# Liver Shunt - Oscar's Story



## littlemanoscar (Oct 20, 2007)

We just lost our beloved Oscar about 3 weeks ago to this terrible condition - he was such a HUGE part of our family, and we're still feeling the pain of his passing, but know that the little angel we were so lucky to have is now our little guardian angel in Heaven. 

Because liver shunts seem to be more prevalent in these little dogs, I thought it would be important to share our experience. Unfortunately our story does not have a happy ending, and by no means do we want to discourage those parents who are currently living with this reality (as there are many, many, many stories of dogs living long, happy lives after surgery) – this post is created in the spirit of sharing Oscar’s story and less importantly, personal therapy!  

Oscar was almost 3 years old before he began showing symptoms of a liver problem. He was a big Maltese (~8 lbs!), and as we learned, the size of dog doesn’t necessarily mean that your dog does not have liver problems (as most sites seem to indicate). The signs, which started around mid-Sept, were mainly listlessness combined with excessive lethargy. We also noted some subtle behavioral changes; for example, he appeared to be drinking a lot more water and seemed to ‘drool’ more than usual. We took him to see the vet soon thereafter – during the general check-up, we thought we had checked off the possibility of a heart murmur (more to come on this) and ran normal blood work tests to confirm that all his levels were in check. We got a call from our vet a couple of days later saying that his liver enzyme levels were abnormal (several levels were off, but she particularly mentioned low albumin levels) and that Oscar would need to return for some additional diagnostic tests. At that time, our Vet had suspected that it could be a portosystemic shunt (PSS).

Oscar returned for more testing to confirm the presence of a shunt. He spent the day having an abdominal x-ray and ultrasound, additional blood work to eliminate the possibility of Addison’s disease, and a pre- and post-meal bile acids test. The potential of a PSS started our exhaustive research into the condition online. There are a lot of great resources online – probably one of the best is the information provided by the University of Tennessee College of Veterinary Medicine (www.vet.utk.edu/clinical/sacs/shunt). The x-rays showed that Oscar’s liver was very small (because the shunt was diverting blood passed his liver, his liver never received proper blood flow and therefore, as he grew, never developed properly). In addition, they also found kidney and bladder stones – tell-tale signs that the blood is not being filtered sufficiently, and that the waste product was building up in his kidneys and collecting in his bladder. The abdominal ultrasound unfortunately did not definitively visualize the shunt due to obstructions during the procedure, but given that his bile acids test were way off kilter (Pre = 259, Post = 412) and that he didn’t have Addison’s, they were almost 100% sure it was a PSS.

Of course, the results of the test were convincing enough for our vet to refer us to a surgical specialist in Annapolis. We quickly made an appointment for a consultation and to schedule his surgery. The 1.5 hour consultation was used to review the test results, answer any questions we had, and to line out a ‘plan of attack.’ Oscar was thrown another punch when, during the consultation, the surgeon picked up a heart murmur while listening to his heart. The presence of one could have big implications to his reaction to anesthesia, so we ran a cardiac ultrasound to reveal the severity and possible cause. Luckily, they assured us that it was minor enough to proceed with surgery. Another obstacle that complicated Oscar’s situation was the stones in both his kidneys and bladder. According to our Vet, size and location of the stones in the kidney, in particular, and the bladder dictate if they need to be operated on. Because the original abdominal x-rays and ultrasound was not definitive with regards to the size/location, another round was required. Normal procedure for shunt ligation with this doctor involves putting the dog under anesthesia and performing the portogram and shunt surgery in sequence. (A portogram is where they make a small abdominal incision, inject a contrast material into the blood vessel prior to the liver that will project on an x-ray to visualize the location and size of the shunt so that the surgeons know how to proceed for the actual ligation.) Because of the stones, the decision was made to try to minimize the stress on Oscar’s body and do the abdominal ultrasound and portogram in one day, allow Oscar to make a full recovery, and then proceed with the shunt and stone surgery at a later time. 

