liver shunt or related issues????
 

My 2yr old baby was recently diagnosed with a possible liver shunt. She is not a candidate for surgery and is currently being medically managed with a special diet & supplements. Anyone experiencing anything similar????:confused:

Yes, several of us have Yorkies with compromised livers.

What are her symptoms?
What testing was done and can you post the blood work results?
What food and supplements is she on?
Why isn't she a candidate for surgery if it is LS?

Ditto to Ellie May's questions..

Many of us have liver compromised yorkies that are being managed through special diet, meds, supplements...

All bloodwork = normal
Urinalysis = normal
BAT = elevated: 69 & 111, indicating liver pathology......

Sasha had 2 seizures in a 2 week span. She had always been healthy prior but had recently become lehargic. She is currently on Hills LD, and is supplemented with Milk Thistle. We will be doing another BAT in about 3 months.

She is not a candidate for surgery due to her size (2.5lbs) and intolerance to anesthesia.

oh...and I am a member of Liver_Shunt_ And _MVD_Support......I was curious as to how many YT member and their babies are going through this . I did't see a support group here.....perhaps we can start one???

Okay, do you have a copy of the blood panel?
The liver enzymes and BUN might be normal but are they high or low normal?

It definately sounds like liver shunt or MVD.
Intolerance to anesthesia is a symptoms.
Be very careful what drugs she is given...no NSAIDs ever.

Your next step is a Protein C Test sent to Cornell.
Normal range indicates MVD and abnormal indicates shunt.
Although the management with a symptomatic dog with MVD or LS (that can't have surgery) would be the same... So I guess you don't have to go further.
Those numbers are in shunt range but it is still very possibly MVD.

Is she on Hills wet or dry?
Is she only on milk thistle?

With two seizures, depression and anesthetic intolerance, I would start full supplementation.

I don't have a copy of the blood panel....just going by the info that my vet gave me.....I will ask for that though.

She is on the Hills LD wet formula and Milk Thistle to start. Doc wants to redo the BAT in a couple of months and also wants to do a sonogram....then we'll go from there.

She has not had another seizure since she has been on the new diet (about 3wks) but just dosen't seem to have an energy. Also, her stools have been small and a bit dry (kind of like rabbit pellets almost) and she had only been going once a day. Doc suggested pumpkin mixed in her food and/or a little Metamucil for natural fiber....this seems to help. I know its important to get her to form more frequent, softer stools to eliminate the toxins from her system.

Do you really trust your vet? Have you considered switching? I ask because while ultrasounds are great at showing bladder stones (secondary to liver issues), they are only 60-80% accurate in the diagnosis of shunts. So unless the vet is looking for other diseases, it could be a waste of money, especially since she can't have surgery anyway and you would treat as symptomatic MVD anyway... A Protein C Test would be much cheaper and helps distinguish between LS and MVD. Also, if a dog has high bile acids and neurologic symptoms (hepatic encephalopathy), they should be on lactulose to help push the toxins out of their bodies (toxins building up makes them feel sick). This is a laxative and should soften her stool. She should have two soft but formed bowel movements a day on it.

She should be on SAMe (Denosyl or Vetri-DMG), lactulose and possibly fish oil and vitamin e. Milk thistle is also good.

I agree with Crystal. You might have to change vets. The problem is that most vets don't see that much liver disease and are not up to date on diagnosis and treatment. If you have a vet school within driving distance, that is your best bet.

An ultrasound is a waste of money since they can be as low as only 60% accurate. Current protocol is to get a Protein C test after a high BAT. You'd be surprised how many vets have never heard of it. Here is information you can share with your vet:

Comparative Coagulation -- NYS Animal Health Diagnostic Center

I had questioned the ultrasound, too....she said she would be looking for inflamation. I'm not sure if it's necessary....that's one of the reasons I started this thread....I'd like to compare notes.

This is a new vet that we are using, it's difficult to place full trust in anyone "new" to us..... I learned alot on the liver shunt site which helps me to both understand the desease and ask the correct questions. She seems petty knowledgable.

I had also asked her about lactulose.....she wanted to try a more natural approach 1st to see how she would do......she said alot of vets have changed their views on lactulose...

I also plan to ask about the protein c test.

Thanks for sharing!

