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Upcoming Surgery

3K views 34 replies 10 participants last post by  Jackie from Concrete, WA 
#1 ·
Today Skye and I met the Vet that is going to do his bilateral cryptorchid surgery. After a lengthy discussion with her I feel comfortable placing him in her hands for the surgery. Three different Vets have been able to palpate one teste but the other one is hidden. She went over the procedure with me and explained how they progress in searching for hidden testes and the locations they "normally" find them. Still, I am sure by the time we go in next Wednesday to get the job done I will be a quivering mass of nerves.
Any prayers sent our way will be greatly appreciated.

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#5 ·
Things have gone from bad to worse. The Vet called with the results of his pre-surgery blood workup. Everything looked great except his ALT was through the roof. Over 300! So Skye's neuter surgery is on hold while we try to trace down the cause of his liver malfunction.

We go in Monday for another blood draw and liver enzyme test to make sure this wasn't an anomaly or error. Assuming he still shows elevated ALT will move on to ultrasound to see if that will reveal any injury, abnormality, or shunts on the liver.

I really don't know what to think. Skye is acting healthy and energetic, no diarrhea, vomiting, blood in urine or stool. No obvious signs of pain. He is such a picky eater, I can't tell for sure but I would say no change in appetite.

Just very surprised and dismayed to get this news.
 
#6 ·
So sorry to hear this. I know how worried you must be. Hopefully it is nothing serious and they can get to the bottom of this and figure out what is going on. Try to hang on to the fact that he is acting so normal and healthy. Sending lots of positive thoughts and prayers your way.
 
#11 ·
Dr Cheng called today with the lab results. Skye's ALT is still over 300. After a lengthy discussion we decided to do an ultrasound to look for any obvious liver abnormalities or other internal problems. This will also be an opportunity to try to locate the hidden testicle. He does need to be neutered, so the ultrasound will give her a decent preview of what to expect during surgery.

During a search here I found a reference to Dr. Karen Tobias at the University of Tennessee. I downloaded her pamphlet on common liver disorders and another article on canine liver enzymes from dvm360.com. So at least I feel comfortable discussing the situation with the doctor. And somewhat reassured that we will get through this. I am also reassured by the fact that the poster of that thread on here had a Hav that lived a long healthy life with cronically elevated ALT and Dr. Chen also told me she has had patients do the same.

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#14 ·
Hello- As you might have read my post on a previous thread: I am so sorry that you are having to go through this. I had a similar experience as yours with my first hav. He was asymptomatic but had elevated BAT and ALT for his entire life. Btw, he lived 11 wonderful years and passed from heart failure. When the vet raised the possiblity of a liver shunt because of his small size and the labs were abnormal, I was a so worried for quite some time. I consulted a vet at a teaching hospital in TN who specialized in micro and macro shunts ( Dr. Tobias). After many discussions with my vet, breeder andspecialists, I decided only to have the ultrasound done (essentially normal, which did not exclude MVD). Weighing all options and knowing how traumatic the liver biopsy could be, I decided to take a watchful waiting approach. His ALT remained chronically elevated, slightly waxing and waning over the years. Keeping his teeth extra clean with regular cleanings also seemed to help. I hope it give you strength to know even if the labs are abnormal, they can sometime still live long happy lives. After all of that, I decided to become less fixated on the labs and just tried to watch my pup to see how he seemed to be doing (which was just fine). I hope that helps a little-



Dr. Tobias sent me this in back in 2009 via email:

Accuracy of unltrasonography depends on the radiolgist or internist. Some specialists are 95-100% accurate and others are less. We use transplenic scintigraphy here to rule out shunting when we suspect MVD from congenital portal hypoplasia (CPH).

MVD/CPH is the most common cause of increased bile acids in clinically normal dogs with normal chem panels. A diagnosis would require ruling out a shunt (since PSS results in the same histologic liver changes) and then obtaining a piece of liver large enough to include at least 5 portal triads. This may require a minimally invasive approach (mini-lap or lalparoscopy), since we often do not get enough tissue on needle/trucut biopsies to be certain of a microvascular anomaly, and because that approach is less dangerous than ultrasound guided biopsy in a small breed dog with a small liver.

