# Regarding Louis and his Liver



## BrookeB676 (Oct 17, 2004)

I wanted to ask those who have a liver compromised maltese. Louis has thrown up bile about 3 times this month. I have only seen him do it once, but I assume it has happened 2 other times because you can tell by the way their little mouths smell. Normally when mine throw up bile, they played too hard, drank too fast, or they only have 1 rare episode. But it is starting to worry me that this might be a sign of something. I'm not sure if it's completely unrelated to his liver and just a coincidence, or it's a sign that I should possibly start him on a low protein diet with the liver supplements that have been recommended (Marin, etc.). Just to re-cap on his situation, it is presumed that he has asymptomatic MVD, he had slightly elevated bile acids, but the Pro C was normal and he shows no signs of being "sick" other than what I have described above. He will be 1 years old in just 2.5 weeks. What do you guys think? He eats and drinks and plays after he throws up, so he acts fine and it's only a tiny amount, but I wanted to get opinions on whether or not you guys things these occurences of bile could have anything to do with the liver. If so, what can we do to get this under control. Obviously normal vets aren't familiar with MVD and it seems to be treated with diet and supplements. Is this all we can do for now?


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## CeeCee's Mom (Sep 14, 2006)

Brooke, I don't know anything about liver disease in Malts but I just wanted to say that I know you will take care of that sweet baby...I just love him to pieces!!!!! Good Luck!!!!


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## Cosy (Feb 9, 2006)

Brooke, often this is due to an empty stomach. I know Toy is prone to doing 
this if she doesn't eat a little before bedtime. Have you noticed any pattern?


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## Nikki's Mom (Feb 13, 2008)

Are you able to locate a veterinary nutritionist or holistic vet in your area? Nikki's vet is one and she's very knowledgeable about diets for all sorts of health conditions that other vets don't see very much.


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## Cathy (Mar 19, 2006)

> I wanted to ask those who have a liver compromised maltese. Louis has thrown up bile about 3 times this month. I have only seen him do it once, but I assume it has happened 2 other times because you can tell by the way their little mouths smell. Normally when mine throw up bile, they played too hard, drank too fast, or they only have 1 rare episode. But it is starting to worry me that this might be a sign of something. I'm not sure if it's completely unrelated to his liver and just a coincidence, or it's a sign that I should possibly start him on a low protein diet with the liver supplements that have been recommended (Marin, etc.). Just to re-cap on his situation, it is presumed that he has asymptomatic MVD, he had slightly elevated bile acids, but the Pro C was normal and he shows no signs of being "sick" other than what I have described above. He will be 1 years old in just 2.5 weeks. What do you guys think? He eats and drinks and plays after he throws up, so he acts fine and it's only a tiny amount, but I wanted to get opinions on whether or not you guys things these occurences of bile could have anything to do with the liver. If so, what can we do to get this under control. Obviously normal vets aren't familiar with MVD and it seems to be treated with diet and supplements. Is this all we can do for now?[/B]



Brooke,

My presumed MVD girl does this too and I've been told that it is nothing to worry about. It happens when she has both an empty stomach and a full one and she plays afterwards as if nothing has happened. She's done this since she was a puppy and she's now two. At first I was worried but now I just clean up the mess and carry on.

Cathy


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## Krystal (Feb 3, 2007)

I have absolutely no clue about liver disease, but I sure hope poor Louis feels better soon. I hate when these little ones get sick, they are so helpless and look so uncomfortable. :grouphug:


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## luvmyfurbaby (Feb 11, 2007)

> I wanted to ask those who have a liver compromised maltese. Louis has thrown up bile about 3 times this month. I have only seen him do it once, but I assume it has happened 2 other times because you can tell by the way their little mouths smell. Normally when mine throw up bile, they played too hard, drank too fast, or they only have 1 rare episode. But it is starting to worry me that this might be a sign of something. I'm not sure if it's completely unrelated to his liver and just a coincidence, or it's a sign that I should possibly start him on a low protein diet with the liver supplements that have been recommended (Marin, etc.). Just to re-cap on his situation, it is presumed that he has asymptomatic MVD, he had slightly elevated bile acids, but the Pro C was normal and he shows no signs of being "sick" other than what I have described above. He will be 1 years old in just 2.5 weeks. What do you guys think? He eats and drinks and plays after he throws up, so he acts fine and it's only a tiny amount, but I wanted to get opinions on whether or not you guys things these occurences of bile could have anything to do with the liver. If so, what can we do to get this under control. Obviously normal vets aren't familiar with MVD and it seems to be treated with diet and supplements. Is this all we can do for now?[/B]



Brooke P is on the liver supports and I know if I give him something I'm not suppose to ie: too much protien he throws it right up. I don't know if it's his system that knows he isn't suppose to have it or what but it's like clock work. The last time he found a piece of those dehydrate chicken breast and I felt bad for him and let him have it it was like 1/8 of a piece. 15 minutes later he tossed his cookies. Same thing with red meat. Think back at what he ate at the time it may be to rich/heavy for him.


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## phesty (May 30, 2006)

I don't know anything about liver issues, but Josie pukes bile fairly regularly when her stomach is empty. It's gotten better since I started leaving food in her kennel overnight, but once in a while, she still pukes.

Josie says: Mommy calls me the Yackmaster!


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## BrookeB676 (Oct 17, 2004)

Thank you guys for the responses! The little guy sleeps right on my neck/chest and threw up on my shirt this morning before we woke up, so I guess he had an empty stomach. He doesn't ever do it at night, which I guess would make sense under the empty stomach theory. He loves to eat, but I think he really will only sit at the food bowl if I'm home or if the other dogs are eating. I may try to make sure he has a meal first thing in the morning just to make sure he has something in his stomach. He does a lot of his eating at night (all of mine do and we free feed since that works best for us and ours are at a perfect weight), but I am definitely going to see if making sure he eats something in the morning helps. Thanks again, the responses were really helpful.


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## jmm (Nov 23, 2004)

I would hazard a guess that is is not a symptom of liver disease. If you want to be sure, just have his chemistry panel and a urine sample checked. Its a good idea to do once or twice a year anyways. 

Empty stomach, eating things they should not, and parasites are all common causes of tummy upset. I'd look at the simple before worrying about anything major if he's otherwise healthy, holding his weight, not vomiting food, no diarrhea, etc.


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## susie and sadie (Jun 22, 2005)

Susie and Sadie both have suspected asymptomatic MVD (high bile acids, but no other symptoms), but they've never had a problem with vomiting. Hopefully this isn't related to Louis' liver. I know how worrisome these things can be; I hope he feels better soon. :grouphug:


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## NewMom328 (Apr 15, 2005)

Jett is like clockwork- he WILL vomit bile if he does not eat within like a 1 hour window of his normal eating time and if he does not have a significant treat before bedtime. Kylee isn't as fragile but she also is bigger (dont know if that has anything to do with it). I was worried but took him to the vet and he said just to make sure he eats regularly!


