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Old 03-13-2009, 10:41 AM   #1
DAB
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Unlove Liver shunt

Hello again!
Here is an Emma (will be age 2 on March 26th) update. To review----Emma was sick over the holidays. She has had many blood tests which were sent to the IDEXX lab in Grafton, MA. All but one tested high for bile acid---over 500. She had an ultrasound done in January which did not show a shunt. The doctor was pretty sure that she did not have a shunt.The procedure was done at Tufts University Foster Hospital for Small Animals. Her bile acid number after the procedure was "normal." But, Another blood test done one month later showed the acid bile count was again high. My Emma has lot of energy and has not been "sick" since the holidays. No clinical signs of a shunt.

However, today, she went back to Tufts for a scintigraphy test. The doctor informed me that a shunt was found----an "unusual one." Tufts also did another ultrasound immediately after the scintigraphy test found the "little" shunt. I am not sure why. I am also not sure what is meant by an "unusual shunt" but I am exprcting a phone call later this afternoon after he confers with a surgeon and will be sure to ask about it at that time. He has contacted my vet and I am also waiting to here from him.

She has been eating Iams Low Residue since December when she became ill. Previously she ate EVO Low fat. My other Yorkie girl, almost 5 years old, eats that food as well without problems. I have been on this site inquiring about Evo. Is it too high in protein? Could it have aggravated anything? Should I stop feeding it to my 5 year old girl? After the dog food recall last year, I was happy that Innova Evo was never on the recall list. Now I just do not know. My daughter also fed Evo but decided to cook food for her Yorkie, Maltese and shihtzu after the recall.

So, I suppose the surgeon will say that surgery is the way to go. I am concerned because of what the side effects might be because I have heard horror stories about seizure disorders, etc. Emma weighs maybe 5 Lbs if that and my vet informed me in January that the surgery is intense. I am very worried. The doctor in charge of her case said sometimes surgery is not done. Tufts has found liver shunts, which are congenital, in dogs as old as 12 years!

Hopefully, I will have more information in a few hours. Then, if Emma is not still radioactive tomorrow (3/14), I will be able to bring her home from the hospital.

I know people on this site have had the surgery done on their little yorkies. has anyone had any bad experiences? Are there specific questions I should be asking the doctor/ surgeon at Tufts? I will have to get all the information from Tufts and my vet, but any advice/comments anyone can give me would be very helpful.

I love my little Emma so much. My 2 girls get along so well. They are so cute together. Did I mention their brother, the cat? They are like 3 peas in a pod just like the 3 Musketeers, "one for all and all for one."

Another question, should I inform the breeder? I know Emma's mother was spaded after she had Emma. Emma was the only puppy in the litter and it was the first and only time her mother gave birth. I do not know if Emma's dad has been neutered. He comes from an AKC champion show line. Emma looks a lot like her dad.

Thanks again. May all your Yorkies be healthy.

DAB
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Old 03-13-2009, 10:48 AM   #2
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Often times shunts are not found using ultrasounds...so not being found using this method is not unusual. Her food did not cause the shunt. It was always present...some dogs are just asympomatic.

Many many yorkies have the surgery completed, yes it is intensive...but they do on to live long healthy lives with completely normal bat results afterward.

Here's more information from the University of Tennessee...Dr Tobias is considered an expert in this field...

Portosystemic Shunts FAQ

Best wishes for Emma...
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Old 03-13-2009, 10:52 AM   #3
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Wow, what an update. At least they found the problem...I have just asked my vet about scintigraphy for Winston. His bile acid test was normal fasting and just slightly elevated after...but he has hypoglycemic seizures. I have been searching for answers for 3 years now. The not knowing what is causing a problem is hard.
I really know next to nothing about the surgery, but I know there are many on here that do...so I'll just wish you and Emma well...and leave the advice to those that really know.
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Old 03-13-2009, 10:58 AM   #4
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Originally Posted by wemple2 View Post
Wow, what an update. At least they found the problem...I have just asked my vet about scintigraphy for Winston. His bile acid test was normal fasting and just slightly elevated after...but he has hypoglycemic seizures. I have been searching for answers for 3 years now. The not knowing what is causing a problem is hard.
I really know next to nothing about the surgery, but I know there are many on here that do...so I'll just wish you and Emma well...and leave the advice to those that really know.
Ellie's was just slightly high once and the next time it went up 90 points.
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Old 03-13-2009, 10:58 AM   #5
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I looked into information about the procedure developed by Dr. Tobias. However, I have also been informed by some vets that there have been some issues with it and the "technology" [for a lack of a better word] is old.

It is all confusing.

DAB
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Old 03-13-2009, 11:04 AM   #6
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I looked into information about the procedure developed by Dr. Tobias. However, I have also been informed by some vets that there have been some issues with it and the "technology" [for a lack of a better word] is old.

It is all confusing.

