They have not told you of a nonsurgical way to manage ammonium urate stones because there is no way other than surgery. The stones are forming because of liver problems, so no matter how you cut it, dealing with the liver shunt issue is going to be part and parcel of the stone issue.

I think that is as clear as we or your vets can be. You need to deal with the shunt.

:thumbup: I agree. It's a shame your regular vet didn't address the underlying cause of the stones earlier, but that doesn't help now.

If the urates are caused by LS, they will stop forming after the LS is treated/repaired. Even the meds used for LS prior to surgery can help keep stones from forming, by removing the amonia in the intestines before it reaches the liver and kidneys where the stones are formed. Without the excess amonia going through his system, the stones won't be able to form there.

If he had been put on these meds right after his last surgery in March, these stones would not have formed. Right now, if they are blocking him from urinating, they are then too big to be treated with medicines.

Sometimes ultrasound waves can be used to bust up the stones into small pieces, but I am not sure if this treatment is appropriate for him at this time, you may want to ask the vet.

Hang in there Brodie's Mom. I know you have a lot on you right now with trying to hold down a new job and deal with all these health issues.

Sounds like you have been given good advice and maybe can find some expert help nearby too.

My fingers are crossed for you and Brodie!

Has anyone had a liver shunt surgery done that can explain to me the process and time tables?

Brodie's vet has recommended a holistic diet of pasta/rice with cottage cheese/hard boiled egg to be eaten with potassium-chlorate. They think since the stones are Brodie's only symptom if we are able to control those no surgery would be necessary. I am, however, concerned about the lifespan of my little dog and how sick he could be down the road. Yes, getting rid of his stones would be fantastic, but if we don't close the shunt (if he has one) then wouldn't this lead to a shorter life or more issues?? I've read a LOT about it and it seems the survival rate of surgery is high and about 85% of dogs post surgery can lead an almost normal life! Is that the same prognosis you guys have seen?

Anyone that has had a shunt surgery if you could reach out to me and explain what you and your dog went through pre, post and during surgery I'd greatly appreciate it.

I posted a picture of my little Brodie in my album if anyone wanted to see him.

Thank you all for all your help so far. I really hope that I am able to make Brodie all better soon. This is so hard on us both!

An ultrasound was done by Dr Kramer -
Atlantic Coast Veterinary Specialists is a Veterinary Emergency and Veterinary Referral Hospital located in Bohemia, Long Island, NY. Veterinary referral services include veterinary surgery, veterinary ultrasound, veterinary Endoscopy, veterinary car

He seems quite reputable. My vet is going to get back to me about what he saw in regards to Brodie's liver.

WOOPS - I meant potassium citrate

The procedures used, the success rate of each procedure, and the timeline of it all being done differs greatly from hospitals/clinics, and the vets experience in performing the individual procedures.

Just to let you know, I am a retired vet tech of 20 years, my own dog has LS and is on medications while awaiting further testing and surgery to control her symptoms, and as I stated before in quite a few of my posts to this thread, the most experienced vets, with the highest success rate for ameroid constrictor LS surgery (considered best and safest procedure) in the world, is the University of Tennessee. All the info you ask is contained on their website, I do not have the time to retype it or copy it here. Each hospital performing LS surgery of whatever type should have their statistics listed on their websites. I have done this research, and given you this information. It is your choice at this point in time, to read what I have posted and learn from it, or just ignore me completely. I do not have the time to keep repeating myself.


Your pup's BAT results are very high, from all the results I've ever seen, way higher than my dog's results. If you do not take care of this problem in a timely fashion, you will be putting your pup at risk of permanent liver damage, Hepatic Encephalopathy, possible seizures, and death. In short, if he has a shunt, which his BAT results indicate he does, his blood is being routed around his liver, and the toxins from the food he eats are not being removed from his blood. His blood is basically poison to him. You need to get him on meds to assist his liver and keep it as healthy as possible, until the time you decide to have surgery done to repair (close off ) the shunt.

