Bile Acid Test - next steps
 

Hi Everyone,

I finally got the bile acid test done on my baby, Kody, and his levels were pre 40 and post 65 (my vet said the scale they use has 25 being the highest level within the normal range). He has never exhibited a single symptom (other than being small) so this test was totally elective on my part (he is 2 years old and weighs in at 2 pounds).

He had some diarrhea issues last month and I switched him to Wellness Venison and Rice allergy formula (having 5 ingredients) and he LOVES the food and eats 4 times a day bigger meals than ever (he was on Innova prior to the diarrhea issues). I switched when they mentioned Irritable Bowel and had him on prescription food that wasn't healthy and he didn't like. I am guessing I need to look for lower protein foods ASAP. I also realize that the protien type and food needs to be adjusted accordingly and red meat is not the best for any dog with a potential liver issue. With all the issues I have had with his diarrhea, I am (1) going to have to go slowly on the switch and (2) going to have have a couple of options for him to try since I want him to LIKE the food. He likes dry food over wet - so any suggestions would be appreciated. The Solid Gold Holistique Blend looks good from what I can tell. Anyone have any feedback on this type? He is still on metronidizole for the diarrhea and panacure for three more days for deworming (just in case).

We have an appointment with a specialist tomorrow actually.

Based on this detail, I hope some of you can give me some quick next steps/questions/ etc for my appointment tomorrow. Thanks.

Cali had 2 Bile Acid test and they were 0/98 and 0/45 or close to that and then they did an ultrasound of her Liver which showed nothing abnormal so the next step was a liver biopsy that was done when she was spayed. She was diagnosed with very mild MVD or internal liver shunt. No treatment was necessary. The specialist said that in her experience when you see BA scores under 100 it is usually an internal shunt versus an external shunt. It sounds like Kody is similar to Cali's scores and hopefully will require no treatment or maybe no shunt at all. I will keep good thoughts for him

I have Roxy and TJ both with abnormal BAT.

I make them a special homemade food. They get minimal protein from sources like eggs, cottage cheese and yogurt. They eat lots of Veggies and Fruit.

I also give them supplements that helps aid the liver.

There is a group over at yahoo. You should join, you'll learn lots of stuff about shunts and MVD.

http://pets.groups.yahoo.com/group/L...d_MVD_Support/

About six weeks ago I got Ellie's bile acids tested. She had a few symptoms like UTI and vaccine reaction. She is also skinny. The preprandial was 4.1 and post was 47. Her vet talked to an internist and they said to deworm her and put her on denosyl and vitamin e. We did that for a month along with a low protein diet. The numbers are now about 10 and 15.8. They are pretty well normal and it could be MVD or maybe not since with MVD the numbers usually don't go back to normal. I have decided to stop testing since the numbers are okay. Ellie will stay on a lower protein diet (about 20%) and probably the supplements also since they won't hurt either way. So I guess you have a few options. You can supplement and change diet and wait, then retest. You can get the major testing over with and do a scintography or portogram with a liver biopsy. Or you can go in the middle and maybe do an ultrasound (although I hear that the person reading it has to be expert so there is a good chance that it is a waste of money) and a protein c test. Had your dog just been on meds (including heartworm and flea) for anything?

more info on meds
 

Hi there - he has been on interceptor for heartworm and frontline for flea (but not since July as we have trouble holding him still which leads to us putting it off). He is rarely outside for any amount of time. No other meds to speak of.

I want to do the right thing for my little guy - he is my baby... at whatever the cost but if it is all going to be inconclusive, I'd rather not throw the money down the drain.

I guess I'll hear from the specialist:

1 - what else they would be looking for that with whatever test? e.g. small liver (my vet said that was a possibility)
2 - if knowing anything more would change the treatment plan from just food and supplements based on him not having symptoms and not being an extreme case

What kind of food do you use at protien less than 20%? I am not the best one for doing the home cooking thing. If it comes to that, I'll certainly do it - I'll do anything, but I'd rather start it out with dry food and home cooked treats (I can manage the treats a little more easily). I am not trying to be a bad mom - I just barely cook for myself at it is :)

I meant frontline since july (he had interceptor last week for heartworms).

We use Royal Canin L/S 14 which is a prescription food but has been working very well for us. If your vet doesnt carry it petsmart does. Your vet just needs to call in the prescription and they give you a card there for it. For treat I give my babies fruits and veggies... mostly fruit though. Check out the yahoo LS group, thay have really kept me sane when I thought I was losing it :eek: You will be able to have tons of info on this too.

Royal Canin LS 14 is good. Ellie was allergic to the corn in it though. Science Diet L/D canned might be okay. The dry has undesirable ingredients in it. You could also go with a vegetarian food like Natural Balance. I'm sure the internist will have suggestions. Right now we do homecooked Dr. Dodds with egg instead of cod. We will get a customized recipe for Ellie next week from a nutritionist. Please don't let anyone tell you that you aren't a good mom if you don't homecook. That just isn't true.

If MVD is suspected and you want a definate diagnosis then liver biopsy has to be done.

