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I'm starting this thread so we can have one place to discuss this very important issue of our beloved Maltese breed. If the thread ends up being informative enough, I'll ask Yung or Joe to pin it for us.

Some of the posts in the other thread that is active on this topic today, but really in the wrong place, are so interesting... Maybe some should be copied and added in this thread, too.

Soooo, if you have information and opinions to share on the AMA Bile Acid Testing guidelines, Liver Shunt surgery, Protein C testing ... let's get it all here in one place.
 

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Finnegans liver shunt is blood vessels bi-passing his liver, so the blood doesn't get cleaned of toxins and they get carried to the brain. He is taking meds so the toxins come out in his stools untill his surgery. There are different types of shunts and liver diseases though.
 

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thanks for the info , it gives me some insight , aww soo scary :( i hope he does well in his surgery ..

so let me ask u this , there are bile test that can determine this before?
Finnegans liver shunt is blood vessels bi-passing his liver, so the blood doesn't get cleaned of toxins and they get carried to the brain. He is taking meds so the toxins come out in his stools untill his surgery. There are different types of shunts and liver diseases though.
 

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Oh Sher, I'm so sorry, I had started a new thread as well on this topic. You can delete mine, and I will paste what I wrote on here. Thanks Sher. (I posted mine under everything else Maltese related, but yours is a much better place) Sorry for the confusion.

Here were my questions/comments:

I am sure there are countless threads here on this topic, so I hope it's okay to start a new one with some questions.

I never heard of liver shunt or bile acid testing until being a member of SM and still do not know much about it.

When I took Mia and Leo in for one of their early visits, I told my vet I wanted a bile acid test done. She looked so concerened and asked me WHY??? Are they showing any symptoms? She said they do not appear to be candidates for the testing and then we did have a discussion on this topic in reference to Mia and Leo. She felt the testing for them was unneccesary. I love my vet dearly and trusted and still trust her call on that.

Anyway, my real questions/thoughts on this topic are:

1) If in the future, I would adopt (purchase) a pup from a True breeder, who has been breeding for years, knows their lines inside/out, upside down, I would possibly feel comfortable if they said no they do not test, as they know their lines. But would it be wise for me to offer to pay for the test anyway and what if they decline? I wouldn't think they would, but just wondering.

2) If a breeder with a smaller program does not bile test for the same reasons listed above, do I still ask for a bile acid test and what if they decline? I also wouldn't think they would, but I would offer to pay for it.

To be very honest, I am quite shy when speaking or asking questions of breeders, I admit, I sometimes feel like I'm probing, and I know I shouldn't feel that way, nor have I ever been made to feel that way, it's just my nature but once the conversation continues then I get a little more comfortable. The only thing I am not shy about, is that the True breeder, loves and completely cares and is attentive to every fur-baby in their care, the boys, the girls and the pups, all of them. That is my very first heartfelt requirement.

After reading recently on here about liver shunt, I think I would not want to adopt (purchase) a pup without having the testing done. Is that on the right track?

I am so not ready to add a new addition, although I would love to, but I have my special two :wub::wub: and am still caring for my MIL, but who knows what the future holds and also I wish to learn more about this topic, in case I am ever in a position to help or advise someone else.

Thanks so much for taking the time to read this and for sharing your knowledge, it is much appreciated.
 

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I'm starting this thread so we can have one place to discuss this very important issue of our beloved Maltese breed. If the thread ends up being informative enough, I'll ask Yung or Joe to pin it for us.

Some of the posts in the other thread that is active on this topic today, but really in the wrong place, are so interesting... Maybe some should be copied and added in this thread, too.

Soooo, if you have information and opinions to share on the AMA Bile Acid Testing guidelines, Liver Shunt surgery, Protein C testing ... let's get it all here in one place.

I hate to lose all the information, links and opinions that were already shared in the other thread. I think to try to copy and paste posts into this thread would not only be a lot of work, we would also loose the continuity and chronologically of the previous discussion.
 

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I know you are talking about maltese, but it's just as important to have yorkies tested. I'm not positive, but I believe they are even more supseptable to liver problems.

