# high bile acid test results



## jessica-01 (Dec 21, 2010)

Sorry if this is a repetition of previous posts. I just wondered is anyone had any more modern thoughts or advice on high bile acid test results? My female Maltese, Lilliput, is 6 years' old and has just had a second bile acid test reading after eating with a level of 114. Post fasting and ore eating was just 1.4. All other results, including liver enzymes, Bun etc are normal. 

I'm crippled by terror. We see a specialist on Monday and hopefully have an ultrasound later in the week. I'm so frightened bcos I've read that liver failure won't show up on bloods until there is 70% damage. 

I understand Maltese can have higher readings. I thought this only went up to around a level of 50 though. Does anyone know if Maltese can have readings this high naturally? Can the gall bladder have a slower response time perhaps? If the post fasting result is normal, the liver is eventually removing the bile acids, surely? However I understand these results are indicative of shunts.

I have read about MVD also but am unsure if we do Protein C tests in the UK. 

Lilliput has no symptons whatsoever. She is energetic and eats well. She never has vomitting or diarrhoea. Sometimes she shakes after eating, which could be a neurological sign of a shunt, but my vet doesn't think this is related. 

Any comments at all would be most appreciated. I can barely breath for fear and wonder if there is any hope this could be a natural reading for her? 

Thank you x


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## sherry (Jan 4, 2013)

Marianne, first and foremost, calm down. My Riley has MVD and his BAT came back much higher than Lilliput. Protein C test would be the next step. I would suggest seeing if their is a University that does this test. In the Us Cornell University does it. I had Riley scheduled for shunt surgery until his Protien C came back. It was 90 % chance MVD, not shunt. I control his with meds and lower protien food. Several dogs on SM have MVD and it is easily controlled.And if her pre test was only 1.4 I would not think she has a shunt. Actually, the ultrasound could totally rule out a shunt.


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## jessica-01 (Dec 21, 2010)

Oh thank you Sherry! That is interesting. I'll look for a Protein C test as you suggest. How lucky you were able to do that for Riley before surgery for a non existent shunt. 

Do you re-test, or is it not worth it with MVD (bcos the results get affected from the MVD are are thus unreliable)? 

Lilliput is on a raw meat diet with organic fruits and veg with bone broth and kefir etc. I'm told this is too high in animal protein, which is hard for me to get my head around as I've always been a believer in species appropriate feeding. Back to the drawing board for me then, perhaps?! 

Have you heard of DogLiverShunt.com? It looks wonderful but I'm worried it's a scam and they're selling bad supplements etc!

Thank you again.


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## wkomorow (Aug 26, 2011)

There is so much conflicting information out there. The chances are that it is not a shunt, but if it is, there are several here who have maltese with shunts, some have done surgery, others manage it with medicine and diet. You may have to change the protein source. Luck is on a vegetarian diet. He is on a hepatic kibble, but complemented with cheese and soy. 

Denamarin is a really good suppement for liver support. A normal ultrasound will determine liver size, but you need a doppler ultrasound to actually see the shunt. Any test is a snapshot, so I would think they woud want to redo the test. The Protein C test is the determiner of shunt versus MVD, the sample is sent to Cornell for analysis.

Please don't worry too much. You will know more as they do more test. However the fact there were no symptoms and L is already 6 suggests this will be a very positive outcome.


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## Snowbody (Jan 3, 2009)

Marianne - be sure to go into the search tab here and type in bile acid/liver shunt, etc and you will find some pinned articles and some others that should help. Cornell Vet School in Ithaca, NY is a wonderful resource...really the go to specialists in this country about this and they definitely work with other specialists so you can try to have your vet call her. I see her number listed as Phone: 607-253-3060 on their site. Maybe Walter has an e-mail address for them. Wishing you luck and take deep breaths.​


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## sherry (Jan 4, 2013)

jessica-01 said:


> Oh thank you Sherry! That is interesting. I'll look for a Protein C test as you suggest. How lucky you were able to do that for Riley before surgery for a non existent shunt.
> 
> Do you re-test, or is it not worth it with MVD (bcos the results get affected from the MVD are are thus unreliable)?
> 
> ...


