# Liver Shunts-MVD & Protein C test info



## tamizami (May 1, 2007)

Information from Cornell on the Protein C test your vet can use if your dog has elevated ALT (liver enzymes) and elevated Serum Bile Acids (SBA).

This test is less expensive than scintigraphy (about $400) and more reliable than ultrasound at telling you whether your dog has a liver shunt. If the Protein C is normal, it may be likely your dog has MVD (microvascular dysplasia), which is also referred to as hepatic microvascular dysplasia (HMD) or portal atresia. However, if the dog is over 4 years old, it may have acquired a liver disease (i.e. hepatitis) that caused the elevated ALT and bile acids, rather than MVD.

http://www.diaglab.vet.cornell.edu/coag/test/proteinC.asp

If you need more information on liver shunts, MVD/HMD/PA, the University of Tennessee has a good website:

http://www.vet.utk.edu/clinical/sacs/shunt/faq.shtml

Hope this helps everyone!


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## bellaratamaltese (May 24, 2006)

thank you soo much for posting this info! I don't think anybody can be too knowledgable on this subject. I just read of another person whose maltese has MVD, and he was a champion from a good breeder. Now he's been neutered and is no longer part of her breeding program. It's scary, I'm telling you!


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## pico's parent (Apr 5, 2004)

That is such good information! When Pico was diagnosed 4 years ago there was no option for a Protein C tests and I just hated to have the Colonic Scintography done but I had no choice at the time.

Thanks for sharing this.


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## Cathy (Mar 19, 2006)

> Information from Cornell on the Protein C test your vet can use if your _young_ dog (under 12 months) has elevated ALT (liver enzymes) and elevated Serum Bile Acids (SBA).
> 
> 
> *I wonder why it should only be done on dogs under 12 months.* Does anyone know? Dr. Jamie, Mary, Jackie???
> ...


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## jadey (Nov 2, 2006)

great information, thank you for sharing this i know a lot of people dont know about liver shunts (me)


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## thefab5 (Feb 1, 2007)

Tami- Thanks again for the information. It was a big help to of had that info. The Cornell web site is hard to navigate so kuddos to you for finding it!
XOXOXOX
NAncy




> Information from Cornell on the Protein C test your vet can use if your _young_ dog (under 12 months) has elevated ALT (liver enzymes) and elevated Serum Bile Acids (SBA).
> 
> This test is less expensive than scintigraphy (about $400) and more reliable than ultrasound at telling you whether your dog has a liver shunt. If the Protein C is normal, it may be likely your dog has MVD (microvascular dysplasia), which is also referred to as hepatic microvascular dysplasia (HMD) or portal atresia.
> 
> ...


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## MaryH (Mar 7, 2006)

> *I wonder why it should only be done on dogs under 12 months.* Does anyone know? Dr. Jamie, Mary, Jackie???
> 
> Cathy A[/B]


Cathy,

I have not read anywhere nor have I heard from Dr. Center that the Protein C test should only be done on dogs under 12 months old. She recommends doing bile acid test on young dogs (under 4 years old) because the older they get, the greater the chance that liver dysfunction could be caused by any number of reasons, not just PSVA/MVD. But that's the only age limit I have ever heard her speak of.

Mary


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

Since we're talking about age, what I don't understand is that I believe I read here that the Bile Acid Test should be given to Malts at 16 weeks or later. So, if most Malts go to their new homes at 12 weeks is it then not possible to have the test done by the breeder? Or do we have to start waiting 16 weeks for our puppies?


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## MaryH (Mar 7, 2006)

> Since we're talking about age, what I don't understand is that I believe I read here that the Bile Acid Test should be given to Malts at 16 weeks or later. So, if most Malts go to their new homes at 12 weeks is it then not possible to have the test done by the breeder? Or do we have to start waiting 16 weeks for our puppies?[/B]


What Dr. Center said at her seminar was that breeders should test the puppies as close to their departure date as possible. Her ideal timeframe would be 16 weeks, but if they go at 12 weeks then test as close to that as possible.

