8 year old blind bull terrier just diagnosed with stage 4

[Susanetta]

My boy, Sid, is an 8 year old, blind, bull terrier, was diagnosed with stage 4 chronic kidney failure last Tuesday.
His bun was 130 , creatine was 16.7, phosphorus was 11+.. Was kept there till Friday on iv fluids and was able to make some improvements by Friday.    I couldn't leave him there anymore so I brought him home and did 1 bag of sub q fluids each day.  He wouldn't eat the kidney food but would eat boiled chicken and rice.
Took him back Monday morning and numbers are back up bun 150+, creatine 9, phosphorus 8.  Vet wants me to do 1 1/2 bags a day now.
I feel like I'm poisoning him by giving him the chicken and rice, do I hold out and hope he starts eating the hill or Royal canin?

[Susanetta]

tony,
Again, thank you so much.
Will do.

[tonyb286]

Let me know what your vet says.

Tony

[tonyb286]

When you say 25ml of alum hydroxide ... what does that equate to in actual aluminium hydroxide (mg). It should explain the strength of the product on the bottle.

Why are you re-starting the cerenia? Is he still vomiting?

Tony

[Susanetta]

40 mg = 1 ml... So 1000

[tonyb286]

Okay. Thanks. The dose you are giving is less than half the recommendation when serum creatinine is above 8.0, so I would suggest to your vet that the dose is progressively but cautiously increased up to a maximum of 5,800mg per day (proportionately divided and given with meals) over the next month.

Tony

[Susanetta]

Sid is 58 lbs.  we are giving him 25 ml every 12 hours.
Went this morning and got more cerenia.

[FawnT]

I have been giving Sadie Azodyl since her CKF diagnosis last Sept. I get it from Drs Fosters and Smith online, because it was double the price from my Vet.  There are a lot of online websites you can buy it from, my Vet's receptionist recommended Fosters and Smith as being reputable. They are currently having a sale until 7/30 with 15% off.  The product has to stay cold, so it is shipped overnight in ice packs.  It's $25 for shipping, but still a big savings as I  have been ordering 2 bottles at a time, especially with the sale.  I have heard  orders from Amazon with the product arriving warm.

Fawn  

[tonyb286]

Hi. Cerenia is only for vomiting so it won't correct the blood values. High calcium is an indicator of parathyroid hormone getting out of control (it starts drawing calcium from bones and teeth), and this is a challenging problem in progressive canine kidney disease. Restricting and then gaining control of phosphorus is the main route to achieving it. Are you still giving aluminium hydroxide? If so, what does your pup weigh and how much are you giving a day?

Talk to your vet about Calcitriol Therapy. This may help, in addition to the phosphate binder. If you are giving the max of aluminium hydroxide (I'll let you know once you answer the enquiries above) then it may be worth adding a smaller dose of calcium carbonate to it, which helps to boost the effect. The alternative is to switch to another binder to see if that has a positive effect, but other effective binders are very expensive.

You might also want to try giving Azodyl ... again, very expensive, but some owners do report some success with this supplement.

Tony

[Susanetta]

Sid is 58 lbs.
i am giving him aluminum hydroxide 25 ml every 12 hours.
Started back on the cerenia this morning and vet did recommend Azodyl

[Susanetta]

Tony,

Sid's  phosphate has gone up this week from 9.2 to 11.7
Bun has gone down 153 to 147
Creatine- 7.8 up to 8.8
Ca++ 13.2 to 14.2
should i get him back on cerenia? He stopped last week.
His very bad breath has come back too.
Any other suggestions?

[FawnT]

Sadie was diagnosed Sept 2015.  We have been doing the Kidney RX diet since then.  I have been using Royal Canin, they have 3 varieties of canned food.    We went June 1st for 2 month routine bloodwork and her values had increased a little.  She was in early stage up until June.  She always has a stress reaction to going to the Vet, with loose stools, stomach upset.  By June 10th, she was getting very picky eating her renal food (I have always supplemented with alternating high quality protein or fresh veggies) on top. When I took her in, Vet ran renal panel and her Creatinine had jumped to 2.7.  She was licking her lips and he said she was likely nauseous.  He did Sub Q fluids there and cerenia shots, got RX for the diarrhea.  Over the next couple weeks she was becoming increasingly pickier about her food, refusing the renal canned and vomited on June 24th and I took her in that day and her Creatinine had spiked to 4 and Bun to 59 & phosphorus to 7.5.  She had 2 days around the clock IV fluids.  We started the phosphate binder then too.  It has taken a few weeks for me to see she is feeling much better.  I was only doing chicken and rice since she wasn't interested in the canned renal food, but found introducing a variety of foods has really helped.  At one point I was mixing it all together with canned food, but found putting separate little piles, where she could choose also helped.  In all cases, I put the shredded boiled chicken or hamburger on top of the canned food, which would help start her off.  There was short time, I just didn't offer the canned food to give her a break.  I also gave her white bread toast.  Like a 1/2 slice cut up in cubes with a tiny bit of butter--she loved it most of all--it is low in phosphorus, but it isn't the best option, but it was better than nothing.  She would never turn her nose up, it was the only thing she would eat sometimes.  Hoping Sid's #'s continue to show improvement.

