:thumbup::thumbup::thumbup:

I will follow the doctor's orders...I know she can't have anything "good"...I just have to overlook those sad eyes. She wasn't too crazy about the kibble but since she hadn't eaten in a couple of days, she ate it...take a bite, look at me, take a bite, look at me....

She is working you Jeanie. Trust me, she is not going to starve. haha they do know how to make you feel guilty

How about you get the canned and bake little treats? Or, just give veggies. I have given pups their kibble as treats after they have adjusted to the food and that made them happy.

I beat you to this one! I went and picked up a some of the canned food at lunch. I read here or maybe you told me before that I could bake the canned food for treats...I'm going to try that. I'm going to stop on the way home and get some veggies, although she's not a big fan, but if she's hungry, she might start to like them. It's difficult as Dr. Jones didn't recommend that Buster eat the l/d kibble...I know there are situations where dogs in the same house are fed different diets but I'm leaving the day time care to DH...Dr. Haug had wanted me to get them on a once a day feeding and we were getting there until I got sidetracked with this and of course there's Buster...I've been leg watching again for the last month. Maggie has to be watched constantly so that she doesn't eat Buster's food...she will eat his food and hers. I will keep her on the foods that Dr. Jones has recommended as I don't want her to be sick.

Did you read the material? It explains that there are varying degrees of liver pathology and conditions and that dogs suspected or diagnosed with MVD/PVD can be very sick to not so much. Most MVD dogs do well with diet and medical management. Medicine isn't always black and white and much of it is an art and requires a knowledgeable diagnostician to get to the bottom of a sick dog and get him to stay well. The lack of a shunt on a sono test means she probably doesn't have a liver shunt problem(though from what I've read abdominal sonograms are not always the best way to test for liver shunts on a small dog due to gas-filled intestines being hard to see through or overlying ribs or lungs making it easy to miss a small shunt here or there and possibly she could still have one or more shunts. I've read nuclear scintigraphy, tests using contrasts and Dopplers are often more sure testing methods in small dogs ) but due to high Bile Acids and whatever symptoms she has, they are making a probable differential diagnosis of MVD or PVH, which means her liver isn't properly cleaning her blood of toxins, most likely due her underdeveloped, hypoplastic portal vessels or atrophied blood vessels and other tissue or who knows what's going on in her liver.

The only true way to diagnose that condition as I understand it is a liver biopsy and maybe the vets either think she's too sick or either her symptoms are not severe enough to put her through that right now as it requires anesthesia and taking a portion of the liver to study. So they treat her with diet consisting of low, easily processed proteins and if she responds, then the vets came to the correct conclusion. If the diet doesn't work, more testing and possibly drugs will be required.

If the case of MVD/PVH isn't a severe one and the portal vessels are not all or too damaged or atrophied, hypoplastic and/or enough for her liver to function fairly well, she probably won't have a lot of liver damage to show up on blood tests. Someone correct me if I'm wrong but a high Bile Acids Test reading shows that she's not properly rapidly reabsorbing the most of her intestinal bile acids after a meal as she should and that's probably due to a liver condition and a reason to further test/continue to treat for liver problems.

Right now, you just want to keep her symptom-fee for a month at a time and then, in 6 months or so, whatever her vets say, stop and re-assess. You can make her treats as I do Tibbe's, soaking his kibble in water and keeping the pieces refrigerated or microwaving or baking the soaked, softened food. She can still have her treats. Tibbe cannot tolerate the green beans I've given him without getting nauseated and vomiting and being down for the day so your girl is blessed but he has a type of IBS in addition to his MVD.

Jeanie, when Max and Teddy were eating different diets, I had to separate them with a baby gate until they were finished. Teddy always wanted to eat out of Max's bowl, and Max let him.

I hope Maggie will enjoy the baked treats and take greater interest in the veggies. It is hard to resist the sad eyes.

I also understand the difficulty of managing another human who is in charge of care. :rolleyes::)

Keeping Maggie in my prayers for the diet and med to bring normal BATs in a few months.

Jeanie, the doctor in no way indicated that Maggie was too ill to have a biopsy performed right away. He didn't have an issue with recommending diet and the Denamarin and taking her back for a retesting in a month. The report does say that a biopsy will most likely be needed to determine the cause of her liver issues. Had he said that one needed to be done right away, I would have agreed. The report says that he is most suspicious of MVD or chronic inflammatory disease. If her bile acids are still high or her labwork isn't normal when he does her recheck I feel that he will recommend a biopsy and I will agree. I went with his recommendations. I hope that diet and the medications are all that she needs.

