# Elevated bile acids/liver enzymes drug therapy duration.



## Iubire14 (Nov 5, 2012)

Sugarplum has had liver issues over the last year , I will post a link to the previous thread at the end

Basically her bile acids were 69 and we did an ultrasound, everything was normal, didn't want to do a biopsy. We had her on antibiotics for two weeks and then on ursodiol and denamarin for 3 months

Just got her tested back in December and her bile acids went down to 31. The specialist said to continue denamarin and ursodiol for another 3-4 and re test. 
we have her on a balance it diet and it seems to be working.

I was just wondering if anyone knows that if her next set of bloodwork is normal then what about the medication ? Has anyone gone through this ? We have petplan insurance so thankfully they cover mostly everything. We had to get her rabies vaccine did the 3 year. Didn't do the parvo/distemper , did a titer instead ( not covered by insurance but still worth it) and she's fine for a least another year for those vaccines. 

I finally feel like we are getting on track but I just wanted to know if anyone has gone through this and how Long your fur babies have lived, if medication is a lifelong thing?


Thank you in advance. 

Prescription dog food. Royal canin vs hill's - Maltese Dogs Forum : Spoiled Maltese Forums


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## aprilb (Jul 9, 2010)

My Eva has MVD...it sounds like this is what you are dealing with...I read your previous thread and agree with the advice you have been given...why is she still on the ursodiol? I don't think she needs it based on the mild elevations she has had...if the diet is working, I would stick with diet and milk thistle...if her liver values(ALT, etc) are now normal, I would get a liver panel in 6 months..forget about bile acids....they go up and down all the time and it can drive you crazy worrying about it...as well as drain your pocketbook and stress out your baby...as long as she is asymptomatic and her liver values are good, you don't need another bile acid....I keep my Eva on a special diet and the chewable Denamarin...(it has less chance of stomach upset than the pills...) Her bile acids and liver values were a lot higher than Sugarplum's...


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## Iubire14 (Nov 5, 2012)

Thank you so much ! Well the specialist wanted her to stay on the ursodiol for a few more months (til end of May). We also give her the chewable denamarin the only problem is, she HATES it. I have to give her 1/4 of a tablet everyday so I crush it up and then funnel it into a bulb syringe and drop it down. Then we give her the ursodiol at night. I actually just called her regular vet to get another liver panel done and a bile acid test, fortunately we have pet insurance on her and have already me your deductible this year for this condition so for peace of mind and her own well being I am going to do the blood tests in feb as well as in May. I just hope that she can stop the ursodiol soon. Everything has been really expensive but I'm so glad that we got pet insurance.


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## pammy4501 (Aug 8, 2007)

My dog Lola was on this medication regime too. When she had her ultrasound it showed lots of sludge in her gallbladder. I kept her on the Ursodiol for that reason. Ursodiol really has very few side effects, so keeping it going isn't going to hurt anything. It helps liver function by improving the flow of bile from the gallbladder to the intestine. It also decreases the amount of cholesterol in the bile. Basically it prevents bile stones and some types of bladder stones as well. 

Denamarin is a liver protectant also helps the flow of bile but it also contains some antioxidants that protect the liver. This is actually the same drug as SAMe but with Silybian. The Silybian helps regenerate liver cells. 

I agree with Aprilb, it sounds like your dog may have MVD. But first and foremost has your dog had liver shunt ruled out? This is really important. There are a few specific tests that should be done to do that. One test that you should consider is a Protein C Assay. Once you have ruled out portal systemic shunt you are kind of left with MVD. A protein restricted diet and these meds can help keep it all in check. Be very careful of diets too high in protein. There is lots of discussion about raw feeding and grain free foods here. Just be careful, some of these foods are very high in protein. There needs to be some form of carbohydrate to decrease the amount of protein in the food. Getting a consult from a nutritionist would be very helpful for you.


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## Iubire14 (Nov 5, 2012)

Thanks so much for your input. She did have an ultrasound done and everything looked normal size and blood flow. They wanted to do a biopsy but I didn't want to. Too risky and they would prob come to the same conclusion. From my first post, the link below it... I think it was primarily my fault because we were giving her too much protein in the beginning. Between 75-100 grams of chicken a day. Now she's on the balance it regular chicken and veggie mix with rice which only has 35 grams of protein along with the balance it supplement and she's doing much better. I just hope that she doesn't need to be on meds forever , she's so young


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## edelweiss (Apr 23, 2010)

pammy4501 said:


> My dog Lola was on this medication regime too. When she had her ultrasound it showed lots of sludge in her gallbladder. I kept her on the Ursodiol for that reason. Ursodiol really has very few side effects, so keeping it going isn't going to hurt anything. It helps liver function by improving the flow of bile from the gallbladder to the intestine. It also decreases the amount of cholesterol in the bile. Basically it prevents bile stones and some types of bladder stones as well.
> 
> Denamarin is a liver protectant also helps the flow of bile but it also contains some antioxidants that protect the liver. This is actually the same drug as SAMe but with Silybian. The Silybian helps regenerate liver cells.
> 
> I agree with Aprilb, it sounds like your dog may have MVD. But first and foremost has your dog had liver shunt ruled out? This is really important. There are a few specific tests that should be done to do that. One test that you should consider is a Protein C Assay. Once you have ruled out portal systemic shunt you are kind of left with MVD. A protein restricted diet and these meds can help keep it all in check. Be very careful of diets too high in protein. There is lots of discussion about raw feeding and grain free foods here. Just be careful, some of these foods are very high in protein. There needs to be some form of carbohydrate to decrease the amount of protein in the food. Getting a consult from a nutritionist would be very helpful for you.


:goodpost:
Also remember that an ultrasound is not entirely reliable here. I would go w/Pam's suggestion of the Protein C Assay.


