Because it's a business decision...:mad:
This is the same vet who wants to keep a case that should have been referred out long ago.

ETA from one of my last posts. Contrast can also be used (air or something I think) to see urates on xray. I don't think they did that in this case. Unless there are others types forming around the urates making them visable, u/s is the better choice.

I was offered a referral when Ellie's bile acids were 47 post with no real symptoms with the stipulation that if she got sick in the month that regular vet tried low protein diet, we were immediately directed to a specialist. When they got to 106, I was pretty much told to go. With bile acids this high and stones, a general vet should really be referring out.

Oh and I forgot to mention... When my vet called the U of Tenn about my dog, they said to put her on Hill's L/D., and that with that single change alone they have seen the most improvement in dogs that were showing symptoms.... mine had just come through a bout of Hepatic Encephalopathy. She was on the meds, but I was feeding her a regular diet cut with easily digested proteins, and vegetables. On the L/D, she's actually gained 2.5 pounds, she doesn't have the skinny, half starved look of a shunt dog anymore. And by the way she acts... one would never guess she has liver shunt.

And just for the sake of comparison: If you buy all the meds and special food for 1 year, including $500.00 for Office visits and bloodwork to monitor the health of the dog... for a 12 pound dog the yearly total is $1857.16. Plus time involved giving meds and preping special food. I also have to watch my dogs eat... they all want the L/D.:confused: So, surgery looks like a really good deal, at $2000.00 all inclusive. Usually 4-6 months after the surgery, they can be transitioned back onto a regular diet. :D

I'm really over concerning myself about the money... I've spent almost 10K and Brodie's only been with me for a year. Has anyone brought there pup to Cornell? How long does he have to be there?

Hello all. For all of you who have been following Brodie's thread I need some QUICK advice. Brodie is once again straining and crying. He has been passing dribbles of urine mostly on himself. I want to bring him to Cornell rather than back to my vet. Do I call the emergency number? Do I make an appointment for tomorrow? When do they perform surgeries? How long would he have to stay? Would I have to be there the whole time? Sorry for all the questions, I'm worried!!!:confused::(

Oh, dear! I am so sorry Brodie is sick again.

I think you will have to go through your vet to get a referral. You'll need to see your vet asap anyway, won't you?

Here is Dr. Center's contact information:

Faculty of the College of Veterinary Medicine - Sharon A. Center

I just saw my vet today, and am suppose to call her again tomorrow. Were you the person who said that there was a internal med specialist close to where I live? Where is that? I do still live there. I really have no idea what to do now and feel horrible :( I just want my little guy to feel better and don't want to have to go through 2 more surgeries - stone removal and shunt surgery. It's so much on him and I.

I'd call their emergency number. I'm sure they could fill you in from there as to the best course of treatment for him.

From Cornell:

The Animal Hospitals at Cornell University


Take current Rabies certificate with you.


Appointments and Directions
Making an Appointment
Appointments can be scheduled at the Cornell University Hospital for Animals for animal medical care Mondays through Fridays from 8am to 5pm and on Saturdays from 9am to noon.To schedule a hospital appointment, please call the appropriate number:

http://www.vet.cornell.edu/images/square20px.gif Companion Animal Hospital
Companion animals including dogs, cats, and exotic animals. 607 253-3060
http://www.vet.cornell.edu/images/square20px.gif Equine and Farm Animal Hospitals
Horses and farm animals, including cattle, sheep, goats, llamas, camels, alpacas: 607 253-3100 http://www.vet.cornell.edu/images/square20px.gif Ambulatory and Production Animal Medicine Service
Staff will travel to your farm to provide care for horses or farm animals: 607 253-3140

When you arrive at the hospital, check in at the admissions desk to sign in your animal and register your vehicle for the parking lot. You will be greeted by a DVM student or animal technician who will escort you and your animal to an examination room, where you will meet the veterinarian. New York State Law requires a valid rabies certificate to be presented upon arrival to our hospital. Failure to do so may result in your pet not being evaluated.
Emergency Care
Life-threatening medical emergencies are treated 24 hours a day. Before bringing your animal to the hospital, please call so that our staff can give you special instructions and prepare for your arrival. Please call the appropriate number for the hospital you wish to contact.

