Bile Acid Test

[Cathy]

page 22 of the handout:
"2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. How old dogs should be at he time of initial testing has not been established. Typically, abnormal bile acids DO NOT normalize as a dog ages ..... " (all emphasis added by Dr. Center)
[/QUOTE]


Yes, I remember Dr. Center telling us that breeders should have the test done prior to the puppy going to a new home. But, the reality is that none do this and most vets have no idea that this should be done at 4 months.

In my case, my girl had elevated ALT when her bloodwork was done for her teeth removal at 6 months. My vet suggested bile acids be tested when she was a year old. Next she developed 2 luxating patellas so she had to have 2 surgeries 2 1/2 months apart. Now we're doing physiotherapy since she is still skipping and exhibiting pain in her spine and has tight thigh muscles. The bile acid test was put off because of her other issues. Today I called to book her 1 year booster and a BA test. Her office told me that she needed to do a 12 hour fast. I told them no and faxed over Dr. Center's info.

Now I'm wondering how many days/weeks apart I should do the booster and the BA test. Any ideas? My girl is now 16 months old.

Cathy A

[dr.jaimie]

Jamie,

When Pixel was a puppy did you do BA or just the usual blood panel? I'm wondering if the BA test is always conclusive when done on a puppy. If so, then we should be doing BA on our new puppies.

Cathy A

[/B]

no i just ran a chem panel...b/c in school i asked a dr there about testing normal acting pups with bile acids and she said there was no need...now i know

[MaryH]

Yes, I remember Dr. Center telling us that breeders should have the test done prior to the puppy going to a new home. But, the reality is that none do this and most vets have no idea that this should be done at 4 months.

In my case, my girl had elevated ALT when her bloodwork was done for her teeth removal at 6 months. My vet suggested bile acids be tested when she was a year old. Next she developed 2 luxating patellas so she had to have 2 surgeries 2 1/2 months apart. Now we're doing physiotherapy since she is still skipping and exhibiting pain in her spine and has tight thigh muscles. The bile acid test was put off because of her other issues. Today I called to book her 1 year booster and a BA test. Her office told me that she needed to do a 12 hour fast. I told them no and faxed over Dr. Center's info.

Now I'm wondering how many days/weeks apart I should do the booster and the BA test. Any ideas? My girl is now 16 months old.

Cathy A[/B]

Seminars, discussion forums, etc. are how we all learn, including our vets. I will never dump on my vet for not knowing something. Vets can't possibly keep current on every species that they treat, much less the breed specific issues within each species. But I do expect my vet to be open to learning and if or when he turns a deaf ear, then I will find a new vet. You were at Sharon's seminar and you got her handout. Read it, learn from it, and share it with your vet so that he/she can learn, too. I don't expect any more from breeders than I do from vets. They can't automatically know every bit of scientific research being done and every scientific breakthrough the minute it happens. But they can learn. And in the end, it's still "Let the Buyer Beware." If you want a particular dog so badly that you will purchase it under any circumstances, then go ahead and do it. Or if you want a dog and the breeder does not want to do a bile acid test first, then perhaps you should ask for a "take back" clause in the sale contract whereby the breeder agrees to take the dog back with a full refund of purchase price if you have a bile acid test done within 7 days of purchase and the numbers are not acceptable to you. If you will only accept a dog with normal numbers, you could be waiting a long, long time if it's true that 70% of the breed is affected. If a person is buying a dog as a pet and the breeder is selling the dog as a pet, and the dog is and remains asymptomatic then I would advise the owner to bile acid test the dog just so that know what the numbers are and won't be in for a big surprise the first time they do a blood panel and find out that their dog has elevated liver enzymes. If a person is buying a dog for show and breeding, I would think that they would want to know bile acid numbers before they make any firm commitment.

As for which to do first, if it were me I would do the bile acid test first. All it is is a couple of vials of blood being taken from the dog and nothing put into the dog. The booster shot can wait a week (or a lifetime, as far as I'm concerned)!

Mary

[Cathy]

Luckily I have a wonderful vet who is open to learning and who is willing to discuss issues thoroughly with me. Once she's read Dr. Center's article she is going to give me a call and we'll discuss when to do the Bile Acid test. After listening to Dr. Center I am curious to know if my girl is one of the 70% with MVD. If she is, there are no symptoms at all. She's crazy (just like Caira! LOL) and has come through 3 anesthesias with no difficulty. Once her patella problems surfaced all plans of showing and possibly breeding her disappeared. Her next operation will be a spay but her poor body needs to fully recuperate from the knee surgeries before I subject her to any more surgery.

It will be interesting to learn how many on the list have Malts with MVD once we get testing done. We'll have to keep track to see what percentage of those tested have the trait.

