# Sticky  Bile Acid Test



## MaryH

For any of you who may be thinking of running a bile acid test on your dog(s), there is a new test out, the IDEXX SNAP test for bile acids. Don't waste your money!! While you will get both pre- and postprandial values, the values are given in ranges -- <12; 12-25; >25. You might get a postprandial value of >25 but the test does not tell you how much greater than 25. And there's a huge difference between 26 and 200 but because all you get is >25, you've just spent good money for a worthless result and now you've got to spend more money to have a traditional bile acid test run to get a meaningful value. This may well be a worthwhile test for breeds that do not have liver issues but it is NOT a good test for Maltese.

Mary


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## Missy&Maggie

This maybe a dumb question, but I am going to ask anyways. Can a Maltese develop liver issues over time like a shunt or MVD or is it something that is noticed by a certain age or something that they are born with? How often should a dog be bile acid tested? I am starting to get worried because it seems like liver issues are becoming more prevalent. Thanks!


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## MaryH

> This maybe a dumb question, but I am going to ask anyways. Can a Maltese develop liver issues over time like a shunt or MVD or is it something that is noticed by a certain age or something that they are born with? How often should a dog be bile acid tested? I am starting to get worried because it seems like liver issues are becoming more prevalent. Thanks![/B]


I'm not positive but I think the consensus is that dogs are born with PSVA/MVD. Dr. Center recommends testing puppies before they're sold (I think her preferred age would be 16 wks.) and the only time that I've read that it's worthwhile to retest is if you have a dog whose shunt was ligated, then retest to insure that the ligation worked. As with any other chronic conditions (cancer comes to mind), whether in humans or animals, I do wonder if there is a higher occurrence or if we have better, more sophisticated means with which to diagnose?

Mary


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## MickeysMom

I think that most of the time it is congenital, but they can develop shunts over time due to liver disease.


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## Malteseluv

Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.
As far as liver shunts and MVD goes. Most dogs who have liver shunt are diagnosed by the age of 1, but I have seen dogs much older than that be diagnosed, from 3-7 yrs old. 
When they have MVD, many times, symptoms go unnoticed, so the dog may not be diagnosed until 2,3, or even much older than that...
Numbers above normal range but below 100, typically point more towards liver shunt.
Numbers above 100, typically point more towards MVD.
There are always exceptions to these "generalizations." I know of a yorkie whose numbers were under 100 and had a liver shunt, and I know several dogs, including my own, who have had number beyond 300 that have MVD.
MVD and liver shunts are usually congenital, but it is possible for a dog to have an "acquired" shunt later in life also.
About 15% of dogs who have liver shunt ligation surgery develop acquired shunts as well...


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## jmm

Can dogs develop high bile acids later in life but were normal as a puppy? Yes: there are MANY types of liver disease out there that develop later in life. Anything from infection to chronic phenobarbital use to a toxin exposure. And yes, dogs with severe liver disease can develop acquired shunts. This is NOT the same thing as the PVSA/MVD that is talked about so frequently with Maltese. This is why when you test an adult Maltese, you raise a question - is this something to worry about or not. Knowing their numbers as pups can help clear that up. 

As many times as you measure the bile acids, you will get a different result. Dr. Center emphasized that abnormal is abnormal. If you get 4/40 and then 5/70 the dog is still abnormal. Bile acids is not a good monitoring test for that reason (unless post-shunt ligation based on the vet's recommendations). When we consulted with Dr. Center on a pair of dogs a number of years back, she recommended appropriate intervals to monitor ALT(SGPT) and full chem panels on those dogs. My "reg vet" (who is a boarded internist and did her residency at Cornell with Dr. Center) has us do a chem panel and check up every 6 months on my current MVD confirmed case and suspects.


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## Malteseluv

The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.


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## Missy&Maggie

This is great information! I'm so happy that I asked! I want to give Maggie time to recovery from her spay and whatnot, but next on my list of things to do is a full blood work-up and bile acid test. I learn so much from this forum!!! Y'all are a wealth of knowledge!!!! :biggrin:


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## jmm

> The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.[/B]


My point was agreeding with Mary that bile acids are not a good monitoring test. It has been recommended to monitor liver enzymes (ALT) at intervals instead of doing repeated bile acids which give you no information. This is NOT a recommendation for diagnostics, but for monitoring.


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## dr.jaimie

yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.


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## Ladysmom

Are Maltese breeders routinely running bile acid tests on adults before breeding them? I've seen ads/websites for Yorkies and Havanese that state that bile acids tests have been done on the parents and the puppy, but never seen it in an ad for a Maltese or on any of the show breeders websites.

Are Maltese breeders just behind the eight ball on this issue?


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## tamizami

> index.php?act=findpost&pid=444147
> 
> 
> 
> 
> 
> 
> 
> The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.[/B]
> 
> Click to expand...
> 
> My point was agreeding with Mary that bile acids are not a good monitoring test. It has been recommended to monitor liver enzymes (ALT) at intervals instead of doing repeated bile acids which give you no information. This is NOT a recommendation for diagnostics, but for monitoring.
> [/B]
Click to expand...

Okay, now I am confused. My dog had normal liver enzymes until her last blood test, when we also did bile acid and ALT was high as were pre and post-prandial bile acids. We suspect she has MVD since the scintigraphy did not indicate a shunt and I have elected not to biopsy.

I thought normal ALT can hide MVD and that only bile acids can tell you if the dog has liver issues?
Sorry for the confusion!


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## Malteseluv

Yes, the bile acid test is much more sensitive to liver function, so yes, it's important to get bile acid testing...
I think what the other poster is trying to say is that it's not a good way to "monitor" levels.

But, in my opinion, if you take the dog to the same vet and have them feed the same amount of the same kind of food as each other time that the bile acid test is done, it might be a better way to keep track of the dog's levels...It wouldn't be completely fool proof, but it would help it be a bit more accurate as far as monitoring goes.


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## jmm

> Yes, the bile acid test is much more sensitive to liver function, so yes, it's important to get bile acid testing...
> I think what the other poster is trying to say is that it's not a good way to "monitor" levels.
> 
> But, in my opinion, if you take the dog to the same vet and have them feed the same amount of the same kind of food as each other time that the bile acid test is done, it might be a better way to keep track of the dog's levels...It wouldn't be completely fool proof, but it would help it be a bit more accurate as far as monitoring goes.[/B]


If you have already determined a dog has a problem, them monitoring will be recommended. This is where bile acids would not be of assistance so you monitor the enzymes like ALT. Like I said in previous posts, this is for MONITORING. 

You check bile acids to rule in/out normal liver function vs. an affected dog. 


You can do the exact same protocol with bile acids every time and still get variation in numbers for the same dog. Abnormal is abnormal.


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## Malteseluv

Yes, I see what you are saying...I should have read back through that again...Once liver disease has been confirmed, there's no need to retest bile acids...They're going to be elevated regardless of anything if the dog has liver disease. Now, if there's a shunt and it has been closed up, then it's important to check the BAT to make sure that the shunt has closed and the numbers have gone down. Also 3-6 months down the road to make sure that the dog didn't acquire a shunt which about 15% of dogs do.
If your dog is asymptomatic and comes up with slightly elevated BAT results, then I think the test should be redone in 30 days. I don't see anything wrong with redoing a bile acid test in that fashion.


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## MaryH

> Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.[/B]


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



> Numbers above normal range but below 100, typically point more towards liver shunt.
> Numbers above 100, typically point more towards MVD.[/B]


I believe you have your numbers backwards in this statement.



> If your dog is asymptomatic and comes up with slightly elevated BAT results, then I think the test should be redone in 30 days. I don't see anything wrong with redoing a bile acid test in that fashion.[/B]


Quoting from p.17 of our handout:
"3. Dogs with MVD are monitored with serial biochemical profiles looking for evidence of active hepatobiliary injury (increased liver enzyme activity) or loss of synthetic function as part of their routine health assessments over their lifetime. _Serial bile acid values do not contribute to assessments of health status in these dogs unless they become profoundly increased._ Bile acid values do not quantitatively correlate with extent of liver injury due to their complex physiologic regulation. Dogs with MVD usually do not have ammonium biurate crystalluria or hyperammonemia." (all emphasis was added by Dr. Center)

In closing, I personally know two Maltese, one with a ligated shunt and the other with MVD, who are living in pet homes and have Dr. Center as their "regular" vet. Both were initially seen, tested, and diagnosed by Dr. Center, and the one with the shunt had the shunt ligated by a surgical team at Cornell under the watchful eye of Dr. Center. Neither of these dogs has been subjected to repeat bile acid testing. They have complete blood panels done at the time of their wellness exams to monitor liver enzyme levels. And Dr. Center advised all who attended her seminar that repeat bile acid testing is of no use in monitoring MVD dogs.

Mary


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## MaryH

> Okay, now I am confused. My dog had normal liver enzymes until her last blood test, when we also did bile acid and ALT was high as were pre and post-prandial bile acids. We suspect she has MVD since the scintigraphy did not indicate a shunt and I have elected not to biopsy.
> 
> I thought normal ALT can hide MVD and that only bile acids can tell you if the dog has liver issues?
> Sorry for the confusion![/B]


Not all MVD dogs have elevated ALT (liver enzymes) so the results of a blood test that shows normal liver enzyme levels is no guarantee that your dog does not have MVD. You are correct that bile acid testing dogs will tell you if the dog has liver issues. But because, as JMM pointed out, there could be any number of causes of liver dysfunction, the "liver experts" recommend running a bile acid test when the dog is young, before any of the other number of causes of liver dysfunction kick into play. 

Mary


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## Cathy

> yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.[/B]



Jamie,

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

Cathy A


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## jmm

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



YES, you should be doing paired bile acids on ALL puppies. Dr. Center recommended it be done right before they go home from the breeder. 

If the dogs have PSVA/MVD, the numbers will be there when they are young. Since this is something they are born with, the bile acids won't magically become abnormal at a year of age (although, like the answer to the orignal question, dogs can acquire OTHER types of liver disease later in life). 

Dr. Center specifically mentioned if the number is abnormal, its abnormal. Like I already mentioned, you will get a different number each time you test. 

