Liver disease

[MauiGirl]

Originally Posted by Yorkieluv

Puppies need more protein than adult dogs, so if you're going to feed the NB Vegetarian, I would add some sort of high quality canned food like Evangers or something like that to your healthy puppy's food until she's "adult".

I'm sure you are right, that's why I've been giving Meika extra portions of chicken. But I will get another high quality puppy food just for her. I kept some of my Thanksgiving sweet potatoes plain/separate, and gave to puppies. They LOVED it.

Only 5 days til Tiki's ultrasound, and I wonder if it will show us anything. Do the Vet Radiologists usually tell you anything right after the test, or do they only send a report to the referring vet?

[Ellie May]

Originally Posted by MauiGirl

I'm sure you are right, that's why I've been giving Meika extra portions of chicken. But I will get another high quality puppy food just for her. I kept some of my Thanksgiving sweet potatoes plain/separate, and gave to puppies. They LOVED it.

Only 5 days til Tiki's ultrasound, and I wonder if it will show us anything. Do the Vet Radiologists usually tell you anything right after the test, or do they only send a report to the referring vet?

If you have an appt. for this, the specialist will talk to you afterwards.
We got to have a long talk with the internist after Ellie's ultrasound.
They will also send a report to your vet.

[MauiGirl]

Originally Posted by Ellie May

If you have an appt. for this, the specialist will talk to you afterwards.
We got to have a long talk with the internist after Ellie's ultrasound.
They will also send a report to your vet.

The way it is set up, the Vet Radiologist who is flying over to Maui to do the ultrasounds will be doing several on the 4th, and I have to go to a different vet office for that. They haven't given me a definite time, and said to expect to drop her off for a couple hours, and they'll let me know if it's morning or afternoon. A little vague, but I'll hear more the day before.

I don't hold very high expectations for the u/s, but will be glad to get if over and move on.

It is so very sad to see how many new people are coming on YT with the same liver problems.

[Ellie May]

Originally Posted by MauiGirl

The way it is set up, the Vet Radiologist who is flying over to Maui to do the ultrasounds will be doing several on the 4th, and I have to go to a different vet office for that. They haven't given me a definite time, and said to expect to drop her off for a couple hours, and they'll let me know if it's morning or afternoon. A little vague, but I'll hear more the day before.

I don't hold very high expectations for the u/s, but will be glad to get if over and move on.

It is so very sad to see how many new people are coming on YT with the same liver problems.

I have noticed that also on YT in the last few days.
If you have to drop her off, then it doesn't sound like a consult , so the report will probably just go to your vet. It would be nice to be able to talk to the internist though because they should know more than your regular vet.

[MauiGirl]

Originally Posted by Ellie May

I have noticed that also on YT in the last few days.
If you have to drop her off, then it doesn't sound like a consult , so the report will probably just go to your vet. It would be nice to be able to talk to the internist though because they should know more than your regular vet.

That's what I thought too, although it isn't even a vet internist (can you believe there isn't one in the whole state of Hawaii). She is a Vet Radiologist; specializing in this. I hoped they'd let me watch, but they said no; I understand. But I will press for results asap.

I've been following the other liver disease/bloodwork threads. Interesting to see that test can be skewed by so many things, including method of blood draw. Tiki's BAT pre=2.1 and post=47.5, sometimes makes me wonder if it is leaning toward mild MVD rather than shunt, or some totally different cause. The ALT at 245, and xray showing slightly smallish liver is a huge concern to me. Just hope a definite diagnosis is made soon.

[bellasmomok]

Originally Posted by Yorkieluv

Puppies need more protein than adult dogs, so if you're going to feed the NB Vegetarian, I would add some sort of high quality canned food like Evangers or something like that to your healthy puppy's food until she's "adult".

^^Do you mean her Morkie that is healthy? Just wanted to clarify since my baby is still a puppy (7 mo. old), and I have been feeding NB Vege..... I've been worrying about dropping her protein for that reason, but since she has liver issues, I'm guessing that reducing her protein is the lesser of the evil??

