Liver Shunt, Hydrocephalus & Heart Murmur

I just came home from the teaching hospital at WSU with the following diagnosis:

Single extrahepatic portocaval shunt, bilateral corneal ulcers with scleral injection, small open fontanel, right sided heart murmur (suspicious of a ventricular septal defect), neurologic deficits localized to a left forebrain lesion in addition to secondary effects of hepatic encephalopathy.

I'm hoping to find a recipe for a homemade diet that will keep her well until she's old enough and big enough for the surgery.

Anyone?

Thanks in advance for any advice.

~Sandra & the Gang, including Patches, with the Liver Shunt

Sandra:
I responded to your introduction with information about liver diets. PM me your email and I'll send you the diet stuff. I've not dealt with hydrocephaly before, however. Have dealt with hepatic encephalopathy.

Sandra, I have had a liver shunt pug and a hydrocephalic pug. The hydrocephalic pug was well over 20 years ago; was late onset and presented with seizures, which were managed. The liver shunt pug was recently, and once she was diagnosed and pre/during/post surgery (while the shunt closed) and she was on a very strict diet, the change was dramatic. She was a sickly pug for her first 12 months until the problem was finally found, but once she was on the diet, all was wonderful. It was the one Blanche has given you. Once she was healed she went to a normal diet and has never looked back!

It sounds like your little guy is in the best of hands between you and his vets. Good luck!

Hi Sandra,

I checked out your intro too.

Definitely keep on the lactulose. And, keep with the vet diet until you can work out a better diet for yourself.

We had a live shunt pug in rescue. She was failing quickly until her liver shunt was diagnosed. When we got her on the lactulose and the vet diet, she improved quickly. It is important to follow the schedule for the lactulose very strictly also.

Good luck!

Well, since returning from the teaching hospital, Patches has grown on the University of Tennessee's Veterinary Hospital's Liver SHunt diet and had a relatively great life taking Laculose. By early December she had grown from barely 2 pounds to six! Her fur is the softest and silkiest, almost more like a cat than a Pug. We were looking forward to Spring and having her surgery.

When my daughter and her two toddlers from out of town were scheduled to spend two weeks with us for the Hoildays, I decided Patches needed to be moved into the Pug room for her own safety. She has her own little pen, but we worried my autistic grandson might try to feed her, to might accidently hurt her if she was in the middle of the living room. Since we have a very small living room, and we have a big table we needed to put in the dining room, it seemed the best option for her.

After she was out there for a few days, I noticed she had a lot more fluid coming out of her nose. She was sneezing and looked miserable. Knowing most Liver Shunt pups also get an antibiotic, and that with Pugs, a cold becomes pneumonia overnight, I decided to give her Amoxicillin to prevent any secondary infections and the build up of bacteria in her system. It is the bacteria, when it dies, that causes the ammonia infilterating the brain creating the neurological symptoms with a Liver shunt. So, after a few days I saw her cold improve, but noted she was sleeping a lot. I attributed this to recovery process. Next, I notices she was acting itchy. Scratching with her back legs. I wondered what was causing that, but was so busy, and distracted, I did what needed to be done to care for her and the other Pugs in the Pug room, while Christi was visiting her mom (she's our granddaughter and the Pug Nanny, but Patches is her Pug), and I was trying to entertain the sick daughter and her two sick kids, while getting ready for Christmas. Christi's mom and two brothers were coming to spend Christmas Eve and stay the night with us. Dinner was a buffet on Christmas Eve, and a sit down dinner on Christmas Day, plus, I still had presents to wrap and shopping to finish.

Everything was going well, then I got sick on CHristmas Day. It was the flu, and I've not been that sick in years. I had to let my husband cook the dinner, I slept sitting up in my chair most of the day. I was miserable for 2 and a half weeks, then more like a regular cold for another week or so.

Meanwhile, Patches was acting more unusual, by sleeping almost all the time. After I got sick, Ron came to me and showed me her armpit had a horrible rash, so I told him it must be the antibiotic, so, since it had been 10 days, I felt it was OK to stop it. A week or so later, he took me by the hand and led me to her pen to show me she was not walking right. She couldn't move either of her back legs right. He had to make a ramp for her to get in and out of her donut bed. SHe was blowing coat, too, so the rash didn't seem all that bad.

