# Liver Enzymes Elevated



## molleysmom (May 27, 2007)

I am new to this stuff, so excuse me if I do not do this quite right. I recently took Molley to the vet to get her teeth cleaned. Her prelim blood work showed mildly elevated (twice normal) liver enzymes and pre and post meal bile acid enzymes were mildly elevated. Nothing conclusive per the vet, except that she did not have a liver shunt. The only thing I can think of is that I had her a a high protein diet (40%). We were using Innova Evo since the dog food scare. We have stopped that, and now I am doing an all home cooked meal. So far it is the only she loves, she never has taken to commercial dog food. Molley is other asymptomatic. Has anyone else had these issues? What was your outcome? Vet has her on antibiotics and an enzyme called SAMe. Me, I am looking for an ativan script! I know she must sense my angst. I do feel better about the homecooked diet though. Thanks for your help.


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## MalteseJane (Nov 21, 2004)

I am sorry I am no help with this. Just bumping this post up.


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## Ladysmom (Oct 19, 2004)

Has your vet considered that Molly might have MVD (microvascular dysplasia)? Unfortunately this liver disease is all too common in our Maltese. We have a number of members here whose dogs have been diagnosed with it. Tanner's Mom, Pico's Mom and JMM all have Maltese with MVD.

Hopefully, they will see this and respond. If not, I'd suggest you pm them for more information. I know it can be tricky to diagnose and they will know which tests need to be done.

SamE is good. It supports the liver. Marin (milk thistle) is also good. That's what I give Lady. She doesn't have liver disease, but she's on seizure meds that can damage her liver.


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## Tanner's Mom (May 27, 2005)

Hey Molly's Mom, I just PM'd you, it was rather lengthy and most everyone here has heard my story before!


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## Maidto2Maltese (Oct 19, 2004)

our administrator on the diabetic board has a mini-schnauzer. She had dental problems and was scheduled for dental at vet. Vet did preliminary blood work... found very high liver enzymes. I don't recall if other tests were also done..but vet suspected the elevations were connected to/due to the bad teeth. They went ahead with the dental... and afterward the liver enzymes came back to normal. Granted her pooch is a mature dog...heading to senior. Just thought I'd pass this info on. 
We've had many there who have had wonderful results with Milk Thistle as liver support. Some have done both Milk thistle and SamE but I'd dare say the Milk Thistle itself did wonderful job.


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## molleysmom (May 27, 2007)

Thank you everyone. I feel better just knowing that we are not alone in this. I think I will be able to sleep tonite. Molley acts fine, I actually think she has more oompf the last two days since we have been on low protein homemade food. Maybe this is time for detoxing before we move on to the next phase of diagnostics. I have a call out to the vet. Shall be interested in hearing what she has to say. Thanks again for your input. Shall let you know.


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## CrystalAndZoe (Jul 11, 2006)

<span style="font-family:Comic Sans Ms">I'm just now reading this thread... so sorry I'm late in responding. You said that liver shunt has been ruled out. Did you have an ultra sound and that is how they know? Elevated liver enzymes could mean so many different things, the body trying to fight off various infections (even periodontal disease or a tooth infection). As Marj (Lady's Mom) said, have they checked for MVD? My Zoe had elevated liver enzymes (scary high ALT's & AST's) and high bile acid test results (not nearly as scary high). After doing an ultra sound the vet discovered her kidneys were dialated and concluded that she had Leptosporosis (Lepto). It could have also been any type of hepatitis, but after running a Lepto titer, the results showed she did have Lepto. Let us know how things are progressing. 

BTW, Zoe was asymptomatic as well. At least as far as my vet and staff were concerned. Mommy on the other hand knew her baby was not her normal energetic self!

Prayers to you and little Molly.</span>


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## ClaBec Maltese (Feb 19, 2007)

If you are wanting to detoxify your baby here is a link to some very good stuff. I have used many of their products with wonderful success, especially with Ezekiel. Also here is their phone number. They will be more than happy to speak with you and try to help you figure out what is best for your baby. The # is 712-644-3535 and the website address is www.petmedicinechest.com

Just explain to them what is going on.