No one knows about diet change. No one has compared long term outcome of dogs with CPH/MVD that are on regular and protein restricted diets. At the very least, I wouldn't give any extra protein, puppy chow, or performance diets. No need to stress the liver.

With CPH/MVD, bile acids will always be high and they do not correlate with severity of disease. Better indicators are albumin, BUN, total protein, urine specific gravity, and urine sediment (for urate crystals and infection). Yearly lab work unless clinical signs occur.

We use scintigraphy here because it's easy and inexpensive, and we have seen dogs with shunts that have normal chemistry panels and mildly increased bile acids. So, for my own dog, I would do a transplenic scintigraphy. If it was normal, I'd probably leave it at that. Denamarin now comes in chewable tablets that have better absorption. Again, research has not been done in dogs with CPH/MVD to determine if it makes a difference, but its contents (milk thistle and SAM-e) have been shown to improve liver function. Owner preference.

No idea about long term prognosis. We tested 139 healthy Yorkies and found that 2/3's had increased bile acids. Most likely this condition is present in the majority of Yorkies, Maltese, and Havanese, so most will live normal lifespans.
 
#15 ·
Hello- As you might have read my post on a previous thread: I am so sorry that you are having to go through this. I had a similar experience as yours with my first hav. He was asymptomatic but had elevated BAT and ALT for his entire life. Btw, he lived 11 wonderful years and passed from heart failure. When the vet raised the possiblity of a liver shunt because of his small size and the labs were abnormal, I was a so worried for quite some time. I consulted a vet at a teaching hospital in TN who specialized in micro and macro shunts ( Dr. Tobias). After many discussions with my vet, breeder andspecialists, I decided only to have the ultrasound done (essentially normal, which did not exclude MVD). Weighing all options and knowing how traumatic the liver biopsy could be, I decided to take a watchful waiting approach. His ALT remained chronically elevated, slightly waxing and waning over the years. Keeping his teeth extra clean with regular cleanings also seemed to help. I hope it give you strength to know even if the labs are abnormal, they can sometime still live long happy lives. After all of that, I decided to become less fixated on the labs and just tried to watch my pup to see how he seemed to be doing (which was just fine). I hope that helps a little-
Thank you for the encouragement. Yours was the post I referred to earlier. I have read and re-read Dr. Tobias' treatise. Unfortunately my reading comprehension and retention are not nearly what they were way back in the day when I aced the ACT. So I will keep studying and try to be as informed and prepared as I can.

As far as the doctor and I can tell Skye is completely asymptomatic. At 15+ lbs he doesn't show inhibited growth. The doctor was amazed. I think she read his chart before she came in to meet us for the first time and was expecting him to be chubby. The first time she picked him up she said "OH MY...he's all fluff!" During his exam she said he is very muscular and even a bit on the thin side as his belly tuck is very pronounced at both the sides and bottom. No signs of jaundice, no skin discoloration, no behavioral indicators. Nothing.

We were not able to schedule his ultrasound until Feb 12th. If a liver biopsy is indicated that could possibly be done at the same time as his neuter surgery. Kind of depends on if and where they find the "missing" testicle during the ultrasound.

So for now we have a reminder to live every day as if it were the last and enjoy the love and life that we share.

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#16 ·
Sounds like you are in good hands. My pup was always small (8 pounds) and very thin. He was an extra picky eater, possibly related to his condition. Nevertheless, he had a wonderful life of 11 years and his faulty cardiac valves were ultimately the cause of his transitioning. I had to learn to not react to Willy's elevated ALT every time we checked before his teeth cleanings and remind myself that he can still live well with this condition.

Skye is fortunate to have you navigating these waters for him. You are so right to live every day as it is the last and enjoy the love we have. Your love and attention are the most important <3
 
#18 ·
Finally Some GREAT NEWS!!!

