Killian/Liver Disease ?

[AdoreMyDogs]

Sue...I know Killi will make it out of this OK...he has to, he is way too loved by your family and us Pet Talkers. I was saddened by the latest news, but I think you are making a great decesion in weighing all the options. From what you said, if it was my dog I think I would opt for the diet/meds and see how that worked. It's hard for me to say, though, since I have not yet been faced with this with any of my doggies.

You are in my prayers.

[Albea]

Sue, I'm so sorry to learn that you still don't know what is causing Killie's problems. I agree with everybody that has told you to try diet and medication first and leave surgery as a last resort.
I know exactly how you feel, I went through a long illness with my second Golden. My thoughts are with you and Killie. Give him many hugs from me.

[3-greys-and-a-mutt]

So very sorry to hear this news. It is so distressing when a pupper is sick.
I don't know if this will help at all: a friend whose dog can't eat anything with more than 12% protein said that the only quality, low-protein treat she could find was Purina Right Bites. I think they are kind of like jerky squares?

[tatsxxx11]

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

[Angels3]

Sue, we had an elderly dog who had to be on a low-protein, low-fat diet because her liver wasn't working well any more. I'd give her rice, mixed with cooked vegetables & only a VERY little bit of a protein food...like chicken. I used balsamic rice because it's lower in starch than ordinary rice.

[Sudilar]

Thank you, Everyone, for your advice and continued prayers. Thanks, Sandra, for your research!

I think that the surgery is too risky for Killian. I would hate for him to hemorrhage and die on me. I'm told that acquired shunts are usually multiple and tying them off in itself is risky and can cause death. The surgery works well for puppies with only one shunt, they say. Killian doesn't exhibit the usual signs of having a shunt, like neurological problems, etc.

This is the part in the above article that scares me:

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.

The IFs of surviving surgery and post-surgery. So if the surgery and post-op don't kill you, then you'll be ok! Scary thought.

Thanks for all your help. Please keep the info coming if you find anything!!!

Sue Killi and Shi

[tatsxxx11]

Just wanted you to know Sue, that I was sitting here thinking of you and Killian. I hope you and he have a quiet, peaceful night. Did you eat your din-din Killi? Please give him a big hug and kiss Sue.
Sandra

[Sudilar]

Sandra, you are so wonderful to be thinking of my sweet Killi today. I think he feels pretty good. He's acting so close to normal now except for not eating as much. He does eat some dog food every day. The bad part is that I can't feed him fish or steak or any of all that good food full of protein anymore. I guess it's up to him to decide that he must eat what's there in his bowl if he wants to live longer (how do you explain that to a dog?) I don't think he'll ever see 110 lbs. again, but if he stays at 95, it won't be so bad. It's kind of hard, but we must fight this. We're hangin' in there!!I am taking in everyone's advice (keep it coming, please) and using every bit of information.
Thank you all for your continued support!!

Slurps and wags, Killian, Sue and Shiloh

Sue

[Gio]

I was off work for a few days and I didn't have a chance to check if there were any news. But I thought of you and Killi a lot and I am really sorry about the news. I would also leave surgery as the last resort. As I can understand Killi is not in any pain and seems happy enough and that's important.

I will keep the prayers up.
Take care
Gio

[Stenograsaurus]

Oh, Sue, I'm so sorry. I know the news must have been very devestating. I honestly believe you made the right choice. I also wanted to let you know that when I first brought home my shepherd/collie mix and weighed her, she only weighed 40 pounds (yes, she was full grown).
Anyway, Killi, keep eating what you can when you can. I'm sending you lots of hugs, kisses and scratches. Keep fighting. You are one strong boy!!!

[Daisy's Mom]

Hi Sue, Killi, and Shiloh. Just wanted to let you know that Daisy and I are thinking about Killian. How is he today?
-Bridget and Daisy

[jackiesdaisy1935]

Hi Sue, I came across this and I don't really understand the problem, but maybe this will help. It comes from the Enclyclopedia of Canine Veterinary Medical Information - Authored by Michael Richards, DVM - the site is http://www.vetinfo.com
there are other things about this medical problem in the question and answers. I hope this helps some. Love and kisses to Killi.
PS in the alphabet under L there are other people with dogs who have the same problem as Killi.
Liver Shunt
Liver shunts are a congenital problem in some dogs. During gestation the placenta delivers blood with food and oxygen from the mother through the umbilical vein. This means that in the fetus, circulation is the reverse of circulation after birh, because the fetus veins have the oxygenated blood and arteries return unoxygenated blood to the heart. In order to make this work, there is a shunt from the liver venous circulation to the arterial circulation. At birth, the pressure within the circulatory system changes as respiration occurs and this shuts the shunt, which eventually disappears. If this reverse in circulation doesn't happen for some reason, the liver is deprived of a blood supple and doesn't develop properly after birth. Many puppies can live with the small functioning portion of the liver for some time but eventually have problems and usually die if the situation is uncorrected. It is possible to surgically close the shunt and the surgery works well. I can remember hearing of one sheltie that was 6 years of age or possibly older before a congenital liver shunt was recognized, so some dogs can live a long time with this problem.

[ July 23, 2001: Message edited by: jackiesdaisy1935 ]

[lizbud]

Hi Sue...Just wanted to post a reference point for you to check out; but saw that
Jackiesdaisy had beat me to it.The Vetinfo
site is excellent!! All info is listed from
A to Z.Check out (L) and Liver disease In DOGS... I,ve used the site to research
Lameness in dogs for Buddy.
There is tons of info there.
Good Luck...Liz

[thelmalu99]

Sue,
I just saw this and wanted to say that your sweet Killian is in my prayers. Hang in there and keep giving him all the love you have!
Tell Killian that we are pulling for him!
love,
Thelma and Yertle
(Charlie is now at the Rainbow Bridge, but I'm sure he's pulling for Killian, too!)

[Corinna]

Sue for what it's worth I think the diet and meds are the best idea . You can get his weight up and maybe the counts down . It gives you time to learn more and strengthen him up. Who knows with all the research beinng done in a year or so they may have the easy answers. Chin up and ever forward. Please also don't go in to info overload, limit you search or it becomes one big blur and you can miss a very good idea. I know we missed a really good why of enhancing Tim's immune system before surgury which could have cut recover in a third of the time. We have a saying be a turtle slow and steady.