# Question about the high ALT liver value



## Marzena (Sep 6, 2012)

Hello Everyone,

First of all I would like to say I loove this website. Anytime I have questions regarding my two sweet Maltese doggies I Google Spoiled Maltese  I'm always impressed with the knowledge you have here. 

I'm writing because my younger Maltese Freddy who is now 1 year and 2 months old had his blood tests done last February and it turned out his ALT level was elevated - 212. My vet said we should wait and repeat the test after 6 months. 

Since then we moved to San Francisco and I found a new vet. I asked him to repeat the blood test and now Freddy's ALT is 289. 
The vet said that:
"The next step in evaluating his liver would be to have x-rays taken to look at the size of his liver and an abdominal ultrasound to look at the structure of his liver and see if there are any abnormalities in tissue or vessels"

But I started reading the posts here and I see that everyone says next step should be BAT. 

Since we got Freddy (November last year) he has always been very cheerful, likes to play, eats and drinks well. 
Having said that he is very slim. He weights 6pounds but looks very skinny. I don't know if it could be because of the potential liver damage or maybe the way he is build. He has long legs and looks totally different from my other dog - Teddy who is very sturdy and compact. 

Also his hair does grow a bit funny. Kind of straight and in different directions. I saw someone mentioning this before on SM.

Also I worry because since we've had Freddy he very often breaths very fast. Of course after exercise it's normal but often he'll be sleeping and breathing really fast. 

He eats NOW! fresh for small breeds, and dr Harvey's mixed veggies (I add protein to it). He takes half of NuVet vitamin a day. I give him freeze dried treats and veggies and fruits. 

Sorry for such long email. I wanted to give a full description so you could advise what I should do next and if he might have problem with liver or maybe his heart. 

Thank you so much
Marzena


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## Marzena (Sep 6, 2012)

Also I forgot to add that he takes Heartgard and the breeder said when he was born he was so small he had to be separated from the mother so he could survive.


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## wkomorow (Aug 26, 2011)

I have experience with heart issues, but Lucky does have a liver shunt. If you are concerned that he may have a shunt, the next step as a Protein C test - about $50. It is a simple blood test that is sent to Cornell to be assayed. It will help distinguish between shunt and MVD. A high percentage of malts have MVD. Many malts live in the world of high bats their entire life without any real health problems. Others have health issues including shunting. If a shunt is indicated, then I would do a ultrasound if necessary. A specialist can tell size and general condition, but you really need a Doppler ultrasound to see well into the liver itself to look for abnormalities. These are typically only at specialized teaching hospitals such as UC Davis. An ultrasound can look at the general size and shape of other organs and can see if high bile levels are causing any build up of stones in the bladder/kidneys. If it is a liver issue than many can be managed medically. 

Depending on the parentage, there can be a lot of variation in non-show dogs in terms of looks and build. No two dogs are the same, but liver issues typically present with digestive issues - vomiting and such, a general failure to thrive, and can lead to hepatic encephalography which leads to behavior changes. Lucky was just 3 when he showed any signs of liver issues and it came on sudden.

Good luck, and I be happy to answer any questions I can on liver issues. Unless there are particular symptoms that are worrisome, I would not become overly concerned. I would continue to investigate with your vet what might be the underlying cause, but I would not panic.


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## Dominic (Nov 4, 2012)

I don't have much to add but yes you should do the BAT test for sure and I would do it ASAP so you know what are you dealing with. He is eating good food, my dogs are on Stella & Chewy raw and Dr Harvey's Veg to Bowl w/ proteins with dehydrated treats as well, they thrive on it. Big hug to Freddy from his Bay Area friends Dom, Ben & Elena.


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## Marzena (Sep 6, 2012)

Hi Walter, thank you so much for your email! Should I do BAT test first or Protein C? Also would the vet perform the BAT test and also take sample to send it to Cornell for the Protein C test? I just want to get as much information as possible. I wonder if the vet even know about those tests since he didn't recommend them....


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## Marzena (Sep 6, 2012)

Dominic said:


> I don't have much to add but yes you should do the BAT test for sure and I would do it ASAP so you know what are you dealing with. He is eating good food, my dogs are on Stella & Chewy raw and Dr Harvey's Veg to Bowl w/ proteins with dehydrated treats as well, they thrive on it. Big hug to Freddy from his Bay Area friends Dom, Ben & Elena.


Hi Beatriz, 
Yes my both dogs Teddy and Freddy love the dr Harvey's food  what brand of freeze dried treats do you use? I give them Oryjien. 

And yes I'm definitely going to do the test ASAP. I only hope my new vet is familiar with them!

Hello to Dom, Ben and Elena


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## wkomorow (Aug 26, 2011)

Marzena said:


> Hi Walter, thank you so much for your email! Should I do BAT test first or Protein C? Also would the vet perform the BAT test and also take sample to send it to Cornell for the Protein C test? I just want to get as much information as possible. I wonder if the vet even know about those tests since he didn't recommend them....