Reasons to draw another sample:
1. Hemolysis of the sample (and you should have your vet spin the clotted blood down while you are in the office because if it is hemolyzed, you need to get another sample)
2. Lipemia of the sample that is not centrifuged out of the sample (fatty blood)
She also recommended the vet collect the blood in a plain red-top tube versus a serum separator. After the blood clots, it should be spun down and the serum put in another plain red-top to go to the lab. 

I've never heard it recommended to retest in 30 days. 

Page 5:
"_Cutoff range considered abnormal:_ we determined an appropriate cutoff value to discriminate normla dogs from abnormal dogs based on review of hundreds of bile acid values in dogs with biopsy confirmed normal or abnormal liver status."

My note: This means that they took large samples of dogs with both normal and abnormal bile acid values. Then they took liver biopsies to see if the bile acid numbers matched pathology vs. no pathology of the liver. 

"...we set the cutoff value to discriminate normal and abnormal >/= 25 uMol/L. We then tested this against a large population of dogs examined by liver biopsy to be sure that this value did not generate in false positive tests (dogs that had no liver abnormality yet still had abnormal test results)."

My note: They specifically tested for false positive.


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## MaryH

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


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


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## Cathy

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


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

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

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

Cathy A


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## dr.jaimie

> index.php?act=findpost&pid=444319
> 
> 
> 
> 
> 
> 
> 
> yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.[/B]
> 
> Click to expand...
> 
> 
> Jamie,
> 
> When Pixel was a puppy did you do BA or just the usual blood panel? I'm wondering if the BA test is always conclusive when done on a puppy. If so, then we should be doing BA on our new puppies.
> 
> Cathy A
> 
> [/B]
Click to expand...

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


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## MaryH

> Yes, I remember Dr. Center telling us that breeders should have the test done prior to the puppy going to a new home. But, the reality is that none do this and most vets have no idea that this should be done at 4 months.
> 
> In my case, my girl had elevated ALT when her bloodwork was done for her teeth removal at 6 months. My vet suggested bile acids be tested when she was a year old. Next she developed 2 luxating patellas so she had to have 2 surgeries 2 1/2 months apart. Now we're doing physiotherapy since she is still skipping and exhibiting pain in her spine and has tight thigh muscles. The bile acid test was put off because of her other issues. Today I called to book her 1 year booster and a BA test. Her office told me that she needed to do a 12 hour fast. I told them no and faxed over Dr. Center's info.
> 
> Now I'm wondering how many days/weeks apart I should do the booster and the BA test. Any ideas? My girl is now 16 months old.
> 
> Cathy A[/B]


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

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

Mary


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## Cathy

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

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

Cathy


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## Humbug

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

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

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

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


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## jmm

> Trixie is on Phenobarb for the seizures and Denosyl to help protect her liver from the Phenobarb. She also has to have a Phenobarb level check and a BAT every six months.
> 
> I am wondering if based on what I have read in this thread if doing a BAT every six months is necessary?[/B]


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


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## tamizami

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

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

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

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

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

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


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## harrysmom

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


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## jmm

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



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


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## Cathy

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


Mary/Jackie,

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

Cathy A


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## jmm

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


Cathy, I've always fasted just because that was always the lab's recommendation. I'm glad for the little pups 12 hours isn't necessary. You wouldn't want to feed her in the am before her first sample anyways. One breakfast is plenty LOL


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## k/c mom

> page 22 of the handout:
> "2: The best approach to avoid "over diagnosis" is to test _bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes._ Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. _How old dogs should be at he time of initial testing has not been established._ Typically, abnormal bile acids DO NOT normalize as a dog ages ..... " (all emphasis added by Dr. Center)
> 
> Yes, I remember Dr. Center telling us that breeders should have the test done prior to the puppy going to a new home. But, the reality is that none do this and most vets have no idea that this should be done at 4 months.
> 
> In my case, my girl had elevated ALT when her bloodwork was done for her teeth removal at 6 months. My vet suggested bile acids be tested when she was a year old. Next she developed 2 luxating patellas so she had to have 2 surgeries 2 1/2 months apart. Now we're doing physiotherapy since she is still skipping and exhibiting pain in her spine and has tight thigh muscles. The bile acid test was put off because of her other issues. Today I called to book her 1 year booster and a BA test. Her office told me that she needed to do a 12 hour fast. I told them no and faxed over Dr. Center's info.
> 
> Now I'm wondering how many days/weeks apart I should do the booster and the BA test. Any ideas? My girl is now 16 months old.
> 
> Cathy A[/B]


Gosh, Cathy, I am so sorry to hear about all of these problems. Is this your darling Smudge that is having these issues? I sure hope that she'll be OK.


----------



## tamizami

> index.php?act=findpost&pid=447793
> 
> 
> 
> 
> 
> 
> 
> Mary/Jackie,
> 
> I have a problem........My BA test is scheduled for next Thursday but my vet wants to do a 12 hour overnight fast and then do a paired sample. She says that Dr. Center's paper isn't totally clear because she still talks about fasting in the paper. She wants her to fast overnight. Then I am to take her to the vet's for 9 AM. They will take blood, feed her, wait 2 hours and then take more blood. Will this work or should I talk to her again? [/B]
> 
> Cathy A[/B]
> 
> Click to expand...
> 
> Cathy, I've always fasted just because that was always the lab's recommendation. I'm glad for the little pups 12 hours isn't necessary. You wouldn't want to feed her in the am before her first sample anyways. One breakfast is plenty LOL
> [/B]
Click to expand...


Jackie - do you recommend bringing in their normal food for the vet to feed after 2 hours or letting the vet feed whatever?


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## Cathy

Cathy, I've always fasted just because that was always the lab's recommendation. I'm glad for the little pups 12 hours isn't necessary. You wouldn't want to feed her in the am before her first sample anyways. One breakfast is plenty LOL
[/QUOTE]


Thanks Jackie, now I feel better knowing that the plan is okay. 

Cathy A


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## Cathy

Gosh, Cathy, I am so sorry to hear about all of these problems. Is this your darling Smudge that is having these issues? I sure hope that she'll be OK.
[/QUOTE]

Yes, this is my Smudge but things actually sounds worse than they are.. She's a real trooper and is crazy just like Caira. She's a super happy girl and nothing gets her down. She likes to instigate (sp?) wrestling matches with Lizzie and will bug her until Lizzie gives in. The patella surgeries were apparently successful so I am thankful for this. Hopefully with continued Physio exercises the skip will disappear. She loves the exercises because she gets treats and thinks we're just playing special games. :biggrin: 

Cathy A


----------



## MaryH

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


Cathy,

All Dr. Center was saying was that they no longer believe it is necessary to fast the dogs for 12 hours first, but 12 hours without food is not going to hurt your dog or skew the results. When we went up to Cornell, we fed the dogs Sunday night at about 9:30 p.m., way later than normal but we had an 8-1/2 hour drive to get to a friend's house in that area who graciously opened her doors to 2 humans and a multitude of dogs. Our appointment was for Monday morning at 8:00, so the dogs didn't have a 12-hour fast but it was close to that, except for the puppies, who were fed again around 5:00 a.m., and they were the last ones to have their their blood drawn. We brought the food that the dogs normally eat (and their water, too) because they MUST eat before the second blood draw and chances are they will eat what they're accustomed to. She recommended bringing water from home only to prevent anyone from getting intestinal upset from a change in water, not because it would have affected the bile acid results. One of the dogs would not eat (picky eater, away from home, etc.) so she got some canned food for him. He turned his nose up at that, too, so she went and got a jar of baby food and spoon fed him. LOL!! They do have to eat before the second blood draw can be done.

Good luck next week. Smudge will do fine.

Mary


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## jmm

> Jackie - do you recommend bringing in their normal food for the vet to feed after 2 hours or letting the vet feed whatever?[/B]


If I recall, Dr. Center specified it should not be a fatty meal. Our internist always uses our food or some I/D if they won't eat their own at the clinic. I do remember Dr. Center recommending keeping the stress low. So that may mean sitting in the lobby, sitting in the car, or going home and returning for the second blood draw.


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## Malteseluv

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


Certain values do not "rule out" liver shunts...There are generalizations that are made about the numbers but numbers are not conclusive...They just show that there's something going on in the liver if they are elevated.
I've known dogs who have had numbers above 25 but under 100, who had a single extrahepatic shunt, and dogs with numbers over 100 (over 300 for my own dog) that have MVD and not a single extrahepatic shunt...


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## JakandMax

First Timer here.

I have a Maltese Jake, 2 years old. We bought him from a great breeder. As a matter of fact both of our dogs are from the same breeder. He has been a great dog, always a little small, full of life and fun. This week Jake went into a deep stare and seemed to lose himself. We immediately took him to the Vet and his ALT was 712 - very high!. He did come back full throtle after a little bit and has been fine since. But we scheduled him for a Acid Bile Test. The results came back this AM. Before the BAT his numbers were 32. After the test they were 97. I know these are elevated and I know I am more than likely getting these confused but you may understand what I am talking about. My question is this. We have him scheduled to go to an Internal Medicine Vet on Sat for a complete workup. With everyones experience here, what are some things that I need to ask the Vet? He is going to Florida Veterinary Specialist in Tampa. Any input would be greatly appreciated.

Tony


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## dr.jaimie

> First Timer here.
> 
> I have a Maltese Jake, 2 years old. We bought him from a great breeder. As a matter of fact both of our dogs are from the same breeder. He has been a great dog, always a little small, full of life and fun. This week Jake went into a deep stare and seemed to lose himself. We immediately took him to the Vet and his ALT was 712 - very high!. He did come back full throtle after a little bit and has been fine since. But we scheduled him for a Acid Bile Test. The results came back this AM. Before the BAT his numbers were 32. After the test they were 97. I know these are elevated and I know I am more than likely getting these confused but you may understand what I am talking about. My question is this. We have him scheduled to go to an Internal Medicine Vet on Sat for a complete workup. With everyones experience here, what are some things that I need to ask the Vet? He is going to Florida Veterinary Specialist in Tampa. Any input would be greatly appreciated.
> 
> Tony[/B]


i would have a protein C test run on ur baby before you go to a specialist. this will help distinguish between MVD and a shunt. if its MVD then your regular vet can call dr center and get her protocol. if it is a shunt then go to the specialist. otherwise u will spend lots of money at the specialist to find out it is MVD which is the most common in malts. who is your regular vet over there? i did an externship there couple yrs ago and was just curious.


