# Our Vet Believes Cozette May Have a Liver Shunt



## socalyte (Nov 15, 2010)

Well, I heard news I didn't really expect or want from the vet. I had been thinking Cozette's tummy issues were from stress, maybe an irritable bowel syndrome, or maybe a food intolerance. I've never done a BAT on Cozette, and maybe that wasn't wise of me, but she seemed so healthy other than her hip issue. She is bit thin, even though she has gained weight and is a whopping 3.7 pounds now. At the time of her hip surgery last March she was 3.2 lbs. 

Anyway, the vet said that dogs with liver shunts often start showing signs of failing to thrive at her age (1-1/2 years old), so he wants to do the BAT sooner rather than later. He said liver shunts often go hand in hand with other issues such as the hip dysplasia she had. I think I'll get the BAT done next week after Pippa has gone through the main postoperative period-- I'd just rather deal with one thing at a time. He did also give us a new food for her called Purina EN, and gave us Reglan and Tagamet for the tummy issues. 

I called Pam (Pammy4501) and she was very supportive and helpful. I was so depressed, and she gave me very good information, and reminded me that there are many here that know a ton about liver issues and would be willing to pass along their knowledge to me. I realize that being upset made me not hear everything my vet was saying, but one thing that stuck out in my mind that he said was that liver shunt dogs usually don't make it past 6 years. 

Anyway, I'm really trying not to be discouraged, but it's hard. I'd appreciate any advice, good wishes and prayers ya'll can send our way.


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## zooeysmom (Aug 1, 2011)

Oh my gosh, this is shocking news  I'm so sorry, Jackie, it must be scary for you. I don't know much about liver shunts, but I'm sure others will have advice. I just want you to know that you and Cozette are in my prayers.

Hugs and kisses,


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## Sylie (Apr 4, 2011)

Oh Jackie that is hard news to take. Your precious Cozette? Sigh. I can't offer any advise, but my heart goes out to you with well wishes for your precious angel. But, from what I can see she is a strong, feisty little girl...like my Ru...and she will over come any obstacle in her way. There are statistics...and then there are determined little girls who thumb their pretty little black noses at those statistics. With all the love of all her aunties, I say Cozette will rise above it and amaze us all.:thumbsup: I hope with all my heart.


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## Bailey&Me (Mar 8, 2010)

Oh Jackie, I am shocked to read this. I am hoping and praying that the vet's suspicion is wrong. I truly thought you were going to say your vet thinks Cozette has IBD or IBS, since I saw your other post about her tummy issues - maybe it really is that. Try not to stress about the liver shunt possibility right now - wait and see how the BAT test turns out next week. I pray that it comes back normal and it really turns out to be something tummy related that can be managed easily. I'll be praying, Jackie!


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## Snowbody (Jan 3, 2009)

Jackie - this wasn't the news I was expecting to read from you. Quite a shock. Were there any things that pointed to liver shunt? Did the vet get back blood results that indicated it? Just can't imagine going from not eating well and digestive issues to that. And never heard a link between things like hip dysplasia and liver shunt. Know so many large dogs have HD so wouldn't think that way. Hoping that the BAT shows otherwise. You know that Doctor Center in Cornell is a wonderful resource. Know that there are many here who know a lot, especially MaryH. Hoping she sees this. I agree, one thing at a time. Happy that Pippa did well today. (((Hugs)))


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## pammy4501 (Aug 8, 2007)

OK, here is a good article:
Portosystemic Shunts FAQ

And a podcast with Dr. Sharon Center of Cornell University :
Genome Barks Podcast - Liver Shunts and Other Liver Anomalies with Dr. Sharon Center - Genome Barks - CastRoller


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## njdrake (Apr 23, 2007)

Jackie, I'm so sorry to hear Cozette may have a liver shunt. That's devastating news but you never know, maybe the testing will show its something else like the IBD. Zoey has IBD and she's doing great and she's healthy. I hope this is the case for you and Cozette too.
Sending hugs and prayers. :grouphug: 


Pam, thanks for the article. I really don't know much about liver shunts so it was very interesting to read.


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## silverhaven (Sep 6, 2009)

Scary stuff :grouphug: try not to worry right now. Just get that test done ASAP so you can know what is going on. So sorry to hear little Cozette isn't doing well.


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## edelweiss (Apr 23, 2010)

Jackie, I am skipping to the end & have only read your initial posting---off to the vet & will read it this aft. but I had a dog born w/liver shunt so know a lot---he was operated (& no one did it then) & he lived a very long life. He did have issues but you can see it did not keep him down. He was a wonderful dog. Just wanted to tell you that quickly. Hugs.


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## allheart (Oct 3, 2008)

I am in complete shock, as I am sure you are at the possiblity. But it reminds me of human doctors, that always give you the worst case scenario. 

I love you and will keep you in and Cozette in my prayers big time. Your vet just maybe being very cautious and I have a feeling the test will show otherwise.
I truly do.

All the hugs and prayers in the world. Cozette sounds like a healthy baby, aside from the hip issue. 

We all are here, and I know Mary H will see this.

Love you,
Christine


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## Summergirl73 (Sep 18, 2011)

Jackie, I just wanted to send your our love and prayers. ~♥♥♥~


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## Maidto2Maltese (Oct 19, 2004)

I know very little about shunts, but it's probably a good idea to have test done just to be sure BUT it very well could be something very different.. From your other post my first thought was IBD/IBS.. or something like food allergy.

I'm sure the possibility of a shunt really threw you, but try to focus on the fact that that is just one thing in a list of possibles.


