Elevated Liver Enzyme
 

I brought our Pixie in this morning to have her spayed. I just received a call from her vet that her pre op bloodwork revealed that her liver enzyme is double the normal range. Their going to do a second test (I forgot the name). We're postponing getting her spayed until we get the 2nd test results. Hopefully, everything is ok.

Oh my....I sure hope everything works out. I'm not good at all these levels of "this and that's" quite yet, but am learning. There are many on here that are. I'm sure they'll have some great info/advice for you soon enough!

Would this second test be called a bile acid test? That test indicates how well her liver is functioning....the results there will indicate whether additional testing is required to determine if she has a liver shunt. As a breed yorkies are 36 more times to have liver shunt than any other breed.

Sending prayers for you and her.

Oh no, I am glad you did the testing prior to surgery. I hope she is ok.

dont despair
 

Hi, I have three yorkies -- one is a dog with microvascular dysplasia (MVD) also known as microscopic liver shunts. Obviously, her liver enzymes are elevated all the time, along with high bile acids readings. However, I'm posting to say that my other adult yorkie who does NOT have liver issues has had elevated liver readings at veterinary visits that are due to laboratory error. I would have the liver values retested and the bile acids test run before you freak out. Good luck!:aimeeyork

I just picked up Pixie from the vet. Her ALT shows 195. Everything else are normal. The second test is bile acid. I'm hoping it turns out normal. I appreciate your prayers guys.

Hoping everything goes well for you guys...

keep us posted!
 

SOrry to hear the ALT is 195, that seems very high. Keep us posted on the bile acids results.

Pixie's bile acid test came back. It reads resting bile acids at 118.7 and post prandial at 6.4. Our vet referred us to UC Davis where they would do a liver imaging with an approx cost of $700 (incl exam, hospital fee). If surgery is necessary, it would cost $3,000. It's now taking 1 1/2 weeks to get an appt with UC Davis. We are so devastated! We love Pixie and we are very concerned right now for her health!

I'm so sorry. :(
UC Davis certainly is a good choice if you have to stay in CA but some people just decide that, because the University of Tennessee and Cornell are so experienced with this and UT is quite cheap, it is a better deal to just get it done out of state. University of Tennessee could likely do surgery (if required) and spay for under $1800. This may even include testing before. Dr. Tobias at UT is the leader in LS surgery anyway. They appear to have the least complications, so it may be considered the safest place along with Cornell. Since it is possible that there is no shunt, you could do a Protein C test first (blood test sent to Cornell) to see if it is likely.

HOLD ON a moment.....Breath :(

Yes that post # of 118.7 is high, but it doesn't mean a definite Liver Shunt. She could have MVD.

I suggest FIRST doing a Protein C test. This is a simple blood test. Costs about $80 to $100 from your General Vet. However, YOUR Vet has to contact Cornell University to get the tubes. And the blood draw has to be overnighted to Cornell. Results come back within a few days.

A Protein C test is a pretty indicator of Liver Shunt.
It reads in %

Below 80% is pretty accurate for a Liver Shunt
Above 80% is either MVD or Normal (can't really distinguish between them)

An Ultrasound is good and bad. #1 it is only about 60-80% accurate is seeing a shunt. You won't see MVD though. It is good to see the size and shape of organs, and if there are any stones present.

My advice is to do the Protein C test and go from there.

NYS Animal Health Diagnostic Center at the Cornell University College of Veterinary Medicine

I live approx 25 miles from UC Davis so I believe that's one of the reasons why my vet recommended them. Ellie May, do you have any contact info for Dr. Tobias?

I'm calling my vet now to inquire about the Protein C test. Thanks, TLC!

I'll let you guys know. I really appreciate everyone's help. I can't think straight right now I'm so upset. You guys are definitely my lifeline.

As Crystal said, U of Tenn is truly the BEST and priced right, which would include EVERYTHING (spay too). Cornell is excellent as well, not sure of price though.
The University of Tennessee College of Veterinary Medicine - Liver Shunt Research

There are lots of folks here with LS who went to U of Tenn (and they were out of state too)

Referrals
Here is the info. Your vet would need to refer you.
Then on the left side of the screen you can click on a tab that says "Small Animal Clinical" and then "Portosystemic Shunts" for some good reading material.

I don't want to make it sound like UC Davis would be a bad choice though. They just don't seem to be one of the leaders in this. I can only say that if my dog was diagnosed with a shunt, I would want her to go to the UT or Cornell because I think they are the best. Bile acids can be up for any problem involving liver function though, so it may not be a shunt at all.

I agree with the previous posters -- If you can get Pixie to UT for surgery (if she in fact needs surgery) then that is where you should go. If it is MVD, a trip to cornell might be the way to go.

My dog with MVD has had very high bile acids depending on her diet, even higher than Pixie's pre reading.

You have to know what you are dealing with exactly before getting upset. Lots of MVD and LS babies do very well on the proper diet after surgery.

