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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.
Dr. Karen Tobias' research at U of T has raised some questions about the accuracy of the Protein C test:


Protein C Test
by
Dr. Karen Tobias






Question: How good is the Protein C test?


Answer: We're re-evaluating the Protein C test here at UT. In the original Cornell paper, normal dogs had Protein C activity between about 70% and 130%; 95% of dogs with MVD/CPH (microvascular dysplasia secondary to congenital portal hypoplasia) had protein C's in that range; and 88% of dogs with shunts dogs had Protein C's below 70%. Most dogs with liver failure had low numbers. Dogs with other liver diseases fell in the normal or abnormal range. So, the test is not completely accurate and should be coupled with other tests to be sure there's a shunt. Currently our dogs with MVD/CPH have very low Protein Cs and we don't know if it is the way we are running our test or whether we are seeing dogs with MVD/CPH that are much more severely affected.

www.yorkieangelpatrol.com/ProteinCTest.doc
 

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Sandi and Susan, thanks for raising such good questions. Certainly provides some food for thought ... no pun intended. While we know that environmental factors play into genetics over time in humans as well as animals, I have heard nothing about diet or vaccinations playing a part in the genetics behind the vascular issues in our dogs. Maltese are a very very old breed, around long before vaccinations and commercially processed food. And liver shunt is not new either. It may not have had a "real name" 40 years ago and diagnostics were not what they are now but liver shunt was around. It's thought now that "Fading Puppy Syndrome" (unexplained death of puppies from birth to 3 weeks old or so) might actually be puppies with liver shunt. Necropsies that have been performed on puppies that young were generally inconclusive as to cause of death. There is also the theory that one of the reasons why Maltese have such small litters is that puppies with shunts die in utero and are resorbed.

I love it when someone asks questions like yours because it keeps us all thinking and learning and, as always, discoveries start with someone thinking.
 

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I just want to say thank you for this thread. I can't believe how fortunate we are to have people that are so knowledgeable here and are willing to spend their free time sharing that knowledge with us. Jackie, Carina and Mary are invaluable and I am very grateful to and for them.

I had been under the misconception as well that you needed to feed an asymptomatic MVD dog a special diet. Mary has selflessly spent hours on the phone with me calming my fears and answering my questions. When I adopted Jett, his levels were all perfect and have been with each CBC. However again I was unaware that you could still have an asymptomatic MVD dog with perfect ALT and AST levels and the BA test would be high. Had I known, I would have had a BA test performed for a baseline. After talking with Mary, she has calmed this overly worrier down and advised me that at this time it really isn't necessary to do a BA test. We suspect that Jett is also asymptomatic MVD. But now that I know that, if ever he should get sick and a BA Test is done and his level is high, it most likely always has been.

So after reading about the Protein C test, just for clarification for those whose vet may say that the next step in testing after a CBC would be a Protein C, a Protein C Test is only indicated after the BA test comes back high and is used to help determine if we are dealing with MVD or PSVA, correct? Sorry but I'm not familiar with the acronym PSVA. What is that?

So if a breeder is really spending the kind of time with the puppies that they should be to fully evaluate them, (in other words does not have an outrageously high # of dogs in their breeding program and too many litters at one time) and you can usually tell by 8 or 9 weeks of age that a puppy is not quite right and are suspecting shunt, then how is it that a reputable breeder sells a dog at 12 + weeks of age with liver shunt? Can a LS puppy not show signs until an older age? Now I'm not saying that just because a breeder has had a puppy with LS they are not a reputable breeder. They can only do so much to try to ensure the healthiest puppies. I am no longer fearful of anyone getting a puppy knowing they have asymptomatic MVD, but just hate the heartache of someone getting a puppy with LS. So even if a breeder is not doing BA tests on their puppies, they should be able to tell if there is something not quite right (suspecting LS) before 12 weeks, correct?