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## tamizami (May 1, 2007)

Hey Brooke, Just saw this post and Stewie does this whenever he has an empty stomach. So we feed 2 or 3 meals a day, last one right before bed. The vet also gave us some Peptid, but I've never given it to him since the food works, lol. Hope that helps!


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## Maidto2Maltese (Oct 19, 2004)

Way back my Puffy would do this 9 always in AM( and I was advised to give a little snack ay bedtime and that took care of it and I've done that for all my pooches since.


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## bonniesmom (Jun 2, 2008)

> I wanted to ask those who have a liver compromised maltese. Louis has thrown up bile about 3 times this month. I have only seen him do it once, but I assume it has happened 2 other times because you can tell by the way their little mouths smell. Normally when mine throw up bile, they played too hard, drank too fast, or they only have 1 rare episode. But it is starting to worry me that this might be a sign of something. I'm not sure if it's completely unrelated to his liver and just a coincidence, or it's a sign that I should possibly start him on a low protein diet with the liver supplements that have been recommended (Marin, etc.). Just to re-cap on his situation, it is presumed that he has asymptomatic MVD, he had slightly elevated bile acids, but the Pro C was normal and he shows no signs of being "sick" other than what I have described above. He will be 1 years old in just 2.5 weeks. What do you guys think? He eats and drinks and plays after he throws up, so he acts fine and it's only a tiny amount, but I wanted to get opinions on whether or not you guys things these occurences of bile could have anything to do with the liver. If so, what can we do to get this under control. Obviously normal vets aren't familiar with MVD and it seems to be treated with diet and supplements. Is this all we can do for now?[/B]


Hi Brooke,
Louis is precious! I don't know that the spitting up bile is necessarily related to the liver issue, but if he has been diagnosed
with MVD, I see no reason not to be proactive and start supporting the liver right away. In hindsight, I wish I had done so -
or that my vet had done so. My Eloise was diagnosed with MVD when she was four, and since she seemed so absolutely
healthy, we just watched and waited and tested (bile acids and ultrasound) every six or eight months. Finally, when she
was six, we did a liver biopsy and she was diagnosed with chronic active hepatitis. She developed a very rare complication
which caused her to be severely anemic and by the time they figured out what was causing the anemia, it was too late.
Whether earlier intervention might have changed the outcome, I can't be sure, but it certainly wouldn't have hurt. The
liver is a very complicated organ and I wouldn't wait to start treating it. I was giving Eloise Denosyl, Actigall, Marin and
Vit. E her last few months, but by then her disease had already progressed too far and destroyed her portal vein and
nobody saw it coming, including Dr. Broussard, the GI guru at Animal Medical Center here in NY. That's why I urge you
to start treatment now, at least with Denosyl. The low-protein diet might be a good idea - it wasn't particularly recommended
for Eloise because they felt that her problem was not diet-related. By the way, I assume you've had an ultrasound and
ruled out a liver shunt? If not, you probably should - at his young age a shunt can be successfully repaired.

Don't mean to scare you - Eloise probably could have lived to a ripe old age with her hepatitis if her portal vein hadn't
gotten involved. But don't be lulled into a false sense of security just because Louis has no symptoms - better safe than
sorry. Best of luck and I hope he'll be just fine.


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## BrookeB676 (Oct 17, 2004)

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Thank you for this information. We don't have Louis on any lier supplement currently but I plan to start them very shortly. The Dr. doesn't believe he has a shunt and we had a Pro C test done to try and rule out liver shunt, which came back normal. What were the results of Eloise's bile acid tests?


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## jmm (Nov 23, 2004)

This is why testing puppies is important. That way we know what their "normal" is and can identify changes later in life. If you only test at age 4, we don't know what was the "normal" MVD numbers and if something was changing to indicate another problem. 

Ultrasound is not a great diagnostic for liver shunt. My radiologist headed the radiology department at UT (where Dr. Tobias does all of her shunt surgeries). He even says his accuracy to find a shunt is approximately 80%. A protein C test is a blood test to help differentiate between shunts and mvd. If further testing is indicated, scintigraphy or MRI are more accurate than ultrasound. Ultrasound can be a great diagnostic for liver disease, but not necessarily for perfusion problems. Ultrasound is also only as good as the person doing it. When in doubt, a boarded radiologist or internist is ideal. 

Low protein diets are indicated for dogs with protein intolerance (hepatic encephalopathy). Feeding low protein diets should be done with the guidance of a veterinarian. 







> Hi Brooke,
> Louis is precious! I don't know that the spitting up bile is necessarily related to the liver issue, but if he has been diagnosed
> with MVD, I see no reason not to be proactive and start supporting the liver right away. In hindsight, I wish I had done so -
> or that my vet had done so. My Eloise was diagnosed with MVD when she was four, and since she seemed so absolutely
> ...


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## jlhajmom (Feb 23, 2008)

Back in February my little girl was having problems - it was either MVD or a liver shunt. I took her to the Univeristy of Pennsylvania. They used to offer nuclear scintigraphy but do not anymore so she had a CT Angiogram (MRI was not an option there either). The shunt showed up very clearly and she was operated on that day. She is now normal - bloodword within normal levels and she is not on any medication or special diet. Ava will be 2 this August so I am grateful I was able to find a board-certified surgeon who could properly diagnose her problem and fix it. I would encourage you to be proactive in getting to the bottom of the liver issue. The earlier you start treatment the better. By the way, Ava was always a finnicky eater before, and when she was 1 year old she only weighed 4 pounds, 6 ounces. Now, my little piggly wiggly weighs 7 pounds 3 ounces....but has been as high as 9 ounces. She just loves to eat now. She has been started on regular exercise and she is trimming down nicely. I've been told 7 pounds 3 ounces is fine for her, but not to get heavier than that.


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## Furbaby's Mommie (Jul 10, 2004)

All I can think when I read these posts is---OMG!! Obviously so little is known about WHAT TO DO when you have an "MVD" dog. Shoni is one, and I could just scream at all the diverse "opinions" about the diet and supplements.

Shoni also has the "finicky eater" syndrome and goes often 24-36 hrs. with hardly more then a bit or two. He also vomits bile occasionally. He has mucusy stools often with no reason discovered as yet.

There are the posters out there with a multiple dog household who don't understand how hard it is to get a finicky eater to eat. When you have multiple dogs vying for the food that eliminates one problem. If your "spoiled finicky eater" (say Shoni) is alone with no competition for food and has no appetite because of an upset digestive system--i.e. liver disease, IBS or IBD, or all 3--you don't get very far throwing some 'whatever' dogfood on the plate for 15 minutes and jerking it up if it isn't eaten. I'd be cleaning up bile and have a very thin sickly little dog.

