Liver Shunt at 4 years old???

[kionini]

If I had a couple of weeks to do my research, then I would have a better grip on how to tackle this LS, but do I have that time?

So far this is what I'm dealing with:

~Need to find out if LS is 'congenital' or 'acquired.' (not only to determine surgery(s) or life time sustainment/management, but also insurance coverage)

~Need to know if it's Extrahepatic (outside) or Intrahepatic (outside) of the liver to determine if it's operable.

~Need to choose best way to diagnose with the least possible invasion and/or risks to my baby:

.......Scintigraphy: Pros; Relatively safe & quick.
Confirms if LS is present or not
Cons; Requires sedation or anesthesia
Requires hospitalization for at least 1 night.
Cannot tell if it's inside or outside of liver.
Cannot tell if it's congenital or acquired

........Portogram: Pros; Usually safe & able to provide a picture (snapshot) of the shunt so it's easier to see where it is and if there are more than 1.
Cons; more invasive than the above method and requires anesthesia

........Ultrasound: Pros; safer
Cons; Requires a ultrasonographer with lots of experience and a specialized machine "Doppler." If person is not experienced, the shunts can be missed

Transcolonic Portal Scintigraphy: Pros; Noninvasive, doesn't require sedation or anesthesia and takes just a few minutes "currently the most accurate and safest way available."
Cons; Doesn't say if it will confirm where shunt is or if congenital. In my experience if they don't talk about it, then it's not there

The problem is that not all this options are available to me where I am. I may have to go to NJ or NY or farther in PA to find proper diagnosis and treatment

[Rescuemomma]

Originally Posted by kionini

If I had a couple of weeks to do my research, then I would have a better grip on how to tackle this LS, but do I have that time?

So far this is what I'm dealing with:

~Need to find out if LS is 'congenital' or 'acquired.' (not only to determine surgery(s) or life time sustainment/management, but also insurance coverage)

~Need to know if it's Extrahepatic (outside) or Intrahepatic (outside) of the liver to determine if it's operable.

~Need to choose best way to diagnose with the least possible invasion and/or risks to my baby:

.......Scintigraphy: Pros; Relatively safe & quick.
Confirms if LS is present or not
Cons; Requires sedation or anesthesia
Requires hospitalization for at least 1 night.
Cannot tell if it's inside or outside of liver.
Cannot tell if it's congenital or acquired

........Portogram: Pros; Usually safe & able to provide a picture (snapshot) of the shunt so it's easier to see where it is and if there are more than 1.
Cons; more invasive than the above method and requires anesthesia

........Ultrasound: Pros; safer
Cons; Requires a ultrasonographer with lots of experience and a specialized machine "Doppler." If person is not experienced, the shunts can be missed

Transcolonic Portal Scintigraphy: Pros; Noninvasive, doesn't require sedation or anesthesia and takes just a few minutes "currently the most accurate and safest way available."
Cons; Doesn't say if it will confirm where shunt is or if congenital. In my experience if they don't talk about it, then it's not there

The problem is that not all this options are available to me where I am. I may have to go to NJ or NY or farther in PA to find proper diagnosis and treatment

(((HUGS))) Sounds like you've got a really good grip on the basics. If you can find a hospital - I agree that the transcolonic portal scintigraphy is the best option, but if not - A VERY skilled internal medicine specialist doing an ultrasound may be able to find where it is. It's hard, especially if your Yorkie is a very small Yorkie, to see them on ultrasound sometime, and it takes a very experienced and skilled specialist to find them with ultrasound, but it can be done. Alot of people say ultrasound isn't worth it because the vets that are skilled enough to diagnose a liver shunt with ultrasound are few and far between, and it's very easy to miss it with ultrasound. Will keep you both in my thoughts and prayers!

[kionini]

My local vet's office finally called yesterday to let me know that I do have some time and so to wait for the referral center's vet to return from vacation (a week and 1/2) to do the ultrasound on Nicky.

So I've been researching, reading tons of stuff. Trying to filter the marketing hype from the facts. So far I have identified the U of Penn's Vet Teaching Hospital Department and the Animal Medical Center in NYC (has the latest equipment and says they know how to use/read the results). I'm not done with research yet, though.

I was on the phone yesterday with other referral centers and a receptionist said that for what I'm looking for (correct diagnosis) I need a Radiologist (this is where AMC in NYC comes in, plus they believe in least invasive, high accuracy ).

