Microvascular dyplasia
 

I typically do not post, but felt compelled to share a few different experiences here today.

This story is a little long-worded, my apologies.

January of 2009, my husband and I was informed that our 10 year old yorkie was terminal with abdominal cancer and there was nothing that could be done to save her. Any surgery performed would only be to stop the internal bleeding when it undoubtly resumed after the fluids has wore off and she was no longer stable. I had been mourning a previous loss of my first yorkie, she passed in July of 2005. Weeks before learning of Sassy's fate, we had finally decided it was time to add a new addition. After humanely ending Sassy's pain Tuesday evening, we went ahead and got a new puppy that week (we have a shih tzu mix that had never been alone).

Coco, a lively little yorkie who annoyed Belle to no end, joined us that Friday. I fell in love with another tiny little yorkie that wasn't quite ready for her forever home and placed a deposit on her as well. We picked up Martini exactly 4 weeks later. There were nights that I sat here wondering why I got 2 puppies so close together. The house-training, the crying at night...but then the kisses, the romping and playing, the snuggling up in my lap to sleep....who cared about a little accident here and there, and the crying at night ended when I put them in our bed.

Little did we know that Martini would only be in our forever home barely 4 months. One night she ate a mushroom outside, because she had an underlying liver shunt....her little body couldn't process the toxins and within 6 hours she was gone. The emergency vet suggested a necropsy, which of course and the shunt was discovered. The NJ broker (who got his puppies from a PA puppy mill, after-the-fact knowledge) blamed me. The vet said mushrooms would typically cause GI issues, even hospitalization in tiny dogs...but around here they weren't fatal.

The next week, I had Coco's bile acids tested. Abnormal, a low abnormal....but abnormal all the same. Began denamarin, and retested in 3 months, no change...had fluctuated 3 points. Continued denamarin and rechecked in 6 months....triple the orginal. Took copies of my labworks and went to University of Penn in Philadelphia. They performed a complete work-up on Coco but didn't retest her BA. Everything else was normal, urine, annomia levels, cholesterol, everything.

The doctor there told me that sometimes a number is just a number is just a number. She advised me that Coco could resume a regular diet and didn't need any meds. SO NOW WHO DO I BELIEVE? Sure she was asymptomatic, but hello....3 abnormal BAs? And a number is just a number is just a number? Who says that to a neurotic, crying pet parent? I phoned my husband before I left the parking lot.....if she had a liver shunt, I was going to the University of Tennessee! (And I am an Alabama Crimson Tide fan! but UT is the best when it comes to liver shunt surgery and that is what I want for my girls, the best). The doctor at U Penn said we could do an ultra-sound but they wanted to keep her overnight, I couldn't leave her there, I didn't know those people. Besides, I knew from everything I had read since June 2009....ultrasounds aren't the most reliable. If she had to go under anesthesia, then go the extra step and do the liver biopsy.

Yes I realize that is extremely much more invasive, but also much more definite as far as answers....why subject them to test after test after test? We had an appointment to have 3 remaining puppy teeth pulled (we had been putting it off because of the BA results and her going under anesthesia again), so my regular vet and I discussed it and came to the conclusion to do the biopsy.

So Saturday I received the call......Coco has microvascular dyplasia. I have so many questions, will it shorten her life? Is it just the denamarin and special diet she stays on? At least with a liver shunt, it can be fixed if you know it is there to fix....but from what I have been reading, this is life long and no cure. It is just managable?

Since all of this began with losing Martini, we have gotten another yorkie...Pickles. Her BA is normal.

Any knowledge to share regarding MVD is greatly appreciated.

Hi There! Welcome to Yorkie Talk and sorry you are dealing with these issues.

I have two MVD dogs, one confirmed via biopsy and the other diagnosed with BAT's only.

This is something you will deal with for the rest of your babies life but it is NOT a death sentence by any means, not even close. Many Yorkies live with this disease their entire life and never show any symptoms.

My dogs could not tolerate Denamarin, so they take other supplements like Milk Thistle to help protect their liver. A specialist I recently saw recommended I get them on Vitamin E as well. I also watch their protein intake and the types of proteins they get. I let them eat chicken, cod, cottage cheese, eggs. Things like beef, lamb, salmon, duck... never touch their lips. I try to keep their protein levels lower then a normal dog but I am much more restrictive with the types of proteins that go into them. Okay, so some say neurotic, but you get the point ;)

There are lots of members here with MVD dogs who can help you out, some I can think of...

Dwerten (she is on a short break at the moment but when she gets back, she is a WEALTH on knowledge on this topic).

