Really scared for Brodie high enzymes please help
 

Hello
My baby Brodie is 8 months old. He was crying in pain and hadn't peed the other day for an extended period of time so I brought him to the emergency room at 4am. The man there was mean to mean when I told him Brodie's belly felt bloated - he told me "yorkie's don't get bloat". I took Brodie out of his travel bag, he felt his belly and told me the dog was probably just constipated, he could run xrays but he recommended I just go home. I took Brodie home and proceeded to listen to him scream for 4 more hours before my normal vet opened. I brought Brodie in first thing and my vet felt his belly and said Brodie had an extremely bloated bladder. I explained to him what I had told the individual the night before and he said Brodie was lethargic because the urine was poisoning him. He took Brodie's temperature and it was low as well. He found it odd that a dog so young would have a blockage but said they had seen it before in a dog four months old. He took Brodie, sedated him, cath-ed him and drained the urine. The urine was extremely bloody and Brodie did have a blockage. The vet xrayed to look for stones but didn't find any in the xray so sent the urine in to be analyzed for crystals. He also sent in blood to be tested. Brodie was put on an IV, pain medicine and an antibiotic.

This morning Brodie's tests results came back - his liver and kidney enzymes were elevated (they weren't sure if it was due to being blocked up though so are rerunning the blood work), the urine analysis came back and there wasn't a very high concentration of crystals so they are concerned that it could be because of a liver or kidney issue. They informed me Brodie has been really chowing down this morning and seemed very pleased to be getting food, but they are keeping him on an IV all day today and probably overnight as well. Today they are running an ultrasound to check for stones that couldn't be seen with the xray and to exam the liver. My vet said it is unlikely that he has a liver shunt as he has none of the other symptoms - drooling, head pushing, slowness.

Has anyone else had these issues? What could be going on with my poor baby? I really want him better and to be able to take him home it is so horrible having an empty house and to know he is in a cage alone thinking I left him. :(

Oh no! Sending hugs and prayers that this is just an isolated incident and that Brodie comes home very soon!!!! Oh, and I want to do this (insert bonking the night attendant at the emergency clinic on the head smiley) to <--- "that" guy!

bumping!:D

When you get his Blood result please post them on this Thread. We have lots of people on YT who may be able to steer you in the right direction.

Sending warm thoughts and prayer's for Brodie to be well again.
Don't hesitate to inform that ER that one of their vet's made
a misdiagnosis and sent you home! Your beloved pet could have died from the backup
of urine. It is poison to the body. It would give me great pleasure to let them know.
It's very upsetting to read, so often, on YT that vet's are rude
and misdiagnos so often.
Glad your vet picked up the problem and is doing his best to make
Brodi well.

Very true! I have never delt with an emergency clinic (knock on wood), but I am beginning to think that those clinics get the vets that can't find a job at a real clinic as many times as I read on here how often the ER clinic messes up. And, I am a huge advocate for vets in general.

I have to wait until tomorrow for a tech to read the ultrasound so poor Brodie is still at the vets tonight. I went and visited him, he had been sedated so was very groggy and unable to stand up. He was trying so hard and when I kissed him he was so happy and licked my face until he was too tired then just lay his head and one leg that didn't have an IV in it in my hand. I feel so bad for the poor little thing :( He still has yet to go on his own so had a cath sewed in. The urine that is coming out is pink in color, not running clear.
They told me his kidneys were inflamed and had a blockage which could be caused by two things - either an infection or liver issues. They said from the ultrasound they would be able to tell if he required surgery or not. I REALLY hope it was caused by an infection and he doesn't require surgery. I want my baby to come home! :(

this sounds like liver shunt to me :( get the pre and post bile acid test done asap - is he on a high protein diet? If so get him on 18% protein diet as sounds like he is not processing the proteins well. Join this group Liver_Shunt_And_MVD_Support@yahoogroups.com you will learn alot

they do not have to have all the symptoms of liver shunt to have a shunt. Some dogs have no symptoms so you need to check this out asap. Alot of vets are not real knowledgeable of liver shunt and it runs in 38% of yorkies so it is very common so you need to have the pre and post bile acid done to rule this out - if bile acids over 100 then very likley it could be a shunt

also unless the tech is real good it is VERY HARD to detect a shunt on ultrasound

