The Liver Shunt - Bile Acid Test Thread

[MaryH]

I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy that is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.

[Nikki's Mom]

Originally Posted by MaryH

I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.

I understand, as I don't like surprises either. What I am concerned about is this: Since not every high BA test number means a shunt, things get complicated. May I ask: What is the next step if a puppy has a high BA number, and the buyer thinks they may still want the dog? Does the breeder do further testing themselves, or do they sell the dog and let the owner decide what to do next?

[Ladysmom]

Originally Posted by MaryH

I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.

Excellent post, Mary.

Since Maltese have been identified by Dr. Center as one of the breeds highly affected by liver disease, there is just no good reason IMO for not having a BAT done on a puppy prior to its sale. Being afraid of the results is certainly not a good reason. To me, it is similar to being in a high risk group for AIDS and not getting a test to see if you are HIV positive out of fear.

Even if a potential buyer backs away from a sale based upon the results of the BAT, isn't that better than having a upset owner find out her puppy has MVD or a liver shunt a few months later and that her breeder could have had this simple, inexpensive test done prior to the sale? That can really damage a breeder's reputation.

[allheart]

Originally Posted by CloudClan

I posted this in the other thread (Christine's), but if it is to be deleted, I will repost it here:
I am going to disagree with your vet. My own vets had a similar reaction. My friendships with knowledgeable people, and my participation in this forum are the reason I know about bile acid tests at all. Most General Practice vets do not know a lot about the test either. I know that the test I had done most recently, they had to look up the procedures in the books. (And here again is the reason that the information is not widely shared among breeders. Many of them rely on their own vets for their recommendations and those vets do not as a routine suggest BA testing).

The truth is you do not need to test Mia and Leo. But the recommendation is to get it done to establish a baseline.

The way I worded it with my vets is that it is a problem in the breed and I am following recommendations.

As for buying from an Ethical Breeder, I think whether they test or not, they should be willing to answer your questions about BA to the extent of their ability. You and the breeder can agree to either have the test done before you take the pups home or soon after (at that 16 week age).

I agree with you that it can be difficult to broach this subject, but I think you will find that an Ethical breeder's response should make you feel glad you asked. I know when I spoke with the two breeders I worked with most recently, I felt that awkwardness when I asked questions about LS and GME and other health issues. I did not want to sound like I was presuming their dogs were anything other than perfect healthy pups; however, the responses they gave me when we talked reassured me. I felt better about both breeders for having made that step forward with them and seeing how they responded to my questions.

Mary H and Carina THANK YOU so much for all that knowledge that you shared. I appreciate it so much. My vet actually knew about bile acid test, but was shocked at my asking, as though I spotted a problem with Mia and Leo. Almost like, why would I put them through that sort of look, when they were symptom free. But both of you and all of you sharing your experinces and knowledge have helped so much. I like the way you worded it to the vet Carina, that makes complete sense.

Suzan you bring up great points as well. Knowing how I am, and this may sound crazy, but regardless of the outcome of the test, I don't think I could walk away or turn the pup away, actually I know I wouldn't be able to, but I would be darn glad to know upfront, what to do and what to expect.

Thank you all so much for your valuable input.

[k/c mom]

Originally Posted by Ladysmom

Excellent post, Mary.

Since Maltese have been identified by Dr. Center as one of the breeds highly affected by liver disease, there is just no good reason IMO for not having a BAT done on a puppy prior to its sale. Being afraid of the results is certainly not a good reason. To me, it is similar to being in a high risk group for AIDS and not getting a test to see if you are HIV positive out of fear.

Even if a potential buyer backs away from a sale based upon the results of the BAT, isn't that better than having a upset owner find out her puppy has MVD or a liver shunt a few months later and that her breeder could have had this simple, inexpensive test done prior to the sale? That can really damage a breeder's reputation.

Marj, great points! I do wonder how it would be with a breeder who was not a good communicator and a buyer who had never heard of liver issues in Malts. I think it may take someone who is good with words and who can adequately explain the situation .. especially in a phone call or email when the buyer is in another town.