Reading about the ultrasound not being as reliable to find a shunt, I preferred the Scintigraphy, but I wonder if there's a difference between a Nuclear Scintography and a Transcolonic Portal Scintography, because the former says it needs anesthesia/sedation and the latter says it does not

Some sites say that Postprandial (after feeding BAT) numbers above 100 are suspicious of LS and my Nicky's was 97.3 (I know, too close anyway), but could be mistaking with HMD (Hepatic Microvascular Dysplasia), which could appear in dogs without LS. Some of the same symptoms of LS may be present and since Nicky's been misdiagnosed before, this time I need doctors to get it right. Someone here said that in the 80s it could mean multiple shunts

So, I made an appointment for a second opinion with a holistic vet that treated Nicky before. She's from Cornell U and I'm hoping she can direct me to the fastest most direct way to tackle this.

If I'm going to be needing a bull's-eye diagnosis and a Scintigraphy is the closest and most likely where I'll end up anyway, I want to cut out the middle man and go straight to the method that will give me what I want...the right diagnosis.

I was looking at some videos of Yorkies with LS today and it broke my heart. What are the chances of both my furkids having LS ???? Nini wonders sometimes, vomits, sleeps long hours and presses her face on the floor. I thought maybe she's just imitating her brother Nicky. I'm having her checked too, just in case

I guess the stress of these few days got to me. I started crying uncontrollably when I saw the videos in Youtube, fearful that this may be the problem with my babies. Nicky's never seen me cry before and so naturally he freaked. He ran to me and started scratching at me leg to pick him up and now he's on my lap kissing me with worried eyes and taking little naps while I work on this, but not letting his mommy out of his sight. He's such an angel


That's where I am. I'm going to follow on the advise you've given me and continue to research more


THANK YOU again

[kionini]

Originally Posted by Rescuemomma

(((HUGS))) Sounds like you've got a really good grip on the basics. If you can find a hospital - I agree that the transcolonic portal scintigraphy is the best option, but if not - A VERY skilled internal medicine specialist doing an ultrasound may be able to find where it is. It's hard, especially if your Yorkie is a very small Yorkie, to see them on ultrasound sometime, and it takes a very experienced and skilled specialist to find them with ultrasound, but it can be done. Alot of people say ultrasound isn't worth it because the vets that are skilled enough to diagnose a liver shunt with ultrasound are few and far between, and it's very easy to miss it with ultrasound. Will keep you both in my thoughts and prayers!

Yeah, I agree. It sounds like the Transcolonic one would be the most accurate. But, I haven't been able to find someone who does it maybe NY? I'll check.
I asked the receptionists about the expertise of the ultrasonographer and can you guess what was the answers? I couldn't find one that didn't say they were highly qualified.

Reading about expertise, I found and agree that having this machine in their office and using it once in a while does not make them experts at it. According to what I read, they have to be using it every day, because only practice makes experience. I agree. And then if the ribs or other organ gets in the way, even an expert will miss it, right? Oh, boy, this is going to be tough, I think. But my babies need me to be tougher, so here I go

And like you say finding one where they are few and far between will take some detective work and ruffling of a few feathers (one of them got angry that I dare ask )

Thank you for the help and prayers (could never have enough positive vibes)

[rubymoon2072]

i wish you the best outcome. i can only imagine your fustration and will keep you and nicky in my thoughts.

[Giorgismom]

You're being very strong. I hope your baby will be ok.

[gemy]

I have an idea, if the Univ of Tennessee is out for you; why not contact Dr Karen Tobias and get a referral from her on the closest expert to you - and seek her opinion on best diagnostic tool. Faculty. She really is a leading expert in this field.

Her receptionist actually might be able to help with at least the names of specialists in your state.

[gemy]

http://www.vet.upenn.edu/Portals/0/m...pring_2006.pdf

Here is an article that may be of interest to you.

[kionini]

Originally Posted by gemy

I have an idea, if the Univ of Tennessee is out for you; why not contact Dr Karen Tobias and get a referral from her on the closest expert to you - and seek her opinion on best diagnostic tool. Faculty. She really is a leading expert in this field.

Her receptionist actually might be able to help with at least the names of specialists in your state.

Thank you!! I'll go and follow the links you suggest.

I found out through the receptionist in AMC in NYC that Scintigraphy is only done in Upstate New York AMC only does ultrasound and they are not Doppler Ultrasounds

I also contacted U. of Penn and they do use Doppler Ultrasound and said that if LS can't be found that way, then they'll do a 'scope' (a liitle semi-invasive procedure).

[gemy]

I just want to say stay strong. It is devastating to get this kind of health news. Anything at all we can direct you to; we will.

The research the weighing is so stressful. NOt to mention the cost of the treatments.

Personally I've not had this with a pup of mine, but I am right now dealing with cancer in one of my dogs. So truly I do know, the critical search for information.

I am so proud of your pro-activism for your beloved pet. Please keep us updated. And we are here to help you go through this.

