# Pleas help! Lily's liver function very high!



## BradyLily (Sep 9, 2009)

Hello everyone, hoping that someone can give me advice about my little Lily. We take Lily & Brady for their dentals every year. Last year Lily had 4 teeth pulled(bottom in front between her canines) because they were loose. Brady has absolutely beautiful teeth, Lily not so much. My vet retired in January and a new vet bought the practice. We brought B&L Wednesday to have their teeth cleaned and the vet called me about 2 hours after we dropped them off and said Brady was done and he has beautiful teeth. Lily on the other hand has a very elevated ALT. I asked what that was and he said it's a liver enzyme. What was it? He said 816. What is normal? Between 10-100. I asked him to look at the blood work from a few months ago. He said, oh that's a good idea hold on. When he came back to the phone he said it was 947! I asked why someone didn't tell me?!?! He didn't know because he wasn't part of the practice a few months ago! Not a good answer. He asked if we wanted to have her teeth cleaned? I said was there more risk because of this level and he said no. I told him to go ahead and clean her teeth because they get so nervous when they go and Lily's breath is really bad. He called a while later and said that Lily had to have teeth pulled. I said how many? He said you don't want to know. I was a nervous wreck until he called back and said he had to pull most of her teeth. She has 4 canines and 2 molders left on the bottom of left and right side. So my poor baby came home in much pains with antibiotics, a rinse twice a day, liver supplement and of course pain meds. She will be going back to the vet for a full liver panel and a bile acid test. I asked the vet to look back and see how long this has been going on but they said it will take them until Monday afternoon to look back further than 2012. I asked if it could be the food I'm feeding? Maybe protein too high and he said no. So I'm asking anyone on this forum to please give me some advice or any experience with this issue. I feed only canned food and switch the proteins every day. Maybe it's just too high. Any and all advice would be greatly appreciated. Thanks. 


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## wkomorow (Aug 26, 2011)

First, take a deep breath. Those numbers are very high. Lucky does have a liver issue but the highest his alt has been has been in the 170 range. Have you seen any odd behaviors in Lily? Certainly the demamarin or marin will help. Often the numbers will go up instead of down at first. What is the protein content of the food you are feeding her. Lowing the protein content and supplementing with a vegetable or dairy protein might not be a bad idea. You should work with your vet or a nutritionist for an optimum diet. If Lily is nonsymptomatic, maybe a lower protein diet with marin would help. 

The next step is a liver profile and a BAT test. If that comes back high, there is a Protein-C test that can help narrow down the issue. At that point you will want to go beyond your local vet to a referral board certified internal medicine vet. Cornell at Stamford has some excellent vets that are board certified and they have the staff of Cornell University for support. They certainly can help with liver issues, but if Lily is not showing any symptoms of liver issues other than the blood test, they will probably manage it with nutrition, diet, and medicine. Try not to worry, most Maltese have some type of liver issue, many go unexpressed and live a completely normal life. If Lily is not showing any symptoms, I would pursue things but not panic.


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## BradyLily (Sep 9, 2009)

I'm trying to be optimistic. I was so upset when they told me and then having so many teeth pulled just put me over the edge. When she came home she was in so much pain and drooling. I've been in search of a good food and have tried Wellness (they got soft poops) BB, not great. They really like Dave's grains free beef and poached salmon and pork dinner. Grandma Mae's Country Naturals beef & liver and I think the same brand, but lamb. Brady has a sensitivity to chicken and sweet potato. I was worried that the food was too high in protein, but when I asked my vet, he said no. I tried Evermore frozen cooked beef and they loved that too. Brady's levels were 109 2 times ago, then 63 then back up to 102. What kind of food do you feed? I'm thinking I'll have to change to a lower protein level (minus chicken and sweet potato for Brady)


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## BradyLily (Sep 9, 2009)

Oh and also, she has had no symptoms that I've noticed. She eats, plays, sleeps, good poops. I haven't noticed anything different. She's such a good girl. She does always want to eat though. Every time we go into the kitchen she looks or follows. She barks when we are getting her breakfast or dinner ready. She loves to eat!


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## edelweiss (Apr 23, 2010)

It is good for most maltese to have a protein value of around 26%. I try to keep Lisi's below this. Her breath starts to smell funny if the protein count is too high.


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## BradyLily (Sep 9, 2009)

So, does that means that an minimum 9.5% crude protein in canned food is low enough? 


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## wkomorow (Aug 26, 2011)

Every dog is different, some react to higher protein more than others. Although I think the food may be a catalyst, there is another reason for the high alt. Lucky is on an hepatic diet, others home cook, etc. Good luck


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## shellbeme (Mar 1, 2011)

I'm sorry you are having to go through this. I would be freaking out too. (And furious that my old vet never mentioned it) The good news is, it sounds like you have a vet who cares and is trying to gather all the information they can for you before slapping down a diagnosis. I would be very happy with that.

Protein is not dangerous. I'm really over, seeing people freak out about protein levels in food. Lack of moisture is what is dangerous-and low quality ingredients. The protein scare comes from a time when chicken feathers, and beaks and all kinds of undigestible crap was used to make up the protein in kibble. It also comes from feeding kibble instead of wet foods and dogs not getting enough liquid in their diet.

There is also heredity. Some dogs are going to have issues, no matter how you feed them. You said you are feeding a canned food? I assume it's a good quality canned? That's great! I can't see that you are doing anything wrong.

