# Looking for help. Sick maltese boy



## summer (Dec 3, 2010)

This is my first post here. I joined because I am looking for help to help my sick maltese. He is ten years old. He started acting very odd a short while ago. I took him straight to the vet. The vet told me his symptoms sounded like it could be his liver, thyroid or kidneys. They ran a complete blood count, including full thyroid panel and urine test. It all came back normal except the alkaline phosphate. The vet told me eventhough the alk phos is high its not that high. He told me sometimes alk phos being high can be cushings, but since my dog's is not that high and he doesnt have symptoms of cushings its not that. He told me to monitor him, which I have been doing. He said it could be a behavioral issue. I am sure its not and that there is something wrong with him causing him to act odd. He will be fine and then all of the sudden he will walk back and forth and back and forth. He does this over and over. I get down and talk to him. I'm pretty sure he hears me. Sometimes I will offer him a treat. He most of the time will eat the treat and then he starts the pacing again. He sometimes goes to places in the house he never has gone before and looks very confused. Then all of the sudden he will act normal again. He will be his old self for a long time, then start acting weird again. I know eventhough his tests look good something is not right. Yesterday, I took him to a different vet. She asked me if he was ever tested for a liver shunt. He hasnt been. I dont know much about that. She said his tests dont look like its that, but sometimes bloodwork can fool. She said that considering his breed he should be tested for mvd/liver shunt. She told me its called a bile acid test. She told me to come back and make sure he has fasted for 12 hours before the test. I came home and read about liver shunts. It all looks confusing to me. From what I read on the forum it looks like the bile acid test is used to confirm liver shunts in puppies? What about old dogs? Is that the right test? Also, can a ten year old dog all of the sudden have a liver shunt? He doesnt have diarhea or vomiting. He loves to eat. So far all of his syptoms seem nuerological. Also, I read that most of the time the alt in the blood work is high. My dog's is normal. Please forgive me for asking so many questions. We are just looking for answers so we can get our baby the right tests to get him the help he needs. I also want to add he seems very noise sensitive. Any advice would be appreciated.


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## harrysmom (Sep 28, 2007)

I'm sorry to hear about your baby's illness. There are many on this forum who are much more knowledgeable about medical issues than I am, however, I had a german shepherd with cushing's and his symptoms started out very similar to the behavior that you're describing in your dog. He got confused and paced and acted strange. He also developed that behavior at about 10 or 11 years of age.

Sometimes it takes so long to come to a definitive diagnosis, even with all of the tests that are available today. I know how hard it is to live with a sick baby and not be able to offer help because you're not sure what's going on. I hope that you find the answers soon. Please keep us posted.

Debbie


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## Cosy (Feb 9, 2006)

Yes, he could have a shunt that didn't show symptoms until now. It could also be an acquired shunt although they are usually manifest by six or seven years. It won't hurt to do a BA. If it's off then scintigraphy may be in order. 
He didn't perhaps have a fall from the sofa, chair, etc., lately, did he? You've ruled out a head injury?


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## revakb2 (Sep 8, 2006)

I am no help at all with the medical problems, but you know your dog best, and if you feel something is wrong, it is. There are many very knowledgeable people on this forum, and hopefully someone will be able to help you understand your pups systems better. I have found more information on Maltese on this forum than at the vets. I am sorry you had to join us with a problem, but many of us joined for the same reason and have found help and support here.


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

You might want to read these 2 threads about Liver Shunts and Bile Acid Tests.

http://spoiledmaltese.com/forum/52-...106856-liver-shunt-bile-acid-test-thread.html

http://spoiledmaltese.com/forum/52-maltese-health-behavior/78171-bile-acid-test.html

Prayers being send for your fluff.


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## njdrake (Apr 23, 2007)

I'm not much help but I wanted to add the same as Reva. You know your dog better than anyone and if you think something's wrong then I'm sure it is. I know if one of my dogs are having an off day, I just know. I hope you get the answers you're looking for and you find help for your pup. Please keep us posted on how he's doing.
Hugs and prayers.


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## princessre (Dec 23, 2008)

I'm sorry about your dog not feeling well. Perhaps you could get a second opinion if your vet cannot figure it out. I'm sure you are correct that something is off. Please let us know what you find out. Hugs and prayers.


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## Furbaby's Mommie (Jul 10, 2004)

10 is not old for a Maltese. "Senior" maybe but not old. I hope you do stick with the Dr. who wants the bile acid test. She will probably have other good ideas if the bile acids are normal. Ask her about neurological deceases, like GME. Or it could be that your baby is having pain from something and that is why he acts funny off and on.

