New and need input on a medical question

[Scoobstersmom]

Hi. I am new to your site and joined today looking for input on a medical question pertaining to my yorkie. My name is Diana and I'm owned by Scooby (14 year old porkie yorkie weighing 11.4 pounds.) We live in Arizona.

My Scooby has always had a moderately elevated ALKP of around 1500. Our vet presumed that it was elevated because Scooby has taken an antifungal medication off and on for most of his life. He took milk thistle and the number never went up or down. He had his last dose of the Fluconazole in August of 2013.

In September we noticed that his ALKP and ALT were on the rise. The ALKP had risen to 1600 and the ALT was around 300. Since then, he has had nearly monthly blood work and the numbers have continued to rise in spite of doing many things to try to bring them down. At the last check, his ALKP had risen to almost 7000 and his ALT is just under 600.

We have changed his diet a few times. First to Royal Canin Hepatic kibble, then to home cooking (Dodd's diet) and now he is on a combination of both. We have tried two long courses of antibiotics, first amoxycillin, then clamavox, and he has also had a long course of metrozonizide. He has been on denamarin since September. He is on Omega 3's. In January we stopped all the antibiotics and put him on Actigall.

Since September he has had two abdominal ultrasounds. The first was done in our regular vet's office and the findings were a slightly enlarged liver with a few mottled areas that were not suggestive of cancer. No nodules, no shunts, no bile duct blockages that could be seen and his gall bladder and adrenals appeared normal. The second one was done last week at the internal medicine doctor's office and read by a board certified radiologist. There were no changes since the first ultrasound. The radiologist suggested that the mottled areas could represent cellular regeneration or possibly neoplasia (no clue what that is), but basically nothing to cause the elevated ALKP. Last week he also had bile acid test. The results were slightly elevated but the vet said not enough to be concerned about. His pretest number was 15.6 and the post test was 35. She said we'd just watch it and test again in three months.

The IM vet has suggested a biopsy, but from everything I've read that doesn't sound like a great plan for him and would likely come back inconclusive. Even the IM vet agreed with that. So we'll likely pass on the biopsy for now. So the new plan is to go with the adjusted meds and diet change and test blood work again in a few weeks. Of course, we have been on one version or another of that plan for six months now, and we're getting no where so I don't have a lot of confidence.

In the meantime, Scooby is doing great clinically. He eats well, is active and hasn't gained or lost weight. The vet says he appears to be a completely healthy dog and she would have never guessed that the blood work would look like that.

I am frustrated because we've wasted six months, several thousand dollars in blood work, tests, and medications and we're no closer to an answer to the rising ALKP than we were six months ago. Obviously something is wrong, and I would rather know now while he's still in fairly good health and while it could still possibly be fixed, rather than just wait to see what happens next. I am hoping someone here might have had a similar situation and can give me some input on what to do next, further tests to request, ANY input would be appreciated.

Thanks for allowing me to join your site.

Diana and the Scoobster

[Buster Brown]

Hi Diana and Scoobster welcome to YT. I do not have the knowledge to help you but I wanted to say Hi and by posting bump your question back to the front and maybe our more knowledgeable members will be able to help you with your questions.

[Yorkiedaze]

Welcome to both of you. Can't really help you with that problem. All I can say is, if he's eating well and seems happy and healthy enough, then just let him live out his life without further testings and medications as long as he isn't in any pain.
You sure are a great mom to him.

[lillymae]

Welcome to YT ! You mentioned your baby is porky, has the vet tested him for Cushings ? as this can cause his test results to be as they are.

[Charlies Mamma]

Hi Diana and Scooby,

Honestly everything I would suggest to you has already been done by you. you have done well to keep him healthy. I might suggest that he has MVD (Mycrovascular Dysplasia) rather than a regular shunt. MVD is a series of tiny shunts in the liver rather than 1 large one, it cannot be fixed surgically, however, with the diet you are feeding him and the meds I would think that by now they would have been able to find a formula that worked for him better to adjust his liver levels.

I guess I wonder how long he was on each medication. my Charlie uses the metrozonizide, he has MVD he has been on it since July last year and takes it 2 times daily. Many member use the mil thistle and swear by it so I will let them speak on that. I have never used it.

There are allot of us here that have babies with liver issues so get ready for some good advise. So far it looks like you are doing the right things by keeping up on his health.