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## molleysmom (May 27, 2007)

:smheat: Just wanted to let you know that Molley is acting just fine, actually better. The raw food diet and supplements seem to be working well. She has gained wt and acts more like herself. I am working up my nerve to take her back to the vet in the next couple of weeks to see where the enzymes are. So far, so good. Thanks to all for the useful information. I purchased a book called Scared Poopless. The writer owns maltese as well. It was very informative and I recommend it as useful reading if you do not already have it in your library.


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## Ladysmom (Oct 19, 2004)

Thanks for sharing the good news!

A lot of us are reading _Scared Poopless_. Isn't it a fabulous book?


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## molleysmom (May 27, 2007)

> <span style="font-family:Comic Sans Ms">I'm just now reading this thread... so sorry I'm late in responding. You said that liver shunt has been ruled out. Did you have an ultra sound and that is how they know? Elevated liver enzymes could mean so many different things, the body trying to fight off various infections (even periodontal disease or a tooth infection). As Marj (Lady's Mom) said, have they checked for MVD? My Zoe had elevated liver enzymes (scary high ALT's & AST's) and high bile acid test results (not nearly as scary high). After doing an ultra sound the vet discovered her kidneys were dialated and concluded that she had Leptosporosis (Lepto). It could have also been any type of hepatitis, but after running a Lepto titer, the results showed she did have Lepto. Let us know how things are progressing.
> 
> BTW, Zoe was asymptomatic as well. At least as far as my vet and staff were concerned. Mommy on the other hand knew her baby was not her normal energetic self!
> 
> Prayers to you and little Molly.</span>[/B]



Oct 12

Well we finally got back in to the vet for repeated enzymes and bile acid tests. Not sure what to make of it. The liver enzymes were improved from previous (180 now vs 225 previously). BA test pre and post are 53.5 and 52.5. I am exhausted. Molley looks great, eats great and acts like herself. What should I do now? I am going to ask for the lepto titer. If this is positive what do they do for it? My husband thinks we should just let things be and see what happens. I am not sure what to think. I dont want to put her thru biopsy and us if it is all unnecessary or if it wont change the outcome. Which who knows what the outcome will be. Molley is on a raw and whole food organic diet - she probably eats better then us - all of her other chemistries are normal. protein, albumin, bun and cr , sodium, potassium - everything else normal except for the liver and BA. I just dont know what to do from here. part of me is skeptical about all this. any thoughts?


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## Cathy (Mar 19, 2006)

We recently had a huge discussion on Bile Acid testing and liver shunts in Maltese. If you look back in the Health and Behavior section you'll see them. There is tons of wonderful information. Since the Bile Acids are over 25 the next step is a Protein C test to rule out a liver shunt. If there is no shunt then it likely is MVD.

Good luck!

Cathy A


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## k/c mom (Oct 9, 2004)

I understand your confusion. It is a confusing subject, for sure. Here are some threads that are a must-read for someone in your situation. I hope they shed some light on things for you. :grouphug: 

Liver Shunts, MVD and Protein C Tests 

Bile Acid Test

Dr. Center/Pixel Update


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## harrysmom (Sep 28, 2007)

Hi! I'm glad to hear that your pup feels better and I can also understand your confusion. If you read the threads about Harry on this forum...I am Harry's mom. Harry has always acted like there is nothing wrong with him...yet the vets tell me that he is very very sick. Now, I know that your pup doesn't have the number of problems that Harry does, but just because a pup acts ok doesn't mean there's not something going on medically. Keep going to the vet and monitoring the situation (if thats what your vet recommends). I'm trying to learn all I can about maltese liver problems. Knowlegde gives you the power to help your pup live a long, healthy life. This forum is a great source of information and support! Good luck!


