Bile Acid Test

[yorkietalkjilly]

Originally Posted by katy-yorkie

Cathy, that's the weird part, I didn't think she had any symptoms. The reason I had the testing done is because the behaviorist put her on two different medications and she couldn't tolerate either...generic Prozac and generic Paxil. She totally quit eating and acted like walking across the room was a struggle, all she did was sleep, on both medications. The behaviorist thought she needed her thyroid and BAT checked. I thought she probably had thyroid issues but not BAT. She is a little plump, she sheds and is a little sluggish, breathes very heavily at times. I've asked the vet about all of the symptoms and he wasn't concerned (she has had all of these symptoms for a few years). She had blood work done at the end of February for her dental, didn't see anything unusual. She won't be taking any of the meds from the behaviorist either. The behaviorist is supposed to be an excellent one but she believes in medication, I don't think mine need it. I was taking them to the behaviorist as Maggie sometimes attacks Buster and it had become more frequent and I was worried for Buster especially with his leg issues.


I won't have a biopsy done, she will see the internist first and we will go from there. (I've written another small book).

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.

[yorkietalkjilly]

Originally Posted by katy-yorkie

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.

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.

[ladyjane]

Originally Posted by yorkietalkjilly

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.

[ladyjane]

Originally Posted by katy-yorkie

So, I'm confused...the dog behaviorist that I have been taking Maggie to see suggested that she have a couple of tests run due to some side effects that Maggie had when she was given a certain medication. She recommended that I have a T4, Free T4 by ED, TSH and autoantibodies - all of these together, and the Bile Acid Test. To my shock the Thyroid was normal but the BAT wasn't normal. The Pre was 2.0 and the Post was 120.0. Her food in between the test was her normal kibble and not very much of that. Maggie will be six in September and has been very healthy. I somehow thought at her age the chance of the BAT being off was not even an issue. When the vet called to explain it, he was busy (story of my life these days) and is ready to send me Texas A&M for a biopsy. I don't know if I should get the liver biopsy done, of course this would be the call of the vets at TAMU or just change her kibble and have the test run again in a few months. Whatever she eats needs to be a kibble that Buster can also eat. They are currently eating Fromm's adult, small breed. Any suggestions?

Originally Posted by yorkietalkjilly

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.

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.

[107barney]

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.

[ladyjane]

Originally Posted by 107barney

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.

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.

[107barney]

Originally Posted by katy-yorkie

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.

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.

[kjc]

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.

[kjc]

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

[ladyjane]

Originally Posted by kjc

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.

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.

[ladyjane]

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.

[katy-yorkie]

Originally Posted by kjc

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

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...

[katy-yorkie]

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.

[ladyjane]

Originally Posted by katy-yorkie

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?

[107barney]

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