Bile Acid Test if Gallbladder Has Been Removed

by Deb B.
(NJ, USA)

Hi Dr. Schonbeck,

Thank you for offering your expertise. I have a cairn terrier with a history of issues that go back to 2004 when he was first diagnosed with allergies (we think it stems from the Advantix we put on him-but only one vet will admit it). He was put on steroids and given steroids shots to try to alleviate the symptoms. Then we found out (in 2005) his liver enzymes were very high. Since then, he's become hypothyroid and is on medication for that and he needed his gallbladder removed last May (2010). Once on the thyroid medication (starting in Oct. 2009) his Alkaline Phosphatase and his cholesterol became normal. Prior to his gallbladder being removed (the day before), his CBC numbers were in range. In Sept. 2010, his numbers were all over the place. The ultrasound revealing the gallbladder issue also indicated that he had cysts on his kidneys and his liver was slightly enlarged (due to the gallbladder problem). During the gallbladder surgery they also did a biopsy of his liver and it was shown to be fine (but I understand it matters where you take the biopsy from). We just had another CBC done plus urinalysis and another ultrasound (March 2010). His numbers got better (even the liver numbers) but it showed a little blood in his urine (possibly due to a very small bladder stone - though not verified). The ultrasound now showed that his "liver is on the small end of normal". His kidney stills has cysts (largest being 5mm - which is less than the largest of last year). Because of the appearance of his liver, we just got a Bild Acid test done and his numbers are Pre Meal - 13.0 (above 10umol/L is considered high) and his Post Meal - 9.1 (less than 20.0 umol/L is considered normal).

At this point, I make his food. I chose salmon because it didn't upset his stomach after the gallbladder surgery. His stomach upset also resulted in us feeding his small meals about 5x/day. Both breakfast and dinner are divided up, spaced by 1-1/2 - 2 hours.

Breakfast and Dinner: Wild Salmon (2 kinds), organic string beans, and organic sweet potato.
Lunch: Canned Wild Salmon
Treats: Wild Fish
Sometimes we give him egg whites (free range) and other treats that are only human organic foods

Now my questions, regarding the Bile Acid test:
Without a gallbladder the bile is constantly flowing so how can the Bile Acid test be accurate? Why would the Pre Meal number be higher? I had read that the Post Meal should be higher.

Also, we had him taking Denamarin chewables which might have helped reduced his liver numbers, etc. but there is very little milk thistle in that plus they now added a "smoke flavor" which is a carcinogen so I'm looking for a new safe brand of SAM-e and Sylimarin (Milk Thistle). The recommended dosage our local vet suggested for SAM-e was 90mg tab 2x/day or 225mg 1x/day and for Milk Thistle 250mg/day. Can you recommend safe brands for these products?

I know it's a long message. Alot has happened over the years (there's more I didn't post). We appreciate all the information you can give us.

Thank you in advance. Deb B.

My Comment:

Hi

For some reason the removal of gallbladder are not that common in Sweden. Maybe this will change in the future, but at present I have no very little experience in these patients. Not that there is something wrong doing this procedure. But different countries and regions have different ways of doing things.

For now at least - gallbladder surgery is not that common in Sweden.

But I can comment on the bile acid test as long you remember that this i merely from a theoretical point of view - not based on practical experience.

Yes, the gallbladder is a reservoir of bile and you should think that after removal of the reservoir this could affect the bile acid test. In humans you could see that the rest of the bile acid system can take over the reservoir function after a bladder removal.

I don't know if this is important in dogs. At least it is one possibility.

The result of the bile acid test is still use full, but it might not be that sensitive as normal.

After starvation and after some fat meal is given you will get and sudden and explosive release of bile acids. This will test the ability of the livers reabsorbing function on its max level - so to say.

You might not have the same release of bile acids in a dog without a gallbladder.

But, still in a severely liver disease I would still expect some bile acid affection. There would still be a possibility that the bile acids is raised, even if the peak bile acid level not as high as in a dog with a gall bladder.

I would think that there could be a problem in detecting relative minor or less severe liver problems, based on the fact that the peak level of bile acids probably is a lot lower. Therefore the "bile acid strain" on the liver would be lower as well.

I cant explain the pre meal value - have been thinking a lot but, sorry I don't know and can't figure it out.

About a safe SAMe/silymarin product I would recommend Zentonil Advanced from the company Vetoquinol. It contains both SAMe and Silybin. It is a Canadian company and you should be able to get in the states as well.

I haven't been able to see a detailed ingredient list, but it is a possibility.

I'll contact the company here in Sweden on Monday to find out more about the ingredients and get back to you when I have more information about the ingredients in detail.

All the best

Per Schonbeck


Comment:

Regarding ingredients Zentonil adv. there is only natural meat flavors.

It should be OK then.

Best regards

Per Schonbeck