We get it! Tiny dogs are adorable! But the term “teacup dog” is usually a red flag that indicates irresponsible breeding practices. Thankfully, you can get a dog that stays small without compromising on health or longevity.

People want small dogs for many reasons. In cities, tiny dogs are perfect for apartment living (your landlord may even have weight limits for dogs) and carrying on public transit. If you fly a lot, a small dog can ride in a bag under the seat. Some hikers prefer small dogs because they are easy to carry if they get tired or hurt. And of course, there is the age-old reason of just wanting a warm little dog to curl up in your lap and cuddle.

Small Dog Breeds

Most dogs who will stay small even as adults come from the toy breeds. The “toy group” is a grouping of breeds that were developed to be small, friendly companions. Many terriers are also petite, but these dogs tend to have a lot more attitude and energy.

Exact weight ranges can vary by breed or mix, sex, and the individual, but breeds and mixes of breeds in the toy group all weigh under 20 pounds, and many weigh far less. We get predictability in size thanks to the efforts of breeders over the centuries who came together to develop and follow the breed standard that acts as a blueprint for each breed.

You can occasionally get outliers who grow larger than their brethren, but this is uncommon when getting a puppy from a breeder who adheres to the breed standard. Mixed breed dogs will of course be more varied than purebred dogs, but if both parents are small, their puppies should be as well.

Toy or Teacup?

All teacup dogs are toys, but not all toy dogs are teacups.

“Teacup dog” is a marketing term that refers to a dog that is unusually small, sometimes so small that it could maybe fit into a teacup. Often this means the dog will weigh less than 5 pounds or so as an adult, but the term has been applied to members of larger who breeds who are just smaller than most of their relatives.

There are no teacup breeds, just individual dogs within breeds that can be considered teacup varieties. For example, a teacup Chihuahua is just an extra-small Chihuahua, not a separate breed.

Some toy breeds that are commonly caught up in the teacup fad include the Chihuahua, Maltese, Pomeranian, Poodle, and Yorkshire Terrier.

Why Teacup Dogs Are Bad

Teacup dogs aren’t inherently bad. The problem is that whenever humans latch onto a specific marketing term, we tend to hyper fixate. All it takes is one celebrity posting a photo of their teeny tiny dog, and suddenly everyone wants one. And, of course, some people jump in to try to make a quick buck breeding these tiny canines.

Breeding happy, healthy dogs is much more complex than just putting two dogs in a room together. Many behavior traits, characteristics, and health factors are controlled by recessive genes that are not obvious to the naked eye. Dogs who appear perfectly healthy could be carrying genes for serious health problems that doom their puppies. It is our responsibility when considering breeding dogs to collect as much information as we can about each individual dog and their relatives to get a more complete picture of the genes that dog might carry and the risks those genes might bring.

Many toy breeds are already predisposed to certain health problems, and it is very easy to make those issues worse if a breeder is only making breeding decisions based on size.

Problems common with toy breed dogs include:

• Luxating patella
• Collapsing trachea
• Portosystemic shunts
• Open fontanelle (literally a hole in the skull that leaves the brain unprotected)
• Legg Calve Perthes Disease
• Mitral valve disease
• Pancreatitis
• Periodontal disease
• Hypoglycemia

Every person breeding toy breed dogs, including mixes, should be aware of these issues and know of the prevalence in their lines. Some of these problems can even be tested for. In Pomeranians, it is recommended that all breeding prospects receive evaluations from the Orthopedic Foundation for Animals (OFA) for their hearts, patellae, eyes, thyroid levels, hips, and Legg-Calve-Perthes disease.

You can find out what health testing is recommended for your breed on the OFA website thanks to the Canine Health Information Center. If considering a mixed-breed puppy, look up all the breeds that are involved with the litter. Tests that are recommended for multiple breeds are the most important for these mixed-breed litters.

