Sue, I found a veterinary info. sight with a large section on liver shunts. I am copying one letter and the response. There are others as well. As you get more info. I will go through them to see which ones pertain to Killi. It gave hopeful news about surgical treatment. Hope it helps you. Love you Killi...Always.

Mike Richards, DVM
4/3/2001



Portosystemic shunts in Golden Retriever puppy

Question: Dear Dr. Richards,

My wife and I recently purchased a Golden Retriever puppy. After a few
weeks we awoke to find her dragging her nose and was wandering around
seemingly intoxicated. After several tests at our local vet (bial
analysis, sonogram etc.), she was diagnosed with an intraheptic
shunt. The vet prescribed a low protein diet together with a lactulose
supplement and suggested we speak to a specialist as soon as possible.

I understand that the new diet will "slow" down the effects of the disease
although the only long-term hope is surgery. My question to you is, how
long can she be expected to live a healthy life before the onset of
seizures, complications etc., and how successful is this surgery?

Finally, I understand that treatment for intraheptic shunts is fairly
revolutionary. Do you know where I can go to find a surgeon that has
treated this condition successfully? We live in the NY/NJ area, but are
prepared to travel further afield if necessary.

Thanks in advance for your help.


Answer: John-

Some dogs with portosystemic shunts can be maintained long term with
dietary therapy, combined with lactulose and an antibiotic such as
neosporin or metronidazole. However, surgery is still considered to be the
best option for most dogs with this problem.

There isn't a good way to predict how long dietary therapy will work to
control the clinical signs associated with portosystemic shunts. This
therapy doesn't really slow down the progression of the problem, it just
controls the symptoms associated with it.

What happens with a portosystemic shunt is that blood returning through the
venous circulation through the liver, where toxins are removed, simply
by-passes the liver and is returned to the circulation unchanged. In
addition, portions of the liver which are dependent on this circulation do
not develop, so dogs with portosystemic shunts do not have normal liver
development or liver function. By surgically tying off the shunt, the
blood is forced back through the liver, as it should have been, and this
allows it to be cleansed of toxins and for the liver to develop in areas it
could not.

This is a high risk surgery. There are increased anesthetic risks, although
these can be reduced by proper planning. There is an increased surgical
risk due to the location of the shunt and the tendency for increased
bleeding in patients with decreased liver function. Finally, when the
surgery is otherwise successful, the increase in blood pressure in the
liver can cause problems in some patients in some patients several hours to
a day or so after surgery.

Despite the risks, surgery is still considered to be better than medical
therapy by most specialists, since it does stop further deterioration of
the liver, when it works. The mortality rate within the first month of
surgery was 29% in a review of 160 cases (Wolschrijn, et al, Utrecht
University, April 2000). If total ligation of a shunt is possible and the
patient survives the surgery and immediate post-surgical period, the
prognosis is very good for long term success. If only partial ligation of a
shunt is possible, about 45% of dogs will have a recurrence of clinical
signs within 4 or 5 years.

Intrahepatic shunts are more difficult to repair than extra-hepatic shunts
and for both it is important to find a surgeon who has some experience in
treating these shunts. I am not aware of a radical new surgery for this
condition, I think it is just difficult enough that it is necessary to find
a good surgeon. I do not know who the most experienced surgeon in your area
is, but I suspect that there are good surgeons at the Animal Medical Center
in Manhattan, at the University of Pennsylvania and at Cornell University.
It is entirely possible that there is an equally competent surgical
specialist closer to you. Your vet will have an idea of who the best
surgeon in your area is, or may suggest one of the referral centers above.

I am sorry you are faced with this problem. Finding the right surgeon is
important. It is worth making a long trip to find an experienced surgeon if
that is necessary.

Mike Richards, DVM
8/25/2000