August 16th 2010 3:40 am
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I've received several comments and private messages from pup parents who have dealt with or are currently living life with a liver shunt dog. I've been touched by them and can certainly relate to the stories told to me. Thank you all for your words of encouragement, and I hope that I've been able to reciprocate and encourage others as well.
As for Bruce, he is now 2 and a half years old. It's been a wild ride up til now and we still take life one day at a time. Which is about all anyone can do. We've settled on a diet that works best for Bruce which is Dr. Dodd's liver cleansing diet, supplemented with a canine multi-vitamin and of course his liver supportive supplement (namely milk thistle and sometimes SAM-e). He also has NB vegetarian kibble out for him all the time and we've found treats that he enjoys and are safe for him. He still gets two doses of Lactulose daily and uses Laxatone to help him get his stool out. He had a full blood panel done last month including a bile acids test and I am thrilled to report that his fasting bile acids were 6.6! As his vet said, we are doing a good job so far of managing our little man's illness. What we've been led to believe is that although the proabability of a PSS is still there, it may be more likely that he has hepatic MVD which would be inoperable but manageable with diet and supplements.
As of right now, since Bruce is doing quite well, we've made the decision to put on hold the scintography at U of T. But we're certainly not ruling that out. That still very well may be in his future. But again, it's one day at a time, and each day with him is a gift. Just as each day with our little girl Chi (Bruce's "sister") is also a gift.
Thank you to all of our wonderful Dogster pals and may God bless and keep all your little one's lovingly in His care.
June 3rd 2009 9:10 pm
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Bruce is now about a year and a half old, he was 3 months old when he came to us. He is currently diagnosed as having a suspected Portosystemic Shunt in his liver as well as suspected MVD (Microvascular Dysplasia). I am starting this diary for two reasons. One-I want to be able to have a place where I can refer back to and check where he's been (progress wise) and where we are presently. Also, this is here for anyone who has a dog with either of these diseases--sometimes it just helps to know you're not alone. This first entry will summarize Bruce's history with PSS/MVD up until now so it will be longer than the entries that will follow.
Bruce was not a very good eater from day one. We tried several different foods...Merrick, Innova, Wellness, Eaglepack...he just seemed picky. Finally we were able to find a kibble that he could tolerate and would accept...Natural Balance L.I.D. Venison and Sweet Potato. We did have better luck with wet food. But even so, he would still not eat well enough and suffered from alternating constipation and diarrhea. Mainly constipation though, he always struggled to have a bowel movement. When he was about 5 months old he started having episodes where he would go and hide under the bed and cry. Or he would become so clingy to me that I couldn't take a step without him wanting up into my arms. We had him x-rayed once thinking he had a blockage but there was nothing.
At one point he was feeling so poorly...he was lethargic, clingy, no appetite and had a round of diarrhea that looked like mucousy muck and smelled exactly like a dead rodent. I took him into the vet and it was assumed that he had a GI infection so he was given antibiotics and Kaopectate along with Prescription ID diet. He improved on the antibiotics (we now know that his improvement was not from a "GI infection clearing up", but from the antibiotics killing off the harmful bacteria that was built up in his system since his liver wasn't doing it's job) so we figured all was well.
Bruce's overall condition would ebb and flow for the next two months. He would still have episodes and we would get more antibiotics or we would adjust his diet down to boiled chicken and rice. We gave him laxatone to help lubricate his intestinal tract and make passing stool easier--which never really helped. But then, at 7 months old he went in to be neutered. We did not have a pre-surgery blood panel done...I wish that I had though.
After his surgery, he was having an excruciating time coming around from the anesthesia (this is notable since we now know that anesthesia is very hard on a liver compromised dog). He would not eat at all, was very clingy and listless. Our vet at the time was an elderly man and felt that we were getting into territory that was out of his range at this point in his life. So we were referred to another vet for blood testing.
Bruce's initial blood panel indicated clearly that "something" was going on with his liver. We then had a bile acid test (BAT) run with the remaining blood from that sample so it was a free collected BAT. The result was an 81! That vet immediately wanted to do a liver biopsy to determine if it was a PSS. Since Bruce was under a year old, it was most likely a congenital PSS. But, I researched up on the subject and felt that a biopsy at that time was too risky of a first step. I'm glad that I passed because I found out later that if that vet had done the biopsy, he would not have been able to perform the surgery to correct a PSS and would have simply sewn him back up and sent us off for another surgery at the university. And we wouldn't have known if the shunt was operable anyway. He did start Bruce on Denamarin though--a veterinary grade neutraceutical containing milk thistle and SAM-e. Both liver supporting properties and overall a very good choice for a dog with liver disease.
So I located an internal medicine specialist vet in our area and took Bruce there. He informed us that they had "the best" ultrasonagrapher on staff who would "most certainly locate a shunt if there was one to be found". We had to delay the ultrasound for two weeks while we figured out how to come up with such a large sum of money so quickly...especially since we'd already spent the "vet savings" on testing and treatment thus far.
