I cannot tell the story of Aahchoo, until I tell a little bit about "Willie" and "Olivia." When Michael and I first met, he would always say he was not a "small dog" person and that he could never see himself with a small dog. Shortly after we began dating, Willie, my first Yorkie, passed away at age 12. While Michael was kind to Olivia, he didn’t want to get "too close". (Remember, he wasn’t a small dog person.) When Olivia and I came to live with Michael, he promptly changed her name to "Cheeseburger." Michael fell in love (she became his little napping buddy) and he would come home everyday at lunch just to spend time with her.  It's a puppy love story really!

Cheeseburger lived with both Michael and I for the last 3 years of her life and we lost her at age 14.5 - after two surgeries for Cancer, which extended her life about a year - a good quality life.  We took her camping at the lake. She went everywhere with us. When Michael and I knew we needed to, we had our vet come to the house and help her cross over the Rainbow Bridge. Michael's heart was broken when we had to do that – mine was as well.  He built a coffin for her himself, and we drove to Greers Ferry, where she is buried on our lot by the lake.  He has since built a little rock garden there, with a small bench to sit and think about Cheeseburger.  I think he is a small dog person now.

For several months, after losing Cheeseburger, Michael would not even discuss getting another dog. We had Bailey, who is our Chow Mix that we found abandoned on a busy highway when she was about 18 months old. (She is now 12 years old.) He had given so much of his heart to Cheeseburger that he could not bear the thought of getting another Yorkie. After a few months, I began "quietly" looking for a Yorkie puppy. I located a breeder halfway across the state and talked with her several times by phone about her new litter of puppies. One Saturday morning, when the litter was ten weeks old, I decided that I couldn’t wait any longer. I told Michael that I just had to go "look" at these puppies. I jumped in the car and headed off for the 3 hour drive.

I fell in love with her the moment I saw her. Of course, she had to come home with me. I called Michael and told him I was bringing our new baby home. As soon as Michael saw her, he had the biggest smile on his face. He said he was going to name her "Aahchoo," because when people sneezed everyone always said "God Bless You" and she was going to need a lot of blessings.

Aahchoo was a normal, energetic puppy; who grew into adulthood. She was never sick.

One Saturday morning, something seemed terribly wrong with Aahchoo. She was pacing close to the walls, staring into space, and drooling. At one point she began walking into the wall and would keep walking. Michael and I were scared to death. When she began to throw up, we immediately took her to our vet, who asked us if there was a possibility that she had gotten into some type of poison. Michael remembered that he had sprinkled rose food in the back yard the day before, so he assumed that’s what was wrong with her. The vet gave her something for nausea, as well as Valium and drew some blood. We left Aahchoo with him for a few hours for observation, but picked her up later that afternoon.

When we got her home, she wouldn’t eat and continued to exhibit the same symptoms that warranted the visit to the vet. She was exhausted, but wouldn’t stop pacing. She kept going behind the television and Michael was afraid that she was going to hurt herself. He set up barricades all over the house, to keep her from being able to jump on things or crawl behind things. On Saturday night, Michael made a bed for himself on the living room floor and tried to get Aahchoo to come lay down. She paced and paced, but finally became so exhausted that she passed out about 4:30 a.m. When she woke up she just seemed really tired, but she was alert and knew us. Her symptoms started again, however, shortly after waking up. All day Sunday and Sunday night there was more of the same. On Sunday evening, her muscles went completely limp – like the life had gone out of her.

We continued to give her the Valium (which I now know should not have been prescribed). For about 5 days she did well and then the pacing and other symptoms began again. We called Dr. M, who suggested that we do a bile acids test. He told us that Aahchoo’s first blood panel indicated some trouble with her liver function. The following morning, we brought her for bile acids testing. I stayed home from work to be with her. We got the bile acid results the following day. They were Pre: 185 and Post: 212. Our vet thought that a liver shunt might be indicated, but he admitted that he didn’t have any experience in this area. I had no idea what he was talking about. He called and got us an appointment with a veterinary hospital across town that also had a surgeon on staff. He thought they could do an Ultrasound to possibly confirm the shunt. He also prescribed Clavamox for her.

I took Aahchoo to the veterinary hospital across town that afternoon and met with one of the vets. Looking at Aahchoo’s bile acid numbers and seeing how severe her neurological symptoms were, she told me that the ultrasound would most likely not help diagnose the shunt. She suggested that surgery was probably in order and that this was a very serious condition. She told me that she would, in all probability, die without the surgery. My heart almost stopped beating. I couldn’t stop shaking. I thought I was going to lose my precious baby. When I calmed down a little, we set April 13, 2006, as the date for surgery. She gave me a prescription for Neomycin Sulfate and Lactulose and advised me to start her on Hill’s K/D. I didn’t ask any questions, because I didn’t know what to ask. It was several minutes before I was able to get back into the car with Aahchoo to drive home.

That evening I started searching the Internet for information on Liver Shunt, and by some miracle, I found my way to the Liver Shunt and MVD Support Group and was invited to join. Several members of the group immediately started answering my questions and providing support. Within the first few hours, I began to have a little hope that Aahchoo could be well again, however, her symptoms were so severe that it was easy to think I would lose her soon. Reading posts from the Liver Shunt and MVD Support Group; coupled with the fact that Aahchoo showed immediate improvement with the change of diet, Lactulose and the antibiotics, gave me reason to believe there was a chance for her to be okay.

