Liver shunts
 

Hello everybody! I'm new to this site and new at even posting on line so forgive my mistakes. My Mia is 9 months old. We go her when she was 2 months and the second day I had her she had a seizure, a few days after that and she had hypoglycemia and when she was 3 1/2 months old she went into a coma for about an hour and our vet. sent us to the small animal hospital at the near by university where the said she very probably had a liver shunt and wanted to keep her for several days and do some extensive testing and surgery or they could treat her condition with medication and a diet (hill's l/d). We decided to try the diet since that was the least expensive because the surgery was $3500 or more depending on the shunt or shunts. I have done some research and found a university about 12 hours from me that is alot cheaper and I'm considering letting her have the surgery. She is doing fine now except some days she doesn't want to eat and we have trouble with the hypoglycemia but I give her some karo syrup and she gets okay. Has any one known of a dog that has underwent the surgery?

There are dogs on YorkieTalk who have had this surgery.

I think the vets may not have explained has much as they needed to.
When young Yorkies seize, it is often liver shunt.
Shunts can be intrahepatic (inside the liver and not really operable) or extrahepatic (outside the liver and operable...this type is common in Yorkies).
Then there is Microvascular Dysplasia (MVD) or small shunting throughout the liver. This is always treated with diet and supplements if there are symptoms. It is usually recommended to do surgery on a young dog who has an extrahepatic shunt. They generally do well with it and most will have a better prognosis. The very best place in the US (and one of the cheapest) is University of Tennessee, Knoxville. Since GA is so close to TN, I really wouldn't even bother with any of the the vet schools there just because UT seems to have the safest track record... Dr. Tobias at UT developed the ameroid constrictor surgery used now.

Has Mia had a blood panel or bile acids test?
What are the results?
Sometimes the bile acids test helps vets diagnose either LS or MVD but it can be up for any liver functioning issue. If the bile acids are up, a good next step is the Protein C Test (blood test sent to Cornell). If the numbers are in normal range, it is likely MVD and the dog is managed on diet and supplements. If the numbers are abnormal it may be a shunt and the next step is scintography. While ultrasounds are used extensively in diagnosing liver shunt, they are only 60-80% accurate. They are great to see if there are bladder stones secondary to liver issues though. Most vets are still really pushing u/s for some reason.

What supplements is Mia on?
Is she on the canned or dry L/D?
How many times a day is she fed?

The university of Tennessee is the one that I was talking about. I dont have the numbers on her test my papers only say elevated ALP, ALT and Bile acids. Mia is on the dry l/d.

How many times a day is she fed?

The canned L/D is a better food for liver compromised dogs because the dry contains pork which is hard for the lvier to process. Most vets just know that dogs with LS need low protein and don't pay close attention to the type of protein being given but this is very important. If you want to feed kibble, Royal Canin makes one called Royal Canin Hepatic LS 14. It is very palatable but RC has made many Yorkies very itchy. It is worth a try though.

The University of Tennessee is one of the best in the country for treating liver disease.

Here is a link from UT explaining liver shunts:

Portosystemic Shunts FAQ

I leave her some out all the time. I first tried the canned food and she refused it. Some times when I cant get her to eat anything else she will eat some cheese. It seems to agree with her system but how bad is it for her. I don't know if I said before she get lactulose 3 times a day. I can alway tell when the toxins build up because her urine is very yellow on the puppy pad.

Thank you for the site information.

Has she been cleared of a urinary tract infection and bladder stones?
These are very common in liver compromised dogs.

Does the vet have her on SAMe (Denosyl or Vetri DMG), milk thistle, fish oil and vitamin e?

Green beans, seedless watermelon and peeled and cored apple bits are good treats.

She shouldn't ever be given red meat because it produces the most ammonia (toxins). I also personally wouldn't give pork and I'd try to stay away from exotics. Skipping organ meat is best because it is hard on the liver.

She should eat 4-6 small meals a day because too much food at one time would cause her body to have to deal with too much protein at once.

This is a great source of information on food for liver compromised dogs.

Liver | B-Naturals.Com Newsletter

I agree with Crystal (I usually do! :D) that she needs to be on milk thistle and Denosyl. I use Marin because it has vitamin E in it:

Marin for Small to Medium Dogs (30 Tablets)

Denosyl | Denosyl for Dogs & Cats

Should I take up the food and offer it 4-6 times a day and try to introduce the canned l/d again. She had a ultra sound but I think they were only looking for the shunt. What is the prognosis if she does have the surgery? Normal life on regular food or is this something that we will constantly deal with. This is my first inside pup and I did wonder why did I get a sick one but the answer is clear. I'll do my best to take care of her.