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## JakandMax

Thanks!

Dr. Saunders and Dr Coder. They did not mention a Protein C test first. How long does that take and how long for the results?


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## Missy&Maggie

> First Timer here.
> 
> I have a Maltese Jake, 2 years old. We bought him from a great breeder. As a matter of fact both of our dogs are from the same breeder. He has been a great dog, always a little small, full of life and fun. This week Jake went into a deep stare and seemed to lose himself. We immediately took him to the Vet and his ALT was 712 - very high!. He did come back full throtle after a little bit and has been fine since. But we scheduled him for a Acid Bile Test. The results came back this AM. Before the BAT his numbers were 32. After the test they were 97. I know these are elevated and I know I am more than likely getting these confused but you may understand what I am talking about. My question is this. We have him scheduled to go to an Internal Medicine Vet on Sat for a complete workup. With everyones experience here, what are some things that I need to ask the Vet? He is going to Florida Veterinary Specialist in Tampa. Any input would be greatly appreciated.
> 
> Tony[/B]


Hi Tony,

I'm from Sarasota, so not too far from Tampa. You also might want to check out the University of Florida's small animal clinic. I took my puppy, Maggie, there after my vet discovered a heart murmur. I know that it is a very different situation, but UF has a top vet school and therefore, amazing vets and the best equipment. I know that is a drive from where we are, but it is well worth it. I was very happy that I made the trip to take Maggie up there. We are very lucky to live in a state with a Vet school. I just looked on there website and they have a Dr. who specializes in liver disease. You might want to check it out. I hope that Jake is ok!! :grouphug: UF Small Animal Clinic


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## dr.jaimie

> Thanks!
> 
> Dr. Saunders and Dr Coder. They did not mention a Protein C test first. How long does that take and how long for the results?[/B]



i sent the protein C test off on my baby and got the results in about 3 days. cornel university is the only place that runs the test. its a fairly new test so ur vet may not know about it. you can also have ur vet contact dr center at cornell now to get more info on the protein C. i will see if i can find some info on the vet forum about it for u to bring to ur vet


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## dr.jaimie

ok i found an article...so if u or ne one PMs me ur email i can email it to u


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## Cathy

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

This is the link for info on the Protein C test from Cornell University.

Cathy A


----------



## MaryH

> First Timer here.
> 
> I have a Maltese Jake, 2 years old. We bought him from a great breeder. As a matter of fact both of our dogs are from the same breeder. He has been a great dog, always a little small, full of life and fun. This week Jake went into a deep stare and seemed to lose himself. We immediately took him to the Vet and his ALT was 712 - very high!. He did come back full throtle after a little bit and has been fine since. But we scheduled him for a Acid Bile Test. The results came back this AM. Before the BAT his numbers were 32. After the test they were 97. I know these are elevated and I know I am more than likely getting these confused but you may understand what I am talking about. My question is this. We have him scheduled to go to an Internal Medicine Vet on Sat for a complete workup. With everyones experience here, what are some things that I need to ask the Vet? He is going to Florida Veterinary Specialist in Tampa. Any input would be greatly appreciated.
> 
> Tony[/B]


Doesn't sound like your numbers are confused at all. A blood draw is taken before a meal and then again 2 hours after a meal. Generally (but not always) the values are lower for the first (pre-prandial) blood draw and higher for the second (post-prandial) blood draw. A value ≥ 25 uMol/L, whether pre- or post-prandial (about 20% of all dogs tested have higher pre-prandial values than post- prandial values) is considered abnormal in the Maltese breed. The best next step (least invasive and least expensive) is to run a Protein C test. Your regular vet can draw the blood and send it off to Cornell University for testing. Because Jake's ALT was so high, I might also ask your vet to examine a urine sample looking for ammonium biurate crystals. If the Protein C test results are normal you can pretty safely assume that Jake has MVD. For an asymptomatic dog with MVD no medical or dietary management is needed. However, if your dog does appear to be symptomatic you should discuss your options for dietary (low protein diet like Hills L/D) and medical management.

If you click on the following link you can read about my experience with the specialists. Good luck with Jake and keep us posted.

Mary

http://spoiledmaltese.com/forum/index.php?...st&p=442151


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## jmm

I'm going to kindly agree with the recommendation to see an internist AND have the Protein C test done. Certainly, shunt needs to be ruled out here, HOWEVER, Jake still had an episode of something that may be related to liver disease. A symptomatic dog should be carefully evaluated and likely receive some treatment. Honestly, even with Dr. Center's long-distance care, I feel it is important to have an internist at home-base if at all possible.


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## MaryH

> I'm going to kindly agree with the recommendation to see an internist AND have the Protein C test done. Certainly, shunt needs to be ruled out here, HOWEVER, Jake still had an episode of something that may be related to liver disease. A symptomatic dog should be carefully evaluated and likely receive some treatment. Honestly, even with Dr. Center's long-distance care, I feel it is important to have an internist at home-base if at all possible.[/B]


I totally agree with seeing an internal medicine specialist, especially because of the seizure-type episode, but I'd still start the diagnostic process with the Protein C test. I cringe every time I hear about one of our little ones being subjected to all kinds of invasive procedures as a first step rather than as a later step if necessary.


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## JakandMax

Ok , Jake went to the Vet on Sat and had an Ultrasound. We had this setup already and just went ahead with the appointment. There was no indication of an Extrahepatic Shunt. No sign of bladder stones. The vet did discuss the poosibility of an Intrahepatic Shunt and MVD. He discussed a biopsy that would rule out a shunt. However, we were not comfortable with the biopsy because of the trauma that he could face. He is only 4 lbs and that I think would be cruel to a point since if a shunt is found, it could be in an area that would be very risky for the liver if removed or maybe not removable at all. We did mention the Protein C and he was not as convinced about the test as those on this board. However, he was a critical care vet. He does agree there is "something" going on and we need to find out what it is. We have started him on medicine/diet as if he were diagnosed with MVD. We will see his regular vet on Tuesday and will schedule him with the Internist in Dec for a consult. We are going to ask for our regular vet to take the blood sample a(Protein C) and send it to Dr. Center so it is available for the consult with the Internist. He continues to be very playful with his brother and very alert. I could not ask for a better dog.

Can anyone give me additional info on Protein C that I can give to my Vet. Dr. Center's address or how we go about this.

Thanks for all your help and concern!!!!

Tony


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## JakandMax

I just saw Cathy's info on Cornell and Dr. Center. Thanks Cathy, I will give to our vet!

Tony


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## harrysmom

Hi Tony! I have a 9 month old maltese named Harry who has serious liver disease. We started out much the same way as you, by visiting an internist. The internist wanted to do a biopsy, since they didn't see a shunt on the ultrasound...but I didn't feel right about it, so I brought Harry to Dr. Center. (I live 4 hours away from Cornell...but it was well worth the drive.) 

You can read my earlier posts about what went on with Harry at Cornell. I tried to post a link to my other posts here, but I don't know how :brownbag: ...the topic was "Harry's visit to Cornell". 

Harry is doing really well today. The doctors at Cornell put him on a special diet....brown rice, tofu, and cottage cheese! It seems to have made a difference in his behavior...he's back to being a pup. :chili: I am going to Cornell with Harry on Wednesday for some blood work. Eventually they are going to let me have the blood work done around here so that I don't have to drive 8 hours in one day,,, but they want to make sure that Harry is stable before they agree to that. (Luckily I'm a substitute teacher, so I can take the days off to be with Harry with no problem.) We don't know how long we have with Harry...so we're enjoying each day that we have. 

This forum is a great resource. I believe that the information I got from the members of this forum saved Harry's life!!! :aktion033: Good luck...I'll be praying for you both! 

Debbie


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## MaryH

> Hi Tony! I have a 9 month old maltese named Harry who has serious liver disease. We started out much the same way as you, by visiting an internist. The internist wanted to do a biopsy, since they didn't see a shunt on the ultrasound...but I didn't feel right about it, so I brought Harry to Dr. Center. (I live 4 hours away from Cornell...but it was well worth the drive.)
> 
> You can read my earlier posts about what went on with Harry at Cornell. I tried to post a link to my other posts here, but I don't know how :brownbag: ...the topic was "Harry's visit to Cornell".
> 
> Harry is doing really well today. The doctors at Cornell put him on a special diet....brown rice, tofu, and cottage cheese! It seems to have made a difference in his behavior...he's back to being a pup. :chili: I am going to Cornell with Harry on Wednesday for some blood work. Eventually they are going to let me have the blood work done around here so that I don't have to drive 8 hours in one day,,, but they want to make sure that Harry is stable before they agree to that. (Luckily I'm a substitute teacher, so I can take the days off to be with Harry with no problem.) We don't know how long we have with Harry...so we're enjoying each day that we have.
> 
> This forum is a great resource. I believe that the information I got from the members of this forum saved Harry's life!!! :aktion033: Good luck...I'll be praying for you both!
> 
> Debbie[/B]


Hopefully this will work ....

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


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## JakandMax

Got the link. Thanks for your help.

I will keep you updated!

Tony


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## pammy4501

What is really condsidered high? My dog had a Bile Acid level of 13. The lab sheet says it may be suggestive of liver disease. My vet said he wouldn't even worry about such a low number. He said itis problematic at the 200 - 300 level. my dog is asymptomaitc, but he is only 6 months.


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## jmm

> What is really condsidered high? My dog had a Bile Acid level of 13. It say it may be suggestive of liver disease. My vet said he wouldn't even worry about such a low number. He said itis problematic at the 200 - 300 level. my dog is asymptomaitc, but he is only 6 months.[/B]



Under 25 is normal.


----------



## jlhajmom

> Are Maltese breeders routinely running bile acid tests on adults before breeding them? I've seen ads/websites for Yorkies and Havanese that state that bile acids tests have been done on the parents and the puppy, but never seen it in an ad for a Maltese or on any of the show breeders websites.
> 
> Are Maltese breeders just behind the eight ball on this issue?[/B]


I bought my Ava Jane from a breeder on the AMA list. I thought I had asked all the right questions and commented on the Code of Ethics. The breeder told me that in 20 years she had "never had any healthy problems with her dogs." Well, when Ava's blood work and then Bile Acids came back elevated (pre-eating 60, post-eating 266) I questioned the breeder about the bile acid tests done on the parents. She told me, "I've never tested them. I've never had to." Well, as many of you may have read Ava had a shunt, which we had repaired back in February. So, even breeders on the AMA list are not following any health screening standards. By the way, I did contact my breeder to let her know what happened and I have never heard back from her.