Mary


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## Cathy (Mar 19, 2006)

Cathy,

I have not read anywhere nor have I heard from Dr. Center that the Protein C test should only be done on dogs under 12 months old. She recommends doing bile acid test on young dogs (under 4 years old) because the older they get, the greater the chance that liver dysfunction could be caused by any number of reasons, not just PSVA/MVD. But that's the only age limit I have ever heard her speak of.

Mary
[/QUOTE]

Thanks Mary. I couldn't find the "12 month limit" in her handout so thought I'd post the question. I hope the Protein C test is available here if I need it.

Cathy A


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## tamizami (May 1, 2007)

> > index.php?act=findpost&pid=449000
> 
> 
> 
> ...



Hi Cathy - 
Mary is right. I just wanted to emphasize that as the dog ages, you cannot assume that a good Protein C test means the dog has MVD. They could have acquired some other type of liver disease that affects their bile acids. Sorry if I caused any confusion. I updated my original post to be more clear.


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## Cathy (Mar 19, 2006)

Hi Cathy - 
Mary is right. I just wanted to emphasize that as the dog ages, you cannot assume that a good Protein C test means the dog has MVD. They could have acquired some other type of liver disease that affects their bile acids. Sorry if I caused any confusion. I updated my original post to be more clear.
[/QUOTE]

Thanks for updating the initial post. My girl is only 16 months so still a young dog. After all the discussion about MVD and liver shunt I'm very curious to find out her test results.

Cathy


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## jmm (Nov 23, 2004)

> Hi Cathy -
> Mary is right. I just wanted to emphasize that as the dog ages, you cannot assume that a good Protein C test means the dog has MVD. They could have acquired some other type of liver disease that affects their bile acids. Sorry if I caused any confusion. I updated my original post to be more clear.[/B]



I have never heard that Protein C is more accurate on young dogs. My internist (who did her residency under Dr. Center at Cornell) did Protein C on a 4 yr old dog of mine 3 years ago...

Pg 8
"We have shown that low Protein C activity occurs in many dogs with PVSA (>90%) as well as in dogs with severe forms of acquired (not genetic) liver disease, but less commonly in dogs with MVD."

So protein C is ruling out a shunt in dogs with elevated bile acids. Low protein C activity indicates a shunt or other liver disease as mentioned above. I didn't find anything about age-based accuracy...anybody else?


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## jmm (Nov 23, 2004)

This all sounds so scarey...but a large portion of the population of the breed will have MVD. Clinically normal dogs with elevated bile acids (and if you're worried Protein C) are still awesome pets. When you purchase or adopt a Maltese, you should be aware that this is a problem in the breed, and be educated by it. But just like Rotties with bone cancer or Westies with Addisons, you understand it is part of owning the breed you love. 

These are some important notes from Dr. Center on MVD

Pg 17
"VERY FEW DOGS ARE SYMPTOMATIC, these may have been shunt dogs where the PVSA was missed..."

Pg 21
"Dogs in Group 2 *are extremely rare and most likely represent misdiagnosed PSVA*..."
Group 2 are the symptomatic MVD dogs - they are rare! 

If you run from every puppy with elevated bile acids, you aren't likely going to come across too many that fit your wants and needs. And yes, I am speaking for myself when I say that. I'd rather have a dog that meshes well with my family and what I want to do with it than settle on one simply for a test value that likely won't influence my dog later in life. And sure, I can be paranoid and run a protein C if I want. No harm done other than to my check book ;-)


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## tamizami (May 1, 2007)

> This all sounds so scarey...but a large portion of the population of the breed will have MVD. Clinically normal dogs with elevated bile acids (and if you're worried Protein C) are still awesome pets. When you purchase or adopt a Maltese, you should be aware that this is a problem in the breed, and be educated by it. But just like Rotties with bone cancer or Westies with Addisons, you understand it is part of owning the breed you love.
> 
> These are some important notes from Dr. Center on MVD
> 
> ...


