# Liver Shunts and no symptoms



## CrystalAndZoe (Jul 11, 2006)

I've now had 2 customers now that have liver shunt dogs that have shown absolutely no evidence of having a shunt. One is a puppy who by all outward appearances is thriving. The only way to tell is to look at the blood work. The dog that is the most intriguing case is 2 1/2 yr. old Toby. He's a good size of 6 lbs. Super high energy. It wasn't until about 6 + months ago his mommy noticed some behavioral changes. She brought him here for Basic Obedience and both the trainer and myself thought she needed to have him checked by her vet to rule out any health issues causing the behavioral changes. We both also thought there was something about his walk that wasn't quite right. Her vet has seen him at least 7 times in the past 6 months due to behavioral changes, starting to throw up more and because myself and the trainer kept encouraging her to take him back in. Her vet kept insisting he was fine. Come to find out they never ran a blood panel before his neuter. :angry: Then Toby had a seizure. Her vet FINALLY ran a full blood panel and of course his ALT's and AST's were sky high as was his BAT. It's a super long story but basically her vet didn't want to do anything for him and gave him 6 months to a year to live, told her he had 'adult onset liver shunt' :wacko1: and got nasty with the sweetest elderly lady I've had the pleasure of getting to know. So she is now taking him to my vet. I drove her there so I could be a 2nd set of ears because she was so overwhelmed. It really showed me how much I've learned here from my years on SM and am so thankful for everyone who has shared their knowledge over the years.

This is the thing that is frightening to me, from all I've read and been told usually a liver shunt dog is showing some signs of not being quite right fairly early, before 12 weeks of age. And to have the sky high numbers that Toby has, he should be on deaths door. But other then starting to have seizures in the past couple of weeks and behavioral changes in the past 6+ months, he appears to be a very healthy dog. My vet kept saying his results to do not match the patient and when she had seen his #'s, she fully expected to walk into the room to a dog that was half dead. Instead, here is Toby very alert and VERY active. The #'s could have been a bit skewed due to the fact the blood draw was done right after a seizure by her old vet. She was questioning the Protein C result and consulted with Dr. Sharon Center. They both recommended referring him to a neurological specialist in Michigan. Even they were saying they don't know what is going on with him but they seriously doubted a shunt because his liver is good sized and he did not present like a liver shunt dog. New blood tests still showed scary high ALT's & AST's. After many tests, they did discover a small shunt.

So why am I sharing this? Because I'm so grateful for all the knowledge that has been shared in years past, I want to add whatever little tiny bit I can. This has even more then ever made me decide if I ever were to get a puppy again, to have the breeder hold on to him/her until 16 weeks of age and have the breeder bile acid test them. I think the world of reputable show breeders and am so thankful they are doing everything within their means to better the breed and help stamp out some of these genetic health issues that plague our beloved breed. But they can only do so much. And despite doing everything right, they can still on the off chance produce a puppy with a genetic health issue like liver shunt. It certainly does not make them a bad breeder. But me...I'd rather not fall in love and get attached to a puppy and then have to go through whatever medical treatments are deemed best to care for or treat a liver shunt dog.

Hope this helps to take a bit of the 'fear' or 'awkwardness' out of asking a breeder to hold on to a puppy until they are 16 weeks of age and do a BAT.


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## Lacie's Mom (Oct 11, 2006)

Crystal -- thanks so much for sharing this. It's always so interesting to hear about these type of cases -- we can all learn so much.

And I agree that SM has been a great learning experience on health, nutrition, grooming, behavior, etc.


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## tamizami (May 1, 2007)

i'm not 100% certain but i thought you can't tell about liver shunt from bloodwork? doesn't the bloodwork result just tell you to investigate further (i.e. via scintigraphy)?

what do you think are sky high numbers? i think every dog could be different, especially with mvd, but stuart's BAT were really high (165) and i know another dog that had ALT in the 1300's and neither has a liver shunt.

also, i am pretty sure other things can cause elevated liver values - lepto (the virus or the vaccine), tainted food, angel eyes and tylan/tylosin......right?


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## tamizami (May 1, 2007)

also, i forgot to mention that i think dr. center is right on to refer to a neurologist. gme is a much scarier dx than liver shunt to me and i'd want to know about that asap to get the treatment going. 

and thanks for sharing this crystal, its all very enlightening the more we learn about our babies and potential issues.


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## pammy4501 (Aug 8, 2007)

I am curious as well. How was the "small shunt" discovered? It cannot be diagnosed by ultrasound or lab values alone. I was also under the impression that scintigraphy was the determining test. That one is a puzzler. I will be interested to hear more about Toby as well.


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## CrystalAndZoe (Jul 11, 2006)

Regular blood work revealing elevated ALT's, AST's and BAT's do tell you to investigate further. And yes, other types of infections can also elevate the liver levels. The Protein C is starting to be used instead of doing an ultra sound or scintigraphy to determine if they are looking at a dog with liver shunt vs. MVD. The old or original vet did the CBC and BAT's and was the one saying he thought we were looking at a shunt...I'm assuming based on Toby's breed and wanted to send him for an Ultra Sound at Purdue. He was not open to test for other possible reasons for the elevated liver levels and I hated to see this 80+ year old woman drive to Purdue and pay for an U.S. that truly is not the most accurate way to see a shunt. From what I understand, it's pretty hard to see a shunt from an U.S. I have to be very careful not to say anything to discredit a vet, so I suggested the Protein C since I really did not expect Toby to have a shunt based on how he was acting. I thought we might be looking at MVD or at least it would be a way to get her old vet to do further testing if there were another type of infection going on. Lepto or Hepatits for example can raise the ALT, AST's and BAT's. The Protein C was clearly saying we were looking at a dog with liver shunt. The Protein C is so new, I think that's why it's results were being questioned. They were sure it had to be something different then a shunt, thus all the other testing that was done. When nothing else was revealed after all other tests were performed, they did the scintagraphy, revealing the small shunt. This whole case is so NOT typical and had everyone...even the experts surprised. But this is why my vet and Dr. Center thought it best to send him to the neurological clinic as opposed to Purdue. No one really thought he had a shunt.

Oh geeze Tami...now you have me concerned that maybe there is something even more going on with Toby other then the shunt. I'm sure they would have tested for GME there. I couldn't go with her to the neuro place in MI. I may call my vet and ask her what all they tested for.