107barney

Ringo1

EllieMay

Hopefully some of them will stop by here soon.

Feel free to PM me any time you have questions.

My Manolo has MVD and was diagnosed about 2 years ago. Yes they can live a very normal life, you must watch the diet. Please Join the Yahoo Group for Liver Shunts and MVD. They helped me so much. Manolo is on a Vegetarian diet. He eats Natures Recipe, Farm Stand Vegetarian. Plus I give him one fish oil cap a day. Fish is a good source of protein. Manolo can never have Beef or Chicken or Pork. This will make him seisure or act slow. Even Heartguard because its beef based. I give him apples and carrots. As a matter of fact, Manolo is having his Dental today and his vet just called and said he did great. You must have a vet that know his stuff. They did a Full CBC prior to surgery. He uses Sevoflurane gas and had no problems. However, he is still there only because my vet wants to monitor the pain meds going thru his system. Its going to be OK. MVD is not a death sentence but a lifestyle change. You will learn so much joining the Yahoo support group. Good Luck to you guys and keep ur chin up, its going to be fine. And remember, it's mainly about the diet. I give NO treats except sweet potato chews. Lissette

Almost forgot, Welcome to YT. :)

Morgan has MVD too based on BATs. She is asymptomatic though and I only did a BAT on a whim (she threw up after eating EVO a few times but that might not even be related). She has eaten many types of kibble and even RAW with no problems. I do not do anything different with her right now. She is not on a special diet (currently eating grassland acana) and she does not take any supplements as of yet. But i am debating putting her on denemarin since it wouldn't hurt.


every MVD case is different as you can see from the people who've already posted. some cases are worse then others, and some show no signs at all.

As you can see, there are quite a few of us dealing with the MVD issue. If you search the threads, you will find a lot of information.

Do you know how severe her MVD is? Hopefully, it IS something you can manage with diet and supplements. It will be lifelong monitoring.

We had two abnormal BATS - only mildly abnormal, however. My Vet is insistent that Lucy does not need a special rx food; just to moniter her protein intake. Pretty vague, huh?

I actually think I've been pretty loosey-goosey with it because she was doing so well; now we've had a couple issues (related or not) that scared me.

I had her on Wellness Limited ingredient (or some such) that was only 20% protein; fairly low compared to EVO, Blue Buffalo, etc. No beef but I did give chicken and Lamb.

Now I'm sticking to strictly chicken/fish/egg white and WAS trying Natural Balance Vegetarian but she is not liking that too well.

If your dog is asymptomatic and you have her on the special food . . so far so good.

Has your regular Vet given you any advice?

You should try to get those numbers down to 16% protein.

kind of off topic for a second... but how big were the kibbles with the wellness?

We are using Innova small bites right now and the kiddos are starting to get "bored" but I have a hard time finding lower protein foods that have small enough kibbles that they will eat.

thanks! :)

I am so sorry for your losses. My Cali(5 years old) has a very mild MVD diagnosed by a liver biopsy when she was 8 months old. Her BA's were somewhere in the 80's and a little lower on retest. She has no symptoms and is on no medicines. I do watch her protein and my vet treats her as liver compromised. She just went under for her first dental and the pre surgery blood work looked great and she did fine. So MVD can definitely be treated and how depends on the severity. I hope your baby continues doing well.

The kibbles are too big. I put a bunch in a baggie and smash them down with a wooden spoon. Primitive, but it seems to work; she likes the smaller pieces but not ground to a fine dust. I do a lot at one time and just keep it in a tupperware container.

I would love to but the lowest I've found so far is the NB Vegetarian; she is not going to eat that. I've tried every topping I can think of and it's a no-go.

What are you feeding . . or do you homecook?

Never mind; I just saw that! Maybe I'll give that one a try.

Try that NB Vegetarian and break open a Cap of 1000mg Fish oil EPA 180mg DHA 120MG. Guarantee your baby will love it. Great for her coat and allergies too. Lots of people use and swear by Royal Canin Hepatic LS. I used it for a while and all of my dogs went nuts over it but Natures Recipe FarmStand Veg is more convenient to buy.

Try that NB Vegetarian and break open a Cap of 1000mg Fish oil EPA 180mg DHA 120MG. Guarantee your baby will love it. Great for her coat and allergies too. Lots of people use and swear by Royal Canin Hepatic LS. I used it for a while and all of my dogs went nuts over it but Natures Recipe FarmStand Veg is more convenient to buy.

WOW!! I am shocked at the response, although I don't know why....I personally have always thought that yorkie people are fabulous people!