I totally agree! But I found that this information has caused a very dramatic change in my philosophy with regards to their food. I was a raw meaty bones proponent before, but now knowing that my guys have somewhat compromised livers, I have changed their diets to a home cooked one that includes vegetables as well as grains such as oats and barley. Molley's mom turned me on to the Whole Pet Diet from Andi Brown and my dogs love it.

And we had some great news today - Stewie's Protein C test came back normal. So I have two asymptomatic MVD dogs - yea! I am now convinced that Shiva's original problems were a physical injury as a result of her bad knees. We're going to give her 3 months on the new diet & restricted stairs before going back for patella surgery.


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## MaryH (Mar 7, 2006)

> If you run from every puppy with elevated bile acids, you aren't likely going to come across too many that fit your wants and needs. And yes, I am speaking for myself when I say that. I'd rather have a dog that meshes well with my family and what I want to do with it than settle on one simply for a test value that likely won't influence my dog later in life. And sure, I can be paranoid and run a protein C if I want. No harm done other than to my check book ;-)[/B]


Well said and so true!!

MVD is a fact of life in our breed. No breed is perfect! There are more than 150 AKC-recognized breeds. No vet should be expected to know every anomaly associated with every breed. What shouldn't happen, however, is the following: your dog gets a stomach upset or is going to get neutered or needs his teeth cleaned, etc., you bring him to the vet, vet draws blood and sees that the liver enzymes are elevated, vet suggests and you agree to a bile acid test, the results are >25, vet suggests and you agree to go to a specialist for an ultrasound, nothing of note is seen the but bile acid numbers speak for themselves, specialist suggests a liver biopsy and/or a colorectal scintigraphy. This is when PANIC sets in. You've already spent a few hundred dollars and could be looking at spending several hundred more. You start to think your dog is dying. You try to decide whether to do the tests or pay the mortgage. And what makes that decision even more difficult is that your dog is acting NORMAL. The reason why Dr. Center recommends testing puppies before they are sold is to protect us and our dogs from being subjected to invasive, expensive and in most cases unnecessary tests and the panic attacks that go with it. Although these discussions about liver issues seem really scary, the good news is that with rare exception our dogs are living very long lives and our breed is not heading toward extinction.

Mary


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## Cathy (Mar 19, 2006)

My vet called with Smudge's bile acid results today. Pre meal was normal at 4 and Post was abnormal at 80. I'm very grateful that I had the opportunity to attend Dr. Center's seminar and that we had a recent lengthy and informative discussion on this site. I feel that I'm reasonably well armed with information and know that there is no need to go into panic mode. My vet is checking to see if the Protein C test is available in Canada.

Cathy A


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## RE823 (Feb 11, 2012)

MaryH said:


> Well said and so true!!
> 
> MVD is a fact of life in our breed. No breed is perfect! There are more than 150 AKC-recognized breeds. No vet should be expected to know every anomaly associated with every breed. What shouldn't happen, however, is the following: your dog gets a stomach upset or is going to get neutered or needs his teeth cleaned, etc., you bring him to the vet, vet draws blood and sees that the liver enzymes are elevated, vet suggests and you agree to a bile acid test, the results are >25, vet suggests and you agree to go to a specialist for an ultrasound, nothing of note is seen the but bile acid numbers speak for themselves, specialist suggests a liver biopsy and/or a colorectal scintigraphy. This is when PANIC sets in. You've already spent a few hundred dollars and could be looking at spending several hundred more. You start to think your dog is dying. You try to decide whether to do the tests or pay the mortgage. And what makes that decision even more difficult is that your dog is acting NORMAL. The reason why Dr. Center recommends testing puppies before they are sold is to protect us and our dogs from being subjected to invasive, expensive and in most cases unnecessary tests and the panic attacks that go with it. Although these discussions about liver issues seem really scary, the good news is that with rare exception our dogs are living very long lives and our breed is not heading toward extinction.
> 
> Mary



this is EXACTLY what I am going through right now... LFTs slight high, BA slightly high around 30s, ultra sound was normal, so waiting for the next step as I am keeping calm. When I look at him, I wonder how is all this possible, he is totally fine........

