[Tanner's Mom]

I have a year old male Maltese named Tanner (he's so cute, he's asleep on my desk at work right now) however, when I took him to the vet to get neutered in Feberuary, his ALT was sky high, like 350. Naturally, we didn't neuter him, put him on vitamins, that didn't work, changed his diet to Science Diet L/D, that didn't work, then sent him to the vet internist for an ultrasound to see if he had a liver shunt, he didn't. That vet suggested we do a liver biopsy but that still may not tell us what's wrong and Tanner is at risk for anesthesia. I decided against the biopsy since he could die from the anesthesia and I still might not know what's wrong with him. Right now he is asymptomatic. I got some really good info from the DogAward website, what a great place. But I'm wondering what I can expect, how doe these things usually progress. Has anyone had any experience with this?

 

[jmm]

This dog needs more of a work up.

1. Bile acids

2. Even if ultrasound did not show a shunt, ultrasound is not the best way to determine if there is a shunt vessel. MRI or nuclear scintigraphy are the choice methods.

3. Depending on what is found there, either the shunt should be repaired with an ameroid constrictor or a liver biopsy should be taken.

Maltese are a breed of dog with hereditary liver shunts and hepatic microvascular dysplasia. With an experienced surgeon at a university of specialty hospital, correcting shunts is the best way to give the dog a long life. If the dog has MVD, you also need to know if it has inflammation in the liver as that is another problem in the breed seen with MVD. Medical management for MVD is different if they have that inflammation.

Dr. Sharon Center at Cornell is the authority on MVD in Maltese and also has a lot of experience with liver shunt. If you are near Cornell, I would go. Another great teaching hospital is the University of Tennessee. Dr. Karen Tobias is a fantastic surgeon with a huge amount of experience with liver shunts and repairs.

 

[kodie]

Here are some related threads on this topic...
http://spoiledmaltese.com/forum/index.php?showtopic=2991&hl=
http://spoiledmaltese.com/forum/index.php?showtopic=2441&hl=
Read this one first.. it explains Liver shunts
http://spoiledmaltese.com/forum/index.php?showtopic=1524&hl=

 

[Tanner's Mom]

Originally posted by Kodie@Jun 13 2005, 09:30 PM
Here are some related threads on this topic...
http://spoiledmaltese.com/forum/index.php?showtopic=2991&hl=
http://spoiledmaltese.com/forum/index.php?showtopic=2441&hl=
Read this one first.. it explains Liver shunts
http://spoiledmaltese.com/forum/index.php?showtopic=1524&hl=
<div align="right">index.php?act=findpost&pid=72334

[/QUOTE]

 

[Tanner's Mom]

Originally posted by JMM@Jun 13 2005, 06:29 PM
This dog needs more of a work up.

1. Bile acids

2. Even if ultrasound did not show a shunt, ultrasound is not the best way to determine if there is a shunt vessel. MRI or nuclear scintigraphy are the choice methods.

3. Depending on what is found there, either the shunt should be repaired with an ameroid constrictor or a liver biopsy should be taken.

Maltese are a breed of dog with hereditary liver shunts and hepatic microvascular dysplasia. With an experienced surgeon at a university of specialty hospital, correcting shunts is the best way to give the dog a long life. If the dog has MVD, you also need to know if it has inflammation in the liver as that is another problem in the breed seen with MVD. Medical management for MVD is different if they have that inflammation.

Dr. Sharon Center at Cornell is the authority on MVD in Maltese and also has a lot of experience with liver shunt. If you are near Cornell, I would go. Another great teaching hospital is the University of Tennessee. Dr. Karen Tobias is a fantastic surgeon with a huge amount of experience with liver shunts and repairs.
<div align="right">index.php?act=findpost&pid=72266

[/QUOTE]

THank you everyone for the wonderful information. I hate that so many of our little bears have this problem, but it's sure nice to know I'm not alone. By the way, bile acid test was done and was fine.

 

[Ladysmom]

There is a new non-surgical neutering that was just approved by the FDA that you might want to look into. It has only been approved in puppies up to 10 months so your Tanner is too old, but they may ease the restrictions as time goes on.

http://www.thewbalchannel.com/news/4521852/detail.html

 

[jmm]

I have heard of a few dogs with shunts who had normal bile acids, but, you should also look into things like drug toxicity (heartworm preventative?) and other causes of elevated liver enzymes (hepatitis, etc.) as well. An internist should be able to guide you.

 

[jmm]

Originally posted by LadysMom@Jun 14 2005, 08:53 AM
There is a new non-surgical neutering that was just approved by the FDA that you might want to look into. It has only been approved in puppies up to 10 months so your Tanner is too old, but they may ease the restrictions as time goes on.

http://www.thewbalchannel.com/news/4521852/detail.html
<div align="right">index.php?act=findpost&pid=72448

[/QUOTE]

I would not be comfortable using this method as of yet.

I have 2 dogs with liver disease and both have tolerated cautious anesthesia without major problems. It requires extra care, but in an asymptomatic dog where Iso gas only is used, the liver disease is unlikely to be the culprit of anesthetic complications. Of course, this should be discussed with their specialist. Perhaps laparoscopic biopsies could be done and a neuter at the same time.

 

[Ladysmom]

When Lady had her last dental, my vet just "masked her down". Her liver values are all still in the normal range after 5 years of seizure drugs, but my vet still felt it was safest to just put her out that way.

Could neutering be done with gas only? I know it's a fairly simple procedure.

 

[jmm]

The Isoflurane gas is the anesthesia. Usually they give the dog an injection to induce them to put a tube in their trachea and then add the gas. You can also mask the dog down until it is sleepy enough to tube and maintain on gas.

 

[Ladysmom]

Thanks for explaining that! Now I feel better that I still spent the normal $200 since it is a little more complicated than just popping a mask on her face!

BTW, how did Mikey's appointment at Cornell go? (I figured others would like an update so I posted it here rather than asking you privately.)

 

[jmm]

His ultrasound looked good. His kidneys have more changes, but we already knew about his kidney disease. So, no gallbladder problems and no bladder stones right now.

They're adjusting his medications again and after 2 weeks on those changes I have to adjust his diet to decrease his fat intake. Dr. Center took pictures of Mikey

She emphasized his need for the dexamethasone to solve the inflammation. She's the best there is so we'll work on her plan.

 

[Ladysmom]

Sounds like a guardedly optimistic appointment. I'm glad that this vet has options and avenues to explore still.

As I've told you before, Dex has made a tremendous difference in Lady's quality of life. The benefits definately outweigh the risks in her case.

How is Mikey feeling generally? That must be a tiring trip for him. (And you too!)

 

[jmm]

The lazy dog is a great traveler...I was really active in conformation when I got him so as soon as he came home he was traveling and in hotels all the time. He sleeps in his kennel, potties when we stop, drinks on each stop. He's totally relaxed about staying in a hotel.

Generally he feels tired. He has a gurgly belly and is nauseous often. But, he is more normal mentally since stopping a number of the medications he was on before...