here is info stating internal shunts are in big dogs external are in small dogs

Portosystemic shunt - Wikipedia, the free encyclopedia

Are you a vet? Or just a person with experience with their dog? I would imagine the fact that my dog was physically cut open and had his kidney and bladder squished, squeezed and cut open would have given my vet an opportunity to look for an external liver shunt? Unless he is a complete idiot (which I rather not believe considering all that surgery was done) why would he not look? He has done many liver shunt surgeries himself (which he has told me) and said it would be a costly operation. Since he is so familiar with liver shunts I assume (maybe I'm dumb?) while he had poor Brodie open he would have looked?? Otherwise why would he so confidently rule out an external shunt???
I don't really know what else to do. I already paid $4,200, not to mention my vet informed me he went ahead and ordered me a case of Hills LD wet dog food and dry (as they only sell by the case). I can't wait for that bill! Maybe this makes me a bad dog owner, but I've had him for 4 months and didn't anticipate him costing so much in such a short period of time. I really can't afford more surgery, or a $300 flight to TN, plus taxis, plus hotel stay, plus food, and time off work... I don't mean to offend but I am not a millionaire or a stay at home doggy mom. I want the best for my little guy but I'm now in debt and my vet seems to think he shouldn't have surgery so I am not sure I should go put another couple thousand on my credit card and rush him into surgery again. :(

ALSO to quote from what you sent me to read - Symptoms of congenital PSS usually appear by six months of age[1] and include failure to gain weight, vomiting, and signs of hepatic encephalopathy (a condition where toxins normally removed by the liver accumulate in the blood and impair the function of brain cells) such as seizures, depression, tremors, drooling, and head pressing.

Brodie has none of this at all... this is why my vet didn't think it was a shunt at all. He also had no symptoms appear until he was 8 months of age and the only symptom being one stone that was in his bladder and much to large for him to pass that happened to be urate. He had no crystals and did not have concentrated urine.

The article also states - Surgery definitively shows the shunt if it is extrahepatic.
Brodie already had surgery, he is just recovering. My vet didn't tell me he saw any external shunts and has suggested he thinks it is an internal one.

And this is the exact reasoning my vet gave for concluding he didn't want to operate on Brodie - Intrahepatic shunts are much more difficult to surgically correct than extrahepatic shunts due to their hidden nature, large vessel size, and greater tendency toward portal hypertension when completely closed.


Am I being really stupid? I really don't understand how my vet could be wrong about it being internal. I also don't understand why Brodie lacks all signs of a liver shunt? I am glad, but it makes no sense to me. In your opinion I should go into my vets office and demand he perform another test because I don't believe he didn't see an external shunt? Then demand I take my dog to Tennessee for a surgery my vet has told me is too dangerous for my baby? :confused:

I want to note - I am not trying to be mean at all. I'm so upset about my baby and more upset that I am not sure I can afford more surgery to fix him! I am a responsible person, but I just don't have the ability to pay off a credit card with much more debt :(:(:(:(:(

Do you have information on how much the surgery would cost at Cornell? That is drivable for me.

not a vet but a VERY WELL INFORMED DOG OWNER. And sadly i think your vet is MILKING YOU. Ask your vet if he looked during surgery to see the shunt? Does your dog have a long scar on belly? If not he did not cut him up far enough to see the liver is my guess. Those numbers are really high on bile acids. I hope your vet is right and knows his stuff but with numbers that high I would have to question him. I was only trying to help you as i have read on liver shunt for 5 years and am a member of liver shunt groups. Did you ever join that group i recommended to you as they know alot about this probably more than many vets so i STRONGLY recommend this group. I know you are upset trust me I spent 10k on pancreatitis over the course of the year and am out over 25k now with 3 dogs in 5 years. It is very costly to own a sick dog and why i do so much research myself and try to help others with what i know as sorry but very disappointed in the vet profession from what i have seen. And in your state and my state it is VERY EXPENSIVE for vet care as what you are seeing. Sadly had you gone to ut it would have cost you about 2k and that includes all diagnostics and surgery so now like myself you are out all this money and still do not have a difinitive answer as to if your dog has mvd or liver shunt and mvd (hmd) those numbers are high for that as everything i sent you shows numbers less than 100 for mvd (hmd) and over 100 most likely shunt - a dog i helped had NO SYMPTOMS but stones and had 3 shunts so dogs do not have to have all the symptoms. Join the group and educate yourself further it will save you money in the long run. I never put 100% of my trust in anyone anymore as they are only human and why i mostly deal with specialists when it is something more serious.