[kionini]

Originally Posted by gemy

I just want to say stay strong. It is devastating to get this kind of health news. Anything at all we can direct you to; we will.

The research the weighing is so stressful. NOt to mention the cost of the treatments.

Personally I've not had this with a pup of mine, but I am right now dealing with cancer in one of my dogs. So truly I do know, the critical search for information.

I am so proud of your pro-activism for your beloved pet. Please keep us updated. And we are here to help you go through this.

Oh, I'm so sorry about your little one
I'm so grateful to you! On top of having your own situation to deal with, you found the time to help me find solutions to mine...I'm so touched, my eyes are getting soaked.
Thank you, I'm proud of you too, you're really a trooper. I wish you the best, especially for you sick baby

[kionini]

Thank you everyone for your help and encouraging words


I have been going insane, calling everyone, emailing, researching, etc. I called Dr. Tobias as Gemmy suggested and wow! I was shocked that her office called me back at home and the nurse gave me so much guidance and support.

To make a long story short, it was more than frustrating for me to go through this and I don't know what would've happened if I couldn't count on you for help and guidance, so thank you from the bottom of my heart.

I know that all of you have your own problems, as Gemy does, yet you came over to assist me and my baby-boy. that makes it even more special to me.

There were moments were I didn't know what to do and thought I would burst out screaming There's such a thing as information overload and I was there. I realized that I had to get a grip when I hit rock bottom and just started to cry after watching some Youtube videos about LS and babies suffering from it.

Needless to say, I freaked out pretty badly in my study room, where I thought I had some privacy Apparently, I was sobbing so loud they heard me upstairs. I heard tiny paws doing the 60-mile dash down the stairs and then somebody was scratching desperately at my leg
It was my baby boy, Nicky. He wanted me to pick him up and kept insisting until I did. I picked him up, put him in my lap and he started to kiss me like a mental patient, as if he knew something was wrong

He stood there on my lap all the time. Where ever I went he followed, he wouldn't leave my side for one second all day long. I thought, okay this is twisted! I'm supposed to be taking care of them not the other way around, get a grip.

So, I've managed to stay afloat enough to take Nicky and Nini to the holistic vet, where we did all the preparations to have a specialist at Cornell University Hospital for Animals see Nicky in the middle of June. (Nini's very healthy, btw, just a bad case of the 'blues' because her brother's getting too much attention---I'm guessing )

The vet says there's no need to have an emergency appointment, we could wait. It looks like I caught this in its early stages and as a consequence time is on our side

Cornell U. wants to do its own tests, starting with blood work and then the ultrasound with Doppler. Our vet says it was Cornell U. who came up with the LS diagnosis and so they specialize in this area, which gives me some comfort as to a correct diagnosis.

I'm still worried sick, but with the difference that now I know what to expect and I'm kind of ready for it. We're leaving for NY a couple of days before and staying close to the Hospital in case they decide to do my baby's surgery right away (should he need one, I'm hoping he doesn't).

I'm trying to cover everything and be ready for anything. I'm very hopeful and I've promised my little one the day I scared him with my sobbing that I'll be strong for him because I know how worthless I would be to him if I'm freaked out stiff

Again, thank you...you have no idea what your help has meant to me

I'll keep you updated.

[kionini]

NO LIVER SHUNT!!!!!!! We were so happy to hear the news The vet came out of to the reception area saying, "no shunt, no shunt, no shunt" I cried, I could not believe it, I was so sure there would be at least one. So the vet took us inside to see the results for ourselves. She explained what we were looking at and what it would have looked like if a LS were present.

The vet advised and we agreed to a CT angiogram for Nicky. He was anesthetized and given a dye to track its trajectory. Everything looked normal

But since Nicky does have some symptoms, specifically; elevated post-prandial bile acid test and tremors, etc., the vet sent out for other tests because she suspects the problem is microvascular dysplasia (MVD), or inflamatory bowl disease (IBD). If any of these two or both are the case, we'll cross that bridge when we get there

For now, I'm so happy it's not LS. Nicky is so delicate, I was very worried about the entire thing because of all the dangers possible We're waiting for the other tests results to see if we need to change his diet and to what we need to change it. In the mean time I have homework to do. The vet suggested I keep a journal and video tape the tremors to make sure he's not just cold

Thank you everyone for supporting us through this trying time

[ladyjane]

I am so happy that Nicky does not have a shunt. Just want to say that he is so lucky to have such a thorough and caring mom!

[gemy]

So very happy for you Katt. What a relief! You are a great Momma to your pups!. Even Mom's need to cry, then you do what you did, lift your chin, square your shoulders and get on with it; cause your pups need you!


I 'll keep you both in my thoughts; please let us know how the rest of the testing goes.