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-   -   Shunt or MVD? Diet management or surgery? So many questions! (https://www.yorkietalk.com/forums/sick-injured-emergencies-talk/174431-shunt-mvd-diet-management-surgery-so-many-questions.html)

iwannalollipop2 06-02-2009 10:33 AM

Shunt or MVD? Diet management or surgery? So many questions!
 
1 Attachment(s)
It has now been about a year since we took little Lacy into the vet and got a blood test, showing sky-high liver ALT values. She was then and is still completely asymptomatic, but further tests still proved something was going on with that liver. We visited a specialist, who did the BATs and got the astronomical 150 and 248 pre and post-prandial values. They also did an ultrasound about a year ago, but her liver was so small they could barely tell if it was a shunt. There were also small calcifications in her urinary tract and/or bladder, I'm not sure. That vet did not recommend surgery on the possible shunt because of Lacy's size, and so we stuck to making her homemade food for dietary management (consisting of mostly rice, tofu, and cottage cheese for protein and carbohydrates, along with vitamins and fat sources).

Recently, she went in for her checkup and we had a new vet. This vet recommended we discuss the matter more, and even consult surgeons to see what they say about the possibility of closing a possible shunt. No vet ever mentioned that Lacy may instead have a combination of MVD and a small shunt, but from research I now think that may be possible and may explain her seemingly perfect health. A recent urinalysis shows calcium oxalate crystals at a "moderate" level, which isn't a good sign either. I did more research, and produced the papers for the Protein C test to the vet yesterday. She was pretty clueless about it, and took a while to read the instructions and figure them out for the blood draw. I think she got it right, but I don't know. It's on its way to Cornell, and I guess the next step is scintigraphy to confirm the presence of a shunt alone, or in combination with HMD, or HMD alone.

In the meantime, I'm worried about the crystals in her urine. I've tried to read documents about dietary management of calcium oxalate crystals, but it's all very confusing. Apparently tofu is high on the list of purine content, so I cut it out of the food and made a modified diet with just the cottage cheese and rice. There are also recipes listed for just stone management, but not liver management--the one recipe seems to include only black beans as a source of protein (I guess to limit both the calcium and oxalate) and includes brown rice instead of white. Should we try this diet? Do we need to be giving her more salt to get her to drink more, or will this affect her liver?

Sorry this post is so long, but there's just so much to think about now, and we're so worried about her. Lacy turned three in February, and on the outside is totally happy and healthy at four pounds--shiny fur, bright eyes, always barking and playing, and no signs whatsoever of encephalopathy (even after meals). If anyone has experience with an asymptomatic dog with a possible shunt, please share any advice! Thank you everyone!

Ellie May 06-02-2009 11:56 AM

Have you talked to a veterinary nutritionist about formulating a diet for her?
How much does she weigh?

TLC 06-02-2009 12:06 PM

Quote:

Originally Posted by Ellie May (Post 2650289)
Have you talked to a veterinary nutritionist about formulating a diet for her?
How much does she weigh?

Yes, I would like to know too? If you haven't yet contacted a Pet-Vet Nutritionist, I can give you the name and info of the Dr. I use for Roxy. He is highly recommended and is from Cornell :) Just let me know.....:aimeeyork

Roxy probably has MVD. She is pretty much asymptomatic. Her urine is clean, her liver is normal shape and normal size. Her Protein C test came back at 165%
Her diet consists of veggies, egg noodles, cottage cheese, shredded colby cheese, vits, oil, salt substitute and a handful of liver aiding supplememts. She is doing very well. Her post BAT # is in the 60 to 100 range though...

chandracz 06-02-2009 12:23 PM

I would also agree to talking to a nutritionist about formulating a new diet for her. That can work WONDERS for your baby!!!! :)

iwannalollipop2 06-02-2009 12:41 PM

I'm currently using the book "Home Prepared Dog and Cat Diets: The Healthful Alternative" by Donald R. Strombeck, DVM, Ph.D. It's a really great book, with diets for normal dogs, along with extensive sections for dietary management of hepatic disorders, urinary stones, and many other disorders. We brought it to the vets office and they made a dozen copies of good recipes for other clients. I could consult a nutritionist, but I don't think he would tell me anything differently from what we're already doing. She's currently on a cottage cheese/rice diet that is for liver management, and I'm thinking about switching to the urinary stone diet with the black beans and brown rice because that cuts out the dairy (and the extra calcium). What we usually do is throw some of the Royal Canin hepatic formula kibble pieces on top of the homemade, because she likes to have something crunchy. I've read that switching to wet food can increase water intake. Should we moisten the food more to get her to drink more water?

Ellie May 06-02-2009 12:51 PM

If you feed kibble, equal parts water can be added to try and increase water intake. As good as the book is, I'm just not sure that it is best in this situation. I think you have the right idea about diet but which one wins out, the liver problem or the calcium oxalate problem? Maybe there is a way that you can combine the two for optimal results.

What is the guaranteed analysis for the black bean and brown rice diet?