For some reason I had just thought of the test and that was that but really I think there is more to it if the results are not good or borderline.

[MaryH]

Originally Posted by Nikki's Mom

I understand, as I don't like surprises either. What I am concerned about is this: Since not every high BA test number means a shunt, things get complicated. May I ask: What is the next step if a puppy has a high BA number, and the buyer thinks they may still want the dog? Does the breeder do further testing themselves, or do they sell the dog and let the owner decide what to do next?

For me, the answer depends on the puppy itself. So now I'll share my whole story and hope that I don't lose you part way through. I got my first brood bitch hopeful in August 2006 as a 12 wk. old puppy before I knew much about liver shunt, MVD or bile acid testing. In October 2006 a breeder friend (the breeder of my Ch. male) had a puppy returned to her because it was diagnosed with a liver shunt. I knew of Dr. Center because of a rescue dog I had taken in in 2004 with a liver shunt. That dog's shunt was surgically repaired at Angell Animal Medical Center in Boston by a vet who years earlier was a colleague of Dr. Sharon Center at Cornell. He consulted with her while treating Mack, our rescue liver shunt dog. I also knew of Dr. Center's expertise with liver issues thanks to Jackie (JMM) who had been consulting with Dr. Center about her beloved little dog Mikey. So when my friend's puppy was returned for a supposed liver shunt I offered to contact Dr. Center. Dr. Center immediately contacted my friend and there started my education on liver issues. In November 2006 my friend and I drove to Cornell with all of her dogs plus two of mine, my 4-1/2 yr. old Ch. male and my 5-1/2 mo. old female. Brigid, the puppy with the alleged liver shunt did not, in fact, have a shunt. She had very high bile acid values (>100), but after a second ultrasound, a Protein C test, and a cholorectal scintigraphy she was diagnosed with asymptomatic MVD. She ultimately was spayed, placed in a pet home with a Cornell Vet School employee, eats a normal diet, is on no medication, and is at the Vet School on a regular basis, not because she is sick but because she gets to go to work with her human mom. My male has normal bile acid values (<5/18). My female has higher than normal bile acid values (11/68). What a bittersweet moment ... a normal male and abnormal female. My first question was "Is it safe to spay her?" knowing that it's the liver that processes out the anesthesia. The response I got from Dr. Center was "Why would you spay her? She is a normal, healthy, bright, active puppy at a good weight, does not have chronic episodes of diarrhea or vomiting, has normal CBC results, has no neurological issues. You should do exactly what you planned to do. Let her grow up and so long as she remains healthy breed her to your normal male. If you cull everything out of your breed with higher than normal bile acid values you will seriously compromise the gene pool. Bile acid test all puppies and do not sell anything with breeding rights for at least two generations." I asked about having a Protein C test done and was told that I could if I wanted to but that the Protein C test was going to tell me what I already knew just by observation ... I have a healthy asymptomatic MVD dog. She grew up, has always been healthy, has had regular wellness exams, and has been bred twice. Her first litter, sired by my male, produced a singleton girl with normal bile acid values. Her second litter, sired by a different male who also had normal bile acid values, produced 3 boys and 1 girl, two of whom have normal bile acid results, one had just slightly higher than normal values (high 20s), and one with what I consider higher values (low 60s). None of the puppies had Protein C tests done as I felt it was not necessary ... they were all happy, healthy, active puppies and are now happy, healthy, active dogs. If I felt that any of the puppies was not quite "right" I would have done a Protein C test without hesitation. When I sell my puppies, I provide the new owner with a complete health history. I spend a great deal of time discussing liver issues and sharing my knowledge. Should the owner want a Protein C test done, unless the puppy is exhibiting signs of symptomatic MVD, then I believe it is the owner's responsibility to pay for any further testing. If the puppy starts showing chronic symptoms of MVD, then I would offer to have my vet do a Protein C test and I would pay for the testing. Should the Protein C test results indicate that further testing should be done then I would also pay for that so long as I have the vet or vet school of my choosing do the testing. I have spoken at length with more than a couple of breeders who have in their lifetime produced a liver shunt puppy. They have all confirmed to me that they knew by 8-9 wks of age that something was not quite right with the puppy and therefore held on to it until it was of an age where further testing would provide more insightful results. I know my puppies because I spend every free waking moment with them from birth to 16 wks. I would know if something was not quite right and would never dream of withholding necessary diagnostic testing. I hope this helps to answer your questions and feel free to keep the dialogue going.

