# Elevated Alt levels...



## Luna'sMom (Oct 7, 2007)

Luna had her stitches removed today - and her second blood test (after her last one showed her alt level was elevated to 120). 

Her second blood test said her ALT levels were 220 - the vet wants her to have an ultrasound to rule out shunt (which will cost about $300). He said the other option is to do a bile acids test and then an ultrasound OR to just keep watching her ALT levels (i.e. another test in 6mths to a year). I asked about a Protein C test - but he didn't know what it was (maybe it's not really done here in Australia yet). 

I am not quite sure what to do  - I mean she seems very healthy and when I look at lists of the 'signs' of liver shunt they don't really fit (besides the occasional vomiting - which I think is because she eats fluff off the carpet sometimes - and drooling in the car) - but I think that it would be better to diagnose now rather than when she is older (if it is even anything at all)

Any advice would be really appreciated - even links to sites about liver shunt or other diseases related to elevated ALT levels etc (thought I have googled it)


I just hope my baby is fine :smcry: 

P.S. do you think I should contact the breeder - after all I don't really know if she has anything yet?


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## pixxee84 (Jan 23, 2008)

> Luna had her stitches removed today - and her second blood test (after her last one showed her alt level was elevated to 120).
> 
> Her second blood test said her ALT levels were 220 - the vet wants her to have an ultrasound to rule out shunt (which will cost about $300). He said the other option is to do a bile acids test and then an ultrasound OR to just keep watching her ALT levels (i.e. another test in 6mths to a year). I asked about a Protein C test - but he didn't know what it was (maybe it's not really done here in Australia yet).
> 
> ...


 :smcry: I hope your baby is fine too, good luck on finding out what is wrong.


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## Ladysmom (Oct 19, 2004)

I agree with you. You do not want to just wait and see if she possibly has a liver shunt.

You should have a bile acids test done first, before an ultrasound. I've attached a few links to recent threads on the same issue that have tons of information for you.

http://spoiledmaltese.com/forum/index.php?...p;hl=bile+acids

http://spoiledmaltese.com/forum/index.php?...p;hl=bile+acids

http://spoiledmaltese.com/forum/index.php?...acids&st=15

http://spoiledmaltese.com/forum/index.php?showtopic=27076

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

http://spoiledmaltese.com/forum/index.php?showtopic=27400

http://spoiledmaltese.com/forum/index.php?...p;hl=bile+acids

http://spoiledmaltese.com/forum/index.php?...p;hl=bile+acids


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## kodie (Aug 24, 2004)

> I agree with you. You do not want to just wait and see if she possibly has a liver shunt.
> 
> You should have a bile acids test done first, before an ultrasound. I've attached a few links to recent threads on the same issue that have tons of information for you.
> 
> ...


This seems to be a HOT topic... liver... so ...maybe Joe can PIN some info related threads... OR maybe a sub section in health related to just Liver?? ???


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

I'm sorry about Luna's ALT. Hopefully you will get some good replies from MaryH, JMM and Jaimie. There has been a lot of these problems (including my Shoni). You need to somehow find out if a Protein C test can be done there. In 1 of the posts I read here about genetic research being done at vet schools over there it named Murdoch University in Western Australia, The Sydney University NSW and the Melbourne University in Victoria. I'm guessing those are vet schools at those universities.
The Bile Acids blood tests, one before a meal and the 2nd 2 hrs. after a normal meal is the first step. The regular kind of ultrasound you could get at most well equiped vet offices isn't adaquate. If after the the bile acids tests and a Protein C and if they still show possible shunt, then you need a Scintigraphy not regular ultrasound. One thing you could do is call the lab at Cornell University in NY and find out if a Protein C can to shipped from Australia or if they know of a lab in Australia that could do it.


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## RMCALLIS (Jan 25, 2008)

I am going through the same thing. Derby was neutered and when the vet drew his blood his ALT levels were very high. We have had his blood evaluated many times and they continually range from 175-156. We did a biopsy and no shunts were evident. I put him on low protein food - I/D and had him scheduled for surgery. He had been on low protein food for one month so I decided to have his blood drawn one more time before surgey and his ATL was normal. NORMAL. We reran his bile acids and those came back high but I think I am going to wait on the surgery. I have a call into my vet to see about the Protein C test but he has no symptoms so I would like to try and monitor him for a couple of months before we have the surgery. I hear it is pretty difficult.

