# So worried!!



## uyu uyu uyu (7 mo ago)

I am a new poster here, but long time lurker. Love seeing all the photos of the fur babies. I have a 2 year old maltese named Uyu who is just the cutest and is the best thing to happen to me. I'm so worried right now because he's been having tummy issues/diarrhea for the past 2-3 days, being a little lethargic, and shaking & shivering at night. I brought him to the vet today after fasting him all day yesterday. They did a blood test and they said his liver enzyme level came out as "no readings" which could mean that it's extremely high?! The vet then did a liver panel, which they will let me know the results of on Thursday.

Of course I started reading about high liver enzyme levels online and have thoroughly freaked myself out. I know there's not much for me to do until the results come back but I am a mess! I am so nervous that he might be sick. He's on my lap sleeping now, still low-energy 

Here is a picture of him, usually so hyper!


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## edelweiss (Apr 23, 2010)

I am sorry to hear about your baby! Please try to stay calm as he assumes your energy & you need for him to do his best regardless of his readings. Let us know what the results are & we can help direct you for help! Where are you located as maybe we have someone nearby who can advise you. Have you done a Bile Acids Assay or test? That is a special 2 tier test that one has to request be done at about 16 weeks to see if your pup has a shunt & gives you a baseline for any future liver issues?


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## uyu uyu uyu (7 mo ago)

The results came back and the vet thinks he has severe liver disease based on the numbers. 
ALT 8146
AST 1060 
Bile acid pre 17
Bile acid post 99

I am checking him in at the emergency/specialty vet now and so scared. How could this happen? He was fine a week ago. I am so scared. 

I’m in Los Angeles. I don’t think we ever got the special tier test done at 16 weeks? I didn’t know.


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## uyu uyu uyu (7 mo ago)

Has anyone even seen ALT numbers that high? It seems absolutely crazy???


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## edelweiss (Apr 23, 2010)

Walter, can you jump in here? You are by far the most experienced in this area. i did have a liver shunt dog but it was a long time ago & I know treatments have changed.


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## uyu uyu uyu (7 mo ago)

The doctor at the specialty hospital believes it’s likely a shunt. She will do an ultrasound. She also wants to do a CT scan but can’t proceed until he’s more stable to handle the anesthesia… this is a nightmare. 😓😓😓 
His blood work was perfectly normal back in January, I am having a hard time understanding how quickly this happened.


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## mss (Mar 1, 2006)

It seems strange it would come on so suddenly. I wonder if a gall bladder problem with clogged bile ducts could cause the liver damage. One of my dogs had a gallbladder mucocele in her senior year and needed surgery, but unfortunately she got aspiration pneumonia. I think another of my dogs might have had that, before they were sufficiently recognized. They show up on ultrasound, but I believe they do not show up on x-rays.


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## uyu uyu uyu (7 mo ago)

mss said:


> It seems strange it would come on so suddenly. I wonder if a gall bladder problem with clogged bile ducts could cause the liver damage. One of my dogs had a gallbladder mucocele in her senior year and needed surgery, but unfortunately she got aspiration pneumonia. I think another of my dogs might have had that, before they were sufficiently recognized. They show up on ultrasound, but I believe they do not show up on x-rays.


Thanks for sharing. They did an ultrasound today and could not see anything unusual. The doctor said it’s common not to be able to see shunts via ultrasound in small dogs (he is only 4.8 lbs) and that she wants to do a CT.

She did mention that they did a blood test again today and his ALT went down to 3000, and AST 300. Still extremely high and not great, but better than the previous numbers… 

I went to visit him earlier today after he was admitted for overnight hospitalization and my heart is so sad and so scared. This is the first time he’s not spending the night at home.


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## wkomorow (Aug 26, 2011)

The ALT or ASP numbers are very high, you will need diet and medication to get them down and have them rechecked in a month or so. I think it would point to an internal injury of some type or if the dog got into something toxic. It could also be a digestive problem. Dogs with shuts would not normally have enzyme values that high. Lucky's were always a few points within normal. Not always, but normally post bile acids under 100 point to MVD rather than a shunt. The next test would be a simple blood test called a protein-c which can help distinguish between a shunt and MVD. The good news is that if it is a shunt, many dogs can live a normal life with medication and diet. If is really important to find an internist that specializes in toy breeds. Let me know of any questions I can answer. Good Luck and try not to worry too much; remember the results of any blood test is a snapshot, and all sorts of things cou!d contribute to elevated values.