That's the way it was with Tibbe. He wasn't too ill to risk getting one nor was he sick enough to justify the risk of one so his vet just suggested going with the same treatment he'd suggest if he did have a positive liver biopsy finding of MVD and it's worked for Tibbe. His first 6 mos. on the diet were rockier than these last 5 or 6, which have been mostly symptom free. He's not had any nausea since February, I think it was. He just has some itching and some eye goo which seemed to start since going on the hepatic diet but that directly reduces with decreasing the hepatic content of his diet. Yesterday I bought him some Hill's ultra-allergy canned, I think it was called, which has low protein and a bag of Wellness Core GF Low Fat to gradually try mixing in with his present Hill's Hepatic/GI combination and see if we can help his itching.

He's going in in 3 weeks I think it is for his routine 6 mos. testing and exam so we'll see how he's doing test-wise then. Going to have his thyroid tested as well as of this spring there seems to be hair on the furniture and yet his coat is very thick and full.

I feel for the dramatics with your little one not liking the change in food. Tibbe wasn't that happy with RC GI once when he had to be on that but we only fed him one meal of that as the itching began immediately after he finished the meal and it was bad. He eats anything but his tummy won't let him eat much other than his special diet. He had a cast iron stomach until he was 3 or 3 1/2 when he began to get sick and vomit, go all day w/out eating if he ate anything - however tiny a portion - of human food the day before - even a tiny bit of bread or a vegetable bite.

Try to ignore her manipulation(easier said than done) and I'm sure she will adjust to her food in time, especially if you vary the way you serve it to her.

Maggie doesn't really have any vomiting. I never see any but every now and then I smell it on her breath when I get home from work and she's kissing me. But I don't find any vomit in the house. She's a good eater, never been a picky eater. I think she will adapt to the new food as she rarely turns up her nose at food. This is why the bile acid being high caught me offguard. She loves to eat grass and dirt and I hear thats a sign of an upset stomach.

If the bile acid is high when she goes for recheck I'm sure he will suggest biopsy, really though she's the picture of health. The only reason I had her tested was because the behaviorist suggested it. He did recommend that I watch her for the next month for any signs of change.

Not necessarily. You can do a biopsy but I don't think he will push for it. He might say it is on your list of options, but I would ask him what he would do if it were his pup. I personally would not do one if they think it is MVD. I don't see the benefit of doing it myself.

Eating grass and dirt -- I know most sources say dogs only do this when they have an upset stomach, and that was the case with our previous dogs. However, Max and Teddy will do it for fun on our walks. :rolleyes: I have read many comments here on YT about Yorkies acting like sheep.

Buster and Maggie only do it when we are out on walks or at the park. They don't do it at home. It's not so much eating the grass, they want to dig into the dirt. Buster usually finds something to eat and is off and chewing before I can get it away from him. I usually have some major face washing to do when we get back home.

Kristin, I've read so much about this, it seems like there's something different in each one. I will ask him what he would do if she were his pup. I asked Buster's surgeon that about the hardware in his knee, what would he do if Buster were his dog...he said he would have the hardware removed, I had it removed. I feel bad that she's gone through so much in the last couple of weeks. I want to hope that my vet did something wrong on the initial testing. When I received the reports, her name was spelled wrong, he had her age wrong. Maybe he had her confused with another patient.

Max and Teddy do a weird thing on their walks where they start sniffing a spot, and it looks like they are digging with their noses. They spin in a circle with their nose stuck to the ground. I'm pretty sure they are into something that is not good, so I move them along.

I would be very unhappy about this, and I would be inclined to repeat the BATs now at a different vet. Even if there was no confusion between patients' results, my understanding is that there is room for error in results if the test is performed incorrectly. Linda, Cathy, is that right?

Tibbe would likely have cleaned his up himself if I hadn't stopped him as dogs routinely eat their own vomit soon afterward. But I used to hear him wretching when he was symptomatic and then he would spit up bile and that no one can miss. Afterward, he was anorexic for a whole day, just refusing all food. These bouts of nausea, spitting up and refusal of food and usually water would then go away, he act and eat normally for two or thee days or more and then another bad bout of nausea/vomiting/anorexia and lethargy. He'd just lie about.

If the bile acids aren't wildly high or she is very symptomatic, what is the purpose of putting her through a surgical procedure to get a liver biopsy when nothing about her treatment likely be changed. Ask your vet what difference it will make in how he treats her if he has a positive liver biopsy result and if he says no difference will be made, then what's the purpose?But maybe he's not sold on the MVD diagnosis and wants to try to nail a specific diagnosis down and if no liver biopsy shows MVD and she's still having symptoms, then he would go on looking with more testing.

You can keep her from attacking your other dog without medications if you'll work at retraining her, monitor her body language and stop her before she gets focused in and keep them separated at times while she's in retraining. Buster's leg issues and his subsequent awareness of how weakened he is are probably seen as a vulnerability to take advantage of in the canine world but you can deter and retrain much of that if you get her behavior in hand. And if she's got a liver condition, these meds weren't healthy for her so I'm glad you took her off them.