Here are some links..

http://www.malteseonly.com/shunt2.html

http://www.upei.ca/cidd/Diseases/cardiovas...mic%20shunt.htm

http://www.acvs.org/AnimalOwners/HealthCon...imalTopics/HMD/


Good Luck.


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## dogloverx3 (Apr 14, 2006)

I am very sorry to hear such anxiety causing news - I hope everything works out :grouphug: Sarah


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## dr.jaimie (Mar 23, 2004)

i would have bile acids done first...ultrasound isnt always 100% ...she could still have a shunt and not be found on ultrasound...scintigrify is the way to go for that...but after bile acids.... if bile acids are high then worry about the next step


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## Luna'sMom (Oct 7, 2007)

Thank you for the advice everyone :grouphug: 

If we do a bile acids test - and it comes back normal would that indicate that nothing is wrong - or could it point us toward something other than a shunt (i.e. do different ranges indicate different diseases)? It would seem like that would be the first step. 

My mom is of the opinion that I should wait 6 months, have her blood/ALT levels tested again and then do an Ultrasound - is it likely that after 2 blood tests 10 days apart that the ALT levels would 'right' themselves? 

My vet uses a ultrasound specialist that comes to them when they need a procedure done - and I am not sure which type of ultrasound they are using :huh:

Would the fact that Luna is on clavamox (sp?) make any difference to her ALT levels? or her recent surgery? 

With the bile acids test - do you do a 12 hr fast before the 1st test or what - there seems to be conflicting information about which 'type' (I want to know so I can make sure the vet does the 'right' one)


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## BrookeB676 (Oct 17, 2004)

> Thank you for the advice everyone :grouphug:
> 
> If we do a bile acids test - and it comes back normal would that indicate that nothing is wrong - or could it point us toward something other than a shunt (i.e. do different ranges indicate different diseases)? It would seem like that would be the first step.
> 
> ...


I can only answer some of your questions based on my experience with Louis. Louis had elevated ALT levels pre-neuter of 132. We opted for a bile acid test, which eas elevated. My interpretation of the bile acid test is that the severity of a liver disease doesn't completely relate to the bile acid level. The bile acid level alone being elevated is an indicator of liver disease. As an article posted above noted: "Bile acids can increase with any liver disease, so high bile acids are not specific to congenital portosystemic shunts or HMD." That being said, just because a dog has an elevated bile acid, doesn't mean they have a shunt or MVD, it just indicates they have some sort of liver disease.

The bile acid test is done in 2 parts. The first part is taken after the dog has fasted, then they feed the dog, and it is taken 2 hours post feeding. 

ALT levels to me don't seem to indicate too much, just that something is "going on" with the liver. A lot of time higher ALT levels will correct themselves, and they will certainly fluctuate, whether or not the dog has shunt or MVD. 

If her bile acids come back normal, I would say that is wonderful news and that she most likely does not have a shunt, as long as the blood was drawn correctly. 

I honestly think its crazy how many of us are dealing with the exact same things as far as high ALT, bile acids, etc. It is very concerning to me.


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## jmm (Nov 23, 2004)

I don't think it is crazy that so many people are seeing it...liver disease is HIGHLY prevelant in the breed and has not been addressed on a wide-scale basis prior to Dr. Center's research. Just like all of the asymptomatic dogs we are now findings...these dogs have gone unnoticed before - it doesn't mean they weren't there. Yet, we still had many healthy pets. 

Ultrasounds, at best, are approximately 80% accurate looking for shunts...and this is a number I got from the former head of radiology at UTenn (where Dr. Tobias has her Yorkie shunt studies). 

Surgical biopsies are not warranted for most young dogs. You have to go through the diagnostic steps and decide what is right for your dog. 

Read through the links posted (thank you!)