People breeding teacup dogs often do little to no health testing. Doing this generation after generation can quickly increase the frequency of health problems within a line or gene pool. These disorders can cause pain and distress for your dog, are costly to treat, and can even be fatal.

Temperament of Tiny Dogs

Temperament and socialization can also suffer when a person is fixated on producing the tiniest puppies possible. If one or both parents are shy or aggressive, the puppies are likely to share those flaws. And while a ferocious Pomeranian may be cute, it isn’t much fun to live with and can make veterinary care challenging.

Puppies need to be safely exposed to a variety of surfaces, smells, people, animals, and experiences while they are young and impressionable. Most toy breed dogs do not go to their new homes until at least 12 weeks of age, so it is critical that the breeder has a plan to provide their puppies with safe experiences to prepare them for the rest of their lives.

If you are considering a “teacup” puppy, ask the breeder for a detailed description of their socialization protocol. Breeders passionate about the wellbeing of their dogs will have an answer, while those who are just taking advantage of the fad likely will not.

Tiny Dog = Big Care

Thanks to their diminutive size, teacup dogs are extremely fragile and require extra day-to-day care compared to larger dogs.

Their tiny bones are extremely fragile, and teacup dogs can experience fractures from simple activities like jumping off a couch, being dropped by a person, or getting caught in a door. They are also vulnerable to being stepped on or sat on by humans or other pets.

Toy and teacup dogs alike are prone to hypoglycemia, or low blood sugar. Puppies require at least three meals a day, often four to five to ensure adequate blood sugar levels. Even in adulthood a teacup dog may require small frequent meals to stay healthy.

Tiny dogs are also vulnerable to hypothermia because of their small size and increased surface area compared to body mass. Puppies and adults alike require access to warm blankets and coats and may need to use a pee pad rather than walking outside in the winter.

How Long Do Teacup Dogs Live?

Lifespan varies by breed, but toy breed dogs routinely live into their mid or upper teens. Unfortunately, the health problems and fragility of teacup dogs can shorten this time by several years.

There are no guarantees, but purchasing a puppy from a knowledgeable breeder who does health testing and can tell you the health and longevity of a litter’s ancestors gives you the best chance at a healthy puppy.

Dogs have a sweet tooth, just like their human companions. With functional sweet taste receptors on their tongues, dogs prefer sugary foods when they’re available. In a series of two-bowl tests reported in the Summer 1984 Neuroscience & Behavioral Reviews, Beagle puppies aged two to four months preferred sugar and nonnutritive sweeteners in semi-moist dog food over the same unsweetened food, and they preferred solutions of lactose, fructose, glucose, and galactose over plain tap water. But is sugar bad for dogs?

The Effects of Sugar on Dogs

Just as in humans, sugars and starches (carbohydrates that the digestive tract quickly converts to sugar) cause canine blood glucose levels to rise. Although the speed of blood sugar spikes varies depending on the type and amount of sugar or carbohydrate, research shows that high-glycemic treats and foods harm dogs by promoting:

• Obesity
• Metabolic disease (including diabetes)
• Dental disease
• Gut/microbiome imbalances
• Joint pain
• Cardiovascular disease

Sugar and starchy carbohydrates are key ingredients in many dog foods and treats that are inexpensive, easy to manufacture, and attractive to dogs. Many dry dog foods and treats contain up to 50% starch, so even if their labels don’t list sugar as an ingredient, they deliver a daily “sugar load” to the dogs who consume them.

Is Sugar Toxic to Dogs?

Sugar in any of its many forms will not immediately poison a dog, but sugar is not part of the natural canine diet. As interest in species-appropriate or biologically appropriate diets grows, more Americans are turning away from commercial kibble and adopting fresh, frozen, freeze-dried, or home-prepared low-carbohydrate raw or gently cooked foods based on meat, bones, and organs.

Are All Carbohydrates Equivalent to Sugar?