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## harrysmom (Sep 28, 2007)

Crystal,

I hope and pray that the fur-baby is okay. Harry was 6 months old when he was diagnosed and they told me he might not live a year... and that was over 4 years ago... so miracles do happen. (Knocking on some wood as I type...lol.)

I hope that your friend is open to changing the pup's diet. I just found out recently how quickly and how greatly the wrong protein can adversely affect a dog with a liver problem. About a month ago Harry started having neurological symptoms... I posted about it at the time and thank God, they're all gone now and he's back to normal. Well, he probably had those symptoms because I gave him chicken. :smilie_tischkante::smilie_tischkante: Prior to that... (and from now on without fail).... he was on a tofu diet. He was doing so well that I though adding a small (less than 1 teaspoon :blink amount of chicken to his food wouldn't hurt... and he loves chicken. Well, it turns out that his liver couldn't handle that protein and thus the scary physical and behavioral symptoms I saw. Within a week of switching him back to the tofu, he was back to normal. Crazy, right? So please encourage your friend to investigate alternative diets.

I also trust Dr. Center's judgment 100%. She called me on Saturday to ask about Harry. She wanted my take on how he's doing for a talk she'll be giving. I told her about the chicken and she said "why would you do that?"...lol. But she is so easy to talk to and so down to earth... and so knowledgeable... that I would not hesitate to recommend her to anyone. The vet I now use in NJ was a resident of hers, and I know that he would not hesitate to call her if he had an issue with Harry. It's great that your friend's vet consulted with her.

If I can help your friend in any way... with diet information, etc.... I would be happy to.

It was so nice of you to help out, Crystal, and sharing knowledge on here is, to me, the most important part of this forum...
Hugs.
Debbie


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## CrystalAndZoe (Jul 11, 2006)

harrysmom said:


> Crystal,
> 
> I hope and pray that the fur-baby is okay. Harry was 6 months old when he was diagnosed and they told me he might not live a year... and that was over 4 years ago... so miracles do happen. (Knocking on some wood as I type...lol.)
> 
> ...


She is more then open to changing his diet. I had told her there were other things she could do other then SD or RC Rx and that my vet will be more then happy to talk to Dr. Center as to what type of diet will be best for Toby. Right now her old vet put him on RC Rx and his protein count is low. Is that how it will be if he's on a low protein diet? Or with a different type of protein...like Tofu...will he be getting more protein? I've gone about as far as I can go with this to what my level of knowledge is and need to learn more from this point on.

The vet at the neurological place in MI (I really need to find the name of the place) told her with the correct diet and meds, she felt he could live a very long life. I'm hoping she is correct.


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## tamizami (May 1, 2007)

yes, i agree that with the right diet and meds he could live a long life, which is great. so sad to hear scintigraphy revealed a shunt, though. 

i think the only way to test for gme is a combo of blood work, spinal tap and mri? but pam would know better than i. i would still go see a neuro since the dog had a seizure. not saying it couldn't be the shunt causing it, i would just want to put my mind at ease. gme is far worse than a shunt imho.


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## CrystalAndZoe (Jul 11, 2006)

tamizami said:


> yes, i agree that with the right diet and meds he could live a long life, which is great. so sad to hear scintigraphy revealed a shunt, though.
> 
> i think the only way to test for gme is a combo of blood work, spinal tap and mri? but pam would know better than i. i would still go see a neuro since the dog had a seizure. not saying it couldn't be the shunt causing it, i would just want to put my mind at ease. gme is far worse than a shunt imho.


He was at the neurological place. The closest one here is in Michigan. He was there yesterday. They were the ones that diagnosed a shunt.


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## Cosy (Feb 9, 2006)

I think some are under the misconception that shunts only manifest at an early age. Shunts can develop up to 7 yrs of age. Sometimes pups with operable shunts will develop another down the line after a successful surgery. 
I haven't heard flaxseed mentioned. Milk Thistle too. Those are very good things for a shunt dog. 
I had a little yorkie (2 lbs and passed from breeder to breeder) who had a shunt at
5 yrs. She also had a heart condition so surgery was out of the question. We treated it with Lactulose, Milk Thistle, Flaxseed, and low protein diet. She did well for two years! I think that was amazing considering she'd been bred twice and was so
tiny. My vet gets all the credit there although I do believe she was amazed too.


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## pammy4501 (Aug 8, 2007)

tamizami said:


> yes, i agree that with the right diet and meds he could live a long life, which is great. so sad to hear scintigraphy revealed a shunt, though.
> 
> i think the only way to test for gme is a combo of blood work, spinal tap and mri? but pam would know better than i. i would still go see a neuro since the dog had a seizure. not saying it couldn't be the shunt causing it, i would just want to put my mind at ease. gme is far worse than a shunt imho.


GME is way scarier. A shunt could be corrected surgically if needed. GME, not so good. If there are neurological symptoms such as lethargic, depressed, blank stare, staggering gait, weakness in the hind legs I would worry. Labs would need to be done to rule out viral and fungal causes such as toxoplasmosis, cryptococcus, tick borne diseases, west nile virus. Then a brain MRI looking for inflammatory brain disease, and a spinal tap for CSF with high eosinphilie count. If all cultures are negative, finally you will be left with the infammation of the CNS being immune mediated or GME/NME.

But this dog with the sky high liver values should be home cooked for. Use Dr. Dodds cleansing diet, milk thistle ect. Also Denamarin can be given (then you don't need more milk thistle, since it is in denamarin) I used this diet when Lola's liver enzymes peaked during her treatment for GME. It worked like a charm


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## CrystalAndZoe (Jul 11, 2006)

Cosy said:


> I think some are under the misconception that shunts only manifest at an early age. Shunts can develop up to 7 yrs of age. Sometimes pups with operable shunts will develop another down the line after a successful surgery.
> I haven't heard flaxseed mentioned. Milk Thistle too. Those are very good things for a shunt dog.
> I had a little yorkie (2 lbs and passed from breeder to breeder) who had a shunt at
> 5 yrs. She also had a heart condition so surgery was out of the question. We treated it with Lactulose, Milk Thistle, Flaxseed, and low protein diet. She did well for two years! I think that was amazing considering she'd been bred twice and was so
> tiny. My vet gets all the credit there although I do believe she was amazed too.