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## SammieMom (Nov 13, 2010)

lots good posts for you here! 
She doesn't seem high but depends on her issues if any. Also-like my Vet told me about testing Sammie after we lost his brother at 7 months to shunts (200 BAT) if you want a diagnosis with ONE test do a scinigraphy. Sammie's BAT was only 53 so we stopped cause he had no issues. Range is 15-25 so he is high. Since he has no issues we do nothing but watch protein levels. I need to add milk thistle to his diet. But having that baseline should he need tests one day is why its important to have a puppy BAT on file IMO with Maltese and Yorkie's even if nothing is wrong. One day it might save your vet thinking there is a liver problem. 
Hope Sugarplum is feeling well.


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## aksm4 (Nov 28, 2011)

Hello my Becky was born with liver shunt , and like Sandi said ultrasound very unconclusive for shunt diagnose , Becky had ultrasound and everything looked perfect but she was getting sicker and sicker her biles were elevated at 126 post , although sugarplum is not that high probably symptomatic mvd , keep her on low protein diet , 21 % max Denamarin supplement with milk thistle and sam-e and monitor her stools she has to go a minimum of 1 a day preferably twice if you see she is sluggish , no apetite i would talk to my vet about lactulose, Becky had normal cbc and liver profiles but still had a liver problem she had surgery for her shunt but still has elevated biles so she has MVD also so we have her on low protein and lactulose she is doing well but still has her days if she gets too much protein , We do not know how long we have with our furbabies but enjoy everyday .forgot to say that once dx with MVD biles will go up and down all her life no need to check all the time .


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## SammieMom (Nov 13, 2010)

pammy4501 said:


> My dog Lola was on this medication regime too. When she had her ultrasound it showed lots of sludge in her gallbladder. I kept her on the Ursodiol for that reason. Ursodiol really has very few side effects, so keeping it going isn't going to hurt anything. It helps liver function by improving the flow of bile from the gallbladder to the intestine. It also decreases the amount of cholesterol in the bile. Basically it prevents bile stones and some types of bladder stones as well.
> 
> Denamarin is a liver protectant also helps the flow of bile but it also contains some antioxidants that protect the liver. This is actually the same drug as SAMe but with Silybian. The Silybian helps regenerate liver cells.
> 
> I agree with Aprilb, it sounds like your dog may have MVD. But first and foremost has your dog had liver shunt ruled out? This is really important. There are a few specific tests that should be done to do that. One test that you should consider is a Protein C Assay. Once you have ruled out portal systemic shunt you are kind of left with MVD. A protein restricted diet and these meds can help keep it all in check. Be very careful of diets too high in protein. There is lots of discussion about raw feeding and grain free foods here. Just be careful, some of these foods are very high in protein. There needs to be some form of carbohydrate to decrease the amount of protein in the food. Getting a consult from a nutritionist would be very helpful for you.


:goodpost: thanks for all info on how these meds work.


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## pammy4501 (Aug 8, 2007)

Iubire14 said:


> Thanks so much for your input. She did have an ultrasound done and everything looked normal size and blood flow. They wanted to do a biopsy but I didn't want to. Too risky and they would prob come to the same conclusion. From my first post, the link below it... I think it was primarily my fault because we were giving her too much protein in the beginning. Between 75-100 grams of chicken a day. Now she's on the balance it regular chicken and veggie mix with rice which only has 35 grams of protein along with the balance it supplement and she's doing much better. I just hope that she doesn't need to be on meds forever , she's so young


I wouldn't do the liver biopsy either. But I would ask about the Protein C. As for staying on meds, if you can get her in control with a protein restricted diet, and have labs checked every 6 months, she should be able to come off the meds. But some people do opt to continue giving the denamarin for it's protective properties.


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## SammieMom (Nov 13, 2010)

Iubire14 said:


> Thanks so much for your input. She did have an ultrasound done and everything looked normal size and blood flow. They wanted to do a biopsy but I didn't want to. Too risky and they would prob come to the same conclusion. From my first post, the link below it... I think it was primarily my fault because we were giving her too much protein in the beginning. Between 75-100 grams of chicken a day. Now she's on the balance it regular chicken and veggie mix with rice which only has 35 grams of protein along with the balance it supplement and she's doing much better. I just hope that she doesn't need to be on meds forever , she's so young


Glad you didn't do it!! Wonder why they wanted a biopsy before a protein c test or a Scintigraphy :blink: My first vet was not aware of protocol or that most Maltese test higher than normal even without issues or a shunt. I think its really important to make sure your Vets are familiar with the expert recommendations for Maltese. 

Like April said adult BATS can change and be confusing so they can really scare you. :w00t: Hopefully you won't have anymore problems with Sugarplum. Lots people see a high BAT in younger dogs and it ends up to be MVD and they do fine. 

Don't know if you seen this. This is the contact link for Dr. Center, an expert on liver disease. 
Research


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## Iubire14 (Nov 5, 2012)

I'm a bit worried today... we took sugarplum for her bile acids test yesterday and the results are in... Her alt is 72 alkaline phos 172 ( which should be under 100) 
But here's the kicker... 
Her pre bile acids were 21 ( which have never been that hight usually a 2-3)
And her post bile acids were 54.3 ( which last test were 31)

This was done at her regular vet, not at the specialist. 

I really don't know what to do anymore and I'm so overwhelmed 

The last few weeks my husband and I both had a pretty bad flu, and she's been feeling under the weather the last few days

Do you guys think that this could have had something to do with her testing so differently? By the way here CBC was normal


Please help (


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## Iubire14 (Nov 5, 2012)

The only other thing was they she got her 3 year rabies shot in December. Could that be a cause ? We didn't get the depo/parvo vaccine... We did a titer instead and they said she's good for another year without the vaccine


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## aksm4 (Nov 28, 2011)

Hello ,

If Sugarplum has MVD her biles will go up and down all the time does not indicate how well she is doing , why do you keep repeating her biles ??? how is she doing other wise ?


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## Iubire14 (Nov 5, 2012)

She's been really funky lately. Hardly eating. Sleeping most of the day. 



aksm4 said:


> Hello ,
> 
> If Sugarplum has MVD her biles will go up and down all the time does not indicate how well she is doing , why do you keep repeating her biles ??? how is she doing other wise ?