When I let the group know that I had scheduled the surgery, they provided me with pertinent questions to ask. The first question was: Is the surgeon board certified? The second one was: Does the surgeon use an Ameroid Constrictor Ring? The answer to both of those questions provided critical information for me. When I called the vet’s office, I was told that Dr. N was a board certified neurologist. When I asked if he used the Ameriod Constrictor Ring, the vet I had spoken with said, "No, Dr. N is old-fashioned and he believes in doing it the old-fashioned way. He uses the suture method." I thanked her for the information and informed her that I was going to locate a board-certified surgeon that would be using the ACR. That, I was told, would allow Aahchoo the best chance of survival and ultimately a normal life.

Upon contacting my regular vet, I was given the name of a board certified surgeon that was supposed to be very good and he came to Little Rock twice a month. I called his office and gave my information to his staff. They listened closely to everything that was going on with Aahchoo and asked me to fax the results of the full blood panel. Dr. D called me back within the hour. He was compassionate and very thorough. He said that her bile acid numbers, in addition to her low BUN indicated a probable shunt. He explained that he had done many surgeries of this type and had a high rate of success. He also advised me to stop giving her the Valium immediately. After talking for quite a while, we scheduled the surgery for April 17, 2006. Immediately after the conversation was over, I felt that I was now in good hands. Both Dr. D and my regular vet let me know that they would be available if I needed them prior to the surgery.

On April 17, 2006, we took Aahchoo in for surgery. We met with Dr. D for a consultation beforehand. I asked him about doing a liver biopsy. His feeling was that if microvascular dysplasia was suspected, he would biopsy the liver to confirm. He did not like to do biopsies of the liver, if this was not suspected, because their livers were already so small. During Aahchoo’s surgery, he did not feel a biopsy was warranted, so it was not done. At the time, I didn’t know that I needed to push harder for the liver biopsy. That is really my only regret.

Dr. D found one large extrahepatic shunt that he repaired, using an Ameroid Constrictor Ring. He informed us that the ACR would gradually close the shunt over a period of a few weeks. We had to leave her overnight, which was really hard. He assured us that she would sleep off and on after the surgery and that she would be fine, but when we arrived at the clinic we could hear her crying.  The vet assistant said she had been crying most of the night.  It wasn't a "pain" cry - more like she was scared or anxious.  (She had never been away from us overnight.) I was surprised to see that she was very aware of her surroundings and she stopped crying the minute she saw Michael and I.  In case you haven't guessed, Aahchoo is pretty spoiled.  She slept in Michael's arms (and a big cozy blanket) on the way home.  When we got her home, we made a big bed on the floor and that's where we stayed with her.  She slept as long as one of us was right there with her, but if we had to get up for anything, she tried to follow us.  She wanted one of us right with her at all times. 

On April 19th, I took Aahchoo back to my regular vet, because she had not had a bowel movement since the surgery. Dr. M prescribed suppositories, which I gave her on the 19th and 20th. On the Friday morning (21st) following surgery Aahchoo yelped in pain, so I took her back to Dr. M. At this point she had still not had a bowel movement. Since Aahchoo was whimpering, Dr. M dispensed additional pain medication. He also noted a bit of abdominal distention.

Michael slept on the floor in the living room with her for almost three weeks, so she wouldn’t try to jump with her stitches. He even stayed home, while I went to a school law conference in Orlando. He had purchased his plane ticket several months in advance to be able to travel with me, but neither of us could bear the thought of both of us being away from her. Michael placed big pillows on the couch and loveseat to keep her from jumping on them and he locked her out of the bedroom during the day for the same reason.  Within a few days she was full of energy but we tried to discourage most activity.  She grew more and more spoiled, (but I think that was probably Michael's fault).

Early on, Aahchoo’s food was switched to L/D and she continued on the Lactulose. On May 31, 2006, we did our first bile acids test post surgery.  The results were: Pre-16 & Post-76-quite a bit of improvement I thought.  On July 25, 2006, another bile acids test was done.  The results were:  Pre-62 & Post-61.  I thought these were kind of strange and the results might be unreliable, but there they were. 

On February 10, 2007, we did another bile acids test.  Aahchoo's results were:  Pre-30 & Post-78.  When Dr. M called me with the results of this last bile acids test, he said these may be the best these numbers we are going to get.  I do understand that is a good possibility.  But he also said that he thought we needed to (over about a week's time) switch Aahchoo's food back to the regular Science Diet (or in Aahchoo's case the Light because she had put on almost 2 pounds since going on the L/D), keep her on the Lactulose and do another bile acids test in about 8 weeks to see how the return to regular food affected the results.

At that time, I chose to keep Aahchoo on the canned L/D, and currently mix the L/D with some of the dry Royal Canin Hepatic LS. She gets steamed carrots and an occasional Yogurt Drop for treats. She also continues to be given Lactulose, as well as Denamarin. I am in the process of researching whether or not I should change or add to the supplements she is currently on, but I have to say that I am extremely happy with how she is doing. She is happy (although a little more anxious, since the H.E. symptoms first appeared). She spends large amounts of time playing with her little sister, Katy Bug, and bugging her big sister, Bailey.

Aahchoo is now a happy healthy girl, who just turned five years old. Although her bile acid numbers have not returned to normal, they dropped significantly, and she is doing well on her current regimen.

I have to say that I am so grateful to the moderators and members of the Liver Shunt and MVD Support Group. After finding this group, we didn’t feel so alone anymore. The knowledge they shared with me along the way and the support they provided for Michael and I has meant the world to both of us. I truly feel that Aahchoo might not be with us today, without the assistance of this group. When I have submitted questions to the group, there has not been one instance in which they failed to provide either practical information, current research, or both. Michael and I want to thank you from the bottom of our hearts.


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