I may go ahead and see if they do the other test or take her somewhere that does. Anyway we go we will have to travel quite a distance and spend the night at a hotel which is fine. I just want what is best for her. I don't want to take her to someone that doesn't know much about shunts etc. My vet doesn't seem to know much about it either. I wish we could fine a good vet here where I live.

You're welcome.

Most internists would be able to explain everything to you in detail, but I wouldn't let just any of them attempt an u/s simply because you have to be highly sklled to find a shunt. So unless they are looking for other things, just be careful about going this way. Some vets anesthetize for scintograohy, so there may be more risk involved. I'm guessing not all vet schools over it either. If you have to travel to either place and you do want to consult at a vet school, then by far UT is the best choice. MSU is supposed to be pretty good with this (I am in MI) and if Ellie ever needed liver shunt surgery, I would still go to UT.

You can take a dfiferent route and just wait, watch, and retest which should be fine for awhile. I would not recommend that with a 96 though. Just a bit too high to guess at (imo).

Can anyone else give me anykind of info please!!! I really need to know what others have done. And does anyone know about how to get in contact with Dr. Tobia in Tenn? If that is where I should take her then that is where we will go. I just don't done want them to run all these test that are unnessasary. Please anyone?? And thanks so much for the ones that have responded, you have been very helpful.

This link is for the Univ of Tenn and will tell you everything you ever need to know about Liver Shunts.

Portosystemic Shunts FAQ

My dog BAT tested at 126. She is eating L/D (low protein) and takes liver support meds. I asked my vet to do an x-ray first to determine the size of her liver and to see if any gallblader problems were evident. (I am cheap and this was the cheapest thing to do, and gives you some insight as to what you're dealing with.) Gallbladder problems can skew the BAT results.

We also did bloodwork, to check the liver enzymes and chemistries... normally done before the BAT, but if it wasn't, you could do it now.

Because her BAT is 126, my dog most likely has a shunt, just on that number alone. As no GB problems evident on xray, her liver is small, next we're going to do an Ultrasound, only bc my vet is confident that her u/s person can do it well enough to find a shunt. I had planned to go to U of T, but as her BAT could be alot higher, I'm thinking maybe she has MVD (bad case) and I didn't want to waste a trip if she ends up with MVD or multiple shunts, as they are not operable. If she appears to have a single shunt, we'll be going to U of T for a scintigraphy and surgery there as they are the most experienced and the least expensive.

Since diagnosis, she has been on a low protein diet and medications (Denamarin and Lactulose) and is doing well.

Because so many BATs have been done, normally any result over 100 means there's a shunt. Any result less than 100 means they have MVD.

If your dog was mine, I would put her on Hill's Prescription L/D diet, and redo the BAT in 30-60 days, provided she shows no symptoms. If she shows symptoms, then I would start her on Denamarin (liver support) and Lactulose.

If her next BAT is less, I would accept that she has MVD and keep her on low protein for life. If it increases, maybe do an ultasound if your vet knows a good one, or go to U of T for further testing.

Read the info on the website, it will help you to understand alot.

The U of T will also accept calls from your vet and discuss treatment plans and testing options for your dog. They are extremely nice folks there.

Ok, thanks so much:)

For a pretty easy read about Portosystemic Shunts by, Karen M. Tobias, DVM, MS, Diplomate American College of Veterinary Surgeons, Professor, Small Animal Surgery, University of Tennessee Department of Small Animal Clinical Sciences...see below:

Liver Shunt Research

I'm sorry to hear about lil Ann!

Dont freak out - as others have said, a BAT of 96 postprandial could be MVD as opposed to a shunt. Daisy's BATs were around this level when we first learned she had MVD.

In our case, Daisy was over 6 when diagnosed and we opted to do the ultrasound through our specialty hospital here as a first step. Our u/s showed a small liver and this led the analysis more down the road of MVD in our internist's analysis.

I have to disagree with some posters. I would not try lactulose, Hill's or any of that until you have had a licensed veterinarian make the correct diagnosis. Once you have that diagnosis, then suggestions here may warrant discussion with your vet. There are some similarities between treatment for dogs with MVD and liver shunt but each dog is an individual and just like us, there is no "ONE SIZE FITS ALL" approach for this or any disease. I say that because my dog is on none of those things. She does not need lactulose, does not eat Hill's L/D, and does not take any supplements. We do excellently with her on a home cooked diet alone and her liver has consistently shown improvement. At nearly age 10, Daisy's blood work is almost completely perfect!

Good luck, we will be praying for little Ann!

Here is some more input for you.

I had heard thru the grape vine of liver issues with a couple other pups from my Roxy's parents, so off we went for a BAT. Which came back at pre 43 and post 100.9

My Vet said it is in shunt range, but he doesn't do any further, so he sent me to a Internal Medicine Specialist for an U/S. I knew going into that they are only about 60% accurate in seeing a shunt, but it was a Doppler u/s and I was assured that their is only one Dr. there that does the u/s (she is the only one skilled enough).

Her U/S showed a normal sized liver, normal shape. No shunt was seen, however, no one could tell me 100% there wasn't a shunt. We did more blood work, clotting tests, urine analysis, and a repeat BAT. All came back normal, except elevated BAT results.

We tried Lactulose and Metro for 10 day and I had already switched Roxy to a low, but quality homecooked diet (created by a Vet-Nutritionist), and I was to watch her behavior to see if the Lactulose and Metro was making any difference.

After 10 days, my report was that I honestly did see any "better" behavior in Roxy, so my Internal Med. Special said Roxy didn't need the Lactulose and Metro. And based on Roxy really have no major HE symptoms (other than she can be docile and has poor muscle tone), both the IMS and my Vet believe she has MVD.

Oh, we also did a Protein C which came back at 165%

If I were you, and going to U of Tenn isn't that big of a deal, that's where I would go for a consult ;)

Roxy is still on her special home cooked diet and she gets liver support (Vetri DMG and Hepato Support both from homevet.com)

Please keep us posted :)

Here's some information on Dr Center's new Bile Acid Protocol and some question and answers from her last seminar.

http://www.ytca.org/health_centermessage.pdf

http://www.ytca.org/health_CenterQue...xpress2010.pdf

http://www.ytca.org/health_biletestproced.doc-1.pdf