Possible Liver Shunt
 

Took my 6 month old baby to get spayed and her liver enzymes were elevated so they also did a Bile Acid test which came back 'off the charts'. I have an appointment for ultrasound for her tomorrow. Currently she is experiencing a little vomiting and diarrhea but this is only recent. So worried about her and came to Yorkie Talk for much needed support. Thank you.

Hi, Welcome to Yorkie Talk. I am sorry that your lil girl is having a problem, and hope that things turn out ok for her. Many members on Yorkie Talk have been in the same situation, and we are all here to support you.

In fact, my Tiki was also suspected of having LS when she was 7 months old, following pre-spay blood work. I know how terrifying that is, and how frustrating it is to go through the various tests. First of all I want to say that although it is scary, it is not a death sentence. If there is a shunt it likely can be repaired, and there is a possibility that it is not a shunt, but something else, like other toxicity, or MVD (microvascular displasia) also known by a new name I can't recall.

My Tiki turned out to have MVD, which is managed medically by diet, and I'm happy to say she is doing just great at 6 years old.

Here is a link to a brochure full of great info about liver diseases which is so common in Yorkies. It is a good overview of liver disease and treatments, and is written by Dr. Tobias, of Univ. of Tennessee, who is the top Doc in dealing with liver disorders.

http://www.vet.utk.edu/clinical/sacs...NAL-201304.pdf

I'm praying all will be well for your little one. Keep us posted on her status, and do come here whenever you need a hug. Many of us have gone through this, and we truly understand how stressful it is.

Thank you so much! Her liver enzymes were only slightly elevated (except for the ALT which was 3 x) and her cholesterol was low -- regular vet said it was all indicative of a shunt and recommended bile acid test which was done same day and results after eating were in the 300's (vet said he had only seen a handful of results that high in his career which of course further alarmed me).

She is 6 months old and now that I think of it, the signs were there but I didn't think anything of it. About a month ago, she started eating less and sleeping more. Also a little vomit and/or diarrhea here and there but nothing persistent. Also, some scratching going on but again I didn't think anything of it because it is summer and she likes to play in the grass.

So, given that her post meal bile acid test was over 300; you would 'think' that she would show more signs of distress but she doesn't.

So fingers crossed tomorrow .... just hoping whatever ails her is treatable and/or fixable. Prepared to do what it takes (like most people, cannot afford surgery but will have to sell items to pay for it) as she is such a sweet girl and deserves to live a long, pampered life.

Will post tomorrow after I get the results.

I'm so sorry it has taken me all day to reply to your message...it's been one of those days! My little girl was also diagnosed with a liver shunt when I took her in to be spayed. We did the BAT and her numbers also were really high - pre 43 / post 237! I felt like someone had kicked me in the gut when my vet called to tell me! That was in February 2009. Lola only weighed 3.5 lbs. She had never been really sick, other than the first weekend I had brought her home and they told me she had been hypoglycemic. She did have a poor appetite and her coat was not full - but no seizures or any other neurological symptoms. I had her shunt "repaired" (ameroid ring) 3/6/09, and she was also diagnosed with MVD. Lola just turned 6, she is hardly ever sick - maybe an ear infection once or twice a year and is doing great! The surgery saved her life and you would never know she had anything wrong. Liver shunt is scary when you read about it, but it is treatable with surgery, diet and medications. Tons of people of YorkieTalk have been through what you are going through...ask lots of questions if you have them and make sure you are comfortable and happy with your vet. I would suggest a specialist when you have the surgery done...prayers coming your way from Texas!

Close by, in your shoes
 

After elevated enzymes when her luxating patellas were fixed in July, the surgeon told me to have Gracie (now 11 months) retested in a few weeks. Those numbers were still high last week, so we did bile acids and they were no better. She is having ultrasound on Friday. I am glad to see encouraging responses to your questions because I have been quite anxious about her. Let's hope they both do well!
Gracie is pretty much asymptomatic, so I hope we are catching this early and she will not have lasting damage. The comment about the coat was interesting--hers is thin and wavy-totally unlike her parents, so maybe that will improve with treatment. A long as she is healthy, though, I will just keep it cut short and cute.
Please keep us updated, and if you want to talk to someone local, please PM me and we can trade notes about what is going on.
If you need a surgeon, we were very pleased with the one who fixed Gracie's patellas, and the specialty center was fabulous.

