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Liver Shunts In Dogs – Why My Dog Went Undiagnosed For 3.5 Years And How You Can Spot It!
My Italian Greyhound is truly my and my husband’s best friend (no, more like a child). Her name is Wendy. She is an absolutely beautiful example of an Italian greyhound – with her sleek body, taut belly, her champion stance and her whimsical gallop. Wendy is now 4.5 years old and her life has been a long, terrible journey.
When we first adopted Wendy, she was a small brown puppy with big black eyes. You couldn’t even tell if she was looking at us because her pupils and eye color hadn’t developed yet. She was very confused for an Italian Greyhound puppy. She had remnants of milky breath and waggled her tail playfully.
Unfortunately, a few weeks after we adopted her, she threw up. It was a little projectile like vomit while my husband was holding her. We didn’t think anything of it because puppies sometimes throw up. She was strictly on a “puppy” diet, her stools were normal and her urine was normal. She was eating and drinking normally and acting normal.
About a month later, things started to change with Wendy. She became less active. She slept all the time. She didn’t want to engage in typical “puppy” play – or if she did, she didn’t last more than a few minutes before she wanted to lie down. We didn’t know any better and thought maybe she was just a “quiet” puppy or had a more “serious” temperament than our other Italian Greyhound.
We soon started to notice that she wasn’t eating as much. It was time to go to the vet. The vet told us her weight is fine and she looks good. We told the vet that her appetite was severely reduced, but he told us to give her chicken soup and rice. We tried and she actually ate some of it, but during the day she stopped eating. We took him back and the vet told us to keep trying. We tried another night and she refused to eat. At this point she also stopped ALL physical activity. She didn’t get up! She didn’t walk, she didn’t do anything. She just looked around while she slept.
We brought him to the vet again, this time my husband was furious. At least 5 veterinarians worked in the veterinary office. He demanded to see a vet, not the same one who had treated Wendy. He told the new vet Wendy’s history and demanded that something be done about her rapidly deteriorating condition. The vet told my husband he thought she had a food allergy and prescribed Hill’s C/D. Fortunately, it helped her to come back to life. I later found out that Hill’s C/D is a low protein food and it was the high protein in her puppy food that killed Wendy.
Wendy did great with this dish. I continued to bring him to the vet at least once a month for colds, fevers and strange behavior. She was constantly peeing all over the place. She never had a good appetite and never drank much. She was still a “quiet” dog, but she got older and we moved to another city. She came of age and we removed her from Hill’s C/D. Crystals immediately started forming in her urine. Italian Greyhounds don’t like to pee outside, so we always have pee pads in the basement or garage. Luckily, as a youngster, Wendy didn’t always make it to the pad and I could see the crystals on the floor!!!
I took her to the vet to get rid of the crystals in her urine. The vet did some blood work and told me her BUN was a little low (and maybe her creatine too – I don’t really remember the creatine reading). I researched this on the net (which was still in its infancy at the time) and found information about liver shunts. Liver shunts are often birth defects that occur in puppies/dogs and these affected dogs usually have low BUN, low creatine, and low ammonium crystals in their urine! I brought it to the vet – she said “no” and “it’s not”. She told us that our previous vets had only diagnosed food allergies. I truly believed my vet – SHE was an EXPERT. I put the idea of a liver shunt completely out of my mind.
Whenever I bring Wendy to the vet, I ask each vet if they think Wendy is too thin. They all told me she was just petite and looked normal. Again, I had instinctive doubts, but I trusted the EXPERTS.
If only I had known then what I know now. After 3.5 years of hell, taking Wendy to many vets and ER vets, I finally found an ER vet who actually took the time to listen to all of Wendy’s history and my concerns. He said the magic words “I think she might have a liver shunt, you should do a bile acid test on her”.
Here are the symptoms of liver shunts:
1. Poor guy: A puppy/dog that is always sick. Because liver shunts cause toxicity in the blood because the dog’s blood is not filtered by the liver. It often causes various diseases.
2. UTI: A puppy/dog that has frequent UTIs or looks like they have a UTI due to many accidents around the house cannot be defecated or urinate in small amounts.
3. BAD ODOR: A puppy/dog with bad breath and/or bad urine odor. Often the urine is also a darker yellow than the normal “barely” yellow color of healthy urine. (Note: Puppy and young dogs should be breathing well. Bad breath is a RED FLAG that something is wrong)
4. Head pressing: Dogs with liver shunts do not filter their blood, resulting in ammonia build up in the blood. Ammonia toxicity makes their heads feel funny, so they rub their heads a lot.
5. CRYSTALS IN URINE: This is from excess ammonia in their system. Any dog with crystals in their urine should have a bile acid test.