By the time I was feeling better, Christi was home and back to caring for her. One day she brought her to me and showed me that her armpit was not only worse, it was nasty looking. She said she thought she'd gotten worse since the armpit had gotten worse. I took her in to the vet the next day. I showed him how she was now not walking very well at all, even though we'd upped her dose of lactulose as she'd grown, and we'd managed to give it to her and feed her on schedule every time, even if one of us had to stay home with her. I told him how she'd gone downhill after being sick, and I showed him her armpit. He did a skin scraping, it was a staph infection, then he examined her skull, and he told me her brain legion must be growing. Or, maybe there was more wrong than we knew.

He put her on Cephilecin and told me we'd need to keep her on it from now on. I brought her home, convinced she'd be fine and back to herself in a few days. As soon as the antibiotic went to work killing all the bacteria so it was manageable again.

I was sadly mistaken. Not much improvement so far. All I've found I can clean her airpit with is Simply Saline, since it only contains some sodium. I wish it was soothing for her, though. She still tries to itch it with her back foot. It's had to keep it clean and get it healed when she's scratching it.

Today I saw her fall and have a seizure. She's been having small ones, and I'm not so sure this is going to get better now. Thanks for listening. I'm feeling pretty sad and alone with the decision that I will soon be forced to make. How much suffering do I put her through? Anyone?

You're in a rotten place. But I will tell you where I am with this kind of stuff. I ask myself two questions when dogs/cats/horses are in this kind of shape:

1.) Is there any quality there--and if there is, is there more good quality than bad.

2.) If it were me, what would I want done--now bear in mind that I'm not one for invasive or heroic measures if the outcome is going to be a poor one. I'd rather let an animal go a week too early than a second too late.

If the outcome won't be improved by invasive/heroic measures, then I don't do them and I try to let my animals go while they are still the animals I know and love. I don't ever want my animals to be just shells.

I'm not sure this helps or not. It's almost impossible to tell someone what to do in a situation like this when you haven't lived with it. But from what you've said, she and you have fought a valiant battle. I don't know that I'd keep on putting her through it, but that is only my opinion and I'm not living with it.

I am so sorry. Sounds like you have given this your very best shot. If there are further complications piling up this is a sad situation. If there is any hope of course you have to keep fighting, but your vet has to be clear that there is a chance. You don't want to let her suffer unnecessarily. My very best to you and Patches.

I want to let you know I'm reading your replies, but I'm unableto respond. I'm just too upset after seeing her struggle today.

I am so sorry you are going through this!

I'm so sorry for you & for Patches. I have to agree with everything that Blanche has said though. I've waited too long to put a pet down before & I have regretted it ever since. I'll be keeping you all in my thoughts & prayers.

My decision is always based on this:

If they are having more bad days than good days then it is time to set them free of the pain and confusion.

My heart goes out to you.

Blanche has given good advice. I am just so very sorry that you and Patches are going through this. You and she are in my thoughts and prayers.

Ok, first, let me tell you how much I needed support, and that you have my gratitude for your kind words! I really needed to get myself into a better place. Now I have managed to pull up my big girl panties, and my attitude is adjusted.

I can not do it. I can't give up on her yet. She's still there and fighting, so I am going to continue to do what I can to make her life as good as possible.

That aid, can anyone recommend any kind of sauve or ointment I can buy that will relieve her discomfort as her skin infection heals? She tries to scratch at it, and I think that's how it got so bad. Her little foot up under her body clawing at the rash, which became raw and got infected. Now, she has some areas of scabbing and that itches, too. I need to find something that will soothe and promote healing, but everything has some kind of chemicals added, even bag balm, which I looked into today, has an anteseptic ingredient. Since her liver doesn't process or filter these things, she can't have anything that can affect her brain if it gets into her bloodstream. If her skin was just dry, it would be different.

I live about 20 miles from a Trader Joe's, but I'm not sure what to look for. Any ideas?

Vitamin E, maybe? I'd use Polysporin, but not sure if that is safe for her or not.

Glad to hear that you're feeling better about things! Can you put a t shirt or something on her to keep her from itching at it? That's what I've done with my fosters who have had itchy skin issues.

Another vote for a onsie or Tshirt to cover the worst patches and prevent too much damage from her nails.

Talk to your pharmacist see what is available, perhaps pure sorbelene lotion or aloe vera pulp are on offer. Whatever you find, do check it with the treating vet first just to be on the safe side.

Other possibilities for soothing may include green tea or camomile tea, cooled and poured on as a leave in rinse or sprayed on frequently.