Well, Bruce was a very good boy for his ultrasound. They were planning to sedate him if he squirmed or fussed but they told me that Bruce lay perfectly still on his back for 45 minutes while they performed the test. What a good little man! Afterwards, the vet informed me that they could not find a shunt. They did see an area indicating abnormal blood flow in the liver, but they did not want to label it a shunt. He performed another BAT to determine if the ultrasound should be done again with sedation (to make Bruce even more relaxed thus possibly showing more on screen). This time the BAT came back with much lower numbers--both for the pre-meal test and the post-meal test. The vet decides that Bruce is nothing to worry about. He acts as though he is giving me nothing but good news. He tells me that if I don't want to keep giving Bruce his Denamarin then I didn't have to because, in his opinion, Denamarin and it's usefulness was poppycock anyway. This is all pretty lousy information actually.
We continued with the Denamarin anyway because after Bruce was started on that, he was so very much improved. We also discovered that many dogs with liver disease take Denamarin and in fact, this supplement has been proven for it liver supporting and re-generating benefits.
So we now were in another holding pattern. Bruce was getting along well enough. I discovered a liver cleansing diet recipe that I would cook for him when he was having GI symptoms that seemed to work wonders. He would have his good days and his bad days. Some days he would just be tired. He would lay around while his "sister" (our other Chihuahua), who was only a couple of months younger than him, bounced off the walls and played all day long. Some days we would battle to get him to eat. His constipation and straining to have a bowel movement continued to plague him. But still, all of this was an improvement to the "pre Denamarin" days.
Then, about two months ago, he had his first neurological episode indicating Hepatic Encephalopathy. He had been laying in his doggy bed and had been fine all day long. But suddenly he was holding stock still and looking at us as though he'd never seen us before. He looked dazed. When he did move his head, it was a very slow and deliberate motion. When we tried to touch him, he yelped out and moved away. We were very worried, but at that time we had no idea that this "episode" was related to his liver issues. After about an hour, he went back to normal and was without another incident until roughly one month later. Then it happened again. This time it was pretty much the same except I thought that perhaps, since he is a toy breed dog who didn't eat well, he was having some hypoglycemia. So I gave him a dab of Nutri-Cal but at that point he was already coming out of it so I didn't know if the Nutri-Cal had made the difference or not.
Now--two weeks ago Bruce went in for his annual vaccinations. This is something that I'm not comfortable with because of his liver issues, but went ahead with anyway. I discussed these "episodes" with his vet and he asked me if they happened after Bruce had had a large meal. Well, they had occurred both times on evenings after Bruce had a good day of eating. The vet then told me that because Bruce has a suspected shunt/MVD, it was most likely a toxin build-up in his bloodstream (due to his liver's failure to filter properly) that caused him to have these neurological episodes. He told me to feed Bruce 3-4 very small and low protein meals per day. No large meals at all.
We started doing this, and I had him on the liver cleansing diet, but it happened again. This time he had the same symptoms but he also became very rigid and his neck would "crick" to the side. It was once again a very scary ordeal and left me feeling helpless. I went online and found a liver shunt/MVD email list. After signing up I realized that I was finally in the right place for the right information. They wrote to me about lactulose. I knew about this drug and had mentioned it to both the specialist and the primary vet before, but had been dismissed. Now I knew that this was necessary. He was having H.E. symptoms and needed the lactulose to draw the ammonia out of his blood and assist in passing it out of his body through soft stools. I also was told that his diet needed a major overhaul and quick! No more red meat, in fact, no meat at all. I now have a liver safe diet recipe that is nutrionally balanced and able to be fed long term. I also spoke with the vet and he agreed to prescribe lactulose.
Two of the ingredients of the liver safe diet had to be ordered online, so I am waiting for their delivery and then I will make the new diet. In the meantime, he is still eating the liver cleansing diet (3-4 small portions a day) and a few pieces of vegetarian kibble. I am also picking up prescription liver diet kibble from the vet on Friday.
The hard thing has been having to cut his meals down, he always seems to want more and be hungry. He can no longer have any of his formerly favorite treats, and I can see that has been making him a little unhappy as well. Instead of a piece of a Milkbone Chicken Drumstix treat after he takes his pill like a good boy, he now gets a plain Cheerio. Poor guy. Also, this new feeding arrangement has been tough on our other Chi as well. No more good old meat based kibble laying in the bowl whenever she felt like having a bite. Now her meals are given to her as well (rationed out like Bruce's so she doesn't feel left out when he's eating!).
Ultimately we want to take Bruce to the University of Tennessee. There is an excellent veterinarian there who is a leader in the treatment/surgical correction of PSS. Only then will we know if he truly has a PSS and if it is operable. He may not have PSS and may have just MVD. There is no surgical cure for MVD but with excellent nutrition and medical management the prognosis is not necessarily a death sentence. But he may have PSS and MVD. The bottom line is that if he does have a surgically correctable PSS, it needs to be fixed and time is of the essence. Sadly, funds are in the way as usual. But we will manage him medically as long as possible whilst we figure out how to come up with the sum needed to get to U of T. We WILL get him there one way or another. He is my baby, he is my heart. I love this little man more than words can say. He came to me at a time in my life when I needed him most. He gives me his undivided attention and devotion each and every day. I will try with everything I have and everything I am to give him what he needs at this time when he needs me most.