Having a liver shunt dog: And so the story begins.
You bring the most adorable golden retriever puppy you have ever seen home - You take all the necessary precautions, the shots, comfortable home, toys and something is nagging at your heart. You know something's wrong with your puppy. He sometimes vomits and then spends the next day getting over that event then in 3 or 4 more weeks, it happens again. You check the back yard what's he eating that he shouldn't be?
Monthly trips to the vet's office begin. It's hard to describe what's going on but there's that same tug at your heart something's wrong, but you can't figure out what it is. Is he going to be ok today or will he vomit again? Why doesn't he have any energy (like the other three golden's you've had who all lived to be over 12 years old). You're always "negotiating" with yourself - Maybe he's just the sweetest, quietest puppy you've ever seen Then the 9th month begins and you begin to plan for neutering. The pre-blood anesthesia test shows high liver enzymes. Not to worry though, maybe it's gotten cold waiting for a pick-up - maybe that's why it's abnormal.
Brinkley tolerates the surgery and anesthesia Your vet says that everything went surgically well, "but there is something wrong with this puppy - I can't put my fingers on it". (At the same time of the neuter, you find out that the puppy has an umbilical hernia and is cryptorchid so that is all surgical fixed). You have this wonderful little soul your new addition to your family. How can anything be wrong with this special "fur-baby"? You try to push all the comments aside and the nagging is still in your heart. There's a complication to the neutering and your rush the puppy back in he has a hematoma but the vet thinks he's re-herniated so he fixes your pup and you go home with a statement "let's redo the enzymes in a month". Also, he hand's you an article about "liver shunts" but you have a conversation and find out that in his 25 years of being a vet, he's never seen one in a golden or bigger dog they're usually always in small dogs. You read the text and it scares you soooo much - this couldn't be happening to my pup .
One month later - the liver enzymes are still high. You start to tell yourself - "Maybe my puppy just has different numbers for his body" Could this be the case you ask? The answer is no. Maybe it's his thyroid. So TSH lab tests are ordered early - they are slightly outside of the normal limits you feel comforted this is something than can easily be fixed it just takes a "synthetic" daily pill.
Again, there's intermittent vomiting and a day after to recuperate is this normal? And then he occasionally "wakes up during the middle of the night" and can't get comfortable he's constantly moving, thrashing, climbing up on your head - What is that all about?
The monthly blood work continues - you dread the "test results" phone call. After 5 months, something should have worked it hasn't. Then there's the comment when you're walking your dog "why is he so thin?" and "have you have any blood testing done he doesn't look healthy". Oh, also you must have gone thru 10 different types of dog food why won't he eat?
Brinkley then starts to hold himself differently (he's hunched in the back). At the same time, during his few "normal" mischievous days, he decides to eat a pillow and quilt sham. I walked into the bedroom with "thousands" of goose feathers flying around me.
An exploratory surgery is performed in May a portion of his liver removed it is bizarre looking and is the color of "cauliflower". Both the piece of liver and his stomach are sent out for biopsy. The results: "undetermined what happened to the liver probable cause physical trauma. (He may have been dropped and kicked just after being born). Prognosis Good, as long as it was adequately excised). So for the first time in this puppy's life - We get a call from our vet everything is looking up Brinkley should now have a normal life but "let's recheck his blood in one month".
Next month: All liver enzymes are still abnormal. New diagnoses are considered - Could it be Addison's Disease? A prednisone shot is administered and you're told that if this is the right diagnosis, you will see your pup jump back to normal within a matter of hours. It doesn't happen you do see something different (better) within 48 hours the blood test comes back at the same time it's not Addisons.
You keep going for 3 more months hoping and "praying" there will be normal acceptable liver enzymes from blood tests That just isn't happening. I start jogging in the morning (I'm not a jogger at all but I'm out there seeing if Brinkley has any energy .) Then there are friends and family members who occasionally see Brinkley and think he's just a sweet, quiet, smaller golden retriever - and you begin to think it's you but still the nagging feeling never goes away .One morning, Brinkley isn't sleeping on the bed when you wake up You find him downstairs on the couch looking like he's dead with bile surrounding him. That was our "worst day" up to one month ago. Brinkley did a 12 hour fast given a pre and post bile acid test the results are "off" the charts reference range is less than 10 on pre Brinkley's was 283 and post -normal is less than 20 - Brinkley is 454. We're scheduled within 48 hours to see a board certified radiologist for a Doppler ultrasound. Yep, he's 95% sure it's an intrahepatic liver shunt on the right side, but he can't totally identify it it's just too deep and in a hard place to get to. We're told that surgical intervention is the only way to give Brinkley a chance for a normal life. Special equipment is mandatory it's not an easy surgery and "you need to go to a veterinary teaching hospital" Tufts in Boston is the closest. So, Tufts is called the next available is September 23rd (it's now August 18th)
Then the nightmare begins on reading about liver shunts While extrahepatic shunts (outside the liver) can sometimes be hard to correct, intrahepatic ones (inside the liver) are harder. Mortality rates for Brinkley's surgery - anywhere from 10-70% depending on what you're reading - and - if he makes it, he will need to be in ICU for at least 4 days and monitored for portal hypertension. If that develops, whatever type of closure they placed in him to close down the shunt - would have to be removed and without surgical intervention, Brinkley would probably only have between 2-10 months before he will die ..