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## Iubire14 (Nov 5, 2012)

Has anyone don't the liver panel at Cornell? And if so how did you guys go about doing it? Also what is the protein c test ? 

I am willing to get that done too I just don't know if we should have her vet or the specialist send it out. And if we do it, what questions will be answered.


And is it possible that all of this happened from the rabies vaccine ?


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## CloudClan (Jan 31, 2007)

Iubire14 said:


> Has anyone don't the liver panel at Cornell? And if so how did you guys go about doing it? Also what is the protein c test ?
> 
> I am willing to get that done too I just don't know if we should have her vet or the specialist send it out. And if we do it, what questions will be answered.
> 
> ...


Honestly, it sounds like MVD is what your dog has and your vet seems to be pinning too much on what is typically an asymptomatic issue that likely is not the cause of any other issues she is having. Given her numbers, I personally would not even do the Protien C test as it would not be necessary to tell me more than I have a dog with asymptomatic MVD. I definitely would not do an ultrasound or biopsy with those numbers. Since 70-80% of Maltese test higher than normal, it seems pretty much overkill to do all of the extra testing when she is not super elevated. I would not suspect a shunt in most dogs under 100 BAT unless there are other consistent symptoms. 

I just went back and read that other thread, Jackie and Crystal and others gave you some really good advice, but it seems like your vet is asking for you to do other things that frankly do not seem consistent with the guidelines I have read over and over from the experts on Maltese MVD. I'm not sure why.


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## Iubire14 (Nov 5, 2012)

Thank you for your response. She started having issues last sept and her BAC was low 60's. In November it went down to 31 after 3 months of denamarin and ursodiol. Three months later BAC was 54 (today). The only thing that was different from November to today was that she got her 3 year rabies vaccine. That's all I can think of. Of course I don't like that her post bile acids were higher than last time but what concerns me is the PRE bile acids were 21 when they have never been over 2 or 3. 


CloudClan said:


> Honestly, it sounds like MVD is what your dog has and your vet seems to be pinning too much on what is typically an asymptomatic issue that likely is not the cause of any other issues she is having. Given her numbers, I personally would not even do the Protien C test as it would not be necessary to tell me more than I have a dog with asymptomatic MVD. I definitely would not do an ultrasound or biopsy with those numbers. Since 70-80% of Maltese test higher than normal, it seems pretty much overkill to do all of the extra testing when she is not super elevated. I would not suspect a shunt in most dogs under 100 BAT unless there are other consistent symptoms.
> 
> 
> 
> I just went back and read that other thread, Jackie and Crystal and others gave you some really good advice, but it seems like your vet is asking for you to do other things that frankly do not seem consistent with the guidelines I have read over and over from the experts on Maltese MVD. I'm not sure why.


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## Grace'sMom (Feb 22, 2012)

Gracie has liver damage...

We see a Holistic Vet.

Any time she has to have a vaccine or medication we do a month of Thuja and Traumeel (both made by Heel)... The Thuja helps detox, and the Traumeel helps lower inflammation.

Grace was on an herbal and homeopathic protocol along with home cooking (she's vegetarian) for a year. Now she is just on the vegetarian home cook diet and does really well. I just have to be really aware of her protein and fat levels.


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## CloudClan (Jan 31, 2007)

Iubire14 said:


> Thank you for your response. She started having issues last sept and her BAC was low 60's. In November it went down to 31 after 3 months of denamarin and ursodiol. Three months later BAC was 54 (today). The only thing that was different from November to today was that she got her 3 year rabies vaccine. That's all I can think of. Of course I don't like that her post bile acids were higher than last time but what concerns me is the PRE bile acids were 21 when they have never been over 2 or 3.


As others have mentioned in an MVD dog, the numbers will be up and down. The changes do not really represent a change in her condition. She simply has MVD. The treatments she is on are not going to change anything about that condition one way or another. She will always have MVD. It isn't worsening or improving. Most MVD dogs do not have symptoms and it seems what you are describing as symptoms may not be related to her liver at all.


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## CrystalAndZoe (Jul 11, 2006)

Iubire14 said:


> She's been really funky lately. Hardly eating. Sleeping most of the day.





CloudClan said:


> As others have mentioned in an MVD dog, the numbers will be up and down. The changes do not really represent a change in her condition. She simply has MVD. The treatments she is on are not going to change anything about that condition one way or another. She will always have MVD. It isn't worsening or improving. Most MVD dogs do not have symptoms and it seems what you are describing as symptoms may not be related to her liver at all.


She could be 'funky' lately and hardly eating because of all the testing, stress at being at the vets, multitudes of antibiotics and the Denamarin. All of these can make a dog not only not feel well, but actually cause some health issues. There are quite a few dogs who do not feel well on Denamarin. I don't understand why your vet or the specialist you are seeing won't simply call the foremost authority in liver issues, which is Dr. Center at Cornell. I think a simple phone call will clear much of this up and relieve you and your husband immensely.


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## Iubire14 (Nov 5, 2012)

She isn't having a multitude of tests all the time. The last time , besides yesterday, was back in November. My main question is if this is a possible reaction from the rabies vaccine, she was on antibiotics for two weeks back in September that's all. The only thing that has changed from November to now is her rabies vaccine. Also, would the vet just be able to call Dr. Center to ask questions without him knowing her, be this I mean does she just talk to any vet or do we need to do blood tests and send them there.


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## pammy4501 (Aug 8, 2007)

One thing though? What did the vet feed her before her post BAT? I have heard that some vets feed a high fat ICU diet and for our malts, it's just too much. If possible for the future (and maybe even consider a repeat test) using something like Gerber chicken sticks.


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## Iubire14 (Nov 5, 2012)

pammy4501 said:


> One thing though? What did the vet feed her before her post BAT? I have heard that some vets feed a high fat ICU diet and for our malts, it's just too much. If possible for the future (and maybe even consider a repeat test) using something like Gerber chicken sticks.



Actually I fed her own food. 

Possible good news though.... 
Her vet just called me and said she spoke to her specialist and he thinks there may be an infection. Her specialist saw that her lymphocytes were a bit elevated from last time so they want her on two weeks of baytril and flagyl and then retest her. At this point I'm hoping it's an infection because that can be treated. 