I'm glad you're not getting the biopsy and taking her to an internist first.

Except for the high Bile Acids and smell of vomit on her breath, she sounds like she's doing well but those two are biggies. Tibbe would likely have cleaned his vomit himself if I hadn't stopped him as dogs routinely eat their own vomit soon afterward in the hopes they can hide their illness from predators and for the food value in it. But I used to hear him wretching when he was symptomatic and then he would spit up bile and that no one can miss. Afterward, he was anorexic for a whole day, just refusing all food. These bouts of nausea, spitting up and refusal of food and usually water would then go away, he act and eat normally for two or thee days or more and then another bad bout of nausea/vomiting/anorexia and lethargy. He'd just lie about.

If the repeat bile acids aren't wildly high or she isn't very symptomatic, what is the purpose of putting her through a surgical procedure to get a liver biopsy when nothing about her treatment likely will be changed? Ask your vet what difference it will make in how he treats her if he has a positive liver biopsy result and if he says no difference will be made, then what's the purpose? But maybe he's not sold on the MVD diagnosis and wants to try to nail a specific diagnosis down and if a liver biopsy shows no MVD and she's still having symptoms or further elevated Bile Acids, then he would go on looking with more testing. It is time for a second opinion.

What???? She is with the best...not to say that second opinions are not good; but why at this juncture would she need this??? I am quite stunned and baffled by this.

Jeanie, please read her original post. She is not doing what they suggested ... they were ready to jump to a liver biopsy just based on elevated BATs...she actually IS on her second opinion with a very well respected board certified internist.

Honestly, I don't see anything out of line with the proposed plan. I don't think a biopsy was recommended or is needed in a dog with no symptoms that can try medical management. He has her on a liver diet and denamarin. There is nothing else to do at this point except repeat blood values. I would not do a biopsy unless my dog was sick and med mgmt didn't improve the picture.

:thumbup::thumbup: Exactly! It was her vet she called who wanted to jump to a liver biopsy. That to me was too aggressive as a start. I understand that some vets do that, but it would not be done to one of my pups.

He is correct that only a liver biopsy can determine a definitive diagnosis. You don't have to do one if and when he suggests it. The regular vet likely went over options and was leaving it to the internist to do the workup. Some people treat dogs for seizure without ever doing an MRI to determine the cause of seizures. They instead use anticonvulsants and say "it's probably epilepsy" -- the same is true here: Yorkie + high postprandial bile acids probably = MVD so just treat as if or if you must know then get a biopsy. I wouldn't and didn't. Even if it's not MVD, there's not really a problem with feeding a liver diet and denamarin in a dog with high BATs if that dog can tolerate the food and nutraceuticals.

I'd ask about doing a trial run on Ursodiol... it's a natural Bile acid to help with digestion... thins out the bile . Tink had a BAT of over 300, and NO shunt! It's common in older yorkies to get a sludgey, thickened bile from the liver to the gall bladder, and can easily be overlooked. Tink did have a liver biopsy, but only because she had surgery anyway and while they were in there it was easy to take one.

Can I ask about other things the trainer/behaviorist is suggesting for Maggie besides medication?

Not that it would hurt anything giving it to her, I can tell you that if Dr. J thought is was needed, he would have ordered it. He did for my Olivia. :) He really is great with liver and other gastro related issues.

Let me also add that the radiologist that did the ultrasound on Maggie is terrific...no way would she overlook an issue with the gall bladder. She diagnosed it in my Olivia.

We were doing a lot of training...a lot. She diagnosed Maggie as being depressed during the one and only session we saw the behaviorist, that is why she prescribed the meds for Maggie. I would prefer the training but it is a lot of training and neither of mine would roll over, Maggie won't do down, it takes a of treats to do the training they want done. The training has basically gone to hell in a hand basket since Maggie could not take the meds and she had all the BAT and thyroid testing and Buster had his issues again with his leg. I think we will be starting from square one if we go back.


Sometimes I think I try too hard...maybe I should let pups be pups...

At this point Maggie has quit eating. I have tried green beans, sweet potatoes, apples, canned food, the kibble....I don't know what to do. I know they will eat when they get hungry but Maggie is strong willed and usually won't give in. She ate a small amount of the canned food when I first got it but she no longer eats it. I know there are different brands, do they taste different, does one brand taste better than the other? I go to the pantry and sneak bites to eat so that she won't see me eat.

Jeanie, you cannot let her do that. You have to sneak to eat? No. I realize she may be strong willed, but it sounds like she works you.

Don't keep offering different things...she will continue to wait to get what she wants. You must be firm with her! Yes, some foods will be more pleasing to them....you can switch .. just call them on Monday and ask what else to use. Maybe just get her the canned food?

Royal Canin Hepatic is another liver diet. My dog never did well on it, but some here use it successfully.