I'm sorry you have to go through this and we send Pixie yorkie hugs.:aimeeyork:aimeeyork:aimeeyork

Apparently, my vet is confused why I'm requesting for a Protein C test instead of going directly to UC Davis. I explained to her what you guys wrote as well as the info on the website. I don't believe she's familiar with the test. She adviced me to go talk to the UC Davis people and see what they say. I called UC Davis and my appt is not until June 29th. Another issue is that I'm leaving the country on Jul 10th and I will not be back until Aug. 2nd (three weeks). I'd like to have the Protein C test done but I'm not sure where to go. Judging by how my vet sounded, I believe I need to go elsewhere going forward.

The imagining test requires inserting radioactive dye into your pup. It is pretty safe but something that would be good to avoid if possible. The dog also has to be anesthetized which is fine as long as it's necessary. The Protein C test could just point you in the right direction. If it indicates a shunt, I'd go to UT. If it indicates MVD, you "may" be able to avoid the scintography. Sometimes shunts can be seen on ultrasound. They are only 60-80% accurate but if bladder stones are suspected (secondary to shunt), it may be a good way to go.

I really don't know why more vets haven't heard of the Protein C test yet.:confused: It seems like everyone has to tell their vet about it and it really shouldn't be that way at all.

Because the preprandial number was so high, I would be conflicted on whether to go to the Protein C test or just go to the scint. right away. An internist should be able to help you but as far as I know, there aren't very many who are into the Protein C test either.

It does not surprise me at all that your vet is unfamiliar with the test, or with knowing alot about the diagnosis and treatment of LS or MVD. That is why a consult with the specialists is so important.

The only way to tell FOR SURE that you are dealing with LS is by exploratory surgery because the ultrasound is unlikely to show a shunt or confirm MVD. Sometimes even scintigraphy does not show the shunt. If I were going to put my dog under anesthesia for exploratory surgery or for scintigraphy, it would be with the assumption that I would be correcting the shunt (if there is a correctable shunt). Therefore, I would take the dog to the place where I was going to inevitably do surgery.

If your dog is diagnosed with LS or MVD, you are going to have to put her on the Hill's L/D diet -- this is because it is the right kind of protein in a low protein amount. Since you are going to be out of the country for 3 weeks, you might want to go with a more vegetarian protein diet now in case it is LS or MVD. You can get something like Natural balance vegetarian or Petguard vegetarian which I know some dogs with mild symptoms and slightly elevated bile acids use. I'd also add bits of plain yogurt (stonyfield farms is good) to help absorb the ammonia. A couple of weeks on a lower vegetarian protein diet won't hurt your dog while you sort this all out. If you are feeding a puppy diet now, that is likely REALLY high in protein anyway so I'd switch to a regular adult food at the very least. Oh and avoid regular treats, too much protein and wrong kind of protein -- feed baby carrots, pieces of plain pasta, bits of apples (no skin) as treats instead and see if your baby can tolerate those.

This is just my opinion owning an MVD dog along with two other yorkies and others may disagree. :aimeeyork

elevated liver values
 

Hi
I know it has been a long time since these post were done but how are your dogs. I went to UC Davis 2 years ago and had the radioactive test and my dog does not have a shunt. He is on hepatic liver special food (low protein), denamarin and probiotics but his values are still rising. At 1000 I believe now.

Any suggestions? He goes back to UC Davis on Tuesday. 2 years ago they said the next step would be a biopsy and I am not sure I want to do that. I need to read more about MVD

Thanks Denise

Here is a link to the best article that I know of about liver shunt and MVD in Yorkies. They talk about the different tests and biopsies. It is written by Dr. Karen Tobias of the University of Tennessee, who is the foremost expert on these conditions in the United States. http://www.vet.utk.edu/clinical/sacs...2013-04-10.pdf

High Enzyme Levels
 

I took Bentley in this morning to have his dental cleaning and tooth extraction. About an hour after dropping him off, the vet called and said that his liver enzyme levels are too high. I am very concerned. Can this be normal for Yorkies?

No, it is not normal. It could be a sign of liver disease. You should consult with your vet about diagnostic tests and perhaps get a referral to an internal medicine specialist if the liver tests continue to be abnormal.

Thx pstinard. They ran a bile test on Bentley this afternoon, and said that I should have the results back on Thursday or Friday.

Really praying for your baby.
Yes, the posts here are right. University of Tennessee is the best of the best. I've had dealings with UT but not with possible liver shunts. The times I was there with my little boy, which had GME, I met so many people there with their liver shunt babies. Everyone had such a sad case but, they were having very successful cure rates, or very successful surgeries, with very little complications.
Now I'm sure there were very bad ones, I think depending where the shunt is in the liver, that UT couldn't help.
Hope you get answers you need.
Good luck

Keep us posted on Bentley's health and progress!