My vet just called me to tell me Brodie is going to need surgery on Monday. He passed a small stone and he believes he has many more that are just undetectable. He says he would cut open his bladder and tract and remove the stones then sew him up again. He has a lot of experience with little dogs as I live in an area that has a lot of them. He also wants to run tests on the stones and such so said Monday would be the earliest. The tech still hasn't done a reading of the ultrasound, it was sent to a specialist as the first tech noted the kidney was inflamed and was concerned. I hope nothing is wrong with the kidneys :(
I unfortunately hadn't put pet insurance on my baby so this is becoming much more expensive than his mommy can afford :(

i think this is all tied to a liver shunt - if it is urate it could be tied to liver disease

Bladder Stones (Urinary Calculi) in Dogs

here is the info on stones

shunt info

Portal Caval Shunts (Liver Shunts) in Puppies

http://www.yorkietalk.com/forums/sic...creatitis.html

read this

are you near cornell university? as dr centers is great at this and dr tobias at university of tennessee is the surgeon and dr centers is an internal medicine specialist

I asked SEVERAL times about the liver and kidneys of my baby. My vet ran blood tests on him 3 times. The first time they both had elevated enzyme levels (immediately after I had brought him in with the inflamed bladder and kidneys), the 2nd and 3d times they were perfectly normal. He tested before and after food intake to see if there were any fluctuations. He wouldn't move forward with surgery unless he got good blood test results both times he told me. He explained if the results pointed to any complications with liver or kidney (which he had originally feared was the issue), he would not touch my baby but would give me the name of a specialist. He has assured me Brodie has a genetic predisposition to kidney stones and while we were going to have to surgically remove them this time due to their size he was sure that they could be controlled with a strict diet.
The specialist that looked at the ultrasound agreed that the kidney was enlarged due to the blockage being there so long before I had gotten Brodie to the vet. He is a tough little puppy so I guess he didn't "complain" of his issue until it was completely unbearable for him.

Does it sound like my vet has done everything right? I very much trust the vets I send him too and the specialist. My vet had a pacemaker and battery pack put in her dog by the specialist and she personally recommends him. They seem to be very thorough and careful. They showed me all of the equipment and room that they would be performing the surgery in. They have also explained each and every test to me and showed me each result. I have even seen 2 of the LARGE kidney stones the poor little dear has passed.

I really hope everything goes okay for him tomorrow! PLEASE let me know if there is anything else I should do?!

what type of stones? urate or struvite? also did he do pre and post bile acid tests - the test goes as follows 12 hr fast pull blood eat and 2hrs on dot not one minute later blood pulled so was this done? If so what were the numbers and were they sent to a lab as inhouse is not sufficient. If you look at the blood work from previous was the ALT ever high? Diet plays alot in stones and depending on the type of stone you will know more what you are dealing with. Does your dog drink alot of water?

Brodie required the surgery to get the large stone out of his bladder as it kept obstructing and they would have to take a needle and dislodge it twice a day. The stone is being sent in for testing - not at my vets office. They told me Saturday they would have the results in 5 business days (I'm guessing after Christmas??). After they find out the results of the stone type they are going to decide what to do from there. They said it could either be he has a genetic condition where he doesn't metabolize food properly or he has a liver problem. I am really, really hoping it is something that can be treated with a diet change or medication as I can't afford much more! It cost me $3700 to have him at the vets this past week and remove the one bladder stone! :( I also don't want the poor little guy to have to go under again. Brodie only weighs 3lbs 9oz, which is a problem - when we purchased him we were told he was a toy, not a tea cup and would grow to 7-10lbs. I have been told this could be a sign of a liver shunt, but it could also just be that he is small. He is leaking small amounts of urine so I have him in a tiny area of the house. He is hating it and wants to come be with his mommy. I'm so worried picking him up because of all the stitches. He also has bruising (red under his skin) on his belly opposite the stitches. Is it dangerous handling him a lot when he had his bladder and belly cut open? I've been feeding him little bits at a time and he keeps cleaning up the bowl. I feel bad because he seems super hungry but the vet told me not to let him eat a lot all at once. Currently I am only feeding him his Wellness wet puppy food about 1-2tbsp at a time.