Fiber, the indigestible part of plants that does not break down into sugar molecules but instead passes through the body, reduces a food’s carbohydrate load. Dog foods and treats list their fiber content on their labels. Subtracting fiber from total carbohydrates gives you the product’s “net carbohydrates,” meaning the carbohydrates your dog’s body can digest.

Some carbohydrates are resistant starches, which slows their digestion in the small intestine. Resistant starches raise blood sugar more slowly than refined starches do. Green bananas, legumes, and some specially treated starches are considered resistant.

High-fiber and resistant carbohydrates may be less likely to cause the serious health problems associated with sugar, but as main ingredients in foods or treats, they both contribute to sugar-related illnesses.

Is Honey Safer for Dogs than White Sugar? What about Brown Sugar? Whole Fruits? Brown Rice Syrup?

When it comes to sweet ingredients, all natural sugars are high in carbohydrates. There is no “safe” sugar, meaning that all natural sugars can contribute to the health problems described here. You can make an ingredient like honey or sweet fruits “safe” by giving your dog small quantities infrequently, but not in large amounts every day.

The glycemic index (GI) is a scale from 0 to 100 that ranks carbohydrate-containing foods by how quickly they raise blood sugar levels. Pure glucose (dextrose), with a GI of 100, acts fastest. According to the Dietitian Prescription’s Glycemic Index Sweeteners Chart, brown rice syrup, which is sometimes incorrectly described as a healthy alternative to refined sugar, has one of the highest possible GI ratings. Fructose, barley malt syrup, and agave nectar’s GI numbers are much lower, but they are still potentially harmful sugars.

• Dextrose (Glucose): GI 100
• Brown Rice Syrup: GI 98
• Tapioca Syrup: GI 70
• Date Sugar: GI 68
• High Fructose Corn Syrup: GI 62-68
• White Sugar (Sucrose): GI 65
• Turbinado Sugar: GI 65
• Honey: GI 58
• Molasses: GI 55
• Maple Syrup: GI 54
• Coconut Sugar: GI 54
• Agave Nectar: GI 15-30
• Palm Sugar: GI 35
• Barley Malt Syrup: GI 42
• Fructose: GI 23

Sugar Contributes to Weight Gain in Dogs

According to the Association for Pet Obesity Prevention, in 2022, 59% of dogs and 61% of cats evaluated by veterinary professionals in the United States were classified as overweight or obese. Dogs easily gain weight on high-carb foods and treats.

Sugar Causes Insulin Resistance and Can Lead to Diabetes in Dogs

Insulin resistance, also known as impaired insulin sensitivity, occurs when cells in muscles, fat, and the liver do not respond to the blood sugar-lowering effects of insulin, a hormone released by the pancreas. Overweight dogs who regularly consume sugar or high-glycemic carbohydrates are at risk for diabetes, which requires daily insulin injections, carefully controlled carbohydrate intake, and lifelong management.

Sugar Causes Dental Disease and Oral Health Problems in Dogs

According to research published in Frontiers in Veterinary Science in 2020, 80% to 89% of dogs over age three have periodontal disease. Sugars in pet foods and treats contribute directly to dental plaque and tartar by altering a dog’s oral microbiome, increasing the risk of gingivitis, tooth loss, oral pain, and systemic (whole-body) inflammation and infections. Sugar-rich treats indirectly harm heart valves and other parts of the body as well as directly affecting the teeth and gums.

Sugar Causes Microbiome Disruption in Dogs

Regular sugar consumption creates microbial shifts in the digestive tract, leading to inflammation, diarrhea, gas, bloating, and even vomiting. Chronic low-grade inflammation can cause intestinal permeability known as “leaky gut,” which allows toxins, bacteria, and undigested food particles to cross the intestinal barrier and enter the bloodstream, triggering immune activation that contributes to autoimmune disorders, lethargy, recurrent infections, and slow wound healing.

