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I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy that is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.
 

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I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.

I understand, as I don't like surprises either. What I am concerned about is this: Since not every high BA test number means a shunt, things get complicated. May I ask: What is the next step if a puppy has a high BA number, and the buyer thinks they may still want the dog? Does the breeder do further testing themselves, or do they sell the dog and let the owner decide what to do next?
 

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I bile acid test puppies for three reasons: (1) so that I know what I am producing; (2) so that I know I am not selling a puppy with a liver shunt; and (3) so that if a puppy has higher than normal bile acid results I am the person who explains to the buyer what that all means. If a buyer chooses to walk away from the puppy is their right. But I'd rather be the person to break the news and explain and educate rather than have a buyer find out from a vet, a friend, or someone on the internet who may have far less breed specific knowledge than me. Just me ... I don't like bad surprises and will try to avoid them if at all possible. And to me the worst surprise of all would be to sell a puppy with a liver shunt, especially when there IS a non-invasive, reasonably inexpensive test known as a bile acid test that will tell me what I need to know beforehand so that I am not selling heartbreak.
Excellent post, Mary. :thumbsup:

Since Maltese have been identified by Dr. Center as one of the breeds highly affected by liver disease, there is just no good reason IMO for not having a BAT done on a puppy prior to its sale. Being afraid of the results is certainly not a good reason. To me, it is similar to being in a high risk group for AIDS and not getting a test to see if you are HIV positive out of fear.

Even if a potential buyer backs away from a sale based upon the results of the BAT, isn't that better than having a upset owner find out her puppy has MVD or a liver shunt a few months later and that her breeder could have had this simple, inexpensive test done prior to the sale? That can really damage a breeder's reputation.
 

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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.
Mary H and Carina THANK YOU so much for all that knowledge that you shared. I appreciate it so much. My vet actually knew about bile acid test, but was shocked at my asking, as though I spotted a problem with Mia and Leo. Almost like, why would I put them through that sort of look, when they were symptom free. But both of you and all of you sharing your experinces and knowledge have helped so much. I like the way you worded it to the vet Carina, that makes complete sense.

Suzan you bring up great points as well. Knowing how I am, and this may sound crazy, but regardless of the outcome of the test, I don't think I could walk away or turn the pup away, actually I know I wouldn't be able to, but I would be darn glad to know upfront, what to do and what to expect.

Thank you all so much for your valuable input.
 

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Excellent post, Mary. :thumbsup:

Since Maltese have been identified by Dr. Center as one of the breeds highly affected by liver disease, there is just no good reason IMO for not having a BAT done on a puppy prior to its sale. Being afraid of the results is certainly not a good reason. To me, it is similar to being in a high risk group for AIDS and not getting a test to see if you are HIV positive out of fear.

Even if a potential buyer backs away from a sale based upon the results of the BAT, isn't that better than having a upset owner find out her puppy has MVD or a liver shunt a few months later and that her breeder could have had this simple, inexpensive test done prior to the sale? That can really damage a breeder's reputation.
Marj, great points! I do wonder how it would be with a breeder who was not a good communicator and a buyer who had never heard of liver issues in Malts. I think it may take someone who is good with words and who can adequately explain the situation .. especially in a phone call or email when the buyer is in another town.

For some reason I had just thought of the test and that was that but really I think there is more to it if the results are not good or borderline.
 

