LIVER SHUNT, THEN NOT!

Hello. My dog was prescribed your k/d canned food due to suspicion of a liver shunt condition. This was due to a severe and almost deadly reaction to poisoning by an anti-inflammatory she was given after MPL surgery. Turns out she does not have a liver shunt, although she does have a degree of microvascular dysplasia. The surgeon feels she should stay on the k/d diet, although I'm unclear about why, since the issue is my dog's liver not her kidneys. She was given the l/d canned food as a trial only because I was having trouble getting her to eat at first. When I asked if she should be on the k/d or l/d now, they said keep her on the k/d. Again, I'm not clear why. Any input would be very helpful. Thanks!

Ingredients for L/D:
Brewers Rice, Pork Fat (preserved with mixed tocopherols and citric acid), Dried Egg Product, Soybean Meal, Powdered Cellulose, Flaxseed, Pork Protein Isolate, Chicken Liver Flavor, Dicalcium Phosphate, Soybean Oil, Potassium Chloride, Dried Beet Pulp, Calcium Carbonate, Glycerol Monostearate, vitamins (Vitamin E Supplement, L-Ascorbyl-2-Polyphosphate (source of vitamin C), Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Vitamin D3 Supplement, Folic Acid, Menadione Dimethylpyrimidinol Bisulfite (source of vitamin K)), Choline Chloride, Iodized Salt, L-Arginine, Taurine, DL-Methionine, minerals (Zinc Oxide, Manganous Oxide, Calcium Iodate, Sodium Selenite), L-Carnitine, L-Tryptophan, preserved with Mixed Tocopherols & Citric Acid, Phosphoric Acid, Beta-Carotene, Rosemary Extract.
Protein: 18%, Fat: 24%, Carbs: 48%

Ingredients for K/D:
Brewers Rice, Pork Fat (preserved with mixed tocopherols and citric acid), Dried Egg Product, Flaxseed, Corn Gluten Meal, Chicken Liver Flavor, Powdered Cellulose, Calcium Carbonate, Dried Beet Pulp, L-Lysine, Potassium Chloride, Potassium Citrate, Choline Chloride, Iodized Salt, Calcium Sulfate, vitamins (L-Ascorbyl-2-Polyphosphate (source of vitamin C), Vitamin E Supplement, Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Vitamin D3 Supplement), Vitamin E Supplement, L-Threonine, Taurine, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), L-Tryptophan, Magnesium Oxide, preserved with Mixed Tocopherols & Citric Acid, Phosphoric Acid, Beta-Carotene, Rosemary Extract.
Protein: 14%, Fat: 19%, Carbs: 59%

Perhaps they want the dog on a lower protein so that's why they went with K/D? I'm spitballing here.

Here's some additional diet info. And I posted the ingredients for the dry kibble and I just noticed they recommend the canned. I'll have to search those out.

Dogs with the condition are managed medically, and treatment is based on the severity of the condition. In some dogs no treatment is needed. The mainstay of medical management is to reduce the amount of protein in the diet. Specific veterinary diets such as Hill's L/d have been formulated for dogs with liver disease. The protein is highly digestible (often milk based or soy) and is only mildly protein restricted. Diets for dogs with HMD should contain about 15-20% protein (roughly 2 g/kg per day of protein), 15-30% fat, and 30-50% highly digestible carbohydrates on a dry matter basis. They should also be high in zinc and Vitamin E and low in manganese. Most dogs with HMD do well on diet change alone.

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.

L/D canned ingredients:
Water, Rice, Egg Product, Chicken Fat (preserved with mixed tocopherols and citric acid), Soybean Meal, Soybean Oil, Corn Starch, Chicken Liver Flavor, Corn Gluten Meal, Powered Cellulose, Fish Oil, Dicalcium Phosphate, Potassium Chloride, Calcium Carbonate, Dried Beet Pulp, L-Lysine, L-Arginine, Iodized Salt, Choline Chloride, Vitamin E Supplement, Taurine, Zinc Oxide, L-Carnitine, Ascorbic Acid (source of vitamin C), L-Tryptophan, Niacin, Thiamine Mononitrate, Vitamin A Supplement, Beta-Carotene, Calcium Pantothenate, Manganous Oxide, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Calcium Iodate, Vitamin D3 Supplement, Sodium Selenite, Menadione Dimethylpyrimidinol Bisulfite (source of vitamin K).
Protein: 17.6%, Fat: 24.2%, Carbs: 49.3%

