# bile acid test came back abnormal



## mnk1220 (Feb 5, 2009)

bile acid test came back abnormal but as the vet said not "crazy high".. Next step he recommends a ultrasound.. Is an enlarged mid section a symptom of liver disease?


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## dwerten (Oct 6, 2007)

what were pre and post bile acid test numbers


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## elly (Sep 11, 2006)

QUOTE (mnk1220 @ Mar 15 2009, 09:13 AM) index.php?act=findpost&pid=745579


> bile acid test came back abnormal but as the vet said not "crazy high".. Next step he recommends a ultrasound.. Is an enlarged mid section a symptom of liver disease?[/B]



Yes, could be fluid. How does he act after a meal, is he quiet or depressed? My Ellie has liver disease and she is very sick right now. There is a good read on the net called Liver Disease: Signs, Symptoms, and Diagnosis.

Will keep Hudson in my prayers
Cathy


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## dwerten (Oct 6, 2007)

http://www.peteducation.com/article.cfm?c=2+2103&aid=315

here is some info and what things to look for on cbc panel as well


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## mnk1220 (Feb 5, 2009)

the only reason we found out about the high liver enzymes was when he went to get his teeth cleaned the blood test picked it up. Still trying to figure out what it is. He had an xray which showed the liver was enlarged. They put him on a supplement then i opt for the bile acid test... Hes not showing any symptoms hes actign him self! he has gained weight but i just thought it was from the special food that hes on due to stones! i am not sure if i want to put him through the stress of a tissue sample specially since hes acting fine.


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## elly (Sep 11, 2006)

QUOTE (mnk1220 @ Mar 15 2009, 09:51 AM) index.php?act=findpost&pid=745596


> the only reason we found out about the high liver enzymes was when he went to get his teeth cleaned the blood test picked it up. Still trying to figure out what it is. He had an xray which showed the liver was enlarged. They put him on a supplement then i opt for the bile acid test... Hes not showing any symptoms hes actign him self! he has gained weight but i just thought it was from the special food that hes on due to stones! i am not sure if i want to put him through the stress of a tissue sample specially since hes acting fine.[/B]


I really think you should be looking into liver support. He sounds like he has something serious if his liver is enlarged. I would have the ultrasound to see if he has fluid. Ellie has not been well enough for a biopsy, we treat things as they come up. You really need to take charge of Hudson, your vet will help but I have learned that I have to do much of the research and reach out to friends on SM who have dogs with liver disease. Great example was Friday when I spoke to her vet about Ellie having trouble walking, he did not recommend the Lactulose, Jackie did, when I called back and asked he gave it to her and she is better today. If I had not taken charge of Ellie's Health she would not be alive today. One more thing, Ellie is very active until she is super sick. She is hard to read.

Cathy


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## Ladysmom (Oct 19, 2004)

Actually, according to Dr. Center's protocol, the next step would be a Protein C test in an asymptomatic dog, although since he has an enlarged liver, they may want to go ahead and do that ultrasound.

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

Bladder stones is also a symptoms of a liver shunt.

Are you close to a vet school? I would take him there if at all possible.


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## jmm (Nov 23, 2004)

Elevated bile acids means liver disease. Most dogs with shunts have small livers. I would continue with the ultrasound. There is obviously disease present and it needs to be addressed. Once again, you should get a referral to an internal medicine vet for further work up. If your dog has fluid in the abdomen, things need to start moving along on a faster pace.


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

QUOTE (JMM @ Mar 15 2009, 12:14 PM) index.php?act=findpost&pid=745632


> Elevated bile acids means liver disease. Most dogs with shunts have small livers. I would continue with the ultrasound. There is obviously disease present and it needs to be addressed. Once again, you should get a referral to an internal medicine vet for further work up. If your dog has fluid in the abdomen, things need to start moving along on a faster pace.[/B]


Jackie is an experienced vet tech and has personal experience and knowledge regarding liver issues. I hope you will get further work up done right away with an internal medicine vet.