Then the miracles begin. I'm on the computer researching until 2 am for a couple of nights. (To this day, I don't know how I found it, but there's a different approach a veterinarian at UPenn, Dr. Chick Weisse, perfected a non-invasive radiology technique "Percutaneous Transjugular Coil Embolization". The mortality rate is less than 5%. Only two places in the country perform it University of Pennsylvania and the University of Michigan (Michigan is on the list because one of their Attendings, Dr. Matthew Beal, did a fellowship under Dr. Weisse). Copies of everything I could find on PCTE was given to our local vet is Brinkley a candidate? Yes!! In the meantime, we need to get him "as medically managed as possible". He is started on lactulose, metronidazole (he's already on Clavamox) and a low residue dog food. Our local vet calls UPenn Dr. Weisse is away, but an appointment is made for September 10th at 11:00 am. When he returns, Dr. Weisse calls. "It's a long ride from Connecticut to Pennsylvania is Brinkley as medically managed as possible"? My answer: Yes, although I was feeding him more, he wasn't gaining weight (still 50 lbs), he wasn't experiencing seizures and his HE was the best it was going to be. So, we keep our appointment for September 10th.
About the same time that I found UPenn Information, I found this liver support group and again I don't know how that happened either. At first, I posted privately to Maria Lelinho, the owner of the group - I have never belonged to a group and just didn't know what to say. She is an "angel" and encouraged me to keep going to get to UPenn ASAP. I started to ask questions, especially on the lactulose here I was trying to get him as "medically managed" as I possibly and I kept on giving him too much lactulose and with it - diaarhea. This group put me on the right path for proper dosage, etc. And on the days before our visit, there were so many wonderful e-mails, telling us that Brinkley was in their prayers and for everyone on the "List" to keep good thoughts coming his way.
On Sept 10th, Dr. Weisse's associate, Dr. Allyson Berent, arrived in the waiting room, took one look at Brinkley and says "there's my liver shunt golden". In the exam room, every intern, resident and nurse who walked in had the same comment Yep, he has a liver shunt - How did they know? "Liver shunt" dogs have a certain look in their face!!!! Dr. Berent began reviewing Brinkley's long medical record - Yes, he had a "classic" background for an intrahepatic shunt in addition to the look on his "face", he was cryptorchid, failure to grow, didn't like food, had exploratory surgery because they all eat something strange, had ulcers and all 15 times of drawing blood, his liver enzymes were high, his cholesterol and albumin always low!! She drew diagrams, answered questions, gave Brinkley lots of kisses, watched over him like a hawk John and I knew that we had found the best "doctor in every way" for Brinkley she was and is phenomenal".
By the end of the day, we were told he was a candidate for the PCTE procedure it was scheduled for September 11th and should take about 50 minutes without Brinkley even being aware that anything happened. Dr. Berent called after the procedure - out of 85 dogs, Brinkley was the hardest instead of 50 minutes he took 3 ½ hours and instead of 3 coils placed, he had 7. The good news -they could tell his own liver started to immediately accept some blood during the procedure and they very rarely see this.
On Friday night, we went to bed early to leave at 4:00 am for the 5 hour trip to get Brinkley in Pennsylvania. At 9:30 pm the phone rang it was Dr. Berent - there's been a complication Brinkley had a grand mal seizure he's unconscious and in ICU That nightmare went on for 5 days. Two calls per day from the ICU veterinarians and at least two calls per day from Dr. Berent (who had to travel to another state to lecture). Drs. Berent and Weisse kept telling us to "hang in there he's a liver shunt dog he can make it thru this". He had to have an induced coma and in doing so, he was given a "huge" amount of medicine we need to give him time to "wake up". Thru this whole ordeal At the same time, the ICU veterinarians were telling us that our dog was beautiful but he's critical and may not make it. I can't write yet about this period it's too painful.
