Liver Shunts?

[kna4977]

Our little 3 yo yorkie has had issues for some time now with throwing up. Usually occurs on weekends when the vet is closed Our first vet back in NC thought it was pancreatitis and treated her with amoxicillin + reglan which seemed to help, but didn't completely cure it. Our new vet here seems to think her symptoms are from a liver shunt. Yesterday we took her for a walk which she gets really excited about and when we got home she started acting funny.....throwing up.....then falling all over the place and contorting....I believe it was seizures. She had 2 of them. I have never been so scared in my life. She seems okay today so far, but I can tell she is really tired. The vet here wants us to take her for a scan. The scan is $420.....My question is for those who may have had it done, if she requires surgery how much in general does it cost?

[TLC]

Ahhh...it does sound like something is not exactly right.

Ok, here's my take. She should first have a Bile Acid Test (BAT) done. This will show how the liver is functioning. It is a blood draw (cost is $40 to $100 - depending on where you live). She will have to be fasted for 12 hours, brought to the Vet and they draw blood, then they feed her special food and 2 hours later they draw blood again. You should get the results the next day. You will get 2 numbers (a pre and a post) Pre should be less than 10 and Post should be less than 20. Honestly the Post number is the most important. "They Say" a post number over 100 is in LS territory, but that isn't always the case. It could also be MVD, which is managed with diet and supplements. Ex: Roxy's first BAT post was 100.9 and after more testing, we feel she has MVD.

So the other tests we did was a CBC, urinalysis, coagulation. All came back normal. We did do a U/S (cost about $350) but all it showed was a normal size and shape liver, and probably wasn't even necessary, as a U/S is not 100% accurate.

So, my advice would be do a BAT, CBC and Urinanlysis. Then you can do a Protein C test and then go from there with those results to see what other tests should be done.

University of Tenn (Dr. Tobias) is suppose to be VERY experienced and knowledgable with LS and lots of people choose them for LS surgery, which I have heard to be about $1500 (give or take) - but it's her experience and success that is most impressive.

Keep us posted

[Yorkieluv]

I am sorry your baby is sick...

Just like TLC said, your first step needs to be a bile acid test, a full blood panel including a CBC, and a urinalysis to check for crystals which is secondary to liver issues. If they find ammonium urate crystals or stones, it is almost guaranteed to be a liver issue because they only form in Dalmations or dogs with PSS.

A bile acid test is necessary because it is much more sensitive to liver function than a regular blood panel. A blood panel is important so you can check her ALT, ALB, BUN, etc.
Next, if those are elevated, your vet might suggest an ultrasound..If he wants an ultrasound to check for crystals/stones in the bladder and to check the size of the liver, then it's worth it, BUT if he's solely looking for a shunt, regular ultrasounds are not very reliable for that.

U of T prices have recently gone up to around $1800 from what I have read.

But at 3 yrs old, you really have to decide if it's better to have the surgery or medically manage the dog. The older the dog, the higher the risk, especially with portal hypertension which can happen after the surgery.
If it's a single extrahepatic shunt and nothing else, surgery may be a good option...
If it's several shunts, they cannot be repaired and need to be managed medically and with appropriate nutrition.
Even if it's not a shunt, it could be MVD, which also cannot be repaired and needs to be managed medically and with appropriate nutrition.

[Ellie May]

I agree with TLC and Yorkieluv.
Doing a scan before a bile acid test wouldn't be the correct order and could lead to unnecessary expense. With the seizures, if the bile acids are high I think I would just go to University of Tennessee and let them manage it because you are so close.

What food is she eating?

[kna4977]

Oh, I forgot to mention that she had already had those other tests. The bile acids were extremely high....in the 800s at there highest.

The univ of TN is not close.

She's on Purina EN dry and canned food

[kna4977]

Originally Posted by Yorkieluv

Next, if those are elevated, your vet might suggest an ultrasound..If he wants an ultrasound to check for crystals/stones in the bladder and to check the size of the liver, then it's worth it, BUT if he's solely looking for a shunt, regular ultrasounds are not very reliable for that.

That is why he suggested the scan. Thanks for all the good info so far. Can't believe I didn't think about a forum before since that's what I usually do for everything else.

[Ellie May]

Originally Posted by kna4977

Oh, I forgot to mention that she had already had those other tests. The bile acids were extremely high....in the 800s at there highest.

The univ of TN is not close.

She's on Purina EN dry and canned food

Oops, I'm sorry.
I read your location too fast and thought it said TN, not TX.
Yes, if the vet wants to do a scintography I would.
You could go to Texas A&M.

[TLC]

Originally Posted by kna4977

Oh, I forgot to mention that she had already had those other tests. The bile acids were extremely high....in the 800s at there highest.

The univ of TN is not close.

She's on Purina EN dry and canned food

Oh boy....YES - she definiatly has liver issues.
She needs to see a specialist ASAP - I too would really recommend the U of Tenn - check into it, the air/hotel and surgery may be less than surgery in your area.

Purina EN dry and canned food - This is not a good food for Liver Issues.
Hopefully others can give you a food instead

[kna4977]

Originally Posted by Ellie May

Oops, I'm sorry.
I read your location too fast and thought it said TN, not TX.
Yes, if the vet wants to do a scintography I would.
You could go to Texas A&M.

No problem....A&M is where she has an appt on Thurs.

[TLC]

Originally Posted by kna4977

No problem....A&M is where she has an appt on Thurs.

GREAT! Keep us posted. I am really concerned about a BAT of 800

[Ellie May]

Purina EN is too high in protein for a dog with liver disease who is having seizures. The protein in the food is vague (animal digest, animal fat) which isn't good because the type of protein fed to a liver compromised dog is very important.

She shouldn't have any red meat or pork.
It is probably best to stay away from exotics and in extreme cases, poultry.

Fish, egg, soy and cottage cheese are sometimes used.

[kna4977]

The vet in NC put her on the EN when he thought she had pancreatitis. She has tolerated that better than various things before. Yesterday is the first time she has ever had a seizure. I'm thinking she either got really hot after the walk and/or she was hypoglycemic---> seizure. That is pretty much all she is allowed to eat other than a few treats every now and then....Dingos....All she has done today is eat and rest.

We will likely need to change her diet. Any suggestions?

[TLC]

When do you go to the specialist?

[Ellie May]

If you are going to the specialist in three days, EN would likely be okay until you talk to him/her.

Science Diet L/D canned (not kibble) is okay and Royal Canin LS 14 kibble is okay but RC has made many Yorkies very itchy. If you feed kibble, you may want to add equal parts water because moisture is very important for liver compromised dogs.

[cvasquez]

Originally Posted by Ellie May

If you are going to the specialist in three days, EN would likely be okay until you talk to him/her.

Science Diet L/D canned (not kibble) is okay and Royal Canin LS 14 kibble is okay but RC has made many Yorkies very itchy. If you feed kibble, you may want to add equal parts water because moisture is very important for liver compromised dogs.

I would suggest getting your little one on an appropriate food. I feed Paisley the above and she is almost 3 weeks post her Liver Shunt surgery.

Paisley is just about 10 moths old and she had the bile acid test, then the scintigraphy, and then we went to the University of Tennessee. We are also in Texas, but it made more sense for us to go to UT. Our estimated fee was a lot less than anything here and since they are the best place for liver shunt surgery I felt it was best for Paisley.

Our total for her l/s surgery, spay, dew claw removal and pulling of some baby teeth was $1300. I couldn't believe the total was so much less than our estimated cost over the phone.

I wish you the best and will look for an update.