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Monthly Archives: January 2009

Ok – I finally have a moment to post a photo of the water-loving Havanese, “Mac”. He’s vacationing in Florida with his people-parents, who took him boating.

Mom, Dad, this is THE BEST!

Mom, Dad, THIS IS THE BEST!

It’s amazing to see how much Mac enjoys life, even when his symptoms are troubling, like the head tremors he has been experiencing on and off for the last several weeks. Every time I see a photo of Mac living life to the fullest in spite of his health issues, I know that I want to be more like him.

Bonnie says that until recently, the longest head tremor lasted about two minutes (about a week and a half ago). She describes them as a “light head movement, back and forth, back and forth.”

Then after a several tremor-free days, he had a longer lasting episode on Wednesday, January 21. Bonnie said it happened “on and off” (9-10 seconds on, 4-5 seconds off) for about four minutes. I know she’s frustrated because she has tirelessly explored the causes with numerous vets, hospitals, testing, and spent as much time managing his various chronic health issues with special diets, supplements, medication and care.

He recently saw a Holistic Vet and I think he’s getting acupuncture. Bonnie may also be taking him to a neurologist. She’s been an active presence on the Dog Liver Disease (DLD) Yahoo Group, so I know the great care he is getting from Mom.

Like other dogs with chronic health issues and special needs, the best care and vigilance cannot provide a cure or even a symptom-free life, but it can greatly improve the dog’s quality of life and often extends his lifespan many times over.

Mac is living proof of a well-managed special needs dog who continues to live and love with enthusiasm.

(Mac the water and fun-loving Havanese, diagnosed Sept 2007 with MVD, Microvascular Dysplasia, and Severe Fibrosis. Born 12-16-05)

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PREFACE
This story is a bit long, but it’s one worth telling. It’s a story of the gift of life, made possible by loving commitment and determination. In the case of dogs, the rewards are almost always worth it and then some!

Sheree is an active member of the Dog Liver Disease (DLD) Yahoo Group, who shares her liver disease experiences and advice freely and generously. She has two Yorkies, both with liver shunts, who are now “alive and well and living in the suburbs”.

[Update 5/30/14]: She is now a moderator on this group, and has been for a while now. The group name is now the Dog Liver Shunt and Disease (DLSD) group: http://pets.groups.yahoo.com/group/DogLiverShuntandDisease/

The stories below are told by Sheree with minimal editing by me.

FIRST THERE WAS GABBY
She came into our lives as a puppy full of health and energy. At about four months of age, she started having bouts of vomiting and stomach pain. Poor little Gabby would roll around and cry, or would vomit so much in a short time that she appeared lifeless.

Miss Pet Appeal 2001 (Gabby the playful puppy)

Miss Pet Appeal 2001 (Gabby the playful puppy)

This is a frequent pose of Gabby’s to this day,  especially when she’s asking to play! Little did we know at this time that she would become so sick.  She was always such a sweet dog.

Misdiagnosis after misdiagnosis, vet after vet, the problems kept resurfacing every few weeks. We finally thought she would have some stability after she was diagnosed with IBD (Irritable Bowel Disease) and put on special canned food, but when we took her to Florida with us, she became very sick towards the end of the two-week stay.

One night she vomited over and over in the middle of the night while we were in an unfamiliar place. We found an animal emergency room open and took her in. They gave her some fluids and we left with her about an hour later, but she got sick again almost as soon as we were back in bed.

By that time, it was almost morning, so we found a vet hospital nearby where they immediately put her on an IV and gave her medication to alleviate her symptoms. We left her there to have blood work done and fluids replenished.

When we returned, the vet told us Gabby might have a liver shunt based on her blood work, symptoms and history. That was the first time we’d heard the words “Liver Shunt”!

When we got back to Michigan, I made it my mission to get to the bottom of Gabby’s health issues once and for all. I researched liver shunts online, resulting in my taking Gabby to the MSU veterinary teaching hospital. There she had the amroid constrictor ring put on in 2003. She was two years old.

One year later, she was sick again! We took her back to MSU. She had blown another shunt! They performed the surgery to close off the shunt, and we came home with a “guarded” prognosis. Little did I know that blowing new shunts, could and would continue to happen. At the time I was not aware of the medical management and supplements that I now know about from the DLD group.

I found the Liver Shunt group in August 2007 and started Gabby on the recommended supplements and proper food and diet. Thanks to the DLD group and especially Olga’s (the founder and head moderator) support and advice, Gabby has been enjoying the best health since her symptoms began. I only wish I had known about the group when Gabby was first sick and diagnosed. The support and information would have provided us with much needed help and saved us from a lot of extra time and grief.

Gabby is now 8-years old and as loved as she is spoiled (in the best way possible of course).

