UPDATE on Sammer's Emma
 

Hi and thanks again for all of you who posted and/or e-mailed me regarding my questions on liver dysfunction and shunts. I'm sorry it has taken so long to post an update (really not much new news), but I've been frantic with worry for her.

As you may remember, Emma is a 10 1/2 month old, 3lb. 12 oz toy yorkie who wasn't eating well. I took her to the vet and her exam was unremarkable. Her urine culture however had crystals in it. Bear in mind as I write this that the vet has told me so many conflicting things and at first acted like she was dying, now acts like it's no big deal. (am changing vets at the same practice-my vet has been on sabbatical teaching, but is now back. I trust him).When I asked the vet what kind of crystals, he said I'd have to wait until the blood test (fasting, then after feeding) was back to discuss it. He phoned me and didn't even tell me her numbers until I asked.

Anyway, her fasting number was 45 and her second number was 63.5. He said the crystals were "urate" crystals. He also said that because her first number was so high, it was an indication of a shunt. She's scheduled on May 18th to have an ultrasound (however, I've read and been told that all ultrasounds do not show shunts---any feedback here?)

The vet first told me not to change her diet, then after I read some of the posts here and did more research, I knew it would help her feel better. He told me lots of carbs and "good" proteins--when I initially asked for a list of good proteins he told me liver! I've read a lot about diet now and it says NO organ meat and red meat causes the most ammonia. No wonder I was confused and thank goodness for this forum.

Anyway, Emma was not eating--she turned her head at everything I tried (and believe me, I bought every food I could find listed). She finally started eating about 4 days ago---she won't eat the prescription diet from the vet (they gave me kidney diet and said it would work for liver). She's now eating some fresh veggies--I found she likes crunchy things--baby carrots, fresh green beans, pea pods. She'll also eat some oatmeal but won't touch other things she used to love to share with me. She eats swiss cheese (can't get her to do cottage cheese, etc.) She is eating 1-2 Kong's full of little Ceasers food--I am giving her the chicken. Even before she got sick she wouldn't eat from a bowl but would eat her Kong. I know this is not the best thing to be giving her, but she's got to eat and was finicky before and now is even more finicky.

I'm praying that the vet made a mistake---I wonder if I should take her to another veterinary practice and have the liver fasting/feed test again. I also don't know if I should do the ultrasound ($300.---I don't care what it costs if it helps her, but if it's something ineffective--I'd rather spend the money on a second opinion).

She seems to be eating "enough", drinking her water (but less than before, before she was drinking 1 cup a day), her bowels are fine and she is sleeping a normal amount (for her) and is playing and fetching and chewing on her toys and chewies.

I'm at a loss here. OH and I bought the supplements the vet recommended (he said it was a mixture of Sam-e and milkweed thistle). It's called Denamarin and she takes one a day on an empty stomach. He's also having me give her about 1/4 a pill of Pepcid AC every other day. (any thoughts here?)

I'm sorry if I sound like I don't know what's going on.. I would do anything for this little baby. Ironically I have a MAED and should be able to figure this out, but I also have agoraphobia and deal with anxiety and depression, so this has thrown me for a loop and I'm having trouble absorbing the information in the more technical articles.

Any suggestions or feedback is deeply appreciated. Prayers for Emma are readily accepted as well. : )

Sammer

First a question for you.
Has she been spayed and if yes, how did she do with the anesthesia?

Drinking excessive is a symptom of LS or MVD.
She was drinking double what she should've been.

It could be MVD or it could be a shunt.
Have you talked about doing a protein c test?
An ultrasound in this case would not be a terrible idea because while it is only 60-80% accurate for showing shunts, it will show if she has ammonium urate stones (instead of just crystals).

The Denamarin is good but even better would be Denosyl (Same) and instead of the marin, something like Hepato Support. Marin contains a small amount of beef liver and yeast which aren't recommended. But then, it is a very small amount. Denosyl is cheap from entirelypets.com and some use Vetri DMG instead.

If she isn't eating it means that she doesn't feel good and toxins are likely buidling up. In this case I would start lactulose immediately to see if that helps.

Vitamin E is great to give as are certain fish oils.

