Liver Shunt Diagnosis And Vet Recommendation

[digitalwingx]

Hi guys, first time poster.

Our 7 month old puppy had two rounds of blood tests (first time around 6.5 months, second around 7 months) showed elevated ALT (150 and 210). The subsequent bile acid test come back abnormal (4, then 108).

She is otherwise acting normal (no neurological symptoms) and have normal growth for a 7 month old. But the bile acid test points to liver problem and the vet believes it is most likely due to liver shunt. The vet recommended ultrasound or CT to determine if it is shunt and the position of the shunt(s).

My questions are:

• Is CT the best next step in term of diagnosing her liver problem (vet said CT is superior to ultrasound - but cost $500 more)? What about Scintigraphy?
  
• Is it worthwhile to seek second opinion from different specialist
  
• And in the case of confirmed liver shunt(s), does anyone have recommendation on a good surgeon in Melbourne?
  

Thanks very much and any info is appreciated.

[*kirty*]

Best surgeon in Melbourne is Dr Arthur House at VRH in Hallam. The most compassionate and skillful surgeon I've ever met. :)

[JulesP]

I have a dog with a liver shunt.

The CT is a better option but is much more expensive as sometimes an ultrasound will not pick up the shunt/shunts. I went for the Ultrasound and the shunts were picked up on that. Scintigraphy is more invasive.

I went to Melbourne Specialists - http://www.melbvet.com.au/ They weren't cheap.

The vet I saw is now at Advanced Vetcare so they might be an option. They aren't as pricey as Melbvet. https://advancedvetcare.com.au/

At 7 months my dog really didn't show any symptoms. She was a bit small and a bit fussy with food. She didn't get sick until she was nearly 1yo.

Just to prepare you sometimes the dog can not be operated on. My dog had multiple shunts and couldn't be operated on. I've managed the condition medically.

[digitalwingx]

Thanks *kirty* & JulesP.

@*kirty*: do you happen to have any of your dogs or know anyone's dogs having successful liver shunt surgery story at VRH in Hallam?

@JulesP: Yeah regarding CT vs ultrasound pricing, the one we got is roughly $2k vs $1.5k. If that extra $500 give us a clearer picture and may aid a better surgery, there seems to be case for spending that extra $500. Regardlessly, this whole ordeal is gonna burn a hole in our wallet.

I understood that not all shunts are equal; it could be multiple or difficult to operate; we won't know after the next step. Based on my research extrahepatic shunts are easier to operate than intrahepatic, is it correct?

Another question, right now is it necessary for us to switch off the high protein commercial kibbles (super premium brand - whatever that means) we feed her?

[JulesP]

Yes the outside shunts are easier to close. What breed is your dog?

You can use either Hills L/D or Royal Canin Hepatic. And the tinned Hills L/D. And you also need to watch treats etc. No bones!

[*kirty*]

Digitalwingz a friend is a vet there and her dog had a liver shunt that was successfully operated on. I worked with the team there and they are absolutely top notch. My foster dog is having major orthopaedic surgery with Arthur next month and I wouldn't trust any other vet to do it. :) Good luck with your little dog.

[TigerJack]

Digitalwingx - My experience with Liver shunt has meant my dog is virtually back to normal.

My Yorkie Lilly was 3 when she suddenly got neurological symptoms back in January this year. I was imagining brain tumours and all sorts of things. My vet said I would think him silly but he thought it might be a liver shunt, apparently Yorkies are top of the small dog list for getting them. She is unusual in that she was older than they are usually picked up, being 3. Her bile salts test was 20ish and then over 240 after food. (Numbers should be around 2 and 20 max.) I had the ultrasound done and it was inconclusive for shunt but showed liver damage. I then needed the CT on top of that to try and show shunt. Sent to SASH for medical consult then CT done which showed her extra hepatic shunt. Lots of extra bloods and things done then too. While she was under I also had a brain CT done as well to completely exclude anything neurological. When I first saw my own vet who thought shunt, we immediately put her on Lactulose and a low protein diet (dairy protein, no meat protein) and her behaviour was immediately much better and her energy levels improved. She was on cottage cheese and rice for a while. Not enough to live on long term but its what she got till we finally got a diagnosis a week or so later. Lilly had one extra hepatic shunt vessel and microvascular hypoplasia of the liver. Her liver was tiny and not very healthy as it had basically been deprived of an adequate blood supply but he shunt for three years.

