liver shunt and leptospirosis vaccine

[magicgenie]

Not too long ago I saw some intersting postings here about the leptospirosis vaccine causing liver disease and/or symptoms thereof. I'm presently reviewing a set of medical records for a 7 mos old puppy that was vaccinated for lepto at 16 and 20 weeks, at which time she developed occasional tremor like symptoms, sometimes also some vomiting after a long drink of water. BAT taken pre-spay at 24 weeks is 2.2 pre-meal, 52.9 post. Ultrasound taken same day diagnoses large single shunt "appears to connect portal vein & cavdal vena cava (illegible and I'm not med savvy). The breeder was about to write a big check to the puppy owner but seeing lepto on the med record is causing him to hold off just a bit. Any suggestions? Thanks very much!

[katelin]

I'm not an expert on this, but I think there is no conclusive evidence of a connection, just anecdotal evidence. If anyone knows of more scientific evidence available now, I'd like to hear it.

This is what makes LS so vicious. There is just no positive proof of what causes it to appear.

[yorkielovs2chat]

Speaking to the LS expert at Cornell and pedigree experts, it has been proven to be genetic and they are getting VERY close to finding the genetic marker. Pedigree experts ahve even found certain lines that are safer than others.
Putting that aside, allergies, underbites, bladder stones are thought to be genetic. Coat coloring, personality...etc all are. Why not LS? Even without the studies to prove it. Bottom line, I wouldn't but a dog from a parent or grandparent who had an LS dog creep up.
For a vaccine or other poisong to cause a shunt, it has to be an EXTREME assault to the liver and that would show up as some kind of liver disease and the shunt would be secondary to that.
The scary thing is that more and more dogs are showing up with multiple congenital shunts (not just one and not MVD) and there is nothing else wrong with the liver. My surgeon is seeing them, Cornell is, and I have met so many who have it.

Originally Posted by katelin

I'm not an expert on this, but I think there is no conclusive evidence of a connection, just anecdotal evidence. If anyone knows of more scientific evidence available now, I'd like to hear it.

This is what makes LS so vicious. There is just no positive proof of what causes it to appear.

[yorkielovs2chat]

Anyone interested can read our blog about how we ended up with this and were SO shocked. I will always bile acid test any yorkie I get. I have since done some research (pedigree) for myself and am shocked as to what I ahve found. Never go by what a person/breeder says no matter how nice they are. Bile acid test. Doesn't mean the breeder is bad, but LS can creep up in anyone's line unless you really have had a pedigree expert work with your breeding. I know dogs who have MVD and have not shown symptoms (yet)and breeders thought they had no problems but because the owners bile acid tested they found it. There are some GREAT breeders out there who have had this creep up but then some breeders out there who have health issues that creep up but yet will not alter their breeding program nor be honest about health issues before selling. :-(
http://www.yorkietalk.com/forums/yor...-my-story.html

[magicgenie]

Thanks, Yorkieloves2chat. I read your posts about this some time back and reread your story today. I don't see where you made any reference to the BAT on your dog. Was it normal too?

This reminds me of a question I've asked before and received no answer to. If you BAT a puppy at 12 weeks and result is normal, does that mean he/she does not have congenital liver shunt and will never have it? Or does it only mean the puppy doesn't have signs of it yet but may get some later?

BAT on adult dogs is another matter and should be done periodically even to catch possible acquired problems.

[magicgenie]

I'm posting in pieces beause once again I keep getting logged out while composing...
We're not medical people, so bear with us as we try to understand these med records. How bad is a BAT of 52.9? Is an ultrasound that says "appears to be a shunt...bla bla bla, and liver appears to be normal size" conclusive enough to warrant opening up a puppy whose tests otherwise do not look bad and has only vague symptoms that just happen to have started after the first lepto vaccine.
A few other irregularities include a surgical cost estimate for intrahepatic shunt when the diagnosis if for extrahepatic shunt. Isn't intrahepatic more complicated?
This vet hospital is part of the VCA chain and we are concerned about possible issues with "clinic revenue augmentation" procedures rather than any real concern for the dog.

[yorkielovs2chat]

Originally Posted by magicgenie

Thanks, Yorkieloves2chat. I read your posts about this some time back and reread your story today. I don't see where you made any reference to the BAT on your dog. Was it normal too?

