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High bile acids

Species: Dog
Breed: Jackapoo
Age: 5-8 years
Hi Dr. Marie

Over the course of the past 9 months, my dog Oreo's liver enzymes have risen. Last month our vet did a bile acid test. His premeal result was 21 and his post meal was 26.9 So the vet put him on SAM-e and told us to recheck in about a month so here we are. Last week we had another test done and his premeal was perfect with a 4.6 but his post meal had risen to 46. I am completely shattered. So much for the SAM-e helping, eh? So the vet knows I am against the prescription dog food stuff. So he supports my desire to try to home cook for Oreo. He told me he is going to look for some recipes for me. In the meantime to just continue on with his current canned dog food. He was surprised it had risen, the post meal, and he said the 46 most likely indicated a microvascular shunt. He said if it was higher it could represent something else. Of course I asked him how do we know for sure and he said liver biopsy was an option but he wasn't pushing it and explained to me there are risks. I might add that Oreo presents as a very happy and hungry little dog. No clinical signs. However he wasnt always a hungry dog. Within the last 4 months or so, his appetite has picked up. But he isn't a very active dog. Very quiet lifestyle and when his appetite picked up, he wasnt on the SAM-e yet. He doesnt appear to be in any distress at all. Ok so not sure how well I am going to do with the home cooking but it's the only option if we have to manage this with dietary change. It was also my vets opinion that even though the post meal had gone up, he was not at deaths door or even close to it.

So flash forward to a few hours after that and a friend recommended I call Dr. Jean Dodds who has many specialties and amongst them, liver disease dogs. She has recipes for home cooked meals. So I gave her Oreo's numbers and she wasn't concerned whatsoever. She said his post meal, while up, could be the result of his two breeds in him causing a fluctuation. She really didnt think he needed home cooking but told me to stay away from corn, wheat and soy. She is a long time veterinarian and that post meal 46 score didnt alarm her. Oh and she told me when we recheck next time, request urine bile acid testing as it is cheaper. Might just do it the same way though with the blood so as to remain consistant with how we tested?

I would like your opinion of his results and of what I was told and if you think the SAM-e could have elevated that post meal from a 26.9 to a 46 in a months time? Why wouldnt it have lowered it? However on the good side, the premeal this second time around was good.

Sorry so long and thank you Dr. Marie!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

Oh, I have had a few cases like this. Interpreting liver bloodwork can be challenging. Personally, I would not be alarmed by a post bile acid result of 46, but I would not want to ignore it completely.

First let me explain how a bile acid test works. What we do is measure the level of bile acids when a dog is completely fasted. If a dog has serious liver disease usually these levels would be very high. Then, what we do is feed the dog some fatty high protein food (like puppy food) and then 1 or 2 hours later we will measure the bile acids again. In a completely normal dog there should be no elevation. However, if the liver is struggling a little bit to process the fat and protein then we will see an increase in bile acids.

In my experience most animals with serious liver disease have really high elevations (like >100). A value of 46 would say to me, "Hmmm...there may be something going on here, but it's not likely super serious right now." Basically it tells me that the liver is not functioning at an optimal level, but it doesn't tell me what the problem is.

I can guarantee you that SAM-e didn't elevate Oreo's bile acids. SAM-e is a supplement that helps to support the liver but it is not a miracle drug. And, who's to say that it didn't help? Perhaps without the SAM-e the bile acids would have been through the roof?

I'm really cautious about advising people to cook their own dog food. It is really hard to balance a dog food diet properly. The only times I will recommend it is in cases of allergies where we want to be sure we are eliminating certain ingredients from the diet.

I have heard of Jean Dodds and I can tell you I have read a few things from her that I question. She tends to disagree with a lot of things that most vets would agree with. Whenever someone mentions her name in my exam room it is usually followed with an explanation about how she disagrees with something that I often do. I don't know enough about her to judge whether she is right or not on these issues, but I can tell you that I view her information with suspicion.

Urine bile acids are not a test that I run very often so I did some research for you. In my opinion this test is not likely to tell you much. From what I've read there are a lot of false negatives. What this means is that if you got a normal test results it's possible that the bile acids are actually high. Additionally, there would be no way to compare to see how Oreo is doing. The urinary bile acid level can't be compared to the blood level. I suppose it is possible to run a urine bile acid test now and then repeat it down the road and see if the levels are rising. But, given that most vets don't use this test it may be difficult for your vet to interpret the results.