Then add to the problem that we don't KNOW what these MVD dogs really need, and that because of their reduced desire for food it takes just the right thing to tempt their appetite every day---and that's where a lot of us are. We are trying everything that sounds right to us, and in my case that could be at least 3 different brands of canned food and 2 or 3 dry ones on any day or week, and adding rice, sweet potatoes, chicken breast, greenbeans, fruit,...etc......to any and all of the above trying to find enough things the little guy will eat to stay in a normal range.

The montra of "an asymtomatic MVD dog does not need a special diet" and leave it there, is not working for many of these dogs. I would give a lot to have a dog who all it requires to be fed and be healthy is a plate of whatever food "I" think is good for him a couple times a day--and no further thought needed! Anyone who thinks I love driving myself nuts over thinking of something Shoni will eat every day--is nuts. It is not a fun thing to work this hard at feeding him. I will do it gladly for the next 16+ years if I can help him stay healthy however! but it is such a stab in the dark the way we have to do it! 

That's my vent for the month I guess. I just wish we could actually help each other with this MVD thing and could actually help these little guys instead of waiting for seizures to tell us they are in trouble.


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## jmm (Nov 23, 2004)

Dee,

Perhaps you and your vet should talk to Dr. Center...who first published on MVD. It is known what to do with an asymptomatic MVD dog - TREAT THEM NORMALLY. And for dogs who are ill (not the norm), they need to be worked up and treated. 

Dogs with protein intolerance need protein restriction. Unless your dog has a concurrent liver problem that worsens, you are not waiting for seizures. 

If your dog has GI problems that are chronic, then discuss with your vet further diagnostics and medication trials. I had a dog with MVD, eosinophilic IBD, and eosinophilic hepatic venule inflammation. This combination can be seen in Maltese and Dr. Center has an excellent treatment protocol. Instead of hypothesizing that MVD is making your dog sick (since that is not the norm), how about seeking an answer for your dog's problem. I've had a dog who would not eat...and was sick and skinny. So I saw an internist and got him properly treated. I did not assume MVD and cut his protein. And considering his problem was an inflammatory disease, cutting protein would have done a whole lot of nothing (other than possibly further restricting what nutrition he desperately needed). 

The alarmist MVD is making my dog sick doesn't cut it for me. I've had the sick dog and I've got the normal MVD dogs. I've driven to Cornell and seen Dr. Center. I've had my local vets work with her over the phone. There is plenty of information on treatment if it is warranted, but you need to seek that through a veterinarian, not on the internet. 

Jackie





> All I can think when I read these posts is---OMG!! Obviously so little is known about WHAT TO DO when you have an "MVD" dog. Shoni is one, and I could just scream at all the diverse "opinions" about the diet and supplements.
> 
> Shoni also has the "finicky eater" syndrome and goes often 24-36 hrs. with hardly more then a bit or two. He also vomits bile occasionally. He has mucusy stools often with no reason discovered as yet.
> 
> ...


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## Nikki's Mom (Feb 13, 2008)

Jackie (JMM) is correct about making the assumption that the symptoms are always from MVD. She is also correct about sifting all the info found on the internet, because there is conflicting info and you can drive yourself crazy. 

I hope I am not hijacking this post, but I'll put my experience here since Nikki was just diagnosed with MVD and I have spent the last few days/weeks doing research on MVD. Nikki isn't a picky eater and she has no symptoms.

There is a yahoo MVD/Liver Shunt online forum and they are very insistant that _all_ MVD dogs, symptomatic or not, should be on a low protein diet, Lactulose, and antibiotics. Their reasoning is that we know that the dog's liver is already compromised, so why tax it further by animal protein? (FYI, there are a few studies around that say Lactulose is completely ineffective.) However, IMO, restricting protein and giving antibiotics shouldn't be a blanket suggestion for every MVD dog, especially young dogs, because malnourishment can occur if protein is restricted, and cause other big problems. That is a decision that should be made by you and the veterinarian, not people on a forum, no matter how informed, intelligent and caring they are. Too much antibiotic use can cause yeast overgrowth and antibiotic resistance. Some say that if your MVD dog is over 6, put them on a senior food which is lower in protein and fat. (That is what my traditional medicine vet told me as well.)

I feed Nikki 2X or 3X a day, depending on whether I am going to be home at midday. She eats regular adult canned dog food. I give her a scant teaspoon of low sodium cottage cheese at bedtime. Her doggie cookie treats are vegetarian, made from fruits/grains/veggies. And she gets fresh apples and other fruit/veggies every day. 

I use three supplements, nothing weird or extreme:
1.Milk Thistle: used 1 week per month. I use a brand called "Gaia" which is found at Whole Foods and other health food stores. It is highly rated on ConsumerLab.com. It is a capsule filled with liquid. I use one per day in Nikki's food. 
2. Digestive Enzymes: Great for stomach/digestion. They have them especially for dogs, and the human brand is good as well. I use human "Enzymedica" Brand, "Digest." They are a good general thing to use for people and humans to help add enzymes into food that are lost with cooking. Perfectly safe. 
3. Plain unflavored (organic if possible) yogurt is good for the digestion as well, even in healthy dogs. If you don't want to buy yogurt, you can use dog probiotics. Good for healthy dogs and people as well. 

Since there is so much conflicting info out there, it can be very confusing. Some say stay away from foods that are high in purines because they creat ammonia in the body and the liver has a hard time processing it, even in an asymptomatic MVD dog. High purine foods are most meats. Dogs with HE are put on prescription food. Although they are nutritionally balanced, I personally do not care for the ingredients in the prescription dog foods like Hills L/D and Royal Canin Hepatic. The food is mostly rice, corn and soy, and I understand why it is in there, but I think that if we are going to restrict protein, we can do better than that. Some people feed their symptomatic dogs vegetarian food like Natural Balance. Some people feed their dogs cottage cheese/tofu/brown rice, plus a vitamin/mineral supplement. Others use Dr. Dodd's updated Liver Cleanse diet (pasted below) Some people use pieces of tofu pups (soy hot dogs) as treats. But most of this is for symptomatic dogs.

I'm exhausted from doing research, honestly. I am taking Jackie's and Dr. Center's advice since they know a lot more than me. I am not putting a 7 month old puppy on a low protein diet. She is eating regular food for the next 2 months.

In 2 months I am consulting with my holistic veterinarian for home cooked recipes for Nikki. The vet will probably consult with Dr. Center. I was going to get homemade recipes anyway, before I found out about the MVD. The vet charges $ for the recipes, but I figure that it will save me a lot of time in research. 

If the vet gives me any additional info or tips, I will gladly share it with you. I wish you all the best with your precious furbabies. 