THEN THERE WAS HARLEY
Harley was a 3-year old Yorkie rescue from Illinois that needed liver shunt surgery. He was very sick and had severe aggression issues, which is  a common symptom of Hepatic Encephalopathy (HE). Harley was transported to Michigan where Olga fostered him until he was stable enough to have the liver shunt surgery and amroid constrictor ring put on in November 2007. He did well after the surgery, eating the prescribed low protein RCH (Royal Canin Hepatic) kibble, taking antibiotics and a number of supplements.

When I first saw pictures of Harley, known as “Charlie” at the time, I fell in love with him. There was something about his eyes that haunted me. I couldn’t stop thinking about him and convinced my husband to consider him for adoption. After all, we were already familiar with LS and the related issues, and this little guy needed a forever home where he could get the love and care he needed and deserved.

We took Gabby with us to meet Harley and Olga for the first time at a nearby park. All went well and my husband not only agreed to adopt him, but he has been as committed to making Harley a part of our family as I was! He even considers Harley “his” dog.

When Harley came to live with us at the beginning of May 2008, boy was he a challenge! He was a sweet dog much of the time but could turn aggressive (“turn Cujo” as we would say) in a heartbeat. I knew Olga had said he was aggressive and that he had bitten her on several occasions, but I was not prepared for anything like this! After months of patience, work and several pretty bad dog bites, I am pleased to say that Harley has turned out to be one great little dog! It has taken persistence and love, but he now completely trusts us and I believe he knows we love him and that he is in his forever home.

I recently sent Harley’s first foster mom in Illinois some pictures of him, and let her know how great he’s been doing. His pictures and update are now on the “Pet Wall” at PETCO where she works. Needless to say, she was thrilled to hear about Harley.

Gabby, however, wasn’t so sure about Harley in the beginning, especially when he had aggression episodes.

Gabby (front) and Harley (top) Sunning

Gabby (front) and Harley (top) Sunning

They co-exist quite well now. In fact, I think having Harley with us has made Gabby more confident and comfortable around other dogs. She has also benefited from the additional supplements that Harley was taking as they’ve been added to her diet as well. They are getting closer together, but slowly, an inch at a time.

See "the gap"

See “the 3-inch gap”

Having two LS Yorkies is a challenge and comes with added responsibility and expense, but the unconditional love Gabby and Harley give us is amazing and I wouldn’t trade it for anything in the world. Gabby is my little heart-and-soul dog. We’ve been through so much together. And Harley’s story and transformation is amazing because it is a story of many caring people coming together to give a sick dog a chance at a good life.

Face-to-Face, almost touching

Face-to-Face, almost touching

Look at him now! This photos shows him checking out Gabby, who loves to float on “her” raft in the pool.


Hepatic Encephalopathy, or “HE” is most simply described as brain disorders due to liver disease. I posted more info on HE a couple posts down.

HE symptoms can include shaking after a meal, aggression, glassy eyes and lethargy. The reason such neurological symptoms are expressed by dogs with liver disease is because damaged livers cannot efficiently clear the blood of toxins or proteins. When toxins remaining in the bloodstream travel to the brain, they cause the neurological symptoms.

A restricted low protein diet reduces the amount of protein in the blood and thus reduces the load on the liver. If the damaged liver can handle the reduced load, then the blood can stay relatively toxin free so that HE symptoms will be less likely to develop. Efforts to manage the liver disease condition and symptoms can make all the difference in a dog’s quality of life as well as his or her lifespan, but even the best efforts will not provide a cure or a symptom-free life.

Understandably, dogs on such restricted diets are often hungry. Some people supplement their dogs’ meals with natural pumpkin, which is low in protein and may help the dog feel more full. White potato soaked in water to remove potassium and phosphates, then boiled in new water and cooled was another recommended food by members of the Dog Liver Disease (DLD)** group.

[Update 5/30/14]: Now called the DLSD (Dog Liver Shunt and Disease) group. Yahoo group URL is now:

http://pets.groups.yahoo.com/group/DogLiverShuntandDisease/


Dixie Belle was a beloved Bichon Frise who was as much part of her family as any other member. She was also the constant and loyal companion of my friend Mary Beth. I always smiled when I saw the two of them walking briskly all over our little town in Colorado, which was pretty much every day.

Here is a lovely portrait of Mary Beth and Dixie:

mb-and-dixie

Although Dixie was very sick in her last months, she was gracious and loving to the end. I present Mary Beth’s words here, minimally edited, which give us a poignant and touching remembrance of Dixie Belle:

    I could write tomes about how special Dixie was to us, how she changed our lives for the better, how she saved us from petty arguments by just running into the room at the right time, and how she sat next to me with her head in my lap when she knew I was lonely.

