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Dr. Karen Tobias And Liver Shunt Repair Hi Again, This is my second post since yesterday, but now seeking a bit more information from anyone that can help. As stated yesterday, Lily who is 4 had very high BAT findings: 166 and 209. Her kidneys are filled with stones and we need to take the next step. Our Vet can no longer handle this. After doing alot of research on specialists, I see there are only a handful that specialize in this, one being Dr. Karen Tobias in Tenn. At this point we are willing to do just about anything. She seems to be the best in this field. Does anyone know if I can directly contact her or does our vet have to contact her. I want to move on this pretty quickly. Thanks for any input. |
I've heard that you can contact her directly and she works out of the University of Tennessee. Her high BATs could be due to the kidney stones. Best of luck, I hope you find some answers soon. http://www.vet.utk.edu/faculty/tobias.php It sounds like she will only reply to emails from vets, but you can call. |
Problem is when she is given any protein at all, she starts bleeding in her urine which lead the Vet to do the BAT as well. She says that the kidney issues are the result of the liver, but until I see a specialist, have no idea what is what. |
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I've heard that Dr. Susan Center at Cornell, works with Dr. Tobias, that's also another possibility. CUVS |
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You're much closer to Cornell than University of Tennessee. Dr Sharon Center was the developer of the bile acid test. Faculty of the College of Veterinary Medicine - Sharon A. Center |
There are all kinds of links on the University of Tenn. website, from directions, to hotels, to referral forms, and a vet will discuss your dog's case with your vet to make recommendations. |
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Both places are good, as are the vets, but they use two different methods. Dr Centers uses a ligation technique to do the repair, Dr Tobias uses ameroid constrictors (sp), to slowly close off the shunt. |
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A urine test was just done last week prior at the same time of the ultrasound to see what type of crystals this are. The urine did not show any crystals in the urine. They are also not showing up on x-rays, just the ultrasound. So we don't know which type they are. She then decided to do the BAT trying to find out what was causing the kidney issues and we were given these BAT results yesterday. She was not looking at the liver during this ultrasound, just the kidneys. So she is saying now we need another ultrasound to look at the liver, but says a specialist has to do this. Problem is what I read about determining a liver shunt by ultrasound is not always effective. From what I gather these ameroid constrictor seems to be the most successful, I have not read much about the other at this point. Thank you for the info on Susan Center. The only indication we have a possible liver shunt right now is these very high BAT's. She does currently have her on Hills U/D to see if she can dissolve these stones, however, if they are calcium oxalate, it won't work, so appears we are dealing with two issues, stones and liver. |
My boy recieved the best of care at UT his bat were way lower than yours are he was diagnosed with MVD good luck to you where ever you decide to go |
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Some dogs that have LS will develop stones, and the fact they don't show on xray indicates they are probably amonium urate, which is a type of stone that developes due to excess amonia in their system. |
Betty, What is MVD, I have been focusing on this liver shunt and have seen MVD come up but not quite sure what it is. I also forgot to mention that the vet said they did note that Lily's liver was very small on the ultrasound, I don't know why then they did not try to look for a shunt at the same time. All indicators were there. So happy to hear your baby did well. I really think we might be headed this way and I am going to call my vet tomorrow and get her to contact Dr. Tobias offiice asap. |
Betty appears to be offline.... MVD Multivascular dysplaysia... symptoms can be the same as Liver Shunt... but no shunt... not operable, treatment with special diet and meds if necessary.. In general, the architecture of the liver is askew and causes it not to function very well. Small liver is also a sign of shunt... they are hard to see on xray and ultrasound unless the vets are superexperienced in looking for them. |
Another thing to consider is cost... U of tenn keeps their prices down... They can probably do the LS surgery and remove the stones all for under $2500.00... including, meds and hospitalization and any further testing... and they have the most experienced vets doing this type of surgery... as they have been doing research on LS for 25 years.... |
U of Tenn has some good info on LS here: Portosystemic Shunts FAQ The menu on the left side of the above link's page has all info on Liver Shunt Here's a link to their contact page... has a link to directions and lodgings at the bottom (some hotels give a discount for people with pets getting treatment at the University) Contact There's also a link to a referral form you could print and have your vet fill it out and fax it or take with you... |
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If yours is put on this food buy a big bag there its about $20. cheaper than i pay at the vets office here and 1 bag will last a very long time...praying fr good results |
There are excellent veterinary specialty hospitals right here in the Northeast. I have responded to your PM with the info you requested on Daisy's doctors. I hope that whatever course you choose, you get the answers you seek. We will all be right here to support you through this. Cathy |
I would also guess that they are ammonium urate because those don't show up on xray and it would make the most sense. Many people can do the surgery. Personally I liek UT and would go there if my girl needed this surgery (followed by Cornell). I've heard many times that UT has the lowest postop seizure rate which is directly related to the highest survival rate. |
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It's not Multivascular Dysplasia, it is Microvascular Dysplasia. It is incorrect to say that MVD is not a shunt. Hepatic Microvascular Dysplasia is microscopic shunting of the liver. Blood is still shunted from being cleansed by the liver and ammonia is still building up in the blood and still can cause symptoms but since there is no single shunt to close off surgically, it can only be managed medically not surgically. I agree that the ultrasound reader is of paramount importance and I would make sure the ultrasound is done by a board certified radiologist who is working in tandem with internal medicine. |
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"Single congenital portosystemic shunts must be differentiated from multiple acquired shunts secondary to portal hypertension, and from hepatic microvascular dysplasia. Hepatic microvascular dysplasia (HMD) signifies a disorganization of the liver's microscopic architecture which is similar to that of dogs with single congenital shunts. HMD has been reported in small breed dogs such as the Yorkshire terrier, Cairn terrier, Maltese, cocker spaniel, and poodle. Dogs with HMD display biochemical, hematologic, and clinical changes consistent with portosystemic shunting but lack a macroscopic portosystemic shunt. Definitive diagnosis is by ruling out a macroscopic shunt through exploratory laparotomy, nuclear scan, or portography. Signs of HMD are managed by low protein diet; lactulose is added if necessary." Note: HMD = MVD So I guess it depends on who one reads... and , yes, I said the symptoms are the same.... |
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You said that the liver can be small with LS and I was pointing out that the liver can be small in MVD as well as LS. That is not a symptom, it is a clinical sign that is observed during diagnostic testing. This dog may not even have a single shunt as her BATs are not astronomically high like some cases I've seen on here where people do not take their dogs into surgery to try to help them. So, yeah, it may depend on who one reads if you want to be technical about the microscopic landscape of the liver, but more importantly it depends on what one does to help their dog and since I have one of the most successfully managed MVD dogs on this board, I will keep sharing her story for those who want to hear it or who can benefit from knowing it. |
Cathy i'm glad that i'm not the only one that keeps sharing these stories if it only helps one that would be a blessing. Micah never showed any symptoms other than being really small his was found after he was bat after the 3rd test over a 6 month period i took him to UT |
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:rolleyes::rolleyes::rolleyes::rolleyes::rolleyes: :rolleyes::rolleyes::rolleyes::rolleyes: |
Thank you Betty, that is encouraging ! Need to do a bit of research on this MVD as well. |
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