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Is this a liver shunt?

Species: Dog
Breed: Toy poodle and caval
Age: 1-2 years
Hello Dr. Marie,

Murphy is 16 months old. For the first 6 months of her life, she seemed quite normal apart from being a little lazy for a puppy so young. She had bloodwork taken when spayed at 6 months old and nothing was abnormal.

She has infrequent episodes, four in total so far, where she seems to show signs of drunkenness. It starts with her being lethargic all day, she won't eat, her head will start to bob and her eyes aren't focused. It looks like a mild seizure almost. The episodes last for about 4 or 5 hours, then she vomits what looks to be partially digested kibble, then returns to her happy self and goes to her dish looking for food.

After the most recent episode two months ago, we have been through many tests. We tested for Addison's and she didn't have it. Her bloodwork is still normal, except for elevated lymphocytes. She did a bile acids test, her fasted result was 58.6 and her post-meal result was 23. Our vet thinks and has thought this entire time that its likely a liver shunt and recommended an abdominal ultrasound at AltaVista Animal hospital. From what I've read, her post-meal result should have been higher if she had a liver shunt. The ultrasound is $700, we've already spent $1400 on tests to this point. My partner and I have one income while I'm at school and we don't know what to do anymore.

Murphy is happy and healthy looking probably 80-85% of the time right now. Except for the 4 episodes of drunkenness, the only other concern is that she has some lazy days where she doesn't want food and sleeps most of day, maybe once every other week. But she has always been a low energy dog.

My partner and I were thinking that we would change Murphy's diet and monitor her closely to see if this causes a change. I'm wondering what you would suggest. Our vet has led me to feel that this is an urgent situation for Murphy, and that if we wait on the ultrasound, her condition might worsen. I don't want to do anything to jeopardize Murph's health, but we are running out of money fast and not finding any solutions. Even if we did the ultrasound and they found a shunt that was a good case for surgical correction, we would really struggle with the $3000-$4700 they quoted us for the procedure.


Online vet, Dr. Marie

Dr. Marie replied:

I'm sorry to hear that Murphy is having these issues. Cases like this can definitely be difficult.

My first thought when you described her symptoms was that this sounded like a liver shunt. Not all cases of liver shunt will have high bile acids. Many do, but not all. An ultrasound is one of the better ways to get a diagnosis but even that can be difficult, especially on a very small dog.

Whether or not this is urgent is a tough question to answer. I think the answer depends on whether or not you would be considering surgery. *If* there was a liver shunt and *if* they felt that she could do better with surgery and *if* you were willing to pay for this surgery then yes, I would say that the sooner this is diagnosed and dealt with the better. I have a few patients who have had liver surgery to correct a shunt and have lived long healthy lives as a result. For dogs who have a shunt but do not have surgery, some can still live quite happy lives, but others can get very sick.

Another option could be to ask your vet about just monitoring Buddy and checking her bile acids every few months, or whenever she is having an episode. If the bile acids start to go up then you can talk about going on medications to help to support the liver and also to help mitigate the effects of the shunt such as lactulose. Now, if you are thinking at all of having surgery then you don't want to wait until she is really sick to decide to have surgery then. You would really want to do it before.

You can also talk to your vet about possibly putting her on a prescription diet that is low protein which may help to reduce the episodes.

There are other possible causes. The next time she is in her drunk state, see if you can video tape it. You can show this to the vet. They may recognize her episodes as a type of seizure. If this happens and if it is very infrequent you may do nothing. If it is more and more frequent she may go on anti-seizure medication.

However, because she is a small breed, a shunt is much more likely.

This is a tough decision. If you have more questions, just let me know.

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.