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Posted by Carroll H. Weiss (more from Carroll H. Weiss) on Thu, 2 Mar 2000 14:02:25


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Here's a lengthy email I send out to owners of Dalmatian stone-formers. Please note vet centers cited, plus info on new vet textbook, distilled water...subjects not breed-specific but of help to the owner of any stone-forming dog.
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There is no reason with all the vet knowledge accumulated to date about urinary stone-forming why a Dalmatian with confirmed urinary crystals/stones cannot live a full and essentially symptom-free life! I am appending a great deal of state-of-the-art information about the problem. There is no short cut to learning and you must slowly and methodically read and reread (including the series of articles on the Internet) until you understand both "the forest and the trees." At that point, you'll hopefully understand two critically important phases:

1. How to TREAT any signs of your Dal's worsening condition, and
2. How to PREVENT that from happening by regularly monitoring his urine yourself (dipsticking), feeding the correct food, providing bottled distilled water and perhaps anti-stone drugs.

If possible you should print out a set of these articles for your vet and urge him/her to consult with one of the three world authorities on canine stone-forming cited below. Given the number of breeds, species of animals and exotics they must learn in vet schools, most general practice vets cannot possibly have more than a superficial understanding of urinary stone-forming but advanced and current knowledge is available to them by the consults with the specialists. I especially urge all vets to purchase the new Jan. 1999 textbook cited below if they have not already.

My own male, Dazzle, had three bladder surgeries removing obstructing stones before he was two years of age. I went on a crash program to learn. This January at the age of twelve years, Dazzle has not had a single problem for the past ten years following the preventative program!

Carroll H. Weiss, Director
Study Group on Urinary Stones
Health & Research Committee
Dalmatian Club of America

carroll@suntech.net
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ABNORMAL URINARY STONE-FORMING IN DALMATIANS

With the current progress of veterinary knowledge, there is no reason why most stone-forming Dalmatians cannot live out their lives today happily and uneventfully so long as knowledgeably preventative methods are conscientiously maintained by their owners. These include (1) a preventative diet, (2) intake of bottled water from the supermarket labeled "distilled," and (3) for some stone-formers, an effective anti-stone medication called "allopurinol."

This lengthy email and the many articles cited or included will certainly brief you on Dalmatian urinary stone-forming. Please do not hesitate to email any additional questions you may have after slowly but thoroughly reading all the material which will answer most questions. Additionally, I urge all owners of confirmed stone-formers to order the 60 pg. information package ("Primer"). It not only will make you as knowledgeable as your vet but it has also been organized to be a refresher compendium for general practice vets confronted with stone-forming Dalmatians, so you can lend your copy or even duplicate it for him/her.

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IMMEDIATE PROCEDURES UPON RECEIVING THIS EMAIL

Firstly, Dalmatians with confirmed diagnoses of urinary stone-forming should receive only bottled water from the supermarket labeled "distilled." Not "purified," not "drinking" but only "distilled." This is the only water, including for cooking for them, that should be used. The rationale is in an appended article. Shift the dog to that as soon as you receive this email.

Secondly, access the series of teaching articles on this subject on the Net. Print them out and give a copy to your vet. Most general practice vets have learned about this breed-specific problem only superficially at vet school yet understandably what with the other breeds and species of animals they must also learn about. But the articles will provide updated status of treating and preventing Dalmatian stone-forming. All vets should also consult with one of the three world authorities in canine stone-forming (details appended).

You will learn from the articles that Dalmatians can form different types of abnormal urinary crystals/stones (crystals "grow up" to become stones). The type of crystal/stone is essential to be accurately identified because their treatment can be the exact opposite. There also is an 85 percent error in identification by local provincial testing labs. Therefore, it is recommended that a routine and inexpensive urinalysis be done on a fasting urine specimen (obtained first thing AM before feeding and after urine has sat in the bladder overnight). If sediment spins out during "centrifuging," that, not the liquid, should be sent to one of the centers for correct identification (Minnesota Stone Center does not charge for this, and your vet should perhaps call or fax them for their submission form to accompany the specimen). Once the correct identification comes back, you can embark on treatment and prevention assured by the assay the methods are correct.

Most Dalmatians form one type of "urates" but this still should be confirmed instead of being presumed. Once confirmed, most vets will prescribe the anti-urate drug "allopurinol," and the prescription anti-urate diet, Hill's u/d. Cautions about both are appended but please do not become alarmed...these side effects have occurred in a very few dogs and are appended for you to print out and give to your vet.