http://www.vet.cornell.edu/images/square20px.gif Companion Animal Hospital 607 253-3060
http://www.vet.cornell.edu/images/square20px.gif Equine and Farm Animal Hospitals 607 253-3100 http://www.vet.cornell.edu/images/square20px.gif Wildlife 607 253-3060

Other Useful Hospital Phone Numbers

http://www.vet.cornell.edu/images/square20px.gif Business Office
Companion Animal Hospital 607 253-3215
Equine and Farm Animal Hospitals 607-253-3100
http://www.vet.cornell.edu/images/square20px.gif Pharmacy
Companion Animal Hospital 607 253-3231
Equine and Farm Animal Hospitals 607 253-3230
http://www.vet.cornell.edu/images/square20px.gif Main Phone Number for the College 607 253-3000 http://www.vet.cornell.edu/images/square20px.gif Flower/Sprecher Veterinary Library 607 253-3510

Our Mailing Address

Cornell University Hospital for Animals
Box 20, College of Veterinary Medicine
Cornell University
Ithaca, NY 14853-6401

Directions from the East - Passenger Vehicles or Trailers

From New York City, Connecticut, Rhode Island, Massachusetts, New Jersey, Pennsylvania
Approximate Driving Times:
1.0 hour from Binghamton
4.5 hours from Albany
5.5 hours from New York City 1. Take I-88, NYS 17, I-84, I-80/I-380, or I-81 to Binghamton.
2. From Binghamton, take I-81 north to exit 8 at Whitney Point onto NYS 79 west.
3. Continue on NYS 79 west for approximately 28 miles toward Ithaca.
4. At the sign for Cornell University, turn right onto Pine Tree Road (Tompkins County Route 174). Continue straight on Pine Tree Road (across the intersection with Ellis Hollow Road and past the shopping center on the right) until it ends at a blinking light at NYS 366.
5. Turn right onto NYS 366; take the second left onto Tower Road and take the first right onto Campus Road. Park in the designated client parking areas, on the left, for the Companion Animal Hospital, Equine/Farm Animal Hospital.

you might try a search on:

www.acvs.org

If I were you, I would insist upon a referral to a board certified specialist!

I'll be keeping you both in my prayers...

I was the one who said there were specialists near Westbury, NY.
Here is a link to a vet specialist hospital in Plainview - they have internal medicine vets on staff.
http://www.livs.org

This is who she wants to see:



Sharon A. Center, DVM

Diplomate - American College of
Veterinary Internal Medicine Professor of Medicine
Attachment 322968

sac6@cornell.edu

Education and Training
University of California, DVM (Cum Laude), 1975
Cornell University, Rotating Internship, 1975-76
Cornell University, Residency in Small Animal Medicine, 1976-77, 1980-81 Board Certification American College of Veterinary Internal Medicine

Cornell may take emergencies. If you left now, you might get there in time, otherwise you will end up somewhere local again. This place is supposed to be good, but I don't know how close it is to you: Animal Medical Center - New York City They may not be great with shunts either.

My guess is that a scintography would have to be done to r/o shunt not just a look at the liver, but could be totally wrong. While they are removing the probable stones, they can get a liver biopsy if you want, but dogs can have both LS and MVD, so having MVD doesn't r/e LS.

It would be nice of your vet to refund what they did today b/c they knew darn well that if he got stones again, they wouldn't be able to see them. So unless they contrasted the xray somehow, I'd be upset.

Hopefully he is just inflamed, but it is more likely another stone or sludge.