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> Thanks for sharing. They did an ultrasound today and could not see anything unusual. The doctor said it’s common not to be able to see shunts via ultrasound in small dogs (he is only 4.8 lbs) and that she wants to do a CT.
> 
> She did mention that they did a blood test again today and his ALT went down to 3000, and AST 300. Still extremely high and not great, but better than the previous numbers…
> 
> I went to visit him earlier today after he was admitted for overnight hospitalization and my heart is so sad and so scared. This is the first time he’s not spending the night at home.


There is a special type of ultrasound called doppler that is used to visualize shuts.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> The ALT or ASP numbers are very high, you will need diet and medication to get them down and have them rechecked in a month or so. I think it would point to an internal injury of some type or if the dog got into something toxic. It could also be a digestive problem. Dogs with shuts would not normally have enzyme values that high. Lucky's were always a few points within normal. Not always, but normally post bile acids under 100 point to MVD rather than a shunt. The next test would be a simple blood test called a protein-c which can help distinguish between a shunt and MVD. The good news is that if it is a shunt, many dogs can live a normal life with medication and diet. If is really important to find an internist that specializes in toy breeds. Let me know of any questions I can answer. Good Luck and try not to worry too much; remember the results of any blood test is a snapshot, and all sorts of things cou!d contribute to elevated values.


Thank you so much. The doctor said since the post bile acid number is right at the cusp (99), she's not sure which it could be. I asked her about Protein C (thanks to SM), but she said it wouldn't help? She said a CT scan would be the best way to tell between a shunt or MVD. 
I also asked her whether it's possible he got injured or ate something toxic because his ALT numbers have been normal previously (53 back in January), but she said his BAT to shunts or MVD. Is that true? 

If anyone has any recommendations of specialists in the LA area, please let me know.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> There is a special type of ultrasound called doppler that is used to visualize shuts.


Thank you for this, I will ask about it today. I'm so nervous about letting them do a CT scan because of the anesthesia.


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## maggieh (Dec 16, 2007)

Walter has a lot of great experience with a liver shunt dog. Please look for an internist who has experience with liver issues in toy breeds.


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> Thank you for this, I will ask about it today. I'm so nervous about letting them do a CT scan because of the anesthesia.


If there is a liver issue, it is not uncommon for the dog to take longer to wake up, the liver processes the chemicals. So don't worry if uyu is in recovery longer than expected. Living close to Cornel and Tufts, I only know the small dog experts here, but it would be worth to see if there is a toy dog internist near you. Remember you have choices in uyu's care, so think carefully if they propose anything invasive like surgery, get a second opinion.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> If there is a liver issue, it is not uncommon for the dog to take longer to wake up, the liver processes the chemicals. So don't worry if uyu is in recovery longer than expected. Living close to Cornel and Tufts, I only know the small dog experts here, but it would be worth to see if there is a toy dog internist near you. Remember you have choices in uyu's care, so think carefully if they propose anything invasive like surgery, get a second opinion.


Thank you so much. I will keep that in mind for the CT scan. 

Is a SMAL specialist the same as a toy dog internist? The doctor who is seeing him today at the emergency hospital is listed on this site I found for small animal doctors. My baby is at MASH, which is a big emergency hospital in Los Angeles.


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> Thank you so much. I will keep that in mind for the CT scan.
> 
> Is a SMAL specialist the same as a toy dog internist? The doctor who is seeing him today at the emergency hospital is listed on this site I found for small animal doctors. My baby is at MASH, which is a big emergency hospital in Los Angeles.


Yes, sounds like uyu is in good care.


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## edelweiss (Apr 23, 2010)

Thank you Walter for jumping in here! I knew you would be the "man of the hour!" You never fail us. I am sending prayers for your baby & it is good to know you are in good hands! Please keep us posted.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> Yes, sounds like uyu is in good care.





edelweiss said:


> Thank you Walter for jumping in here! I knew you would be the "man of the hour!" You never fail us. I am sending prayers for your baby & it is good to know you are in good hands! Please keep us posted.


Yes, thank you both so much. I was a ball of anxiety and this thread made me feel a bit better about Uyu's care and his doctors. 

He came home yesterday, because his levels went down a bit (still very, very high at 4000something) and the doctor thought he would rest better at home, as the hospital is a pretty stressful environment and Uyu is alert and stable. The doctor doesn't believe Uyu has a shunt, even though he can't be sure until a CT scan... he also let me know of the risks with the CT scan and we decided to wait until Uyu is feeling a bit better. He also suggested a liver biopsy sometime in the future, but said he was uncomfortable moving forward right now (I felt the same). 

