portosystemic shunt

[MauiGirl]

Originally Posted by Ladymom

Cloud Star makes dehydrated sweet potato chips:

http://www.cloudstar.com/8B85D0640D2...E42118096B204A

I love Cloud Star's Itty Bitty Buddy Biscuit Sweet Potato Madness.

Just make sure you are giving Tiki enough protein. Unlike dogs with kidney disease, low protein diets are not appropriate for liver compromised dogs. They can actually damage the liver further and/or prevent it from repairing itself. The key is to feed high quality protein from dairy or chicken and fish. Protein should be about 20% of their diet.

Thanks for the info, I'll try to get those. So far I have just modified Tiki's diet by switching to NB Vegetarian dry, and still give her boiled chicken and brown rice too, and occasionally eggs, in smaller amounts 4 times a day, plus her Marin. Her u/s is Thursday.

[Ellie May]

Originally Posted by LillyBug

I have an appointment with the vet tomorrow to discuss options. I will certainly request a repeat of BAT. The vet originally put Lilly on Adenosyl when her first liver enzyme came back high. Funny thing is when I took her in for the BAT he said her liver enzymes had come down to normal? I have continued her on the Adenosyl as he never said to stop it. Any suggestions for low protein treats? She is always chewing on my golden's bones, I assume I should keep these away from her?

It would be good to keep her on the Denosyl while the bile acids are in question. Ellie's post bile acids were 47 and ALT was 118. Next draw the post went to 15 and the ALT came back down. I stopped supplementing and kept her on low/moderate protein and the bile acids went back up to 106. I think ALT has remained okay. So they can fluctuate.

Good treats for liver compromised dogs are watermelon, peeled and cored apple bits and green beans.

[bellasmomok]

Originally Posted by MauiGirl

Do you make your own Dried Sweet Potato, or is it available is stores? Sounds like just what I need for my Liver Challenged/ not yet diagnosed, Tiki.

I found this "recipe" for sweet potato chips/fries:
peel and slice sweet potatoes in 1/4-1/2" slices
put them on a piece of foil sprayed with olive oil
bake at 200-250 F for 1 hr, then turn over and bake for another hour or so
watch to make sure they don't burn!
(the thicker they are, the longer they take)
they get more chewy when you put them in a ziplock in the fridge, but pups still love them!

And this one too:
steam the potatoes first
then plop them into boiling water (helps get the skin off really easily)
(Don't cook them too much or they will crumble!)
slice them into whatever shape you want--chips or long strips for chewing
then bake at a low temperature until you get the texture (chewy/crispy/etc...) you want

Just remember that sweet potatoes are very high in manganese, so you shouldn't give too much, especially if you have a symptomatic dog (neurological symptoms especially)!

[Yorkieluv]

Originally Posted by Ladymom

Cloud Star makes dehydrated sweet potato chips:

http://www.cloudstar.com/8B85D0640D2...E42118096B204A

I love Cloud Star's Itty Bitty Buddy Biscuit Sweet Potato Madness.

Just make sure you are giving Tiki enough protein. Unlike dogs with kidney disease, low protein diets are not appropriate for liver compromised dogs. They can actually damage the liver further and/or prevent it from repairing itself. The key is to feed high quality protein from dairy or chicken and fish. Protein should be about 20% of their diet.

You are absolutely correct that protein is extremely important

I just want to emphasize how to get a symptomatic dog reach those levels of protein...It's not just as easy as feeding a 20% protein food to a symptomatic dog because a lot of those dogs can't handle that much without exhibiting symptoms of hepatic encephalopathy and having ammonia built up in their systems. Miko is one of those dogs...

For symptomatic dogs, it's best to start out at the lower level of protein intake and work up from there. Each week, if the dog handles the amount of protein well, I increase by .5 g of protein every 7-10 days. This needs to be done in conjuction with feeding small, frequent meals (preferably 4-6/day) to lighten the load on the liver and to keep their blood glucose levels up, giving lactulose 3x/day at doses that will achieve 2 soft stools per day, supplements (ie. milk thistle, denosyl, vit e, etc.), probiotics, antibiotics. ALL of these in combination will help a dog that is symptomatic reach those "higher" levels of protein without exhibiting symptoms.
These are Dr. Center's recommendations:
http://www.homevet.com/petcare/docum...veranddiet.pdf

If I decide to skip lactulose for Miko and keep his protein intake the same, he will seizure. If I give him 2 large meals instead or his regular 5 meals, he will get sick and begin to exhibit symptoms.

[Sharlee]

Hi all,
First time poster, but I visit YT on a daily basis. First of all, I just want to say you guys are awesome! What a kind, compassionate and above all, knowledgeable group you all are! I have learned sooo much about my furbaby here and I'm very grateful for all the shared information. Unfortunately, my girl also had high bile acid results come back. Unlike some of you, my previous vet didn't have any good numbers for me as her tests only showed a pre number of 5 and a post number of "above 30". I have since changed vets and I'm currently in the process of having my baby's Protein C test sent to Cornell U. After reading all the posts here I decided this should be the next step, although both vets wanted to go with an Ultrasound in the beginning. My current Dr. was very open to my request for a Protein C test although he had not heard of it beforehand. See how valuable you been in educating us! I wanted to let everyone know the comparative costs associated with both tests. Ultrasound was quoted at $300.00 and the Protein C is $31.50 plus next day air shipping and whatever fee your vet will charge for the blood draw. Quite a difference!