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I understand, as I don't like surprises either. What I am concerned about is this: Since not every high BA test number means a shunt, things get complicated. May I ask: What is the next step if a puppy has a high BA number, and the buyer thinks they may still want the dog? Does the breeder do further testing themselves, or do they sell the dog and let the owner decide what to do next?
For me, the answer depends on the puppy itself. So now I'll share my whole story and hope that I don't lose you part way through. I got my first brood bitch hopeful in August 2006 as a 12 wk. old puppy before I knew much about liver shunt, MVD or bile acid testing. In October 2006 a breeder friend (the breeder of my Ch. male) had a puppy returned to her because it was diagnosed with a liver shunt. I knew of Dr. Center because of a rescue dog I had taken in in 2004 with a liver shunt. That dog's shunt was surgically repaired at Angell Animal Medical Center in Boston by a vet who years earlier was a colleague of Dr. Sharon Center at Cornell. He consulted with her while treating Mack, our rescue liver shunt dog. I also knew of Dr. Center's expertise with liver issues thanks to Jackie (JMM) who had been consulting with Dr. Center about her beloved little dog Mikey. So when my friend's puppy was returned for a supposed liver shunt I offered to contact Dr. Center. Dr. Center immediately contacted my friend and there started my education on liver issues. In November 2006 my friend and I drove to Cornell with all of her dogs plus two of mine, my 4-1/2 yr. old Ch. male and my 5-1/2 mo. old female. Brigid, the puppy with the alleged liver shunt did not, in fact, have a shunt. She had very high bile acid values (>100), but after a second ultrasound, a Protein C test, and a cholorectal scintigraphy she was diagnosed with asymptomatic MVD. She ultimately was spayed, placed in a pet home with a Cornell Vet School employee, eats a normal diet, is on no medication, and is at the Vet School on a regular basis, not because she is sick but because she gets to go to work with her human mom. My male has normal bile acid values (<5/18). My female has higher than normal bile acid values (11/68). What a bittersweet moment ... a normal male and abnormal female. My first question was "Is it safe to spay her?" knowing that it's the liver that processes out the anesthesia. The response I got from Dr. Center was "Why would you spay her? She is a normal, healthy, bright, active puppy at a good weight, does not have chronic episodes of diarrhea or vomiting, has normal CBC results, has no neurological issues. You should do exactly what you planned to do. Let her grow up and so long as she remains healthy breed her to your normal male. If you cull everything out of your breed with higher than normal bile acid values you will seriously compromise the gene pool. Bile acid test all puppies and do not sell anything with breeding rights for at least two generations." I asked about having a Protein C test done and was told that I could if I wanted to but that the Protein C test was going to tell me what I already knew just by observation ... I have a healthy asymptomatic MVD dog. She grew up, has always been healthy, has had regular wellness exams, and has been bred twice. Her first litter, sired by my male, produced a singleton girl with normal bile acid values. Her second litter, sired by a different male who also had normal bile acid values, produced 3 boys and 1 girl, two of whom have normal bile acid results, one had just slightly higher than normal values (high 20s), and one with what I consider higher values (low 60s). None of the puppies had Protein C tests done as I felt it was not necessary ... they were all happy, healthy, active puppies and are now happy, healthy, active dogs. If I felt that any of the puppies was not quite "right" I would have done a Protein C test without hesitation. When I sell my puppies, I provide the new owner with a complete health history. I spend a great deal of time discussing liver issues and sharing my knowledge. Should the owner want a Protein C test done, unless the puppy is exhibiting signs of symptomatic MVD, then I believe it is the owner's responsibility to pay for any further testing. If the puppy starts showing chronic symptoms of MVD, then I would offer to have my vet do a Protein C test and I would pay for the testing. Should the Protein C test results indicate that further testing should be done then I would also pay for that so long as I have the vet or vet school of my choosing do the testing. I have spoken at length with more than a couple of breeders who have in their lifetime produced a liver shunt puppy. They have all confirmed to me that they knew by 8-9 wks of age that something was not quite right with the puppy and therefore held on to it until it was of an age where further testing would provide more insightful results. I know my puppies because I spend every free waking moment with them from birth to 16 wks. I would know if something was not quite right and would never dream of withholding necessary diagnostic testing. I hope this helps to answer your questions and feel free to keep the dialogue going.
 

