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Old 04-06-2012, 06:05 PM   #1
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Unhappy Need advice on a decision

My 9 year old, Cami, has been having liver problems on and off since I've adopted her almost 6 yrs. ago. Unfortunately, the problems are getting worse and happening more frequently. Recently, I have taken her to a specialist and a surgeon who recommends exploratory surgery. Her bile acids test is extremely high suggesting she may have a portal shunt. However, there is no guarantee that is the problem. She may have microvascular dysplasia. If there is a shunt and they put on a constrictor, again, there is no guarantee. Especially if the liver has a lot of scar tissue (won't know until biopsy results), it will cause the liver enzymes to increase and it will kill her. The protocol for now is Denamarin 90 mg. 1 x a day; Amoxitabs 50 mg. 2 x a day; Lactulose 2 mls. 2 x day; Pepcid AC 10 mg. 1/4 tab 1 x day. Her diet is Hill's L/D canned. She still has bouts of vomiting, diarrhea, and not wanting to eat. I have to force feed her when she gets like that. However I should mention, too, she is a very picky eater and always has been. If she doesn't eat, the stomach pains (gurgling sounds), vomiting and sometimes diarrhea starts. Then we end up at the vets getting fluids.

I don't know whether to go through with the surgery or not. My heart tells me no because she will be in pain and without me for 3 - 4 days. If she was 3 or 4 years old, I wouldn't have a problem with this, but she is 9 years old! She was a rescue and since I've had her, I have babied her. She gets separation anxiety if I'm not with her for more than 1 day. I can visit her in the hospital at 15 minute intervals. Also, there is no guarantee and she may die sooner than later. Logic tells me if she gets the surgery, we will know what is wrong with her liver. Today I consulted her regular vet and he, too, thought it would be best if she gets the surgery. I just don't know. I feel like I'm damned, if I do and damned, if I don't!

What would you do?
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Old 04-07-2012, 05:46 AM   #2
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Natalie - I don't have any experience with what you are going through but I am sure some more experienced members will pop in and give you great advice. I just wanted to say that I am sorry poor Cami is going through all this and in the end whatever decision you make will be the best. Sending best wishes for you both.
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Old 04-07-2012, 06:01 AM   #3
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Natalie, I don't have any experience in this area or advice to offer, but I want express my support for you and Cami. Sending prayers for both of you.
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Old 04-07-2012, 08:21 AM   #4
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I think your vet should support whichever decision you make in this instance. You are obviously a very good, loving and responsible owner. You do what you think best. Thats all you can do anyway.
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Old 04-07-2012, 09:12 AM   #5
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go with your heart. there are circumstances here that make it less than easy to decide. sometimes less invasiveness to an issue is really the best way to go.
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Old 04-07-2012, 09:31 AM   #6
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I don't have any advice either, but wanted let you know I will pray for your baby. I can understand what a difficult decision you are faced with, I'm so sorry. Know we are all here for you.
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Old 04-07-2012, 10:25 AM   #7
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Quote:
Originally Posted by NatalieE View Post
My 9 year old, Cami, has been having liver problems on and off since I've adopted her almost 6 yrs. ago. Unfortunately, the problems are getting worse and happening more frequently. Recently, I have taken her to a specialist and a surgeon who recommends exploratory surgery. Her bile acids test is extremely high suggesting she may have a portal shunt. However, there is no guarantee that is the problem. She may have microvascular dysplasia. If there is a shunt and they put on a constrictor, again, there is no guarantee. Especially if the liver has a lot of scar tissue (won't know until biopsy results), it will cause the liver enzymes to increase and it will kill her. The protocol for now is Denamarin 90 mg. 1 x a day; Amoxitabs 50 mg. 2 x a day; Lactulose 2 mls. 2 x day; Pepcid AC 10 mg. 1/4 tab 1 x day. Her diet is Hill's L/D canned. She still has bouts of vomiting, diarrhea, and not wanting to eat. I have to force feed her when she gets like that. However I should mention, too, she is a very picky eater and always has been. If she doesn't eat, the stomach pains (gurgling sounds), vomiting and sometimes diarrhea starts. Then we end up at the vets getting fluids.