Will be thinking about you while they test and try to help him. Mommies know when things aren't right.:wub:


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## summer (Dec 3, 2010)

harrysmom said:


> I'm sorry to hear about your baby's illness. There are many on this forum who are much more knowledgeable about medical issues than I am, however, I had a german shepherd with cushing's and his symptoms started out very similar to the behavior that you're describing in your dog. He got confused and paced and acted strange. He also developed that behavior at about 10 or 11 years of age.
> 
> Sometimes it takes so long to come to a definitive diagnosis, even with all of the tests that are available today. I know how hard it is to live with a sick baby and not be able to offer help because you're not sure what's going on. I hope that you find the answers soon. Please keep us posted.
> 
> Debbie


Thank you for the response. That is very interesting about cushings. I am going to ask the vet about cushings again. It really is so hard. Everytime he starts with the pacing and the other odd behavior I feel completely crushed inside.


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## summer (Dec 3, 2010)

Cosy said:


> Yes, he could have a shunt that didn't show symptoms until now. It could also be an acquired shunt although they are usually manifest by six or seven years. It won't hurt to do a BA. If it's off then scintigraphy may be in order.
> He didn't perhaps have a fall from the sofa, chair, etc., lately, did he? You've ruled out a head injury?


No, he didn't have a fall. He really isn't a jumper. I will call the vet and make an appointment for the bile acid test. I just wanted to make sure as I read a thread earlier and I thought it said that only will diagnose a young dog. Thank you for the response.


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## summer (Dec 3, 2010)

Furbaby's Mommie said:


> 10 is not old for a Maltese. "Senior" maybe but not old. I hope you do stick with the Dr. who wants the bile acid test. She will probably have other good ideas if the bile acids are normal. Ask her about neurological deceases, like GME. Or it could be that your baby is having pain from something and that is why he acts funny off and on.
> 
> Will be thinking about you while they test and try to help him. Mommies know when things aren't right.:wub:


oh yes, I didn't really mean old. Just older than what I thought was the typical age for a dog to be first having signs of a possible liver shunt. Thank you for the information.


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## summer (Dec 3, 2010)

Thank you to all the posters who have responded. This has been so hard for us, but we are determined to find answers. I'm glad to know that you understand what I am saying about knowing that something isnt right physically.


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## Green444 (Jul 2, 2010)

Please check your dog's sight. I know of a dog who began to act like this when she lost her sight. She would often pace, and she was super sensitive to sounds.


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## jmm (Nov 23, 2004)

In an older dog bile acid elevation can be from any number of liver diseases. Yes dogs can be diagnosed with shunts at that age, but other disease processes are also high up on the list.


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## summer (Dec 3, 2010)

Green444 said:


> Please check your dog's sight. I know of a dog who began to act like this when she lost her sight. She would often pace, and she was super sensitive to sounds.


That is very interesting you mention that as one day I thought he could not see good. I took him right to the vet and the vet looked in his eyes and told me he could see fine. Honestly though I keep wondering if maybe sometimes he can't see as good as other times. Do you know if there are eye doctors for dogs that maybe do a more detailed eye exam than a regular vet?


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## summer (Dec 3, 2010)

jmm said:


> In an older dog bile acid elevation can be from any number of liver diseases. Yes dogs can be diagnosed with shunts at that age, but other disease processes are also high up on the list.


Ok, yes thats what I thought I read. Do you know if a dogs liver enzymes on a regular blood test would be in normal range if the dog had any of those other liver diseases?


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## jmm (Nov 23, 2004)

It really depends on the type of disease process. I had a dog that would be in liver failure with values that weren't very high. I've also seen plenty of senior dogs with high liver enzymes and no outward problems. When it comes down to liver disease in the long-term, you often end up treating based on clinical signs instead of labwork. 
Have you been offered a referral to a specialist for an ultrasound? 
I would hesitate to rule out Cushing's. Dogs can get SARDs (blindness) secondary to it. I've seen all sorts of pacing/panting/odd behavior with it.


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## mss (Mar 1, 2006)

I had a little dog that had liver failure and they were never sure what had caused it. She was at least 12 years old. She had other symptoms, such as lack of appetite and significant weight loss, besides some personality and behavior changes..

The highly trained specialists at the vet school tested her eyesight by putting a box on the floor of the exam room to see if she could find her way around it. She did.


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

Yes - there are vets that specialist in Opthamology.