So there is such a thing as adult onset liver shunt? I had never heard that. Or are you saying it's there and unless blood work is done that reveal elevated liver levels and further testing is done, they may not show any symptoms up until 7 yrs of age? I'd not heard that either. From what info I've gathered, I was under the impression there are usually signs at really young ages...even by 8 weeks.

My vet put him on milk thistle but wanted to hold off until we had a definite Dx and then consult with Dr. Center on diet and meds...including things like milk thistle. I had not heard about flax seed being helpful before either. Thanks!


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## pammy4501 (Aug 8, 2007)

The liver cleansing diet has been formulated by W. Jean Dodds, DVM. Dr. Dodds recommends a formula of 2 cups of pollack, cod or any other low fat white fish fillet to 6 cups of veggies and potatoes, or 25% pollack, cod or any other low fat white fish fillet to 75% veggies and potatoes. This diet has proved extremely successful in reversing liver damage.


1 and 1/2 cups moist white cooking potatoes​​1 and 1/2 cups sweet potatoes
1 and 1/2 cups of zucchini
1 and 1/2 cup string beans, celery or summer squash
2 cups pollack, cod or any other low fat white fish fillet​​Scrub the potatoes well and cut them up crosswise into 2" pieces so the skin circles the potatoes. OR, you can peel the potatoes before you cook them. Simmer for 45 minutes to 1 hour. When cooled, remove the skins. 
Wash the zucchini and cut up with string beans, celery or squash and steam or cook until very tender.
2 cups pollack, cod or any other low fat white fish fillet poached in a frying pan with water until fish is white and flaky.
Mix all ingredients together until it is well blended. This will give you approximately 8 cups of food. Depending on the size of your dog, you can double or triple the recipe. For flavor you can add a pinch of garlic powder and a little Italian Seasoning to each meal.
For supplementation use the recommend dose of infants liquid multi-vitamin.
If you have been feeding kibble please remember that kibble has many more calories than the liver cleansing diet. You will need to feed at least 25% to 50% more home cooking than kibble until you are sure your dogs weight is holding where you want it. Dogs can loose weight very quickly on the liver cleansing diet so you need to monitor their weight carefully.
With liver disease try to feed in 3 or 4 small meals, the last one being at bedtime. This puts less stress on the liver. Put 3 days of meals in baggies and freeze what you won't use in 3 days. You should be able to cook once a week and freeze what you don't use. This recipe will stay fresh for 3 days in the fridge.
White low-fat fish has a specific amino acid that actually helps heal the liver. Soy and fat-free cottage cheese also have this specific amino acid, but should not be used in a diet until the liver enzymes test comes back in a normal range.
NOTE:
Home cooking is very rich. If you have been feeding commercial dog food you will need to switch very slowly to the liver cleansing diet to avoid diarrhea. Start with 3/4 of your commercial dog food and 1/4 liver cleansing diet for a few days. Then 50% commercial food and 50% liver cleansing for a few days. Then 1/4 old food and 3/4 liver cleansing for a few days and then switch over completely to the liver cleansing diet. Make sure the stools are somewhat firm before you move to the next level.
IMPORTANT:
If you are switching from kibble, and/or canned dog food, to home cooking and your dog is on potassium or sodium bromide, please be aware that there is considerably less sodium (salt) in home cooking than kibble or canned (which can have large amounts of sodium). Sodium, or salt, in the diet "uses up" the bromide and less salt in the diet could raise bromide levels substantially which would cause bromism. After switching over to home cooking, if your dog has weakness in its legs, trouble climbing stairs, gets "wobbly" or loses it's balance, your vet can reduce the bromide dose slowly and in small amounts. W. Jean Dodds, DVM, recommends reducing the dose of bromide slightly or by 1/3 at the most to see if the signs of bromism go away or are lessened. In a month, have the bromide levels checked to make sure they are in the therapeutic range. Don't worry about lowering the bromide as long as it stays in therapeutic range. Less bromide and home cooking will be healthier for your dog in the long range.
MILK THISTLE
Dr. Dodds recommends using milk thistle to help heal the liver along with feeding the liver cleansing diet.
​


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## CrystalAndZoe (Jul 11, 2006)

pammy4501 said:


> GME is way scarier. A shunt could be corrected surgically if needed. GME, not so good. If there are neurological symptoms such as lethargic, depressed, blank stare, staggering gait, weakness in the hind legs I would worry. Labs would need to be done to rule out viral and fungal causes such as toxoplasmosis, cryptococcus, tick borne diseases, west nile virus. Then a brain MRI looking for inflammatory brain disease, and a spinal tap for CSF with high eosinphilie count. If all cultures are negative, finally you will be left with the infammation of the CNS being immune mediated or GME/NME.
> 
> But this dog with the sky high liver values should be home cooked for. Use Dr. Dodds cleansing diet, milk thistle ect. Also Denamarin can be given (then you don't need more milk thistle, since it is in denamarin) I used this diet when Lola's liver enzymes peaked during her treatment for GME. It worked like a charm


Yep, I've already talked to her about Dr. Dodd's liver cleansing diet. She's totally open to home cooking.

And I agree GME IS way scarier. And the thing my vet and both myself noticed with Toby was how he walked...like his back legs/hip/pelvic area were really stiff. And when my vet ran her fingers down along his spine like she does when checking for acupuncture points, he would go down into a really funny sitting position. My vet had asked her if Toby had ever had a spinal injury. What would the odds be that he could have both a shunt and GME??

btw..have they ever determined an age that usually a dog is no longer prone to develop GME? Another question on GME..probably should start another thread...but I was under the impression they didn't know what caused it meaning it was not genetic. But then another thread started about a month ago made me think that GME is genetic since they have found the genetic marker for NME. I'm a bit confused.


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## jmm (Nov 23, 2004)

GME most likely has a genetic predisposition that is set off by something in the environment. 

Most liver shunts are diagnosed in young adult dogs. Many of these dogs are normal pups. I'm rather surprised the "Experts" were surprised since this has been common knowledge for a years.


