Extrahepatic shunt

[iwannalollipop2]

After getting sky-high results for a couple of blood tests, and a bile acid test at about 248 and 150 (instead of 10 and 20), we took Lacy to a specialty internist vet about three hours' drive away. She did an ultrasound, and couldn't tell definitively, but thought she could see a shunt outside of her liver, and could not see the normal vein capacity inside the liver. Her portal vein, which should be large, appeared tiny, if it was there at all. Lacy is only two years old, and is totally asymptomatic. She only got the first blood test because she was a little sick for another reason. The vet mentioned the surgery, but didn't really advise it because Lacy is so tiny (4 lbs, 3 ounces), and because even if they close the shunt that portal vein might not be able to carry all that blood through her liver. I had no idea until about a week ago what this condition was or that yorkies were predisposed to it. We told the breeder, and she had never heard of it, but she said she would advise to the owners that they test their dogs.

We are going to try to manage her dietarily, because the surgery fatality rate is just so high, and we don't want to put her through that stress if she doesn't even have any symptoms. She's totally fine, and all she wants to do is play. She's always gotten homemade food anyway, she'll just get it with less protein now.

Anyone else who has had experience with this disorder want to share some thoughts? What was your opinion of the surgery? I think the best thing we can do with Lacy now is hope that she stays as happy as possible for the few years that she can probably live.

[Belamia]

Is this the "liver shunt"?
Thank god i do not know much about it and i am so very sorry to hear that you found it out about your baby....
I was reading it here a few times about this condition, there is a 3 letter abreviation to it i can not remember , but i read many posts about this condition right here.
I also read something else on a pet shop, an article saying how common it is to the yorkies to have that. As far as i understand it can be more severe or not so severe, and it does not mean it is fatal at all... it can be managed with diet... the surgery may not be an option for every diagnosed dog...
Since i read about it and found that it can show no simptoms for years i keep my eyes open on it...
I remember reading a long post of someone who knows a lot about it... Mvd?MDV??? something like this.... reaserch on other threads and you will find it.... there are long discussions on it....

Good luck with your yorkie !!!!

[Brooklynn]

As with any surgery comes risk but if your baby has liver shunt and it's external I would recommend the surgery. I've heard of many success stories on liver shunt surgeries and they can live normal lives again on normal food again. They use a constricter ring to slowly close the shunt and it is very successful but an expensive surgery but again I would recommend the surgery if in deed the yorkie has the shunt. You can have the vet do a stinigerphy* I can't spell it and it will tell you for sure it's a shunt. That is what I would do first.
I hope this helps.
Donna Bird
Brooklynn's Yorkshire Terriers

[SassyAnn101]

I lost my Gizmo February 1st to a liver shunt. He was almost four years old. He had some problems/symptoms from the time I brought him home at 12 weeks. He wouldnt eat dog food at all, he would shake and stagger around after eating, or sometimes for no reason at all. I was told it was a drop in his blood sugar. I would give him Nutri Cal or Kyro Syurp and in about 10-15 min. he would recover. He als had very dry flaky hair and did not gain weight. I fed him baby food (chicken), broiled chicken with white rice, or chicken hot dogs most of his life. His first year was hard, then he had over two good years with very little episodes. Then in this past November he started going down hill. We tried almost everything, but he was only getting worse. After being diagnosied at the University Of Tennessee with a Liver Shunt. He had the surgery on January 29th, although he pulled through the surgery I lost him on February 1. After the surgery the doctor told me that his liver was very small and the vessels inside the liver was very small. There was concerns that his liver could function after the shunt was closed becasue of the condition of the liver. I was told that the younger the baby is when surgery is done the better chance that the liver will recover. I am very sorry for poor Lacy. I understand how you must feel. I am torn most of the time with the what if question. I am thankful for the three + years that I had with my baby, but if I had him tested as a puppy would I still have him even today? Some times L/S can be treated with a proper diet and medication. The surgery is risky. I wish the best for you and your baby. I hope my story has helped in some way. If you have any more questions I will be happy to try and help.