Oh little Brodie I am so sorry you are not feeling well. Hope you and Mommy get some rest and feel better:)

Poor baby, he has been through a lot and Mom too. Do you have a crate you can put in your bedroom and keep him in there until he heals. I will keep him in my prayers.

i recommend if stones is an issue and not liver shunt related the natural balance vegetarian diet as high protein causes stones usually. Were they not able to see if he had a shunt while under for the bladder stone? If the stone is urate and not struvite then it is probably tied to liver shunt. The liver shunt surgery is not too costly if you can get to university of tennessee to dr tobias. Being a smaller yorkie they are more susceptible to liver shunt as stunted growth is part of it :(

Brodies stones were urate. The vet said this was due to a congenital issue. He wants to do more blood work on Monday because he is concerned his liver may be too small tho he said it looked fine on the ultrasound. He is consulting a nutritionist bc brodie is so small and young. I'm so worried. Brodie has peed a few drops what seems like hundreds of times today. I have now payed $4500 and really can't afford much more. I don't want to lose my baby! What can I do?

urate is tied to liver shunt are you near cornell university as dr centers is a good source for liver shunt and if surgery university of tennessee dr tobias will be the cheapest route. So sorry :( Did they run bile acid tests ? I would recommend hill's L/D as your dog needs to be on a low protein diet 18% or below. If your dog is not having seizures you may want to just do natural balance vegetarian as that is low in protein and i know a yorkie on this after having stones

I know you keep telling me all these things are connected to liver shunts, but my vet seems to have ruled this out. He says Brodie doesn't present any of the characteristics other than being small and having kidney stones which can be caused by many other things. He also says he saw nothing wrong with the liver when he did the ultrasound (or when the specialist looked at it). After Brodie had been on IV for several days they reran his tests and everything came back the way it should have. He had proper enzymes and function in both his kidney and liver. He also cut open his bladder, I would think when he did that he would have checked to see if there was a liver shunt even if he was doing nothing about it? I will ask tomorrow. He is concerned Brodie's liver is too small and not able to keep up with him. He is running more blood tests to check for his liver efficiency. Is that a possibility anyone has heard of before?
My vet told me Brodie would not require more surgery unless he got more stones. He saw nothing wrong with any of his organs that could be fixed with surgery. The test was being run to see what was going on with his liver and to change his diet or give him medicine accordingly. Do you guys think my vet is actually wrong and just didn't see the shunt? And the specialist didn't either? I want to believe them but all I've heard from everyone on YT is that he has a shunt and that is making me very worried that perhaps my vet isn't doing a good job. HELP!? I care very much about my baby and want this to all be over.

Also, I live no where near Tennessee. It would cost me quite a bit of money to get him there (probably like $1000).

when you say specialist are you seeing an internal medicine specialist? What tests is your vet running? Did he run pre and post bile acid tests? A regular blood test does not ALWAYS show signs of liver shunt my dogs did not but when pre and post biles were done she has a liver issue. Are you near cornell university as dr center is excellent with this. So what is his reasoning for a small liver? For urate stones? Does he know urate stones are tied to liver shunt? Sadly many vets are not familiar with liver shunt - i went to 3 vets and no one mentioned liver shunt in my dog with mvd and finally on vet 4 he asked if she was ever bile acid tested and i asked what was that and he said all yorkies and maltese should be bile acid tested as it runs so prevalent so the fact that your dog has a small liver and urate stones really concerns me but maybe we are wrong as we are not vets it just sounds like it and i would make sure you take all your blood work and test results and have it reviewed with dr centers as to why your dog has urate stones - what diet is the vet putting your dog on ? Is it a low protein diet? what meds is he referring to ?

