Prednizone for liver disease?

[kjc]

Originally Posted by Becca1

Thank you for this article I hadn't seen; I will place it in my file. Okay, here's an off-topic question for you - how do you place multiple quotes in one response??

I just happened to look that up for you and noticed their info has been updated... might be worth a look around there if it's been a while since your last visit.

PS: They have increased their pricing, and they're due to increase again by 10% around the end of the month. They gave me a quote of $1800. - $2300. for Tink just this morning. In Sept/Oct they had quoted $1300. - $1800.

[kjc]

Originally Posted by Maximo

Becca, sending best wishes for your little one. If I understand correctly, the shunt was discovered when your baby was 3 years old. Is this unusual for a congenital shunt to go undetected that long? I'm asking because Max will be 3 later this year.

Tink's shunt wasn't suspected until she was 2 years old. She had been bred and had puppies by one of her previous owners, then turned over to the Humane Society. She was adopted out, but returned there after they found out she had high liver enzymes, and difficulty recovering from her spay surgery. Then DH and I adopted her, bc she was set to be PTS in 2 days (bc she had 'problems'). We scheduled her first BAT for the next month, and it came back slightly elevated.

To answer your question, no, it's not uncommon for dogs to be diagnosed at an older age. This is why a few members on here are recommending having any Yorkie Bile Acid Tested every 2 years or so, so it can be caught early. Many Yorkies show no symptoms. Many start with having frequent or recurring Urinary Tract Infections. Others have gone into full blown Hepatic Encephalopathy. Each dog is different, each shunt is different, and each liver is different.

[Ellie May]

I see you wrote you have been misquoted. Will go back and read this thread in the next couple weeks (hopefully).

But her first BAT was only mildly elevated? Was that when they were 126? Because that isn't a mild elevation at all. That is of the level where an IMS is needed asap. I know there are many dogs with higher BAs, but that is still 5 times higher than it ever should be.

[107barney]

Originally Posted by Ellie May

I see you wrote you have been misquoted. Will go back and read this thread in the next couple weeks (hopefully).

But her first BAT was only mildly elevated? Was that when they were 126? Because that isn't a mild elevation at all. That is of the level where an IMS is needed asap. I know there are many dogs with higher BAs, but that is still 5 times higher than it ever should be.

I am surprised also that 126 postprandial was interpreted as a "mild" elevation. The lab report itself informs the doctor of the interpretation and clearly states that animals with post readings >100 umol/L are "markedly increased" The normal postprandial reading is <20 umol/L.
A lab report would have alerted the veterinarian to the probability of shunt and to the markedly increased postprandial value.

Here is what Antech has to say at the bottom of the Bile Acids report-- this is a direct quote cut and pasted --

FASTING BILE ACID CONCENTRATIONS
Elevated fasting bile acid concentrations can occur with inadequate fasting, spontaneous gall bladder contraction and with
hepatobiliary disease. The probability of hepatobiliary disease increases when fasting bile acids exceed 25 umol/ L.
Fasting bile acids may be higher than those of postprandial samples. Potential causes include gall bladder contraction and
delayed gastric emptying. If either result exceeds 25 umol/L, abnormal liver function should be considered.

POSTPRANDIAL BILE ACID CONCENTRATIONS
Elevated postprandial bile acids are supportive of hepatobiliary disease. The majority of animals with congenital or acquired
portosystemic shunting have markedly increased postprandial values (>100 umol/L).

[107barney]

Originally Posted by kjc

I just happened to look that up for you and noticed their info has been updated... might be worth a look around there if it's been a while since your last visit.

PS: They have increased their pricing, and they're due to increase again by 10% around the end of the month. They gave me a quote of $1800. - $2300. for Tink just this morning. In Sept/Oct they had quoted $1300. - $1800.

That does not seem that bad! What is the additional cost if they remove stones (if they are removable). Are you able to get to UT? I hope you can find a way.

[107barney]

Originally Posted by lillymae

She has followed her vets instructions to the T so are you saying her vet doesn't have a clue ??? Dogs who don't feel well do NOT act like Tinkerbell does or have the appetite that she does either. The only people dictating here are the 2 of you. She has seen one specialist & consulted with another. Are you accusing her of Lying ??? Because that's what it appears to me.

If her vet interpreted a 126 postprandial reading as a mild elevation and did not refer to a specialist, then she has sadly been led down an incorrect path. But, she did her own research as she has told us over and over and over again, but somehow missed that normal postprandial BATs are under 20 umol/L and a 100 or higher BAT is markedly increased and indicative of a shunt.

