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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 23805
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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I have an 9 yo shitzu who has viral encephalitis /epilepsy

Customer Question

I have an 9 yo shitzu who has viral encephalitis /epilepsy controlled on zonisimide- previously phenobarbital for 4 yrs. transitioned to zonizomide last year due to elevated liver enzymes. They are normal now with the exception of ALP which was last 308 and continues to downtrend. He was recently diagnosed with bladder stones and had a cystotomy. Stone analysis came back as uremic stones covered by calcium oxalate stones. Vet suggested bile acid testing which came back with fasting level of 272 and post prandial level 63.8. He was started on hills prescription U/D diet. Vet now suggesting seeing specialist for further testing/imaging. Dog is doing great. I've already spent a mini fortune. Is there anything empirically I can do? What will further testing get me?
Submitted: 21 days ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 21 days ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.

Expert:  Dr. Michael Salkin replied 21 days ago.

Crystal, it sounds as if Yoshi is trying out all of the diseases to see which he likes best. I commend your excellent attention and care of Yoshi. I can understand what that has entailed.

Can you clarify "uremic" stones for me? Urates, possibly? The u/d would be appropriate for both urates and oxalates.

Those elevated serum bile acids tell me that primary hepatic disease, microvascular dysplasia, or a portosystemic shunt (the latter two disorders are disorders of the vasculature associated with Yoshi's liver) exist and dictate further hepatic evaluation and possible hepatic biopsy. Unfortunately, measurement of serum bile acids doesn't reliably distinguish among different hepatobiliary diseases and you're left without knowing how best to help Yoshi - presumptively, symptomatically, or specifically. There's quite an arsenal for treating the liver and disorders that affect the liver and a treatment for one might be harmful for another. I'm going to encourage that you continue on to determine why those bile acids are so high. That will entail ultrasound of Yoshi's abdomen +/- ultrasound needle biopsy of his liver. Tell Yoshi that he needs to get a job.

Please respond with further questions or concerns if you wish.

Customer: replied 21 days ago.
urate stones. And if I proceede with the further work up of the liver is this a very expensive venture? Also is the outcome likely medical or surgical management?
Expert:  Dr. Michael Salkin replied 21 days ago.

I can't know what you'd be charged but a ballpark figure is less than $1500. Always ask for a written estimate before anything is done. A medical therapy is most likely. Surgery is reserved for shunts and I'd be surprised if Yoshi had a shunt just now becoming a problem at 9 years of age. Please continue our conversation if you wish.

Customer: replied 21 days ago.
Thanks. I was doing a little reading and some article suggests vitamin E, Sam e, milk thistle, and ursodiol as something's that may help ? Do you have any thoughts on that or other supplements?
Expert:  Dr. Michael Salkin replied 21 days ago.

Those supplements are antioxidants and may be of value. The best I can say is that they won't be harmful. Ursodiol is used to address biliary stasis/sludging. It's best to reserve its use when confirmation of stasis/sludging is made. It's potentially dangerous to give in association with complications associated with gallstones (biliary obstruction, biliary fistulas, cholecysititis, pancreatitis, and cholangitis). I'm not aware of any other supplements of potential value for nonspecific hepatopathy.

Customer: replied 21 days ago.
Lastly would you recommend hills u/d or l/d for dietary management?
Expert:  Dr. Michael Salkin replied 21 days ago.

u/d to help prevent recurrence of stones and help avoid hepatoencephalopathy (a poorly functioning liver intoxicating the brain)