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## pammy4501 (Aug 8, 2007)

GME dogs most likely have a genetic predisposition to the disease. The genetic marker has been discovered in Pug dogs. Research is being conducted to find a similar marker for Maltese dogs. If the dog is born with the predisposition they may or may not develope GME. Something triggers it to start. Could be vaccines, toxins in the environment, an infection of any kind or some unknown agent. I would not think that just because the dog has a small shunt, that he could not have GME. My dog has MVD, GME and LP's LOL! (God love her). But I would deal with liver stuff and see of most of these symptoms subside before looking for bigger problems.


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## CrystalAndZoe (Jul 11, 2006)

jmm said:


> GME most likely has a genetic predisposition that is set off by something in the environment.
> 
> Most liver shunts are diagnosed in young adult dogs. Many of these dogs are normal pups. I'm rather surprised the "Experts" were surprised since this has been common knowledge for a years.


They were surprised not because of his age, but his size and how he presented and the fact that his liver was normal sized..not tiny and not big. They were thinking there was probably another reason for the elevated liver levels. Sorry I used the term 'experts'. They are not experts compared to Dr. Center per se, but she has been consulted. But they are the best we have within driving distance in our area.

I'm the one that was under the impression that you can usually tell if a dog has liver shunt as a young puppy due to some of the info shared here on SM. For example if a puppy comes back with high BAT's, I was told as long as they were able to put on weight, clear eyed, playful, no head pressing, etc...not to panic until a protein C was done because most likely they were asymptomatic MVD. That was another reason why I thought I would share this story here.


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## CrystalAndZoe (Jul 11, 2006)

pammy4501 said:


> GME dogs most likely have a genetic predisposition to the disease. The genetic marker has been discovered in Pug dogs. Research is being conducted to find a similar marker for Maltese dogs. If the dog is born with the predisposition they may or may not develope GME. Something triggers it to start. Could be vaccines, toxins in the environment, an infection of any kind or some unknown agent. I would not think that just because the dog has a small shunt, that he could not have GME. My dog has MVD, GME and LP's LOL! (God love her). But I would deal with liver stuff and see of most of these symptoms subside before looking for bigger problems.


Thanks...it's making more sense to me now. Just like some women being tested if breast cancer runs in their family to see if they have the gene. They are genetically predisposed to getting it, but does not mean they will just because they have the gene. So technically GME is genetic.

Have they discovered an age that if a dog reaches, they will more then likely not get GME?


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## jmm (Nov 23, 2004)

Typically dogs with GME are diagnosed as young adults (and females are affected more than males) ages 2-5. It is unusual for an older dog to be diagnosed, though it does rarely happen. I believe the GME study for normal dogs will want the dogs sampled to be 5-7 years of age if that's any indication.


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## jmm (Nov 23, 2004)

Its important to consider that bile acids alone are only a good indicator of shunt vs. normal when done on pups. Once the dog is older, any number of diseases or environment factors could give you abnormal results. 
Ultrasound is not a good way to look for a shunt. Its a good general look at the liver, but its not a good test to refer a dog for when looking specificially for a shunt. You need scintigraphy or an MRI for that.


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## CrystalAndZoe (Jul 11, 2006)

This is where my vet sent Toby. Is this not a good place?

ANIMALNEUROLOGY.COM : 248-960-7200 : DOCTORS ON CALL 24/7


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## bellaratamaltese (May 24, 2006)

This has been very interesting reading!

I do want to say though that it isn't a 'red flag' if a responsible breeder places their puppies at 12 weeks with the recommendation that a bile acid be done when the puppies reaches 16 weeks. It is not something that is in the AMA code of ethics for responsible breeding, that they be kept until 16 weeks and placed after bile acids are done, so just because a breeder doesn't keep until 16 weeks, it does not make them irresponsible. I can definitely see both sides here but just wanted to mention it!


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## CrystalAndZoe (Jul 11, 2006)

bellaratamaltese said:


> This has been very interesting reading!
> 
> I do want to say though that it isn't a 'red flag' if a responsible breeder places their puppies at 12 weeks with the recommendation that a bile acid be done when the puppies reaches 16 weeks. It is not something that is in the AMA code of ethics for responsible breeding, that they be kept until 16 weeks and placed after bile acids are done, so just because a breeder doesn't keep until 16 weeks, it does not make them irresponsible. I can definitely see both sides here but just wanted to mention it!


Oh gosh Stacy that was not at all what I was thinking or even trying to insinuate. I really hope it didn't come across that way. I know everyone is anxious to get their new baby and have a hard time waiting until they are 12 weeks. I'm just suggesting that to avoid heartaches...especially if they have gone through one already, to ask their breeder to hold on to them until they are 16 weeks and do a BAT. I know I found it uncomfortable to ask Cheryl if she would do a BAT on Callie...like I was questioning her as a breeder. But now going through this, I don't think I would feel awkward in the least asking a breeder to do this. I would of course pay for the BAT and not expect this to be the breeders responsibility. I was hoping this would help others to not feel so awkward in asking a breeder to do this. Does that make sense?


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## bellaratamaltese (May 24, 2006)

Crystal&Zoe said:


> Oh gosh Stacy that was not at all what I was thinking or even trying to insinuate. I really hope it didn't come across that way. I know everyone is anxious to get their new baby and have a hard time waiting until they are 12 weeks. I'm just suggesting that to avoid heartaches...especially if they have gone through one already, to ask their breeder to hold on to them until they are 16 weeks and do a BAT. I know I found it uncomfortable to ask Cheryl if she would do a BAT on Callie...like I was questioning her as a breeder. But now going through this, I don't think I would feel awkward in the least asking a breeder to do this. I would of course pay for the BAT and not expect this to be the breeders responsibility. I was hoping this would help others to not feel so awkward in asking a breeder to do this. Does that make sense?


Oh i know what you were trying to say and I wasn't trying to imply anything! I just mentioned it because with threads like this, they are used for research by people who aren't members of SM/lurkers and I just wanted to have it out there, that it isn't the 'norm' for breeders to hold until 16 weeks and doesn't mean that a show breeder is irresponsible by placing at 12 weeks. Does that make sense?


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## CrystalAndZoe (Jul 11, 2006)

bellaratamaltese said:


> Oh i know what you were trying to say and I wasn't trying to imply anything! I just mentioned it because with threads like this, they are used for research by people who aren't members of SM/lurkers and I just wanted to have it out there, that it isn't the 'norm' for breeders to hold until 16 weeks and doesn't mean that a show breeder is irresponsible by placing at 12 weeks. Does that make sense?