It would be nice, but I know there is no way it is going to happen! I called the emergency number for Cornell and spoke with a very nice attending. She explained that all they could do for him tonight would be stabalize him so if he was stable I could keep him at my house but if he showed any signs of getting worse to bring him to an emergency vet here to get him on fluids. She told me to talk to my vet this morning and get a referral to the medicine specialist at Cornell. She said that Brodie should be on medication to better manage his condition. Unfortunately Cornell will not accept any of the tests that my vet did. So all of the xrays, ultrasounds and blood work that was done will have to be redone (even though they were just taken yesterday and my vet gouged me for another $130 blood panel). She told me that Brodie would have to be there 24 hours and if the stones looked serious they would have to remove them. I had told her about the livershunt and she said they would do more tests to see if it actually was a shunt but that surgery probably wouldn't be performed at this time. Why would that be? I hate that he might have to be opened up twice more (stones and possibly a shunt!).
I work full time and have to tell my manager in advance what days I want off. Since I am a new employee I haven't accrued much time. Anyone have any idea how long I'd be in Cornell if I went today? She said at least 24 hours but I know when he had his first surgery he was at the vet for 3 additional days. I don't want to leave him up there by himself but there is no way I could get off Monday and Tuesday on top of today and Friday! I only have 2 accrued days :( Do you think he would be able to come home by Sunday?

Cornell does see emergencies. I posted the info above.


If she spent $10,000 at this vet on this pup in less than a year with no resolution, only to prolong this baby's pain and suffering, I would be seeking more than that. I think I'd have this case put under investigation. Even a lay person can Google urates and see the connection to LS and that more could have been done to prevent the stones from forming in the first place. For this vet to be fooling around with this all this time is just totally inexcusable.
But that's just me....

That's weird. I would get a referral and fax it to them and speak with Dr Centers, have them tell her to call you back. It would be rediculous to have to put him under twice to get these problems taken care of. They will need to see him to determine exactly what needs to be done, and I would explain your work situation to them also. It's not good for him to be shuffled around place to place. Cornell should keep him till the testing and treatment is done. Maybe 5 days at least. I don't believe the attending put you off like that. Tell them you will pay boarding fees if necessary because you can't do anything for him he needs medical attention and you want it done now. Running him back and forth from Cornell is not an option. He is in pain and crying, and he needs to be seen. Get their fax number and call your vet and tell her to fax them the referral, so you don't have to take him in there and give your vet a chance to talk you into doing more crap. If this doesn't work, let us know. Maybe call the vet that barney107 recommended.

I'm so upset right now I'm about ready to make some phone calls myself!

It's not unusual for most hospitals to want to do their own tests. As they are more specialized, this would make sense, as many regular vets are not as familiar with specific test protocols and procedures.
One can see a shunt with an ultrasound, but they have to be very experienced to do it successfully. Usually, once the BAT is done by the regular vet, most are referred to vets/hospitals that specialize in liver disorders.

Well, I agree, but they'll find a way to try and show that most of the stuff was necessary." Very sad situation. OP: when this is all over you can report them to the state board and they will be investigated.

I am sooo fuming still! That Cornell attending Vet (student) should never have turned her away. Stabilization and futher workup is what this pup needs. Why would someone even call and be willing to drive 5 hours if it wasn't an emergency? I guess that's the ER Tech in me coming out in a rage! Some night folks just don't really like to work! And, no, one cannot diagnose over the phone or a forum, but a crying pup that cannot pee and has a history of stones needs to be seen asap! And why a puppy is producing stones this quickly needs to be investigated, asap. And a pup with a BAT like his needs medication, at the very least, also asap!
:confuse8: :crazy: :facepalm:



And the Mommie doesn't need to be running him all over the place and back trying to get all this done, while trying to hold down a job!

That is who you recommend and I am not doubting her credentials. I was simply giving her options for someone close by since she may need it in an emergency.

I had a liver shunt puppy fixed by Dr. Scavelli at the Garden State Veterinary Hospital in New Jersey. He is a renowned surgeon and people come from all over to bring their babies there. You don't have to go all the way to Cornell. It is not far from NYC. If you would like to talk to me, you can PM me your phone number. I'd be more than glad to talk to you. I read your entire sad story about Brodie and it is heartbreaking. However, I felt from the first post that Brodie had LS and a lot of other posters on here gently told you the same. Now you need to have it ruled out, fixed or learn how he can live with it. I don't mean to be harsh. It is very hard to know what to do when our babies, furry or human are sick and we trust our drs to take care of them but I have found that we need to be really educated when it comes to vets. You have learned a ton from what you've been through with Brodie. I doubt your vet meant any harm but you needed a specialist after the first emergency. You've learned a lot from this, I'm sure... and that's what these forums can be very good for... nobody told you they thought he had liver shunt to be mean. Good luck to you and him. Believe me, I feel your pain.

