# Update on Misha



## CT Girl (Nov 17, 2010)

Have they done a bile acid blood test?


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## Chagall's mom (Jan 9, 2010)

I wish I had something to offer, but I just don't! You've done a masterful job of investigating things. I know you'll do right by Misha, whatever you decide. I was glad to get an update on your 3.7 pounder. She's really put weight on! So sorry for what you're going through! I hope things go well for her.


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## N2Mischief (Dec 3, 2012)

Yes, they did bile acids. Her fasting levels were at the high end of normal and after eating they were at 28, normal range is 0-14.


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## MollyMuiMa (Oct 13, 2012)

Just a wish here for a good outcome, whatever you decide to do! Misha is a lucky little Girl to have such a devoted Mom! You'll be in my prayers.....
Hugs & Wet Puppy Kisses,
Laurel & Molly


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## CT Girl (Nov 17, 2010)

I am not sure what I would do if I were in your shoes. It would depend on the vet. If you feel confident in them follow his recommendation. I would try to find out how experienced he is with liver issues. From what I am reading on the Internet I am a little surprised that Misha was not put on lactalose or milk thistle or both. I don't have a clue though and I realize medical research on the Internet does not stack up against a vet's opinion. If you are not sure of your vet it may be best to travel to someone with expertise with this condition. Whatever decision you make I hope all goes well.


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## N2Mischief (Dec 3, 2012)

CT Girl, it is confusing and no I don't trust this vet yet, I just started going there. She is so nice and young and seems to know what she is talking about, but the people on the liver shunt forum say to find a new vet.

I have ordered the Milk Thistle and SAM-e. I do think she needs lactulose but the vet wouldn't prescribe it. She said it would just give her diarrhea for no reason. 

sheesh!

BTW, with the levels that her Blood Acids came back, the people on the liver shunt forum say it leans more towards MVD of the liver rather than liver shunt. If this is the case, she would not need surgery and a low protein diet may be all she needs to live a normal life!


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## pandj (Jun 12, 2013)

If it were me I would fly to U T and have them do it. Vet Schools have access to the newest and best resources that a local Vets just doesn't have. They also see many more cases. Experience has taught me go to the best it will be cheaper in the long run...not to mention that you provided your little one with the best availabl

You and Misha are in my thoughts. 

Sent from Petguide.com Free App


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## Tiny Poodles (Jun 20, 2013)

I (thankfully) know little about this subject, but I will say that when my girls have a specific medical issue, I have learned to go straight to a specialist - optomologist, dermatologist, and cardiologist are all veterinary specialists that I've used, and they always demonstrated expertise far and above what the regular Vet had. Their fees may be a little higher, but the way that they will get directly to the root of the problem will cost you less (angst and money), then the round about way that the general Vet will (try, and may never get there) will do it.
Thinking of a Friend who had their Shi Tzu's entropian eyelid operated on twice by their regular Vet, were about to let her make a third attempt when I convinced them to go to the Optomologist at the AMC, and sure enough, the Optomologist fixed it!

But one point if you do go to a teaching hospital - MAKE SURE that it is an Attending, not a Resident or a Student who performs any procedures on her - from working in human hospitals for many years, I know that you would be shocked how often Attendings sit in the corner of the room chatting on the phone or even napping, while the Residents and Students do the surgery!

Wishing you the best of luck in whatever you decide to do - you are one incredible Poodle Mom, and Misha is so lucky to be loved by you!


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## KirklandPoodle (Oct 22, 2012)

Hi there - I can't seem to find your initial posting about Misha's symptoms. Could you post a link to that thread?

I too had pugs for many years, but they all kept dying off by age 8 of horrid genetic problems, despite coming from reliable breeders. My first pug had liver shunts - but not the type that can be operated on, his were Hepatic Microvascular Dysplasia, which is spread throughout the entire liver and is inoperable. It is much more manageable than shunts though. One of the signs of it - which we didn't recognize until after diagnosis - was that while his bile acids did go out of range for normal, they were no where near as high as for shunts.