Before I got Ava I had found a gorgeous little yorkie girl, she was 6 months old and 2 1/2 lbs, it wasn't the size as much as her sheer cuteness that attracted me. Anyway, I paid the breeder's vet to do a bile acid test as the breeder didn't think it was necessary. The numbers came back high enough that she would most likely have MVD. Not as bad as a shunt, and a special diet and supplements can keep their health in check. I passed on this pup and saved myself a ton of money having to buy food different from my other dogs.

The liver shunt operation is a big deal. Ask Kodie's mom - Kodie had it done. And my friend Elaine's Kodie (a yorkie) had it done also - he still has seizures now and then...and it's been about 5 years now.
 

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Oh Sher, I'm so sorry, I had started a new thread as well on this topic. You can delete mine, and I will paste what I wrote on here. Thanks Sher. (I posted mine under everything else Maltese related, but yours is a much better place) Sorry for the confusion.

Here were my questions/comments:

I am sure there are countless threads here on this topic, so I hope it's okay to start a new one with some questions.

I never heard of liver shunt or bile acid testing until being a member of SM and still do not know much about it.

When I took Mia and Leo in for one of their early visits, I told my vet I wanted a bile acid test done. She looked so concerened and asked me WHY??? Are they showing any symptoms? She said they do not appear to be candidates for the testing and then we did have a discussion on this topic in reference to Mia and Leo. She felt the testing for them was unneccesary. I love my vet dearly and trusted and still trust her call on that.

Anyway, my real questions/thoughts on this topic are:

1) If in the future, I would adopt (purchase) a pup from a True breeder, who has been breeding for years, knows their lines inside/out, upside down, I would possibly feel comfortable if they said no they do not test, as they know their lines. But would it be wise for me to offer to pay for the test anyway and what if they decline? I wouldn't think they would, but just wondering.

2) If a breeder with a smaller program does not bile test for the same reasons listed above, do I still ask for a bile acid test and what if they decline? I also wouldn't think they would, but I would offer to pay for it.

To be very honest, I am quite shy when speaking or asking questions of breeders, I admit, I sometimes feel like I'm probing, and I know I shouldn't feel that way, nor have I ever been made to feel that way, it's just my nature but once the conversation continues then I get a little more comfortable. The only thing I am not shy about, is that the True breeder, loves and completely cares and is attentive to every fur-baby in their care, the boys, the girls and the pups, all of them. That is my very first heartfelt requirement.

After reading recently on here about liver shunt, I think I would not want to adopt (purchase) a pup without having the testing done. Is that on the right track?

I am so not ready to add a new addition, although I would love to, but I have my special two :wub::wub: and am still caring for my MIL, but who knows what the future holds and also I wish to learn more about this topic, in case I am ever in a position to help or advise someone else.

Thanks so much for taking the time to read this and for sharing your knowledge, it is much appreciated.
I posted this in the other thread (Christine's), but if it is to be deleted, I will repost it here:
I am going to disagree with your vet. My own vets had a similar reaction. My friendships with knowledgeable people, and my participation in this forum are the reason I know about bile acid tests at all. Most General Practice vets do not know a lot about the test either. I know that the test I had done most recently, they had to look up the procedures in the books. (And here again is the reason that the information is not widely shared among breeders. Many of them rely on their own vets for their recommendations and those vets do not as a routine suggest BA testing).

The truth is you do not need to test Mia and Leo. But the recommendation is to get it done to establish a baseline.

The way I worded it with my vets is that it is a problem in the breed and I am following recommendations.

As for buying from an Ethical Breeder, I think whether they test or not, they should be willing to answer your questions about BA to the extent of their ability. You and the breeder can agree to either have the test done before you take the pups home or soon after (at that 16 week age).

I agree with you that it can be difficult to broach this subject, but I think you will find that an Ethical breeder's response should make you feel glad you asked. I know when I spoke with the two breeders I worked with most recently, I felt that awkwardness when I asked questions about LS and GME and other health issues. I did not want to sound like I was presuming their dogs were anything other than perfect healthy pups; however, the responses they gave me when we talked reassured me. I felt better about both breeders for having made that step forward with them and seeing how they responded to my questions.
 

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I know you are talking about maltese, but it's just as important to have yorkies tested. I'm not positive, but I believe they are even more supseptable to liver problems.