At this point, I would work directly with my vet to find out what is going on and what kind of diet I should have my dog on. You can also, ask your vet for a referral to a specialist-or perhaps a dietary specialist if you are needing to change the diet. I would at least give this vet a chance first.

Some of the foods you mentioned, I don't recognize, myself. That doesn't mean they are bad. Keep us updated as things progress.


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## edelweiss (Apr 23, 2010)

shellbeme said:


> I'm sorry you are having to go through this. I would be freaking out too. (And furious that my old vet never mentioned it) The good news is, it sounds like you have a vet who cares and is trying to gather all the information they can for you before slapping down a diagnosis. I would be very happy with that.
> 
> Protein is not dangerous. I'm really over, seeing people freak out about protein levels in food. Lack of moisture is what is dangerous-and low quality ingredients. The protein scare comes from a time when chicken feathers, and beaks and all kinds of undigestible crap was used to make up the protein in kibble. It also comes from feeding kibble instead of wet foods and dogs not getting enough liquid in their diet.
> 
> ...


I think that it is simplistic to say that protein doesn't matter. . . maybe in your case (or with a healthy dog) it doesn't. Have you had a dog w/a liver shunt? It certainly is true that water is important---but this is not necessarily an either/or situation. For example: if you were trying to lose weight calories might be important, or carbs, but so is exercise & a few other things. 
I, for one, will continue to monitor the protein levels for Lisi---with Kitzi it isn't as crucial as he has no issues.


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## N2Mischief (Aug 18, 2013)

When the dog has possible MVD, like mine, protein levels are very important. Of course we don't know at this point if your girl does have MVD, just saying that protein may indeed be an issue. How we discovered her MVD was because I switched to a high protein food and she would vomit on a regular basis. I was told by Dr. Dodds that she had to be on low protein food. I started Denamarin and lower protein food and the vomiting immediately stopped. Also I was told not to feed beef. Vegetable and Dairy protein are best, but Misha wouldn't touch it so we used white fish for awhile and now kangaroo.

Canned food protein levels are very deceiving. There is a formula, you would need to google it, that you use to figure out the actual level. Most likely it is much higher than what the can says. Something to do with dry matter??

I feed California Natural Kangaroo and red lentil...it is the only food I could find that was grain free, lower protein (min 21%) and lower fat for my other dog. I soak it in water and leave enough water so there is "gravy" and they lap it up.


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## elly (Sep 11, 2006)

Mercedes has had issues with high protein food. When she was a puppy I was feeding Evo her kidney enzymes were elevated. I changed food and all went back to normal. Last summer I had a CBC and her liver enzymes were elevated. I was hoping it was a fluke so we tested again and they were higher. I changed her food to Canine Caviar special needs and gave her denamarin. We retested and her enzymes were normal. I believe some small dogs have issues with the higher protein food. I am sorry you are going through this and I hope everything will be fine.


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## BradyLily (Sep 9, 2009)

shellbeme said:


> I'm sorry you are having to go through this. I would be freaking out too. (And furious that my old vet never mentioned it) The good news is, it sounds like you have a vet who cares and is trying to gather all the information they can for you before slapping down a diagnosis. I would be very happy with that.
> 
> Protein is not dangerous. I'm really over, seeing people freak out about protein levels in food. Lack of moisture is what is dangerous-and low quality ingredients. The protein scare comes from a time when chicken feathers, and beaks and all kinds of undigestible crap was used to make up the protein in kibble. It also comes from feeding kibble instead of wet foods and dogs not getting enough liquid in their diet.
> 
> ...



Thanks! I am trying to be calm, but it's not easy. She has always seemed very healthy. Had a problem a few years ago when I went on vacation, my mom watched B&L and her friend stayed with her. Lily ended up with what the emergency vet thought was pancreatitis. I believe her friend was feeding Lily cheese its. He never admitted to it but they were on our counter when I came home the next day and she was pooping orange. He's an older man who thought I was crazy when I told them to only give B&L their dog food and dog cookies. She never got sick again after that incident. I only buy their food at small holistic stores in the area. I will do anything to keep my babies healthy. I read about dental disease causing high alt levels. She is on a supplement and I'm praying that her level goes down. Her gums are healing and she didn't need any pain meds today. Still eating like a trooper. Ate that night after most of her teeth were pulled. She's a good girl. 🐾


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## BradyLily (Sep 9, 2009)

Thanks. I'll google the formula to figure out the actual protein level. I was feeding Natural Balance canned for a couple years, but it became inconsistent and a little stinky. That's when I switched to Blue Buffalo, then to the others I listed. I will look into Canine Caviar. Lily has been taking Denamarin for a couple of days now. I'm so anxious for my vet to pull her records and see how long this has been going on. I'm very disappointed in my last vet. How could he not tell me? She could have been being treated for over a year now and who knows, maybe longer. 