No one is "dictating" to her nor is anyone calling her a liar and I don't care what your interpretation of our posts are as I think very little of yours, especially the ones where you suggest tea bags instead of veterinary care.

[Ellie May]

Going with Dr. Centers' values, I think her cut-off is 25 (which imo is kinda high). Idexx is 15 post. Ellie's was 15.7 at one point and that was considered ever so slightly elevated. When it was 47, it was something we needed to watch and be cautious. When it went to 106, her vet said she had some choice words to say while reading the report. lol. Not mild at all. Not okay. It means the liver isn't functioning well at all in most cases.

With numbers like that, even with a regular vet who isn't bothered by it, it is still best to go to an IMS.

[Maximo]

Originally Posted by kjc

Tink's shunt wasn't suspected until she was 2 years old. She had been bred and had puppies by one of her previous owners, then turned over to the Humane Society. She was adopted out, but returned there after they found out she had high liver enzymes, and difficulty recovering from her spay surgery. Then DH and I adopted her, bc she was set to be PTS in 2 days (bc she had 'problems'). We scheduled her first BAT for the next month, and it came back slightly elevated.

To answer your question, no, it's not uncommon for dogs to be diagnosed at an older age. This is why a few members on here are recommending having any Yorkie Bile Acid Tested every 2 years or so, so it can be caught early. Many Yorkies show no symptoms. Many start with having frequent or recurring Urinary Tract Infections. Others have gone into full blown Hepatic Encephalopathy. Each dog is different, each shunt is different, and each liver is different.

That would include shunts that develop later though, the non-congenital variety, correct? They are rarer, aren't they?

Also, is there any correlation between shunts and size of the Yorkie? Are smaller ones more prone to them?

^^Questions are for everyone

[kjc]

My apologies.... that was not my vet's interpretation at all, it was mine. First I look to see if the results are within normal limits, if not, then are they under 100, if not, then how far over 100. Hence my description of slightly elevated and I meant slightly over 100, as under 100 most times means the dog has MVD, and as 107Barney can attest, her Daisy's were a bit over 100, but were brought down through diet and meds(?).

As Tink is a barker (in a cage/kennel) and a Spontaneous Gall Bladder Contractor, it was thought to try diet/meds and retest the BAT at a later date, and instead of leaving her at the hospital overnight, I would fast her at home and bring her in early for the BAT.

Seven months later I was going to schedule the test, when she began having H. E. So we got that under control, and went to reschedule the BAT again, when she ate rancid cooking grease at Grandmom's house. Her liver enzymes were very high, so it would take some time to get them back down again. So in 6 months she was retested, and the results were not good at all.

Then I was trying to arrange getting Tink to UT, and to figure out if she could fly, practiced life in a kennel, looked into airfare and couriers, car rides (11 hours) .... with her barking I am truly fearful of the surgery, but UT said they use sedatives to keep them quiet, which I didn't think was okay due to her shunt, but they have done it, so now I need to do a practice run with my vet, and her sedated so I know what to expect. UT said I could take her to the motel each night if needed (after the first or 2nd if all goes fine.

So as nothing was coming together, I decided to go ahead and do the Ultrasound so I knew where Tink was at... is she operable or not.... and good thing .. she is!

So that's her end of it, then on the homefront I have to wait for DH to realize she's sick (US helped alot), then to get a vacation, and get care for my daughter or travel by myself (I am sooo geographicallly challenged it's not funny)(yes, even with Google) so I start looking closer to home for surgeons... and now we're here. US report says to keep her on L/D, Lactulose and Metronidazole until surgical intervention can occur.... no time frame mentioned.... (I know...ASAP)

[lillymae]

Originally Posted by 107barney

If her vet interpreted a 126 postprandial reading as a mild elevation and did not refer to a specialist, then she has sadly been led down an incorrect path. But, she did her own research as she has told us over and over and over again, but somehow missed that normal postprandial BATs are under 20 umol/L and a 100 or higher BAT is markedly increased and indicative of a shunt.

No one is "dictating" to her nor is anyone calling her a liar and I don't care what your interpretation of our posts are as I think very little of yours, especially the ones where you suggest tea bags instead of veterinary care.

http://www.yorkietalk.com/forums/sic...-all-over.html
You might want to check out this thread and see for yourself that the Tea Worked.