Sugar Contributes to Hyperactivity and Behavioral Problems in Dogs

Rapid blood glucose variations in dogs who consume sugary foods and treats have been associated with short-term hyperactivity followed by energy “crashes” and increased hunger, behavioral problems, and weight-management challenges such as begging, food-seeking, and overfeeding habits that are difficult for dogs and their owners to break.

Sugar Causes Inflammation

Compounds called Advanced Glycation End-products or AGEs, which form when sugars bind to proteins, have been linked to chronic systemic inflammation in dogs, contributing to joint degeneration, arthritis, cognitive decline, and accelerated cellular aging.

Is Sugar Content Listed on Dog Food and Treat Labels?

Sugar content is almost never listed on dog food and treat labels, but you can learn the Dry Matter (DM) carbohydrate content of any food or treat with information that appears on the product’s package. See What to Look for on Labels.

Start by reading the first five ingredients on the label. The ingredient that weighs the most in the product comes first, and the ingredient that weighs the least comes last. Any treat whose first ingredients include obvious sugars or starches should be approached with caution. A small treat or two every few days probably won’t cause a problem, but high-carb treats given several times a day along with high-carb foods can wreak havoc with your dog’s health.

Some manufacturers provide carbohydrate content on their websites. For example, the website of a popular soft dog training treat whose first ingredients are peanut butter, potato, wheat flour, cane molasses, glycerin, peanuts, chicken fat, banana, and peas lists its Dry Matter carbohydrate content as 59%. This treat is extremely high in sugar!

Hidden Sugars in Dog Food and Treats

As you read ingredient lists of dog foods and treats, watch for all forms of sugar, which produce sharp glycemic spikes and are especially problematic in treats and semi-moist foods. These include:

• Agave nectar
• Barley malt extract
• Barley malt syrup
• Beet sugar
• Brown rice syrup
• Cane juice crystals
• Cane sugar
• Carob syrup
• Coconut sugar
• Corn maltodextrin
• Corn syrup
• Date sugar
• Demerara sugar
• Dextrose
• Evaporated cane juice
• Fructose
• Fruit juice concentrate
• Glucose
• High-fructose corn syrup (HFCS)
• Honey
• Invert sugar
• Lactose
• Maltodextrin
• Maltose
• Maple syrup
• Molasses
• Palm sugar
• Raw sugar
• Rice syrup solids
• Sucrose
• Tapioca syrup
• Turbinado sugar

High-glycemic Carbohydrates in Dog Food and Treats

Just as important are starches that a dog’s digestive system quickly converts to glucose, causing blood sugar spikes. These ingredients are not sweet to taste but they quickly break down into glucose and can make up 30% to 60% of a dry dog food.

• Rice
• Wheat
• Corn
• Potato
• Barley
• Oats
• Peas
• Chickpeas
• Tapioca
• Other processed grains, tubers, and legumes

Beware of Xylitol

Dogs are attracted to sweet tastes, including the tastes of artificial sweeteners and sugar substitutes. The most dangerous of these is xylitol, a popular ingredient in sugar-free chewing gum, mints, peanut butter, allergy medications, and other products. Even small amounts can lead to canine hypoglycemia, liver failure, and death. Read labels carefully and keep your pup away from any products containing xylitol.

Are Artificial Sweeteners Safe for Dogs?

Xylitol is by far the most dangerous artificial sweetener to dogs and should be avoided at all times. According to Emergency Vets USA, other artificial sweeteners have the following effects:

