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Discussion Starter #1
For any of you who may be thinking of running a bile acid test on your dog(s), there is a new test out, the IDEXX SNAP test for bile acids. Don't waste your money!! While you will get both pre- and postprandial values, the values are given in ranges -- <12; 12-25; >25. You might get a postprandial value of >25 but the test does not tell you how much greater than 25. And there's a huge difference between 26 and 200 but because all you get is >25, you've just spent good money for a worthless result and now you've got to spend more money to have a traditional bile acid test run to get a meaningful value. This may well be a worthwhile test for breeds that do not have liver issues but it is NOT a good test for Maltese.

Mary
 

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This maybe a dumb question, but I am going to ask anyways. Can a Maltese develop liver issues over time like a shunt or MVD or is it something that is noticed by a certain age or something that they are born with? How often should a dog be bile acid tested? I am starting to get worried because it seems like liver issues are becoming more prevalent. Thanks!
 

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Discussion Starter #3
This maybe a dumb question, but I am going to ask anyways. Can a Maltese develop liver issues over time like a shunt or MVD or is it something that is noticed by a certain age or something that they are born with? How often should a dog be bile acid tested? I am starting to get worried because it seems like liver issues are becoming more prevalent. Thanks![/B]
I'm not positive but I think the consensus is that dogs are born with PSVA/MVD. Dr. Center recommends testing puppies before they're sold (I think her preferred age would be 16 wks.) and the only time that I've read that it's worthwhile to retest is if you have a dog whose shunt was ligated, then retest to insure that the ligation worked. As with any other chronic conditions (cancer comes to mind), whether in humans or animals, I do wonder if there is a higher occurrence or if we have better, more sophisticated means with which to diagnose?

Mary
 

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Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.
As far as liver shunts and MVD goes. Most dogs who have liver shunt are diagnosed by the age of 1, but I have seen dogs much older than that be diagnosed, from 3-7 yrs old.
When they have MVD, many times, symptoms go unnoticed, so the dog may not be diagnosed until 2,3, or even much older than that...
Numbers above normal range but below 100, typically point more towards liver shunt.
Numbers above 100, typically point more towards MVD.
There are always exceptions to these "generalizations." I know of a yorkie whose numbers were under 100 and had a liver shunt, and I know several dogs, including my own, who have had number beyond 300 that have MVD.
MVD and liver shunts are usually congenital, but it is possible for a dog to have an "acquired" shunt later in life also.
About 15% of dogs who have liver shunt ligation surgery develop acquired shunts as well...
 

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Can dogs develop high bile acids later in life but were normal as a puppy? Yes: there are MANY types of liver disease out there that develop later in life. Anything from infection to chronic phenobarbital use to a toxin exposure. And yes, dogs with severe liver disease can develop acquired shunts. This is NOT the same thing as the PVSA/MVD that is talked about so frequently with Maltese. This is why when you test an adult Maltese, you raise a question - is this something to worry about or not. Knowing their numbers as pups can help clear that up.

As many times as you measure the bile acids, you will get a different result. Dr. Center emphasized that abnormal is abnormal. If you get 4/40 and then 5/70 the dog is still abnormal. Bile acids is not a good monitoring test for that reason (unless post-shunt ligation based on the vet's recommendations). When we consulted with Dr. Center on a pair of dogs a number of years back, she recommended appropriate intervals to monitor ALT(SGPT) and full chem panels on those dogs. My "reg vet" (who is a boarded internist and did her residency at Cornell with Dr. Center) has us do a chem panel and check up every 6 months on my current MVD confirmed case and suspects.
 

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The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.
 

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The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.[/B]
My point was agreeding with Mary that bile acids are not a good monitoring test. It has been recommended to monitor liver enzymes (ALT) at intervals instead of doing repeated bile acids which give you no information. This is NOT a recommendation for diagnostics, but for monitoring.
 

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yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.
 

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Are Maltese breeders routinely running bile acid tests on adults before breeding them? I've seen ads/websites for Yorkies and Havanese that state that bile acids tests have been done on the parents and the puppy, but never seen it in an ad for a Maltese or on any of the show breeders websites.

Are Maltese breeders just behind the eight ball on this issue?
 