Before I got Ava I had found a gorgeous little yorkie girl, she was 6 months old and 2 1/2 lbs, it wasn't the size as much as her sheer cuteness that attracted me. Anyway, I paid the breeder's vet to do a bile acid test as the breeder didn't think it was necessary. The numbers came back high enough that she would most likely have MVD. Not as bad as a shunt, and a special diet and supplements can keep their health in check. I passed on this pup and saved myself a ton of money having to buy food different from my other dogs.

The liver shunt operation is a big deal. Ask Kodie's mom - Kodie had it done. And my friend Elaine's Kodie (a yorkie) had it done also - he still has seizures now and then...and it's been about 5 years now.
This of course is your decision, and a personal one, but this is one thing that may be discouraging some breeders from testing. If pet owners react to MVD (a common problem in the breed 75-80% affected) in this way then it makes not knowing make more sense to some.

I am not suggesting that you did this, but many buyers will learn of a result like this and move on to another breeder who does not test at all to purchase their pup. So they pass on the breeder who knows and discloses and move to a breeder who does not test and does not know.

The fact is that special diets are not required for all MVD dogs. Most live completely normal lives and never get sick from anything related to their liver.
 

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Oh Sher, I'm so sorry, I had started a new thread as well on this topic. You can delete mine, and I will paste what I wrote on here. Thanks Sher. (I posted mine under everything else Maltese related, but yours is a much better place) Sorry for the confusion.

Here were my questions/comments:

I am sure there are countless threads here on this topic, so I hope it's okay to start a new one with some questions.

I never heard of liver shunt or bile acid testing until being a member of SM and still do not know much about it.

When I took Mia and Leo in for one of their early visits, I told my vet I wanted a bile acid test done. She looked so concerened and asked me WHY??? Are they showing any symptoms? She said they do not appear to be candidates for the testing and then we did have a discussion on this topic in reference to Mia and Leo. She felt the testing for them was unneccesary. I love my vet dearly and trusted and still trust her call on that.

Anyway, my real questions/thoughts on this topic are:

1) If in the future, I would adopt (purchase) a pup from a True breeder, who has been breeding for years, knows their lines inside/out, upside down, I would possibly feel comfortable if they said no they do not test, as they know their lines. But would it be wise for me to offer to pay for the test anyway and what if they decline? I wouldn't think they would, but just wondering.
Christine, I would never buy a Malt without the test .. now that I know about it! I got Claire from the type of breeder you describe in #1 and she paid for the Bile Acid test on Claire. I would have been glad to pay and would do so if the breeder didn't want to.
 

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In the other thread where I mentioned that the University of Pennsylvania was doing metabolic urine testing for possible portosystemic shunts, I wasn't sure JMM and I were talking about the same urine test. I asked Dr. Urs Giger at UPENN a couple of questions about the test and here's his response:



Dear Joy,

our metabolic screening test is based upon metabolite studies in urine used for hereditary metabolic diseases. It may suggest a shunt but cannot diagnose a shunt. It cannot discover carriers but only affecteds and not specifically.
It is not a DNA test and to the best of my knowledge there is no DNA test for portosystemic shunts.

By the way we are interested in hearing about Maltese who have eaten Chinese Chicken Jerky Treats and developed some kidney issues. We are working on characterizing this problem known as Fanconi Syndrome in the Maltese and a few other small breed dogs. Our metabolic screen is helpful for this purpose.

Sincerely
Urs Giger





 

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Hi Christine -- Thanks for asking some great questions. I can understand your vet's position given that most breeds do not have liver issues and therefore bile acid testing would only be done if a dog presented as "sick". Because of what I've learned about Maltese and liver issues, I would have had the bile acid testing done despite my vet's opinion. As Carina mentioned, having a baseline now when a pup is young and healthy could prove invaluable later in life. Baselines are so important in humans and are as important in animals.

In answering your questions, as a person looking to buy a pet, here's what I would do:

1. I, too, would not be uncomfortable if they are not testing puppies. I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test (generally runs $125 to $150). If the breeder refused to test I would walk away.

2. Just because it's a smaller, lesser known breeder, I would not see it as a red flag that he/she is not routinely bile acid testing puppies. Again, I would ask that a bile acid test be done on the puppy I wanted to purchase and I would offer to cover the cost of the test. If the breeder refused to test I would walk away.

