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17 year old recently diagnosed with kidney disease/failure
My 17 year old best friend has been diagnosed with kidney disease. I brought her in on Monday because She had not eaten in 5ish days. She stayed in the hospital for 3 nights after blood work showed indicators of kidney failure. I was not given a copy of the results, however, from what I can recall, her BUN was around 60 (that number sticks out) and her creatinine was 6.5 I believe. She stayed on fluids for 3 days. She did finally start to eat again on day 2 when I brought chicken and rice. Now, day 4, she is much more lively and willing to eat, just not dog food yet. The vet sent her home today to see how she handles being off of the fluids, however, she isn't hopeful. She believes she will rapidly decline. Ive been researching and reading since the diagnosis, but her Vet doesnt seem too interested in trying to help me figure out a home care routine. I spoke with another vet today at their office who was much more helpful and is willing to help set us up with subcutaneous fluid administration at home if need be as well as sent us home with KD food. I guess I don't really know what I'm asking here, maybe just looking for some support? I'm trying to deal with this as best as I can but it's hard. Ive had this girl since I was 7. Shes my best friend. I'm dealing with a lot of guilt and blame. Any advice on making my girl more comfortable at home? As selfish as it is, I need to prolong her life. I'm not ready to let go of her yet. She is currently sleeping next to me in my bed, where she has slept most every night for 17 years.
Hello. Welcome to our User Group, though I'm sorry you feel a need to be here. First things first, what's your dog's name? It makes it easier to respond with support and/or suggestions.
Please ask your vet for copies of all the tests you have had done. You own these reports. You paid for them - and you need them. Once you have them, please let me know the results for phosphorous, calcium, sodium, amylase, potassium, WBC, RBC. If there are any particular blood results that are marked abnormally high or low, please let me have them in addition to those above. If you have a urinalysis report, please give me the results of that too.
The IV fluids were the right thing to do - but they must be followed up with SubQs, which you can continue giving at home (probably for at least a month). Daily doses are the best. Once your vet gives you the dose he is recommending, let me know the weight of your dog and the type of fluids he gives you - and the dose he prescribes.
There's lots you can do to help prolong life and improve quality of life, though it's never a predictable journey. Did your vet check blood pressure - if not, it needs doing. 90%+ of dogs with kidney failure also have high blood pressure, and that can increase the deterioration rate of kidney failure. Treatment is a must in such circumstances. Again, let me know the result and I will suggest the best medication.
Finally, please have a read of my article (link below) which will help get you off the ground running with ways to manage the disease from here onwards.
http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure
Tony
Please ask your vet for copies of all the tests you have had done. You own these reports. You paid for them - and you need them. Once you have them, please let me know the results for phosphorous, calcium, sodium, amylase, potassium, WBC, RBC. If there are any particular blood results that are marked abnormally high or low, please let me have them in addition to those above. If you have a urinalysis report, please give me the results of that too.
The IV fluids were the right thing to do - but they must be followed up with SubQs, which you can continue giving at home (probably for at least a month). Daily doses are the best. Once your vet gives you the dose he is recommending, let me know the weight of your dog and the type of fluids he gives you - and the dose he prescribes.
There's lots you can do to help prolong life and improve quality of life, though it's never a predictable journey. Did your vet check blood pressure - if not, it needs doing. 90%+ of dogs with kidney failure also have high blood pressure, and that can increase the deterioration rate of kidney failure. Treatment is a must in such circumstances. Again, let me know the result and I will suggest the best medication.
Finally, please have a read of my article (link below) which will help get you off the ground running with ways to manage the disease from here onwards.
http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure
Tony
7 Comments
Thank you for your response. Her name is Boots. I will call her vet in the morning and see if they can email me a copy of her results, or see if I can go pick them up. As far as the SubQ goes, her vet will set us up with one when we go back for a recheck on Thursday if she needs it. Right now she is on Aluminum Hydroxide Gel, 1.5mL twice a day, Benazepril 1/4 tablet (5mg) once a day, Tramadol 1/4 tablet (50mg) twice daily for pain, and Carprofen caplets 1/2 tablet (25mg) twice a day.
She weighs 11 pounds.
Any advice on getting her to eat? At this point the vet is only concerned with getting her to eat something rather than what it is. But she is just not interested. All she ate today was 2 ham sandwiches, (2 pieces of bread and 3 pieces of ham total). She would not touch her chicken and rice or any dog food I offered. She is also not drinking. Not like she was, anyway. She used to guzzle down a bowl of water every couple of hours. Today she went to the bowl 3 times. She also urinated around 5 times today. I don't know how to help her. I feel so helpless.
She weighs 11 pounds.
