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Liver Shunts In Dogs – Why My Dog Went Undiagnosed For 3.5 Years And How You Can Spot It!
My Italian Greyhound is truly the best friend (no, more like a child) of my husband and I. Her name is Wendy. She’s absolutely a beautiful specimen of an Italian Greyhound – with her sleek body, her tucked tummy, her champion like posture and whimsical gallop. Wendy is now 4.5 years old and her life has been one long terrible journey.
When we first adopted Wendy – she was a tiny fawn puppy with large black eyes. You couldn’t even tell if she was looking at us because her pupils and eye color had not developed yet. She was very fuzzy for an Italian Greyhound puppy. She had remnant milk breath and wagged her tail in play.
Unfortunately, a few weeks after we adopted her, she threw up. It was a small projectile like vomit while my husband was holding her. We did not think anything of it because puppies will throw up sometimes. She was on a strictly “puppy” food diet, her stools were normal and her urine was normal. She was eating and drinking normally and behaving normally.
Approximately a month later, things started to change with Wendy. She became less active. She laid down all the time. She didn’t want to engage in typical “puppy” play – or if she did, she didn’t last more than a few minutes before she wanted to lay down. We didn’t know any better and thought maybe she was just a “quiet” puppy or had more of a “serious” temperament than our other Italian Greyhound.
We soon began to notice that she was not eating as much. It was time to go to the vet. The vet told us that her weight was fine and she looked fine. We told the vet that her appetite had greatly decreased, but he told us to give her some chicken soup and rice. We tried, and she did eat some of it, but within a day she stopped eating. We took her back and the vet told us to just keep trying. We tried for another night and she refused to eat. At this point she also stopped ALL physical activity. She didn’t get up! She didn’t walk, she didn’t do anything. She just was looking around her while she was laying down.
We brought her back to the vet again, this time my husband was furious. The vets’ office had at least 5 vets working in it. He demanded to see a vet and NOT the same one who had been treating Wendy. He told the new vet Wendy’s history and he demanded that something be done about her quickly deteriorating condition. The vet told my husband he thought she had a food allergy and prescribed Hill’s C/D. Well, luckily – this did help her come back to life. Later, I learned that Hill’s C/D is a low protein food and it was the high protein in her puppy food that was killing Wendy.
Wendy did fine on this food. I kept bringing her to the vet at least once a month for colds, fevers and strange behavior. She constantly urinated all over the place. She never had a good appetite and never drank a lot. She was still a “quiet” dog, but she grew older and we moved to a different town. She became an adult and we took her off of the Hill’s C/D. She immediately started to develop crystals in her urine. Italian Greyhounds do not like to urinate outdoors, so we always made it a point to use pee pads in a basement or garage area. Fortunately, as a youngster, Wendy didn’t always quite make it to the pad and I was able to see the crystals on the floor!!!
I took her to the vet specifically to address the crystals in her urine. The vet ran some blood tests and told me that her BUN count was a little low (and maybe her creatin too – I can’t quite remember the creatin reading). I researched this on the net (which was still developing at the time) and found information about liver shunts. Liver shunts are often congenital defects that occur in puppies/dogs and these affected dogs typically have low BUN, low creatin and ammonium crystals in their urine! I brought it up to the vet – she said “no” and “that’s not it”. She told us it was just the food allergy that our earlier vets had diagnosed. I truly believed my vet – SHE was the EXPERT. I completely put the idea of a liver shunt OUT OF MY MIND.
Every time I brought Wendy to the vet, I kept asking each vet if they thought Wendy was too skinny. They all told me that she was just petite and that she looked normal. Again, I had instinctual doubts but believed the EXPERTS.
If I had only known then what I know now. After 3.5 years of going through hell bringing Wendy to tons of vets and ER vets – I finally found an ER vet who actually took the time to listen to Wendy’s full history and my concerns. He said the magic words “I think she might have a liver shunt, you should get a bile acid test done on her”.
Here are the symptoms of liver shunts:
1. Poor Doer: A puppy/dog that is always getting sick. Because liver shunts cause toxicity in the blood because the dog is not having its blood filtered by the liver. This causes various illnesses to occur often.
2. UTIs: A puppy/dog that has frequent urinary tract infections or looks like it is having a urinary tract infection due to having many accidents all over the house, isn’t able to be housebroken or urinating small amounts.
3. BAD ODOR: A puppy/dog that has bad mouth odor and/or bad urine odor. Often, the urine is also a darker color yellow instead of the “barely” yellow of normal healthy urine. (Note: Puppy and young dogs should have good breath. Bad breath is a RED FLAG that something isn’t right)
4. Head Pressing: Dogs with liver shunts don’t filter their blood which results in ammonia build up in the blood. Ammonia toxicity causes their heads to feel funny – so they rub their heads a lot.
5. CRYSTALS IN URINE: This is from the excess ammonia in their system. Any dog with crystals in the urine should have a bile acid test.
