The Liver Shunt - Bile Acid Test Thread - Page 2 - Maltese Dogs Forum : Spoiled Maltese Forums

**vjw** · 07-14-2010, 03:01 PM

In the other thread where I mentioned that the University of Pennsylvania was doing metabolic urine testing for possible portosystemic shunts, I wasn't sure JMM and I were talking about the same urine test. I asked Dr. Urs Giger at UPENN a couple of questions about the test and here's his response:

Dear Joy,

our metabolic screening test is based upon metabolite studies in urine used for hereditary metabolic diseases. It may suggest a shunt but cannot diagnose a shunt. It cannot discover carriers but only affecteds and not specifically. It is not a DNA test and to the best of my knowledge there is no DNA test for portosystemic shunts.

By the way we are interested in hearing about Maltese who have eaten Chinese Chicken Jerky Treats and developed some kidney issues. We are working on characterizing this problem known as Fanconi Syndrome in the Maltese and a few other small breed dogs. Our metabolic screen is helpful for this purpose.

Sincerely
Urs Giger

**MaryH** · 07-14-2010, 03:22 PM

Hi Christine -- Thanks for asking some great questions. I can understand your vet's position given that most breeds do not have liver issues and therefore bile acid testing would only be done if a dog presented as "sick". Because of what I've learned about Maltese and liver issues, I would have had the bile acid testing done despite my vet's opinion. As Carina mentioned, having a baseline now when a pup is young and healthy could prove invaluable later in life. Baselines are so important in humans and are as important in animals.

In answering your questions, as a person looking to buy a pet, here's what I would do:

1. I, too, would not be uncomfortable if they are not testing puppies. I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test (generally runs $125 to $150). If the breeder refused to test I would walk away.

2. Just because it's a smaller, lesser known breeder, I would not see it as a red flag that he/she is not routinely bile acid testing puppies. Again, I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test. If the breeder refused to test I would walk away.

I don't like asking the tough questions, either. And I really don't like answering them. But they are questions that deserve to be asked and deserved to be answered.

Now, from a breeder perspective, running bile acid tests and disclosing results can be pretty darn scary. I do bile acid test all my puppies at or slightly before 16 wks. old. I do have an indepth conversation with every puppy buyer and potential puppy buyer about liver issues in our breed and how I personally am addressing those issues. I do provide a new owner with a complete health history including bile acid results, a printout of the Liver Shunt/MVD article on the AMA website, and an offer to speak directly with the new owner's vet should the vet have questions or concerns about the bile acid results. My fear is always that the new puppy owner is going to bring the puppy to their vet, the vet is going to look at the bile acid results, and the vet is going to say either "Your breeder must have produced liver shunt before and that's why she is testing puppies now." or "You have a very sick dog on your hands." The "sick dog" situation has happened to me. Did the vet read the info I gave the new puppy owner? Did the new puppy owner even share that info with the vet? Who knows. All I know is that I got a call from the new puppy owner saying she brought her puppy in for preanesthetic bloodwork prior to his neuter, the vet (who was not the "regular" vet of this puppy owner) drew the blood and then read through the file, got to the bile acid results, and said the puppy is very sick and should have a liver biopsy done. Luckily the owner remained calm, said that she would be calling me to discuss the situation, and then would continue the discussion with the vet after the bloodwork results were in. She called me, we talked again about bile acid testing and results and what it all means, I sent her more info, and offered again to speak directly with her vet. She called me three days later to let me know that the puppy's bloodwork was normal, she talked with her regular vet who agreed with me that there was no liver issue, and assured the puppy owner that he would have a discussion with the "other" vet about liver issues. And just so you all know, the bile acid results for this particular puppy was in the high 20s.

I think as buyers and as breeders we are trying to do the right thing. Open, honest discussion goes a long way toward that end. And discussion has to be a two-way street.

**MaryH** · 07-14-2010, 03:44 PM

Quote:

Originally Posted by uniquelovdolce

thanks for the info , it gives me some insight , aww soo scary

i hope he does well in his surgery ..

so let me ask u this , there are bile test that can determine this before?

Liza, here's a link to the AMA Health pages: American Maltese Association Health Information

Once you get there, click on "Gastrointestinal" and then click on "Portosystemic Vascular Anomalies" to get to the writeup on liver shunt. It is a basic overview of Liver Shunt/MVD. The bile acid test can give you a very good idea if a puppy has a serious liver issue, further testing would then tell you what the issue is. Personally, if I was looking for a pet I would want to know that there is no shunt before I buy the puppy. If the puppy's results indicate MVD, but the puppy is at a good weight, normal activity level, bright eyed, etc., I would not be concerned about higher than normal bile acid values. Heck, my puppy will be in the same boat as most other Maltese!

