PORTO SYSTEMIC SHUNT
Prior to finding out more about a Porto Systemic Shunt, I have included this story of Ramses, his parents said I could alter their story, but I have left it exactly as it was. Ramses was a wonderful cat, who brought so much love into this world, be it only for a short time, I felt it only right to leave it. I would like to thank Roger and Vickie, for loving Ramses and giving him, so much love in return. Also allowing me to be part of his life. This story only touches a little bit on the problems that the Porto systemic shunt had on Ramses, but Roger and Vickie never gave up on him. Thank you.
It can be very hard as a breeder, you hope that every kitten that leaves your home, will have a very long happy life, with people that you feel will help to achieve this. It is heart breaking when something goes drastically wrong. As in the case of Ramses.
© Vickie & Roger Ball
Ramses was born on the 6th March 2002. He came into our lives about 6 weeks later, when we were interviewed by the Adoption Agency [AKA Christine Richards] In June he came to live with us and captured our hearts.
Ramses was named after the Pharaoh Ramses the First. As a boy Ramses was ailing and died at quite a young age. It was unfortunate that our Ramses also had more than his share of problems. He had been with us for about a month and was sitting on my lap learning computer skills, [I was trying to do some work on the computer and make a fuss of the little lad].
Whilst stroking his neck I felt a lump, some further examinations confirmed that there was definitely something there. The following morning we went with Ramses to our local vet'. Richard and David had been friends of the family for a long time and had checked Ramses when he first came to us, so they were quite surprised to see him back so soon.
An examination soon confirmed that there was a lump of some type. An ultra sound scan didn't clarify what it was so it was decided to operate. It turned out to be a lymph gland, which had grown very large. It was removed as it was pressing on the little lad's throat and causing him some difficulty in swallowing. The growth was sent for dissection and report. The lab confirmed it to be a swollen lymph gland, which was not carcinogenic. The lab commented that they had seen similar lymph glands before but never in a cat so young.
Ramses recovered from the operation very quickly and was growing quite rapidly, which was to be expected at that age. In the September the time had come for him to be neutered. As we all know it is normally a very simple procedure in male cats a very small incision, which often doesn't need a stitch. Nothing could be straight forward, for Ramses. One of his testicles hadn't descended. David had to go searching for it. This caused the operation to be a somewhat more involved task. Once again Ramses recovered very quickly and was soon his playful affectionate self.
By this time we had moved 200 miles to Devon. Very late one Saturday night Ramses started wheezing and was having difficulty in breathing. His heart rate was quite high and at 3am Sunday morning he was getting worse. We had to find a vet that would see him. We phoned the local practice and were re-directed to the practices duty vet in Totness. We spoke to the vets wife and explained the symptoms and history. The vet, Chris Jones was put on the phone and asked us if we could come over straight over to Totness Surgery. At 4am we were in the surgery with one rather poorly Ramses.
An antibiotic and steroid injection were given to him and we were asked to take him back at 12 noon. He was a lot better but still not completely right so he was given a course of antibiotics. A couple of weeks later he had another session of difficulty breathing and rapid heart rate. This time his heart sounded as though it was missing a beat every now and then. At this point Chris decided to refer Ramses to a specialist Veterinary practice in Gloucestershire. I took Ramses there for the day he had an ECG and an Xray of his heart. The verdict was his heart was OK. The ''missing beats'' were not missing but there was an irregularity which made it sound as though it was a beat missing. We returned home somewhat happier that at least his heart was OK.
He kept on having the breathing problems. In the new year of 2003 we were away for a weekend. Ramses was with us as was my youngest daughter Hayley. Hayley is a qualified Veterinary Nurse and she was quite concerned to see Ramses having one of his attacks. She started to analyse the symptoms and came up with a suggestion of a Porto systemic shunt. This is a condition, which is quite rare, but she had seen it in a puppy and had assisted in the operation to correct it.