Lilly's shunt, being extra hepatic was operable. The intrahepatic ones are sometimes fixable (good article in the last dogs NSW journal about a dog who had one done via a catheter dropping coils into the shunt to block it off rather than open surgery) but more often managed medically I am told. I was lucky, Lilly could be operated on. Lilly went onto anti seizure medication and a bunch of different antibiotics and anti nausea things plus the lactulose and then went into SASH for 6 days and was operated on by Andrew Marchevsky. Her surgery involved opening her up from just below her sternum down to her groin (tiny 2.4 kilo dog) and placing a cellophane band gadget around the shunt. Once the shunt was in place she was in their ICU for a day or so and I could not visit that day. Had to keep her very quiet. The danger, when the blood is sent back through the liver on its correct pathway rather than bypassing it via the shunt, is that the liver doesn't cope with the high toxins in the blood and they get the encephalopathy again and even seizures. She did well and went to their regular ward and eventually came home on day 6. Still on 4 drugs and Hills LD and strictly no animal protein for 4 months before review. At that point, she went in for most of the day and had lots of retesting done and her results were fabulous. Her liver was regenerating and she was able to come off all the drugs. I had been told I could wean her back to normal kibble after 2 months but I had been too scared to (plus one bag of that lasts a very long time for one little Yorkie) so after her 4 months review I tried normal food again. All good.

Lilly is an agility dog and had been getting slower and a bit apathetic about it all. I had put it down to jealousy over a new baby brother but in retrospect, I think she had a raging headache and failing liver for well over a year. Her energy levels had flagged. She was much improved just with the diet and drugs pre-op and is fabulous now. She needs a bit more time for her liver to get back to completely normal and she now needs to build up fitness again as she basically had had 6 months off doing nearly nothing. She is back to competition and apart from being a bit unfit still, is a different dog. So much more energy.

Our experience is fantastic, virtually a complete recovery. I am told she has a normal life expectancy, no need for ongoing medication or diet and can do all her pre-illness activities. I'm still a bit terrified of giving her meat protein but I test it with little bits here and there and so far all good.

She is probably one end of the spectrum, not all have as great a result. I am also extremely lucky that she is insured as I got all the tests she needed and went straight into surgery asap without any worries. All up, I have gotten over $12,000 back from insurance, including her 4 month post op testing. If you don't have insurance I don't know what you do. I probably would have tried to manage her medically for as long as possible while saving for surgery.

I know things don't always turn out to have operable, fixable shunts. When Lilly was just home for SASH I did a little Facebook blurb about her being home and safe and was contacted by a friend who also has a yorkie who had been doing odd things. She described symptoms and sent videos of the odd behaviour and it was almost a carbon copy of my Lilly's. I told her to go in and demand the bile salts test and she did that next day. Vet laughed at her but did it anyway and then they found she had wildly abnormal results too. She also went to SASH and had the same workup as Lilly but in her case no shunt was found. Doesn't mean there isn't one but means nothing that can be seen or operated on. She is being managed medically so will be on diet and drugs possibly for life.

There is a great Yahoo group to give you really good information on dogs with liver disease. It is called 'Dog liver shunt and disease.' Lots of people on there with dogs in this situation and they are really good at hunting down information on diet and drugs and supplements to keep dogs going. Their files section has a lot of good research on symptoms and treatment and diets and drugs etc. Helped me a lot.

I can't help with vets or surgeons in Victoria but SASH were great in Sydney. Go straight for the CT with angiogram, its a more definitive result than ultrasound. It all does cost a bomb, I hope you are insured. Good luck.

Jo and Lilly

[digitalwingx]

@JulesP: it's a Shiba so it's medium sized dog - a little hard to predict what type of shunt we are looking at.

@*kirty*: yeah it's the vet we visited; it's reassuring that you heard success stories.

@TigerJack: yeah it seems shunts in Yorkies are fairly common. We are lucky we found out this early at 7 months, but unlucky since we are not insured. From the numbers I gather the tests and ops all up should be around $3~5k, whereas the $12k number is rather high so let's hope it's not as expensive.

We have booked for CT at VRH next Wednesday and fingers crossed it's an operable shunt.

[*kirty*]

Good luck! You are in the best hands at VRH. :)

[dragonwoman]

Best surgeon in Melbourne is Dr Arthur House at VRH in Hallam. The most compassionate and skillful surgeon I've ever met. :)

I second that

[bel]

My Shih Tzu Logan has just had surgery to repair a very large liver shunt.