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## dwerten (Oct 6, 2007)

agree with jackie when it comes to situations like this an internal medicine specialist is best as they have much further education and specialized in internal organs as you may spend a bunch with vet and have to ultimately see a specialist in the end and some do not take ultrasounds from others as that happened to me when dex got pancreatitis -- i had to pay for another ultrasound as they did not know the person who did the previous one and did not want to treat without having their own done so it cost me another $400  it is worth it in the long run cost wise and pet health wise to get to specialist if vet is picking up something internally and you will not second guess it knowing you went to the specialist 

what were the pre and post biles? Did they do protein c test as well ? Those are the two tests most specific to the liver 


QUOTE (JMM @ Mar 15 2009, 12:14 PM) index.php?act=findpost&pid=745632


> Elevated bile acids means liver disease. Most dogs with shunts have small livers. I would continue with the ultrasound. There is obviously disease present and it needs to be addressed. Once again, you should get a referral to an internal medicine vet for further work up. If your dog has fluid in the abdomen, things need to start moving along on a faster pace.[/B]


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## mnk1220 (Feb 5, 2009)

i should have maybe just gotten the tissue sample from the start. cuz after all these tests everyone says to do.. in the end your still going to need a tissue sample...


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## jmm (Nov 23, 2004)

QUOTE (mnk1220 @ Mar 15 2009, 03:14 PM) index.php?act=findpost&pid=745750


> i should have maybe just gotten the tissue sample from the start. cuz after all these tests everyone says to do.. in the end your still going to need a tissue sample...[/B]


As I explained to you before, doing a biopsy does not always change your treatment plan. It is not without risk and should not be taken lightly. I strongly urge you to consult an internist before putting your pet through this surgery.


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## mnk1220 (Feb 5, 2009)

the vet told me no matter what they will need a tissue sample cuz they dont know whats wrong... i dont know


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## elly (Sep 11, 2006)

QUOTE (JMM @ Mar 15 2009, 03:30 PM) index.php?act=findpost&pid=745757


> QUOTE (mnk1220 @ Mar 15 2009, 03:14 PM) index.php?act=findpost&pid=745750





> i should have maybe just gotten the tissue sample from the start. cuz after all these tests everyone says to do.. in the end your still going to need a tissue sample...[/B]


As I explained to you before, doing a biopsy does not always change your treatment plan. It is not without risk and should not be taken lightly. I strongly urge you to consult an internist before putting your pet through this surgery.
[/B][/QUOTE]

Both Ellie's vet and internist told me that biopsy is very risky and does not always change treatment.

Cathy


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

QUOTE (mnk1220 @ Mar 15 2009, 05:06 PM) index.php?act=findpost&pid=745765


> the vet told me no matter what they will need a tissue sample cuz they dont know whats wrong... i dont know[/B]


Are you planning to contact an internal medicine specialist?


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## mnk1220 (Feb 5, 2009)

this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...


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## elly (Sep 11, 2006)

QUOTE (mnk1220 @ Mar 15 2009, 04:59 PM) index.php?act=findpost&pid=745784


> this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...[/B]


My first vet and specialist would not treat without a biopsy, I found a new vet. 

Cathy


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## dwerten (Oct 6, 2007)

i would have too as the only way i would have done biopsy is during spay or during liver shunt surgery if LS as there are tests that are less invasive that can give results 


QUOTE (Elly @ Mar 15 2009, 06:35 PM) index.php?act=findpost&pid=745805


> QUOTE (mnk1220 @ Mar 15 2009, 04:59 PM) index.php?act=findpost&pid=745784





> this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...[/B]


My first vet and specialist would not treat without a biopsy, I found a new vet. 

Cathy
[/B][/QUOTE]


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## dwerten (Oct 6, 2007)

100% agree with Jackie too get to an internal medicine specialist - here is the look up - put your state in there and hit search - print out and call around in your county all the vets offices and find out who most refer to as those are the best ones - this is how i found mine and she is awesome ---- NO BIOPSY- you can even have them consult with dr centers at cornell for second opinion as she is very familiar with liver in maltese breed 

http://acvim.org/websites/acvim/index.php?p=3

QUOTE (JMM @ Mar 15 2009, 04:30 PM) index.php?act=findpost&pid=745757


> QUOTE (mnk1220 @ Mar 15 2009, 03:14 PM) index.php?act=findpost&pid=745750





> i should have maybe just gotten the tissue sample from the start. cuz after all these tests everyone says to do.. in the end your still going to need a tissue sample...[/B]


As I explained to you before, doing a biopsy does not always change your treatment plan. It is not without risk and should not be taken lightly. I strongly urge you to consult an internist before putting your pet through this surgery.
[/B][/QUOTE]


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## dwerten (Oct 6, 2007)

you are in new york? My friend has a liver shunt dog and has a specialist there so i will check with her and post it if you want to check this person out 


QUOTE (mnk1220 @ Mar 15 2009, 05:59 PM) index.php?act=findpost&pid=745784


> this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...[/B]


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## mnk1220 (Feb 5, 2009)

QUOTE (dwerten @ Mar 15 2009, 07:02 PM) index.php?act=findpost&pid=745823


> you are in new york? My friend has a liver shunt dog and has a specialist there so i will check with her and post it if you want to check this person out
> 
> 
> QUOTE (mnk1220 @ Mar 15 2009, 05:59 PM) index.php?act=findpost&pid=745784





> this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...[/B]


[/B][/QUOTE]



thank you i will def check it out!