• Erythritol, used in sugar-free baked goods, candies, and weight-loss products can cause diarrhea, vomiting, and decreased appetite if consumed in large amounts.
• Stevia, one of the most popular sugar substitutes, is considered non-toxic to dogs and cats.
• Aspartame, used in sugar-free sodas, low-calorie sweets, and the sugar replacement product Equal, is unlikely to impact a dog’s health.
• Saccharine, found in Sweet N Low, is listed as non-toxic to dogs although it can cause mild gastrointestinal upset if consumed in large amounts.
• Sucralose, commonly known as Splenda, is a staple in many homes. Though generally safe for dogs, it can lead to diarrhea if consumed in large amounts.
• Monk Fruit, from a plant native to Southeast Asia, is used as a sugar replacement in some ice creams, diet sodas, protein bars, and low-fat baked goods. It is considered safe for dogs.
• Allulose, an increasingly popular sugar substitute, does not appear on the Emergency Vets USA list, but in September 2017, the Journal of Veterinary Medical Science published ”The long-term safety of D-allulose administration in healthy dogs”, which concluded that allulose is well tolerated in dogs and deserves future study because it may be appropriate in the treatment of dogs with diabetes or obesity.

Dogs can develop congestion just like humans do, resulting in snuffling, snorting, and loud breathing. Dog congestion has many potential causes, and treatment will depend on what sort of infection or illness your dog has.

Symptoms of Dog Congestion

• Loud, wet sounds when breathing through the nose
• Snorting
• Snoring
• Sneezing
• Discharge from the nose
• Coughing
• Open-mouth breathing

In severe cases, your dog may gag or even vomit after heavy coughing fits, and he may also have difficulty breathing. Difficulty breathing is an emergency and requires immediate veterinary care.

Should I Panic if My Dog Is Congested?

Most cases of dog congestion are mild and will resolve on their own. If your dog sounds congested but seems otherwise fine, you can monitor him at home for one to two days.

Here are some things you can do to support your dog’s health:

• Encourage rest. Less activity means less strain on his inflamed and irritated airways.
• Increase humidity. Break out your humidifier if you have one or keep your dog in the bathroom while you take a hot shower. The steam will help to clear his airways and relieve congestion. Ideally your dog should be in a steamy room for 5 to 10 minutes at least once a day.
• Encourage hydration. Be sure your dog has plenty of fresh, clean water available and that he is drinking.
• Provide good nutrition. A complete and balanced diet will help to support your dog’s whole body and health.
• Clean his nose as needed. Crusts and discharge can be wiped from the nose with a warm damp cloth. This will both help your dog feel better and clear his external nostrils.

If your dog has other symptoms of illness or doesn’t improve within 48 hours, it’s time to call your vet.

Why Dogs Get Congested

Many things can cause congestion in dogs:

• Upper respiratory infections caused by bacteria, viruses, or fungi
• Allergies
• Foreign body stuck in the nasal passages
• Chronic heart failure
• Heartworms
• Tumor within the respiratory tract

Brachycephalic dogs with smooshed faces, obese dogs, unvaccinated dogs, and dogs living in crowded conditions have the highest risk of developing congestion.

Your veterinarian will determine the cause of your dog’s congestion based on his symptoms and lifestyle. A dog with a dry, honking cough probably has the upper respiratory infection called kennel cough, which can be caused by viruses or bacteria. If your dog sounds congested and is reverse sneezing plus has reddish eyes and paws, he may have allergies.

Treatment will vary by the case. For mild congestion that hasn’t responded to home care, your vet may prescribe a short course of steroid or anti-inflammatory medication to give your dog relief. Bacterial infections can be treated with antibiotics, while viral infections require either antiviral medications or just supportive care. If the congestion is caused by something stuck in your dog’s nose, removing the offending object will resolve the issue.

Most dogs will experience congestion at some time in their lives. To minimize your dog’s risk, keep him at a healthy weight and up to date on his vaccinations and heartworm preventive medications. Vaccines are especially important if your dog goes to doggy daycare, boarding kennels, dog training classes, or dog shows.

Bug bites on dogs can be just as irritating as they are on humans! Whether fleas, black flies, ticks, or any other biting bug, your dog may experience pain, itchiness, and inflammation. Many bug bites resolve on their own, but some may require treatment.

What Do Flea and Tick Bites Look Like on Dogs?