I had questioned the ultrasound, too....she said she would be looking for inflamation. I'm not sure if it's necessary....that's one of the reasons I started this thread....I'd like to compare notes.

This is a new vet that we are using, it's difficult to place full trust in anyone "new" to us..... I learned alot on the liver shunt site which helps me to both understand the desease and ask the correct questions. She seems pretty knowledgabl,though.

I had also asked her about lactulose.....she wanted to try a more natural approach 1st to see how she would do......she said alot of vets have changed their views on lactulose...

oops! sorry for the double post!!

This is a new one for me.
Ellie will be starting lactulose shortly and we don't even know if she is having neurologic symptoms. We will see if it makes her feel any better (although she feels fine and she is energetic, I want to see if she is at all slowed down due to toxins) and stops her occasional shaking. Fiber is good but it isn't going to bind toxins and push them out like lactulose dose. I wonder what the problem with it is.:confused:

If the vet does believe this is LS, I don't really understand why you'd need to spend $200 so she could look for inflammation. She could go on EPA and DHA (fish oil) to help bring any inflammation down. Milk thistle should also help with this. Why hasn't the vet put her on SAMe?

I mean, an ultrasound really is a great diagnostic tool and would show everything going on in her abdomen but I'm just not sure it is needed here since the vet is so sure it is liver shunt (which she can't be because it is also likely MVD...).

My original post stated "possible liver shunt".....It very well may be MVD. I agree about the ultrasound....I am not convinced it is needed. I'll have to ask about the SAMe......what would the dosage be (for a 2.5 lb dog)?

Thank you for the info link! Where in NC are you located? We have a place in Atlantic Beach....I'm down there quite often!

The smallest dose of Denosyl is 90mg for dogs up to 12 pounds.
You could also look into using Vetri DMG instead which can be given in liquid for and the dose is more accurate. It isn't as popular though.

A dog under 12 pounds gets one tablet daily on an empty stomach. Marin is also good to add. I get both at Entirely Pets.

Denosyl | Denosyl for Dogs & Cats

Marin for Small to Medium Dogs (30 Tablets)

I am in Moore County (Pinehurst area).

The only issue with lactulose deals with diabetics...It should be used with caution in diabetics....

Other than that, the only real side effect of lactulose is diarrhea which happens if you give too much at once.

Lactulose is generally very safe.

Natural fiber will not do what lactulose does.

Liver shunt
 

To respond to your note:

My yorkie girl was seen at Tufts University Foster Small Animal Hospital after my vet suspected a liver shunt. Her Acid Bile Test was off the chart at 576! This incident began right at the holidays.

She was put on Metronidazole 2x a day before going to Tufts and now and now only 1x a day. She had an ultrasound at Tufts even though I questioned the effectiveness of the test. According to the doctor everything seems normal. A retest of the blood for acid bile fasting and then again after being fed a bit, showed a relatively normal bile acid count. She will have another blood test taken at the end of the month while still on the medicine which neutralizes acid, etc. in her stomach. If all is well, she will come off the medication and if there are no further problems with bloody diareah or vomiting bile, she should be ok. Perhaps, the original blood test results were wrong-----the vet at Tufts stated that a very good lab was used by my vet initially.

Right now she is also on a low residue kibble by IAMS. I may have to keep her on it forever.

CAUTION!! Just an extra note, my little girl developed an eye ulcer while in the hospital for the ultrasound! She needed to be sedated to keep her still. Sedation causes the eyes to dry out b/c the dogs cannot blink to remoisture their eyes. It is quite a large ulcer. I knew immediately that something was wrong because she did not look right after she was given back to me. her face/ left eye was too droopy. I questioned the vet and as I now recollect, was told she was a "bit drunk" after the sedation and that she would be fine soon. The next day she was not fine and would not open her eye. The following morning I was at my vet immediately and then learned about the eye ulcer. She is now on 2 types of eye drops. One is an antibiotic 4x a day and the other is a pain med which dilates the eye. She received that one 2x a day for a week and is now getting it 1x a day. I am going to see my vet once a week for an eye check. My little Emma needs to wear an e-collar 24/7 so she does not touch/paw at her eye. She is a real trooper! Of course, I contacted Tufts. I just wish, they had explained that a side effect from the sedation could be an eye ulcer. I would have insisted they look at her eye before she went home. :(

So the saga continues. I did tell my vet about the C Protein test. Thank you this forum for all the info that came my way from the Cornell University site. I printed it down and my wonderful vet read it and checked it out. He sat and explained what the C Protein test would indicate----most likely opening up more questions depending on the numbers that come back. It would at least point us in a direction. However, we have agreed that is Emma's BAT number is high at the end of the month or any time afterwards that we will have the test done immediately. He was very happy for the information as he was not aware of the test.

