Liver disease

[MauiGirl]

Originally Posted by 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

I wondered the same thing, "small, compared to what". Tiki is 7# but skinny because she is tall and long.

Complete comments about kidneys were small in size (3.2-3.7 cm in length, saggital plane), normal in shape, with good corticomedullary definition. The mesenteric lymph nodes were moderately enlarged and hyperechoic. Of course I do not understand any of that, but you probably do.

Like you with Bella, I have relaxed somewhat, feeling that this is not an emergency situation, and is something we will deal with over time.

Probably my next big decision will be whether or not to go ahead with spay & liver biopsy. Tiki is 8 months old now, and I can't believe she hasn't come in heat yet. I'm feeling extra cautious now, and am sort of thinking I'd rather let her go thru a heat and continue her diet and supplements in hopes that her liver will be better able to handle surgery, anethesia & meds in a few months. In the grand scheme of things, I'm wanting to enjoy her as she is for a while without further risk of complications. We'll see what the vet suggests tomorrow, but I'm not up to more drama right now.

We appreciate your continued support, and will have more news tomorrow.
Sandy

[bellasmomok]

Just for comparison....I measured Bella's kidneys while I was looking at her bladder and they were 3.17 and 3.19 cm in length (saggital). She is 3.7 lbs now I guess (she was 4.0 before we started with the vege diet, so I'm expecting her to pick back up to 4.0 soon since I started home cooking), and she is long-ish too--at least, I think she looks long. (She is a normal looking height, though....my aunt's Yorkie looks a little short-legged to me, and Bella doesn't look like that.) I know Tiki and Bella don't weigh the same, and I have no idea if Bella's kidneys would be considered small by a Vet Radiologist or not, but I don't think I'd hold too much stock in that. I'd be more concerned with shrinking (which you wouldn't find unless you did several US's) or hydronephrosis or cortical thinning (which is when the parenchymal tissue starts thinning....I see this in renal failure and elderly patients). Otherwise.....I don't know how size could be a very good indicator of anything at all???

I know exactly what you mean about wanting no more high drama for awhile!! I'm in the same boat......I have seriously taken this on like I would if it were my daughter (because Bella really is my daughter....and my first one at that!), so I have been stressed, even more so that I actually realized. Today was a little stressful since Bella has decided she doesn't care for brown rice much and hasn't eaten much at all today, but Dr. W. gave me lots of help with that, thank goodness!!! I don't know how I'd ever do this without him and without you all.....I'd never make it!

I'll be checking back in to hear more after your consult....can't wait to hear what he says!

[MauiGirl]

After a long consult with the vet/surgeon, we have decided to manage Tiki with diet and supplements and NOT do further invasive diagnostics/surgery at this time.

Her bile acids are not terribly high, ultrasound did not find a shunt, she shows no symptoms, so it will likely turn out to be MVD (and hopefully mild). As far as doing spay, and a liver biopsy, the vet says spay is easy, but adding biopsy means larger incision, longer time under anesthesia.... and if he were to do that then he should also be looking for a shunt and trying to fix it which increases mortality risk. That is all just TOOOO much.

So, I'm not even going to get her spayed right now. I'm just going to enjoy her and give her the best diet and supplements to support her compromised liver. I asked if we should repeat bile acid tests at some point, he said he feels there is no need as long as she is eating well and producing 1-2 stools per day. No problem there, she loves her homecooked food and vegetarian kibble. I'll continue to fine tune her diet with the help of the YT members and the yahoo groups, and possibly a dietitian.

[Ellie May]

Originally Posted by MauiGirl

After a long consult with the vet/surgeon, we have decided to manage Tiki with diet and supplements and NOT do further invasive diagnostics/surgery at this time.

Her bile acids are not terribly high, ultrasound did not find a shunt, she shows no symptoms, so it will likely turn out to be MVD (and hopefully mild). As far as doing spay, and a liver biopsy, the vet says spay is easy, but adding biopsy means larger incision, longer time under anesthesia.... and if he were to do that then he should also be looking for a shunt and trying to fix it which increases mortality risk. That is all just TOOOO much.

So, I'm not even going to get her spayed right now. I'm just going to enjoy her and give her the best diet and supplements to support her compromised liver. I asked if we should repeat bile acid tests at some point, he said he feels there is no need as long as she is eating well and producing 1-2 stools per day. No problem there, she loves her homecooked food and vegetarian kibble. I'll continue to fine tune her diet with the help of the YT members and the yahoo groups, and possibly a dietitian.

I'm glad you're finally getting some answers.
Since he would be the one to do the shunt repair if she had one, he would need to look for one while he is in there. General vets who do the biopsy with the spay aren't really looking for shunts or trying to repair them... So this is a bit of a different situation.

I know you're probably nervous about anesthesia (as I would be) but pyometra is very common in older unspayed females which would be very unhealthy (that's why Ellie's vet wanted her spayed...she didn't want to have to go in and try to take a pus-filled uterus out later without spilling it...). If she goes through two heats, she will also have a 26% chance of getting mammary cancer. There are definately risks to it but the benefits in mildly liver compromised dogs outweigh the risks.

If she is doing well on the veggie kibble, I think you could avoid a nutritionist altogether unless you want to homecook.

