Latest on my "Lethargic Yorkie" thread - it's probably a shunt:(

[fifilame]

It's been up and down with little Gucci and how she feels. Hasn't seemed to be in much pain in the past week or so. In my previous thread I wrote how she was lethargic, not eating, hiding out in her crate and would some days cry out when you picked her up. Poor thing, she's had x-rays, blood work, ultrasound, you name it and the doctor could not find anything wrong with her except that she was having a "false pregnancy", i.e. her mammary glands were still swollen and sore from her first heat which I wanted her to have before I got her spayed. Anyway, her meds were going to run out over this past weekend and I was worried that if it happened to her again and they were closed I would be in trouble. So, I called the doctor, found out he was on vacation so his partner said he would look at her file and call me back. After reviewing her file, he decided to do a urinalysis and the full bile acid test, after fasting and after eating. I just got a call today from him. He is not sure because he is still awaiting results later this week from other tests he gave her, but he is pretty sure she has a liver shunt and that she is so tiny it didn't show up on the ultrasound. He said he will then know for sure and if there is a kidney stone, later this week. I asked how it is treated and he said with meds and a special diet. My question is - is this condition a death sentence or will it shorten her life? Also - does anybody know will she continue to have these periods when she is in horrible pain from this problem? Does it mean diet/meds now and surgery down the road? I read about it online but never really saw the answers to those questions. I'd really appreciate whatever information anyone can give about this problem.

[Sammy Mommy]

I'm so sorry that Gucci isn't feeling well. I don't know much about liver shunt but there are many knowledgable yorkie lovers here who would advise you. I hope Gucci gets better soon.

[hsanders]

Originally Posted by Sammy Mommy

I'm so sorry that Gucci isn't feeling well. I don't know much about liver shunt but there are many knowledgable yorkie lovers here who would advise you. I hope Gucci gets better soon.

As do I! positive thoughts headed your way!

[Lizzie07]

You need to do a search on liver shunts on this forum. From what I have read on this forum, there are two types, MVD and external. The external is operable, usually, and your puppy will have a normal life. The BAT results are used as an indicator for what type it might be.

I do think you need to do the research. Time after time, I have seen people recommend the Univ of Tennessee for the surgery. At the very least, I think you need to start thinking specialist.

I am so sorry your puppy is going through all this, I hope things work out well. I really hate that she might have a shunt, as she has been through so much already. Good luck, please keep us updated on her condition. My prayers for you both.

[kjc]

Liver Shunt is not normally a painful condition, for dogs who do not show any symptoms of it. Also, dogs who do have symptoms usually have them within 30 minutes of eating a meal.

Dogs in heat or having a false pregnancy can be a bit touchy or oversensitive to what would be normal stimuli or things that do not bother them when they are not in heat or having FP.

I need to read your other thread But will post this now. (PC problems!)

[kjc]

I thought I read that a bile test had already been done and came back normal? (from your earlier thread?)

Did they test her for pancreatitis?

I do believe that a first heat and swollen mammary glands can be a very painful condition. Is she having any discharge and/ or bleeding at all?

It is also common for them to go off their feed for a bit. Is she drinking, urinating and pooping okay? Are her stools normal?

What is her normal diet, including treats and chew toys or anything else she has access to up to the point of her not feeling well?

Did her abdomen appear normal in the Xray?

When were her last vaccinations and what did she get?

[fifilame]

I thought I read that a bile test had already been done and came back normal? (from your earlier thread?) her regular vet said he did it and it was fine - however, his partner did it after fasting and after eating and said her numbers were 27 and 90. Her regular vet did not do it that way to my knowledge. Since she had been taking Zeniquin, Prednisone and Metacam, I wondered if that could change her numbers but he didn't think it would change it "that significantly".

Did they test her for pancreatitis? I am unsure - was just told that they took blood and tested her for "like 20 different things" but didn't state what those "things" were. Her CBC was done like 3 times and was always normal though. I will ask about that. Could that cause these problems?

I do believe that a first heat and swollen mammary glands can be a very painful condition. Is she having any discharge and/ or bleeding at all? Had discharge for a day or two after about a week but haven't noticed anything in the past month.


It is also common for them to go off their feed for a bit. Is she drinking, urinating and pooping okay? Are her stools normal? Was not eating when all this started. I boiled chicken and made rice for a few days and then I changed her diet from Royal Canine for Yorkies to adding Benefull chicken stew to it to get her going. I now am adding Nutro with lamb & rice which was his next suggestion. Always drank and pees and poops okay - poops always stayed normal. Dr. said there was a lot of sediment in the pee.

What is her normal diet, including treats and chew toys or anything else she has access to up to the point of her not feeling well? Normal diet was just Royal Canine mini for yorkies. I do give her the chew sticks.