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## edelweiss (Apr 23, 2010)

Jackie, I hope Cozette passes her BAT w/low numbers! 
In all honesty I am always a bit concerned w/"little" dogs---and now I have one! My Kirby was born w/liver shunt and I saw symptoms as soon as he was weaned, but then I see EVERYTHING way before I am supposed to. He exhibited digestive issues, head pressing, was more in the "pray" position than not. He didn't actually have seizures until after the shunt was corrected & they got pretty bad. We tried the drugs mentioned for the digestive issues but unfortunately they didn't help. We were told "he might live one yr. w/out the surgery" so we found someone in Austria who was a specialist in that area & he did the surgery & it was successful. We fear that he developed more shunting later, causing the seizures. He did phenobarbital all his almost 17 yrs. of life. We tried other stuff but nothing worked like the pheno. I also kept him on a diet for liver issues which I made myself at home.
Please remember this was a long time ago---no one knew much then. He was diagnosed at the U. of Colorado & we had him in a study for a few years there. 
Have you checked w/your breeder to see if there is a genetic history w/others in Cozette's line? I have never heard of HD being associated w/liver issues. 
PM me if you have other questions---my brain is slow today.


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## aprilb (Jul 9, 2010)

What??? Jackie, I too, am shocked to hear this knowing Cozette's history. What is it with some vets?! Every time they see a sick Maltese, they think it's the liver!:angry: I know when my Lily(4lbs) got so sick, my old vet thought it was her liver. Guess what? She was WRONG!:angry: I got a second opinion and ended up changing vets and my tiny girl is doing very well. She had IBD. I did have all the tests done(including BAT) and they were NORMAL. I know this is scary for you, but vets don't know everything. Please do not think she has a shunt until after tests are done. Hang in there..:grouphug::wub:


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## LuvMyBoys (Jan 2, 2012)

I am shocked to hear this and really hoping that the vet is just being over cautious. I have found in the past that they sometimes go for the biggest diagnoses then work their way down as results come in. Please let that be the case here. 

xoxoxoxo


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## aksm4 (Nov 28, 2011)

I am really sorry Jackie , and pray your vet is just being cautious to rule out anything , please dont worry and know we are all here for you <3

anna and luna xoxoxo


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## lynda (Oct 11, 2005)

Jackie, I am so upset and sorry to read this news about your sweet baby. I am sending you positive thoughts and prayers. I hope the Vet is mistaken about Cozette. She is such a little doll and reminds me so much of my Gigi. I fell in love with her when I met her at Nationals. 
You have both been through so much and she is such a little trooper. Hang in there Jackie. Things have got to get better:grouphug::grouphug:rayer:rayer:


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## donnad (Aug 22, 2006)

I will be praying for Cozette that all turns out fine and she does not have a liver shunt.


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## Ladysmom (Oct 19, 2004)

I strongly disagree with your vet about a liver shunt being a death sentence. I have been a member of a Yorkie forum for quite a few years and have seen many Yorkies diagnosed with a shunt since they are so rampant in the disease. Most shunts can be surgically repaired. Karen Tobias at U of Tennessee is one of the experts in liver shunt surgery.

You are a long way from that, though. Get the BAT done, then take it from there. It could be perfectly normal and you will have worried for nothing.


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## harrysmom (Sep 28, 2007)

Jackie,

My Harry has had liver issues and as a result, acquired liver shunts since he was 6 months old. I've learned a lot over the past 5 years. First of all, you have to get the results of the BAT before you know anything for sure, right? If those results point to a liver shunt, then you need to decide what to do. If Cozette has no symptoms, such as fluid retention in the abdomen or neurological issues, then maybe just a diet adjustment to a lower protein food might do the trick. We put Harry on a special diet (He now eats the tofu diet and Royal Canin Hepatic LS.) and we treat symptoms as they arise. 

And please don't be discouraged!!! When Harry was first diagnosed, Cornell said that he might not live more than a year, but he'll be 5 soon and (knock on wood) he's doing great. A few months ago I spoke to Dr. Center and she said that she sees no reason why Harry can't live a long life at this point. 

After you get the BAT results, I hope that you'll let us know. Certain tests are not always the right way to go with liver dogs.

And, like others have said, I'm sure MaryH can advise you further. 

Hang in there!!!!
Hugs.
Debbie and Harry


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## MoonDog (Jun 6, 2011)

Jackie, I'm joining with the others in praying the vet is wrong and Cozette's tummy issues have nothing to do with her liver and that whatever it is will not be serious. I feel so bad for you that you're having to deal with this right now...


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## MaryH (Mar 7, 2006)

socalyte said:


> Well, I heard news I didn't really expect or want from the vet. I had been thinking Cozette's tummy issues were from stress, maybe an irritable bowel syndrome, or maybe a food intolerance. I've never done a BAT on Cozette, and maybe that wasn't wise of me, but she seemed so healthy other than her hip issue. She is bit thin, even though she has gained weight and is a whopping 3.7 pounds now. At the time of her hip surgery last March she was 3.2 lbs.
> 
> Anyway, the vet said that dogs with liver shunts often start showing signs of failing to thrive at her age (1-1/2 years old), so he wants to do the BAT sooner rather than later. He said liver shunts often go hand in hand with other issues such as the hip dysplasia she had. I think I'll get the BAT done next week after Pippa has gone through the main postoperative period-- I'd just rather deal with one thing at a time. He did also give us a new food for her called Purina EN, and gave us Reglan and Tagamet for the tummy issues.
> 
> ...


Hi Jackie,

I haven't been actively reading much on SM lately so please forgive me if I ask questions that have already been answered. My first piece of advice is don't plan the funeral!! Other than the hip surgery and a gurgling stomach has Cozette been sick lately? My experience with liver shunt dogs who have not been bile acid tested and identified as such at an early age is that they start showing signs of something being wrong generally around the 9-12 month age. And I have had a lot of conversations with a lot of well-known vets and researchers and I have NEVER heard of a correlation between liver shunt and hip dysplasia or any other orthopedic issue. When Cozette had her hip surgery was a pre-surgical blood panel done? If so, what were her ALT/AST values? ALT/AST values can be elevated for any number of reasons, not just liver issues, but in a dog with a liver shunt those values would in all likelihood be elevated to a point of concern. I would recommend that you have a bile acid test done but I would be doing that BEFORE a change of diet or medication. Why would a vet recommend treatment, either drug or dietary, for an unconfirmed condition? And a change of diet and medication could definitely skew the true bile acid results. I would be happy to speak with you further. Feel free to send me a PM with your phone number or I can send you mine if you want to talk. I'm not on the computer much anymore unless someone emails me an "alert" which is why I'm suggesting a phone call.

