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Originally Posted by ladyjane  Please show me the research that states this is a common thing. I have never heard of anything like that. Perhaps it is possible..............but..... Am I not correct in saying that putting off surgery for a long time puts a dog at risk for multiple shunts? |
I didn't say it was 'common', I said I saw people on YT who have had to get 2nd LS surgeries for their dogs.
http://www.yorkietalk.com/forums/yorkie-health-diet/228696-food-after-liver-shunt.html http://www.yorkietalk.com/forums/sick-injured-emergencies-talk/52419-second-liver-shunt-my-indy.html http://www.yorkietalk.com/forums/2283685-post9.html
The best time for LS surgery is when the pup is less than one year of age. Older dogs, such as Lucy, 3 Years old, or my Tink, who was diagnosed at 3 years old are already at a higher risk from not being diagnosed and surgically repaired as puppies.
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Originally Posted by ladyjane Is it not true that it is more likely to happen to a dog who has NOT had the surgery? I mean, seriously, are you recommending AGAINST liver shunt surgery? What do you suggest...that an owner ignore a shunt and not do surgery because the dog might throw more shunts? Seriously? |
I don't know, I haven't seen any statistics. I think it happens at the genetic level, and the gene or genes that control the formation of the liver shunt (which is present in all dogs at birth) is damaged and malfunctions. No, I don't think a shunt should be ignored. But I do think owners need to be aware that surgery can't always correct the problem, and that the liver can produce more shunts after being repaired. And owners also need to be aware that sometimes LS surgery does work.
Acquired Shunts occur when the pressure in the liver becomes too great, and rather than have the liver burst, it produces shunting to relieve the pressure. When a shunt is repaired, it can cause more pressure in the liver, and the pressure is measured during LS surgery to determine what the liver can handle, so the decision is then made as to how much to close off the shunt, or to only partially close it off. So I guess it again depends on the exact problem of each individual dog, whether multiple shunting is more likely to occur in dogs that have shunts that are or are not repaired.
The liver produces and stores bile for the gall bladder, and if the bile gets too thick (called sludge) then this can also increase the pressure in the liver and cause it to throw multiple acquired shunts. These are different than Congenital Liver Shunts, they are smaller and more branched in appearance. (I suspect that this is Tink's problem as her surgeon prescribed Ursodial, which is supposed to thin the bile out.)
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Originally Posted by aproctor I did call to make sure Dr Myers was there and the tech I spoke to was very nice and she understood my anxiousness and said that she was in today and that she was going to review and speak with my Vet as soon as she could.
A couple of hours later my Vet did call and I just got off the phone with him and the summary of what he said is this: Because of the BAT's coming back elevated it indicates that there is still inflammation due to either hepatitis or possibly a shunt. Because of her not having any symptoms, and her blood tests being as good as they are they gave me these options:
Exploratory surgery/Biopsy (If there is a shunt they would repair it and if not they would just get the biopsy)
* Dr Myers feels this is the best route to go(to get a biopsy) because if there is a bleed they can control it and if there is a shunt then she would only end up with one surgery.
Laparoscopic biopsy
Ultrasound guided biopsy OR L/D Diet and Denemarin (sp?) and testing again in 6 weeks to see if her BAT's improve.
As of this moment my head is spinning and I need to talk to my hubby, I ordered the L/D and Denamarin because either way I think to start her on this diet would be best and then we will make our decision from there.
It just freaks me out to think of her under the knife because she is sooo little! 
I think it would be different if she actually seemed sick or had any symptoms at all then I would not hesitate.
If we do anything at all I think we would do an ultrasound because I don't want to have her go through any type of surgery that may or may not be necessary. |
As your dog is not a puppy under one year old, I don't believe 6 weeks will make any difference in her diagnosis or prognosis, unless the
diet and meds (as also recommended by the vet) work, and her BAT returns to normal. I'm sure they would have pushed the surgery option more had she appeared ill in any way during her exam.
Many dogs with Liver Shunt do not show any symptoms. They are frequently suspected of LS when pre-op bloodwork is done just prior to having a spay or neuter done, and the liver enzymes results are elevated.
I am just wondering if her BAT result isn't more indicative of a gall bladder issue, as the involuntary contraction of the gall bladder in the middle of the night (common in small breeds) can cause the preprandial result to be elevated higher than the postprandial result.
An xray may be a good option, as it can show the vet the size of the liver. The liver in most dogs with Liver Shunt tends to be undersized, and appears small in comparison with the body size on the xray.
The high ALT on her earlier bloodwork is 3x higher than what is seen in most dogs with LS. The higher elevations are more frequently associated with some form of toxicity. The fact that this number came down so quickly makes me think she has a fairly efficient liver. When Tink ingested an unknown amount of grease, it took her liver over 6 months for the ALT to start decreasing. Certain drugs can affect the BAT, so I am assuming certain toxins can affect it too.
I would definitely discuss everything with your vet. It is accepted protocol to make diet changes and redo the BAT in 2-3 months, when abnormal results are obtained the first time.
I would also ask your vet to contact the University of Tennesee. Vets there are more than willing to discuss cases over the phone to help with diagnoses. My vets contacted them during Tink's treatment to be sure nothing was missed or overlooked.