6. Complete Blood Count (CBC): This test can easily be done at the vet’s office. Liver shunt dogs often have lower BUN and creatine levels than normal.
7. Depression: Liver shunt dogs are not very active or may be active for very short periods of time. They are known as “quiet” puppies or “silent” dogs. A “quiet” puppy is usually not very normal, and all “quiet” puppies should have a bile acid test to make sure they are okay.
8. Low weight: Puppies with liver shunts look normal with milk bellies etc. As they become dogs, it is obvious that they are too thin. Their ribs are visible, their bones are defined and they do not develop muscle mass. However, not all liver shunt dogs are underweight, but many are. They are underweight because their livers cannot absorb and process the nutrients for these liver shunt dogs to reach a normal weight.
9. Small: Dogs with liver shunts often don’t grow as much as their siblings. They have smaller livers and sometimes smaller than normal features. Wendy never developed the strong leg muscles that all Greyhound breeds have.
10. Anorexia: Many liver shunt puppies/dogs do not eat normally. They eat very little dog food. They may eat newly introduced canned food or human food, but they always go back to not eating too much. They don’t feel good when they eat food because they have more toxicity after a meal, so they tend to avoid food.
11. Breed: Any breed can have a liver shunt, but Yorkshire terriers are notorious for it.
Here is my advice to anyone who has a dog with the following symptoms:
GET YOUR DOG TO HAVE A BILE ACID TEST IF YOU SUSPECT LIVER SHUNT AND/OR YOUR DOG IS EXHIBITING SOME OF THE ABOVE SYMPTOMS!!!! Don’t take “no” for an answer. Tell them you want to MAKE SURE and cover all your bases. A bile acid test is about $100.00 and could save your dog’s life.
Once your dog has been diagnosed with a liver shunt, you can begin the process of determining treatment. In the meantime, ask your vet about lactulose, which may cause diarrhea at first but will immediately help clean your dog up significantly. Also, immediately put the dog on Hill’s L/D diet, which is low in protein. Do not give your dog food that contains protein! Protein contributes to toxicity in liver shunt dogs.
There are several treatment options. You may want to do a scintigraphy to see if the shunt is intrahepatic or extrahepatic. Usually, the liver shunt is extrahepatic (outside the liver), which is easy to operate. Intrahepatic shunts (inside the liver) are much more difficult to operate on and are usually found in larger breed dogs. Your vet may or may not recommend surgery. It is generally recommended to medically manage your dog rather than operate with intrahepatic shunts.
Surgery: One of the best and cheapest places to get surgery is the University of Tennessee in Knoxville, TN. And I mean the BEST and cheapest. They specialize in liver shunt surgery. I would not have trusted any other surgeon to treat Wendy. In addition, UTK uses a surgical method for extrahepatic shunts that cannot be beaten by simple ligation.
Puppies inside their dog mother’s womb receive nutrients from their mother through the portal vein. This vein should close at birth. It does not close in liver shunt dogs. Instead, this portal vein acts as a “bypass” and most of the blood bypasses the liver. The liver is what cleans the blood. The liver also performs thousands of other vital functions!!! 94% of Wendy’s blood bypassed her liver!!!
The classic surgical method has been portal vein ligation (close, close, release…). Unfortunately, the tying method can send the body into shock and kill the dog because the circulatory system stops! UTK developed a much better and much safer method. The metal ring is coated with a substance that expands when exposed to moisture. It expands SLOWLY (takes about a month to fully expand). This ring, called the ameroid constrictor, is placed on the AP portal vein. The ameroid constrictor slowly closes over time until the vein is closed. Not only does this help the body go into shock, but it also helps prevent infection from being tied up! The liver is able to slowly accept more and more blood as the constrictor does its job. No shock to the liver or circulatory system.
I HIGHLY recommend ameroid constrictor surgery – you can research it all on the net to make up your mind. The UTK program includes scintigraphy to detect the shunt, surgery, hospital stay AND LIVER BIOPSY for about $1,600 (2007). They do a great job!
What to expect after surgery: Your dog will experience pain for a few days after surgery. Fortunately, there is not much pain because the only incision is the skin of the abdomen and the biopsy. Ameroid constrictor placement usually requires no cutting.
Over the next 4 months you will notice the following: weight gain, muscle development, loss of puppy fur (if your dog has retained puppy fur), improvement in overall appearance (shinier), MUCH more ENERGY and no more head rubbing.
After 4 months, you will need to repeat the bile acid test to check how the ameroid constrictor is working. Wendy had a 0 on her bile acid test!!! After 4 months, if the bile acid test returns to normal, you can put the dog back on regular food!!!!
I can’t tell you how happy I was to be able to surgically correct Wendy.
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