6. Complete Blood Count (CBC): This test is easily given in the vet’s office. Liver shunt dogs often have a lower than normal BUN and Creatin count.
7. Depression: Liver shunt dogs are not very active or they may be active for very short periods of time. They are known as “quiet” puppies or “quiet” dogs. A “quiet” puppy usually isn’t very normal and all “quiet” puppies should have a bile acid test to make sure they are okay.
8. Low Weight: Puppies with liver shunts look normal with a milk belly, etc. As they grow into dogs it is obvious they are too skinny. Their ribs show, their bones are prominent and they don’t develop muscle mass. Not all liver shunt dogs have low weight though, but many do. They tend to have low weight because their liver cannot absorb and process nutrients to bring these liver shunt dogs to their normal weight.
9. Small: Dogs with liver shunts often do not grow as much as their siblings. They have smaller than normal livers and sometimes smaller than normal features. Wendy never developed the strong leg muscles that all greyhound breeds exhibit.
10. Anorexia: Many liver shunt puppies/dogs do not eat normally. They eat very little dog food. They may chow down on a newly introduced canned food or people food – but they invariably resort back to not eating very much. Eating food makes them not feel well because of the higher toxicity they have after a meal – so they tend to shun food.
11. Breed: Any breed can have a liver shunt, but Yorkshire Terriers are famous for having them.
Here is my advice to anyone who has a dog with these symptoms:
FORCE YOUR VET TO DO A BILE ACID TEST IF YOU SUSPECT A LIVER SHUNT AND/OR YOUR DOG IS EXHIBITING SOME OF THE ABOVE SYMPTOMS!!!! Don’t take “no” for an answer. Tell them you want to MAKE SURE and cover all of your bases. A bile acid test is about $100.00 and can save your dog’s life.
Once your dog has been diagnosed with a liver shunt, you can then begin the process of determining treatment. In the meantime, ask the vet for Lactulose which may cause diarrhea at first but will immediately help to greatly detoxify your dog. Also, immediately put your dog on Hill’s L/D diet which is low protein. Do not give your dog any people food that has protein! Protein promotes toxicity in liver shunt dogs.
There are several treatment options. You may want to have a scintigraphy done to find out if the shunt is intrahepatic or extrahepatic. Usually the liver shunt is extrahepatic (outside the liver) which is easily operable. Intrahepatic shunts (inside the liver) are much more difficult to operate on and are usually found in larger breed dogs. Your vet can recommend whether to operate or not. Usually, it is recommended to medically manage your dog rather than operate with intrahepatic shunts.
Surgery: One of the best and cheapest places to have the surgery performed is at the University of Tennessee at Knoxville, TN. And I do mean the BEST and the cheapest. They specialize in liver shunt surgery. I wouldn’t have trusted Wendy to any other surgeon for treatment. In addition, UTK utilizes a surgical method for extrahepatic shunts that cannot be surpassed by mere ligation.
Puppies in in the uterous of their momma dog get nutrients from momma through a portal vein. At birth, this vein is supposed to close up. In liver shunt dogs, it doesn’t close up. Instead, this portal vein acts as a “bypass” and most of the blood bypasses the liver. The liver is what cleans the blood. The liver also performs thousands of other vital functions!!! 94% of Wendy’s blood bypassed her liver!!!
The classical surgical method has been to ligate the portal vein (close it off, shut it down, get rid of it….). Unfortunately, the ligation method can throw the body into shock and kill the dog because there is a halt to the circulatory system! UTK developed a much better and much safer method. A metal ring is coated with a substance that expands upon contact with moisture. It expands SLOWLY (it takes a month or so for it to fully expand). This ring, called an ameroid constrictor, is placed AROUND the portal vein. The ameroid constrictor closes slowly over time until the vein is closed. This not only helps the body from going into shock, but it also helps to prevent infection that is caused by ligation! The liver is able to slowly accept more and more blood as the constrictor does its job. There is no shock to the liver or the circulatory system.
I HIGHLY recommend the surgery with an ameroid constrictor – you can research all of this on the net to make your decision. The UTK program includes a scinitigraphy to locate the shunt, surgery, hospital stay, AND A BIOPSY OF THE LIVER for about $1,600 (2007). They do a great job!
What to Expect Post Op: Your dog will be in some pain for a few days after the surgery. Fortunately, there is not a lot of pain because the only cutting involved is the skin on the belly and for the biopsy. There is usually no cutting done for placing the ameroid constrictor.
Over the next 4 months, you will notice the following: weight gain, muscle development, loss of puppy fur (if your dog retained its puppy fur), improvement in general appearance (shinier), LOTS more ENERGY and no more head rubbing.
At 4 months, you will need to redo the bile acid test to check on how the ameroid constrictor is operating. Wendy had 0s on her follow up bile acid test!!! After 4 months, if the bile acid test comes back normal, you can put your dog back on regular food!!!!
I can’t tell you how glad I was that I was able to have Wendy surgically corrected.
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