Please post some pictures of your Scooby and again Welcome to YT

[wemple2]

I have nothing to offer but my thoughts and prayers...I do hope you get the answers you seek. Welcome to YT, I'm sure you will get some helpful advice here along with many well wishes.

[Scoobstersmom]

Originally Posted by Buster Brown

Hi Diana and Scoobster welcome to YT. I do not have the knowledge to help you but I wanted to say Hi and by posting bump your question back to the front and maybe our more knowledgeable members will be able to help you with your questions.

Hi and thanks for the welcome. Just wanted to say, I absolutely LOVE your Buster Brown's wardrobe in the pictures. So cute! My Scooby likes to wear his t-shirts and sweaters (but we don't have anything THAT cute) but it's usually too hot here in Phoenix to wear them. He drags them around the house though.

Diana and the Scoobster

[Scoobstersmom]

Originally Posted by Yorkiedaze

Welcome to both of you. Can't really help you with that problem. All I can say is, if he's eating well and seems happy and healthy enough, then just let him live out his life without further testings and medications as long as he isn't in any pain.
You sure are a great mom to him.

Thanks for the welcome Yorkiedaze. And thanks for calling me a great mom, which is something I needed to hear. Lately I haven't been feeling like such a great mom because I haven't been able to figure this out for him. I'm one of those "Type A" people that always need to have the answers and fix things, and I'm bombing this time. Maybe you're right though. Maybe this is something that just is, and I won't be able to figure this out or fix it. I just hate to miss something important though.

He does eat well and seems content, and I don't think he's in any more pain than I would be if I lived to his age. I mean, he's 14. He has a little arthritis, and he doesn't see that well anymore, but he still loves to snuggle with Dad in the recliner chair, howl at sirens when he hears them and tromp through the forest when we visit our mountain cabin. So I guess he's pretty content.

If those are all your yorkies in your signature, I can't imagine how you keep up with them all. This one little guy keeps me on my toes!

Diana and the Scoobster

[Scoobstersmom]

Originally Posted by lillymae

Welcome to YT ! You mentioned your baby is porky, has the vet tested him for Cushings ? as this can cause his test results to be as they are.

I guess maybe "Porkie Yorkie" isn't the best description, although we call him that all the time. He's not fat, he's just a big boy. Definitely not one of the tiny, fine boned, perfect ones you see in pictures with beautiful coats and bows in their hair. But he sure is cute! He weighs around 11 pounds and is sturdy and stocky but not overweight for his size. He's weighed the same since he was a couple of years old.

As for the Cushings though, I am interested in that and wonder if you have any experience? I read someplace but can't find it again, that there is a simple, non invasive urine test that can at least rule it out?? We have mentioned Cushings to both our regular vet and the Internal Medicine specialist we saw last week. Our regular vet has said, he doesn't have Cushings symptoms and then she read off a whole list of things he doesn't have. Thinning coat, skin changes, drinks too much and pees too much, pot belly, etc. And no, he doesn't have any of those symptoms but he does have the sky high ALKP. She said, it's not recommended to test unless there are symptoms because they only treat Cushings to control the symptoms. On the other hand, I asked for bile acid testing a dozen times and finally had to go around her to the IM vet to get that done. About the bile acid test, she said it wouldn't give us information we need. Would only show that his liver is not working well, which we already know because his ALKP is sky high. Which wasn't the case. We did finally get the bile acid test last week and the numbers were only slightly elevated. So his liver is working pretty efficiently. (And yes, we are in the market for a new vet! So frustrated!)

We again brought it up to the Internal Medicine vet last week, and she said in her opinion he does not "look Cushingoid", whatever that means. So she said, lets do another ultrasound and the bile acids and go from there. Nothing remarkable was found in either of those tests, so we are back to square one. I would like to find the info on that urine test so that I can request it specifically. We go back in for blood work in a couple of weeks, and I would really like to explore the Cushings further.

Diana and the Scoobster

[Scoobstersmom]

Originally Posted by Charlies Mamma

Hi Diana and Scooby,

Honestly everything I would suggest to you has already been done by you. you have done well to keep him healthy. I might suggest that he has MVD (Mycrovascular Dysplasia) rather than a regular shunt. MVD is a series of tiny shunts in the liver rather than 1 large one, it cannot be fixed surgically, however, with the diet you are feeding him and the meds I would think that by now they would have been able to find a formula that worked for him better to adjust his liver levels.

