Liver shunt surgery for a Yorkie?

[kjc]

Originally Posted by MyLittleLooster

Thanks for all of the replies! We live in Florida, so Tennessee is sort of out of the question. We are having to save (like we have been) for the surgery. I'm pretty sure we're going to choose the surgery over medically treating him. My number one desire is to have him as long as I possibly can, so the surgery is a big consideration.

Kjc: I'll ask my local vet about Denamarin. I'm also wondering if I should put him on milk thistle since I've heard it does wonders for the liver.

I'm hoping our next visit will be better. I was thinking that, since he did go through liver failure, maybe it's just liver disease? I have no idea.

Again, thank you!

Denamarin is milk thistle and SamE... very good in toxicity cases too. But get him on it asap.

Originally Posted by MyLittleLooster

marlenemaria: Thank you! He's been doing so much better since we've put him back on his K/d; I just wish he were this happy on his birthday

gemy: I'm praying that is it an extra-hepatic shunt and that surgery is successful. I would hate to choose surgery and then something go horribly wrong.

I'm extremely protective over Louie; therefore, I would have stayed probably 4 or 5 nights AFTER the surgery just to be safe. Louie doesn't really like car rides, so driving home right after (even if it is two days after) surgery wouldn't be an option.

It's really up to my parents on where the surgery is done. Here in Jacksonville, we have Affiliated Veterinarian Specialists, which is where Lou went when his liver failed. Doctor Carlos Aragon is who Dr. Tashach (internal medicine specialist) recommended for us, but I most definitely will look into Dr. Tobais' recommendation.

I've looked over his chemistry test results a few times. His protein was 1.9 December 31, and on January 29 it was 2.2 (said it could have been a misreading, but I don't believe it). His ALT in Dec. was 59; Jan it was 38. So, from what I see, he's still IMPROVING. To me, his ALT wouldn't just "elevate." He has to be getting better some way or anything. Also, with the test results in January, we were feeding him that little bit of Royal Canin and he was off of his Clavamox. The only thing that was actually wrong was the bloody diarrhea, but Yorkies have sensitive digestive systems.

I am just so lost at what we should do. I know surgery is the best option, but we'd have to save, causing the surgery to be a little late.

In LS dogs, more than one liver enzyme will be high, and only 2-3 times the normal value. If you dog's ALT is the only enzyme affected... that is due to the toxic event, IMHO. The link I posted discusses bloodwork results, and it is the Univ of Tennessee, Dr Karen Tobias.

[MyLittleLooster]

Originally Posted by myboy

She has the Extrahepatic. From what the test have showen so far. Nakisha will be 4 yrs in April. A year ago she was sick and while in the vet and staying there a couple of days we thought it was just something else. Back then I had tried and tried to get a hold of my breeder and ask her ? for my vet and she would not return calls or emails. And then she got worse just within the last month or so. And we ran test and redid them and redid the to make sure they all came back the same . And than that is what we found out was the Porto Shunt and it is Extrahepatic. So we are going to 1st try the diet and meds.. Some days are good but never the same. She just isn't herself. lays around and is always spaced out alot, Just so sad.. But thank you for your reply. I just hope we are doing the right thing.

Have you considered the surgery? I've heard from the vet and from online that it's riskier when the dog is older, but the liver shunt surgery has basically been perfected over the past 10 years. You are going to notice the BIGGEST difference once you which her. She will be just like she used to! I promise! I really so, anyway. I'm sure she will. Louie does just fine on his medicine and low protein diet, but I'm just worried about the long run, honestly.

[MyLittleLooster]

Originally Posted by kjc

Denamarin is milk thistle and SamE... very good in toxicity cases too. But get him on it asap.



In LS dogs, more than one liver enzyme will be high, and only 2-3 times the normal value. If you dog's ALT is the only enzyme affected... that is due to the toxic event, IMHO. The link I posted discusses bloodwork results, and it is the Univ of Tennessee, Dr Karen Tobias.

What should I look at on his test results? Meaning as, what should be elevated/low? Dr. Locke (an internal medicine specialist here in Jacksonville) told me that the levels that are elevated in LS patients weren't elevated with Louie. That's obviously good, but I don't want to risk the chance of him having a shunt. It seems like he doesn't do too well on a normal diet.