The usual steps are:
Chemistry panel, CBC, bile acids
Based on bile acids, procede with Protein C or decide to stop
Based on Protein C, decide to go to scintigraphy or stop
Based on scintigraphy, blood results, and the dog's individual case, decide if the shunt should be surgically corrected or treated medically, or if there is no shunt and you want to procede with surgical biopsy or assume MVD.

Asymptomatic MVD dogs do not require treatment. Even you have an MVD suspect with some symptoms, treatment will be based on the individual dog (and can include diet, supplements, and medications in many different combinations). 

Dr. Center explained to me that surgical biopsy sometimes does not make a big different in how the pet is treated. So, I would be sure to know my options before jumping to surgery.


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## Luna'sMom (Oct 7, 2007)

My vet told me today that Protein C tests aren't avaliable (at least through their pathologist) in Australia. She also said that here in Australia Bile Acid tests aren't believed to be useful :huh: 

She thinks I should have the ultrasound done (apparently their technician is one of the best - he comes into their surgery by appointment only) and/or see a specialist. 

I called to talk to her but they were very busy tonight - she should call back later to talk.


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## Harley & Dakotas Mum (Jun 11, 2005)

Kylie I'm sorry I'm just seeing this now. If you are happy with your current vet, then stick with it - you can only do what your vet advises - BUT - if you are unsure, and there is nothing wrong with that, then I would say there is absolutely nothing wrong with seeking a 2nd opinion. 

Both Harley & Dakota have been to the vets at Sydney Uni (Harley for his neuter and x-rays for suspected patella issues, and Dakota for her spay/dental), and they are wonderful. Harley's skin specialist also practices there, but we saw her at a clinic closer to home. I would recommend them - I felt very comfortable there because they are a learning facility, and I figure they should be right on top of the latest in everything.

Of course you don't have to seek a 2nd opinion if you are happy with your current vet, but it's an option if you are uncertain in what to do next.

Good luck, kisses to Loony Luna!! xxx :grouphug:


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## Luna'sMom (Oct 7, 2007)

I talked to the vet and she advised me to seek a referral to Sydney Uni Vet - as they have a "top" shunt surgery specialist there and lots more diagnostic equipment there (though the ultrasound guy is the same ) 

We have decided that as she doesn't show any symptoms we are going to modify her diet and test her ALT levels again in a month - if they are still high I will be going to Sydney Uni where they will preform a Ammonia Tolerance test (they don't do Protein C either) and doing further testing (i.e. Ultrasound). I am keeping a close eye on her until then. 

Vet mentioned changing the diet to low fat and increasing Vitamin K - I have to call back tomorrow and get more details - conversation wasn't long as they were Very Very busy tonight! 

Funny thing is I did work experience at Sydney Uni vet back in Year 10  so I know behind the scenes just how great they are!

I am thinking of getting in touch with Luna's breeder - but was going to wait until more conclusive results (i.e. till we know for sure if it is anything)

:grouphug: 


Kylie and the loony Luna (who wishes people would stop taking blood :smpullhair: and making her go to the vet)


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## phesty (May 30, 2006)

I don't have any advice, but wanted to know I'll keep you and Luna in my thoughts and prayers.
:grouphug: :grouphug: :grouphug: :grouphug:


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## RMCALLIS (Jan 25, 2008)

Great News. I spoke with another vet today and she said Maltese's are indeed known for high bile acids. I put my puppy on a low protein diet., not lowfat. There is a difference. The protein in the food is what makes their livers work a little harder. I changed his diet to I/D and started giving him purified water based on the recommendation form my vet and within one month his ALT went from high to normal. The bile acids are another story but I hear that vets use high protein food when they perform the test - and yes you have to fast twelve hours before - so sometimes that causes a spike in the acids as well. Continue to keep us in the loop. Good luck.


