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Old 03-06-2008, 07:51 PM   #1
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Unlove Elevated Bile Acids/Liver Shunt ?- Need advise

I logged onto this site as I have learned that Liver Shunts can be common in Yorkies and hope to get advise from those that have experienced this misfortune. My Joey is 4 1/2 years old (5.5 lbs.) and has experienced seizures for the past 2 years that have become more frequent. He is currently on phenobarbital. A year ago I was referred to a canine neurologist who discovered that Joey's bile acids were elevated suspecting that he has a liver shunt. It is unknown whether this is causing his seizures or if they are strictly caused by some neurological defect. He has even been through an MRI which didn't show any abnormality except for a minor Cairy 1 brain stem abnormality which the neurologist said was insignificant to his problems. Joey also had great difficulty coming through the anesthetic last time he had his teeth cleaned likely d/t to this supected liver shunt. Just recently we visited the University of Florida where they recommended a scan which requires general anesthetic to be followed immediately by corrective surgery if a shunt is found and if he is tolerating the anesthetic.
I am very apprehensive to act at this time because Joey looks great, is happy, and just seems to good to rock his little world. He has not seized since 12/16 which prior to that one seemed to be starting to occur monthly with each seizure lasting at least 7 hours.
My first concern is that he may not survive the anesthetic. Secondly, if they find and correct a problem it might cause more problems if in fact the shunt had formed d/t problems in the liver. I don't want to put Joey through any unneccesary misery. Sometimes it is better just to leave well enough alone yet if I can give him a longer heathier life I will. Hopefully your shared experiences can help with our decision for Joey.
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Old 03-06-2008, 07:58 PM   #2
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Welcome to YorkieTalk

It is hard (impossible) to say whether it is liver shunt or MVD without further testing. There is no surgery for MVD. I know the testing and surgery is expensive but the only place I'd want to have this surgery done would be University of Tennessee followed by Cornell.

Have any tests been done besides the bile acid test?
What were the bile acid results?
What are you feeding?
What supplements are you giving?
What anesthesia was used that he reacted badly to?

By the way, my Yorkie doesn't have a shunt or MVD but does have high bile acids.
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Old 03-06-2008, 08:46 PM   #3
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Joey has had LFT's drawn which were normal. Also amonia drawn once was elevated. His bile acids have been drawn about 6 times running very inconsistent between 25-120+. Strangley he had a normal result 6 weeks ago which prompted me to hold sugery but then 2 weeks ago it came back at 70. He is on a "kidney diet" dry food without any other supplements or medicatons at this time except the phenobarbital. The vet said if things progress we may need to add Flagyl to decrease bacteria in GI tract. She also said we could hold off on surgery at this point but my fear is that if he becomes symptomatic he would be too sick to survive the surgery. As far as the prior anesthetic goes I am unsure. He was probably given the full gamit of usual drugs since a problem was unknown at that time.

If your pups bile acids are elevated but there is no shunt or MVD how was this determined and what is your course of treatment? Is you little one symptomatic?
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Old 03-06-2008, 09:02 PM   #4
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Thanks for the reply. I replied to you but it hasn't appeared so I will type this again. Joey has had LFT's drawn that were normal. One amonia drawn was high but unsure if processed correctly. Bile acid were drawn about 5 times ranging for 25-120+. Strangely 6 weeks ago it was normal and when repeated 2 weeks ago it was 70. He is on a "kidney diet" dry food with no other supplements or meds except for phenobarb. The vet said we would have to use Flaygl to decrease GI bacteria when he starts to become symptomatic. The anesthestic is unknown to me. It was probably the entire gammit of meds used as we didn't know of a problem at that time. The vets says we can hold off on scan and surgery as he is doing OK at this time. My fear is that when he becomes ill and needs intervention it will be too late and he will not handle the anesthetic or surgery.

How have you found out that your pup doesn't have a shunt or MVD with these elevated bile acids? What are your pups symptoms and how are you treating the problem? The University wants $4000 for scan and surgery which would be well spent if I knew it was in Joey's best interest.
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Old 03-06-2008, 09:20 PM   #5
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Ellie was having a frequent urination issue, she had a severe vaccine reaction and she was poorly bred, so I wanted her tested. Liver biopsy and ultrasound were normal except for an inflamed pancreas (pancreatitis). She is on a lower protein diet and Denosyl for now.


