# Liver Shunts



## Maltese Adora-Belle (Jan 23, 2005)

Hi Everyone! I found out yesterday that Belle most likely has a liver shunt problem. From her pre-op blood test her Vet is pretty positive that the liver shunt problem is there. She is going to the University of Davis Vet Hospital on Feb. 7th for more definitive testing. I am in such a state of unbelief as she appears to be so healthy and vibrant. This is very scary. I will have to leave her overnight at the teaching hospital and she has never been away from me. I contacted her breeder and she was surprised but very nice. She told me that I may keep Belle and she will send me another puppy. I don't know that I can afford to have two Maltese babies as much as I would love to. That would mean I would have to sell the puppy and put that money towards Belle's expenses. That sounds so cold to me. I have no idea how I would be able to sell a new baby and be sure it is in a good home or if I could once I have her for a couple of days. Has anyone here had to deal with a liver shunt problem? If so can you share with me what I may be
up against. I know it can be diet and/or surgery. Is the diet going to make Belle feel deprived. She loves to eat. Thanks~ ~ Jackie & Belle


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## nataliecmu (Aug 12, 2004)

I'm sorry to hear about this!

Maybe you should ask the breeder to refund some of your money for medical expenses???

I'll be thinking about you and your baby


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## LexiAndNikkisMom (Apr 13, 2004)

> _Originally posted by nataliecmu_@Jan 28 2005, 01:05 PM
> *Maybe you should ask the breeder to refund some of your money for medical expenses???
> <div align="right">index.php?act=findpost&pid=32124*


[/QUOTE]

I agree with Natalie.

I'm sorry to hear about your furbaby! Lexi sends lots of kisses.


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## danah (Jan 8, 2005)

I am so sorry to hear this. Best of luck to you and Belle. Both of you will be in my prayers.


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## Ladysmom (Oct 19, 2004)

I believe JMM (Jackie) recently quoted a price of about $3,000 for liver shunt surgery. 

What kind of guarentee did you get from your breeder? How old is your Bella?

I agree. You shouldn't have to become a puppy broker to get money for Bella's surgery. A reputable breeder should stand behind the health of her puppies. 

Such a sad situation. I feel so badly for you. My Lady has a host of genetic/health problems and I know how devastating emotionally and financially they can be. Hers are chronic, diabetes and epilepsy. The good news with a liver shunt is that it is surgically correctable, although that kind of genetic defect can raise red flags about what other "ticking time bombs" your Bella may be carrying.

I hope you can work something out with your breeder.

This is why it is so important to insist that a breeder do a simple liver bile acids test on the puppies BEFORE they are sold.


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## jmm (Nov 23, 2004)

You should request a refund from the breeder for her surgery if she needs it rather than another puppy. 

Has she had bile acids done yet? They will want to do that and then choice of 3: ultrasound, scintigraphy, or MRI to see if there is a single repairable shunt. The next step is surgery to either repair the shunt and take a liver biopsy OR to just take a liver biopsy if there is no shunt. If she's doing really well, medical management alone may even be an option. It is definately not the end of the world and she can live a long, normal life with a little extra care. 

I've been through this with my own 2 dogs and have been in touch with numerous other people who have. 

If money is a big concern, the University of TN usually does shunts for under $1500. You would have to fly out there, but depending on what you are quoted at UC Davis, it may be cheaper. It is something to consider. Dr. Tobias at U Tenn is amazing. 

You should request that her liver biopsy be sent to Dr. Sharon Center at Cornell University who is doing research on shunts and microvascular dyplasia in Maltese. If you go through her (not their path depart) you only pay for special stains instead of the pathology. 

You can e-mail me privately if you want my phone number.


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## Sisses Momma (Dec 29, 2004)

I have no words of advice, but we send our good thoughts and prayers to you and Bella....