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## Luna'sMom (Oct 7, 2007)

We tried the Hills L/D this weekend - and she eats it with no fuss :smilie_daumenpos: It looks so strange (and is hard) but hey if it helps than I am all for it! Are there any other 'prescription' diets like the Hills one? My vet did say the other option is home cooking  - guess she doesn't know how poorly I cook :HistericalSmiley: 

She had a very active weekend with a long walk on the beach followed by a paddle in the lagoon (more like just dunking her head and running around like a crazy loony toon) and along with lots of playing outdoors in the grass (she is an apartment dog hasn't had as much off leash grass action - I am only just getting comfortable with taking her to the big parks - though she is very BAD and doesn't listen when I call her). She had so much fun playing with my Parents 9 year old pug (Nu-Nu) - who is soooo patient with her (she just stands there taking it ) and even tries to 'play' sometimes (i.e. does a play bow and runs around her a little). Their Maltese cross (Xin) even warmed up to Luna a tiny bit - letting her sit near her (but not on her blanket) :HistericalSmiley: Luna absolutely adores Xin and tries to follow her everywhere. Poor Xin is feeling her age though - and likely needs patella surgery  

We will be retesting her in a month and going from there - I am very anxious as I really don't want anything to be wrong with her :smpullhair:


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## elly (Sep 11, 2006)

> We tried the Hills L/D this weekend - and she eats it with no fuss :smilie_daumenpos: It looks so strange (and is hard) but hey if it helps than I am all for it! Are there any other 'prescription' diets like the Hills one? My vet did say the other option is home cooking  - guess she doesn't know how poorly I cook :HistericalSmiley:
> 
> She had a very active weekend with a long walk on the beach followed by a paddle in the lagoon (more like just dunking her head and running around like a crazy loony toon) and along with lots of playing outdoors in the grass (she is an apartment dog hasn't had as much off leash grass action - I am only just getting comfortable with taking her to the big parks - though she is very BAD and doesn't listen when I call her). She had so much fun playing with my Parents 9 year old pug (Nu-Nu) - who is soooo patient with her (she just stands there taking it ) and even tries to 'play' sometimes (i.e. does a play bow and runs around her a little). Their Maltese cross (Xin) even warmed up to Luna a tiny bit - letting her sit near her (but not on her blanket) :HistericalSmiley: Luna absolutely adores Xin and tries to follow her everywhere. Poor Xin is feeling her age though - and likely needs patella surgery
> 
> We will be retesting her in a month and going from there - I am very anxious as I really don't want anything to be wrong with her :smpullhair:[/B]



When Ellie was on Hills ld the Vet also said she could eat the hills kd, and she liked kd better. You can bake the ld for treats, I never did, I just bought a bag of dry ld and kd


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

> We tried the Hills L/D this weekend - and she eats it with no fuss :smilie_daumenpos: It looks so strange (and is hard) but hey if it helps than I am all for it! Are there any other 'prescription' diets like the Hills one? My vet did say the other option is home cooking  - guess she doesn't know how poorly I cook :HistericalSmiley:
> 
> She had a very active weekend with a long walk on the beach followed by a paddle in the lagoon (more like just dunking her head and running around like a crazy loony toon) and along with lots of playing outdoors in the grass (she is an apartment dog hasn't had as much off leash grass action - I am only just getting comfortable with taking her to the big parks - though she is very BAD and doesn't listen when I call her). She had so much fun playing with my Parents 9 year old pug (Nu-Nu) - who is soooo patient with her (she just stands there taking it ) and even tries to 'play' sometimes (i.e. does a play bow and runs around her a little). Their Maltese cross (Xin) even warmed up to Luna a tiny bit - letting her sit near her (but not on her blanket) :HistericalSmiley: Luna absolutely adores Xin and tries to follow her everywhere. Poor Xin is feeling her age though - and likely needs patella surgery
> 
> We will be retesting her in a month and going from there - I am very anxious as I really don't want anything to be wrong with her :smpullhair:[/B]


Tanner was initially on Hill's LD, but I took him off and now he eats Canidae Platinum w/ 6% protein, Chicken Soup Senior 7.5% protein, Innova Senior 4.4% protein and Merrick Rocky Mtn Trout (don't have that can in front of me). I have so many kinds because he is so picky and will turn his nose up at the same food more than twice in a row! When I read that asymptomatic MVD dogs can eat regular food, I started feeding him what the others ate, which is Grammy's Pot Pie, Wing-a-Ling and other Merrick foods with chicken. Unfortunately, little darling put on some weight, so he's back to the low protein.


