Very poorly terminal pup || Very worried owner || Please help (Liver Shunt)

Hello

I hope this is the right place for this, apologies if it is not.

Please can someone help my beautiful girl Inca who has had the most horrific start in life and really needs some TLC to make her few remaining days a little easier on her.

Inca has an Intra Hepatic Porto Systemic Shunt of the Liver and suffers from Hyperammonaemia and Addisons disease. But she is the most amazing, loving dog you could ever wish to meet and I love her with all my heart.

We rescued Inca from an absolute hell hole where she had been used as a bait animal and fed on sugar water, unfortunately what we had initially thought to be malnuturion turned into being something much much worse.

Incas prognosis is terminal, the very best dog liver specialist here in the UK (who is 340 miles away from us) has said that the shunt is inoperable and we need to make her as comfortable as possible.

The problem I am having is feeding her, when we got her just a month ago she was 16 weeks old and had never chewed solid food. We taught her how using porridge. Now she is such a fussy eater and just will not eat dry food and only wants sugar rich porridge which is very low in proteins.

When we feed her chicken breast intended for humans she is happier for 10 mins before collapsing with toxic blood from the protiens.

The saddest part is watching her eat knowing in an hour you will lose her for 12 hours and she will just be spaced out and comatose.

Inca deserves a good life, and I am going to move mountains to give her it. But I need some help with the nutrition side of things.

If I feed her a dairy or vegetable based diet very low in protein but high it nutrients I could give Inca a normal life for upto five years. If things carry on as they are I will lose her in a few weeks.

Please can you connect me to any nutritionist you may know, or provide some guidance on the foods to feed Inca.

Thank you in advance for any help you can offer my beautiful girl.

Kind regards
Gemma

Hi Gemma. That is such a sad story, but being such an unusual condition very few people will have the experience to give you an answer. I really do feel for you and am sorry that I'm unable to give you the answer you need.

Have the vet or specialist not been able to suggest anything to help? The specialist should be able to at least suggest the most suitable diet or things to avoid.

I hope you manage to find someone who can give you the help you need.

This is a sad situation and it is not unknown to me because it occurs in my own breed from time to time.  However, I have no personal experience of PSS.  The nearest experience I have is of my own dog having a liver tumour.  My vet recommended Royal Canin Hepatic diet - I think it may have been this one and I chose the wet food for ease of digestion.  It was expensive and an experienced friend suggested that I replace it with Chappie wet.  It's not a food I like but I could see the sense in it as it is low fat and protein.  I carried on with the RC though. 

The vet also suggested liver support supplements and the one that I remember is Samylin.  It contains milk thistle which is recommended for liver problems.  Looking back, although the diet and medication was palliative, I was also trying to prolong her life but I could have taken the view just to let her enjoy whatever she wanted because, like your dog she was terminally ill.  It's difficult but I think you are doing the right thing because you are trying to make her comfortable and that is good palliative care.

On my own forum we have a member whose dog was diagnosed with this last year.  It is not as severe as yours.  She has picked up a lot of information about diet and blood results so I have sent a message to ask if she would join the forum and reply to your thread.  It won't be for a little while because she lives in the USA and will be in bed  right now.  Also, she has to go to work.

As you probably know, the liver deaminates (breaks down) food substances, particularly protein. It also produces bile which breaks down fat so you may need to be looking at food that is low in protein and fat.  These parameters can be set on the Dog Food Directory of this site.  However, as David has said, it is such a specialist thing that you need to be guided by your vet.  The only other thing is that there is an animal nutrition department at Liverpool University but I only happened upon this recently due to a television programme about obesity in dogs so I don't know anything about it and I think you would need a vet referral anyway.

Edit: I have just remembered that one of the problems associated with PSS is frequent urinary tract infections. With this in mind it may be worth sticking with wet food to increase the fluid intake. However, that is just my thinking. TBH it might be worth trying Chappie. It's easily available and you can buy just one tin, giving a few spoonful at a time in order to see how your dog responds. Check with the vet though.

So very sorry to hear you are going through this with Inca. I have had no experience of liver problems myself but as others have said, hopefully you can get good advice and support from your vet and Incas life can be made more comfortable.

I have heard from our member who has a dog with porto systemic shunt and she is going to reply later.  Hopefully what she has to say may help in Inca's dietary management.

I very sorry to hear about Inca's condition.  I have a 7 year old cairn terrier that suffers from PSS liver shunt as well, although he is not suffering from many of the symptoms at this time.  We have worked with a team of veterinarians to stabilize his condition.  (I am from the U.S.A. so am not sure what medications and dog foods are available to you.)  You did not mention if she is on medication for the shunt.  I feel she will need to be on antibiotics and Lactulose to rid the toxins from her system for the rest of her life.  Sadly I do not think diet will do it alone.  Sounds like you should not be feeding her the chicken if she goes into shock after eating.