On Wednesday, September 17th John took some time off. To put it mildly, I did not do well emotionally thru these 5 days. I remember walking in a store that afternoon and I literally couldn't remember what I was looking for totally opposite from how my brain usually works. When returning, I "rushed" as always to the answering machine and heard Kim, the nurse telling me she had sat with Brinkley that afternoon and he "stretched" which was a good sign. Five minutes later, Dr. Berent called - I start to tell her about stretching and she said to "sit down" Brinkley is awake and eating!!. He's not out the woods, but he woke up!!!
Saturday the 19th We're still getting "good" calls from Drs. Berent that he's making slow and steady progress and still receiving the "bad and guarded" ones from ICU He can't walk he can't see he needs an extreme amount of nursing care will we be able to take care of him?? That's it! We need to see Brinkley! Took the 5 hour trip stayed 90 minutes and came home. What did we find? A miracle! Brinkley knew us and tried so hard to get out of his pen to be with us. The people in ICU didn't know what was going on. He was talking so loudly to us, they thought he needed to go to the bathroom he didn't he was telling us that he knew we were there and we knew he was neurologically there!!
Monday the 21st: Drs. Berent and Weisse returned, examined Brinkley and wanted to get him home with us ASAP. We met at 4pm. Brinkley was pretty anxious and moaning and groaning. He came down on a gurney because he couldn't walk. I asked Dr. Berent if this was our new "neurological dog". She said she didn't think so that he had to go to the bathroom! And she was right. While she taught me how to administer seven different meds, John, Brinkley and Kim went to a grassy area where he pooped and "walked"!!! As. Dr. Berent told me "Could I guarantee you that he'll walk again? No. BUT HE DID! Can I guarantee you that he'll see? No, but I think he will"!! Her last words prior to our leaving PA I couldn't guarantee you that he would wake up either but he did!! On our way home, we stopped 4 times and at each stop he walked not a lot of steps but he walked!
Skip to Today, October 21st. Brinkley takes least 3 -20 minute walks/day. When he taught himself to "walk again", his back legs are not yet strong enough to support his body the way it needs to, so he is going to rehab once a week for the next month. He's up to walking on the treadmill in water for Ό mile and is beginning to swim. He LOVES TO EAT and has between 4-6 cans of dog food a day and weighs 56 lbs. (When we left UPenn, he was about 45 lbs). His personality is a sweet as ever. One week home, he started giving kisses again. He no longer pulls his head away when touched and has stopped having "anxious attacks". Both the vet at rehab as well as our own local one, believe he may be seeing something, maybe just a dark shadow, as he hardly ever walks into anything in his way. John and I are not sure yet but we're sure praying for another miracle!!! He knows the entire house and has even mastered going up and downstairs. His best friend "Mr. Moose", a gift from Dr. Berent and Kim from UPenn never leaves him. He's even starting to go into his own toy box .
Brinkley is still on a lot of meds he's being slowly weaned off of anti-seizure medicine that Dr. Berent feels may be hindering his neurological recovery. It's a delicate balance Brinkley's body has been thru so much, she doesn't want him to risk another seizure. I'll finish this story, hopefully with another miracle that Brinkley's eyesight has come back.
In the meantime, Dr. Berent was anxious for Brinkley's one month blood test post his procedure. We received them today. For the first time in his life, his liver enzymes are normal!!! As Dr. Berent wrote in Brinkleys discharge summary Hes a ROCK STAR recovering slowly but surely
For anyone reading this, please know one thing about the "bad days". This list "kept us going". There were frequent "just checking in on you e-mails and telephone calls" and there are still two e-mails posted on our refrigerator with the following BIG, BOLD WORDS: HOPE, PATIENCE, CONFIDENCE, and DON'T GIVE UP!! - Here, we had only been on this list for a very short time and these wonderful people are constantly trying to "hold me up" and when I was giving up emotionally, they didn't let me!!! John "always knew" that Brinkley would make it just like Dr. Berent did. But I almost "let go" If it wasn't for this group, I would have lost it. I hope this conveys what this liver group is all about. Never ever give up Miracles DO happen with these "Liver Dogs"!
Wish there was a word to use to indicate how grateful we are all we can say is our heartfelt "Thank you" for praying for the miracle we received!!!!
Fondly, Kathy, John and Brinkley (Our "Rockstar") Hangen
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