Roxi & possible liver shunt

[Micah my love]

I think normal is around 25 if i am remembering correctly, so 38 is not to bad

Micah's ran in the 50's he was tested 3 times over a period of 6 mos before he
had the other test that i mentioned above..hopefully this baby can be treated with a low protein diet...please keep us updated on her...big hugs to you i know
how you are feeling at this time i was so afraid for my sweet boy..but he does good most of the time but i can always tell when he isn't feeling well

[Roxi Ree]

Roxi was a 43 on her BAT. Her dr. told me normal is in the 20's and the note from the lab said that liver shunts are usually in the 100's so her score isn't extremely high, but that we do need to find out what is going on with her. We are lucky that there is a board certified surgeon in Wichita that has a special interest in hepato-billary surgery. Roxi has a consultation appt. tomorrow morning. Because of this board, I purchased a pet insurance plan on Roxi...one that covers genetic diseases. I'm so thankful that I did. I'm still staying positive (which has me a little worried because I am usually such a pessimist). I think it's because my little furbutt is so energetic, happy and healthy that's it's hard to believe that she might have something wrong with her.

[107barney]

I'm so glad Roxy will be seeing a specialist tomorrow. I hope you get all the answers you seek. Many yorkies have microvascular dysplasia or MVD and areanaged by diet and/or supplements. My Daisy has MVD and she is almost 11 and has lived a great quality of life with proper medical management. I will look for your updates!

[susan lynn]

My prayers are with you and Roxy.

[Roxi Ree]

Well, I left Roxi with the surgeon for a few hours. Her BAT results are not consistent with liver shunt and he wants to redo it just to make sure that we're not looking at a lab error. Some of her other results are not what you would see if you are looking at a liver shunt. He is going to go ahead and do the ultrasound, but doesn't expect to see anything. Depending on the results of the new bloodwork, he wants to go ahead and change her diet and put her on lact??? (I don't remember the full name but know that I have read of other dogs on it on this board). He wants to go ahead and schedule her for surgery in 2 weeks to do liver biopsy or fix if it's an external shunt and would go ahead and do her spay. The surgery center has an animal dentist on staff and if Roxi is doing OK after all this, they will have the dentist come in and pull her baby teeth that haven't fallen out at the same time. Seems like alot to do on her at one time, but he assured me that she would be fine...that it all depends on how she does while she is under. I'll find out more when I go pick her up.

Thanks for the prayers and well wishes.

[MauiGirl]

Yes it does sound like a lot, but it also sounds like she is in good hands.

Good luck with it all, and keep us posted. We really do care about Roxi and hope they find out what is going on so she can have a long healthy happy life.

[Roxi Ree]

Received some good news...the ultrasound showed a very healthy liver which didn't really surprise the dr. The dr. told me her test results just don't make sense. He is redoing her BAT test (should get results today). He also did some other test in his office (another type of bile acid test) and Roxi came up good on that also. So as of right now, he thinks she's perfectly fine. If the results do come back even a little elevated, he does want to go ahead and do a liver biopsy...but we'll cross that bridge when and if it needs to be done. And she does so good for the drs. My little girl may be a small little runt, but she sure does make up for it in spunk and personality.

[107barney]

Originally Posted by Roxi Ree

Received some good news...the ultrasound showed a very healthy liver which didn't really surprise the dr. The dr. told me her test results just don't make sense. He is redoing her BAT test (should get results today). He also did some other test in his office (another type of bile acid test) and Roxi came up good on that also. So as of right now, he thinks she's perfectly fine. If the results do come back even a little elevated, he does want to go ahead and do a liver biopsy...but we'll cross that bridge when and if it needs to be done. And she does so good for the drs. My little girl may be a small little runt, but she sure does make up for it in spunk and personality.

I'm so glad the ultrasound results were normal. I have to say with the BATs being normal and the ultrasound being normal and a dog with no symptoms, I'm not sure I'd be so quick to do a liver biopsy if this were my dog. What is his reasoning for wanting to do the procedure in a very small dog when the results are only a little elevated? I'm just curious because I've had very conservative internal medicine specialists for my dogs, including the one with an abnormal liver and high BATs that are much higher than your dog's. Did the dr discuss the option to medically manage her?

[MauiGirl]

I'm glad you are receiving good results, but in view of all that positive info I am very curious why a vet would even want to proceed with a liver biopsy.

A liver biopsy, even done in conjunction with a spay involves additional risks. When I was looking at the same options, my Tiki's vet explained that it means a longer incision, longer anesthesia time, potential for infection in an otherwise healthy liver.

That is a lot to consider, especially since she is only 2.5 lbs.

[Ringo1]

Originally Posted by 107barney

I'm so glad the ultrasound results were normal. I have to say with the BATs being normal and the ultrasound being normal and a dog with no symptoms, I'm not sure I'd be so quick to do a liver biopsy if this were my dog. What is his reasoning for wanting to do the procedure in a very small dog when the results are only a little elevated? I'm just curious because I've had very conservative internal medicine specialists for my dogs, including the one with an abnormal liver and high BATs that are much higher than your dog's. Did the dr discuss the option to medically manage her?

I wouldn't want to say anything in opposition to your Vet - but I have to agree with 107barney - unless she has to be spayed at the same time. However, even then, a liver biopsy is very invasive.

Just be aware and do your research.

Ultimately, it does sound like this vet is very thorough.

Keep us posted!

[Patti]

That is good news. Cali had a little higher BA tests and ultrasound was normal. The board certified surgeon did a liver biopsy when she was spayed. It showed such a mild case of MVD that no treatment was necessary. Hopefully Roxi will be just fine.