Uyu is on medication at home (Denamarin, Metronidazole, Lactulose Solution). Overall it seems like he is feeling a bit better today - definitely has more energy than when we first checked him into the emergency hospital. Please send all the prayers and good thoughts our way that his numbers are MUCH lower when we have our followup on Wednesday.


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## mss (Mar 1, 2006)

Sending those prayers and vibes for Uyu and those who care for him. {{{{{}}}}}


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> Yes, thank you both so much. I was a ball of anxiety and this thread made me feel a bit better about Uyu's care and his doctors.
> 
> He came home yesterday, because his levels went down a bit (still very, very high at 4000something) and the doctor thought he would rest better at home, as the hospital is a pretty stressful environment and Uyu is alert and stable. The doctor doesn't believe Uyu has a shunt, even though he can't be sure until a CT scan... he also let me know of the risks with the CT scan and we decided to wait until Uyu is feeling a bit better. He also suggested a liver biopsy sometime in the future, but said he was uncomfortable moving forward right now (I felt the same).
> 
> Uyu is on medication at home (Denamarin, Metronidazole, Lactulose Solution). Overall it seems like he is feeling a bit better today - definitely has more energy than when we first checked him into the emergency hospital. Please send all the prayers and good thoughts our way that his numbers are MUCH lower when we have our followup on Wednesday.


Lactulose will bind any ammonia in uyu's system. You may notice a change in stools, they may get a bit softer and more frequent. You might suggest a Protein C test. It is a simple blood test that is sent to Cornell for analysis. the good thing is it does require any difficult protocols in the draw. I am glad he is home. It is best to stay away from food with high protein content. Avoid products with red meat, especially. If he is not sensitive to dairy, dairy is an excellent source of protein that is very easy on the liver. Is uyu on a special diet! Good luck.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> Lactulose will bind any ammonia in uyu's system. You may notice a change in stools, they may get a bit softer and more frequent. You might suggest a Protein C test. It is a simple blood test that is sent to Cornell for analysis. the good thing is it does require any difficult protocols in the draw. I am glad he is home. It is best to stay away from food with high protein content. Avoid products with red meat, especially. If he is not sensitive to dairy, dairy is an excellent source of protein that is very easy on the liver. Is uyu on a special diet! Good luck.


I did notice he's not having diarrhea like before, but his stools are still loose. Thank you for this information! 

I asked about the Protein C test to the first doctor who saw him at the hospital and she dismissed it, saying the CT scan will show us more details. I wasn't sure so I didn't push back. I will ask his new doctor in case he has a different opinion. 

The hospital gave us canned Hills i/d with his discharge, but Uyu does not like it... he has always been very picky! I've been feeding his regular Open Farm kibble, but sticking with only chicken (he was rotating beef and pork previously). I used to mix with Open Farm freeze dried raw (beef, turkey, lamb) but decided to drop it until we figure out what's wrong, and have been shredding small pieces of boiled chicken breast instead. I will try the yogurt and see if he likes it! And if you have any favorite low-medium protein foods, please let me know. Thank you Walter a thousand times!


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## wkomorow (Aug 26, 2011)

Especially avoid beef, a small bit of low fat string cheese, yogurt are good safe protein sources instead of flesh. Make sure they do not have artificial sweeteners. The yogurt will provide some probiotic, but still a pro/prebiotic is a good addition. Veggies/fruits like carrots, peas, banana, apples in moderation are also good.

You can also get a remote nutrition consult from Cornell. Not sure of the cost. They have a lot of experience wirh small dogs and liver issues.


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## mss (Mar 1, 2006)

Hills I/D is supposedly a balanced diet, but I don't think it's particularly low protein. Most of my dogs have liked it. Maybe you could add some other things to it to make it more palatable (and lower protein) such as the veggies and fruit that Walter recommends.

I liked its smooth texture when I needed to syringe feed a dog which wouldn't eat.

From what I remember from 1995/96, when my small dog had liver failure, the vet at University of California Davis told me that Lactulose was/is originally a laxative, and the purpose of giving it to my dog was that "speeding up" the digestion meant there was less time for the protein to be absorbed. But from recent reading, that was an oversimplification. But in any case, diarrhea for once is not a bad thing -- just awkward to manage. Hopefully potty pad use can help with that!

(That vet went on to teach at Cornell for quite a number of years, but I think his specialty there was cats.


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## Goldiemomma (Aug 20, 2021)

Sending prayers to you and your precious one.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> Especially avoid beef, a small bit of low fat string cheese, yogurt are good safe protein sources instead of flesh. Make sure they do not have artificial sweeteners. The yogurt will provide some probiotic, but still a pro/prebiotic is a good addition. Veggies/fruits like carrots, peas, banana, apples in moderation are also good.
> 
> You can also get a remote nutrition consult from Cornell. Not sure of the cost. They have a lot of experience wirh small dogs and liver issues.