After you post the bile acids results, we will be able to help you more.
If it is MVD, she won't need surgery.
Did they see a shunt on the ultrasound?
If you are ever worried about her urine, she should go to the vet for a urinalysis.
I think UT's success rate is 85% but there can be problems years later and this surgery isn't that old, so I don't think we can say what might happen years down the road. Dogs with MVD can lead normal lives if they are on the right protocol. If you want to skip the surgery if it is liver shunt, the prognosis wouldn't be as good. However, that is something I'd want to talk to the vets at UT about. They can help you make the decision. Whatever you decide to do and whether it is LS or MVD, when it needs to be managed forever or for the time being with diet and supplements, the management is the same. It just depends on symptoms.

Lactulose 3x per day should be given. The amount given should be altered to produce two soft but formed stools.

SAMe should be given everyday. For dogs 12 pounds and under, the 90mg pill is given. The pill should never be crushed and has to be given an hour before eating. You can give Vetri DMG instead but most vets don't know about it. It comes in liquid, is cheaper and can be given with food.

Milk thistle is excellent as well. I just give one from a vitamin shop. The dose is 10% of an adult human's dose for a 5 pound dog and 15% of an adult human's dose for a 15 pound dog. An adult human's dose is about 400mg daily. So my 6 pound dog gets about 50mg daily. It is thought to be more effective to split the dose over 3-4 times a day. You can use Marin and Hepatosupport if you want. In severely liver compromised dogs, sometimes Marin is skipped because the small amount of liver used to flavor it and the yeast is a concern. The vitamin e in it is also not a large enough dose for some dogs. I just find that giving the regular milk thistle is cheap and vitamin e can be added if I want.

Vitamin E can be given. My dog was on 400IU for awhile. It was also sold at a vitamin store. This dose is quite high. I would consult your vet before using some of these things but they are all very safe.

Yes, pick the food up. Split up what she is supposed to have between 4-6 sevvings. I would try the canned again or get the other kibble because it is way better. It made Ellie very itchy though.

Unfortunately, ultrasounds aren't that reliable (as low as 60%) for diagnosing shunts. Most vets just don't see enough cases of liver disease to be up to date on the current protocol for diagnosing and treatment. You can waste a lot of time and money with your regular vet. I would definitely take her to UT.

Was a Protein C test done? That is the next step after a high bile acids test, not an ultrasound.

Comparative Coagulation -- NYS Animal Health Diagnostic Center

I tried to call the vet to get the numbers on her bile acid test and he is closed for the holidays. I'll get it on Monday and post it. In the mean time I'll get the suppliments and try her on the canned again. Thank you for your help.

Need to edit the milk thistle dose.
The dose for a 10 pound but is 15% of a human's.

I don't think the Protein C level was done but I'll ask on monday.

Milk Thistle Dosage (from the newsletter "Healthy Pets - Naturally"):

Dog's size
Dose as % of adult human dose

5 lbs 10%
5-10 lbs 15%
11-20 lbs 20%
21-40 lbs 30%
41-70 lbs 50%
71-100 lbs 75%
100 lbs 100%

Hi everybody! Just thought I'd chime in here. It's been quite a long time since I posted last. I know from experience about the University of Tennessee. I took my little girl Grace down there when she was about 3-4 months old. Grace had what my vet and Dr Tobias at UT thought was a shunt, but when Dr Tobias opened her up, she was surprised that Grace had no portal vein. Her shunt was her lifeline! Dr Tobias described the portal system like a tree and she said that Grace's looked like it was just snapped off. She said that she only sees that in 1-2% of the dogs that she does surgery on. Dr Tobias spayed her and sewed her back up. She gave her 1 to 5 years to live.

I was devastated. I was by myself and Grace wanted to be held all the way home (5.5 hours). She came home on Science Diet L/D and lactalose. There was also another drug that I can't remember the name of (Marin?). Anyway, she didn't do well on that drug, so she just gets lactalose and Sciene Diet L/D. Grace loves apples and pears and handles those well. She likes dry cereal (plain Cheerios). Every night before bed, she gets Activia Plain Yogurt which she LOVES. We are very careful that she gets nothing that is over 18% protein. Grace has had no repeat episodes since the day she was first diagnosed by my local vet. She will be two years old in January and is a very active, loving little girl. She weighs 6 pounds and my vet just scratches her head. I will send Dr Tobias an e-mail on Grace's birthday and thank her again for everything. Dr Tobias is great to help my vet when she has questions.

University of Tennessee is the best place to go for this type surgery. The surgery is only about $1400-$1500. Grace didn't have the ultrasound before her surgery because it was down. I don't know what the charge for that is. If I can offer any information to anyone, I will be happy to do so.

I wouldn't trade Grace for a million dollars! She is a joy and we are blessed to have her. I learned a valuable lesson and will only buy from a breeder that offers a health guarantee in the future. We paid $550 for Grace, 1700.00 in Tennessee for surgery and my expenses for 4 days plus all the vet bills Grace had before she was diagnosed. Oh, but look at this little face and tell me that it wasn't worth every penny!

Debbie

Your Grace is beautiful. I hope you have many, many years with her!

Grace is beautiful. I hope that the were wrong and that you have more time with her. I can't even think about loosing Mia. Thanks for the reply.