The K/D that some vets give does contain pork which isn't recommended.
The Royal Canin LS 14 is very palatable and may work here.

I would strongly consider going to see Dr. Center at Corness since you aren't too far away. It would be by far better than local vets.

I'm so sorry to hear that you are having such a hard time with this...it is so hard when our babies are sick! Lola's numbers were so much higher than Emma's, it was quite obvious that she had a shunt, so her treatment was a no brainer....but now since her surgery, it's like she is a different dog. She, too, was such a finicky eater that I worried constantly about her eating. Now, she tries to eat everything - so obviously she feels much better. We'll know in the next 3-4 weeks when we have her re-tested, until then she is on the prescription diet. I did not have much confidence in my local vet either, but if Emma does have a shunt or MVD, it is vitally important that she be on lactulose and a very low protein diet....it really will make her feel so much better. It is so, so important to have a vet that is knowledgeable about liver disease. I hope your old vet can help you. Good luck ~ sending you and Emma thoughts and prayers!

replies
 

Thank you Ellie Mae and Lola's Mom,

I am located in Middlebury, VT, so I don't know how far I am from the type of veterinarian Emma needs. Where are you both from and how close was the doctor you used?

Ellie Mae, Emma was just spayed in early April. I was told everything went well and I was able to pick her up fairly early--I will call and see if she had any problems with the anesthesia--thank you for the tip.

What is lactulose? Also what does the Protein C test show?

I will get her some Royal Canin L food today and some Vitamin E oil. I am also going to make some phone calls to my old vet and see if he'll take over her case. Thanks also for the tip on the supplement.

Lola's Mom, thank you for all of your continued support and prayers. I'm so very glad Lola is doing so much better.

Hugs,
Sammer

Corness is in New York.
Dr. Center is one of the leaders in LS.
She developed the bile acids test.
University of Tennessee is the other place of choice.
If Ellie ever needed LS surgery or was sick from high bile acids and a local vet couldn't figure it out, I would go to either of these places.

Lactulose is lika laxative that binds the toxins and then they are eliminated.
You have to have a prescription. It is very important in the management of LS and MVD.

We were in Houston and flew to Knoxville for Lola's surgery...but as I said before, there was no doubt about Lola's shunt and the fact that she needed the surgery. It would have cost more to have the surgery done in Houston than to fly to University of TN and have Dr Tobias do it - including my air and hotel! Of course I opted to take Lola there, Dr Tobias was supposed to be one of the best, but I am sure there are others that are just as qualified. I was just not comfortable with my vet here and luckily have not even had to see her since Lola's surgery on March 6....that is an indication of how well Lola is doing! She had dissolvable stiches and has not had a problem since leaving Tennessee (keeping fingers crossed)! I have been VERY careful with her diet and absolutely no treats - but it has been worth it. I see a difference in her each day; even last night my husband commented on how much energy she had, more than when we brought her home at 11 weeks! She is still on the lactulose 3 times a day to flush all the toxins out, but has never been on any supplements. We also will not give any vaccinations until we get her next BAT results back. I hope your old vet can help - it makes such a huge difference to have someone there that you can trust. Please don't hesitate to ask any other questions - I don't know how much help I can be, but I'll try to answer your questions the best I can with our personal experience.

I don't have info on the Protein C test. We did not do it. We did Scintigraphy once we got to UT - it was included in the price that I was quoted. All that I did in Houston was the BAT and her numbers were so high, it was obvious Lola had a shunt. I was advised by several different people not to waste any more money on any other tests that might be "inconclusive" and to take her to University of TN. That is what we did. I feel very fortunate that they were able to take Lola the following week. Each case if different - this is what we chose to do with Lola and had great success. I think each baby has to be evaluated by their symptoms, test results, etc. and then decide what is best for them. My thoughts are with you...I know how very stressful all of this is!

I don't have the link for the Protein C test but it's a blood sample sent to Cornell. Below 70 indicates shunt, above indicates nothing at all or MVD.

Hi. Maybe this will help. U of Tenn Liver Shunt link

Portosystemic Shunts FAQ

Also try www.livershunt.com

A diet is listed also my vet said that using cottage cheese and/or hardboiled egg are better proteins for liver challenged dogs.