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## BradyLily (Sep 9, 2009)

N2Mischief said:


> When the dog has possible MVD, like mine, protein levels are very important. Of course we don't know at this point if your girl does have MVD, just saying that protein may indeed be an issue. How we discovered her MVD was because I switched to a high protein food and she would vomit on a regular basis. I was told by Dr. Dodds that she had to be on low protein food. I started Denamarin and lower protein food and the vomiting immediately stopped. Also I was told not to feed beef. Vegetable and Dairy protein are best, but Misha wouldn't touch it so we used white fish for awhile and now kangaroo.
> 
> Canned food protein levels are very deceiving. There is a formula, you would need to google it, that you use to figure out the actual level. Most likely it is much higher than what the can says. Something to do with dry matter??
> 
> I feed California Natural Kangaroo and red lentil...it is the only food I could find that was grain free, lower protein (min 21%) and lower fat for my other dog. I soak it in water and leave enough water so there is "gravy" and they lap it up.



Lily very rarely vomits. Maybe she got sick a year ago right after she ate and I thought she just ate too fast. She really loves to eat. She barks as I am opening the can! She is a trip! Great dog! They both are. She has been taking Denamarin for a couple of days now. I hope it helps. 


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## kweldon (May 1, 2013)

The last few years with Angel her liver enzymes came back high regularly. My vet seemed to think it was because of her teeth and the infections in her mouth. I had her teeth cleaned yearly but she had terrible teeth. She had a severe underbite and her jaw popped in and out of the socket regularly so I couldn't brush her teeth for fear of hurting her (I couldn't brush her face either, I just kept it very short) 

Was there a lot of infection in Lily 's mouth? Is it possible that an infection due to the teeth caused the elevated levels?


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## BradyLily (Sep 9, 2009)

I asked my vet and he said no. I did a little research myself and found this article (see the link below). It mentions dental disease possibly elevating liver enzymes. Did Angel's levels go back to normal after her dental?

http://dogaware.com/health/liver.html

Let me know your opinion about this article

Thanks!


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## BradyLily (Sep 9, 2009)

Yes, I believe my vet said her gums were infected. Her breath was really bad. I used the Petzlife spray every day, but it didn't help. 


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## kweldon (May 1, 2013)

BradyLily said:


> I asked my vet and he said no. I did a little research myself and found this article (see the link below). It mentions dental disease possibly elevating liver enzymes. Did Angel's levels go back to normal after her dental?
> 
> DogAware.com Health: Liver Disease in Dogs
> 
> ...


It took a while but yes....I think 3 blood tests and a few rounds of antibiotics. But then it went back up at her next dental. She was probably 9 when it started showing up in the presurgery blood work. 

I know it's scary. I hope you can find the problem and fix it.


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## BradyLily (Sep 9, 2009)

Do you remember the level? Lily is 6 years old. 


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## kweldon (May 1, 2013)

BradyLily said:


> Do you remember the level? Lily is 6 years old.
> 
> 
> Sent from Petguide.com Free App


He never told me the exact number. I know he felt strongly it was the infection in her mouth. I don't know for sure that's what it was. It may have been a coincidence but I just wanted to mention it since yours seems to be a similar situation.


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## BradyLily (Sep 9, 2009)

I took Lily to the vet on Wednesday to have a full liver panel and bile acid test. Should be getting the results today. She's been on antibiotics for over a week(will be done tomorrow), still rinsing her mouth after meals and giving her the liver supplement at night. Praying that her ALT levels have come down. I've been scouring this site looking for a good lower protein canned food, pate is preferred. I would like to keep Brady & Lily on the same food and am afraid that I somehow contributed to her high levels. I want to feed them the best food I can find. Brady can't have chicken or sweet potato, so I've been feeding them beef, lamb and venison. My vet said that the protein level is fine, but I feel that they don't have that much knowledge about nutrition. My babies eat only canned food. They don't like kibble. Again, any advice would be greatly appreciated. I trust this site and the people who post on it. You all have so much experience with this breed and I always check this site when I have questions. 


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## maggieh (Dec 16, 2007)

BradyLily said:


> I took Lily to the vet on Wednesday to have a full liver panel and bile acid test. Should be getting the results today. She's been on antibiotics for over a week(will be done tomorrow), still rinsing her mouth after meals and giving her the liver supplement at night. Praying that her ALT levels have come down. I've been scouring this site looking for a good lower protein canned food, pate is preferred. I would like to keep Brady & Lily on the same food and am afraid that I somehow contributed to her high levels. I want to feed them the best food I can find. Brady can't have chicken or sweet potato, so I've been feeding them beef, lamb and venison. My vet said that the protein level is fine, but I feel that they don't have that much knowledge about nutrition. My babies eat only canned food. They don't like kibble. Again, any advice would be greatly appreciated. I trust this site and the people who post on it. You all have so much experience with this breed and I always check this site when I have questions.
> 
> 
> Sent from Petguide.com Free App


Tessa had high alt a year ago and we brought them down with milk thistle. I keep her on a lower (not very low) protein food. It's not canned, it's dehydrated and when I reconstitute it with water, it is like canned. I use Addiction Dehydrated Raw and rotate through five grain free formulas.


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## kweldon (May 1, 2013)

I am just checking for an update. Praying her numbers are down.


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## maggieh (Dec 16, 2007)

http://spoiledmaltese.com/forum/52-.../169954-tessas-six-month-odyssey-success.html

I'm finally at my laptop where I could search for the thread (too hard to copy/paste with iPad). Here is my thread from last fall about Tessa's liver enzymes.


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## elly (Sep 11, 2006)

maggieh said:


> Tessa had high alt a year ago and we brought them down with milk thistle. I keep her on a lower (not very low) protein food. It's not canned, it's dehydrated and when I reconstitute it with water, it is like canned. I use Addiction Dehydrated Raw and rotate through five grain free formulas.