It isn’t always possible to identify which type of bug bit your dog from the bite alone, as the bites from many different bugs often look similar. The appearance and location of the bite itself as well as considering the time of year and your dog’s recent activities can give you some clues to narrow down the suspect.

Flea bites on dogs generally appear as tiny red dots on the skin. The bites hurt and are itchy. You may also see some fine, dark, gritty material on your skin. This is flea dirt, a combination of flea feces and blood. Flea bites can occur anywhere on the body, but your dog’s back end around his tail and haunches are a prime location. If your dog is one of the unlucky ones with flea allergy dermatitis, his skin will also be red and inflamed, severely itchy, and he will suffer hair loss over time until the fleas are addressed.

Tick bites on dogs generally look like a small red circle. Dogs usually do not get the same bullseye rash that humans do. The bites themselves don’t hurt, but the area may become itchy. Tick bites can occur anywhere on the body, but are most common on the dog’s head, ears, and neck.

Black fly bites on dogs generally look like a large reddish welt and may take on a bullseye appearance. The bites hurt and are extremely itchy. Black flies travel in swarms, so your dog will likely have multiple bites close together. These bites can occur anywhere on the body, but the belly, inner thighs, and inside of the ears are common sites.

Mosquito bites look like small bumps and are usually itchy. Some dogs just get small welts from mosquito bites, while others may have more dramatic swelling.

The bites from sarcoptic mange and demodex mites are too tiny to see, but over time these infestations cause hair loss and crusty, irritated skin.

Ant bites are usually small, raised, and kind of look like a pimple. Fire ants can cause an allergic reaction resulting in widespread hives, itchiness, and even difficulty breathing. This is more common if your dog receives many ant bites at once.

Bug Bite Treatment for Dogs

Most bites will resolve on their own and heal within a few days.

For painful bites, ice the area for 5 to 10 minutes. This numbs the skin, lessening pain and itchiness, and helps to reduce swelling. You can ice your dog’s bug-bite wounds several times a day. Wrap the ice pack in a thin cloth so it doesn’t stick to the skin.

If the bites are itchy, you can apply a small amount of hydrocortisone or diphenhydramine (Benadryl) ointment to the area. Do not let your dog lick these ointments. The ideal times to apply are right before giving your dog a meal or right before taking him on a walk so he is distracted.

Dog Severe Reaction to Bug Bites

If your dog is experiencing extreme pain or swelling, it’s time to call your vet. Difficulty breathing, lethargy, or collapse after receiving a bug bite is an emergency and requires immediate care.

Based on your dog’s symptoms, the number of bites, and which bug is the likely culprit, your vet will recommend coming in for an appointment or oral medications such as Benadryl or a dog-safe pain medication.

Flea and tick bites can be prevented by giving regular preventive medications, and there are dog-safe bug sprays that can help to deter black flies and mosquitoes. If your dog is sensitive to bug bites, keep him on preventives year-round and use dog-safe bug spray when going outside during black fly season.

About 80% of canine liver shunts are present at birth (congenital) and involve the portal vein. In utero, puppies have a vessel called the ductus venosus that shunts blood flow around the liver since it is not functioning pre-whelping. When a puppy is born, however, this vessel should collapse so normal canine anatomy takes over.

“Five out of every 1,000 dogs in the general population are born with an inherited liver shunt,” says Jerold S. Bell, DVM, of Tuft’s Cummings School of Veterinary Medicine, in his paper “Exploring the Mysteries of Liver Shunts.”  Caught early on, however, puppies with a congenital portosystemic shunt can go on to have a normal life once the shunt is corrected. Note: These dogs should not be bred however, since there is a genetic component.

Shunts may occur within the liver (intrahepatic) or outside the liver (extrahepatic).  Secondary shunts can occur in older dogs due to cirrhosis with multiple small blood vessels interfering with the normal blood flow plan.

What Is a Liver Shunt in a Dog?