if you are close to cornell then take all diagnostics to dr centers as she is very familiar with this along with dr tobias they are the top two in this field and they are constantly doing studies on it. Dr centers is an internal medicine specialist and dr tobias is a surgeon. Dr centers is able to treat without surgery in some cases so i would take everything to her get copies of all reports from your vet and do a consult with her and have her check everything. Ask your doctor if he knows dr centers or dr tobias if he doesn't then he is not real up on the subject as those two are well known around the country for their works. Follow dr centers advice and JOIN THAT GROUP

i am telling you your vet is not real familiar as the odds of a yorkie having an internal shunt is a LONG SHOT. They have external internal run in BIG dogs and yes i am asking you to question this vet. I helped a dog that was older than yours had NO SYMPTOMS FOR YEARS had stones like your dog and whamo 3 shunts when dr tobias opened him up and she closed him up and could do nothing - now had shunt been repaired when a pup then 3 shunts would not have occured. Multiple shunts are acquired due to one shunt not being repaired early enough the dogs body throws more shunts to adapt to shunt and if a dog has multiple ones no repair can be done. I have friends with shunt dogs where the symptoms do not appear until 2 years of age so it is not unlikely but your dog is showing a symptom - urate stone is a symptom of liver disease, the bile acids are very high too another symptom. Unless your vet did the test wrong or gall bladder contracted but even so the numbers would still not be that high.

I had a question about Dr. Centers. How do I go about getting in touch with her? I don't just drive my dog up there do I? It is a very far drive for us both (8 hours), so we don't want to get there and then be told that she doesn't see animals like that. Brodie has been very lethargic and isn't his perky self at all since his surgery. He sleeps most of the day and can't hold his bladder (he pees every 15mins or so, at least tries to - it is usually only a tiny bit). I can't have him upstairs with me anymore because he can't make it back to his wee pad and will just stop and go. He seems incredibly unhappy and unhealthy. I want to get him the medical attention immediately.

I already joined that group you referred me too. I filled out the spreadsheet and forwarded it back to the group.

Thanks!

so sorry he is not doing well :( You can make an appointment with her at cornell university and let them know you are driving 8 hrs to see her as i know someone else that did that and ended up having to stay an extra day as she had an emergency situation so be prepared it is a university hospital so plan a couple days if you can - here is the number and it is dr sharon center internal medicine

Cornell University Hospital for Animals

keep in mind they usually are not feeling well after a surgery so give it a bit of time with that- that group will help you ALOT and be a great support for you as well so hang in there i know it is not fun having a sick one as i have an ongoing one myself and my other one was sick for a year :(

thank you so much for all of your help! I am going to call!

I am so confused now!

I called Dr Centers at Cornell and she was incredibly nice and explained the entire process to me. She will be in the vet hospital in a week and a half and said she would be more than glad to see Brodie. She asked me to bring him in on a Monday so that we could get the testing out of the way to see if he was even a candidate for surgery. I was very happy with this - yes, I'd have to take time off work, but at least Brodie would be getting looked at and hopefully fixed!

THEN, the group you had me join on yahoo informed me that Dr Centers was a very bad choice, that they would not take their dogs there as she was inexperienced and that just pretests alone with her would cost me $3500. They told me the only good choice was Dr. Tobias. Now, I understand Dr Tobias may be the best, but I live no where near UT. I'd have to take a plane, rent a car, get a hotel, take off work, hope I could get Brodie on the plane, be alone in TN (I'm a young female, I feel so unsafe doing that), and then hope that Brodie was a candidate for surgery or I'd have wasted my time. Is Dr Centers really that expensive? I thought she too was under $2000 for the full surgery and pre-op work? Is she really a bad choice?

she is not the surgeon so for surgery no i would not have her do surgery - dr tobias is a surgeon and dr centers is an internal medicine specialist. you would only be going to dr centers as a consult to review all the tests you have already done to discuss his case. Call her back ask if they do the scintigraphy there and ask her the cost and tell her you have all these tests done already and do not want them duplicated you just want her to review the tests and get back with you and maybe you can even do over the phone as a phone consult as i think your vet can overnight the ultrasound, and you or vet can send all records for her to review this may save you the trip - I do agree dr tobias is the best for surgery and cheapest - are you near new jersey? I know someone else on a yorkie group that is very pleased with her surgeon that did the shunt surgery and could get you her info as she could not make the trip either - The group has a list of hotels, etc over there and it is very safe i believe as my friend flew from california stayed a week and had everything done there as it was very expensive to have it done here and the surgeon had not done alot of them here so she was more comfortable going to ut and flight hotel, surgery all was cheaper than surgery here

brodies mom
 

Hey I was just checking to see how Brodie was doing?? I hope all went well or if not I am soo soo sorry! I have been following your posts and could find no further post . Thanks Cindy and Crimson in Alabama

Brodie was doing well, he had gained weight and was acting much more like a "normal" puppy! Unfortunately, Brodie looks like he needs another trip to the vet! :( He has been straining to go to the bathroom and I am not sure if it is another stone or what could be wrong. He looks like he is trying to poo and when he does go it is in little tiny bits. Because he is straining to poo so much he has peed all over himself. He is drooling excessively and otherwise in pain. I'm completely distressed and am waiting for my vets office to open so I can bring the little guy in... again. I hate this so much :( :( :(

Did you have a consult with Dr. Centers or Dr. Tobias? I'm seeing this thread for the first time... just wondering if anything had changed? Hope it's something simple at the vet's today. I'll keep you and Brodie in my prayers....