Hang in there,


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## MaryH (Mar 7, 2006)

I just re-read your post. Is the food/drug treatment for stomach issues or possible liver issues?


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## SammieMom (Nov 13, 2010)

I am so sorry to hear this Jackie. When I lost Kirby to shunts he was 7 mo old he was very ill. I was told that they norm show signs in first yr or less. Guess depends on who u talk to. I spoke with MaryH here and she was very helpful. I hope she is just in the higher numbers. We could not diag a His shunt for sure without the testing. I am praying for you. :wub:

I just noticed Mary is already on. I've seen a bad shunt first hand and cozette just does not sound like it. I know there are lessor degrees which they can have and we never know it or treatable with diet. I'm praying this is something else.


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## socalyte (Nov 15, 2010)

Thank you all so much for your concern and support. It truly means the world to me. I can't imagine a more supportive group and I'm incredibly grateful. My poor hubby-- I'm so teary about everything--the stress is getting to me and he feels helpless. 

Mary, the medication is for tummy issues-- Reglan is for heartburn, nausea and vomiting, and prolonged feeling fullness after meals (slow stomach emptying), as well as loss of appetite, and the Tagamet is to decrease gastric acid. It wouldn't surprise me if she had slow stomach emptying because when she vomits long after a meal such as the middle of the night, there is usually a good deal of undigested food. 

One thing that stands out to me is that during the times the issue shows up, she doesn't want to eat and has to be encouraged to do so because she has nearly complete food avoidance at these times-- fortunately because of the competition for food in the household, she will eat when she believes her share of food is being threatened. But, that is the only way she'll eat at those times. That makes me think that she feels ill during or shortly after eating, and I'm not sure if that would point to liver or not. I have IBS, though, and I can tell you that I do not feel well while I eat if the IBS is flaring. 

Another thing that stands out is that she does have periods of time when she feels just fine-- I'm talking weeks to a month where she has no apparent issues surrounding eating at all. It's all very confusing.


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## pammy4501 (Aug 8, 2007)

aprilb said:


> What??? Jackie, I too, am shocked to hear this knowing Cozette's history. What is it with some vets?! Every time they see a sick Maltese, they think it's the liver!:angry: I know when my Lily(4lbs) got so sick, my old vet thought it was her liver. Guess what? She was WRONG!:angry: I got a second opinion and ended up changing vets and my tiny girl is doing very well. She had IBD. I did have all the tests done(including BAT) and they were NORMAL. I know this is scary for you, but vets don't know everything. Please do not think she has a shunt until after tests are done. Hang in there..:grouphug::wub:


I don't think the vet is wrong to investigate a small malt with digestive issues for possible liver issues. It would actually be irresponsible if he didn't. When Lola had her first seizure this vet told me that it could likely be hepatic encephalopathy. Why? Because statistically that would have made the most sense with this breed of dog. When the number didn't bear that out, he started looking at other scenarios. That is how medicine works. You investigate the most likely things first. This still could turn out to be something quite different. But the vet is completely correct to get the BAT.


Ladysmom said:


> I strongly disagree with your vet about a liver shunt being a death sentence. I have been a member of a Yorkie forum for quite a few years and have seen many Yorkies diagnosed with a shunt since they are so rampant in the disease. Most shunts can be surgically repaired. Karen Tobias at U of Tennessee is one of the experts in liver shunt surgery.
> 
> You are a long way from that, though. Get the BAT done, then take it from there. It could be perfectly normal and you will have worried for nothing.


What vet said that this is a death sentence? I didn't see that anywhere? Did I miss something?


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## Snowbody (Jan 3, 2009)

pammy4501 said:


> What vet said that this is a death sentence? I didn't see that anywhere? Did I miss something?


Pam - I think this was the quote from Jackie that they were referring to in her OP: 

_I realize that being upset made me not hear everything my vet was saying, but one thing that stuck out in my mind that he said was that liver shunt dogs usually don't make it past 6 years._


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## pammy4501 (Aug 8, 2007)

MaryH said:


> Hi Jackie,
> 
> I haven't been actively reading much on SM lately so please forgive me if I ask questions that have already been answered. My first piece of advice is don't plan the funeral!! Other than the hip surgery and a gurgling stomach has Cozette been sick lately? My experience with liver shunt dogs who have not been bile acid tested and identified as such at an early age is that they start showing signs of something being wrong generally around the 9-12 month age. And I have had a lot of conversations with a lot of well-known vets and researchers and *I have NEVER heard of a correlation between liver shunt and hip dysplasia or any other orthopedic issue*. When Cozette had her hip surgery was a pre-surgical blood panel done? If so, what were her ALT/AST values? ALT/AST values can be elevated for any number of reasons, not just liver issues, but in a dog with a liver shunt those values would in all likelihood be elevated to a point of concern. I would recommend that you have a bile acid test done but I would be doing that BEFORE a change of diet or medication. Why would a vet recommend treatment, either drug or dietary, for an unconfirmed condition? And a change of diet and medication could definitely skew the true bile acid results. I would be happy to speak with you further. Feel free to send me a PM with your phone number or I can send you mine if you want to talk. I'm not on the computer much anymore unless someone emails me an "alert" which is why I'm suggesting a phone call.
> 
> Hang in there,


I have not heard of that either Mary. I don't know dog medicine as well as human medicine. But I know that in infants, when certain anomalies are present at birth, the doctors will start to look for other anomalies. Portosystemic shunts (also something that happens to human babies) have relationships to certain other disorders. I don't know this, but since LCP is essentially a vascular disorder that affects the bone, could there be a relationship? Don't know, just thinking. But I will honestly be surprised if Cozette does indeed have a shunt. But I do get why the vet is checking her for this.