Here is Dr. Dodd's UPDATED Liver Diet if you choose to use it. It doesn't say, but the fish is to be poached and the veggies boiled:*
*<div align="center">*
*
<div align="center">*DR. DODD'S HOMEMADE DIET*


*Updated** homemade diet that has been submitted by a nutritionist from the **University** of **Tennessee** at **Knoxville**. The nutritionist spoke with Dr. Dodd about the changes recommended to make the diet more balanced and complete. *



*LIVER FRIENDLY DIET (canine) *



*1 pound cod filets *

*1/2 pound sweet potatoes *

*1/2 pound white potatoes *

*1/2 pound green beans *

*1/2 pound carrots *

*1 Tablespoon canola oil *

*3 tablets (750 mg) Calcium carbonate *

*1 Capsule Vitamin E (100 IU) *

*1000 mg Omega 3 fatty acids *

*1/2 Vitamin B complex human vitamin tablet *



*Mix all ingredients together until it is well blended. This will give you approximately 8 cups of food. Depending on the size of your dog, you can double or triple the recipe.*

*With liver disease try and feed in 3 or 4 small meals, the last one being at bedtime. This puts less stress on the liver. Put one-meal portions in baggies and freeze what you won't use in 3 days. You should be able to cook once a week and freeze what you don't use. This recipe will stay fresh for 3 days in the fridge.*

*Cod fillets or white low-fat fish has a specific amino acid that actually helps heal the liver. Soy and fat-free cottage cheese also have this specific amino acid, but should not be used in a diet until the pre- and post-meal bile acid test comes back in a normal range.*

*Calcium carbonate is 40% elemental calcium. If another calcium compound is selected, the percentages vary and the dose should be recalculated for accuracy. Please use canola oil as other oils do not contain similar amounts of linoleic* acid. Please note that this is still a low fat diet. The vitamin E, fish oils, B complex vitamins, and L-carnitine* are suggestions that we make for patients with liver disease, as these animals have altered absorption of these nutrients. This recipe can be used for long term feeding without reservation. The recipe makes about 1400 grams of food containing 1150 kcalories. *


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## Furbaby's Mommie (Jul 10, 2004)

> I hope I am not hijacking this post, but I'll put my experience here since Nikki was just diagnosed with MVD and I have spent the last few days/weeks doing research on MVD. Nikki isn't a picky eater and she has no symptoms.[/B]


Thank you Susan for posting all that. Dr. Dodds has been very nice and easily communicated with, and I have tried the fish diet at her recommendation. Shoni would not eat the fish! You are so lucky Nikki isn't so hard to feed. She does feel Shoni should be on the liver cleansing diet, contrary to what Dr. Center recommends in her papers.

Back in Dec. when Shoni had his first Bile Acid test come back high, I joined the Yahoo liver group. You are right about their protocol. After Jackie and MaryH provided us with Dr. Center's protocol and I found he had normal Pro C, I abandoned the group. Don't really know if I should have......

*Jackie*--(Again) I have not nor will I be feeding Shoni a low protein diet. My problem with him is getting him to eat, and I thought it was interesting that someone said their dog started eating after shunt surgery. Dr. Dodds thinks Shoni has IBD and I take that seriously. It does not take much in the way of veggies to get mucusy stools going. Dr. Center has not acknowledged any of the many attempts to contact her by myself or my vets. I can not just drive there from Oregon as you can from your location. I do not hypothesize MVD is making him sick, I just hope for continued and improved info on keeping him well. I just am very frustrated that we don't really KNOW how to raise and care for an MVD dog. We are (and Dr. C is) guessing that "MVD" is their problem when they have high bile acids and normal Pro C. Then we are guessing we should feed and care for them as if nothing is compromised.

Added to my frustration is getting my finicky dog to eat--period. Added to that he has an IBD/IBS digestive system.

I could spend another fortune and have an MRI or scintigraphy done for a better diagnosis of the liver, but I have taken your word and Dr. Center's that it isn't necessary and he should be fed normally. I do choose to use a less anmonia (toxin) producing protein rather than red meat. I like that idea even if there is nothing to worry about. There is no internist or nutritionist in my area. That is why I consulted Dr. Dodds.


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## jmm (Nov 23, 2004)

I think the bottom line is if you think your dog is sick, go to the vet and get your dog properly worked up, MVD or not. And trust your instincts. I've had 2 dogs where I thought something was not right...and I was right. But I took them in and pursued a second opinion with a specialist to get them properly cared for. AFTER that, I looked around on the internet. I am not going to make medical decisions for my dog on my own or based solely on internet information. And I discuss anything I want to change with my vet first, to be sure I'm on the right track - this includes major dietary changes and supplements. 

Dee, if you think there is something wrong with Shoni, get a referral to an internist and pursue it. It will do no harm to him to be examined by another vet. And find one you are comfortable with, even if that means getting a 3rd opinion.


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## jmm (Nov 23, 2004)

> . I just am very frustrated that we don't really KNOW how to raise and care for an MVD dog. We are (and Dr. C is) guessing that "MVD" is their problem when they have high bile acids and normal Pro C. Then we are guessing we should feed and care for them as if nothing is compromised.
> 
> Added to my frustration is getting my finicky dog to eat--period. Added to that he has an IBD/IBS digestive system.
> 
> I could spend another fortune and have an MRI or scintigraphy done for a better diagnosis of the liver, but I have taken your word and Dr. Center's that it isn't necessary and he should be fed normally. I do choose to use a less anmonia (toxin) producing protein rather than red meat. I like that idea even if there is nothing to worry about. There is no internist or nutritionist in my area. That is why I consulted Dr. Dodds.[/B]


Dee, Dr. Center's recommendations are based on research, including biopsy samples of many, many, many dogs. Assuming MVD in a puppy based on labwork is different than having an adult dog with unknown other issues. Think of a puppy as a clean slate. When I saw Dr. Center, she told me of dogs she had followed long-term. So I don't think treating asymptomatic dogs normally is an assumption. 

Get him evaluated, diagnostics done, and treatment started for his tummy problems.


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## Nikki's Mom (Feb 13, 2008)

Let me add that it really is a must to find a vet you are comfortable with who is willing to discuss nutrition with you and not automatically put your dog on a prescription food without listening to you. 

The internet has changed things in that there is access to information for everyone and many people are more informed when they walk into a doctor's office and can actually discuss things intelligently with their medical professionals. 

I've had to change vets because I felt that I was being brushed off and not listened to. 

I love Nikki's new regular vet, but he admits he is not up on nutrition and supplements. So I have a holistic/nutritionist vet whom I will work with for this. I like her because she knows that I do a lot of research and she isn't impatient with my questions and she is willing to take the time to discuss nutrition in detail. Yes, she charges more but to me it is worth it to have someone who will listen.


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## Nikki's Mom (Feb 13, 2008)

> Back in Dec. when Shoni had his first Bile Acid test come back high, I joined the Yahoo liver group. You are right about their protocol. After Jackie and MaryH provided us with Dr. Center's protocol and I found he had normal Pro C, I abandoned the group. Don't really know if I should have......[/B]



The yahoo group is good and they mean well but there is no one-size-fits-all treatment and IMO they go overboard in their protocol.

Some holistic vets and veterinary nutritionists do phone consultations. Maybe you could go that route. It's difficult because you want to do the best for your furbaby and it's so confusing.