[MauiGirl]

Originally Posted by Ellie May

I'm glad you're finally getting some answers.
Since he would be the one to do the shunt repair if she had one, he would need to look for one while he is in there. General vets who do the biopsy with the spay aren't really looking for shunts or trying to repair them... So this is a bit of a different situation.

I know you're probably nervous about anesthesia (as I would be) but pyometra is very common in older unspayed females which would be very unhealthy (that's why Ellie's vet wanted her spayed...she didn't want to have to go in and try to take a pus-filled uterus out later without spilling it...). If she goes through two heats, she will also have a 26% chance of getting mammary cancer. There are definately risks to it but the benefits in mildly liver compromised dogs outweigh the risks.

If she is doing well on the veggie kibble, I think you could avoid a nutritionist altogether unless you want to homecook.

She still gets part homecooked (chicken, brown rice, veggies), in addition to her veggie kibble. I know some liver diets allow chicken, others do not. Since she is still a puppy (8 months) I have included chicken so far. I know I need to get more specific about the amount she eats, total protein, etc.. The vet said there is no scientific proof that milk thistle and sam-e help; however based on the positive results YT and yahoo members have experienced I will be continuing to use them.

Another side note, he had not heard of Protein C tests, and thanked me for bringing in the info about it. I hope they will utilize it in the future for other dogs too.

Tiki should come into heat any time now, and we will go thru this one, and probably be able to have her spayed before the next one.

[Ladymom]

Originally Posted by MauiGirl

After a long consult with the vet/surgeon, we have decided to manage Tiki with diet and supplements and NOT do further invasive diagnostics/surgery at this time.

Her bile acids are not terribly high, ultrasound did not find a shunt, she shows no symptoms, so it will likely turn out to be MVD (and hopefully mild). As far as doing spay, and a liver biopsy, the vet says spay is easy, but adding biopsy means larger incision, longer time under anesthesia.... and if he were to do that then he should also be looking for a shunt and trying to fix it which increases mortality risk. That is all just TOOOO much.

So, I'm not even going to get her spayed right now. I'm just going to enjoy her and give her the best diet and supplements to support her compromised liver. I asked if we should repeat bile acid tests at some point, he said he feels there is no need as long as she is eating well and producing 1-2 stools per day. No problem there, she loves her homecooked food and vegetarian kibble. I'll continue to fine tune her diet with the help of the YT members and the yahoo groups, and possibly a dietitian.

Sounds like a good plan. We had a Maltese on another forum get very sick following a liver biopsy during her spay. She had internal bleeding and needed several transfusions to save her life. It turns out all she has is asymptomatic MVD, but she had a vet who wasn't knowledgable about the current protocol for liver shunts/disease and recommended a biopsy during Adrian's spay.

This is one of the main reasons Dr. Center recommends all Yorkie puppies have a BAT test as puppies. This is from page 22 of Dr. Center's seminar handout:


"2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. How old dogs should be at he time of initial testing has not been established. Typically, abnormal bile acids DO NOT normalize as a dog ages ..... "

[bellasmomok]

^^^ I have a question about the Dr. Center quote above....

I read that same quote, but I also read somewhere else that a dog's bile acids should be tested after 20 weeks (I think?), because before that organs aren't finished developing. So do you think she means to have a BAT before they go home (at 3 mo.) so you have a baseline, but then you'd need another at 20+ weeks after the liver has finished developing to know for absolute sure???

None of this is very simple, is it?

[Ladymom]

Originally Posted by bellasmomok

^^^ I have a question about the Dr. Center quote above....

I read that same quote, but I also read somewhere else that a dog's bile acids should be tested after 20 weeks (I think?), because before that organs aren't finished developing. So do you think she means to have a BAT before they go home (at 3 mo.) so you have a baseline, but then you'd need another at 20+ weeks after the liver has finished developing to know for absolute sure???

None of this is very simple, is it?

Dr. Center used to recommend a BAT test at 16 weeks or before the puppy went to his new home. She has recently revised her recommendation to twenty weeks to give the organs another month to develop based upon her research .

It gets confusing now, doesn't it? What many reputable Maltese breeders are doing is showing new owners proof both parents have been BAT tested, then mutually agreeing that the puppy will be tested at 20 weeks. Reputable breeders cover genetic conditions for at least a year anyway.

The problem is what happens if the puppy does have a high BAT? Before, breeders and owners were pushing the BAT test up to 12 weeks so the puppy could be tested before he came home. How heartbreaking it would be to bond to a puppy, only to find out six weeks later that he has a liver shunt.

I pray Dr. Center is successful in fining a genetic marker for liver shunts so all parents can be cleared before breeding.

[bellasmomok]

Ok, thank you for the extra info. I sincerely hope she will be successful too....it would be wonderful to know that future puppies (of responsible breeders anyway) will be healthy at least in that respect and be able to live normal healthy lives!

[Ladymom]

Originally Posted by bellasmomok

Ok, thank you for the extra info. I sincerely hope she will be successful too....it would be wonderful to know that future puppies (of responsible breeders anyway) will be healthy at least in that respect and be able to live normal healthy lives!

Here's more information on Dr. Center's research if you are interested:

http://www.yorkiefoundation.org/purina1.pdf