He had his frontline top spot and interceptor on January 20th, it was his second month receiving it as I only got him in December.

How old is he?

iT IS POSSIBLE THAT THE FLEA AND HEARTWORM MEDS MAY HAVE SOMETHING TO DO WITH THE RESULTS. i WOULD WAIT FOR A COUPLE OF WEEKS TO HAVE THE PRE AND POST BILE ACID DONE. tHE WAY i HAVE THE TEST DONE IS FAST OVERNIGHT, GO IN FIRST THING IN THE MORNING FOR A BLOOD DRAW, FEED AN ADULT FOOD UP TO TWO TABLESPOONS RIGHT AFTER, WAIT EXACTLY 2 HOURS AND HAVE THE POST BLOOD DRAW.

iF THE RESULTS ARE HIGH START HIM ON A LOW PROTEIN DIET LIKE rOYAL CANINE hEPATIC. YOUR VET CAN PRESCRIBE LACTULOSE AND MILK THISTLE THAT DOESNT CONTAIN ALCOHOL. I GIVE MY LIVER COMPROMISED DOG LIQUID HEPPATO, LACTULOSE AND SOME VITAMINS. I WOULD DO THE TESTING BEFORE ANYTHING AND SEE IF IT COMES OUT HIGH.
tHE BEST PLACE NEAR YOU THAN WOULD BE CORNELL UNIVERSITY.
MANDY

Joey is 8 months old today. Do you think it could be the frontline and/or interceptor?? Is there any harm in doing the sonogram? My vet thought there was no reason to do the acid bile test with the fasting because the initial draw was very high according to him. I am so confused.

I don't think the meds would've skewed the results since they were given so long ago. There are other things to take into consideration though like did the gallbladder contract when your vet drew the blood? That would raise the results for no reason. It is a good idea to repeat the test and do the pre and post but you don't have to.
You can do the u/s if you want but a lot of it depends on if the internist is skilled in looking for shunts. In some cases it is a waste of money.

The protocol is to first get a bile acids test (paired samples around a meal) and if they are high, a Protein C test which will tell you if you are dealing with a shunt or MVD. If the Protein C test is normal, there is no need to get an ultrasound.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

Dr. Center from Cornell is one of the leading experts on liver disease in the country. She developed the bile acids test. Since you are in New York, you could consult with her.

i THINK CALLING CORNELL IS THE BEST ADVICE. IF THE NON FASTING WAS HIGH YOU COULD DO JUST THE POST. THAT WOULD MEAN FEEDING THE DOG ADULT DOG FOOD AND THAN HAVING BLOOD DRAWN 2 HOURS LATER. I BELIEVE A HIGH PRE TEST WILL TELL YOU ABOUT GALL BLADDER. YOU CAN ALSO GET IN TOUCH WITH DOGLIVER DISEASE @YAHOO.COM THEIR FILES WILL GIVE YOU A LOT OF INFORMATION.
MANDY

Hi Mandy :)

I am Nicole from the Yahoo Group (with Roxy and TJ) :aimeeyork

Thanks for giving your suggestions, this Mom sounds very worried :(

Thank you so much everyone. I feel like this site is a lifeline. I am going to fax my vet the information about the Protein C test. Can Joey suddenly become symptomatic if he is acting completely normal now? I go to work and the dogs are home for a few hours a day alone in the morning and then in the afternoon. Someone is always here for awhile midday.

Here's another good one to print off and show to your vet. Dr. Center explains how bile acids tests should be done:

PSVA and MVD Research Summary

Yes, symptoms can appear out of nowhere but if he is completely asymptomatic, I would expect a problem more so after a high protein meal (maybe containing red meat) or after meds/vaccines are given.

He will be ok...don't worry

I was thinking more about how to explain things to you.

A Bile Acid Test is pretty inexpensive. Runs $80 to $100 depending on where you live.

When you go to a specialist (and you may have to), the consult will run about $100 to $150. I can guarantee you that since you didn't have a pre and post BAT from your regular Vet, the specialist will insist on doing it, and at the speciality hospitals the tests always cost a bit more. They will also insist on doing the urinanalysis and an ultrasound. Your visit could run into the $700 and up range.

So, what we are suggesting is that you get a BAT done at your regular Vet, at the same time they can do a urinanalysis, and a Protein C test. Once you get those results, you will have a better idea of what is going on and 'if' you need to see a specialist asap and from the results you can decide 'if' a U/S is nessecery (which it may be).

Since we have been down this road, we are just trying to help guide you in the right direction and to not waste money by jumping into major things without doing the minor things first, that actually will give you better results ;)

And remember, my Roxy has no symptoms. Her first BAT was pre 43 and post 100.9 - This should be in the shunt territory, but she doesn't have a shunt, she has MVD. She eat special food and supplements. She gets blood work, BAT and urinanalysis every year now just as a 'keep an eye on things' reason ;)

Does that make any sense :cool:

I just wanted to say at the vet I use, a pre & post bile acid test is only $41.50 so it really is very inexpensive here. When I went to Texas A&M University, it was about $300 for the ultrasound (before my student discount) and only $56 (before discount) for the exam/consult with internal medicine. So I'm not sure if all vet schools tend to be less expensive than a non-vet school referral hospital??? I'm just wondering if Cornell would be on the lower end so far as some prices go too.

What you are telling me makes total sense and I am going to approach my vet with this tomorrow. I just got the feeling that as soon as he saw the initial test, he was like, get this pup to a specialist. He said he only sees dogs with liver shunts or MVD once or twice a year. I get the feeling he is going to insist all further work be done at Oradell. Oradell is also a regular animal hospital and I know people who use them for routine vet visits. Anyway, that's where I think this will be heading.

Joey also has really bad breath and he eats exactly the same food as Sadie who has no doggy breath at all. His teeth are kept clean. Could this have anything to do with his liver? The way he processes proteins or am I crazy?

You know..Lacy usually has aweful breath too (we're in the process of diagnosing what's going on with her liver). I brush both my yorkie's teeth and use petzlife gel pretty regularly, they both eat raw medallions, and both have great teeth. Rylie's breath doesn't smell like that though...and Lacy's is usually pretty stinky. So I've wondered the same thing...she's had gastrointestinal upset due to her liver issues so maybe it has something to do with that