The solid gold holistique isn't really recommended because of the fact that it contains fish meal which is high in purines. Natural Balance Vegetarian or Royal Canin LS 14 would be a better choice.

As far as an ultrasound goes, doppler is best if you're going to have it done. The u/s is good to check the size of the liver and to check for possible bladder stones, but it's not usually very conclusive as far as finding a shunt. It's only as good as the person reading it.

The only way to 100% diagnose MVD, you would need a liver biopsy. It might be a good idea to put her on one of the foods I mentioned above and a couple of supplements to see if the numbers are still abnormal. If the numbers are still abnormal 30 days after the change, then she more than likely has a liver issue.

Metronidazole, in very small doses, is actually recommended for dogs with liver problems, particularly when they're exhibiting symptoms.

Be careful with treats because they are pretty high in protein. The only treats I give are veggies or fruit, yogurt, cottage cheese, etc.

I am not a vet, I just have a lot of experience with liver shunt/mvd.

Hey Yorkieluv - I have read many of your posts in using this forum for research. It sounds like you have a lot of history / knowledge in this area. I appreciate anything you have to share.

I am a little worried because it seems like everyone moves to home cooking of a while of doing the dry kibble. It seems like there are a lot of rules to follow and not too many options (aside from controlled home cooking).

I understand your concerns about the homecooking and the kibble...I switched to homecooking after a bit of trial and error. Miko really needed this because he forms stones so he needs a diet that is high in moisture, and he's doing great!
If you feel more comfortable with kibble, there's no reason why you couldn't do that. You just have to make sure it's okay for him. The Royal Canin Hepatic is a good one and if your dog isn't having symptoms, the Natural Balance Vegetarian may be okay. I'm still trying to learn a bit more about this food.
For homecooking, it's tough to get it right at first. I know of several people who have actually just gone to nutritionists so that they know they are doing it right. I cook Miko's food in huge batches so that I only have to cook once every 3 weeks. I freeze in 2 day portions and thaw out the night before.

It seems like there is something wrong with every dry food (it all isn't perfect for our babies who need it to be). Wouldn't it be nice if there was a company that could custom make a dry kibble for special needs babies? And you could omit certain ingredients?

I like the every three weeks idea - that I might could handle. I'll let you know how the doctor works out today and what he feels. I am also confused because it sounds like there are a million supplements I need to learn about and I am clueleess. I feel like I need someone to really decode what the needs are, the measurements, why they need certain things (I can't do it without understanding), where to buy it, etc. I am really needy, right? I just feel like the info on the other site is helpful yet overwhelming. Wish me luck at the doctor today.

Thanks everyone for your feedback and info. It is hard for me to adjust my thinking for my baby who has no symptoms yet is sick (I really want to believe he is okay because it scares me so much).

Keep us updated ;) I will go through that soon :(

I know how you feel.
But, once you understand everything, it will be easy.

You have to decide on the food.
Dry Kibble or Home Cook. That's your first step.

Next, supplements...I order from: www.homevet.com
I get these 2 items.
* Hepato Support
* Vetri-DMG

I feed Roxy and TJ 2x a day.

In their morning meals I add the supplements as follows.
Roxy is 5lbs. She gets 3 drops of Vetri DMG and a little less than 1/2 of the capsule of the Hepato Support.
TJ is 7 lbs. He gets 5 drops of the Vetri DMG and a little more than 1/2 of the Hepato Support.

In their PM meals I add the supplements as follows.
The same above of the Ventri and Hepato and also:
I add 1/2 of a Vitamin E Capsule - EACH
I add 1/2 of a Fish Oil Capsule - EACH
A tiny pinch Eggshells for Calcium


You all ready have him on the Metronidazole and than the Specialist may also prescribe to you Lactulose.

So, once you get all this figured out, it is really quite simple, just a little more time consuming than normal ;)

Did you join the liver shunt group? Is that the other group you're talking about? I know it can be overwhelming, but ask questions if you don't understand. Don't be afraid to ask anything. I'll try to explain the supplements.

The hepatosupport contains milk thistle which helps protect the liver from future damage and also helps repair the parts that are already damaged.

Vetri-DMG or denosyl/sam-e is another supplement that is important for liver compromised dogs. This supplement is different from milk thistle but also helps protect the liver.

Both of those supplements are important for liver support.

Dogs that are liver compromised need more vitamin E than normal dogs, so that has to be supplemented.

Fish oil is also good to supplement for the omega-3's, but don't use flax seed oil as it's not recommended for liver compromised dogs.

Vitamin b-complex is also very important to supplement for liver compromised dogs. The vitamin b can be found in Hepatosupport.

When you're homecooking, the calcium is very important. Dogs need supplemented calcium, so you have to give it to them in the form of either eggshells or calcium carbonate. Bone meal is not recommended for liver compromised dogs. Personally, I prefer the eggshells.
As far as the metronidazole, remember that if it's for long-term use, it needs to be in LOW doses.

Oh Yorkieluv - You are so good!

Miko is one lucky pup to have such a wonderful Mom like you ;)

Miko sure does have it good.:)

Yorkieluv, why isn't flaxseed oil recommended for liver compromised dogs?

