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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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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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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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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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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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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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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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Discussion Starter · #21 ·
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.
I did notice he's not having diarrhea like before, but his stools are still loose. Thank you for this information!

I asked about the Protein C test to the first doctor who saw him at the hospital and she dismissed it, saying the CT scan will show us more details. I wasn't sure so I didn't push back. I will ask his new doctor in case he has a different opinion.

The hospital gave us canned Hills i/d with his discharge, but Uyu does not like it... he has always been very picky! I've been feeding his regular Open Farm kibble, but sticking with only chicken (he was rotating beef and pork previously). I used to mix with Open Farm freeze dried raw (beef, turkey, lamb) but decided to drop it until we figure out what's wrong, and have been shredding small pieces of boiled chicken breast instead. I will try the yogurt and see if he likes it! And if you have any favorite low-medium protein foods, please let me know. Thank you Walter a thousand times!
 

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Discussion Starter · #25 ·
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.
He really loves the string cheese! I've been bribing him with it to eat his regular chicken kibble mixed with the Hills ID.

Hills I/D is supposedly a balanced diet, but I don't think it's particularly low protein. Most of my dogs have liked it. Maybe you could add some other things to it to make it more palatable (and lower protein) such as the veggies and fruit that Walter recommends.

I liked its smooth texture when I needed to syringe feed a dog which wouldn't eat.

From what I remember from 1995/96, when my small dog had liver failure, the vet at University of California Davis told me that Lactulose was/is originally a laxative, and the purpose of giving it to my dog was that "speeding up" the digestion meant there was less time for the protein to be absorbed. But from recent reading, that was an oversimplification. But in any case, diarrhea for once is not a bad thing -- just awkward to manage. Hopefully potty pad use can help with that!

(That vet went on to teach at Cornell for quite a number of years, but I think his specialty there was cats. :)
Wow, that's interesting about Lactulose. Uyu saw the doctor again today, and he suggested to cut his Lactulose dosage in half to help with the diarrhea. I don't mind it (he mostly goes potty outside), it just made me worried that his tummy was upset.


Sending prayers to you and your precious one.
Thank you!

An update... Uyu's ALT levels are down to 1400, which is still extremely high -- but better from 4000 which was last Friday. He didn't do a BAT today because I didn't fast him, but he will do another blood test along with BAT in two weeks. We are hoping that both is ALT/AST and BAT are back to normal by then. He will stay on Denamarin until then. Overall, he seems much more energetic and more like himself, even though his levels are still very concerning.
 

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Discussion Starter · #27 ·
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!
 
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