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## k/c mom (Oct 9, 2004)

> Hi! I'm glad to hear that your pup feels better and I can also understand your confusion. If you read the threads about Harry on this forum...I am Harry's mom. Harry has always acted like there is nothing wrong with him...yet the vets tell me that he is very very sick. Now, I know that your pup doesn't have the number of problems that Harry does, but just because a pup acts ok doesn't mean there's not something going on medically. Keep going to the vet and monitoring the situation (if thats what your vet recommends). I'm trying to learn all I can about maltese liver problems. Knowlegde gives you the power to help your pup live a long, healthy life. This forum is a great source of information and support! Good luck![/B]


Yes, Harrysmom's threads should be helpful, as well. I meant to include them in my post but had a "senior moment" and forgot!! Here they are:

http://spoiledmaltese.com/forum/index.php?showtopic=27000

http://spoiledmaltese.com/forum/index.php?showtopic=27076

http://spoiledmaltese.com/forum/index.php?showtopic=27264

http://spoiledmaltese.com/forum/index.php?showtopic=27400


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## Cathy (Mar 19, 2006)

:

http://spoiledmaltese.com/forum/index.php?showtopic=27000

http://spoiledmaltese.com/forum/index.php?showtopic=27076

http://spoiledmaltese.com/forum/index.php?showtopic=27264

http://spoiledmaltese.com/forum/index.php?showtopic=27400
[/QUOTE]


Thanks for posting the actual links. I tried to figure out how to do that last night and finally gave us. Lots of great info them.

Cathy A


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## tamizami (May 1, 2007)

Hi Molley's mom,
I'm sorry to hear that Molley's liver enzymes and BATs were still on the higher side, but (if she isn't over 4), I would guess that she is an asymptomatic maltese with MVD like both of mine - and an estimated 60-70% of all maltese! The Protein C test (a simple blood test) can rule out the liver shunt. Don't be surprised if your vet hasn't heard of it, I think it just came out in December 2006! The links that others posted previously have links where your vet can read about the Protein C test.

The only way to know definitively that your dog has MVD is to do a biopsy, but since MVD has no treatment, other than medical management (i.e. diet, supplements), my vet and I didn't think it was worth the risk of surgery. And your vet should be aware of the MVD for any anesthetic procedures as it can be a little more difficult for MVD dogs to come out of anesthesia.

In the meantime, I have to thank you so much for referring me to Andi Brown's book and Spot's Chicken Stew - my babies both love it! I am now cooking for them and adding the supplements per the book, including green foods (algae). They both are the picture of health and Stewie just came through his neuter with flying colors. I'm working up the nerve to start introducing raw foods back into their diets.

If you have any questions, there are many who are more knowledgeable about this than I am (JMM and Mary H come to mind), but don't hesitate to call or PM me. I just went thru all of this, was panicked at first (didn't have Mary H's wise advice at the time) and am now back to normal.


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## molleysmom (May 27, 2007)

> Hi Molley's mom,
> I'm sorry to hear that Molley's liver enzymes and BATs were still on the higher side, but (if she isn't over 4), I would guess that she is an asymptomatic maltese with MVD like both of mine - and an estimated 60-70% of all maltese! The Protein C test (a simple blood test) can rule out the liver shunt. Don't be surprised if your vet hasn't heard of it, I think it just came out in December 2006! The links that others posted previously have links where your vet can read about the Protein C test.
> 
> The only way to know definitively that your dog has MVD is to do a biopsy, but since MVD has no treatment, other than medical management (i.e. diet, supplements), my vet and I didn't think it was worth the risk of surgery. And your vet should be aware of the MVD for any anesthetic procedures as it can be a little more difficult for MVD dogs to come out of anesthesia.
> ...



thanks so much for your insight. Just knowing that mvd is medical management is useful. shall call vet tomorrow and schedule protein c test. i love my little fuzz butt endlessly, dealing with a chronic disease is stressful and we do not want to put her thru unneccessary procedures nor do i want to throw good money after bad. must be the nurse in me coming out. do you give your malts heartworm medication or topical flea/tick protection? i wonder if the oral interceptor is adding to our dillema, but i am very concerned that not giving it to her is more risky. we travel about 3 times a year to different parts of the country. i am a travel nurse and we follow the sun. i know that the books say that they should not need it on the proper diet and supplements, that is the only thing i am holding on to so far. please feel free to call me as well. just let me know how to get the info to you.

pat your little fluff butts head for me and i will scratch molleys belly too!

shall post when i have the protein test results.


