Toby Update: High Bile Acids - No Shunt
 

Hello all! Its been a while since we posted about Toby. We are on our way back (30 hours drive total) from the Western
College of Vet Medicine in Saskatoon, Saskatchewan, Canada. Toby (4 year old
Chorkie) was diagnosed with a probable liver shunt back in January 2013 due to
high BATs (pre 63/post 174) and exhibiting HE like seizure symptoms. Medical
liver shunt management and diet changes did not seems to relieve his symptoms to
a manageable level.

After 3 days of extensive testing (urinalysis, chem panel - standard SA, pre and
post ammonia tolerance test, abdomen ultra sound, MRI, CS spinal tap and spinal
fluid analysis) Toby's liver tested normal in both size and function and no
liver shunt was found or suspected. We could not grasp why his bile acids were
so high yet no liver shunt and liver enzymes/liver size/liver function perfect?

Apparently there are several reasons for elevated bile acids and one is that
some dogs gall bladders will excrete excessive amounts of bile before the food
reaches that area of the intestine. They found they could induce his HE symptoms
by pressing on his jawline. A dental X-ray showed no dental problems according
to the dental specialist. The case was now turned over to the neurological team.
An MRI showed the brain was clear of leisons so a spinal tap revealed excess
fluid on the spine. The fluid was tested for spinal disease (which is fatal) and
cleared of that. The excess fluid was caused by some unknown earlier trauma and
was the cause of all neurological HE like symptoms. Toby has been HE free for 3
days now on his new meds of Prednisone and Gabapentin. It is hoped this
treatment can be removed after the spinal fluid dissipates but time will tell!
And that is the story of the liver shunt doc that wasn't! Folks on this site
always say to go to a vet med school for testing and they are absolutely
correct! Never have we experienced that quality of care and professionalism!
Kudos WCVM!

Wow! Glad you got some answers. I'm surprised the vets didn't put him on Omeprazole, it slows the production of spinal fluid in dogs. I'll assume they think the pred will reduce the swelling enough to be curative.

Are you supposed to get his BAT redone in a few months?

I am glad no shunt was found. Hopefully he will do well on the medicines.

Good for you! Going to a specialist or vet school for these very sick pups is essential imho in arriving at a diagnosis and treatment.
I am particularly impressed with that trip you took!!! I travel 45 minutes each way to the specialist and 2.5 hours each way to the vet school and think that is long. You are GOOD! :)
I am glad you went and have shared this with all of us.
Hope that Toby improves. Did they consider MVD?

Been wondering where you were. Glad to hear there's no shunt! That's a big deal from what I've read from others posts. Hope the future is much brighter now.

glad that there isn't any liver shunt// hope the meds help

Sounds like they took very good care of Toby and gave him a full work up. Great news :)

That is exactly what they were thinking and they did mention they could introduce a medication that would minimize the formation of spinal fluid. They started with low doses of pred to see what happens. We are keeping strict notes on his progress. They want a report in two weeks and will move forward from there.

Thank you very much! The lengthy trip was well worth it! Yes they did mention that mild MVD is possible but they felt the ammonia tolerance test (pre blood work followed by the dog drinking chocolate milk with ammonia in it and then followed by post blood work) clearly showed that the liver was cleansing and functioning the way it should.

That's great! That is a test I have not heard of...interesting! I love specialists...the level of care for a sick pup is just amazing. The things they know never ceases to amaze me.

Glad to hear that you found out some answers. That is a long drive but I see it was worth it

that is quite an adventure I am so glad that you finally got answers, now Toby can move on to recovering.

I'm so glad you've gotten some information! I also want to say that I'm totally impressed that you traveled over 30 hours to help your dog! Some people won't travel even two or three hours for a specialist. The world needs more people like you. You have a very lucky dog!

Thank you, you are very kind! We hold the both our local vet (who made the referral) and the specialists in very high regard.