portosystemic shunts

portosystemic shunts is when an abnormal blood vessel(s) re-direct blood around the liver and directly into systemic circulation (heart).
this diversion leads to a collection of toxins in the blood and potential liver failure.

the way i understand it is that all the nutrients are usually absorbed from the digestive tract and then go straight to the liver for processing.
a shunt diverts the blood away from the liver, so the vital food nutrients are not absorbed and used.
in addition, the shunted blood is not 'cleaned' or detoxified by the liver, and these waste products recirculate again and again.
all of this adds up to increased loads on the other organs, which would explain the kidney and bladder inflammation.

there are 2 kinds of shunts-
congenital (extrahepatic) - usually single shunts, found outside of the liver.
acquired (intrahepatic) - usually multiple shunts, found within the liver.
apparently the single shunts can be surgically tied off and have a very high rate of success...
the acquired shunts present a much more difficult road, as they are within the actual liver and there is usually more than 1.
from everything i've heard thus far, it is most likely that 'acquired' is the type sway has...

some of the symptoms of this condition are:
non-regenerative anemia w/ microcytosis (which sway has)
anorexia (which sway has)
elevated ALT (which sway has)
dilute urine (which sway has)
elevated ALP, white blood cell count, liver enzymes, bile acids (which sway has), blood ammonia
hypocholesterolemia, hypoalbuminemia, hypoglobulinemia
some of the clinical signs are:
drinking/urinating too much (sway has)
poor weight gain (sway has)
stunted growth (sway has)
excessive sleeping/lethargy (sway has)
diarrhea (sway has)
straining to urinate
blindness/seizures
pressing head against wall (she does this sometimes)
pacing and aimless wandering (sway does this)
abnormal behavior after eating

the first step in diagnosing this is to have a bile acid test done...
i had this test administered at hemopet on monday and the results are already back-
the numbers showed that there is a very significant problem in the liver.
her pre-food result was 79.7 (normal range 0-12)
her post-food result was 111.9 (normal range 5-25)

dr. dodds then arranged for sway to get a scintigraphy scan over at the medical imaging center in tustin...
this is being done as i type this, as i dropped her off before i came into work today.
it involves placing a radioactive 'dye' into the intestine and then recording the route of dye absorption.
in a normal animal the dye is absorbed into circulation and moved to the liver.
in an animal with a portosystemic shunt, the dye bypasses the liver and appears in the heart.
the procedure is performed without sedation or anesthesia and only takes a few minutes...
she needs to stay at the facility all day though as to let the radioactive material pass through her system.
this should provide a far more detailed idea as to what we are up against, whether a surgery is necessary or even possible.

needless to say, my emotions are all over the place.
i'm elated that we might have finally found A REASON WHY we've had such a difficult time over the past year and a half.
i'm scared that sway is so far beyond 'a normal case' that any surgery would put her life in jeopardy.
i'm elated that sway could eventually get her liver function back and face AIHA with a full set of tools.
...the possibilities,
sway has been living with AIHA for 22 months now and who knows how much of that was spent with a compromised liver.
that means all the treatments, medications, supplements she was getting...might not of even been absorbed at all!

i am committed to going the distance in the name of my dogs restored health.
and i'm just praying for some clarity soon.
scan results could be in tomorrow,