# Can anyone shed a light on this matter?



## Jaxon (Dec 13, 2008)

I do not even know how to start such a topic, so please bear with me through this story. 

I took my 10 month old Maltese last Friday to have him neutered. I agreed on having the prescreening bloodwork done and if anything was abnormal the vet would call. Well sure enough the vet called. She said, Jaxon had a liver value that was extremely high so they would not be neutering him today. I said OK!!! She said that the liver value reading was so high that her vet office could not read it. She wanted to take time to feed him and redo the bloodwork to see if anything would change, so I said OK. Well after redoing the bloodwork she called and nothing changed worthwhile. So she told me she would need to send the bloodwork out and to come pick Jaxon up. She also told me on the phone that the red and white blood cell count was good and the bile test was fine, protein was normal, blood sugar was normal but the concern was the ALT value which was extremely high and the ALP was rocky, which according to her all that is to do with the liver. She was to call me on Saturday but close to closing time I ended up calling her. Which bothered me for I was already in the dark over night. Anyways when I called she said the ALT value was 1810 with a normal being 118 and the ALP value was 168 with a normal being 131. She was not really concerned with the ALP but the ALT. She suspected a shunt in his liver. So she says that I would need to have an ultrasound done ASAP. She referred me to a specialitst named Doctor Toal in Fairfax, Virginia at SouthPaws. We immediately called the specialist and thankfully they were open on Saturday. So my dear husband to us down the road. It was just a two hour trip. So we had the ultrasound done. The ultrasound showed no shunt. He said the liver looked normal to him. 

So at this point I was lost. I called her today and she said they would retest the blood in a few weeks to see if anything was changing and I just needed to be patient. She could recommend exploratory surgery or maybe a radioactive ultrasound? Well I told her I did not want to do either of those unless I absolutely had to resort to this. She said that they could also go in and do a biopsy of his liver and I said I would rather not for he is not showing any signs of pain, discomfort or any other signs of distress.

Needless to say I am so happy that they did not find a shunt because of procedures that would need to be done but $500 dollars later and no answer I am torn and still lost. So can anyone help shed a light on this matter?

I hope I have not missed any important points, if so just let me know. Sorry if I have caused any confusion.

Thanks for taking the time to read and trying to help me out, I so greatly appreciate it!!!!!!!!!!!!!!!!!!!!!!


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## Jaxon (Dec 13, 2008)

Sorry about the errors in my typing in the post above


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## Ladysmom (Oct 19, 2004)

The problem with ultrasounds is that they aren't that reliable in detecting shunts, especially in small dogs:

Ultrasonography: Ultrasonography can detect "classic" features: small liver, hypovascular intrahepatic portal system, large kidneys, uroliths, and *in 60 to 90% of cases* (depending on ultrasonographer skill) identification of an aberrant shunting vessel. Doppler color flow interrogation identifies PSVA associated turbulence in the vena cava. Otherwise, a slow, tedious, systematic search of the portal vasculature is required. 

http://www.vin.com/proceedings/Proceedings...5&O=Generic

The current protocol recommends first a bile acids test, then, if indicated, a Protein C test.

http://www.cairnterrier.org/health/2007_02...ter_summary.php

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

Here is a great article from the University of Tennessee:

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

Are you anywhere close to a vet school? You can waste a lot of time and money with local vets who really aren't that knowledgeable about liver disease.


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## cuevasfam (Jul 13, 2008)

I am so sorry... I don't have a clue as to what it could be. I just wanted to tell you maybe you go to another vet for another opinion???? I don't know. God Bless you and we will keep you in our prayers and wish you good thoughts. rayer: rayer: rayer: rayer:


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

Gosh, I'm so sorry to hear what you are going through. Here is an article pinned in the Health sub-forum. Read through it as there is a lot of info sprinkled throughout...

http://spoiledmaltese.com/forum/index.php?showtopic=26958

I edited your title to add "Live issue" to the subtitle so that you will get more responses, since a lot of folks here have had experience with this subject.


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## jmm (Nov 23, 2004)

I know Dr. Toal very well and he was in the radiology dept at the University of TN for years. He is excellent at finding shunts and, if he cannot see it, measuring the velocities in the vasculature of the liver to tell whether a shunt is likely. He has ultrasounded many of my dogs. I think bile acids and seeing Dr. Toal is a good start. Dr. Toal knows a lot about Maltese and shunts. 

If there is a shunt, I recommend VRA Veterinary Referral Center in Gaithersburg (Dr. Williams and Dr. Saylor) or driving up to Cornell in NY (which is about 6 hours from Fairfax). Not all Maltese with shunts should have them corrected, so even if one is found, don't jump at anything.


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## coconuts (Apr 19, 2009)

My experience with maltese I have learned that as puppies they have abnormal ALT and as they get older it turns out to be normal. So don't panic! Sure everything is ok. Coconuts did that when she was 6 months and they were all worried and then when she was around 11 months did blood work again and it turned out perfect.


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## dwerten (Oct 6, 2007)

did they do a pre and post bile acid test? where they fasted him for 12 hrs pulled blood then fed him waited 2hrs on dot then pulled blood to see how liver functions? If not that is the first test along with protein c test I would have done. If the post is over 100 then i would do further testing. 

Has he had any signs of liver shunt? Head pressing, picky eater, seizures, vomitting, acting spaced out after eating? These are all signs of liver shunt


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## dwerten (Oct 6, 2007)

This is what i have read as well as my dd is mvd so she had 3 bile acids done over a year so very familiar and i had read alot on liver shunt mvd group on yahoo that maltese tend to test high on bile acids normally - my dd is a yorkie though. I would not put him through a bunch of stuff unless showing signs myself -- the true test for liver shunt is scintigraphy below is a link to it and they wanted to put my dd through this and i said no way she is below 100 on post bile acids and no symptoms i am not putting her through this and so glad i didn't - she is on low protein diet and no signs of any liver issues other than her bile acids -

here is info on scintigraphy 

http://www.avmi.net/newfiles/Scintigraphy/Portal.html

basically they put a radio active dye capsule in their butt and it travels through their body and they take 100's of pics to see if the capsule by passes the liver which is indicative of a shunt - they keep the dog the entire day as they have to make sure they pass all the radioactive material before they leave. They do not always have to sedate the dog but if the dog is stressed they will sedate. Dr Broome is suppose to be excellent and he is by me and this is his site but I would not put my dog through this unless she was showing some serious symptoms. 