Brodie and I are from NYC area. My vet sees tons of small dogs every day as that is what the majority of people have. An ultrasound specialist looked over the ultrasound as the technician that took it said everything looked fine but since Brodie is such a small dog he wanted to be certain. My vet had Brodie fast overnight and this morning is running a pre and post Bile acid test. He told me I could pick Brodie up in aprx 3 hours. He said that livers that are too small are common in this kind of animal, but the test would also tell if there was a shunt - though if there is it should be controllable with diet and medication as it was not large enough to be detected on the ultrasound. After the test results come back (how long does this take??), my vet told me he was going to meet with a nutritionist to decide Brodie's diet.

The test should be back in 24-48hrs tops and then you will know how the liver is functioning - if there is a shunt I would have it fixed and by dr tobias at ut as if you have it done there it will be more expensive than flying to ut or driving. I would at least get an estimate. It may just be mvd so wait for the results but if the pre or post are over 100 I would do scintigraphy next. What can happen if you do not fix a single shunt early on is it can blow more shunts and then it can never be repaired. Diet alone will not stop symptoms if the dog has a shunt. If it is mvd then yes diet helps a low protein diet of fish, vegetarian, soy works. My dog has mvd and her pre and post biles were below 100

Wow, poor little Brodie. Hopefully when all the tests come back they can provide an appropriate treatment, even if it's just a strict diet. You both are in my thoughts.:animal-pa

sorry but not real thrilled with vet :( just being honest anything over 100 is usually an external shunt in a yorkie not an internal. Internal shunts happen is large dogs not small dogs so i really have a red flag up about this vet and have since your first post as i knew this was liver shunt related. Mvd or hmd is what my dog has and that is usually when a dog is asymptomatic meaning no signs and bile acids are below 100 anytime it is above 100 usually is a shunt and one is easy to correct if your dog blows more shunts due to one shunt not being corrected then you will not have surgery as an option. The next thing i recommend is a scintigraphy as that is more precise in determining if shunt or not NOT AN ULTRASOUND. These dogs are tiny and shunts are almost impossible to see on an ultrasound. The scintigraphy cost about $390 and only certain specialists can do it as it is radioactive dye- if this were my dog I would have the scintigraphy done next and i would go to ut because if it is a shunt and shows up in scintigraphy i would want dr tobias to do the surgery immediately so my dog could live a normal life. Have you joined this group as they can help you alot as they helped me out alot when dd was diagnosed with mvd.

Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

here is what a scintigraphy is

Portal Scintigraphy in Veterinary Medicine

basically they put a dye capsule in your dogs butt and it travels through the body and they take hundreds of pics to see if it bypasses the liver if it does then there is a shunt if it does not then no shunt. It is the only true test for liver shunt that is accurate. Protein c is a blood test for it but a dog with 3 shunts showed negative for a shunt so i do not think that test is so accurate anymore. The dog does not have to be sedated if calm and you have to leave for entire day as all dye has to be out of them before they can come home.

mvd

MVD

liver shunt

Do all dogs with high bile acids have shunts?

Bile acids can be increased with any liver disease. Bile acids can also be mildly increased in normal dogs, particularly in some breeds (such as Maltese) where chemicals in their blood interfere with the test. Most dogs with liver shunts have fed bile acids over 100 (normal <15-20). If the bile acids are only mildly increased or the animal seems normal, many veterinarians will simply rerun the test in 3-4 weeks.

Congenital Portosystemic Shunts

this is a very good site

Portosystemic shunts - liver shunts