Case of the Month

Killer

Killer is a 10 month old Yorkshire Terrier that presented to the Emergency service with the complaint of progressive weakness over the previous 2-3 days. His owners explained that Killer was becoming increasingly depressed and dull over this time period, and had progressed to the point where he was minimally responsive to them and would not eat any food that was offered to him. Dr. Carolyn Stafford first attended to Killer and found him to be severely depressed, very thin as well as blind. Blood samples were obtained to screen Killer for diseases and to confirm or rule-out Dr. Stafford's suspicion that he was born with a problem with his liver. These blood tests supported her suspicion that Killer was born with a portosystemic shunt. This is a disease where an abnormal blood vessel exists that circumvents the liver. The liver's responsibilities to the body includes filtering toxins from the blood, and if a blood vessel exists that provides a way for the blood to go around the liver, then the patient is exposed to very dangerous levels of these toxins. These can translate into serious ramifications to the brain, gastrointestinal tract or urinary tract most commonly.

To confirm the diagnosis, an ultrasound of Killer's abdominal organs was performed by Dr. Derek Nestor, the Internal Medicine Specialist at IVS. Dr. Nestor confirmed the diagnosis of a portosystemic shunt via identification of the abnormal blood vessel. This same-day diagnosis proved to be critical for Killer's chances of being made well again. This was clearly evident as attempts to medically stabilize his disease resulted in only a progressive depression to the point of obtundation and a lack of response to any attempts to roust Killer. Surgical correction was then offered as Killer's best chance of regaining his young and active lifestyle.

Surgical correction involves the identification of the abnormal blood vessel and subsequent placement of a medical device around the abnormal blood vessel to slowly constrict and eventually obliterate the blood vessel. The surgical team headed by Dr. Stanley Wagner and Dr. Brent Reimer performed this surgery the next morning. Killer did very well with the necessary anesthesia and surgery and the medical device was successfully placed around the blood vessel. He recovered from the surgery and began to eat well the next morning. He regained his eyesight 24 hours later and was discharged to his owners at that time. Since his surgery, Killer has continued to eat well, grow, and act like a normal puppy-for better or worse! Due to the collaborative efforts of the entire IVS team, Killer's prognosis is excellent for a long and healthy life.

The team at Iowa Veterinary Specialties provides expert care which has resulted in impressive success rates with a myriad of complex diseases including portosystemic shunts. To this point, the largest study of portosystemic shunts such as Killer's has a published mortality rate of 7.1%. With the level of care routinely available to our patients, we have been able to obtain an astounding 0% mortality rate in the 31 dogs affected with portosystemic shunts that have used IVS as their team for correction of this serious and potentially deadly disease.

Glad to have you back Killer!

• Killer
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