Preventatively, owners of stone-forming Dalmatians should learn to monitor the dog's urinary pH by dipsticking (described in one of the articles). A definite trend over weeks to abnormal urinary acidity or alkalinity is an early sign to consult with the vet. Known stone-formers should also have a routine urinalysis periodically to monitor if abnormal crystals are forming and, if so, the sediment sent to Minnesota to confirm they are the same type as originally assayed. The best dipsticks (available from the vet or a local "medical supply company") are unfortunately also the most expensive. Their brandnames are "Chemstrips" or "Medistrips;" specify you want to use them primarily to test the pH of urine.

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URINARY STONE-FORMING INFORMATION ON THE INTERNET

The following are a series of articles available on the newly-revised homepage of the Dalmatian Club of America (DCA). The series include the latest article, a 15-year retrospective survey of almost 3,000 Dalmatian urinary stones.

The web pages permit downloading and printout in a choice of formats for filing or sharing with the veterinarians treating the stone-forming Dalmatian:

URINARY STONE-FORMING IN DALMATIANS & OTHER DOGS:
http://www.thedca.org/dal_book.html

URINARY STONES: EMERGENCY PROCEDURES FOR OBSTRUCTED DALS:
http://www.thedca.org/emergency.html

URINARY STONES: GENERAL PREVENTATIVE PROCEDURES:
http://www.thedca.org/genlprev.html

URINARY STONES: 1992 SEMINAR BY DR. JOSEPH BARTGES:
http://www.thedca.org/seminar.html

URINARY STONES: DIPSTICKING TO MONITOR STONE-FORMERS:
http://www.thedca.org/dipstick.html

URINARY STONES: TABULATION OF PURINE-YIELDING FOODS:
http://www.thedca.org/purines.html

THE FALLACY OF "LOW PROTEIN" VS. "HIGH PROTEIN" IN DAL DIETS:
http://www.thedca.org/fallacy.html

FIFTEEN YEARS OF DATA ON ALMOST 3,000 DALMATIAN STONES:
http://www.thedca.org/stonecharts.html

OTHER HEALTH PROBLEMS FOR DALMATIAN OWNERS & BREEDERS:
http://www.thedca.org

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VET SPECIALISTS FOR CONSULTATION ON DALMATIAN STONE-FORMING

Today, owners of stone-forming Dalmatians are fortunate that there are three world-renown specialists in canine stone-forming. They have pioneered in both state-of-the-art treatment of the stone-forming dog and also in maintenance regimens to prevent future recurrences. Any vet treating a stone-forming Dalmatian should consult with one of these experts because most veterinary schools cannot possibly include everything in their curriculums for the students on this health problem. Only limited knowledge on breed-specific problems like Dalmatian stone-forming is taught and, accordingly, these specialists are available for immediate consultation by general practice veterinarians to assure the treatment and maintenance of their Dalmatian patients is the best possible and reflect current expert knowledge.

Important! If abnormal urinary stones are obtained either by surgery or abnormal crystals spin out during a urinalysis' centrifuging from your Dalmatian, they should be sent to one of the two vet school departments for assay (Minnesota does not charge). There is a reported error as high as 85% by provincial identification labs! Because proper treatment is directly related to what kind of stone/crystals the dog is forming, this identification is very important and its accuracy essential for the success of preventative measures. I do not believe there is any restriction for specimens from other than U.S. Dalmatians to be sent through.

Minnesota Urolith Center

Carl A. Osborne, DVM, Phd, Chief

Dept. of Small Animal Clinical Sciences
U. of Minnesota Veterinary School
C-339 Veterinary Hospitals
1352 Boyd Avenue.
St. Paul MN 55108

Telephone (612) 625-4221
Fax (612) 624-0751
Email: osbor002@maroon.tc.umn.edu

Dr. Osborne is difficult to reach.
Contact his chief resident:
Telephone (612) 625-1719
FAX (612) 624-0751

Urology Laboratory for assay results:
Telephone (area 612) 625-1919
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Gerald V. Ling, DVM, Chief

Urinary Stone Analysis Laboratory
U. California Center at Davis
Dept of Medicine
School of Veterinary Medicine
U. of California at Davis
Davis CA 95616

Telephone (916) 752-3558
Fax (916) 752-0414
Email: gvling@ucdavis.edu
============
Joseph Bartges, DVM, Ph.D