[Brooklynn]

Originally Posted by SassyAnn101

I lost my Gizmo February 1st to a liver shunt. He was almost four years old. He had some problems/symptoms from the time I brought him home at 12 weeks. He wouldnt eat dog food at all, he would shake and stagger around after eating, or sometimes for no reason at all. I was told it was a drop in his blood sugar. I would give him Nutri Cal or Kyro Syurp and in about 10-15 min. he would recover. He als had very dry flaky hair and did not gain weight. I fed him baby food (chicken), broiled chicken with white rice, or chicken hot dogs most of his life. His first year was hard, then he had over two good years with very little episodes. Then in this past November he started going down hill. We tried almost everything, but he was only getting worse. After being diagnosied at the University Of Tennessee with a Liver Shunt. He had the surgery on January 29th, although he pulled through the surgery I lost him on February 1. After the surgery the doctor told me that his liver was very small and the vessels inside the liver was very small. There was concerns that his liver could function after the shunt was closed becasue of the condition of the liver. I was told that the younger the baby is when surgery is done the better chance that the liver will recover. I am very sorry for poor Lacy. I understand how you must feel. I am torn most of the time with the what if question. I am thankful for the three + years that I had with my baby, but if I had him tested as a puppy would I still have him even today? Some times L/S can be treated with a proper diet and medication. The surgery is risky. I wish the best for you and your baby. I hope my story has helped in some way. If you have any more questions I will be happy to try and help.

I'm so sorry about your loss I feel it's easier on a younger dog than an older one since the liver is already compromised and hasn't been functioning right for a long time. I think although with diet and medication it can be controlled but only for a certain length of time. That is why it's so important to health test before breeding.
Donna

[Ladymom]

Can you take Lacy to a vet school for a second opinion? Most vets, even specialists, don't know that much about liver disease.

Ultrasounds are only 80% accurate in diagnosing shunts according to Dr. Tobias (University of Tennessee) and as low as 60% according to Dr. Center (Cornell). What Lacy need is a scintigraphy for an accurate diagnosis.

Did you know that Yorkies are 36 times more likely to have a liver shunt than all other breeds combined? Dr. Center recommends that all Yorkie puppies have a bile acids test before even going to their new home.

Here are a couple of good articles from UT and Dr. Center:

Hepatic Vascular Disorders - WSAVA 2006 Congress

The Univ. of TN College of Veterinary Medicine - Portosystemic Shunts

[bailey12]

Hi. My Zeus has mvd and was diagnosed at 10 mos. He will be 7 in May. He is doing really well on denosyl sd4 and a prescription diet specifically formulated for liver disease. He's happy and "healthy". He had bloodwork done in Mar. and all levels were great. Juliet

[Yorkieluv]

Have you joined the liver shunt and mvd group yet?
Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support
You will get excellent guidance there, and there's a ton of information in the FILES that you can print up and take to your vet.

On pups and younger dogs, the success rate is very high, but the older the dog gets, the higher the risks because the liver has been damaged for a long time. There are more complications with older dogs, but I do know of several dogs who had surgery above the age of 2 and survived.

My yorkie does have liver problems and is medically managed with a special diet, supplements to support his liver to the fullest, and lactulose. My yorkie is now 4 yrs old, and he is doing great!! He had a very rough start, but we have worked diligently to make him as healthy as possible, and he is doing great. You would never know he has liver problems by looking at him.

Ultrasounds are not very accurate in determining whether or not there is an extrahepatic shunt. A Protein C test would help determine whether it's likely to be MVD or extrahepatic shunt.

If you do decide to go ahead with the surgery, make sure that it's with a board certified surgeon who has extensive experience with liver shunts and liver disease. A vet school is probably a good idea.

If your baby has MVD, it has to be managed medically and with dietary changes. One of the major staples for a dog with liver disease is lactulose. See, when the liver is not functioning properly, it cannot filter the ammonia that is produced from the protein and then the ammonia enters the bloodstream. If it accumulates, it will cause neurological symptoms and hepatic encephalopathy. The lactulose helps bind the toxins from the blood and pushes them through the colon.

Milk thistle is highly recommended to help the protect the liver from further damage. Do not buy the liquid kind, the capsules are better and you can open them up and dump the amount your dog needs on her food. If you need the dosages, let me know, and I'll dig them up for you.

Denosyl also helps protect the liver and is beneficial for them. If your dog is smaller, then Vetri-DMG may be better for her because Denosyl tends to cause nausea in the tinier yorkies because the dosage is the same for them as for a 10 lb dog.

She has absolutely no symptoms at all? Is she ever a picky eater or has she ever had UTIs, darker urine, head pressing after high protein meals, hypoglycemic episodes?

Also, I want to add that meat and poultry proteins produce the most amount of ammonia which makes it hard on an already compromised liver. Dairy, vegetable, soy, and egg white proteins are easiest on the liver and produce the least amount of ammonia. Small, frequent meals are recommended as well for several reasons.

[iwannalollipop2]

Originally Posted by Yorkieluv

Have you joined the liver shunt and mvd group yet?
Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support
You will get excellent guidance there, and there's a ton of information in the FILES that you can print up and take to your vet.

On pups and younger dogs, the success rate is very high, but the older the dog gets, the higher the risks because the liver has been damaged for a long time. There are more complications with older dogs, but I do know of several dogs who had surgery above the age of 2 and survived.