The absolute best thing I did for my pug was go to an internist. By your discussion about Lactulose, I gather you are not seeing one. (Your vet gave you incorrect info about Lactulose. Once you determine bowel tolerance, you don't have diarrhea. And if you do it properly, you can avoid diarrhea entirely.) I completely agree with Tiny Poodles on her recommendation for an internist.

I am not familiar with Scintigraphy. Would that diagnose Hepatic Microvascula Dysplasia as well as full blown shunts?

We went the liver biopsy route for diagnosis.

If you are in Southern Cal, UC Davis is quite good with livers, as well as the vet school in Colorado. I also looked seriously into traveling out to Cornell in upper NY, but after a phone consultation decided I was best off with my incredible internist.

Good luck.


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## KirklandPoodle (Oct 22, 2012)

Doh, found the symptoms thread! Yup, unfortunately I stand by my earlier post. I think you'll save money by starting with an internist.


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## N2Mischief (Dec 3, 2012)

Kirkland poodle, I did pug rescue for years and was a "pug person" for a very long time. I couldn't get a pug to make it past 11 years, so I too gave up the breed.

I think you and tiny poodles, pandj and CT Girl are right, I need to take it to a specialist. 

I am told as well that though her bile acids are abnormal, they are NOT pointing to shunt. The lowest they have seen on the other forum I am on is 35 on a yorkie that had shunt, but that was a fluke. They are saying that to indicate shunt the level would most likely be over 100. Misha's were just 28. On that forum they are saying possible MVD which is totally treatable through diet, lactulose and Demarin.

Because of this, I am thinking a trip to University of Tennessee is possibly NOT in order since she wouldn't need surgery and plane flight alone is $700 and then another $250 to fly Misha, hotel fare, car rental etc. But maybe an internist or liver specialist here in southern california.

In the scintigraphy, they inject a dye into the rectum and then do scans and watch where the dye goes. I know it would show intrahepatic and extrahepatic shunt 100% of the time. As to if it would show MVD or HMD I don't know, the way you described HMD sounds like it might detect it as it follows the blood flow through and/or around the liver. 

I think a liver biopsy would show both MVD and HMD but not shunt. Yet they can have shunt concurrently with the other two.


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## Tiny Poodles (Jun 20, 2013)

What about UC Davis?


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## N2Mischief (Dec 3, 2012)

I have to look at how far that is from me. We also have a very good group of hospitals in Irvine California. Its a business park and each building has its own specialty. They have an eye specialist, and a orthopaedic, and Internal Medicine and more. I also took my cat Loomis to a place near there for Radio Active treatment of his thyroid and I know they do scintigraphy. Still researching, but Davis is definitely on my radar!


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## CT Girl (Nov 17, 2010)

Nu2mischief, I think you are doing the right thing in seeking a specialist. You probably have seen this but here is Dr. Jean Dodd's diet for dogs with liver issues.

Liver Cleansing Diet and Milk Thistle

I also saw that numbers for dogs with liver shunts are much higher than Misha. Hopefully by carefully controlling her diet and giving her some supplements this can be controlled. I really think you are on the right track now.


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## outwest (May 1, 2011)

I am still leaning towards her being on a high protein, grain free diet. She has such a tiny little body and she is still a puppy. The diet may have been too much for her. If she is acting well now, how about just having her blood tests repeated since you took her off the grain free/high protein before getting more aggressive with treatment/diagnosis?


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## N2Mischief (Dec 3, 2012)

Outwest, I was thinking that too. Rerun the bile acids in a month or so and see what we get?? I need to talk to you about human stuff. Hubby was diagnosed with Paget's Disease today, just found it interesting, I'll call you soon!


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## outwest (May 1, 2011)

Yah, rerun the tests in a month on her currect diet. You may be surprised and pleased. 

Now, is there anything else life can throw your way? Has he broken any bones? 
Keep smiling.


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## N2Mischief (Dec 3, 2012)

hahaha, has he broken any bones?? UMmmmm, he has been hit by cars 5 times on his motorcycle. One ankle he broke twice, lots of pins and screws. But the Paget's is in his pelvis. Ironically enough, he had to have a scintigraphy on Monday! I wish I could have just slid Misha in under the radar and had her done at the same time! lol


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