Having a
liver shunt dog: And so the story begins.
You
bring the most adorable golden retriever puppy you have ever seen home - You
take all the necessary precautions, the shots, comfortable home, toys and
something is nagging at your heart. You know something's wrong with your
puppy. He sometimes vomits and then
spends the next day getting over that event then in 3 or 4 more weeks, it
happens again. You check the back yard what's he eating that he shouldn't
be?
Monthly
trips to the vet's office begin. It's hard to describe what's going on but
there's that same tug at your heart something's wrong, but you can't
figure out what it is. Is he going to be ok today or will he vomit again?
Why doesn't he have any energy (like the other three golden's you've had
who all lived to be over 12 years old). You're always "negotiating" with
yourself - Maybe he's just the sweetest, quietest puppy you've ever seen
Then the 9th month begins and you begin to plan for neutering.
The pre-blood anesthesia test shows high liver enzymes. Not to worry though,
maybe it's gotten cold waiting for a pick-up - maybe that's why it's
abnormal.
Brinkley tolerates the surgery and anesthesia Your vet says that
everything went surgically well, "but there is something wrong with this
puppy - I can't put my fingers on it". (At the same time of the neuter, you
find out that the puppy has an umbilical hernia and is cryptorchid so that
is all surgical fixed). You have this wonderful little soul your new
addition to your family. How can anything be wrong with this special
"fur-baby"? You try to push all the comments aside and the nagging is still
in your heart. There's a complication to the neutering and your rush the
puppy back in he has a hematoma but the vet thinks he's re-herniated so he
fixes your pup and you go home with a statement "let's redo the enzymes in a
month". Also, he hand's you an article about "liver shunts" but you have a
conversation and find out that in his 25 years of being a vet, he's never
seen one in a golden or bigger dog they're usually always in small dogs.
You read the text and it scares you soooo much - this couldn't be happening
to my pup
.
One
month later - the liver enzymes are still high. You start to tell yourself -
"Maybe my puppy just has different numbers for his body" Could this be the
case you ask? The answer is no. Maybe it's his thyroid. So TSH lab tests are
ordered early - they are slightly outside of the normal limits you feel
comforted this is something than can easily be fixed it just takes a
"synthetic" daily pill.
Again,
there's intermittent vomiting and a day after to recuperate is this
normal? And then he occasionally "wakes up during the middle of the night"
and can't get comfortable he's constantly moving, thrashing, climbing up
on your head - What is that all about?
The
monthly blood work continues - you dread the "test results" phone call.
After 5 months, something should have worked it hasn't. Then there's the
comment when you're walking your dog "why is he so thin?" and "have you
have any blood testing done he doesn't look healthy". Oh, also you must
have gone thru 10 different types of dog food why won't he eat?
Brinkley then starts to hold himself differently (he's hunched in the back).
At the same time, during his few "normal" mischievous days, he decides to
eat a pillow and quilt sham. I walked into the bedroom with "thousands" of
goose feathers flying around me.
An
exploratory surgery is performed in May a portion of his liver removed
it is bizarre looking and is the color of "cauliflower". Both the piece of
liver and his stomach are sent out for biopsy. The results: "undetermined
what happened to the liver probable cause physical trauma. (He may have
been dropped and kicked just after being born). Prognosis Good, as long as
it was adequately excised). So for the first time in this puppy's life - We
get a call from our vet everything is looking up Brinkley should now
have a normal life but "let's recheck his blood in one month".
Next
month: All liver enzymes are still abnormal. New diagnoses are considered -
Could it be Addison's Disease? A prednisone shot is administered and you're
told that if this is the right diagnosis, you will see your pup jump back to
normal within a matter of hours. It doesn't happen you do see something
different (better) within 48 hours the blood test comes back at the same
time it's not Addisons.
You
keep going for 3 more months hoping and "praying" there will be normal
acceptable liver enzymes from blood tests That just isn't happening. I
start jogging in the morning (I'm not a jogger at all but I'm out there
seeing if Brinkley has any energy
.) Then there are friends and family
members who occasionally see Brinkley and think he's just a sweet,
quiet, smaller golden retriever - and you begin to think it's you but
still the nagging feeling never goes away
.One morning, Brinkley isn't
sleeping on the bed when you wake up You find him downstairs on the couch
looking like he's dead with bile surrounding him. That was our "worst day"
up to one month ago. Brinkley did a 12 hour fast given a pre and post bile
acid test the results are "off" the charts reference range is less than
10 on pre Brinkley's was 283 and post -normal is less than 20 - Brinkley
is 454. We're scheduled within 48 hours to see a board certified radiologist
for a Doppler ultrasound. Yep, he's 95% sure it's an intrahepatic liver
shunt on the right side, but he can't totally identify it it's just too
deep and in a hard place to get to. We're told that surgical intervention is
the only way to give Brinkley a chance for a normal life. Special equipment
is mandatory it's not an easy surgery and "you need to go to a veterinary
teaching hospital" Tufts in Boston is the closest. So, Tufts is called
the next available is September 23rd (it's now August 18th)
Then
the nightmare begins on reading about liver shunts While extrahepatic
shunts (outside the liver) can sometimes be hard to correct, intrahepatic
ones (inside the liver) are harder. Mortality rates for Brinkley's surgery -
anywhere from 10-70% depending on what you're reading - and - if he makes
it, he will need to be in ICU for at least 4 days and monitored for portal
hypertension. If that develops, whatever type of closure they placed in him
to close down the shunt - would have to be removed and without surgical
intervention, Brinkley would probably only have between 2-10 months before
he will die
..