My yorkie does have liver problems and is medically managed with a special diet, supplements to support his liver to the fullest, and lactulose. My yorkie is now 4 yrs old, and he is doing great!! He had a very rough start, but we have worked diligently to make him as healthy as possible, and he is doing great. You would never know he has liver problems by looking at him.

Ultrasounds are not very accurate in determining whether or not there is an extrahepatic shunt. A Protein C test would help determine whether it's likely to be MVD or extrahepatic shunt.

If you do decide to go ahead with the surgery, make sure that it's with a board certified surgeon who has extensive experience with liver shunts and liver disease. A vet school is probably a good idea.

If your baby has MVD, it has to be managed medically and with dietary changes. One of the major staples for a dog with liver disease is lactulose. See, when the liver is not functioning properly, it cannot filter the ammonia that is produced from the protein and then the ammonia enters the bloodstream. If it accumulates, it will cause neurological symptoms and hepatic encephalopathy. The lactulose helps bind the toxins from the blood and pushes them through the colon.

Milk thistle is highly recommended to help the protect the liver from further damage. Do not buy the liquid kind, the capsules are better and you can open them up and dump the amount your dog needs on her food. If you need the dosages, let me know, and I'll dig them up for you.

Denosyl also helps protect the liver and is beneficial for them. If your dog is smaller, then Vetri-DMG may be better for her because Denosyl tends to cause nausea in the tinier yorkies because the dosage is the same for them as for a 10 lb dog.

She has absolutely no symptoms at all? Is she ever a picky eater or has she ever had UTIs, darker urine, head pressing after high protein meals, hypoglycemic episodes?

Also, I want to add that meat and poultry proteins produce the most amount of ammonia which makes it hard on an already compromised liver. Dairy, vegetable, soy, and egg white proteins are easiest on the liver and produce the least amount of ammonia. Small, frequent meals are recommended as well for several reasons.

Thanks a lot for the helpful advice, everyone! We have pretty much decided to not consider the surgery. We wouldn't want to put her through something so dangerous and traumatic, when as far as she knows, she's totally fine. I mean, she could die very easily on the table, she's so small. We're going to get another blood/bile test in a couple of weeks and see where she is. She is on Denosyl once a day now, and her diet consists of special liver diets from the book "Dog and Cat Diets" (a book that we were actually using for more than a year before she was diagnosed.) The vet thinks that the fact that she has received such high-quality homemade proteins and carbs almost all her life has contributed to her very good health right now. She has some small kidney calcifications that the vet wants to keep an eye on, and if that gets worse I think they'll put her on Lactulose, which they should do anyway to get her GI tract moving faster. We've cut her meal size down to teeny tiny muffin-cup portions, and she gets four of those little snacks a day, so about half a cup or more of food total.

In response to your comments, no, Lacy has had NO symptoms whatsoever, EVER. She has been totally, completely normal. When I was first researching what this could be, I practically ruled out a liver shunt on my own because she doesn't fit any of the symptoms. She passed through anesthesia with flying colors when she was spayed. Even when we've given her meat in the past, she's been totally okay. she's never head-butted a wall or anything like that. I wouldn't say she's a voracious eater, but she's usually finishes her meals and has a very good appetite. I don't know, but it makes me hope that maybe the shunt itself isn't that bad, and she's getting some blood filtered in there.

[pack leader]

What a heartbreaking story! I have a 2.5 pound male (15 months) who has been
diagnosed with L/S. His bile acid test was 130. My vet has only done one of these
procedures and all I keep hearing on line is UTK and Dr. Tobais. I live in S. Florida
and would prefer to find someone local. The ameroid constrictor seems to be the way
to go, but not all vets use it.
At UTK they boast a success rate of 95% and 35% of all surgeries are Yorkies.
It's so sad that yours was not part of that percentage.
After reading your story, I am very confused on what to do, and where to do it.
My Bubba will not eat that low protein food....K/d, E/N, U/D. etc. He's not eating
and he even refuses Nutrical, now!
Any ideas????
Thanks in advance.
Pack Leader

[Sunnie]

Originally Posted by iwannalollipop2

Thanks a lot for the helpful advice, everyone! We have pretty much decided to not consider the surgery. We wouldn't want to put her through something so dangerous and traumatic, when as far as she knows, she's totally fine. I mean, she could die very easily on the table, she's so small. We're going to get another blood/bile test in a couple of weeks and see where she is. She is on Denosyl once a day now, and her diet consists of special liver diets from the book "Dog and Cat Diets" (a book that we were actually using for more than a year before she was diagnosed.) The vet thinks that the fact that she has received such high-quality homemade proteins and carbs almost all her life has contributed to her very good health right now. She has some small kidney calcifications that the vet wants to keep an eye on, and if that gets worse I think they'll put her on Lactulose, which they should do anyway to get her GI tract moving faster. We've cut her meal size down to teeny tiny muffin-cup portions, and she gets four of those little snacks a day, so about half a cup or more of food total.

