Really scared for Brodie high enzymes please help

[Ellie May]

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?

[Brodies Mommy]

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?

[Ellie May]

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?

[Brodies Mommy]

Originally Posted by Ellie May

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.

[Ladymom]

Originally Posted by Brodies Mommy

Brodie update:

Bile acid test results:
Pre meal - 290
Post meal - 366

He has no external liver shunts so they believe it is an internal liver shunt that is causing him the issues. The only way they could find this is to do a liver biopsy which is very dangerous and costly. My vet has recommended Hills LD and has ordered me a bag of dry and a case of wet food as well. He is going to monitor Brodie's urine and blood once every 3 months. He said Brodie could have lots of complications down the road but right now he is playful and healthy and he sees no reason to do a very dangerous surgery that could kill a 3lb dog if it can be controlled by diet and constant regulation. He said Brodie could have Hepatic micro dysplasia. :'(

What to do now?

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

[Ellie May]

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.

[Brodies Mommy]

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!

[Ringo1]

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.

[Brodies Mommy]

Originally Posted by Ringo1

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?!

[Ringo1]

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!

[kjc]

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.

[Ellie May]

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.

[kjc]

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....

[107barney]

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.

[107barney]

Originally Posted by Brodies Mommy

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.

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).