Personally if it was a shunt I would fly to Tennessee and have Dr Tobias do the surgery as she is excellent from what i read and has a very high success rate. Dr Centers and Dr Tobias are the experts on this - Dr Tobias is a surgeon and Dr Centers is internal medicine specialist and she is at Cornell. 

I was freaked out too when they called me about dd bile acids and wanted me to do a bunch of tests but I joine liver shunt mvd group on yahoo and stayed up 24 hrs reading everything on liver shunt and mvd and read terry shumsky's site with all the info and really educated myself and then i made the decision since post bile was less than 100 as it was 73 to hold off -- Now if she was having symptoms and seizures etc I would have done scintigraphy with dr broome then been on a plane to tennessee to have the surgery with tobias. I think the cost of surgery with her is appx 1600 from what i have read and many surgeons charge more and she has worked on some tiny dogs as i am on a bunch of yorkie groups as well and they all fly to dr tobias to have surgery. 

I would not stress too much and take a step back and get educated about it -- i would recommen joining the liver shunt mvd group on yahoo and ask questions and start reading as much as you can on that group as they are very sharp and know alot about blood work as well

What is the protein count on your dog food? 


QUOTE (Coconuts @ Jun 4 2009, 08:48 PM) index.php?act=findpost&pid=785817


> My experience with maltese I have learned that as puppies they have abnormal ALT and as they get older it turns out to be normal. So don't panic! Sure everything is ok. Coconuts did that when she was 6 months and they were all worried and then when she was around 11 months did blood work again and it turned out perfect. [/B]


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## kathym (Aug 5, 2006)

:grouphug: :grouphug:


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## harrysmom (Sep 28, 2007)

Hi!

I'm really sorry to hear about Jaxon's problems and I definitely understand how confused you are.
My dog, Harry, who is now almost 2 1/2 years old, was diagnosed with a liver problem when I brought 
him in to be neutered, just like Jaxon. 

The best advice that I can give you is don't do any invasive
procedures!!!!!! Harry's liver was such a mess that even a biopsy might have killed him!!! 
I agree with the earlier posts, I would bring Jaxon to a vet school. I drive 4 1/2 hours
to bring Harry to Cornell and I consider it well worth the time. We have some great vets
here in NJ, and lots of specialists, but they didn't know what to recommend with Harry, and
they recommended exploratory surgery or a biopsy.... which as I stated above could have killed
him. 

Good luck with Jaxon.... you will get lots of great advice and support here on SM. If
you have any other questions, feel free to PM me.

Debbie


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## Jaxon (Dec 13, 2008)

QUOTE (LadysMom @ Jun 4 2009, 04:19 PM) index.php?act=findpost&pid=785690


> Are you anywhere close to a vet school? You can waste a lot of time and money with local vets who really aren't that knowledgeable about liver disease.[/B]


Not to my knowledge unless Blue Ridge Community College in Weyers Cave, VA is considered a vet school also. All I know is my brother's ex got her LVT from there and she adopted the dog they did all the learning and testing on. Guess I should call on Monday and find out.


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## Jaxon (Dec 13, 2008)

QUOTE (cuevasfam @ Jun 4 2009, 04:20 PM) index.php?act=findpost&pid=785692


> I am so sorry... I don't have a clue as to what it could be. I just wanted to tell you maybe you go to another vet for another opinion???? I don't know. God Bless you and we will keep you in our prayers and wish you good thoughts. rayer: rayer: rayer: rayer:[/B]


Thanks for the prayers, they are so appreciated!!!


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## Jaxon (Dec 13, 2008)

QUOTE (K/C Mom @ Jun 4 2009, 04:23 PM) index.php?act=findpost&pid=785693


> Gosh, I'm so sorry to hear what you are going through. Here is an article pinned in the Health sub-forum. Read through it as there is a lot of info sprinkled throughout...
> 
> http://spoiledmaltese.com/forum/index.php?showtopic=26958
> 
> I edited your title to add "Live issue" to the subtitle so that you will get more responses, since a lot of folks here have had experience with this subject.[/B]


Thanks for the edit!!! Great article, I learn something new all the time on this board!!! Thanks again!!!


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## Jaxon (Dec 13, 2008)

QUOTE (JMM @ Jun 4 2009, 04:28 PM) index.php?act=findpost&pid=785696


> I know Dr. Toal very well and he was in the radiology dept at the University of TN for years. He is excellent at finding shunts and, if he cannot see it, measuring the velocities in the vasculature of the liver to tell whether a shunt is likely. He has ultrasounded many of my dogs. I think bile acids and seeing Dr. Toal is a good start. Dr. Toal knows a lot about Maltese and shunts.
> 
> If there is a shunt, I recommend VRA Veterinary Referral Center in Gaithersburg (Dr. Williams and Dr. Saylor) or driving up to Cornell in NY (which is about 6 hours from Fairfax). Not all Maltese with shunts should have them corrected, so even if one is found, don't jump at anything.[/B]


YAY!!! Someone has heard of Dr. Toal. I felt he was a well educated man. I liked him very much. As he stated, "I do not see a shunt." I am trusting in him but I will certainly keep the other referrals you posted in mind just in case something changes in a few weeks.