I wish you luck, and my prayers to you and Brodie for a successful resolution to your dilema.

If your pup's specialists don't think you need to go any farther, then that is their call, but please understand if there is a shunt present, it can cause more b/c of the pressure. This pup needs an internal medicine specialist immediately. Preferably it would be someone who has a ton of experience (Cornell or better yet, UT if surgery is being considered). But really at this point any board certified specialist should be seeing him over a general vet.

I have read EVERYTHING you have posted as well as UP AND DOWN that website. NO where in that website does it say "dogs will have surgery on Monday .... and usually be able to go home in ___ days". I know you have kept up very well with me and should know taht I need an EXACT number of days to ask off from my job. I can't just not show up. So if I take off 4 days and Brodie needs to be there 5 are they going to throw him in a UPS box and ship him back?! I think not! Also, I read the stories of other dogs with shunts. I read nothing about any dog that had survived beyond his initial surgery!? How long after the surgery do they live? Do they live a normal life? Maybe I wasn't clear in my questions. What I wanted to know is anyone that had a shunt dog and what his life was like 1, 3, 5 years down the road. I have been in contact with Dr Center's since I posted. She currently is in Africa, so isn't able to call me or be at the center to look at my little pup. I'm sorry you feel as though I am wasting your time and you keep repeating yourself (which you do, I agree). But the questions I am asking you aren't answering. I know WHERE to bring him. I know he NEEDS surgery. I want to know what that surgery is like for my baby and what his life will be like after. I cried reading the doggy stories on UT's site. How horrible that some people give up their little ones and others get surgeries and die. I hope and pray Brodie doesn't have this luck! Please don't think I am ignoring you. I very much appreciate your help and kindness, I just want more information on what to prepare for for the rest of Brodie's life. He is, after all, only one year old. I hope we have many more years to look forward to together!

With all due respect to Dr. Kramer, this website shows that he is a cardiologist. Cardiologists are heart specialists - not liver specialists. If this were me, I'd be again asking myself why I am flushing my money down the toilet. You are running in a corner with this and for that I feel badly.

Ultrasound can only see a shunt IF THE READER IS VERY EXPERIENCED with looking at the LIVER (not the heart) so chances are you may not find out the full condition of the liver. You need to be with a LIVER specialist.

I have concerns about the "holistic diet" you were given. How much protein is in the diet? Were you given a recipe? There is MUCH misconceptions by vets and owners about how to do a home cooked meal properly for a regular pet let alone a pet with severe liver disease. Did they recommend the Hill's L/D diet? That is the diet of choice in liver shunt babies. I'm not sure what they hope to gain with this diet - are they trying to prevent stones? I'm sorry but the shunt is a far greater concern than the stones IMO.

Here is a suggestion - call UT and ask them what the typical time frame is. They will be able to give you this information. They are the world renowned hospital for shunts. Dr. Karen Tobias invented the procedure. There is NO ONE ON THE PLANET more qualified to perform the ameroid constrictor LS surgery.

Hills faxed the holistic diet recipe to my vet. It wasn't created by her. She called the nutritionalist for hills and spoke with them. They said that he should use the L/D diet which she explained he was already on. They then recommended this. He has been on the Hills L/D diet for 6 months already and has seen no improvements.

This is what Dr. Center's from Cornell said to me : "We do not usee ameroid band constricters at Cornell, rather we tie the shunts off to the dogs individual tolerance determined in surgery. Ameroid constricters contract on their own after being placed around the shunt: some dogs cannot tolerate total ligation and they then develop multiple shunts when the ameroid constricts. To avoid that possibility, some surgeons place a "too large" ameroid that cannot totally occlude the shunt. When it contracts one hopes it optimally tied off the shunt to the dogs tolerance. As I said, we individually tie according to the dogs response, and do not use these constrictors."

As I said, we have been corresponding via email as she is in Africa.