[kjc]

Originally Posted by Maximo

That would include shunts that develop later though, the non-congenital variety, correct? They are rarer, aren't they?

Also, is there any correlation between shunts and size of the Yorkie? Are smaller ones more prone to them?

^^Questions are for everyone

The U of T has really redone their site... here is a link to the results of their research (easy read):

The University of Tennessee College of Veterinary Medicine - Liver Shunt Research

And from: Portsystemic (liver) shunts, their resolution and their more rare, extended realities | PetMD

Some dogs, unfortunately, (and some humans too) have a congenital malformation that leads blood vessels to bypass the liver. It’s called a “portosystemic shunt” but is also often referred to as a “hepatic shunt” or “liver shunt.” Others have the "acquired" form of the disease, which is typically secondary to severe, diffuse liver ailments in [usually] older dogs.

When buying a puppy I would avoid the runt of the litter and the smallest pups, especially when the pups in the same litter show a large difference in size.

Many dogs with LS tend to be 'picky' eaters. Tink was for a time, till she got on her special diet and the meds. Then her appetite improved, and she started gaining weight. She now weighs 13.5 pounds. She is also on probiotics to help her digestion. Any dog that is a picky eater, appears thin (one can see the spine and ribs), and has difficulty maintaining or gaining weight should probably be BAT tested.

Dogs with LS can show stunted growth, so a pup that doesn't appear to be growing normally and gaining weight as expected should be BAT tested. So I don't think it's correct to say small Yorkies are prone to shunts, because a shunt canl make them small. This is confusing but bear with me: One can't say that all small Yorkies have shunts. Maybe all Yorkies with congenital shunts are small, but I'm sure there are exceptions.

Also, on xray, a dog with LS may have an undersized liver, and may show stones in the bladder.

Tink was a 2.5 year old when I adopted her. (Sorry, there was some confusion over her age at the time) She was thin and bony, but appeared to be full grown. She weighed 9.6 pounds. She did have a UTI, her urine was dark brown, and smelled of ammonia. Her bowel movements were almost yellow all the time. These symptoms all cleared once she got on her new diet and meds.

I don't know if Tink's shunt is congenital or acquired.... I'm assuming acquired as she had not been diagnosed as a puppy. I haven't found any statistics on shunts yet...

[107barney]

Originally Posted by kjc

My apologies.... that was not my vet's interpretation at all, it was mine. First I look to see if the results are within normal limits, if not, then are they under 100, if not, then how far over 100. Hence my description of slightly elevated and I meant slightly over 100, as under 100 most times means the dog has MVD, and as 107Barney can attest, her Daisy's were a bit over 100, but were brought down through diet and meds(?).

As Tink is a barker (in a cage/kennel) and a Spontaneous Gall Bladder Contractor, it was thought to try diet/meds and retest the BAT at a later date, and instead of leaving her at the hospital overnight, I would fast her at home and bring her in early for the BAT.

Seven months later I was going to schedule the test, when she began having H. E. So we got that under control, and went to reschedule the BAT again, when she ate rancid cooking grease at Grandmom's house. Her liver enzymes were very high, so it would take some time to get them back down again. So in 6 months she was retested, and the results were not good at all.

Then I was trying to arrange getting Tink to UT, and to figure out if she could fly, practiced life in a kennel, looked into airfare and couriers, car rides (11 hours) .... with her barking I am truly fearful of the surgery, but UT said they use sedatives to keep them quiet, which I didn't think was okay due to her shunt, but they have done it, so now I need to do a practice run with my vet, and her sedated so I know what to expect. UT said I could take her to the motel each night if needed (after the first or 2nd if all goes fine.

So as nothing was coming together, I decided to go ahead and do the Ultrasound so I knew where Tink was at... is she operable or not.... and good thing .. she is!

So that's her end of it, then on the homefront I have to wait for DH to realize she's sick (US helped alot), then to get a vacation, and get care for my daughter or travel by myself (I am sooo geographicallly challenged it's not funny)(yes, even with Google) so I start looking closer to home for surgeons... and now we're here. US report says to keep her on L/D, Lactulose and Metronidazole until surgical intervention can occur.... no time frame mentioned.... (I know...ASAP)

Yes, Daisy's values were brought down from 107 post to 33 with the Hill's L/D and Marin. However, Daisy does not have a single liver shunt, she has MVD. Her BATs now are 13 pre and 3.9 post, from diet alone, and she is no medications at all except for heartworm and flea and tick meds.