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## Snowbody (Jan 3, 2009)

Just wanted to wish you the best and thank you for being so concerned about your Maltese. My Tyler just had the BAT done a few weeks ago. You have them fast, then they take a blood sample and then feed and take another. It takes about 2 hours and I left Tyler there and picked him up 2 hours later. And yes there are dog ophthalmologists. Also where do you live? A lot of members here know a lot of excellent vets, specialists and medical schools. That might help. I'm sending prayers to you that you find out what's wrong. Happy you found us.


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## vjw (Dec 20, 2006)

I'm so very sorry about these symptoms your maltese is experiencing. These could be caused from a number of diseases/conditions. Because of your malt's age, one of the first conditions which came to my mind was perhaps "canine cognitive dysfunction syndrome"??.

Here's a link to an article on canine cognitive dysfunction syndrome:

Cognitive Dysfunction & Senility in Dogs



Joy


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## mss (Mar 1, 2006)

"Senile" and "senility" just means old, it doesn't mean demented. I'm skeptical that "canine cognitive dysfunction syndrome" might just be a diagnosis to support the sale of a drug which turned out not to be helpful for Cushings. One of my dogs was on that years ago--expensive and didn't seem to do anything for her.  

Anyway, I hope your vets can come up with a firmer diagnosis for your dog, and a treatment plan. {{{{}}}}


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## vjw (Dec 20, 2006)

mss said:


> "Senile" and "senility" just means old, it doesn't mean demented. I'm skeptical that "canine cognitive dysfunction syndrome" might just be a diagnosis to support the sale of a drug which turned out not to be helpful for Cushings. One of my dogs was on that years ago--expensive and didn't seem to do anything for her.
> 
> Anyway, I hope your vets can come up with a firmer diagnosis for your dog, and a treatment plan. {{{{}}}}


 
:blink:

I've been through canine cognitive dysfunction with a senior dog and it was a heartbreaking experience. Max was blind, deaf, and had kidney failure, and we worked through some difficulties with these, but the Vet. and I had to make the decision to put him down because of his cognitive decline.


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## maltlovereileen (Jan 19, 2009)

I don't have any suggestions or answers...just wanted to offer my moral support and best wishes that you can find a good answer to what's going on! Keeping you in prayers and positive thoughts...


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## allheart (Oct 3, 2008)

I too, don't have any answers, but like the others have said, you know your baby, and you know when something just isn't right. Good for you. Sending good thoughts and hoping the best for you and your baby.


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## mss (Mar 1, 2006)

vjw said:


> :blink:
> 
> I've been through canine cognitive dysfunction with a senior dog and it was a heartbreaking experience. Max was blind, deaf, and had kidney failure, and we worked through some difficulties with these, but the Vet. and I had to make the decision to put him down because of his cognitive decline.


I'm so sorry about your Max. It is heartbreaking to see our senior canine friends having such problems. I am just awkwardly trying to question canine cognitive dysfunction as a diagnosable, treatable illness. There are so many distinct health problems that that can cause changes in behavior and that have different treatments. The FDA has said that cognitive dysfunction syndrome is a diagnosis of exclusion. That is, exclude other diagnoses before making a diagnosis of CDS:



> The diagnosis of CDS in dogs is a diagnosis of exclusion, based on thorough behavioral and medical histories, in conjunction with appropriate testing and diagnosis. Periodic patient monitoring to evaluate the response and tolerance to the drug and for the presence of concurrent or emergent disease is recommended.


CVM APPROVES FIRST BEHAVIORAL DRUGS FOR DOGS


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## dwerten (Oct 6, 2007)

summer said:


> This is my first post here. I joined because I am looking for help to help my sick maltese. He is ten years old. He started acting very odd a short while ago. I took him straight to the vet. The vet told me his symptoms sounded like it could be his liver, thyroid or kidneys. They ran a complete blood count, including full thyroid panel and urine test. It all came back normal except the alkaline phosphate. The vet told me eventhough the alk phos is high its not that high. He told me sometimes alk phos being high can be cushings, but since my dog's is not that high and he doesnt have symptoms of cushings its not that. He told me to monitor him, which I have been doing. He said it could be a behavioral issue. I am sure its not and that there is something wrong with him causing him to act odd. He will be fine and then all of the sudden he will walk back and forth and back and forth. He does this over and over. I get down and talk to him. I'm pretty sure he hears me. Sometimes I will offer him a treat. He most of the time will eat the treat and then he starts the pacing again. He sometimes goes to places in the house he never has gone before and looks very confused. Then all of the sudden he will act normal again. He will be his old self for a long time, then start acting weird again. I know eventhough his tests look good something is not right. Yesterday, I took him to a different vet. She asked me if he was ever tested for a liver shunt. He hasnt been. I dont know much about that. She said his tests dont look like its that, but sometimes bloodwork can fool. She said that considering his breed he should be tested for mvd/liver shunt. She told me its called a bile acid test. She told me to come back and make sure he has fasted for 12 hours before the test. I came home and read about liver shunts. It all looks confusing to me. From what I read on the forum it looks like the bile acid test is used to confirm liver shunts in puppies? What about old dogs? Is that the right test? Also, can a ten year old dog all of the sudden have a liver shunt? He doesnt have diarhea or vomiting. He loves to eat. So far all of his syptoms seem nuerological. Also, I read that most of the time the alt in the blood work is high. My dog's is normal. Please forgive me for asking so many questions. We are just looking for answers so we can get our baby the right tests to get him the help he needs. I also want to add he seems very noise sensitive. Any advice would be appreciated.