I don't like asking the tough questions, either. And I really don't like answering them. But they are questions that deserve to be asked and deserved to be answered.

Now, from a breeder perspective, running bile acid tests and disclosing results can be pretty darn scary. I do bile acid test all my puppies at or slightly before 16 wks. old. I do have an indepth conversation with every puppy buyer and potential puppy buyer about liver issues in our breed and how I personally am addressing those issues. I do provide a new owner with a complete health history including bile acid results, a printout of the Liver Shunt/MVD article on the AMA website, and an offer to speak directly with the new owner's vet should the vet have questions or concerns about the bile acid results. My fear is always that the new puppy owner is going to bring the puppy to their vet, the vet is going to look at the bile acid results, and the vet is going to say either "Your breeder must have produced liver shunt before and that's why she is testing puppies now." or "You have a very sick dog on your hands." The "sick dog" situation has happened to me. Did the vet read the info I gave the new puppy owner? Did the new puppy owner even share that info with the vet? Who knows. All I know is that I got a call from the new puppy owner saying she brought her puppy in for preanesthetic bloodwork prior to his neuter, the vet (who was not the "regular" vet of this puppy owner) drew the blood and then read through the file, got to the bile acid results, and said the puppy is very sick and should have a liver biopsy done. Luckily the owner remained calm, said that she would be calling me to discuss the situation, and then would continue the discussion with the vet after the bloodwork results were in. She called me, we talked again about bile acid testing and results and what it all means, I sent her more info, and offered again to speak directly with her vet. She called me three days later to let me know that the puppy's bloodwork was normal, she talked with her regular vet who agreed with me that there was no liver issue, and assured the puppy owner that he would have a discussion with the "other" vet about liver issues. And just so you all know, the bile acid results for this particular puppy was in the high 20s.

I think as buyers and as breeders we are trying to do the right thing. Open, honest discussion goes a long way toward that end. And discussion has to be a two-way street.
 

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thanks for the info , it gives me some insight , aww soo scary :( i hope he does well in his surgery ..

so let me ask u this , there are bile test that can determine this before?

Liza, here's a link to the AMA Health pages: American Maltese Association Health Information

Once you get there, click on "Gastrointestinal" and then click on "Portosystemic Vascular Anomalies" to get to the writeup on liver shunt. It is a basic overview of Liver Shunt/MVD. The bile acid test can give you a very good idea if a puppy has a serious liver issue, further testing would then tell you what the issue is. Personally, if I was looking for a pet I would want to know that there is no shunt before I buy the puppy. If the puppy's results indicate MVD, but the puppy is at a good weight, normal activity level, bright eyed, etc., I would not be concerned about higher than normal bile acid values. Heck, my puppy will be in the same boat as most other Maltese!
 

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This of course is your decision, and a personal one, but this is one thing that may be discouraging some breeders from testing. If pet owners react to MVD (a common problem in the breed 75-80% affected) in this way then it makes not knowing make more sense to some.

I am not suggesting that you did this, but many buyers will learn of a result like this and move on to another breeder who does not test at all to purchase their pup. So they pass on the breeder who knows and discloses and move to a breeder who does not test and does not know.

The fact is that special diets are not required for all MVD dogs. Most live completely normal lives and never get sick from anything related to their liver.
:goodpost:
 

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The percentage of Maltese who have asymptomatic MVD is pretty high, as I understand it, right?

What makes breeder Bile Acid Testing tricky is if a dog tests high, and it turns out that the dog has asymptomatic MVD, then the buyer might pass up an otherwise healthy dog. With the large percentage of MVD dogs, a person might pass up several great puppies.

I learned Nikki had MVD when she was 6 months old. If she'd been Bile Acid Tested at 4 months by the breeder, I still wouldn't have known whether it was a shunt or MVD, unless further, more expensive testing was done. So how far does testing go? If a potential buyer still wants a puppy that tests high on Bile Acid Test, does the breeder or the buyer pay for a protein C test, or an ultrasound, or a nuclear scintography?

And what about those puppies who have tested high on bile acids but only have asymptomatic MVD and are perfect otherwise? What if nobody wants them?

