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Discussion Starter · #1 · (Edited)
I am a new poster here, but long time lurker. Love seeing all the photos of the fur babies. I have a 2 year old maltese named Uyu who is just the cutest and is the best thing to happen to me. I'm so worried right now because he's been having tummy issues/diarrhea for the past 2-3 days, being a little lethargic, and shaking & shivering at night. I brought him to the vet today after fasting him all day yesterday. They did a blood test and they said his liver enzyme level came out as "no readings" which could mean that it's extremely high?! The vet then did a liver panel, which they will let me know the results of on Thursday.

Of course I started reading about high liver enzyme levels online and have thoroughly freaked myself out. I know there's not much for me to do until the results come back but I am a mess! I am so nervous that he might be sick. He's on my lap sleeping now, still low-energy :(

Here is a picture of him, usually so hyper!
Dog Dog breed Carnivore Companion dog Plant
 

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Sandi-- w/Kitzel (Kitzi) & Lisel (Lisi)
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I am sorry to hear about your baby! Please try to stay calm as he assumes your energy & you need for him to do his best regardless of his readings. Let us know what the results are & we can help direct you for help! Where are you located as maybe we have someone nearby who can advise you. Have you done a Bile Acids Assay or test? That is a special 2 tier test that one has to request be done at about 16 weeks to see if your pup has a shunt & gives you a baseline for any future liver issues?
 

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Discussion Starter · #3 ·
The results came back and the vet thinks he has severe liver disease based on the numbers.
ALT 8146
AST 1060
Bile acid pre 17
Bile acid post 99

I am checking him in at the emergency/specialty vet now and so scared. How could this happen? He was fine a week ago. I am so scared.

I’m in Los Angeles. I don’t think we ever got the special tier test done at 16 weeks? I didn’t know.
 

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Sandi-- w/Kitzel (Kitzi) & Lisel (Lisi)
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Walter, can you jump in here? You are by far the most experienced in this area. i did have a liver shunt dog but it was a long time ago & I know treatments have changed.
 

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Discussion Starter · #6 ·
The doctor at the specialty hospital believes it’s likely a shunt. She will do an ultrasound. She also wants to do a CT scan but can’t proceed until he’s more stable to handle the anesthesia… this is a nightmare. 😓😓😓
His blood work was perfectly normal back in January, I am having a hard time understanding how quickly this happened.
 

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It seems strange it would come on so suddenly. I wonder if a gall bladder problem with clogged bile ducts could cause the liver damage. One of my dogs had a gallbladder mucocele in her senior year and needed surgery, but unfortunately she got aspiration pneumonia. I think another of my dogs might have had that, before they were sufficiently recognized. They show up on ultrasound, but I believe they do not show up on x-rays.
 

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Discussion Starter · #8 ·
It seems strange it would come on so suddenly. I wonder if a gall bladder problem with clogged bile ducts could cause the liver damage. One of my dogs had a gallbladder mucocele in her senior year and needed surgery, but unfortunately she got aspiration pneumonia. I think another of my dogs might have had that, before they were sufficiently recognized. They show up on ultrasound, but I believe they do not show up on x-rays.
Thanks for sharing. They did an ultrasound today and could not see anything unusual. The doctor said it’s common not to be able to see shunts via ultrasound in small dogs (he is only 4.8 lbs) and that she wants to do a CT.

She did mention that they did a blood test again today and his ALT went down to 3000, and AST 300. Still extremely high and not great, but better than the previous numbers…

I went to visit him earlier today after he was admitted for overnight hospitalization and my heart is so sad and so scared. This is the first time he’s not spending the night at home.
 

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Walter & Casper with Lucky (forever in my heart).
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The ALT or ASP numbers are very high, you will need diet and medication to get them down and have them rechecked in a month or so. I think it would point to an internal injury of some type or if the dog got into something toxic. It could also be a digestive problem. Dogs with shuts would not normally have enzyme values that high. Lucky's were always a few points within normal. Not always, but normally post bile acids under 100 point to MVD rather than a shunt. The next test would be a simple blood test called a protein-c which can help distinguish between a shunt and MVD. The good news is that if it is a shunt, many dogs can live a normal life with medication and diet. If is really important to find an internist that specializes in toy breeds. Let me know of any questions I can answer. Good Luck and try not to worry too much; remember the results of any blood test is a snapshot, and all sorts of things cou!d contribute to elevated values.
 

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Thanks for sharing. They did an ultrasound today and could not see anything unusual. The doctor said it’s common not to be able to see shunts via ultrasound in small dogs (he is only 4.8 lbs) and that she wants to do a CT.

She did mention that they did a blood test again today and his ALT went down to 3000, and AST 300. Still extremely high and not great, but better than the previous numbers…

I went to visit him earlier today after he was admitted for overnight hospitalization and my heart is so sad and so scared. This is the first time he’s not spending the night at home.
There is a special type of ultrasound called doppler that is used to visualize shuts.
 

