Xena was an eight-week old, four pound black schnauzer puppy, shivering
in a wee Pet Taxi as the baggage handler gently brought her into the terminal
from the plane coming from Houston to Minneapolis. I wrapped her in the
soft receiving blankets I had purchased for her and we made the 8 hour trip
back to Gladstone, in Michigan's Upper Peninsula.
She seemed a happy healthy puppy, except that she had no interest in food.
My local vet said to give her a couple days to adjust, but I could hardly entice
her to eat anything at all. She was sleeping 22 hours a day, and getting weaker
and weaker. Ten days after she arrived, she was still not eating, so my vet suggested
I bring her in on my way to work so all four of the vets could observe her for the day.
At 2:30 in the afternoon, Dr. Bunno called to say that Xena was not responding
and asked that I take her ASAP to the Fox Valley Veterinary Referral Center
in Appleton, WI - a two and a half hour trip. Xena went into a coma on the
way there. When we arrived, they whisked her away immediately. After what
seemed like hours, but actually was only a matter of minutes, my partner and
I were ushered into an examining room where the emergency vet told us that they suspected Xena had a liver shunt.
I had never heard of such a thing. What a nasty, nasty way to learn. She said
they wanted to do an ultrasound and a bile acid test as well as other blood tests
to be sure. She explained the differences between extrahepatic and intrahepatic shunts and the treatments for each. She said Ameroid constrictor surgery has a 95% success rate, with approximately 15% of dogs having post op complications such as acquired shunting. If I agreed to the diagnostic testing, it would cost approximately $1200. I signed the paper, with my head spinning and my heart breaking. The ultrasound was done the next day by Dr. Terri Cole, the board certified internist on staff.
An extrahepatic shunt was confirmed, with a petite liver. During a phone conference of over an hour with Dr. Cole, I decided to go ahead with the surgery. Approximate cost for the surgery alone - $3500. Xena's Hepatic Encephalopathy could not be stabilized before surgery, so that meant more chance for post op complications.
The ameroid constrictor was placed, but the veins to her liver were very small.
Dr. Tunneson, the board certified surgeon, did a liver biopsy that came back negative for MVD. Xena aspirated vomit into her sinus passages, which caused a nasty infection. She had to have three plasma transfusions, and was in critical condition for 48 hours after her surgery. The wonderful staff spent many hours on the phone with me, updating me and discussing treatment plans. When she was finally allowed to come home, at 3 pounds her backbone felt like it would cut through her skin if I touched her.
She was on 5 medications, and needed meds every two hours, round the clock. Her crate sat on the nightstand by my bed and I put a heating pad turned on low under it with 6 layers of receiving blanket on the floor of the crate to keep her from shivering at night. She still would not eat. In a frantic call to Dr. Cole, she gave me some suggestions of human food that I could try. Xena lived on baby rice cereal and vanilla yogurt for three weeks. Every three days, I offered her a bit of Hill's l/d on a spoon and every three days she turned her nose up at it. Then one day, she ate it, so I gave her more, and
she ate that! Soon she was eating strictly canned l/d, and getting stronger.
Her sinus infection cleared up, and she was off two of her meds. One month post surgery blood testing showed no improvement in liver function. Then her tummy started to bulge. It was Ascites, a sign of portal vascular hypertension, which causes acquired shunting. Diuretic medicine brought it down within a week. She was steadily gaining weight, and had lots of puppy energy. Three month post surgery bile acid test was only 4.5 points higher than normal post-prandial and within the normal range pre-prandial. Blood tests were all in the normal range except for a low protein count, which was most likely caused
by her low protein diet. Three and a half months post surgery, she weighed 12.5 lbs., was able to have her puppy shots with no reactions, went for her first walk out of the yard, went to the groomer and will be spayed at 6 ½ months old.
She knows sit, stay, lie down, shake hands, and has been housebroken since 4 ½ months old. She is alive and happy today thanks to the team effort of the wonderful staff at Escanaba Veterinary Clinic; Fox Valley Veterinary Referral Center in Appleton, WI; the friends, relatives and co-workers who prayed for her, and of course the Care Credit bank.
This is a very long narrative, I know, but if it gives hope to even one pet owner with a liver shunt furbaby, I've done well.
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