Edited to add...OOPS!! Just went to the link on the AMA website Mary posted and now know what PSVA is. ::blushing a LOT right now::
 

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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.
now i am a little confused: why would you test a 12 week old puppy when the recommendation from dr. center is 16 weeks? also, what testing would you recommend next if a 16 week old puppy has high bile acids?

also, i am not suggesting that a puppy owner shouldn't have a baseline BAT done at 16 weeks or a little older, they should along with a CBC and other wellness check when they get their puppy and before any vaccines are administered.
 

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now i am a little confused: why would you test a 12 week old puppy when the recommendation from dr. center is 16 weeks? also, what testing would you recommend next if a 16 week old puppy has high bile acids?

also, i am not suggesting that a puppy owner shouldn't have a baseline BAT done at 16 weeks or a little older, they should along with a CBC and other wellness check when they get their puppy and before any vaccines are administered.
Tami, Dr. Center's revised protocol is to have a second BAT at six months. I would assume that would be a failsafe for puppies who had a BAT done a little earlier or puppies whose organs develop a little more slowly.

http://www.ytca.org/health_CenterQuestionsExpress2010.pdf

Dr. Center has always stressed the importance of having a BAT before the puppy goes to her new home.
 

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Tami, Dr. Center's revised protocol is to have a second BAT at six months. I would assume that would be a failsafe for puppies who had a BAT done a little earlier or puppies whose organs develop a little more slowly.

http://www.ytca.org/health_CenterQuestionsExpress2010.pdf

Dr. Center has always stressed the importance of having a BAT before the puppy goes to her new home.

I'm pretty sure my understanding of Dr. Center's revised protocol of having another BA Test at 6 months is for those who are breeding and considering using that puppy in their breeding program. I don't think that is for the pet owner. I think she is recommending a BA test for the pet owner (if the breeder hasn't done it, soon after 16 weeks for a base line only. It does not need to be redone after 6 months.
 

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I'm pretty sure my understanding of Dr. Center's revised protocol of having another BA Test at 6 months is for those who are breeding and considering using that puppy in their breeding program. I don't think that is for the pet owner. I think she is recommending a BA test for the pet owner (if the breeder hasn't done it, soon after 16 weeks for a base line only. It does not need to be redone after 6 months.
Hmmm....I don't see where Dr. Center makes that distinction at her YTCA seminar last October.

3. What is the best age to have a puppy/dog bile acid tested?

16 weeks and again at 6 months.

Are you referring to another study or article?

Maybe MaryH has attended one of her recent seminars and can clarify.
 

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Hmmm....I don't see where Dr. Center makes that distinction at her YTCA seminar last October.

3. What is the best age to have a puppy/dog bile acid tested?

16 weeks and again at 6 months.

Are you referring to another study or article?

Maybe MaryH has attended one of her recent seminars and can clarify.
I got that from Mary H's post in the other thread.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Quote:
Originally Posted by
Ladysmom
Dr. Center has been recommending for years that all puppies have a bile acids test before going to their new homes. If all breeders were doing this routinely, it would save new owners a lot of heartache and expense.

2: The best approach to avoid "over diagnosis" is to test bile acids in young dogs of highly affected breeds (at 4 mths of age) while they are clinically healthy and before they are adopted into pet homes. Highly affected breeds include: Yorkshire Terrier, Cairn Terrier, Maltese, Tibetan Spaniels as well as many other "terrier" type breeds (Miniature Schnauzer, Lhasa Apso, Shih Tzu, Dachshund, Bichon Frise, Pekingese, Toy and Miniature Poodles, and Havanese and others).

Dr. Center has recently revised her protocol and now recommends a BAT be done at 16 weeks and again at six months.

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



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Quote:
Originally Posted by Cosy
While that's all well and good, most pups are sold at three months, not four months. Something has to give here. The AMA needs to adjust the age if we are ever to get a grip on this awful disease.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

We all need to remember before putting out certain info that we should know the context in which the advice was given. The better time to run a bile acid test is when the puppy is a bit older, at or after 16 wks. But we have also been advised that testing a younger puppy, say at 12 wks., is better than not testing at all. The advice about testing again at 6 mos. or after was advice given to BREEDERS regarding dogs that they are considering keeping for BREEDING PURPOSES. This was never meant for puppies who were tested at an appropriate age and placed on a spay/neuter contract.

