Possible Shunt/Liver Disease

[aproctor]

Originally Posted by AprilLove

Hi Ann,
I am in MN too, welcome to YT, and sorry it is under these circumstances. I just wanted to tell you that I had to take one of my babies to the U of M for a different issue (cardiology), and they do have board certified specialists in most disciplines, and internal medicine for sure.
The way it worked for me is my Vet called them to make the referral, then they (U of M) called me and set up the appointment, I believe it was on a Friday, and I was in to see them on Monday. (You don't have to have a referral, but I believe it gets you in quicker)
I would highly recommend you go there if you can, it is a teaching hospital, but they always have the certified doctors see your baby along with the resident/tech. A resident may see her first, but at the appointment, you will also see a board cert specialist, who is the one who will be in charge of your case. It is a top notch place from my experience, and we felt very comfortable there with the way they handled my furbaby and our situation.
Hope this helps at least in understanding how it works there.

Good luck with your baby and I hope you can get some answers soon!

Thank you!! Tomorrow I am taking her to Blue Pearl because the specialist there actually studied and did her internship at the U of M and she comes highly recommended so I will see what she says but if I feel the need I will take her to the U of M as well.

Thanks again and I hope we do get some answers tomorrow! I will keep you informed.

[107barney]

Hope the consult went well. Update when you can!

[BabyGirl Rosie]

Checking in to see how your visit went.

[Maximo]

Looking forward to your report on the consult.

[aproctor]

Hi everyone!

I just started a very long thread here and all of a sudden it was gone-love computers!! UGH!

Well today was a long day and I am sure Lucy will sleep very well tonight, she panted and shook all the way there but was quiet and sleepy all the way home!

I am very happy that we went to see Dr Myers today! My husband and I made sure to tell her everything that we have been experiencing with Lucy since we got her last year up until today. I asked A LOT of questions and she was very nice and patient happily answering all of them and telling me they were good, valid questions.

I did ask her why she was not Board Certified as she did her residency at the U of M and went through it all...She explained that she finished her residency and passed the "big test" but that she has not finished her paper, she has to finish a paper and have it published before she can get the BC stamp!
So that made me feel better....

We talked about Lucy's enzyme levels and her bile acids and she said she was concerned about the enzyme levels but not really the bile acids. She explained that if there was a shunt whether one or many an ultrasound would not be the best way to detect that. She talked about several options surgical biopsy, ultrasound and laperscopic (sp?) She said she recommend a surgical biopsy (can't remember what the technical word is) because they would be able to see not only the liver while inside but then if they saw anything they could take care of it right there BUT.....at this point because of Lucy currently being healthy and happy she thought the way to go at this point was to just take another blood sample and check all of her levels again. She said the blood test they take would check more things that our previous vet wasn't able to.

At this point I asked her "if you were us and this was your dog what would you do?" and she said she would start with another blood sample and go from there.
(of course there was much more in between but I can't remember it all) She is going to send me an email tomorrow with all the information we discussed and all of the numbers.
So....Lucy went back to have yet another prick of the needle and have some more blood taken....and she told me she would have the results tomorrow.

Well guess what????????????!!!!!!!! On my way home her assistant called me at 5:30pm and said the results were back!!!!!

Guess what??????????????????????????? ALL OF HER LEVELS CAME BACK NORMAL!!!!!!

Dr Myers told us at this point she would do nothing more but just monitor Lucy and take her back to our normal vet to do a follow up blood test again in 4-6 weeks to see if they are still normal but there seemed to be no reason to do any further testing at this point (unless we wanted to)!

She said it could have been an unknown toxin or simply a combination of the Nutro and my mom feeding her table food was just too much for her system but we may never know.

She looks and acts like a very healthy dog right now and I will be keeping a close eye on her and if she has ANY symptoms we will take her right back in.

We both agreed and trusted what Dr Myers told us and we are very HAPPY with the results!

