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My dog ginger was diagnosed with chronic renal failure severalmonths ago. since then it has been  a winding road or like a roller coaster ride with ups and downs. Initialy I had her on traditional medications such a compazine and megace because her appetite was so poor but eventually changed to remeron with a little progress. Since then I have also incorperated homeopathic medications also. Recently she has been displaying bizzarre behavior trying to eat bark and grass but still wont eat her regular food no matter what I cook for her although her appetite has improved some and i am not sure if it is the remeron or the homeopathic medications or both two nights ago she had two seizures and i thought i would have to have her put to sleep butthe vet did not feel it was time yet and she ate two meals that day and seemed better. anyone who is going through this or has gone through this  with their dogs please share any information you can with me. she is going to have labs today with her lasrt ones last month being elevated but not outrageusly to where she should  not be exhibiting symptoms of lack of appetite. hhas anyone notice this kind of behavior in their dog with  the eating of inappropriate objects.  thank you for your support

[Arnold L Goldman, D.V.M.]

Dear Robino54,

Your post includes several elements about which I would like to comment.

Pica, eating nonfood items, is  a common complaint in dogs and occurs for  a variety ofr reasons, and also at times for no discernable reason. Do your best to prevent it.
That said it is not uncommon for kidne disease patients to be inappetant. Treating the causes when possible will be more effective than simply trying to stimulate appetite.
See further detail below.

The reported diagnosis of "polynephritis" as diagnosed by ultrasound is confusing, as that term is not in common use. Perhaps, you mean "pyelonephritis" which is  a kidney infection. If so, ultrasound is supportive of such a diagnosis, but would require a culture of cystocentesis derived (by needle and syringe) urine to prove. In such a case antibiotic medication would be indicated. You did not report their use.

Both mirtazepine and megesterol acetate (Remeron and Megace) are used in such cases as appetite stimulants. You reported using no other medications or treatments.
For example hypertension (high blood pressure) may be a cause or an effect of kidney disease. That should be assessed and medicated as required. Some renal disease patients feel nauseous due to stomach irritation or ulceration. Often a coating agent, sucralfate, is used along with antacids such as famotidine (Pepcid) ranitidine (Zantac) and others to address this. There are also other treatable issues that arise with chronic kidney disease which you should be made aware of by your doctor.

You should choose one general practice veterinarian you trust to supervise and oversee the care of your dog. Your use of what you describe as "traditional" medicine and also "homeopathic" medicine has made me wonder if you are using  two doctors. The use of two poses the problem of conflicting advice and incompatible treatments, unless a single doctor is prescribing both types of care. In the latter case, ask ore questions about the treatment goals and prognosis.

Finally, there is only one type of medicine: that which works and that which doesn't. Intelligent people can argue forever about the effectiveness of various treatment modalities and the strength of the proof that they do or don't. There is no benefit, however, in artificially categorizing various treatment approaches under names like "traditional", "western", "eastern", "holisitic", "homeopathic", "herbal" and the like. There is just medicine that works and that which doesn't. If something is trendy, be suspicious. Diseases seek treatments. Treatments should never seek diseases.

Choose your providers carefully, and never hesitate in getting a second opinion. When possible, seek such second opinions from recognized specialists, those who are board certified, such as in internal medicine for example. That way, your dog will receive the best care possible.

Good luck with your dog and her illness.

Sincerely,

Dr. Arnie Goldman

[Aleda M Cheng, D.V.M., C.V.A]

It sounds as if your vet is providing Ginger with great care.  Trying to control chronic renal failure is quite a challenge and requires a great deal of nursing and ongoing diagnostics since it is a dynamic process, i.e.: progressively changing, thus the roller coaster effect.  

When kidneys don’t operate normally nitrogenous waste products in the urine are not completely filtered out.  When these toxins cross the blood brain barrier the result in the aberrant behavior that you have described and even seizures.  However, the aberrant behavior and seizures could be caused by something totally unrelated to kidney disease, such as a brain lesion.  Unfortunately, the most common cause of  seizures in an older dog is a lesion in the brain.  

Chronic renal failure is irreversible, but can be managed by dietary management, medical therapy, and holistic therapies (homeopathy, acupuncture, Chinese and Western herbal medicines).  In your dog’s case, all of the components must be medically supervised.

The key to medical management is IV and Sub cutaneous fluid therapy (can be performed at home), this is the canine equivalent of human dialysis.  Vitamin and mineral supplementation is necessary depending on blood parameters, for example,  if phosphate is high phosphate binders are necessary; if calcium is low, calcium supplementation with or without calcitriol is necessary;  if anemic erythropoietin administration may be necessary; if hypertensive, than antihypertensive therapy should be instituted.  Antibiotics are necessary for any secondary urinary tract infections.

Gastrointestinal therapies often include Pepcid to calm stomach acid,  and Reglan or other anti-nausea medication, probiotics, glucosamine, Omega 3 fatty acids, and B-Complex vitamins.

Acupuncture and Chinese and Western herbal medications can be very valuable but must be given by a veterinary acupuncturist.  There are board certified veterinary acupuncturists in the Holmdel, NJ area.  Just make sure that they practice herbal medicine.  Some only practice acupuncture.

[Aleda M Cheng, D.V.M., C.V.A]

Hello again,  

Please try taking your pet to a veterinary acupuncturist and herbalist who is also qualified in regular veterinary medicine.  The proper practitioner may be able to coordinate all of the problems your pet is experiencing.  

The Chi Institute (www.tcvm.com) and the American Holistic Veterinary Medical Association has lists of veterinarian's in your area.