Did her abdomen appear normal in the Xray? Yes. He said all organs look good and I have a copy of the ultrasound report and that dr. said his conclusion is that the dog's mammary glands must still be bothering her. That "There was no obvious evidence of cancer or congenital portosystemic shunt noted during this dog's general evaluation".


When were her last vaccinations and what did she get? on Feb 7th she got corona, DHL-PPv annual and on March l5th she got her 3 yr. rabies.

You sound quite knowledgeable and if you have any ideas I would be so grateful because I am so in love with my little girl and I just really want to get to the bottom of this. Thanks...

[Ladymom]

At this point I would ask for a referral to an internal medicine vet. You can waste a lot of time and money trying to get a diagnosis from a general practice vet who isn't familiar with liver shunts as I suspect your vet is not. An internist will repeat all the tests anyway.

For example, a bile acids test is always the first step. In fact, all Yorkies should have one done once they reach six months old since shunts are so prevalent in the breed. In the United States, Yorkshire terriers have almost a 36 times greater risk of developing shunts than all other breeds combined.

Portosystemic Shunts FAQ

Fasting is not required for a bile acids test. Also, ultrasounds can be as low as 60% reliable especially on small dogs. Scintigraphy is much more reliable.

PSVA and MVD Research Summary

Hepatic Vascular Disorders - WSAVA 2006 Congress

[gaijingirl]

I totally agree with Ladymom in that you will be much better off getting to a specialist ASAP. If your dog does have a shunt or MVD, you'll need to get to a specialist to get the most accurate testing (scintigraphy, biopsy) anyway and they will repeat anything your GP will do. You'll save yourself a lot of time and money in the end.

I would also suggest that you look at joining the Yahoo Liver Shunt and MVD Support Group. You can find a lot of information there.

Even if your dog doesn't have a shunt, those BA test results seem high and may indicate MVD. From what I understand, it is usually results over 100 that would indicate a shunt, but not always the case, and Scintigraphy is the only way to know for sure if a shunt is present.

My dog was (finally) diagnosed with MVD at UT through Biopsy about a month and a half ago. He also had a lot of GI problems (clostridial overgrowth producing endotoxins), which was really what was making him sick all the time. It took a long time to figure out what it was. He wasn't necessarily showing symptoms of liver disease, which was why we did not look at that as what was causing the big problem, but according to his specialist, the symptoms of the bacterial overgrowth was exacerbated by MVD. So, at least having the GI symptoms made us look at other things, allowing us to discover MVD sooner, rather than later.

Others might know more on this, but I *think* that dogs with MVD do often have normal CBC results.

Also, you may want to talk to your vet about changing your food. If your dog does have liver disease you will need to have her on the right diet to help her live a normal life. I would be concerned that if she does have it, the food you are feeding is too high in protein.

[fifilame]

Thank you all for responding. This has all felt like a roller coaster ride... The doctor called me yesterday and said now he doesn't think she has a shunt but that some type of microvascular thing is going on. Said the bloodwork from the second lab came in and while they did find signs of bacteria, nothing grew in the dish which he felt could be the result of the antibiotics which were still in her system. So now, the plan is she is back on antibiotics (Baytril this time) and gave her the Lactulose solution, along with changing her diet to Hills U/D food (low protein diet). He wants her on this for at least a week and then wants to do another urine test on her. I have started all this last night and I can't help but think my poor baby is so hungry! Apparently she will have to be on this special diet the rest of her life (and she is only 13 months old). My idea is to go along with this for now, and then maybe go to a specialist if I don't see any improvement after the week is up and the urine test is redone. (You have to get a referral anyway to see one here). Does this all sound about right?

[Ladymom]

Originally Posted by fifilame

Thank you all for responding. This has all felt like a roller coaster ride... The doctor called me yesterday and said now he doesn't think she has a shunt but that some type of microvascular thing is going on. Said the bloodwork from the second lab came in and while they did find signs of bacteria, nothing grew in the dish which he felt could be the result of the antibiotics which were still in her system. So now, the plan is she is back on antibiotics (Baytril this time) and gave her the Lactulose solution, along with changing her diet to Hills U/D food (low protein diet). He wants her on this for at least a week and then wants to do another urine test on her. I have started all this last night and I can't help but think my poor baby is so hungry! Apparently she will have to be on this special diet the rest of her life (and she is only 13 months old). My idea is to go along with this for now, and then maybe go to a specialist if I don't see any improvement after the week is up and the urine test is redone. (You have to get a referral anyway to see one here). Does this all sound about right?

By "microvascular", it sounds like your vet suspects Microvascular Dyplasia/MVD.

What type of urine test does he want to do? To check for infection?

I personally would ask for a referral to a specialist rather than guessing at a diagnosis.

[Wylie's Mom]

Originally Posted by gaijingirl

Others might know more on this, but I *think* that dogs with MVD do often have normal CBC results.

