[Specs]

Hello all! Its been a while since we posted about Toby. We are on our way back (30 hours drive total) from the Western
College of Vet Medicine in Saskatoon, Saskatchewan, Canada. Toby (4 year old
Chorkie) was diagnosed with a probable liver shunt back in January 2013 due to
high BATs (pre 63/post 174) and exhibiting HE like seizure symptoms. Medical
liver shunt management and diet changes did not seems to relieve his symptoms to
a manageable level.

After 3 days of extensive testing (urinalysis, chem panel - standard SA, pre and
post ammonia tolerance test, abdomen ultra sound, MRI, CS spinal tap and spinal
fluid analysis) Toby's liver tested normal in both size and function and no
liver shunt was found or suspected. We could not grasp why his bile acids were
so high yet no liver shunt and liver enzymes/liver size/liver function perfect?

Apparently there are several reasons for elevated bile acids and one is that
some dogs gall bladders will excrete excessive amounts of bile before the food
reaches that area of the intestine. They found they could induce his HE symptoms
by pressing on his jawline. A dental X-ray showed no dental problems according
to the dental specialist. The case was now turned over to the neurological team.
An MRI showed the brain was clear of leisons so a spinal tap revealed excess
fluid on the spine. The fluid was tested for spinal disease (which is fatal) and
cleared of that. The excess fluid was caused by some unknown earlier trauma and
was the cause of all neurological HE like symptoms. Toby has been HE free for 3
days now on his new meds of Prednisone and Gabapentin. It is hoped this
treatment can be removed after the spinal fluid dissipates but time will tell!
And that is the story of the liver shunt doc that wasn't! Folks on this site
always say to go to a vet med school for testing and they are absolutely
correct! Never have we experienced that quality of care and professionalism!
Kudos WCVM!