Overall I'm hoping we get to the bottom of this soon because we plan on going to Mexico the first week in April for 10 days and leaving her with my parents. And if she's not doing better by then there is no way I would leave her when she's not well. 

So basically I have to give her four meds a day for two weeks

Prayers are appreciated that it's hit an infection


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## maggieh (Dec 16, 2007)

I sent you the name of a highly regarded holistic vet in the city - have you contacted her for an evaluation? If it is MVD it is often easily controlled through diet and supplements. If you want to consult a specialist, like I said in my PM, either UI At Champaign or UW Madison have excellent vet schools. I know someone who has two liver shunt dogs (both rescues) who has had wonderful results at Madison.


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## aksm4 (Nov 28, 2011)

Good Morning ,

I have heard some dogs feel nauseated with Denamarin do u give her pepcid ?? maybe she gets upset tummy with Denamarin , what is she eating ? does she have a bowel movement everyday ?


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## Iubire14 (Nov 5, 2012)

aksm4 said:


> Good Morning ,
> 
> I have heard some dogs feel nauseated with Denamarin do u give her pepcid ?? maybe she gets upset tummy with Denamarin , what is she eating ? does she have a bowel movement everyday ?



Yes she has a bowel movement every day. Most times 2-3 
She was fine with the previous bottle, they were darker in color. This bottle she is being a little weird with it. It's a lighter color tab than before


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## Iubire14 (Nov 5, 2012)

Just did another round of blood tests.her liver panel was within normal limits but her bile acids went up a little. 
Last time her pre was 20.6 and post was 51.3

Now her pre was 37.8 and post was 60.3

She on denamarin and 30 mg of ursodial daily

Unfortunately it seems that her bile acids are slowly raising every time we do a test 

She's not eating much, but she's acting normal, usually sleeps a lot , playing and pooping as normal. 

Is anyone else going through this ?

Her protein c test was high which ruled out a shunt so it's most likely MVD. 
The only thing that freaked me out is when I asked the vet that if they keep going up, does that mean that it will eventually lead to liver failure. She said most likely which breaks my heart. 
Does anyone else have/had issues with slightly elevated bile acids before and how did it profess. I'm lost on what to do as the next step. 









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## jmm (Nov 23, 2004)

If she has MVD her bile acids will be elevated by varying numbers every time. Bile acids is not a good monitoring test for a dog with MVD. I don't know why your vet is wasting your money repeating this so many times. 

How are her liver enzymes? Does she have any symptoms of illness at this time?


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## maggieh (Dec 16, 2007)

Iubire14 said:


> Just did another round of blood tests.her liver panel was within normal limits but her bile acids went up a little.
> Last time her pre was 20.6 and post was 51.3
> 
> Now her pre was 37.8 and post was 60.3
> ...





jmm said:


> If she has MVD her bile acids will be elevated by varying numbers every time. Bile acids is not a good monitoring test for a dog with MVD. I don't know why your vet is wasting your money repeating this so many times.
> 
> How are her liver enzymes? Does she have any symptoms of illness at this time?



In February, I sent you the name of a highly regarded holistic vet located in the city via. PM. With MVD dogs, rather than subjecting them to expensive repeat testing, diet and natural supplements can manage the situation ad you monitor it with simple blood work every six months or so. 

Did you contact Dr. Royal? What was her advice? Honestly, traditional vets often struggle with managing MVD and often recommend testing and treatment that doesn't help and can makes things worse long term.


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## CloudClan (Jan 31, 2007)

I hate to seem like I am repeating myself and repeating what others in this thread have said but WHY is your vet continually repeating Bile Acid tests?

You know she has abnormal numbers the actual digits will go up or down, but won't change that diagnosis, nor monitor her actual liver function.


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## Iubire14 (Nov 5, 2012)

I actually looked up her reviews and people said she isn't that good. But I will give her a call and possibly see. Also I have insurance so it doesn't cost me more than 200 a year to do all of her test, but money is no issue when it comes to her 


maggieh said:


> In February, I sent you the name of a highly regarded holistic vet located in the city via. PM. With MVD dogs, rather than subjecting them to expensive repeat testing, diet and natural supplements can manage the situation ad you monitor it with simple blood work every six months or so.
> 
> 
> 
> Did you contact Dr. Royal? What was her advice? Honestly, traditional vets often struggle with managing MVD and often recommend testing and treatment that doesn't help and can makes things worse long term.






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## Iubire14 (Nov 5, 2012)

All of her other liver values are within normal limits. And she just isn't eating very well. She doesn't eat her food everyday but she will eat raw carrots, lettuce, and blueberries. 

She just sleeps A LOT. this is my first dog so I just want to do what is best for her in all aspects. We only feed organic blueberries lettuce carrots. She also eats watermelon, apples, and mango. I make her the balanceit chicken and rice home cooked meal and use the balance it vitamins. She had her whole work up for her annual and everything was good , vitamins, bilirubin and everything else. It was just her bile acids that were the issue. The first time we did her BAT her
Pre was 0 and now it's slowly risen to the 30's 






jmm said:


> If she has MVD her bile acids will be elevated by varying numbers every time. Bile acids is not a good monitoring test for a dog with MVD. I don't know why your vet is wasting your money repeating this so many times.
> 
> How are her liver enzymes? Does she have any symptoms of illness at this time?






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## CloudClan (Jan 31, 2007)

Iubire14 said:


> I actually looked up her reviews and people said she isn't that good. But I will give her a call and possibly see. Also I have insurance so it doesn't cost me more than 200 a year to do all of her test, but money is no issue when it comes to her
> 
> 
> 
> ...


So your vet keeps repeating the test which tells no new information because they can keep billing the insurance???


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## bellaratamaltese (May 24, 2006)

My maltese sleep a LOT. I definitely don't worry about it, esp in the absence of any symptoms!

I also agree with Carina and others - there is no reason for your vet to keep testing the bile acids. How many sets of bile acid testing has your baby had? Is your vet just doing these or are you asking him to retest over and over?


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## Iubire14 (Nov 5, 2012)

She had had about 5 in the last year and half. Every 3-4 months. I feel horrible that I keep taking her but I'm just doing as they say because I have never been in the situation before. She does very well with blood tests unfortunately but I refuse to do the liver biopsy. She usually sleeps all day and when my husband comes home from work she wants to play. She doesn't like to play with me as much as she does with him. 

This is my first dog and I love her to pieces. It just seems that after every test things keep getting worse and I don't know what else to do. I'm going to contact that holistic vet and see. I know that no matter what the cost is I will take care of her. And that God blessed us with her for as long as He will allow us to have her because we will do everything we possibly can to care for her. 

My husband and I have both been crying for most of the day today cuz we don't know what else we can do to help her. 
She is literally the most spoiled dog on the face of this planet but she's equally sweet.

















bellaratamaltese said:


> My maltese sleep a LOT. I definitely don't worry about it, esp in the absence of any symptoms!
> 
> I also agree with Carina and others - there is no reason for your vet to keep testing the bile acids. How many sets of bile acid testing has your baby had? Is your vet just doing these or are you asking him to retest over and over?





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## Iubire14 (Nov 5, 2012)

I can't say yes or no to that. I pay for it and insurance reimburses me. But I think they also want to check if the medication is working. 


CloudClan said:


> So your vet keeps repeating the test which tells no new information because they can keep billing the insurance???






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## CloudClan (Jan 31, 2007)

There is no reason for all the bile acid tests. It is not something that should be run over and over again every few months. You are not getting new information, you may be getting new numbers, but they are not telling you anything new. If you do not believe this, please ask at Cornell where Dr. Center developed this test.


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## Iubire14 (Nov 5, 2012)

CloudClan said:


> There is no reason for all the bile acid tests. It is not something that should be run over and over again every few months. You are not getting new information, you may be getting new numbers, but they are not telling you anything new. If you do not believe this, please ask at Cornell where Dr. Center developed this test.




I'm not saying I don't believe it. I even did a protein c test per my request and that came in over 100. So most likely it's not a shunt, and the ultrasound we did can back normal

Like I said this is my first dog and I'm trying to do everything i can to keep her healthy. 
I will contact the holistic vet as well. I'm just wondering are this BAT values very high to the point that I should be worried about liver failure ? It's really stressful because I want to do right by my dog, she's our only baby for now and we give her more attention and more care than other people give their own children. We want her around for as long as possible. 



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## CloudClan (Jan 31, 2007)

I feel like your vet is confusing you. It is pretty simple really. The Bile Acid numbers changing is NOT A CAUSE FOR CONCERN. They are still in the same window that says MVD over and over again. MVD is common in maltese. Most have it. Most do not need any intervention at all to live a totally normal life with the condition. But, if she has symptoms related to MVD she can be on a special diet as others have mentioned in both of your threads. Other than the numbers (which are not changing her diagnosis) I am not sure what new symptoms your dog has that have you so concerned. The numbers will vary like this. It is normal. Running the test over and over again is not telling you she is getting sicker. Those are typical changes. There is nothing in those numbers that indicate liver failure. Your vet saying that the numbers changing might mean liver failure at some point in the future is frankly bizarre to me. Nothing I have seen from what you have posted indicates that to me.


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## maggieh (Dec 16, 2007)

CloudClan said:


> I feel like your vet is confusing you. It is pretty simple really. The Bile Acid numbers changing is NOT A CAUSE FOR CONCERN. They are still in the same window that says MVD over and over again. MVD is common in maltese. Most have it. Most do not need any intervention at all to live a totally normal life with the condition. But, if she has symptoms related to MVD she can be on a special diet as others have mentioned in both of your threads. Other than the numbers (which are not changing her diagnosis) I am not sure what new symptoms your dog has that have you so concerned. The numbers will vary like this. It is normal. Running the test over and over again is not telling you she is getting sicker. Those are typical changes. There is nothing in those numbers that indicate liver failure. Your vet saying that the numbers changing might mean liver failure at some point in the future is frankly bizarre to me. Nothing I have seen from what you have posted indicates that to me.


Carina is absolutely correct. At this point, there is no shunt, and you have every reason to believe your dog has MVD. What you need now is a vet who will work with you to manage it through diet and supplements. If you're reluctant to work with Dr. Royal (not sure what reviews you saw - the ones I saw were glowing) who has been referred to as "an internationally-renowned pioneer in integrative veterinary medicine" then please contact Cornell and get their advice on a diet that is appropriate for an MVD dog. And, MVD dogs do not end up with liver failure. Knowledgeable vets will tell you that an MVD dog that is properly managed can and will live a normal life span. 

It sounds as if your vet doesn't fully understand MVD in toy breeds; please listen to the advice provided here and find someone to help you with a diet and supplement routine that will help your pup.

And as for dogs sleeping all day and wanting to play when daddy gets home, that is perfectly normal. Maltese don't eat a lot either - each of my dogs gets 1/8 cup of food twice a day. That's it - they are toy breeds and don't need a lot of food to stay healthy.


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## aprilb (Jul 9, 2010)

Carina(Cloud Clan) and Maggie are right!! Stop subjecting your baby to constant bile acid tests...vets can't know everything about every breed...Dr. Center of Cornell and Dr. Tobias of the University of Tennessee will both tell you abnormal bile acids will always be abnormal...they go up and down all the time...Carina has at least 20 years of experience with Maltese, I have 17 years of experience, as do quite a few of us on SM..we don't claim to be vets, but we do know our breed very well and the health problems they are prone to..the average vet will not have extensive knowledge of every health condition. In these situations, I have always relied on a specialist who then advises my regular vet...


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## Iubire14 (Nov 5, 2012)

Thank you everyone so much for all of this advice. I will call Dr royal for an appt 


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## Iubire14 (Nov 5, 2012)

Made an appt to see dr royal on the 3oth. 


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## maggieh (Dec 16, 2007)

Good luck with the appointment! Let us know what she says.


