Tottie was always a little bit “nice but dim”, she had a bad start with a Mum that was careless to say the least. Some bitches just never really settle into the maternal role and Tottie’s Mum certainly resented the time spent cleaning and feeding the squirmy little babies. I went to visit the litter five days after they had been born, to cut a long story short, I came home with three tiny Spinoni wrapped in a blanket in an apple box......

Two of the pups flourished , greedily sucking the bottle and getting stronger by the hour. Tottie just seemed to lack the will to live, I dripped milk into the corner of her mouth as she lay in the palm of my hand , seemingly lifeless. The turning point came  36 hours later as with a sigh and a shudder she opened her mouth to accept the sweet milk, I could finally get some sleep!

As the three pups grew, Tottie was still smaller than the other two and her coat had the quality of a Merino lamb! How could I not love her? She was playful and charming and bright as a button.

The months passed, then one evening I noticed that she wouldn’t settle as she normally would. My sofa is always piled high with a tangle of dogs, mostly snoring and muttering about what a hard day they’ve had, but Tottie continued to wander about the room, aimlessly restless. Eventually she flopped into her basket as bedtime approached. Anyone who has dogs or children will understand that half sleep when you feel something is “brewing”, so when at around three in the morning I heard rustling and thudding from the kitchen I was down there in a moment.

Tottie was wandering around the kitchen, she didn’t acknowledge that I was there, odd in itself, normally she bounced to me in a series of gleeful bounds. I watched as she continued to walk clockwise around the room, bumping into corners , just not seeing anything. I couldn’t get a response when I waved my hand in front of her, by now I was terribly worried, her legs just kept walking even when I picked her up, she had become an automaton , her muscles jerking as she struggled to move and keep walking.

I was blessed that morning to have such an intuitive and well informed Veterinary Surgeon, after careful consideration she shared with me her concern that this may be Portosystemic Liver Shunt. The next few hours would tell, the emergency therapy was Lactulose as an enema as well as given by mouth and a large dose of antibiotic. A drip was started to flush her system through.

Tottie was so very poorly, we really didn’t know if she would respond. My Vet tried several Veterinary Hospitals  with specialist knowledge and none could squeeze her in, and so we waited.

Six hours later, what a transformation! Tottie was jumping out of her skin, shouting and running around as if she had been given the elixir of life, which in a way, she had.

Tottie has now been diagnosed with liver shunt by the use of ultra sound imaging.

What is Liver Shunt or PSS?

In the fetus a shunt, called the patent ductus venosus, is present and bypasses blood away from the liver to the placenta so that the mother can cleanse the blood for the fetus. Once the puppy is born the shunt closes within three days after birth and the puppy's liver must clean the blood.  Sometimes the shunt does not close off. A portosystemic shunt, therefore is an abnormal vessel that allows blood to bypass the liver. As a result the blood is not cleansed by one of the bodies filters: the liver. These dogs also have much less blood that flows to the liver which causes the liver to remain small. There are many variations of congential portosystemic shunts that are found at surgery, however there are  two main groups:  shunts located in the liver (intrahepatic shunt) and shunts located outside of the liver tissue (extrahepatic shunt).  The intrahepatic shunt is most commonly found in large breed dogs and extrahepatic shunts are seen in small breeds. 

So why did Tottie’s behaviour become so bizarre? The toxins built up and caused symptoms of, blindness, poor weight gain and  unsteady gait to name just a few. I have found in my research that even aggression and obsessive behaviour can flag up a possible Liver Shunt to a switched on Veterinary Surgeon.

As a breeder, my concern was the possible inherited link. Just how many dogs have this condition and is there any way of testing? The number of dogs that have Liver Shunt that goes undetected is impossible to quantify, many animals show no signs or symptoms until they undergo anaesthetic, the poor recovery rate is because the drug is not being processed through the liver in the normal way , instead it lingers .The risk of death under anaesthetic for an animal with PSS is a real one.

There are some breeds that have a known propensity for PSS among them the Irish Wolfhound and the Yorkshire Terrier The mode of inheritance is unknown as yet, I include a study from the USA in 2003.

C247 Veterinary Teaching Hospital, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee 37996-4544, USA.

A hereditary basis for congenital portosystemic shunts (PSS) in Yorkshire terriers was explored through record and pedigree analysis and a breeding trial. The odds ratio for PSS in Yorkshire terriers was 35.9 times greater than for all other breeds combined. Wright's coefficient of inbreeding was approximately twice as high for Yorkshire terriers with PSS as compared to normal members of the breed (P=0.09). No common ancestors were found that were significant to the PSS group. Two affected Yorkshire terriers were bred and produced two normal puppies. Congenital PSS appears to be hereditary in Yorkshire terriers; however, the mechanism of inheritance has yet to be elucidated.

So where do we go from here, one simple answer is not to repeat a mating where the condition occurs in one or more pups. Tottie was the result of a repeat mating, none of the other 12 puppies produced in the two litters has shown any sign of PSS.

There is a test that can be used on a litter to determine the presence of PSS, it measures ammonia concentration and bile acid, this from The Veterinary Record, Vol 144, Issue 25, 693-696
Copyright © 1999 by British Veterinary Association

Five hundred and sixty-six Irish wolfhound puppies aged sixto 15 weeks were tested for congenital portosystemic shuntsby the dynamic bile acid method. Plasma ammonia concentrationwas also measured in 165 of the puppies both fasting and postprandially.Nineteen puppies (3·4 per cent), nine males and 10 females,had portosystemic shunts. Smaller litters appeared to be morelikely to contain affected puppies. The postprandial bile acidconcentration was a reliable predictor of the presence of ashunt, with the highest concentration in a normal puppy being38 µmol/litre and the lowest in an affected puppy being43 µmol/litre. In contrast, fasting bile acid concentrationswere normal in the majority of the affected puppies. There wasconsiderable overlap in fasting plasma ammonia concentrationsbetween normal and affected puppies (26 puppies, 15·8 percent of those tested). Postprandial ammonia concentration appearedto give better separation between the two groups, apart fromtwo individuals which produced bizarre results. It was concludedthat the postprandial or dynamic bile acid test is an appropriatetest for the mass screening of Irish wolfhound puppies for portosystemicshunts, and guidelines are proposed for the interpretation andfollow-up of the test.

For Tottie her longevity is uncertain, I did consider the surgical option but after research I decided that management through diet and drugs would be my choice for her. I stress that it is a personal choice, should any reader have the misfortune to encounter this condition themselves, I suggest you make your own decision based on your own research and advice from a professional source. A short life but a merry one is what I envisage for Tottie, she is bonny and happy now, she has lactulose twice a day along with antibiotics and a diet that is restricted in high quality protein.

As for Tottie’s brother Tobi and her father Geezer, they have had the acid bile test and are clear of PSS

In conclusion I thought it would be useful to share with you some of the symptoms associated with PSS, only through sharing knowledge can we hope to know more.

  Failure for a puppy to grow
· Poor weight gain
· Depression, Listlessness, apathy.
· Weakness
· Seizures
· Salivation, drooling
· Vomiting
· Poor appetite
· Balance problems
· Bladder stones
· Blindness

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