Any advice on getting her to eat? At this point the vet is only concerned with getting her to eat something rather than what it is. But she is just not interested. All she ate today was 2 ham sandwiches, (2 pieces of bread and 3 pieces of ham total). She would not touch her chicken and rice or any dog food I offered. She is also not drinking. Not like she was, anyway. She used to guzzle down a bowl of water every couple of hours. Today she went to the bowl 3 times. She also urinated around 5 times today. I don't know how to help her. I feel so helpless.
Hi. Ok. The aluminium hydroxide is, in my opinion, the best phosphate binder there is. It is vital you continue to restrict phosphorous as much as possible in the diet (so get to know what foods have the most phosphorous and avoid them). As you have not been able yet to give me the phosphorous blood reading, I can't advise on whether you are giving the right dose or not - but we can revisit that one once you get the copies. In the meantime, make sure you give the binder with every meal, as it only works on food being eaten.
Benazepril is a good medication for canine kidney disease. It is ordinarily given to dogs with high blood pressure (did they do the check?), but it's also useful regardless, as it helps improve blood flow through the kidneys. However, if Boots does not have high blood pressure, extreme care is needed, because this drug can cause low blood pressure. Your vet needs to take blood pressure readings at least every 2 weeks for some time while it is being given, to assess what effects it is having.
I am concerned about the Tramadol. This drug causes kidney disease to deteriorate (increasing stress on the organs and a greater volume of toxins to circulate in the blood stream). What pain is Boots in - and from what? If it is another illness, then there may be a better pain killer for it.
Carprofen is another dangerous drug for dogs with kidney disease. Cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity. This drug needs re-assessment by your vet and changing to something more appropriate, if its effects remain necessary..
I'll give you a link to another two articles of mine on diet ... please read both of them. They will help you appreciate just how crucial diet changes are. There are tricks to getting Boots to eat. One is to ask your vet for a good anti-nausea medication such as Mirtazipine, together with Cerenia. There are other options too, such as adding a teaspoon drizzle of organic natural honey or unflavored and unsweetened yogurt to the top of her meal.
http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease
Tony
Benazepril is a good medication for canine kidney disease. It is ordinarily given to dogs with high blood pressure (did they do the check?), but it's also useful regardless, as it helps improve blood flow through the kidneys. However, if Boots does not have high blood pressure, extreme care is needed, because this drug can cause low blood pressure. Your vet needs to take blood pressure readings at least every 2 weeks for some time while it is being given, to assess what effects it is having.
I am concerned about the Tramadol. This drug causes kidney disease to deteriorate (increasing stress on the organs and a greater volume of toxins to circulate in the blood stream). What pain is Boots in - and from what? If it is another illness, then there may be a better pain killer for it.
Carprofen is another dangerous drug for dogs with kidney disease. Cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity. This drug needs re-assessment by your vet and changing to something more appropriate, if its effects remain necessary..
I'll give you a link to another two articles of mine on diet ... please read both of them. They will help you appreciate just how crucial diet changes are. There are tricks to getting Boots to eat. One is to ask your vet for a good anti-nausea medication such as Mirtazipine, together with Cerenia. There are other options too, such as adding a teaspoon drizzle of organic natural honey or unflavored and unsweetened yogurt to the top of her meal.
http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease
Tony
I have the results to her blood work from last Monday. I also picked up the SubQ fluids to begin at home, against her vets wishes apparently. Her vet is pushing me to euthanize, however, I am not ready for that. I would like to at least give her a shot at the little bit of life she has left.
Her test results: (abnormals)
ALT (SGPT) 144 HIGH
Urea Nitrogen 172 HIGH
Creatinine 11.0 HIGH
BUN/Creatinine ratio 16
Phosphorus 16.4 HIGH
Calcium 13.4 HIGH
Magnesium 2.9 HIGH
Precision PSL 275 HIGH
RBC 4.5 LOW
Hemoglobin 10.8 LOW
Hemotocrit 33 LOW
Platelet count 454 HIGH
Everything else was normal ranges.
The vet is suggesting to give 50mL of fluid twice a day.
Her test results: (abnormals)
ALT (SGPT) 144 HIGH
Urea Nitrogen 172 HIGH
Creatinine 11.0 HIGH
BUN/Creatinine ratio 16
Phosphorus 16.4 HIGH
Calcium 13.4 HIGH
Magnesium 2.9 HIGH
Precision PSL 275 HIGH
RBC 4.5 LOW
Hemoglobin 10.8 LOW
Hemotocrit 33 LOW
Platelet count 454 HIGH
Everything else was normal ranges.
The vet is suggesting to give 50mL of fluid twice a day.
I wish I had seen your comment before I went to the vet so I could have asked about the medication. But if I am being honest, its a dead end with this vet. Next week I am going to make an appointment with the other vet in that office as she is much more willing to listen and explore options. It was absolutely a hassle to get the fluids from her current vet because she is pushing the euthanization. I was told, "yeah the fluids might make her a little more perky for the time being but her kidneys are shutting down. its time to consider humane euthanization. You need to think of Boots' best interest."