----------



## bonniesmom

> This maybe a dumb question, but I am going to ask anyways. Can a Maltese develop liver issues over time like a shunt or MVD or is it something that is noticed by a certain age or something that they are born with? How often should a dog be bile acid tested? I am starting to get worried because it seems like liver issues are becoming more prevalent. Thanks![/B]


Hi,
My last Maltese showed elevated liver enzymes at age 4, but have no idea how long they had been elevated because they
had never been checked before. Are you worried for any particular reason? Has she shown any symptoms or had any
abnormal test results? If you have some reason for concern, have the liver enzymes done first, and if they're high, have
the bile acids. I think in most cases the liver issues are genetic, but may not show up right away. If you're really concerned,
I certainly think once a year would be often enough. Good luck.


----------



## jmm

> Hi,
> My last Maltese showed elevated liver enzymes at age 4, but have no idea how long they had been elevated because they
> had never been checked before. Are you worried for any particular reason? Has she shown any symptoms or had any
> abnormal test results? If you have some reason for concern, have the liver enzymes done first, and if they're high, have
> the bile acids. I think in most cases the liver issues are genetic, but may not show up right away. If you're really concerned,
> I certainly think once a year would be often enough. Good luck.[/B]


A normal chemistry panel does not rule out perfusion disorders of the liver (MVD/shunts). Even dogs with shunts can have normal ALTs and no symptoms. 

Bile acids do not need to be repeated for asymptomatic MVD dogs. For every time you do them, you will get a different number. If they are abnormal, bottom line is they are abnormal. Repeating them annually would not provide you with any further information for the typical asymptomatic MVD Maltese.


----------



## lori

After reading this thread, I'm a little confused as to whether or not you should insist on a bile liver test BEFORE bringing your puppy home. Can somebody clear this up for me? I have been in touch with Bea Ane's Maltese and when I asked her if she did this test, she told me that she doesn't need to because her dogs are healthy and she wouldn't sell a sick pup. 

Thanks.


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## Nikki's Mom

QUOTE (Lori @ Jul 14 2008, 05:11 PM) index.php?act=findpost&pid=605269


> After reading this thread, I'm a little confused as to whether or not you should insist on a bile liver test BEFORE bringing your puppy home. Can somebody clear this up for me? I have been in touch with Bea Ane's Maltese and when I asked her if she did this test, she told me that she doesn't need to because her dogs are healthy and she wouldn't sell a sick pup.
> 
> Thanks.[/B]



I would ask that the bile acid test be done before I purchased the puppy. No one can tell whether a puppy has a liver shunt or MVD unless the dog is tested, no matter how healthy the line seems to be.


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## BrookeB676

I would never buy another maltese (or yorkie for that matter) without having the results of bile acid tests. I personally think that a breeder who demands that their dogs are healthy and therefore don't need this test is being closed minded. While that may very well be the case, what would be the harm in having the extra piece of mind. The bile acid test is the best indicator of possible liver shunt/MVD without having to opt for an invasive option, such as a biopsy. And, a blood panel would not be enough for me as we have seen other dogs with normal blood levels (ALT) and they still have high bile acids. There are several great breeders out there, I would say to keep looking until you find one that is willing to work with your needs. After all, YOU are the one that has the responsibility of dealing with this once the puppy leaves the breeders hands. And once you get attached to a maltese, there is no giving them up should they become sick one day, or "trading" them for a healthy pup. I would say most everyone just deals with the heartache and takes care of their baby.


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## tamizami

QUOTE (Nikki's Mom @ Jul 14 2008, 02:16 PM) index.php?act=findpost&pid=605275


> QUOTE (Lori @ Jul 14 2008, 05:11 PM) index.php?act=findpost&pid=605269





> After reading this thread, I'm a little confused as to whether or not you should insist on a bile liver test BEFORE bringing your puppy home. Can somebody clear this up for me? I have been in touch with Bea Ane's Maltese and when I asked her if she did this test, she told me that she doesn't need to because her dogs are healthy and she wouldn't sell a sick pup.
> 
> Thanks.[/B]



I would ask that the bile acid test be done before I purchased the puppy. No one can tell whether a puppy has a liver shunt or MVD unless the dog is tested, no matter how healthy the line seems to be.
[/B][/QUOTE]

I also agree with this and BrookeB676. As JMM pointed out a few posts earlier, a simple blood chemistry panel may show normal ALT levels even if the dog has MVD/shunt. MVD does not necessarily mean a "sick pup", either. Many of them lead normal, asymptomatic lives well into their teens. Its estimated by Dr. Center that approximately 60% of maltese have MVD. JMM posted the reasons its important to have a baseline test while your pup is young (before you bring them home preferably) in this thread or another. The goal is to identify liver shunt before getting a puppy and the bile acid test along with protein c is the only way to inexpensively rule out liver shunt.

I hope that helps clear it up.


----------



## ClaBec Maltese

I totally agree with what everyone else is saying. I think that it is almost a must this day and age with the shunts baring its nasty head to do the test. It does not harm the pup. I always wait until the puppy is at least 11 weeks old to do the test. That way they are normally heavy enough to go over night without eating.


----------



## lori

Thank you for all of your responses and for clearing this up for me. As I mentioned, I have been in contact with Bea Ane's Maltese regarding her puppies. After reading all of this info. on the need for a bile acid test, I emailed her again and told her that I would only take a puppy home if they were tested first -regardless of whether or not they were showing any symptoms. I asked her whether she would be willing to have the test done at MY expense. Here's her response: 

I called my Vet and they said you would be wasting your money. I guess you better try some where else. Best of luck in your search.............b

Hmmm.....I am very shocked that she wouldn't have the pup tested -regardless of whether or not it was a "waste" of money. After all, it was MY money that was being "wasted". Clearly, I will be looking elsewhere for a pup. I am so glad that I found this site to educate me and I thank you all for sharing your experiences with me-good and bad.


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## BrookeB676

QUOTE (Lori @ Jul 15 2008, 11:51 AM) index.php?act=findpost&pid=605702


> Thank you for all of your responses and for clearing this up for me. As I mentioned, I have been in contact with Bea Ane's Maltese regarding her puppies. After reading all of this info. on the need for a bile acid test, I emailed her again and told her that I would only take a puppy home if they were tested first -regardless of whether or not they were showing any symptoms. I asked her whether she would be willing to have the test done at MY expense. Here's her response:
> 
> I called my Vet and they said you would be wasting your money. I guess you better try some where else. Best of luck in your search.............b
> 
> Hmmm.....I am very shocked that she wouldn't have the pup tested -regardless of whether or not it was a "waste" of money. After all, it was MY money that was being "wasted". Clearly, I will be looking elsewhere for a pup. I am so glad that I found this site to educate me and I thank you all for sharing your experiences with me-good and bad.[/B]


Kudos to you for being so patient and extremely responsible in purchasing your new maltese baby. Not to worry, there are so many great maltese breeders out there with puppies available now that would be willing to work with you. I really admire your persistence and understanding how important these things are with this particular breed. I can tell you that I was not this way when I purchased my first yorkie five years ago! While there is no guarantee that with all the tests in the world that your baby will be 100% healthy, it sure does give you a much better chance. After all, who wants to play russian roulette when it comes to purchasing a puppy companion.


----------



## MaryH

QUOTE (Lori @ Jul 15 2008, 12:51 PM) index.php?act=findpost&pid=605702


> Thank you for all of your responses and for clearing this up for me. As I mentioned, I have been in contact with Bea Ane's Maltese regarding her puppies. After reading all of this info. on the need for a bile acid test, I emailed her again and told her that I would only take a puppy home if they were tested first -regardless of whether or not they were showing any symptoms. I asked her whether she would be willing to have the test done at MY expense. Here's her response:
> 
> I called my Vet and they said you would be wasting your money. I guess you better try some where else. Best of luck in your search.............b
> 
> Hmmm.....I am very shocked that she wouldn't have the pup tested -regardless of whether or not it was a "waste" of money. After all, it was MY money that was being "wasted". Clearly, I will be looking elsewhere for a pup. I am so glad that I found this site to educate me and I thank you all for sharing your experiences with me-good and bad.[/B]


Lori,

I know of two pups available, one male and one female, 16 wks. old, champion sire and dam, they have been bile acid tested already (and got good results). Both the sire and dam have been bile acid tested, too. Feel free to PM me if you would like further details.

MaryH


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## Tina

Across the board, most veterinarians in the US are going to tell you it is a waste of $. I consider my vet a very well educated man. When I brought up Dr. Center, he had no idea who she was. His lab book (a new one) did not list the Protein C. He had not heard of it either. I am on my daughter's snail dial up computer, so I am not looking up much. I get the feeling that the Protein C isn't a new test, but one that got thrown away awhile back. Mary correct anything I am saying if it's wrong. 
Most vets believe that testing the pups for liver shunt or MVD is going to come out normal 99% of the time. So, they think it is a waste of your money to do so. Vets in my area don't see very many people being proactive in the health of their dogs. Especially now with the economy crashing. If it's not something you have to have, people are not putting out the money for it. Puppies are not selling right now. Especially male puppies. I have, now with the new puppies, 5 males that need homes. I know of several breeders with puppies available right now. So, in light of all of this, veterinarians are not wanting to do testing that in most cases would be negative. We all know that it can show up at any time in any ones lines. Breeder's do listen to their veterinarians. And that is what Bea is doing. Her vet does't think it important and Bea is following his/her advise. 
One area people are not looking at is the trauma we are doing to these puppies at 10 to 12 weeks old. They are being held down and a needle is stuck in their little leg, not once but twice. It hurts, they are scared, it causes trauma. I know this is trivial in comparison to them having liver shunt show up later. As the breeder of Maltese I do take the responsibility of what I produce. In some ways it makes me be very embarressed to whelp puppies, but I like to show dogs and the only way I can afford a dog is to produce it myself. 
We've come a long way in the way we take care of pets now. 
Tina


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## jmm

We treat puppies on a regular basis...unless they're being manhandled, there is no reason for a puppy to be traumatized by a blood draw.


