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Liver Shunt and Hepatic Encephalopothy Diagnosis
  • esootsesoots
    Posts: 12
    Hey all!

    I'm brand new to the forums - you can meet Pippa, our 10 month old puppy here http://www.shibainuforum.org/forum/discussion/14598/meet-pippa#Item_5! I'm writing a post today in the hopes that it might help diagnose your dog early instead of going through all of the mystery and heartache that we've recently gone through!

    So for the past couple months, Pippa has been obsessseeeddd with drinking water. She's always loved water more than anything in life, but recently it had gotten a lot worse. We tracked her water intake daily, and even with trying to limit it, she was drinking about 90-100 ounces a day. Not good. If she was awake, Pippa was begging for water. At night she couldn't sleep for more than 2-3 hours before waking up because she was so thirsty. And as you can imagine, all of that water meant a LOT of pee. She couldn't hold it for more than 3 hours and would often pee her kennel at night or if we were gone for any length of time.

    We took her to the vet, and they ran a bunch of general blood tests, a urinalysis, and a urine culture. All of her findings came back pretty normal - her kidney levels were actually a bit lower than normal, but the vet didn't seemed concerned about any of it. There were a few crystals and a bit of bacteria in her urine, so they gave me Clavamox (an antibiotic) to clear that up. It seemed to help a little bit with the peeing, but she was still drinking a TON.

    A week later, we came home and let her out of her kennel to discover that her back legs were not functioning properly. The front half of her was bouncy and normal, but her back legs were floppy and would not support her weight. She was able to gain function back after several minutes and a bunch of water, but she remained very clumsy, tripping and listing a lot and not very steady on her feet.

    We took her to the vet again, and it didn't appear that her spine or legs were injured in any way. They did notice that she still had tapeworms (even though we've been giving her a monthly worming medicine, but apparently it doesn't treat tapeworms) so they gave me Droncit to give her.

    1 and a half days after giving her the Droncit (while she was still on the Clavamox) Pippa had some serious changes. She was obsessively pacing and couldn't stop. She wasn't eating or drinking (which is saying something considering how much she had been drinking lately), was stumbling around and was in a sort of trance, like she didn't see the world around her. I caught her a few times trying to wedge herself into tight places like behind the toilet, or under the bushes outside. She began peeing in the house without realizing it and later started panting for no reason as she wandered aimlessly in circles. So we brought her to the emergency vet.

    The people in the ER said she was in pretty dire shape and it appears that she had had a mini/partial seizure on the way to the hospital. She was whisked away and they began taking her vitals. The came back and said she was circling (or wandering/listing to the right which made her form circles) and that she was pressing her head agains the walls of her kennel. We had a consult with a neurologist who said they wanted to do a spinal tap to test for neurological infections and/or cancer and then a bile acids test to check her liver function. They narrowed it down to either something like a tumor or infection in her brain, or a liver shunt. They had to put her under anesthesia to do these tests and it took a LONG time for her to come out of it. Like 2-3 times longer than a normal dog and they weren't sure if she would wake up at all.

    Luckily she did wake up. We got the test results back this morning and they feel very strongly that it is a liver shunt - they are confirming it with an ultrasound as we speak. Essentially, they said that her liver has vessels that don't function properly and therefore don't extract protein and toxins from the food she eats and what her body produces, so these toxins get into her blood and go to her brain, which causes hepatic encephalopothy aka inflammation and the neurological symptoms/issues. It's very likely she's had this shunt from birth and her problems have only gotten worse because she is now bigger and has more to process in her body. Fortunately, we should be able to manage her condition with a low-protein/bland diet and a few different medications to help her body with getting rid of toxins and ensuring she doesn't have any more seizures. Surgery might also be an option later on if they decide her shunt is easily accessible/repairable. She will very likely have a few years shaved off her lifespan, but if we follow her new regiment strictly, she should be able to have great quality of life.

    Here is a link to the symptoms of this disease: http://www.petmd.com/dog/conditions/endocrine/c_dg_hepatic_encephalopathy. It is more common in puppies less than a year old. Pippa had the following symptoms, though there are others that could indicate a liver shunt:

    - excessive thirst
    - excessive urination
    - lethargy
    - compulsive pacing
    - circling
    - head pressing
    - trying to get into small spaces
    - lack of appetite
    - symptoms worse after eating
    - disorientation/confusion
    - muscle weakness/shaking
    - seizures
    - prolonged recovery from anesthesia
    - inability to process medications