Looking back Logan had signs all along but nothing was distinctive of a shunt. He was a sole surviving puppy who his mother would try and bury every time he fed so we had to bottle feed him. We put his aggression down to that but it's also a sign of a shunt.

Logan was always skinny but not overly small for the breed. His coat was never as good as what the breed should have.

He wasn't diagnosed until he was just under 4 years old. Late last year he vomited blood , vet check we started antibiotics and he seemed to recover. Less then 6 months later he vomited blood again but was not back to his self so we did blood tests. All signs pointed to a portosystemic shunt. Off to ARH in Canberra and he had surgery. The specialist couldn't believe he was 4 and was still a very bright and happy dog. He couldn't believe how large Logan's shunt was. It's now been over 3 months and Logan is now a normal happy healthy dog. It cost me under $4000 but that was only the ct and surgery as I work in a vet clinic so all his meds I got through my work. He lived on hills l/d for about 8 weeks post surgery and is now on normal adult dry food

Edited September 3, 2016 by bel

[digitalwingx]

Thanks for sharing the story bel. Yeah I feel the symptoms of liver shunt can sometimes be overlooked if you are not looking for it; the hepatic encephalopathy can be devastating to the pets and their owners. I'm pretty sure if I ever get another dog first thing I'm gonna do is to do a blood test.

On food since we have been doing a lot of researching, a lot of opinions on the Internet is that "commercial food is the devil"; I'm wonder how people on this forums think about it? If home made diet better? (our cat has always been on home made raw diet and have beautiful furs).

[TigerJack]

I initially thought the same about going to a home made raw diet but do some research first. Meat based protein is harder to digest than dairy based protein. You've got to keep the ammonia levels in the blood down and meat protein must produce more than dairy. I was advised to avoid all meat initially and go with cottage cheese. Got her on to Hills id and she did really well. Lilly's coat has come back to being beautiful and healthy since the surgery. Fixing things so her liver could regenerate and function properly had more to do with that than initial diet. Go check out the yahoo group 'dog liver shunt and disease' as they have a lot of people who have tried all sorts of diets and treatments and narrowed down what works well.

[WoofnHoof]

I only just found this thread so I'm a bit late to the party but I also have a liver shunt dog. His was intrahepatic and he had surgery at ten months of age, performed by Dr Geraldine Hunt back when she used to work at Sydney Uni, she's been poached overseas for a while now I believe. Anyway my boys surgery was successful and he's been pretty normal ever since, he will be 11 years old in September.

[Schnauzermummy]

My little girl Olive as investigated for a liver shunt today at the Animal Referral Hospital in Essendon Fields.  CT scan has been completed and report will be available by the end of the week.  $2100 for the CT scan. Prior to this we have had full blood analysis at our local vet $760 as well as urine tests and other investigation.  Surgery will most probably be likely for her and suspect it to be around $6000.

[WoofnHoof]

It's a very expensive exercise for sure! I assume your little one will have an extra hepatic shunt which has a much higher success rate than intra. Best of luck for the surgery! 

[Green_tomatooo]

Hi,

My puppy has high LTA, normal untrasound, bile acid test shows problem in liver. Vet suspect liver shunt.

Does anyone’s dog has successful treatment and please recommend us your vet.

We live in Melbourne.

 

Thank you!

[Mairead]

I'm in Sydney with no experience of this but I have put a notice in the News section to have a look here.

It may help to read all the posts on this thread, make notes and have questions ready for your vet and for here.

Also may help to make it a new topic instead of tacked on to an old thread.

[Papillon Kisses]

18 hours ago, Green_tomatooo said:

Hi,

My puppy has high LTA, normal untrasound, bile acid test shows problem in liver. Vet suspect liver shunt.

Does anyone’s dog has successful treatment and please recommend us your vet.

We live in Melbourne.

 

Thank you!

Does your vet have a recommendation? They would be familiar with internal medicine specialists in Melbourne if referral is needed.

[JulesP]

I went to Melbourne Veterinary Specialist Centre in Glen Waverley. Your vet would need to write you a referral. 

 

Liver shunts are often not detectable on a normal ultrasound at your vets. 

 

Once diagnosed the treatment is an operation to close the shunt. Not all shunts can be operated on. The alternate is treating with medication and a special diet, the lifespan of the dog might be reduced following this route. 

 

Has the vet put your puppy on a different diet now? Or any medication? 

 

Do you know what your test results actually were for the bile test?