**bellaratamaltese** · 07-14-2010, 04:53 PM

Quote:

Originally Posted by CloudClan

This of course is your decision, and a personal one, but this is one thing that may be discouraging some breeders from testing. If pet owners react to MVD (a common problem in the breed 75-80% affected) in this way then it makes not knowing make more sense to some.

I am not suggesting that you did this, but many buyers will learn of a result like this and move on to another breeder who does not test at all to purchase their pup. So they pass on the breeder who knows and discloses and move to a breeder who does not test and does not know.

The fact is that special diets are not required for all MVD dogs. Most live completely normal lives and never get sick from anything related to their liver.

Nikki's Mom · 07-14-2010, 05:58 PM

The percentage of Maltese who have asymptomatic MVD is pretty high, as I understand it, right?

What makes breeder Bile Acid Testing tricky is if a dog tests high, and it turns out that the dog has asymptomatic MVD, then the buyer might pass up an otherwise healthy dog. With the large percentage of MVD dogs, a person might pass up several great puppies.

I learned Nikki had MVD when she was 6 months old. If she'd been Bile Acid Tested at 4 months by the breeder, I still wouldn't have known whether it was a shunt or MVD, unless further, more expensive testing was done. So how far does testing go? If a potential buyer still wants a puppy that tests high on Bile Acid Test, does the breeder or the buyer pay for a protein C test, or an ultrasound, or a nuclear scintography?

And what about those puppies who have tested high on bile acids but only have asymptomatic MVD and are perfect otherwise? What if nobody wants them?

Just some things to think about and discuss. I have no answers, just thoughts.

**The A Team** · 07-14-2010, 06:00 PM

Quote:

Originally Posted by CloudClan

This of course is your decision, and a personal one, but this is one thing that may be discouraging some breeders from testing. If pet owners react to MVD (a common problem in the breed 75-80% affected) in this way then it makes not knowing make more sense to some.

I am not suggesting that you did this, but many buyers will learn of a result like this and move on to another breeder who does not test at all to purchase their pup. So they pass on the breeder who knows and discloses and move to a breeder who does not test and does not know.

The fact is that special diets are not required for all MVD dogs. Most live completely normal lives and never get sick from anything related to their liver.

Carina, if I didn't already have three dogs here it wouldn't have mattered, but I see what Elaine goes through....three dogs with liver problems and two without.

You're right, MVD isn't a big problem, but the size of my house is

. And if I don't want to have to feed someone inside a crate...it's easier that they can all enjoy the same food. Plus Abbey is a thief....she thinks everyone else has something better than her.

**k/c mom** · 07-14-2010, 06:24 PM

Quote:

Originally Posted by Nikki's Mom

The percentage of Maltese who have asymptomatic MVD is pretty high, as I understand it, right?

What makes breeder Bile Acid Testing tricky is if a dog tests high, and it turns out that the dog has asymptomatic MVD, then the buyer might pass up an otherwise healthy dog. With the large percentage of MVD dogs, a person might pass up several great puppies.

I learned Nikki had MVD when she was 6 months old. If she'd been Bile Acid Tested at 4 months by the breeder, I still wouldn't have known whether it was a shunt or MVD, unless further, more expensive testing was done. So how far does testing go? If a potential buyer still wants a puppy that tests high on Bile Acid Test, does the breeder or the buyer pay for a protein C test, or an ultrasound, or a nuclear scintography?

And what about those puppies who have tested high on bile acids but only have asymptomatic MVD and are perfect otherwise? What if nobody wants them?

Just some things to think about and discuss. I have no answers, just thoughts.

I was thinking the same thing. I think it really can be a tricky issue. It is not just a simple test with a black/white result.

**jmm** · 07-14-2010, 06:39 PM

I've had 3 MVD Maltese, 1 of whom was sick with concurrent liver issues....none required special diet for the liver. Jonathan is 11 1/2 years old and has never had special diet or medications. A symptomatic MVD is an exception to the rule - an unusual occurrence. Back in the day when Jonathan was diagnosed it was liver biopsies. Today we have non-invasive tests like Protein C which only require a blood draw. I would not hesitate to purchase a Maltese with MVD. Nor would I look down upon a breeder who was breeding MVD dogs with the goal of better test results. Phenotype-to-phenotype is how we reduce hip dysplasia in big dogs...no reason not to respect the same principles with our liver dogs (plus this approach has been successful in other breeds).