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## msmagnolia (Sep 8, 2004)

Jackie,
I just knew that people here would be able to help and encourage you! I've been doing research since we emailed last night. I agree that you should try and get the breeder to refund your purchase price rather than you have to sell a puppy UNLESS you want another puppy. I'll be watching for your posts. Thank goodness the 7th isn't too far away!
Susan


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## kodie (Aug 24, 2004)

> _Originally posted by JMM_@Jan 28 2005, 02:50 PM
> *Has she had bile acids done yet? They will want to do that and then choice of 3: ultrasound, scintigraphy, or MRI to see if there is a single repairable shunt. The next step is surgery to either repair the shunt and take a liver biopsy OR to just take a liver biopsy if there is no shunt. If she's doing really well, medical management alone may even be an option. It is definately not the end of the world and she can live a long, normal life with a little extra care.
> 
> I've been through this with my own 2 dogs and have been in touch with numerous other people who have.
> ...


[/QUOTE]
I too have gone threw most of these tests for Kodie. He saw Dr. Center at Cornell (which was 5hrs from my house..haha.. but well worth it) Kodie had many blood tests and a bile acid test done many different times, 2 ultra sounds, scingraphy, they checked his urine for these crystal things, and many other cell counts. After all the findings... it was decided that kodie will NOT go through any surgery... he had MVD (Microvascular Dysplasma). This is a none surgical type of shunt (liver disease). Kodie is on Hills prescription dog food l/d... its low protein. They told me veggies are better for him than other dog treats and he does not need any medicine or supplements at this time. He may NEVER develop symptoms of MVD or he may develop them later in life. He will also live a normal life. I would just say one thing... looking back after 8 months of going through all that testing with kodie to find out if he had a shunt... my advice would be the following things... 1) go to a university that specializes in shunts (you are going to a university which is good... so you dont waste money going to other doctors) 2) If your dog is diagnosised with MVD and the liver counts go up and down.. sometimes the count is normal and sometimes slightly above but not high enough to be a shunt ...and your dog is healthy other than those counts... it isnt always necessary to take a biopsy of the liver (I was told its unnecessary to cut kodie open just to take the biopsy of his liver to confirm MVD because its was very obvious he had MVD. If Kodie becomes sick.. or shows signs of MVD.. then they would like the biopsy so they can treat it correctly. You said Belle is healthy otherwise... so thats why I just wanted to let you know this detail) 3) have Belle on a low protein diet as soon as possible even before she goes in for more testing. 4) take a deep breath... remember you are not alone.. because going through all the drama with kodie.. i was a very upset, worried, and scared mommy. 

I dunno if your able to or not.. but Cornell was wonderful. I really suggest there.. i dunno how well they are at surgery for a shunt.. but they will know right away if its MVD or not. Dr. Center was very very good. she loved kodie! I was told she took pictures of him and put them on her desk! haha. 
JMM... knows alot about shunts also because again she has gone through this. Pico's mom did too. He has MVD also. 
I am not a doctor but just trying to let you know what happened with Kodie. Keep us posted... I would love to find out everything... i find it very interesting because my Kodie has been through this. Do you have any blood counts?


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## pico's parent (Apr 5, 2004)

I understand exactly how you feel, Jackie. But it may not be a shunt. I was stunned when Pico's pre-dental blood work showed elevated Bile Acids. After an ALTS test came back skewed also, the next step was a sonogram to rule out a tumor or growth. Negative.

Next was a Transcolonic Portal Scan (nuclear medicine study) to evaluate for the possibility of abnormal blood flow through the liver. (shunt) 

"Pico was anesthetized with intravenous propofol and isoflurane. Technetium99m was placed in his rectum. A series of dynamic images were obtained with the gamma camera. There was visualization of the liver prior to visualization of the heart and the heart was found normal. (this was good).

The calculated shunt fraction of blood bypassing the liver and going directly to the heart was 6-7%. (normal is considered less than 15-20%) Conclusion: No evidence of a portosystemic shunt.