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## pammy4501 (Aug 8, 2007)

Agreeing strongly with the gals here. And going forward, is there a possibility that you might find a vet that is a small breed specialist? They are out there. You might call around your area and talk to a few different vets and ask about their expereince with toy breed dogs. You will not have to go through all of this if you find the right vet.


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## Chardy (Oct 30, 2008)

pammy4501 said:


> Agreeing strongly with the gals here. And going forward, is there a possibility that you might find a vet that is a small breed specialist? They are out there. You might call around your area and talk to a few different vets and ask about their expereince with toy breed dogs. You will not have to go through all of this if you find the right vet.


Pam, On that note... I have found one and it really makes a difference. The difference I have found, is she weighs the pro's and con's of doing something that is text book vs what may be in best interest for the small dog. She also is a newly graduate of Cornell (within 5 years)- She said to me today, (Bimmer had some baby teeth pulled earlier this am) that a maltese can test higher on a BAT and absolutely have nothing wrong, and most are heathy asymptomatic their entire life. I asked is that MVD then? She said if you want to call it that, She said I have seen so many maltese have above normal BAT's with absolutely nothing ever wrong. So is that asymptomatic or just a Maltese? She also said you can do that same test 100 different times and the result is going to be different each time. The main thing to watch is liver enz and how well the dog is doing and thriving. 

This isn't the thread for everything else we discussed, but I was quite impressed with her knowledge and she was not being forceful with vaccine protocols for my two. She said they are making strides in research where some of these vaccines can attack gene mutations that are weak in small breed. 

:thumbsup:


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## Iubire14 (Nov 5, 2012)

So... We went to Dr Royal and she recommended increasing the amount of protein she gets. She also put her on SAT( milk thistle, artichoke, and turmeric) as well as a b-complex liquid with dandelion root, and probiotic. She still has to take the denamarin and ursodial So now I am giving her 5 meds a day and she wants to retest her bile acids in 3 months. She basically said that she needs more protein because she's not a fan of balanceit diets as well as the fact that her condition will eventually lead to liver failure  

It breaks my heart. It seems that it is a big issue. Although her liver enzymes are high but within normal limits her BAT values keep rising. 
I don't even know what to believe anymore

The only difference in behavior since we've been giving her this new medication is that she has been "digging" more often ( scratching her bed and the couch with her paws either standing up or laying down, but she's done that since she was little. )



















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## Iubire14 (Nov 5, 2012)

Do you think that if I email dr center with all of Sugarplums past tests she would answer me or does she only correspond with vets ?


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## Chardy (Oct 30, 2008)

Sharon A. Center, DVM

I would call and ask what the protocol is to get a consult. 

The good news is that her liver enz are still in the normal range. High quality human grade proteins (i.e.: grass fed, antibiotic and hormone free) are a good choice for dogs with liver disease. I am not sure what diet you are feeding but I would consult with a nutritionist that can specialize in a good liver diet. You can feed a diet for a couple months without essential vitamins added (cannot for a puppy) and only balance the calcium and phos. ratio for that time and see if the liver numbers change. 

As far as the "Digging" that is very normal. Also, once you have a BAT done that is a base line... and each time you do it, it is going to go up and down. I would consult with Dr Center and in the interim enjoy her.. Sounds like she is doing really well and the supplements are really helping.


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## CloudClan (Jan 31, 2007)

Iubire14 said:


> So... We went to Dr Royal and she recommended increasing the amount of protein she gets. She also put her on SAT( milk thistle, artichoke, and turmeric) as well as a b-complex liquid with dandelion root, and probiotic. She still has to take the denamarin and ursodial So now I am giving her 5 meds a day and she wants to retest her bile acids in 3 months. She basically said that she needs more protein because she's not a fan of balanceit diets as well as the fact that her condition will eventually lead to liver failure
> 
> It breaks my heart. It seems that it is a big issue. Although her liver enzymes are high but within normal limits her BAT values keep rising.
> I don't even know what to believe anymore
> ...


I just do not get it. What is with retesting the Bile Acids? This is not part of the protocol or purpose of that test. And if her ALTs are in the range, her behavior is normal (other than a digging thing that is also likely normal) what is with the concern about Bile Acids which will stay abnormal for her life, but do not indicate a shunt. 

I also again do not get why they say this will lead to liver failure. Most MVD dogs live normal healthy lives without ongoing complications. 

If you can get a consult with Dr. Center, it seems worth the effort at this point.


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## sherry (Jan 4, 2013)

My Riley has MVD. He had one bile acid test and his numbers were much higher than anything you are showing. His protein c test came back in the normal range. We put him on RC Hepatic food, four small meals a day. I put lactulose on all meals. First thing in the morning I give him Denamarin. Thirty minutes after meals I give him a liquid antibiotic. He is doing great! I see no need to retest him. When I visited a surgeon he informed me Riley would eventually die of liver failure. I don't believe this to be the case. Many doctors do not understand MVD as I have found out firsthand. I think you are being misled by your vet who probably doesn't know any better. My vet called Dr. Center and has learned from our experience.


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## maggieh (Dec 16, 2007)

I'm glad you got Dr. Royal's opinion. High quality protein is important - with a liver problem you don't want her system to be trying to digest a lot of questionable ingredients. What did she recommend you feed her?

The supplements she recommended are all good liver support. Don't worry about how many - Tessa gets five daily and five days a month I add milk thistle just for a little liver support since she had elevated enzymes.

A consult with Dr. Center sounds like a good idea, and remember that your little one is young and may have a number of years ahead with good maintenance and care!


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## aprilb (Jul 9, 2010)

CloudClan said:


> I just do not get it. What is with retesting the Bile Acids? This is not part of the protocol or purpose of that test. And if her ALTs are in the range, her behavior is normal (other than a digging thing that is also likely normal) what is with the concern about Bile Acids which will stay abnormal for her life, but do not indicate a shunt.
> 
> I also again do not get why they say this will lead to liver failure. Most MVD dogs live normal healthy lives without ongoing complications.
> 
> If you can get a consult with Dr. Center, it seems worth the effort at this point.


