From my experience in the 15 plus years of breeding these little fur babies, a handful (1 in 30), of Maltese puppies will have bloodwork done in their first year probably prior to being spayed or neutered and their ALT’s will come back elevated. There are so many questions as to the severity of the diagnosis of your pet’s liver once this happens. Could it be a Portosystemic Shunt, Microvascular Dysplasia, or a Small Liver? These are all totally separate issues that affect the same organ – The Liver. PSS likely does have a genetic cause, and is thankfully less common. MVD does not seem to be as simple. I have been told by a highly respected veterinarian that there is no test for being a carrier of either condition, unfortunately. The MVD is trickier because there may be some influence of environment plus a genetic tendency. This may mean a mother that gets a virus and runs a fever and is more likely to have an affected puppy. Or a perfectly normal set of parents can have an affected puppy. Ugh! My practice as a responsible breeder is to not breed the same sire and dam together again to possibly avoid the same occurrence.
In every case, the numbers (ALTs) will vary depending on the actual diagnosis and the higher the number the stronger chance it is an actual portosystemic shunt. This is a very scary and nerve racking time for the owner, veterinarian and breeder and unfortunately is typically a process that is diagnosed in stages. I say this because I have seen it unfold in stages where as the results are normal enough that further stages of testing are not necessary and just monitoring the bloodwork from time to time is enough. In many cases, the puppy just needs to finish maturing which could mean up until 1 year to a 1 1/2 years of age. Another scenario would be to perform a bile acid test following the first set of bloodwork and this test is done with the puppy fasting, blood sample is taken and then he/she is fed and after waiting approximately an hour or two, then another sample of bloodwork is done and sent off. The numbers from this test will show how severe the numbers are and if there are concerns at that point the next step would be to have an ultra sound. Some patients won’t need to continue through every step, again depending on how high the numbers are.
As soon as there is a concern, most veterinarians feel it is best to put the puppy on either Denamarin or Denosyl which is beneficial to any animal with liver issues. For a 5-10 lb dog, 25-35mg of Silamarin (active ingredient) is optimum. Milk thistle is also one of the main ingredients in these drugs. During this time most asymptomatic dogs with liver issues do not need significant protein restrictions in their regular diet so any high quality but not high protein (<26) is a fine choice. Some of the higher end dog foods, while they are well known for being an excellent choice for pets contain way too much protein for Maltese especially if there is an underlying liver issue. I feed Royal Canin and my veterinarian is comfortable with the protein level in it. I would also avoid Grain Free, there is discussion about grain free and the heart so while the jury is still out on that I would recommend avoiding it all together.
For families that have purchased a puppy through me most have heard a story a tell to everyone of my families. When I purchased my first Maltese, I didn’t even know what a Maltese was and someone close to me had recommended this breed for non-shedding reasons. We purchased our little boy, Oliver from Nell Boykin, Bluefield Kennels in Wilson, NC and when it was time to have him neutered we took him to have him neutered and they called me the day of and said after doing his bloodwork prior to going under anesthesia they weren’t able to proceed with the surgery because his ALT’s were abnormally high. I was of course scared beyond words and had no idea what it meant or what could be wrong with my baby. I called my breeder, Nell and she suggested I see her veterinarian Dr Glennon with Wilson Veterinary Hospital. I did just that and after more maturing and another set of bloodwork, Dr Glennon eventually neutered Oliver and he lived with us 17 healthy memorable years.
So, I want to say to you, don’t panic but take this one day at a time and be sure you feel very comfortable with your veterinarian. Some truly understand exactly what steps to take next without having you over spend to get to the most accurate diagnosis for your fur baby.