Thank you for your replies! Both those who have gone through this and of course those who are going through this right now. You have no idea how much I appreciate the support.

My adult pup, Teddy Bear, had surgery for liver shunt last February and he is doing fine now. :)

I see you have been given some good information already. Hope all goes well tomorrow...will keep your pup in my thoughts and prayers. Please keep us posted.

Welcome to YT!

Also, good luck to Gracie....does she have a thread about her testing?

I guess I should start one!
 

I had added an update to an earlier post when we last week, but it has disappeared under all of the newer stuff. I will start a thread when we get ultrasound results.

Here is hoping for both little sweeties!

Update on Appointment with Internal Medicine
 

Took Sophie to get an ultrasound but after talking with Dr. they recommended not to do one and do surgery instead for a couple of reasons. 1) ultrasound may or may not show a shunt -- only 75% of time and 2) they would need a liver biopsy anyway. So, I saved some money there that I can apply toward the surgery.

Dr. said pretty sure it is a shunt or multiple shunts or of course liver disease. But I felt that she was betting on a shunt.

Put her on lactulose, Hills low protein Rx food and an anti-seizure medicine. She has not had seizures but she said dogs who have surgery, sometimes have seizures post-op and want to prevent that so Sophie will take that medicine for one week prior to surgery.

I asked about Sophie's very high BAT results 300 + and she said that is not indicative of the severity of her disease which made me feel good.

Getting Rx filled tonight but immediately purchased the low protein food and gave her (just hoping she does not react to it). Originally Dr. was not going to change her diet right before surgery but later changed her mind -- perhaps because surgery would not be for 2 weeks or so. I have a surgery consult next Tuesday and we go from there.

Also said she was 'thin' for a puppy :( and they tried to take a urine sample but her bladder was empty. Sent me home with a cup which I will try to do and take it right up to my normal vet.

Hi there. I know exactly what you're going through as my beloved Nalah was diagnosed with liver shunt (PSS) about 4 years ago. She was having seizures followed by partial blindness, which really scared us. After the blood work was completed, we finally opted for the portal scintigraphy exam to confirm her diagnosis. I was a wreck when I found out... At the time, I was a college student and unable to afford the surgery. I suggest surgery if your baby is a good candidate. We medically managed Nalah's condition daily with Lactulose, Sam-E, Hills L/D food and a STRICT diet. She did great with treatment! You would have never known she was sick for the last 4 years of her life.

Just want to let you know we are here for you. You are not alone. You and your baby can get through this.

God bless.

I also had the scintigraphy done rather than an ultrasound. I was told that the scintigraphy was much more accurate in positively identifying a shunt. Did the surgeon advise putting your baby on anti-seizure meds? Just curious because mine was never put on any. I'm so glad you are having the consult next week - what a lucky baby that you are taking care of this so quickly. You'll be happy you did! Please keep us posted - good luck!

Lolasmom: Hmmm...I was never offered a scintigraphy but vet made it very clear that with or w/o an ultrasound, she would still need a biopsy, hence the suggestion to skip ultrasound and go right to surgery. I have not met with surgeon yet but it was the internal medicine vet who recommended the anti-seizure medicine to be taken at least one week prior to surgery. At the vet hospital, they have different specialties under one roof but each specialty is a different practice/company. She did speak to the surgeon when I was there waiting about Sophie so perhaps that is what the surgeon told her. Since I do not have the surgery scheduled, have not started her on the anti-seizure meds.

Thank you for sharing your experience. So, did your baby have or not have the surgery? I have heard of dogs being medically managed without surgery and of course if there are multiple shunts presents (which I pray not), that would be the course of action. Personally, I would like to hold off on surgery for a month or two and get her acid levels down and weight up, etc. Would also give me a little time to come up with the money. I am a single woman who just paid for my daughter's wedding in St. John, USVI ! But I do have a responsibility to my dog and will make it work financially regardless. Worse case scenario for her is that it is not a single shunt and instead multiple shunts or something else that cannot be corrected.