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The thing about regular "routine" bloodwork is that abnormalities in the liver (elevated numbers) won't show up until the liver is 70% damaged. That's why it's important to bile acid test. It's much more sensitive to liver function.[/B]
My point was agreeding with Mary that bile acids are not a good monitoring test. It has been recommended to monitor liver enzymes (ALT) at intervals instead of doing repeated bile acids which give you no information. This is NOT a recommendation for diagnostics, but for monitoring.
[/B]
Okay, now I am confused. My dog had normal liver enzymes until her last blood test, when we also did bile acid and ALT was high as were pre and post-prandial bile acids. We suspect she has MVD since the scintigraphy did not indicate a shunt and I have elected not to biopsy.

I thought normal ALT can hide MVD and that only bile acids can tell you if the dog has liver issues?
Sorry for the confusion!
 

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Yes, the bile acid test is much more sensitive to liver function, so yes, it's important to get bile acid testing...
I think what the other poster is trying to say is that it's not a good way to "monitor" levels.

But, in my opinion, if you take the dog to the same vet and have them feed the same amount of the same kind of food as each other time that the bile acid test is done, it might be a better way to keep track of the dog's levels...It wouldn't be completely fool proof, but it would help it be a bit more accurate as far as monitoring goes.
 

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Yes, the bile acid test is much more sensitive to liver function, so yes, it's important to get bile acid testing...
I think what the other poster is trying to say is that it's not a good way to "monitor" levels.

But, in my opinion, if you take the dog to the same vet and have them feed the same amount of the same kind of food as each other time that the bile acid test is done, it might be a better way to keep track of the dog's levels...It wouldn't be completely fool proof, but it would help it be a bit more accurate as far as monitoring goes.[/B]
If you have already determined a dog has a problem, them monitoring will be recommended. This is where bile acids would not be of assistance so you monitor the enzymes like ALT. Like I said in previous posts, this is for MONITORING.

You check bile acids to rule in/out normal liver function vs. an affected dog.


You can do the exact same protocol with bile acids every time and still get variation in numbers for the same dog. Abnormal is abnormal.
 

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Yes, I see what you are saying...I should have read back through that again...Once liver disease has been confirmed, there's no need to retest bile acids...They're going to be elevated regardless of anything if the dog has liver disease. Now, if there's a shunt and it has been closed up, then it's important to check the BAT to make sure that the shunt has closed and the numbers have gone down. Also 3-6 months down the road to make sure that the dog didn't acquire a shunt which about 15% of dogs do.
If your dog is asymptomatic and comes up with slightly elevated BAT results, then I think the test should be redone in 30 days. I don't see anything wrong with redoing a bile acid test in that fashion.
 

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Discussion Starter #16
Yes, thank you for posting this information. Do not waste your money on idexx snap...Get a regular serum bile acid test (pre-prandial and post-prandial). The dog is fasted overnight for 12 hours, taken in for a blood draw. They feed the dog, then 2 hrs later take another blood draw.[/B]
This information is outdated. The bile acid test was developed at Cornell by Dr. Center. They wrote the initial protocol and have since updated it. Taken from Page 5 of the handout Dr. Center gave us at her recent seminar:
"7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial)." (all emphasis was added by Dr. Center, not me)

Numbers above normal range but below 100, typically point more towards liver shunt.
Numbers above 100, typically point more towards MVD.[/B]
I believe you have your numbers backwards in this statement.

If your dog is asymptomatic and comes up with slightly elevated BAT results, then I think the test should be redone in 30 days. I don't see anything wrong with redoing a bile acid test in that fashion.[/B]
Quoting from p.17 of our handout:
"3. Dogs with MVD are monitored with serial biochemical profiles looking for evidence of active hepatobiliary injury (increased liver enzyme activity) or loss of synthetic function as part of their routine health assessments over their lifetime. Serial bile acid values do not contribute to assessments of health status in these dogs unless they become profoundly increased. Bile acid values do not quantitatively correlate with extent of liver injury due to their complex physiologic regulation. Dogs with MVD usually do not have ammonium biurate crystalluria or hyperammonemia." (all emphasis was added by Dr. Center)

In closing, I personally know two Maltese, one with a ligated shunt and the other with MVD, who are living in pet homes and have Dr. Center as their "regular" vet. Both were initially seen, tested, and diagnosed by Dr. Center, and the one with the shunt had the shunt ligated by a surgical team at Cornell under the watchful eye of Dr. Center. Neither of these dogs has been subjected to repeat bile acid testing. They have complete blood panels done at the time of their wellness exams to monitor liver enzyme levels. And Dr. Center advised all who attended her seminar that repeat bile acid testing is of no use in monitoring MVD dogs.