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## jmm (Nov 23, 2004)

> thanks so much for your insight. Just knowing that mvd is medical management is useful. shall call vet tomorrow and schedule protein c test. i love my little fuzz butt endlessly, dealing with a chronic disease is stressful and we do not want to put her thru unneccessary procedures nor do i want to throw good money after bad. must be the nurse in me coming out. do you give your malts heartworm medication or topical flea/tick protection? i wonder if the oral interceptor is adding to our dillema, but i am very concerned that not giving it to her is more risky. we travel about 3 times a year to different parts of the country. i am a travel nurse and we follow the sun. i know that the books say that they should not need it on the proper diet and supplements, that is the only thing i am holding on to so far. please feel free to call me as well. just let me know how to get the info to you.
> 
> pat your little fluff butts head for me and i will scratch molleys belly too!
> 
> shall post when i have the protein test results.[/B]


Yes, I keep my dogs (even the MVD dogs) on Interceptor and Frontline. If there is heartworm where you travel, I would be very hesitant to stop the interceptor. Your dog could eat the whole box and it would not be toxic. It is not in their system for a whole month. It should be out of their system in no more than 3 days.


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## tamizami (May 1, 2007)

From everything I've read lately on this topic, it probably won't seem like you are living with a dog with a chronic disease. Those were my first fears as well, but its so prevalent in this breed, yet they have nice long lives. I am going to bet money that at least 75% of malt owners don't even know their dogs have MVD. I also wonder how much of it (liver "issues") have to do with the stress of the vet visit or things like the fact that our little babies are getting picked up so much (my vet said that mild blunt trauma can cause elevated ALT). I'm not worrying about it anymore and just focus on giving them the healthiest diet, supplements, exercise, mental stimulation and LOVE I can. 

Re the medications: I've had 2 vets tell me we don't live in an area where there is a heartworm threat (it gets too chilly at night for the mosquitos and the heartworm larvae), so we don't use it. I had heartguard and it made Shiva violently ill. If I had to use one, it would definitely be interceptor. As a precaution, I get their blood tested every 6 months. 

I keep Frontline & Advantage on hand, but rarely use them. The only time they get fleas is after the vet, LOL!

You have to let me know if your travels ever take you to sunny SoCal, we definitely need to get together!


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## molleysmom (May 27, 2007)

> From everything I've read lately on this topic, it probably won't seem like you are living with a dog with a chronic disease. Those were my first fears as well, but its so prevalent in this breed, yet they have nice long lives. I am going to bet money that at least 75% of malt owners don't even know their dogs have MVD. I also wonder how much of it (liver "issues") have to do with the stress of the vet visit or things like the fact that our little babies are getting picked up so much (my vet said that mild blunt trauma can cause elevated ALT). I'm not worrying about it anymore and just focus on giving them the healthiest diet, supplements, exercise, mental stimulation and LOVE I can.
> 
> Re the medications: I've had 2 vets tell me we don't live in an area where there is a heartworm threat (it gets too chilly at night for the mosquitos and the heartworm larvae), so we don't use it. I had heartguard and it made Shiva violently ill. If I had to use one, it would definitely be interceptor. As a precaution, I get their blood tested every 6 months.
> 
> ...


We are leaving Oregon for Yuma, AZ next week. I will be flying out of San Diego in Nov to Hawaii to see our son before he deploys to Iraq. SD is only a few hours away, would like to get together some time while we are in the area for the winter. 