FROM THE UT WEBSITE - seems ameroid constrictor placement still is what Dr. Tobias still recommends --

"What is the prognosis for dogs after ameroid constrictor placement around a shunt?
Survival rate from the surgery is over 95% for dogs with shunts treated by ameroid constrictor placement, and our long-term prognosis is better with this technique than with most other methods. Many dogs are clinically normal within 4-8 weeks after the surgery. Long term, about 85% of dogs with liver shunts closed with ameroid constrictors do well clinically. About 15% continue to have problems, probably because the tiny blood vessels inside the liver were also abnormal. Usually these dogs develop multiple acquired shunts and must be managed with a protein restricted diet and lactulose for life."

Here is the home cooked diet that Dr. Tobias links to on the UT website.
I'd listen to her before a Hill's employee.

http://www.vet.utk.edu/clinical/sacs...Liver_diet.pdf

I unfortunately can't get enough time off work to make a trip to Tennessee so have elected to go to Cornell as that is my next best option. Brodie has an appointment on August 12th to do an evaluation and CT. The following is going to be done "a multisector CT. That requires that he be anesthetized for about 20 minutes and a scan done. This is reconstructed using a computer to without a doubt verfiy whether he has a shunt, where it is, and a presurgical assessment that will help determine what might be done surgically." This was the earliest appointment they had available.

My fingers are crossed he at least starts to feel better soon. Dr. Center's said that she didn't recommend a holistic diet and as I still have the L/D food I think I am going to keep him on it. Currently he is not eating much of anything and is spending a good majority of his time sleeping. I have to trick him into eating with bits of "treats" ie some orzo mixed in. Even then he is only picking at his food. He has me very worried but at least it looks like we are moving in the right direction. I have been working with my vet AND an internal med doctor from the Atlantic group I sent you the link to. They are still quite convinced it isn't a shunt. I will be interested to see what the test results from Cornell say!

I think the diagnostics you have had could not lead to the conclusion of "no shunt" - more is needed so I'm glad you are going to go to Cornell with your dog. Good luck.

I'm sorry.

U of Tenn: appts given around 2 weeks from the time you call, may have changed... check with them.

Length of stay in hospital: 3-6 days... but could be longer if any complications arise.

Normally, when dogs are first diagnosed, they are put on Lactulose, Denamarin (or similar), and a course of antibiotics. All this is to help the liver, eliminate toxins through the intestines before reaching the liver, and to prevent stone formation and UTIs., and a protein restricted diet.

I highlighted some answers you were looking for: (I think!)


From: Portosystemic Shunts FAQ


What medical management is needed for an animal with a shunt?
Dogs with shunts are usually stabilized with special diets and medications to reduce the amount of toxins that are produced and absorbed in the large intestines. Dogs that are severely ill may require intravenous fluids to restore blood sugar, an enema to remove intestinal toxins before they are absorbed, and medications such as valium to stop seizures.

Diet: Because many of the toxins produced in the intestines come from protein, it is important to reduce the amount of protein in the diet. Dog food for adults and puppies usually contains 25% and 29% protein, respectively, and may have meat byproducts. Dogs with shunts need high quality proteins made from milk or vegetable, and are restricted to a protein content of 18% or less (on a dry matter basis). The diets should be easily digestible, rich in antioxidants and vitamins, and low in copper and iron.

***Lactulose: Much of the toxins absorbed from the intestines are produced by normal intestinal bacterial. Lactulose changes the pH in the large intestines, which decreases absorption of ammonia and other toxins and makes the environment unfavorable for the toxin-producing bacteria. It also encourages the intestinal contents to leave the area more quickly, so that toxins have less time to be absorbed. Lactulose is basically a sugar solution; its primary side effect is diarrhea. Because of this, veterinarians will instruct owners to adjust the dose so that the dog's feces is soft but formed.

