Liver Shunt Update



Dr. Karen Tobias

Shunt Management Team

For the UTmost Care

22 April 2009

We have been using the Angel Fund for several things:  clinical research,
cost reduction (for all shunt patients), and extra support for a few shunt
patients that have special needs.  Most recently, our special needs
patients included a Yorkie with a shunt that had complications (the bill
exceeded the owner's budget),  a shunt dog with a stomach ulcer and
pneumonia that needed extra care, and a rescued Golden retriever with an
intrahepatic shunt that needed a CT to confirm the diagnosis.

Our current research project is on the Protein C test.  The previous study
on Protein C (from Cornell) showed that Protein C activity overlaps in dogs
that have a variety of liver conditions.  If we are only comparing shunt
dogs and dogs with MVD (microvascular dysplasia secondary to congenital
portal hypoplasia), then any value below 70% were shunts.  In our current
study, we are finding more overlap in our groups; in fact, our dogs with
other congenital defects like PDAs (heart defects) had low Protein Cs. So,
we are going to be revisiting the accuracy of the Protein C test, which
should be very helpful to our Yorkie owners. That project is being
partially funded by the Angel Fund and is expected to be completed by the
end of the summer.

We've recently published 3 other studies on CT and transplenic scintigraphy
for diagnosing shunts; these projects were also partially funded by the
Angel Fund and 2 of the projects won awards for best clinical research.
Our next project is to review the past 500 shunts and get follow-up.  We
have a summer work study student (veterinary student doing a summer
research project) who will be partially funded by the Angel Fund.  As with
the other projects, we will publish the results of the retrospective study
so that there will be more information for practitioners and owners on
outcomes of surgery. As you've noted, the Angel Fund has helped to keep
costs low for all animals; my understanding is that an uncomplicated case
costs about half as much as what is charged in most major cities.  The
added benefit to us is the huge number of patients that we see, and
therefore the extensive experience we have in managing these animals. We
believe that improves our chances for a good outcome after surgery.  In the
last 2 weeks we have had people fly (or drive) in from Texas, Indiana, and
California because they think we are the best, and because we are

I no longer have a television show.  I just finished submitting my first
surgery textbook (due out in October) and will soon begin to edit the
Textbook of Small Animal Surgery.  Because of all the wonderful clinical
"case material" - especially our Yorkie patients- I've been able to publish
over 50 articles- most commonly on shunts- and have been given the honor of
this editorship because of my expertise.  The research, writing, and
surgery clinics (about 22 weeks a year on surgery) have limited my ability
to do continuing education talks and I no longer do online shunt consults
for private individuals (although I still answer questions forwarded to me
by officers of YAP and YTNR). Those are the main areas that has been
affected by my busy schedule.

I'm really looking forward to Dr. Center's genetic testing- I hope this
will revolutionize our breeding programs. With luck, I will be out of a job
(at least as far as Yorkie shunts are concerned), so it's a good thing I'm
diversifying my career objectives!



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