Molley is indeed under 4 years old (2) and asymptomatic. I think I am about emotionally toasted. Just gonna do the diet and all the love and let nature take care of the rest. Glad to know about the interceptor. Shall continue to give her that and then use the Advantix only as I need too. Have only used it once this season while here in Oregon. Should not have any trouble in the desert, at least not with fleas/ticks.

Gonna have some coffee and knitting therapy. keep in touch


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## Malteseluv (Feb 6, 2007)

This is just my opinion, but I would *never* recommend raw meat for a dog that is liver compromised. If the dog has MVD, that means that the liver isn't working the way it's supposed to, therefore, the load on the liver should be lightened as much as possible and support should be given to the liver so that there is no damage in the future... 
A raw meat diet is extremely high in protein, and a liver that is compromised cannot handle that. 
Meat produces toxins that are supposed to be filtered through the liver, but because it's not functioning right with MVD, the toxins don't get filtered and enter their system and can cause neurological symptoms. Even if your dog handles it okay at first, you would still be putting that liver under a large amount of stress...That can cause a great deal of damage to it. Like I said, this is just my opinion, and I would love to see Dr. Center's opinion on this.

Also, I know of several liver compromised dogs who have ended up with E.Coli...If this can happen to a dog who is not eating raw meat, then I'm sure it can happen to a dog who is eating raw meat and has a compromised immune system..

As far as the heartworm prevention goes, Dr. Jean Dodds' (a vet who is very well known for her research on liver issues) recommendation on this for liver compromised dogs is Plain Hearguard not Plus every 6 weeks instead of every 4 weeks if you want to give a heartworm preventative.


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## jmm (Nov 23, 2004)

> This is just my opinion, but I would *never* recommend raw meat for a dog that is liver compromised. If the dog has MVD, that means that the liver isn't working the way it's supposed to, therefore, the load on the liver should be lightened as much as possible and support should be given to the liver so that there is no damage in the future...
> A raw meat diet is extremely high in protein, and a liver that is compromised cannot handle that.
> Meat produces toxins that are supposed to be filtered through the liver, but because it's not functioning right with MVD, the toxins don't get filtered and enter their system and can cause neurological symptoms. Even if your dog handles it okay at first, you would still be putting that liver under a large amount of stress...That can cause a great deal of damage to it. Like I said, this is just my opinion, and I would love to see Dr. Center's opinion on this.
> 
> ...



I just want to clarify that fact that there is no need to protein restrict your dog's food if they are suspect of being MVD dogs and are clinically normal. Protein restriction is meant for dogs intolerant of protein (those with hepatic encephalopathy). 

I don't recommend raw simply for the risk factors of salmonella and e.coli. You can get very, very sick dogs.


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## Cathy (Mar 19, 2006)

shall post when i have the protein test results.
[/QUOTE]

Hi,

I'm just letting you know that I'm now dealing with high bile acid results too. Pre meal was 4 and post was 80. I'm disappointed but not terribly surprised. Thankfully, I'm armed with some knowledge that is keeping me out of panic mode. The recent discussions have been great and increased everyone's awareness. Next week my vet wants to do a urine bile acid test and she's looking into how I can get a Protein C test. I'm in Canada so we're not sure if it's a possibility or not. 

I hope that Molley continues to be okay and that your travels to your winter home go well. Keep us updated on Molley's progress.


Cathy


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## jmm (Nov 23, 2004)

> Hi,
> 
> I'm just letting you know that I'm now dealing with high bile acid results too. Pre meal was 4 and post was 80. I'm disappointed but not terribly surprised. Thankfully, I'm armed with some knowledge that is keeping me out of panic mode. The recent discussions have been great and increased everyone's awareness. Next week my vet wants to do a urine bile acid test and she's looking into how I can get a Protein C test. I'm in Canada so we're not sure if it's a possibility or not.
> 
> ...


Cathy, why the repeat of the bile acids?


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## Cathy (Mar 19, 2006)

Cathy, why the repeat of the bile acids?
[/QUOTE]

Jamie,

She wants to see if there is a spill over of the bile acids into the creatinine and also look for ammonium biurate crystals in the urine. I know, this isn't necessary but I hated to question her. This shouldn't be an expensive test.