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For me, the answer depends on the puppy itself. So now I'll share my whole story and hope that I don't lose you part way through. I got my first brood bitch hopeful in August 2006 as a 12 wk. old puppy before I knew much about liver shunt, MVD or bile acid testing. In October 2006 a breeder friend (the breeder of my Ch. male) had a puppy returned to her because it was diagnosed with a liver shunt. I knew of Dr. Center because of a rescue dog I had taken in in 2004 with a liver shunt. That dog's shunt was surgically repaired at Angell Animal Medical Center in Boston by a vet who years earlier was a colleague of Dr. Sharon Center at Cornell. He consulted with her while treating Mack, our rescue liver shunt dog. I also knew of Dr. Center's expertise with liver issues thanks to Jackie (JMM) who had been consulting with Dr. Center about her beloved little dog Mikey. So when my friend's puppy was returned for a supposed liver shunt I offered to contact Dr. Center. Dr. Center immediately contacted my friend and there started my education on liver issues. In November 2006 my friend and I drove to Cornell with all of her dogs plus two of mine, my 4-1/2 yr. old Ch. male and my 5-1/2 mo. old female. Brigid, the puppy with the alleged liver shunt did not, in fact, have a shunt. She had very high bile acid values (>100), but after a second ultrasound, a Protein C test, and a cholorectal scintigraphy she was diagnosed with asymptomatic MVD. She ultimately was spayed, placed in a pet home with a Cornell Vet School employee, eats a normal diet, is on no medication, and is at the Vet School on a regular basis, not because she is sick but because she gets to go to work with her human mom. My male has normal bile acid values (<5/18). My female has higher than normal bile acid values (11/68). What a bittersweet moment ... a normal male and abnormal female. My first question was "Is it safe to spay her?" knowing that it's the liver that processes out the anesthesia. The response I got from Dr. Center was "Why would you spay her? She is a normal, healthy, bright, active puppy at a good weight, does not have chronic episodes of diarrhea or vomiting, has normal CBC results, has no neurological issues. You should do exactly what you planned to do. Let her grow up and so long as she remains healthy breed her to your normal male. If you cull everything out of your breed with higher than normal bile acid values you will seriously compromise the gene pool. Bile acid test all puppies and do not sell anything with breeding rights for at least two generations." I asked about having a Protein C test done and was told that I could if I wanted to but that the Protein C test was going to tell me what I already knew just by observation ... I have a healthy asymptomatic MVD dog. She grew up, has always been healthy, has had regular wellness exams, and has been bred twice. Her first litter, sired by my male, produced a singleton girl with normal bile acid values. Her second litter, sired by a different male who also had normal bile acid values, produced 3 boys and 1 girl, two of whom have normal bile acid results, one had just slightly higher than normal values (high 20s), and one with what I consider higher values (low 60s). None of the puppies had Protein C tests done as I felt it was not necessary ... they were all happy, healthy, active puppies and are now happy, healthy, active dogs. If I felt that any of the puppies was not quite "right" I would have done a Protein C test without hesitation. When I sell my puppies, I provide the new owner with a complete health history. I spend a great deal of time discussing liver issues and sharing my knowledge. Should the owner want a Protein C test done, unless the puppy is exhibiting signs of symptomatic MVD, then I believe it is the owner's responsibility to pay for any further testing. If the puppy starts showing chronic symptoms of MVD, then I would offer to have my vet do a Protein C test and I would pay for the testing. Should the Protein C test results indicate that further testing should be done then I would also pay for that so long as I have the vet or vet school of my choosing do the testing. I have spoken at length with more than a couple of breeders who have in their lifetime produced a liver shunt puppy. They have all confirmed to me that they knew by 8-9 wks of age that something was not quite right with the puppy and therefore held on to it until it was of an age where further testing would provide more insightful results. I know my puppies because I spend every free waking moment with them from birth to 16 wks. I would know if something was not quite right and would never dream of withholding necessary diagnostic testing. I hope this helps to answer your questions and feel free to keep the dialogue going.
Thanks so much for taking the time out to explain this. It does help very much. Knowing what I know now, I am not concerned about asymptomatic MVD and don't consider it to be a huge issue. I just wanted some clarification because there are others who are new to this issue, and I don't want them to be frightened away from a wonderful pup they may be considering. Thank you.
 

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I want to thank MaryH and Jackie (JMM) for sharing their hard won knowledge with us. I should point out that Mary is in large part responsible for much of the information that is out there within the AMA on this issue.

I also want to make this point. At SM we have benefited from the wealth of information they have shared. Many breeders do not have as much access to these two ladies as we do here on this forum.

It is one of the great things about SM that we should value.

Thanks so much for taking the time out to explain this. It does help very much. Knowing what I know now, I am not concerned about asymptomatic MVD and don't consider it to be a huge issue. I just wanted some clarification because there are others who are new to this issue, and I don't want them to be frightened away from a wonderful pup they may be considering. Thank you.
Thank you Suzan for making this point. This is one of the things that often worries me when Bile Acid tests are brought up. Though we have a lot of knowledge here, there are many people who are "afraid" of owning a dog with elevated numbers. As MaryH pointed out in her personal story, and you pointed out in yours, MVD is not something that should have people run away in terror. Obviously, it would be better if our breed did not have this problem as it is related to the much scarier liver shunts, but for most pet owners MVD will never be a true cause for concern.
 