Dept. of Small Animal Clinical Sciences
College of Veterinary Medicine
University of Tennessee
P.O. Box 1071
Knoxville TN 37901-1071

Telephone: (423) 974-8387
Fax: (423) 974-5554
e Mail: JBARTGES @UTK.EDU

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MINIMIZE OR AVOID PURINE-YIELDING FOODS

FOODS HIGHEST IN PURINES
anchovies
brains
kidney, beef
game meats (venison, etc.)
gravies
herring (including roe)
liver (calf or beef)
mackerel
meat extracts
mussels
sardines
scallops
yeast

FOODS MODERATELY HIGH IN PURINES
asparagus
bacon
breads & cereals, whole grain
cauliflower
eel
fish (fresh & saltwater)
legumes (kidney, navy & lima beans, lentils, peas)
meat (beef, lamb, pork, veal)
meat soups & broths
mushrooms
oatmeal
peas, green
pork (including ham)
poultry (chicken, duck, turkey)
shellfish (crab, lobster, oysters)
spinach
tongue
tripe
wheat germ & bran

FOODS LOWEST IN PURINES
beverages (coffee, tea, sodas, cocoa)
butter
bread & cereal (except whole grain)
cheese
eggs
fats
fish roe (including caviar)
fruits & fruit juices (avoid citrus to minimize abnormally acidic urinary pH)
gelatin
milk (including butter, condensed, malted)
nuts (including peanut butter)
pasta (evaluate sauce ingredients separately)
sugars, syrups, sweets
vegetables (except those above)
vegetable & cream soups (made with acceptable vegetables. but not with beef stock)

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FOOD & VITAMIN SUPPLEMENTS FOR STONE-FORMING DALMATIANS ON VERY LOW PROTEIN ANTI-URATE DIETS

Firstly, be sure that your Dal is NOT allergic to eggs. If he is not, add one hardboiled egg to his AM meal of the anti-stone food formulation and 1/2 to his PM meal. Purchase Canola oil from the supermarket and spoon one (1) Tablespoon over the u/d food in his bowl, each meal. As you peel the hardboiled eggs (I boil up a dozen at a time), save the shells in a refrigerated container until you have enough to pulverize into a fine powder in a coffee grinder. Save the powder in a refrigerated baggie and sprinkle 1/4 teaspoonful over each of his daily meals.

In addition to the distilled water, he should also get daily vitamins but NOT the ones made for dogs all of which are in a base of desiccated liver, the worst food a urate stone-former can receive. Instead, get standard human children's vitamins at K-Mart, Wal-Mart or wherever. Pro-rate your Dal's weight to that of a child from the labeling and then figure out the correct number of vitamin pills he should get. Give them once daily AFTER his AM meal. My male, for example, weighs 75 lbs. and my female 40 lbs., so I translated each of those to what ages a human child would weigh in, and then read the labeling for how many vitamin pills that meant.

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DISTILLED WATER FOR DALMATIAN STONE-FORMERS

Overly simplified, urate stone-forming in Dalmatians can be regarded as a metabolic defect in the normal solubility of certain chemicals so that they become insoluble in urine and thereby abnormally crystallize out as undesirable urinary crystals or stones. Urine is the single, largest liquid waste of the body. With that said, it is possible that the corresponding single, largest source of liquid intake - namely, water - may possibly be one of several factors of stone-forming if that water is significantly impure and contributes to the insolubility of stone-forming chemicals in urine. For example, water containing abnormal lead tends to be acidic, a urinary environment in which formation of Dalmatian urate crystals and stones thrives.

A July 1997 issue of Consumer Reports, known for excellence in scientific articles, reported some aspects of U.S. tap water quality. The article noted, "...people who get their water from a private well or from one of the thousands of small water systems that serve only a few thousand customers can't be...certain about the quality of what they're drinking. And even water from large systems may be contaminated by pipes in [their] neighborhood or [their] own home or may be subject to breakdowns at the treatment plant." The article quoted the 1997 head of the U.S. Environmental Protection Agency as stating "Unfortunately, at this time we cannot take for granted the safety of our drinking water."

Many contaminants were reported for tap water such as lead, rust, dissolved iron, calcium, sulfur sediment, chlorine, organic and industrial chemicals and some pathogens such as certain species of coliform bacteria. Many faucet filter systems do not remove some of these chemicals and bacteria and may filter only for taste and smell.

