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Possible Liver Shunt - Need Advice Carson's legs have been giving out on him lately, can hear his nails on the floor - when he gets excited and turns he loses his balance. He stopped being able to jump up onto the bed (even though we have a stool). He is also a bit over weight, even though he doesn't get any treats - only Halo, as well 2 1/2 years old. We got him tested and they say he has a liver shunt (they did a complete blood panel, including fasting and then 2 hours after eatting). We've got him on Hills L/D, along with Flagyl and Cephulac (Lactulose) - since Thursday night. We don't see any difference, maybe he's even a bit worse. What should be our next steps? I've heard an ultra sound might not be the best test, is there something else? The vet also says there is a possibility that he can survive with diet and meds - but I've read that dogs don't do well for very long without surgery. Thank you for your advice! |
Liver shunt can't be diagnised with blood testing (can only be somewhat certain). Diagnostic imaging is needed to confirm. If a single shunt outside the liver is present, surgery is usually recommended. U/S is sometimes not recommended because it is very difficult to find shunts this way. They are about 60-80% accurate with a skilled sonography. Nevertheless, they are used extensively and may work for your pup. I'd be concerned that he is getting worse. Since your vet thinks it's a shunt, I'd go to an internal medicine specialist as soon as possible. |
Can you post the results of the Bile Acids Test? |
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My husband is going to get the tests faxed to him tomorrow, and I believe our vet is calling the emergency clinic for a second opion. His head doesn't tilt to the side, and he eats a lot - so some of the signs don't match up. |
I would lean towards doing an xray first. Dogs with LS typically have small livers, and the xray would also show any disk, back, neck, or head problems, which can be a cause of his legs going out from under him. Are his symptoms worse right after he eats? Does he press his head against walls, or do any circling, pacing back and forth, inability to settle down for any length of time? Has he had any falls, or walked into anything? If his liver enzymes are elevated, putting him on Denamarin or a similar product will help to protect and regenerate his Liver, LS or no. |
They did do an xray, but I don't think it showed any issues with the actual size of the liver. Hopefully we can get more information when we call the vet for the results today. There are no other symptoms that he is showing, we actually thought it was weight gain that was causing his legs giving out - but then when he wouldn't jump up on the bed we thought we should get him checked out. Originally my vet said we should take him to a neurologist for an MRI, but then when he did the test he came back with the shunt. I hate to see him this way so I think I don’t want to wait two weeks to see if the diet and meds will make a difference. I’ve already lost Oscar (Feb ’09) from a six-month battle with lymphangectasia (SP?) – it was devastating and extremely expensive. I’m not sure if I’m going to be able to handle this… |
Hang in there, Carson needs you! I know how tough it is. Carson and your family will be in my thoughts, I hope this goes well for Carson. |
Here is the information from the tests: Bile Acids (Pro) 46.0 / 0.0-6.0 normal Bile Acids (Post) 43.0 / 0.0-15.0 normal CK 604 / 5-235 normal Lipase 1025 / 0-900 normal Trace of protein in his urine I think the vet said the liver xray was okay |
Odds are that he may have MVD, but not Liver Shunt. The University of Tennessee (LS researchers) has tested thousands of Yorkies and say that Post BATs less than 100 most likely are MVD, over 100 most likely a shunt. MVD dogs are usually managed with a low protein diet, and medications if needed. The pre prandial result can be high due to an involuntary release of bile in the middle of the night. Other conditions can cause elevated BAT results. |
Here's what we did with moderately elevated numbers - tapered down the protein a bit (not much - cut out protein treats, etc) and re-tested in 30 days. She could test fine in 30 days OR have similar numbers and you can go from there. |
What does MVD mean? My breeder seems to think it's insuffilitus (sp?), a brain infection and needs to be put on Prednizone asap. She said anything under 100 isn't a shunt. We are going to try the prednizone today, as he is not getting better with the liver shunt diet and meds. |
Does he go for walks.. how well does he tolerate any kind of exercise? MVD Multivascular Dysplasia... basically the architecture of the liver is wrong but still functional not 100% Encephalitis... |
Was any swelling in the skull evident on the Xray? Does he do this behavior all the time or only when he's excited? (losing his legs) Next tests may be Spinal Tap then an MRI (for definitive diagnosis) May want to see a Neurologist. But, if only when excited... elevated CK could indicate a Heart problem.... |
He pulls us like a sled dog, but this is when he has the most traction and we don't really see him fall over too much. Do you think it could also be Encephalitis? His legs give out all the time, he can walk straight ok, but when he turns they give out. The more excited he gets though the worse it is. We have put rugs down by the front door to help him keep stable when we come home and he gets excited. He also wants to stay in his crate and sleep for most of the time. |
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