 
I think I will try this for Mercedes and Edgar. They love CC special needs and I really hate to change but with all the problems it is scary. On a side note I do know that some of the smaller food companies are being prepared and packaged in peoples home:w00t: they are just required to send in samples for inspection:w00t:


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## BradyLily (Sep 9, 2009)

So I got a call from our vet yesterday with Lily's results. Not good. 😞
Her bile acids are 107.7 should be between 0.0-6.9 
Bile ACCP is 119.7 should be between 0.0-14.9
ALT went down a little to 778 should be between 10-100 (last week it was 817)
Now they want me to bring her to a specialist for an ultrasound and liver biopsy. Really? I asked if they were going to do a needle biopsy or if she had to have surgery and my vet wasn't sure. I told her I wanted to know what was going to be done and not go in blindly. The vet's office called last night to tell me that she need to fast before the procedure for 12-15 hours. I said what procedure?? I haven't even made a decision yet! Her ALT a 1-1/2 ago was 947 and my vet who retired in January decided to do the test, charge me for the test and never gave me the results! I'm furious! We could have been a 1-1/2 ahead of this issue!! When I asked the girls in the office why he didn't tell me, the receptionist said, I don't know, I think he was just done. Really, really?? Done? She said there are many issues the new vet has to deal with. I don't know what to do. I took her to a well known vet and I trusted him. I don't know how long this has been going on and now my poor Lily's numbers are way out of whack!!
I'm going to look for lower protein food today. The vet said that would probably be a good idea. She was going to tell me something about my old vet, but both rooms were occupied and she didn't want to tell me in the waiting room. I'm hoping she calls me today. Any advice? Please?


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## wkomorow (Aug 26, 2011)

If it were me, biopsy should NOT be the next step. Ultrasound may be helpful depending on the skills of the radiologist and if it is doppler. The next step would be a protein C test which is an inexpensive blood test that is sent to Cornell to be read. For a BAT reading over 100, Protein C helps to distinguish between MVD and liver shutting. Lucky has a liver shunt, so I have been through this and recently meet with Dr. Center at Cornell to discuss his treatment. 

A lower protein food is really needed right now. If Lily is show no signs of liver distress but is being diagnosed my blood work, I would start her on a hepatic food soon and supplement that with plant and dairy proteins - peanut butter, cottage cheese, feta cheese, some pasta, a little ice cream. Several people here are managing their Maltese's liver issues medically and nutritionally.

I can also tell you any advise you get, anything you read, there will be an opposite opinion out there. Liver issues are very confusing and the information on them is contradictory.

Luck was diagnosed with a liver shunt almost a year ago and just last week he had a visit with Dr Center to evaluate his progress. He is being medically managed and is doing great, very active, healthy, etc. Under the right conditions and managed well medically, a liver shunt dog can live to their teens. But one needs to be vigilant. I am saying Lily has a shunt, I am just saying liver issues can be managed for many dogs.

In terms of biopsies, some dogs with liver shunts have lipoglanulomas and aspirations will not tell this well. Lipogranulomas make prognosis of surgery not so good. It correlates with additional shunting and with other problems. If we decide on surgery for Luck, I was told to get surgical biopsies of three lobes before proceeding.

Cornell University vet clinic is in Stamford CT and if it were me I would make an appointment with an Internal Medicine specialist there or travel to Cornell in Ithica as a next step. Luck was seen at Tufts and at Ithica, and our experience at Cornell was more helpful as least for us.

Good luck, try not to worry, there are lots of options and you do not have all the information yet; free to PM me with any questions.


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## BradyLily (Sep 9, 2009)

Thanks so much for the advice. Do you think her liver issues could be caused by her dental disease? She did have most of her teeth pulled last week. I bring them for a dental every year. Her ALT did go down from 816 last week to 778 this week. She's been on Denanarin for a week. My vet wants me to bring her to New Haven Central to see Dr. Lance Ruzear. What food do you feed? Canned? I will change her food immediately, just not sure what to get. 


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## Chardy (Oct 30, 2008)

I know Dr Dodds has a liver detox home made diet on line that you can make yourself- It is also listed here on SM in one of the threads. I think it is just a liver detox diet and not meant for long term use for ie: Liver Shunt- That way you can purchase your own fish etc and make sure it is top quality vs something else for now. If I remember off the top of my head, the diets protein is white fish, maybe cod? Hope this helps.


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## Chardy (Oct 30, 2008)

http://spoiledmaltese.com/forum/60-maltese-food-snacks-treats/95052-dr-dodds-updated-liver-diet.html

This is the post I was referring too.


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## wkomorow (Aug 26, 2011)

Lucky is on RC hepatic 1/3 - 1/2 cup depending on how hungry he is. He get feta cheese - a couple of teaspoons and some peanut butter cereal - maybe 10 pieces - each morning. He has his hepatic kibble during the day and he gets some vegs and fruit for supper. Before bed he gets a teaspoon of vanilla ice cream.

I know a lot of people worry about the quality of Royal Canine, but you use what works. Hills also has a hepatic canned food, but Luck hated it. The advantage is that these formulae have the mineral and vitamin content balanced for liver support. It has been successful for him and he loves it, so for him I use what works.