10 years old to be liver shunt would be rare unless acquired shunting. 

If there were no crystals in urine and blood work was good I would have to doubt this is it at that age. 

The best advice i can say is you know your dog better than anyone and if your gut is telling you something is not right TRUST IT and if vet cannot figure it out get to a specialty hospital where there are neurologist, orthopedic and internal medicine specialists.

Cushings is a hard one to detect as well and due to age I would bet on this before liver shunt from what I know about liver shunt.

some signs of cushings 

excessive thirst
excessive urination
pot belly 
loss of hair
excessive hunger

here is some info on cushings to read 

http://www.petplace.com/dogs/hyperadrenocorticism-cushing-s-syndrome-in-dogs/page1.aspx

just wanted to point this out from above link 

*The biochemical profile is a useful diagnostic test, because the majority of dogs with Cushing's syndrome have an abnormally high concentration of alkaline phosphatase*. *The enzyme alkaline phosphatase is produced in the liver in response to stimulation by cortisone or as a consequence of primary liver disease. An abnormally high concentration of alkaline phosphatase is one of the most consistent abnormalities found in dogs with Cushing's syndrome.* Other biochemical abnormalities may include mild increases in other (e.g. alanine aminotransferase), mildly increased blood glucose concentration, and high blood concentration.

The urinalysis also may provide clues to the presence of Cushing's syndrome. Due to the presence of increased water consumption and increased urination, dilute urine often is observed in dogs with Cushing's syndrome. Urine concentration is assessed by a test that measures urine specific gravity that compares the concentration of urine to. Dilute urine is found in approximately 85 percent of dogs with hyperadrenocorticism. Unfortunately, many other diseases also result in dilute urine. Occasionally, protein is present in the urine. Urinary tract infections are common in dogs with Cushing's syndrome, and urine culture should be performed as part of the clinical assessment.

I know someone with a dog with cushings and she she said after blood work that this is the next test that is not too invasive to see if cushings is a possibility 

The urine cortisol-to-creatinine ratio can be used as a screening tool
in the evaluation of dogs suspected to have Cushing's syndrome. A negative result strongly suggests that a dog does not have Cushing's syndrome, but a positive test result does not necessarily mean
that a dog does have Cushing's disease. False-positive results occur because the stress of non-adrenal illnesses can lead to an abnormal cortisol-to-creatinine ratio. Regardless, the urine cortisol-to-creatinine ratio is a useful and easy screening test because it only requires a single morning urine sample.


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## dwerten (Oct 6, 2007)

summer said:


> Thank you for the response. That is very interesting about cushings. I am going to ask the vet about cushings again. It really is so hard. Everytime he starts with the pacing and the other odd behavior I feel completely crushed inside.


the pacing and odd behavior to me could be a sign of pain or disorientation


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## dwerten (Oct 6, 2007)

Green444 said:


> Please check your dog's sight. I know of a dog who began to act like this when she lost her sight. She would often pace, and she was super sensitive to sounds.


yep was thinking this as well due to age


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## dwerten (Oct 6, 2007)

summer said:


> That is very interesting you mention that as one day I thought he could not see good. I took him right to the vet and the vet looked in his eyes and told me he could see fine. Honestly though I keep wondering if maybe sometimes he can't see as good as other times. Do you know if there are eye doctors for dogs that maybe do a more detailed eye exam than a regular vet?


yes there are opthamologists who have better equipment for eyes than some vets so worth investigating

http://www.acvo.com/

http://www.eyevet.com/pethealth.htm

the hardest part is the diagnostics as it can be so many things and narrowing it down takes time so hang in there and hoping the best for you and your little one


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## summer (Dec 3, 2010)

Thanks to everyone for the information and the good thoughts.


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## SammieMom (Nov 13, 2010)

I wish I could help, but I am new too. Praying for a quick recovery for your little boy! rayer:rayer:


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