Thank you all so much so far. The responses and well wishes are gratefully received. A few responses if I can remember all the questions.

I did join the yahoo Liver_Shunt_MVD_Support group, thanks for that recommendation.

Coco's case is rather mild I think....she has scored under 100 with each BAT. The liver biopsy was really at my insistance. I had much rather tackle an issue in the beginning, then wait for something to happen. Since Coco and Martini had came from the same broker, I had to test Coco after Martini's passing. I am perfectly ok with being neurotic. My vet is good, she listens to me and finds me answers if she doesn't have them.

She did put Coco on Royal Canin Renal MP Modified back in October, after the second test. Denamarin has been a regular part of our routine since last July. We have been lacks for about a month and a half after the visit at U Penn and the internist there feeling Coco was fine. (I should have followed my gut.)

But we are back on track now, however I want to incorporate a RAW diet, although from what I have seen....I may just homecook for Coco. The one thing I have been a little confused about is mixed opinions on chicken? I have seen that you can use it and then that it shoudn't be used.

Also, we tried the special diet treats from the vet....she wouldn't eat them. Nor would Pickles and she eats anything. One thing that I have been giving her and i THINK it is ok, should probably ask my vet....Coconut and Pumpkin Crunchers which has crude protein of 10%, Zuke's Mini Bakes containing crude protein of 11%, and Zuke's Hip Action containing 10% crude protein. Funny thing, while just checking all these treats, I checked the Hill's Prescription Treats and it is 13% crude protein. So I guess the others are good!

I am still a bit overwhelmed by this all. But so very thankful to hear from others and to be learning how managable this can be. Thank you all!

Happy reading, fill us in if you find something new. I cant feed chicken to Manolo. He does react, somtimes seisure or just acts real slow and confused. They LOVE Sweet Potato.

Hi and welcome to YT. As you've already heard, you're in good company as many of us have an MVD dog.

My Daisy was diagnosed as probable MVD at age 6. Her numbers for her ALT as well as her bile acids were bad. Her postprandial number was 106. She was right at the cusp of MVD vs. liver shunt. Given her age, we opted to try medical management first before putting her through a biopsy or exploratory surgery. Although there is a possibility that shunts are not detected on ultrasound, we went for it anyway since an expert in imaging would be conducting it as opposed to our general vet. In our case, the ultrasound revealed some anatomical features that supported an MVD diagnosis.

To make a long story short, Daisy is going to turn 10 years old this year. She is in the best health of her life, thanks to Dr. Remillard at the MSPCA Angell Memorial Hospital in Boston who formulated a home cooked diet for her that greatly improved the quality of her life. Her liver enzymes and her bile acids are within NORMAL ranges.

We currently only do the home cooked diet using vegetarian sources of protein and carbohydrates and her fats consist of therapeutic dosing of omega-3 fish oils. We plan to add milk thistle back to her regimen but we have to do a follow up with her internist first before we just put her back on.

Dogs with MVD can do fine on chicken, but some cant. If you want to home cook, your best bet is to contact a vet nutritionist for a program tailored to your dog. We love Dr. Remillard so recommend her, but there are others out there too. Our dog Daisy never did good on meat - she also has irritable bowel issues and severe allergies (those issues have resolved on the diet too).

To sum it up, MVD is not a death sentence. Your dog needs to be managed but many of us do it every day with success. Daisy is a miracle dog and she is very active. She runs around the yard, she plays ball for hours, she plays at puppy class when Teddy goes, and all the things dogs do. You'd never know she was sick.

Good luck!

Is Coco actually showing any signs of MVD or do you just know because of the BATs and biopsy?

Sounds great!


I found this from Dick Van Pattons NB. INGREDIENT LISTING
Brown Rice, Oatmeal, Cracked Pearled Barley, Peas, Potato Protein, Canola Oil, Potatoes, Tomato Pomace, Vegetable Flavoring, Calcium Carbonate, Dicalcium Phosphate, Flaxseed, Potassium Chloride, Choline Chloride, Taurine, Natural Mixed Tocopherols, Spinach, Parsley Flakes, Cranberries, L-Lysine, L-Carnitine, Yucca Schidigera Extract, Kelp, Vitamin E Supplement, Iron Proteinate, Zinc Proteinate, Copper Proteinate, Ferrous Sulfate, Zinc Sulfate, Copper Sulfate, Potassium Iodide, Thiamine Mononitrate (Vitamin B-1), Manganese Proteinate, Manganous Oxide, Ascorbic Acid, Vitamin A Supplement, Biotin, d-Calcium Pantothenate, Manganese Sulfate, Sodium Selenite, Pyridoxine Hydrochloride (Vitamin B-6), Vitamin B-12 Supplement, Riboflavin (Vitamin B-2), Vitamin D-2 Supplement, Folic Acid.