This reminds me of a question I've asked before and received no answer to. If you BAT a puppy at 12 weeks and result is normal, does that mean he/she does not have congenital liver shunt and will never have it? Or does it only mean the puppy doesn't have signs of it yet but may get some later?

BAT on adult dogs is another matter and should be done periodically even to catch possible acquired problems.

He had no symptoms at all. Big, healthy, no eating problems...nothing. at 1 1/2 year old he got bladder stones. Now, this is around the time (3 years for femals) that bladder stones show up in a dog who hasn't shown symptoms but I found out that there were relatives in his family who had stone problems (after the fact). Still, he showed no other symptom. When going in for surgery, the surgeon saw the shunts, saw a healthy liver (no disease), and took a biopsy. Cornell revisited all this and came to the same conclusion--congenital shunts. Cornell also did BATs and they were high. I am not an expert, but in my opinion, I want to get my story out there because although his liver appears to be doing well, we are having a BIG struggle with the bladder. I am averaging $200-$400 a month in medical bills due to bladder (and it is me all alone having to pay for all this). Had I done BATS, we may have been able to prevent the bladder problem. Had I known about stone problems in the line and what UTI's were, I woudlhave known what to look for.
I've had friends test their dogs to be on the safe side and some friends have come back and thanked me because they found problems but will be able to prevent them from getting expensive like mine has.
I hope I can help.

[yorkielovs2chat]

Originally Posted by magicgenie

I'm posting in pieces beause once again I keep getting logged out while composing...
We're not medical people, so bear with us as we try to understand these med records. How bad is a BAT of 52.9? Is an ultrasound that says "appears to be a shunt...bla bla bla, and liver appears to be normal size" conclusive enough to warrant opening up a puppy whose tests otherwise do not look bad and has only vague symptoms that just happen to have started after the first lepto vaccine.
A few other irregularities include a surgical cost estimate for intrahepatic shunt when the diagnosis if for extrahepatic shunt. Isn't intrahepatic more complicated?
This vet hospital is part of the VCA chain and we are concerned about possible issues with "clinic revenue augmentation" procedures rather than any real concern for the dog.

BAT of 52.9 I believe is more of an indication of MVD...but I'm not an expert. Still need to be addressed. If the ultra sound says shunt, I would do the surgery. Right now he/she is okay...but what happens as time goes on. You could end up with bills like I have or worse!!! Some dogs have gone YEARS with a shunt and no one knew and then something dramatic happened to bring it to light or they caught it by fluke. If it is a single shunt, it was not caused by that vaccine but the vaccine may have aggrivated it. My vet says no more vax for my dog because the liver can't handle it. I don't know much about intrahepatic. MVD is multiple internal shunting and cannot be operated on. I've read about some single intrahepatic shunts in big dogs that I guess could have surgery????? I'm not sure about that.
Extrahepatic can be operated on as long as it isn't multiple in nature which is becoming more frequent.
if I were you DO the surgery. Go to a really good internal medicine surgeon and get it done.
I am NOT an expert and only share what I know from doctors I've talked to and what I've read.

[Yorkieluv]

A Protein C test will help determine if it's MVD or liver shunt. MVD is tiny shunts throughout and is inoperable. If the ultrasound clearly saw an extrahepatic shunt, then the surgery should be done.
The Protein C test is relatively inexpensive though and will help decipher between MVD and liver shunt. This would be the next step before surgery.
OR a scintigraphy, but it's more costly.
BAT results under 100 are more indicative of MVD whereas numbers above 100 are more indicative of a liver shunt.
That being said, it's important to note that these are only guidelines.
I have seen cases where a dog with numbers under 100 have had an extrahepatic liver shunt, and I know of dogs with numbers above 100 who have had MVD.

[magicgenie]

Originally Posted by Yorkieluv

A Protein C test will help determine if it's MVD or liver shunt. MVD is tiny shunts throughout and is inoperable. If the ultrasound clearly saw an extrahepatic shunt, then the surgery should be done.
The Protein C test is relatively inexpensive though and will help decipher between MVD and liver shunt. This would be the next step before surgery.
OR a scintigraphy, but it's more costly.
BAT results under 100 are more indicative of MVD whereas numbers above 100 are more indicative of a liver shunt.
That being said, it's important to note that these are only guidelines.
I have seen cases where a dog with numbers under 100 have had an extrahepatic liver shunt, and I know of dogs with numbers above 100 who have had MVD.