In response to your comments, no, Lacy has had NO symptoms whatsoever, EVER. She has been totally, completely normal. When I was first researching what this could be, I practically ruled out a liver shunt on my own because she doesn't fit any of the symptoms. She passed through anesthesia with flying colors when she was spayed. Even when we've given her meat in the past, she's been totally okay. she's never head-butted a wall or anything like that. I wouldn't say she's a voracious eater, but she's usually finishes her meals and has a very good appetite. I don't know, but it makes me hope that maybe the shunt itself isn't that bad, and she's getting some blood filtered in there.

I am no expert on liver shunts for sure, but wow! those bile acid tests are HIGH! Please PM Ronnlunn on here. Her baby had the surgery not long ago and she is TINY.. she did fine. Please try to send her a PM and ask her about it. I would hate to see you wait until it is too late.

[pack leader]

Thanks for the advice, but I am new to this chat stuff! How do I find this Ronnlunn?
There was someone from Miramar who spoke of having a successful surgery in S. Fla
but I can't seem to find that person again, now that I am officially a member and
able to ask questions.
Appreciate your feedback,
Pack Leader

[bchgirl]

Originally Posted by pack leader

Thanks for the advice, but I am new to this chat stuff! How do I find this Ronnlunn?
There was someone from Miramar who spoke of having a successful surgery in S. Fla
but I can't seem to find that person again, now that I am officially a member and
able to ask questions.
Appreciate your feedback,
Pack Leader

At the top of the page...beneath your name..you will see a link which says private messages click that...click send new message and type Ronnlunn into the send to box. It's similar to sending someone an email.

[Ellie May]

I'm sorry.

Those numbers are high but because ultrasounds are so hard to read, the interpreter could've been wrong and maybe it's MVD...

Dogs with extrahepatic shunts should all be considered for surgery.
They will usually live a longer life with it.
The only place that I would want touching my dog for this is University of Tennessee. It is worth at least talking to them, especially if your current vet doesn't do the surgery and just knows how to do a bile acid test...

That being said, if you still don't want the surgery (totally understandable), with numbers like that and a suspected shunt, I think Lacy needs to be on lactulose. It can only help.

Could you post the ingredients of the diet that you are feeding and the nutrient analysis?

Fish oil can also be good but not just any kind.

[Yorkieluv]

Originally Posted by pack leader

What a heartbreaking story! I have a 2.5 pound male (15 months) who has been
diagnosed with L/S. His bile acid test was 130. My vet has only done one of these
procedures and all I keep hearing on line is UTK and Dr. Tobais. I live in S. Florida
and would prefer to find someone local. The ameroid constrictor seems to be the way
to go, but not all vets use it.
At UTK they boast a success rate of 95% and 35% of all surgeries are Yorkies.
It's so sad that yours was not part of that percentage.
After reading your story, I am very confused on what to do, and where to do it.
My Bubba will not eat that low protein food....K/d, E/N, U/D. etc. He's not eating
and he even refuses Nutrical, now!
Any ideas????
Thanks in advance.
Pack Leader

I'm so sorry that your baby may have a liver shunt...
K/D, U/D, S/D, etc are not recommended at all for liver compromised dogs. Yes, those foods are low in protein *but* they are the wrong kind of protein. These foods contain pork liver or meat proteins which are not recommended because they are very, very hard on the liver. Also, the dry varieties of Hill's diets are not recommended because they contain ethoxyquin which is a carcinogen.

Only canned L/D is recommended for liver compromised dogs...Its specifically formulated for them and contains high amounts of vitamins and minerals they specifically need like vitamin E and zinc and are low in vitamins and minerals they don't need much of like copper.
Royal Canin Hepatic LS 14 is a dry food that is for liver compromised dogs that is highly recommended. Most dogs find it very palatable, and it is also lower in fat. Both L/D and Hepatic LS 14 contain vegetable, soy, or dairy proteins because these are the safest and easiest on their livers.

Animal proteins produce the most amount of ammonia and in a liver which is not functioning properly, the ammonia cannot be filtered and therefore enters the bloodstream. Once in the bloodstream it causes symptoms like inappetance, head pressing, and even seizures...As the liver becomes more damaged, the symptoms become more severe.

Lactulose is very important...It helps bind the toxins and pushes them through the colon. The goal with this med is to get them to have 2-3 soft stools per day. This is important, so the amount you give needs to be based on this. The recommended dosage should be broken up into 3-4 doses per day.

Can you share any symptoms that your baby has exhibited including inappetance, drooling, staring, head pressing, dark urine, etc?