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## bonniesmom (Jun 2, 2008)

> > index.php?act=findpost&pid=587501
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Hi ,
When we first tested Eloise's bile acids at age 4 (after some very high liver enzyme levels), they were
33 (pre) and 100.8 (post). I can't find the ones from when she was 5, but when she was 6, they were
197.6 and 349.5 respectively. Those numbers are off the charts, but she was still asymptomatic
and remained so until the anemia started. But she had more than just MVD - her portal vein was
being destroyed by inflammation and she got portal hypertension, which is what killed her. As I said,
this is an EXTREMELY RARE complication, so there's no reason to think little Louis might be in such
serious trouble. It sounds like you're keeping on top of things and I'm sure he'll be fine!


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## BrookeB676 (Oct 17, 2004)

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> 
> ...


Thank you for this information. We don't have Louis on any lier supplement currently but I plan to start them very shortly. The Dr. doesn't believe he has a shunt and we had a Pro C test done to try and rule out liver shunt, which came back normal. What were the results of Eloise's bile acid tests?
[/B][/QUOTE]

Hi ,
When we first tested Eloise's bile acids at age 4 (after some very high liver enzyme levels), they were
33 (pre) and 100.8 (post). I can't find the ones from when she was 5, but when she was 6, they were
197.6 and 349.5 respectively. Those numbers are off the charts, but she was still asymptomatic
and remained so until the anemia started. But she had more than just MVD - her portal vein was
being destroyed by inflammation and she got portal hypertension, which is what killed her. As I said,
this is an EXTREMELY RARE complication, so there's no reason to think little Louis might be in such
serious trouble. It sounds like you're keeping on top of things and I'm sure he'll be fine!
[/B][/QUOTE]

We had Louis's bile acids tested a few months ago as well as the Pro C, and because he eats normal (however I do have to admit that having other dogs around helps him eat) and is acting fine, I will just be monitoring him and getting blood work etc. every 6-12 months UNTIL he becomes symptomatic.


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## Furbaby's Mommie (Jul 10, 2004)

> Let me add that it really is a must to find a vet you are comfortable with who is willing to discuss nutrition with you and not automatically put your dog on a prescription food without listening to you.
> 
> The internet has changed things in that there is access to information for everyone and many people are more informed when they walk into a doctor's office and can actually discuss things intelligently with their medical professionals.
> 
> ...


-------------------------------------------------------------------------------------------------------------
:sorry: *Brooke! I didn't mean to hyjack your post! Louis is one of my favorites and his health is very important to me---so sorry!!
*-------------------------------------------------------------------------------------------------------------
My vets are very open to the newer info on foods, and even to homeopathic methods I mention, although they do practice regular medicine. They are patient with my interests down that line and have agreed with any info I come up with. Dr. Amsberry, the owner, even knows Dr. Dodds, or at least is familar with her work. He was glad I talked to her about Shoni.

Unfortunately all the 2nd opinions and consultations in the world won't help his tummy if he won't eat what is recommended--so knowing him and all I've tried to feed him I don't know if it is worth more doctors at the moment. He wouldn't eat Dr. Dodds' fish diet. I will try again because nothing stays the same for long with his tastes.

He is on ForteFlora for the tummy and went through a recent antibiotic course. Also gets Pepcid for bad times. He liked a sample of Healthwise Chicken and Oatmeal dry so I got a bag but it isn't going too good. He was on Organix canned along with Natural Balance Duck and Potato dry, but has quit eating it. Lately about all he will eat is rice mixed with chicken breast, a little Natural Balance turkey roll, or egg, or cottagge cheese, a little sweet potato and tiny bit of green beans with the ForteFlora and his Missing Link. He doesn't digest carrots even cooked and in tiny pieces, they come out whole.

:back2topic:


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## Nikki's Mom (Feb 13, 2008)

> -------------------------------------------------------------------------------------------------------------
> :sorry: *Brooke! I didn't mean to hyjack your post! Louis is one of my favorites and his health is very important to me---so sorry!!
> *-------------------------------------------------------------------------------------------------------------
> My vets are very open to the newer info on foods, and even to homeopathic methods I mention, although they do practice regular medicine. They are patient with my interests down that line and have agreed with any info I come up with. Dr. Amsberry, the owner, even knows Dr. Dodds, or at least is familar with her work. He was glad I talked to her about Shoni.
> ...





:back2topic: 

Sorry for veering off. I wish you all the best. I hope you find a solution to the eating problem.

:grouphug:


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## BrookeB676 (Oct 17, 2004)

Oh gosh, it's really no big deal! All of our babies health is equally important and so if you can get important questions answered, feel free! Your questions are surely things that I should know as well since our babies have such similar health history and age.


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## jmm (Nov 23, 2004)

> -----------------------------------------------------------------------------------------------------------
> My vets are very open to the newer info on foods, and even to homeopathic methods I mention, although they do practice regular medicine. They are patient with my interests down that line and have agreed with any info I come up with. Dr. Amsberry, the owner, even knows Dr. Dodds, or at least is familar with her work. He was glad I talked to her about Shoni.
> 
> Unfortunately all the 2nd opinions and consultations in the world won't help his tummy if he won't eat what is recommended--so knowing him and all I've tried to feed him I don't know if it is worth more doctors at the moment. He wouldn't eat Dr. Dodds' fish diet. I will try again because nothing stays the same for long with his tastes.
> ...



Dee, if he has IBD, the goal of treating him would be for him to eat better and not have an upset stomach. While diet is an important part of IBD treatment, medications also play an important part. Pepcid, carafate, metronidazole, tylan, prednisone, mirtazapine, etc. can all be pieces of the puzzle. And a short course is not always good enough. IBD is usually thought to be based on food allergy. You can have a home cooked diet properly formulated for him via a phone consult with a nutritionist. UC Davis has a nutrition service that your vet can do over the phone. 

The only way to truly diagnose IBD would be endoscopic or surgical biopsies. Sometimes the biopsies are helpful in choosing treatment, sometimes they don't make a difference. If it were eosinophilic inflammation, I would recommend using Dr. Center's protocol.


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## MaryH (Mar 7, 2006)

> All I can think when I read these posts is---OMG!! Obviously so little is known about WHAT TO DO when you have an "MVD" dog. Shoni is one, and I could just scream at all the diverse "opinions" about the diet and supplements.
> 
> This is where I rely on the experts in their respective fields. Dr. Sharon Center, on p. 21 of her handout, says the following:
> 
> ...


I will be driving 6-1/2 hours each way at the end of the week for an appointment with Dr. Center. If any of you have questions that you'd like me to pass along to her I would be happy to do so if you PM your questions to me. I cannot guarantee that she will have time to answer them but I'll give it my best shot.