[Nikki's Mom]

Originally Posted by MaryH

For me, the answer depends on the puppy itself. So now I'll share my whole story and hope that I don't lose you part way through. I got my first brood bitch hopeful in August 2006 as a 12 wk. old puppy before I knew much about liver shunt, MVD or bile acid testing. In October 2006 a breeder friend (the breeder of my Ch. male) had a puppy returned to her because it was diagnosed with a liver shunt. I knew of Dr. Center because of a rescue dog I had taken in in 2004 with a liver shunt. That dog's shunt was surgically repaired at Angell Animal Medical Center in Boston by a vet who years earlier was a colleague of Dr. Sharon Center at Cornell. He consulted with her while treating Mack, our rescue liver shunt dog. I also knew of Dr. Center's expertise with liver issues thanks to Jackie (JMM) who had been consulting with Dr. Center about her beloved little dog Mikey. So when my friend's puppy was returned for a supposed liver shunt I offered to contact Dr. Center. Dr. Center immediately contacted my friend and there started my education on liver issues. In November 2006 my friend and I drove to Cornell with all of her dogs plus two of mine, my 4-1/2 yr. old Ch. male and my 5-1/2 mo. old female. Brigid, the puppy with the alleged liver shunt did not, in fact, have a shunt. She had very high bile acid values (>100), but after a second ultrasound, a Protein C test, and a cholorectal scintigraphy she was diagnosed with asymptomatic MVD. She ultimately was spayed, placed in a pet home with a Cornell Vet School employee, eats a normal diet, is on no medication, and is at the Vet School on a regular basis, not because she is sick but because she gets to go to work with her human mom. My male has normal bile acid values (<5/18). My female has higher than normal bile acid values (11/68). What a bittersweet moment ... a normal male and abnormal female. My first question was "Is it safe to spay her?" knowing that it's the liver that processes out the anesthesia. The response I got from Dr. Center was "Why would you spay her? She is a normal, healthy, bright, active puppy at a good weight, does not have chronic episodes of diarrhea or vomiting, has normal CBC results, has no neurological issues. You should do exactly what you planned to do. Let her grow up and so long as she remains healthy breed her to your normal male. If you cull everything out of your breed with higher than normal bile acid values you will seriously compromise the gene pool. Bile acid test all puppies and do not sell anything with breeding rights for at least two generations." I asked about having a Protein C test done and was told that I could if I wanted to but that the Protein C test was going to tell me what I already knew just by observation ... I have a healthy asymptomatic MVD dog. She grew up, has always been healthy, has had regular wellness exams, and has been bred twice. Her first litter, sired by my male, produced a singleton girl with normal bile acid values. Her second litter, sired by a different male who also had normal bile acid values, produced 3 boys and 1 girl, two of whom have normal bile acid results, one had just slightly higher than normal values (high 20s), and one with what I consider higher values (low 60s). None of the puppies had Protein C tests done as I felt it was not necessary ... they were all happy, healthy, active puppies and are now happy, healthy, active dogs. If I felt that any of the puppies was not quite "right" I would have done a Protein C test without hesitation. When I sell my puppies, I provide the new owner with a complete health history. I spend a great deal of time discussing liver issues and sharing my knowledge. Should the owner want a Protein C test done, unless the puppy is exhibiting signs of symptomatic MVD, then I believe it is the owner's responsibility to pay for any further testing. If the puppy starts showing chronic symptoms of MVD, then I would offer to have my vet do a Protein C test and I would pay for the testing. Should the Protein C test results indicate that further testing should be done then I would also pay for that so long as I have the vet or vet school of my choosing do the testing. I have spoken at length with more than a couple of breeders who have in their lifetime produced a liver shunt puppy. They have all confirmed to me that they knew by 8-9 wks of age that something was not quite right with the puppy and therefore held on to it until it was of an age where further testing would provide more insightful results. I know my puppies because I spend every free waking moment with them from birth to 16 wks. I would know if something was not quite right and would never dream of withholding necessary diagnostic testing. I hope this helps to answer your questions and feel free to keep the dialogue going.