I absolutely agree..you need a consult...


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## Iubire14 (Nov 5, 2012)

Do they do consults over the phone? And she recommended giving her more protein so I am adding natural beef and lamb that I baked in the oven on top of her food. She isn't really eating that much, I don't think she likes the liquid b complex 


She was also totally against giving her any sort of kibble because she says that they are high in carcinogens. 

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## wkomorow (Aug 26, 2011)

I am not sure they consult over the phone, typically they work through a local vet or want to see the dog; it is worth a try though. Lucky has a liver shunt and not MVD, so I do not know about MVD. Bile acids vary with time and their ups and downs really do not tell you much; enzyme levels are more important to test - ALT ALP, BUN is also important. My understanding is if the liver is normal size and there are no symptoms, it is more important to be vigilant than to alter things to much. You need to becareful with anesthetics, vaccines, and medications since the liver may not be able to process these as well. Luck did recently have a reaction to the rabies vaccine.'

Cornell has a strong nutritional department and they have worked with a large number of dogs with liver issues. They will do a phone consult and I think it would be especially worth it to consult with them particularly if you are home cooking. For example, I am not certain it is best to increase red meat as a way to increase protein for a dog with liver issues. Typically fish and chicken are more highly recommended.

In terms of kibble, Dr. Center recommended that I include kibble with each meal because it has balanced nutrition, especially for dogs with liver issues. But I am not certain that a modified diet is needed for a dog simply with elevated BA.


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## Iubire14 (Nov 5, 2012)

Since putting her on all the meds from dr royal and my regular vet Sugarplum hasn't really been eating. Yesterday I didn't give her any medicine and she ate more than any other day she has in a while. Could it be that the meds just make her nauseous and she doesn't want to eat?


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## maggieh (Dec 16, 2007)

Iubire14 said:


> Since putting her on all the meds from dr royal and my regular vet Sugarplum hasn't really been eating. Yesterday I didn't give her any medicine and she ate more than any other day she has in a while. Could it be that the meds just make her nauseous and she doesn't want to eat?


A lot of small dogs have problems with denamarin although your vet will tell you otherwise. I wound up calling the manufacturer because denamarin was the only thing that had changed. Sure enough they have nausea as a possible adverse reaction particularly in small dogs. So yes the meds could be causing nausea. I'm not familiar with the ursodial but side effects include vomiting so my guess is it would also cause nausea.

I would suggest asking both vets what they think, keeping in mind your traditional vet may not be as aware of side effects as they could be.


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## Iubire14 (Nov 5, 2012)

I'm gonna call her specialist tomorrow and set up an appt and see if he thinks it would be ok to keep her off meds for a few weeks and retest because I don't want to dope her on meds if it isn't helping. She's miserable taking them and I'm miserable giving them to her


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## maggieh (Dec 16, 2007)

Iubire14 said:


> I'm gonna call her specialist tomorrow and set up an appt and see if he thinks it would be ok to keep her off meds for a few weeks and retest because I don't want to dope her on meds if it isn't helping. She's miserable taking them and I'm miserable giving them to her


If your specialist insists the meds won't make her nauseous, the manufacturer of denamarin can tell him otherwise - they track adverse reactions.


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## Chardy (Oct 30, 2008)

If it's any comfort my last dog Chardy did not do well with denamarin... her story was heart disease and the liver gets drawn to the situation in the end.. she stopped eating when I gave her the med and when I stopped the med she was back to herself with appetite. My vet warned me this could be a problem and it was.

Quality protein in the big KEY to a dog with MVD issues... I would try not using any commercial kibble and home cook for a month. Don't worry about balancing any vitamins during this time except maybe making sure there is enough calcium to balance out the phos. That is simple to do- Try a diet with organic hormone antibiotic free chicken and maybe add a carb to it like organic sweet pot's just as a trial for one month. Do a tad more protein then carb to start. If the dog was say 7 pounds you could do 3 ounces of protein and 1/2 cup sweet pots and feed this total amount for one day in two separate meals. I would also try getting "ANSWERS" goat milk and feed an ounce a day for the same month. Then go do some blood work.. not BAT but just some liver numbers... You will be doing the happy dance... 

I would also consider maybe trying commercial raw slowly. But you have to make sure it is Stella and Primal (two that I am mentioning) because they use hormone and antibiotic free protein. Stay away from the red meat to start. There is no waste in raw food for the liver to deal with-- nothing is processed-


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## Iubire14 (Nov 5, 2012)

I've been giving her denamarin in the morning. I'm waiting for a call back from the specialist. Maybe i should give it to her at night.


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## maggieh (Dec 16, 2007)

You're already giving milk thistle which is one of the ingredients in denamarin. If it's making her sick I would try a few days without the denamarin and see if it makes a difference.


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## Iubire14 (Nov 5, 2012)

Spoke to the specialist and he said that it would be ok not to give her meds for a week and then go in and test her liver values. He said he may also want to do an ultrasound to see if anything has changed in the last year. I would love if one of her vets would be ok with calling dr center but I wouldn't want them to get upset and make them feel like I don't trust their judgement.


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## maggieh (Dec 16, 2007)

Iubire14 said:


> Spoke to the specialist and he said that it would be ok not to give her meds for a week and then go in and test her liver values. He said he may also want to do an ultrasound to see if anything has changed in the last year. I would love if one of her vets would be ok with calling dr center but I wouldn't want them to get upset and make them feel like I don't trust their judgement.


Who is your specialist? 

I have stopped worrying about offending vets and doctors with requests for second opinions. This is my dog and I want what's best for her. If they seem to be stumped or if what they are telling me doesn't make sense I do not hesitate to very politely ask if we can't try another option.


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## wkomorow (Aug 26, 2011)

You can pay for a consultation vet to vet with Cornell. My vet did not want to do that but strongly recommended that I bring Luck to Tufts. I was not totally satisfied with what Tufts recommended, so my vet thought it important for me to take Luck to Cornell. I know the vet at Tufts and our vet had followup conversations. My vet has been following Cornell's protocols. Don't forget this is all about your little one and not about vet's feelings. If the vet does not see it that way, then maybe its time to find a vet who will.