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## aprilb (Jul 9, 2010)

pammy4501 said:


> I don't think the vet is wrong to investigate a small malt with digestive issues for possible liver issues. It would actually be irresponsible if he didn't. When Lola had her first seizure this vet told me that it could likely be hepatic encephalopathy. Why? Because statistically that would have made the most sense with this breed of dog. When the number didn't bear that out, he started looking at other scenarios. That is how medicine works. You investigate the most likely things first. This still could turn out to be something quite different. But the vet is completely correct to get the BAT.
> I never said Jackie's vet was wrong to investigate for possible liver issues. I said that IMO some vets think a sick Maltese is always because of a liver issue.(Namely, my old vet) Now that Jackie has shared more of what is going on with little Cozette, I think the BAT should be done, too. The nausea, reluctance to eat, and vomiting at night are concerning. My first Malt had liver disease and his numbers were through the roof, but with a good homemade diet, meds, and supplements, he lived to be 10 years old. Jackie, no worries! I believe sweet Cozette will be with us for a long time, yet.:wub:


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## michellerobison (Dec 17, 2009)

I'm so sorry ,I hope they can treat her and she will live a long happy life... I hope there are SMers who can help you. We've never dealt with that so far.
You're all in our hearts.


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## SammieMom (Nov 13, 2010)

Jackie,
The only thing I can add is that our Kirby begin showing signs (post neuter) and progressed steadily with eating, darker urine issues, circling and head pressing. 
He did not have the longer periods of normal you describe in cozette and if my memory is correct, cozette did fine after her hip surgery. 
xoxo praying for your baby.

I realize there are diff types of liver probs. this is just what i saw for comparison, having had a dog with a shunt.


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## MaryH (Mar 7, 2006)

pammy4501 said:


> I have not heard of that either Mary. I don't know dog medicine as well as human medicine. But I know that in infants, when certain anomalies are present at birth, the doctors will start to look for other anomalies. Portosystemic shunts (also something that happens to human babies) have relationships to certain other disorders. I don't know this, but since LCP is essentially a vascular disorder that affects the bone, could there be a relationship? Don't know, just thinking. But I will honestly be surprised if Cozette does indeed have a shunt. But I do get why the vet is checking her for this.


I agree, Pam, that checking for liver issues is always worthwhile (as you know, I'm a HUGE advocate of bile acid testing) but sometimes vets know just enough to send someone into unnecessary panic mode. PDA is also a vascular disorder but I wouldn't be suggesting an echocardiogram to the owner of a dysplastic dog. The lesions (perivascular cuffs) found in the brain of a GME dog are, interestingly, the same lesions (perivascular cuffs) found in the livers of dogs with liver disease. But I wouldn't make any statement, much less draw a conclusion, that GME and liver shunt may be related. Again, I'd be looking first at the ALT/AST levels assuming a blood panel was done prior to Cozette's surgery before I ever would have suggested that there might be a liver issue. And if the ALT/AST was markedly elevated, as an owner I'd be questioning why that had not been discussed with me prior to any surgery.


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## socalyte (Nov 15, 2010)

Thanks for all the input. Now that I've had some time to get myself out of auto-panic mode, a few things are notable. One is that Cozette has never had problems with anesthesia. She has had anesthesia three times, and some of you may recall they actually let her come home earlier than anticipated when she had her hip surgery because she was so perky. Hopefully a good sign? Unless the type of anesthetic used wasn't as taxing on the liver as it used to be.


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## pammy4501 (Aug 8, 2007)

MaryH said:


> I agree, Pam, that checking for liver issues is always worthwhile (as you know, I'm a HUGE advocate of bile acid testing) but sometimes vets know just enough to send someone into unnecessary panic mode. PDA is also a vascular disorder but I wouldn't be suggesting an echocardiogram to the owner of a dysplastic dog. *The lesions (perivascular cuffs) found in the brain of a GME dog are, interestingly, the same lesions (perivascular cuffs) found in the livers of dogs with liver disease. But I wouldn't make any statement, much less draw a conclusion, that GME and liver shunt may be related.* Again, I'd be looking first at the ALT/AST levels assuming a blood panel was done prior to Cozette's surgery before I ever would have suggested that there might be a liver issue. And if the ALT/AST was markedly elevated, as an owner I'd be questioning why that had not been discussed with me prior to any surgery.


Interestingly, these perivascular cuffs are histologically an inflamatory response. They are commonly seen in MS, and are part of the demyelinating process. Some research is seeing a link between GME and MS. So, for the dog that has liver disease and neurologic symptoms, there may actually be an association somewhere. Not necessarily cause and effect, but a link none the less. 

As for the PDA's, the ductus arteriosis and the ductus venous are both part of fetal circulation. When they fail to close at birth, can cause multiple related problems. That's all I was alluding to.


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## Mini Pearls Mom (Mar 4, 2011)

Jackie - I don't know much about liver shunt but I do know a lot now about Inflammatory Bowel Disease, unfortunately. Some of little Cozette's symptoms are similar to Pearl's. I am NOT saying it is the same thing at all - Pearl had shunt ruled out by a blood panel.

BUT I couldn't get her to eat EN and I wanted you to know about FRESHPET - that "bologna-looking" food in the fridge section of the pet food aisle. It's been an amazing bounce-back for Pearl with that food. Sometimes I forget this is a chronic disease - she seems so well - that I want to go back to old foods, but she ADORES Freshpet and she would only nibble at EN or any of the other Rx foods. This is such pure food - no additives/preservatives and has helped her so much. I found it through the recommendation of a Vet Nutritionist Specialist. She also takes 5mg of Pepcid morning and night.

I hope this isn't what you fear!!!


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## Lovkins mama (Dec 15, 2011)

Im sending prayers, and casting out any kind of sickness! We can not have a sick cozette her's is to precious.


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## SammieMom (Nov 13, 2010)

socalyte said:


> Thanks for all the input. Now that I've had some time to get myself out of auto-panic mode, a few things are notable. One is that Cozette has never had problems with anesthesia. She has had anesthesia three times, and some of you may recall they actually let her come home earlier than anticipated when she had her hip surgery because she was so perky. Hopefully a good sign? Unless the type of anesthetic used wasn't as taxing on the liver as it used to be.


Jackie, 
Kirby had his surgery same time Cozette had hers, so there was no better/newer anesthetic at that time, because we asked for the right one for Malts. I think the fact that she does so well with surgery is a big plus, as we were told many times surgery is very hard on one with a shunt. And he got sick right after.