Do a BAT test first. It is an easy test from a blood draw. If the number is over 100, then move to a Protein C. It it is under 100, then with high ALT, it really would point to MVD, which can be non-symptomatic or can develop into symptoms. An ultrasound will provide only basic information (liver size and shape, the condition of other organs) unless it is a Doppler ultrasound. If you do an ultrasound and are looking for liver abnormalities, it really needs to be read by true board certified radiologist with lots of experience - typically someone who is teaching radiology at a vet school. I think it is important unless there are serious symptoms to go as far as possible with non-invasive tests.


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## maggieh (Dec 16, 2007)

You have gotten some great advice from Walter - BAT, then Protein C. 

If it is a shunt, you will want to talk about options with a specialist. Sometimes a shunt can be managed medically with diet and supplements, and other times surgery will be needed.


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## sherry (Jan 4, 2013)

Walter's advise is right on! My boy Riley has MVD. The protein C test saved him from the surgery we had scheduled for a liver shunt. He is on prescription food and several meds and lives a normal life.


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## Marzena (Sep 6, 2012)

Thank you everyone! I've just emailed my vet and requested BAT. 
I've also looked at the website of the place he recommended for ultrasound (it's VCA San Francisco Veterinary Specialists) and they perform Doppler ultrasound there. Hopefully it won't go that far...


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## Marzena (Sep 6, 2012)

wkomorow said:


> Do a BAT test first. It is an easy test from a blood draw. If the number is over 100, then move to a Protein C. It it is under 100, then with high ALT, it really would point to MVD, which can be non-symptomatic or can develop into symptoms. An ultrasound will provide only basic information (liver size and shape, the condition of other organs) unless it is a Doppler ultrasound. If you do an ultrasound and are looking for liver abnormalities, it really needs to be read by true board certified radiologist with lots of experience - typically someone who is teaching radiology at a vet school. I think it is important unless there are serious symptoms to go as far as possible with non-invasive tests.


Thanks Walter! I've contacted the vet about BAT.
I have one more question. What does Lucky uses for heartworm protection? Is there any medicine out there that is kinder to the liver?


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## Marzena (Sep 6, 2012)

Freddy says thank you


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## Snowbody (Jan 3, 2009)

Great advice from Walter. Freddy is so handsome. :wub::wub:


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## wkomorow (Aug 26, 2011)

Look at that face. Freddy is adorable. Lucky was on Interceptor 12 months a year before it went off the market. I still think it is the safest one. Before his liver issue was detected - the vet put him on Heartguard - one month later he had liver symptoms. He always had a hidden liver issue - a shunt, but we never knew it until all **** broke loose last summer. The vet felt Revolution (a topical) was the safest for him, but he has a heartworm test each spring and I only give it to him in June July and August. I will be discussing this with his specialist when we see her in March for his annual evaluation. 

Our situation is very unique. He is really of low risk for mosquitoes. Lucky never goes out other than to the vet and groomers and it is cold here most of the year. At -15 degrees, you just don't see many insects. I wish interceptor was available again but .... I do use a peppermint as part of his bath - it is a natural repellent,and it makes him smell good.


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## Marzena (Sep 6, 2012)

Yes I've heard so much about the Interceptor. So sad it's not possible to buy it anymore. I used live in NYC and since it was cold there in winter I wasn't using anything on my dogs. I would usually start again n spring too. But I have a feeling here in SF I probably need protection year around. 

After I found out about Freddy's results I asked my new vet if we should switch Heartgard to topical revolution (my other doggie uses that) but the vet said no. I don't think he has much knowledge about liver problems. I'm thinking to just start using Revolution on Freddy from now on anyway? 
Also I worry a bit because I run out of heartguard (it's being delivered to me some time next week). Last time Freddy had Heartgard it was September 1. They did the heartworm test on him October 13 and it was negative. It's been 4 days since then and I'm thinking to use Revolution on him today, but what if he got heartworm in the last 4 days??


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## Marzena (Sep 6, 2012)

Snowbody said:


> Great advice from Walter. Freddy is so handsome. :wub::wub:


Thank you  and your Tyler is a great looking dude too )


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## Dominic (Nov 4, 2012)

We are in the Bay Area and have never used heartworm medication as there are no Mosquitos around. That's a very personal choice and the more you read about the benefits, treatments Vs the need of medication the better you can make a decision. We also don't use flea medication, I rather treat a flea problem when and if they get a flea than give the medicine monthly. We don't vaccinate for bordatella or lepto. Those are all decisions based on lots of research and in agreement with their vet.


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## Marzena (Sep 6, 2012)

Dominic said:


> We are in the Bay Area and have never used heartworm medication as there are no Mosquitos around. That's a very personal choice and the more you read about the benefits, treatments Vs the need of medication the better you can make a decision. We also don't use flea medication, I rather treat a flea problem when and if they get a flea than give the medicine monthly. We don't vaccinate for bordatella or lepto. Those are all decisions based on lots of research and in agreement with their vet.