The Nuclear Medicine vet recommendation: "We can assume that Pico has hepatic microvascular dysplasia; a biopsy would be necessary to confirm this (this vet, I and Pico's vet all agreed not to biopsy) I would consider the special diet for the liver (l/d), as well as the love and affection, which he is already receiving. Pico is adorable!!!!!!Thanks for trusting us to care for him."

Pico was diagnosed at almost exactly 2 years old. He will be 4 on April 14 and he weighs in a 4.5 pounds and his weight has been steady for the two years after diagnoses. We are careful what we feed him, veggies, pupcorn and whole grain toast crumbs form the bulk of treats in addition to the Hill's Science Diet l/d, both canned and kibble.

Upon my vet's recommendation (he has 3 Maltese and one has MVD and is now 13) I give Pico Denosyl90 supplement daily. He goes in for his yearly bloodwork on the 11th of February and I will post the results for you.

I know it is scary to have your little one put through these diagnostics but Pico seemed unfazed by it all. I was a wreck but he was fine through it all. So hope for the best and we will be praying for a good outcome. Keep in touch and Pico, the little flirt, sends kisses to Belle the Beautiful.


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## jmm (Nov 23, 2004)

One of my dogs, Jonathan, was found to have MVD purely by accident. He seizures about twice a year and he was worked up for the epilepsy and we found the MVD. His bile acids were only 30-40. His seizures are idiopathic epilepsy and his ALT is normal. Dr. Center recommended not treating him unless he had symptoms or his bloodwork changed. Then she would recommend the tofu diet, denosyl, and vit E. Again, he is a special case because his bloodwork is normal. 

Mikey on the other hand LOL I just think I should say first that he is a bizarre case and every vet who sees him says so. He has MVD, eosinophilic hepatic venule inflammation, IBD, and recently some other hepatopathy. He's a bit of a freak of nature so he's not a good example of typical MVD. He is on Denosyl for his liver and a laundry list of other medications. 

Diet is sooo important to liver dogs. They can live very long, normal lives if you stick with it.


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## Maltese Adora-Belle (Jan 23, 2005)

> _Originally posted by LadysMom_@Jan 28 2005, 12:28 PM
> *I believe JMM (Jackie) recently quoted a price of about $3,000 for liver shunt surgery.
> 
> What kind of guarentee did you get from your breeder? How old is your Bella?
> ...


[/QUOTE]

The guarantee I have on Belle is that she will be replaced with another puppy. She will be 6 months old on Feb. 5th and I am hoping she will not go into heat before we get this taken care of but I know that is the least of my problems. I had just heard it is best to spay them before their 1st heat. The breeder was very nice and I believe I posted that she said I may keep Belle and she will give me another puppy. I am going to contact her again after we go to Davis and see if she won't give me the money towards the Vet bills instead. I can't see why she wouldn't. UD Davis does charge on a sliding scale basis according to your finances.

I did not know anything about a liver bile acids test on puppies before buying. I certainly would have asked for that; also in retrospect I wish I had taken out health insurance on Belle but I don't know if it would have covered congenital issues.


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## Maltese Adora-Belle (Jan 23, 2005)

> _Originally posted by msmagnolia_@Jan 28 2005, 01:18 PM
> *Jackie,
> I just knew that people here would be able to help and encourage you!  I've been doing research since we emailed last night.  I agree that you should try and get the breeder to refund your purchase price rather than you have to sell a puppy UNLESS you want another puppy.  I'll be watching for your posts.  Thank goodness the 7th isn't too far away!
> Susan
> <div align="right">index.php?act=findpost&pid=32138*


[/QUOTE]

Thanks Susan. Everyone here is so nice and supportive, it is like belonging to a large family that genuinely cares and wants to help. I am going to ask my breeder for the money rather than the puppy after I go to U. C. Davis. I would love another puppy but it just wouldn't be feasible for us. My husband is crazy about little Belle and spoils her rotten if I don't watch him but is afraid of watching her when I go out without her because she is so tiny and fragile. He is afraid of our very young grandchildren too as far as holding them, etc. For the most part Belle goes just about everywhere I go except Church. She used to go to church with me too but now is a little too nosey and thinks people are there to make over her. I'll be posting on the 7th or 8th whenever I know something new. ~ Jackie


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## Brinkley & Neyland's Mom (Jun 14, 2004)

I don't have any words of wisdom or advice...but you and Belle are in my thoughts...poor baby...Brinkley sends lots of lovey licks and wiggles.