I was crushed to hear that Oscar would have to go through multiple surgeries to make him better, but knew that if we didn’t proceed that we would inevitably lose him, so we made the decision that we had to try. The portogram procedure went as planned – they confirmed the location and operability of the shunt and also ran the ultrasound for the stones. One large stone in the right kidney needed to be removed, so the tentative plan for the more invasive surgery was to close the shunt and remove the one large stone.

The day we were to pick Oscar up from the surgical center after the portogram and ultrasound, we got a call from our doctor saying that they had to keep Oscar another night because his blood pressure and glucose levels had dropped. We went to visit him in the center for piece of mind; it was hard to see him connected to all these monitoring systems, but he was alert and greeted us with lots of energy, talking, and a happy tail. So we left feeling better and with high hopes that we could take him home the next day. As the night progressed, sadly his conditioned worsened. He exhibited more extreme behaviors of a weak, failing liver (disorientation, head pressing) and eventually began seizuring. We drove back that night and the next morning to try to comfort him and get his spirit back up, but we knew looking at him that he was not well. That morning, the doctors, who continued to treat and provide support for his fragile body, could not give us any reassurance. The prognosis was not good. Looking at my little angel in that room with no life in his eyes was the most difficult thing to bare witness to – it was clear that there was little chance to bring him back, so we made the decision after a lot of anguish to let him go.

Many, many tears have been shed since, and I still sit here with a lot of grief and sadness that my Little Man is no longer here. We were told that dogs at Oscar’s age do carry some risk with procedures since their bodies are not as adaptive as young puppies, but the doctors could not explain his reaction to this even minor surgery. I knew it was going to be an uphill battle, with his small liver and heart murmur having to handle the anesthesia, but there was no way to predict that we would lose him the way we did.

Although we lost our baby to PSS, we want to make sure people know that there are a lot of success stories that we’ve read online about dogs who have received care and are now happy and healthy, especially those dogs where the condition is caught early. Even then, we found out from a relative that their miniature schnauzer received shunt surgery at age 5 and lived to be 14! By telling Oscar’s story, we wanted to share our experience and perspective on PSS with other Maltese lovers. As well, we wanted to send our best wishes, hopes, and positive thoughts to those families dealing with this condition.


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## Bonnie's Mommie (Mar 2, 2006)

Thank you so much for sharing your story. Oscar was a beautiful little boy. I'm so sorry for your loss.


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## beckybc03 (Jul 6, 2006)

I'm so sorry to hear of your loss of Oscar :grouphug: Thank you for sharing your story though because there are many other people that have maltese with similar problems. Just know that we are here for you if you need us :grouphug:

Oscar was an absolute doll :wub:


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## gatiger40 (Jun 7, 2007)

Oscar was a beautiful spirit. Thank you so much for sharing that story, it really touched my heart. I'm sure it will help so many people. 

I am so very sorry for your loss. What a sweet little face he had. You are right about having a little angel in heaven to watch out for you now. I know liver issues are what scares me most with this breed. 

Again thank you for Oscar's story!


Stephanie


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## k/c mom (Oct 9, 2004)

Oh, thank you for sharing your story, even though it is heart breaking. I am so very sorry for your loss of precious Oscar. :grouphug: 

[attachment=28356:bridge_w..._wording.jpg]


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## Cathy (Mar 19, 2006)

Thank you for telling us Oscar's story. It must have been tough for you to relive the events that lead up to his death. My heart goes out to you and your family. Losing a Malt is like losing a child. May your wonderful memories with him help sustain you now and forever.

:grouphug: :grouphug: :grouphug: 

Cathy A


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## The A Team (Dec 1, 2005)

I'm so sad to learn that little Oscar didn't make it, I'm crying as I type this. A friend of mine has a yorkie who has undergone the liver shunt surgery and another that has MVD - it's such a shame these poor sweet tiny creatures have to go through all this. Hopefully time will heal your heart.

But I do want to add that Oscar was unbelieveably adorable!


