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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 husband and I’s best friend (no, more like a child). Her name is Wendy. He is an absolutely gorgeous specimen of the Italian Greyhound – with his slim body, tucked-in belly, champion posture and whimsical canter. Wendy is now 4.5 years old and her life has been one long horrible journey.
When we first adopted Wendy – she was a small blonde puppy with big black eyes. We couldn’t even tell if she was looking at us because her pupils and eye color hadn’t developed yet. She was very hairy for an Italian Greyhound puppy. She had residual milky breath and waggled her tail in play.
Unfortunately, a few weeks after we adopted her, she threw up. It was a little projectile like vomit when my husband held her. We didn’t think anything of it because puppies will throw up sometimes. 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 began to change for Wendy. She became less active. She was lying down the whole 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 he was just a “quiet” puppy or had a more “serious” nature 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 fine. We told the vet that her appetite had decreased significantly, but he told us to give her chicken soup and rice. We tried and she ate some of it, but she stopped eating by the end of the day. We took her back and the vet told us to keep trying. We tried another night and she refused to eat. She also stopped ALL physical activity at this point. She didn’t get up! She didn’t walk, she didn’t do anything. As she lay there, she looked around.
We brought her to the vet again, this time my husband was furious. The veterinary office was staffed by at least 5 veterinarians. He demanded a vet visit and NOT the same one who treated Wendy. He told the new vet Wendy the history and demanded that something be done about her rapidly deteriorating condition. The vet told my husband he thought he had a food allergy and prescribed Hill’s C/D. Well, luckily – that helped her come back to life. I later learned that Hill’s C/D is a low protein food and it was the high protein in the puppy food that was killing Wendy.
Wendy handled the dish well. I still took her to the vet at least once a month for colds, fevers and strange behavior. She was constantly peeing everywhere. She never had a good appetite and never drank much. She was still a “quiet” dog, but she grew up and we moved to another city. She became an adult and we took her from Hill’s C/D. Immediately, crystals began to form in her urine. Italian Greyhounds don’t like to pee outside, so we’ve always tried to use pee pads in the basement or garage. Luckily Wendy didn’t always make it all the way to the mat as a cub and I could see the crystals on the floor!!!
I took her to the vet to treat the crystals in her urine. The vet did some blood work and told me her BUN count was a little low (and maybe her creatine – I can’t remember the exact creatine reading). I researched it on the net (which was still developing at the time) and found information about liver shunts. Hepatic shunts are often congenital defects found in puppies/dogs and these affected dogs typically have low BUN, low creatine and ammonium crystals in their urine! I brought it to the vet – she said “no” and “that’s not it”. She told us it was just a food allergy that our previous vets had diagnosed. I really trusted my vet – SHE was an EXPERT. I completely put the idea of a liver bypass out of my head.
Every time I brought Wendy to the vet I kept asking each vet if they thought Wendy was too skinny. Everyone told me she was just petite and that she looked normal. Again, I had instinctive doubts, but I trusted the EXPERTS.
If I knew then what I know now. After 3.5 years of going through hell bringing Wendy to tons of vets and ER vets – I finally found an ER vet who actually took the time to listen to Wendy’s entire history and my concerns. He said the magic words “I think she might have liver shunt, you should do a bile acid test.”
Here are the symptoms of liver shunts:
1. Poor: A puppy/dog that keeps getting sick. Because liver shunts cause toxicity in the blood because the dog does not have blood filtered by the liver. This often causes various diseases.
2. UTI: A puppy/dog that has frequent urinary tract infections or appears to have a urinary tract infection due to many accidents around the house, is unable to be around the house, or urinates small amounts.
3. BAD ODOR: A puppy/dog that has bad breath and/or bad urine odor. Also, the urine is often a darker yellow color instead of the “barely” yellow of normal healthy urine. (Note: Puppies and young dogs should have good breath. Bad breath is a RED FLAG that something is wrong)
4. Pressure on the head: Dogs with liver shunts do not filter the blood, resulting in a build-up of ammonia in the blood. Ammonia toxicity makes their heads feel funny – so they rub their heads a lot.
5. URINE CRYSTALS: These come from excess ammonia in their system. Any dog with urine crystals should have a bile acid test.
6. Complete Blood Count (CBC): This test can easily be done at the vet’s office. Hepatic shunt dogs often have lower than normal BUN and creatine counts.
7. Depression: Liver shunt dogs are not very active or may be active for a very short 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 fine.
8. Low weight: Puppies with liver shunts look normal with milk bellies etc. As they grow into dogs it is obvious that they are too thin. Their ribs are visible, their bones are prominent and they do not develop muscle mass. Not all hepatic shunt dogs are underweight, but many are. They tend to be underweight because their livers cannot absorb and process nutrients to bring these shunt dogs to their normal weight.
9. Small: Dogs with liver shunts often don’t grow as much as their siblings. They have smaller than normal livers and sometimes smaller than normal features. Wendy never developed the strong leg muscles that all greyhound breeds exhibit.
10. Anorexia: Many liver bypass puppies/dogs do not eat normally. They eat very little dog food. They may enjoy the newly introduced preserves or folk food – but they always resort to not eating much. They don’t feel well after eating because of the higher toxicity they have after eating – so they tend to avoid food.
11. Breed: Any breed can have a liver shunt, but Yorkshire terriers are known to have them.
Here is my advice to anyone who has a dog with these symptoms:
GET YOUR VETERIN FOR A BILE ACID TEST IF YOU SUSPECT LIVER SHUNT AND/OR YOUR DOG IS EXHIBITING ANY 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 costs about $100.00 and can save your dog’s life.
Once your dog is diagnosed with liver shunt, you can begin the process of determining treatment. In the meantime, ask your vet for lactulose, which may cause diarrhea at first, but will immediately help your dog detox significantly. Also, immediately put your dog on Hill’s L/D low protein diet. Do not give your dog any food that contains protein! Protein promotes toxicity in dogs with liver shunt.
There are several treatment options. You may want to do a scan to determine if the shunt is intrahepatic or extrahepatic. Usually, the hepatic shunt is extrahepatic (outside the liver), which is easily operable. Intrahepatic shunts (inside the liver) are much more difficult to operate on and usually occur in larger breed dogs. Your vet can recommend whether or not to operate. It is usually recommended to treat your dog medically rather than operate on 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 operations. I would not trust any other surgeon to treat Wendy. In addition, UTK uses a surgical method for extrahepatic shunts that cannot be overcome by ligation alone.
Puppies in their mom’s womb receive nutrients from mom through the portal vein. At birth, this vein is supposed to close. 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 was ligation of the portal vein (closing, closing, getting rid of…). Unfortunately, the ligation method can send the body into shock and kill the dog as the circulatory system shuts down! UTK has developed a much better and much safer method. The metal ring is coated with a substance that expands when in contact with moisture. Expands SLOWLY (takes about a month to fully expand). This ring, called the ameroid constrictor, is AROUND the portal vein. The ameroid constrictor slowly closes over time until the vein is occluded. This not only helps the body go into shock, but also helps prevent infection that is caused by the ligature! The liver is able to slowly take in more and more blood as the constrictor does its job. There is no shock to the liver or circulatory system.
I HIGHLY RECOMMEND the ameroid constrictor surgery – you can research everything on the net and make up your own mind. The UTK program includes scinitigraphy to localize the shunt, surgery, hospital stay AND LIVER BIOPSY for approximately $1,600 (2007). They do a great job!
What to expect after surgery: Your dog will be in some pain for a few days after surgery. Fortunately, she doesn’t suffer much pain because the only incision is the skin on her abdomen and for the biopsy. Usually, no cutting is done to locate the ameroid stricture.
Over the next 4 months you will notice the following: weight gain, muscle development, loss of puppy coat (if your dog has retained puppy coat), improved overall appearance (shinier), MUCH more ENERGY and no more head rubbing.
After 4 months you will need to do the bile acid test again to check how the ameroid constrictor is working. Wendy had a 0 on her bile acid control test!!! After 4 months, if the bile acid test comes back normal, you can put your dog back on a regular diet!!!!
I can’t tell you how glad I was to have Wendy’s surgery.
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