How did the vet come to the conclusion that there is no external shunt? When Brodie had surgery, the vet didn't think there was a liver problem at all, so they may not have even looked at the liver. It does require a high incision to se it. That tells me they are going by ultrasound alone and that is only 60-80% accurate for this. Many things can cause high bile acids, but with urate stones and this being a Yorkie, it is almost certainly a shunt or MVD. Really if the money is just not there to get a positive diagnosis for one of these things, then all that is left is supportive care (which is all that can be done with MVD anyway). If it is an external shunt (could have missed it), then surgery is likely his best option. Drooling indicates neurological issues and he will need to be supplemented at the least (which he already should be). What does the vet currently have him on?

Poor Brodie has been through SO much and he just turned 1! UGH! He passed a very large urate stone today (which was why he was straining and crying). The vet said the drooling was likely because he was stressed, hurting and drinking so much - he had gone through 2 bowls of water. Since he passed the stone he has calmed down significantly and isn't crying in pain any longer. However, he had his last stones removed in March and the vet said they shouldn't be forming this quickly. Today she sent me home with some pain medicine for him should he need it and told me to call her in the morning and let me know how he was doing. We took another set of xrays, which showed no stones (of course the first time she did xrays no stones showed and then surgery removed 2large ones, so I really can't understand why she insists I waste my money on this each time). If he was straining and in pain tomorrow she wanted to run another ultrasound. While I was there she ran another blood panel to look at his liver function. His liver has been deemed "normal" size. Unless there in an internal shunt they have seen nothing on the exterior.

Anyone else have an issue with urate stones? How can I prevent them?

Not really sure why the vet is making you spend money on xrays when the stones that your pup gets are radiolucent (not seen on xray). Drooling could have been from the pain, but the stones shouldn't be forming without a liver problem and the problem is probably not being controlled. What supplements is you pup on?

Other than the Hills L/D diet my Brodie hasn't been told to take anything. In fact my vet said she called Hills and they said he couldn't have any treats of any kind with the type of issue he is having. His liver is not functioning properly, which is what his blood panel has shown the last 2 times it has been done. He has been on the food for 6 months now and I will be interested to see if this panel shows any improvement. I am not sure what else I can do? Should he be on supplements? He is still straining some to pee but keeps drinking and his pee is a light yellow color - no discoloration, brownness or blood. He has also stopped crying while he goes.

With these results, I can practically guarantee Brodie has a liver shunt. You are wasting your money dealing with your current vet. Brodie needs to be seen by an internal medicine specialist or at Cornell. General practice vets just aren't that knowledgeable about liver disease.

Ultrasounds can only be 60% reliable. Bladder stones are a classic symptom of a dog with a shunt.

Portosystemic Shunts FAQ

If they are still urate, then a low protein, low purine diet is usually recommended. I don't know if the L/D is low purine or not, but I'm guessing no. Also, the more moisture the better. Canned food...

I'd also wonder about the affect of lactulose and if binding ammonia with it could help the bladder issue.

No idea why no supplementation is going on when bile acids are so high and stones are present.

Liver compromised dogs can have treats, but if the food is being used b/c of its low purine content, then the acceptable treat list will vary from the ones that are normally given for liver shunt/mvd.

I agree with LadyMom. Your pup needs an internist. Something is off with the current protocol.

If no external livershunt is present, would Cornell actually be able to help me? I was under the impression internal shunts weren't "treatable". I would do anything to help the poor guy stop suffering from stones! He has none of the characteristics of a "shunt" dog, other than low body weight and these stones!

How did they determine that there is no external liver shunt? Brodie's BAT results are really high and the urate stones are something that many liver shunt dogs deal with.

Poor Brodie! I hope you get some answers soon.

I agree with everyone that he needs to be seen by an internist - can your local vet refer you somewhere? Cornell would be nice . . . but doesn't have to be Cornell unless you are close.

Preferably someone very knowledgeable about liver shunts - external OR internal.

