Molly Needs Liver Shunt Surgery

Dear Kismutt Dog Rescue,

We got Molly, a Yorkiepoo, on Nov 17. She is 11 weeks old (birthday Sep 11). She is so sweet and the joy of our family (I live in a multigenerational home with my 2 parents), but the joy was short-lived as we discovered that Molly has been having seizures since the day we got her. It was subtle at first and we did not recognize it, but in less than a week after we got her, she started having cluster seizures that have been more violent, longer in duration and she was having more than 10 seizures a day for 48h. We took her to the Mississauga- Oakville VCA ER hospital on Nov 27 and the vet suspects a liver shunt. She had electrolytes, creatinine, BUN, liver enzymes and ammonia done which all came back normal. She did not have a bile acid test or any diagnostic imaging, however the proof is in the pudding. After we took her home, for 1 day, I gave her phenobarbital and valium as instructed by the vet but it had no effect on her seizures, if anything, it made her uncoordinated. 

So I decided to fast her for 24h and her seizures disappeared which strongly points to a liver shunt. However, even after fasting for 24h, her mentation did not return completely to normal. Even though she no longer had seizures and is very active, she still exhibited signs of hepatic encephalopathy: Pacing around aimlessly, turning her head in all direction as if looking at a butterfly flying around her head that doesn't exist, she does not respond to her name or any commands she previously learned and does not look at us in the eyes anymore. She used to follow us around all the time, sit at our feet and stare at us but she doesn't do any of that anymore. There are short period where she seems more lucid and will look at us in the eye and follow us again, but 90% of the time, she looks like a ghost of herself.

Her seizures are focal motor seizures. The more subtle ones she started with were head tremors followed by loss of bowel function, the latter ones involved violent myoclonic jerks of her head and a whole side of her body and loss of bowel and bladder function. Immediately after a seizure, she will have a period of FRAP-like hyperactivity where she acts as if she was possessed; running into walls and even once the gas fireplace, we've had to confine her to her playpen or the fenced backyard when she has that in order to prevent her from hurting herself. 

After the ER hospital, I took her to the vet clinic near my house the next day. He prescribed some lactulose and metronidazole to help decrease the ammonia level which I started giving her. I also started feeding her small amount of low-protein food that the ER hospital gave me and small amount of bananas, and even with barely any proteins in her diet, she started having seizures again though they are much more brief (only a few seconds as opposed to 1-4 minutes previously) and much less frequent, and she does not always lose bowel function with her seizures like she used to 100% of the time.

The vet said a puppy so young cannot be managed with a low-protein diet, since they need a protein-rich diet to grow and be healthy, but a high-protein diet gives her uncontrollable seizures refractory to phenobarbital so she is between a rock and a hard place. 

Her only hope of survival would be surgical treatment, and that is presuming the best case scenario where she only has a single shunt, not multiple. We were told that the cost of diagnostic imaging and surgical treatment would be around 10,000$. Although I did buy Molly pet insurance, all pet insurances have a 14-day exclusion period, Molly got sick so fast that she didn't make it to the 14-days exclusion period to be covered by the insurance, it is now considered a pre-existing condition.

We would not be able to afford the cost of treatment even if her shunt was treatable surgically. The vet at the VCA ER hospital talked about euthanasia or surrendering her to the Mississauga Humane Society, however I do not know what happens to dogs like her when they are surrended to the humane society. The only reason I'd consider surrendering her is if I thought they would be able to crowdfund her surgical treatment and save her life. But if they are going to put her down, I'd rather keep Molly with our family and give her a good end-of-life. I don't want her to spend her last days alone in a kennel. We are 3 adults at home 100% of the time and caring for her 24/7. Who's going to be around to clean her up and her kennel when she has a seizure, loses her bowel function and soils herself and her kennel? As I said, she has FRAP-like symptoms following a seizure, she's been stepping on her own poop and smearing it all over herself and her playpen after a seizure. Unless someone is there to actively remove her poop before she invariably steps in it and runs all over her playpen with dirty paws, her playpen will completely covered in poop after a single seizure. When she was having 10 seizures a day, me and my parents were cleaning her playpen multiple times a day and bathing her 3 times a day to keep her clean. Now that I feed her a low-protein diet and her seizures are much less frequent and she doesn't lose her bowel function everytime, it's been much more manageable, but she cannot be sustained on a low-protein diet forever, she will become malnourished eventually. We are obviously heartbroken and feel very helpless.

Do you think the humane society or your rescue would be able to fund the cost of treatment for a liver shunt if I were to surrender her? Is there any organization that can help us appeal to the public to crowdfund her care? Do you think it is likely that she will be put down if we surrendered her?

Thank you, 
Izabelle
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Kimberly Thomas 
Organizer
St Marys, ON
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