Cathy

[Humbug]

I am a little confused by this topic but very interested. Can someone tell me where I can get a copy of Dr. Center's article you are referring to?

My baby, Trixie, began having seizures around April of this year. I have spent the past 6 months trying to determine if her seizures were being caused by some other illness or if she just has seizures. We did a BAT and her levels were higher than my vet liked but, I am also not sure which type of test she did initially. She sent me to a specialist who ran several tests including an ultrasound to check for a liver shunt, which he determined was not likely. I was told it was possible Trixie had MVD but, without doing a biopsy, it was not possible to verify this. The biopsy was not recommended since it was invasive and there is no treatment for MVD. He suggested we do another BAT to compare to the first. We did that in June and I was told by my vet that we did the wrong test. I am thinking now that the test she did was the one mentioned earlier where it only gives a range. Anyway, we did another BAT in Sept and I was told her values looked really good and close to normal.

Trixie is on Phenobarb for the seizures and Denosyl to help protect her liver from the Phenobarb. She also has to have a Phenobarb level check and a BAT every six months.

I am wondering if based on what I have read in this thread if doing a BAT every six months is necessary?

[jmm]

Trixie is on Phenobarb for the seizures and Denosyl to help protect her liver from the Phenobarb. She also has to have a Phenobarb level check and a BAT every six months.

I am wondering if based on what I have read in this thread if doing a BAT every six months is necessary?[/B]

To monitor for MVD, no, SBA is not appropriate. They will fluctuate. Above normal is above normal. It is up to your vet as far as monitoring with the phenobarb. Again though, the SBA can be elevated with MVD and mean nothing about drug toxicity. Phenobarb is VERY harsh on the liver. For that reason, we usually try to place dogs on KBr as first choice.

[tamizami]

I recall from Dr. Center's presentation paper (I wasn't at the show, but got a copy from my breeder) that an easy test to rule out Liver Shunt is the Protein C test. This is another blood test and the sample is sent to Cornell (by your vet's lab) and if its normal then a dog with high serum bile acids is probably MVD rather than liver shunt.

Ultrasounds are inconclusive, especially on small dogs and especially with inexperienced radiologists. Scintigraphy will tell you yes there is a liver shunt or no there isn't one, but it won't tell you if the dog has MVD. Only a biopsy will do that and you need a surgical biopsy from 3 sections of the liver (needle biopsy does not give you enough tissue).

I did a scintigraphy on my little girl with high SBA, the results came back no shunt and we've elected not to biopsy, since MVD is only medically managed and she is asymptomatic. I've adjusted their diet and now include milk thistle along with their regular vitamins, enzymes and probiotics.

After reading Dr. Center's paper, my vet is now doing a Protein C (about $140) on my boy with high SBA, to save the expense of scintigraphy (about $400).

MaryH - great point about vets. I was starting to lose faith in their abilities and getting very frustrated. I think their fees are in line with someone that is an expert, but thats another story. Anyway, I feel better that mine has been very open to learning new info I've given him from reputable sources and putting it into practice.

After personally going through this, it sounds to me like breeders/owners should be doing SBA tests on all 4 month old maltese and if the SBA's are high, then do the Protein C blood test to rule out a shunt. Is this correct?

[harrysmom]

I have a question....i've read on various websites that the bile acid values for maltese can be elevated even if there is no liver problem. So then in what range would the bile acid numbers be indicative of a problem in a maltese? Does a certain value indicate or rule out a liver shunt?

[jmm]

I have a question....i've read on various websites that the bile acid values for maltese can be elevated even if there is no liver problem. So then in what range would the bile acid numbers be indicative of a problem in a maltese? Does a certain value indicate or rule out a liver shunt?[/B]

This is FALSE. Elevated bile acids are not normal. Dr. Center said >25 is abnormal. A common generalization is a number of over 100 is indicative of a shunt. This is a generalization and SBA are NOT diagnostic for a shunt. A Protein C can be run if the bile acids are >25 to rule out a shunt.

[Cathy]

This information is outdated. The bile acid test was developed at Cornell by Dr. Center. They wrote the initial protocol and have since updated it. Taken from Page 5 of the handout Dr. Center gave us at her recent seminar:
"7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial)." (all emphasis was added by Dr. Center, not me)


Mary/Jackie,

I have a problem........My BA test is scheduled for next Thursday but my vet wants to do a 12 hour overnight fast and then do a paired sample. She says that Dr. Center's paper isn't totally clear because she still talks about fasting in the paper. She wants her to fast overnight. Then I am to take her to the vet's for 9 AM. They will take blood, feed her, wait 2 hours and then take more blood. Will this work or should I talk to her again? [/B]

Cathy A