Do not be afraid to give the info to your vet. Has anyone had the C Protein test done with good results indicating what exactly was wrong with their yorkies? I am just annoyed with myself for forgetting to ask the Tufts vet about it while I was there. Right now we are all wondering if the original lab forgot to place a decimal point in the 576 number ( 5.76?) .

Best of luck with your little yorkie. I will keep this forum update either here or under my log on name "DAB. "

hemolysis can affect the results...Check the lab results and see if that's mentioned at all.

:thumbup: Excellent point!

The bile acid test is very reliable but the red blood cells MUST be separated from plasma (the clear part of blood) before they are sent to lab for analysis (centrifuged or spun to allow plasma separation from blood cells). Results can be falsely abnormal if the bile acid samples are lipemic (lots of fat IF the fat is not adequately removed by the laboratory analyzing the sample) or if hemolysis (burst red blood cells, makes the plasma red) occurs. The red color interferes with the color of the end point dye in the bile acid test. A clinician can tell if the sample is hemolyzed when they centrifuge the sample to separate the red blood cells from the plasma. If it is hemolyzed they should collect another sample. Drawing blood with a vacutainer needle into a vacutainer (suction of the tube facilitates the collection) may be too traumatic for some red blood cells augmenting hemolysis. Using a syringe and needle or syringe and butterfly needle appears to collect the best samples. After the blood is collected, the needle should be removed from the syringe and the top removed from the vacutainer so that the blood may be gently transferred to the vial. Results of the bile acid test should state if the samples were lipemic or if hemolysis occurred. In this case, the tests should be repeated.



PSVA and MVD Research Summary

liver shunt blood work
 

Wow! I can only think that Tufts University with all of its state of the art equipment and good doctors knew what they were doing when they repeated the fasting blood test and then the one they gave after feeding my baby. I only hope and I assume that everything you explained was done properly as they should know what they are doing. Any one out there from Tuft's who can tell me? It would seem, logically, that there would be a nationwide procedure across the board in place for separating red blood cells, etc.

Thank you so much for the info. How does one go about questioning lab people ( especially if the blood work is sent out to be analyzed ) about their procedures? How do I know?

It should state on the lab report if hemolysis occured...they note those kinds of things.

Liver shunt
 

Thanks again for the info.

I just did not know to ask about the test being lipemic or hemolysis and I never saw the report ( not that I would have understood what the terms meant had I read it). I will be asking my vet as I am certain all results were sent to him.

My girl goes for a vet for a check up tomorrow( 1/22 ) for her eye ulcer so I will ask about the test.

DAB

Liver shunt ?
 

My little yorkie's eye ulcer, acquired when she underwent sedation for an ultrasound to check for a liver shunt at Tufts University Small Animal Hospital, has healed. She has been on medicine for her stomach. Now, however, blood tests taken on Monday, 2/2, show that the bile acid is still high. The IDEX lab will repeat the serum blood test again tomorrow with the same blood sample to recheck the reading ( 500 ).

My little girl will go back to the vet for a fasting blood sample and then a sample after she has been fed. She will most likely return to Tufts for a different test using a dye injection to look for the shunt. If the dye goes to the liver then the heart, that will be good news. If it goes first to the heart bypassing the liver,that will indicate a liver shunt. I wish that test had been done to begin with. My yorkie girl will again need sedation. Hope we do not have a repeat of the eye ulcer. Clinically, she is fine. She is running around, she eats well, is very alert and just loves to play.

The doctor at Tufts seems to feel that the Protein C test is just an OK test. Therefore, my yerk has not had one. According to my vet, the injection dye test will definitely tell what is wrong with my little girl as far as having a liver shunt.

Please keep my little girl in your prayers and positive thoughts. I will keep you posted.

