High Alt Levels In Asymptomatic Young Dog

[JulesP]

Amber's bile readings were heaps higher than that: 187 pre 215 post.

Is she a normal size? That is usually a good indication of a shunt. Amber is tiny.

I would be tempted to wait 6 weeks and re-do the tests. Perhaps feed milk thistle and SAMe during that time to help out the liver and reduce load by feeding Hills L/D.

Amber looked like I was trying to kill her at meal times btw. She would pick up one piece of kibble and then spit it out. Some food she was ok with so I just thought she was fussy So the fact your dog is eating happily is a good sign in terms of shunts.

[julesluvscavs]

Jules P, if you haven't already see my update in my liver thread.

[Guest LittleMissOdie]

Amber's bile readings were heaps higher than that: 187 pre 215 post.

Is she a normal size? That is usually a good indication of a shunt. Amber is tiny.

I would be tempted to wait 6 weeks and re-do the tests. Perhaps feed milk thistle and SAMe during that time to help out the liver and reduce load by feeding Hills L/D.

Amber looked like I was trying to kill her at meal times btw. She would pick up one piece of kibble and then spit it out. Some food she was ok with so I just thought she was fussy So the fact your dog is eating happily is a good sign in terms of shunts.

Hi Jules, Odie is currently sitting at 11 kilos and is 10 months old. From what I've read that's an ideal weight for a female Frenchie. She is definitely classified in the "petite" category but has had no problems with putting on weight.

We have tested her before (4 months ago) when this all started, it returned a bile acid "pre" result at 111, but strangely the "post" result dropped back down to the normal range. Very strange.

Her appetite is definitely a good sign since most of the shunt cases I've read about involved a fussy appetite. She is nowhere near fussy and never has been when it comes to food. I actually have to be mindful not to overfeed her, as she gobbles up her meal and then proceeds to follow me around the house, begging for more. I've seen her inhale chewy treats in 4 seconds flat (hence the reason I never give her any type of bone). Her eyes go big and wide if you get her to sit for a treat, she just loves her food. I guess this is the only thing that's keeping me from going into panic mode!

I will definitely look into the milk thistle and SAMe. Just out of curiosity, if her blood results do improve on these supplements, do you know if that would indicate that it is indeed a condition like MVD and not a shunt? Or would a biopsy be the only way to tell

Thanks again you have been very helpful :)

[JulesP]

Her piggy behavior may be why the pre bile reading is high. Apparently even the smell of food can get the bile going!

A biopsy would show HMD but not a shunt. The specialist thinks Amber had HMD which is what caused the shunts. We didn't do a biopsy because the treatment wouldn't have changed.

Dogs with shunts and HMD usually need a fair bit of drug support so if you got improvements with just diet change and supplements I would hope your pup has something less sinister. Sometimes dogs do just have weird readings, one of my dogs had a really low white blood count, she died of old age at 15yo.

[Guest LittleMissOdie]

Hello DOLers, here to pick your brain again. Basically after a number of tests this week, we've come to the following conclusions:

1) due to odie's ALT levels being high (around the 1000 mark) BUT seemingly normal bilirubin, protein, urea, cholesterol, the vet has come to the consensus that a liver biopsy would be the route to take at this point in order to come to a diagnosis.

2) a liver shunt has not been ruled out yet, but as I previously mentioned, her ultrasound 4 months ago did not detect an extrahepatic shunt.

3) a clotting profile has been done, and it came back normal, which means that the risk of putting her through anesthesia/surgery are low (but still present).

My question is, do we go with the specialist for the liver biopsy and spay (to be done at the same time), or stick with the vet for these procedures as he is a qualified surgeon and these are, as I understand, routine procedures. He has also been handling Odie's case with a high level of care since the beginning..