***Antibiotics: If clinical signs are not controlled with a protein-restricted diet and lactulose, veterinarians will often prescribe antibiotics to reduce the number of toxin-producing bacteria in the intestines. Antibiotics will also be needed if the animal has a urinary tract infection.
Can dogs with shunts be treated with only medical management?
Most animals improve immediately with proper diet and medicine, and about one third of the dogs treated medically will live a relatively long life. Unfortunately, over half of the dogs treated medically are euthanized, usually within 10 months of diagnosis, because of uncontrollable neurologic signs, such as seizures and behavior changes, or progressive liver damage. Dogs that tend to do well with longterm medical management are usually older at the time of diagnosis, have more normal bloodwork, and have less severe clinical signs. Surgery provides the best chance for a long healthy life in most dogs.
How is a shunt corrected surgically?
Because shunts inside the liver are more difficult to find and close off, surgery of dogs with intrahepatic shunts is best performed by a board certified surgeon (ACVS Diplomate). Surgery for congenital extrahepatic liver shunts is slightly easier, particularly if the veterinarian has a lot of experience, and is performed at most veterinary surgery referral centers. The surgeon must find the abnormal blood vessel and close it off to force blood to flow back through the liver. Unfortunately, the blood vessels inside the livers of some dogs are so poorly developed that they will not open quickly. Therefore, most surgeons will use a device that slowly closes the shunt, such as an ameroid constrictor. Other options include placement of a suture or cellophane band around the shunt or coils inside of the shunt. Placement of coils can be performed through a catheter in the neck ("jugular") vein; however, because they tend to cause rapid obstruction of the shunt in animals, their use is still being researched.
***How does an ameroid constrictor work?
An ameroid constrictor is a metal band with an inner ring of casein, a protein found in milk. In the belly, the inner ring absorbs normal fluid and gradually swells, pressing on the shunt and encouraging it to scar shut. Shunts usually close within 3-4 weeks of ameroid constrictor placement. Because of the metal outer ring, the constrictor will always be visible on x-rays of the belly.
***What are the complications of shunt surgery?
Surgery with ameroid constrictor placement is faster and complications are fewer compared to other techniques, but the puppies can still get very cold or develop low blood sugar during or after the procedure. Occasionally dogs will develop pain and bloating if the constrictor kinks the vessel or if a suture or a cellophane band is used. This can progress to shock and death, so animals must be watched carefully for several days after the procedure. A small percentage of dogs may also have seizures after surgery. Dogs with intrahepatic shunts are more likely to have complications and usually require several days of intensive care and possible blood transfusions.
What care is needed for dogs after shunt surgery?
Dogs are kept on a protein-restricted diet for at least 6-8 weeks after surgery. Lactulose can be continued as well, or can be gradually decreased over 2-4 weeks. Most dogs do not need antibiotics unless they have infections in the urine or other sites. The liver will begin to grow as the shunt closes, and will often be normal sized in 2-4 months. To check liver function, blood tests (BUN, albumin, liver enzymes, and bile acids) are usually evaluated at 8-12 weeks after surgery. If these are still abnormal, they are repeated in another 3 months. If they are normal, the diet is gradually switched to an adult maintenance dog food. A scintigraphy can be performed at 3-6 months to confirm that the shunt is closed.
What is the prognosis for dogs after ameroid constrictor placement around a shunt?
Survival rate from the surgery is over 95% for dogs with shunts treated by ameroid constrictor placement, and our long-term prognosis is better with this technique than with most other methods. Many dogs are clinically normal within 4-8 weeks after the surgery. Long term, about 85% of dogs with liver shunts closed with ameroid constrictors do well clinically. About 15% continue to have problems, probably because the tiny blood vessels inside the liver were also abnormal. Usually these dogs develop multiple acquired shunts and must be managed with a protein restricted diet and lactulose for life.
Dr. Karen Tobias is an Associate Professor in Small Animal Surgery at the University of Tennessee College of Veterinary Medicine

Sounds like you are on your way to determining shunt or no shunt. It will be good to see what Cornell has to say and should point you in a definitive direction forward with Brodie. I hope he feels better before then though on the special food. You can try hand feeding or mixing with some low protein alternatives if he isn't eating. Fingers crossed for both of you.