Then
the miracles begin. I'm on the computer researching until 2 am for a
couple of nights. (To this day, I don't know how I found it, but there's a
different approach a veterinarian at UPenn, Dr. Chick Weisse, perfected a
non-invasive radiology technique "Percutaneous Transjugular Coil
Embolization". The mortality rate is less than 5%. Only two places in the
country perform it University of Pennsylvania and the University of
Michigan (Michigan is on the list because one of their
Attendings, Dr. Matthew Beal, did
a fellowship under Dr. Weisse). Copies of everything I could find on PCTE
was given to our local vet is Brinkley a candidate? Yes!! In the
meantime, we need to get him "as medically managed as possible". He is
started on lactulose, metronidazole (he's already on Clavamox) and a low
residue dog food. Our local vet calls UPenn Dr. Weisse is away, but an
appointment is made for September 10th at 11:00 am. When he
returns, Dr. Weisse calls. "It's a long ride from Connecticut to
Pennsylvania is Brinkley as medically managed as possible"? My answer:
Yes, although I was feeding him more, he wasn't gaining weight (still 50
lbs), he wasn't experiencing seizures and his HE was the best it was going
to be. So, we keep our appointment for September 10th.
About
the same time that I found UPenn Information, I found this liver support
group and again I don't know how that happened either. At first, I
posted privately to Maria Lelinho, the owner of the group - I have never
belonged to a group and just didn't know what to say. She is an "angel" and
encouraged me to keep going to get to UPenn ASAP. I started to ask
questions, especially on the lactulose here I was trying to get him as
"medically managed" as I possibly and I kept on giving him too much
lactulose and with it - diaarhea. This group put me on the right path for
proper dosage, etc. And on the days before our visit, there were so many
wonderful e-mails, telling us that Brinkley was in their prayers and for
everyone on the "List" to keep good thoughts coming his way.
On Sept
10th, Dr. Weisse's associate, Dr. Allyson Berent, arrived in the
waiting room, took one look at Brinkley and says "there's my liver shunt
golden". In the exam room, every intern, resident and nurse who walked in
had the same comment Yep, he has a liver shunt - How did they know? "Liver
shunt" dogs have a certain look in their face!!!! Dr. Berent began reviewing
Brinkley's long medical record - Yes, he had a "classic" background for an
intrahepatic shunt in addition to the look on his "face", he was
cryptorchid, failure to grow, didn't like food, had exploratory surgery
because they all eat something strange, had ulcers and all 15 times of
drawing blood, his liver enzymes were high, his cholesterol and albumin
always low!! She drew diagrams, answered questions, gave Brinkley lots of
kisses, watched over him like a hawk John and I knew that we had found the
best "doctor in every way" for Brinkley she was and is
phenomenal".
By the
end of the day, we were told he was a candidate for the PCTE procedure it
was scheduled for September 11th and should take about 50 minutes
without Brinkley even being aware that anything happened. Dr. Berent called
after the procedure - out of 85 dogs, Brinkley was the hardest instead of
50 minutes he took 3 ½ hours and instead of 3 coils placed, he had 7.
The good news -they could tell his own liver started to immediately accept
some blood during the procedure and they very rarely see this.
On
Friday night, we went to bed early to leave at 4:00 am for the 5 hour trip
to get Brinkley in Pennsylvania. At 9:30 pm the phone rang it was Dr. Berent
- there's been a complication Brinkley had a grand mal seizure he's
unconscious and in ICU That nightmare went on for 5 days. Two calls per
day from the ICU veterinarians and at least two calls per day from Dr.
Berent (who had to travel to another state to lecture). Drs. Berent and
Weisse kept telling us to "hang in there he's a liver shunt dog he can
make it thru this". He had to have an induced coma and in doing so, he
was given a "huge" amount of medicine we need to give him time to "wake
up". Thru this whole ordeal At the same time, the ICU veterinarians were
telling us that our dog was beautiful but he's critical and may not make
it. I can't write yet about this period it's too painful.