AMA cannot mandate testing, let alone the timing for it. I do keep my puppies until they are 16 wks. old and I do bile acid test all of them before they leave my house. THAT MAKES ME A BIT OF A CONTROL FREAK BUT DOES NOT NECESSARILY MAKE ME A BETTER BREEDER THAN SOMEONE WHO DOES NOT TEST THEIR PUPPIES. I don't have the benefit of 20 years' worth of breeding experience behind me so I cannot say "I've bred for X years and have never produced a shunt." I am relatively new to breeding, I don't have the luxury of several generations of related dogs to work with, so consequently I use the only tool I have available to me ... the bile acid test. I know and highly respect certain breeders who do not test every puppy. But they DO test all of their breeding stock, they have been breeding for years, and they will absolutely test a puppy if the purchaser wants the puppy tested before the purchase takes place. Responsibility is a two-way street, especially here on this forum where there is probably more good breed-specific info on liver issues than you will find anywhere else on the internet. Buyers as much as breeders should be wanting bile acid testing done on their potential new bundle of joy.
 

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now i am a little confused: why would you test a 12 week old puppy when the recommendation from dr. center is 16 weeks? also, what testing would you recommend next if a 16 week old puppy has high bile acids?

also, i am not suggesting that a puppy owner shouldn't have a baseline BAT done at 16 weeks or a little older, they should along with a CBC and other wellness check when they get their puppy and before any vaccines are administered.
What Dr. Center said to us at her seminar at the NJ National was that the preferred time for testing is 16 wks. BUT if a puppy is being sold at 12 wks. it is still better to test then than not at all. One is likely to get a more accurate bile acid value on a more mature liver. BUT, if a breeder is going to sell a puppy at 12 wks. of age it is still better to test then than not to test at all.

An example -- As a rule, I keep my puppies until I can test at 16 wks. old. However, I am selling a puppy to someone who lives out of state and will be vacationing here in my area when the puppy is 12 wks. old. Personally, I'd rather place the puppy at 12 wks. knowing it will fly home in the cabin of the plane rather than wait 4 more wks. and ship the puppy as cargo. So I'm going to test that puppy at 12 wks. If, say, I get a bile acid value of 40 and by all appearances the puppy is healthy, well, not a huge concern as I'm placing the puppy in a pet home. Waiting to test at 16 wks. or even at 6 mos. I might have gotten the same value, a bit lower, or a bit higher but generally there are not huge swings. But what if the bile acid value is 150 at 12 wks? I'd be postponing the sale until the puppy is more mature to get a more accurate value which would help me to decide whether or not to pursue further testing. If the puppy was one that I was thinking of keeping for breeding I would wait to test a mature liver. The variation at an older age might be one more factor in deciding whether I keep that puppy as a future hopeful in my breeding program. There are a number of good reasons why breeders sell puppies at 12 wks. old and I still think it is better to test then to try to avoid surprise or heartbreak.

At whatever age, if a puppy has extremely high bile acid values (greater than 100) I personally would do a Protein C test next. If a puppy has moderately high bile acid values (50-99) I would think about doing a Protein C test after taking into consideration other factors ... weight, activity level, occurrences of diahrrea and/or vomiting, behavior after meals, neurological symptoms, etc.
 

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Hmmm....I don't see where Dr. Center makes that distinction at her YTCA seminar last October.

3. What is the best age to have a puppy/dog bile acid tested?

16 weeks and again at 6 months.

Are you referring to another study or article?

Maybe MaryH has attended one of her recent seminars and can clarify.

:smilie_tischkante: I'm losing my patience ... :smilie_tischkante:

What you keep referencing (and putting your own spin on) is a synopsis of a seminar given to breeders for breeders. Nowhere in that synopsis is there discussion about pets. I can't spend any more time explaining this because my head is starting to hurt.
 