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## socalyte (Nov 15, 2010)

Thank you all so much for all the valuable information, support and prayers! Gosh we have an amazing community here at SM. 

Kandis, thanks for that information about the anesthetic. Cozette did recover exceptionally well from surgery so I'm glad that points to good things. 

Mary and Pam, the fetal circulation information is really interesting. It's easy to forget just how complex fetal growth and development are and that there are so many things that can cause things to go awry during the development process. 

Sheil, what I've read of Pearl's symptoms did make me wonder if IBD was more her issue. So far I've given Cozette two doses of Reglan and Tagamet, and she ate a good dinner tonight. Fortunately she seems to like the canned EN, but forget the dry stuff! The kibble is bigger than the Blue Buffalo she has been on, for one thing, and she is so small I do think that was an issue for her. I'm happy to have her eat the canned, so if she does well on it, I'll keep it up; otherwise, I will try the Freshpet. I did look it up, and I guess there are several kinds, including the one you can only get from a vet. Which is Pearl on?


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## KAG (Jun 1, 2006)

Aww Jackie. I'll be lighting candles for you and your little beauty. 
Xoxoxoxo


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## allheart (Oct 3, 2008)

MaryH said:


> Hi Jackie,
> 
> I haven't been actively reading much on SM lately so please forgive me if I ask questions that have already been answered. My first piece of advice is don't plan the funeral!! Other than the hip surgery and a gurgling stomach has Cozette been sick lately? My experience with liver shunt dogs who have not been bile acid tested and identified as such at an early age is that they start showing signs of something being wrong generally around the 9-12 month age. And I have had a lot of conversations with a lot of well-known vets and researchers and I have NEVER heard of a correlation between liver shunt and hip dysplasia or any other orthopedic issue. When Cozette had her hip surgery was a pre-surgical blood panel done? If so, what were her ALT/AST values? ALT/AST values can be elevated for any number of reasons, not just liver issues, but in a dog with a liver shunt those values would in all likelihood be elevated to a point of concern. I would recommend that you have a bile acid test done but I would be doing that BEFORE a change of diet or medication. Why would a vet recommend treatment, either drug or dietary, for an unconfirmed condition? And a change of diet and medication could definitely skew the true bile acid results. I would be happy to speak with you further. Feel free to send me a PM with your phone number or I can send you mine if you want to talk. I'm not on the computer much anymore unless someone emails me an "alert" which is why I'm suggesting a phone call.
> 
> Hang in there,


Mary, I am so glad you popped in on here. This makes far more sense to me, going this route (aside from the digestive issues), then concluding possiblre liver shunt with no dircect testing of it. 

Hugs of and to you Jackie and your drear baby. Like Mary said, hang in there. Just take one step at at time.'


Huge hugs.


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## socalyte (Nov 15, 2010)

A quick update for ya'll: Last night and this morning Cozette is like a new dog. Her eyes have that sparkle in them again, and she is eating the Purina EN quite well (if I hand feed her, but that's okay for now). She is taking the Reglan and Tagamet without any problems. She is super spunky and just tearing around the house like-- well, like Cozette, LOL. She has never recovered from a spell like this so quickly before-- usually it's days and days before she will eat more than a few nibbles here and there. I am thrilled beyond measure! I still will get the BAT test done so I can put that issue at rest one way or another. But honestly, I am absolutely amazed at how great she is doing!


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## Ladysmom (Oct 19, 2004)

socalyte said:


> A quick update for ya'll: Last night and this morning Cozette is like a new dog. Her eyes have that sparkle in them again, and she is eating the Purina EN quite well (if I hand feed her, but that's okay for now). She is taking the Reglan and Tagamet without any problems. She is super spunky and just tearing around the house like-- well, like Cozette, LOL. She has never recovered from a spell like this so quickly before-- usually it's days and days before she will eat more than a few nibbles here and there. I am thrilled beyond measure! I still will get the BAT test done so I can put that issue at rest one way or another. But honestly, I am absolutely amazed at how great she is doing!


Great news! :aktion033::aktion033::aktion033:


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## LuvMyBoys (Jan 2, 2012)

Yeah! That's great news! So glad she back to herself so quickly.l


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## Snowbody (Jan 3, 2009)

Great news, Jackie. Best to get the BAT test done (I did) and I'm really praying that it isn't a liver shunt but from the sound of things, I just don't feel it's that in my gut. :wub::wub:


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## aprilb (Jul 9, 2010)

What wonderful news, Jackie!!:chili::chili: I agree with Sue..hope she continues to do well.:wub:


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## pammy4501 (Aug 8, 2007)

That's great news Jackie. I bet her tummy feels good for a change!!


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## Lacie's Mom (Oct 11, 2006)

Jackie -- I was soooooooooo sad to read your original post about Cozette. You know how special that little girl is to her Awntie Lynn. So I was very glad to read that she is doing better and so quickly. 

Of course you will want to get the BAT done and go from there, but don't "borrow" trouble until the results are in. It may not be a liver stunt at all. Sending hugs and prayers your way. Please give that sweet little girl a hug from me.


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## silverhaven (Sep 6, 2009)

So happy to hear she is back to her old, rambunctious self  :biggrin: but yes, the BAT test is good to have as a baseline anyway.


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## zooeysmom (Aug 1, 2011)

Wonderful news, Jackie! I just hate it when my baby isn't feeling well. You feel so helpless. Then you appreciate it when they're well, so much more! 

I truly hope Cozette doesn't have a liver shunt, and it doesn't sound like she does, but I'm glad to learn that there are treatment options.

Hugs,


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## Mini Pearls Mom (Mar 4, 2011)

socalyte said:


> ....
> Sheil, what I've read of Pearl's symptoms did make me wonder if IBD was more her issue. So far I've given Cozette two doses of Reglan and Tagamet, and she ate a good dinner tonight. Fortunately she seems to like the canned EN, but forget the dry stuff! The kibble is bigger than the Blue Buffalo she has been on, for one thing, and she is so small I do think that was an issue for her. I'm happy to have her eat the canned, so if she does well on it, I'll keep it up; otherwise, I will try the Freshpet. I did look it up, and I guess there are several kinds, including the one you can only get from a vet. Which is Pearl on?