K/D canned ingredients:
Water, Egg White, Corn Starch, Pork Liver, Chicken Fat (preserved with mixed tocopherols, and citric acid), Sucrose, Flaxseed, Dried Whey, Chicken Liver Flavor, Calcium Carbonate, Calcium Sulfate, Caramel Color, Choline Chloride, Vitamin E Supplement, Potassium Chloride, Magnesium Oxide, Iodized Salt, Taurine, Ferrous Sulfate, Ascorbic Acid (source of vitamin C), Zinc Oxide, Thiamine Mononitrate, Beta-Carotene, Niacin, Calcium Pantothenate, Vitamin B12 Supplement, Manganous Oxide, Copper Sulfate, Pyridoxine Hydrochloride, Biotin, Vitamin D3 Supplement, Riboflavin, Calcium Iodate, Folic Acid, Sodium Selenite.
Protein: 14.8%, Fat: 26.7%, carbs: 54%

Again, I'm guessing that they want the lower protein for this dog. BUT that's only a guess on my part.

I'm so sorry you and your baby are having such issues. I would tend to agree with Blanche on the lower protein theory. I hope she's okay!

Just wanted to say thanks to all of you who have responded so quickly. I guess the low-protein diet does make sense due to the MVD, I just wondered why the k/d which is specified for renal health was chosen over the l/d which is specified for liver health. Luckily, she's eating it, as long as I mix it with cooked carrots or apples, which the doctor ok'd, and she's really doing so great these past few days! Not to look a gift horse in the mouth, but I am still a little concerned about one other thing -- when it was believed that she had a liver shunt, I had read quite a bit about the neurological symptoms the surgeon mentioned could occur with a liver shunt. My pug had been demonstrating many of these neurological symptoms for a long time, but I had always assumed that's what dogs do. Now that I'm told she does not have a liver shunt, I'm left wondering why she's displaying these symptoms (head mashing, pacing, staring, most comfortable walking up against a wall, etc.). I need to just relax, I think, and enjoy her! Thanks again!

pugmama wrote:Just wanted to say thanks to all of you who have responded so quickly. I guess the low-protein diet does make sense due to the MVD, I just wondered why the k/d which is specified for renal health was chosen over the l/d which is specified for liver health. Luckily, she's eating it, as long as I mix it with cooked carrots or apples, which the doctor ok'd, and she's really doing so great these past few days! Not to look a gift horse in the mouth, but I am still a little concerned about one other thing -- when it was believed that she had a liver shunt, I had read quite a bit about the neurological symptoms the surgeon mentioned could occur with a liver shunt. My pug had been demonstrating many of these neurological symptoms for a long time, but I had always assumed that's what dogs do. Now that I'm told she does not have a liver shunt, I'm left wondering why she's displaying these symptoms (head mashing, pacing, staring, most comfortable walking up against a wall, etc.). I need to just relax, I think, and enjoy her! Thanks again!

My understanding is that MVD dogs can display the same symptoms neurologically as shunt dogs. The other thing that should be ruled out if it hasn't been already is PDE.

Here's some additional diet advice from another site and they do mention the K/D diet:
There are a number of reduced protein diets that might be helpful, including Hills k/d (tm) and l/d (tm) diets, Purina's NF diet and others. Lactulose dosage is adjusted to individual patient's needs by using it to obtain a soft but formed stool. Neomycin is usually given at a dosage of 22mg/kg of body weight twice a day and metronidazole at 7.5mg/kg twice a day. This is a lower metronidazole dosage than is used for many other conditions. I have seen recommendations for the use of other antibiotics but these two are the most commonly mentioned ones.

And it does appear that severely affected dogs can have many of the same symptoms as liver shunt dogs:
Severely affected dogs may be wobbly or act drunk or blind and can even seizure.

With your descriptions my mind went to PDE as well, which I hope is not the case. I hope you can find some answers and things settle down.

Quick response to your predicament. I have had two pugs with both liver shunt issues and PDE. Dogs with liver shunts are put either on l/d or k/d for the low protein. They used k/d before the l/d because the l/d formula is rather new. If your dog had a liver shunt, specific lab work would show it especially an ammonia level.
As far as the PDE is concerned, some of the symptoms you are describing are significant. For a piece of mind you might want to take your pup to a vet Neurologist. I spent alot of time and money from average vets with good intentions who were unaware. I finally received the information I needed from the specialist.
For the sake of your pup and sanity, go to a vet neurologist if you can. I wish you much luck and I hope your baby stays well.