Health
Dennis's Story
Porto-Systemic Shunt ( Liver Shunt )
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Dennis was born in 1991 and quickly became the ‘greedy boy’ of the litter. He was always looking for more. We kept Dennis and his sister Treacle and they grew and played together very happily with no outward signs of what was to come.
When Dennis was seven months old he suffered from a bad attack of diarrhoea and vomiting. (He had up to this point had a few minor bouts of diarrhoea from which he rapidly recovered). We took him to the vets and he was given medication along with the usual instructions to starve for twenty-four hours and then a light diet. He would recover but a few days later the symptoms returned. The pattern continued with recovery followed by relapse. At this point Dennis became so ill he could hardly walk. X rays had not shown anything but blood tests indicated a liver problem. Sean our vet told us that cancer was a possibility and suggested that a biopsy be taken. He carried out a blood-clotting test first and to our horror it showed that his blood was not clotting. Sean managed to get us an appointment the next day at Liverpool University with Dr. Bryn Tennant.
Terry stayed at home with the dogs and David drove me to Liverpool with one very sick dog. Bryn wanted to carry out tests and scans which meant I had to leave Dennis there and pick him up at 3pm the next day, I think that was one of the longest nights of my life! I must admit that I was expecting the worse when I met Bryn the next day, Dennis had become so weak and lifeless. He very gently and patiently told me that Dennis had a Liver Shunt, he drew diagrams and explained what was happening. He thought that with a strict diet and some medication Dennis might have a year or two at the most. Although the news was devastating, it could have been worse – I still had Dennis.
A liver shunt can be an extremely distressing illness; it produces similar signs of liver failure due to cirrhosis. When a puppy is 2/3 days old certain blood vessels between the portal vein and the main blood vessels into and out of the liver become redundant and close down. The liver is then ready to play it’s part in the breakdown of protein from the digestive process. Occasionally these shunts do not close completely after birth and this causes leakage of blood into the main bloodstream. It has bypassed the liver and therefore the blood is carrying unprocessed chemicals direct from the bowel into the main bloodstream. This unprocessed protein can cause severe damage to body organs and in particular will affect brain tissue and brain function. The liver plays a very important role by cleansing the blood. The shunt also deprives the liver cells of the necessary nutrients required to synthesis proteins and other substances needed to aid the dog’s growth.
The amount of leakage through a shunt can be highly variable, as are the symptoms. Some can live with shunts unnoticed for their entire life, at the other end of the scale a dog can die at a very early age. With some shunts it is possible to operate and either tie off or partially tie off. It is dangerous and difficult to do with a fairly low survival rate. If successful the dog can lead a normal life and reach old age. The other route is medication and a very strict low protein diet.
We did not have the option of choosing the operation for Dennis. He had a ‘star burst’ shaped shunt which meant there were too many vessels open to tie off. The classic signs of the illness are, poor appetite, depression, unsteady walking, falling over, trying to walk through walls, difficulty in co-ordinating movement and fits especially after a feed. Looking back it is very apparent that it was me who caused Dennis’s frequent relapses before the shunt was diagnosed. Every time we completed the twenty-four hour fast and rice and chicken bit I would make him something like macaroni cheese, stew beef etc. as a treat. All high in protein and very unsuitable. This is when the diarrhoea and sickness would take hold again. Those were always his main symptoms of the illness, followed by excitability after a feed. He would run up and down the garden like a mad man. If he felt unwell he would chew on something hard like a large stone. Before we were able to stabilise Dennis he had good days and quite a lot of bad days. The only treatment we could give him was loads of love and a low protein diet; I became an expert on reading food labels in a bid to keep his appetite stimulated. He had a tin of Hills Prescription Diet low protein food for lunch and supper was a dish of spaghetti with cottage cheese with a small amount of meat juices or cat food stirred in to vary it for him. He had a few drops of Lactulose on his food: this helped to reduce the amount of ammonia absorbed by the colon. Finally he had vitamin and calcium tablets daily. At the beginning I kept a food diary showing exactly what he had eaten and how he was in himself. This made it much easier to find the right combination of food to keep him happy and stable. Fortunately Dennis had a good appetite so feeding him a bland diet was not a problem. We gave him the same ‘treats as our other dogs but only very small amounts so he didn’t feel he was missing out. He had to go for regular blood tests to monitor his condition and it became our little outing. After the test I would drive to a shop near a park and buy him a small milky bar (he loved them) We would go for a walk and then back to the car for his treat.
One of his last blood tests showed that all his levels were even higher and his kidneys indicated signs of damage. His bile acid test result showed the level to be 173; a normal reading should be between 0.00 – 5.00. Sean was amazed at how well Dennis looked; he had gained weight and was full of energy. For the vast majority of his life Dennis enjoyed himself. He grew at the normal rate and did not look ill. He and Treacle spent many happy hours chasing each other; he chewed up shoes, etc. One day we spent hours picking out small bits of foam from their coats because he had ripped some cushions apart, all normal behaviour really! He was a really lovely boy with a fighting spirit. Dennis was just three years old when we lost him. It was very sudden and shockingly quick. He gave so much in his short life and is always in our hearts.
Shirley Carr. 15-11-05
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