    I spent much more time with Dixie than I did with Wayne in the 12 years we had her. When he was in New Orleans for 2-1/2 years, she was pretty much all I had. As you know so well, these wonderful little four-footed hairy people bring joy to us in a way that only they can do. They don’t judge, pout, or talk back. They just want our love, and even when they don’t get it, they continue to be loyal and devoted.

    Dixie had what the doctor believed to be a cancerous tumor(s) on her spleen. He said surgery would not return her to her normal life though it might extend it. We opted to not put her through it.

    She suffered her first episode in October 2008. Internal bleeding resulted in a blood count of 45. The normal range for dogs is 200-500, I think. Amazingly, she recovered, and seemed to have completely regained her energy and personality.

    Then on Thanksgiving, during her late night trip outside, her gums turned gray and she collapsed in the snow. We took her to bed, put her between us, and spent the next several hours crying, thinking that each breath was her last. Again, she revived, and again left us befuddled but overjoyed with her recovery.

    Finally, on December 10, 2008, after an active but short morning walk, breakfast, and a romp with me, she collapsed, breathing with great difficulty.  She died in my arms about half an hour later, maintaining her sweet personality through it all.

    This little dog should be an inspiration to humans.  Death with dignity takes on a whole new meaning.  I can only hope to be as brave when it’s time for me to meet her in heaven.  And speaking of Heaven, if dogs aren’t there, then I don’t want to go!

    She is buried in our backyard garden under a little yard plaque that says, “One is nearer God’s heart in a garden than anywhere else on earth.”  We couldn’t think of a better epitaph.  She has to be in God’s heart now because there’s such a huge hole in mine.  I don’t think it’s just weird chance that DOG is the mirror image of GOD.

    dixiebelle

    We love you Dixie Belle! (1996-2008)


HE stands for Hepatic Encephalopathy, the “behavioral, psychological, and neurological changes associated with advanced liver disease.” (answers.com)

    Hepatic: “Of, relating to, or resembling the liver. Acting on or occurring in the liver.” (answers.com)Encephalopathy: any disorder or disease of the brain (wordnet.princeton.edu)

    en·ceph·a·lop·a·thy \inˌsefəˈläpə-thē\ (merriam-webster.com)

Damaged livers do not have the capacity to rid the blood of toxins. Those toxins remain in the bloodstream, reaching the brain, and subsequently causing HE.

Petplace.com has a good write-up on HE, which I excerpt here:

    Hepatic encephalopathy is a neuropsychiatric disorder that occurs in animals and people with advanced liver disease. While any severe liver disease can lead to HE, portosystemic shunts in dogs  (where blood is diverted around the liver) are the most likely disorder to produce HE symptoms. About 95% of animals with portosystemic shunts show signs of HE.HE is often expressed in a range of neurologic abnormalities. The first signs are usually behavioral. At first, the changes are subtle. As the disorder progresses, the signs become more obvious. Symptoms may be triggered by a meal. They often come and go, also varying in degree of seriousness.

    A grading system has been modified from human medicine, for use in animals. In this system animals with HE are graded on a scale of 1 to 4.

  • Grade 1. Listlessness, depression, mental dullness, personality changes, excessive urination.
  • Grade 2. Staggering or incoordination, disorientation, compulsive pacing or circling, head pressing, apparent blindness, personality changes, salivation or drooling and excessive urination.
  • Grade 3. Stupor, severe salivation and seizures, although uncommon, are present.
  • Grade 4. Coma
  • Other symptoms may include: collapse or weakness, hyperactivity, head or muscle tremors, and/or  deafness.


The ALT blood test is one of the usual tests done in a series of tests when liver disease is suspected.

ALT stands for “Alanine aminotransferase”, an enzyme important in liver function.

A high amount of ALT found in the blood is often an indicator of liver damage or inflammation. Even though the ALT test is considered to be a sensitive test for liver disease, high ALT levels in the blood can be caused by many different conditions, such as lead poisoning, drug reactions, shock, etc. For this reason, other testing is typically done in order to better interpret the ALT test.

The reason a high amount of ALT appears in damaged livers is because liver cells release this enzyme into the bloodstream when they are damaged. Although an abnormally high level of ALT in the bloodstream is greater in damaged livers, it may or may not correlate with the seriousness of the liver disease or predict what the outcome or course of the disease will be.

    Shaili’s ALT level: 783 **HIGH**
    Normal ALT range: (14-151 U/L)

What is the unit U/L?

    U/L is “Units per Liter”
    • A unit is an arbitrary amount agreed upon by scientists and doctors.
    • A liter is a measure of volume that is slightly larger than a quart.

References: “Symptoms and Diagnosis of Liver Disorders in Dogs” by Veterinary & Aquatic Services Dept., Drs. Foster & Smith web site;  http://www.peteducation.com; Web MD; and http://www.gastromd.com.