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## Iubire14 (Nov 5, 2012)

What is a vet to vet consultation? 
After 5 days of no meds Sugar seems soooo much happier ! I hate to give them to her. When her specialist said no meds for a week and then test her blood, I don't think like that's enough time to see if anything changes, but then again I'm not a vet.


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## wkomorow (Aug 26, 2011)

Your vet will send the info to Cornell, and they will arrange for a telephone call to discuss with the vet to discuss the case. They can provide him/her guidance for the vet for treatment. I probably should now but what part of the country do you live. There are liver experts - though Center is best of the experts. 

What are your primary concerns?

What are your vets concerns?

If it is MVD, there is no cure and most dogs are simply managed for symptoms. Bile Acids fluctuations are not significant in MVD.

https://secure.vet.cornell.edu/consult/


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## Iubire14 (Nov 5, 2012)

Got Sugars liver panel results after 10 days no meds and it looks good  I will continue the natural meds and ursodiol. 

This picture is the ones from June. So there isn't much change and everything is within normal limits. Sooo happy. 









On a side note I asked the specialist if he has ever heard of dr center and he had no idea... Wish there were better doctors here. 

Here are some pics that I took from researching MVD in case it might help anyone.


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## Iubire14 (Nov 5, 2012)

Update on sugarplum;

Last bile acid tests weren't that great but her liver values weren't bad. 
Since we have stopped the denamarin she hasn't thrown up once, which is great. 
appetite is still poor ( except for carrots, lettuce, and blueberries)
We started giving her freeze dried beef liver and lamb lung again, which she loves. 




Went back to see Dr Royal today and she recommends feeding Sugarplum darwin's intelligent design raw dog food LS (white fish and potato diet) that Dr Royal herself has formulated. Has anyone used Darwins raw dog food ? I am not comfortable with raw, and she said that I could sear the food. 
I just feel like she is prescribing a lot of supplements and it can be overwhelming

Right now we are giving :
- ursodiol
- SAT by thorne ( which has milk thistle, artichoke heart, and tumeric)
- aminobcomplex with dandelion root
- probiotics 
- balance it vitamins in conjunction with standard process. 
And now is recommending fish oil and Sam-e 


This is just so much medicine for a 6 lb dog.


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## aksm4 (Nov 28, 2011)

Hello ,

My Becky had surgery for her liver shunt but her biles are still high 41 post probable mvd she is on royal canin hepatic wet food and lactulose I dont see you give her lactulose very important , she also gets metronidazole 2 times daily , she is doing great , the denamarin made Becky sick also .... so we dont give it anymore....


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## Iubire14 (Nov 5, 2012)

GREAT NEWS!

Our wonderful vet based in Chicago has actually been emailing dr center about sugarplum and this is what dr center said 

" I am happy to help folks that have a confirmed diagnosis- what I see here is data from a Maltese dog with high bile acids, a protein C in the normal reference range and no biopsy. Maltese are commonly affected with the PSVA/MVD trait (portosystemic shunt/microvascular dysplasia trait) with far more having MVD. If these dogs concurrently have inflammatory bowel disease they can develop a progressive hepatopathy associated with increases in ALT. If this dog has increased bile acids due to MVD and no substantial liver injury then I do not treat with ursodiol as the reason the bile acids are high is the microscopic vascular malformation rather than liver injury. 
If MVD is the suspected diagnosis it is important to recall that this disorder does not cause clinicopathologic abnormalities other than increased serum bile acids, does not shorten lifespan, does not cause ammonium biurate crystalluria or uroliths, and does not cause hepatic encephalopathy. Thus, MVD does not require dietary modification to a protein restricted diet or administration of lactulose or low dose metronidazole or neomycin. The only concern is to restrict dosage of drugs given orally that have high first pass hepatic extraction as these will have a greater effect in an MVD dog.

I will not speculate on additional treatments without a biopsy. Note: MVD and PSVA are not usually differentiated based on biopsy- that takes imaging and a simple YES / NO with colorectal scintigraphy. Antioxidants are usually indicated if there is long term liver enzyme increases esp. ALT.
Other treatments for dogs with the Maltese acquired hepatitis that I discussed at the ACVIM a couple of years ago are used when the lesion is specified by biopsy not "suspected". If biopsies are ever procured- make sure to also sample the intestines. If the dog is biopsied and you wish to have me help, please submit the samples to Cornell so I can directly inspect them."

Sharon Center


As stated before her bile acids are elevated but her liver enzymes are within normal range 

We can stop the ursodiol )))

We have started her on a frozen raw ( which I still cook) food by dr Barbara royal for liver issues which consists of fish and tripe

We are mixing that in with her balanceit food and she's actually eating. We are also giving her half a capsule of SAT by thorne research daily and a probiotic. she is thriving

Thank you so much for everyone that posted on this thread and for all of your support. Thank you from the bottom of my heart. 💛💛💛


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## maggieh (Dec 16, 2007)

Good news! Out of curiosity, was this your specialist or Dr. Royal?


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## sherry (Jan 4, 2013)

This sounds great! My boy has MVD but we have not seen a specialist. He is on lactulose and neomycin as well as a liver supplement! And Royal Canin hepatic food. So if this is correct, he can live normally! I will contact my vet!


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## Iubire14 (Nov 5, 2012)

This is her primary vet not dr Royal and not her specialist either. Dr Royal never heard of dr center.


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## Iubire14 (Nov 5, 2012)

sugarplum has had her first normal pre and post bile acids in three years !!!! 
We are beyond happy!
She has been on Thorne Research S.A.T. for the last year and since starting that we haven't had to give her denamarin anymore. No puking in over 6 months !!!


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## Iubire14 (Nov 5, 2012)

So in June of this year pre was 1.9 post was 8.4. In March of 15 pre was 2.1 post was 21.5. And in November of 2014 pre was 3.5 and post was 107.4. That is a dramatic difference and now she has been eating normally and just loving life!


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