I'm assuming Vets calling tomorrow to suggest a liver bx??? oh geezee....


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## pammy4501 (Aug 8, 2007)

RE823 said:


> this is EXACTLY what I am going through right now... LFTs slight high, BA slightly high around 30s, ultra sound was normal, so waiting for the next step as I am keeping calm. When I look at him, I wonder how is all this possible, he is totally fine........
> 
> I'm assuming Vets calling tomorrow to suggest a liver bx??? oh geezee....


Well, this is an older thread, but still timely info. I certainly would not jump from slightly high BAT to liver biopsy. Please suggest a Protein C to you vet. You may just be dealing with MVD, which is controllable by diet and meds. If your vet isn't terrible familiar with toy breeds you may want to seek a second opinion.


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## CloudClan (Jan 31, 2007)

RE823 said:


> this is EXACTLY what I am going through right now... LFTs slight high, BA slightly high around 30s, ultra sound was normal, so waiting for the next step as I am keeping calm. When I look at him, I wonder how is all this possible, he is totally fine........
> 
> I'm assuming Vets calling tomorrow to suggest a liver bx??? oh geezee....


Are they suggesting invasive tests on a dog who is only slightly high? Eek, seriously, >25 is not "normal" but it is normal for our breed. 70-80% having abnormal numbers. And yes he is probably "totally fine." MVD is usually asymptomatic and the vast majority of dogs with it live a long and normal life expectancy. Other than test numbers why are your vets recommending more testing? I would not even do a Protein C on a dog that was in the 30s for BAT and not showing any other symptoms. I certainly would not do ultrasound as they seem rather unreliable.


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## SammieMom (Nov 13, 2010)

CloudClan said:


> Are they suggesting invasive tests on a dog who is only slightly high? Eek, seriously, >25 is not "normal" but it is normal for our breed. 70-80% having abnormal numbers. And yes he is probably "totally fine." MVD is usually asymptomatic and the vast majority of dogs with it live a long and normal life expectancy. Other than test numbers why are your vets recommending more testing? I would not even do a Protein C on a dog that was in the 30s for BAT and not showing any other symptoms. I certainly would not do ultrasound as they seem rather unreliable.


I totally agree here. :thumbsup: I wouldn't do PC or any more tests with well dog in that range either. I went through same thing after the BAT testing before I brought my 3rd puppy home. BAT was in normal range for Malts's at #24. So I was very happy she was in range (as my first MALTESE passed away from puppy shunt of some form and his BAT was 200+, then we tested his brother and he was a #53/MVD. I must add they both were from a BYB before I knew better). 

Well, this Vet wanted more tests (for the new puppy with a #24) and said "something is wrong, because normal would not be higher than about 11". Well, once I gave them all the info from dr center she was very grateful. :thumbsup: wrote a nice note. This is thing I try to tell folks getting a BAT to tell talk to the Vet prior about MALTESE ranges. I see so many go through the initial scare with elevated nums because most vets are unaware and trying to follow guidelines. Up to us to learn about our breed best we can. She is 3 yrs old now and no issues.


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## aprilb (Jul 9, 2010)

I absolutely agree with Kandis and Carina...a Protein C test does not diagnose a liver shunt...my Eva had an ALT of 335, BAT was 44/85, and Protein C was 47..the BAT is consistent with MVD...but the internist wanted to do surgery because of the low Protein C...I refused(she did have a doppler ultrasound which showed blood flowing through her portal vein)...at the time, Eva had a case of thrombocytopenia(low platelets)..the internist said it was probably brought on by a vaccine reaction...this may account for why the Protein C was low...Eva is 2 and 1/2 now and doing very well and her liver enzymes are normal....she is on a restricted protein diet and does take Denamarin..