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## Jaxon (Dec 13, 2008)

QUOTE (Coconuts @ Jun 4 2009, 09:48 PM) index.php?act=findpost&pid=785817


> My experience with maltese I have learned that as puppies they have abnormal ALT and as they get older it turns out to be normal. So don't panic! Sure everything is ok. Coconuts did that when she was 6 months and they were all worried and then when she was around 11 months did blood work again and it turned out perfect. [/B]


I am so sorry you had to experience this same anxiety!!! I can only pray that the same turns out for Jaxon that turned out for Coconuts!!! BTW, cute name :wub:


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## Jaxon (Dec 13, 2008)

QUOTE (dwerten @ Jun 4 2009, 09:49 PM) index.php?act=findpost&pid=785818


> did they do a pre and post bile acid test? where they fasted him for 12 hrs pulled blood then fed him waited 2hrs on dot then pulled blood to see how liver functions? If not that is the first test along with protein c test I would have done. If the post is over 100 then i would do further testing.
> 
> Has he had any signs of liver shunt? Head pressing, picky eater, seizures, vomitting, acting spaced out after eating? These are all signs of liver shunt[/B]


They did do pre and post bile acid test. At this time all I know is she said numbers did not change enough to matter. I will get a copy of the blood work next week. Not sure about a protein c test. That is the problem, the only sign he shows is a picky eater and since malts can be picky I could not pin point his eating to this issue so other than that he has not shown any signs of a shunt only this ALT value of 1810. That is one of the reasones I rushed to get the ultrasound done for I was afraid after that high value. I am a first time dog owner also so everything freaks me out!!! I will get back with you on all the results once they are in hand.


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## Jaxon (Dec 13, 2008)

QUOTE (kathym @ Jun 5 2009, 06:32 AM) index.php?act=findpost&pid=785931


> :grouphug: :grouphug:[/B]


Thanks I feel your hugs!!!!


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## Jaxon (Dec 13, 2008)

QUOTE (Harrysmom @ Jun 5 2009, 07:19 AM) index.php?act=findpost&pid=785937


> Hi!
> 
> I'm really sorry to hear about Jaxon's problems and I definitely understand how confused you are.
> My dog, Harry, who is now almost 2 1/2 years old, was diagnosed with a liver problem when I brought
> ...


I am sorry for you having to go through this also!!! It is so hard!!! I do not believe I will do any invasive procedures!!! I hope to find a vet school so I can get some info. Can you tell me what the vet school did for Harry that a Vet did or could not do. Sorry but like I said earlier this is my first so I am learning. Hope Harry is well!!!


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## Jaxon (Dec 13, 2008)

Okay, so maybe I did the wrong thing by replying to each one of you individually like I did... but I wanted you all to know that I appreciate your thoughts, prayers and concerns. I will update everything once I get copies of the bloodwork next week. Thanks again, for bearing with me!!! You all are AWESOME!!!!!!!! :grouphug:


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## thefab5 (Feb 1, 2007)

Our little Ben had a high ALT once. He had just a high ALT with NO SHUNT or high red/ white cells. Our Vet felt that he had some sort of insult to the liver and put him on a month of antibiotics......and It worked the alt went down all at once.!!!! We too went through many tests as well as contacting Dr. Center at Cornell university to get her opinion and do further blood work (protein C test). It all just boiled down to a insult that was corrected by antibiotics. We never knew what that insult was. 

Unfortunately Ben passed this Feb 6th to kidney failure. Nothing to do with liver issues. He also went blind after his liver issues and they chalked it all up to SARDS. SARDS is a very vague illness that strikes many breeds of dogs. Anyway Ben was our bubba we worried like crazy for him. So please know I feel your anxiety and understand what you are going through. I believe you will get through this with flying colors. 

From your story and knowing malt's as I do it very well could be a puppy thing. Maybe a course of antibiotics could do the trick. Wishing I coould be more help!

Nancy


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## dwerten (Oct 6, 2007)

yes get a copy of all blood work and tests and start a file as i always keep everything in a file for each dog in ascending order so most recent on top this way if you have to go to emergency and vets office is closed you grab your file and off you go so you are prepared with everything so no questions unanswered These are my first 3 dogs as well and boy have i been through the ringer and have learned to take a step back as sometimes it sounds worse than it is and you can end up rushing to do unnecessary things i have learned and did learn this when was told by vet to have dd do scintigraphy and i was like hold the phone here we are going to slow down and i am going to start doing my own homework. I went to a holistic vet as well and consulted with her and the bats were not that bad. I was a nervous wreck --if the bats are not that bad then I would wait until next blood work test and see how that goes. Trust me i know how you feel been there and almost lost my boy yorkie to pancreatitis and that was life and death situation. It is not fun but here is one thing a specialist told me - TREAT THE DOG NOT THE BLOOD WORK. If the dog is acting fine and something is a little off then hold off as not all blood work is perfect. If the machines are not maintained properly the numbers can be off. This is why it is always important to have blood work sent out to a lab as many times more accurate than inhouse tests. I hope they did bats through a lab and not a snap test as those only go up to 30 i think and that is not a true bile acid test. If that is what they did i would have it re done - if sent to lab i would feel comfortable. I always request it done at lab --idexx or antech. 

My demi is a picky eater maltese as well and she is very healthy  

hang in there and many of us have been through what you are going through and we will help you as much as we can  I think your baby is ok - How long has this vet been practicing? I am glad that at least they are aware of liver shunt as sadly many vets are not that familiar with it 


QUOTE (Jaxon @ Jun 5 2009, 08:54 PM) index.php?act=findpost&pid=786262


> QUOTE (dwerten @ Jun 4 2009, 09:49 PM) index.php?act=findpost&pid=785818





> did they do a pre and post bile acid test? where they fasted him for 12 hrs pulled blood then fed him waited 2hrs on dot then pulled blood to see how liver functions? If not that is the first test along with protein c test I would have done. If the post is over 100 then i would do further testing.
> 
> Has he had any signs of liver shunt? Head pressing, picky eater, seizures, vomitting, acting spaced out after eating? These are all signs of liver shunt[/B]


They did do pre and post bile acid test. At this time all I know is she said numbers did not change enough to matter. I will get a copy of the blood work next week. Not sure about a protein c test. That is the problem, the only sign he shows is a picky eater and since malts can be picky I could not pin point his eating to this issue so other than that he has not shown any signs of a shunt only this ALT value of 1810. That is one of the reasones I rushed to get the ultrasound done for I was afraid after that high value. I am a first time dog owner also so everything freaks me out!!! I will get back with you on all the results once they are in hand.
[/B][/QUOTE]


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## jmm (Nov 23, 2004)

There is not a vet school "local" to Northern VA. Virginia Tech is about 4 1/2 hours away. University of TN is 7 hours. Cornell is 6 hours. 