Until you know what is behind this, I would stick to safe proteins, such as dairy, tofu, etc., certainly for a week or two it would be safe. You have to be careful that the protein is not one likely to build up ammonia in the system. Dogs with liver issues need protein to support the liver but it needs to be safe protein. Bile Acids over 100 can point (not always) to shunting. Low protein C makes shutting most likely.

Lots of things can raise ALTs, but those are super high. At this point, you know there is an issue and you can address it to give Lily a great life. A probiotic is probably a good idea along with the milk thistle. The good biotics will compete with the bad ones that can lead to ammonia accumulaion in the digestive tract.

Long term I would work with a nutritionist, but right now it is most important to do no harm. You need to stabilize her numbers to give you time to determine the course of action.

Good luck, and try not to worry too much.


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## BradyLily (Sep 9, 2009)

Thanks for the link. I want to change her food immediately. Is there a canned food you would recommend? 


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## BradyLily (Sep 9, 2009)

wkomorow said:


> Lucky is on RC hepatic 1/3 - 1/2 cup depending on how hungry he is. He get feta cheese - a couple of teaspoons and some peanut butter cereal - maybe 10 pieces - each morning. He has his hepatic kibble during the day and he gets some vegs and fruit for supper. Before bed he gets a teaspoon of vanilla ice cream.
> 
> I know a lot of people worry about the quality of Royal Canine, but you use what works. Hills also has a hepatic canned food, but Luck hated it. The advantage is that these formulae have the mineral and vitamin content balanced for liver support. It has been successful for him and he loves it, so for him I use what works.
> 
> ...



Thanks so much for taking the time to reply. I really appreciate it! I called Shoreline and they have records from 4 years ago when I was on vacation. They said they will fax them to my vet and email them to me. I know 4 years ago Shoreline thought Lily had pancreatitis and told me to follow up with my vet. He said she was fine back then! I'm very curious to see what her bat and alt were 4 years ago. You go to someone and trust that they will do the best for you and look what happens. 


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## Chardy (Oct 30, 2008)

BradyLily said:


> Thanks for the link. I want to change her food immediately. Is there a canned food you would recommend?
> 
> 
> Sent from Petguide.com Free App


I think Walter did a great post and suggestion on what he is doing that is working and you can get that quickly and start today. Good luck and I love what he said so I will repeat it... TRY NOT TO WORRY TO MUCH..


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## BradyLily (Sep 9, 2009)

Absolutely! I agree! Thanks Walter! 


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## BradyLily (Sep 9, 2009)

Thanks to you too Carol! 


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## MalteseObsessed (Mar 7, 2010)

I just wanted to leave a note to let you know I am praying for Lily and you. It is so nice of everyone here to share their knowledge, and I am learning too from reading this thread. TY


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## kweldon (May 1, 2013)

BradyLily said:


> So I got a call from our vet yesterday with Lily's results. Not good. 😞
> Her bile acids are 107.7 should be between 0.0-6.9
> Bile ACCP is 119.7 should be between 0.0-14.9
> ALT went down a little to 778 should be between 10-100 (last week it was 817)
> ...


I'm so sorry. My personal opinion ...I would recommend further testing even if it's just starting with xrays or ultrasound and then possibly a biopsy. 

When I lost Angel Feb 2013 the vet felt it was that her cancer spread. She had tumor removed Oct 2012, good margins but it was grade 2. My vet felt he got it all but a 2 could go either way. When she got sick in Feb we rushed her to the vet. It all happened so fast, from her first sign something was wrong until the end was less than 48 hrs. He did xrays, which didn't show any tumors, but her liver was not shaped normal. I don't know if this was due to cancer or the fact that she had the high enzymes at least once a year the last few years. We always got it back in the normal range but it would go back up. My vet didn't offer any tests, he made it sound like no big deal since it went back to normal. 

Sorry I started rambling, losing her was so hard. I feel so badly telling you this because I'm not trying to scare you. If I could go back I would find a new vet and do the tests even though Angel was much older. Most likely it was the cancer but I would have done anything for a few more years. I will be praying for your Lily (my new maltese is also Lily) and following this to see how she's doing.


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## edelweiss (Apr 23, 2010)

There is so much good information here from Walter that I would like to suggest that it be compiled into a sticky for those w/liver issues so he doesn't have to write it out each time?? Administration?


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## wkomorow (Aug 26, 2011)

kweldon said:


> I'm so sorry. My personal opinion ...I would recommend further testing even if it's just starting with xrays or ultrasound and then possibly a biopsy.
> 
> When I lost Angel Feb 2013 the vet felt it was that her cancer spread. She had tumor removed Oct 2012, good margins but it was grade 2. My vet felt he got it all but a 2 could go either way. When she got sick in Feb we rushed her to the vet. It all happened so fast, from her first sign something was wrong until the end was less than 48 hrs. He did xrays, which didn't show any tumors, but her liver was not shaped normal. I don't know if this was due to cancer or the fact that she had the high enzymes at least once a year the last few years. We always got it back in the normal range but it would go back up. My vet didn't offer any tests, he made it sound like no big deal since it went back to normal.
> 
> Sorry I started rambling, losing her was so hard. I feel so badly telling you this because I'm not trying to scare you. If I could go back I would find a new vet and do the tests even though Angel was much older. Most likely it was the cancer but I would have done anything for a few more years. I will be praying for your Lily (my new maltese is also Lily) and following this to see how she's doing.


