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What has been done so far?
Testing:
A full blood panel, urinalysis, possible urine culture and bile acids test need to be done immediately. How old is she? The problem with doing a bile acids test now is the liver isn't fully developed, so the results may not be accurate. It is best to wait until 20 weeks for accurate results. On the other hand, you need the results now, so just be aware that you may need to repeat the test later. If all is normal and your vet doesn't know what is going on, I'd see a specialist. If the bile acids are high, you will have to start talking about Protein C testing (blood test sent to Cornell) and scintography. A lot of people skip ultrasound because it's only 60-80% accurate at detecting a shunt, but because the bladder is involved in this case, it may be a good diagnostic tool. If it turns out to be an extrahepatic shunt, surgery will probably be recommended and should be done. If it's microvascular dysplasia (small shunting throughout the liver), no surgery can be done and medical management is needed.The best places for surgery are University of Tennessee (very cheap compared to most everywhere else) and Cornell. UT has an excellent safety record. I would avoid in-state hospitals/specialists that charge double the price without the safety record of one of the better places...
Low protein diets are good but low protein diets with the right type of protein should be the focus. Red meat and organ meat are some of the worst. They tend to produce ammonium (toxin) and that builds up and causes hepatic encephalopathy (neurologic symptoms). Hills canned L/D and
royal Canin Hepatic LS 14 are two choices. Hills dry L/D and Hills K/D canned and dry are not recommended because they may be low in protein, but it isn't the right type. Non meat proteins are best (like cottage cheese). Eggs and sometimes fish can be used also. If feeding kibble, you should add equal parts water because moisture is very important for these dogs, especially those with bladder involvement.
Supplements that should be giving are SAMEe (Denosyl, Vetri DMG), milk thistle (Hepatosupport or human milk thistle giving with vitamin e) and lactulose. Others that may be good are fish oil and extra vitamin e.
I think the first part of this came out a little funny.
Sorry about that. I just woke up.