Whew! :smheat: Glad it didn't come across that was what I was saying. I would hate to have that happen. And it's probably overkill to have a breeder who has been successfully breeding for many many years without producing a liver shunt dog to do a BAT. But if I had gone through the heartache of having a dog with a genetic health issue, I probably would ask even someone with many many years experience to BAT them. Of course we all know the worrier that I am. :blush:


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## aprilb (Jul 9, 2010)

Thanks, Crystal for this information. You are so sweet to help that poor lady. :wub:


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## MaryH (Mar 7, 2006)

jmm said:


> Typically dogs with GME are diagnosed as young adults (and females are affected more than males) ages 2-5. It is unusual for an older dog to be diagnosed, though it does rarely happen.


I know of more than the "rare" dog over the age of 5 that has been diagnosed with GME. I also know of a number of dogs, some well beyond the age of 5, that died of "unknown" causes and that, unfortunately, were not necropsied.


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## Cosy (Feb 9, 2006)

This little yorkie had normal values until the age of 5. I do think there is, as others said here, a predisposition but it doesn't always mean it may become symptomatic in tests, etc. as a young pup.


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## MaryH (Mar 7, 2006)

tamizami said:


> i'm not 100% certain but i thought you can't tell about liver shunt from bloodwork? doesn't the bloodwork result just tell you to investigate further (i.e. via scintigraphy)?
> 
> what do you think are sky high numbers? i think every dog could be different, especially with mvd, but stuart's BAT were really high (165) and i know another dog that had ALT in the 1300's and neither has a liver shunt.
> 
> also, i am pretty sure other things can cause elevated liver values - lepto (the virus or the vaccine), tainted food, angel eyes and tylan/tylosin......right?


Tami, you are correct that bloodwork is not going to tell you absolutely that a dog has a shunt. But it will tell you that there might be liver issues that should be investigated further. Personally, if one of my puppies had a bile acid value over 100 that puppy would not be sold and I would have further testing done to determine if there is a shunt. ALT/AST values could be elevated for any number of reasons including infection, ingested toxins, etc. But what are the chances that an infection would go unnoticed in a 16 wk. old puppy? What are the chances that a 16 wk old puppy would have ingested toxins? What are the chances that any sane breeder would be using tylan or angel eyes on a 16 wk old puppy? And bile acid values could certainly become elevated in a mature dog for any number of reasons, i.e., ingesting poisons, chronic untreated hepatitis, etc. Which is exactly why we are encouraged to test young puppies so that we know what their baseline is long before any environmental factors might come into play. There are dogs like yours who have very high bile acid values and do not have liver shunts. But there are also dogs with those same high bile acid values who do have liver shunts. Keeping a puppy an extra 4 wks and spending approximately $100 for a bile acid test works best for me on a number of fronts: (a) I know what my breeding choice has produced; (b) I know what I'm selling; and (c) I sleep better at night. 



tamizami said:


> also, i forgot to mention that i think dr. center is right on to refer to a neurologist. gme is a much scarier dx than liver shunt to me and i'd want to know about that asap to get the treatment going.
> 
> and thanks for sharing this crystal, its all very enlightening the more we learn about our babies and potential issues.


Liver shunt and GME are both very scary diseases. One (liver shunt) is genetic and the other (GME) may possibly have a genetic component to it. Both are deadly if not treated, both are expensive to treat, and effective treatment is not a guarantee for either disease.


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## tamizami (May 1, 2007)

thanks for the additional insight mary and again, thanks crystal for starting this informative thread!

for me, i don't know if i would insist on a breeder doing a bile acid test before placing a puppy if i was interested in a 12 week old. BUT, i definitely would want to do the baseline test on a puppy and share the results with the breeder (along with a whole host of other things!). 

there are no perfect dogs and no guarantees in life and my current philosophy on acquiring puppies is that i am a willing participant/partner with responsible breeders to do whatever i can to help further the health and well being of the breed. that means i need to be educated on the issues and be in communication with my breeders. that means that sometimes sad things happen despite the best efforts and when it does, its an opportunity to learn and potentially help the canine health foundation and universities that research these diseases. we know we are going to outlive our pups regardless, so my focus is to make every day precious. i just love this breed so very much and am so grateful for all the hard work that responsible breeders put into these dogs, i never want to be without one.


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## edelweiss (Apr 23, 2010)

Just want to say that I find this one of the BEST threads I have encountered on SM---and there have been other good ones! I love the learning angle!


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## CrystalAndZoe (Jul 11, 2006)

tamizami said:


> thanks for the additional insight mary and again, thanks crystal for starting this informative thread!
> 
> for me, i don't know if i would insist on a breeder doing a bile acid test before placing a puppy if i was interested in a 12 week old. BUT, i definitely would want to do the baseline test on a puppy and share the results with the breeder (along with a whole host of other things!).
> 
> there are no perfect dogs and no guarantees in life and my current philosophy on acquiring puppies is that i am a willing participant/partner with responsible breeders to do whatever i can to help further the health and well being of the breed. that means i need to be educated on the issues and be in communication with my breeders. that means that sometimes sad things happen despite the best efforts and when it does, its an opportunity to learn and potentially help the canine health foundation and universities that research these diseases. we know we are going to outlive our pups regardless, so my focus is to make every day precious. i just love this breed so very much and am so grateful for all the hard work that responsible breeders put into these dogs, i never want to be without one.


I can't stress enough how important I think it is to have a full blood panel performed and BAT as a baseline when they are young puppies. Think of how much easier any future diagnosis will be if you know that as a young and healthy puppy they have an elevated BAT and are asymptomatic MVD. Also, since it's believed that the majority of Maltese and Yorkies are asymptomatic MVD, it's good to know that up front to continue with yearly blood work to monitor the ALT and AST levels.

And I agree whole heartedly with this statement of yours.