[aproctor]

Sorry the update is so late, when we got home we had some other issues to deal with (not furbaby related) so I wasn't able to get on for any length of time until now.

I will update with her numbers once I get the email tomorrow but I also took the Dr's card which has her email and if I don't hear from her by noon I will be emailing or calling because I want to see them all myself!!

Thanks for all your support and prayers and for putting up with me when I had my little meltdown...you are all such good people and I wouldn't know how I would have gotten through this without you all!!

[MaddiesMommie]

Wonderful news. Thanks for updating.

[BabyGirl Rosie]

That is great news!! I know you are so relieved!!!

[ladyjane]

Not that it matters in this particular case since the op has made her choice and is happy with it; but for people reading this thread here is a web site of interest regarding specialty vets and board certification:

AVMA Guidelines on the Identification of Board Certified Veterinarians

A quote from the site:


In the opinion of the AVMA and the ABVS the terms "board eligible" or "board qualified" are misleading and should not be used by any veterinarian. One is either board certified, having met all of the criteria of the specialty college or board, or one has no board credentials.

[aproctor]

Originally Posted by ladyjane

Not that it matters in this particular case since the op has made her choice and is happy with it; but for people reading this thread here is a web site of interest regarding specialty vets and board certification:

AVMA Guidelines on the Identification of Board Certified Veterinarians

A quote from the site:


In the opinion of the AVMA and the ABVS the terms "board eligible" or "board qualified" are misleading and should not be used by any veterinarian. One is either board certified, having met all of the criteria of the specialty college or board, or one has no board credentials.

I just want everyone to know that Dr Myers never "claimed" anything, my vet thought she was board certified so that is why I asked her why she is not and she simply answered my question.

I completely understand why some of you only trust BC vets (because of your experiences) but I believe that she is a good Vet and she knew what she was talking about in our case.

Just a thought to ponder: What do you call a DR that got D's in school? A Dr!

Big degrees don't always mean someone is the best of the best, someone that struggles a bit more than the other and finally achieves what they are striving for imho means a lot!
I honestly think that if she was alarmed by our case or thought there was something really wrong that she would have referred us to the BC surgeon there to do the biopsy but we would have declined at this point.
Lucy is acting like her old self and has not had any issues at all for almost two weeks and her blood tests came back normal this time so why would we choose to put her through surgery?
I honestly think this was a fluke and that she will be just fine but if something arises I will take her back to the Vet immediately and go from there!

I love my dogs and ALL animals so I would not make this choice lightly if I didn't think it was the best thing to do at this point for my Lucy (and ultimately it is our decision not the Vets) then I would go further or even take her somewhere else but I don't feel that is what we need to do right now.

At this point with the blood tests coming back normal and with Lucy acting completely healthy like her normal self.....what would you do?

If the next step is some type of surgery then why would I put her through that if it is not necessary at this time?

I know you all have my best interests in mind and I thank you greatly for that!!

[ladyjane]

Originally Posted by aproctor

I just want everyone to know that Dr Myers never "claimed" anything, my vet thought she was board certified so that is why I asked her why she is not and she simply answered my question.

I completely understand why some of you only trust BC vets (because of your experiences) but I believe that she is a good Vet and she knew what she was talking about in our case.

Just a thought to ponder: What do you call a DR that got D's in school? A Dr!

Big degrees don't always mean someone is the best of the best, someone that struggles a bit more than the other and finally achieves what they are striving for imho means a lot!
I honestly think that if she was alarmed by our case or thought there was something really wrong that she would have referred us to the BC surgeon there to do the biopsy but we would have declined at this point.
Lucy is acting like her old self and has not had any issues at all for almost two weeks and her blood tests came back normal this time so why would we choose to put her through surgery?
I honestly think this was a fluke and that she will be just fine but if something arises I will take her back to the Vet immediately and go from there!