However, we have am amazing team of boarded vet in private practice. Dr. Gasser at the Hope Center in Vienna is a boarded internist. SouthPaws has a couple new ones whom I am not personally familiar with. Dr. Jared Williams at VCA Veterinary Referral Associated in Gaithersburg is very well versed in this type of thing. If you PM me, I can give you the name of another internist who does not see regular referrals...


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## dr.jaimie (Mar 23, 2004)

im confused...were the bile acids results normal? if they r normal then shunt wouldnt be suspected. i would consider a lepto titer


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## coconuts (Apr 19, 2009)

QUOTE (dwerten @ Jun 4 2009, 09:01 PM) index.php?act=findpost&pid=785825


> This is what i have read as well as my dd is mvd so she had 3 bile acids done over a year so very familiar and i had read alot on liver shunt mvd group on yahoo that maltese tend to test high on bile acids normally - my dd is a yorkie though. I would not put him through a bunch of stuff unless showing signs myself -- the true test for liver shunt is scintigraphy below is a link to it and they wanted to put my dd through this and i said no way she is below 100 on post bile acids and no symptoms i am not putting her through this and so glad i didn't - she is on low protein diet and no signs of any liver issues other than her bile acids -
> 
> here is info on scintigraphy
> 
> ...





> My experience with maltese I have learned that as puppies they have abnormal ALT and as they get older it turns out to be normal. So don't panic! Sure everything is ok. Coconuts did that when she was 6 months and they were all worried and then when she was around 11 months did blood work again and it turned out perfect. [/B]


[/B][/QUOTE]

I put Coconut on a low protein diet and it helped. I think the puppy food she was on made her have a higher ALT and I think that may be a common problem in maltese but not sure.


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## coconuts (Apr 19, 2009)

QUOTE (Jaxon @ Jun 5 2009, 07:49 PM) index.php?act=findpost&pid=786260


> QUOTE (Coconuts @ Jun 4 2009, 09:48 PM) index.php?act=findpost&pid=785817





> My experience with maltese I have learned that as puppies they have abnormal ALT and as they get older it turns out to be normal. So don't panic! Sure everything is ok. Coconuts did that when she was 6 months and they were all worried and then when she was around 11 months did blood work again and it turned out perfect. [/B]


I am so sorry you had to experience this same anxiety!!! I can only pray that the same turns out for Jaxon that turned out for Coconuts!!! BTW, cute name :wub:
[/B][/QUOTE]


I did alot of praying when all this first happened with Coconut. It all started when they were going to spay her and they called me and said they couldn't do it till they did the bile acid test. They actually did two and they came back abnormal , then I took her all the way to Auburn vet school and they ran the same test and it came back normal, they also did ultrasound on her there and other blood work and everything came out ok. But to rule out a liver shunt they spayed her at Auburn vet school to actually look at the liver and didn't find one. Yeah!! But she is on a low protein diet now and her blood work is perfect now.

Just try not to worry, Just pray for your baby and I will too!!

Oh before the bile acid test don't cook anything that he could smell because food smells can trigger something in the liver and make it go up. I just got straight up when I took her and didn't eat anything and waited till she was at the vet to go get something to eat. I also feel bad eating in front of her if she can't eat. LOL
They told me this at the vet school.


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## ilovemymaltese (Oct 9, 2008)

QUOTE (JMM @ Jun 5 2009, 11:03 PM) index.php?act=findpost&pid=786345


> There is not a vet school "local" to Northern VA. Virginia Tech is about 4 1/2 hours away. University of TN is 7 hours. Cornell is 6 hours.
> 
> However, we have am amazing team of boarded vet in private practice. Dr. Gasser at the Hope Center in Vienna is a boarded internist. SouthPaws has a couple new ones whom I am not personally familiar with. Dr. Jared Williams at VCA Veterinary Referral Associated in Gaithersburg is very well versed in this type of thing. If you PM me, I can give you the name of another internist who does not see regular referrals...[/B]


They are great at VA tech vet school! They have many doctors of all kinds. I also live in NOVA and I drove the 4.5 hours to that vet a couple times with my first maltese, Imani. Our vet in this area was not so good(which is why I have a new vet now with Gigi that we LOVE) she suspected my Imani had a liver shunt. Long story short, we went to VA tech and they had to keep my Imani a coule of days. They were so knowlegdable! They called us every hour to give us updates. After many tests later they found that my Imani had many other problems so we had to end her suffering. The vet cried with us as they put her sleep in our arms. Her body was in buried in their memorial garden. A couple days later they sent me her tiny paw print engraved in a dough material along with her name. They also sent me a wonderful card. They loved my Imani soo very much.


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## dwerten (Oct 6, 2007)

Jackie is that Dr Greene that jayne goes to as i know she said she is tough to get into ?


QUOTE (JMM @ Jun 5 2009, 11:03 PM) index.php?act=findpost&pid=786345


> There is not a vet school "local" to Northern VA. Virginia Tech is about 4 1/2 hours away. University of TN is 7 hours. Cornell is 6 hours.
> 
> However, we have am amazing team of boarded vet in private practice. Dr. Gasser at the Hope Center in Vienna is a boarded internist. SouthPaws has a couple new ones whom I am not personally familiar with. Dr. Jared Williams at VCA Veterinary Referral Associated in Gaithersburg is very well versed in this type of thing. If you PM me, I can give you the name of another internist who does not see regular referrals...[/B]


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## dwerten (Oct 6, 2007)

Jaimie what is the number the inhouse snaps go up to on bile acids is it 30?


