LIVING WITH LIVER SHUNT
Now, where does one begin. How does one explain the misery of seeing a dog that one loves desperately, suffer week after week, month after month for two and a half years. Two years of which he had myself and Vets from two practices completely baffled. From the start he was different from his litter mates. He did not play with the others, although his mum would try. He would also blunder into things, so much so that as a puppy we had his eyes checked. We now know that this is yet another symptom of Liver Shunt.
About three to four months of age he started having what can only be described as fits. As these usually happened every night around 2 in the morning, he always sleeps in my bedroom. He would wake barking at his rear end, race around, stopping at walls and cupboards and just bark at them. He is very hyperactive at these times. The far away look in his eyes makes it impossible to gain his visual attention in the hope of distracting him. In my boy's case he does not have many physical symptoms, they are almost all neurological. It was suggested to me at this time, by the breeder of my boy's dam that it could be a digestive disturbance and to change his time of feeding. The Vet said it could be but they had never experienced it in a dog before and still felt the cause of the pain was in his rear end.
When he was 18 months old we took him to our new vet as we had moved. He was diagnosed as having Hip Dysplasia and Castration was advised to calm him down a bit prior to hip surgery. Subsequently one hip was operated on. The fits continued, only since the castration they had become aggressive. He had an eye ulcer, so bad that his eye had to be stitched on three occasions. This was followed by severe vomiting, in retrospect it may well have been the anaesthetic that caused this. He became so ill we almost lost him. As the Vets were beginning to have doubts that all his problems were from his hips, he spent a week at the Vets, firstly to aid his recovery but also for observation, blood tests, etc. Because he had not eaten for 3 days all the blood tests came back clear. They therefore concluded, yes he was ill, but he was also a very clever dog who fooled them as they had never been fooled before, as they could not, with any certainty, define what was wrong with him. It was therefore decided to go ahead and operate on his other hip.
These aggressive fits are extremely disturbing to watch. He will absolutely savage anything that he can lay his teeth to in the immediate vicinity of his own body. He wouldn't for instance rush to attack anyone specifically, but if he cannot find anything to bite he will bite his own tail. He goes around in circles throwing his basket in the air, and nobody can get near him at these times. It is very distressing as there is nothing we can do to help him. These attacks occur mostly on waking, though many is the time I've been up with him in the middle of the night for 2 to 3 hours and he will only settle again if I am there. My other Shih Tzus all retire to a safe distance when he has one of his turns, they seem to sense something is wrong with him. He also has very depressive periods where he is his very quiet very sleepy and cuddly.
He was terrible after the second hip operation suffice to say I wouldn't want any dog to go through what he went through. We have since been told by Cambridge Veterinary College that anaesthetic is the worst thing for Liver Shunt and that we were lucky not to have lost him.
It was after the last hip operation that the breeder of my boy's dam rang and asked me to read an article about Liver Shunt in that week's Dog World. The symptoms described were very like those suffered by my boy. The edition was 3.4.92. The article was written by Frank Edwards. I rang my vet first thing the following morning and spoke to one of the senior partners who had not dealt with my boy's problems much up to this point, although he had seen him for the odd injection, etc. Fortunately he was prepared to listen to what I had to say and was very open minded. I do feel that a couple of the other vets were rather sceptical about my theories and I would urge anyone who feels that their dogs are displaying any of the symptoms that I have described, to ask their vet to do bile acid tests. My vet came out that morning and took blood for testing. He also witnessed one of my boy's aggressive attacks and at last I felt that someone could actually understand what he could be like. The test proved that with a high bile acid count Liver Shunt was a possibility. He therefore referred him to the Veterinary College at Cambridge University.
At the age of 2 years 6 months, my boy was diagnosed by Cambridge Veterinary College as having Liver Shunt. Basically this is a shunt or vein of blood that goes either through the liver (intra-hepatic) or around the liver (extra-hepatic) without being cleaned of ammonia and toxic waste. The symptoms can and do manifest themselves in many ways, both physically and neurologically, repeated vomiting & diarrhoea, etc. Cambridge said at the time of my consultation they had two dogs in that had been referred to them as having anaemia and hydrocephalus (water on the brain), both proved to have Liver Shunt as well. Cambridge also said there are far too many factors involved to be able to prove or disprove whether or not it is hereditary.
The symptoms I have described were apparently classic to Liver Shunt dogs. When they gave him a mild sedative prior to investigation x-rays and ultrasound it knocked him out completely for hours, they told me that it was a fraction of the amount usually given to a dog of his size and this was another symptom of a shunt. They felt he would benefit from surgery to close the shunt, as from the ultrasound, etc. they thought it was an extra-hepatic (around the liver). Sadly when they operated it proved to be an intra-hepatic shunt, complicated and inoperable.
The only option then was to put him on what is called medical management. He has antibiotics twice daily that are gut specific to try and control the bugs that cause ammonia. He is also on a very low protein diet. He has to have some protein but it must be of very high quality - chicken, fish, eggs and milk were suggested plus vegetables, pasta, cereals, fruit and potatoes for bulk. The vet also prescribed the Hill's science diet, either K/D or U/D.* I personally find that he is better on the Hill's diet because it is very well balanced with the essential nutrients, and the protein whilst being of very high quality, is very low. It is expensive, but the dried version works out considerably cheaper. My boy is 2 years 10 months now. He is very fit physically and is extremely enthusiastic at the prospect of, and during, exercise, including long walks every day. However, how long we shall have him for I don't know he could live a full life span or he could have some complication. We do our very best for him and love him dearly. We are lucky not to have a young child in the house because of his aggressive turns, we couldn't take the risk. Obviously if we thought he was suffering in any way we would have him put to sleep. The fits still occur daily, although Cambridge have assured us that he is unaware that he is having these attacks. They have also told us that he is mentally retarded due to his condition. He is an extremely lovable little dog and as long as he can cope with it, we can. I must say to any of you that have a dog with any form of strange behaviour, please see your vet about this and have tests done. According to Cambridge a dog can be born with Liver Shunt. It can also acquire it in later life, e.g. a placid dog that suddenly becomes aggressive could well have acquired a Liver Shunt. In fact they said that whatever a dog is referred to them for, they now always test for shunt. It is quite common to them and the symptoms are so varied, some never showing aggressive tendencies, but they can be physically ill and just not thrive very well. Young vets do seem completely aware of the problem, whereas the older vets seem to be more vague; this point being borne out by other people's experiences of talking to their vets. It does make one wonder how many dogs have died or been put to sleep because of bad temperament, actually suffered from a shunt. This article is not meant in any way to criticise, everyone did their best for my dog. Hopefully it will make people more aware of this problem and save them having to go through the experience that we and our dog have had to endure. This problem is right across the board, in all breeds. big and small. I know of a Pomeranian and a Great Dane; and a lady was put in touch with me who had a Maltese with shunt.
Update , The author of this article tells me that the dog in question lived, medically managed, until 2001 when he died aged 11.
*LD, Hills now produce a diet specifically for dogs with Liver problems, Hills LD