I could be totally wrong, but someething doesn't seem right here.
Why was she tested to begin with (I forget)?
Her bile acids were post 500, right?
Then the ultrasound showed nothing?
Then didn't the bile acids go back to normal?
Then 500 again or do I have this wrong?

If the vet at Tufts thinks that the Protein C test is just okay but likes the ultrasound, I think I'd hesitate to proceed with them. They may be right about the Protein C test but ultrasound isn't great for this and they should've known that. Scintography is a good way to go with bile acids of 500 but if she is "completely" asymptomatic, those numbers just don't make sense.:confused:

Liver shunt
 

My little yorkie was originally tested for a liver hunt. Yes, it is confusing. The test you mentioned is the test, I believe, is the next one she will have if she has to return to Tufts. At first, it was thought that a decimal point error was made in the original blood test done in December (576 instead of 5.76?) because when her blood was retested after the ultrasound after a pre and post fasting, the numbers were normal. Perhaps the first lab made an error. ???

Now that she has been retested, the oridinal lab has her number at 500 again. The specialist there spoke with my vet and is confirming the high number.

Hopefully this will be resolved soon. My vet and I are very concerned. We will have her retested by my vet perhaps tomorrow. She will not be given anything to eat in the morning. The vet will take a blood sample then feed her and take another to be sent out for testing. We are checking and double checking!

I will keep you posted. Thanks for your response.

If a dog has LS, their bile acids don't just go back to normal like that.
In my opinion, it is very possible that one or two of those bile acids test were done incorrectly. It would have been either the first and the third or the second alone but something isn't right. Did the same vet do all three or did someone else do the second one? Were they done differently (like no food was given or something)? If they are consistenly 500, I would do the scintography and get it over with most likely.

So sorry to hear about your baby.

My Yorkie had surgery yesterday. She is still in the hospital recovering. I just spoke to the nurse. This morning she doesn't want to eat. They want me to call again around 2pm to see how she does the rest of the day. Not only did they fix the liver shunt, they spayed her, they took stones out of the bladder (which I was told were not the same ones they saw in the ultrasound) and they did a liver biopsy.

Up to surgery day......She had an ultrasound done by a board certified radiologist. Was told where shunt is located, can be operated. Also saw stone, which is due to liver shunt. We had to come up with the money. Therefore, in the meantime they put her on lactulose (to soften her stool) and Metronidazole (for bacteria. it's an antibiotic). Also she was put on a low protein diet.

I hope you get a second opinion.

I wish you good luck and a happy ending.

Liver shunt
 

The medication my little girl has been on since the holidays is the metronidazole. We began with 1ml 2x a day and now she gets 1ml 1x a day. She had also been on a 1/4 tablet of peptid AC. She is no longer on the Peptid.

I agree, the numbers are confusing.....very high in December, 576. Normal after testing at Tufts, and now the liver bile is 500!

So to recap:

The first blood test ( December) was sent to the IDEX lab. Later, in early January, they were done right at Tufts University. This week, February 1st, my vet again drew the blood sample and the IDEX lab tested it. The liver bile number of 500 was tested twice by the IDEX lab. As noted, my vet spoke directly to the specialist the day he received the results (24 hours later) to insist that the blood serum sample be tested again. The specialist confirmed the 500 reading.

Tomorrow, Feb. 5th, my baby will go to the vet again. She will not eat anything in the morning. My vet will take a "fasting" blood sample, then feed her and draw another sample for the IDEX lab to test. Remember, that a fasting and post fasting test was the procedure done at Tufts the day of the ultrasound.

Tufts had her fasting and post fast number as "normal" when she was there last month. Again,this week, the IDEX lab had her at 500 ( she had eaten about 3 hours prior to the test).

So, as stated previously, she wil go to the vet tomorrow. If the IDEX lab's numbers are high, she will be back at Tufts for the other ( dye injection) test.

Good grief! I just want a definitive answer. I wish both labs would agree on the results. How can they be so off? Things that make me go "hmmm".
The Idex lab agrees that Tufts is a great place, nationally recognized, to go for this testing. Tufts agrees that IDEX is a top rated lab. Go figure!

I will keep everyone posted as to the blood test results we get from tomorrow's blood sample. They should be back within 24 hours.

Thanks to everyone for all the suport. Bless all your yorkies! :dogsm3: