Liver Shunts

[Millyo8]

My 4yr old Shih Tzu has a liver shunt. So far do not know if it is external or internal. Blood test confirmed it but 2 ultra sounds could not detect it. Trying to get her fit enough to go to Sydney Uni for a CT scan and if an external shunt is found surgery will be performed on that day.

When first diagnosed in May she was put on Hills l/d diet canned food, laculose and penicillin. The next 6 weeks she became so well and put on 800grams but then she suddenly stopped eating & had a temp. Vet had her liver enzymes checked and they were okay so decided she had an unrelated problem so put her on additional antibiotics. She refused the Hills food so I cooked up the recipe online and she liked that. After a few days she went back to Hills. Every day is a battle. She really is not interested in eating and I have to put each piece of food in her mouth and push it back in as she tries to spit it out. She is sleeping a lot and has lost interest in her toys and playing with her Lhasa Apsos sister. If I stopped force feeding her I feel she would let herself die. Vet says she is not in any pain. Loves being cuddled and brushed.

Is there anyone else out there who is familiar with this condition who could give me any pointers? My aim is to get her in 'tip top' condition to go to Sydney Uni. Vet doesn't want to see her till she's at her optimum.

[megan_]

Try PMing JulesP - I believe one of her Border Collies has a liver shunt.

[JulesP]

Hello, sorry you are going through this.

Yes, I have a dog with a liver shunt. Well multiple liver shunts so she can't be operated on. Amber was diagnosed a year ago now and is still with me.

They don't eat because they feel really poorly. Amber would have starved herself to death too. She used to pick one piece of kibble up in her mouth, look at me really sadly and then drop it again.

BTW you can't confirm a shunt with a blood test. You need to actually see it. Amber's blood levels were not that bad.

What medicine is she currently on? Amber has been doing better since she has been on Metrogl (Metronidazole). It seems to be better at clearing out the toxins that make them feel sick.

Go to Chemists Warehouse, look in the baby formula section and get a product called PediaSure in Vanilla. It is the child version of Ensure. This got Amber over the initial bump when she was first diagnosed.

With food you need to give lots of small meals a day. They don't eat big quantities and you aren't going to get a dog with liver problems fat.

[Millyo8]

Hello, sorry you are going through this.

Yes, I have a dog with a liver shunt. Well multiple liver shunts so she can't be operated on. Amber was diagnosed a year ago now and is still with me.

They don't eat because they feel really poorly. Amber would have starved herself to death too. She used to pick one piece of kibble up in her mouth, look at me really sadly and then drop it again.

BTW you can't confirm a shunt with a blood test. You need to actually see it. Amber's blood levels were not that bad.

What medicine is she currently on? Amber has been doing better since she has been on Metrogl (Metronidazole). It seems to be better at clearing out the toxins that make them feel sick.

Go to Chemists Warehouse, look in the baby formula section and get a product called PediaSure in Vanilla. It is the child version of Ensure. This got Amber over the initial bump when she was first diagnosed.

With food you need to give lots of small meals a day. They don't eat big quantities and you aren't going to get a dog with liver problems fat.

[Millyo8]

Thank you Jules. Milly had the blood test where they test the liver enzymes before and after eating and the Specialist told me it shows she does have shunt (s).

The Radiologist spent an hour looking at the U/S but could find nothing so they wonder if she has internal shunts however because external are more common in small dogs they want to do the C/T scan to find it. The Surgeon said if she is in top condition and they find an external shunt she will be operated on after the C/T scan. They could do the C/T scan anytime but it is a long drive to Sydney for someone who only drives to the Supermarket and I asked if the two things could be done at the same time.

She is on Hills canned l/d prescription diet,Laculose, Amoxil and has been on one lot of Metrogyl. A couple of days ago she was given another course of Metrogyl and I checked it out online and it said it was good for removing toxins but not to be used for dogs with liver problems and that is why I posted here. You have had no problems so that has made me more confident in giving it to her again. I might say that there was no improvement after the last course which was given to her in an attempt to get her eating again. Yesterday her total intake was just over an 8th of a can and I felt so dispirited but it is lunchtime and she has already eaten almost 1/4 can today. Yes I do try to feed her small meals often but most days it's such a struggle as she spits it all out. The Drs at Sydney University told me the laculose and amoxil were to remove the toxins from her large bowel. Do you give Amber anything else besides Metrogyl? and is the Pediasure like a tonic to get the dog eating? I had been thinking of Pentavite which I used to give my children. Do you have this up and down eating pattern? A locum Vet at mylocal Vets said to give her multi B vitamins and milk thistle. I haven't done anything because I am so worried about doing the wrong thing. I hope you reply.

[JulesP]

Amber is on metrogyl all the time. I have got it down to one tablet a day but have upped it again at the moment as she has had a few symptoms. She was on Clavamox prior but think she has been much better on the metrogyl. They need to stay on the antibiotic though. It is a matter of finding which one works best for your dog.

Amber also gets a diuretic daily as she has ascities (fluid in belly).

I haven't had to use lactulose yet as her poos are pretty soft. I also haven't used any herbal products as she is going well on what I am doing. You can use milk thistle, SAMe, pro-biotics, vitamins etc.

The Pediasure is for sick kids. It is a drink that contains vitamins and fats. Good for getting nourishment into an animal that doesn't want to eat. If is also very easy on the liver in terms of processing. Gives the liver a bit of a break.

With the food they can only eat very small amounts. Amber has half a tin of the L/D and maybe a cup of the L/D kibble and she is a border collie. If she just had tinned I would probably only give her a tin a day. Every time I have tried to increase the amount she has started to get worse. Luckily Amber loves her L/D but again if she is having an off day she is funny about eating it. Not eating is usually my first sign that Amber's liver is playing up.

This Yahoo group was very helpful when Amber first got sick - http://pets.groups.yahoo.com/group/DogLiverShuntandDisease/ It is a little frustrating though as they are American and we can't get a lot of the food/herbals that they recommend here. Lots of great info though.

[Millyo8]

I was told Milly needs 3/4 can a day so I was surprised how little Amber eats because I think she would be a lot heavier than Milly's 5.6kg. I did find that American Site and was tempted to use the supplements but didn't because my main aim right now is to get her fit enough to go to Sydney and find out which shunt she has. Has Amber's activity level dropped and does she lie around a lot? Milly used to be so full of life. If someone visits who she likes she is back to her old self for a few secounds with excitement but then she just fades again. Also was the vanilla flavour a problem? Because the Amoxil tabs are so huge I got some from the chemist in liquid form but Milly hated the flavour which was raspberry! Has Amber had any neurolgical symptoms? It is just so good to hear from someone who is going through this. My own Vet had no experience with Shunts and I have only been to Sydney Uni once. Lastly does Amber ever eat any fruit or vegies?

[JulesP]

Amber is around 14 kilos. She is pretty little. Most people think she is still a puppy. She was 1yo when diagnosed and it is like she is frozen at that age.

When Amber first got sick there was a very noticeable change in her behaviour. I had to pull her out of obedience classes as I just couldn't keep her going. She also struggled on walks, 30 mins was about the most she could manage. Now she is very bouncy! It makes me smile to see her bouncing around.

Amber loves the pediasure as does my other border collie and the 2 cats have thought it is pretty good too. It mainly tastes milky.

Yes Amber has and continues to have neurological issues. The worst was a bad seizure after I gave her a lamb flap, the specialist said it would be ok on occasion. Last week she was standing with a very glazed look on her face, flicking her tongue in and out. Has Milly had anything like this?

Amber sometimes gets sweet potato. Because she has the neurological problems I was advised not to give her home cooked foods. The main thing you need to watch with veggies and fruits is that they are low purine as dogs with shunts are also prone to stones and urinary problems.

[Millyo8]

Well Milly loved milk so she would probably like it. She will sometimes lie there barking at nothing or licking. She loves to lick till recently she just groomed Poppy the Lhasa Apso but now she licks furniture and things like the oil heater (not on), specially things that are shiny.

I sometimes give her apple or pear, peeled and she really loves pumpkin. Does Amber eat the Hills l/d? and does she eat it on her own? I hate pushing it into Milly's mouth.I gave her the Metrogyl tonight as well as the Amoxil and laculose after reading your reply. I will see if it makes a difference. We have a Soul Pattinson Chemist so I will check out the Pediasure. By the way Milly has crystals in her bladder.

[JulesP]

Yes Amber eats the L/D. It is actually the only dog food that she has eaten happily. She was always really fussy even from a puppy. She never really scoffed her food.

Not sure if you should feed the Amoxil and Metrogyl at the same time. Best to ask your vet that.

Amber had crystals and a urinary tract infection at the beginning that was why she started on the clavamox. She took that for about a month before starting on the metrogyl.

What was the homemade diet that you were feeding? Was Milly eating that?

[Millyo8]

Metrogyl is not an antibiotic and the Vet said it was okay to take with the Amoxil. I just hope there is an improvement this time. Yes Milly loved l/d at first but has lost interest. I am going to make up the home made diet again and see if I can get her interested in food again. Ifound that once I had the ingredients lined up I was able to make it up quite quickly. Instead of the beef I use chicken as that is what she prefers. I only made it with beef once. I just looked up Liver Shunt Diet and found the recipe and this is it:-

www.vet.utk.edu/clinical/sacs/shunt/Liver_diet.pdf I couldn't find corn oil so used rice oil.