Pearl's on the one from THE SUPERMARKET of all places! (The nutritionist said that one was fine and so much easier to get). $3.29 for one "loaf" and it lasts us about 4 days. But, honestly, what a total thrill to watch her devour this food!

I am thrilled that little Cozette is back to her spunky self! I KNOW how you feel, Jackie, believe me! Now whenever Pearlie shows her feistiness I grin from ear to ear.

Just wondering - cuz I have my own suspicions for Pearl - do these symptoms at all coincide with flea/tick or heartworm preventatives or any shots do you think?


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## Maidto2Maltese (Oct 19, 2004)

Woo-Hoo!!! So happy to see Cozette is doing so much better!! :chili:


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## Snowbody (Jan 3, 2009)

Mini Pearls Mom said:


> Pearl's on the one from THE SUPERMARKET of all places! (The nutritionist said that one was fine and so much easier to get). $3.29 for one "loaf" and it lasts us about 4 days. But, honestly, what a total thrill to watch her devour this food!
> 
> I am thrilled that little Cozette is back to her spunky self! I KNOW how you feel, Jackie, believe me! Now whenever Pearlie shows her feistiness I grin from ear to ear.
> 
> Just wondering - cuz I have my own suspicions for Pearl - do these symptoms at all coincide with flea/tick or heartworm preventatives or any shots do you think?


Interesting that that's the one the nutritionist suggested. They also make Vital and I even think that Freshpet might be available at most Petco's. That's where I got it for Tyler. My vet also liked it and said that she knew a nutritionist who visited the plant and saw what everything was and how it was made and it was spotless.


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## Furbabies mom (Jul 25, 2011)

So happy that Cozette is feeling better!


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## maggieh (Dec 16, 2007)

Mini Pearls Mom said:


> Just wondering - cuz I have my own suspicions for Pearl - do these symptoms at all coincide with flea/tick or heartworm preventatives or any shots do you think?


A couple of years ago, Sweetness and Tessa both started having "tummy issues" the day after they got Heartguard. This usually continued for a week and then would start up again after the next monthly dose. This is why we switched to Interceptor and we have not had a problem since.


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## Mini Pearls Mom (Mar 4, 2011)

maggieh said:


> A couple of years ago, Sweetness and Tessa both started having "tummy issues" the day after they got Heartguard. This usually continued for a week and then would start up again after the next monthly dose. This is why we switched to Interceptor and we have not had a problem since.


For Pearl I suspect Frontline. I just ordered some kind of bio collar tag for fleas/ticks. Hope I'm not sorry...my indoor cats don't need her bringing in fleas.

Sue - I did a Forum Search about FRESHPET and came up with an entire and huge thread that went back a few years. There was a SM member who worked for FreshPet and gave numerous raving details - even when pushed against the wall. Strenuously.

The nutritionist has originally recommended Freshpet Deli not SELECT but I had a hard time finding it (that's the one in Petco now and possibly vets). So, she researched the Select and told me it had even fewer ingredients than the Deli line, which is what Pearl needs. I've had many dogs in my life but have NEVER seen a pooch soooo in love with any food. It is amazing. Especially considering she'd lost 2 lbs. in 2 months and was emaciated. Now I have to limit her meals! 

How is Cozette doing now Jackie???


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## Mini Pearls Mom (Mar 4, 2011)

maggieh said:


> A couple of years ago, Sweetness and Tessa both started having "tummy issues" the day after they got Heartguard. This usually continued for a week and then would start up again after the next monthly dose. This is why we switched to Interceptor and we have not had a problem since.


Thanks for saying this, Maggie. I have Interceptor waiting in Pearl's cabinet and I've been really nervous about beginning it again. Isn't that one they've discontinued?


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## hoaloha (Jan 27, 2012)

socalyte said:


> A quick update for ya'll: Last night and this morning Cozette is like a new dog. Her eyes have that sparkle in them again, and she is eating the Purina EN quite well (if I hand feed her, but that's okay for now). She is taking the Reglan and Tagamet without any problems. She is super spunky and just tearing around the house like-- well, like Cozette, LOL. She has never recovered from a spell like this so quickly before-- usually it's days and days before she will eat more than a few nibbles here and there. I am thrilled beyond measure! I still will get the BAT test done so I can put that issue at rest one way or another. But honestly, I am absolutely amazed at how great she is doing!



That's great news to hear she is feeling better!!!! I agree with you and the others to get the bile acid tests done just so you know. I'll still be sending over good thoughts that she continues to feel well! reglan can have some side effects (which is why we try not to use it in kids too much) so maybe after some time, little Cozette may not even need it if she feels well! i'm not a vet (haha although one would argue that Peds and vet med have their fair share of similarities!) but I can relate to the doc telling you the possibilities (most common and most serious). However, it's best not to worry until the data/labs are back and the fact that she feels better is wonderful!!! :Happy_Dance:


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## SammieMom (Nov 13, 2010)

Mini Pearls Mom said:


> Thanks for saying this, Maggie. I have Interceptor waiting in Pearl's cabinet and I've been really nervous about beginning it again. Isn't that one they've discontinued?


Sheil,
They did not discontinue it, the plant was shut down for violations for a while. A lot people are getting a few months supply until it all gets straightened out.


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## maggieh (Dec 16, 2007)

Mini Pearls Mom said:


> Thanks for saying this, Maggie. I have Interceptor waiting in Pearl's cabinet and I've been really nervous about beginning it again. Isn't that one they've discontinued?


Not to go OT, but Interceptor is the one that's "suspended." I bought a years' supply for both girls from my vet while they still had it. Novartis claims they will be back in production soon, but I don't want to be caught short.


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## Mini Pearls Mom (Mar 4, 2011)

Thanks a lot, Kandis and Maggie. Sorry for "highjacking" the thread!

Now, back to Cozette. How is she?