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I just want to say thank you for this thread. I can't believe how fortunate we are to have people that are so knowledgeable here and are willing to spend their free time sharing that knowledge with us. Jackie, Carina and Mary are invaluable and I am very grateful to and for them.
...
So if a breeder is really spending the kind of time with the puppies that they should be to fully evaluate them, (in other words does not have an outrageously high # of dogs in their breeding program and too many litters at one time) and you can usually tell by 8 or 9 weeks of age that a puppy is not quite right and are suspecting shunt, then how is it that a reputable breeder sells a dog at 12 + weeks of age with liver shunt? Can a LS puppy not show signs until an older age? Now I'm not saying that just because a breeder has had a puppy with LS they are not a reputable breeder. They can only do so much to try to ensure the healthiest puppies. I am no longer fearful of anyone getting a puppy knowing they have asymptomatic MVD, but just hate the heartache of someone getting a puppy with LS. So even if a breeder is not doing BA tests on their puppies, they should be able to tell if there is something not quite right (suspecting LS) before 12 weeks, correct?
Thank you Crystal, but I would not know anything about this if it were not for the knowledge shared by MaryH and Jackie. Even what I have learned from my vet has ultimately been insignificant or incomparable/incompatible with their expertise.

I think Mary answered the rest of your questions, but on the topic of what a breeder may or may not recognize I would say that it is true that often there are signs and if breeders do not spend enough time with their dogs they may miss them, but it is a very case by case situation and that would not be true all the time. Yes, a puppy may not display clear signs until an older age.

In the case of Finnegan and Rocco, one thing that might raise a red flag for me is the dramatic difference in size. A 2 pound pup and a 6 pound pup in the same litter can certainly happen, but any 2 pound pup would cause me grave concern that something might not be quite right.

now i am a little confused: why would you test a 12 week old puppy when the recommendation from dr. center is 16 weeks? also, what testing would you recommend next if a 16 week old puppy has high bile acids?

also, i am not suggesting that a puppy owner shouldn't have a baseline BAT done at 16 weeks or a little older, they should along with a CBC and other wellness check when they get their puppy and before any vaccines are administered.
I think the main reason that a pup might be tested at 12 weeks is the issue of the age when most breeders release their puppies. Frankly, waiting until 16 weeks is not something many breeders or pet owners want to do, for a variety of reasons. So then you are left with the question of should the test be done at 12 weeks before the pup leaves home, or at 16 once the family has already bonded with the pup.

I personally would be willing to take home a 12 week old pup and test at 16. But that is part of the individual discussion and decisions that each breeder and buyer must go through.


I'm pretty sure my understanding of Dr. Center's revised protocol of having another BA Test at 6 months is for those who are breeding and considering using that puppy in their breeding program. I don't think that is for the pet owner. I think she is recommending a BA test for the pet owner (if the breeder hasn't done it, soon after 16 weeks for a base line only. It does not need to be redone after 6 months.
As Mary has said, this was in a presentation to Breeders. So Dr. Center's recommendations targeted them. It does not need to be redone for pets at 6 months.
 

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I got that from Mary H's post in the other thread.



We all need to remember before putting out certain info that we should know the context in which the advice was given. The better time to run a bile acid test is when the puppy is a bit older, at or after 16 wks. But we have also been advised that testing a younger puppy, say at 12 wks., is better than not testing at all. The advice about testing again at 6 mos. or after was advice given to BREEDERS regarding dogs that they are considering keeping for BREEDING PURPOSES. This was never meant for puppies who were tested at an appropriate age and placed on a spay/neuter contract.

That seems to contradict what I have read from Dr. Center. This is Dr. Center's most current bile acids protocol linked on the Yorkshire Terrier Club of America website. The recommendation to test again at six months is included in the basic protocol with no qualifications for dogs used for breeding.

http://www.ytca.org/health_biletestproced.doc-1.pdf

The YTCA website is a great source of up to date information on liver shunts since the breed is so highly affected by them. Yorkies are 36 times more likely to be born with a shunt than all other breeds combined.

There are copies of a recent letter from Dr. Center to the club updating the results of her research study, too.
 