I don't know whether to go through with the surgery or not. My heart tells me no because she will be in pain and without me for 3 - 4 days. If she was 3 or 4 years old, I wouldn't have a problem with this, but she is 9 years old! She was a rescue and since I've had her, I have babied her. She gets separation anxiety if I'm not with her for more than 1 day. I can visit her in the hospital at 15 minute intervals. Also, there is no guarantee and she may die sooner than later. Logic tells me if she gets the surgery, we will know what is wrong with her liver. Today I consulted her regular vet and he, too, thought it would be best if she gets the surgery. I just don't know. I feel like I'm damned, if I do and damned, if I don't!

What would you do?
what I would do is consult with Dr Tobias at Univ of Tennessee. They do liver shunt surgeries and pre surgery consults all day every day.

I don't want to make assumptions, but I thought a scintography is the tool to use to clearly understand if you are dealing with a portal shunt, or something else wrong with the liver.

You are facing a multi-faceted decision area. There are no right answers or easy as pie kind of decisions.

For me, if I was to break this down into a decision tree I would:

a) find out "for sure" if there is a liver shunt ... and by the best specialists around.
b) consult with these experts as to the success rate of liver shunt surgery with a girl of her age and health record.
c) Consult with self same experts to see if no surgery; what can be done to manage the condition and her quality of life?
c) then decide if the risks of surgery, the anticipated benefits(ie quality of life issues), the costs, and other factors personal to you point you in the direction of which way to go.

My heart goes out to you and Cami. You will both be in my prayers and positive thoughts.
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Old 04-07-2012, 10:51 AM   #8
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Originally Posted by gemy View Post
what I would do is consult with Dr Tobias at Univ of Tennessee. They do liver shunt surgeries and pre surgery consults all day every day.

I don't want to make assumptions, but I thought a scintography is the tool to use to clearly understand if you are dealing with a portal shunt, or something else wrong with the liver.

You are facing a multi-faceted decision area. There are no right answers or easy as pie kind of decisions.

For me, if I was to break this down into a decision tree I would:

a) find out "for sure" if there is a liver shunt ... and by the best specialists around.
b) consult with these experts as to the success rate of liver shunt surgery with a girl of her age and health record.
c) Consult with self same experts to see if no surgery; what can be done to manage the condition and her quality of life?
c) then decide if the risks of surgery, the anticipated benefits(ie quality of life issues), the costs, and other factors personal to you point you in the direction of which way to go.

My heart goes out to you and Cami. You will both be in my prayers and positive thoughts.
My heart goes out to you and your baby, as you are trying to wade through a multitude of pros and cons, if's, ands, and buts.....as I started to try to share what I would do, gemy saved me a whole bunch of writing, as she outlined EXACTLY the course I would take if I was in your dilemma. Dr.Tobias and the team at UT are the benchmark in liver shunt surgery and liver shunt research. I would consult them, let them give me a plan of action, and then I personally would follow their direction. My thoughts and prayers are with you and little Cami......
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Old 04-09-2012, 05:39 AM   #9
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Thank you all for the your advice.:

I have made a decision. I don't know if it is the right one, but I am going with my gut instinct and NOT go with the surgery. Considering her age and what "gemy" said about "what can be done to manage the condition and her quality of life", made me think about what all doctors said. Surgery or not, she would still continue with a low protein diet (Hill's L/D), lactulose, denamarin and antibotics. I liked what "impish" said "sometimes less invasiveness to an issue is really the best way to go".

Right now, Cami, seems to be doing very well. When she gets serious bouts with vomiting and/or diarrhea, we will go to the vet. When the time comes where her quality of life is gone and nature hasn't take of it, then I'll decide to put her down (with her in my arms and telling her goodbye and I love her).
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