Is Brody peeing now? Did they do anything for him or put him on meds yet? If Brody get on the meds, that could possibly buy you more time... when can you get a week off? In 6-8 months? He may be able to be medically managed until then or longer.

Not eating/ picky eater is a sign of LS. Is he on the dry L/D or canned? If dry, you could moisten it with some warm water or chicken broth (low sodium). You can also offer him green beans, fruits, noodles/pasta, cottage cheese mixed in with the food.

Did you ask about the ultrasonic treatment for stones? Wondering what they said...

There are YT members that live near the UofT, and may be able to offer assistance (pick him up and keep him till you could get there to pick him up)....

Links to YT LS dogs.... Liver shunt surgery - Google Search

Some pilots will take a pet in the cabin with them to send them home... just another possibility. I'll find the link and post it... Pilots N Paws|Saving the Lives of Innocent Animals they normally work with rescues but they may be able to help.

There are also pet friendly airlines...

I realize you still need to find out if he has a shunt or not first, just brainstorming by myself...I'd like you to be able to have a choice .... even if it means having a stranger helping out...

These are great low protein alternatives to mix in. Lucy loves them all mixed in with her food - except for fruit - she likes to eat that by itself. Maybe it will help him eat.

A good news update! Brodie has been peeing and pooping (he actually went poo 8 times in a day!!!). This morning he came and woke ME up and was bouncing around trying to get me to put him on my bed! I was delighted to see his eager face. I know I am by no means in the clear, but this will definitely be much easier on both of us if he isn't suffering for 2 weeks while we wait to get to Cornell. He is still peeing in smaller bits and thinks he has to go every 15-20mins but at least there is no blockage right now.
He eats the hills dry and wet food. For some reason whenever he eats the wet food (I think he eats too fast) he gets sick and lethargic. I think its because when he has the dry food he picks so doesn't get all the protein at once. Just an idea. Question about a food - Brodie LOVES cheerios. Are they okay for him to have? I read the box and they are very low in calories, fat and protein (1%). He will do anything for a cheerio.

I only get 10 vacation days a year and I must accrue them. That means I get about 1.5hrs weekly. Not even a full day a month! I have been with the company for a little over 3 months.

Great! Cheerios are fine, just in moderation. Info: The L/D canned has chicken fat in it, the dry has pork fat. Does he have any allergies? Small, frequent meals would be best for him... maybe he's eating too much at one time? You could add water to both to increase his intake. If he still reacts the same way I think I would discontinue the canned..

Did his poop look normal? I would ask your vet to at least prescribe Lactulose. It will help keep him pooping, and help his system with processing toxins... won't hurt him if he doesn't have LS... It will help prevent the stones from getting bigger....


So in 6 months you'll have 5 days.

Did Cornell give you a price on the LS surgery, if he should need it?

Also thinking to fly him down to U of T on the weekend, leave him there for the week, fly back down to pick him up the following weekend. No missed work! They'll keep in touch with you by phone...

They said 1700-2500 depending. I thought this sounded fairly reasonable.
The poop was very normal looking - not diarrhea or excessively hard. I think he may have been constipated before. I have been very careful to make sure he continuously drinks water. I am going to my vets today to ask about lactulose. Center's recommended it for him as well.

Wow, that's not bad. I had no clue. Does that include everything: Tests, surgery, hospital stay, etc? The Lactulose should make him feel alot better. :D

Yea, she said that would be the final cost but the vet tech could tell me more and make a closer quote once we see what exactly we are dealing with with Brodie. I was also quite surprised especially after what my vet has already charged me!

Ha! Yeah, that isn't really adding up too well. I saw in one of those linked posts the charge for LS surgery was between $3000-$4000. I forget where, but it is worth calling around. I really thought Cornell would be much more expensive. I like pleasant surprises!:D