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In the case of Finnegan and Rocco, one thing that might raise a red flag for me is the dramatic difference in size. A 2 pound pup and a 6 pound pup in the same litter can certainly happen, but any 2 pound pup would cause me grave concern that something might not be quite right.
That's what I was thinking. Yet another reason why I don't understand why people are truly wanting teeny tiny ones and the runts of the litter. No a teeny tiny does not automatically indicate LS, but I always worry when someone announces they have a new baby and it's extremely small.

That seems to contradict what I have read from Dr. Center. This is Dr. Center's most current bile acids protocol linked on the Yorkshire Terrier Club of America website. The recommendation to test again at six months is included in the basic protocol with no qualifications for dogs used for breeding.

http://www.ytca.org/health_biletestproced.doc-1.pdf

The YTCA website is a great source of up to date information on liver shunts since the breed is so highly affected by them. Yorkies are 36 times more likely to be born with a shunt than all other breeds combined.

There are copies of a recent letter from Dr. Center to the club updating the results of her research study, too.
Seriously? Marj are you not seeing the above posts by Mary H and Carina?
 

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Seriously? Marj are you not seeing the above posts by Mary H and Carina?
Crystal, I have read the posts by Mary and Carina. Again, they seem to contradict the current protocol verbatim from Dr. Center posted on the YTCA website.

I am not trying to be argumentative. With all due respect to Mary and Carina, I personally would prefer to follow a protocol set out by Dr. Center herself rather than someone else's interpretation of it.

I suggest we agree to disagree on this one and move on.
 

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Crystal, I have read the posts by Mary and Carina. Again, they seem to contradict the current protocol verbatim from Dr. Center posted on the YTCA website.

I am not trying to be argumentative. With all due respect to Mary and Carina, I personally would prefer to follow a protocol set out by Dr. Center herself rather than someone else's interpretation of it.

I suggest we agree to disagree on this one and move on.
Marj,

I think the point you are missing is that you are taking it out of context. The context in which those recommendations were given was when Dr. Center was speaking to breeders.

If it were your own decisions regarding your own pets then I would not be concerned and happy to move on and agree to disagree as you say. It is not a big deal to run a BA test again. However, when you post here that this should be done on all pets at 6 months I think you need to understand that you could be costing people collectively a small fortune.
 

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Marj,

I think the point you are missing is that you are taking it out of context. The context in which those recommendations were given was when Dr. Center was speaking to breeders.
Could someone please show me where in Dr. Center's most current bile acid protocol it says anything about it being only for puppies being used for breeding? Or has any qualifications?

This was not taken from a seminar. It is a pinned link on the YTCA website, Health Committee section, entitled Bile Acid Testing: Optimal Conditions on Dr. Center's letterhead.

http://www.ytca.org/health_biletestproced.doc-1.pdf
 

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Discussion Starter #60 (Edited)
Could someone please show me where in Dr. Center's most current bile acid protocol it says anything about it being only for puppies being used for breeding? Or has any qualifications?

This was not taken from a seminar. It is a pinned link on the YTCA website, Health Committee section, entitled Bile Acid Testing: Optimal Conditions on Dr. Center's letterhead.

http://www.ytca.org/health_biletestproced.doc-1.pdf
This link is great. It explains everything so simply and in such a straightforward way.

I do hate to see this thread get bogged down on one point but there is nothing in this link at all about breeding stock, etc. The way it is written, it sounds like this is general advice. So this makes for confusion regarding whether the information just wasn't written with all of the details included or if indeed she is recommending a 2nd test for all at 6 months.

Copied & Pasted from the link above. Written by Dr. Center:
Additional Information;
*It is no longer recommended to fast a dog for 12 hours before first collection or meal. The same size and type of meal that the dog normally eats is what should be used for the meal.
*Test puppies at 16 weeks and again at 6 months. Dogs > 4 years of age can have other liver problems that will affect the Bile Acid test.
*If the dog is stuffed or if the dog is frightened the test result can possibly be skewed.
*The draw can be done one day pre feeding, then the dog can be taken home and fed and another draw done 2 hours post-feeding. It is not imperative it be done the same day.
 
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