If this was my case and the dog was feeling good and eating well then I would likely do exactly what your vet is doing. I'd recommend monitoring him for now and rechecking the levels in a while. I'd probably recommend a prescription food but if you're against that I'd recommend a good quality commercial food before I recommend home feeding. And I would also be giving you the option of an ultrasound with a biopsy. Sometimes this can give us an answer...but not always which is frustrating.

I hope this helps!

I am traveling today and likely will not get to check my email until late tonight. But if you have more concerns just hit reply and I'll get back to you later.

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Hi Dr. Marie

Thanks for your reply back.

Well I am literally a mess over this. My health is suffering alot. I know I have developed a bleeding ulcer and will find out for sure tomorrow.

In some ways I feel like I am slowly killing Oreo because I do not believe in those prescription dog foods but yet I dont really want to home cook for him either. So that leaves me with canned dog food that he has eaten. I am so undecided Dr. Marie. I want something quick and easy. I wont do anything until I decide but I dont see that coming any time soon. I dont mean to rebel against what you or my vet suggests about the prescrption diets, but I have read the reviews about them on dogfoodanalysis.com and it is downright frightening. Besides my dog wont eat kibble. I know Hills had a l/d one but again, reviews on that leave me literally ill. Have you encountered owners in your practice that were opposed to it also? I surely cant be the only one. For now, I just keep him on what he was eating but my vet isn't super fond of that idea. He is supposedly gathering home cooked meal recipes for me but told me to give him a while to do that as he has a super busy practice. He is in with 3 other vets whom I love also and while I respect them all, I disagree with the prescription diet. So not sure what to do and that, over the past month has landed me the bleeding ulcer.

Thanks for your opinion on the Dr. Dodds issue. I was glad when she told me his post meal 46 didnt worry her. But it's gone up so I wonder why? Next month it could be up to 70 perhaps? I feel like I want to repeat BAT's in another month hoping for the numbers to go down so I can breathe again and get relief. My vet is not suggesting that though.

I wont do the urine bild acid test. I want to do the testing with how we've been doing it. That just makes sense to me.

Dr. Marie, Oreo is on 100 mg of the SAM-e once a day. I stick it in a little piece of hot dog as I tried sticking it down his throat, the pill, but he just coughs it up on me. So that SAM-e has 20 mg. of milk thistle in it already but I went and bought a bottle of canine liquid milk thistle at petwellbeing.com . The serving size is 25 drops and the suggested dosage is for twice a day, administer 1 drop for every 2 pounds of body weight. So Oreo is 20 pounds so that is 10 drops twice a day. But I am only giving him 5 drops twice a day. My vet seemed to think this would be ok, and not overdosing. I keep praying that maybe this additional suppliment would make a difference in another month or so. Do you think that dose is safe? I know too much milk thistle isnt good either.

You spoke of an ultrasound with biopsy. My vet doesnt do those but there is a vet in town who has a travelling vet come in to his clinic to do those. What is your opinion on the safety of those? When I spoke to my vet the other night on the phone, he suggested a liver biopsy, we would get more to the point he said. But that comes with risk he told me. What is the difference between the two?

My vet told me that the 46 post meal hinted at perhaps a microvascular liver shunt? Dr. Dodds agreed with that. My vet also said since he has a hunch that is what it is, he's not sure it's necessary plus it comes with some risk. How crucial is it to know exactly what the problem is? I am sure some people dont have the money to persue exact diagnosis?

Well I am sorry this is so long. I am just torn over this though...hoping others who are going through this now or in future, can learn something here.

Thank you Dr. Marie!

Suzie


Customer reply:

Dr. Marie

I am sorry forgot to ask you if you can recommend a good commercial dog food here in the states? I feed Oreo a variety of the highest line possible. He likes Dick Van Pattens Natural Balance and Innova Senior. But both contain meat and as I undertstand, meat is a no-no for a liver dog?

Thanks again!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

Gosh, pet food is a tough thing to talk about. I get really irritated that there are so many bad things written online about some good foods. I really do believe in the prescription brands like Hill's and VMD (Medi-cal). I honestly think that a lot of the bad stuff that is written about them is written from a perspective of fear-mongering and not from science. I plan to write a series of articles soon on some of the false beliefs that are out there in regards to food.

Here is an idea for you. If your vet is suggesting a prescription food, why not try one for a period of a few months and see how things go? If after a few months the bile acids have come down then this is great. If you find that you are not liking how Oreo is doing on the food you can always switch to something else.