Could you post the name of or the ingredients of the kidney diet?
I am VERY surprised that he isn't on Denosyl or VetriDMG and Hepatosupport or Marin. Lactulose is necessary to push the toxins out of the symptom so he doesn't have seizures. Please get him on supplements.

A member of YorkieTalk, Yorkieluv, has a Yorkie, Miko. He had to have the surgery to somehow make his pee hole larger. He was peeing out 20 stones a day. These were ammonium urate, I believe. It is a side effect of liver shunt. He also seized often. His problem is inoperable. Anyway, it did not look good for him and the vet even thought they were going to lose him and he is still here!!! Yorkieluv made some adjustments to his protocol and he is doing much better. Hopefully she will see this thread.

U. of Tenn. is the best in the world for this surgery (if his is operable) and I think they charge less than $1500 (this may not always be the case) plus portogram or scintography. $4000 is WAY too much.

This is a great group. They can help you:
http://pets.groups.yahoo.com/group/L...d_MVD_Support/
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Old 03-06-2008, 09:21 PM   #6
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Here's some liver shunt info from Dr. Tobias. She's considered an expert in the field.

http://glassyorkies.homestead.com/DrTobias.html
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Old 03-06-2008, 09:38 PM   #7
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I have Zeus, who has MVD. Thought he had an operable shunt, opened him up, realized his situation, closed him up and told me he wouldn't live to see 2. He was 10 mos. old at the time. He will be 7 in May. He just had bloodwork done last Fri. and is fairly normal. Bilirubin a tad high and some of his globulins. He is on Hill's LD and Denosyl and is doing just great!!! We are actually changing his diet to the WD because he is a little chubby at 9.7 lbs Hence the elevated globulins We'll see how that goes. Hopefully won't negatively affect anything. We are basically switching 2 grams of fat for 2 grams of protein, but the protein content is still pretty low. Anyway, I think figuring out the correct protocol for your dog's situation is key. Hopefully the vet can figure out what is driving all of this and give you some definitive answers. I wish you all the best. Juliet
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Old 03-08-2008, 09:39 PM   #8
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Hi I'm so sorry that your baby has seizures

I see that you mentioned your dog is on a kidney diet. If you are referring to Hill's k/d, this food is absolutely NOT recommended for liver compromised dogs because of the fact that it contains pork liver. Yes, it is low protein, but it contains the wrong *kind* of protein. Pork liver is an organ meat which completely overworks the liver and is one of the worst foods that can be given to a liver compromised dog. It's also high in purines, so if your dog has ever had stones due to his liver condition, it will cause more problems in that department as well.

Any food that contains red meat (beef, venison, lamb, etc) or organ meat (liver, kidney, etc) need to be completely avoided because they are very hard on the liver when a dog has a compromised liver.

Hill's L/D canned food is the food that is recommended for liver compromised dogs because it is specifically for dogs with liver conditions. OR Royal Canin Hepatic LS 14 is another alternative which most dogs find very palatable and contains increased amounts of vitamins/minerals that they need like vitamin E and zinc and decreased amounts of vitamins/minerals that their bodies don't need as much of.

Seizures are definitely a symptom of liver problems...Is your dog ever a picky eater? Is he on any supplements?

Considering that your dog is on phenobarb, he should at the very least be taking milk thistle. This is a supplement that helps protect the liver from further damage and helps repair the parts that already are damaged.

Phenobarbitol, itself, can cause more liver damage, so it's important to provide the liver with maximum support by giving supplements like milk thistle or Hepatosupport and denosyl (SAMe) or vetri-dmg. These help protect the liver from damage.

Phenobarb is not recommended for liver compromised dogs. Potassium bromide is preferred over the phenobarb for them.