I guess I wonder how long he was on each medication. my Charlie uses the metrozonizide, he has MVD he has been on it since July last year and takes it 2 times daily. Many member use the mil thistle and swear by it so I will let them speak on that. I have never used it.

There are allot of us here that have babies with liver issues so get ready for some good advise. So far it looks like you are doing the right things by keeping up on his health.

Please post some pictures of your Scooby and again Welcome to YT

Yeah, I am running out of ideas too Charlie's Mama. But I feel like it's the VET that should be coming up with the ideas instead of leaving it to me to figure out. Grrr....

How is MVD diagnosed? Is it visible on ultrasound, or does it require a biopsy? Our vet has suggested a biopsy, but not sure I can agree to that as anesthesia is pretty risky with his liver numbers.

As far as the medications, this all started in September of 2012. So he has been on Denamarin for six months. He has been on Enalapril and Omega 3 a little longer than that. He has fluid filled cysts in his kidneys which caused some protein in the urine, and has high blood pressure. It is controlled well with Enalapril. His UPC is down to 1, so we're comfortable with that and it is not affecting his kidney numbers. He was first on Amoxycillin for about a month and did well, but when he finished it, his appetite fell off, so the vet decided to put him on Clamavox. And he was on that for 90 days. No change. He did not really have any signs of an infection, in that his WBC etc has always been normal, but we did the antibiotics in case there was something hiding that hadn't been found. He has been off Clamavox now for about a month. He was on Metro-however you spell it - zide for about 4 or 5 months. It didn't seem to help or hurt anything either way, and he HATES that pill and will do everything he can to spit it out! The IM vet just took him off that last week, hoping he was having a rare side effect to it that was driving up the ALKP. Haven't noticed any difference since we stopped it. He started Actigall on January 27th, after his last terrible blood test, so it might be helping and it might not. I don't notice any difference, but then he's not really had any symptoms except in the blood work, so I guess I wouldn't notice anything. We're scheduled for blood work in about ten more days, after he's been on Actigall a month, to see if there might be an improvement from that. So there you have it. I am completely out of fresh ideas.

Diana and the Scoobster
(Who talks to much! LOL Not the Scoobster- his crazy mom!)

[Scoobstersmom]

Originally Posted by Charlies Mamma

Hi Diana and Scooby,


Please post some pictures of your Scooby and again Welcome to YT

Oh, and thanks for the welcome. As far as pictures, I'm having enough problem just trying to figure out how to get my posts to show up. I'll work on the pictures after I figure that out!

Diana and the Scoobster

[Buster Brown]

Originally Posted by Scoobstersmom

Hi and thanks for the welcome. Just wanted to say, I absolutely LOVE your Buster Brown's wardrobe in the pictures. So cute! My Scooby likes to wear his t-shirts and sweaters (but we don't have anything THAT cute) but it's usually too hot here in Phoenix to wear them. He drags them around the house though.

Diana and the Scoobster

Thanks I made the vampire costume and modified his tux from one I bought. Buster will wear clothes if it's chilly here but prefers his fur. I am lucky he is really good with posing for pictures as long as I have treats.LOL

[Yorkiedaze]

Originally Posted by Scoobstersmom

Thanks for the welcome Yorkiedaze. And thanks for calling me a great mom, which is something I needed to hear. Lately I haven't been feeling like such a great mom because I haven't been able to figure this out for him. I'm one of those "Type A" people that always need to have the answers and fix things, and I'm bombing this time. Maybe you're right though. Maybe this is something that just is, and I won't be able to figure this out or fix it. I just hate to miss something important though.

He does eat well and seems content, and I don't think he's in any more pain than I would be if I lived to his age. I mean, he's 14. He has a little arthritis, and he doesn't see that well anymore, but he still loves to snuggle with Dad in the recliner chair, howl at sirens when he hears them and tromp through the forest when we visit our mountain cabin. So I guess he's pretty content.

If those are all your yorkies in your signature, I can't imagine how you keep up with them all. This one little guy keeps me on my toes!

Diana and the Scoobster

You are doing a super job with your little man, and he does sound very happy and pain free and living the perfect life for his age.