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## momtoboo (Jan 30, 2006)

I'm so sorry. :smcry: Little Oscar was beautiful. I hope sharing his story has helped in some way to ease your pain. :grouphug:


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## littlemanoscar (Oct 20, 2007)

I am truly touched by all your kind thoughts and words, and for that I am very thankful! Our family has spent the last few weeks recounting all the wonderful memories and pictures of Oscar over the 3 short years we had this amazing dog - he was truly perfect in every regards. I've enclosed a link to additional pictures of Oscar - as you'll see, he had quite the personality and was oh so photogenic!

Thanks again for all your support - it has really meant a lot!

Judy, Dave & Moxie (our schipperke)

http://www.flickr.com/photos/[email protected]


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## Ladysmom (Oct 19, 2004)

I am so sorry for your loss. What a beautiful boy your Oscar was.

Thank you so much for sharing your story with us. :grouphug:


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## MalteseJane (Nov 21, 2004)

What a beautiful little boy he was. So sorry for your loss. :grouphug: :grouphug:


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## harrysmom (Sep 28, 2007)

I am very sorry to hear about your loss. Oscar was a beautiful pup!


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## Cathy (Mar 19, 2006)

http://www.flickr.com/photos/[email protected]
[/QUOTE]

Judy,

I loved your album of Oscar. He was a gorgeous boy and looked like so much fun. He certainly seemed to be the picture of health. His lovely face is looking down on you from the Rainbow Bridge and telling you how much he loves you.

Take care and please stay part of the group. I know that when I lost my 2 year in 2006 being part of Maltese groups helped my heart to heal.

Cathy A


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## ClaBec Maltese (Feb 19, 2007)

I am so sorry for you loss. I know it took a lot to find the courage to share Oscar's story. May God give you peace during this terrible time. Oscar was a beautiful little boy. I know he will forever live in your families heart. Thank you for sharing his story with us.


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## ClaBec Maltese (Feb 19, 2007)

[/QUOTE]

Judy,

I loved your album of Oscar. He was a gorgeous boy and looked like so much fun. He certainly seemed to be the picture of health. His lovely face is looking down on you from the Rainbow Bridge and telling you how much he loves you.

Take care and please stay part of the group. I know that when I lost my 2 year in 2006 being part of Maltese groups helped my heart to heal.

Cathy A
[/QUOTE]
Yes Judy please stay around. I know that last week when my Ezekiel was so sick this group really gave me comfort that I would never expected. The people here actually do understand your love and devotion for Oscar. And will give you strength that you did not realise you have. Hugs to you and your family.


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## Scoobydoo (May 26, 2005)

I am so very sorry for your loss of sweet little Oscar :grouphug: 
Thank you so much for sharing your story, you have certainly given me some great insight into PSS, I really do appreciate the knowledge


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## msmagnolia (Sep 8, 2004)

I'm so sorry for the loss of the adorable Oscar. Thank you for sharing your story! I hope that you will stick with this board and continue to post. Some of us have suffered a loss and this board is a wonderful, invaluable support system.


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## carrie (Aug 24, 2004)

thank you for taking the time to tell oscar's story. 
he was very beautiful, you were so very lucky to have such a wonderful boy in your life. 
:grouphug:


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## kathym (Aug 5, 2006)

Iam so sorry for your loss :grouphug:


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## Tina (Aug 6, 2006)

:smcry: :grouphug: I am so sorry for your loss of Oscar. They want to make us happy they forget about caring for themselves. They use their whole bodies to tell us they love us. :grouphug: :smcry: 

Tina


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## Furbabymom (Dec 17, 2004)

I am so sorry for your loss of your beautiful boy who loved you so much. Thank you for telling us about the events that led up to losing Oscar to help others on this list. I am truly so sorry for your loss. I can tell how much you loved him and he loved you.


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## precious paws (Jun 7, 2006)

I'm so sorry for your loss. Oscar was a beautiful little boy. :grouphug:


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