Portasystemic Shunts

[coopersmom]

My neighbor's dog is very ill and the vet thinks she may have a Portasystemic Shunt. She a Chihuahua, less than one year old. The neighbors say they don't have the money for shunt surgery, which is quoted at around $2500.00. Are there any medical treatments that could help Marley or is surgery the only option?

 

[The Quahog]

My neighbor's dog is very ill and the vet thinks she may have a Portasystemic Shunt. She a Chihuahua, less than one year old. The neighbors say they don't have the money for shunt surgery, which is quoted at around $2500.00. Are there any medical treatments that could help Marley or is surgery the only option?

This may run the risk of 'interference', because if their veterinarian felt that medical management was reasonable they presumably would have discussed it, but yes there are medical attempts.

We currently have a patient with microvascular dysplasia, which is similar to a shunt but, because the connection between the liver circulation and the general circulation- (the problem with a shunt- the blood from these two systems should not mix) - is at the capillary level rather than as a large blood vessel which can be tied off, there is no operation.

Medical management generally consists of using lactulose and metronidazole to control ammonia levels , plus dietary considerations. Yes, the surgery is more promising.
Here is a link, a little technical, it discusses medical management only to prepare a patient for surgery, but then it is written by the American College of Veterinary Surgeons, so is basically an article about the surgery.
- Dr. Mac

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/PortosystemicShunts(PSS)/

 

[coopersmom]

Thank you for your information. I will see that they get the article. I am encouraging them to see a specialist for explore medical options, if any. Do you think a non-specialist would be qualified to do the shunt surgery if they could find someone who did not charge as much for surgery as the specialists?

 

[BarbV]

How did they diagnose the shunt? What were the symptoms and what tests did they do?

Bacca has highly elevated ALT levels (641, where they should be between 5 and 95) but no other obvious symptoms. In his case, it's an important nuance.

We are currently treating it with a normal protein diet (he had been on high protein - 40%) and liver supplements (primary ingredient is milk thistle). He goes back in a week or so to get his blood retested to see if there is any difference.

If not, then we'll be looking at ultrasound to determine if there really is a shunt, followed by possible surgery.

 

[The Quahog]

Bile acids remains the test of choice, as far as I know.
This is a tough surgery, I'm afraid I would have to recommend a board certified surgeon.

In answer to your initial query, note this line from the surgical link-

=The treatment of choice for a single PSS is surgical attenuation (narrowing) or full ligation (tying off) of the abnormal shunt vessel. =

There is the clear implication that for cases where surgery is not practicable there are at least other modalities one can try. - Dr. Mac

 

[coopersmom]

Marley was spayed a few weeks ago and has been ill since with vomiting, diarrhea, no appetite. When Mary took her in to the vet Friday they ran blood work and two liver enzymes were high. I can't recall which ones but one was over 1000. The vet is suspecting a shunt. They did the bile acid this morning and will probably know about it on Wednesday. I saw Marley today, she isn't eating anything. She looked o.k., was brighter than yesterday.

 

[BarbV]

Bacca had the bile acids done as well, but notwithstanding, we've decided to wait for the next round of bloodwork before pressing on.

Bacca went through a period for months when he went off his food for a week or so, then would eat for a few days, then go off it.

Since he's been on hypthyroid meds and the milk thistle, he is a whole new dog. He scarfs his food almost as fast as Porky, and jumps and plays non-stop.

As far as I know, if the bile acides test positive, they still will do an ultrasound before going to surgery. Good luck to you.

It's interesting that she comes up with this after a normal spay (any infection there?). Were there any symptoms before she was spayed? Bacca started going downhill after some kind of mouth/jowl infection. It's been about 20 months of up and down.