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## BrookeB676 (Oct 17, 2004)

> > index.php?act=findpost&pid=518095
> 
> 
> 
> ...


I suspect asymptomatic MVD with Louis (as I don't suspect shunt- fingers crossed), but I am hesitant to put him on a low protein diet because he is so tiny and really needs to grow and gain some weight. I will have to evaluate him at a year old and proceed as to what we should do. I have heard from a few vets that maltese run higher bile acids, but I only think that indicates that a large portion of the breed has asymptomatic MVD, but that's just my interpretation.

Right now my dogs eat Wysong Synorgon, which they love (it's really the only food out of several I could get them to eat), and I just noticed on Wysong's website that they have prescription diets available, one specifically for the liver called "Heparone." Wysong's foods are rated well in the whole food dog journal and I believe them to be higher quality than science diet, I would probably look into it if/when I switch Louis.


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## jmm (Nov 23, 2004)

Asymptomatic MVD dogs do NOT need to have protein restriction. Dogs NEED protein in their diet.


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## Malteseluv (Feb 6, 2007)

My dog is symptomatic MVD, and his protein does have to be restricted somewhat, but that does not mean he does not get protein...He gets the recommended (according to one of Dr. Center's articles) 2-3 grams of protein per kg of body weight per day, and he is doing very well now.


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## Luna'sMom (Oct 7, 2007)

Would putting Luna on a lower protein diet such as a Senior formula dog food (18% protein) be a better choice than putting her on Hills I/D (4.6% protein) - as we aren't sure if she even has anything - or is I/D really the best option? I have noticed that so far Luna is doing much larger stools and they are a yellowy light brown and quite soft - which isn't very nice for a house dog - and her tear staining has started back up again (which had just settled down after teething and putting her on Nutrience) ... Afterall if we aren't sure if she is asymptomatic MVD or has a shunt or whatever... would a really low protein diet be detrimental to a 7 month old puppy growing etc  If that makes sense to anybody 

Do heart worm medications, flea treatments, worming medications etc pose a risk to a dog with potential liver problems? If so what brands are safer? 

By altering her diet am I just masking the signs of her disease making it harder to diagnose further down the track? I wanted to wait to do the ultrasound for a month anyway so she can recover from her surgery - probably isn't good to poke and prod areas which are still healing from the spay (or is that not really a concern?)

I've done some reading on the subject but haven't been able to find satisfactory answers. Its so frustrating knowing that in the USA they can do a protein C test but here that isn't possible ... though the Sydney Uni vet will do an Ammonia Tolerance Test as a second diagnostic before the ultrasound...


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

I know how you feel---the waiting and not knowing for sure if your dog should be on a restricted diet is really the pits! :smpullhair: Shoni didn't have high ALT's, so I don't know how to answer your questions. He has high Bile Acids and a not good Pro C with no symptoms. He is 8 mo. and seems to be still growing a little. I would not want a puppy who is growing on a low protein diet, unless the dog were really sick. The high ALT might be of more concern then is Shoni's case, I don't know. In Shoni's case I have chosen to simply use protein that is said to be easier on the liver then red meat protein is. Chicken and fish are supposed to be better. I add cottage cheese (very little) or a spoonful of yogurt and occasionally a softly scrambled egg. I am giving him Natural Balance Duck and Potato dry right now and a little canned chicken based canned food. I used nothing except a food that is ultra-premium, mostly organic, and holistic---just trying to stay away from preservatives and impure ingredients like "meat-by-products". I don't use any of the all or mostly meat food, dry or canned, I understand with liver disease a certain amount of good carbs like potato and some veggies are good. Shoni likes fruit better then dog food  so he gets at least a few bites of fresh fruit every day, like bananas, apples or pears.
I hope the waiting is over soon and you can retest soon. I would also give Luna Denosyl and Marin. You can use both since they do not work the same way, but both do help with liver problems. I get them from EntirelyPets.com. without a RX. Ask your vet about them.