[kjc]

Originally Posted by MyLittleLooster

What should I look at on his test results? Meaning as, what should be elevated/low? Dr. Locke (an internal medicine specialist here in Jacksonville) told me that the levels that are elevated in LS patients weren't elevated with Louie. That's obviously good, but I don't want to risk the chance of him having a shunt. It seems like he doesn't do too well on a normal diet.

Any dog with a liver problem will do better on a low protein diet, it does not always indicate a Liver Shunt. Dogs can live well with 1/4 of a functioning liver. Denamarin will support the liver in regeneration of liver cells, so it's very important to have him on this, to prevent further loss of liver cells, and to make new liver cells. The link I posted in my earlier reply shows tests and results specific to LS. An xray will show the size of the liver... LS dogs typically have small livers. With older dogs, kidney stones may also be a problem.

Liver enzymes: From: Testing for liver disease in dogs and Diagnosis of canine liver disease | Canine Liver Disease Foundation

Important Liver Enzymes
Traditionally the medical practitioner has measured the relative concentration of several enzymes which may indicate alterations in liver health. The following enzymes typically change values in the face of liver failure
Alanine Aminotransferase: ALT – Liver specific. Cell damage will cause elevations of ALT due to leakage. The elevation of the enzyme correlates with the number of cells damaged. Falling levels of ALT may indicate recovery or may indicate a failing number of functional liver cells. Rapid increases in ALT may indicate an acute process, while slow increases may indicate bile duct obstruction.
Normal Test Range: 10-100 U/L*
Aspartate Aminotransferase: AST - an enzyme seen in the liver, heart, kidney, skeletal muscle and brain. The half life of the AST in the blood stream is much shorter than that of ALT, therefore the values of AST tend to drop more rapidly once liver function is resumed. AST elevations and ALT elevations should parallel each other in liver disease
Normal Test Range: 5-55 U/L*
Alkaline Phosphatase: ALKP/ALP – This enzyme is present in many tissues, therefore it not very specific in liver disease, but it appears very early in the progress of liver disease, therefore it is considered quite sensitive. ALP tends to be slightly more specific in the cat, but not quite as sensitive. A similar enzyme or isoenzyme is secreted as a result of high levels of cortisone, therefore an effort must be made to separate Cortisole induced ALP or CALP and normal ALP. Liver ALP is released from the liver when many anticonvulsant drugs are administered to the dog. This must be taken into account when evaluating ALP levels. ALP levels typically are greatly elevated in the young, growing animal and therefore a veterinarian should not mistake any elevations as disease in a young animal.
Normal Test Range: 23-212 U/L*
Gamma Glutamyltransferase: GGT – This enzyme is has its highest concentration in the kidneys and pancreas, but it is also found in the liver and other organs. The major proportion of GGT in the serum seems to come from the liver. Elevations of GGT in disease seem to stem from new synthesis rather than leakage, therefore the changes seen due to disease are not spectacular. Large elevations of GGT are more commonly associated with pancreatitis and bile duct obstruction.
Bile Acids
These series of organic acids circulate almost entirely in the localized blood flow between the intestines
and the liver (a.k.a. the Portal system). The flow is typically from the liver, into the bile duct system, then excretion into the intestines to aid digestion after a meal, to be re- absorbed into the portal system and recycled by the liver. Very little of the bile acids escape from the portal circulation system into the rest of the body. Leakage is considered abnormal and is a sure sign of a liver abnormality. This is one of the most sensitive tests available to diagnose liver disease. While the liver does actually manufacture this product, it has tremendous reserve capacity and can easily meet the bodies demand for bile acids despite severe disease. As a result of this reserve, the bile acid levels do not typically drop due to liver disease.
Normal Test Range: Pre = Less than 7.0 umol/L, Post = Less than 15.0umol/L*

[MyLittleLooster]

Originally Posted by kjc

Any dog with a liver problem will do better on a low protein diet, it does not always indicate a Liver Shunt. Dogs can live well with 1/4 of a functioning liver. Denamarin will support the liver in regeneration of liver cells, so it's very important to have him on this, to prevent further loss of liver cells, and to make new liver cells. The link I posted in my earlier reply shows tests and results specific to LS. An xray will show the size of the liver... LS dogs typically have small livers. With older dogs, kidney stones may also be a problem.