Cathy


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## jmm (Nov 23, 2004)

> She wants to see if there is a spill over of the bile acids into the creatinine and also look for ammonium biurate crystals in the urine. I know, this isn't necessary but I hated to question her. This shouldn't be an expensive test.
> 
> Cathy[/B]



Urine bile acids take both the bile acid and creat levels in the urine and set up an equation UBA/Cr x 100. It doesn't offer more information that what you already have (they're elevated). Understand the urinalysis though...makes sense. 

Cornell's lab does Protein C. I don't know if you can ship there with customs. Perhaps calling their lab they could make a recommendation.


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## Cathy (Mar 19, 2006)

Cornell's lab does Protein C. I don't know if you can ship there with customs. Perhaps calling their lab they could make a recommendation.
[/QUOTE]

Thanks, I will contact Cornell. Hopefully there is a work around. If not, a shopping trip to the US may be in order.  

Cathy


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## jmm (Nov 23, 2004)

> Thanks, I will contact Cornell. Hopefully there is a work around. If not, a shopping trip to the US may be in order.
> 
> Cathy[/B]


LOL Hmmm...somehow I think you get double benefits doing it that way hehehe


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## molleysmom (May 27, 2007)

> > index.php?act=findpost&pid=456245
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Thanks for your input. Molley is asymptomatic with LFT of 185 improved from 225. Our raw diet is not exclusive, I purchase a frozen product made by Northwest Naturals here in Oregon. Her mainstay is a homemade diet. Thanks again for your input, I would never want to take unnecessary chances with our little fuzz butt!


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## Malteseluv (Feb 6, 2007)

> > index.php?act=findpost&pid=456245
> 
> 
> 
> ...


I'm not necessarily talking about protein restriction...I'm talking about the Kind of protein, and also like I mentioned the risk of e.coli. Some strains of E.coli are extremely difficult to get rid of. I have a friend with a liver compromised dog that has been trying to fight this for a very long time.


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## MaryH (Mar 7, 2006)

> > index.php?act=findpost&pid=456330
> 
> 
> 
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I agree .... why the repeat? Read your handout and ask your vet to read it too about the difficulties involved in getting an accurate reading from a urine bile acid test. Why not call Cornell or send Dr. Center an email yourself and ask if she has ever run a Protein C test on blood being shipped from Canada or ask if she knows of a Canadian lab in your area that runs the test. If your vet is looking for ammonium biurate crystals she can easily see them in a simple urine sample. Cathy, please remember that Smudge is a 16 mo. old normal acting adorable Maltese who had already had surgery and didn't have any negative reaction to anaesthesia. Don't get all sucked up into alot of unnecessary tests. I'm betting that a Protein C test is going to tell you what you already know .... Smudge is FINE!!

Mary


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## Cathy (Mar 19, 2006)

I agree .... why the repeat? Read your handout and ask your vet to read it too about the difficulties involved in getting an accurate reading from a urine bile acid test. Why not call Cornell or send Dr. Center an email yourself and ask if she has ever run a Protein C test on blood being shipped from Canada or ask if she knows of a Canadian lab in your area that runs the test. If your vet is looking for ammonium biurate crystals she can easily see them in a simple urine sample. Cathy, please remember that Smudge is a 16 mo. old normal acting adorable Maltese who had already had surgery and didn't have any negative reaction to anaesthesia. Don't get all sucked up into alot of unnecessary tests. I'm betting that a Protein C test is going to tell you what you already know .... Smudge is FINE!!

Mary
[/QUOTE]


Ok, urine bile acid test has been cancelled and the Protein C draw is scheduled for tomorrow morning. It is possible to have the sample shipped to Cornell via a broker. The total cost with vet fees, test fee, shipping and brokerage fees will be $200. Once the results are in showing that she doesn't have a shunt there won't be anymore more tests. This matter will be put to rest unless symptoms develop. 

Cathy A


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