QUOTE (Dr.Jaimie @ Jun 5 2009, 11:32 PM) index.php?act=findpost&pid=786359


> im confused...were the bile acids results normal? if they r normal then shunt wouldnt be suspected. i would consider a lepto titer[/B]


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## dr.jaimie (Mar 23, 2004)

QUOTE (dwerten @ Jun 5 2009, 11:41 PM) index.php?act=findpost&pid=786392


> Jaimie what is the number the inhouse snaps go up to on bile acids is it 30?
> 
> 
> QUOTE (Dr.Jaimie @ Jun 5 2009, 11:32 PM) index.php?act=findpost&pid=786359





> im confused...were the bile acids results normal? if they r normal then shunt wouldnt be suspected. i would consider a lepto titer[/B]


[/B][/QUOTE]


we dont run snaps...they are not accurate. have to send to lab


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## dwerten (Oct 6, 2007)

good to know as i always make them send to lab for everything so i am doing the right thing  thanks 


QUOTE (Dr.Jaimie @ Jun 6 2009, 12:49 AM) index.php?act=findpost&pid=786393


> QUOTE (dwerten @ Jun 5 2009, 11:41 PM) index.php?act=findpost&pid=786392





> Jaimie what is the number the inhouse snaps go up to on bile acids is it 30?
> 
> 
> QUOTE (Dr.Jaimie @ Jun 5 2009, 11:32 PM) index.php?act=findpost&pid=786359





> im confused...were the bile acids results normal? if they r normal then shunt wouldnt be suspected. i would consider a lepto titer[/B]


[/B][/QUOTE]


we dont run snaps...they are not accurate. have to send to lab
[/B][/QUOTE]


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## Jaxon (Dec 13, 2008)

Again *THANKS* to everyone one. I finally got a copy of the bloodwork so let me know what you think. I tried to scan this and it would not work so sorry if I confuse you. TR stands for Test Result and RR stands for Reference Range and U stands for Units. The Differential Absolute is done by test result and percentage and reference range. Just let me know.

*CHEMISTRY PANEL*
Total Protein TR-5.3 RR-5.0-7.4 U- g/dl 
Albumin TR-3.4 RR-2.7-4.4 U-g/DL 
Globulin TR-1.9 RR-1.6-3.6 U-g/dl
AST (SGOT) TR-728 (HIGH) RR-15-66 U-U/L 
ALT (SGPT) TR-1810 (HIGH) RR- 12-118 U-U/L 
verified by repeat analysis

Alkaline Phosphatase TR-168(HIGH) RR-5-131 U-U/L
GGTP TR-10 RR-1-12 U-U/L 
Total Bulirubin TR-0.1 RR-0.1-0.3 U-mg/dL 
Urea Nitrogen TR-28 (HIGH) RR-6-25 U-mg/dL 
Glucose TR-117 RR-70-138 U-mg/dL 

*COMPLETE BLOOD COUNT* Hemoglobin TR-13.1 RR-12.1-20.3 U-g/dL
Hematocrit TR-39.4 RR-36-60 U-% 
WBC TR-9.0 RR-4.0-15.5 U-can't read this one 
RBC TR-5.54 RR-4.8-9.3 U-can't read this one 
MCV TR-71 RR-58-79 U-fl
MCH TR-23.6 RR-19-28 U-pg
MCHC TR-33.2 RR-30-38 U-g/dl
Platelet Count TR-295 RR-170-400 U- can't read this one 
Platelet Estimate TR-Adequate RR-Adequate 

*Differential Absolute %* Neutrophils TR-4590 51% RR-2060-10600 
Bands TR-0 0% RR- 0-300 
Lymphocytes TR-3420 38% RR-690-4500 
Monocutes TR-540 6% RR-0-840 
Eosinophils TR-360 4% RR-0-1200 
Basophils TR-90 1% RR-0-150 

*BILE ACIDS* Pre Meal Bile Acids TR-10.7 (HIGH) RR <10.0 U-umol/L 
*BILE ACIDS (POST)*  Post Meal Bile Acids TR 8.0 RR<20.0 U- umol/L 
Verified by repeat analysis 

-----------------Bile Acid Interpretive Comment---------------------------------
FASTING BILE ACID CONCENTRATIONS Elevated fasting bile acid concentrations can occur with inadequate fasting, spontaneous gall bladder contraction and with hepatobilary disease. The probability of hepatobilary disease increases when fasting bile acids exceed 25umol/L . Fasting bile acids may be higher than those of postprandial samples. Potential causes include gall bladder contraction and delayed gastric emptying. If either result exceeds 25 umol/L, abnormal liver function should be considered. POSTPRANDIAL BILE ACID CONCENTRATIONS Elevated postprandial bile acids are supportive of hepatobilary disease. The majority of animals with congenital or acquired portosystemic shunting have markedly increased postprandial value(>100umol/L) 

Then another sheet has this information: 
*Chemistry (SPOTCHEM EZ) * 
BUN result 28 Normal Range 10-29 
Creatinine result 0.9 Normal Range 0.6-1.6
Total Protein result 5.7 Normal Range 66-120
ALT OVER 1000 FLAG Normal Range 10-120
ALP 153 FLAG Normal Range 0-140

Then I have Dr. Toals report
RADIOLOGY CONSULT
ULTRASOUNOGRAPHIC FINDINGS

LIVER: The liver is normal size and slightly increased in echogenicity and shows normal background portal markings. I see no intrahepatic shunts or abnormal vessels.
GALLBLADDER: Within normal limits
SPLEEN: Within normal limits
KIDNEYS:
Left: Normal size at 3.4 cm and normal shape
RIGHT: Normal to slightly marginal size at 3 cm and normal shape 
URINARY BLADDER: Normal bladder and no evidence of stones are identified
ADRENALS:
LEFT: Normal size at 2.4 mm and normal shape
RIGHT: Normal size at 3.8 mm and normal shape
STOMACH: Within normal limits
SMALL INTESTINES: Within normal limits
COLON: Somewhat gassy
PANCREAS: Area of the right quadrant appears normal
PERITONEUM: Within normal limits
LYMPH NODES: Within normal limits

I evaluated the portal vein, vena cava and aorta and no evidence of extrahepatic shunt vessel is identified. The vessels on the left side of the abdomen appeared normal also. 

ULTRASONOGRAPHIC DIAGNOSIS:
1. No sonographic evidence to support a macroscopic extrahepatic or intrahepatic shunt. 
2. The possibility of microvascular dysplasia has not been totally ruled out as these do not show macroscopic structural changes. 
3. The kidneys are normal size no evidence of stones in the renal system identified.