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## jmm (Nov 23, 2004)

The reasoning behind restricting protein is that dogs who have protein intolerance (have symptoms of illness when eating higher protein) will have fewer symptoms with less protein. Less ammonia build-up in their system means better health. I have a biopsy-confirmed MVD dog. He does NOT have signs of protein intolerance/ammonia buildup. He eats a NORMAL diet per Dr. Center. You need to carefully discuss your dog's diet with your vet based on the individual case. Please do not put your dog on a low protein diet without proper veterinary advice. Yes, in some cases it could potentially be detrimental to the dog. 

The lighter colored stool on L/D is normal in my experience. 

I would avoid ivermectin (that includes Heartgard and Iverheart). Interceptor is safe for liver dogs. Topical flea/tick like Frontline or Advantage are safe. I would avoid pyrethrins. 

If she's going to be spayed and you are that concerned, why not take a biopsy at that time. You still aren't ruling out an intrahepatic shunt (which you aren't ruling out with ultrasound either). 






> Would putting Luna on a lower protein diet such as a Senior formula dog food (18% protein) be a better choice than putting her on Hills I/D (4.6% protein) - as we aren't sure if she even has anything - or is I/D really the best option? I have noticed that so far Luna is doing much larger stools and they are a yellowy light brown and quite soft - which isn't very nice for a house dog - and her tear staining has started back up again (which had just settled down after teething and putting her on Nutrience) ... Afterall if we aren't sure if she is asymptomatic MVD or has a shunt or whatever... would a really low protein diet be detrimental to a 7 month old puppy growing etc  If that makes sense to anybody
> 
> Do heart worm medications, flea treatments, worming medications etc pose a risk to a dog with potential liver problems? If so what brands are safer?
> 
> ...


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## Malteseluv (Feb 6, 2007)

Luna's Mom, 
If you are feeding I/D canned, it's actually not as low as you think...I looked up Hill's I/D canned in Australia, and it is 25% protein on a dry matter basis. That is what normal dogs, even puppies, without liver problems eat, so you're not actually restricting her protein in the least by giving her this food....
Many people with liver compromised dogs regardless of symptoms try to stay away from red meat, since it is the hardest on the livers and produces the most toxins.
If you decide to go with the Senior food, which on a dry matter basis is probably closer to 20% protein, take a look at what meats are in the food.

JMM, you are so lucky that your MVD dog is asymptomatic. I have heard of several maltese like this...
I also know of several other biopsy-confirmed MVD dogs that are symptomatic and need to have their diet monitored very closely...If these dogs eat the "right kind" of protein, they can eat more of it because it causes less ammonia build-up than if they eat the "wrong kind" of protein...Also, these symptomatic dogs benefit greatly from the use of lactulose and supplements....


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## jmm (Nov 23, 2004)

> Luna's Mom,
> If you are feeding I/D canned, it's actually not as low as you think...I looked up Hill's I/D canned in Australia, and it is 25% protein on a dry matter basis. That is what normal dogs, even puppies, without liver problems eat, so you're not actually restricting her protein in the least by giving her this food....
> Many people with liver compromised dogs regardless of symptoms try to stay away from red meat, since it is the hardest on the livers and produces the most toxins.
> If you decide to go with the Senior food, which on a dry matter basis is probably closer to 20% protein, take a look at what meats are in the food.
> ...



I lost a dog to MVD (with hepatic venule inflammation and IBD)...my other dogs are quite lucky.


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## Malteseluv (Feb 6, 2007)

Oh no!! That is so sad  I am so sorry to hear that...I know how hard it is to have a symptomatic dog...We have been through some tough times with him, but thankfully, we have his diet, lactulose, supplements, and everything under control now even though the vets had basically given up. 
I'm glad that the other baby you have is asymptomatic...