[Ellie May]

Originally Posted by Sharlee

Hi all,
First time poster, but I visit YT on a daily basis. First of all, I just want to say you guys are awesome! What a kind, compassionate and above all, knowledgeable group you all are! I have learned sooo much about my furbaby here and I'm very grateful for all the shared information. Unfortunately, my girl also had high bile acid results come back. Unlike some of you, my previous vet didn't have any good numbers for me as her tests only showed a pre number of 5 and a post number of "above 30". I have since changed vets and I'm currently in the process of having my baby's Protein C test sent to Cornell U. After reading all the posts here I decided this should be the next step, although both vets wanted to go with an Ultrasound in the beginning. My current Dr. was very open to my request for a Protein C test although he had not heard of it beforehand. See how valuable you been in educating us! I wanted to let everyone know the comparative costs associated with both tests. Ultrasound was quoted at $300.00 and the Protein C is $31.50 plus next day air shipping and whatever fee your vet will charge for the blood draw. Quite a difference!

Welcome to YT but I'm sorry your girls ble acids are high also.
Why did you test to begin with?
Are you going to redue the BAT and send it to a lab instead of do it in-house? The SNAP BAT is really pointless because it doesn't read over 30 and 30 isn't that high. That could be in the range where possibly a medication taken too close to the test could've skewed it or the gallbladder contracted at a bad time.

The Protein C test was a good idea though.
Ellie had an ultrasound (it may have been at the place where your vet was going to send you) and it showed nothing (except pancreatitis...good to know but not what we were looking for). Thankfullly for us, we don't think it's a shunt anyway. If you have anymore vet issues, I might have a recommendation for you (or maybe you are seeing him now).

[LillyBug]

I can't believe how many others are going through this elevated BAT's. While I hate to say it as I don't wish it on anyone, but it is nice to hear and talk with other's going through the same thing. Everyone has been so helpful to me and have made me feel more at ease with all this.

[Sharlee]

Based on what I've read here, I wanted to test her before her spay. She also seemed to develop an aversion to meat shortly after her rabies vac. I was suspect of the shot in the beginning and am still not convinced it had nothing to do with her inappetance. She is currently on Hills L/D and eats like a little piglet..snorts and all!! She is asymptomatic as far as I can tell from the symptoms reported here. Thank you for the offer on a vet recommendation. My groomer really likes the Dr. I'm seeing now and she thinks he's pretty knowledgable about Yorkie issues, so we'll see. If her Protein C comes back with problems I don't know if more blood work is in order or if a diagnostic test like the ultrasound would be scheduled..it seems like it takes a while to get the actual diagnosis. I'll have an ulcer by then, no doubt!

[Ellie May]

Originally Posted by Sharlee

Based on what I've read here, I wanted to test her before her spay. She also seemed to develop an aversion to meat shortly after her rabies vac. I was suspect of the shot in the beginning and am still not convinced it had nothing to do with her inappetance. She is currently on Hills L/D and eats like a little piglet..snorts and all!! She is asymptomatic as far as I can tell from the symptoms reported here. Thank you for the offer on a vet recommendation. My groomer really likes the Dr. I'm seeing now and she thinks he's pretty knowledgable about Yorkie issues, so we'll see. If her Protein C comes back with problems I don't know if more blood work is in order or if a diagnostic test like the ultrasound would be scheduled..it seems like it takes a while to get the actual diagnosis. I'll have an ulcer by then, no doubt!

if the Protein C test comes back abnormal, the next step is a nuclear scintography. They probably do them at MSU. rabies vaccines seem to be very hard on small dogs.

[Sharlee]

I agree! That's why I was very excited to see that Cornell offers a VAX test to provide vets with the opportunity to access and monitor the need for vaccinations. You can bet I will be doing this before my girl has any type of "boosters"! Does immunity really fade as time goes on?

[Ellie May]

Originally Posted by Sharlee

I agree! That's why I was very excited to see that Cornell offers a VAX test to provide vets with the opportunity to access and monitor the need for vaccinations. You can bet I will be doing this before my girl has any type of "boosters"! Does immunity really fade as time goes on?

It really depends on the type of vaccine and this is still being researched. One popular animal immunologist does modified live virus vaccines once or twice after his dogs' immune system's are fully mature and then may titer once and then no more vaccines. This doesn't apply to rabies though. Titers show humoral immunity or that having to do with antibodies but not cellular immunity, so a low titer doesn't necessarily mean an unprotected dog.