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## Nikki's Mom

My .02. I don't mean to offend, but I have my opinion.

Despite the extra cost and stress, I would insist on a bile acid test before I purchased another Maltese puppy from a breeder. Perhaps some breeders and vets think it is a waste of money and is too much stress for a 12 week old puppy, but I would want to know asap if the puppy had a shunt. Shouldn't the breeder and the vet want to know as soon as possible if a puppy has a shunt? Of course no test is 100% perfect and a shunt can be acquired later on, but we all know that Liver Shunt and MVD are genetic medical issues for Maltese. Approximately 3 months after purchase, the owner usually takes the pup in for a spay/neuter and usually gets bloodwork done pre op. If the pup has abnormal liver values, a bile acid test is usually done. So we're talking about a difference of three months, in stressing the pup. 

Perhaps it all comes down to deciding who really wants to know if the pup is okay, and when do they want to know it, and who ends up being responsible to care for a pup who has liver shunt or MVD.


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## MaryH

QUOTE (Tina @ Jul 16 2008, 02:24 PM) index.php?act=findpost&pid=606219


> I get the feeling that the Protein C isn't a new test, but one that got thrown away awhile back. Mary correct anything I am saying if it's wrong.[/B]


Actually, Tina, the Protein C test is a fairly new test. It is a human test that was modified by Cornell University and first used in early 2006 to test dogs who were suffering from aflotoxin poisoning (related to the Diamond Pet Food recall). Here's a link to that issue and the article talks about the Protein C test.

http://www.news.cornell.edu/stories/Jan06/....dying.ssl.html

QUOTE


> Most vets believe that testing the pups for liver shunt or MVD is going to come out normal 99% of the time. So, they think it is a waste of your money to do so.[/B]


As those of us who routinely test our Maltese know, the vets saying this are wrong. My vet, a Papillon breeder, is totally in synch with bile acid testing because of the known prevalence of liver issues in certain small breed dogs.

QUOTE


> One area people are not looking at is the trauma we are doing to these puppies at 10 to 12 weeks old. They are being held down and a needle is stuck in their little leg, not once but twice. It hurts, they are scared, it causes trauma.[/B]


Having been present during the blood draws for more than 20 dogs ranging in age from 7 weeks to 12 years old, I promise you that I've never seen a dog react any differently than when they are getting vaccinations.

QUOTE


> As the breeder of Maltese I do take the responsibility of what I produce. In some ways it makes me be very embarressed to whelp puppies, but I like to show dogs and the only way I can afford a dog is to produce it myself.[/B]


Tina, you are knowledgeable, act responsibily, and obviously care tremendously for your dogs. No need for you to be embarrassed about anything!

MaryH


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## Cosy

The trauma of a blood draw at 12 weeks compared to 
LS surgery later is miniscule. Vets who are not educated
in this area should not be taken at their word. Breeders who
are on forums and keep up with the problems in their breed
know vets don't always know it all when it comes to every 
breed and disease, disorder and inherited problems.


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## jmm

It is not only the pet owner knowing what they're getting. As a breeder, you need to know what you are producing. If you don't test the puppies or require owners to do so and return the results to you, you're keeping blinders on.


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## BrookeB676

QUOTE (Tina @ Jul 16 2008, 01:24 PM) index.php?act=findpost&pid=606219


> Across the board, most veterinarians in the US are going to tell you it is a waste of $. I consider my vet a very well educated man. When I brought up Dr. Center, he had no idea who she was. His lab book (a new one) did not list the Protein C. He had not heard of it either. I am on my daughter's snail dial up computer, so I am not looking up much. I get the feeling that the Protein C isn't a new test, but one that got thrown away awhile back. Mary correct anything I am saying if it's wrong.
> Most vets believe that testing the pups for liver shunt or MVD is going to come out normal 99% of the time. So, they think it is a waste of your money to do so. Vets in my area don't see very many people being proactive in the health of their dogs. Especially now with the economy crashing. If it's not something you have to have, people are not putting out the money for it. Puppies are not selling right now. Especially male puppies. I have, now with the new puppies, 5 males that need homes. I know of several breeders with puppies available right now. So, in light of all of this, veterinarians are not wanting to do testing that in most cases would be negative. We all know that it can show up at any time in any ones lines. Breeder's do listen to their veterinarians. And that is what Bea is doing. Her vet does't think it important and Bea is following his/her advise.
> One area people are not looking at is the trauma we are doing to these puppies at 10 to 12 weeks old. They are being held down and a needle is stuck in their little leg, not once but twice. It hurts, they are scared, it causes trauma. I know this is trivial in comparison to them having liver shunt show up later. As the breeder of Maltese I do take the responsibility of what I produce. In some ways it makes me be very embarressed to whelp puppies, but I like to show dogs and the only way I can afford a dog is to produce it myself.
> We've come a long way in the way we take care of pets now.
> Tina[/B]


Interesting how vet opinions differ so dramatically from one another. While I am not a breeder, and therefore do not have to worry about spending additional money to test my pups, I wanted to add my thoughts in case anyone comes to read this post and interprets possible inaccurate information. I take a strong interest in this particular subject as I have had to read a lot and learn a lot because of our tests with Louis.

I think it is quite the contrary from what you are saying, as in fact, many pups will have elevated bile acids (not normal) even though they actually don't have shunt. Hence why it is estimated 50-60% of maltese have MVD (although I think that sounds a little high and am not quoting that number specifically, the point is that MVD is quite common and would be assumed with high bile acids if no shunt is found). 

Also, having a bile acid test performed on a pup doesn't neccesarily mean you have to rely on the Pro C test that your vet hasn't heard of. That just happens to be the least invasive way to assume your pup does not have shunt. Other options that a vet may recommend include a biopsy, ultrasound, or a scintigraphy. All have their pros/cons. I just bring this up because you mix Dr. Center and the Pro C test in the same conversation as the bile acid test. I'm not sure anyone is discussing the reliability or neccesity of the Pro C test at this point. 

I would think that in a hurting economy, vets would be even more willing to perform any test that a patient would want. While I would have to agree that you could assume people may not be as proactive in the health of their dogs due to the economy, that doesn't mean that breeders shouldn't be proactive when they are selling pups. I'm also not trying to suggest that vets are greedy, but I certainly wouldn't expect a vet to discourage a test that a dog owner would want, if it gives the owner piece of mind and the vet some additional cash. The original poster offered to pay for the bild acid test to be performed, which seems completely reasonable to me.


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## ClaBec Maltese

I do want to add my experience with vets in my town in this thread. I was and I strongly say WAS seeing a vet that had no clue about liver shunts and bile acids except how to preform the test, did not want to do anything out of their way to get all my adults tested, and when I had my very first test done they had the wrong name on the results. Not to mention their was nine different vets at this hospital. So I changed vets. 

In my interviewing of new vets one of the very first questions was their opinion on Liver Shunts and about Dr Center if they knew of her. He began to tell me things that I had learned through the Internet and my mentors, told me where Dr Center is located and so on and so forth.

The point I am trying to make here is, I do not live in a small town. It is not a big city by any means but not a small town. And there were two different clinics with different views on liver shunt and testing. Some vets go above and beyond their call by learning what they can about the dogs and what is going on. While some sit and spin their wheels. And I know for a fact first hand that my former vet was spinning their wheels.


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## MaryH

I don't think we should blame the vets who are advising against doing bile acid tests in all cases. Looking at the big picture, there is only a very very small percentage of breeds who are born with liver issues. In the largest percentage of breeds, testing puppies will produce normal results because they are breeds don't have genetic liver issues. As educated owners we should be sharing our knowledge of our breed with our vets because our vets can't possibly keep current on every issue and every development in every breed. It's what our vets choose to do with the knowledge that should be why we decide to continue using our vet or find a new one. And there really are vets out there who will try to help their breeder clients save money. Some vets are also breeders/exhibitors and they know first hand the costs involved in developing and maintaining a solid responsible breeding program. Of those vet, some (mine for one) are very generous with discounting their charges for their breeder clients. By giving a break to a breeder client a vet helps the breeder to continue to be able to afford to breed and show good sound dogs and in return if the breeder is selling some of his or her pets locally the vet may pick up some new clients.

MaryH


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## Tina

QUOTE


> Nikki's Mom wrote: Perhaps it all comes down to deciding who really wants to know if the pup is okay, and when do they want to know it, and who ends up being responsible to care for a pup who has liver shunt or MVD.[/B]


I think you are right with this one sentence. It is something to think about.

All I was pointing out is that Bea is following her veterinarian's advice. I was pointing out that "general" (meaning not specialized) veterinarians think about this issue in very different ways. Even in the same clinic.


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## ClaBec Maltese

QUOTE (Tina @ Jul 17 2008, 12:21 AM) index.php?act=findpost&pid=606591


> QUOTE





> Nikki's Mom wrote: Perhaps it all comes down to deciding who really wants to know if the pup is okay, and when do they want to know it, and who ends up being responsible to care for a pup who has liver shunt or MVD.[/B]


I think you are right with this one sentence. It is something to think about.

All I was pointing out is that Bea is following her veterinarian's advice. I was pointing out that "general" (meaning not specialized) veterinarians think about this issue in very different ways. Even in the same clinic. 


[/B][/QUOTE]
Thank you for clarifying this for me Tina. I was at a loss. And that is why I said what I said about the vets doing things different ways. Some vets obviously do not see the need for the testing. I do not agree with them. But there are those that do and we can not hold it against them for following what their vet suggested. 

I do want to add that I was already about ready to change my vet before the incident with the bile acids test. Because of my Ezekiel. We all remember him. And now when I think of it when I told the vet to do what they had to do to find out what was wrong with him in the beginning they did not do the bile acids test. They ran test and I got results. But at that time I did not know anything about the test or liver shunt in general. I had just gotten on a computer for the first time in my whole life. And now hind site 20/20 I truly believe my baby had a shunt even though they said no he did not. He had all of the signs. He produced crystals so bad they had to re route his urethra and litterly made him a vagina. Then he got to feeling better because he was passing the crystals. But not for long. Four short months later he took his last breathe because he blew every disk in his lower back and they said there was nothing we could do but try and keep him as comfortable as possible but did not know if we could even do that. So we made the decision and he went to the bridge. 