My Vet checked it out and was quite happy with it.

Milly had lots of things going on for most of her life but the local Vet wasn't experienced in shunts and I suppose her symptoms were somewhat vague. I did keep telling him I believed she had a bladder problem and she was going to the toilet too often. He tested her for diabetes which came back clear but as soon as she was given antibiotics it cleared up for awhile. She always had periods of vomiting up her food and not wanting to eat. When she was about two she went off her food and got so sick she was on a drip in the hospital for a few days.

When she goes off her food she loses weight very quickly and because she is small she can't afford to. I can't go out and leave her for too long as I need to feed her and she will only eat when I put each piece in her mouth. My other dog Poppy has an 'itch' and is on cortisone which makes her so hungry so I can't leave food out for Milly as Poppy would eat it. Milly doesn't like the dry food very much and will only eat 2/3 pieces of kibble at a time. By the way their photos are in my Profile.

[JulesP]

Metrogyl is an antibiotic.

I would not be feeding any meat product to a dog with a liver shunt. You can use egg whites instead. The bread might be a problem because of purine levels.

[Millyo8]

Apart from 3 local Vets the Vets at Sydney University okay this Diet.

[Millyo8]

Oops I made a big mistake. Yes Metrogyl Is an antibiotic but works differently than the Amoxil.

[jans]

Hi Milly

Sorry to hear about your diagnosis.

My girl was diagnosed with a shunt about 4 years ago and had the surgery at the Universtiy of Melbourne's vet school. The surgeon at the time was Dr Ben Landon, who is a specialist in shunt surgery and was doing a big research project on shunts at the time. I was very very happy with him treating my girl (who is still with me BTW).

I notice that Ben is now with the University of Sydney's vet school, so if you can, see if you can get a referral to Ben.

[Millyo8]

It was lovely to hear from you. I believe Dr. Landon has been replaced by Dr Alberto Gines who we saw in June. He had just taken the position and came out from England. He was quite experienced having done a shunt operation every week. His photo is on their website. I am trying to get Milly well enough to go back to him. She actually started eating again on Saturday and yesterday and this morning she actually ate from the plate herself. I have been having to put each piece of Hills in her mouth. She vomited a lot last night but I suspect after not eating much she suddenly ate too much. I will watch out for that today. May I ask what breed your dog is? Does she eat Hills l/s or now on other food? Can you tell me how long she was in Hospital etc?

[jans]

Hi Milly

She is a Maltese, around the age of 3 or 4 when diagnosed. Can't be sure of her age as she was a rescue. I made the decision post surgery to keep her on the Hills l/d, just to be on the safe side and while the shunt was closing and have never taken her off it. She gets a hand full of dry for breakfast and then half a tin of the wet at dinner time. I have 2 other dogs who think that the l/d dry is the best thing ever and will try to steal it from her if she drops a piece, so it must be OK. At diagnosis she was 3.8 kilos and is now 6.8 kilo. Ben said that I could wean her off the l/d but since she likes it and as I was nervous about doing so, I didn't. I do give her "normal" treats.

I'm trying to remember how long she was in hospital for. For the initial diagnosis, she was in for 2 days. They put a radioactive dye in her system and monitored that to watch the shunt. She then came home for a couple of weeks with the medications that you have already posted about, and the l/d, to build up her strength for surgery. I think she was in ICU for one day post surgery, then a normal ward for about 2 days or maybe 3 - I can't exactly remember. The first 24 hours are the worst, incase she rejected the band they put on the blood vessel.

The worst part was prior to surgery, watching her be such a sick little girl, and hoping that she'd make it through to surgery date. The recovery post surgery was a breeze compared to prior.

I wouldn't hesitate to do it again faced with the same diagnosis.

[Millyo8]

Jans you have given me such hope. I was trying to remember how long she has to be stable and I think they said 4 weeks. I will see how she is if she is still okay after the next two weeks.Radioactive dye wasn't offered. Maybe Melbourne is further advanced. She has had 2 ultra sounds with no sign of the shunt but the blood tests say Yes she has one. There is a chance it is internal shunts but they say they will find it with a C/T scan. When she was first on Hills she was fine for 6 weeks before she crashed so I missed a window of opportunity then. Dislikes the kibble but has mostly liked Hills cans. Having read the ingredients can't understand why any self respecting dog would eat it! I may ask you more questions as we progress.

[jans]

Hi Milly. All the best and certainly if you have any questions, ask away. Fingers crossed for surgery sooner rather than later.

[WoofnHoof]

My husky had a shunt as well, it was intrahepatic (inside the liver) and he had surgery at about 10 months of age which worked well.

Hope your girl has a simple shunt and a successful surgery :)