I am so sorry for your loss of Angel. Dopplar ultrasound in the right hand can tell quite a bit. At that point one needs to go to a vet school because you are getting into more cutting edge medicine.


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## elly (Sep 11, 2006)

My own experience with Liver Disease is it is not a one size fits all. Usually the best you can do is manage it with diet and support. Some dogs with high ALT and ALP do very well with diet and support especially if discovered early. Needle biopsy and ultrasound really give very little info and IMO are a waste of money. Scintigraphy or protein c would be the 2 tests I would do if diet and liver support do not bring the numbers down. Good luck and try not to panic. My Mercedes had high alt last summer and changing her food and adding denamarin her numbers went back to normal thankfully.


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## wkomorow (Aug 26, 2011)

Correction, I reread my post: *I am saying Lily has a shunt, I am just saying liver issues can be managed for many dogs. Should have read*I am NOT saying Lily has a shunt, I am just saying liver issues can be managed for many dogs. Sorry about that. Other than blood work does Lily show any signs of liver issues? Head pressing, drooling, staring into space?


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## BradyLily (Sep 9, 2009)

No, she has no symptoms at all. She plays, has a great appetite, goes for walks. No issues that I've ever noticed. Th only problem she's ever had were bad teeth. Well now she only has 6 teeth left in her mouth. She finished the antibiotic yesterday and I called and drove all over the place yesterday and today looking for lower protein food. I picked up a can of NB duck & potato last night because it was pretty low protein. She woke me up at 3:30 this morning gagging. I brought her outside, gave her a little Maalox and she was fine this morning. Never vomited. I fed her a little of her old food(higher protein) this morning with some scrambled egg and she seemed fine I picked up a can of Nutro Turkey & Potato today. Not buying more than one can at a time for now. Couldn't find RC Hepatic food anywhere. The small places where I usually shop for food are telling me RC is garbage. I explained that she needs lower protein. I found Dave's Restricted Diet Protein-Phosphorus online. Protein 4.30% which calculates to 17.2% - fat 6.5% which calculates to 26%. What do you think of those numbers? 


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## BradyLily (Sep 9, 2009)

kweldon said:


> I'm so sorry. My personal opinion ...I would recommend further testing even if it's just starting with xrays or ultrasound and then possibly a biopsy.
> 
> 
> 
> ...



I am so very sorry for your loss. I wasn't sure if my vet was jumping the gun when she immediately wanted to schedule the ultrasound and biopsy. After reading your thread, I'm questioning myself once again. 
Thank you for your prayers, I really appreciate it. I'm so happy you have a new baby. Great name 


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## BradyLily (Sep 9, 2009)

elly said:


> My own experience with Liver Disease is it is not a one size fits all. Usually the best you can do is manage it with diet and support. Some dogs with high ALT and ALP do very well with diet and support especially if discovered early. Needle biopsy and ultrasound really give very little info and IMO are a waste of money. Scintigraphy or protein c would be the 2 tests I would do if diet and liver support do not bring the numbers down. Good luck and try not to panic. My Mercedes had high alt last summer and changing her food and adding denamarin her numbers went back to normal thankfully.



Thank you so much. I'm learning a lot in a very short period of time. Walter also mentioned the protein c. I read about the scintigraphy. I really need to change her food to a lower protein soon. I looked all weekend long and didn't find any food that I thought would be low enough. I'll keep looking. 


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## maggieh (Dec 16, 2007)

https://www.addictionfoods.com/products/dog-formulas/raw-dehydrated

You can find this from several online retailers. Protein is around 20%.


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## BradyLily (Sep 9, 2009)

maggieh said:


> https://www.addictionfoods.com/products/dog-formulas/raw-dehydrated
> 
> You can find this from several online retailers. Protein is around 20%.



Ok Maggie, now that's interesting. Lower protein, lower fat, higher carbs. I'm guessing if I purchased this food I would need to switch over slowly. Although Lily is having the issues, I'd like to switch Brady over as well. Are you feeding this food? 


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## BradyLily (Sep 9, 2009)

MalteseObsessed said:


> I just wanted to leave a note to let you know I am praying for Lily and you. It is so nice of everyone here to share their knowledge, and I am learning too from reading this thread. TY



Thank you so much for your prayers. Very much appreciated. Yes, everyone has been wonderful! 


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

I have posted many times about the liver problems Tanner has. He had a liver biopsy several years ago before the Protein C test was available and unfortunately, a sample was very very small and only taken from one lobe of the liver which I ultimately sent to Dr. Center. Tanner's diagnosis is MVD which is managed with diet. Liver dogs can't process the amonia in beef, so Tanner eats only chicken. I change his food periodically, and over the years he's been on Chicken Soup for the Dog Lover's Soul, NB Chicken, Holistic Select Chicken, and right now hes eating Wellness Chicken. All are canned. I choose food with a protein level of 9% or less, preferably less. Additionally, I boil chicken breasts and sprinkle that on his food. His ALT has ranged from a high of 900 to a low of 111 where it's at now. I think the reason it's so low now is because of the 1/4 tab of Marin he gets daily. When I took him off the Marin recently, ALT went back up. Put him back on it, it went down. Tanner is now 10 years old and is a healthy, happy, active little boy.