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## tamizami (May 1, 2007)

Here is information to give your vet AND your internal medicine specialist regarding the Protein C test Dr. Center of Cornell recommends:

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

My experience has been that our local vets and our local internal medicine specialists were NOT familiar with this information. I had to print out copies of presentations from Dr. Center and give them to my vet and IM to read. They were very unwilling to change their diagnostic approach. I have since found a new vet, who is more than willing to contact Dr. Center with any questions. I would recommend the following for you as well, otherwise it can get very costly with inconclusive results. 

Good luck with your baby, I hope its nothing to worry about. Many Maltese have high bile acids (mine were VERY high, like 145 pre- and post-prandial) with no liver shunt or hepatitis. Dr. Center estimates that nearly 60-70% of Maltese have hepatic microvascular dysplasia, which is manageable with supplements (milk thistle, like Marin's) and diet (I recommend the liver cleansing diet I posted in the recipe section, its from our nutritionist). Its often difficult to do, but we have to be the advocate for our dogs' well-being, unfortunately many vets will often result to business as usual or expensive and invasive tests. There are many threads on SM about high bile acids and the latest testing protocol. 
:grouphug:


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## dwerten (Oct 6, 2007)

are you close to cornell university ? it is in new york ? I would just drive to dr center and have her handle your case - worth the drive and you are not very far i do not think?


QUOTE (mnk1220 @ Mar 15 2009, 06:11 PM) index.php?act=findpost&pid=745830


> QUOTE (dwerten @ Mar 15 2009, 07:02 PM) index.php?act=findpost&pid=745823





> you are in new york? My friend has a liver shunt dog and has a specialist there so i will check with her and post it if you want to check this person out
> 
> 
> QUOTE (mnk1220 @ Mar 15 2009, 05:59 PM) index.php?act=findpost&pid=745784





> this is where im confused the only treatment i am doing rite now is giving him a supplement.. nothing else has changed.... he thinks it may be chronic hepatitis.. but he said he wont know until the tissue sample...[/B]


[/B][/QUOTE]



thank you i will def check it out!
[/B][/QUOTE]


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## dwerten (Oct 6, 2007)

Animal Medical Center in Manhattan is the facility my friend recommended


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## jmm (Nov 23, 2004)

I've taken my dog to Cornell to see Dr. Center...she is the best.


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## mnk1220 (Feb 5, 2009)

thank you all~~ is there a website dr center has?? with the address and some information?


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## jmm (Nov 23, 2004)

http://www.vet.cornell.edu/hospital/


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## dwerten (Oct 6, 2007)

http://www.vet.cornell.edu/about/contact.htm

QUOTE (mnk1220 @ Mar 15 2009, 08:54 PM) index.php?act=findpost&pid=745891


> thank you all~~ is there a website dr center has?? with the address and some information?[/B]


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## dwerten (Oct 6, 2007)

if it were me i would go to cornell and drive but if you are close to new jersey a friend recommended this person but she is referral only so my friend would have to call referral in for you Dr Rebecca Green.........Red Bank Animal Hospital in Red Bank NJ- i am confirming this is an internal medicine specialist though


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## dwerten (Oct 6, 2007)

yes she is an internal medicine specialist and my friends dog is a liver shunt survivor and has kidney disease as well and this is who she recommends if you do not want to drive and live close to this place- I tend to like to work with women as they are more detail oriented and compassionate usually - sorry men on group 


QUOTE (dwerten @ Mar 15 2009, 09:17 PM) index.php?act=findpost&pid=745911


> if it were me i would go to cornell and drive but if you are close to new jersey a friend recommended this person but she is referral only so my friend would have to call referral in for you Dr Rebecca Green.........Red Bank Animal Hospital in Red Bank NJ- i am confirming this is an internal medicine specialist though[/B]


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## mnk1220 (Feb 5, 2009)

thanks


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