# Maltese Liver Shunt



## m_n_m84 (Jun 13, 2012)

Help! My 6yr old Maltese was just diagnosed with a liver shunt. This diagnosis was based off of her being symptomatic and then she had a Bile Acid blood test completed and her levels were in the Severe category. I read so much online about surgery v/s medical treatment. I would like to avoid surgery as I think this would be hard on her (she only weighs 4lbs) but then if me just administering her meds and changing her food is not going to give her a full healthy life then I don't want to rule out the surgery option! Is there anyone out there that has faced a shunt diagnosis? If so, what did you choose for treatment? How long has your fur baby been living with the diagnosis? Any and all information would be greatly appreciated as I am a nervous wreck about this!

Thank you


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## sherry (Jan 4, 2013)

First of all, what did her BAT read? Second, did they do a Protein C test which would be sent to Cornell for testing. My boy was diagnosed with a liver shunt because of his BAT and scheduled for surgery. Thanks to this site I was informed of the Protein C test. It came back right before his surgery date. There are other tests that can be performed but in my area this was all I had. The protein C test said it was only 10% chance of shunt and 90% chance of MVD. I chose to do med and diet for him. That was 4 years ago and he is doing great. MVD is rampant in maltese and most are non symptomatic. My boy was symptomatic. With diet and meds he is doing just fine.


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## Tanner's Mom (May 27, 2005)

My Tanner is like Sherry's Riley above. He was diagnosed with MVD years ago and that is managed with diet and drugs (Marin). Tanner never had a Protein C because it didn't exist when he was diagnosed, but he's almost 14 now and just as spunky as ever.


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## m_n_m84 (Jun 13, 2012)

They did not do a protein c test that I am aware of. I will most definitely ask about it when we go for follow up appointment. She diagnosed shunt off of the results of the BAT test. Her level was 8 on the pre test, which the vet said was on the higher end but not alarming. Then the post test said she was at a 38 which she said registers in the severe category? I really don’t know much about this stuff which is why I’m reaching out for help from people who have been through this. The original reason for being tested is bc she wasn’t eating and kept getting upset stomach and had 1 bloody stool and started to have petit mal seizures at bedtime. Is he protein c test a blood test? Just one draw of blood or a series of before and after feeding like the BAT test?


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## m_n_m84 (Jun 13, 2012)

Tanners Mom, what age was your Maltese diagnosed with MVD


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## m_n_m84 (Jun 13, 2012)

What meds are your dogs on for MVD? And what kind of diet?


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## wkomorow (Aug 26, 2011)

My Luck has a liver shunt - diagnoses when he was 2; he is now going on 8 and is doing fine. He is on lactoluse and denamarin.

Liver shunts are not diagnosed just with BAT as Sherry points out. A protein C test is done and if that and the BAT indicate a shunt - a Doppler ultrasound is used to confirm.

38 is not high for a Maltese. Typically dogs with shunts have BATs over 100. 

Typically local vets are not tried in small dog shutting. The expert in shunts in small dogs is Sharon Center at Cornell. Luck goes to see her once a year.

Your dog does not sound like she has a shunt, she most likely has MVD. The danger in shutting and in MVD is that certain foods break down into ammonia in the system. A normal liver is able to convert that ammonia into urea - which is safe. Shunt dogs allow the ammonia to pass through the blood stream. Ammonia can cross the brain/blood barrier and can cause brain injury.

You will want to support the liver - Denamarin and other Same products will do that, as will dandelion. You will also want to avoid dark meat and fish, Luck is on Royal Canin hepatic and follows an otherwise vegetarian diet with lots of dairy protein to supplement his intake of protein.

What symptoms are you dog having? Typically lactulose and an antibiotic are given to reduce the gut bacteria that cause the ammonia to grow.

Good luck, but honestly, it sounds a lot more like MVD than a shunt.


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## m_n_m84 (Jun 13, 2012)

My dog has been a VERY finicky eater her whole life. That being said, she occasionally would puke up yellowish foam and then would have a quick bout of yellow mucus covered stool. In the past we have always put her on chicken and rice and once her stomach was calmed the other issues worked themselves out. This past time that prompted the bloodwork was similar in nature but she quit eating and then passed a bloody stool, this was followed up by a couple of very small seizures. 
Are the shunt and the MVD treated the same as far as diet and meds are concerned?


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## sherry (Jan 4, 2013)

Your girl's bat numbers are actually very low. I would do the Protein C test, which is one blood draw and sent to Cornell. I would also have my vet get me lactulose to put on all her meals. And you can order denamarin on Amazon to give in the morning an hour before her first meal. The Protein C test will probably rule out a shunt. And yes, an antibiotic might be beneficial at this time.


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## maggieh (Dec 16, 2007)

The advice you've gotten so far is spot on. Also, the vomiting, colitis and bloody stool you've described don't always mean liver shunt. The seizures are, I suspect, what sent the vet in that direction, but a lot of vets see "little white dog" and automatically think "liver shunt." 