    That all goes to say, I spent a TON of time searching the forum and the internet while we were still trying to figure out what was going on with Pippa, and I'm hoping that this information will be helpful if someone ever finds themselves in the same situation. I don't want any other puppies or humans to suffer because of this confusing disease!!
    Post edited by esoots at 2016-03-24 14:41:14
  • imBLASIANimBLASIAN
    Posts: 412
    Oh wow that is pretty intense, thanks for sharing and glad Pippa is making it out okay. How has the low protein diet working so far?
  • esootsesoots
    Posts: 12
    She's still in the hospital now (we brought her into the ER last night), so haven't been able to try out her new diet yet! Hopefully we get to bring her home tonight and go from there :/
  • niki82niki82
    Posts: 434
    Oh no. I am so sorry you and Pippa are going through all this. Poor puppy. I'm glad it sounds like she's going to be alright. Your a strong person by the sounds of it and obvisiously a loving puppy mum.
  • sunyatasunyata
    Posts: 8589
    :( I am so sorry that you are having to deal with this.

    Have you spoken with your breeder, as congenital liver shunts are thought to be genetic and it is recommended that the parents of the affected dogs be removed from the breeding population.
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • esootsesoots
    Posts: 12
    Sunyata, yes we've already emailed the breeder - good suggestion! We found out only through this problem and some deeper digging and research that this breeder isn't a good one, so I'm not surprised to have found out that she has this problem. I'm just glad we were able to save her and provide a loving and healthy home for her!
  • esootsesoots
    Posts: 12
    Thank you Niki - it's definitely been hard to be strong, but we managed to be brave for our little girl! It sucks that she's had to suffer so much and we are hoping that her new diet and meds will help her get back to normal!
  • LilikoiLilikoi
    Posts: 1272
    I'm very glad that you love your girl and are now aware that her breeder isn't reputable, but please don't look at it like you saved her... You are saving her, you are being a fantastic owner, I don't mean to cheapen that. But be aware that you supported a terrible practice and do what you can to keep others from going to the same breeder. What's done is done and you are taking care of your girl and providing her a great home, but phrasing it like you "saved" her encourages others who are searching for breeders to see it the same way. That breeder is making a living off of people that don't do enough research, he's ignoring health testing and not dedicated to the standards of the breed... He doesn't care if his dogs are healthy and taken care of, he breeds them constantly to make a happy buck. It's sad to think of what the parents have to be put through. I'm not trying to make you feel bad or anything, I understand you're now aware that he isn't a reputable breeder and you're doing everything you can to take care of and love your pup. But be careful about advocating "saving" a dog from a bad breeder; it only fuels their sick business.

    Anyway, sorry to hear about her health troubles. :( hope she continues to improve. Keep us posted with how her new diet and everything goes! This is a terrible situation but respectable that you are sharing it to try to help and prepare others who may experience the same thing.
    Post edited by Lilikoi at 2016-03-25 16:44:13
  • pyleapylea
    Posts: 235
    This is incredibly sad. Poor Pippa. Going through so much and only 10 months old! :'(

    I really hope the breeder takes some responsibility, stops breeding those particular parents, and pays your vet bills.
  • Lrose1990Lrose1990
    Posts: 80
    I'm sorry to hear you've gone through that! I know how scary shunts can be and it's absolutely devastating to hear your pup has a problem like that. *hugs*

  • esootsesoots
    Posts: 12
    Lilikoi, thank you for your comment! That's a good way of phrasing it - I guess I should have used better wording. All I meant was that I'm glad she ended up with us instead of a home that would have just put her to sleep when they found out she was sick - that we are able to work on making her better where some other owner might have given up on her. I definitely don't think that people should be trying to "save" puppies from bad breeders!
  • esootsesoots
    Posts: 12
    Pylea yeah it's super hard that she's going through this when she's only a baby! :( We've contacted the "breeder" several times and he hasn't responded, so I doubt that we will get any compensation from him, unfortunately :/
  • esootsesoots
    Posts: 12
    Lrose - shunts are seriously scary! I've shed a lot of tears this last week :( But it luckily she's taking to the new food and medications really well and she's more like her bouncy happy self again! Getting a check up in a week to see how she's doing and where to go from there. *hugs*
  • LilikoiLilikoi
    Posts: 1272
    @esoots - very true, I know so many people who would opt to put their pets down over paying for any medical needs. :( it is definitely good that she ended up in a home where she is valued and loved. Hope she continues to do well! Keep us posted on her check up! Poor baby puppy.
  • esootsesoots
    Posts: 12
    @Lilikoi thank you so much! We just had her 1 week recheck this morning and she is doing SO well! A total 180 from where she was last week - she's actually a normal bouncy puppy again! She will have to be on a combo of meds (4 different pills/liquids 5 times a day) and continue her special diet, but they are really pleased with her progress! So glad to have our girl back :)
  • niki82niki82
    Posts: 434
    Its great she is doing so well! Is the medication Pippa is on something she will take her whole life? How do you go about giving Pippa her meds?Am so happy for you and Pippa.

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