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## maggieh (Dec 16, 2007)

BradyLily said:


> Ok Maggie, now that's interesting. Lower protein, lower fat, higher carbs. I'm guessing if I purchased this food I would need to switch over slowly. Although Lily is having the issues, I'd like to switch Brady over as well. Are you feeding this food?
> 
> 
> Sent from Petguide.com Free App


In order to lower protein you have to increase carbs from non-protein sources. This is the food I have been feeding my two for almost a year. This, along with Animal Essentials /animal Apawthecary Detox Blend dropped her ALT from 278 to 20.


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## BradyLily (Sep 9, 2009)

Tanner's Mom said:


> I have posted many times about the liver problems Tanner has. He had a liver biopsy several years ago before the Protein C test was available and unfortunately, a sample was very very small and only taken from one lobe of the liver which I ultimately sent to Dr. Center. Tanner's diagnosis is MVD which is managed with diet. Liver dogs can't process the amonia in beef, so Tanner eats only chicken. I change his food periodically, and over the years he's been on Chicken Soup for the Dog Lover's Soul, NB Chicken, Holistic Select Chicken, and right now hes eating Wellness Chicken. All are canned. I choose food with a protein level of 9% or less, preferably less. Additionally, I boil chicken breasts and sprinkle that on his food. His ALT has ranged from a high of 900 to a low of 111 where it's at now. I think the reason it's so low now is because of the 1/4 tab of Marin he gets daily. When I took him off the Marin recently, ALT went back up. Put him back on it, it went down. Tanner is now 10 years old and is a healthy, happy, active little boy.



Wow, that's encouraging! I'm so happy Tanner is doing well. I have been boiling chicken and giving it as treats for a long time. She loves her chi chi. I have been feeding her a good amount of beef, venison and lamb. I am definitely changing her food(still looking) and will talk to my vet tomorrow about the protein c test as well as an ultrasound. I've been giving her Denamarin for a little over a week now. It was easiest to give an hour before dinner. My vet said 30-60 minutes prior to food, but I read that overnight fast is preferred. I'm thinking that means an hour before breakfast. That's a little hard because my girl wakes up, goes outside to do her business and then wants to eat. 


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## BradyLily (Sep 9, 2009)

maggieh said:


> In order to lower protein you have to increase carbs from non-protein sources. This is the food I have been feeding my two for almost a year. This, along with Animal Essentials /animal Apawthecary Detox Blend dropped her ALT from 278 to 20.



Wow! That's great! Did you have a bile acid test done? 
How much of the dehydrated food do you feed. Where did you purchase the detox blend?


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## maggieh (Dec 16, 2007)

BradyLily said:


> Wow! That's great! Did you have a bile acid test done?
> How much of the dehydrated food do you feed. Where did you purchase the detox blend?
> 
> 
> Sent from Petguide.com Free App


Tessa is a rescue, was more than a year old when I got her, had no symptoms of a shunt and responded to the supplements so both my holistic and primary vet saw no reason to do a BAT. If she had had a baseline as a puppy, then we would have but since she was a stray, I have no idea if that was done. FYI, we tried Denamarin but it caused nausea so we stopped that after about 2 weeks and relied solely on the holistic supplement. Follow up blood work showed that the ALT is remaining normal with only a few days of Detox Blend per month, so her problem may be MVD but more likely is related to the fact that she has a hiatal hernia. 

She gets 1/8 cup of the dehydrated food plus 1/8 c water twice a day. And I order the Detox Blend as well as the food from Pampered Pet Boutique (Crysta&Zoe) on this forum.


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## maggieh (Dec 16, 2007)

edelweiss said:


> There is so much good information here from Walter that I would like to suggest that it be compiled into a sticky for those w/liver issues so he doesn't have to write it out each time?? Administration?



Done!

Here's the link:

http://spoiledmaltese.com/forum/52-...uckys-liver-treatment-information-walter.html


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## wkomorow (Aug 26, 2011)

Lily is not showing any symptoms, but she has high values on the liver panels. I would be very careful in making to many radical changes. Right now you do not know what is wrong with her liver. If she has MVD or a liver shunt, the type of protein (not just quantity) is important. Animal flesh, especially darker meats are broken down into ammonia in the digestive tract. This ammonia passes through the liver to be changed into Urea. Urea is safe, ammonia is not. If there is some type of shunting, the ammonia is bypassing the liver and is being circulated throughout the body. The ammonia can break through the brain/blood barrier and lead to hepatic encepholaphy - which is very serious. Reducing the amount of protein in the food would take some of the strain off the liver and allow it to rest and regenerate. If there is shutting changing the protein to a safe vegetable or dairy protein will reduce the likelihood of HE. Dairy proteins and soy mostly break down into Urea which is safer for the body. Dogs with liver issues such as shutting or MVD have unfiltered blood flowing through them and this makes them more susceptible to other conditions such as infections and the creation of stones in the urinary tract. 

I think making an appointment with an board certified internist is important. Remember you are in control of Lily's treatment and you need to be comfortable with it. If the treatment sounds to invasive, you should think about it and make your best judgments. If they suspect a liver shunt, a protein C test will help distinguish between a shunt and MVD, A protein C test is a very simple non-invasive blood test.