Now I have a question. Mary, Tina, maybe one of you or someone can answer this. He was producing those crystals for a reason. He showed every sign of a shunt. If he did have the shunt and would have had the surgery wouldn't the crystals have stopped forming and he would have had the padding around his disk that the crystals had taken away? Or am I way off base here on this. I don't know. I guess I just really want answers. And I probably will never get any. 

Sorry guys for taking up so much time. I do want to say this before I end this post. All Breeders do things for certain reasons. I test my dogs and take top care of my dogs because I do not want to produce another baby that has to go through what my Ezekiel did and I do not want a innocent loving family suffer the way I still suffer to this day. 

OK again I am sorry for taking up so much time.


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## Nikki's Mom

QUOTE (Tina @ Jul 17 2008, 01:21 AM) index.php?act=findpost&pid=606591


> QUOTE





> Nikki's Mom wrote: Perhaps it all comes down to deciding who really wants to know if the pup is okay, and when do they want to know it, and who ends up being responsible to care for a pup who has liver shunt or MVD.[/B]


I think you are right with this one sentence. It is something to think about.

All I was pointing out is that Bea is following her veterinarian's advice. I was pointing out that "general" (meaning not specialized) veterinarians think about this issue in very different ways. Even in the same clinic. 


[/B][/QUOTE]

Yes, I've come across two vets personally who were clueless about Liver shunt and MVD. The most important issue is the health of the dog. If a buyer is willing to pay for the bile acid test, then there is no reason it shouldn't be done. Find a vet who will do it. But even if a buyer doesn't want to pay, I believe that Maltese breeders should have this test done before they sell the puppies. If their vet won't work with them then they should find another vet. It's the dog's health that is the most important thing here, not the vet's opinion. I respect veterinarians, but they do not make decisions FOR me and never will.


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## jmm

QUOTE (Clabec Maltese @ Jul 17 2008, 12:55 AM) index.php?act=findpost&pid=606600


> Now I have a question. Mary, Tina, maybe one of you or someone can answer this. He was producing those crystals for a reason. He showed every sign of a shunt. If he did have the shunt and would have had the surgery wouldn't the crystals have stopped forming and he would have had the padding around his disk that the crystals had taken away? Or am I way off base here on this. I don't know. I guess I just really want answers. And I probably will never get any.
> 
> Sorry guys for taking up so much time. I do want to say this before I end this post. All Breeders do things for certain reasons. I test my dogs and take top care of my dogs because I do not want to produce another baby that has to go through what my Ezekiel did and I do not want a innocent loving family suffer the way I still suffer to this day.
> 
> OK again I am sorry for taking up so much time.[/B]


If he was a candidate for surgical correction and it was successful then yes, it should stop the crystal formation. Often times medical management can help reduce these problems as well for dogs who are not candidates for surgery. Each case is individual.


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## luvmyfurbaby

I think we should find vets and also breeders that are willing to learn and accomodate the clients wishes. My vet did not know about the Protien C test but she has heard of Dr. Center. She did do Bile Acids on P but she said they weren't necessary on the Malts when I told her I wanted to do it??? Same thing goes for the titers she said "oh they are expensive" I told her "Oh I'm the one paying".......LOL At least she humors me even if she thinks I spend to much time on dog forums and does what I ask even if she has never heard of it.


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## ClaBec Maltese

QUOTE (JMM @ Jul 17 2008, 06:47 AM) index.php?act=findpost&pid=606645


> QUOTE (Clabec Maltese @ Jul 17 2008, 12:55 AM) index.php?act=findpost&pid=606600





> Now I have a question. Mary, Tina, maybe one of you or someone can answer this. He was producing those crystals for a reason. He showed every sign of a shunt. If he did have the shunt and would have had the surgery wouldn't the crystals have stopped forming and he would have had the padding around his disk that the crystals had taken away? Or am I way off base here on this. I don't know. I guess I just really want answers. And I probably will never get any.
> 
> Sorry guys for taking up so much time. I do want to say this before I end this post. All Breeders do things for certain reasons. I test my dogs and take top care of my dogs because I do not want to produce another baby that has to go through what my Ezekiel did and I do not want a innocent loving family suffer the way I still suffer to this day.
> 
> OK again I am sorry for taking up so much time.[/B]


If he was a candidate for surgical correction and it was successful then yes, it should stop the crystal formation. Often times medical management can help reduce these problems as well for dogs who are not candidates for surgery. Each case is individual.
[/B][/QUOTE]
Thank you for the reply Jacki.


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## puppy

QUOTE (Malteseluv @ Sep 27 2007, 09:02 PM) index.php?act=findpost&pid=444090


> Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.
> As far as liver shunts and MVD goes. Most dogs who have liver shunt are diagnosed by the age of 1, but I have seen dogs much older than that be diagnosed, from 3-7 yrs old.
> When they have MVD, many times, symptoms go unnoticed, so the dog may not be diagnosed until 2,3, or even much older than that...
> Numbers above normal range but below 100, typically point more towards liver shunt.
> Numbers above 100, typically point more towards MVD.
> There are always exceptions to these "generalizations." I know of a yorkie whose numbers were under 100 and had a liver shunt, and I know several dogs, including my own, who have had number beyond 300 that have MVD.
> MVD and liver shunts are usually congenital, but it is possible for a dog to have an "acquired" shunt later in life also.
> About 15% of dogs who have liver shunt ligation surgery develop acquired shunts as well...[/B]


Hello,

I'm trying to understand the bile acid reading #s and am confushed by your example below. Could you please explain.

"Numbers above normal range but below 100, typically point more towards liver shunt.
Numbers above 100, typically point more towards MVD.

There are always exceptions to these "generalizations." I know of a yorkie whose numbers were under 100 and had a liver shunt, and I know several dogs, including my own, who have had number beyond 300 that have MVD."

Wouldn't the yorkie's and other examples follow the rule you gave and not be exceptions, if I'm understanding this right?

Thanks


:blink:


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## TwinkieMom

QUOTE (MaryH @ Sep 27 2007, 04:54 PM) index.php?act=findpost&pid=444045


> For any of you who may be thinking of running a bile acid test on your dog(s), there is a new test out, the IDEXX SNAP test for bile acids. Don't waste your money!! While you will get both pre- and postprandial values, the values are given in ranges -- <12; 12-25; >25. You might get a postprandial value of >25 but the test does not tell you how much greater than 25. And there's a huge difference between 26 and 200 but because all you get is >25, you've just spent good money for a worthless result and now you've got to spend more money to have a traditional bile acid test run to get a meaningful value. This may well be a worthwhile test for breeds that do not have liver issues but it is NOT a good test for Maltese.
> 
> Mary[/B]


So does that mean that we shouldn't do the bile acid test or not the IDEXX SNAP test? My vet said that we should do the bile acid test because my dog Twinkie is so tiny (1.6 pounds) and it's a good idea for him to get that test. Thank you for the understanding B) !!!


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## jmm

QUOTE (TwinkieMom @ Oct 23 2008, 09:00 PM) index.php?act=findpost&pid=656729


> So does that mean that we shouldn't do the bile acid test or not the IDEXX SNAP test? My vet said that we should do the bile acid test because my dog Twinkie is so tiny (1.6 pounds) and it's a good idea for him to get that test. Thank you for the understanding B) !!![/B]


DO NOT DO THE SNAP TEST. 

You want to do a bile acid assay with pre- and post-prandial samples sent to a lab.


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## TwinkieMom

QUOTE (JMM @ Oct 23 2008, 07:05 PM) index.php?act=findpost&pid=656733


> QUOTE (TwinkieMom @ Oct 23 2008, 09:00 PM) index.php?act=findpost&pid=656729





> So does that mean that we shouldn't do the bile acid test or not the IDEXX SNAP test? My vet said that we should do the bile acid test because my dog Twinkie is so tiny (1.6 pounds) and it's a good idea for him to get that test. Thank you for the understanding B) !!![/B]


DO NOT DO THE SNAP TEST. 

You want to do a bile acid assay with pre- and post-prandial samples sent to a lab.
[/B][/QUOTE]
Thank you soooo much! i didnt really know what the bile test really is. Our vet said that we had to drop Twinkie off and then they will feed him and 2 hours later, they will look at some kind of results and again feed him. I was confused! is this really the Bile Acid Test?


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## jmm

Yes. They take a blood sample, feed, take another blood sample 2 hours later.


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## rockydog

QUOTE (TwinkieMom @ Oct 23 2008, 09:13 PM) index.php?act=findpost&pid=656739


> QUOTE (JMM @ Oct 23 2008, 07:05 PM) index.php?act=findpost&pid=656733





> QUOTE (TwinkieMom @ Oct 23 2008, 09:00 PM) index.php?act=findpost&pid=656729





> So does that mean that we shouldn't do the bile acid test or not the IDEXX SNAP test? My vet said that we should do the bile acid test because my dog Twinkie is so tiny (1.6 pounds) and it's a good idea for him to get that test. Thank you for the understanding B) !!![/B]


DO NOT DO THE SNAP TEST. 

You want to do a bile acid assay with pre- and post-prandial samples sent to a lab.
[/B][/QUOTE]
Thank you soooo much! i didnt really know what the bile test really is. Our vet said that we had to drop Twinkie off and then they will feed him and 2 hours later, they will look at some kind of results and again feed him. I was confused! is this really the Bile Acid Test?
[/B][/QUOTE]

I have a Maltese puppy who is five months and 2 lbs. 13 oz- she has MVD- you can read up on all my stuff but she's doing great!


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## coconuts

QUOTE (MaryH @ Sep 30 2007, 10:34 PM) index.php?act=findpost&pid=445847


> QUOTE





> Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.[/B]


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

QUOTE


> Numbers above normal range but below 100, typically point more towards liver shunt.
> Numbers above 100, typically point more towards MVD.[/B]


I believe you have your numbers backwards in this statement.