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It will always be at the forefront of my thoughts just why I learned about shunts and MVD in Maltese. When my first dogs were diagnosed, MVD was still a relatively new diagnosis. Nobody was able to tell me what would happen to my dogs until we ended up on a 6+ hour drive for some last miracle.
Dr. Center told me I had to understand what was wrong in order to understand how to help my dog. Down I sat at the microscopes with a couple of vet students and a resident. Dr. Center took Mikey's picture the first time we visited. She said she saved all of them. I was still shocked to hear years later on one of Mary's visits that Dr. Center remembered my Mikey Man.
Mikey was a rare case. We lost him at just 5 years of age. Unfortunately, his lines produced other dogs who died of their shunts or required chronic medical care.
Mikey's lesson to me was not to run from another MVD dog...but to realize how RARE sick MVD dogs are. And that the sick ones usually have some concurrent condition. And yes, I purchased another pup with MVD who is normal, happy, and healthy.
Mikey, my "original" Dust Mop with Drive
 

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It will always be at the forefront of my thoughts just why I learned about shunts and MVD in Maltese. When my first dogs were diagnosed, MVD was still a relatively new diagnosis. Nobody was able to tell me what would happen to my dogs until we ended up on a 6+ hour drive for some last miracle.
Dr. Center told me I had to understand what was wrong in order to understand how to help my dog. Down I sat at the microscopes with a couple of vet students and a resident. Dr. Center took Mikey's picture the first time we visited. She said she saved all of them. I was still shocked to hear years later on one of Mary's visits that Dr. Center remembered my Mikey Man.
Mikey was a rare case. We lost him at just 5 years of age. Unfortunately, his lines produced other dogs who died of their shunts or required chronic medical care.
Mikey's lesson to me was not to run from another MVD dog...but to realize how RARE sick MVD dogs are. And that the sick ones usually have some concurrent condition. And yes, I purchased another pup with MVD who is normal, happy, and healthy.
Mikey, my "original" Dust Mop with Drive
I remember following Mikey's story on other forums. Thank you and others who have helped to shine the light on liver disease in Maltese.

Mikey will always be the face of liver disease to me. A brave and exceptional boy who captured all our hearts.

Do you still have that picture of Mikey in his pumpkin costume?
 

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awww, jackie, i love seeing pictures of your mikey man. thank you and mary and carina for all of your insight, we are so lucky to have you here on SM.

my experience with 2 MVD dogs was that they had very high bile acid values (>130). at the time of their bile acid tests, they also had elevated ALTs, but for the last 18 months stuart's ALTs have been in the normal range. i am not afraid of an MVD dog and i don't make any assumptions based on the bile acid numbers.

sooooo, when i think about BATs being recommended at 16 weeks by Dr. Center, and so many maltese having high BATs, why wouldn't it be more prudent (and less invasive) if breeders just did Protein C tests??? new owners can get the BAT at 16 weeks or older for a baseline, but at least the breeder has pretty much ruled out a liver shunt before placing the puppy.
 

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sooooo, when i think about BATs being recommended at 16 weeks by Dr. Center, and so many maltese having high BATs, why wouldn't it be more prudent (and less invasive) if breeders just did Protein C tests??? new owners can get the BAT at 16 weeks or older for a baseline, but at least the breeder has pretty much ruled out a liver shunt before placing the puppy.
The Protein C test was never intended to be a stand alone diagnostic test for liver function; instead when used in conjunction with bile acid testing it helps to differentiate between PSVA and MVD in dogs whose bile acid results are abnormal. The majority of dogs with confirmed MVD also show high Protein C activity whereas dogs with confirmed PSVA show low Protein C activity. Protein C activity on its own does not tell anyone what liver function is and could be high or low for any other number of reasons. It's more like a law of averages scenario -- if bile acids are X and Protein C is Y, then we can reasonably conclude with an accuracy of about 95% that this dog is diagnosed with Z. If I were selling a puppy I would never feel comfortable saying that the puppy does not have serious liver issues based solely on a Protein C test. If I were buying a puppy I would never feel assured that there were no serious liver issues based solely on a Protein C test. If a puppy is tested at 12 wks. and has higher than normal bile acid values chances are at 16 wks. it is still going to have higher than normal bile acid values. If at 12 wks. a puppy has sky high bile acid values at least the breeder is aware and can cancel or postpone a sale until further testing is done.
 