It is difficult to give advice, because Lily is not my dog. Given that she is showing no symptoms, given that you are meeting with a internist soon, given that this condition has been going on for a while, what I would do is reduce rather than change her current food and add some carbs temporarily to it - some vegs like a "little" green beans and carrots and potatoes and rice. I would supplement it with some dairy (feta cheese or cottage cheese, skimmed is best, even plain vanilla ice cream or greek yoghurt (no artificial sweetners in them, though) or even peanut butter). I would add a probiotic - we use gentle digest, but there are lots of them and I would add sam-e and milk thistle. Some dogs are lactose intolerant, but most are not. Too much dairy will result in gastric upset in many dogs.

It is really difficult when you know there is a health issue with your dog. But the adage do no harm is as important. Given you are making an appoint with an Internist soon, I would be care of drastic changes. If Lily were exhibiting symptoms, that would be different, then I would look for a radical change. Good luck.

There are many on here that have successfully managed their dogs with liver issues. There are many approaches that one. Many of us who have liver shunt/MVD dogs have been very successful managing them with RC hepatic formula supplemented with other foods.


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## BradyLily (Sep 9, 2009)

I have an appointment with New Haven Central on Thursday morning for an ultrasound. Lance Rozear, DVM, ACVR will be performing and interpreting the ultrasound. They will send the results to my vet within a couple of hours and hopefully I will get them soon after. I've change Lily's food to turkey from beef, venison & lamb. My vet doesn't want me to make too many changes until we know what we are dealing with. I will keep you posted. Thanks again for all the info. I've learned a lot in a weekend. Really appreciate it 


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## edelweiss (Apr 23, 2010)

Just a gentle warning that many have been unhappy with doing an ultrasound as it is only as good as the radiologist who interprets it. Generally it is more reliable to do a protein C test as the 2nd step in what can be a long procedure of diagnosis of liver shunt. (Yes, I had a dog w/liver shunt, but back then it was relatively difficult to diagnose/treat & my dog did have shunt surgery.) Protein C is a non-invasive blood test.
I am not trying to 2nd guess your vet---just letting you know what others have experienced. I sure hope you find out what you need to know as I know how worrisome it can be. Good luck.


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## BradyLily (Sep 9, 2009)

I asked for a protein C test and my vet (along with another vet I consulted) said to do the ultrasound first. From what I've been told, this radiologist is amazing at finding shunts via ultrasound and I was told if anyone will find it, he will. Believe me, I wanted the protein C test first, but I'm being told to do the ultrasound first. I will keep you posted. Thanks again for the advice. 


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## wkomorow (Aug 26, 2011)

What the ultrasound is most likely to show is the size and shape of the liver and the general health of other organs. If it is shunting, toxins are flowing through the system and there can be damage to other organs, such as increased incidents of stone formation in the urinary system. Depending on the type of ultrasound used and the skill of the radiologist, some scans can actually see into the liver and will tell you about the size of the shunting vessel and the size of the vessels that carry blood through the liver. As Sandi said, if shutting is suspected, then a protein-C test will help distinguish between MVD and Portosystemic Shunting.

Depending on how cooperative Lily is, they may have to mildly sedate her to do the ultrasound - and they will need to shave her belly.


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## BradyLily (Sep 9, 2009)

Hi everyone, vet called and said Lily's test wasn't perfect, but not bad either. Everything looked good, but her liver and kidneys were a little more dense then usual. Size, shape, fine. Didn't see a shunt or anything leaking from the liver, but they know she's having an issue because of her levels. Not worried at all about kidney because those levels are fine. Most likely MVD, but she doesn't have symptoms. Next step would be a liver biopsy, but he said not now. Keep her on the supplements and do another liver panel in a month to see if her values go down. He doesn't think they will ever return to normal, but he said that may be normal for her. Checked all other organs and everything looks good. No tumors or other abnormalities. I'm feeling cautiously optimistic. Thanks for all of the advice and well wishes. I will keep you all posted. 


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

Yay! Remember, Tanner has MVD and he's 10.


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## elly (Sep 11, 2006)

BradyLily said:


> Hi everyone, vet called and said Lily's test wasn't perfect, but not bad either. Everything looked good, but her liver and kidneys were a little more dense then usual. Size, shape, fine. Didn't see a shunt or anything leaking from the liver, but they know she's having an issue because of her levels. Not worried at all about kidney because those levels are fine. Most likely MVD, but she doesn't have symptoms. Next step would be a liver biopsy, but he said not now. Keep her on the supplements and do another liver panel in a month to see if her values go down. He doesn't think they will ever return to normal, but he said that may be normal for her. Checked all other organs and everything looks good. No tumors or other abnormalities. I'm feeling cautiously optimistic. Thanks for all of the advice and well wishes. I will keep you all posted.
> 
> 
> Sent from Petguide.com Free App


Here is the deal with LD. Unless you have a shunt that can be repaired the treatment is pretty much all the same. Liver support and diet. My Ellie had normal ultrasound, sintigraphy, biopsy did not have protein C because I did not know about that test at the time. She had very high B/A and liver values. She became very sick at the age of 3 with pancreatic insuffiency secondary to her liver. She died at 5. Most dogs do very well on a good diet, Ellie was the exception. My best advice is note anything that is not her normal. Read everything about liver disease.


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## BradyLily (Sep 9, 2009)

Tanner's Mom said:


> Yay! Remember, Tanner has MVD and he's 10.



That's awesome! Hoping that Lily will continue to show no symptoms and be healthy. 


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