He really loves the string cheese! I've been bribing him with it to eat his regular chicken kibble mixed with the Hills ID. 



mss said:


> Hills I/D is supposedly a balanced diet, but I don't think it's particularly low protein. Most of my dogs have liked it. Maybe you could add some other things to it to make it more palatable (and lower protein) such as the veggies and fruit that Walter recommends.
> 
> I liked its smooth texture when I needed to syringe feed a dog which wouldn't eat.
> 
> ...


Wow, that's interesting about Lactulose. Uyu saw the doctor again today, and he suggested to cut his Lactulose dosage in half to help with the diarrhea. I don't mind it (he mostly goes potty outside), it just made me worried that his tummy was upset. 




Goldiemomma said:


> Sending prayers to you and your precious one.


Thank you! 

An update... Uyu's ALT levels are down to 1400, which is still extremely high -- but better from 4000 which was last Friday. He didn't do a BAT today because I didn't fast him, but he will do another blood test along with BAT in two weeks. We are hoping that both is ALT/AST and BAT are back to normal by then. He will stay on Denamarin until then. Overall, he seems much more energetic and more like himself, even though his levels are still very concerning.


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## maddysmom (Mar 8, 2012)

I totally agree with Walter. asking to do a Protein C test can rule out a shunt. That’s how i was able to rule out a shunt vs. MVD for my older girl.
I don’t know but, I certainly would question why they didn’t offer that test first, over doing a scan. And if that doctor doesn’t know what a PC test is, I would move on and find someone a bit more current.


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## uyu uyu uyu (7 mo ago)

An update… he was doing pretty well at home but this morning I noticed he was being odd (licking his nose, staring off) and he threw up twice. He was also shivering and his gums were pale. We are at emergency again now. Please send prayers that he’s OK!


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> An update… he was doing pretty well at home but this morning I noticed he was being odd (licking his nose, staring off) and he threw up twice. He was also shivering and his gums were pale. We are at emergency again now. Please send prayers that he’s OK!


I hope he is ok!


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## mss (Mar 1, 2006)

I'm sorry to hear this. I hope he is doing better today. {{{{{{}}}}}


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## Coster (Oct 26, 2015)

I am so sorry your going through this. Hope he feels better soon.


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## uyu uyu uyu (7 mo ago)

Update.. Uyu seems to be doing better - he is more playful and energetic, and acting more like himself.
His ALT went down to 210 which is a significant improvement from 1400+ 2 weeks ago. However, he did a new BAT and it's INCREASED to pre 159 and post 116 (vs post 99 a month ago).

The doctor and I are both surprised by the bile acid numbers. He suggested doing a CT scan in 2-3 weeks to see if there is a shunt, and maybe possibly a liver biopsy. We are also going to get a Protein C test done tomorrow. I feel very anxious that his BAT numbers are this high, and even worse than a month ago when I was starting to feel like Uyu was getting back to normal...


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## mss (Mar 1, 2006)

Thanks for posting an update! I was worried for you and him because it had been a while. I am glad he is better in some ways, and I hope the additional diagnostics offer good guidance for future care. {{{{}}}}


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## wkomorow (Aug 26, 2011)

uyu uyu uyu said:


> Update.. Uyu seems to be doing better - he is more playful and energetic, and acting more like himself.
> His ALT went down to 210 which is a significant improvement from 1400+ 2 weeks ago. However, he did a new BAT and it's INCREASED to pre 159 and post 116 (vs post 99 a month ago).
> 
> The doctor and I are both surprised by the bile acid numbers. He suggested doing a CT scan in 2-3 weeks to see if there is a shunt, and maybe possibly a liver biopsy. We are also going to get a Protein C test done tomorrow. I feel very anxious that his BAT numbers are this high, and even worse than a month ago when I was starting to feel like Uyu was getting back to normal...


Good news on the enzyme numbers. Thes BA numbers are not a sliding scale. They are typically analyzed as high or not high. Remember every test is just a snapshot. Bile Acids are released by the Gall Bladder, so the higher number this round could be the result of a recent ejection of Bile Acids from the GB. The blood draw for the Protein C will be sent to Cornell for scoring. Even if it comes back that he has a shunt, medical intervention and careful diet can still lead to a normal healthy life for most dogs. The most important thing is to make sure there is no ammonia build up in the system, controlled with medication and diet. Good luck and let us know how things are going.