Rabies has to be given by law in Michigan by four months, then one year later, then every three years after that. Titers aren't an acceptable replacement and if your dog goes without the shot and would bite or there would be a question of whether they have rabies, they would have to be quarantines and the state could go as far as to euthanize and test brain tisue. The way around this is to have your vet write you a medical exemption (to be within the law) but I'm sure protocol is similar if they are suspected of having rabies medical exemption or not...

Dr. Dodds (expert on vaccines) says give pup shots, booster one year later and then titer every year after (except rabies has to be given). This wouldn't work for the non-core vaccines that really don't last long and it is questionable whether the non-core ones should be given to most dogs at all. Depends on the circumstances. We just had a long discussion about duration of immunity on YorkieTalk with Kris Christine, founder of the Rabies Challenge Fund. The titer was something like "Ellie's distemper titer is low again". If you type "distemper" into the search on YT, you might find it becasue I think that will give you something better to read then what I just posted.

[LillyBug]

I met with the vet today to talk about Lilly's abnormal BAT's. I got a copy of her lab results and her ALT was 119, AST 75, BUN 20, BAT fasting 33.7 and Post 68.4. I was kinda let down by my vet today. I talked with him about repeating the labs and it was decided to repeat in 3-4 months. He prescribed lactulose and was going to check with his "company" to recommend a low protein food for Lilly. I already changed her to the natural balance with chicken. So I guess the next step is to treat medically and wait to repeat the levels.

[Ladymom]

Originally Posted by Ellie May

It really depends on the type of vaccine and this is still being researched. One popular animal immunologist does modified live virus vaccines once or twice after his dogs' immune system's are fully mature and then may titer once and then no more vaccines. This doesn't apply to rabies though. Titers show humoral immunity or that having to do with antibodies but not cellular immunity, so a low titer doesn't necessarily mean an unprotected dog.

Rabies has to be given by law in Michigan by four months, then one year later, then every three years after that. Titers aren't an acceptable replacement and if your dog goes without the shot and would bite or there would be a question of whether they have rabies, they would have to be quarantines and the state could go as far as to euthanize and test brain tisue. The way around this is to have your vet write you a medical exemption (to be within the law) but I'm sure protocol is similar if they are suspected of having rabies medical exemption or not...

Dr. Dodds (expert on vaccines) says give pup shots, booster one year later and then titer every year after (except rabies has to be given). This wouldn't work for the non-core vaccines that really don't last long and it is questionable whether the non-core ones should be given to most dogs at all. Depends on the circumstances. We just had a long discussion about duration of immunity on YorkieTalk with Kris Christine, founder of the Rabies Challenge Fund. The titer was something like "Ellie's distemper titer is low again". If you type "distemper" into the search on YT, you might find it becasue I think that will give you something better to read then what I just posted.

You are absolutely right. I don't think that most people realize that even if your vet gives you a waiver for the rabies vaccine, all it protects you from is a fine. If your dog bites or is exposed to rabies, he would have to be quarantined, possibly euthanized.

[Ellie May]

Originally Posted by LillyBug

I met with the vet today to talk about Lilly's abnormal BAT's. I got a copy of her lab results and her ALT was 119, AST 75, BUN 20, BAT fasting 33.7 and Post 68.4. I was kinda let down by my vet today. I talked with him about repeating the labs and it was decided to repeat in 3-4 months. He prescribed lactulose and was going to check with his "company" to recommend a low protein food for Lilly. I already changed her to the natural balance with chicken. So I guess the next step is to treat medically and wait to repeat the levels.

Have you thought about a second opinion.
The vet shouldn't have to check with his company on the food to give a liver compromised dog. He should already know. Lactulose is fine but I forgot, is she symptomatic? You may not need to give this if she is asymptomatic... Denosyl or Vetri DMG or one of these AND lactulose would be a more common thing to do. Those numbers weren't terribly high. You could retest in a month but waiting 3 or 4 may not be a good idea. The vet could also send you to an internist. It is very possible that it is microvascular dysplasia and not a large shunt.

[LillyBug]

Originally Posted by Ellie May

Have you thought about a second opinion.
The vet shouldn't have to check with his company on the food to give a liver compromised dog. He should already know. Lactulose is fine but I forgot, is she symptomatic? You may not need to give this if she is asymptomatic... Denosyl or Vetri DMG or one of these AND lactulose would be a more common thing to do. Those numbers weren't terribly high. You could retest in a month but waiting 3 or 4 may not be a good idea. The vet could also send you to an internist. It is very possible that it is microvascular dysplasia and not a large shunt.

My first reaction as I was listening to him, was, "I am going to see someone else for a second opinion". I definately thought it was odd that he had to check with his company on which food to recommend, you would think he would know. Lilly has no symptoms at all. Initially when her pre surgery liver enzymes were high he gave me Denosyl for 30 days which I have continued to give to her. At first he was going to recheck in a year- which I was like, NO WAY. He diagnosed her with portosystemic shunt. I even mentioned that I had been doing research which says >100 is more likely for a shunt, he really didn't seem to listen to me. Lilly's pre surgical liver enzymes were high however when they performed the BAT they fell in normal range. I just feel like he didn't even listen to me and didn't explain. I am so confused now on what to do.