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Liver Shunts in Dogs


Hope in June 2011
Hope, my foster beagle pup, has been diagnosed with an intrahepatic (internal) liver shunt (portosystemic shunt or PSS), so I am doing research on how to best help this poor tiny little girl. I'm using this page as a place to contain my research, but if you are in the same place, I hope it helps you, too!

5/8/11 - Hope came into B.O.N.E.S. beagle rescue. She weighed about 9 pounds and was all skin and bones. You can read her beginning here.

Update 9/2/11:
Through many trials & errors, trying this raw food, that bagged food, this other frozen food, and lots and lots of reading, we followed Hope's lead and settled on a diet of cooked egg, yogurt, and oatmeal. She was eating 6 -7 small meals a day, but would still regurgitate and get pneumonia. We started her on metronidazole (sp?), and she's taken off! She eats about 1 cup of the mix at each meal, and eats about 4-5 times a day. She started out weighing only 9 pounds, but a month ago was at 14 pounds! She hasn't had any pneumonia since starting the meds as she's not regurgitating! Woohoo! Now we follow the surgeon's suggestion of waiting until she's 1 year (November) and weighs more. Once we get there, we can re-evaluate her and see if surgery would help. Even if it won't, it's great to see her looking and acting like a normal dog and not looking all skin and bones! Yay, Hope!

Update 10/6/11:
Hope weighs 19.5 pounds! I spoke with the surgeon this past week since she has gotten so healthy and saw our regular vet. Our vet thinks she is healthy enough for surgery, so we will schedule her spay. She will go to the board certified surgeon for the spay and have a vascular portogram at the same time. The vascular portogram will show us how much of the liver has blood flowing through it and how much is being bypassed. This will give us more of an idea as to her long term prognosis. However, since she is thriving on the diet & meds, we probably won't try surgery to correct the shunt as it is very risky. Here are new pictures of her. See how good she looks!

Hope 9-24-11
www.SueCollura.com


Research from the first few months:

AFter all our research and experiences, I feel like I could write a book, but it would have to be titled "My foster dog with a liver shunt" as each dog with a shunt responds differently! You really have to go into it armed with all the different schools of thought and then try things and listen to the dog.

What works for Hope is to keep her food all easily digestible proteins. When the micro-organisms in the colon break down protein, they produce ammonia. You want proteins that move through quickly to keep ammonia at a minimum. The antibiotic kills some of the organisms so not as much ammonia is produced. The liver is supposed to remove excess ammonia, but where part of her liver is bypassed by the shunt, the liver doesn't work effectively. When the ammonia stays in the blood, it goes to the brain and causes intoxication problems. She has to eat a larger quantity of food than other dogs because her body doesn't absorb everything she eats. Basically, she was eating before diagnoses, but she was still malnourished.

The surgeon doesn't recommend corrective surgery due to the location of Hope's shunt. The corrective surgery (intra-venous embolic coil) could cause more issues than correct, and Hope is responding so well to diet/nutrition. The surgeon thinks she'll need to stay on this diet for life, although she may need some tweaks to her medicines as she grows older. We really need to find a home that will take everything we've learned and stick to it even if their vet doesn't believe it until he's seen it. We've done all of that research and trial/error, so we need someone who will continue it. :)

Here is where we started with research:

"Poor little girl :-(.  I think the digestive enzymes sound good (you sure want one good at digesting protein).  I'd probably add a really good probiotic and most definitely "Thisilyn" milk thistle.  Other stand-outs for liver support include selenium and alpha-lipoic acid.  Perhaps your daughter could do a bit of research on these things and see what's doable.  I'm not a fan of tofu.  As for for protein; think quality (if she does well on eggs...that's good).  Kymythy R. Schultze, CN, CNC, AHI"


B-Naturals Newsletter, Liver (I found this article EXTREMELY helpful!)



What Are Portosystemic Shunts?

Locate an ACVIM Board-certified Veterinary Specialist in Your Area

Information on Liver Shunt & Other Diseases (Yorkie Rescue website)
Changing the type of bacteria that live in the intestines can also decrease toxin production and absorption. This can be accomplished by giving lactulose syrup or yogurt. Some veterinarians may prescribe antibiotics for a short time as well. Nutriceuticals- compounds that are not considered "drugs"- can also improve liver function. Milk thistle ("silymarin") can help improve liver function and regeneration. Because the government does not regulate over-the-counter compounds, purchase of specially formulated veterinary supplements is recommended. Two veterinary companies that sell milk thistle include Nutrimax ("Marin") and RxVitamins ("Hepatosupport"). Veterinarians may also prescribe Denosyl (SAM-e) to improve liver function.
Milk Thistle dosage: Dried herb: 15-20mg/poun once a day; concentrated or alcohol extract: 2-5 mg/pound every 8-12 hours. See manufacturer recommendations for veterinary-formulated supplements. 
Liver Disease: Signs, Symptoms, and Diagnoses (The Epi Guardian Angels website)

Liver Cleansing Diet and Milk Thistle (The Epi Guardian Angels website)
The liver cleansing diet has been formulated by W. Jean Dodds, DVM. Dr. Dodds recommends a formula of 2 cups of pollack, cod or any other low fat white fish fillet to 6 cups of veggies and potatoes, or 25% pollack, cod or any other low fat white fish fillet to 75% veggies and potatoes. This diet has proved extremely successful in reversing liver damage along with reducing Phenobarbital.
1 and 1/2 cups moist white cooking potatoes
1 and 1/2 cups sweet potatoes
1 and 1/2 cups of zucchini
1 and 1/2 cup string beans, celery or summer squash
2 cups pollack, cod or any other low fat white fish fillet
Scrub the potatoes well and cut them up crosswise into 2" pieces so the skin circles the potatoes. OR, you can peel the potatoes before you cook them. Simmer for 45 minutes to 1 hour. When cooled, remove the skins.
Wash the zucchini and cut up with string beans, celery or squash and steam or cook until very tender.
2 cups pollack, cod or any other low fat white fish fillet poached in a frying pan with water until fish is white and flaky.
Mix all ingredients together until it is well blended. This will give you approximately 8 cups of food. Depending on the size of your dog, you can double or triple the recipe. For flavor you can add a pinch of garlic powder and a little Italian Seasoning to each meal.
For supplementation use the recommend dose of infants liquid multi-vitamin.
With liver disease try to feed in 3 or 4 small meals, the last one being at bedtime. This puts less stress on the liver. Put 3 days of meals in baggies and freeze what you won't use in 3 days. You should be able to cook once a week and freeze what you don't use. This recipe will stay fresh for 3 days in the fridge.

White low-fat fish has a specific amino acid that actually helps heal the liver. Soy and fat-free cottage cheese also have this specific amino acid, but should not be used in a diet until the liver enzymes test comes back in a normal range.
Milk Thistle (The Epi Guardian Angels website)
It specifically protects the liver against toxins (including some drugs and heavy metals), activates protein synthesis, and stimulates growth of new liver cells to replace those that are dead or damaged.
Liver Shunt Diet (Yorkie Rescue website)

Portosystemic Shunts FAQ, University of Tennessee, Institute of Agriculture
Dogs with shunts need high quality proteins made from milk or vegetable, and are restricted to a protein content of 18% or less (on a dry matter basis). The diets should be easily digestible, rich in antioxidants and vitamins, and low in copper and iron.
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