Poor Brodie has been cut open to remove stones. My vet said that while he thought it was a liver shunt Brodie's liver looked "normal". Cornell is the closest to me of the "teaching hospitals". Amazing I live in NYC and have to drive 5 hours to get to a good vet! You'd think with all the small dogs around here SOMEONE would know what they were talking about?! :confused:

Well, it would be great to go to Cornell. But I would think that living in NYC you would have internists a little closer to you. I know I was referred to Columbus to a teaching hospital that was 3 1/2 hours away (but then I live in WV). But perhaps the 'teaching hospital' is the key.

I do feel for Brodie. I know Lucy has spent wayy too much time at the Vet for a dog less than one year old. It took numerous trips to figure out it was time to do the BAT's; then trips to figure out what to do after the results; then re-testing; then we found out she has luxating patella . . . and I finally had her spayed. All in less than a year.

I do hope you get to the bottom of Brodie's problem and can get the stones under control. No one likes to see their baby in pain.

I know it's hard when you get conflicting information everywhere; even the Vets don't agree! Just like regular doctors!

Did your vet do a culture and sensitivity on the urine, or a urinalysis? Was Brodie prescribed antibiotics at any time when the stones were discovered?

His BAT numbers do indicate a shunt. They can be very hard to see on x ray and ultrasound.

His recurring problem with bladder stones goes hand in hand with Liver Shunt.

Normally, when dogs are first diagnosed as having a possible shunt (high BAT), they are put on a course of antibiotics, to clear the bacteria in the intestines (which produce amonia that can cause the stones to form), along with Lactulose, which binds with the amonia in the intestine before it can get to the liver or kidneys and cause stones and has a laxative effect so the food moves faster through his system leading to less bacterial growth, And a product called Denamarin (or a similar product), which is a homeopathic remedy known to help the liver rid itself of toxins, prevents liver cell death, and helps the liver to regenerate new cells.

Many dogs with Liver Shunts show no symptoms, it is discovered during bloodwork for spay/neuter surgeries. My dog has LS. She is on the meds I mentioned above. She developes UTI's without these meds. We are planning a surgery for her at the U of Tenn. this summer. They will do any testing, surgery, procedures, hospitalization etc... all included.... for under $2000.00. This is the most affordable place to go (I've done the research), and the most experienced doctors do the surgeries. (Important when you look at success rates).

You or your vet can call them and discuss your case. They will tell you what needs to be done next. He really needs to go on those medications asap.

Please don't put this off any longer. LS/MVD is treatable, but it can be deadly if not treated.

If it's MVD, he will be medically managed. Whether or not other internists can do as good a job as Dr. Center, it's somewhat doubtful b/c she spends her life studying this stuff. But that doesn't mean there aren't other good choices there. Isn't there an Animal Medical Center there? I think the key now is to talk to somebody else about this b/c more can potentially be done.

Think about this. My car is in the shop. Last time I called U of Tenn., they were two weeks to get an appointment. I'm right off I95 in Baltimore, 4 hrs from NYC. 10 hours from here to U of Tenn. I can help drive, I am insured. We could share a room, split expenses, be support for each other. Can you schedule a week vacation from work? I have to ask my DH too if it's okay with him, then synchonize our appts at U of Tenn. They do about 10 surgeries a week, and the pups are in the hospital 4-5 days, includes any testing, surgery and recovery. Note: U of Tenn is the best place for LS surgery in the world...

Just an option....:)

You are in NYC - you have some of the best medical care and vet care available to you. I see you are or were in Westbury, NY - there is a specialist hospital right there and they probably have an internist on site. Our dog Daisy has MVD and we see a liver specialist right here in RI. I grew up in NY and could have gone to Cornell, but the reality is that it makes sense for me to have a Dr close by. I think either way you need to find someone nearby to manage your dog's long term care, whether or not you go the UT route

It's a damn shame your vet did not refer you to a specialist. I am SICK AND TIRED of these vets who want to keep cases that should be referred out. Talk about arrogance... But that's for another thread.

Even if the Hill's L/D shows improvement, with BATs that high, it is unlikely you are dealing with MVD as others have said. Over 100 is usually the line in the sand for MVD vs. LS. Your dog is WAY over that. Even if the food dropped the BATs down some, that does not mean you are out of the woods. My dog Daisy had BAT readings over 100 and they dropped over time - today, they are "normal" readings - yet she has liver disease and must be managed every day of her life. As for the stones, I am not sure what kind you had - we just treated our dog for struvite crystals and a small stone with something called Uro-eze. This medication changes the bladder environment so that struvites can not form and those there can dissolve. This medication is not a treatment of choice by regular vets as they tend to use the Hill's prescription diets, but it was recommended by a board certified specialist in veterinary nutrition and has worked great in our dog. I think this is something to ask about -- once you get to a specialist -- as this may work for your dog's stones (depends on kind and size, etc).