Obviously cost is a factor in all of this, and if push comes to shove we will do whatever it takes to ensure the best care. I just don't know if it's wise going down the specialist route for these procedures, especially if there needs to be further testing down the road that will definitely need to be done via a specialist, we have spent thousands already and more testing would definitely be thousands more. Do not get me wrong, I will sell all my possessions to ensure Odie's well being but I do want to be wise about how we proceed from here.

Can anyone please shed some insight if they've ever had a furbaby undergo a liver biopsy that wasn't the fine point needle kind? Should I be worried about this procedure? What's the recovery time like?

Frankly I'm scared to death the vet has also put her on some medication + a low protein diet leading up to the ops. It will take place 2 weeks from now.

Apologies to keep taking over the forum with my questions. I'm just worried sick for my little girl.

[WoofnHoof]

My boy (husky) had an intrahepatic shunt and my advice would be prioritize the specialist, my local vets had never seen a shunt and on speaking to the specialist he picked up on it straight away even before bloods were done.

I second ML's recommendation of University of Sydney my boy had his op there and even though my surgeon is no longer there they have a great team there.

I went to the specialist for the ultrasound they detected it but weren't 100% sure whether it was inside or outside the liver, he was leaning towards inside and he was correct. The vets at USyd did another ultrasound when he arrived they said it was better than the one he had at the specialist centre in Brisbane I think it might have been a dye one? Anyway that's just to let you know all ultrasounds are not created equal.

Regardless of whether or not you are dealing with a shunt in my experience your best bet is to get straight onto the canine internal medicine specialists they are more experienced in these out of the box type problems.

[zeebie]

Several possibilities for raised ALT in abscence of any clinical evidence of liver abnormality.

If dog had been fasting for several hours prior to procedure (spaying)then dhydration sets in especially in brachy dogs.

Some dogs have raised ALT in relation to use of certain worming products/vitamin mineral supplements/ general food ingredients (some of the speciality diets),even in response to stress which in your dog would have definately been happening in an unfamilair environment and having bloods done.

It would seem that this phenomomen is very common among FB if you look at the net response google french bulldogs and elevated ALT, there are many people with same question for same breed population, so maybe this is just a normal elevation in the breed. If a specific study was to be done they may indeed document it as 'normal for the breed in abscence of disease'

My personal attitude is watch and wait, if dog is developing, healthy, happy and eating without any concerns, no diarrhoea/vomiting etc, then don't interfere. Any organ biospy can be dangerous unless the risk is totally warranted.

[Guest LittleMissOdie]

My boy (husky) had an intrahepatic shunt and my advice would be prioritize the specialist, my local vets had never seen a shunt and on speaking to the specialist he picked up on it straight away even before bloods were done.

I second ML's recommendation of University of Sydney my boy had his op there and even though my surgeon is no longer there they have a great team there.

I went to the specialist for the ultrasound they detected it but weren't 100% sure whether it was inside or outside the liver, he was leaning towards inside and he was correct. The vets at USyd did another ultrasound when he arrived they said it was better than the one he had at the specialist centre in Brisbane I think it might have been a dye one? Anyway that's just to let you know all ultrasounds are not created equal.

Regardless of whether or not you are dealing with a shunt in my experience your best bet is to get straight onto the canine internal medicine specialists they are more experienced in these out of the box type problems.

Thanks Woof, we had a specialist from USyd do her ultrasound and he could not detect anything, our vet has had several specialists on board the case and all of them have recommended a biopsy as the next step.

They are leaning towards MVD at this point, though an intrahepatic shunt has still not been ruled out, just rare in the case of a small dog.

[Guest LittleMissOdie]

Several possibilities for raised ALT in abscence of any clinical evidence of liver abnormality.

If dog had been fasting for several hours prior to procedure (spaying)then dhydration sets in especially in brachy dogs.

Some dogs have raised ALT in relation to use of certain worming products/vitamin mineral supplements/ general food ingredients (some of the speciality diets),even in response to stress which in your dog would have definately been happening in an unfamilair environment and having bloods done.

It would seem that this phenomomen is very common among FB if you look at the net response google french bulldogs and elevated ALT, there are many people with same question for same breed population, so maybe this is just a normal elevation in the breed. If a specific study was to be done they may indeed document it as 'normal for the breed in abscence of disease'

My personal attitude is watch and wait, if dog is developing, healthy, happy and eating without any concerns, no diarrhoea/vomiting etc, then don't interfere. Any organ biospy can be dangerous unless the risk is totally warranted.

Thanks Zeebie, in all other instances I would advocate the "wait and see" approach especially in a dog with no clinical signs, however, her ALT levels have been tested several times now and they are above 1000 and slowly rising (the Frenchie cases I googled mentioned ALT levels below this). According to the specialists and the vet, is definite cause for concern and warrants further investigation, especially because her bile acids are also abnormal. Diet has been ruled out as a factor in this as well.

We ordered a coagulation profile to be done which measures the clotting of the blood, and thankfully this came back normal, which means she is by all accounts fit to undergo surgery.

But I do agree with you, a biopsy is very serious thing. However I would rather her go through it now than wait until we see symptoms, in which case it may be harder to put her through the anesthesia/surgery. These are the hard decisions we have to make as pet owners I suppose, it's a very hard thing

[MalteseLuna]

Several possibilities for raised ALT in abscence of any clinical evidence of liver abnormality.

If dog had been fasting for several hours prior to procedure (spaying)then dhydration sets in especially in brachy dogs.

Some dogs have raised ALT in relation to use of certain worming products/vitamin mineral supplements/ general food ingredients (some of the speciality diets),even in response to stress which in your dog would have definately been happening in an unfamilair environment and having bloods done.

It would seem that this phenomomen is very common among FB if you look at the net response google french bulldogs and elevated ALT, there are many people with same question for same breed population, so maybe this is just a normal elevation in the breed. If a specific study was to be done they may indeed document it as 'normal for the breed in abscence of disease'

My personal attitude is watch and wait, if dog is developing, healthy, happy and eating without any concerns, no diarrhoea/vomiting etc, then don't interfere. Any organ biospy can be dangerous unless the risk is totally warranted.

Thanks Zeebie, in all other instances I would advocate the "wait and see" approach especially in a dog with no clinical signs, however, her ALT levels have been tested several times now and they are above 1000 and slowly rising (the Frenchie cases I googled mentioned ALT levels below this). According to the specialists and the vet, is definite cause for concern and warrants further investigation, especially because her bile acids are also abnormal. Diet has been ruled out as a factor in this as well.

We ordered a coagulation profile to be done which measures the clotting of the blood, and thankfully this came back normal, which means she is by all accounts fit to undergo surgery.

But I do agree with you, a biopsy is very serious thing. However I would rather her go through it now than wait until we see symptoms, in which case it may be harder to put her through the anesthesia/surgery. These are the hard decisions we have to make as pet owners I suppose, it's a very hard thing

I would go to the specialist if it was my dog. But then I wouldn't have the biopsy unless she developed symptoms. Have they talked about doing a Protein C test I linked before. It boggles my mind that there is an easy non-invasive test but that vets (in Australia) don't seem to be aware of it... or something :S

Has your vet consulted with a specialist from Sydney Uni? If not then I wouldn't be making any decisions regarding biopsy or not until talking to them.

[zeebie]

I would go to the specialist if it was my dog. But then I wouldn't have the biopsy unless she developed symptoms. Have they talked about doing a Protein C test I linked before.

Has your vet consulted with a specialist from Sydney Uni? If not then I wouldn't be making any decisions regarding biopsy or not until talking to them.