Please insist on the Protein C to see if you're dealing with a true shunt or MVD. There are also GI disorders that can produce similar symptoms, so make certain that what you're dealing with can't be handled by medication before agreeing to surgery.


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## Tanner's Mom (May 27, 2005)

m_n_m84 said:


> Tanners Mom, what age was your Maltese diagnosed with MVD


Tanner was 2 years old when he was diagnosed with MVD. I gave him Denamarin for a while--until I started finding the pills all over the kitchen! Now I give him Marin Plus, half a tab every other day. Whatever liver supplement you give him needs to have silibin in it. Liver dogs can't process the amonia in beef (see Walter's comments above) so Tanner only eats chicken/turkey. I give him two tablespoons of canned food--right now he's eating Blue Buffalo Basics, Turkey & Potatoe. Once that case is gone he'll get Canidae Chicken & Rice, then Natural Balance chicken. I also boil chicken breasts, chop those up and mix 2 tblsps with his wet food. He is a grumpy old man now at the ripe old age of 14.


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## m_n_m84 (Jun 13, 2012)

Thank you all for the information! My last question to all of you; if I choose to go the diet and medication Route is it necessary to have the protein c test done? The reason I am asking is because it seems like the medicine and diet treatment is quite similar wish both conditions. Please let me know your thoughts on this.


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## Kathleen (Aug 4, 2011)

I am so glad you came here and are getting such good advice from those with experience.
I just wanted to mention that a vet once told me that most vets are not aware that there is a higher range of BAT results for Maltese - this is the study concluding that a liver shunt cannot be diagnosed based on a BAT test for Maltese, in case it is useful.
https://www.ncbi.nlm.nih.gov/pubmed/7646375
Best wishes to you in going forward. I am sure you will figure out the best treatment!


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## wkomorow (Aug 26, 2011)

A protein C test is a simple blood test that is used to further confirm a shunt. The blood sample is sent to Cornell to be tested. As far as I know they are the only lab equipped to do so. It costs about $50, is non-invasive and only requires a very small sample of blood and is worth it. There is no special treatment of the blood sample - in other words there is no special handling of the blood. If it comes back high (low is bad) it will help to reassure you. The only true diagnosis is visualization through a special ultrasound, scintigraphy, or exploratory surgery. Honestly, it sounds more like a GI issue with MVD than a shunt.

Please do not let the vet talk you into exploratory surgery until you know more. If it is MVD or a shunt, the antibiotic and lactulose will treat the symptoms very quickly by getting rid of the ammonia (lactulose is very safe - it is a milk sugar but you need a prescription for it).


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## m_n_m84 (Jun 13, 2012)

Thank you! yes she is currently on an antibiotic, Pepcid, and lactulose. She has also been prescribed Royal Caniin Hepatic formula. She seems to be feeling much better on this alone. I am not a fan of surgery on such small animals unless it is a life threatening condition so I am going to proceed with the medical treatment instead. I will ask for the protein C testing so that I know for sure what I am dealing with, but hopefully the current treatment plan will get her back on track!


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## m_n_m84 (Jun 13, 2012)

I'm so glad I found this group of helpful people


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## edelweiss (Apr 23, 2010)

Let us know how the blood test comes out, please. Best wishes to you & your baby.


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## wkomorow (Aug 26, 2011)

m_n_m84 said:


> Thank you! yes she is currently on an antibiotic, Pepcid, and lactulose. She has also been prescribed Royal Caniin Hepatic formula. She seems to be feeling much better on this alone. I am not a fan of surgery on such small animals unless it is a life threatening condition so I am going to proceed with the medical treatment instead. I will ask for the protein C testing so that I know for sure what I am dealing with, but hopefully the current treatment plan will get her back on track!


Also,

Just to note there is no surgical fix to MVD.


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## LOVE_BABY (May 5, 2015)

Sorry no advice to offer , only my prayers for you and Maya that you can get to the bottom of what is causing the symptoms and Maya will be feeling better!


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## m_n_m84 (Jun 13, 2012)

Thank you for the prayers and encouraging words! Currently I have to get her through these antibiotics and try to get her eating good before we go for the Protein C test. I don't want to have any more blood drawn or any unnecessary stress until she is feeling a little better.


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## m_n_m84 (Jun 13, 2012)

I wanted to update everyone that we had a CT scan done and she does NOT have a liver shunt. We are still trying to pinpoint the cause of what is going on with her. She is currently hospitalized due to a severe hypoglycemic episode after the fasting process for the CT scan. We are supposed to go get her tomorrow morning. She has had lab work drawn for insulinoma tumors and Addison's disease now. If all of this comes back normal we are back to square one and I have spent close to $4000 on vet bills in less than a month  I feel like the veterinary practice I have her at now is actually a little more knowledgeable of the breed and they have better capability of testing and monitoring her as she should be. I am just hoping and praying that we get an answer of some kind so we can move forward from here and have a happy healthy dog again! I have been lost these past two nights without her here with me, but I know she is in good hands. She is a a Blue Pearl clinic and I think she is being taken care of well. I will let each and every one of you know if we get any answers from the new testing!!


