Possible Shunt/Liver Disease

[ladyjane]

Originally Posted by aproctor

Now I am really confused. I just called the U of M again to verify how long it would take to get in and this person said a few days but when I told her what we needed done and what for she went on to say that they "wouldn't do an abdominal ultrasound" for a shunt and that they would do either one of two procedures that I have never heard of and talked about surgery right away when we don't even know if she will need that. AND they are significantly more expensive too.

I think I need a drink! UGH...again my head is spinning!
I have a call into MY vet to ask her what that would all mean and to ask her if she would take her pet to Blue Pearl?! I am waiting for her to call me back either today or tomorrow.

Word of advice: Don't call these places and get yourself upset. I am not sure why you are calling yourself? Your vet should be making a referral to a specialist, period! THEN, the specialist will advise you about what should be done.

[ladyjane]

Originally Posted by BabyGirl Rosie

I am so sorry you are going through this. I know when your baby is sick it is so hard. Add trying to determine where to go and what to have done just adds to it. Hopefully your vet will guide you to what is best for you.

What two procedures are they suggesting? Maybe LJ will know about them.

No one but a specialist should advise anything imho. A specialist will speak with her vet, look over Lucy's records and either advise further tests OR suggest an appointment where he/she can examine Lucy and go from there.

[Tae1107]

Did they mention a liver biopsy (that could be surgery depending on how they did the biopsy) or a scintigraphy to look for a shunt?

They did find the shunt the second time with the ultra sound with Quinn...however if I had to do it all over again... or with another dog... I would just go with the biopsy with the plan to close shunt if they found one during the biopsy...however Quinn's bile levels were tyipcal of a shunt dog...lower pre higher post...

[Ellie May]

Deep breaths. It's incredibly overwhelming, but you can do it.

Liver shunts are only seen on ultrasound 60-80% of the time if one is present and a lot of it depends on the experience of the sonographer. That is why some vets prefer to do them and some don't. Some vets think it's worth it (because they might find something and there are other things they can see in the abdomen that are related to liver disease by ultrasound). Some think it's not worth it because there are better tests available to find a shunt. Those tests would be scintography or portogram. It's at the specialist's discretion.

Board certified vets have gone the extra mile and they are almost always very good. When is doubt, always choose one. That said, if I know that a non board certified vet is very good, I have no problem going that direction. But when in doubt about their abilities in a certain area, choose the BC.

If the doctors at U of MN believe that the ultrasound should be skipped in this case, you may end up saving money. If these other vets find nothing on ultrasound, you'll have to go to the other tests anyway. However, before deciding what to do and getting really stressed over all of it, it's best to talk to a specialist about where to go. They will take you one step at a time.

My girl also has high bile acids (but not extremely high liver enzymes). We did the ultrasound with a board certified vet.

[Patti]

I know how confusing it is when you have a sick baby that needs specialized care. When Cali had her liver issues I took her to a board certified internist that my vet referred us to. I am fortunate that I live 5 minutes from a 24 hour er vet with board certified internists and surgeon. If at all possible I would try and get her to a board certified doctor. Cali has very mild MVD and her bile acid scores were 1. 0/93 ish and on retest 0/46 ish. The internist and surgeon both felt that with scores under 100 post she most likely had MVD not a external shunt. We did the ultrasound and found nothing so we had a liver biopsy done during her spay. All this was done by the board certified surgeon and I felt better knowing she was in her hands. Also, with the further complication of a collapsed trachea the Univ may be the best place. The Care Credit is great to have. I just paid off Cali's UTI with no interest and now have used it for Pixie's UTI expenses. I think they said if the charge was over 300.00 I could get interest free for 12 months. It takes a little of the worry out of the whole process. I will keep your baby in my prayers and you to as you go through this difficult and confusing time.

[aproctor]

Originally Posted by ladyjane

Word of advice: Don't call these places and get yourself upset. I am not sure why you are calling yourself? Your vet should be making a referral to a specialist, period! THEN, the specialist will advise you about what should be done.

