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Hello, my name isXXXXX am a licensed veterinarian and I will try and help you as best as I can.
I am sorry to hear Tinkerbell is not doing well
liver shunts can be very hard to manage and often do not respond well to treatment
The ascites is from the low albumin
The low albumin is because the liver is not functioning properly, not related to the diet
The low protein diet is helping to minimize signs of hepatic encephalopathy
For that reason, you don't want to add protein to her diet
Spironolactone would be the next treatment, to try to pull fluid out, however it may not work for a very long time given how low her albumin is. The belly will continue to fill with fluid because of the low albumin.
I would give the Spironolactone a try if you are not ready to let go right now, but it is only a temporary fix unfortunately
How do we get the blood albumin up to stop the ascites if adding protein to the diet won't work? Plasma infusion? Anything else we cant try? She is so young and so full of life
The only other thing you can do would be plasma transfusions. They would need to be regular: multiple transfusions a week, which can get very cost prohibitive after a few weeks
And to just drain off the liquid every week or two?
Typically we will start with once every 7-10 days, then sometimes increase to as much as every other day
depending on her signs (mainly respiratory difficulty)
What would be the easiest protein for her liver to turn to albumine?
unfortunately the particular protein source is not relevant in this case. The problem is the liver itself and its ability to work normal which is not dependant on the protein source. I would stick with the l/d diet, it is the best available for this disease
She was completely well before,no ascites until the low protein diet, that's why I thought changing the diet may help.
A high protein diet will not alter the albumin levels, it will however increase the ammonia levels in the blood, which the liver is currently unable to eliminate well, which will make the signs worse. I think the timing here is just a coincidence
A transfusion is the only thing that will increase the protein levels in the blood (albumin)
So if we drain the fluid depending on her respiratory signs what will happen next?
Essentially, you continue to do that until she declines enough and you are ready for humane euthanasia. The belly will continue to fill with fluid, she will slowly worsen as far as becoming lethargic and dehydrated, she will lose muscle mass, and eventually the protein levels will get so low that she will be full again within 24 hours after draining.
What if the external shunt can be operated? How does one know if the liver is cirrhotic or fibrotic without a biopsy? The uss was done by a vet specialist who said the liver was smaller than it should be, in keeping with shunting, there is a small external shunt which may be operable but the internal shunts are multiple and not operable. Is it a congenital issue with shunting causing the liver damage or is liver damage for some reason the cause of the shunting?
The shunt is a congenital problem and is breed related. The external shunt can be operated on, but the internals cannot. Given the internal shunts, it is likely signs would not improve with surgical closing of the external shunt. A biopsy is indeed needed for definitive diagnosis, however given the age, breed, clinical signs, and ultrasound findings, it is a pretty easy diagnosis
I need to know that I have done everything possible, is there nothing else? What about the liver's regeneration potential?
The liver will not regenerate with a shunt present due to the abnormal blood flow. You are doing everything you can, but unfortunately this is a disease that in this case you really can do nothing to affect long term outcome. The spironolactone and plasma transfusions may help in the short term, but you will never be able to cure this disease or regenerate lost liver. I'm sorry
Thank you for explaining everything, it's just so hard, I love her so much, she's given me so much joy, I just didn't expect her life to be so short. I 'll see how she goes and take her to sleep when she deteriorates again. Thank you.
You're very welcome.
I wish you the best with little Tinkerbell. It sounds like she has a great home and a wonderful owner. Please feel free to contact me again if you need any further information, otherwise please feel free to leave positive feedback for this conversation. My goal is 100% customer satisfaction. If you do not believe you have received this, please reply back before rating and I will help you further. Thank you and have a great day.