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## Luna'sMom (Oct 7, 2007)

> The reasoning behind restricting protein is that dogs who have protein intolerance (have symptoms of illness when eating higher protein) will have fewer symptoms with less protein. Less ammonia build-up in their system means better health. I have a biopsy-confirmed MVD dog. He does NOT have signs of protein intolerance/ammonia buildup. He eats a NORMAL diet per Dr. Center. You need to carefully discuss your dog's diet with your vet based on the individual case. Please do not put your dog on a low protein diet without proper veterinary advice. Yes, in some cases it could potentially be detrimental to the dog.
> 
> The lighter colored stool on L/D is normal in my experience.
> 
> ...


Luna was already spayed - on the 17th of January (when her first blood test was done and ALT levels were found to be high) - seeing as my vet doesn't seem to have too much experience with Maltese and liver shunts etc (i.e. diagnosed a few... but they were symptomatic ones) I am glad they didn't take a biopsy - they may not have know how to do it properly! If this next test shows still elevated ALT's than were are transferring to a specialist vet i.e. Sydney University Vet. 

I had talked to the vet - she seemed to think hills I/D or a home cooked diet would be a good idea until our next blood test in late Feb. I tried to talk to her yesterday R.E. heart guard and the fact that I/D seems to be giving her loose stools - but she didn't call me back :shocked: 

I really do appreciate the advice that you guys are giving me - thank you so much JMM and MalteseLuv and EVERYONE! I know its probably a topic gone over many times but it helps to have people reply to your individual questions and concerns :thumbsup:


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## BrookeB676 (Oct 17, 2004)

> I know how you feel---the waiting and not knowing for sure if your dog should be on a restricted diet is really the pits! :smpullhair: Shoni didn't have high ALT's, so I don't know how to answer your questions. He has high Bile Acids and a not good Pro C with no symptoms. He is 8 mo. and seems to be still growing a little. I would not want a puppy who is growing on a low protein diet, unless the dog were really sick. The high ALT might be of more concern then is Shoni's case, I don't know. In Shoni's case I have chosen to simply use protein that is said to be easier on the liver then red meat protein is. Chicken and fish are supposed to be better. I add cottage cheese (very little) or a spoonful of yogurt and occasionally a softly scrambled egg. I am giving him Natural Balance Duck and Potato dry right now and a little canned chicken based canned food. I used nothing except a food that is ultra-premium, mostly organic, and holistic---just trying to stay away from preservatives and impure ingredients like "meat-by-products". I don't use any of the all or mostly meat food, dry or canned, I understand with liver disease a certain amount of good carbs like potato and some veggies are good. Shoni likes fruit better then dog food  so he gets at least a few bites of fresh fruit every day, like bananas, apples or pears.
> I hope the waiting is over soon and you can retest soon. I would also give Luna Denosyl and Marin. You can use both since they do not work the same way, but both do help with liver problems. I get them from EntirelyPets.com. without a RX. Ask your vet about them.[/B]


D- Do you think that Denosyl and Marin are helpful if the dog has asymptomatic MVD. I may add those supplements to little Louis's diet, but I am unsure if its the same idea as the protein (that you shouldn't decrease protein unless symptomatic and/or instructed).


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## jmm (Nov 23, 2004)

> D- Do you think that Denosyl and Marin are helpful if the dog has asymptomatic MVD. I may add those supplements to little Louis's diet, but I am unsure if its the same idea as the protein (that you shouldn't decrease protein unless symptomatic and/or instructed).[/B]


Last time I asked, I was told no, nothing was needed for my asymptomatic dogs.


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## tamizami (May 1, 2007)

Mine are asymptomatic and I don't restrict protein, but they are on a 1/3 white fish (i.e. sole, whitefish, cod, tilapia), 1/3 potato, 1/3 sweet potato diet per Dr. Dodds. This is actually a pretty high protein (35%), but Shiva's ALT dropped 200 points in 3.5 weeks on this diet! I stopped using the Marin since it has liver in it and just use human Milk Thistle capsules added to their food once its cooled. We don't use Denosyl - isn't that SAMe? I took SAMe for a bit to test it out and it kinda made me feel weird....I think its also a natural antidepressant? Anyway, I don't give it to the kids.


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