MaryH


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## Malteseluv (Feb 6, 2007)

Loss of appetite is most definitely a sign/symptom of liver problems in dogs and humans. In fact, many times this is one of the first/only symptoms a person observes before finding out that their dog may have liver problems...

http://www.acvs.org/AnimalOwners/HealthCon...imalTopics/HMD/
Dogs with HMD can present with signs similar to dogs with congenital portosystemic shunts; however, many dogs have no clinical signs at all. Often affected dogs are 3 to 4 years old before they have clinical signs. Some affected dogs are smaller than normal, with poor muscle development. They may seem less intelligent or quieter because of the toxins that depress their brains. *They may have a loss of appetite* or occasional bouts of vomiting and diarrhea. Some dogs may have a greater risk of infections or develop bladders stones. Severely affected dogs may be wobbly or act drunk or blind and can even seizure. Rarely, dogs will develop fluid filled bellies from liver failure.
http://uimc.discoveryhospital.com/main.php?id=3307
What are the signs and symptoms of the disease?
Symptoms partly depend on the type and the extent of liver disease. In many cases, there may be no symptoms. Signs and symptoms that are common to a number of different types of liver disease include:

* jaundice, or yellowing of the skin
* darkened urine
* nausea
* * loss of appetite*
* unusual weight loss or weight gain
* vomiting
* diarrhea
* light-colored stools
* abdominal pain in the upper right part of the stomach
* malaise, or a vague feeling of illness
* generalized itching
* varicose veins (enlarged blood vessels)
* fatigue
* hypoglycemia (low blood sugar)
* low grade fever
* muscle aches and pains
* loss of sex drive
* depression 

http://www.merckvetmanual.com/mvm/index.js...tm&word=PSS
Hepatoportal microvascular dysplasia is often seen in animals predisposed to congenital PSS, including mixed-breed cats and small-breed dogs (particularly Yorkshire Terriers and Cairn Terriers). Affected animals may be asymptomatic or show clinical signs, which include *anorexia*, vomiting, diarrhea, hepatic encephalopathy, and dysuria due to ammonia biurate crystals.


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## BrookeB676 (Oct 17, 2004)

QUOTE (Malteseluv @ Jun 13 2008, 10:20 PM) index.php?act=findpost&pid=590854


> Loss of appetite is most definitely a sign/symptom of liver problems in dogs and humans. In fact, many times this is one of the first/only symptoms a person observes before finding out that their dog may have liver problems...
> 
> http://www.acvs.org/AnimalOwners/HealthCon...imalTopics/HMD/
> Dogs with HMD can present with signs similar to dogs with congenital portosystemic shunts; however, many dogs have no clinical signs at all. Often affected dogs are 3 to 4 years old before they have clinical signs. Some affected dogs are smaller than normal, with poor muscle development. They may seem less intelligent or quieter because of the toxins that depress their brains. *They may have a loss of appetite* or occasional bouts of vomiting and diarrhea. Some dogs may have a greater risk of infections or develop bladders stones. Severely affected dogs may be wobbly or act drunk or blind and can even seizure. Rarely, dogs will develop fluid filled bellies from liver failure.
> ...


Louis doesn't have a loss of appetite. In fact, he eats a ton. I have attributed his bile to having an empty stomach because since I have been giving him some canned food in the am and pm, I have not seen throw up anywhere.


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

QUOTE (Malteseluv @ Jun 13 2008, 11:20 PM) index.php?act=findpost&pid=590854


> . . . . .
> 
> http://uimc.discoveryhospital.com/main.php?id=3307
> What are the signs and symptoms of the disease?
> ...


Just wondering, is this list (above) for canines or is it possibly instead for humans?


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## Nikki's Mom (Feb 13, 2008)

QUOTE (K/C Mom @ Jun 14 2008, 11:02 AM) index.php?act=findpost&pid=590987


> QUOTE (Malteseluv @ Jun 13 2008, 11:20 PM) index.php?act=findpost&pid=590854





> . . . . .
> 
> http://uimc.discoveryhospital.com/main.php?id=3307
> What are the signs and symptoms of the disease?
> ...


Just wondering, is this list (above) for canines or is it possibly instead for humans?
[/B][/QUOTE]



That is a list for humans.


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## Malteseluv (Feb 6, 2007)

The first one and the last one are for dogs and the middle one is for humans...I only included the one for humans because I stated that loss of appetite is a symptom in dogs and in humans in my original post.

Hi BrookeB676, the only reason for this post is because I read earlier in the thread that loss of appetite/pickiness is not a symptom of liver problems, but indeed it is according to ACVS. I'm not trying to imply that anyone's dog is picky...I'm just putting the information out there.


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## jmm (Nov 23, 2004)

QUOTE (Malteseluv @ Jun 14 2008, 10:36 AM) index.php?act=findpost&pid=591001


> The first one and the last one are for dogs and the middle one is for humans...I only included the one for humans because I stated that loss of appetite is a symptom in dogs and in humans in my original post.
> 
> Hi BrookeB676, the only reason for this post is because I read earlier in the thread that loss of appetite/pickiness is not a symptom of liver problems, but indeed it is according to ACVS. I'm not trying to imply that anyone's dog is picky...I'm just putting the information out there.[/B]


The earlier point was that a dog with presumed MVD that has GI upset may have a concurrent issue (such as IBD or inflammation elsewhere, possibly including the liver). Since the research on MVD indicates most dogs are not sick from it, a dog who is sick should be thoroughly worked up, not brushed off as having problems from MVD.


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## Malteseluv (Feb 6, 2007)

Thanks for the clarification 

Just as a side note, milk thistle has been found to be beneficial in dogs with IBD, so this may be a good option if the dog has IBD and MVD. Here's a link on the info: http://www.canine-epilepsy-guardian-angels...ilk_thistle.htm

Also, there's a human probiotic that research has been shown to be very helpful in cases of IBD and some research indicates that it may be useful in cases of liver problems. It's called VSL#3. This may also be helpful for the poster with the maltese that has IBD and MVD.


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## Furbaby's Mommie (Jul 10, 2004)

QUOTE (Malteseluv @ Jun 14 2008, 08:36 AM) index.php?act=findpost&pid=591001


> The first one and the last one are for dogs and the middle one is for humans...I only included the one for humans because I stated that loss of appetite is a symptom in dogs and in humans in my original post.
> 
> Hi BrookeB676, the only reason for this post is because I read earlier in the thread that loss of appetite/pickiness is not a symptom of liver problems, but indeed it is according to ACVS. I'm not trying to imply that anyone's dog is picky...I'm just putting the information out there.[/B]


Hi Malteseluv,

Thank you for your input and links. Shoni is the one mentioned that is so hard to feed, and I really appreciate your comments. I know if I have a stomach full of bile I feel nauseous and don't feel like eating. Also the symptoms mentioned in the human article sound very much like the canine don't they. B)


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## BrookeB676 (Oct 17, 2004)

QUOTE (JMM @ May 19 2008, 07:02 PM) index.php?act=findpost&pid=579554


> I would hazard a guess that is is not a symptom of liver disease. If you want to be sure, just have his chemistry panel and a urine sample checked. Its a good idea to do once or twice a year anyways.
> 
> Empty stomach, eating things they should not, and parasites are all common causes of tummy upset. I'd look at the simple before worrying about anything major if he's otherwise healthy, holding his weight, not vomiting food, no diarrhea, etc.[/B]


I have been thinking about this a lot lately because Louis is now one and I am trying to figure out the best plan to maintain his health. My question is, if I do get a chemistry panel and urine sample, what would I be looking for? Also, I would suspect that his bile acids are still high. Would it be accurate to say that even if his bloodwork was the same (which I assume it is), there would be no treatment unless he became symptomatic?