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Discussion Starter · #11 ·
The ALT or ASP numbers are very high, you will need diet and medication to get them down and have them rechecked in a month or so. I think it would point to an internal injury of some type or if the dog got into something toxic. It could also be a digestive problem. Dogs with shuts would not normally have enzyme values that high. Lucky's were always a few points within normal. Not always, but normally post bile acids under 100 point to MVD rather than a shunt. The next test would be a simple blood test called a protein-c which can help distinguish between a shunt and MVD. The good news is that if it is a shunt, many dogs can live a normal life with medication and diet. If is really important to find an internist that specializes in toy breeds. Let me know of any questions I can answer. Good Luck and try not to worry too much; remember the results of any blood test is a snapshot, and all sorts of things cou!d contribute to elevated values.
Thank you so much. The doctor said since the post bile acid number is right at the cusp (99), she's not sure which it could be. I asked her about Protein C (thanks to SM), but she said it wouldn't help? She said a CT scan would be the best way to tell between a shunt or MVD.
I also asked her whether it's possible he got injured or ate something toxic because his ALT numbers have been normal previously (53 back in January), but she said his BAT to shunts or MVD. Is that true?

If anyone has any recommendations of specialists in the LA area, please let me know.
 

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Walter has a lot of great experience with a liver shunt dog. Please look for an internist who has experience with liver issues in toy breeds.
 

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Thank you for this, I will ask about it today. I'm so nervous about letting them do a CT scan because of the anesthesia.
If there is a liver issue, it is not uncommon for the dog to take longer to wake up, the liver processes the chemicals. So don't worry if uyu is in recovery longer than expected. Living close to Cornel and Tufts, I only know the small dog experts here, but it would be worth to see if there is a toy dog internist near you. Remember you have choices in uyu's care, so think carefully if they propose anything invasive like surgery, get a second opinion.
 

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Discussion Starter · #15 ·
If there is a liver issue, it is not uncommon for the dog to take longer to wake up, the liver processes the chemicals. So don't worry if uyu is in recovery longer than expected. Living close to Cornel and Tufts, I only know the small dog experts here, but it would be worth to see if there is a toy dog internist near you. Remember you have choices in uyu's care, so think carefully if they propose anything invasive like surgery, get a second opinion.
Thank you so much. I will keep that in mind for the CT scan.

Is a SMAL specialist the same as a toy dog internist? The doctor who is seeing him today at the emergency hospital is listed on this site I found for small animal doctors. My baby is at MASH, which is a big emergency hospital in Los Angeles.
 

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Thank you so much. I will keep that in mind for the CT scan.

Is a SMAL specialist the same as a toy dog internist? The doctor who is seeing him today at the emergency hospital is listed on this site I found for small animal doctors. My baby is at MASH, which is a big emergency hospital in Los Angeles.
Yes, sounds like uyu is in good care.
 
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Sandi-- w/Kitzel (Kitzi) & Lisel (Lisi)
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Thank you Walter for jumping in here! I knew you would be the "man of the hour!" You never fail us. I am sending prayers for your baby & it is good to know you are in good hands! Please keep us posted.
 

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Discussion Starter · #18 ·
Yes, sounds like uyu is in good care.
Thank you Walter for jumping in here! I knew you would be the "man of the hour!" You never fail us. I am sending prayers for your baby & it is good to know you are in good hands! Please keep us posted.
Yes, thank you both so much. I was a ball of anxiety and this thread made me feel a bit better about Uyu's care and his doctors.

He came home yesterday, because his levels went down a bit (still very, very high at 4000something) and the doctor thought he would rest better at home, as the hospital is a pretty stressful environment and Uyu is alert and stable. The doctor doesn't believe Uyu has a shunt, even though he can't be sure until a CT scan... he also let me know of the risks with the CT scan and we decided to wait until Uyu is feeling a bit better. He also suggested a liver biopsy sometime in the future, but said he was uncomfortable moving forward right now (I felt the same).

Uyu is on medication at home (Denamarin, Metronidazole, Lactulose Solution). Overall it seems like he is feeling a bit better today - definitely has more energy than when we first checked him into the emergency hospital. Please send all the prayers and good thoughts our way that his numbers are MUCH lower when we have our followup on Wednesday.
 

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Yes, thank you both so much. I was a ball of anxiety and this thread made me feel a bit better about Uyu's care and his doctors.

He came home yesterday, because his levels went down a bit (still very, very high at 4000something) and the doctor thought he would rest better at home, as the hospital is a pretty stressful environment and Uyu is alert and stable. The doctor doesn't believe Uyu has a shunt, even though he can't be sure until a CT scan... he also let me know of the risks with the CT scan and we decided to wait until Uyu is feeling a bit better. He also suggested a liver biopsy sometime in the future, but said he was uncomfortable moving forward right now (I felt the same).

Uyu is on medication at home (Denamarin, Metronidazole, Lactulose Solution). Overall it seems like he is feeling a bit better today - definitely has more energy than when we first checked him into the emergency hospital. Please send all the prayers and good thoughts our way that his numbers are MUCH lower when we have our followup on Wednesday.
Lactulose will bind any ammonia in uyu's system. You may notice a change in stools, they may get a bit softer and more frequent. You might suggest a Protein C test. It is a simple blood test that is sent to Cornell for analysis. the good thing is it does require any difficult protocols in the draw. I am glad he is home. It is best to stay away from food with high protein content. Avoid products with red meat, especially. If he is not sensitive to dairy, dairy is an excellent source of protein that is very easy on the liver. Is uyu on a special diet! Good luck.
 
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