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This thread is excellent---makes me excited to be on the SM forum! Thanks to Mary & others who take time to share their knowledge w/us.
As mentioned earlier 18 yrs. ago I had a seriously ill dog, Kirby, w/shunting. I knew very early on that something was wrong, but after seeing numerous vets in Europe I finally took him to the US where he was diagnosed at Colorado State vet school. He was operated, was on meds for seizures his entire life (phenabarb), had a consistently low protein diet and lived to be an old man! He did have some health issues throughout his life---but he was a tough little fighter and always won---until we finally had to put him to rest---by then he was also blind and deaf. Oh, but so loved!
We still miss him and that was almost 18 yrs. ago now.
One question I have been thinking about? Is it possible that the high-protein dog foods that we love to feed our dogs contribute to this predisposition? Any thoughts here?
 

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This thread is excellent---makes me excited to be on the SM forum! Thanks to Mary & others who take time to share their knowledge w/us.
As mentioned earlier 18 yrs. ago I had a seriously ill dog, Kirby, w/shunting. I knew very early on that something was wrong, but after seeing numerous vets in Europe I finally took him to the US where he was diagnosed at Colorado State vet school. He was operated, was on meds for seizures his entire life (phenabarb), had a consistently low protein diet and lived to be an old man! He did have some health issues throughout his life---but he was a tough little fighter and always won---until we finally had to put him to rest---by then he was also blind and deaf. Oh, but so loved!
We still miss him and that was almost 18 yrs. ago now.
One question I have been thinking about? Is it possible that the high-protein dog foods that we love to feed our dogs contribute to this predisposition? Any thoughts here?

Good question.

I am no medical expert at all, but IMO, I don't think that food has much to do with the genetic aspect of a liver shunt.

IMO, the fear of high protein food, in general, is overblown - IF you feed your dog high-quality protein, and IF you provide enough water.

I am much more suspect of the QUALITY of the protein and QUALITY of the fats in commercial dog foods, than protein itself. I may be wrong, but I don't think that there have been any studies done on hereditary liver shunts and diet. If anyone is aware of one, then please let us know.

BTW, Nikki has been eating a good amount of protein since I started home cooking for her, and her liver values are normal. She doesn't have a shunt, though, just MVD.
 

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I would agree Susan, but I am thinking long-term---say generations back? We know that what we feed our dogs, or what people eat does make a difference in how healthy the next generation is, and the next, and the next. . . . (you get the idea :)).
Kirby and I were in a study done by the U. of CO. way back then---it had already been determined that a large degree of small breed dogs are genetically liable for liver issues.
I am aware that this is a different issue but in South Africa more babies are born w/primary liver cancer than any country in the world and it is suspected that this is loosely connected w/FAS (fetal alcohol syndrome)----over time. Just wondering about consumption/environment/etc. over the l o n g haul!
'Thrilled your Nikki is doing so very well!
 

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I hate to open up a can of worms here, but I also think that the reason why liver disease in small dogs is so common might just be due to a generation of over-vaccinating with the same exact dose that a Great Dane receives.
 

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I would agree Susan, but I am thinking long-term---say generations back? We know that what we feed our dogs, or what people eat does make a difference in how healthy the next generation is, and the next, and the next. . . . (you get the idea :)).
Kirby and I were in a study done by the U. of CO. way back then---it had already been determined that a large degree of small breed dogs are genetically liable for liver issues.
I am aware that this is a different issue but in South Africa more babies are born w/primary liver cancer than any country in the world and it is suspected that this is loosely connected w/FAS (fetal alcohol syndrome)----over time. Just wondering about consumption/environment/etc. over the l o n g haul!
'Thrilled your Nikki is doing so very well!
Yes, agreed. I still don't think it isn't high protein, per se, that is causing a lot of issues. I think it is poor quality protein, chemically-laden, rancid fats, and poor quality vitamin mixes from China (hate to single out one country, but that's where 99% of vitamins are from) in dog foods that are causing disease in dogs.

I would imagine the same could be said for humans, too, regarding processed people food.
 

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Good question.

I am no medical expert at all, but IMO, I don't think that food has much to do with the genetic aspect of a liver shunt.
I agree, Suzan.

May I suggest we stick to the topic of liver shunts and bile acids in this thread so Sher doesn't haven't to start yet another thread because this one went off topic, too? LOL
 

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Since this subject just came up in another thread, I guess it's a good time to bring it up here. Many vets are under the misconception that fasting is required before a bile acids test. That is inaccurate.

"It is no longer recommended to fast for 12 hours before first collection or meal."

http://www.ytca.org/health_CenterQue...xpress2010.pdf

"Dogs DO NOT need to be fasted for 12-hours to conduct this test."

PSVA and MVD Research Summary
 
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