Yes, they sure can have normal CBCs.

Originally Posted by fifilame

Thank you all for responding. This has all felt like a roller coaster ride... The doctor called me yesterday and said now he doesn't think she has a shunt but that some type of microvascular thing is going on. Said the bloodwork from the second lab came in and while they did find signs of bacteria, nothing grew in the dish which he felt could be the result of the antibiotics which were still in her system. So now, the plan is she is back on antibiotics (Baytril this time) and gave her the Lactulose solution, along with changing her diet to Hills U/D food (low protein diet). He wants her on this for at least a week and then wants to do another urine test on her. I have started all this last night and I can't help but think my poor baby is so hungry! Apparently she will have to be on this special diet the rest of her life (and she is only 13 months old). My idea is to go along with this for now, and then maybe go to a specialist if I don't see any improvement after the week is up and the urine test is redone. (You have to get a referral anyway to see one here). Does this all sound about right?

I don't understand the urine test either? What is it for?

Did the vet talk about doing a liver biopsy? Bc usually, that would be the next step to diagnose MVD more definitively.

[Woogie Man]

Originally Posted by Wylie's Mom

Yes, they sure can have normal CBCs.



I don't understand the urine test either? What is it for?

Did the vet talk about doing a liver biopsy? Bc usually, that would be the next step to diagnose MVD more definitively.

Just thinking out loud, but *possibly* the urine test is to give the vet something to go on other than the bile acid test. Apparently 2 BATs have been done already with conflicting results. Add to that the medications she's on that could skew the numbers. Though not as definitive as a BAT, the urine test could offer more info in light of these other factors.

Here's a piece from an article......

"Recurrent urinary calculi [crystals] is another presenting complaint" (1500). "Normal hepatic function is essential for converting ammonia to urea" and 'a decrease in detoxification and uric acid metabolism result[s] in increased excretion of ammonia and uric acid, with eventual discharge of ammonium biurate crystalluria." Tobias reports, that ammonium crystals are seen in as much as 74 percent of reported cases. A routine urine sediment examination will reveal the crystals and the presence of the crystals is specifically distinctive or characteristic of the disease. These crystals are different form normal urinary crystals which are square or rectangular in shape (Tobias 1994). According to Tobias (1993), "Ammonium biurate crystals have a thornapple shape and golden color" and "Any breed except in Dalmatians ammonium biurate crystalluria is suggestive of PSS'' (300). "In one study 50 percent of affected males were cryptorchid'' (298) indicating that other deformities coexist along with the liver-shunt (298)"

From this link....Canine Portal Caval Liver Shunt Disease

[Ladymom]

Originally Posted by Woogie Man

Just thinking out loud, but *possibly* the urine test is to give the vet something to go on other than the bile acid test. Apparently 2 BATs have been done already with conflicting results. Add to that the medications she's on that could skew the numbers. Though not as definitive as a BAT, the urine test could offer more info in light of these other factors.

Here's a piece from an article......

"Recurrent urinary calculi [crystals] is another presenting complaint" (1500). "Normal hepatic function is essential for converting ammonia to urea" and 'a decrease in detoxification and uric acid metabolism result[s] in increased excretion of ammonia and uric acid, with eventual discharge of ammonium biurate crystalluria." Tobias reports, that ammonium crystals are seen in as much as 74 percent of reported cases. A routine urine sediment examination will reveal the crystals and the presence of the crystals is specifically distinctive or characteristic of the disease. These crystals are different form normal urinary crystals which are square or rectangular in shape (Tobias 1994). According to Tobias (1993), "Ammonium biurate crystals have a thornapple shape and golden color" and "Any breed except in Dalmatians ammonium biurate crystalluria is suggestive of PSS'' (300). "In one study 50 percent of affected males were cryptorchid'' (298) indicating that other deformities coexist along with the liver-shunt (298)"

From this link....Canine Portal Caval Liver Shunt Disease

I wondered if she was referring to urine bile acid testing, too.

I sure hope the OP consults a specialist. She could waste a lot of money on unreliable tests and get no diagnosis.

[gaijingirl]

Originally Posted by fifilame

Dr. said there was a lot of sediment in the pee.

Maybe this has something to do with additional urine tests?

I think if you are going to treat the dog like it has MVD, for the rest of it's life, especially with conflicting BA results, it's a good idea to consider biopsy for definitive results. Personally, I would not want to have my dog on a special low protein diet for the rest of his life, unless I was sure that was what he required.
I was really concerned about doing it for my dog at first and had definitely considered it one of the last things I wanted to do, but having my dog at a place like UT where I knew they had specialists who knew what they were doing and when they could explain the risk vs. benefit helped. They tested him for clotting ability first and then felt comfortable that they could do the procedure.