You really need another vet now, not in a week's time. There are substantial problems, and you need a vet that's pro-active and prepared to put in some effort. The most evident issue from the blood results is anemia. This needs dealing with fast. It could be either regenerative or non-regenerative anemia, and your vet needs to diagnose which and then treat quickly. It will become life-threatening if you leave it.
She needs to be taking 1100mg of aluminium hydroxide a day, divided into whatever number of meals you give each day. I realise you are giving 1.5ml of aluminium suspension and the container should tell you how many mgs are in 1 ml. Check it and let me know. Alternatively, let me have the name and supplier of the suspension.
The high ALT suggests some liver problems. This is no surprise given that the liver needs to take over some functions of the kidneys - and it will also partly be suffering from the pain killing meds we previously discussed. I would start immediately giving milk thistle as a supplement, as this may help support the liver a little.
The high calcium can be a problem, because it can develop into hypercalcemia. I suspect it is high partly due to the very high phosphorous - so, get the phosphorous down, and hopefully the calcium will fall back in line. One of the problems of high calcium is kidney stones and bladder stones can develop, so this is a matter not to be ignored.
Your vet is suggesting euthanasia. I appreciate he is thinking old dog and kidney failure, so better to call it a day. There is some rational consideration to be thought about there. Personally, I can also understand you wanting to do everything you can to prolong life and improve quality of life. But, kidney disease is a fatal condition, so good management and a pro-active vet may gain a few weeks, a few months or maybe a year. This is a decision for you to make, and only you CAN make it. I tend to look at a dog and ask them what they want. Maybe that sounds crazy, but there s so much communication between owner and their best friend - and it's all in the eyes. Owners invariably know when their own dog is telling them "I've had enough now." If Boots isn't saying that yet, then fighting on is the right thing to do.
Tony
She needs to be taking 1100mg of aluminium hydroxide a day, divided into whatever number of meals you give each day. I realise you are giving 1.5ml of aluminium suspension and the container should tell you how many mgs are in 1 ml. Check it and let me know. Alternatively, let me have the name and supplier of the suspension.
The high ALT suggests some liver problems. This is no surprise given that the liver needs to take over some functions of the kidneys - and it will also partly be suffering from the pain killing meds we previously discussed. I would start immediately giving milk thistle as a supplement, as this may help support the liver a little.
The high calcium can be a problem, because it can develop into hypercalcemia. I suspect it is high partly due to the very high phosphorous - so, get the phosphorous down, and hopefully the calcium will fall back in line. One of the problems of high calcium is kidney stones and bladder stones can develop, so this is a matter not to be ignored.
Your vet is suggesting euthanasia. I appreciate he is thinking old dog and kidney failure, so better to call it a day. There is some rational consideration to be thought about there. Personally, I can also understand you wanting to do everything you can to prolong life and improve quality of life. But, kidney disease is a fatal condition, so good management and a pro-active vet may gain a few weeks, a few months or maybe a year. This is a decision for you to make, and only you CAN make it. I tend to look at a dog and ask them what they want. Maybe that sounds crazy, but there s so much communication between owner and their best friend - and it's all in the eyes. Owners invariably know when their own dog is telling them "I've had enough now." If Boots isn't saying that yet, then fighting on is the right thing to do.
Tony
Its been a rough couple of days. Boots is still hanging on, but barely. She hasn't eaten a bite in two days. Will barely drink. Today shes having trouble standing for long periods. Shes mostly been sleeping. I think shes starting to get confused. I think ive come to the decision to put her to sleep. I was hoping for a peaceful death at home but everything I've read says that wont happen. That she will be fearful and in pain. I don't want that for my best friend. I'm hoping to get our vet to come to our home so she can leave this world in her own bed. I am heart broken and entering a very dark area, myself, but I've got to think of her. Thank you for all your help. You've been wonderful.
I truly appreciate these are the hardest decisions we will ever make as dog owners. It hurts us so much. It is excruciatingly painful. Yet, despite our own pain and despair, we make these decisions for all the right reasons. We make them because we love our best friends and only want the very best for them.
I cannot say whether this is the right time or not. You can only take on board what your vet tells you, what your own heart tells you and what Boots might be saying. You are charged with this dreadful responsibility - and I know it is extremely difficult and heart-wrenching.
We are here for support either way. Never feel you are alone.
Tony x
I cannot say whether this is the right time or not. You can only take on board what your vet tells you, what your own heart tells you and what Boots might be saying. You are charged with this dreadful responsibility - and I know it is extremely difficult and heart-wrenching.
We are here for support either way. Never feel you are alone.
Tony x
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