Comment: There is a 15% chance that i could have missed a very small shunt. However the fact that normal vascular markings are seen in the liver and that the kidneys are normal size (not enlarged) and no stones are noted would suggest that a macroscopic shunt is not present. Repeat liver enzymes and bile acids would be suggested in two to 4 weeks. I am told by the owner that clinically this patient is acting normal. I see nothing to prevent surgery for neutering should you desire other that identifying the small testes. Keep me posted on this case if I can help you further. 

If you have any further questions after reviewing this report please feel free to give me a call. However I will be calling you with a verbal report.

Sincerely, 
R Toal, DVM, MS, DACVR, Radiology


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## Jaxon (Dec 13, 2008)

I thought it was best if I did not reply to anymore questions until I got these reports so that is why I have not tried to answer other posts. I lost internet connection for a minute :shocked: but thank goodness the post got there!!!!!!!!!


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## dr.jaimie (Mar 23, 2004)

that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?


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## Jaxon (Dec 13, 2008)

QUOTE (Dr.Jaimie @ Jun 10 2009, 07:12 PM) index.php?act=findpost&pid=788731


> that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?[/B]


They did not want to do the bloodwork again for a couple of weeks  
As far as I know lepto was not checked for. 
Can you tell me what lepto is so I can call and request it?
Thanks


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

QUOTE (Jaxon @ Jun 12 2009, 02:45 PM) index.php?act=findpost&pid=789850


> QUOTE (Dr.Jaimie @ Jun 10 2009, 07:12 PM) index.php?act=findpost&pid=788731





> that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?[/B]


They did not want to do the bloodwork again for a couple of weeks  
As far as I know lepto was not checked for. 
Can you tell me what lepto is so I can call and request it?
Thanks
[/B][/QUOTE]

Here's a link that might help explain what it is ...

http://www.peteducation.com/article.cfm?c=2+2102&aid=454


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## Jaxon (Dec 13, 2008)

Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed. 

By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally? 
Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!

Thanks to everyone for your thoughts and prayers :grouphug:


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## Jaxon (Dec 13, 2008)

QUOTE (Jaxon @ Jul 11 2009, 01:58 PM) index.php?act=findpost&pid=803927


> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of <strike>1830</strike>. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


Sorry that should of been 1810 not 1830


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## dwerten (Oct 6, 2007)

no thought is stupid ever  alot of time taking notes and narrowing down things is what helps to figure this stuff out as the body is a very complex thing. 

I think it is a strong possibility as every drug affects the liver as the liver processes everything and is what helps detox the body. Anything you do topically or internally goes into the blood stream. So i would say yes this could have affected the numbers. 

Are you doing low protein diet, using denomarin (milk thistle and sam-e combined into one)? These things will help lower the numbers of the ALT. Also if you juice zucchini and celery as zucchini cleanses the liver and celery cleanses the urinary tract it will help as well. You juice them together and poor juice over food and put pulp on food as well - always use organic. my friend did this with her bull mastiff after he ate a toxic plant and his liver enzymes went through the roof - she only did milk thistle and juiced the z and c and his liver enzymes went down drastically. I do not use any topical flea or heartworm prevention in mine but i am not in an area where it is necessary thank goodness. For flea if i was in an area that required it i would do touchofmink.com minksheen shampoo if dog does not have allergies as works great for many and natural and for heartworm that is tough check the map and if you are in high risk area maybe jmm or dr jaimie can shed better light on that for you as i do know for small dogs interceptor is better than heartguard in what i have read so maybe that is better 

this group will have great advice as well as the know a ton about the liver [email protected]

I believe dr tobias assistant is even on the group as well and she is an expert in this field along with dr centers. 



QUOTE (Jaxon @ Jul 11 2009, 12:58 PM) index.php?act=findpost&pid=803927


> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


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## CrystalAndZoe (Jul 11, 2006)

QUOTE (Dr.Jaimie @ Jun 10 2009, 07:12 PM) index.php?act=findpost&pid=788731


> that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?[/B]


Zoe's ALT's were scary high like that, AST's not as scary high like Jaxon's and her Bile Acids were fine. She had Lepto. Are they doing a Lepto Titre? 

QUOTE (Jaxon @ Jul 11 2009, 01:58 PM) index.php?act=findpost&pid=803927


> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


I'm glad the ALT's are coming down but I'd still be concerned about some sort of an infection. Something caused those levels to go sky high.


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

With your doc's approval, milk thistle (sold for dogs as Marin) is a great herb for the liver. Also, zucchini, watermelon, and artichokes are good liver cleansing foods. I don't know what you currently feed your baby, but cutting down on highprotein/red meat when the ALT is high is always a good idea. 

You could also try Dr. Dodds liver cleansing recipe which is pinned here:

http://spoiledmaltese.com/forum/index.php?showtopic=43958

This recipe wouldn't hurt your dog in any way.

When I took Nikki to be spayed last year, her ALT was high and her bile acid test was mildly high. About a month later, she was spayed, and her liver was biopsied. They diagnosed her with MVD. 

She is on home cooking (moderate protein) no special supplements or meds, except for probiotics and colostrum.

She is doing great now, and her ALT number is very good. 

So don't worry too much, but definitely do a Lepto Titer blood test. 

Keep us posted.


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## Jaxon (Dec 13, 2008)

Thanks for not making me feel so stupid over the asked question 

Jaxon is a very picky eater so we eat boiled or baked chicken tenders with green beans and carrots. Occasional roast beef when he is tired of chicken. I have purchased several types of dog foods and have had no success, from the best that has been recommended to the cheap kibbles and bits, that is the only grocery store food I ever tried. Even done the 3 day no food deal a couple of times and he still will not eat dog food. Did not like the fish and sweetpotato recipe either. So I feel that I must do what I do so he will eat something.  

I did not do the milk thistle because I wanted to see if the number would come down without special treatment. I asked the vet if I had to do the heartworm pill and she said yes due to the our living area and the mosquitos around here plus I have an inground pool. I have mixed emotions about Frontline, but too scared not to use something. 