**Tanner's Mom** · 07-14-2010, 07:43 PM

Tanner is an asymptomatic MVD dog. When I had the preanesthesia bloodwork done before his neuter, his ALT was in the high 300's. He was not neutered that day. Later, I had an ultrasound done (lucky for me the vet who did it trained under Dr. Center at Cornell), and she didn't see a shunt but recommended a biopsy which was done 4 years ago. Because I didn't get a definitive dx from the biopsy, I sent the tissue sample to Dr. Center & best we could determine, Tanner has MVD. I take him in 2 or 3 times a year for blood work & his ALT has ranged from a low of 129 to a high of 500.

I feed Tanner low protein canned food, i.e., 8% or less, & mix a few pieces of whatever kibbles the others are eating. He doesn't know what beef is, he only eats chickens. Also, he gets 1/4 tab of Marin daily. I tried Denosyl and he wouldn't touch them no matter how they were disguised. Feeding him a different food from the others really hasn't been a problem.

When I had his bile acids done, they were in the low 40's.

Tanner is now 6 years old. He weighs 8#s (he was a BYB boy) and is a happy, active, little boy. At one point, I was hoping to have him til he was 5; now he's 6 and I think/hope he'll be around a long, long time.

Nikki's Mom · 07-14-2010, 08:15 PM

Nikki's blood work has been perfect for over 2 years, and she'll be 3 in November. Her ALT numbers returned to normal about 6 months after her liver biopsy/MVD diagnosis, and they have been that way ever since.

She does not eat a special low-protein diet. She has no symptoms, and the vet thinks she is in perfect health.

What if I'd changed my mind about buying her, or returned her, just because of her bile acid test result? What a shame!

07-14-2010, 03:22 PM	#12 (permalink)
MaryH Maltese Guru Name: Mary Join Date: Mar 2006 Location: Massachusetts Posts: 2,150	Hi Christine -- Thanks for asking some great questions. I can understand your vet's position given that most breeds do not have liver issues and therefore bile acid testing would only be done if a dog presented as "sick". Because of what I've learned about Maltese and liver issues, I would have had the bile acid testing done despite my vet's opinion. As Carina mentioned, having a baseline now when a pup is young and healthy could prove invaluable later in life. Baselines are so important in humans and are as important in animals. In answering your questions, as a person looking to buy a pet, here's what I would do: 1. I, too, would not be uncomfortable if they are not testing puppies. I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test (generally runs $125 to $150). If the breeder refused to test I would walk away. 2. Just because it's a smaller, lesser known breeder, I would not see it as a red flag that he/she is not routinely bile acid testing puppies. Again, I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test. If the breeder refused to test I would walk away. I don't like asking the tough questions, either. And I really don't like answering them. But they are questions that deserve to be asked and deserved to be answered. Now, from a breeder perspective, running bile acid tests and disclosing results can be pretty darn scary. I do bile acid test all my puppies at or slightly before 16 wks. old. I do have an indepth conversation with every puppy buyer and potential puppy buyer about liver issues in our breed and how I personally am addressing those issues. I do provide a new owner with a complete health history including bile acid results, a printout of the Liver Shunt/MVD article on the AMA website, and an offer to speak directly with the new owner's vet should the vet have questions or concerns about the bile acid results. My fear is always that the new puppy owner is going to bring the puppy to their vet, the vet is going to look at the bile acid results, and the vet is going to say either "Your breeder must have produced liver shunt before and that's why she is testing puppies now." or "You have a very sick dog on your hands." The "sick dog" situation has happened to me. Did the vet read the info I gave the new puppy owner? Did the new puppy owner even share that info with the vet? Who knows. All I know is that I got a call from the new puppy owner saying she brought her puppy in for preanesthetic bloodwork prior to his neuter, the vet (who was not the "regular" vet of this puppy owner) drew the blood and then read through the file, got to the bile acid results, and said the puppy is very sick and should have a liver biopsy done. Luckily the owner remained calm, said that she would be calling me to discuss the situation, and then would continue the discussion with the vet after the bloodwork results were in. She called me, we talked again about bile acid testing and results and what it all means, I sent her more info, and offered again to speak directly with her vet. She called me three days later to let me know that the puppy's bloodwork was normal, she talked with her regular vet who agreed with me that there was no liver issue, and assured the puppy owner that he would have a discussion with the "other" vet about liver issues. And just so you all know, the bile acid results for this particular puppy was in the high 20s. I think as buyers and as breeders we are trying to do the right thing. Open, honest discussion goes a long way toward that end. And discussion has to be a two-way street. __________________ MaryH If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place. - Margaret Mead Last edited by MaryH; 07-14-2010 at 04:58 PM.