"there are no perfect dogs and no guarantees in life and my current philosophy on acquiring puppies is that i am a willing participant/partner with responsible breeders to do whatever i can to help further the health and well being of the breed. that means i need to be educated on the issues and be in communication with my breeders. that means that sometimes sad things happen despite the best efforts and when it does, its an opportunity to learn and potentially help the canine health foundation and universities that research these diseases. we know we are going to outlive our pups regardless, so my focus is to make every day precious. i just love this breed so very much and am so grateful for all the hard work that responsible breeders put into these dogs, i never want to be without one" 

Very well said. :aktion033:


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## CrystalAndZoe (Jul 11, 2006)

Cosy said:


> This little yorkie had normal values until the age of 5. I do think there is, as others said here, a predisposition but it doesn't always mean it may become symptomatic in tests, etc. as a young pup.


Brit thank you so much for sharing this. Even my friend who is currently not practicing veterinary medicine was not aware this could happen. She was telling me probably what the lady's old vet was doing was trying to cover himself by not catching it earlier because he had never done a full blood panel on Toby. What's especially frightening was he didn't do it before putting him under a general for his neuter when he was 6 months old.

I'm wondering...on the Yorkie when her ALT's and AST's had remained normal up until 5 yrs of age, was a BAT done earlier in life too, and was that normal as well?


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## CrystalAndZoe (Jul 11, 2006)

MaryH said:


> Tami, you are correct that bloodwork is not going to tell you absolutely that a dog has a shunt. But it will tell you that there might be liver issues that should be investigated further. Personally, if one of my puppies had a bile acid value over 100 that puppy would not be sold and I would have further testing done to determine if there is a shunt. ALT/AST values could be elevated for any number of reasons including infection, ingested toxins, etc. But what are the chances that an infection would go unnoticed in a 16 wk. old puppy? What are the chances that a 16 wk old puppy would have ingested toxins? *What are the chances that any sane breeder would be using tylan or angel eyes on a 16 wk old puppy? *And bile acid values could certainly become elevated in a mature dog for any number of reasons, i.e., ingesting poisons, chronic untreated hepatitis, etc. Which is exactly why we are encouraged to test young puppies so that we know what their baseline is long before any environmental factors might come into play. There are dogs like yours who have very high bile acid values and do not have liver shunts. But there are also dogs with those same high bile acid values who do have liver shunts. Keeping a puppy an extra 4 wks and spending approximately $100 for a bile acid test works best for me on a number of fronts: (a) I know what my breeding choice has produced; (b) I know what I'm selling; and (c) I sleep better at night.
> 
> 
> 
> Liver shunt and GME are both very scary diseases. One (liver shunt) is genetic and the other (GME) may possibly have a genetic component to it. Both are deadly if not treated, both are expensive to treat, and effective treatment is not a guarantee for either disease.


I think the part I highlighted in red is so telling about Angel Eyes and using Tylan on puppies when they are having excessive tearing due to teething. And sadly, many SM'rs and lurkers will totally gloss over this and when another newbie comes and asks about Angel Eyes for their puppy, people will tell them it's perfectly fine. Tylan can raise the ALT and AST levels.


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## MaryH (Mar 7, 2006)

Crystal, there is also the possibility that your friend's dog has both liver shunt and MVD. It's not always an either/or situation. Toby may have had a small shunt, it may have been present from birth or it may have erupted later, depending in some part on the overall condition of the liver. When a shunt is repaired the blood that beforehand was being shunted around (bypassing) the liver is now being directed into the liver. There are cases where the pressure of all that blood now being directed into the liver will cause other shunts to occur. Much depends on the condition of the liver and this is why not all dogs are good candidates for liver shunt surgery. For dogs with surgically corrected shunts, repeat bile acid tests over a period of time are a good indication of success. One always hopes that the first post-surgery bile acid test comes back with good results, not needing to be in the normal range, but substantially lower than they were pre-surgery. And then one hopes that six months to a year later when another bile acid test is done the results should be not markedly different that the first post-surgery results.

I'm no expert but I would wonder in the case of your friend's dog and others who don't present with the obvious symptoms early on if they are dogs with very small (micro) shunts that over time worsen, thus causing symptoms to appear and worsen so gradually as to not be easily recognized as being shunt-related until the occurrence of a major event like seizure because the body has finally reached a saturation point where the build up of toxins like ammonia in the system ultimately cause the dog to seize ... food for thought?


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## MaryH (Mar 7, 2006)

tamizami said:


> thanks for the additional insight mary and again, thanks crystal for starting this informative thread!
> 
> for me, i don't know if i would insist on a breeder doing a bile acid test before placing a puppy if i was interested in a 12 week old. BUT, i definitely would want to do the baseline test on a puppy and share the results with the breeder (along with a whole host of other things!).
> 
> there are no perfect dogs and no guarantees in life and my current philosophy on acquiring puppies is that i am a willing participant/partner with responsible breeders to do whatever i can to help further the health and well being of the breed. that means i need to be educated on the issues and be in communication with my breeders. that means that sometimes sad things happen despite the best efforts and when it does, its an opportunity to learn and potentially help the canine health foundation and universities that research these diseases. we know we are going to outlive our pups regardless, so my focus is to make every day precious. i just love this breed so very much and am so grateful for all the hard work that responsible breeders put into these dogs, i never want to be without one.


Tami, this is why you are every breeder's dream come true when placing a puppy. Unfortunately, not every new puppy owner will run a bile acid test after placement. And not every new puppy owner has the financial ability to treat liver shunt or heart problems or GME or cancer. I know many on this forum and elsewhere believe that if one does not have the financial ability to care for any potential health issue that arises over the life of the dog then they should not own a dog. I disagree with that to some extent. There are so many wonderful, loving, caring people in the world who are so deserving of owning a wonderful pet but who just are not in a position where they can come up with several thousand dollars for treatment of whatever. A responsible breeder would always refund the purchase price of a puppy with a shunt. But oftentimes treatment of a condition far exceeds the purchase price. Now both breeder and buyer are in a devastating situation. Breeder loves the buyer, buyer loves the puppy, both are agonizing both emotionally and financially as to what to do, where to turn for advice and treatment, etc. That is exactly the situation I will bend over backwards to avoid for my own sake and the sake of a wonderful, loving, caring purchaser by holding onto a puppy for an extra 4 weeks and doing the testing myself.