Skye had his ultrasound today. His liver is normal size and shape with no abnormalities. All other internal organs checked out fine. So after the "normal in all respects" ultrasound we went ahead with bile acid tests. Doctor Chen said those results were "ridiculously normal"! Low range both before and after eating. She feels comfortable that with the proper cautions he will be able to handle anesthetics fine, so Skye is scheduled for neutering on the 20th. We could have pursued the high ALT further with liver biopsies and whatnot, but since the objective for now is to get him neutered to preclude testicular cancer, I feel it is prudent to do that surgery now and monitor closely for any symptoms in the future. The doctor's curiosity is piqued. She asked if she could do another ALT test "on the house" just to see if ALT has come down. She said he could have come in contact with some toxin that caused the ALT to be raised for a prolonged period and now the liver has recovered.

The ultrasound also located the "missing" testicle in a place that will be easy to get to.

So all in all today was a Good News Day!

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#24 ·
I heard Pam in a long conversation, last night, with another breeder about a dog that had an elevated ALT. She said that it can be caused if the dog is on flea, tick, and/or heartworm medication, and it's best to wait a while to see if it comes down after that stuff has had a chance to get out of the dogs system, if there were no other symptoms.
 
#25 ·
This is not surprising since they are all pesticides and the liver will try to filter them out I assume. I no longer use these medications, however when I did Mia's thyroid values kept dropping and I feared she would become hypothyroid. After taking her off of everything, her values were back to normal. Some flea/tick meds can stay in the system a fairly long time too.
 
#26 ·
I did pick up the Heartgard for Skye, but I haven't started him on it. Our higher temps only stayed around for a few days so I figure that we should be safe from infected mosquitos for a bit longer. He is on no other meds or supplements. I don't use chemicals on the yard so I have no idea what he might have ingested.

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#28 ·
I did pick up the Heartgard for Skye, but I haven't started him on it. Our higher temps only stayed around for a few days so I figure that we should be safe from infected mosquitos for a bit longer. He is on no other meds or supplements. I don't use chemicals on the yard so I have no idea what he might have ingested.

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Dogs and people are exposed to toxins in many ways...not just by ingestion. I believe you moved to a new house recently? Some of the worst toxins are actually indoors. Could the previous owners have cleaned their carpets or sprayed pesticides inside or out? Did they do some painting...takes awhile for those VOCs to gas off. Also, the paths you walk on... are they be sprayed? Fertilizers are also toxic...not just pesticides. Cleaning products and synthetic fragrances are super toxic too. Avoiding toxins is pretty much impossible but it helps to be aware of them and do our best to avoid them. I believe you were also considering the rabies vaccine. Did you do that? Vaccines contain toxic substances too. Just a few thoughts on how Skye may have come into contact with toxins. Here are a couple articles:

https://www.bustle.com/p/7-hidden-indoor-toxins-in-your-home-might-be-making-you-sick-7743371

https://www.whole-dog-journal.com/care/could-your-dog-be-breathing-in-toxins-in-your-home/
 
#29 ·
Successful Surgery!

I dropped Skye off at 7:30 AM yesterday and the doc called a little after noon with the good news. Surgery went very smoothly and Skye did great throughout. She wanted to keep him under observation for a while so we were not able to pick him up until 5. He was still pretty groggy at that time. He stood up and looked around a couple times but didn't start walking until after 8.

He has 2 incisions. The "treasures" were some distance apart. He has grudgingly accepted wearing an inflatable collar and/or a onesie. Hopefully we will be able to contain his boundless exuberance for the two week recovery period.

Two more bits of good news. The neuter went quickly enough and Skye was doing so well with the anesthesia that she was able to go ahead and extract the one lingering baby incisor. The "free" ALT test came back at 205. Not a good number, but much better than the 300+ of the first two tests.

Thanks to all of you for your thoughts and prayers throughout our ordeal.

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#30 ·
Wonderful news for you and Skye!!!!I am so very happy for you. Glad about the ultrasound results and successful neutering. Perhaps the ALT wil continue to decrease and even if it doesn't Skye will likey be just fine. Gratitude is so uplifting! And yes, how could all of the positive energy sent towards you and Skye not have helped~ Now recovery from neutering feels like a gift :)
 
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