Urate stone, possible PSS?
 

I have a 21-month-old, Franklin, who had a bladder stone removed 16 days ago (was diagnosed following a urinary tract infection). The laboratory tests came back a couple days ago and indicated that the stone was a urate stone.

I know that these stones are most commonly associated with a portosystemic shunt in small breeds such as Yorkshire Terriers. However, he has had no symptoms that are indicative of PSS other than the stone itself. He is full of energy, has never had vomiting problems or diarrhea, and has no visible neurological defects. Tomorrow, he is having blood work performed in an attempt to diagnose the condition.

Needless to say, I am worried sick. Is there any chance that he might have another condition that does not have as dire a prognosis as that associated with PSS? Any information on this would be greatly appreciated!

I would get bats done and then go from there. Most likely liver related as yorkies are 38% more likely than any other breed to have liver disease

What percentage of protein have you been feeding? What Food?

You need to have your baby on low protein for sure now after having a urate stone.

Some liver dogs only have one symptom they do not have to have all of them and stones is one of the symptoms of liver disease especially urate stones

I have noticed the boy yorkies tend to get the stones though as there was another one I helped and he was 4 and only symptom he had was stones and he had multiple shunts so it can happen.

Let us know the bat results and we can help you

Currently, he is being fed Hills T/D (for tartar build-up...another problem there). It contains 14.0% crude protein. Is there any particular food that you would recommend feeding to him while I am waiting on the lab tests?

As an aside, collecting a urine sample from a yorkie who is not holding his bladder very well (started after surgery and is also being addressed by vet) is a frustrating endeavor.

best way to collect urine is when they first get up in morning put on wee wee pad that is flipped over and collect with a syringe and bottle from vet and take in. This may be easier for you

14% is ok on protein - is it dry? How long have you been feeding 14% protein? You want to be below 18% with liver symptoms like stones.

I'm assuming the stone was removed with surgery right? did the vet do a full blood panel before the surgery? Did the vet report any problems during surgery or post op (vitals and recovery)?

Yes, the stone was removed via surgery (about the size of a small pinky nail). There were no problems during the surgery or immediately afterward (he is still dribbling urine, however, after he passes the majority). Some blood tests were done, but apparently, more are needed to determine whether or not he could have a shunt. I have not seen the original blood panel work and am not currently privy to which tests were run. I just moved so I am now using a different vet than the one who performed the surgery. All info was faxed to new vet so said individual is aware of prior tests performed.

Its good that he did well with the anesthesia because most dogs with shunts do not do well.

I'd ask your new vet for a full blood panel and a bile acid test to be done.

dripping urine after surgery is normal. hopefully an x-ray was taken after the surgery to ensure all the stones were removed. the dripping should stop soon and he should be back to normal.

First off, I have a question that concerns Franklin's condition at the current moment: after he finishes urinating the first time, he typically dribbles a bit of urine on the next several passes. Of concern, however, is the fact that on the third or fourth try, he starts making sputtering noises. One can hear what sounds like gas being passed from about ten feet away. Could this be emanating from his urethra and if so, what would cause this? It does not sound normal in the least.

...

Just got the bile acid tests back:

Pre-meal: 33.1 uM
Post-meal: 119.3 uM

Way elevated past normal (13-25 for both tests). Vet believes that he has PSS. We've been referred to a "specialist" who will administer ultrasound
(how much does this cost by the way?) to confirm shunt(s). Then, we will decide how to proceed. I don't know if I can justify spending $4000-$5000 on the surgery, especially as it is a risky procedure. :(

Anybody have any anecdotes concerning quality of life post-diagnosis of PSS? I don't even know how I would go about administering different diets to my two little guys, since they are used to eating very slowly and together. In addition to this, Franklin only eats after Geoffrey (my other one) starts eating so to put them in different rooms to eat will prove difficult.

I'm especially worried that if we choose not to operate, he is going to get more stones that will necessitate surgery which would drive costs up to that of fixing the shunt in the first place. Is there a medication that can break up stones as they form?

So sad. He is such a friendly little guy with so much personality!

those numbers are close to 100 - what percentage of protein are you feeding now and have been for last 30 days? Over 100 indicates shunt - however if you are feeding a high protein diet then the test can be skewed a bit and since you are close to 100 I would feed 18% protein and retest in 30 days. With the urine issue though that is a tough call as that is a symptom of shunt as well so this is a tough one as there was another little guy on here having uti issues as well and turned out to be a shunt but his numbers post were much higher than your dogs.

Are you close to university of tennesse where dr tobias is as if you are it is much cheaper to do testing there and honestly ultrasound is a waste many times as it is hard to see a shunt on a tiny dog unless they are really good like dr tobias group. It is better to do scintigraphy as that test is way more accurate

If this was my dog I would call dr tobias and dr center and do a phone consult with them immediately and i would fax over all vet records for both to review then decide which way to proceed from there

My vet also recommends skipping ultrasound and going straight to scintography. He says ultrasound is not always reliable.

When my Lucy's numbers came back high (not that high though); we decided to wait 30 days and re-test.

You could do the same and possibly lower those numbers a great deal by feeding lower protein; and cutting out protein treats, etc.

Liver shunt does not have to be a death sentence. Many dogs do fine after the surgery. You could also find out that it is NOT a shunt; but rather MVD - which hopefully you can manage with diet.

I just don't want you to think it's all hopeless.

He has consumed a dry food diet containing 14.0% protein for at least one year. I currently live in St. Louis and work long hours as I am studying for my Ph.D (I work full-time in a lab). This makes traveling, especially on weekdays, very difficult.

Also, I do not feed my dogs treats or "human food". I think Geoffrey ate a garbanzo bean that I dropped today though. :)

well that is a low percentage of protein to have bats like that so bats would probably be higher with higher protein so probably why you are not seeing symptoms so if that low of protein and still had a stone removed may be shunt.

Was the stone removed a urate stone as that is indicative of liver issue if that type of stone.

Gallbladder can contract as well while doing bats causing higher numbers.

I would do a consult with tobias (surgeon) and centers (internal medicine) and have them refer someone in your area for surgery but it does not have to cost that much and you can get CareCredit Healthcare Finance - Payment Plans and Financing for Cosmetic Surgery, Dental, Vision, Hearing, Veterinary & Other Medical Procedures to extend out the cost as well with no interest.

Liver shunt dogs can live a great normal life after surgery - this may sound bad but i would take that over allergies as no real cure for allergies but at least with this there is a surgery and a cure and a normal life.

The scintigraphy is about the same cost as ultrasound and much more accurate - the only prob is it is radioactive dye capsule they shoot through the butt and follow it to see if it bypasses the liver thus showing a shunt is present

here is scintigraphy information

Portal Scintigraphy in Veterinary Medicine

I would not do this until talking to tobias and centers first to get their perspective on all the testing previously done though

Since he has been on such a low protein diet and has urate stones, he needs to see an internist. Ultrasounds are good for some things related to liver and bladder issues, but it is sometimes hard to diagnose a shunt with one. Skipping to a scintography ma be a cheaper option because you may have to have one done even with a "normal" ultrasound.

Five thousand dollars is an extremely high estimate for PSS surgery. There are places that will do it cheaper (UT) if that's the diagnosis. If there is a shunt present (and there may not be), prognosis is probably poor without surgery, esp. with bladder involvement, etc. The surgery does have risks, but in the right hands, there is a very good chance that things will go just fine. :)