UT Angel Fund Update

by

Dr. Karen Tobias

Shunt Management Team

For the UTmost Care

15 October 2010

Summary of UTCVM Angel Fund: July 1, 2009 through June 30, 2010

The Angel Fund of University of Tennessee College of Veterinary Medicine is funded by donations from clients, the public, and support groups. Our biggest donor in 2009-2010 was the Yorkie Angel Patrol.

For the fiscal year of July 2009 to July 2010, the UTCVM Angel Fund provided money for several research projects and for financial support of numerous dogs previously diagnosed with or suspected to have portosystemic shunts (PSS).

Patient Support:

            In total, $2,009.10 was spent in support of 8 dogs. Patients included six Yorkshire terriers, one schnauzer donated for treatment of PSS, and one dachshund. Besides the clinical support provided to these patients, the Angel funds provided money for exploration of advanced technology. For instance, “Sam” the dachshund was referred to UTCVM because of recurrence of clinical signs after ameroid constrictor placement on a PSS; trans-splenic scintigraphy confirmed that another shunt was present. With use of Angel Funds, we performed a dual phase computer tomography that helped us to locate the second shunt before we went to surgery. Sam recovered successfully from the procedure.

            For 5 dogs, money from the Angel Fund allowed us to recheck trans-splenic scintigraphy on 5 Yorkshire terriers, 3 of which had previously had PSS corrected with ameroid constrictors, and 2 of which were offspring of other shunt dogs. Both of the offspring- “Madison” and “Woodstock”- had been previously evaluated for PSS. Because of lack of clinical signs and near normal bile acids, PSS were not suspected in these puppies at 8 weeks or 6 months of age. Woodstock later developed increased bile acid (>100 mmol/L); on trans-splenic scintigraphy we found a single congenital shunt, and Woodstock underwent successful ameroid constrictor placement, paid for with Angel Funds.

            The Angel Fund also paid for measurement of blood glucose and protein C activity in numerous dogs suspected to have PSS. These dogs are included in the clinical research projects described below.

Research Projects Funded:

Besides the experience we receive through funding of surgery and advanced technologies, we also are learning a great deal through studies involving our clinical patients. One study assessed our current methods for measuring blood glucose (blood sugar) in our dogs before and after shunt surgery. This study has been published and was later cited as an excellent example of useful clinical research. Another project involved development of a standardized protein C activity test for UTCVM to increase the availability of this test for clients and veterinarians, and subsequently determining whether shipping or freezing would affect results of the test, research that had not been previously been evaluated for dogs. Our final study- a review of all of our shunt patients over the last decade- is ongoing. We hope the results from this last study will provide more information about diagnostics, surgery, and outcome in regards to congenital PSS in dogs. A summary of the projects is listed below.

Respectfully submitted by Dr. Karen M. Tobias, DVM, MS, Diplomate ACVS, Professor of Small Animal Surgery, University of Tennessee Veterinary Medical Center

Johnson BM, Fry MM, Flatland B, Kirk CA: Comparison of a human portable blood glucose meter, veterinary portable blood glucose meter, and automated chemistry analyzer for measurement of blood glucose concentrations in dogs. J Am Vet Med Assoc 2009, 235:1309-1313

Summary: In this project, we compared the accuracy of small handheld devices for measuring blood sugar in dogs. For the project, the Angel Fund paid for a handheld glucometer and for some of the hormone assays. We measured blood glucose of dogs with portosystemic shunts and other diseases using each of the instruments. We found that the human portable glucometer falsely lowered the blood sugar by an average of 15.8 mg/dL, and that the veterinary portable glucometer falsely increased the blood sugar by an average of 2.4 mg/dL.  Veterinarians that use these devices should be aware of the differences in results and should therefore use the same machine when looking at a series of blood sugar tests in the same dog. Owners should be aware that results can vary from machine to machine, and that use of a human blood sugar monitor could give a falsely low level.

Williamson B, Tobias KM, Fry MM: Evaluation of preanalytical variables on canine Protein C activity.   Research completed fall of 2009; paper in progress.

Summary: In this project, we had several objectives: 1. To develop a test for Protein C at University of Tennessee that could be used to evaluate liver function in dogs.; and 2. To determine what effects shipping and storage conditions (such as freezing) have on protein C activity. Protein C is being used at Cornell to differentiate between dogs with MVD secondary to congenital portal hypoplasia (CPH) and dogs with congenital PSS. Because the samples are being mailed in, we did not know what effect differences in temperature and time would have on results. We have finished the sample and statistic analyses for both projects and are currently in the process of writing the paper. We now have a working Protein C test at UTCVM, thanks to the Angel Fund and the UT Companion Animal Fund. And, we have learned that there is some loss of activity with storage over time, and there are some differences after mailing the sample and between Cornell’s lab and ours. However, the differences are not enough to make a normal dog falsely appear to be abnormal on the test.

Hodshon R, Tobias KM: Retrospective evaluation of results of ameroid constrictor placement in dogs with congenital portosystemic shunts.  Research started January 2010; expected completion date November 2011.

Summary: Dr. Hodshon is reviewing all of the shunt surgeries from the last 10 years to determine several things: 1. Which animals have an increased risk of complications? 2. Is Protein C was useful in differentiating dogs with PSS and dogs with MVD secondary to congenital portal hypoplasia? 3. What is the long term outcome of dogs with seizures after PSS surgery? 4. Does anything help us predict poor long term outcomes in any PSS dog?  For this project, the Angel Fund has provided a computer and salary for a work study student to collate data and make phone calls.