A liver shunt is an anatomic defect that directs blood flow from your dog’s gastrointestinal tract, including the pancreas, plus the spleen around the liver instead of through it. With the portal vein shunted off, the liver isn’t doing its normal functions of handling nutrients and filtering out toxins. You will often see the term “portosystemic shunt” used since the portal vein is usually the culprit.

The liver has multiple important functions in the body. With nutrients not being handled efficiently, puppies with liver shunts tend to be smaller than littermates. They are often less active as well. As toxins build up in the blood, neurologic signs are noted.

Signs of a Liver Shunt in a Dog

Dogs with liver shunts may circle, press their heads into corners and “be stuck,” act disoriented, and eventually progress to seizures. Some may show gastrointestinal signs such as vomiting and diarrhea. Often clinical symptoms are seen after a high-protein meal due to the metabolites from protein.

Some dogs may form bladder stones and others will exhibit pica, which is a tendency to eat unusual items. Some breeds, ranging from Irish Wolfhounds to Yorkshire Terriers, have a genetic predisposition to portosystemic shunts.

Diagnosing a Portosystemic Shunt in Dogs

Diagnosing a portosystemic shunt may be easy or tricky. Bloodwork is often the first step. A complete blood count and a blood chemistry panel, combined with the physical exam and history, will often be diagnostic but not always.

Some dogs will have mild anemia and some abnormally small red blood cells. Low levels of blood urea nitrogen (BUN) and albumin (a protein) are common. Liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are elevated. A urinalysis may show ammonium biurate crystals. Beyond the basic laboratory tests, the next step is often a bile acid test. Dogs with shunts tend to have increased bile acids.

For bile acid testing, two samples are required. The first is a fasting sample that gives your dog’s baseline for bile acids. A second sample is taken after your dog’s normal meal (usually breakfast). Bile acid numbers are expected to increase after a meal.

Imaging procedures are next. A plain X-ray may show a small liver. Ultrasound with contrast may illuminate abnormal blood flow pathways. CT scans, MRIs, and X-rays with dye can all help to pinpoint the location of the problem. Recent work out of Cornell University’s College of Veterinary Medicine using CT scans has helped to illustrate intrahepatic shunts, showing that in at least some cases, the shunts are between liver lobes, not located in liver tissue.

Caring for a Dog with a Liver Shunt

For mild liver shunts and true intrahepatic shunts, medical management may provide decent quality of life. These dogs need strict dietary management to minimize the toxin buildup. The goal for treatment is to decrease the production and absorption of toxins from the gastrointestinal tract into the bloodstream.

If your dog shows signs of hepatic encephalopathy (neurologic signs), his dietary protein needs to be managed carefully. All dogs need protein in their diets, so severe restrictions are generally not recommended. High-quality protein that is highly digestible is ideal. Some dogs do better with dairy or plant-based proteins versus meat proteins.

Lactulose is often recommended to help decrease the absorption of ammonia and other toxins. This is a non-absorbable synthetic disaccharide that decreases transit time in the gut by acting as an osmotic laxative, meaning that digested nutrients move through the intestinal tract faster than normal. This could lead to diarrhea, so generally dosing starts at a very low level and is gradually increased so your dog’s gastrointestinal tract can adapt somewhat. Antibiotics may change the intestinal microbiome and help to reduce toxins as well.

Medical therapy may work for mild cases or for older dogs with cirrhosis who can’t handle surgery. In addition, for cases that are truly intrahepatic, it may be next to impossible to surgically correct the problem.

Surgery is the ideal treatment, particularly for extrahepatic shunts. The basic idea is to close the shunt, with accessory blood vessels picking up the load and delivering most of the blood to the liver instead of bypassing it. Very few dogs can handle an acute closure of the shunt. Portal hypertension can cause abdominal pain, endotoxic shock and even death.

Luckily newer surgical techniques using rings, bands, constrictors, or intravenous coils can all act to gradually close the shunt, allowing time for the underused vessels to replace it. These surgeries are usually referred to a board-certified veterinary surgeon.