Preventatively then, purified bottled water from supermarkets labeled "distilled" may possibly be beneficial for Dalmatians in an overall program of anti-stone diet, drugs and liquid intake. It should be noted, however, there are no published scientific studies in veterinary or human medical journals proving or disproving the use of distilled water for confirmed urinary stone-formers.

An archaic caution with distilled water was that it may "leech" some minerals from the body. Consumer Reports also stated that "Distilled water...isn't bad for you. Distillation removes nearly all particulates as well as dissolved substances including trace quantities of minerals but your body won't miss them..."

Bottled "distilled" water should not be confused with labeling of "purified" or "drinking" water. For the stone-former benefiting from distilled water, it is important that it also be used for all cooking or moistening of dry foods.

Owners of stone-forming Dalmatians who wish to test their own water supply can obtain information from the U.S. EPA Safe Drinking Water Hotline, telephone (800) 426-4791. Testing can cost from under $20.00 to well over $100.00 depending on the testing laboratory and the number of water contaminants requested to be tested.

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CAUTION SUGGESTED FOR STONE-FORMING DALMATIANS ON LONG-TERM, VERY LOW-PROTEIN DIETS

[Urge your vets to read: "Idiopathic Dilated Cardiomyopathy in Dalmatians: Nine Cases (1990-1995)" by Lisa M. Freeman, DVM, PhD, and coauthors in Journal of the American Veterinary Medicine Association, volume 209, pp. 1592-1596 (Nov. 1) 1996.]

Extremely isolated reports of a certain type of heart problem in a few Dalmatians are being reported nationally. The condition is called "cardiomyopathy" or "cardiac myopathy." It is being seen in Dalmatians who have been fed very low-protein diets for long periods of time because they were urinary stone-formers.

Immediate research to explore the relationship of diet to the heart problem was started by veterinary academic centers including those which specialize in canine stone-forming. Preliminary findings suggest that a dietary deficiency of one or both of two amino acids may perhaps be factors in the strange onset of the heart symptoms. They are "taurine" and "carnitine." Taurine deficiency has been known by veterinarians to be associated with cardiomyopathy in cats but rarely if ever in dogs. Because of the small number of reports, it cannot be positively or even probably concluded at this time that diet, alone, is responsible. Other coincidental factors have yet to be finally evaluated such as for example, heart problems in the breedline.

Stone-forming Dalmatians being successfully maintained symptom-free on home-cooked low-protein diets or on prescription anti-urate food formulations should not be shifted from their food regimens. (As of April 1995, Hills Prescription Foods added taurine to both dry and canned versions of their u/d(r) formulation.) For stone-formers on any anti-urate, low-protein food formulation including home-cooked ones, daily supplementation with a high-protein but low purine-yielding food such as hard boiled eggs may be considered unless the dog is allergic to them.

PLEASE CONSULT WITH YOUR VETERINARIAN IF YOUR STONE-FORMING DALMATIAN STARTS TO COUGH UNCHARACTERISTICALLY OR TO SHOW OTHER SUSPICIOUS SYMPTOMS OF POSSIBLE HEART PROBLEMS.

The owner of one of the first Dalmatians reported with cardiac myopathy has graciously given her permission to be contacted by anyone wishing to learn of the successful treatment of her afflicted male, Levi, who is being maintained as a frisky "normal" Dalmatian: Mrs. Victoria (Vicki) Emmel, Delta PA, tel. (717) 456-7358.

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CAUTIONS ABOUT ALLOPURINOL DOSAGE FOR URATE STONE-FORMING DOGS

Abstractor's note: When treating a stone-forming Dal with allopurinol, some vets are very aggressive in the total daily amount of dosage regimen, others more conservative. Some vets specializing in canine stone-forming suggest aggressively high dosages for a short period of time are required to *dissolve* existing urate stones, as compared to the aforementioned maintenance dosage of 300 mg. daily for prevention only. The following 1991 report, albeit on only 9 Dalmatians suggests THE HIGHER AND MORE EXCESSIVE THE DOSAGE OF ALLOPURINOL, THE GREATER THE RISK OF DRUG-INDUCED FORMATION OF XANTHINE STONES. However, specific dosage is a vet's decision so that a stone-forming Dalmatian is not denied the proven anti-urate effectiveness of the drug.