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## edelweiss (Apr 23, 2010)

Jackie, just popping in the AM for a minute as life is sort of complicated at the moment---be sure your vet does a base-line BAT on Pippa also, IF you haven't done that yet. It can't hurt anything (except your wallet) and you will have it for future needs. Doing it at the same time as Cozette's saves another vet trip!


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## mom2bijou (Oct 19, 2006)

maggieh said:


> A couple of years ago, Sweetness and Tessa both started having "tummy issues" the day after they got Heartguard. This usually continued for a week and then would start up again after the next monthly dose. This is why we switched to Interceptor and we have not had a problem since.


UGH! Our vet gave us HeartGuard b/c they are out of Interceptor. B&E have only ever been on Interceptor and I've never had an issue. Now I am worried to begin this month's dose of HeartGuard! :blink::w00t:

SO GLAD that Cozette's sparkle has come back and she is feeling better!:aktion033:


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## CrystalAndZoe (Jul 11, 2006)

I'm so behind here and I'm so sorry. I may have missed an update. Do you have the results of her BAT yet? Please try not to panic until you have a definite diagnosis. For some reason vets always jump to liver shunt when they're dealing with a Maltese with upset tummy issues. And sadly, many vets have never seen a truly well bred Maltese and don't realize the preferred breed standard is in the 4 to 6 lb range. At least that's the case in my area. Most Malts that are bred around here are 10 to 15 lbs and that is what they think is normal.


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## socalyte (Nov 15, 2010)

We are scheduled to have Cozette's BAT test on Monday morning, and we should get the results back on Tuesday sometime. I'm having palpitations just thinking about it!


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## donnad (Aug 22, 2006)

So happy to hear that Cozette's feeling better!!! Hope all goes well on Monday.


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## BellaEnzo (Nov 1, 2011)

Just caught up. So glad to hear that she is feeling better! I will keep you and Cozette in my thoughts and hope all comes out well Monday.


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## zooeysmom (Aug 1, 2011)

mom2bijou said:


> UGH! Our vet gave us HeartGuard b/c they are out of Interceptor. B&E have only ever been on Interceptor and I've never had an issue. Now I am worried to begin this month's dose of HeartGuard! :blink::w00t:


If it makes you feel better, Tammy, Zooey is on HeartGuard and has never had a problem with it.



socalyte said:


> We are scheduled to have Cozette's BAT test on Monday morning, and we should get the results back on Tuesday sometime. I'm having palpitations just thinking about it!


Deep breaths, Jackie! Will be thinking of you and praying that all goes well on Monday. It won't be too much longer until you'll have some answers.


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## SweetMalteseAngels (Oct 16, 2011)

Oh no! I will be praying that all is ok with Cozette. I can imagine what you must be going through. It's so hard when our fluffs are sick. I hope to hear good news.


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## socalyte (Nov 15, 2010)

Phew, done with the BAT test! Now we will just wait for the results which should be back tomorrow. Thanks for all the good thoughts and prayers-- I'll be sure to let you all know what the numbers are.


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## Ladysmom (Oct 19, 2004)

Fingers crossed for good results!


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## SammieMom (Nov 13, 2010)

Sending special prayers and :hugging: The waiting is always the pits. At least its only a day.


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## Furbabies mom (Jul 25, 2011)

Pray that all is well!


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## Snowbody (Jan 3, 2009)

Jackie - happy the BAT test is done and praying for normal results. :wub::wub:


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## socalyte (Nov 15, 2010)

*Results!*

I got Cozette's BAT results back-- AND-- they are *normal*!:aktion033: All the rest of her blood panel was normal too, so everything is good! I'm SO thankful, and am so grateful for all the prayers, good wishes and support from SM. A special thank you also goes to MaryH, who was willing to offer her time and expertise when I was so upset over the possibility of Cozette having a liver shunt. 

Cozette is still underweight (3.2 lbs), but hopefully we can get her to gain some weight slowly. The Reglan and Tagamet have helped a lot, and she has only had one episode of vomiting since we started her on them. I guess IBS seems like a more likely disorder, so we'll just keep her on the meds for a little while longer and try to slowly increase her food/calorie intake. She is on the Purina EN, which she is tolerating well. It wouldn't be my first choice of food, but at this point she is eager to eat, which is unusual for Cozette. I don't even have to hand feed her with this, so that's a definite plus! 

Thanks again everyone! What an amazing Valentine's Day gift this is!:wub::wub:


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## MoonDog (Jun 6, 2011)

Jackie, that is the very best news I've heard all day!!! Thank God!


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## angelsugar (Apr 22, 2006)

That is totally awesome!!! I am so happy for the good news!!!

I was praying all along .... God Bless!!!

:chili: :aktion033: :wub: :aktion033: :chili:


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## Lacie's Mom (Oct 11, 2006)

Jackie -- great news about Cozette. I just knew that she didn't have a liver shunt -- the symptoms just didn't fit. I'm sure that you feel like a huge weight has been lifted.

Cozette -- my little energizer bunny -- please gain some weight for your Mommy.

Hugs


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## Snowbody (Jan 3, 2009)

Jackie - talk about a Valentine's Day present. :chili::chili: I'm so glad for you and Cozette. I know that you'll be able to handle IBS. Give that little girl a ton of kisses for passing her test. Go to the head of the class.:HistericalSmiley:


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## edelweiss (Apr 23, 2010)

♥♥♥---elated for you!!


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## Furbabies mom (Jul 25, 2011)

So very happy!!!!Good news!!!


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## Ladysmom (Oct 19, 2004)

Great news!


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## silverhaven (Sep 6, 2009)

So happy to hear that news :biggrin:


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## donnad (Aug 22, 2006)

Such wonderful news!!!


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## elly (Sep 11, 2006)

Great news!!!


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## S&LP'S Mommy (Feb 20, 2011)

Great news! Now you can enjoy Valentine's day! I'm sure she will be extra spoiled today.


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## Summergirl73 (Sep 18, 2011)

YEAHHHHHH!!!! SOOOO happy for you guys!