I am calling myself because when my vet said either the U of M OR Blue Pearl I went with Blue Pearl because she said they are good too.
I called the U of M to see what the costs would be and I should not have. I have a call into my vet and after that I should be able to either stick with my decision or switch to the U of M.

[aproctor]

Originally Posted by ladyjane

No one but a specialist should advise anything imho. A specialist will speak with her vet, look over Lucy's records and either advise further tests OR suggest an appointment where he/she can examine Lucy and go from there.

imho??

[Maximo]

Originally Posted by ladyjane

Word of advice: Don't call these places and get yourself upset. I am not sure why you are calling yourself? Your vet should be making a referral to a specialist, period! THEN, the specialist will advise you about what should be done.

I agree, your vet should be doing this.

Ann, write everything down, organize it, and talk to your vet and make sure both of you understand the plan of action and the purpose. Your vet should then make the phone calls for you.

Regarding the collapsed trachea, who diagnosed that? My understanding is that an xray needs to be done to diagnose it definitively. Make sure all doctors who see Lucy are aware of it.

[ladyjane]

Originally Posted by aproctor

imho??

In my humble opinion.

[Ellie May]

The owner has to do the calling here. General vets says go to a specialist, but after that it is owner's problem. They don't exactly refer here in MI.

They do give a recommendation on where to go though.

[aproctor]

Originally Posted by Maximo

I agree, your vet should be doing this.

Ann, write everything down, organize it, and talk to your vet and make sure both of you understand the plan of action and the purpose. Your vet should then make the phone calls for you.

Regarding the collapsed trachea, who diagnosed that? My understanding is that an xray needs to be done to diagnose it definitively. Make sure all doctors who see Lucy are aware of it.

The collapsed trachea was diagnosed when she was a puppy by another vet before we got her. Lucy was 2 1/2 when we took her from the previous family that wanted to give her a new home because they had family issues and didn't have time for her anymore.

[Ellie May]

By the way, enzymes were very high and bile acids were kinda weird in this case. Of course I in no way can tell you what is wrong, but I do think there are other possibilities besides liver shunt. Only a specialist can make that determination though. That's why I wouldn't concentrate so much on the tests they may or may not do and instead concentrate on getting her into a specialist for evaluation of their choosing asap.

[ladyjane]

Originally Posted by Maximo

I agree, your vet should be doing this.

Ann, write everything down, organize it, and talk to your vet and make sure both of you understand the plan of action and the purpose. Your vet should then make the phone calls for you.

Regarding the collapsed trachea, who diagnosed that? My understanding is that an xray needs to be done to diagnose it definitively. Make sure all doctors who see Lucy are aware of it.

An xray is not conclusive for CT. I had a pup with CT and it clearly showed on xray. He was diagnosed in another state and years later when he had herniated cervical discs and was admitted to A&M for emergency surgery I advised them of the CT. They did an xray and said it looked fine and that they felt the surgery would not be an issue. He almost died following that surgery (he could not be extubated...was very scary)...they explained it was a combination of the endo tube...but also because of the manipulation of the trachea to operate on the cervical spine. After the first awful 24 hours, they put a trach in and he had it few days. Luckily he was able to have that removed and he was fine. I learned from that experience that sometimes a CT will show on xray and sometimes not! Sometimes it depends upon positioning when the xray is taken.

[ladyjane]

Originally Posted by Ellie May

By the way, enzymes were very high and bile acids were kinda weird in this case. Of course I in no way can tell you what is wrong, but I do think there are other possibilities besides liver shunt. Only a specialist can make that determination though. That's why I wouldn't concentrate so much on the tests they may or may not do and instead concentrate on getting her into a specialist for evaluation of their choosing asap.

Exactly my point. Lucy needs to be seen and evaluated first by a specialist.

[ladyjane]

Originally Posted by Ellie May

The owner has to do the calling here. General vets says go to a specialist, but after that it is owner's problem. They don't exactly refer here in MI.

They do give a recommendation on where to go though.

I make my own referrals now because I am familiar with the specialists; but new patients must have a vet referral.

Texas A&M always did that as well. I have not been there in years though since I have great specialists here.

But, I am confused here on this one. Did the vet recommend a specialist or advise her to schedule an ultrasound?