Then the question is, what is symptomatic. As far as I know, he is very playful, has great stools, is skinny, but maintains his weight, and acts just like the others. He occasionally has the bile throw up episodes, but I think I have been able to attribute that to an empty stomach bc it seems to happen when he doesn't eat a tablespoon of wet food before bed. 

Even with all the reading I have done, I still am confused about a maintenance plan. What would be the point of bloodwork if it is consistently leading towards elevated liver levels, when he is still not symptomatic. Maybe I am missing something. I don't suspect Louis has shunt, but now I wonder what treatment would consist of if it wasn't shunt, yet he had elevated liver levels. 

Maybe the appropriate question is what is a typical treatment plan for a maltese with symptomatic MVD. 

The worst part in all of this (and the reason I continue to post on the subject) is that there are very few vets who I could just take Louis to and they would know how to handle this. The information regarding shunt and MVD is so new to them, that there guess seems typically as good as mine. I feel like it is my responsibility to be as knowledgable as possible on this subject and bring to a vet what exactly I am looking for. 

I really appreciate your input on all of this Jackie. You have been a wealth of information.


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## BrookeB676 (Oct 17, 2004)

QUOTE (bonniesmom @ Jun 8 2008, 03:31 PM) index.php?act=findpost&pid=588468


> QUOTE (BrookeB676 @ Jun 6 2008, 11:07 PM) index.php?act=findpost&pid=587518





> QUOTE (bonniesmom @ Jun 6 2008, 09:27 PM) index.php?act=findpost&pid=587501





> QUOTE (BrookeB676 @ May 19 2008, 06:04 PM) index.php?act=findpost&pid=579498





> I wanted to ask those who have a liver compromised maltese. Louis has thrown up bile about 3 times this month. I have only seen him do it once, but I assume it has happened 2 other times because you can tell by the way their little mouths smell. Normally when mine throw up bile, they played too hard, drank too fast, or they only have 1 rare episode. But it is starting to worry me that this might be a sign of something. I'm not sure if it's completely unrelated to his liver and just a coincidence, or it's a sign that I should possibly start him on a low protein diet with the liver supplements that have been recommended (Marin, etc.). Just to re-cap on his situation, it is presumed that he has asymptomatic MVD, he had slightly elevated bile acids, but the Pro C was normal and he shows no signs of being "sick" other than what I have described above. He will be 1 years old in just 2.5 weeks. What do you guys think? He eats and drinks and plays after he throws up, so he acts fine and it's only a tiny amount, but I wanted to get opinions on whether or not you guys things these occurences of bile could have anything to do with the liver. If so, what can we do to get this under control. Obviously normal vets aren't familiar with MVD and it seems to be treated with diet and supplements. Is this all we can do for now?[/B]


Hi Brooke,
Louis is precious! I don't know that the spitting up bile is necessarily related to the liver issue, but if he has been diagnosed
with MVD, I see no reason not to be proactive and start supporting the liver right away. In hindsight, I wish I had done so -
or that my vet had done so. My Eloise was diagnosed with MVD when she was four, and since she seemed so absolutely
healthy, we just watched and waited and tested (bile acids and ultrasound) every six or eight months. Finally, when she
was six, we did a liver biopsy and she was diagnosed with chronic active hepatitis. She developed a very rare complication
which caused her to be severely anemic and by the time they figured out what was causing the anemia, it was too late.
Whether earlier intervention might have changed the outcome, I can't be sure, but it certainly wouldn't have hurt. The
liver is a very complicated organ and I wouldn't wait to start treating it. I was giving Eloise Denosyl, Actigall, Marin and
Vit. E her last few months, but by then her disease had already progressed too far and destroyed her portal vein and
nobody saw it coming, including Dr. Broussard, the GI guru at Animal Medical Center here in NY. That's why I urge you
to start treatment now, at least with Denosyl. The low-protein diet might be a good idea - it wasn't particularly recommended
for Eloise because they felt that her problem was not diet-related. By the way, I assume you've had an ultrasound and
ruled out a liver shunt? If not, you probably should - at his young age a shunt can be successfully repaired.

Don't mean to scare you - Eloise probably could have lived to a ripe old age with her hepatitis if her portal vein hadn't
gotten involved. But don't be lulled into a false sense of security just because Louis has no symptoms - better safe than
sorry. Best of luck and I hope he'll be just fine.
[/B][/QUOTE]

Thank you for this information. We don't have Louis on any lier supplement currently but I plan to start them very shortly. The Dr. doesn't believe he has a shunt and we had a Pro C test done to try and rule out liver shunt, which came back normal. What were the results of Eloise's bile acid tests?
[/B][/QUOTE]

Hi ,
When we first tested Eloise's bile acids at age 4 (after some very high liver enzyme levels), they were
33 (pre) and 100.8 (post). I can't find the ones from when she was 5, but when she was 6, they were
197.6 and 349.5 respectively. Those numbers are off the charts, but she was still asymptomatic
and remained so until the anemia started. But she had more than just MVD - her portal vein was
being destroyed by inflammation and she got portal hypertension, which is what killed her. As I said,
this is an EXTREMELY RARE complication, so there's no reason to think little Louis might be in such
serious trouble. It sounds like you're keeping on top of things and I'm sure he'll be fine!
[/B][/QUOTE]

My question would be, if she was still Asymptomatic, yet her bile acids were continuously increasing by the year, what would be he treatment plan at that point? Would the goal be to try and reduce the bile acids? Is that even possible? My problem with treating an asymptomatic MVD dog normally, is the fact that the bile acids could continue to increase, and what does that mean? I obviously don't know enough yet, because I would have assumed that as long as a dog is asymptomatic, that you can treat them normally, but obviously with Eloise that wasn't the case.

Does increasingly high levels of bile acids compromise their health? And if so, wouldn't that mean that leaving an Asymptomatic dog alone would potentially compromise their health.


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## jmm (Nov 23, 2004)

Excellent questions. MVD itself is not a progressive disease to the best of my knowledge and from what I gathered from Dr. Center's recommendations on how to monitor my asymptomatic dogs and her telling me about how the dogs can live long lives (it was a very positive picture). It is a structural change in the liver that alters the blood flow. 