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## maddysmom (Mar 8, 2012)

Just throwing this out there to think about? Have the doctors mentioned IBD based on your dogs symptoms dx by endoscopy/biopsy? I know you mentioned seizures...there are tick diseases that can cause seizures, low calcium can also cause seizures, have they checked your fluff for these? High/ low blood sugar can also cause seizures.


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## m_n_m84 (Jun 13, 2012)

maddysmom said:


> Just throwing this out there to think about? Have the doctors mentioned IBD based on your dogs symptoms dx by endoscopy/biopsy? I know you mentioned seizures...there are tick diseases that can cause seizures, low calcium can also cause seizures, have they checked your fluff for these? High/ low blood sugar can also cause seizures.


They did a test for IBD in one of the labs. It was supposed to check for "gut rot" and other digestive issues and it came back with normal values. As far as tick diseases go, I get her groomed every 6 weeks and she's never had a tick removed from her? I know that doesn't rule it out. Calcium levels were normal in the initial blood panel drawn the first night in the ER. Is there a more specific panel that can be tested for the Calcium levels?


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## maddysmom (Mar 8, 2012)

m_n_m84 said:


> They did a test for IBD in one of the labs. It was supposed to check for "gut rot" and other digestive issues and it came back with normal values. As far as tick diseases go, I get her groomed every 6 weeks and she's never had a tick removed from her? I know that doesn't rule it out. Calcium levels were normal in the initial blood panel drawn the first night in the ER. Is there a more specific panel that can be tested for the Calcium levels?


You can not get a firm dx for IBD from labs. Texas A&M has a GI panel that can dx a lot of GI issues but IBD can only be dx thru endoscopy. This will tell you which type of IBD the dog may have, treatments vary depending on which IBD and the dog. What works for my dog, may not work for yours. Again, the labs do not always show GI issues, same goes for pancreatitis.
My girls CBC ect. was excellent but she continued to waste, vomit, watery stools, fever, shake, collapse, tremor. Through endoscopy/biopsy, she was dx with severe upper and lower IBD, colitis, PLE, SIBO, EPI.
Calcium was done thru the GI panel from Texas A&M.
You don't need to find a tick to get tick disease, so like you said, it doesn't rule it out.
Have you seen an IMS, or are all these test being done thru ER?


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## sherry (Jan 4, 2013)

I'm so sorry your girl is so sick. I hope you can get a diagnosis soon. Hugs, and keep us informed. We're here for you.


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## wkomorow (Aug 26, 2011)

You will want to add safer proteins. Dairy is good if there are no digestive issues. A tiny bit of vanilla ice cream is great or vanilla nonfat yoghurt. All natural and only real sugar - the artificial stuff is dangerous to dogs. Try cutting up the kibble and mixing it with a little shredded carrots and mash a quarter teaspoon of food an yoghurt or ice cream into it. Cottage cheese is also good, but it loosened Luck's stools.


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## m_n_m84 (Jun 13, 2012)

Maya had a really bad bout with hypoglycemia and it landed her in the ER. Due to this emergency visit we finally got to the bottom of it all! She tested positive for Addison's disease, and this particular spell is what they called Addison's Crisis. Her levels before and after the stimulation testing were EXTREMELY low. The specialist said that most likely her adrenal glands are not working at all by looking at her test results. She started treatment today for this condition and they said it will take a few months to get the dose just right. They also sent her home with two rounds of parasite medications to rule out any other issue going on with her digestive tract. She is sleeping a lot since we got her home but she has been hospitalized for 2 days and 3 nights so I'm sure she is exhausted!! I know I Am!!


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## maddysmom (Mar 8, 2012)

m_n_m84 said:


> Maya had a really bad bout with hypoglycemia and it landed her in the ER. Due to this emergency visit we finally got to the bottom of it all! She tested positive for Addison's disease, and this particular spell is what they called Addison's Crisis. Her levels before and after the stimulation testing were EXTREMELY low. The specialist said that most likely her adrenal glands are not working at all by looking at her test results. She started treatment today for this condition and they said it will take a few months to get the dose just right. They also sent her home with two rounds of parasite medications to rule out any other issue going on with her digestive tract. She is sleeping a lot since we got her home but she has been hospitalized for 2 days and 3 nights so I'm sure she is exhausted!! I know I Am!!


I'm sooo glad the vets figured it out! I'm so happy for you. What a huge relief! She will feel so much better once the meds kick in. 
Again..so very happy for you!


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