Liver enzymes: From: Testing for liver disease in dogs and Diagnosis of canine liver disease | Canine Liver Disease Foundation

Important Liver Enzymes
Traditionally the medical practitioner has measured the relative concentration of several enzymes which may indicate alterations in liver health. The following enzymes typically change values in the face of liver failure
Alanine Aminotransferase: ALT – Liver specific. Cell damage will cause elevations of ALT due to leakage. The elevation of the enzyme correlates with the number of cells damaged. Falling levels of ALT may indicate recovery or may indicate a failing number of functional liver cells. Rapid increases in ALT may indicate an acute process, while slow increases may indicate bile duct obstruction.
Normal Test Range: 10-100 U/L*
Aspartate Aminotransferase: AST - an enzyme seen in the liver, heart, kidney, skeletal muscle and brain. The half life of the AST in the blood stream is much shorter than that of ALT, therefore the values of AST tend to drop more rapidly once liver function is resumed. AST elevations and ALT elevations should parallel each other in liver disease
Normal Test Range: 5-55 U/L*
Alkaline Phosphatase: ALKP/ALP – This enzyme is present in many tissues, therefore it not very specific in liver disease, but it appears very early in the progress of liver disease, therefore it is considered quite sensitive. ALP tends to be slightly more specific in the cat, but not quite as sensitive. A similar enzyme or isoenzyme is secreted as a result of high levels of cortisone, therefore an effort must be made to separate Cortisole induced ALP or CALP and normal ALP. Liver ALP is released from the liver when many anticonvulsant drugs are administered to the dog. This must be taken into account when evaluating ALP levels. ALP levels typically are greatly elevated in the young, growing animal and therefore a veterinarian should not mistake any elevations as disease in a young animal.
Normal Test Range: 23-212 U/L*
Gamma Glutamyltransferase: GGT – This enzyme is has its highest concentration in the kidneys and pancreas, but it is also found in the liver and other organs. The major proportion of GGT in the serum seems to come from the liver. Elevations of GGT in disease seem to stem from new synthesis rather than leakage, therefore the changes seen due to disease are not spectacular. Large elevations of GGT are more commonly associated with pancreatitis and bile duct obstruction.
Bile Acids
These series of organic acids circulate almost entirely in the localized blood flow between the intestines
and the liver (a.k.a. the Portal system). The flow is typically from the liver, into the bile duct system, then excretion into the intestines to aid digestion after a meal, to be re- absorbed into the portal system and recycled by the liver. Very little of the bile acids escape from the portal circulation system into the rest of the body. Leakage is considered abnormal and is a sure sign of a liver abnormality. This is one of the most sensitive tests available to diagnose liver disease. While the liver does actually manufacture this product, it has tremendous reserve capacity and can easily meet the bodies demand for bile acids despite severe disease. As a result of this reserve, the bile acid levels do not typically drop due to liver disease.
Normal Test Range: Pre = Less than 7.0 umol/L, Post = Less than 15.0umol/L*

January's test results:
ALT- 38 (was 59 in December)
ALKP-79 (181 in December)
GGT- 7 IN DECEMBER. I don't know what it was in January.

[myboy]

Originally Posted by MyLittleLooster

January's test results:
ALT- 38 (was 59 in December)
ALKP-79 (181 in December)
GGT- 7 IN DECEMBER. I don't know what it was in January.

Thank you for information. First time I have seen it. Thank you

[yorkietalkjilly]

Here is a thread I just read today and if you use the Search here, you can probably find lots of others. The second link is to the Sick-Injured Forum where other threads might help you.

http://www.yorkietalk.com/forums/sic...er-schunt.html

Sick & Injured / Emergencies Talk - YorkieTalk.com Forums - Yorkshire Terrier Community

[MyLittleLooster]

Originally Posted by myboy

Thank you for information. First time I have seen it. Thank you

What do you think about those results? They were taken when he had a GI tract infection (or so they think). He was having diarrhea and was vomiting from the Royal Canin.