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## uyu uyu uyu (7 mo ago)

wkomorow said:


> Good news on the enzyme numbers. Thes BA numbers are not a sliding scale. They are typically analyzed as high or not high. Remember every test is just a snapshot. Bile Acids are released by the Gall Bladder, so the higher number this round could be the result of a recent ejection of Bile Acids from the GB. The blood draw for the Protein C will be sent to Cornell for scoring. Even if it comes back that he has a shunt, medical intervention and careful diet can still lead to a normal healthy life for most dogs. The most important thing is to make sure there is no ammonia build up in the system, controlled with medication and diet. Good luck and let us know how things are going.


Thank you so much, Walter. I feel a little better today after worrying a ton yesterday. I think it's a good sign that Uyu hasn't shown signs of discomfort or pain lately - he is playing a lot, eating OK, and overall in good spirits. I will update this thread when we get the Protein C test back next week. 



mss said:


> Thanks for posting an update! I was worried for you and him because it had been a while. I am glad he is better in some ways, and I hope the additional diagnostics offer good guidance for future care. {{{{}}}}


Thank you so much! Me too.


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## uyu uyu uyu (7 mo ago)

The Protein C test came back and the result is "normal" at 110! We are going to keep him on medicine and diet supportive care and do another panel in 4 weeks. 

In other good news, he seems to be liking the Royal Canin wet hepatic food!


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## wkomorow (Aug 26, 2011)

Great news on all accounts. Typically a Protein C under 70% is indicative of a shunt, one over 70% is associated with MVD and yes the test can go up to 130%. So that is pretty good news.


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## uyu uyu uyu (7 mo ago)

I just wanted to give a quick update! Uyu had another full blood panel + bile acid test back in August. ALT was down to 200s and bile acids were still high at 80s.

He had another blood test today (2 months after his last one) and his ALT is down to *77*!!!!! Everything else is in normal range too. We are so so so relieved. The vet said he can slowly get off the lactulose and the metronidazole. Thank you everyone on this thread who helped us through this ♥ so much love in this community! ♥

some photos for fun:
when he was a tiny puppy: 









a few days ago when he was asking for some of my sweet potato:


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## Snuggle's Mom (Jan 3, 2008)

What wonderful news and thank you for sharing it with us here at SM!! And your little one is absolutely adorable!!


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## edelweiss (Apr 23, 2010)

I agree w/Snuggle's Mom!!!!! Yay God! It is wonderful to see the difference! I could not be more thrilled w/you. Sweet photos for sure.


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## wkomorow (Aug 26, 2011)

Great news. Except for softer bowel movements, lactulose is not known to have any negative side effects and is not harmful long term.


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## mss (Mar 1, 2006)

What wonderful news! And his pictures are adorable. 💓


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## Eli’s mom (Jul 20, 2021)

uyu uyu uyu said:


> I did notice he's not having diarrhea like before, but his stools are still loose. Thank you for this information!
> 
> I asked about the Protein C test to the first doctor who saw him at the hospital and she dismissed it, saying the CT scan will show us more details. I wasn't sure so I didn't push back. I will ask his new doctor in case he has a different opinion.
> 
> The hospital gave us canned Hills i/d with his discharge, but Uyu does not like it... he has always been very picky! I've been feeding his regular Open Farm kibble, but sticking with only chicken (he was rotating beef and pork previously). I used to mix with Open Farm freeze dried raw (beef, turkey, lamb) but decided to drop it until we figure out what's wrong, and have been shredding small pieces of boiled chicken breast instead. I will try the yogurt and see if he likes it! And if you have any favorite low-medium protein foods, please let me know. Thank you Walter a thousand times!


Yikes! Remove all meat! My liver shunt 3 lb-er also hated the Hills so another vet switched him to Royal Canin hepatic. He likes the flavor but it very gooy and really sticks to his teeth. I grind the dry, As too big for his mouth , and mix with the wet so it’s easier to pick up. Sweet potato with butter, any fruit or vegetables he will eat. I was once told goats milk was good, but it was too much protein and he would just sit and spit up. I do give him some warm cereal with some cows milk. Anything to keep calories in.


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## mss (Mar 1, 2006)

Sweet potato is not recommended if a dog has calcium oxalate crystals or stones. I try to avoid it generally, though various people include it in their homemade suggestions. My first Maltese had to have bladder surgery because he was full of those stones.


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## PB2 (9 mo ago)

My 13 and a half year old Peyton went in for dental work and in the preop blood work to see if she would be able to go under they have told me she has high liver enzyme's and are sending me for an ultra sound. Reading what you have gone through has helped me a lot. Thanks for your post uyu uyu uyu.


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