What supplements is she on for liver support?

iwannalollipop2 06-02-2009 01:17 PM

Here is the liver diet:

Cottage Cheese and Rice Diet (High Sodium)
1.5 cups rice, long-grain, cooked
1 cup cottage cheese
1 tablespoon chicken fat
1/4 salt substitute (KCl)
3 bonemeal tablets
1 multiple vitamin tablet
Provides 598 kilocalories, 34.5 grams protein, 17.1 grams fat, .647% sodium

Here is the oxalate diet. I actually meant to say black-eyed peas, not black beans:

Black-Eyed Peas and Rice Diet
2/3 cup black-eyed peas, boiled
2 cups brown rice, long-grain, cooked
1 tablespoon canola oil
2 bonemeal tablets
1/4 tablespoon KCl
1 multiple vitamin tablet
1/10 teaspoon table salt
Provides 696 kilocalories, 19.3 grams protein, 17.8 grams fat. Provides calcium at 55%, phosphorus at 102%, sodium at 33%, vitamin D at 63% of requirements

She is also taking Denosyl hepatosupport supplement (SAM-e). The black-eyed peas diet appears to be protein-reduced by percentage of mass . . . since Lacy has no symptoms, I've read she should be given as much vegetable or dairy protein as she tolerates without reducing it. According to a nutrition websites, black-eyed peas have about half the protein content per serving of cottage cheese. Is the protein in this recipe enough, or should we try to combine the two--maybe add a quarter cup of cottage cheese?

Ellie May 06-02-2009 01:24 PM

Quote:

Originally Posted by iwannalollipop2 (Post 2650403)
Here is the liver diet:

Cottage Cheese and Rice Diet (High Sodium)
1.5 cups rice, long-grain, cooked
1 cup cottage cheese
1 tablespoon chicken fat
1/4 salt substitute (KCl)
3 bonemeal tablets
1 multiple vitamin tablet
Provides 598 kilocalories, 34.5 grams protein, 17.1 grams fat, .647% sodium

Here is the oxalate diet. I actually meant to say black-eyed peas, not black beans:

Black-Eyed Peas and Rice Diet
2/3 cup black-eyed peas, boiled
2 cups brown rice, long-grain, cooked
1 tablespoon canola oil
2 bonemeal tablets
1/4 tablespoon KCl
1 multiple vitamin tablet
1/10 teaspoon table salt
Provides 696 kilocalories, 19.3 grams protein, 17.8 grams fat. Provides calcium at 55%, phosphorus at 102%, sodium at 33%, vitamin D at 63% of requirements

She is also taking Denosyl hepatosupport supplement (SAM-e). The black-eyed peas diet appears to be protein-reduced by percentage of mass . . . since Lacy has no symptoms, I've read she should be given as much vegetable or dairy protein as she tolerates without reducing it. According to a nutrition websites, black-eyed peas have about half the protein content per serving of cottage cheese. Is the protein in this recipe enough, or should we try to combine the two--maybe add a quarter cup of cottage cheese?

I "think" it's supposed to be 2-3 grams of protein per day per kg of body weight but don't quote me. I don't normally go by grams. I go by the guaranteed analysis/protein percentage which isn't posted.

Is she on milk thistle? Maybe Azodyl? Omegas and vitamin e?

iwannalollipop2 06-02-2009 01:24 PM

Is there anywhere to find the Royal Canin wet canned food in the US? I can only find it on UK websites. I was thinking maybe we could switch to that instead of the kibble, as that would up her water intake as well. I read that dogs who eat moist food consume more water than dogs that drink water after eating dry food. Most of her food is wet anyway, it's just a few bits of kibble so it wouldn't make that much of a difference, but still . . .

chandracz 06-02-2009 01:29 PM

Quote:

Originally Posted by iwannalollipop2 (Post 2650412)
Is there anywhere to find the Royal Canin wet canned food in the US? I can only find it on UK websites. I was thinking maybe we could switch to that instead of the kibble, as that would up her water intake as well. I read that dogs who eat moist food consume more water than dogs that drink water after eating dry food. Most of her food is wet anyway, it's just a few bits of kibble so it wouldn't make that much of a difference, but still . . .

You can find the Royal Canin at Petco & Petsmart in the US. Also, kibble expands in their stomachs, so it's not always the best to use as their only chioce in diet is what i've heard... :) It's harder to digest.

iwannalollipop2 06-02-2009 01:38 PM

Well I was thinking either we could moisten the LS kibble we have now that we simply add a little to her homemade diet, or just buy the wet. The kibble does expand, but it's a specially formulated diet for dogs with liver shunts so I'm not too worried about it. And it provides some of the antioxidants and omega-3s that aren't in her other diet from the multivitamin.

TLC 06-02-2009 01:44 PM

I have to be honest. I would either stick to the RC kibble (with added water) ~ or I would consult a Pet Nutritionist and go homemade.

With her liver issues and stones, I wouldn't have the confidence in any other.

The Dr. I use is wonderful. We communicate via email. The diet cost $140 - well worth it in my mind for peace of mind....

TLC 06-02-2009 01:44 PM

Also, have you joined this group yet?

DogLiverDisease : Dog Liver Disease

Ellie May 06-02-2009 01:58 PM

Quote:

Originally Posted by TLC (Post 2650443)
I have to be honest. I would either stick to the RC kibble (with added water) ~ or I would consult a Pet Nutritionist and go homemade.

With her liver issues and stones, I wouldn't have the confidence in any other.

The Dr. I use is wonderful. We communicate via email. The diet cost $140 - well worth it in my mind for peace of mind....

But what do you think about the RC with the oxalate crystals?

iwannalollipop2 06-02-2009 02:15 PM

Well I'd like to keep giving her the RC because it's such a good diet for her liver, and the added water will hopefully help the crystals. I think I'll keep going with the cottage cheese+rice with moistened kibble for a few weeks, then have another urinalysis done to see how it goes. Very little research has been done on managing oxalate crystals dietarily, and they don't really know if cutting out the components from the diet (calcium and oxalate) actually helps the condition. I guess it's worth a try, and the vet said if I thought it was a good idea to take out the tofu, then that's okay. I don't want to limit her calcium intake too much, because she still needs calcium. Let's just hope she likes wet kibble . . . gross!


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