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## Caesar's Mommie (Apr 8, 2004)

Awww poor lil Bella







This must be very hard for you.







You and Bella are in our thoughts.


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## littlepeanut (Dec 5, 2004)

Good luck with the tests. I hope Belle will be okay.


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## Ladysmom (Oct 19, 2004)

If I can offer any encouragement, please know that these little guys are a lot tougher than they look. I have no idea why my Lady is still alive at age 9 with all her problems. She almost died twice, once from complications from diabetes, once from cluster seizures. Both could have left her with permanent damage to her organs or brain. Not only did she survive both times, she had no lasting effects. She's on tons of medications including steriods and phenobarbital, all with their own set of side effecs and risks. She's been on Pheno for 5 years, a pretty high dose and it is known to be very hard on the liver.

She had a complete blood panel done in late October and everything was in the normal range. My vet is amazed!

So hang in there. You love your Bella and I know you will take good care of her. Once these guys steal your heart you couldn't give them back. Living with a chronically ill dog can be difficult emotionally and financially, but it also creates a bond that is so much deeper than with a healthy dog.


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## Maltese Adora-Belle (Jan 23, 2005)

The latest on Belle and possible liver shunt. She has had the urine test, all the blood tests and sonogram. Her X-Ray (radioactive) showed no liver shunt. 
Because she needs teeth pulled and will be spayed they are going to do a liver biopsy at the same time. They are suspecting Belle has Microvascular Dysplasia but want a liver biopsy since she will already be having surgery to make sure that is what we are dealing with or if it is something else with her liver. She has been at Davis since we took her Monday but we get to pick her up tonight at 5:15. Yeah!, poor little girl. I emailed her breeder and asked about money rather than another puppy and she replied as to how sorry she was that Belle & I are going through this and to keep her posted but didn't address the issue of money nor another puppy. In my initial phone conversation with her she had said another puppy so I don't know what she will do - but as long as Belle is OK that's what matters most. Thanks to everyone for all your information and if you have more please keep it coming.







P.S. Belle will be spayed and have the biopsy on Tuesday, February 15th.


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## Ladysmom (Oct 19, 2004)

It doesn't sound like Bella's breeder is going to assist with the cost of her surgery, does it?

I don't know what your finances are, but here is a link to IMOM. 

http://www.imom.org/

They financially assist people who have pets facing life threatening medical conditions. They have a list of criteria to qualify, but they are a fantastic group. They have provided much-needed funds to many of our members on the canine diabetes forum.

I pray all this will work out for Bella. It is so heart breaking to have a dog with a serious disease.


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## jmm (Nov 23, 2004)

I hope the biopsy is good news. She'll certainly be getting excellent care at the teaching hospital. Let us know how it goes.


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## kodie (Aug 24, 2004)

aw.. i'm so glad to hear that there is no shunt! Thats a scarey situation to deal with. I hope all is well with the biopsy. I posted earlier about how the decision with kodie was NOT to cut him open for the biopsy. They didnt want to sudate him too long (he had to have 7 teeth pulled and was neutered at the same time) and they didnt want to put him through that since hes so tiny. Keep us posted!


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## sherylmint (Nov 27, 2004)

Belle my prayers are with you and your family. I pray the breeder refunds your money towards Belle's medical expenses instead of giving you a new puppy. The only advise I have to offer is get a second opinion and be well.