Providing the explanation took much longer than expected. I did numerous rewrites, checked my facts, had my sister who is a microbiologist proof it, and read it to various people to see if it was easily understood.

The sister who proofed it is the one who has the 1.5 year-old son with no functional small intestine and a liver that was failing. The link about baby Bo is in the side bar under “My Nephew’s Rare Disease

I have not done the ALT or bilirubin write-ups yet, but they’re coming. Please note that the BAT is usually one of several tests in a panel of tests for liver disease.

Back to the BILE ACID TEST (BAT). First, if you haven’t seen Shaili, the athletic Pug, she is featured two posts down. Her recent blood work came back with some high Bile Acid Test numbers:

Fasting Bile Acid Test (BAT):

    Shaili’s result: 13.4 µmol/L **HIGH**
    Normal range: (0.0-12.0) µmol/L

2HRS Bile Acid Test (BAT):

    Shaili’s result: 44 µmol/L **HIGH**
    Normal range: 5.0-25.0 µmol/L

“But what does this all mean?!” you ask?

Most dogs are given the BAT to determine if there is a problem with their liver, or if another test they had done for liver disease was inconclusive.

For instance, as in Shaili’s case, if liver disease is suspected, but the biliruben test shows normal levels, the BAT is run because it is a more sensitive test for liver damage.

The BAT result numbers show how much bile acid is in the blood stream at the time each blood sample was taken.

    1) On an empty stomach (no food for 12 hours)
    2) Two hours after a (high-fat) meal is eaten

A high amount of bile acids in either blood sample means the liver is not adequately doing it’s job of pulling bile acids out of the bloodstream, which indicates liver damage.

The bile acid level in the blood sample two hours after the meal should only be slightly higher than the bile acid level before the meal because a healthy liver is able to remove most of the bile acids after two hours.

When a dog eats, food going into his body is in part “digested” by the bile acids that break down fats. Those bile acids are initially released from the gall bladder into the intestine to help with digestion.

After the food is digested, the bile acids go into the blood stream where the liver retrieves them and returns them to the gall bladder for storage until the next meal. This is why some articles state that the liver “recycles” bile acids.

Here is a simplified progression of the events upon feeding the dog:

    1) The dog eats, triggering bile acids to be released from the gall bladder into the intestines.
    2) While in the intestines, the bile acids help digest the food and break down fats from the meal.
    3) After the food has been digested, the bile acids in the intestines move into the bloodstream.
    4a) At this point, a properly and fully functioning liver would efficiently take the bile acids out of the bloodstream and return them to the gall bladder to be released and used again at the next meal.
    4b) If the liver is damaged and not functioning properly, it will not be able to remove the bile acids at a normal rate, so the blood sample taken will show a high level of bile acids in it.

Upon eating, the body triggers the release of BA from the gallbladder into the intestine, where it helps break down fats ingested. Once the food is digested, the BA goes back into the bloodstream where it is recaptured by the liver.

Even though this test is a good indicator of liver disease, the results do not provide information on how severe the damage is, what caused the damage, whether the liver can recover and what the expected outcome would be.

Shaili’s “Fasting” Bile Acid Test is a bit higher than the normal range, and her “2-Hour” BAT level was double or more than levels in the normal range. Look at these results again along with the BAT results for a Pug Puppy that likely has a liver shunt:

Fasting Bile Acid Test (BAT):

    Normal range: (0.0-12.0) µmol/L
    Shaili’s result: 13.4 µmol/L **HIGH**
    Pug Pup with suspected liver shunt: 287 **VERY HIGH** This is 21 times Shaili’s BAT level

2HRS Bile Acid Test (BAT):

    Normal range: 5.0-25.0 µmol/L
    Shaili’s result: 44 µmol/L **HIGH**
    Pug Pup with suspected liver shunt: 1877 **VERY HIGH** This is over 42 times Shaili’s BAT level

UNITS DEMYSTIFIED:

    • “µmol/L”  is  “micromoles per Liter”
    • A mole (mol) is an amount of a substance that contains a large number (6 followed by 23 zeros) of molecules or atoms.
    • A micromole (µmol) is one-millionth of a mole. (definition from Healthwise web site)

A note about the Pug puppy above. If this puppy does have a liver shunt and it is operable, it actually has a chance of living a good quality of life as well as enjoying a longer or even normall life span given that it’s condition is managed by proper diet and supplements.

If you are looking for more information, a support group, and practical advice from experienced dog liver disease moderators, please visit the Dog Liver Shunt and Disease (DLSD) Yahoo Group. You are not alone if you have a dog with liver disease or suspected liver disease. There you will find hope and help for managing the condition, reducing the symptoms, and increasing the life span of your dog..