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## zooeysmom (Aug 1, 2011)

Yay! What a wonderful Valentine's gift  IBS can definitely be managed. Have you considered Freshpet? I know it is working so well for little Pearl  

Hugs,


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## CrystalAndZoe (Jul 11, 2006)

Oh yeahhh! Great news!! I bet you'll get a very good nights sleep tonight. :thumbsup:


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## allheart (Oct 3, 2008)

socalyte said:


> I got Cozette's BAT results back-- AND-- they are *normal*!:aktion033: All the rest of her blood panel was normal too, so everything is good! I'm SO thankful, and am so grateful for all the prayers, good wishes and support from SM. A special thank you also goes to MaryH, who was willing to offer her time and expertise when I was so upset over the possibility of Cozette having a liver shunt.
> 
> Cozette is still underweight (3.2 lbs), but hopefully we can get her to gain some weight slowly. The Reglan and Tagamet have helped a lot, and she has only had one episode of vomiting since we started her on them. I guess IBS seems like a more likely disorder, so we'll just keep her on the meds for a little while longer and try to slowly increase her food/calorie intake. She is on the Purina EN, which she is tolerating well. It wouldn't be my first choice of food, but at this point she is eager to eat, which is unusual for Cozette. I don't even have to hand feed her with this, so that's a definite plus!
> 
> Thanks again everyone! What an amazing Valentine's Day gift this is!:wub::wub:


That is WONDERFUL news!!!!! :chili: :aktion033:


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## pammy4501 (Aug 8, 2007)

socalyte said:


> I got Cozette's BAT results back-- AND-- they are *normal*!:aktion033: All the rest of her blood panel was normal too, so everything is good! I'm SO thankful, and am so grateful for all the prayers, good wishes and support from SM. A special thank you also goes to MaryH, who was willing to offer her time and expertise when I was so upset over the possibility of Cozette having a liver shunt.
> 
> Cozette is still underweight (3.2 lbs), but hopefully we can get her to gain some weight slowly. The Reglan and Tagamet have helped a lot, and she has only had one episode of vomiting since we started her on them. I guess IBS seems like a more likely disorder, so we'll just keep her on the meds for a little while longer and try to slowly increase her food/calorie intake. She is on the Purina EN, which she is tolerating well. It wouldn't be my first choice of food, but at this point she is eager to eat, which is unusual for Cozette. I don't even have to hand feed her with this, so that's a definite plus!
> 
> ...


:chili: :chili: :chili: :chili:

Doing cartwheels here!! (if I were younger and more flexible that is!) That is the best news EVER!!!! Talk to you soon...


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## Furbaby's Mommie (Jul 10, 2004)

Shoni has high BA but is asymptomatic and does not have a stunt. He also had what we thought was IBS or similar stomach issues as Cozette until I finally found Nature's Variety Instinct Raw Frozen food. He stopped having stomach problems immediately when started on it about 2 yrs. ago. I rotate the chicken, beef, lamb and venison flavors and do let him have 1/8 cup of a dry holistic grain free dry just for further variety---and cause he likes it. He also gets a spoonful of plain natural Greek yogurt for probiotics.

I had tried almost every canned, dehydrated and dry food listed as excellent and natural, reg. or grain free. He also tried FreshPet rolls. They were fine but he didn't like them. The raw frozen little medallions in his Nature's Variety Raw are easy and defrost in an hour or so. He only eats 2 a day. They are an excellent complete food and he has just blossomed on them. Not only that he loves them! :thumbsup:

So glad Cozette's BA turned out normal. If they had done complete blood work before any surgery like they should have they would have known if her liver enzymes were normal she didn't have a shunt. It is always good to get the BA also before any first surgery so they know how to best handle the anesthetic and protect the liver incase of high BA's which many have like Shoni but have normal liver enzymes.


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## aprilb (Jul 9, 2010)

Yea!! I am so happy to hear this wonderful news!!!:chili::chili: What a great Valentine's gift!:wub::wub:


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## revakb2 (Sep 8, 2006)

Great news!


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## SammieMom (Nov 13, 2010)

Awesome news!! I just remembered an rushed to log on.


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## MaryH (Mar 7, 2006)

Jackie, I'm thrilled to hear this news. My personal advice-- slow and steady wins the race. Multiple small meals, tiny treat midday and bedtime, and stay away from rich "high end" foods. Maybe Cozette likes the food because it likes her ...


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## hoaloha (Jan 27, 2012)

Jackie, that is WONDERFUL news! yippee! so glad Cozette is eating better too :-D


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## Rocky's Mom (Apr 10, 2010)

Oh Jackie, that is certainly not what you wanted to hear. I am so sorry to hear it too, but I am going to tell you this..don't believe it till you get proof. Keep positive. The best of doctors for humans say things too soon and have been wrong. I have had a lot of experience with this with my family members and myself. Try not to panic till it's time to panic. And it's not time. Cozette is a strong little fighter and she won't put up with no liver shunt! Also all her Aunties will be praying for her. love and hugs, 

Dianne and Rocky


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## Rocky's Mom (Apr 10, 2010)

Jackie, I just posted to you and then saw that you already posted this great news! I am so HAPPY for you and for Cozette. 
love and hugs, 
Dianne and Rocky xo



socalyte said:


> I got Cozette's BAT results back-- AND-- they are *normal*!:aktion033: All the rest of her blood panel was normal too, so everything is good! I'm SO thankful, and am so grateful for all the prayers, good wishes and support from SM. A special thank you also goes to MaryH, who was willing to offer her time and expertise when I was so upset over the possibility of Cozette having a liver shunt.
> 
> Cozette is still underweight (3.2 lbs), but hopefully we can get her to gain some weight slowly. The Reglan and Tagamet have helped a lot, and she has only had one episode of vomiting since we started her on them. I guess IBS seems like a more likely disorder, so we'll just keep her on the meds for a little while longer and try to slowly increase her food/calorie intake. She is on the Purina EN, which she is tolerating well. It wouldn't be my first choice of food, but at this point she is eager to eat, which is unusual for Cozette. I don't even have to hand feed her with this, so that's a definite plus!
> 
> Thanks again everyone! What an amazing Valentine's Day gift this is!:wub::wub:


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