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## jmm (Nov 23, 2004)

> _Originally posted by Kodie_@Feb 10 2005, 08:39 AM
> *aw.. i'm so glad to hear that there is no shunt!  Thats a scarey situation to deal with.  I hope all is well with the biopsy.  I posted earlier about how the decision with kodie was NOT to cut him open for the biopsy.  They didnt want to sudate him too long (he had to have 7 teeth pulled and was neutered at the same time) and they didnt want to put him through that since hes so tiny.  Keep us posted!
> 
> 
> ...


[/QUOTE]

The nice thing with girls is that you already have an abdominal incision to do the spay. It takes just a little longer and the incision will be just a little larger to add a liver biopsy.


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## kodie (Aug 24, 2004)

JMM.... that is true!


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## pico's parent (Apr 5, 2004)

I'm glad Belle doesn't have to have that expensive surgery for a liver shunt. That's good news.

Please keep us posted after Belle's surgery and biopsy......MVD cannot be corrected through surgery like a liver shunt but my vet's dog is 13 or 14 now and has MVD so the prognosis is very good.

If it is MVD you'll just give her a special diet and watch her treats. I can't give Pico the normal chew things so he gets green beans, sweet potato, he loves squash, brown rice, cheerios, Pup-corn, sweet corn, noodles.......he thinks those are all delightful treats! So MVD is not as bad as it sounds.


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## msmagnolia (Sep 8, 2004)

Jackie,
Maybe the breeder didn't think that she needed to address the money issue if Belle wasn't going to have to have surgery for the liver shunt. You'll know more after the biopsy and can decide to keep pressing for money or something. I'm not sure that I'd want to let her off the hook though. Is the MVD hereditary? Is it related to breeding or a fluke? If it is related to breeding I think I'd keep after her, but maybe after you know more later this month. Good luck and I'm keeping you and Belle in my thoughts.
Susan


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## jmm (Nov 23, 2004)

MVD is considered hereditary in Maltese. Just like with liver shunt, the parents and any siblings of the affected dog should not be bred again.


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## pico's parent (Apr 5, 2004)

Pico and I will be waiting to hear that Belle's spay and biopsy both have good results! We're saying a little prayer for her.


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## Maltese Adora-Belle (Jan 23, 2005)

> _Originally posted by Pico's Parent_@Feb 14 2005, 09:58 AM
> *Pico and I will be waiting to hear that Belle's spay and biopsy both have good results!  We're saying a little prayer for her.
> 
> 
> ...


[/QUOTE]
Thank you Pamela and Pico. How very sweet of you. Tomorrow is surgery day and we will be sooo happy to have that behind us. Then it is just a matter of waiting for the biopsy results. This is such a great website. Everyone is so caring and nice. A big thank you to all of you!







We will post the results as soon as we get them. Belle and I appreciate all of you.


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## Ladysmom (Oct 19, 2004)

I will keep you and your Bella in my thoughts and prayers tomorrow!


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## littlepeanut (Dec 5, 2004)

Good luck with the surgery. We will be thinking of you and Belle!!!!!


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## msmagnolia (Sep 8, 2004)

Jackie,
Did the vet say how long before you'd know the results of the liver biopsy? Hope it won't take too long. Good luck to you and Belle tomorrow. We'll be watching for your post once you know that she is on the road to recovery!


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## kodie (Aug 24, 2004)

Kodie and I send our thoughts and love!







Let us know ASAP whats going on!!


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## Sisses Momma (Dec 29, 2004)

Joe and I will keep you both in our thoughts.....sending prayers and hugs.


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## Brinkley & Neyland's Mom (Jun 14, 2004)

Good luck and lots of xoxoxoxo's


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## dr.jaimie (Mar 23, 2004)

good luck to u and belle..paker sends lots of XOXOXO belle's way!


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

I hope all goes well.... I know it is so hard to deal with situations such as this... You're in my thoughts.....


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## sheila2182 (Nov 28, 2004)

Sending prayers all will be well!


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