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## Chardy (Oct 30, 2008)

I am trying to educate myself on LS and MVD. 

1. What does it mean if the pre BAT is over 25 (25-50 range) and the post is normal? 

2. Is there a test that can tell how much ammonia there is?

3. Can you still have a shunt if the protein C is normal? I am confused on the protein C thing... as stated above it can be low due to other reasons and not a shunt, but I was wondering what if the opposite?

Thanks...


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## N2Mischief (Aug 18, 2013)

I agree with Candace, Carina, and April. The reason I am on a Maltese forum, and own a toy poodle, is because through my research I learned that Maltese had such a high incidence of MVD. It was hard to find info on the poodle forum. 

I found vets to be quite the alarmists when a BAT comes out even slightly high. When the vet called me with Misha's BAT results she made it sound as if Misha had very little chance for survival. She wanted to immediately do an ultrasound and liver biopsy. Misha's BAT was 19 pre and 29 post. 

Thanks to information here, I refused the ultrasound, and took Misha to Dr. Dodds. She advised against biopsy, had me start off with a liver diet, then graduate to a lower protein food and we are good! It's been over a year, Misha has no symptoms, and all is well.


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## sherry (Jan 4, 2013)

Chardy said:


> I am trying to educate myself on LS and MVD.
> 
> 1. What does it mean if the pre BAT is over 25 (25-50 range) and the post is normal?
> 
> ...


The only one of these questions I can answer is Protein C. If it comes back in the normal range there is a 10% chance of a shunt. Cornell said that 90 percent of dogs with a shunt test between 40 and 70, which is low. Riley's was 94 so in the normal range, so small chance of a shunt. His BAT was off the charts, pre was 71 and post was 263. The surgeon concurred it to be 90 percent probable MVD.


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## jmm (Nov 23, 2004)

The pre can be higher than the post depending on when the gallbladder contracts. High is high, pre or post. 
You can test for ammonia but it needs to be done at a hospital who can do it in house immediately. For accuracy the sample has to be very carefully handled. Testing for ammonia is not really helpful most of the time. High ammonia is treated based on the dog having symptoms of hepatic encephalopathy. 
Yes you can still have a shunt with a normal protein C, but only about 10% of shunts have normal protein C.


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## SammieMom (Nov 13, 2010)

jmm said:


> The pre can be higher than the post depending on when the gallbladder contracts. High is high, pre or post.
> You can test for ammonia but it needs to be done at a hospital who can do it in house immediately. For accuracy the sample has to be very carefully handled. Testing for ammonia is not really helpful most of the time. High ammonia is treated based on the dog having symptoms of hepatic encephalopathy.
> Yes you can still have a shunt with a normal protein C, but only about 10% of shunts have normal protein C.


:ThankYou: for answering these ?'s. 
A couple people I know had a higher pre and now I rem it was to do with gall bladder. Like you say high is high. I lost Kirby after a surgery without knowing he had one. So if my dog was showing signs of a shunt and I got a high BAT and norm PC, I'd most likely confirm further that it wasn't one of the 10% shunts for future anesthesia. They can be tricky.


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## Chardy (Oct 30, 2008)

SammieMom said:


> :ThankYou: for answering these ?'s.
> A couple people I know had a higher pre and now I rem it was to do with gall bladder. Like you say high is high. I lost Kirby after a surgery without knowing he had one. So if my dog was showing signs of a shunt and I got a high BAT and norm PC, I'd most likely confirm further that it wasn't one of the 10% shunts for future anesthesia. They can be tricky.


Thank you both for clarifying more clearly my questions. I have learned valuable information regarding LS/MVD from this forum. I constantly have my eye open for the slightest change in behavior, eating habits, and energy levels and like to have a blood panel drawn twice a year. When all is *asymptomatic*, we should sit back and enjoy our dogs. 

We had a graduation party one year and there was a 10% chance of rain, it rained, not for long but it rained.


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