[kjc]

Originally Posted by Ellie May

Going with Dr. Centers' values, I think her cut-off is 25 (which imo is kinda high). Idexx is 15 post. Ellie's was 15.7 at one point and that was considered ever so slightly elevated. When it was 47, it was something we needed to watch and be cautious. When it went to 106, her vet said she had some choice words to say while reading the report. lol. Not mild at all. Not okay. It means the liver isn't functioning well at all in most cases.

With numbers like that, even with a regular vet who isn't bothered by it, it is still best to go to an IMS.

The newer info from UT (Re: Breeding vs pet):

The University of Tennessee College of Veterinary Medicine - Liver Shunt Research
Bottom line is we don't know how it's passed. All breeding dogs should have normal fasting and fed bile acids (true normal -- i.e. less than 10 and less than 20; versus "okay as a pet" normal, i.e. 25-40 range). At the very least, dogs that have produced puppies with shunts should not be bred to the same lines (their own or that of the other parent). Obviously the best breeders would never breed the parents again, and they may consider spaying and neutering the littermates as a "just in case" precaution. If, however, shunts are found in all lines of Yorkies, then even that may not solve the problem.



This (below) is why my vet opted to treat Tink through Medical Management.

Portosystemic Shunts FAQ

Can dogs with shunts be treated with only medical management?
Most animals improve immediately with proper diet and medicine, and about one third of the dogs treated medically will live a relatively long life. Unfortunately, over half of the dogs treated medically are euthanized, usually within 10 months of diagnosis, because of uncontrollable neurologic signs, such as seizures and behavior changes, or progressive liver damage. Dogs that tend to do well with longterm medical management are usually older at the time of diagnosis, have more normal bloodwork, and have less severe clinical signs. Surgery provides the best chance for a long healthy life in most dogs.

[107barney]

Originally Posted by kjc

The newer info from UT (Re: Breeding vs pet):

The University of Tennessee College of Veterinary Medicine - Liver Shunt Research
Bottom line is we don't know how it's passed. All breeding dogs should have normal fasting and fed bile acids (true normal -- i.e. less than 10 and less than 20; versus "okay as a pet" normal, i.e. 25-40 range). At the very least, dogs that have produced puppies with shunts should not be bred to the same lines (their own or that of the other parent). Obviously the best breeders would never breed the parents again, and they may consider spaying and neutering the littermates as a "just in case" precaution. If, however, shunts are found in all lines of Yorkies, then even that may not solve the problem.



This (below) is why my vet opted to treat Tink through Medical Management.

Portosystemic Shunts FAQ

Can dogs with shunts be treated with only medical management?
Most animals improve immediately with proper diet and medicine, and about one third of the dogs treated medically will live a relatively long life. Unfortunately, over half of the dogs treated medically are euthanized, usually within 10 months of diagnosis, because of uncontrollable neurologic signs, such as seizures and behavior changes, or progressive liver damage. Dogs that tend to do well with longterm medical management are usually older at the time of diagnosis, have more normal bloodwork, and have less severe clinical signs. Surgery provides the best chance for a long healthy life in most dogs.

Since surgery is the best chance for a long healthy life in most dogs, and because your dog was young (age 2?) at the time of dx, I still can't understand the "medical management" option. I also do not understand the failure to immediately refer to internal medicine for those #s which are 5 times normal and "markedly" elevated. And, L/D and denamarin did not bring her down because her BATs went up to nearly 300 (15x normal) as you said around the time of the rancid grease.

By the way, how long does it take grease to go rancid?

[kjc]

Originally Posted by 107barney

Since surgery is the best chance for a long healthy life in most dogs, and because your dog was young (age 2?) at the time of dx, I still can't understand the "medical management" option. I also do not understand the failure to immediately refer to internal medicine for those #s which are 5 times normal and "markedly" elevated. And, L/D and denamarin did not bring her down because her BATs went up to nearly 300 (15x normal) as you said around the time of the rancid grease.

By the way, how long does it take grease to go rancid?

I believe (I wiil check with the specialist on Monday) that by 'young' it means less than 1 year old. So, at 2.5 years, she was considered older... Also, my vets did confer with a vet at UT within the first 6 months of her first BAT, and from there made a treatment plan for her. Her 2nd BAT was done about 7 months after the grease eating incident. We had to wait that long for her ALT/AST to return to more normal levels.

Rancid grease: depends on the amount of oxygen it is exposed to as to how quickly it will turn. The rancidity is harmless, I have since learned, but the fat content is what was harmful.