The chemistry panel would be looking for rising liver enzymes. The urine sample would be looking for ammonium urate crystals. These are good ways to monitor for changes in liver function. Rising numbers or seeing crystals would tell you it may be time to re-evaluate. 

Once you know bile acids are elevated there is no point in repeating them. For every time you do them, you will get a different number. So you might get a 70 one time, 40 the next, 75 the next. Bile acids are NOT a good monitoring test. Over 25 is abnormal and that's the bottom line. Bile acids measure perfusion through the liver. MVD is a perfusion problem. The dog will always have elevated numbers. 

Symptomatic means the dog is having problems. Vomiting and diarrhea, bladder stones, dullness, disorientation after eating, lethargy, etc. If the dog develops problems, then he needs to be worked up to find out if it is due to liver disease or a concurrent problem. MVD itself is microscopic shunting within the liver. When adults develop symptoms, the dogs may have a concurrent problem like inflammation in the liver (and GI tract) called eosinophilic hepatic venule inflammation that is seen in Maltese. This can be treated with medications quite successfully. Depending on the symptoms, diet, antibiotics, lactulose, steroids, supplements, etc can be added. There is no single protocol because it depends on the dog's symptoms and what else is going on. 

Mikey is a good example. Normal puppy. As an adult he developed GI signs. Eventually, MVD was diagnosed BUT he had the whole Maltese package to include eosinophilic IBD and eosinophilic hepatic venule inflammation. It was not the MVD itself that made him sick, it was the inflammatory diseases that went with it. 

I hope that helps. Did I answer all of your question? 


QUOTE (BrookeB676 @ Jul 2 2008, 09:08 AM) index.php?act=findpost&pid=599606


> I have been thinking about this a lot lately because Louis is now one and I am trying to figure out the best plan to maintain his health. My question is, if I do get a chemistry panel and urine sample, what would I be looking for? Also, I would suspect that his bile acids are still high. Would it be accurate to say that even if his bloodwork was the same (which I assume it is), there would be no treatment unless he became symptomatic?
> 
> Then the question is, what is symptomatic. As far as I know, he is very playful, has great stools, is skinny, but maintains his weight, and acts just like the others. He occasionally has the bile throw up episodes, but I think I have been able to attribute that to an empty stomach bc it seems to happen when he doesn't eat a tablespoon of wet food before bed.
> 
> ...


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## Nikki's Mom (Feb 13, 2008)

Jackie, thanks. Even though I didn't ask the question, your answer was very succinct and very helpful. I guess those of us that have asymptomatic MVD dogs worry, mostly for no good reason, or maybe we started worrying because of all the conflicting information. Thanks to you and to Mary H for making things clear and giving us peace of mind.


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## BrookeB676 (Oct 17, 2004)

QUOTE (JMM @ Jul 2 2008, 01:07 PM) index.php?act=findpost&pid=599691


> The chemistry panel would be looking for rising liver enzymes. The urine sample would be looking for ammonium urate crystals. These are good ways to monitor for changes in liver function. Rising numbers or seeing crystals would tell you it may be time to re-evaluate.
> 
> 
> Mikey is a good example. Normal puppy. As an adult he developed GI signs. Eventually, MVD was diagnosed BUT he had the whole Maltese package to include eosinophilic IBD and eosinophilic hepatic venule inflammation. It was not the MVD itself that made him sick, it was the inflammatory diseases that went with it.
> ...


Thank you for taking the time to respond once again! My concern is that when I get the Chem panel and urine sample, that the vet would not know the appropriate treatment plan at that point. For example, my MIL had horrible neck and arm pain a few weeks ago. She went to the doctor, they could not figure out what was going on. Then she went to the chiropractor, and he put her on steroids and pain medicine telling her that it was the beginning of arthritis. So, she saw a doctor, got the appropriate tests and evaluations done. Well she came here to visit shortly after and ended up having a heart attack. So, the cardiologist presumed that the previous pain was related to heart problems. My point in giving this example is that I could bring Louis to all the vets in Houston, get the appropriate bloodwork, and still not be treating him for what is actually wrong (if anything at all). I'm not even sure there is a solution to this concern, but I am just not sure what to look for in the panels and urine sample and since each dog is treated individually, I would not be confident that a vet here would be able to perscribe the appropriate treatment plan.

As far as Mikey, did the MVD possibly cause the inflammatory disease? Are they at all related? How were you abl to find out how to treat him?

For now I am wondering if I should start the Marin. I am thinking of taking Louis tomorrow to have the chem panel and urine sample to see where his levels are and then determine if I should be supplementing his diet. I just feel lost and am not sure there will ever be any comfort simply because of the fact that he has MVD (asymptomatic or not). Oh, and another conern is that I wouldn't know exactly what to do if his MVD became symptomatic.


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## preciouspups (Apr 13, 2008)

QUOTE (Nikki's Mom @ Jul 2 2008, 02:20 PM) index.php?act=findpost&pid=599696


> Jackie, thanks. Even though I didn't ask the question, your answer was very succinct and very helpful. I guess those of us that have asymptomatic MVD dogs worry, mostly for no good reason, or maybe we started worrying because of all the conflicting information. Thanks to you and to Mary H for making things clear and giving us peace of mind.[/B]



:goodpost: :amen:


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## jmm (Nov 23, 2004)

You have a VERY valid concern. There are still vets out there telling people that elevated ALTs and bile acids are normal for Maltese and indicate no pathology. 

I lucked out in that the local internal medicine specialist I chose (and she was my 3rd opinion) did her residency at Cornell with Dr. Center. I had all of the latest and greatest information and treatment available. 

So after all of my experience with Mikey's disasters, what I did with Soda as a baby was I went to an internal medicine specialist and had them do his puppy screening (chem panel, cbc, bile acids, urinalysis - all of my puppies get this). We had an established relationship so that she would correspond with me on follow up labwork even if I couldn't get in to her to do it. While my regular vet is AWESOME...they aren't specialists. They can't possibly keep up to date on all of the newest findings on liver stuff. Now I can have my regular vet call and confer with the internist at any point. That has been my solution. 

I know Dr. Center is hard to get in touch with, but your vet can call and have her paged. Be persistent. She is incredibly busy. 

I guess my bottom line is you have to go a step further. You have to be pushy. You have to do some homework and find someone near you who DOES know OR someone you want your vet to consult with via phone. If you can spend the money for an IMED consult (its around $100 in private practice, less at a university) and establish a relationship, I think it gives you the most security. 

I was clueless about this when my first dog was diagnosed. The only reason I know is because I had a sick dog for 3 years of his 5 year life. It was learn and search on my own or accept a sad prognosis. I was pushy and I had a happy dog for longer than anyone thought I would. 

The MVD did not cause the inflammatory disease. As I understand it, that type of inflammation along with MVD is a "package" that is seen in Maltese (so I'd assume some hereditary component). Dr. Center told me that dogs do very well with her protocol of medication...Mikey was just the exception to all rules. But he taught me to be pushy to prevent more dogs from ending up like him.


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