abnormal Bile Acid, info needed please
 

My poor little Gretel started having having little episodes of vomiting after drinking water. Stool test showed no worms and dr. prescribed pepcid. Then I noticed short episodes of little tremors but still vet wasn't concerned. Last week when she went for spay they did bile acids and they were very high--1 before eating and 48 after. Regular blood panel was all normal except platelets were 402. Ultrasound says they think there's a big extrahepatic shunt and they want to do surgery immediately. I'm so afraid for my little girl. Even after surgery dr. said she will need medication and special diet the rest of her life. I'm extra worried because I thought the bile acid would have to be more than 100 for this to be a big shunt. Bladder and urine were fine, no crystals. I'm very confused and the breeder's vet doesn't think 48 is all that high and just wants her to restest in a few weeks. I'm so mad that the breeder won't give me my money until the testing is more conclusive. She's also mad that Gretel got lepto vaccines.

Praying for little Gretel, I don't know much about her condition, but someone with experience will respond to you soon... Hope she recovers promptly...

:2hearts2:I Love My Furbabies, :aimeeyorkNygee, :aimeeyorkGizmo & :aimeeyorkGypsy!!:2hearts2:

I'm so sorry that you are going through this with your baby. Did the vet actually see an extrahepatic shunt?? If you have any doubts at all, I highly recommend that you give your vet information about the Protein C test which helps decipher whether your dog has a liver shunt or MVD. This is basically just a blood test that is relatively inexpensive, and other than a prick for blood, non-invasive.
Under 100 is typically more indicative of MVD and over 100 usually points more towards shunt, but I know of a yorkie who had bile acid test results of under 100 (around 50 to be more specific), and actually had an extrahepatic shunt that was operable. Same thing goes for the other side. I know of several yorkies with results over 100, including my own that have MVD.
If your baby has an extrahepatic shunt and they do a biopsy and find that she does *not *have underlying MVD, then after your baby has surgery to close off the shunt (preferably with an ameroid constrictor), you will have to keep her on special diet, lactulose, and supplements only until her bile acid test results come back normal.

If your baby has an extrahepatic shunt and they do a biopsy and find that she *does* have underlying MVD as well, then they will have to close off the shunt, but your baby will still need maximum liver support for the rest of her life. This includes special diet, lactulose, supplements. This really is not that much work. You just give her a different food and add certain supplements to her food each day. It's really not too bad at all.

If your baby does not have an extrahepatic shunt but has MVD, then there is no surgery to correct the MVD, and she will need max. liver support. The reason I say special diet, lactulose, and supplements. Your baby is symptomatic, otherwise, she wouldn't have tremors. In these cases, you really have to watch what she eats so that the symptoms don't get worse. Certain foods cause toxin build-up and over time cause symptoms that get worse and worse if she is not maintained properly. But with just a couple of small changes, you will see a vast improvement.

48 is not that high. It is way too early to suggest surgery.

The next step would be a Protein C test, then scintigraphy, depending on the results. (Don't do an ultrasound. They are at best only 80% effective at detecting shunts.)

You may very likely be dealing with asymptomatic MVD which is very common and should not cause any problems.

Here is a link for you from Dr. Center who developed the bile acids test:

Hepatic Vascular Disorders - WSAVA 2006 Congress

Thanks everyone. Surgery is scheduled for Tuesday and I'm having such doubts since sitting down and looking through all the test results and comparing to things I've read about here. I've read stories of people whose dogs had unnecessary surgery too, so I'm trying to be extra careful. The regular blood panael showed no problems whatsoever. I don't even know why they went on to bile acid, the vomiting maybe? Dr. says there appears to be a shunt on the ultrasound. The prognosis isn't even good, expecting to have diet and meds for life. I know somebody whose Yorkie has had a full cure after surgery, and I've hear of plenty of liver shunt or MVD dogs that are living fine without surgery but with diet and meds. I feel like I'm being rushed.

If it was me, I would tell the vet that you would like time to seek a second opinion. No vet should even question that, and in fact, should welcome it.

If a bile acid test is the ONLY thing they are basing this on,I would surely seek another opinion. Surgery should not be done until it is confirmed.

All the above posts are great advice, and right on reguarding Liver Shunts. The vet should do the protien test, then the stintigraphy test which is much better than an
ultrasound. I would also find out how experienced your vet is on preforming surgery for Liver Shunts in Yorkies, and exactly what methods of closure he uses. This is happening to fast for you. With only the symptoms you are describing there is no cause to rush things. Changing your babies diet and limiting protien intake will help with the symptoms until a more informed diagnosis can be made, and you will have time to research Liver Shunt/MVD and be more informed also on what is happening to your baby. I hope everything works out for you and your baby.

I've decided to postpone Tuesday's surgery while I do more investigating. We're looking at BAT of 1 pre and 48 post and an u/s report that says "appears to be a large shunt." I would expect a large shunt to return a bat over 100. And that word "appears" on the report seems too uncertain to open up a tiny dog to look around. AND, the prognosis they gave me is lousy---meds and diet for life. Seems to me we can do that without the surgery. This vet is with a VCA hospital chain. Is anyone familiar with them? Somebody said sometimes these big corporations put a lot of pressure on their vets to bring in the revenues, and liver shunt surgery is a big ticket item. Very disturbing-

It is good that you are putting off the surgery. I can't believe a vet would push for surgery that fast. I would hope that you do not give her any more lepto shots. The lepto shot is very hard on these little dogs and should not be given unless your dog is outside in an area where lepto is prevalent. Vaccinations can effect the results of the bile acid test. I pray your little girl will be okay.