I would not feed raw diet to a liver dog. I had Riley on hepatic kibble for a long time but a year ago switched to The Honest Kitchen Turkey which is dehydrated. He does good on it. I wish my two liked fruit and veggies, but not too much. They get a teaspoon of cottage cheese for lunch. Riley gets Denamarin every morning and lactulose on his food. I'll look at the site you mentioned, had not heard of it. Please don't worry, this would be something Lilli has had all her life.


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## harrysmom (Sep 28, 2007)

Hi!

My little guy Harry has a malformed liver and as a result, acquired liver shunts. When he was first diagnosed, at 6 months old, he was retaining fluids. After changing him over to a vegetarian diet, supplemented with the same hepatic kibble that Walter's pup Lucky eats, he is pretty normal. I just have to be very diligent about not letting him get any meat at all because that causes big problems for him. 

If your pup has no symptoms and acts happy and healthy, then I seriously would think twice about doing anything at all, except maybe cutting down on the protein in his food. When Harry was diagnosed, my vet wanted to do a biopsy. We found out after going to Cornell that a biopsy would have killed Harry because of the massive amount of veins he has in his liver. 

Harry is turning 10 years old in February, so a liver shunt that is medically managed through diet, and sometimes supplements, absolutely works for these little guys.

Good luck!
Debbie


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## jessica-01 (Dec 21, 2010)

wkomorow said:


> There is so much conflicting information out there. The chances are that it is not a shunt, but if it is, there are several here who have maltese with shunts, some have done surgery, others manage it with medicine and diet. You may have to change the protein source. Luck is on a vegetarian diet. He is on a hepatic kibble, but complemented with cheese and soy.
> 
> Denamarin is a really good suppement for liver support. A normal ultrasound will determine liver size, but you need a doppler ultrasound to actually see the shunt. Any test is a snapshot, so I would think they woud want to redo the test. The Protein C test is the determiner of shunt versus MVD, the sample is sent to Cornell for analysis.
> 
> Please don't worry too much. You will know more as they do more test. However the fact there were no symptoms and L is already 6 suggests this will be a very positive outcome.


Thank you Walter. We re-did the BAT and it was the same - low preparedial (1.4) and high postprandial (114). How interesting about the Doppler Ultrasound. I'd not heard of that before, thank you! We did an ultrasound on Tuesday and the vet was a specialist in imaging but could not see any shunt at all. She said it could be microscopic in size. I have yet to have a consultation with her since she gave me the main result briefly over the phone, but I assume MVD must also be a possibility...or she said maybe this is just a naturally high reading for Lilliput. 

I'm determined to have the Protein C test, but we're based in the UK. I'm trying to find out if we can get the bloods to them quickly enough. I emailed Cornell on a general addressi found online, but so far have not had a reply. You don't have any email contact details, perchance? Sorry to be such a bother. I don't want to do an invasive biopsy, but understand that a CT Scan may also help. Is that right, do you know? I am worried about the need to change her diet since, having done so much research over the six years into nutrition, this is something that would pain me greatly (although of course I'll do whatever I need to). 

Thanks so much again for all your help!


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## jessica-01 (Dec 21, 2010)

Snowbody said:


> Marianne - be sure to go into the search tab here and type in bile acid/liver shunt, etc and you will find some pinned articles and some others that should help. Cornell Vet School in Ithaca, NY is a wonderful resource...really the go to specialists in this country about this and they definitely work with other specialists so you can try to have your vet call her. I see her number listed as Phone: 607-253-3060 on their site. Maybe Walter has an e-mail address for them. Wishing you luck and take deep breaths.​


Golly, thank you for the Cornell phone number Susan! I've asked Walter if he has any contact details, as we are based in the Uk and so an email address would be amazing. We did an ultrasound on Tuesday and the vet was a specialist in imaging but could not see any shunt at all. She said it it could be microscopic in size. I have yet to have a consultation with her since she gave me the main result over the phone briefly, but I assume MVD must also be a possibility...or she said maybe this is just a naturally high reading for Lilliput. Hum...