"XANTHINE-CONTAINING URINARY CALCULI IN DOGS GIVEN ALLOPURINOL"

by GERALD V. LING, DVM and others.
Journal of the American Veterinary Medicine Association
Volume 198, Pages 1935-1940 (June) 1991

Ten male dogs of which 9 were Dalmatians and 1 an Australian Shepherd all were treated with allopurinol because they had formed stones confirmed to be urates. After either surgical removal of the urate stones or passing them while urinating, the 10 dogs again developed subsequent stones all of which now contained xanthine as a result of their allopurinol dosage.

Total daily dosage of allopurinol for the Dalmatians had ranged from 450 mg. up to 2,400 mg. One Dal had received 450 mg. daily, 6 Dals had received 600 mg. daily, 1 Dal 900 mg. and 1 Dal had gone over the course of three years from 900 mg. to 2,400 mg. daily before the drug-induced stones were removed by two episodes of surgery. The Australian Shepherd had received 1,500 mg. of allopurinol daily.

Before the xanthine stones were removed, 6 of the Dalmatians were known to have been maintained on K/D prescription food and of those, 1 Dal had the K/D also supplemented with rice.

Duration of the allopurinol treatment in the 10 dogs ranged from five months to six years. Following prior removal of their urate stones, onset after surgery of the symptoms of the xanthine stones ranged from as soon as five weeks in a three year old Dal receiving 600 mg. allopurinol daily, to as long as four years in a nine year old Dal receiving 450 mg. allopurinol daily. The Dal receiving the enormous dosages was 6 years old and, over three years after urate stones had been removed surgically, had his allopurinol increased from 900 mg. daily to 2,400 mg. daily because his stone-forming "had worsened;" two final surgeries, eight months apart, confirmed the stones removed to be xanthine in content.

To retain the therapeutic benefit of allopurinol treatment for urate stone-forming Dals, the authors urge a special 24 hour collection of the dog's urine be done with accurate measurement of the volume of urine produced during that time. THIS IS THE ONLY ACCURATE METHOD BY WHICH EACH DAL'S DAILY EXCRETION OF URIC ACID CAN BE DETERMINED. If the uric acid amount is greater than 300 mg. daily, the dosage of allopurinol must be increased to prevent urate stone-forming. If the uric acid amount is less than 300 mg. daily, allopurinol dosage must be decreased to prevent xanthine stone-forming.

Specialized methods are required to differentiate if urinary crystals or stones are urate or xanthine. Both minerals look almost identical under the polarizing microscope. Both stones look similar under gross examination. Even the usual specialized testings by a urinary stone laboratory will not help in differentiating between the two minerals. The authors recommend "high pressure liquid chromatography" to distinguish between urates and xanthine because this test is "quantitative, sensitive and accurate" and, unlike other assays, can be done on a smaller amount of testing material.

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SURGERY FOR AN OBSTRUCTED MALE DALMATIAN - WHAT IS A "URETHROSTOMY"

If surgery is unavoidable, most obstructed Dalmatians can have simple surgery whereby the bladder or the urethra (tube from bladder to outside) is excised, the offending stone(s) removed and the incision closed up. But please note drastic surgery called a "urethrostomy," generally reserved as a last resort, can be also suggested. Firstly, do not confuse your vet saying "urethrostomy" (with an "s") as compared to a "urethrotomy" (no "s"). A urethrostomy is NOT the usual bladder surgery whereby the dog's urinary bladder and/or urethra is surgically opened and stones removed from them.

"Urethrostomy" (with an "s") is an artificial opening surgically created before the "os penis" anatomical area within the penis where most male stone-forming Dals obstruct. It generally is done as *A LAST RESORT* and must be carefully evaluated because:

(1) it is a very delicate operation and the surgeon should be experienced and knowledgeable in the surgical procedure;

(2) it is a very bloody operation and, postoperatively, the dog heals very slowly;

(3) it is generally done at the base of the scrotal sacs and - even there - if a large enough stone subsequently forms, that size stone can obstruct BEFORE it reaches the urethrostomy. Therefore a urethrostomy by no means is a panacea nor removes the daily caution of observing the male dog to monitor if they are urinating normally or have obstructed. It is important that the decision for a urethrostomy should be finalized after a consultation with one of the three stone-forming veterinary specialists in the U.S..

(4) once performed, the Dal may be prone to more-frequent-than-normal urinary infections.