I started Sophie on the L/D food (canned) last night and she also had some this morning. She was barking at me when I was fixing it (mixed some with her old food) this morning because she wanted it so bad. She inhaled it when I gave it to her and could have eaten more but of course I don't want to overfeed her belly then she will throw up for sure. Weird thing is that she has not had a BM for past 2 meals of canned food and you would think this stuff would make her go poo due to it being wet food and an alteration in diet. I'm watching her outside to see if she goes and of course looking in my house for areas she might sneak to, to go poo as she is not house broken yet -- which is another issue but the least of my concerns right now.

I know this sounds odd and probably a coincidence, but since starting Sophie on her new low protein diet at 8pm last night along with the lactulose, I see an increase in appetite along with energy level. This morning after she ate, she ran around and played when before she would eat and go right back to sleep.Two hours after her morning meal, I had to give her another small serving of food and when she saw me prepare it, she started doing her tricks I have taught her without me asking -- so cute.

Maybe not a coincidence at all. Put vey simply (becasue I had to have it put simply to me!) when you feed her "normal" food, it's like poison to her. It makes her nauseous and sometimes makes her head hurt, thus the head pressing and seizures. These toxins stay in their little bodies and build up - that is also why they have thin coats. As soon as you start feeding them food that no longer makes them sick, they have more energy and feel better! The lactulose helps rid them of the toxins. She should be having very regular, soft bowel movements on the lactulose...if not, I'd call my vet and inform them that she is not - they may want to increase her dose. The lactulose takes a little while to get the correct dose for each pup! So glad she is feeling better. I think the surgery made a huge, huge difference in Lola's life! I don't think she would have lived as long or as healthy without it!

Would the change over show results that quickly? Great if so! I am not a vet and maybe don't know best but I personally would like her to improve before going in to surgery (and I hope surgeon feels the same way). I hope he recommends another BAT and regular blood panel in a week or two to see if she is a little better. No, the food and meds will not cure her but I would like to see some improvement before surgery and also give her a little time to adjust to new diet, etc. and just generally feel better. I am still going through with surgery no matter what unless all her tests were completely normal (unlikely). I also switched her to 100% filtered water -- I know this does not effect her liver but did so just for overall good health. They said the lactulose would make her stools soft but I have not seen a BM yet to verify. Will call vet if I don't see one today -- perhaps the change in food is stopping her up temporarily. And yes, the vet said I might have to alter the lactulose dose a bit. So glad Lola is healthy and happy now!

No, we did not get the surgery. We chose to medically manage since Nalah's health changed dramatically after we changed her diet--no more seizures or walking along the walls. Perhaps your pup's digestive system is still getting used to the change in diet. We fed Nalah a combo of the wet and dry Hills food. Best of luck!

Feeding Sophie now AGAIN, third time already today and it's only noon -- have never seen her eat like this ever. And again, while preparing her food she went crazy!!! And yes, careful not to overfeed her...just doing mini meals but she just can't get enough of this food and that is why I am spacing them out. She also needs to gain some weight since vet said she was a little skinny.

Just a little update regarding Sophie in hope that my experience will help others. 24 hours after switching food and taking two doses of Lactulose -- Sophie is eating A LOT (just can't seem to get enough food), playing like a puppy again and had her first BM with the food (soft but not diarrhea).

Now prior to all this she was not 'sickly' but was not eating much and sleeping a lot. I have seen a big change in her already and can tell she feels so much better.

I know this is not a cure and we are not out of the woods but it is nice to see Sophie feeling better and back to her puppy antics.

Thank you again for your support!

Super!
 

:):):)

So happy to hear this! She is lucky to have such a wonderful mom! :)

Happy to hear she is moving in a positive direction.

my baby may have a liver shunt too
 

Just been reading this post today... My little Suki has been very timid, sleepy and just not 'right' the past 5 days.She has hardly eaten very much . I took her to my vet last Friday. He took some bloods and started her on antibiotics. I did happen to mention to him that I was worried that it may be a liver shunt. Anyway the blood results came back and showed a slight neutropenia, I also commented on her bile salts levels which were high..One other observation is her coat is quite thin. She follows my hubby around everywhere and her behaviour is a bit odd.