I'm determined to have the Protein C test. I'm trying to find out if we can get the bloods to them quick enough from the UK. I emailed Cornell on a general address I found online but so far have not had a reply. I don't want to do an invasive biopsy, but understand that a CT Scan may also help. Is that right, do you know? I am worried about the need to change her diet since, having done so much research over the six years into nutrition, this is something that would pain me greatly (although of course I'll do whatever I need to). 

Thanks so much again for all your amazing help. I'm so grateful!


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## maggieh (Dec 16, 2007)

You've been given a lot of good advice here! Denamarin is a great supplement for liver support. My Tessa tested high for ALT after a vaccine reaction and unfortunately could not tolerate Denamarin - it aggravated her IBS. However, she did fabulously on milk thistle which is one of the ingredients in Denamarin, so it you find that Denamarin causes nausea you can try just the milk thistle (Tessa is actually on file with the manufacturer as an adverse reaction, so although it's rare, it can happen according to the maker of the drug).

A really great lower protein "raw" food is Addiction Dehydrated Raw. I use the grain free formulas and my girls love it. That might be a good alternative for you rather than the higher protein raw or the processed kibble. I order it through Chewy.com and I think they ship outside the US. 

There are also a lot of homeopathic and holistic supplements for liver support as well as more traditional medicines. 

At this point I wouldn't panic but would switch to a lower protein food and - with the advice of your vet - add the Denamarin or something similar to support liver function. Then you can continue to be on the watch for new symptoms but not rush into anything drastic.


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## jessica-01 (Dec 21, 2010)

sherry said:


> I would not feed raw diet to a liver dog. I had Riley on hepatic kibble for a long time but a year ago switched to The Honest Kitchen Turkey which is dehydrated. He does good on it. I wish my two liked fruit and veggies, but not too much. They get a teaspoon of cottage cheese for lunch. Riley gets Denamarin every morning and lactulose on his food. I'll look at the site you mentioned, had not heard of it. Please don't worry, this would be something Lilli has had all her life.



Thank you Sherry. I'm so against Kibble I think I would cry if I had to fed that. I agree dehydrated is so much better! Thanks for the recommendation. Cottage cheese sounds good also. My girl is the same with the fruit and veggies. I make a smoothie for her which I freeze and give one icecube of per day. It's all I can do to hide it in her meat. These Maltese are so wily and she always spots it! 

I'd be so interested to see what you think of the liver website. I'm getting very sceptical bcos, although the testimonials sound amazing, their emails are very commercially aggressive - they just list loads of effusive reviews with exhortations to "act now before it's too late!!" scaremongering missives in the middle of all their paragraphs like a spam marketing message. It's such a shame. 

We did an ultrasound on Tuesday and the vet was a specialist in imaging but could not see any shunt at all. She said it could be microscopic in size. I have yet to have a consultation with her since she gave me the main result briefly over the phone, but I assume MVD must also be a possibility...or she said maybe this is just a naturally high reading for Lilliput. Hum..

I'm determined to have the Protein C test, but we're based in the UK. I'm trying to find out if we can get the bloods to them quickly enough. I emailed Cornell on a general addressi found online, but so far have not had a reply. I don't want to do an invasive biopsy, but understand that a CT Scan may also help. Is that right, do you know? I am worried about the need to change her diet since, having done so much research over the six years into nutrition, this is something that would pain me greatly (although of course I'll do whatever I need to). 

Thank you again so much.


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## jessica-01 (Dec 21, 2010)

harrysmom said:


> Hi!
> 
> My little guy Harry has a malformed liver and as a result, acquired liver shunts. When he was first diagnosed, at 6 months old, he was retaining fluids. After changing him over to a vegetarian diet, supplemented with the same hepatic kibble that Walter's pup Lucky eats, he is pretty normal. I just have to be very diligent about not letting him get any meat at all because that causes big problems for him.
> 
> ...


