It's 495 for a scintigraphy now =/. it went from 395 to 495 as of Dec. 1 2009

I know how you feel =/. Over here, surgery will cost $3,000 to $6,000!!! Put her on lactulose and metrondazole syrup. It helps my Sasha a lot.

Hi. The best treatment for any pup is if it is less than a year old when diagnosed with LS is surgery, to allow the pup a normal, long life. Dogs over 1 year and older tend to do better on medication and diet.

And actually the next step for Sashabear0430's pup would be the test to determine if there actually is a shunt or not. If it's not and is MVD, surgery is not an option, she'll be on meds and diet only. Here's a link to important LS info: Portosystemic Shunts FAQ

This tells the whats and whys and explains a whole lot.

Also info from a similar thread:

Originally Posted by kjc http://www.yorkietalk.com/forums/ima...s/viewpost.gif
after skimming through some of the posts here I need to give some more info: Liver damage can be reversed to some extent with proper medication and feeding. The liver can regenerate and the medications support this regeneration. After you give her the Lactulose, you may see marked improvement within 24-48 hours if not some immediate improvement.

This is what happens: All puppies have a liver shunt. The shunt carries dirty blood past the pups liver to the mom before they are born and the mom's liver does the job of cleaning it. Normally this shunt will close up after birth and the pup will maintain normal liver function. In a Liver shunt pup, it does not close and the some of the dirty blood is taken to the heart or the brain and released back into the circulatory system. The pup becomes toxic after a while depending on the severity of the shunting.

When you feed the pup, bacteria in the gut break down the food and ammonia is released. Normally the liver removes this. In an LS pup the ammonia circulates in the blood stream and can cause symptoms like shaking, incoordination, seizures, head-pressing, etc. To help the pup, antibiotics are given to kill the bacteria and stop the ammonia production. Lactulose is given to absorb/bind the remaining ammonia, so the liver has less work to do remove it. It also hurries the food from the gut so it spends less time in the pup and he poops it out. Then Denemarin (or similar product) is given to support the liver by helping to remove toxins, preventing liver cell death, and promoting liver cell regeneration.

Feeding low protein, vegetable protein foods help by not overworking the liver. It is recommended to feed nothing over 18-19% protein. Hard boiled egg and cottage cheese contain good, easily digested forms of protein and can be added to her food.

So even though she's very sick now, on these medications her health can improve greatly. Some pups with LS are managed solely with proper food and medications, and can live a relatively normal life.

Originally Posted by kjc http://www.yorkietalk.com/forums/ima...s/viewpost.gif
after skimming through some of the posts here I need to give some more info: Liver damage can be reversed to some extent with proper medication and feeding. The liver can regenerate and the medications support this regeneration. After you give her the Lactulose, you may see marked improvement within 24-48 hours if not some immediate improvement.

This is what happens: All puppies have a liver shunt. The shunt carries dirty blood past the pups liver to the mom before they are born and the mom's liver does the job of cleaning it. Normally this shunt will close up after birth and the pup will maintain normal liver function. In a Liver shunt pup, it does not close and the some of the dirty blood is taken to the heart or the brain and released back into the circulatory system. The pup becomes toxic after a while depending on the severity of the shunting.

When you feed the pup, bacteria in the gut break down the food and ammonia is released. Normally the liver removes this. In an LS pup the ammonia circulates in the blood stream and can cause symptoms like shaking, incoordination, seizures, head-pressing, etc. To help the pup, antibiotics are given to kill the bacteria and stop the ammonia production. Lactulose is given to absorb/bind the remaining ammonia, so the liver has less work to do remove it. It also hurries the food from the gut so it spends less time in the pup and he poops it out. Then Denemarin (or similar product) is given to support the liver by helping to remove toxins, preventing liver cell death, and promoting liver cell regeneration.

Feeding low protein, vegetable protein foods help by not overworking the liver. It is recommended to feed nothing over 18-19% protein. Hard boiled egg and cottage cheese contain good, easily digested forms of protein and can be added to her food.

So even though she's very sick now, on these medications her health can improve greatly. Some pups with LS are managed solely with proper food and medications, and can live a relatively normal life.
To clarify: Melody needs to be on Amoxicillin, Lactulose, and Denamarin

I wanted to post this info again...
Medications will help, probably more than surgery right now. Melody screams because the ammonia levels in her blood have gone to her brain. This is what causes all the neurological problems Krystal is seeing. This means this pup is very toxic. The AB's and Lactulose will immediately begin to remove and limit the amount of ammonia getting into her circulatory system, and will make surgery safer as she will have cleaner blood when she does have the sx.
Lactulose can also be given as an enema during a seizure to immediately decrease ammonia levels in the bowel.
That Melody have survived this long tells me that she has some part of a functioning liver. The Denamarin helps to protect and regenerate the working parts, while the AB's and Lactulose stop toxins from reaching the liver from the intestines (digesting the food she eats).

And about the surgery: Not all pups are good candidates for surgery. The ones that are are young, and have one shunt located outside of the liver.
A band (made with milk proteins) is placed around the shunt and closes it off as it absorbs fluid. This takes about 3 weeks to happen. Then, if the liver doesn't throw another shunt, all should be good. If the liver produces another shunt, surgery will need to be performed again.
The pups with multiple shunts, and/or internal shunts (inside the liver itself) or MVD (Hepatic Microvascular Dysplasia) are not candidates for surgery. Tests to determine the type of shunting in a pup runs between $500-$1000, and surgery runs between $1400-$4000. The U of T tries to keep the price down as this is such a common problem, and it adds to their research.

Hope this helps...

Sorry some stuff was duplicated in above post...

It is nice having someone my own age too!
Umm .. honestly we had no clue she had a shunt. She showed no symptoms at all! We were taking her to get fixed and because shunts are common in yorkies and having one makes it harder for them to wake up from the anesthesia, the vet checked her bile acid numbers and it showed up that hers were high.

What symptoms did your yorkie have?

I have good news, sorta.

My family decided that we need to skip our family vacation and get Muffy's surgery this summer instead.

So, the stintography is just the test to see if she has a shunt right? Then there is an actual surgery?

Yes, that is right. She may not have a shunt...then you can go on vacation. ;)
I see you are in AL, so I'm guessing University of Tennessee isn't extremely far from you. This would be the best place to do the surgery because they are so experienced and they don't see as many complications as other hospitals. It is also likely the cheapest place to have it done. You may be able to get the surgery and scintography for under $2000.

That is wonderful news!!!

How far away are you from the U of Tenn???

They are the BEST for Liver Shunt surgery, and I have seen quotes $1300 to $1800 for the Spay, Bloodwork, Scintography and Liver Shunt Surgery repair...

I think you should check into it ;)

Yes! :) We are very close to the University of Tennessee! I'm so excited that Muffy is going to get to have her surgery. My dad thought of the idea :)

great news and yes i would only trust tobias with this surgery :) hopefully not a shunt though

I hope not :)

My yorkie had almost all of the symptoms of a liver shunt except puking and diahrea. But she only had the symptoms once. Thats great that you're getting your babys surgery done this summer!!! I wish I could do that for my sasha =(. But I need to do a BAT first, hopefully my dad will lend me money. he is more into helping me out with this stuff than my mom is. my mom is like "she looks fine, leave her as she is" whereas my dad will agree with what I think should be done. thats great that you have your parents support

I will definitely pray for y\'all that there is someway for Sasha to get the surgery!
Keep us updated!