I love my dogs and ALL animals so I would not make this choice lightly if I didn't think it was the best thing to do at this point for my Lucy (and ultimately it is our decision not the Vets) then I would go further or even take her somewhere else but I don't feel that is what we need to do right now.

At this point with the blood tests coming back normal and with Lucy acting completely healthy like her normal self.....what would you do?

If the next step is some type of surgery then why would I put her through that if it is not necessary at this time?

I know you all have my best interests in mind and I thank you greatly for that!!

I am not questioning your vet. I am merely saying that the comments regarding board certification were really not accurate is all. The answer is that she is not board certified. Period.

Am I saying she is a bad vet? No. Am I saying you should do something else? No. I knew all along what you were going to do and that is your choice.

There were many comments that I found concerning for others...not for you. You pretty much had your mind made up as soon as the credit thing was settled and you made a call to that vet. You said that your vet said that you would see a resident at the Univ of Mn and go from there. Yes, you would see either a student or resident....but that does not mean you would not see a board certified vet! Additionally, the board certified vets are always, always supervising. I was actually surprised a vet would say that ... that is something I see people on YT saying who probably have had no experience with large veterinary practices and/or understanding of how it all works. There is an extremely high level of care at the teaching hospitals. I am again not saying they are the only answer..I just don't quite get why a vet would say such a thing.

Bottom line: I am happy your Lucy is fine. I am not posting for you or for her as that is settled. I am posting for the other people who want the information since it has been brought up and they need to know all sides.

[ladyjane]

Also: I am not sure where you are coming from with regards to the next step being surgery.

Never did I suggest she needed surgery as a next step. I don't know that anyone did.

Let us remember that a website was posted for board certified internests...NOT surgeons. There is a difference. The reason? So that you could get a diagnosis. Too often people jump on the LS bandwagon and that is not the only reason for alterations in enzymes.

Again...thankfully you now know that Lucy is fine and don't need to think about anything else but enjoying her!

[aproctor]

Originally Posted by ladyjane

Also: I am not sure where you are coming from with regards to the next step being surgery.

Never did I suggest she needed surgery as a next step. I don't know that anyone did.

Let us remember that a website was posted for board certified internests...NOT surgeons. There is a difference. The reason? So that you could get a diagnosis. Too often people jump on the LS bandwagon and that is not the only reason for alterations in enzymes.

Again...thankfully you now know that Lucy is fine and don't need to think about anything else but enjoying her!

And I trust that you are very experienced in this so I am grateful for your input and help!
LS?bandwagon...not sure what that stands for?
What do you think would cause her enzymes to be so elevated and then shoot back to normal a week and a half later? Have you ever seen something like that?

Also, it was my vet here in Alex here that first recommended the U of M but then kept saying that it's a long process and that we would be seen by a student but I know that a BC vet oversees the case-Dr Myers never said that. Dr Myers said that the U of M is a wonderful place to go and I think if she thought I needed to go there she would have referred us to them.

Oh and the U of M takes Care credit too so that is not the reason I made up my mind to go to BP and not U of M.

As far as the surgery goes, I just meant that if her numbers came back high again that the next step would be a biopsy and she recommended the type of biopsy where they open her up (I can't remember what it was called).

[Maximo]

Ann, I am very happy that Lucy is doing well and that her blood tests brought good news.

I know very little about liver shunt (other than they can be very tricky to diagnose) or liver issues related to exposure to a toxin. Do you know what blood tests were performed yesterday?

I pray Lucy is fine now. Be sure to do the follow up testing and if Lucy has any more symptoms, get into the doctors right away.

[107barney]

What would I do? Well since you asked, I would insist bile acids testing be repeated, not just general chemistry because that was an abnormal result.

The vet is not board certified and it doesnt matter why she isn't (paper or some other requirement). It's not simply a rite of passage, it's a serious endeavor with strict scrutiny. Not board certified = not qualified enough in my estimation. Just my opinion.

I am thrilled your Lucy is feeling well. I hope she lives a long, healthy, and wonderful life. Best wishes.