The shunt is a vein, which by passes the liver. As the blood does not go through the liver, it doesn't get cleaned. Instead the toxins in the blood build up and cause the symptoms Ramses was exhibiting. Hayley spoke to Chris and they came to the conclusion that another referral to the specialist in Gloucestershire was the correct course of action.
The Gloucestershire vets agreed that the problem could well be a shunt. They felt it would be more appropriate to refer Ramses to a specialist practice in Hertfordshire, at Hitchen. The appointment was made and we travelled up in the car with the caravan in tow.
Ramses was examined and it was decided to operate. First a Porto Veno-gram would be taken. This is an Xray which shows the blood vessels around the liver. It confirmed that there was a shunt. A ligature was fitted to the shunt [to stop blood bypassing the liver] and Ramses was admitted to the practice hospital. He was kept in for the rest of the week.
When we returned home Ramses was much better, it looked as though he was going to be OK. Unfortunately 4 or 5 months later he was back at the Hitchen practice for another operation. We knew that if this didn't work everything that could be done had been done. By November he was getting worse again and this time there was no mistaking that he was loosing the battle.
At the beginning of December I was away at work for the week and on the Tuesday he was having a lot of problems with breathing and walking. Chris, his vet came and spent several hours with him in the evening. Following several injections he was a little better.
We had already discussed with Christine what would happen when the time came for him to be put to sleep. When I got home on the Friday, I took one look at him and called Chris and asked him to call round and help us send Ramses on his way. It was decided that we would send him off on Saturday afternoon.
For nearly a year Ramses had been on a low protein diet. His favourite food was Duck and at this late stage it was not going to harm him to have such a rich meal. We all sat down to lunch and Ramses had his roast duck and roast potatoes. He cleared his plate and then settled down with his sister and brother, Iset and Seti, to have an afternoon sleep.
Chris arrived during the afternoon and prepared the drugs. We gave Ramses two injections the first to sedate him, so that he would feel no discomfort and the second to put him to sleep.
Ramses was cremated and returned to us. He now resides in a wooden urn carved in the shape of a cat. His body may have gone but his spirit remains. Ramses was with us for just 18 months but in that time he changed our lives, we will never forget him.
Finally I would like to thank all those who helped the little lad.
Dart Vale Vets- Chris Jones in particular and his wife who we disturbed in the small hours of the morning.
The vets in Glouster who he was first referred to.
Davies White Veterinary practice at Hitchen and Dr Carolyn Burton who took such good care of him
Last but not least Christine Richards, without her, our lives would not have been enriched by Ramses.
What is a Portosystemic Shunt?
The condition may be congenital or acquired.
In normal cats veins carrying blood rich in absorbed nutrients from the intestines are carried via the portal vein into the liver. The portal vein divides throughout the liver into smaller capillaries to metabolise the nutrients and break down harmful toxins. In Portosystemic disease the portal vein bypasses the liver, thus not allowing this to occur. Because of the back flow of fluid, congestive heart failure is acquired as a secondary to the primary condition. Because of the extra fluid in the chest the cat finds it more difficult to breath. But many heart problems go undetected as the cat takes on a more sedentary life style.
Sometimes when the original vein is ligatured, another vein bypasses the liver.
What are the functions of the Liver.
Production of Bile, a product of broken down red blood cells and certain hormones and toxins i.e. drugs , which aids the digestion of fatty foods and colours and deodorises faeces.
Helps to maintain blood sugar levels, by converting and storing glycogen
Breaks down fatty acids
protein metabolism, into toxic ammonia, which is then excreted via the kidneys, without this function, death will occur very quickly [reason for low protein diet]
Synthesis of bile salts, which aid the emulsification and absorption of fats
Storage, in addition to glycogen the liver stores vitamins.
Activates Vitamin D, which contribute to the homeostasis of body fluids.
But these functions can only be maintained by a good blood supply entering the liver.
I would personally like to thank all the wonderful people who have helped, loved and cared for this special little soul. I have cried another thousand tears whilst I wrote this as did his wonderful parents. We hope Ramses story, will some how help another little person.
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