DAB
The two techniques I know of are the cellophane band and the ameroid constrictor. The AC closes it off slowly to reduce the risk of portal hypertension and more shunting I think. The cellophane band is said to close it too fast. The University of Tennessee has the smallest seizure rate post surgery which is directly related to survival. Some say they don't like the AC but I'm not sure why. It would be nice to have a study that actually shows which one is safer.
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Old 03-13-2009, 11:04 AM   #7
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Please join this group: DogLiverDisease : Dog Liver Disease
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Old 03-13-2009, 11:12 AM   #8
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I looked into information about the procedure developed by Dr. Tobias. However, I have also been informed by some vets that there have been some issues with it and the "technology" [for a lack of a better word] is old.

It is all confusing.

DAB
If you mean use of a constrictor...I have been told VA Tech does not use this method, but there are several ways they can be repaired...

You may want to read Dr Center's site too.

CFYTC Health & Grooming - Liver Shunt

Cornell and University of Tennessee are both considered premier in this field.

I am attending a seminar of Dr Center's in a week and I am really interested in hearing what she has to say regarding recent discoveries.
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Old 03-13-2009, 11:15 AM   #9
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I am going to try to make this reply as unemotional as possible, because I know there is a lot of emotion involved when you are hit with this news and you just want answers. I have a 1 yr old yorkie that I always suspected had a liver shunt becasue she was so small (2.5 - 3 lbs) and would not eat. I was reassured by my vet that she was showing no neurological signs and was just spoiled and most probably did not have a shunt because she was gaining weight. I tried to get them to do the Bile Acid Test several times but they felt it was unnecessary. My Lola was supposed to be spayed in March, but after reading a story about a little female that was liver compromised and spayed that did not make it through the surgery, I insisted 2 1/2 weeks ago that we do the BAT. Two days later the results came back abnormally high. They wanted to run other tests after this. I started to do A LOT of research and found a group on Yahoo (Liver_Shunt_And_MVD_Support Liver Shunt & MVD/HMD Support) that has been invaluable. I decided not to have any further tests run here, but to take Lola to the experts at University of Tennessee, Dr Tobias, to have the tests done. They did a scintigraphy on Thursday, 3/5/09 that did show a shunt. They closed the shunt last Friday, 3/6/09, and I picked her up Saturday evening. We have not had one complication and Lola is doing great. The surgery was much less at UT than it would have been at the specialist here, so it came out the same once I paid for the hotel and air. I was worried about Lola being so small and they say the 24 hours after surgery is just as important as the surgery itself. I can not say enough wonderful things about Dr Tobias and UT. They do many of these each week - the surgeon I was referred to in Houston said they only do 1-3 per week. You do have to keep them calm for 2 weeks after the surgery, and have them retested (BAT) 3 months post op to see if that was the only shunt or if they were tiny ones that have to be maintained by diet. Good luck - please let me know if you have any other questions...it is still very fresh in my mind.
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Old 03-13-2009, 11:28 AM   #10
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The post surgery seizure problem {I have also read about blindness occurring] is what is worrisome. Has anyone had this liver shunt surgery done at the Tufts University Foster Hospital for Small Animals? I will have to ask them about their success rates and whether or not there have been problems with seizures. I know that with any surgery, doctors always say that something could go wrong. I would feel horrible and so sad if Emma were not the same cute and energetic love after surgery. I would hate to see her suffer with seizures and other complications due to surgery. Should surgery be the only answer, I wonder if I can insist on a VERY EXPERIENCED surgeon and not a student since this is a teaching university hospital.

Feeling sad already.
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Old 03-13-2009, 11:41 AM   #11
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If you join the Yahoo group: DogLiverDisease : Dog Liver Disease

You will speak with many LS parents that had surgery and all went well and you will speak with a few that had complications as well, but are wokring thru them. They will guide you and support you to make the right decision (for you and your baby)
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Old 03-13-2009, 11:53 AM   #12
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I agree with TLC. There should be somebody there that had the surgery done at Tufts. As far as insisting on somebody experienced...no students, I'm not sure if they will let you but I would not let any student do this or any other surgery on Ellie honestly.
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Old 03-13-2009, 01:03 PM   #13
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Unlove Emma and liver shunt issue

Thanks for your support. It means much to me. It is 5:00 pm and I am still waiting for Tufts to get back to me. I am supposed to get a call before 6:00pm.

Again, anyone out there who had the liver shunt surgery done at Tufts? The last time I was there one of the doctors said that the surgery is done there all the time on small dogs.

Hope I can have her back home tomorrow. I am wondering though if they will just want to keep her if they think surgery is the way to go. Will keep you posted.

DAB
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Old 03-13-2009, 02:15 PM   #14
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I am so glad you had a scintigraphy done. Ultrasounds can be as low as 60% accurate in detecting shunts according to Dr. Center. Smaller shunts can be missed and small dogs, especially if they wiggle, are most likely to have a shunt missed. That sounds like what happened with your Emma.

Please don't think that feeding Emma Evo had anything to do with her shunt. It is too high in protein and her diet will have to be modified, but shunts are congenital.

I am just so glad you persisted and finally got a diagnosis.
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Old 03-13-2009, 03:42 PM   #15
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Ellie's was just slightly high once and the next time it went up 90 points.
So would you suggest I retest Bile Acid levels? Even though more than one vet has said that he is not a liver shunt dog? The thing that was recommended in his case was a liver biopsy for glycogen storage. Is that the same as PSS? Now I'm confused.
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