[Ellie May]

Originally Posted by MauiGirl

That's what I thought too, although it isn't even a vet internist (can you believe there isn't one in the whole state of Hawaii). She is a Vet Radiologist; specializing in this. I hoped they'd let me watch, but they said no; I understand. But I will press for results asap.

I've been following the other liver disease/bloodwork threads. Interesting to see that test can be skewed by so many things, including method of blood draw. Tiki's BAT pre=2.1 and post=47.5, sometimes makes me wonder if it is leaning toward mild MVD rather than shunt, or some totally different cause. The ALT at 245, and xray showing slightly smallish liver is a huge concern to me. Just hope a definite diagnosis is made soon.

That is really hard to believe.
How sad.
Not one internal medicine specialist in all of Hawaii?
Does anyone even do LS surgery there or do you have to come to the continental US?

[Yorkieluv]

Originally Posted by bellasmomok

^^Do you mean her Morkie that is healthy? Just wanted to clarify since my baby is still a puppy (7 mo. old), and I have been feeding NB Vege..... I've been worrying about dropping her protein for that reason, but since she has liver issues, I'm guessing that reducing her protein is the lesser of the evil??

You are doing this temporarily until you can find out more, right? You will be retesting soon or doing further testing? Correct me if I'm wrong.
Yes, puppies need more protein than adults. Keep in mind appropriate kinds of protein though.
If the dog is doing well at the protein amount that she is eating, you can increase protein gradually every 7-10 days. Just make sure the protein type is appropriate - dairy/vegetarian. And don't add it all in one meal, spread the amount of protein out evenly throughout each meal. These recommendations are for puppies and for adults...

[MauiGirl]

Originally Posted by Ellie May

That is really hard to believe.
How sad.
Not one internal medicine specialist in all of Hawaii?
Does anyone even do LS surgery there or do you have to come to the continental US?

Sad but true; when I got the first blood results my vet said if we were on the mainland she'd be sending me to an internist, but there isn't one in Hawaii. There is only one Vet Radiologist who flies over to Maui about once a month when the waiting list reaches 6. There are only 2 Board Certified Surgeons in Hawaii, and luckily one is with my vet clinic, so he will do any surgeries.

Like I said before, I can't take Tiki out of Hawaii, due to quarantine restrictions. If I did, I couldn't bring her back into Hawaii for 6-10 months, and she'd need rabies shots (which I wouldn't give her). We are doing the best we can, and that's why I've tried to learn so much about what I can do to help her in the area of diet and supplements. I'm still a little put off that they didn't want to do Protein C before ultrasound, but am going along with their plan because I don't have a lot of other choices. Other than that, we just pray for a good outcome.

[MauiGirl]

Tiki's first BAT was Nov. 1 (drawn Nov. 1, shipped then processed Nov. 4). Her pre= 2.1, and post=47.5, and ALT=245. Still no symptoms. She has been on modified diet and Marin for one month now. Should we do another BAT yet?

She is having ultrasound tomorrow, if LS is found she will next have surgery to repair and spay. If nothing is seen, likely Protein C next (would have preferred to do it first), and if cleared for anesthesia she will be spayed and have liver biopsy.

I'm getting nervous all over again.

[Ellie May]

Originally Posted by MauiGirl

Tiki's first BAT was Nov. 1 (drawn Nov. 1, shipped then processed Nov. 4). Her pre= 2.1, and post=47.5, and ALT=245. Still no symptoms. She has been on modified diet and Marin for one month now. Should we do another BAT yet?

She is having ultrasound tomorrow, if LS is found she will next have surgery to repair and spay. If nothing is seen, likely Protein C next (would have preferred to do it first), and if cleared for anesthesia she will be spayed and have liver biopsy.

I'm getting nervous all over again.

That sounds right.
If she has a shunt repaired, BA wiill be tested every couple months after that for awhile most likely. If she is diagnosed with MVD, you may be about to stop BATing because it is what it is and if you have her on the best protocol possible, there is no way to change it. You can monitor as often as you want though... Since you have moved on to other testing, I don't think you need to redue the BAT right now. Now would've been the time to redue it "if" you weren't getting the ultrasound and/or protein c test. It would be nice to see if the ALT came down though.

[MauiGirl]

Tiki had her ultrasound yesterday, but I won't hear the results until next week. The vet flew over to do about 8 in a row, and would not talk to any owners. She takes it all home to review and sends reports to the referring vets.

I hate waiting. But, I am feeling optimistic about it not being shunt, because her bile acid numbers aren't that high, and based on additional info I have received from the dog liver disease yahoo group.

So I'm mentally preparing for what's next. If shunt is not seen, I think they should do Protein C test to confirm no shunt. After that if she is cleared for spay, they may also want to do liver biopsy. How invasive is that, and what more could it tell them? Would that just confirm MVD or something else?

Thanks for the PMs inquiring about the u/s. Nice to know people are thinking of us and following Tiki's case.

[Ellie May]

Originally Posted by MauiGirl

Tiki had her ultrasound yesterday, but I won't hear the results until next week. The vet flew over to do about 8 in a row, and would not talk to any owners. She takes it all home to review and sends reports to the referring vets.

I hate waiting. But, I am feeling optimistic about it not being shunt, because her bile acid numbers aren't that high, and based on additional info I have received from the dog liver disease yahoo group.

So I'm mentally preparing for what's next. If shunt is not seen, I think they should do Protein C test to confirm no shunt. After that if she is cleared for spay, they may also want to do liver biopsy. How invasive is that, and what more could it tell them? Would that just confirm MVD or something else?

Thanks for the PMs inquiring about the u/s. Nice to know people are thinking of us and following Tiki's case.

A biopsy is a good idea if the dog is already being spayed because they are right there and the diagnosis of MVD could be confirmed but, in my opinion, it is not absolutely necessary. I personally would do it just because high bile acids don't always mean LS or MVD. It could be any liver functioning issue. Remember that several samples should be taken and not just one. Ellie only had one sample taken and it showed no MVD. So widespread MVD has been ruled out but not local...

Most liver compromised dogs do fine with the right kind of anesthesia and the right pain medications.

[MauiGirl]

Tiki's u/s results: No shunt was found; small liver, small kidneys with good internal architecture, moderate mesenteric lymphandenopathy (of concern and suggests active infection or inflamation within the abdomen).

The primary vet thinks the enlarged lymph nodes are from liver not cleansing out toxins.

I feel somewhat relieved in not seeing an obvious shunt, even though I know shunt cannot totally be ruled out yet.

Tuesday I'm meeting with the other vet/surgeon to go over all tests so far, evaluate her for surgery (spay & liver biopsy), and review treatment plan including diet and supplements. I've heard his reputation is to go slow, so we'll see. I have learned so much here that I do feel hopeful and prepared for Tiki's future health care, and am ready to move forward.

[bellasmomok]

Correct me if I'm wrong, but I've had several vets tell me that getting a size on liver won't do much good unless you do it serially. What I was told was that especially for small dogs who have an ultrasound, they almost all have a "small liver" because there are way too many dog sizes and breeds to have a good range of normal for each dog. There are 2 lb and nearly 20 lb Yorkies, so that already has me questioning even using a "breed" guideline for normal. HOWEVER, I have been told (since that is what I do for a living anyway...for people) that I could certainly measure her liver over time and we would be able to have a clearer picture of whether her liver cells are dying (which would cause it to shrink--high ALT is found in puppies but can also indicate liver cell death, so that was why I was told that.)

I'm glad they didn't see a shunt (even though that doesn't necessarily mean she that doesn't have one)....that's a good step!

I'll look forward to keeping up on your baby....don't forget to keep us posted!

Tara