I will check the yahoogroup out!!!




QUOTE (dwerten @ Jul 11 2009, 02:09 PM) index.php?act=findpost&pid=803929


> no thought is stupid ever  alot of time taking notes and narrowing down things is what helps to figure this stuff out as the body is a very complex thing.
> 
> I think it is a strong possibility as every drug affects the liver as the liver processes everything and is what helps detox the body. Anything you do topically or internally goes into the blood stream. So i would say yes this could have affected the numbers.
> 
> ...





> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


[/B][/QUOTE]


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## Jaxon (Dec 13, 2008)

I asked the vet about Lepto due to someone thinking that that could be a possible issue with his ALT and she said that if Jaxon had Lepto he would be very sick. So she said the test was not necessary. Trust me, I am still concerned about the high number and I am just trying to work through the best that I know how. 

QUOTE (Crystal&Zoe @ Jul 11 2009, 02:51 PM) index.php?act=findpost&pid=803944


> QUOTE (Dr.Jaimie @ Jun 10 2009, 07:12 PM) index.php?act=findpost&pid=788731





> that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?[/B]


Zoe's ALT's were scary high like that, AST's not as scary high like Jaxon's and her Bile Acids were fine. She had Lepto. Are they doing a Lepto Titre? 

QUOTE (Jaxon @ Jul 11 2009, 01:58 PM) index.php?act=findpost&pid=803927


> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


I'm glad the ALT's are coming down but I'd still be concerned about some sort of an infection. Something caused those levels to go sky high.
[/B][/QUOTE]


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## Jaxon (Dec 13, 2008)

I'm sure you read the other post where I said I did not try the Milk thistle due to seeing if the ALT would come down naturally and you probably seen our diet but I will try zucchini so we can have another vegetable 

I am glad Nikki is doing better. Can you tell me what probiotics and colostrum is? 
I do not want to put Jaxon through a biopsy yet. Pray it does not go that far!!!

QUOTE (Nikki's Mom @ Jul 11 2009, 03:20 PM) index.php?act=findpost&pid=803954


> With your doc's approval, milk thistle (sold for dogs as Marin) is a great herb for the liver. Also, zucchini, watermelon, and artichokes are good liver cleansing foods. I don't know what you currently feed your baby, but cutting down on highprotein/red meat when the ALT is high is always a good idea.
> 
> You could also try Dr. Dodds liver cleansing recipe which is pinned here:
> 
> ...


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## CrystalAndZoe (Jul 11, 2006)

QUOTE (Jaxon @ Jul 11 2009, 03:31 PM) index.php?act=findpost&pid=803957


> I asked the vet about Lepto due to someone thinking that that could be a possible issue with his ALT and she said that if Jaxon had Lepto he would be very sick. So she said the test was not necessary. Trust me, I am still concerned about the high number and I am just trying to work through the best that I know how.
> 
> QUOTE (Crystal&Zoe @ Jul 11 2009, 02:51 PM) index.php?act=findpost&pid=803944





> QUOTE (Dr.Jaimie @ Jun 10 2009, 07:12 PM) index.php?act=findpost&pid=788731





> that is a very high ALT but bile acids are normal so i wouldnt suspect a shunt. have they rechecked his alt? i would also consider testing for lepto how is he feeling?[/B]


Zoe's ALT's were scary high like that, AST's not as scary high like Jaxon's and her Bile Acids were fine. She had Lepto. Are they doing a Lepto Titre? 

QUOTE (Jaxon @ Jul 11 2009, 01:58 PM) index.php?act=findpost&pid=803927


> Just wanted to let everyone know that I took Jaxon back to the vet for his bloodwork and his ALT came down to 599. It's still not normal but beats the heck out of 1830. They will retest him again in 30 days. Not sure where this is going but they still won't neuter him. I get a copy of his bloodwork on Tuesday so I will see if anything else changed.
> 
> By chance, does anyone know if the Frontline Plus or the Interceptor Tab would of thrown his bloodwork off originally?
> Probably not, but I have to wonder... For I did not change his diet, nor did I treat him with any meds or any other natural products for this issue... So by not giving him his heartworm pill or using the Frontline on him was the only thing that was different this time!!! It's just a thought, maybe a stupid one, but it really does make me wonder!!!!
> ...


I'm glad the ALT's are coming down but I'd still be concerned about some sort of an infection. Something caused those levels to go sky high.
[/B][/QUOTE]
[/B][/QUOTE]

Zoe did not act sick when she was diagnosed with Lepto. I was aware of some changes in her behavior that had me concerned and it was during the first dog food scare so I insisted on a full blood panel. My vet and the techs kept telling me she was NOT a sick dog. Then the results came back and they were just shocked. It was caught so early that the first Lepto Titer came back negative. But when she had her ultrasound done, it showed the liver fine, but the kidneys were dialated. From my understanding, it's really rare for the vet to be able to notice the kidneys during the ultrasound. So my vet knew it HAD to be Lepto. So she treated her for Lepto and we re-titered after a month and sure enough, it came back with a very low marker. Most dogs don't survive Lepto or if they do, they have kidney damage because it's not caught until the dog is in kidney failure. Because we caught it so early, she is not only a survivor, but has no permanant kidney damage.

With home cooking, you really need to consult a vet nutritionist for the correct added supplements to ensure it is complete and balanced. For example, the phospherous level is so high in meat you need to balance it with enough calcium. Also with any home diet, you need to do full blood work ups every 6 months or so at first to ensure your baby is getting everything they need nutritionally and then I still would have them done yearly. I had a customer in this past winter who had been home cooking for her Chi for over a year when she all of a sudden started to have seizures. After a full blood work up, it showed a bunch of things including her electrolytes were out of balance causing the seizures because the home cooked diet was not complete and balanced.

And it is good not to do homeopathic remedies until you have a diagnosis. It's really difficult to get a diagnosis when the results could be altered due to the homeopathic remedies. Once you have a diagnosis, I'm all for working with homeopathic remedies in conjunction with your vet. So good choice on your part to wait.