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## MaryH (Mar 7, 2006)

Crystal&Zoe said:


> I think the part I highlighted in red is so telling about Angel Eyes and using Tylan on puppies when they are having excessive tearing due to teething. And sadly, many SM'rs and lurkers will totally gloss over this and when another newbie comes and asks about Angel Eyes for their puppy, people will tell them it's perfectly fine. Tylan can raise the ALT and AST levels.


Not intending to change the direction of this thread, but I totally agree with you. I have used tylan in the past and would use it again in certain situations ... but NEVER on a young puppy. I've haven't used any other tear staining products and probably won't. Flushing the eyes with Bausch & Lomb's Collyrium for Fresh Eyes has always worked well for me. Flushing tear ducts has also worked well for dogs who I felt had blocked tear ducts. I sold a puppy last winter who, after her teething phase was over with, continued to have excessive tear staining. The owner sent me pictures, we spoke about the situation, and I honestly felt that the dog's tear ducts were blocked and advised getting them flushed. I will leave it to the owner to tell the whole story if she wants, but the tear duct flushing has improved the staining. It's a simple procedure and there is no long-term use of antibiotics.


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## CrystalAndZoe (Jul 11, 2006)

Cosy said:


> I think some are under the misconception that shunts only manifest at an early age. Shunts can develop up to 7 yrs of age. Sometimes pups with operable shunts will develop another down the line after a successful surgery.
> I haven't heard flaxseed mentioned. Milk Thistle too. Those are very good things for a shunt dog.
> I had a little yorkie (2 lbs and passed from breeder to breeder) who had a shunt at
> 5 yrs. She also had a heart condition so surgery was out of the question. We treated it with Lactulose, Milk Thistle, Flaxseed, and low protein diet. She did well for two years! I think that was amazing considering she'd been bred twice and was so
> tiny. My vet gets all the credit there although I do believe she was amazed too.


I wanted to go back and look at some of my notes I've been taking when talking to my friend and my vet about Toby because she was wanting to know options even before there was an accurate Dx. My understanding is that often times when other shunts develop after a successful surgery, it's because the original shunt was closed quickly. I had originally thought that if a Malt was a good candidate for surgery, then that was the best possible solution. But now I'm really questioning if surgery really is the best route and why with my friend, when she asked me my opinion, I told her I would try controlling his condition with diet and meds and observing. What are some thoughts on this? 

I think the thing that is very sad and even frustrating is there are some people who have walked through this that can share some valuable info but because of fear of reputations being ruined, are afraid to share their experience and knowledge. 

I just don't get it and probably never will. To me if you are truly wanting to better the breed and wipe out these genetic health issues, and as a knowledgeable breeder know full well that even when doing everything correctly you can still produce a liver shunt dog, why would it ruin a reputation? Maybe I'm being overly simplistic here, but I wonder how much more knowledge we would have concerning MVD, Shunts, etc.. if there were the safe freedom to share experiences. 



MaryH said:


> Crystal, there is also the possibility that your friend's dog has both liver shunt and MVD. It's not always an either/or situation. Toby may have had a small shunt, it may have been present from birth or it may have erupted later, depending in some part on the overall condition of the liver. When a shunt is repaired the blood that beforehand was being shunted around (bypassing) the liver is now being directed into the liver. There are cases where the pressure of all that blood now being directed into the liver will cause other shunts to occur. Much depends on the condition of the liver and this is why not all dogs are good candidates for liver shunt surgery. For dogs with surgically corrected shunts, repeat bile acid tests over a period of time are a good indication of success. One always hopes that the first post-surgery bile acid test comes back with good results, not needing to be in the normal range, but substantially lower than they were pre-surgery. And then one hopes that six months to a year later when another bile acid test is done the results should be not markedly different that the first post-surgery results.
> 
> I'm no expert but I would wonder in the case of your friend's dog and others who don't present with the obvious symptoms early on if they are dogs with very small (micro) shunts that over time worsen, thus causing symptoms to appear and worsen so gradually as to not be easily recognized as being shunt-related until the occurrence of a major event like seizure because the body has finally reached a saturation point where the build up of toxins like ammonia in the system ultimately cause the dog to seize ... food for thought?


Well I was actually wondering the same thing. That perhaps the shunt was so small it just took this much time for whatever toxins to get to such a level as to finally cause behavioral changes and then the seizures. I just wish blood work had been done on him as a puppy like it should have been so we would have known if his liver levels were elevated back then. 

When I looked at Toby's records from his previous vet, I see where she had taken him quite a few times because he seemed to vomit often. Why blood work wasn't done then I don't know. Seems like that is what should have been the first step after a few of those episodes. Vomiting can be a symptom of liver shunt and MVD.


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## kathym (Aug 5, 2006)

I just wanted to thank everyone for all your knowledge on the subjects that were discussed on these issues ..It was very informative to me.
It was here that learned about the Dr Dodds diet that Baci is still on.
It was here that i had leverage to discuss with my Vet what was going on with Baci's blood tests ..
Thank you Kathy xoxo


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## Snowbody (Jan 3, 2009)

Excellent thread and Crystal, you help your customers so much with your knowledge - this is such a rarity in a business like yours. I haven't come across it here. I know what you mean about how much information we have gotten on SM. I feel so lucky to have found this site. 
A quick question - I never heard of scintigraphy before. What kind of diagnostic procedure is that? Does the dog have to be put under for it?


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## MaryH (Mar 7, 2006)

Driving and don't have notes with me. Search web for cholorectal scintigraphy dogs. I will write more later.


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## CrystalAndZoe (Jul 11, 2006)

This is from the University of Tennessee.

*What is scintigraphy?*
Scintigraphy is a nuclear scan that measures blood flow. To evaluate a dog for a shunt, a radioactive material in inserted into the colon (by a high enema) and the animal is scanned with a special camera hooked to a computer. The computer measures the amount of radioactive blood in the heart and in the liver and compares the two. Normal animals have a shunt fraction (amount of blood in the heart divided by amount in the liver) of less than 15%. In other words, at least 85% of the radioactive material ends up in the liver. Dogs with shunts usually have shunt fractions >60%, because most of the blood bypasses the liver and goes straight to the heart. Scintigraphy is safe and quick but does require heavy sedation or anesthesia. Animals must be hospitalized for at least one night after the procedure until they have expelled the radioactive material by defecation and urination. Scintigraphy tells us that shunting is present; however, in most cases the veterinarian cannot tell whether the shunt is inside or outside of the liver, whether there is more than one shunt, or whether the shunt is congenital or acquired.

