Liver shunt

[DAB]

Hi Everyone!
I am still having a difficult time with this site. I can't find the posts and replies I started with last week.

Emma went to the Tufts Univ. Foster Hospital today. I had to postpone her apt. on Wednesday due to the snow/ice storm we had here. She had an ultrasound and the doctor is pretty certain she does not have a liver shunt. However, b/c paperwork from my vet showed that her bile acids were so high (576), The Tufts vet tested her again---drew blood then fed her a bit of wet cat food (to make her stomach seize) then drew blood a bit later. Now we need to wait for the results which should be back by Monday, Jan. 12th.

Now it is just a wait and see situation. Besides liver shunts, does anyone know of other problems associated with the liver? She is losing weight so the vet said to increase her food intake. Right now, she is on the IAMS Low Residue dry kibble to which I add boiled fresh white chicken meat and water.I add her medication to the food. She is absolutely ravenous when she eats----she always has been! Prior to geting sick, she ate EVO light plus the fresh boiled chicken and water. Has anyone had problems with the Evo (made by Inova).

Your comments and prayers are sincerely appreciated. I will keep all yorkies here in my prayers to St. Jude, St. Francis of Assisi and St. Rocko. May
the Good Lord heal them all.

Than you.
DAB

[Ellie May]

Here is your old thread:
http://www.yorkietalk.com/forums/sic...tic-shunt.html

With bile acids over 500 and U/S only being 60-80% accurate, more testing should probably be done. Did the vet say anything about a Protein C Test? Any liver functioning issue can cause high bile acids but since LS is so common in Yorkies, that is usually the culprit. What were her symptoms again?

[MauiGirl]

Originally Posted by Ellie May

Here is your old thread:
http://www.yorkietalk.com/forums/sic...tic-shunt.html

With bile acids over 500 and U/S only being 60-80% accurate, more testing should probably be done. Did the vet say anything about a Protein C Test? Any liver functioning issue can cause high bile acids but since LS is so common in Yorkies, that is usually the culprit. What were her symptoms again?

I sure hope we see more Protein C tests done in the future, as one of the first steps in diagnosis to rule out liver shunt.

[Ladymom]

I agree with Crystal. This is what Dr. Center says about the reliability of ultrasounds:

Abdominal ultrasound with color
flow doppler is one of the least
invasive imaging techniques, but
also one of the most difficult to
perform and interpret. Ultrasound
requires an experienced ultrasonographer
as shunts can be easily
missed, especially if the dog is small
or uncooperative.

http://www.yorkiefoundation.org/purina1.pdf

Ultrasonography can detect "classic" features: small liver, hypovascular intrahepatic portal system, large kidneys, uroliths, and in 60 to 90% of cases (depending on ultrasonographer skill) identification of an aberrant shunting vessel. Doppler color flow interrogation identifies PSVA associated turbulence in the vena cava. Otherwise, a slow, tedious, systematic search of the portal vasculature is required.

Hepatic Vascular Disorders - WSAVA 2006 Congress

A Protein C test would definitely be the next step:

Comparative Coagulation -- NYS Animal Health Diagnostic Center

[Ellie May]

Originally Posted by MauiGirl

I sure hope we see more Protein C tests done in the future, as one of the first steps in diagnosis to rule out liver shunt.

That would be nice.
It is frustrating when the latest and greatest test is out and is cheap, but vets don't use it. If they think that it isn't reliable that's one thing, but we pay big money to see internists. They certainly better know what a Protein C Test is. Even Ellie's regular vet brought the Protein C test up the other day to me. Now if she knows about it and doesn't specialize in liver issues, I don't see why we should have to explain to internists what it is. Ellie's internist never brought it up either.

[MauiGirl]

Originally Posted by Ellie May

That would be nice.
It is frustrating when the latest and greatest test is out and is cheap, but vets don't use it. If they think that it isn't reliable that's one thing, but we pay big money to see internists. They certainly better know what a Protein C Test is. Even Ellie's regular vet brought the Protein C test up the other day to me. Now if she knows about it and doesn't specialize in liver issues, I don't see why we should have to explain to internists what it is. Ellie's internist never brought it up either.

Yeh, my vet thanked me for bringing him the info on Protein C, and he was trying to figure out how much it would cost so he could double it. I was afraid since it would be their first time, that they might not draw and process properly and the results would be skewed. I went ahead with u/s and still don't know for sure if there is LS.

[DAB]

Hi Again!