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

Probiotics are good bacteria, like what is in yogurt, to help with digestion. Colostrum is a milk product that helps the immune system. Both are beneficial with no side effects at all, but you should ok it with your doc first, especially since the ALT is so high.

I agree that you should find a veterinary nutritionist either in person or by phone to help you design a good diet for your dog.

I wish you the best.


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## jmm (Nov 23, 2004)

Please PM me. I'd like to refer you to a vet in the area who is expert in this type of thing.


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## Jaxon (Dec 13, 2008)

QUOTE (JMM @ Jul 11 2009, 09:19 PM) index.php?act=findpost&pid=804093


> Please PM me. I'd like to refer you to a vet in the area who is expert in this type of thing.[/B]


Will be calling tomorrow 7/16 to make an appt. Thank you so much for the info.

So I thought possibly things were looking up for Jaxon and this liver issue but we went to the vet today for an ear issue and orange bile foamy throw-ups and he has an ear infection with a yeast smell to it, she said. Also she has decided to put him on Pepcid as well as SamE? Some type of pill for the liver that contains Milk Thistle and something else... When I asked her opinion about Milk Thistle she decides to put him on a pill he will not take  . She still would not do the Lepto test but did do a 6 panel bloodwork and his ALT was 1635 today... It was just 599 a week or so ago... So it is time to move on!!! She has no clue what is going on since there was no shunt involved so I will go to the vet that JMM has recommended as soon as we can get in. 

BTW does anyone know who or where I can get help with a diet for Jaxon? He would not eat the fish and sweet potato recipe...

Thanks for everyones concerns and for helping and hearing me out, I am just so confused!!!!!


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## Jaxon (Dec 13, 2008)

QUOTE (Jaxon @ Jul 15 2009, 11:05 PM) index.php?act=findpost&pid=805912


> QUOTE (JMM @ Jul 11 2009, 09:19 PM) index.php?act=findpost&pid=804093





> Please PM me. I'd like to refer you to a vet in the area who is expert in this type of thing.[/B]


Will be calling tomorrow 7/16 to make an appt. Thank you so much for the info.

So I thought possibly things were looking up for Jaxon and this liver issue but we went to the vet today for an ear issue and orange bile foamy throw-ups and he has an ear infection with a yeast smell to it, she said. Also she has decided to put him on Pepcid as well as SamE? Some type of pill for the liver that contains Milk Thistle and something else... When I asked her opinion about Milk Thistle she decides to put him on a pill he will not take  . She still would not do the Lepto test but did do a 6 panel bloodwork and his ALT was 1635 today... It was just 599 a week or so ago... So it is time to move on!!! She has no clue what is going on since there was no shunt involved so I will go to the vet that JMM has recommended as soon as we can get in. 

BTW does anyone know who or where I can get help with a diet for Jaxon? He would not eat the fish and sweet potato recipe...

Thanks for everyones concerns and for helping and hearing me out, I am just so confused!!!!!
[/B][/QUOTE]
Also amoxicillian every 12 hours and an ear ointment that is called Animax for 7-10 days but it is no way the little tube will last.


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## jmm (Nov 23, 2004)

I would hold off on changing anything until your consult.


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## Jaxon (Dec 13, 2008)

Update: The vet I have been referred to is not accepting new patients, man I am so bummed :smcry: 
Maybe theres hope somewhere else. Maybe I will just try another vet in my area and see if she can help.


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

QUOTE (Jaxon @ Jul 16 2009, 12:16 PM) index.php?act=findpost&pid=806040


> Update: The vet I have been referred to is not accepting new patients, man I am so bummed :smcry:
> Maybe theres hope somewhere else. Maybe I will just try another vet in my area and see if she can help.[/B]


Don't take "no" as an answer from the vet. Since Jackie recommended them is it possible that she could get you in? Or can you perhaps speak with the practice manager and explain how complicated your case is and that you desperately need someone experienced and tell who recommended you, etc. If she wont talk to you then write a letter to the practice manager explaining the situation and hand deliver it.

I had this happen with my medical doctor and I eventually got in. I didn't give up. 

Please ... keep trying ... and good luck!!!


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## jmm (Nov 23, 2004)

There are a few internists at the Hope Center in Vienna (I like Dr. Gasser) and Dr. Jared Williams and VCA VRA in Gaithersburg.


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## lottapaws (Mar 29, 2006)

Yes, please try again with the dr who is not taking new patients. We ran into the same situation with my son who was attending an out of state college, and needed to see a particular subspecialty in cardiology. We were referred to a particular dr but found he was not taking new patients. I finally found a way into the practice through someone in the office, a young man who wasn't an administrator or office manager or anything, yet he got us an appointment! 

Maybe explaining that you just want a diagnosis for your regular vet to treat, that your vet cannot find answers and is at a loss for what is wrong. This way, you wouldn't be a long term client, just a short term client. 

Good luck, and we'll keep you and Jaxon in our thoughts and prayers!! rayer:


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## jmm (Nov 23, 2004)

That vet does not take regular referrals. There are many other internists in the area who see all referrals.


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## Jaxon (Dec 13, 2008)

OK I just called back to the vets office that JMM referred us to and explained my situation again to a different lady today and I got the same answer, we are not accepting new patients. So I ask her to please just ask if the vet would just take a look at Jaxon and his paperwork and see us just for some answers, if that is possible and not as a long term patient until she is excepting new patients. She took my name and number and said she would ask and someone would call us back. Hopefully we will be able to see this vet!!! I, too, ask if she could refer another internist to us and she said no. I also called Doctor Toals office (the vet that did the ultasound) and ask if they could refer us to someone like the vet (btw they new of this vet just by name, that was impressive) JMM referred us to she said they have an interalist there but when looking at Jennifer Gieg's Special Interests and Expertises on The South Paws website, liver disease is not listed so I am not sure to see her or not. Will be calling the other vet in Vienna that JMM mentioned as soon as I hear back from the original lady I spoke of at the beginning of this post. 

Prayer is needed here!!! THANKS!!!!


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## jmm (Nov 23, 2004)

I dont know Dr. Gieg....I worked with Dr. Gasser occasionally when I worked in the ICU at Hope Center. You have some great options.


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