Ellie May, you summed it all up perfectly!
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Old 03-08-2008, 09:49 PM   #9
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Quote:
Originally Posted by bailey12 View Post
I have Zeus, who has MVD. Thought he had an operable shunt, opened him up, realized his situation, closed him up and told me he wouldn't live to see 2. He was 10 mos. old at the time. He will be 7 in May. He just had bloodwork done last Fri. and is fairly normal. Bilirubin a tad high and some of his globulins. He is on Hill's LD and Denosyl and is doing just great!!! We are actually changing his diet to the WD because he is a little chubby at 9.7 lbs Hence the elevated globulins We'll see how that goes. Hopefully won't negatively affect anything. We are basically switching 2 grams of fat for 2 grams of protein, but the protein content is still pretty low. Anyway, I think figuring out the correct protocol for your dog's situation is key. Hopefully the vet can figure out what is driving all of this and give you some definitive answers. I wish you all the best. Juliet
Hi Juliet, I just wanted to mention that you might try giving Royal Canin Hepatic LS 14 instead of the L/D if your baby is becoming chubby. It contains Much less fat and is specifically for liver compromised dogs. I prefer it over the L/D just because most dogs actually love it and it is much lower in fat. W/D contains chicken, so is not optimal for liver compromised dogs. RC Hepatic is very palatable, contains increased amounts of Vitamin E and zinc that liver compromised dogs need, and much better for liver compromised dogs than W/D.
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Old 03-09-2008, 08:12 AM   #10
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Thanks for the suggestion. The switch was recommended by the vet and she didn't mention the royal canin. I actually asked specifically if there was a lower fat LD food. He's doing so well, and making any sort of change is always difficult. Thanks again for the info and I will do some more "research". Juliet
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Old 03-09-2008, 08:16 AM   #11
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I just want to send a prayer to Joey that he will get better.
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Old 03-09-2008, 03:22 PM   #12
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First of all thanks for all of the feedback I am getting. I have a lot to absorb and learn from all of this. In trying to respond to everything,

Joey is on the Hills KD which contains brewers yeast, pork fat, dried egg, flax seed, corn meal, soy fiber. percentages are crude pro 12%, fat 16%, and fiber 2.8%.

I am readin about LD food which sounds like a canned product and Royal Canine Hepatic. I would rather stick to a dry food to make my life easier. Also I have another little yorkie who shares the same bowl. Any problems with that do you think??

I am also seeing the mention of denosyl, vetriDMG, hepatosupport, and marin. I will have to learn more about these as I haven't heard of any of this. Are they necessary at this time due to the normal LFTs at this point. Or am I using other things mentioned here to prevent a problem? Thanks!

The only tests that show abnormal for Joey thus far are the bile acids (several times) and amonia level once which I question the handleing of the specimen. I am very very puzzled by the fact that his phenobarb levels are normal range. I would think that if the blood was shunting past the liver I would see sky high phenobarb levels and more seizure activity since it was not being metabolized by the liver.

For those of you that have experienced shunts or MVD what signs will I see next do you think? Joey is 4 1/2 years old and looks and acts completely healthy at this time except for the seizures which I have not seen since 12/16 and mid November prior to that.

I will have to figure out how to get a picture of my 2 babies on this site. They sure are precious. Thank you everyone for all of the input. The uncertainty of little Joey breaks my heart. He replaced my son when he left for the Coast Guard. I should have know to avoid the pet store. I took in a cockerspaniel when my son went off to kindergarten!! I sense a pattern.
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Old 03-09-2008, 03:36 PM   #13
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Royal Canin LS 14 is the best hard food for this unless your dog is allergic to corn. Other dogs should NOT share because it is too low in protein for a healthy dog.

Some symptoms you might see are circling, head pressing, GI upset, lethargy...

It is very important to get him on either Denosyl or VetriDMG and lactulose.

Ellie doesn't have a major liver disease but the high bile acids make it important to put her on something. She is on Denosyl.
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Old 03-09-2008, 05:09 PM   #14
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LD comes in both canned and dry form. I used to mix them, but Zeus eats only dry food now. Zeus has done great on LD, and the Denosyl has made a huge difference for him.
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Old 03-09-2008, 07:12 PM   #15
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What causes her bile acids to be elevated? Have you had any advanced testing done such as scans?
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