Elevated liver enzymes...need advice!

[tokipoki]

I just picked up Toki from her ultrasound appointment. They were unable to detect a liver shunt but they did find some bladder stones (the vet said that there were stones but no crystals...not sure what the significance of that is). She didn't seem so concerned about it and said we could have them surgically removed and sent off to be tested or see if they improve with a change in the diet. I also chose to have them take a blood sample and send it off to Cornell for them to do a Protein C panel.

My vet suspects MVD based on the ALT and BAT values which she said will not require surgery and can be treated medically (as you've all mentioned). She said if I wanted to, we could do the scintigraphy at NCSU. I have an appointment tomorrow with an internist at the vet school where they are basically going to do an exam and redo bloodwork and I will have to schedule another appointment for the scintigraphy. I'm not sure if I should keep it or wait for results from the Protein C panel to come back or wait a few months after having her on the RC Hepatic and milk thistle.

I don't know what to do. The lady I spoke with on the phone said that a basic liver workup could be as high as $1500 (before the scintigraphy). I want to do what is best for Toki but I'm trying to balance that with not having unlimited funds. After running all of these tests, they may come to the same conclusion as my general vet that we just need to change her diet. I hope I don't sound like a terrible person

[107barney]

I would proceed with ncsu.

[LuvTaycieGirl]

Originally Posted by 107barney

I would proceed with ncsu.

I would also proceed with NCSU.

[Specs]

I am so sorry to hear about Toki, we have been through the shock and feeling of helplessness by learning our Toby has LS/MVD also. In our case he was showing some symptoms with pre/post BAT (65/170). We are waiting for a vet school appointment for ultra sound also. Medical management has turned Toby around completely and he is now on a balanced home made diet (Hilary's Blend) and lactulose and is doing very well.

May I ask you how invasive was the ultra sound? Did Toki need to be shaved and sedated? Also, how invasive is scintigraphy and what does it involve for the dog? I ask these questions because Toby can no longer tolerate anesthetic or even vaccinations.

All the very best, our thoughts and prayers are with you! Please let us know the results!

[tokipoki]

Originally Posted by Specs

I am so sorry to hear about Toki, we have been through the shock and feeling of helplessness by learning our Toby has LS/MVD also. In our case he was showing some symptoms with pre/post BAT (65/170). We are waiting for a vet school appointment for ultra sound also. Medical management has turned Toby around completely and he is now on a balanced home made diet (Hilary's Blend) and lactulose and is doing very well.

May I ask you how invasive was the ultra sound? Did Toki need to be shaved and sedated? Also, how invasive is scintigraphy and what does it involve for the dog? I ask these questions because Toby can no longer tolerate anesthetic or even vaccinations.

All the very best, our thoughts and prayers are with you! Please let us know the results!

I am currently at NCSU and have just spoken with a 4th year student and waiting for the specialist to come speak with us. From what I've read scintigraphy is not invasive but I'm sure the other ladies here will know more.

The ultrasound was not invasive at all. They did shave her underside (she looks a lot slimmer haha) but she didn't even need to be sedated. Relatively quick procedure.

[Teresiana]

Good luck Toki! We have our fingers crossed for you

[LuvTaycieGirl]

Good Luck Toki! You both are in my thoughts!

[kjc]

I've given this a lot of thought... I can't recall ever hearing of letting bladder stones resolve on their own or with diet change. I've always been told that this is quite serious as the stones could block the bladder which is life threatening.

If this were me, I'd have the stones surgically removed, and at the same time have an exploratory done and see if there's a shunt or not, repair it if there is one, and get the liver biopsy at the same time.

In older dogs (over 2YO), there is also the problem of Gall Bladder sludge, which causes the same symptoms as Liver shunt, and often does not show on xray or Ultrasound. It can show up in the liver enzyme bloodwork, if the vet knows to look for it. It will also be evident during an exploratory surgery, and the bile duct can be cleared at that time, or be put on a medication that helps to disolve the sludge and restore normal pressure in the liver..

Although any dog may feel and act better on Lactulose, Denamarin, and antibiotics, none of this helps or solves the problem of Gall Bladder sludge. This condition creates pressure in the liver and causes multiple tiny shunts to form to alleviate the building pressure.

Also a complete Urinalysis should be done, as various bacterias, one being E Coli, can cause the Gall Bladder to develope sludge. It takes at least a 30 day course of antibiotics to clear E coli, and may need to be repeated.

[kjc]

Diagnosis of Portosystemic Shunts

Nuclear scintigraphy is a noninvasive means of evaluating dogs for portal venous shunting. In dogs 99mtechnetium pertechnetate is extracted from the circulation primarily by the liver. In animals with shunts, the pertechnetate rapidly circulates to the heart and lungs. Normal dogs have a shunt fraction of less than 15% on scintigraphy; most dogs with shunts have fractions greater than 60%.
Magnetic resonance angiography (MRA) and CT scans have also been used to diagnose portosystemic shunts.
The ultimate diagnostic tool is laparotomy. Once experience is obtained, most extrahepatic shunts and approximately half of intrahepatic shunts can be identified on exploratory.

[tokipoki]

I had actually been thinking about those bladder stones last night too and was thinking it might be a good idea to just have them surgically removed and analyzed and at the same time get a biopsy done on her liver (the vet at NCSU recommended that).

Anyway, I just got back from NCSU. I ended up dropping her off. Today, they will be re-doing her bloodwork, performing a UA, and doing an ultrasound on her urinary tract (a board certified radiologist performed the ultrasound yesterday but I wanted them to get another look at her bladder stones). Then we will bring her back tomorrow early in the morning to have the scintigraphy performed... she'll end up spending the night and coming home Thursday morning. It already feels like it's been such a long day! Poor Toki...she always knows that something is up when I don't give her breakfast and then pack her up in the car. I'll keep you all posted.

[107barney]

I think you're doing the right thing. Best wishes.

[appraisol]

Buddy, my silkie yorkie has been a pickie eater since I adopted him last March. I have tried so many kibble, organic, grain free, etc and he never seemed to settle on one. I tried roasted chicken, I know thats not the best thing, but at one point he would eat that and nothing else, now he turns his nose up at that. I had been giving him AllerG3 for his coat and itching and reliably could put it in chicken pill pockets and he would gobble that down, now he turns his nose up at that. Recently had his dentil done and the usual checkup. He is/was fine. Two days later he had bloody diarhea they said was worms, despite being on Trifexis. So now I have to give him an antibiotic every 12 hrs and worm him a week and a half after they gave him worm meds in the office. The antibiotics went down ok in a pill pocket until 3 days ago, now he refuses them. He wont even consider the peanut butter pockets. His wt was down about 1/2 lb from his prior wt, but still at 8.5. Tried waiting him out, just at my wits end. He is lethargic and I worry. Any ideas?

[mperran1974]

Please keep us posted. You are your pup are in my prayers.

[Maximo]

I'm glad you are working with NCSU. Keeping Toki in my prayers.

[marlenemaria]

Praying your all goes well and I can see you are getting great advice