Just some things to think about and discuss. I have no answers, just thoughts.
 

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This of course is your decision, and a personal one, but this is one thing that may be discouraging some breeders from testing. If pet owners react to MVD (a common problem in the breed 75-80% affected) in this way then it makes not knowing make more sense to some.

I am not suggesting that you did this, but many buyers will learn of a result like this and move on to another breeder who does not test at all to purchase their pup. So they pass on the breeder who knows and discloses and move to a breeder who does not test and does not know.

The fact is that special diets are not required for all MVD dogs. Most live completely normal lives and never get sick from anything related to their liver.
Carina, if I didn't already have three dogs here it wouldn't have mattered, but I see what Elaine goes through....three dogs with liver problems and two without.

You're right, MVD isn't a big problem, but the size of my house is :blush:. And if I don't want to have to feed someone inside a crate...it's easier that they can all enjoy the same food. Plus Abbey is a thief....she thinks everyone else has something better than her. :HistericalSmiley:
 

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Discussion Starter #17
The percentage of Maltese who have asymptomatic MVD is pretty high, as I understand it, right?

What makes breeder Bile Acid Testing tricky is if a dog tests high, and it turns out that the dog has asymptomatic MVD, then the buyer might pass up an otherwise healthy dog. With the large percentage of MVD dogs, a person might pass up several great puppies.

I learned Nikki had MVD when she was 6 months old. If she'd been Bile Acid Tested at 4 months by the breeder, I still wouldn't have known whether it was a shunt or MVD, unless further, more expensive testing was done. So how far does testing go? If a potential buyer still wants a puppy that tests high on Bile Acid Test, does the breeder or the buyer pay for a protein C test, or an ultrasound, or a nuclear scintography?

And what about those puppies who have tested high on bile acids but only have asymptomatic MVD and are perfect otherwise? What if nobody wants them?

Just some things to think about and discuss. I have no answers, just thoughts.
I was thinking the same thing. I think it really can be a tricky issue. It is not just a simple test with a black/white result.
 

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I've had 3 MVD Maltese, 1 of whom was sick with concurrent liver issues....none required special diet for the liver. Jonathan is 11 1/2 years old and has never had special diet or medications. A symptomatic MVD is an exception to the rule - an unusual occurrence. Back in the day when Jonathan was diagnosed it was liver biopsies. Today we have non-invasive tests like Protein C which only require a blood draw. I would not hesitate to purchase a Maltese with MVD. Nor would I look down upon a breeder who was breeding MVD dogs with the goal of better test results. Phenotype-to-phenotype is how we reduce hip dysplasia in big dogs...no reason not to respect the same principles with our liver dogs (plus this approach has been successful in other breeds).
 

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Tanner is an asymptomatic MVD dog. When I had the preanesthesia bloodwork done before his neuter, his ALT was in the high 300's. He was not neutered that day. Later, I had an ultrasound done (lucky for me the vet who did it trained under Dr. Center at Cornell), and she didn't see a shunt but recommended a biopsy which was done 4 years ago. Because I didn't get a definitive dx from the biopsy, I sent the tissue sample to Dr. Center & best we could determine, Tanner has MVD. I take him in 2 or 3 times a year for blood work & his ALT has ranged from a low of 129 to a high of 500.

I feed Tanner low protein canned food, i.e., 8% or less, & mix a few pieces of whatever kibbles the others are eating. He doesn't know what beef is, he only eats chickens. Also, he gets 1/4 tab of Marin daily. I tried Denosyl and he wouldn't touch them no matter how they were disguised. Feeding him a different food from the others really hasn't been a problem.

When I had his bile acids done, they were in the low 40's.

Tanner is now 6 years old. He weighs 8#s (he was a BYB boy) and is a happy, active, little boy. At one point, I was hoping to have him til he was 5; now he's 6 and I think/hope he'll be around a long, long time.
 

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Nikki's blood work has been perfect for over 2 years, and she'll be 3 in November. Her ALT numbers returned to normal about 6 months after her liver biopsy/MVD diagnosis, and they have been that way ever since.

She does not eat a special low-protein diet. She has no symptoms, and the vet thinks she is in perfect health.

What if I'd changed my mind about buying her, or returned her, just because of her bile acid test result? What a shame!
 
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