Before you go too much farther with this, wait a month or 6 weeks and have the test redone. If he was under a lot of stress at the vets, or as my tiny girl did the first time, fought the procedure to draw the blood, it can cause false raised readings. Granted, the readings you got back are higher than acceptable, they are not off the chart, as was my girl that had a shunt, both her readings were over 300. If the second set comes out high, then go for other tests. Oh and by the way, my girl never had any symptoms either, not a single one until she got a bladder infection.

Roxy and TJ are lucky to have a mom like you too!! You have done so much for them :)
Same with you, Ellie's mom :) You guys are great!

This is all a learning process and we all learn new things everyday.

I agree with you, Baron. Maybe change her diet and put her on a couple of supplements. Then, retest her and see what the results are. If they are still elevated, then that means that there is some type of abnormality in the liver.

Flax seeds are high in manganese, tryptophan, phenylalanine, and tyrosine which increase the likelihood of neurological symptoms. We had a discussion about this on the liver shunt group recently...

HI Everyone - I just got back from the specialist here locally. He basically said he thinks the diarrhea/colitis is either separate from or causing the high acids (the liver is not causing the colitis).

He also said due to Kody's size/weight/body fat that anything he did here locally would be inconclusive. I need to take him somewhere (my closest options are VA Tech and NC state) and he recommends NC State b/c they have some nuclear scanning device that is completely noninvasive where they could track exactly the the food going through the liver and confirm a diagnosis. And while there, have an endoscopic exam to check the colitis (since they would be cheaper than him doing it) and he needs to be put under for that and with a potential liver issue, it would need to be determined if that was the right thing to do.

He doesn't think my dog is in any rush (over the next month) to do anything due to no symptoms or ill effects, other than the fact that he is just over two and if he needed surgery, I would want to not let him get any older. He doesn't want to me to up and change his diet until I make a decision on the course of treatment such we just switched food and he is eating so much with the new food. I realize not to wait on that too long due to long term liver damage (I get what everyone says, believe me).

So I can:
1 - Treat the colitis w/ metronidozole (as I am currently) and focus on that and turn a blind eye to the liver (which I would NEVER do)
2 - Treat the colitis w/ metronizole and try to get the bile acid test down w/ food changes/suppliments without knowing exactly what is wrong and get more bile acid testing done (to look for decreases)
3 - Go somewhere for further conclusive testing on the colitis and the liver

I am needing to talk to my husband. I am obviously for option 3 to know for sure. Any advice from those who have gone to major schools for testing/procedures. Has anyone gone to NC State specifically?

How far are you from Knoxville, TN? The University of Tennessee and Dr. Tobias are the best you could ask for with liver problems.

I agree. I think you need to have your eyes open to both the Colitis and Possible Liver Issues - At the same time. Maybe you could achieve both with Dr. Tobias :confused:

9 hours....

Wow... that's pretty far.

NC State is 2 hours and VA TEch is 5 hours (and that is my alma mater so I am fine w/ going there). I have friends in both areas to help offset overnight costs.

I'm in a holding pattern with my baby girl, GiGi too. I think she has MVD, but my vet, (who only has 1 other patient with liver shunt) says her numbers are very very high, and she most definitely has a shunt. She's had 2 BAT, and both came back about the same.... pre in the 2 range, and post in the high 70's low 80's. She has no symptoms, except she is small. we changed her food to Hills L/D, canned, and we giver her Milk Thistle and Lactulose every time she eats. Oh, and I had a complete blood panel work up done on her, and every other test came back normal, only the BAT came back high.

I hesitate to have our ONLY board certified surgeon in the state do anything to her because he only will do the dye test AFTER he opens her up, and he CAN'T FIND A SHUNT. And he doesn't do liver biopsies on Yorkies, because their livers are so small to begin with, especially if they have liver issues.... so that really doesn't help me much at all. I could spend $2600 and the only thing I would know is that he didn't SEE anything. I'm about 8 hour from UT, but I've thought about bundling her up and making the drive.... as soon as I can scrape together the money.

But, then if everything is being well controlled by diet, and she's having no symptoms, and she's happy and eating well, and her blood work is coming back normal except for the BAT.... isn't that what you would do for MVD anyway? So, I feel you pain from wanting to do what is best for your baby, but not wanting to throw money in the wind, when you don't have to.

I am a member of the yahoo group..... they are a great group, and I learn from them everyday!

I am in the process of my referral to NC State for the nuclear scan. I am really nervous. I think I would be out of my mind always wondering if I didn't proceed with this step. I will keep everyone posted.

Hello, can you tell me what fruits and veg's you give as treats. My little one was just prescribed denamarin and antibiotics for possible liver disease. Her values were low and the vet is just being over cautious. Her level was 15 prior to feeding (normal is 7) and after feeding 25 (normal is 15)

vet said that dogs with liver problems have numbers in the hundreds so she is just wanting to start the antibiotics and supplement bc she is being over cautious. so....before i started the denamarin...i wanted to research. I feed wellness reduced formula dry and wellness venison and sweet potato as treats and to give meds. I am interested in fresh fruits and vegs too. :-)