I personally find it difficult to read a food label and determine what a good food is. Is corn bad? If so why? Is chicken bad? I eat chicken! What I go by is that I know there are certain foods that consistently produce nice healthy coats and solid stools. I recommend Iams, Science Diet and Royal Canin for good commercial foods.

Unfortunately I can't advise you on the milk thistle. It's not something that I commonly use.

Dr. Marie.



Customer reply:

Right now I am going to go with Natural Balance Vegetarian formula until I can get my hands on some Science Diet L-D I guess. It wont hurt to try it although I am still nervous about the ingrediants on label. Heck it might just bring his numbers down a bit.

I am curious though and I know no vet would probably know for sure, but his second round of testings, the post meal had shot up to 46 from a 26.9 I was shocked and the vet was surprised too. However his pre meal was better. Being on the SAM-e how could that have shot up? During that month I did have him on a few different dog foods.

One thing that bothers me is his appetite is huge. It never was up until about 6 weeks ago, before he went on SAM-e. Most of his life, he has been a poor eater and often going 3 days without eating before caving in. Then out of no where, the appetite took off. He sleeps with me and I can hear his tummy growling all the time and he prowls the kitchen alot too. He never use to. I mentioned it to the vet and he said that might indicate a problem but didnt address it further. So heck...I dont know what kind of a problem it could mean....?

Ok well thank you again!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

I think that's a good idea. One of the things that I learned at the nutrition conference was that you actually can't tell much by looking at the ingredients on the label. I'll explain that fully when I write my article. But I'd be much happier with you using the Natural Balance food than cooking your own.

Bile acids are tricky to figure out. I really don't know why you saw the changes you did in Oreo's levels.

SAM-e shouldn't cause a big appetite. I'm thinking that he is actually feeling better and therefore has a better appetite.



Customer reply:

Yep the cooking is not my bag. So will use the Natural Balance and then try the Science Diet. Sure do look forward to your article. Dont let me miss it! :-)

Regarding the change in the post meal, maybe it was because I was bouncing around with dog foods. Tricky stuff isn't it, these numbers. Heck the vet was stumped too. He told me it wasn't what he expected.

Regarding the appetite, that increased before he began the SAM-e. And has contiunued.

Is it a necessity to know exactly what kind of liver issue a dog has? I suppose not everyone has the funds to persue it with ultrasounds and further even. My vet, while he didnt push it, he told me if we really wanted to know for sure, he could do a liver biopsy. He would perform it but he said it could pose risks. Have you done them and if so, did it go well. Is it more risky than any operating procedure?

Ok thanks once again!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

I wouldn't be too worried about getting a diagnosis as long as Oreo is feeling well.

I have a specialist who does liver biopsies for me. In my opinion the risk is small. But, there is a risk that it could cause some bleeding on the liver. I've had lots of biopsies done and have yet to see that happen. Usually the vet will want to do something called a coagulation panel first to make sure the the dog can clot properly in case there is bleeding.

At this point from what you've told me I would likely hold off on a biopsy. It's not even guaranteed to give us an answer.



Customer reply:

Very interesting! I will hold off then and again he wasn't pushing it. Yes Oreo feels well but our lifestyle is very calm and quiet so he isn't bouncing off the walls but his eyes are bright, gums pink, all those good things I know you look at when you see a pet. It's very funny to see him so hungry all the time. Having had him since he was a puppy, and I had to force feed him, now he comes running to the kitchen at every opportunity...Thanks for all your answers...I will try not to get too worked up over his numbers. I hope others will learn from this conversation too. Cant think of any more questions at the time. Which is odd for me. haha!!

Suzie


Customer reply:

Hi Dr. Marie

I have come up with another question for you.

I was in touch yesterday with someone on a yahoo board for canine liver disease. She told me just because Oreo looks happy and acts happy, that doesn't mean anything. Of course, unfortunately I take alot of things I read online to heart which I know isn't healthy for me.

However, it sure seems if he were gravely ill, he would be lethargic, not begging to eat, doing all the things that seriously ill liver dogs do.

So do you believe with his post meal reading of 46 and the fact that his appetite is good, his coat looks fine, eyes clear and perky, gums nice and pink...you know all that stuff you look for in a dog, I should probably disregard what that one person told me? In other words she was basically telling me just because he is asymptomatic, it doesnt mean bad things arent happening inside.

Your thoughts on this? And thank you Dr. Marie!

Suzie


Online vet, Dr. Marie

Dr. Marie replied:

I don't think I can really add much to what's already been said. Anything from here would be just speculation. The best advice I can give is to trust the advice from your vet. They know your dog and his situation the best.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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