Portosystemic Shunts FAQ

So interesting because they are also saying a shunt can be congenital or acquired. Up until now, the only thing associated with shunt here has been congenital.

So I'm guessing a shunt can be acquired due to liver disease? And with liver disease...is that mainly due to either an infection or environmental toxins?


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## Snowbody (Jan 3, 2009)

Crystal&Zoe said:


> This is from the University of Tennessee.
> 
> *What is scintigraphy?*
> Scintigraphy is a nuclear scan that measures blood flow. To evaluate a dog for a shunt, a radioactive material in inserted into the colon (by a high enema) and the animal is scanned with a special camera hooked to a computer. The computer measures the amount of radioactive blood in the heart and in the liver and compares the two. Normal animals have a shunt fraction (amount of blood in the heart divided by amount in the liver) of less than 15%. In other words, at least 85% of the radioactive material ends up in the liver. Dogs with shunts usually have shunt fractions >60%, because most of the blood bypasses the liver and goes straight to the heart. Scintigraphy is safe and quick but does require heavy sedation or anesthesia. Animals must be hospitalized for at least one night after the procedure until they have expelled the radioactive material by defecation and urination. Scintigraphy tells us that shunting is present; however, in most cases the veterinarian cannot tell whether the shunt is inside or outside of the liver, whether there is more than one shunt, or whether the shunt is congenital or acquired.
> ...


Thans for the description. :new_shocked::new_shocked: Sounding like a doggie colonoscopy....not really but I had no idea that would be how they would do any shunt diagnosis that way. Very interesting.


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## MaryH (Mar 7, 2006)

About disclosure ...a person has a good job, saves their money, buys an affordable house, pays timely, economy tanks, this person loses job, runs through life savings, can't sell house, can't find employment, loses house to foreclosure. Some will say "so sad that bad things happen to good people" while others will say "deadbeat". Same thing happens in the breeding world. I could do every available test and still produce a shunt. Some will say "she did everything possible to prevent this" while others will say "don't buy from Mary because she is riddled with liver issues". Do people disclose issues privately? I hope and pray that they do.


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## jmm (Nov 23, 2004)

Acquired shunts would be secondary to some other liver disease. I've seen it in dogs with inflammatory conditions in their livers, but yes, anything that damages the liver can cause the body to form a shunt. Acquired shunts typically have a different appearance than a single, congenital PSS. 

I think it is important to consider that the rare sick MVD dogs are often sick from an inflammatory condition in their liver (and IBD), not from microscopic shunting itself.


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## Cosy (Feb 9, 2006)

Crystal&Zoe said:


> Brit thank you so much for sharing this. Even my friend who is currently not practicing veterinary medicine was not aware this could happen. She was telling me probably what the lady's old vet was doing was trying to cover himself by not catching it earlier because he had never done a full blood panel on Toby. What's especially frightening was he didn't do it before putting him under a general for his neuter when he was 6 months old.
> 
> I'm wondering...on the Yorkie when her ALT's and AST's had remained normal up until 5 yrs of age, was a BAT done earlier in life too, and was that normal as well?


I really have no way of knowing that since she came to me after years of being passed around. I was JUST her forever home. I can tell you when I got her at age four I had all tests done including BAT. Nothing was out of line. Only her heart condition showed. A year later obvious signs were there for liver problems. Tests were done again, leading to scintigraphy and diagnosis. With proper treatment and diet it was manageable and she acted as normal as a little caged dog for four years could act...for two years.


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## Luna'sMom (Oct 7, 2007)

MaryH said:


> About disclosure ...a person has a good job, saves their money, buys an affordable house, pays timely, economy tanks, this person loses job, runs through life savings, can't sell house, can't find employment, loses house to foreclosure. Some will say "so sad that bad things happen to good people" while others will say "deadbeat". Same thing happens in the breeding world. I could do every available test and still produce a shunt. Some will say "she did everything possible to prevent this" while others will say "don't buy from Mary because she is riddled with liver issues". Do people disclose issues privately? I hope and pray that they do.


Thats really sad isn't it. Where there is no genetic (DNA) test for a disease all that breeders can do is exclude abnormal animals/lines from their breeding and do health testing where possible. Unfortunately due to the nature of complex diseases/disorders things like shunts can/do pop up even if the breeder is being responsible. I personally would prefer a breeder to be upfront and tell me about any issues that they have had in their lines - and the steps they have taken to avoid them. I would have no qualms buying a dog from a breeder that discussed such things with me. 

We can only hope that in the future genetic (DNA) tests for diseases/disorders such as Liver Shunts, MVD, GME, Luxating Patellas etc could be developed. I just hope that research budgets stop being slashed or this will never happen :blink:


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## kodie (Aug 24, 2004)

pammy4501 said:


> GME is way scarier. A shunt could be corrected surgically if needed. GME, not so good. If there are neurological symptoms such as lethargic, depressed, blank stare, staggering gait, weakness in the hind legs I would worry. Labs would need to be done to rule out viral and fungal causes such as toxoplasmosis, cryptococcus, tick borne diseases, west nile virus. Then a brain MRI looking for inflammatory brain disease, and a spinal tap for CSF with high eosinphilie count. If all cultures are negative, finally you will be left with the infammation of the CNS being immune mediated or GME/NME.


I would have to agree with this statement... this coming from a owner of a maltese with congential neurologic issues... my kodie also has MVD and before he neurologic symptoms.. life was a breeze! MVD was no big deal to us... but now neurologic symptoms can occur at any time and not related to his MVD... and docs dont have REAL CLEAR answers why things occur when they occur... its the scariest thing happen to your dog. I also agree that most neurologic issues can not be cured only maintained... and eventually there is nothing more a doc can do for you. :mellow: Success rates for liver shunt surgeries are MUCH higher than neurologic issues being corrected surgerically.

Everyone has stated very useful information on liver shunts and MVD... I have also taken kodie to see Dr Center and she was dead on with his diagnosis... i cant say enough about her and her knowledge. I wish every owner on the east coast that has a dog that is in question if they have a liver shunt or not should be recommended to go see her BEFORE just jumping into exploratory surgery.


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