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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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Walter & Casper with Lucky (forever in my heart).
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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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Walter & Casper with Lucky (forever in my heart).
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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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Walter & Casper with Lucky (forever in my heart).
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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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Walter & Casper with Lucky (forever in my heart).
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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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Especially avoid beef, a small bit of low fat string cheese, yogurt are good safe protein sources instead of flesh. Make sure they do not have artificial sweeteners. The yogurt will provide some probiotic, but still a pro/prebiotic is a good addition. Veggies/fruits like carrots, peas, banana, apples in moderation are also good.

You can also get a remote nutrition consult from Cornell. Not sure of the cost. They have a lot of experience wirh small dogs and liver issues.
 
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An update… he was doing pretty well at home but this morning I noticed he was being odd (licking his nose, staring off) and he threw up twice. He was also shivering and his gums were pale. We are at emergency again now. Please send prayers that he’s OK!
I hope he is ok!
 
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