[Susanetta]

How is your sheltie now?  How long ago was her diagnosis and what stage was she?  Thanks for giving me some great ideas.

[FawnT]

Hi, my Sheltie went thru a period where she would not eat the kidney diet canned food either.  I looked for low phosphorus foods to try to entice her with something different.  Possibly a scrambled egg white, it is very low in phosphorus and a high quality protein, but not the egg yolk--it is very high in phosphorus.  I also was able to get her to eat some sticky white rice, drizzled with organic honey--which was a suggestion by Tony in his articles.  Lean boiled hamburger with some white pasta--I put a little butter to entice her.  Also, my dog loved mashed sweet potato, which I added a tiny bit of butter and cinnamon (but she has had issues with her potassium levels, so that is only an option without a potassium issue).  My vet started me out on the liquid alum hydroxide and it was hard to administer.  It took me a while to learn how to work with the syringe so that it didn't pour out of her mouth.  After getting thru the liquid, my Vet did prescribe a power form of the alum hydroxide and it was compounded at a people pharmacy near my home, they were able to compound it the same day my Vet called it in.  It is much easier to give in pill form, I use a little bit of cream cheese to put the pill in, but can only be given with food.  I hope Sid feels better, I know how stressful it is to have them not eat.  It looks like his creatinine and phosphorus have come down significantly.  

[Susanetta]

He is refusing the boiled chicken now...ground turkey and rice?

[tonyb286]

Hi. Yes, ground turkey and rice is fine. Ideally, use sticky white rice as it's slightly lower in phosphorus.

Tony

[Susanetta]

Thank you for responding.
Sid is 58 lbs.  LRS 1000 ml bags so doing 750 ml in the am and 750 ml at night.
How long can I give hm the cerenia-  without it he will hardly eat.  The liquid aluminum hydroxide is very hard to administer to him, is it available in a pill and is this given for the rest of his life?

[tonyb286]

Hi Susanetta. LRS (Lactated Ringer Solution) is a good and balanced choice of fluids for SubQ. The dosing for maintenance purposes is generally around 40 mL/kg/day, which means 58lbs converts to 26.3kg ... and a daily fluid dose recommended of 1052ml. It's useful to note that when blood levels are high, vets often increase the recommended rate - and this is good practise, but it also means regular blood testing is required to ensure serum minerals and electrolytes don't start being lost due to increased urination.

Cerenia can be given indefinitely. If his eating is not regular or he is refusing familiar foods, ask your vet about Mirtazipine. This is a useful appetite stimulant, anti-nausea medication and anti-depressant too. It can be taken with cerenia to boost the effects. It doesn't work for all kd dogs, but for some its effects are nothing short of amazing.

Aluminium hydroxide is available in a gel powder format, which some dogs prefer. It is sprinkled on food. You can ask your vet about this - or buy it direct from Thriving Pets.

Tony

[tonyb286]

Hi. SubQs are so important, but management takes longer than with IV fluids, so keep going. What is the type of fluids your vet has prescribed? How much does your dog weigh? How much fluid is in each bag?

Chicken and rice is fine for now. Feed small amounts more often - so up to about 6 meals a day, every 2 to 3 hours - and when I say small, I mean literally a couple of tablespoons. This will help spread out the work the kidneys need to do to deal with the food by-products. It should also help reduce nausea and give the fluids a better chance of working.

Tony

[Susanetta]

He was on cerenia for 5 days, off now,
Aluminum hydroxide - morning and night
Pepcid
1 1/2 bag of Lrs
Benazipril
Metronidazole

So I read some other posts-  no potatoes?