That information is very helpful. I'm worried about accepting an ultrasound report that says "appears to be a vein..." I'd prefer to see "clearly visible shunt...," and a BAT over 100 before opening up the poor puppy. Are those reports usually more conclusive? I also got a very bad feeling about the vet herself when I saw she vaccinated twice in two months for Lepto, which is suspected of causing liver malfunction. I know it doesn't cause shunt, but I've been reading of cases where something looked like shunt and got traced back to a lepto reaction. The puppy happens to have started little tremors after getting the first shot...I've had some bad vet experiences this year with other things, so I know for a fact they do not always tell the truth, and this is too important to screw up. Do they ever come back after surgery and say "oops, it wasn't really l/s." Another bothersome thing is they talk about how the puppy will be on meds and diet for life. I thought the objective of surgery was a complete cure. !?!?! If they say they think it's a single extrahepatic shunt and they can see it on ultrasound, and with BAT not being very high, ordinary common sense tells me it's a small shunt that should be 100% repairable, or close to it. Anyway, all the paperwork has been sent off for another vet opinion.

[Yorkieluv]

Originally Posted by magicgenie

That information is very helpful. I'm worried about accepting an ultrasound report that says "appears to be a vein..." I'd prefer to see "clearly visible shunt...,"
Ultrasounds are only as good as the person reading them when it comes to looking for a shunt. They are not completely accurate. U/S are better for determining if the liver has atrophied and if there are bladder stones which are secondary to liver disease. How is your dog's urine? Dark? Ever had a UTI?
and a BAT over 100 before opening up the poor puppy.
Sometimes they go for exploratory surgery
Are those reports usually more conclusive?
The scintigraphy is much more accurate in determining if there is an actual shunt. The Protein C test helps determine if it is more likely to be a shunt or MVD (multiple tiny shunts throughout
I also got a very bad feeling about the vet herself when I saw she vaccinated twice in two months for Lepto, which is suspected of causing liver malfunction. I know it doesn't cause shunt, but I've been reading of cases where something looked like shunt and got traced back to a lepto reaction. The puppy happens to have started little tremors after getting the first shot...
Dogs with liver disease do not handle vaccinations very well at all. I would stop giving vaccinations completely until your dog gets better.
I've had some bad vet experiences this year with other things, so I know for a fact they do not always tell the truth, and this is too important to screw up. Do they ever come back after surgery and say "oops, it wasn't really l/s."
Yes, but in these cases, it's important that they take a biopsy of the liver to check for liver disease. A biopsy will tell you if there is MVD, fibrosis, or cirrhosis for sure. Sometimes they do just go in for exploratory surgery if all signs point to shunt.
Another bothersome thing is they talk about how the puppy will be on meds and diet for life.
If the dog has an extrahepatic shunt that is completely corrected, then he will only need to be on meds and special food until his BAT results come back normal, unless he blows more shunts because it can't handle all the blood flow. Also, many times, they may have an extrahepatic shunt AND MVD. In which case, the dog will need special diet, care, and supplements for life. That's why it's important that they do a biopsy if they go in. The third scenario is that the dog has MVD and no extrahepatic shunt. In this case again, the dog will need special diet, care, and supplements.
I thought the objective of surgery was a complete cure. !?!?!
If there is an extrahepatic shunt, it should be repaired. If they say they think it's a single extrahepatic shunt and they can see it on ultrasound, and with BAT not being very high, ordinary common sense tells me it's a small shunt that should be 100% repairable, or close to it. Anyway, all the paperwork has been sent off for another vet opinion.

Does this help answer some of your questions?

[Yorkieluv]

If there is an extrahepatic shunt, it needs to be repaired. Ameroid constrictor is the method of choice.

[svirgo74]

I have a 12 week old yorkie who has balder stones however her BAT test was normal. What should I do next?

[TLC]

Originally Posted by svirgo74

I have a 12 week old yorkie who has balder stones however her BAT test was normal. What should I do next?

What does your Vet say? I would BAT again to be sure.

[svirgo74]

Before her BAT he totally thought she had a liver shunt, 12 weeks stones??? He was confused. What started this all was she couldn’t urinate and had blood in her urine. He gave her some antibiotics which help. She’s fine now. I probably will do another BAT when she’s 16 weeks I hear the test gives better results at that age. I had a second opinion and that Vet said it’s very likely that she got the stone because of the infection.