Bailey is on the following medications: Sam-e with milk thistle (Denamarin) which is given in between meals for the best absorption into his system, Metronidazole (Flagyl) 62mg. twice a day during meals (low dosage of an antibiotic), and an oral Lactulose (Generals 10GM/15ML solution) 5 ml - twice a day.  The Lactulose is a stool softener which is essential to help flush the system of the toxins.  It works by reducing blood ammonia levels.  Bailey is prone to Urinary tract infections as well, which they feel maybe a result from the shunt.   Treatment for these UTIs is another antibiotic called Baytril – used only when he has an UTI. 

His diet is still in the testing phase.  Bailey is being monitored very closely so that we maintain his Albumin levels near 2.8 – when he was first diagnosed (about 6 months ago) they were very high at 4.0.    He follows a low-purine diet that consists of liver-friendly proteins such as egg, dairy or soy.  Vegetables that are low in purine are good to add as treats.   The dog food he is on now is Purina Veterinary Diets HA (dry) 1/3 of a cup – twice a day.  Royal Canine Hepatic diet is another one that was recommended to us.  I have been working with a nutritionist so all the dog food recommendations are a prescription plan.  I was given the choice of home cooked or prescription and for convenience sake I am trying the prescription first but will switch if it will benefit Bailey.

You will have to do a lot of research on 'low purine foods'--some vegetables that are good are: apples, carrots, zucchini, cucumber green beans, sweet red peppers, cooked potato, and cooked sweet potato.  Try mixing yogurt or cottage cheese with the kibble to see if Inca will eat better.  Also can use the moist dog food, I believe Royal Canine sells a prescription one.

I hope that this will help you and if you have any questions, please let me know.
 

Thank you so much for replying hawkeye.  So much excellent information there.  I do hope that our member returns to the thread and that this advice is helpful.

Hello Dottie, Hawkeye & Tinyplanets

Thank you so so much from the bottom of our hearts for your kind words and advice, it is so so appreciated.

Hawkeye especially, my Vet says you may have just helped us down the process massively. So thanks dosent quite cover it. I dont know what else to put here but thank you.

Our vets have done all they can but we live in very rural England and know that this is quite a specialist thing so things like diet plans and holistic approaches are slightly beyond their general veterinary medicine capabilities.

Inca has been on Oral Lactulose for a month and also Antrobie antibiotics for the past three weeks to reduce the amount of bacteria in her blood crossing the blood/brain barrier and causing the fog in her head. Sadly Inca is still terribly tired, sleeping 20+ hours each day.

I have decided to feed her a home cooked diet, I am a foodie and own a wholefoods online health shop working from home which means Inca is never alone unless she choses to be by going into another room and I have the time to cook for her.  I have stopped the porridge / oats and replaced with Organic fruit salad for breakfast (Apples, Banana, Grapes & Blueberries) and then for lunch & dinner she is eating boiled Organic Chicken Breast with pureed garden vegetables (Green Beans, Broccoli, Carrot & Swede). I have decided to feed little and often as she is having "episodes" of extreme hunger after more than a few hours and then eats so fast she regurgitates her food. Inca then becomes restless and unresponsive to even her own name.

I am afraid that what ever Inca eats the end results are the same, she is not having much of an existence at all. But occasionally, maybe twice a week, Inca will have these burst of sunshine and will be a "normal dog" for a few hours and be playful and happy. So right now Im not ready to call it just yet.

Right now our vets will not vaccinate or microchip for fear she will not survive, I am not sure how much this is genuine fear or precaution but it is not filling us with much confidence.  What fills me with confidence is to hear that Bailey is seven and is doing well with no symptoms! If we got another seven months with Inca I would be over the moon.

We are next at the Vets on Monday morning, and I will be taking details of all of these medicines and supplements with me and talking to them about what we give her.

I am also going to do lots of reading and dietary research and put a meal plan together which I will find a way to share online.

I will report back and let you know how we get on. But again, I just want to say thank you so much for taking the time to help our family by sharing your knowledge and experience.

Kind regards
Gem, Mark, Hettie & Inca

We had a very poorly puppy with an inoperable liver shunt on the forum some time ago.  It was particularly sad because he was such a youngster.  Inca's situation is all the worse for her poor start in life and having had a poorly elderly rescue myself I understand how you feel that you want to make her life as good as it can be.  Well done for at least trying and not giving up on her.  When the time comes for you to say goodbye you will surely know it and she will have spent the past however long with someone who cares about her.  She will be aware of that I am sure and when the time comes it will help you to cope with the loss because you have done all you can.   I hope that between you and your vet you can make Inca as comfortable as possible for the remainder of the life she has left.  Please let us know how you get on and my thoughts are with you and with Inca. 

Hi Gem and really sorry for not responding sooner. I'm not sure I will have much to add to the fantastic advice already posted but I will do my best. First off though, how has the home cooked diet been going down?

On Thursday, 19th May at 6.30pm My Pet Nutritionist is hosting a live Facebook video discussion on Best Diet for Liver Shunt in Cats and Dogs.
These videos are available after the live event and usually there is a blog at a later date. This is definitely one for owners of dog breeds that are susceptible to this condition.

Breeds More Commonly Affected by Liver Shunts
Dog breeds that develop liver shunts more commonly than other breeds include:

Yorkshire terriers
Cairn terriers
Beagles
Irish wolfhounds