QUOTE


> If your dog is asymptomatic and comes up with slightly elevated BAT results, then I think the test should be redone in 30 days. I don't see anything wrong with redoing a bile acid test in that fashion.[/B]


Quoting from p.17 of our handout:
"3. Dogs with MVD are monitored with serial biochemical profiles looking for evidence of active hepatobiliary injury (increased liver enzyme activity) or loss of synthetic function as part of their routine health assessments over their lifetime. _Serial bile acid values do not contribute to assessments of health status in these dogs unless they become profoundly increased._ Bile acid values do not quantitatively correlate with extent of liver injury due to their complex physiologic regulation. Dogs with MVD usually do not have ammonium biurate crystalluria or hyperammonemia." (all emphasis was added by Dr. Center)

In closing, I personally know two Maltese, one with a ligated shunt and the other with MVD, who are living in pet homes and have Dr. Center as their "regular" vet. Both were initially seen, tested, and diagnosed by Dr. Center, and the one with the shunt had the shunt ligated by a surgical team at Cornell under the watchful eye of Dr. Center. Neither of these dogs has been subjected to repeat bile acid testing. They have complete blood panels done at the time of their wellness exams to monitor liver enzyme levels. And Dr. Center advised all who attended her seminar that repeat bile acid testing is of no use in monitoring MVD dogs.

Mary
[/B][/QUOTE]


How did your friends dog with mvd do? My maltese is around 14 months old and was diagnosed with mvd around 7 months old. She had a elevated ATL so they did bile acid test that came back abnormal so I took her to Auburn University Vet School and they did test and couldn't find anything so they spayed her and took a liver biopsy and that is when the found it. She eat Science Diet L/D and hasn't ever shown any signs of liver problems. Blood work is perfect now ever time we test it.


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## Nikki's Mom

Nikki has MVD and is doing just fine. No problems at all. Everything is normal.


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## dwerten

my dee dee has mvd and is doing fine -- her pre and post were post only first 73.1, then pre 3 and post 54.9, and then on low protein diet purina ha pre 3.9 and post 27.4 - she is even on temarilp which affects liver and is fine and blood work normal including ALT but bile acids were high


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## jmm

I have 2...they eat normal diet and are healthy.


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## Furbaby's Mommie

Shoni is MVD, with normal ALT, and is doing fine at almost 2 yrs. old. He eats mostly dry Karma and canned California Natural lamb, yogurt, Missing Link Plus, and FortiFlora. Treats are Cheerios, bananas, Natural Balance.


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## Maglily

QUOTE (tamizami @ Jul 14 2008, 07:07 PM) index.php?act=findpost&pid=605290


> QUOTE (Nikki's Mom @ Jul 14 2008, 02:16 PM) index.php?act=findpost&pid=605275





> QUOTE (Lori @ Jul 14 2008, 05:11 PM) index.php?act=findpost&pid=605269





> After reading this thread, I'm a little confused as to whether or not you should insist on a bile liver test BEFORE bringing your puppy home. Can somebody clear this up for me? I have been in touch with Bea Ane's Maltese and when I asked her if she did this test, she told me that she doesn't need to because her dogs are healthy and she wouldn't sell a sick pup.
> 
> Thanks.[/B]



I would ask that the bile acid test be done before I purchased the puppy. No one can tell whether a puppy has a liver shunt or MVD unless the dog is tested, no matter how healthy the line seems to be.
[/B][/QUOTE]

I also agree with this and BrookeB676. As JMM pointed out a few posts earlier, a simple blood chemistry panel may show normal ALT levels even if the dog has MVD/shunt. MVD does not necessarily mean a "sick pup", either. Many of them lead normal, asymptomatic lives well into their teens. Its estimated by Dr. Center that approximately 60% of maltese have MVD. JMM posted the reasons its important to have a baseline test while your pup is young (before you bring them home preferably) in this thread or another. The goal is to identify liver shunt before getting a puppy and the bile acid test along with protein c is the only way to inexpensively rule out liver shunt.

I hope that helps clear it up.
[/B][/QUOTE]



If a test was not done as a puppy, it is recommended to get it done sooner than later . Jodi is 2 years old (has no problems) but should I ask for the bile acid test so I have baseline information if needed in the future ?


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## jmm

Yes, I think it is a good idea to get a baseline. That way if your dog gets sick later on, the vet won't find the results alarming if you already know the dog has MVD numbers. Its a good way to avoid unnecessary procedures later in life.


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## Maglily

QUOTE (JMM @ May 12 2009, 10:42 AM) index.php?act=findpost&pid=775070


> Yes, I think it is a good idea to get a baseline. That way if your dog gets sick later on, the vet won't find the results alarming if you already know the dog has MVD numbers. Its a good way to avoid unnecessary procedures later in life.[/B]



Thanks, I'll ask for it. BTW, what does MVD mean?


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## dwerten

Microvascular dysplasia also known as HMD as it gets confused with heart disease mvd alot 

http://www.yorkieangelpatrol.com/mvd.htm


QUOTE (Maglily @ May 12 2009, 09:19 AM) index.php?act=findpost&pid=775091


> QUOTE (JMM @ May 12 2009, 10:42 AM) index.php?act=findpost&pid=775070





> Yes, I think it is a good idea to get a baseline. That way if your dog gets sick later on, the vet won't find the results alarming if you already know the dog has MVD numbers. Its a good way to avoid unnecessary procedures later in life.[/B]



Thanks, I'll ask for it. BTW, what does MVD mean?
[/B][/QUOTE]


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## Maglily

Jodi got his booster vaccines today, and I arranged a bile acid test for next week, just to get the baseline #'s.

With re to teeth, he doesn't have much tartar, just a small amount , thankfully nothing alarming but I did get some toothpaste (CET ) and some dental chew samples (with enzymes) , one is a CET product, one is Medi-cal. For other dental treats I was given some very large pieces of Medi-cal dental and T/D small bites (which i think is a Hills product - I think a no no to most here).

Are these good choices for chews ?

And just to boot, Jodi is 1 lb heavier than last year....he is 9.6 lbs vs. last years 8.6 lbs. I swithched the scale to kg...and he was an even 4 kg. (but we don't have to go there haha). I have to watch his weight he is at his max.


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## dwerten

the cet chews have chlorhexedine in them which helps keep bacteria down in mouth - make sure vet dental products do not have sorbitol in them as some do and that is not good for dogs - brushing is the best -- i use gauze around a cotton swab as best for small mouths and cet enzymatic tooth paste chicken flavor as i think the vanilla mint has sorbitol in it 


QUOTE (Maglily @ May 13 2009, 08:41 PM) index.php?act=findpost&pid=775984


> Jodi got his booster vaccines today, and I arranged a bile acid test for next week, just to get the baseline #'s.
> 
> With re to teeth, he doesn't have much tartar, just a small amount , thankfully nothing alarming but I did get some toothpaste (CET ) and some dental chew samples (with enzymes) , one is a CET product, one is Medi-cal. For other dental treats I was given some very large pieces of Medi-cal dental and T/D small bites (which i think is a Hills product - I think a no no to most here).
> 
> Are these good choices for chews ?
> 
> And just to boot, Jodi is 1 lb heavier than last year....he is 9.6 lbs vs. last years 8.6 lbs. I swithched the scale to kg...and he was an even 4 kg. (but we don't have to go there haha). I have to watch his weight he is at his max.[/B]


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## Maglily

I will check re the sorbitol, thanks for the info DW.


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## yumyum

QUOTE (Dr.Jaimie @ Sep 28 2007, 10:50 AM) index.php?act=findpost&pid=444319


> yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.[/B]


Please, who is Dr. Center. I am looking for help getting my service dog the liver shunt surgery. 

I purchased a one year old Squaw Creek Kennels bred Maltese from Sportsman's Kennels on May 18, 2008 for a service dog. She came with 3 health certificates. In March 2009, I took her to be spayed. Blood work for anesthesia revealed 3 elevated liver enzymes. Bile acid tests were elevated and revealed her liver function is abnormal. These indicate either a portosystemic liver shunt or microvascular shunts, both Congenital Conditions that would be undiscoverable until symptomatic, without specific blood tests. 

Several professionals believe that Pollyanna was sold and returned, and perhaps her condition was known, partly because the kennel only produced 4 months of vet records ending in September 2007 for a year of residence. They also sold her for less than half the original asking price.

I went out to Sportsmans Kennels on Friday with Pollyanna to ask them to pay the $1800 diagnostic fees and $3000 surgery fees I was quoted. Helen, the owner, told me I was legally entitled to nothing because of the Lemon Law that protects the Kennel after 2 weeks. After 2 hours discussion, Helen, said she would pay for the portogram and necessary surgery. She reiterated this over and over. 

On Monday, I called my vet and told him Sportsmans Kennels had assured me she would pay for the care. He called Helen and she shouted him down and told him that she had reconsidered and would not honor her verbal commitment to me. 

She called me the next night yelling. She said her vets said it was "overkill" to treat this dog. She said that the dog is too small and will die in surgery. She said she would give me $1300 for the dog, I could keep her but don't treat her, and a puppy: because Pollyanna “would have a short life and I could train the puppy to be a service dog and then when Pollyanna dies you well not feel bad.” I told her Pollyanna could be saved if I had the money. She said I was entitled to nothing; she said her vets said it was probably just an infection. I told her that her Web site claims a 2 year Genetic Guarantee and she said that only reimburses the price of the dog. . I told her I would contact Squaw Creek Kennels if she didn't feel it was her responsibility, and she warned me not to contact "Ed", "If you call Ed, you are done with me." 

My vet sent all the blood work to her vets by Friday. On Saturday she called me and told me she had no legal obligation. I reminded her repeatedly that she had made a verbal contract with me to pay the portagram and the surgery. She said she never said she would do the right thing. "I don't talk like that." She was furious. She said her vets said it could be 100 things and was most likely a bacterial infection. She said I lied when I said the dog was going to die, and that I committed slander against her. I said that is what I was told. 

After insisting that she would not pay, she said she wanted the dog on antibiotics for one week and then wanted the blood work (which was done twice) redone by her vets. She said she wanted the sonogram and portogram by her vets. I said, by somebody impartial, and she said no, her people. She was supposed to call on Monday but never called. 

Since my dog is getting worse and since my vet and blood work say she does not have an infection, I decided to borrow the money and have a sonogram done. Unfortunately, the sonogram (only 25% reliable to reveal a shunt but necessary to see if the other organs are normal. The portogram is 100% reliable and more expensive.) showed that Pollyanna has an "extra vessel" which could be a true shunt or a vessel caused by microshunts. A portagram will specify. Her liver is normal size on the right and extra small on the left. 