My conclusions are that she does have a shunt . She is very lethargic during the day and if I go near her she runs away. She only eats a little bit food . I believe she is toxic at these times .


My vet is going to do a BAT next week.


I don't mean to hijack this thread but should she be started on the Hills canned food and lactulose now. I am so stressed with it all with her not eating enough and to top it all I am having surgery on knee tomorrow ( only in hospital for the day).


Shirl

Sorry to hear about your baby and no, you are not hijacking this thread. From reading your post, it appears 'you', not the vet suspect a liver shunt? Just having elevated liver enzymes does not mean so and could indicate another problem. What my vet told me was it was the combination of liver enzymes (especially the ALT), low cholesterol and couple other his or lows in my Sophie's blood panel results that made the vet think it was possibly a liver shunt. A BAT still won't confirm a shunt but the results will help determine the next step.

My advice to you, is that after the BAT results come back and they indicate possibly a shunt (post meal 100+); I would inquire to your vet about lactulose and Hills Rx L/D diet. Then go see an internal medicine Vet. All I can tell you is that there was a huge change in my baby's behavior after changing her diet and giving her the lactulose which the internal medicine vet prescribed, not my normal vet. We are still waiting to see the surgeon for a consult. I also stress that the diet and medication is not a cure, but something to help until we know why Sophie's bile acids are high and then once we find that out through a biopsy; we fix the shunt or 'medically manage' if multiple shunts or something else that cannot be corrected via surgery.

Is your dog showing other symptoms like drinking more water, itching, etc.?

NEW booklet about MVD and liver shunt by Dr. Tobias!
 

Hello! This is the second edition of this booklet written by Dr. Karen Tobias which has a lot of new information. It was just released a few days ago.

Help! My Dog was Diagnosed with a Liver Problem!
https://vetmed.tennessee.edu/vmc/Dow...D-Brochure.pdf

We had our surgery consult this morning and were notified of the risks of liver shunt surgery, etc. First an MRI must be done and if no liver shunt seen, they will do a biopsy which would be way less invasive then opening her up. Vet 80% sure it is a shunt. I asked her prognosis if no surgery done and he said very well she should live to 10 years old but the L/D diet is not meant for long term and dogs need their protein to be healthy. The risks for infections, siezures is 10% which is very high in my opinion but I feel I have not choice. Waiting on MRI and surgery which must be done within a week of each other until probably December or January -- this is so I can get my finances in order to pay for it. She is not in any distress right now nor shows any symptoms of liver disease which is good. The vet was okay with waiting until then as long as her health remains good. Obviously, if she starts shows symptoms; we will have to get the surgery done sooner and of course better to do surgery on a healthy dog versus a sick one. For those wondering the cost: the MRI is $850 and the surgery is $2400 to $2800 which includes follow-up visits, etc.

You will be in our thoughts in the next few months. It is great that your baby is doing well in the meantime--it isn't easy with a sick pup. Just think about spring when she will be in great shape and tearing up her world!

hello i find your post interesting, my nine month old female just had routing blood test with bile acid,, her fast# was2 her post number is 43,, my vet just based on number says it's MVD,, my puppy acts 100% normal and he says this is an accidental finding, they sugges i do nothing not even a diet change since she has no symptoms - had we not done a complete physical we would not have known but i feel unsettled, they said its not needed right now to spend money on all kinds of ultrasounds etc. rather watch her and repeat blood in 6 months

Sorry to hear this. I believe MVD is medically managed through diet and meds. Even though your pup has no symptoms; I would highly suggest a 2nd opinion regarding change in diet and meds. In other words, you don't want to wait until your pup starts showing symptoms to start treating the MVD. But again your vet is speculating and is not certain as I believe only an ultrasound would confirm this. Hopefully other posters whose dog has MVD can offer up some suggestions. Good luck to you!