[Roxi Ree]

I would be lying if I said that I am not questioning the need for exploratory surgery at this time. I think his thinking is that since we are going to have her open for the spay, that he would just go ahead and do the liver biopsy at the same time (so that she wouldn't possibly have to go under a 2nd time at a later date). He is just recommending this course of action to determine the cause of all the lab abnormalities. I think he has ruled out single congenital extraheptic shunt and/or microvascular dysplasia, but he does suspect some sort of liver dysfunction (at least that's the way I read it in his notes). He did mention to me that there was another way to do the liver biopsy without invasive surgery, but said we would discuss later the pros and cons of both procedures.

He was going to send me home with lactulose and have her start on Prescription diet L/D, but we both decided to just wait for today's results before we do anything...not worth starting it if we don't have to.

I still haven't heard back from the clinic. I'm thinking it will probably be tomorrow. Thanks for all your feedback. Believe me, I have been doing alot of research and I know more about the liver than I thought I ever would. I even considered not having that beer last night, but than was like, nope, I really need it

[Ringo1]

Originally Posted by Roxi Ree

I would be lying if I said that I am not questioning the need for exploratory surgery at this time. I think his thinking is that since we are going to have her open for the spay, that he would just go ahead and do the liver biopsy at the same time (so that she wouldn't possibly have to go under a 2nd time at a later date). He is just recommending this course of action to determine the cause of all the lab abnormalities. I think he has ruled out single congenital extraheptic shunt and/or microvascular dysplasia, but he does suspect some sort of liver dysfunction (at least that's the way I read it in his notes). He did mention to me that there was another way to do the liver biopsy without invasive surgery, but said we would discuss later the pros and cons of both procedures.

He was going to send me home with lactulose and have her start on Prescription diet L/D, but we both decided to just wait for today's results before we do anything...not worth starting it if we don't have to.

I still haven't heard back from the clinic. I'm thinking it will probably be tomorrow. Thanks for all your feedback. Believe me, I have been doing alot of research and I know more about the liver than I thought I ever would. I even considered not having that beer last night, but than was like, nope, I really need it

You needed it and you deserved it!

[DAB]

My yorkie girl was operated on for a liver shunt repair when she was 2 years old...diagnosis was failure to thrive. She is now 4 years old and doing very well...she has grown and her coat is very pretty. She has lots of energy as well. The blood work was sent to an IDEX lab.....they are in various areas. Hers was tested in Grafton, MA. She was operated on by Dr. John Berg at Tufts University Foster Hospital for Small Animals....also in Grafton, MA. Prior to surgery she had 2 ultrasound tests and then a scinctigraphy ( I reccommend skipping the ultrasound as the scintigraphy is more accurate) ...why waste the money on an ultrasound that is not really reliable. Had I known prior, I would have done just that! She needs to take a little metronidozole 1x a day with her breakfast....probably for life. but she is doing quite well....we are very grateful to Tufts. The entire experience was made easier by the great treatment she received there. I had considered Dr. Tobias in Tenn but logistically, it was not possible to get our little girl there. Lucky for us we had Tufts about an hour or so away from our home.... our surgeon, of course, was very familiar with Dr. Tobias' work. I hope all works out for you and your baby!

[TLC]

Originally Posted by Roxi Ree

I would be lying if I said that I am not questioning the need for exploratory surgery at this time. I think his thinking is that since we are going to have her open for the spay, that he would just go ahead and do the liver biopsy at the same time (so that she wouldn't possibly have to go under a 2nd time at a later date). He is just recommending this course of action to determine the cause of all the lab abnormalities. I think he has ruled out single congenital extraheptic shunt and/or microvascular dysplasia, but he does suspect some sort of liver dysfunction (at least that's the way I read it in his notes). He did mention to me that there was another way to do the liver biopsy without invasive surgery, but said we would discuss later the pros and cons of both procedures.

He was going to send me home with lactulose and have her start on Prescription diet L/D, but we both decided to just wait for today's results before we do anything...not worth starting it if we don't have to.

I still haven't heard back from the clinic. I'm thinking it will probably be tomorrow. Thanks for all your feedback. Believe me, I have been doing alot of research and I know more about the liver than I thought I ever would. I even considered not having that beer last night, but than was like, nope, I really need it

I have to agree with you about questioning an invasive surgery. So good for you!

I am glad you are going to a Board Cert Specialist, but *some* of them still get carried away...

With a Bile Acid Post reading of 43 - she probably has MVD, which can only be determined by a liver biopsy (and the needle biopsy is NOT recommended), bc sometimes a dog can have MVD in only one part of the liver, hence making the needle biopsy useless.

The Lactulose is good, and I had my Roxy (whose first BAT was Pre: 43 and Post: 100.9) for about 10 days as instructed by her IMS, whom said to watch her closely and if I saw even the slightest improvement in any area of her behaviors or personality, then the Lactulose would be a good route for her. Well after 10 days, I honestly saw nothing that would make me think she benefited from it. So the IMS said she didn't need it.

They suggested a Liver Biopsy for my Roxy too, but she was already 3yr and was spayed, so I saw NO point in putting her through an invasive surgery. With MVD dogs, wether you have an accurate MVD dx or Not...the Medical Management is still the same. I didn't need that liver biopsy confirmation, surgery wasn't worth it for me.

Roxy eats Royal Canin Hepatic LS 14 (RX dry food from the Vet).
Dry Hills l/d has "meat" product in it (no-no for liver issues dogs) and the Wet Hills l/d is too high in fat!

The Yahoo Groups: DogLiverDisease
Excellent group to be in for Liver Issues and Medical Management

Best Wishes