GUARANTEED ANALYSIS
Crude Protein 18.0% minimum
Crude Fat 8.0% minimum
Crude Fiber 4.0% maximum
Moisture 10.0% maximum
Omega-3 Fatty Acids 0.3% minimum
Omega-6 Fatty Acids 2.0% minimum

For comparison purposes, Daisy's home cooked diet is formulated, on a dry matter basis, to be
Protein 15%
Fat 5%
Fiber 16%

Glad your baby is doing well. Last Question - I promise. Is the RC Hepatic LS by prescription only? If so, my vet absolutely will not give it to me. He said again tonight that a prescription food for her is not necessary; her numbers are too low to warrant that.

my answers in red above.

Ellie has...something wrong with her liver. Biopsy ruled out widespread MVD, but not a more localized form. Her bile acids have been as high as 106 post, so it is theoretically possible that a shunt is present. She has no neurological symptoms and her u/s didn't show a shunt, so we aren't doing anymore testing right now. Because the bile acids have been so high, so is still treated as if she has MVD. This is most important for her when talking about anesthesia and pain meds used. I do give SAMe (Denosyl) because it can't hurt and I want to do something. She is on low to moderate protein. I don't like giving red meat or exotics to liver compromised dogs. Vegetarian protein, eggs, and whitefish seems to work best for the majority. Some do very well on poultry and some don't. Depends on the dog. When treating a severely affected dog, vegetarian proteins or fish or generally used...

In Ellie's case, her bile acids went from 47 to 15 to 106 post, so they got better and then worse. I'd be very surprised to see bile acids normalize for life in an MVD dog. Even if they do, the disease is not cured (but managed very well!).

Royal Canin 14 is rx only.

Sorry about my run-on paragraph. :)

She had loose stools occasionally, after being told we could go back to a regular diet and vomited once, all of which may or may not be related.

But she hasn't had a bundle of clinical symptoms that prompted me to believe she is sick. If not for the second loss last year, she wouldn't have been tested until clinical symptoms appeared.

Wow yes it is Prescript. What are her Bat nums. I think Manolos were, 30 pre 60 post. He does seisure but has not in a long time. He did have a biopsy.

Her last BAT was <5 pre and 35 post. So . . pretty low. Because she is not yet a year old; he didn't want to restrict her protein too much. He thought the 20% Wellness was a low as we should go.

I wouldn't have tested morgan either if i wasn't a crazy momma. LOL She never has loose stools or vomits, and she's pretty healthy all around. The only thing i ever noticed was the two times i tried to put her on Innova Evo (at least a year apart) she would vomit after 2-3 days of eating it. I'd start to mix it in with her current food and for the first day or so she would be fine. But then by day 3 she starts to vomit. Since Evo is so high in protein, that was my only clue.

I also worked for a vet er and referral hosp at the time so i had all the tests and specialists at hand. i did BATs and an ultrasound. BATs were high (65 post) the two times i did them there. Ultra sound showed normal liver and some sludge in the gall bladder. Internal med vet said since she isn't showing signs and her BATs/US didn't show anything too bad i didn't need to alter her diet or do anything different.

My vet did wait until after her first birthday to change her over to a restricted diet. Coco's first BAT was 25.1 in July 09, second was 22.9 in Oct 09, and last was 69.8 in Apr this year.

Denamarin was added in July, the diet change in October...because of these changes and the even higher BAT in April, my vet had actually suspected a portosystemic shunt.

Personally I am still annoyed that I went to U Penn and the "specialist" there told me that nothing was wrong with her because the annomia, cholesterol, and u/a came back normal. I probably shouldn't be but, that doctor is a teaching doctor, educating future vets. I feel like that because Coco is asymptomatic they were just dismissive, even with copies of the labwork in hand. Actually I am more disappointed, in myself...I knew something wasn't right. That feeling is what prompted us, after weeks of back and forth struggling, to say "go ahead, let's do the biopsy". I felt that if a number is just a number is just a number applied to the BATs, then perhaps it applied to the normal results as well.

Anywho....so here we are. And look at this fabulous forumI joined back in October and had never utilized!!! The responses, people taking the time to share their experiences, what they have learned....it is absolutely amazing.

Many thanks to all of you. There is a comfort in knowing that this is not uncommon, although I wish all of our baby were completely healthy without restrictive diets...but healthy with assistance, well that is why there is veterinary medicine, right?
:ghug::yorkietal