Mary
 

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Discussion Starter #17
Okay, now I am confused. My dog had normal liver enzymes until her last blood test, when we also did bile acid and ALT was high as were pre and post-prandial bile acids. We suspect she has MVD since the scintigraphy did not indicate a shunt and I have elected not to biopsy.

I thought normal ALT can hide MVD and that only bile acids can tell you if the dog has liver issues?
Sorry for the confusion![/B]
Not all MVD dogs have elevated ALT (liver enzymes) so the results of a blood test that shows normal liver enzyme levels is no guarantee that your dog does not have MVD. You are correct that bile acid testing dogs will tell you if the dog has liver issues. But because, as JMM pointed out, there could be any number of causes of liver dysfunction, the "liver experts" recommend running a bile acid test when the dog is young, before any of the other number of causes of liver dysfunction kick into play.

Mary
 

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yes for those of u that havent run a bile acids on ur malt..i suggest u do so..... it will be interesting to see how many out there have a high BA and are not symptomatic. if ur malt does come back with a high BA i suggest u contact dr. center with ur bredder/ pedigree info to help her out in her research.[/B]

Jamie,

When Pixel was a puppy did you do BA or just the usual blood panel? I'm wondering if the BA test is always conclusive when done on a puppy. If so, then we should be doing BA on our new puppies.

Cathy A
 

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When Pixel was a puppy did you do BA or just the usual blood panel? I'm wondering if the BA test is always conclusive when done on a puppy. If so, then we should be doing BA on our new puppies.

Cathy A[/B]

YES, you should be doing paired bile acids on ALL puppies. Dr. Center recommended it be done right before they go home from the breeder.

If the dogs have PSVA/MVD, the numbers will be there when they are young. Since this is something they are born with, the bile acids won't magically become abnormal at a year of age (although, like the answer to the orignal question, dogs can acquire OTHER types of liver disease later in life).

Dr. Center specifically mentioned if the number is abnormal, its abnormal. Like I already mentioned, you will get a different number each time you test.

Reasons to draw another sample:
1. Hemolysis of the sample (and you should have your vet spin the clotted blood down while you are in the office because if it is hemolyzed, you need to get another sample)
2. Lipemia of the sample that is not centrifuged out of the sample (fatty blood)
She also recommended the vet collect the blood in a plain red-top tube versus a serum separator. After the blood clots, it should be spun down and the serum put in another plain red-top to go to the lab.

I've never heard it recommended to retest in 30 days.

Page 5:
"Cutoff range considered abnormal: we determined an appropriate cutoff value to discriminate normla dogs from abnormal dogs based on review of hundreds of bile acid values in dogs with biopsy confirmed normal or abnormal liver status."

My note: This means that they took large samples of dogs with both normal and abnormal bile acid values. Then they took liver biopsies to see if the bile acid numbers matched pathology vs. no pathology of the liver.

"...we set the cutoff value to discriminate normal and abnormal >/= 25 uMol/L. We then tested this against a large population of dogs examined by liver biopsy to be sure that this value did not generate in false positive tests (dogs that had no liver abnormality yet still had abnormal test results)."

My note: They specifically tested for false positive.
 

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Discussion Starter #20
Jamie,

When Pixel was a puppy did you do BA or just the usual blood panel? I'm wondering if the BA test is always conclusive when done on a puppy. If so, then we should be doing BA on our new puppies.

Cathy A[/B]
page 22 of the handout:
"2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others). Proactive assessment of serum bile acids will limit the awkward circumstance imposed when an MVD dog, with minor health issues, is suddenly recognized to have abnormal bile acids by a pet owner's veterinarian. This circumstance can lead to unnecessary diagnostic confusion and unwarranted invasive tests such as liver biopsy and portovenography. How old dogs should be at he time of initial testing has not been established. Typically, abnormal bile acids DO NOT normalize as a dog ages ..... " (all emphasis added by Dr. Center)
 
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