liver shunt #3
 

Hi all
I haven't posted in a year or so, but I had some disturbing news yesterday and needed to talk to people that would understand, so here I am. I don't know if some of you remember my posts in 06 and 07 regarding my Yorkie Indiana (Indy). He had a liver shunt at 6months, that I had fixed and he seemed to thrive, but at 1yr, 6mos, he developed shunt #2, which I also had fixed. Here we are 2 years later, Indy is 4 now, and his bile acids climbed yet again so we were at the ultrasound doctor and Indy has shunt #3. All shunts are extra hepatic (outside his liver), including this one. But, the surgeon feels he is not a good candidate for another surgery because he feels there is something going on in the liver that is causing hypertension on the portal vein, therefore making his body produce these shunts as "relief valves" to relieve the pressure. Here's the odd part. His liver seems perfectly normal. Ultrasound shows it is healthy and normal size, no change from shunt #2 pictures, he had a biopsy done during surgeries for both previous shunts and no MVD was shown, liver tissues were completely healthy and normal. His liver enzymes in the CBC that we did were perfectly normal, as was everything else on the CBC. I am completely frustrated. I am seeing an Internal Medicine vet next Wed to see about supportive measures we can do to keep his liver healthy as long as we can. Any suggestions out there? Anyone ever heard of this before?

Many times liver problems aren't indicated in a cbc simply because not enough damage has occurred. What were his bile acid results? That's the real indicator of liver function...

ETA - I see you are in PA. Honestly were he my dog and this many liver problems. I'd make an appointment at Cornell. Dr Sharon Center is at Cornell and it was she that developed the BAT. They treat 100's of dogs for this condition

Another thought....shunts can be acquired. That may be the case here...usually the dog has some other liver issue.

Thanks for the info. I have been thinking about making up a "medical resume" of sorts outlining all of his surgeries and tests and emailing to schools like Cornell or University of Pennsylvania. It is nice to have a name to reference at Cornell. His bile acids before his first surgery were 144 after the eating, can't remember what the fasting were, after the first surgery they came down a good bit, I think his eating one came down to 17, but they didn't stay there before they shot up again to 90. After the second surgery they came down to 5 eating, 4 fasting and stayed there until this last one that came up to 44eating, 44 fasting. Granted, not hugely high, but definitely up from 5! I also know my dog and he just wasn't right, which is why I requested the bile acid test. He has been on the LD diet since his last surgery, and he gets no table scraps or extra food except a couple treats during the day.

Those last numbers aren't really indicative of a shunt....it is usually MUCH higher than that....as in triple digits. Dr Center states "normal" is a post fast of 25.

There are outside influences that can affect the results of this test. Medications or simply what they've eaten. Bile acids do fluxuate from day to day...they aren't constant.

I'm not so sure I wouldn't just re-test in a week or so. Or perhaps contact Cornell and have them examine him before proceeding further.

I agree, I would get him a consult at Cornell University. :(

Also, join the yahoo group:
DogLiverDisease : Dog Liver Disease

What method was used to closed shunts 1 and 2?
Was it the ameroid constrictor?

What diet and supplements is he on now?

Yes, ameroid constrictor. They are not the same shunts they have all been in different places. I have nice ultrasound pics of all of them! I had a follow up ultrasound done after the 2nd shunt just to make sure it had closed off all the way and it had. I had 3 bile acid tests done during the course of the following year and they were all perfectly normal, HE was acting normal. He isn't on any meds, but after the 2nd shunt I kept him on the LD diet. He's a big Yorkie, bigger than my Jack, and weighs 16 lbs. When I started seeing his particular shunt signs, I took him for a bile acid test. They were alot higher than his last ones, and definitely above normal, although not as high as the previous shunts, yet. This shunt is smaller than the first two, the first two were pretty big. If I told you his signs, you would probably think I'm a nut case, the surgeon did until he saw the ultrasound. He squints. He never has done it any other time, only when he has the shunts. Also subtle changes. He eats, but not with his usual 'inhale it" enthusiasm, plus he is alot more loving, almost as if he knows he doesn' t feel good. I see the changes because I pay attention. I know my dog.

I don't have any experience with liver shunt, but I had the joy of meeting you and Indy a few years back. What a sweet boy Indy is. He really made an impression. I'm soooo sorry to hear he is having problems again. I'll be keeping you both in my prayers and keeping an eye out for updates.

lol, you're not a nut case.
Vision issues can accompany the hepatic encephalopathy from the toxins building up as does the appetite change.

Any reason after he got the second shunt and the vet realized this was going to be an issue that he wasn't put on Denosyl, milk thistle, vitamin e, omegas and lactulose for any neurologic symptoms?

Are you using the canned or dry L/D?

I would definately be talking to Dr. Tobias or Dr. Center as soon as possible.

You can call U. T. and maybe get in touch with Dr. Karen Tobias, she is the very best. My 2 year old yorkie just had surgery on her LS, March 26th, Dr.
Tobias did it. I would see about get the lactulose, and Denamarin, (denamarin is one pill that has denosyl , and milk thistle in it), it easier to give just one instead of two. The lactulose will flush the toxins out of the liver. Here is number to U.T, (865) 974-8387. They are so very nice there. Sandy

I don't think he thought it was going to be an issue. He assumed, because the liver was so good, that the second one was a fluke. He said that he had only seen one other 2nd shunt and he had never seen a 3rd one. He did say that there was always a possibility, but he didn't think it would happen with Indy because there didn't seem to be any other liver issues. For a year his bile acids were very low after the surgery and he seemed to thrive. I mix the dry with the canned. I prefer dry, but when he was sick he wouldn't eat it dry so I mixed just a little canned with it. It's the only way he'll eat it.

I have emailed Dr. Center at Cornell, thanks for the information on Dr. Tobias. I have heard of her work, but was under the impression that her liver shunt research with Yorkies was only on AKC registered dogs, and Indy is not AKC registered. But I will call the number and talk to them. I am assuming that when I see the Internal Medicine vet on Wed that she will put Indy on lactulose and maybe other things. Her speciality is on treating dogs with liver problems and putting them on a regimen that will support the liver.

The dry L/D contains pork which can be hard on the liver.
How about Royal Canin LS 14? Or canned L/D all the time?
Most vets would probably say the dry L/D is fine but really it isn't the best. Vegetarian foods or egg are best, then white fish and then poultry.

That's interesting! I didn't know that about the LD food. Is Royal Canin a prescription also? I don't think I have ever heard of it. I have read some information and read posts here that some people actually cook for their dogs and make home made treats. That is such a neat idea, you would know for sure what he's getting. Where can you find recipes that support dogs with liver problems? I am beginning to think that I need to be more proactive with this because now I am going to have look at things for him in terms of life with a liver shunt, not "he's all better now". I want to do whatever I can for him.