(5) a urethrostomy does not affect the underlying stone-forming of the dog. It merely (if successful and well done) minimizes or prevents urinary obstruction by stones continuing to be formed and expelled.

Wherever possible, an unavoidable urethrostomy should be performed by a "Board-Certified" veterinary surgeon and one who is experienced in this surgical procedure. We also suggest that the general anesthetic be "ISOFLURANE" which has demonstrated significantly fewer anesthetic deaths than its predecessor anesthetics.

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A brand new, state-of-the-art textbook has been issued on canine urolithiasis. It is WONDERFUL! The series of articles are based on 77,000 canine stones and cover diagnosis, treatment, drugs, diagnostic methods of x-rays, 25 years experience of uropropulsion, etc. (This volume is a follow-up to their two-volume 1986 textbooks...)

Details are as follows:

THE VETERINARY CLINICS OF NORTH AMERICA
January 1999 Volume

"The ROCKet Science of Canine Urolithiasis"

In U.S., order by calling toll free:

1-800-654-2452.

P.S. The chapter on urate urolithiasis is written by one of the three co-editors, Joseph Bartges DVM, PhD, who gave the 1992 DCA annual Education Seminar - and who mentions the DCA website and the series of teaching articles there in his published chapter! Note that one of the other co-editors, Jody Lulich, DVM, PhD, is a specialist in calcium oxalate urolithiasis should any of your feline/canine patients have those minerals.

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BULLETIN FOR DCA REGIONAL CLUBS
From: Study Group on Urinary Stones
Health & Research Committee, Dalmatian Club of America

For more information, contact:

Carroll H. Weiss, Director
8290 N.W. 26th Place
Sunrise, FL 33322-2951
carroll@suntech.net For Immediate Release

NEW CANINE STONE-FORMING TEXTBOOK CAUTIONS AGAINST USE OF BICARBONATE-OF-SODA

For decades, sodium bicarbonate has been known and used by Dalmatian fanciers when their dogs have been confirmed with abnormal urate urinary crystals/stones. It now appears that sodium bicarbonate may worsen and complicate the dog's urate stone-forming. According to the Dalmatian chapter in the latest and most definitive teaching textbook for veterinarians on canine stone-forming:

"Because sodium may combine with uric acid to form sodium urate, potassium citrate may be preferable to sodium bicarbonate as a urine alkalinizing agent."

Unfortunately all Dalmatians are born with the potential urinary problem for urates. Why some Dalmatians become overt stone-formers while others including littermates do not, is unknown. Sodium urate is only one type of urate but all urates are characterized as thriving in an abnormally acidic urine. Therefore, one component of treatment and prevention is to reverse that abnormal acidity by attempting to neutralize it with alkalinizing chemicals such as potassium citrate. This should be started only by consulting with your veterinarian.

The DCA Study Group is very impressed with the vast spectrum of state-of-the-art knowledge in the new textbook for treatment and prevention of canine stone-forming, encompassing years of experience with data on over 75,000 canine stones! We urge all owners of afflicted dogs to question if their vet's reference library has acquired it.

Ordering details are as follows:

THE VETERINARY CLINICS OF NORTH AMERICA
January 1999 Volume: "The ROCKet Science of Canine Urolithiasis"

In U.S., order by calling toll free: 1-800-654-2452
In Canada, order by calling toll free: 1-800-387-7278

(End, September 1999 bulletin)
--------------

A brochure summarizing information on Dalmatian stone-forming (including preventative and emergency procedures) is available free-of-charge, effective Oct. 1st, 1996 so long as a stamped, self-addressed #10 envelope is sent.

The second edition of "A Primer on Urinary Stones for Dalmatian Breeders & Fanciers," an elaborate 60 page information package on the subject of urinary stone-forming in Dalmatians also is available for a charge. New to the second edition are: (1) a wallchart for Dalmatians' veterinarians showing microscopic appearance of abnormal urinary crystals, (2) updated 15 year statistics on almost 3,000 Dalmatian stones, and (3) a section discussing home-cooked anti-stone food formulations.

Out-of-pocket reimbursement, including postage, is:
Non-DCA members @ U.S. $10.00 - DCA members @ U.S. $7.50.

Please make checks payable to: Carroll H. Weiss

Mail to:

Carroll H. Weiss, Director
Study Group on Urinary Stones
DCA Health & Research Committee
8290 N.W. 26th Place
Sunrise FL 33322-2951

Email - carroll@suntech.net