Yes, those are three of my four Yorkies. I need to have a picture taken of all four together to use. My girls are not that much work, really, but it can be expensive with yearly teeth cleaning, shots, tags, license, home cooking, and so on, but it still isn't nearly as expensive as my sons were when they lived at home, especially when we had them in UC Santa Barbara and UC Berkeley at the same time. WEW! We survived, but after they graduated and got on with careers, I was left with a major empty nest, so decided to adopt me a few daughters, even if they are of the hairy-legged variety!

[Charlies Mamma]

Originally Posted by Scoobstersmom

Yeah, I am running out of ideas too Charlie's Mama. But I feel like it's the VET that should be coming up with the ideas instead of leaving it to me to figure out. Grrr....

How is MVD diagnosed? Is it visible on ultrasound, or does it require a biopsy? Our vet has suggested a biopsy, but not sure I can agree to that as anesthesia is pretty risky with his liver numbers.

As far as the medications, this all started in September of 2012. So he has been on Denamarin for six months. He has been on Enalapril and Omega 3 a little longer than that. He has fluid filled cysts in his kidneys which caused some protein in the urine, and has high blood pressure. It is controlled well with Enalapril. His UPC is down to 1, so we're comfortable with that and it is not affecting his kidney numbers. He was first on Amoxycillin for about a month and did well, but when he finished it, his appetite fell off, so the vet decided to put him on Clamavox. And he was on that for 90 days. No change. He did not really have any signs of an infection, in that his WBC etc has always been normal, but we did the antibiotics in case there was something hiding that hadn't been found. He has been off Clamavox now for about a month. He was on Metro-however you spell it - zide for about 4 or 5 months. It didn't seem to help or hurt anything either way, and he HATES that pill and will do everything he can to spit it out! The IM vet just took him off that last week, hoping he was having a rare side effect to it that was driving up the ALKP. Haven't noticed any difference since we stopped it. He started Actigall on January 27th, after his last terrible blood test, so it might be helping and it might not. I don't notice any difference, but then he's not really had any symptoms except in the blood work, so I guess I wouldn't notice anything. We're scheduled for blood work in about ten more days, after he's been on Actigall a month, to see if there might be an improvement from that. So there you have it. I am completely out of fresh ideas.

Diana and the Scoobster
(Who talks to much! LOL Not the Scoobster- his crazy mom!)

After being in the ER clinic and finding the bladder stones our vet did surgery to remove them and when the results of the stone type came back is when we were referred to the specialist, in the mean time I called and spoke with Dr Karen Tobias' team @ Univ of Tenn. (Portosystemic Shunts FAQ) to get the most effective information that I could (they are the best with liver shunts) they were able to tell me things that I should ask, tests that I could ask to have done and who should be doing them. The website I listed is to their site, the test that they wanted me to have done (scintigraphy) was not available to me so I had to do the ultrasound, I was instructed that if I was going to have the ultrasound that I needed to make sure that the person doing it had a high experience of CORRECTLY diagnosing a liver shunt BY Ultrasound, I made clear when we went to the specialist that this is what I wanted and there was only 1 vet there with this experience. I was fortunate that the specialist that I went to was very familiar with Dr Tobias and how she worked.

An external shunt could not be found on Charlies xray and Charlie was not symptomatic in the typical way, he had only a couple of the symptoms and not that often, other than the stones of course taking his history into consideration the specialist believed that Charlie does have shunting but it is the MVD this is based on his health history and the ultrasound. MVD cannot be seen on an ultrasound but can be found with the scintigraphy.

Now the lactulose we use to keep his PH level the lowest we can and to help prevent him form getting more stones. the metrozonizide I have compounded into a liquid that tastes like chicken he loves that. Its allot of work and at times allot of worry but I would not change anything about what I have to do for him, he is SO healthy now and you can just tell he is happy. He on occasion has a bad day but we just take extra care at those times. I know I already said this but the vet is the main key to your babies health, they have to be good, they have to know yorkies and their health issues, its just a must.

[yorkiemini]

ScoobstersMama, I vote for you as geriatric-Yorkie Mama Hall of Fame

What a fabulous job you have done through the years caring for this pup, and doing all you can for him. I just love that!

I lost my previous Yorkie when she was 11 years old and had been in renal failure for quite some time. My goal,was much like yours .... To give her the best life possible and lots of love. Clearly, you are a super Yorkie mom to still have your loving baby with you at 14 years of age!