Thanks so much for taking the time out to explain this. It does help very much. Knowing what I know now, I am not concerned about asymptomatic MVD and don't consider it to be a huge issue. I just wanted some clarification because there are others who are new to this issue, and I don't want them to be frightened away from a wonderful pup they may be considering. Thank you.

[CloudClan]

I want to thank MaryH and Jackie (JMM) for sharing their hard won knowledge with us. I should point out that Mary is in large part responsible for much of the information that is out there within the AMA on this issue.

I also want to make this point. At SM we have benefited from the wealth of information they have shared. Many breeders do not have as much access to these two ladies as we do here on this forum.

It is one of the great things about SM that we should value.

Originally Posted by Nikki's Mom

Thanks so much for taking the time out to explain this. It does help very much. Knowing what I know now, I am not concerned about asymptomatic MVD and don't consider it to be a huge issue. I just wanted some clarification because there are others who are new to this issue, and I don't want them to be frightened away from a wonderful pup they may be considering. Thank you.

Thank you Suzan for making this point. This is one of the things that often worries me when Bile Acid tests are brought up. Though we have a lot of knowledge here, there are many people who are "afraid" of owning a dog with elevated numbers. As MaryH pointed out in her personal story, and you pointed out in yours, MVD is not something that should have people run away in terror. Obviously, it would be better if our breed did not have this problem as it is related to the much scarier liver shunts, but for most pet owners MVD will never be a true cause for concern.

[jmm]

It will always be at the forefront of my thoughts just why I learned about shunts and MVD in Maltese. When my first dogs were diagnosed, MVD was still a relatively new diagnosis. Nobody was able to tell me what would happen to my dogs until we ended up on a 6+ hour drive for some last miracle.
Dr. Center told me I had to understand what was wrong in order to understand how to help my dog. Down I sat at the microscopes with a couple of vet students and a resident. Dr. Center took Mikey's picture the first time we visited. She said she saved all of them. I was still shocked to hear years later on one of Mary's visits that Dr. Center remembered my Mikey Man.
Mikey was a rare case. We lost him at just 5 years of age. Unfortunately, his lines produced other dogs who died of their shunts or required chronic medical care.
Mikey's lesson to me was not to run from another MVD dog...but to realize how RARE sick MVD dogs are. And that the sick ones usually have some concurrent condition. And yes, I purchased another pup with MVD who is normal, happy, and healthy.
Mikey, my "original" Dust Mop with Drive

[Ladysmom]

Originally Posted by jmm

It will always be at the forefront of my thoughts just why I learned about shunts and MVD in Maltese. When my first dogs were diagnosed, MVD was still a relatively new diagnosis. Nobody was able to tell me what would happen to my dogs until we ended up on a 6+ hour drive for some last miracle.
Dr. Center told me I had to understand what was wrong in order to understand how to help my dog. Down I sat at the microscopes with a couple of vet students and a resident. Dr. Center took Mikey's picture the first time we visited. She said she saved all of them. I was still shocked to hear years later on one of Mary's visits that Dr. Center remembered my Mikey Man.
Mikey was a rare case. We lost him at just 5 years of age. Unfortunately, his lines produced other dogs who died of their shunts or required chronic medical care.
Mikey's lesson to me was not to run from another MVD dog...but to realize how RARE sick MVD dogs are. And that the sick ones usually have some concurrent condition. And yes, I purchased another pup with MVD who is normal, happy, and healthy.
Mikey, my "original" Dust Mop with Drive

I remember following Mikey's story on other forums. Thank you and others who have helped to shine the light on liver disease in Maltese.

Mikey will always be the face of liver disease to me. A brave and exceptional boy who captured all our hearts.

Do you still have that picture of Mikey in his pumpkin costume?