I just posted a reply to an "eye ulcer" problem someone was having asking for advice as my little yorkie now has one! When all her procedures were done at Tufts and she was returned to me, her eye looked funny. I thought it was the result of the sedation. Her eye would only open slightly yesterday and today it seemed sticky. I washed it gently with warm water but it still did not look right. So, off to my vet my husband and I went this morning only to discover she has an eye ulcer! My vet thinks that her eye must have been inadvertently scratched during the procedures. We were dumbfounded!

Of course, we phoned Tufts immediately and are now awaiting a return phone call from the doctor we saw there. She is now on 2 kinds of eye drops every 6 hours for a month. She must wear an e- collar 24/7 for a month as well as she must not paw at the eye. We are not very happy right now.

The good news is that the blood results for the bile acid are back and they are "normal". A couple of weeks ago the reading was 576 with the normal range being in the single numbers ---less than 7! Go figure! We will have her blood tested again at the end of the month. Tufts has now ruled out microvascular dysplasia. We are going to monitor her and will have her acid bile level checked again at the end of the month. Yeah--no surgery needed! She has been through so much this past month.

THANK YOU to the person who gave me the Cornell University site for the protein C testing. I printed the info. and gave it to my vet this morning. He is going to look into the test as he had not known about it. We will see him again on Thursday for Emma's eye and will talk to him about having a blood sample sent out to Cornell.

In the mean time, Emma has lost weight and we have to "fatten" her up a bit! We had been instructed to feed her minimally b/c any food would turn toxic inside her. The Tuft's doctor said that she will stay on the Iams Low Residue food. Also, she will be getting her 1 ML of Metronidazole 1x a day instead of 2x a day. We no longer have to give her the 1/4 tab of Peptid AC either. In addition, I am adding fresh boiled chicken tender meat and water ( as I always have to her food ) to the IAMS and will be feeding her 3x a day.

Does anyone have any comments or advice for Emma's diet or eye ulcer?

Thank you for your prayers and positive thoughts. I prayed for divine intervention from the Lord with prayers of assistance from St. Jude, St Francis of Assisi, and St Rocko. Thank You!

[Ellie May]

I have no idea how the ey could've gotten scratched.
The change in those BAT results don't seem possible.
I would have to wonder if it was done incorrectly the first time.

Why was she sedated?

[TLC]

Good News so far....

Personally, I don't like the IAMS company, so if all works out well for her, I would change to a 'better' company. Innova is a good one, but it was too 'rich' for my two and caused problems.

Natural Balance Veggie Formula is recommended for Liver Issue dogs. I would probably skip the boiled chicken and get Friendship Low Sodium Cottage Cheese if you need to add "a tiny bit" to entice eatting. This would be easier on her liver.

Also feeding multiple small meals throughout the day is best.

Apple bits (no skin) and Watermelon are great treats.

[Patti]

I am glad the BA results were normal! I would be upset anout the eye ulcer too. I had a yorkie with one once and it healed pretty quickly with the medicines and he was fine after.

[MauiGirl]

So glad to hear bile acids are normal, but sorry to hear about the eye. That's great that your vet is now knowledgable about the Protein C test, though it might not be needed now that bile acids are normal. Too bad he didn't know about it earlier, as it "might" have saved you from the ultrasound and all the other drama. It still is almost unbelievable that bile acids can vary that much, and I too wonder if the tests were skewed.

[Catherine852]

My Yorkie - Had liver shunt surgery on Nov 19 and had complications due to the surgery.

Does anyone have experience with this?

He is home after a month in intensive care. He is beginning to get basic functions back but seems to still be blind or unable to process sight. Any experience with such complications would be great to hear about. Thanks.

[TLC]

Originally Posted by Catherine852

My Yorkie - Had liver shunt surgery on Nov 19 and had complications due to the surgery.

Does anyone have experience with this?

He is home after a month in intensive care. He is beginning to get basic functions back but seems to still be blind or unable to process sight. Any experience with such complications would be great to hear about. Thanks.

I am so sorry that you and he are going thru this....

This is a link to a Yahoo Group dedicated to Liver Disease. There are many, many, many LS babies on that group and they have tons of info and tons of experience, and I think they can give you support and guidance.
DogLiverDisease : Dog Liver Disease

Prayers are coming your way...

[Catherine852]

Thank you so much for the website info. I will check in to it tonight and thank you for your prayers - they are so thoughtful.

[TLC]

Originally Posted by Catherine852

Thank you so much for the website info. I will check in to it tonight and thank you for your prayers - they are so thoughtful.

You are very welcome. I am a member at that Yahoo Group as well. My baby girl has MVD (mild) but I still have to be aware of her needs regarding her liver issues.

I really feel for you right now, as from the little bit that you gave us it does sound critical right now. The Yahoo Group will guide you, will give you answer and support and the best possible recommendations to help your baby recover.

Please keep us posted on his progress