The vet is going too fast.
A Protein C test could be done.
Were they going to do the surgery with the constrictor?
How many have they done?
What is their success rate?
I believe most dogs who have the surgery can eat a normal diet awhile after surgery.

Something just doesn't seem right...

I am glad to read that you postponed the surgery. Please ask your vet to do a Protein C test. You can google it and get the information from Cornell's website to print off and give to your vet.

BelindaY.....How soon after she had the lepto shot did they do the BAT's?

For those that recommend a Protein C test.......Would any vet that knows how to do a BAT know how to do a Protein C test? If a Protein C test will tell what kind of liver shunt the dog has then why would one need to do a BAT test? Would a Protein C test rule out a liver shunt? I am asking because some breeders routinely do BAT's and if they are not accurate then why not just do a Protein C test if it is more accurate? The vet I use never heard of a Protein C test and I can't find that much information on the internet about it. I know some of the Universities use it so is that where you would have to go?

I'm getting quite an education these past few days. From what I can gather, Protein C was developed at Cornell and is a fairly new way to neasure blood flow through a shunt vein. Not being medically trained some of this is way over my head. Some people seem to favor it as an intermediate step before going on to ultrasound and scintigraphy. I've read where some pet owners are printing out the info from Cornell on protein C and taking it to their vets. The result is supposed to distinguish shunt from MVD. Vaccine reaction is another thing I keep stumbling upon during this research but I'm not getting much on long term consequences. I've read so much stuff that now I'm forgetting where I learned what. Somewhere I read something about Yorkies possibly tending towards a mild MVD that gets mistaken for shunt and that for them is probably quite normal and is requires only slight dietary adjustment.

Bile acid testing is the best way to screen.
Any vet who can draw blood should be able to do a Protein C test.
If the numbers are in one range it is indicative of MVD and if the numbers are in another it is indicative of shunt. The range that the numbers fall in to suggest MVD are also the "normal" range I believe. So dogs with large shunts have abnormal Protein C numbers. If the number came back in normal range you wouldn't know if the dog has MVD or is normal. That is why the BAT is used...

So what you are saying is the Protein C will just rule out an external shunt but will not rule out MVD?

Yes.

If the numbers come back in one range the dog most likely has a large shunt.
If the numbers come back in the normal range they could have MVD.
If the bile acids are high and either a large shunt or MVD is suspected, this will help distinguish which one...

Of course, like any test, it isn't 100% accurate.

Thanks for sharing that information. I was wondering why do the BAT if the Protein C will be a step closer to a diagnosis. But, your statement clarified that for me.

:thumbup::thumbup::thumbup:

Belinda,

I have a yorkie that I bought from a show breeder in Connecticut. He has multiple external shunts and is on diet and meds and doing great (except for bladder problems since bladder surgery). I have met others with MVD and/or external shunts and they are doing well on diet. Don't get me wrong, I was horrified with the first diagnosis and was very angry to have paid $1600 to a breeder for a dog that 1 1/2 years later had a genetic condition, but now I have calmed down and can see that as long as I feed him properly, we will be fine.

This is amazing. Puppy is 7 mos, bat is 48 and taken 1 month after 2nd lepto shot, the rest of the blood work is normal except possibly platelet count--402--don't know if that immune system or even noteworthy. When an ultrasound report says "appears to be large vein.." doesn't that leave a lot of doubt when the bat is so low? This vet is so anxious to go to surgery it's scary. Anyway, I'm trying to get to a major place where they see a lot of these cases.

Liver shunt info....
 

I Really suggest you look at this website, it is from the University of Tennesee, wher Dr Tobias is, she invented the corrective surgery and deciates her life to yorkies with liver shunts and MVD, I took the trip out there to see her, THE BEST!!!

The University of Tennessee - College of Veterinary Medicine - Portosystemic Shunts

Bile acids are only indicators of liver /gall bladder problems , but usually in yorkies it id due to a liver shunt or MVD (microvascular dysplasia).

As far as the breeder, do you get a health garantee(contract signed?) If not there might not be much you can do:(

I agree about the vet being part of VCA.. My vet is as well, and as much as I like my vet, it seems like it is money, money, money. There is another really good vet here in town that I think I am changing to and they do offer 24 hour emergency service where my current vet does not.

Liver Shunt Surgery
 

Please, please, please get a second and third opinion before you allow surgery. You have gotten some wonderful advice from the gals on this site and I have nothing to add other than 48 truly isn't that high a reading so there is no emergency here yet. Please, get that second opinion and delay the surgery UNLESS you baby is in dire straights. Otherwise you have TIME to get YOUR HEAD TOGETHER and get your little one examined by one or two others. My prayers are with you on this one but I implore you to NOT RUSH INTO ANY SURGERY AT ALL until you get that second opinion from a respected specialist. Where do you live? In NY, there is the Animal Medical Center (AMC) where they have the best specialists in the country and THERE YOU WOULD GET MAXIMUM EDUCATION AND HELP FOR YOUR LITTLE ONE. THEY ARE FABULOUS.

Please keep us informed. I wish you so much of the very best. YorkieSue