On
Wednesday, September 17th John took some time off. To put it mildly, I
did not do well emotionally thru these 5 days. I remember walking in a store
that afternoon and I literally couldn't remember what I was looking for
totally opposite from how my brain usually works. When returning, I "rushed"
as always to the answering machine and heard Kim, the nurse telling me she
had sat with Brinkley that afternoon and he "stretched" which was a good
sign. Five minutes later, Dr. Berent called - I start to tell her about
stretching and she said to "sit down" Brinkley is awake and eating!!. He's
not out the woods, but he woke up!!!
Saturday the 19th We're still getting "good" calls from Drs.
Berent that he's making slow and steady progress and still receiving the
"bad and guarded" ones from ICU He can't walk he can't see he needs an
extreme amount of nursing care will we be able to take care of him??
That's it! We need to see Brinkley! Took the 5 hour trip stayed 90 minutes
and came home. What did we find? A miracle! Brinkley knew us and tried so
hard to get out of his pen to be with us. The people in ICU didn't know what
was going on. He was talking so loudly to us, they thought he needed to go
to the bathroom he didn't he was telling us that he knew we were there
and we knew he was neurologically there!!
Monday
the 21st: Drs. Berent and Weisse returned, examined Brinkley and
wanted to get him home with us ASAP. We met at 4pm. Brinkley was pretty
anxious and moaning and groaning. He came down on a gurney because he
couldn't walk. I asked Dr. Berent if this was our new "neurological dog".
She said she didn't think so that he had to go to the bathroom! And she
was right. While she taught me how to administer seven different meds, John,
Brinkley and Kim went to a grassy area where he pooped and "walked"!!! As.
Dr. Berent told me "Could I guarantee you that he'll walk again? No.
BUT HE DID! Can I guarantee you that he'll see? No, but I think he
will"!! Her last words prior to our leaving PA I couldn't guarantee you
that he would wake up either but he did!! On our way home, we stopped 4
times and at each stop he walked not a lot of steps but he walked!
Skip to
Today, October 21st. Brinkley takes least 3 -20
minute walks/day. When he taught himself to "walk again", his back legs are
not yet strong enough to support his body the way it needs to, so he is
going to rehab once a week for the next month. He's up to walking on the
treadmill in water for Ό mile and is beginning to swim. He LOVES TO EAT and
has between 4-6 cans of dog food a day
and weighs 56 lbs. (When we left UPenn, he was
about 45 lbs). His personality is a sweet as ever. One week home, he
started giving kisses again. He no longer pulls his head away when touched
and has stopped having "anxious attacks". Both the vet at rehab as well as
our own local one, believe he may be seeing something, maybe just a dark
shadow, as he hardly ever walks into anything in his way. John and I are not
sure yet but we're sure praying for another miracle!!! He knows the entire
house and has even mastered going up and downstairs. His best friend "Mr.
Moose", a gift from Dr. Berent and Kim from UPenn never leaves him.
He's even starting to go into his own toy box
.
Brinkley is still on a lot of meds he's being slowly weaned off of
anti-seizure medicine that Dr. Berent feels may be hindering his
neurological recovery. It's a delicate balance Brinkley's body has been
thru so much, she doesn't want him to risk another seizure. I'll finish this
story, hopefully with another miracle that Brinkley's eyesight has come
back.
In the
meantime, Dr. Berent was anxious for Brinkley's one
month blood test post his procedure. We received them today. For the
first time in his life, his liver enzymes are normal!!! As Dr. Berent
wrote in Brinkleys discharge summary
Hes a ROCK STAR recovering slowly
but surely
For
anyone reading this, please know one thing about the "bad days". This list
"kept us going". There were frequent "just checking in on you e-mails and
telephone calls" and there are still two e-mails posted on our refrigerator
with the following BIG, BOLD WORDS: HOPE, PATIENCE, CONFIDENCE, and DON'T
GIVE UP!! - Here, we had only been on this list for a very short time and
these wonderful people are constantly trying to "hold me up" and when I was
giving up emotionally, they didn't let me!!! John "always knew" that
Brinkley would make it just like Dr. Berent did. But I almost "let go"
If it wasn't for this group, I would have lost it. I hope this conveys what
this liver group is all about. Never ever give up Miracles DO happen with
these "Liver Dogs"!
Wish
there was a word to use to indicate how grateful we are all we can say is
our heartfelt "Thank you" for praying for the miracle we received!!!!
Fondly, Kathy, John and Brinkley (Our "Rockstar") Hangen
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