Could not agree more on this.... having a dog who had similar situation under 12 months of age we decided to wait and watch and if at any time there were symptoms suggestive of sinister outcome we would go further, nine years later no problems and after 2 years all bloods were normal, so am so glad I waited. :D

A very wise professor of vetinary medicine said to me at the time 'You can't see the forest for the trees', because at the time I was so focussed on this problem my own dog had that I was not seeing the 'whole' dog and I was constantly waiting for something to happen I could not enjoy him, once I realised this I just treated him like a wonderful pet and the end result speaks for itself

[Guest LittleMissOdie]

That's certainly very encouraging to hear Zeebie I am glad your little one is doing well after all these years!

Unfortunately I have heard from people who have not been so lucky, one lady told me that her dog was asymptomatic and experienced sudden liver failure at the age of 3. At that point the dog's condition went downhill fast and there wasn't anything they could do, turned out to be an undiagnosed liver condition. That's the hardest part about being a dog owner, you are the one who has to call all the shots. A lot of these things comes down to the process of elimination. I will keep your encouraging words in mind though, thank you :)

Luna, the vet has spoken to several specialists, all are leaning towards a biopsy as the more logical approach, though there's a good chance a CT scan needs to be done anyway to completely rule out a shunt, so it just comes down to which order. The vet has also been investigating the Protein C test, it's not available in Australia which is ridiculous indeed, seeing as it is supposedly non-invasive and quite effective from what I've read

[MalteseLuna]

That's certainly very encouraging to hear Zeebie I am glad your little one is doing well after all these years!

Unfortunately I have heard from people who have not been so lucky, one lady told me that her dog was asymptomatic and experienced sudden liver failure at the age of 3. At that point the dog's condition went downhill fast and there wasn't anything they could do, turned out to be an undiagnosed liver condition. That's the hardest part about being a dog owner, you are the one who has to call all the shots. A lot of these things comes down to the process of elimination. I will keep your encouraging words in mind though, thank you :)

Luna, the vet has spoken to several specialists, all are leaning towards a biopsy as the more logical approach, though there's a good chance a CT scan needs to be done anyway to completely rule out a shunt, so it just comes down to which order. The vet has also been investigating the Protein C test, it's not available in Australia which is ridiculous indeed, seeing as it is supposedly non-invasive and quite effective from what I've read

If there is a chance that you need to do a CT scan anyway (after a biopsy) why not just do the CT which is less invasive?

At the end of the day the decision if up to you and your vet (and the consulting specialists) - the people who are seeing the full test results and the dog (in person) as a whole picture.

I hope that your pup is one of those whom is asymptomatic/normal for her entire life! Let us all know how it goes!

[Rappie]

If you are going to proceed with a spey, then taking a liver biospy at the same time will not add much time / pain / stress to the procedure. Doing a surgical biopsy (as opposed to an ultrasound guided TruCut biopsy) means there is good visualisation and the chance to ensure that there is no bleeding from the biopsy site. It also allows a much better sample to be collected.

A CT might still be required to identify an intra-hepatic shunt, however a biopsy would still be recommended.

[Guest LittleMissOdie]

Hi all, just an update for those interested. We decided after speaking at length with the vet and specialist to go ahead with a liver biopsy and spay, which was done last Thursday. Odie recovered from the anesthetic brilliantly, and regained her appetite and energy in 24 hours, with no severe side effects upon recovering.

The biopsy results shows that Odie indeed has microvascular dysplasia, with acquired shunting in the liver (inoperable). Our only option is to manage her medically and through diet. I've read of cases where dogs have lived out their full lifespans through careful lifelong monitoring, and I've read of cases where some dogs weren't as lucky. Odie is currently asymptomatic, so I am hoping she is going to turn out to be one of the luckier cases. Either way, our goal is to give her the best quality of life possible.

I just wanted to say thank you for everyone who offered advice and shared their experiences, it definitely helped along the way to finding a diagnosis.

[JulesP]

Very sorry to hear LittleMissOdie . Glad she made it out of the op ok though.

[WoofnHoof]

Thanks for the update I was wondering how she was going, fingers crossed the medical management will keep her a symptomatic for many years for you