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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. |
Enchephalitis symptoms would occur mostly all the time, except while sleeping. What color are his gums? Does he scratch alot on his head, neck or shoulders? |
He is out of balance all the time, he does like to rest a lot. I think his gums are okay. Breeder is giving us prednizone to see if in a few days he is getting better - do you think that could be harmful? |
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Has the breeder had neuro issues come up in any other pups? Is this where Oscar came from? |
Thank you, I think my husband is going to pick him up and take him to the emergency clinic. My vet is still standing by the fact that he has a shunt - aren't the levels too low? |
I think a shunt may be possible but not likely...I can't rule it out bc I am not a vet.... but with the numbers I've seen ( I have a LS dog) those numbers are way low. Plus legs giving out is not a major symptom of LS, even though it can be different for each dog. Also with numbers that low, very rarely are there any symptoms evident. Usually suspected on pre-op elevated liver enzymes (ALT, AST, GGT, ALP). Be sure to take the bloodwork with you to the ER. Maybe the Xray too. Keeping you and Carson in my prayers... And my deepest sympathies on your loss of little Oscar.... Very cute pups in your avatar! |
Thanks for all you advice, I will keep you posted once we hear back from the emergency vet. |
You're Welcome... Best of Luck and prayers for a quick diagnosis and even speedier recovery.....:D |
After reading your post it kind of sounds like what I just went through with my little Dior. Dior is 6mths and she was basically just falling over and tripping over her feet. At first we thought it was cute that she was so clumsy, but then it started to bother me that she wasn't jumping or doing most things puppies do. She slept A LOT and just wasnt a carzy normal puppy. I took her to the vet and we did a bile acid test, her levels were elevated, but not over 100 like they should be if it was a true shunt. They then did an x-ray of her neck and we found out that it was AAI (Atlantoaxial instability). Basically spinal cord was being pinched and her feet weren't receiving brain signals correctly so she basically didn't know where they were. I would ask the vet about that because it's not very common but VERY serious until corrected. I don't want to scare you, but its a good thing to rule out if they are expressing neurological symptoms (basically walking drunk or stumbling). |
Just checking in for an update.... hoping everything went well at the vets.... |
Sophie's number was much higher than that and her internest 95% ruled out shunt because she has NO symptoms. |
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These symptoms can be AAI , Chiari , GME or LS. Kjc had mentioned MRI & Spinal Tap and if this were my pup that would be my next step. Also with Chiari it can throw off liver enzymes and I believe GME can also. All of these things are treatable. Did your baby recently have vaccinations ? If yes then it could be GME. |
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Sorry everyone, been away from the computer and didn't realize anyone had posted recently. Emergency clinic visit is tomorrow morning, it's 3:45am here and as you can see I can't sleep. I'm going to print down all the possible reasons for this situation... no, he doesn't rest his head on anything. We did give him two days of Prednisone, and will tell the vet tomorrow. My breeder just scared me so much that I worried if we didn't and something happened I wouldn't live with myself. So the DR can decide if he should stay on it, or not – I just hope we haven’t done any more harm. We are seeing the Internal Med Specialist tomorrow, and I don't know if he will suggest the Neurologist. The Internal Med Specialist is the same one that we saw for my late Oscar, so knowing how much I spent on him (10K) I am hoping he doesn’t just send him for every test in the book. My breeder had a client whose dog had the same symptoms, and when they were put on Prednisone they got better. I believe she said it was encephalitis; however, her vet thought it was a leg issue and operated. She has been breeding yorkies for 12 plus years, and was taking the shunt very seriously – she has never had a case. Well I am going to try to get a few hours of sleep, as my munchkins just came out to see where I was... so I should go climb back in bed with them. |
I forgot to mention that he did get a rabies shot on June 10th, and he had a lump on his back for about 6 weeks afterwards (I think it took a few days to show up - as we didn't put them together at first). Carson is the one on the left in my avitar - he really is a beautiful yorkie. |
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