Read "Puppy Mill Probe .." on Topix. http://www.topix.com/forum/city/east-north...PGKDT0GOJ2F6O03


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## Ladysmom

QUOTE (YumYum @ Jun 17 2009, 02:12 AM) index.php?act=findpost&pid=792410


> QUOTE (Dr.Jaimie @ Sep 28 2007, 10:50 AM) index.php?act=findpost&pid=444319





> yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.[/B]


Please, who is Dr. Center. I am looking for help getting my service dog the liver shunt surgery. 

I purchased a one year old Squaw Creek Kennels bred Maltese from Sportsman's Kennels on May 18, 2008 for a service dog. She came with 3 health certificates. In March 2009, I took her to be spayed. Blood work for anesthesia revealed 3 elevated liver enzymes. Bile acid tests were elevated and revealed her liver function is abnormal. These indicate either a portosystemic liver shunt or microvascular shunts, both Congenital Conditions that would be undiscoverable until symptomatic, without specific blood tests. 

Several professionals believe that Pollyanna was sold and returned, and perhaps her condition was known, partly because the kennel only produced 4 months of vet records ending in September 2007 for a year of residence. They also sold her for less than half the original asking price.

I went out to Sportsmans Kennels on Friday with Pollyanna to ask them to pay the $1800 diagnostic fees and $3000 surgery fees I was quoted. Helen, the owner, told me I was legally entitled to nothing because of the Lemon Law that protects the Kennel after 2 weeks. After 2 hours discussion, Helen, said she would pay for the portogram and necessary surgery. She reiterated this over and over. 

On Monday, I called my vet and told him Sportsmans Kennels had assured me she would pay for the care. He called Helen and she shouted him down and told him that she had reconsidered and would not honor her verbal commitment to me. 

She called me the next night yelling. She said her vets said it was "overkill" to treat this dog. She said that the dog is too small and will die in surgery. She said she would give me $1300 for the dog, I could keep her but don't treat her, and a puppy: because Pollyanna “would have a short life and I could train the puppy to be a service dog and then when Pollyanna dies you well not feel bad.” I told her Pollyanna could be saved if I had the money. She said I was entitled to nothing; she said her vets said it was probably just an infection. I told her that her Web site claims a 2 year Genetic Guarantee and she said that only reimburses the price of the dog. . I told her I would contact Squaw Creek Kennels if she didn't feel it was her responsibility, and she warned me not to contact "Ed", "If you call Ed, you are done with me." 

My vet sent all the blood work to her vets by Friday. On Saturday she called me and told me she had no legal obligation. I reminded her repeatedly that she had made a verbal contract with me to pay the portagram and the surgery. She said she never said she would do the right thing. "I don't talk like that." She was furious. She said her vets said it could be 100 things and was most likely a bacterial infection. She said I lied when I said the dog was going to die, and that I committed slander against her. I said that is what I was told. 

After insisting that she would not pay, she said she wanted the dog on antibiotics for one week and then wanted the blood work (which was done twice) redone by her vets. She said she wanted the sonogram and portogram by her vets. I said, by somebody impartial, and she said no, her people. She was supposed to call on Monday but never called. 

Since my dog is getting worse and since my vet and blood work say she does not have an infection, I decided to borrow the money and have a sonogram done. Unfortunately, the sonogram (only 25% reliable to reveal a shunt but necessary to see if the other organs are normal. The portogram is 100% reliable and more expensive.) showed that Pollyanna has an "extra vessel" which could be a true shunt or a vessel caused by microshunts. A portagram will specify. Her liver is normal size on the right and extra small on the left. 

Read "Puppy Mill Probe .." on Topix. http://www.topix.com/forum/city/east-north...PGKDT0GOJ2F6O03
[/B][/QUOTE]


Dr. Center is at Cornell. Here is her contact information:

http://www.vet.cornell.edu/faculty/Center/

Where are you located? Dr. Tobias at the University of Tennessee is also an expert on liver shunts.


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## jmm

It is not always a good idea to surgically correct a shunt in a Maltese. Have your vet call and page Dr. Center to discuss the case. Many dogs do very well on special diet and medication for many, many years.


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## yumyum

Hi LadysMom and JMM,

Thank you so very much for the contact information. I am desperate to save Pollyanna and really appreciate your kind help. 
The Kennel told me don't treat her, just let her die; that she will die in the surgery anyway because she is too small. She is only 2 years old. 
And so very sweet, energetic and imaginative. She is a trained service dog. I can't believe that God sent her to me after I lost Yum Yum, just so she could die. I believe that he knew I would fight for her with the same conviction I fought my own multiple melanoma.


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## CJ Maltese Mom

Our one year-old, male, 3.8 pound maltese was diagnosed with a liver shunt last week. We are trying to medically manage this with ld food, metamucil, lactulose and metriniazole. Surgery is to costly for us. Is anyone managing their maltese this way?


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## Pure Paws

Since the subject of the liver has come up. Have you ever seen this site The Rabies Vaccine for Dogs: Side Effects and Precautions You Can Take


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## Ladysmom

CJ Maltese Mom said:


> Our one year-old, male, 3.8 pound maltese was diagnosed with a liver shunt last week. We are trying to medically manage this with ld food, metamucil, lactulose and metriniazole. Surgery is to costly for us. Is anyone managing their maltese this way?


I'd suggest starting a new thread to get some feedback.

Was surgery recommended and just too expensive or did your vet feel it could managed without surgery?


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## tamizami

also, not to second guess your vet or specialist, but how was the shunt diagnosed?


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## Nikki's Mom

Yes, please start a new thread about your dog's shunt. Some folks might miss this thread.


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## bfab116

Hi, i'm just reading this thread about liver shunts and bile acid tests. My little guy just had a bile acid done and it was 238. The vet says it is liver shunt. I'm in the investigational stage right now. I'm also in PA. Could you tell me who did your surgery and how is your precious malt now? Any advice would be greatly appreciated. Please e-mail me at [email protected]
Thanks Barb Fabrizio


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## Chri77pher88

I think that most of the time it is congenital, but they can develop shunts over time due to liver disease. 
__________________


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## Debra

Malteseluv said:


> Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.
> As far as liver shunts and MVD goes. Most dogs who have liver shunt are diagnosed by the age of 1, but I have seen dogs much older than that be diagnosed, from 3-7 yrs old.
> When they have MVD, many times, symptoms go unnoticed, so the dog may not be diagnosed until 2,3, or even much older than that...
> Numbers above normal range but below 100, typically point more towards liver shunt.
> Numbers above 100, typically point more towards MVD.
> There are always exceptions to these "generalizations." I know of a yorkie whose numbers were under 100 and had a liver shunt, and I know several dogs, including my own, who have had number beyond 300 that have MVD.
> MVD and liver shunts are usually congenital, but it is possible for a dog to have an "acquired" shunt later in life also.
> About 15% of dogs who have liver shunt ligation surgery develop acquired shunts as well...


I adopted a little girl in Sept and had Bile Acid test done. Most numbers was within range. Alt was 86 reference range is 8-75......GGT 11 ref range is 0-2......Glu 185 ref range is 77-150. vet wants me to have ultrasound...Has anyone had these test?


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## Debra

I adopted a little girl in Sept and had Bile Acid test done. Most numbers was within range. Alt was 86 reference range is 8-75......GGT 11 ref range is 0-2......Glu 185 ref range is 77-150. vet wants me to have ultrasound...Has anyone had these test?


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## jmm

If she is otherwise healthy, I'd wait and retest in 4-6 weeks.


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## MaryH

What were the bile acid test results? The results you posted would have been from a blood panel and none of those results seem so remarkable as to warrant an ultrasound. Did you have a bile acid test done? A paired sample ... meaning a blood draw, feed a meal, wait 2 hours, and then a second blood draw? If you had that done you will get two results, one from each blood draw.


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## Grace'sMom

Hope this is okay I post this here... I know this is an ongoing post, but hasn't been responded to in a year.... 

In Grace's case - all the vets believe her liver issues are from her vaccine injury.

They are hoping her liver heals itself......

So does repeating the BAT in her case seem worthwhile?

We've done 2 now, waiting on her 3rd (done today)..... her 2nd was better than the 1st. But still high (need to get copies of results so I can post them).....hoping the 3rd comes back better.

In a case where the liver damage was *caused* by something like a vaccine mistake - would the BAT ever be normal?

Or is it just a waste of time and since Grace has liver issues she will always have liver issues?


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## nycmermaid

Unfortunately, we had the same issue with our maltese. The vet believes that they are born with the liver shunt....it just inevitably gets worse with time. The good news is that I really managed to keep her heath under control with a lot of hard work, she lived to be almost 13. You must NOT feed the dog anything with any protein in it!!! The only acceptable dog food is Science Diet L/D - for Liver Disease. Absolutely no table food ever or dog treats with protein in it. We gave her crackers as a treat. You also cannot give any medications that are not absolutely necessary - they compromise the liver too. Also exposure to chemicals: lawn, cleaning, etc. adds to liver damage. You must be very viligant. Let me know if you have any further questions. Good luck!


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## Grace'sMom

nycmermaid said:


> You must NOT feed the dog anything with any protein in it!!! The only acceptable dog food is Science Diet L/D - for Liver Disease. Absolutely no table food ever or dog treats with protein in it. We gave her crackers as a treat.


Protein is essential to all cells. You have to have protein so that their bodies can work, heal, regenerate any damage.... Protein is essential.

Protein needs limited. And the best form of protein for "liver dogs" is vegetarian. You do feed lower protein, but it is important to feed some protein otherwise the dog will go into HE (Hepatic Encephalopathy).

Grace eats a very clean and simple home cooked diet. She is given plenty of bright colorful veggies that will give her good vitamins and antioxidants. She is fed vegetarian protein (dairy, eggs, tofu, legumes). Occasionally she has a small amount of white fish. But always in a mix of the other proteins.


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## rossipiperscout

Tori,

I'm curious to find out more about Gracie's vaccine injury. Can you give more info on that?

We just had Scouts BAT and the vet said her numbers are very high. Although she has no symptoms, they suspect a shunt. But she hasn't yet had any ultra sounds/MRI or CT to back up the diagnosis. All this happened recently, as she was about to be spayed and we got the pre-surgery blood results.

She got very sick after her Lepto vaccine. Is there a coincidence?


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