Barbara

Any info on Brodie today?

Personally, as much as I respect Cornell and have heard wonderful things about Dr. Center, I'd be going to an internist nearby at least preliminarily. The point I'm making here is that if you live in Westbury and you are working and your dog needs care and you can't get time off or you can't trek back and forth to Cornell which can take more than 5 hours by car in bridge traffic, I think at least getting Brodie to an internist to deal with treatment of the stones is urgent before there is a life threatening emergency you are contending with.

Please keep us posted. BTW, the place in Plainview, NY that I gave you a link for is where my brother's cat had chemotherapy. He had a good experience with their hospital but I'll tell you right now they are not cheap just like most other things in NY.

I had a liver shunt puppy fixed by Dr. Scavelli at the Garden State Veterinary Hospital in New Jersey. He is a renowned surgeon and people come from all over to bring their babies there. You don't have to go all the way to Cornell. It is not far from NYC. If you would like to talk to me, you can PM me your phone number. I'd be more than glad to talk to you. I read your entire sad story about Brodie and it is heartbreaking. However, I felt from the first post that Brodie had LS and a lot of other posters on here gently told you the same. Now you need to have it ruled out, fixed or learn how he can live with it. I don't mean to be harsh. It is very hard to know what to do when our babies, furry or human are sick and we trust our drs to take care of them but I have found that we need to be really educated when it comes to vets. You have learned a ton from what you've been through with Brodie. I doubt your vet meant any harm but you needed a specialist after the first emergency. You've learned a lot from this, I'm sure... and that's what these forums can be very good for... nobody told you they thought he had liver shunt to be mean. Good luck to you and him. Believe me, I feel your pain.

Barbara

That is why I always try to tell people not to waste time and money with their regular vets when dealing with more complicated diseases and diagnoses. Vet schools and specialists will always repeat tests.

I hope you can get Brodie to Cornell soon.

Sorry for the lack of updates. I feel like I have been on the phone all day :( So that I can be closer and Brodie can get attention as he needs it he is currently going to be referred to BrightHeart which happens to be very close by (and was never previously mentioned by my vet until I called him telling him I wanted a referral to a specialist at cornell). Has anyone heard of this group? Are they good?

Also, I find myself feeling like I'm on a treadmill! Does anyone know what CAN be done for Brodie now that he already has urate stones??? Are their nonsurgical options?? And what are the options for his future? I feel like I'm getting no answers from anyone. Everyone just keeps suggesting the SAME tests be run and telling me nothing. I've lost count at the number of blood panels that have been run! I would really love to know what should be done and how quickly we can make Brodie feel better. I'd also like to know how to keep him feeling better. I'm so worried I'm going to lose the little guy it makes me sick!!

Brodie's mom -
I was mistaken when I gave you the plainview location
The westbury hospital bright heart is where my brother's cat was treated for cancer.
They seem very competent. I'd call and ask if they know and treat LS issues.

As for the urates - do you know what kind they are? If they are struvites, we just used the product Uro-eze with Teddy with good results.

I don't know of any nonsurgical options for urates. After they are removed again (if they are there), then a specialist should be talking to you about prevention. If they have doubts about the diet, then a board certified veterinary nutritionist needs to be brought in.

I know it's not the answer that any owner would want, but it's the only one there is.

I think they are ammonium urate.

Yes, I am making an appointment with the medicine specialist at Cornell once the current stones are taken care of to decide on an appropriate way to manage his condition. I was hoping for a nonsurgical way to manage his current stones... but they haven't told me any! Currently his is still straining but is going to the bathroom in puddles not drips.