Yes Beatriz I totally agree with you. I try to use as little medication as possible for my dogs. I always refuse bordatella even though every vet tries to push it every time. Only Teddy got one bordatella shot when I didn't know better. Since then I try to be tough. They never had lepto. Now Teddy is due Dapp and I asked to do a titter test instead since he is already 2.5 years old and is probably already immune but the new vet doesn't like this idea. I'm going to insist anyway. 

But I live in Embarcadero/Financial District area of SF, right near the Bay and we had terrible mosquitoes here. I got bitten so many times recently and my friend got very bad reactions to the bites. It's like some kind of monster mosquitoes here... So I prefer to use the heartworm protection for now. I wonder if I can skip it in winter here? I'm very new to Bay Area. I just moved here last August.


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## Dominic (Nov 4, 2012)

Marzena said:


> Yes Beatriz I totally agree with you. I try to use as little medication as possible for my dogs. I always refuse bordatella even though every vet tries to push it every time. Only Teddy got one bordatella shot when I didn't know better. Since then I try to be tough. They never had lepto. Now Teddy is due Dapp and I asked to do a titter test instead since he is already 2.5 years old and is probably already immune but the new vet doesn't like this idea. I'm going to insist anyway.
> 
> But I live in Embarcadero/Financial District area of SF, right near the Bay and we had terrible mosquitoes here. I got bitten so many times recently and my friend got very bad reactions to the bites. It's like some kind of monster mosquitoes here... So I prefer to use the heartworm protection for now. I wonder if I can skip it in winter here? I'm very new to Bay Area. I just moved here last August.



That's great to hear how you handle the vaccines and meds. So important to be on top of it. I guess you'll need the heartworm then, why take a chance but I wouldn't worry at all about the 4 days he's not on medication. I hope you love the city, we could have a play date before it gets too cold


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## wkomorow (Aug 26, 2011)

Agree absolutely, it is important to use as little medications/vaccines as possible. If mosquitoes are not a problem, the risk of heartworm is probably low. But it is a very personal decision that you need to make with your vet.


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## Snowbody (Jan 3, 2009)

Marzena said:


> Yes Beatriz I totally agree with you. I try to use as little medication as possible for my dogs. I always refuse bordatella even though every vet tries to push it every time. Only Teddy got one bordatella shot when I didn't know better. Since then I try to be tough. They never had lepto.* Now Teddy is due Dapp and I asked to do a titter test instead since he is already 2.5 years old and is probably already immune but the new vet doesn't like this idea.* I'm going to insist anyway.
> 
> But I live in Embarcadero/Financial District area of SF, right near the Bay and we had terrible mosquitoes here. I got bitten so many times recently and my friend got very bad reactions to the bites. It's like some kind of monster mosquitoes here... So I prefer to use the heartworm protection for now. I wonder if I can skip it in winter here? I'm very new to Bay Area. I just moved here last August.


Maybe a different vet would be a good idea. He sounds like he's not up on newer methods and possibly the idiosyncrasies of taking care of toy dog breeds like Maltese and Yorkies who can have liver issues.


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## Marzena (Sep 6, 2012)

Yes I will definitely be on a lookout for someone else. For now he emailed me back and agreed to do the BAT test. I wonder if I should tell him I don't want the IDEXX SNAP, just in case? Does it still apply? I saw a thread here about the difference between the bile tests.

Beatriz play date would be great! Also this Sunday there's a Maltese play date meetup at China Basin Park at 11:30 am. I'm going for sure! Here's a link to it: SF MALTESE MEETUP - The San Francisco Maltese Meetup! (San Francisco, CA) - Meetup


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## wkomorow (Aug 26, 2011)

Most malts have higher than normal bile acid levels. You really need a number, not just to know that it is higher than average. SNAP test is not helpful for this breed. There are specific protocols for the collection of the blood and handling it. 

http://spoiledmaltese.com/forum/52-...2734-dr-centers-bile-acid-test-procedure.html


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## Dominic (Nov 4, 2012)

Marzena said:


> Beatriz play date would be great! Also this Sunday there's a Maltese play date meetup at China Basin Park at 11:30 am. I'm going for sure! Here's a link to it: SF MALTESE MEETUP - The San Francisco Maltese Meetup! (San Francisco, CA) - Meetup



Oh cool, have fun! We've been twice at this meet up but it doesn't work well for us. Ben doesn't like to be around so many strangers and the area is not gated, it's not possible to handle 3 on the leash with other 15 dogs around. Bummer


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## maggieh (Dec 16, 2007)

For heartworm, we use Sentinel which is the same med as interceptor. Unfortunately it also has a growth inhibitor for fleas but since both of my dogs got sick on ivermectin I stick with sentinel.

Dr. Sharon Center at Cornell is one of THE experts on liver problems in dogs. I would encourage your vet to contact her after you have test results for consultation.


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## sherry (Jan 4, 2013)

Marzena said:


> Freddy says thank you


OMG! Freddie is a doll!


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## Marzena (Sep 6, 2012)

sherry said:


> OMG! Freddie is a doll!


Thank you Sherry  he is a sweetie  we love him very much!


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