Thank you Debbie. How interesting about the meat causing problems. I do think I need to look at reducing animal protein for Lilliput also I'm so glad cute Harry is doing well now. They are such a worry aren't they?! And flip re the biopsy! That's just shocking. Thank goodness you didn't proceed and hurrah to Cornell. That story sends a shiver down my spine. I wish we were closer to them.

We did an ultrasound on Tuesday and the vet was a specialist in imaging but could not see any shunt at all. She said it could be microscopic in size. I have yet to have a consultation with her since she gave me the main result briefly over the phone, but I assume MVD must also be a possibility...or she said maybe this is just a naturally high reading for Lilliput. Hum...

I'm determined to have the Protein C test, but we're based in the UK. I'm trying to find out if we can get the bloods to Cornell quickly enough. I emailed them on a general address I found online, but so far have not had a reply. You don't have any email contact details, perchance? Sorry to be such a bother. I don't want to do an invasive biopsy, particularly after your experience, but understand that a CT Scan may also help. Is that right, do you know? 

Thanks so much again for all your kind help!


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## wkomorow (Aug 26, 2011)

jessica-01 said:


> Thank you Walter. We re-did the BAT and it was the same - low preparedial (1.4) and high postprandial (114). How interesting about the Doppler Ultrasound. I'd not heard of that before, thank you! We did an ultrasound on Tuesday and the vet was a specialist in imaging but could not see any shunt at all. She said it could be microscopic in size. I have yet to have a consultation with her since she gave me the main result briefly over the phone, but I assume MVD must also be a possibility...or she said maybe this is just a naturally high reading for Lilliput.
> 
> I'm determined to have the Protein C test, but we're based in the UK. I'm trying to find out if we can get the bloods to them quickly enough. I emailed Cornell on a general addressi found online, but so far have not had a reply. You don't have any email contact details, perchance? Sorry to be such a bother. I don't want to do an invasive biopsy, but understand that a CT Scan may also help. Is that right, do you know? I am worried about the need to change her diet since, having done so much research over the six years into nutrition, this is something that would pain me greatly (although of course I'll do whatever I need to).
> 
> Thanks so much again for all your help!



[email protected] but they do not usually give advise without first seeing the dog. They will work with other vets however. I would not do a biopsy, in fact I would not do anything additional other than a diet change if there are no symptoms.


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## jessica-01 (Dec 21, 2010)

wkomorow said:


> [email protected] but they do not usually give advise without first seeing the dog. They will work with other vets however. I would not do a biopsy, in fact I would not do anything additional other than a diet change if there are no symptoms.


Ah super, thanks Walter! Ill pass that to my vet and ask him to get in touch with Cornell. Thanks also for the advice, that makes complete sense!


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## Kathleen (Aug 4, 2011)

Hi Marianne! Lilliput is just adorable.
I thought I would provide a link to the study showing Maltese have a higher reference range for bile acid than other dogs, in case you need it for your vet. It says that 79% of Maltese are above the normal reference range, so bile acid results can't be relied upon to determine whether there is a shunt.
I was told by our vet once that many vets aren't aware of Maltese having higher results so thought I would pass it along.
https://www.ncbi.nlm.nih.gov/pubmed/7646375

I sure hope it is nothing - you must be very worried. It seems like a very good sign that she doesn't have symptoms. I don't have any experience with shunts, but my Daisy had elevated liver enzyme levels when she was young, and like Maggie, I gave her milk thistle. Animal Essentials makes a good one called Liver Defense. She took it for about six months, and her liver values have been better ever since. You may want to ask your vet if it might help

It is great that you home "cook" for her. I would think that if she needs a lower protein diet, you could easily adjust the percentage of protein that you are giving her. Do they have holistic or integrative vets where you are? I have had great luck addressing some health issues with diet and supplements. It sounds like you are really focused on good nutrition, so a holistic or integrative vet might be a good option for you to consider.


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