07-14-2010, 06:39 PM	#18 (permalink)
jmm Maltese Guru Join Date: Nov 2004 Posts: 8,156	I've had 3 MVD Maltese, 1 of whom was sick with concurrent liver issues....none required special diet for the liver. Jonathan is 11 1/2 years old and has never had special diet or medications. A symptomatic MVD is an exception to the rule - an unusual occurrence. Back in the day when Jonathan was diagnosed it was liver biopsies. Today we have non-invasive tests like Protein C which only require a blood draw. I would not hesitate to purchase a Maltese with MVD. Nor would I look down upon a breeder who was breeding MVD dogs with the goal of better test results. Phenotype-to-phenotype is how we reduce hip dysplasia in big dogs...no reason not to respect the same principles with our liver dogs (plus this approach has been successful in other breeds). __________________ JMM - JaMi Maltese, Home to Performance Maltese Becoming a Follower on our Blog!!!

07-14-2010, 07:43 PM	#19 (permalink)
Tanner's Mom Maltese Guru Name: Marti Dog's Name: Tanner, Frankie, Jamie, Kelsey Join Date: May 2005 Location: Walterboro, S.C. Posts: 2,098	Tanner is an asymptomatic MVD dog. When I had the preanesthesia bloodwork done before his neuter, his ALT was in the high 300's. He was not neutered that day. Later, I had an ultrasound done (lucky for me the vet who did it trained under Dr. Center at Cornell), and she didn't see a shunt but recommended a biopsy which was done 4 years ago. Because I didn't get a definitive dx from the biopsy, I sent the tissue sample to Dr. Center & best we could determine, Tanner has MVD. I take him in 2 or 3 times a year for blood work & his ALT has ranged from a low of 129 to a high of 500. I feed Tanner low protein canned food, i.e., 8% or less, & mix a few pieces of whatever kibbles the others are eating. He doesn't know what beef is, he only eats chickens. Also, he gets 1/4 tab of Marin daily. I tried Denosyl and he wouldn't touch them no matter how they were disguised. Feeding him a different food from the others really hasn't been a problem. When I had his bile acids done, they were in the low 40's. Tanner is now 6 years old. He weighs 8#s (he was a BYB boy) and is a happy, active, little boy. At one point, I was hoping to have him til he was 5; now he's 6 and I think/hope he'll be around a long, long time. __________________

07-14-2010, 03:01 PM	#11 (permalink)
vjw Maltese Guru Join Date: Dec 2006 Posts: 3,363	In the other thread where I mentioned that the University of Pennsylvania was doing metabolic urine testing for possible portosystemic shunts, I wasn't sure JMM and I were talking about the same urine test. I asked Dr. Urs Giger at UPENN a couple of questions about the test and here's his response: Dear Joy, our metabolic screening test is based upon metabolite studies in urine used for hereditary metabolic diseases. It may suggest a shunt but cannot diagnose a shunt. It cannot discover carriers but only affecteds and not specifically. It is not a DNA test and to the best of my knowledge there is no DNA test for portosystemic shunts. By the way we are interested in hearing about Maltese who have eaten Chinese Chicken Jerky Treats and developed some kidney issues. We are working on characterizing this problem known as Fanconi Syndrome in the Maltese and a few other small breed dogs. Our metabolic screen is helpful for this purpose. Sincerely Urs Giger

07-14-2010, 05:58 PM	#15 (permalink)
Nikki's Mom Maltese Guru Name: Suzan Dog's Name: Keiko & Nikki Join Date: Feb 2008 Posts: 6,250	The percentage of Maltese who have asymptomatic MVD is pretty high, as I understand it, right? What makes breeder Bile Acid Testing tricky is if a dog tests high, and it turns out that the dog has asymptomatic MVD, then the buyer might pass up an otherwise healthy dog. With the large percentage of MVD dogs, a person might pass up several great puppies. I learned Nikki had MVD when she was 6 months old. If she'd been Bile Acid Tested at 4 months by the breeder, I still wouldn't have known whether it was a shunt or MVD, unless further, more expensive testing was done. So how far does testing go? If a potential buyer still wants a puppy that tests high on Bile Acid Test, does the breeder or the buyer pay for a protein C test, or an ultrasound, or a nuclear scintography? And what about those puppies who have tested high on bile acids but only have asymptomatic MVD and are perfect otherwise? What if nobody wants them? Just some things to think about and discuss. I have no answers, just thoughts.

07-14-2010, 08:15 PM	#20 (permalink)
Nikki's Mom Maltese Guru Name: Suzan Dog's Name: Keiko & Nikki Join Date: Feb 2008 Posts: 6,250	Nikki's blood work has been perfect for over 2 years, and she'll be 3 in November. Her ALT numbers returned to normal about 6 months after her liver biopsy/MVD diagnosis, and they have been that way ever since. She does not eat a special low-protein diet. She has no symptoms, and the vet thinks she is in perfect health. What if I'd changed my mind about buying her, or returned her, just because of her bile acid test result? What a shame!

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