Aa
Graham has Kidney Failure AND Cushings
Hi Tony, thank you for running this group. I hope it is alright if I jump right in with a question, but after receiving my dog's latest blood results I am very worried. I have posted some of his results, they are in the English system, I'm sorry I didn't convert them to what is used in the US.
My 16 year old dog Graham was diagnosed with kidney failure three years ago, and with Cushings in June this year.
He is having Fortekor 2.5mg for the kidneys and started 10mg Vetoryl for the Cushings, under close observation because it is not recommended for dogs with kidney failure. He became unwell after 6 weeks on it and I stopped it immediately. He is currently not being treated for the Cushings disease.
He had a blood test this week - Urea (33.2mmol/L) Creatinine (201.0 umol/L) Cholesterol (13.06 mmol/L) Potassium (6.27 mmol/L) Inorganic Phosphorus (2.38 mmol/L) All of these are increased since his last test two months ago.
He also had an ACTH - pre 95.2 nmol/L and post 596 mol/L
He seems well in himself and has a reasonable appetite, His Cushings symptoms seem to have almost disappeared although some days he drinks a little more water than normal, but not the massive amounts he used to.
I am worried that by not treating the Cushings, it is making his kidney problem worse. Could this be true? Or would it be even worse if the Cushings was treated?
I would be very grateful for any advice.
My 16 year old dog Graham was diagnosed with kidney failure three years ago, and with Cushings in June this year.
He is having Fortekor 2.5mg for the kidneys and started 10mg Vetoryl for the Cushings, under close observation because it is not recommended for dogs with kidney failure. He became unwell after 6 weeks on it and I stopped it immediately. He is currently not being treated for the Cushings disease.
He had a blood test this week - Urea (33.2mmol/L) Creatinine (201.0 umol/L) Cholesterol (13.06 mmol/L) Potassium (6.27 mmol/L) Inorganic Phosphorus (2.38 mmol/L) All of these are increased since his last test two months ago.
He also had an ACTH - pre 95.2 nmol/L and post 596 mol/L
He seems well in himself and has a reasonable appetite, His Cushings symptoms seem to have almost disappeared although some days he drinks a little more water than normal, but not the massive amounts he used to.
I am worried that by not treating the Cushings, it is making his kidney problem worse. Could this be true? Or would it be even worse if the Cushings was treated?
I would be very grateful for any advice.
Hi Betty. It's usually a 100gm capsule. Most good pet stores sell them and you can always order online if you have difficulty. Vit E is necessary with salmon oil, because the omega-3 in the oil depletes Vit E in the canine body.
Tony
Tony
1 Comments
Thank you Tony, I'll get some.
Hi Tony, I just wanted to let you know that I took your advice and bought some Hills kd and much to my surprise - Graham seemed to like it! Early days of course, but at least he has eaten something. I also bought the salmon oil. Thank you.
2 Comments
That's great. Did you get Vit E supplements to go with the salmon on oil?
No, I must have missed seeing about the vit E. Is it a tablet?
Well, it's somewhat strange for a vet to behave that way, in my experience. Most would recognise the SYMPTOM being associated with kidney disease and any treatment (?) or investigations (blood and urinalysis) would be equally associated with it for insurance purposes. I suppose the question is what the insurance policy wording states ... some don't recognise a course of treatments for an illness, whereas others do.
I still rather feel this vet doesn't appreciate the connection between inappetence and kidney failure, which is odd as it's a fundamental symptom.
Tony
I still rather feel this vet doesn't appreciate the connection between inappetence and kidney failure, which is odd as it's a fundamental symptom.
Tony
He gave him 2 injections, took a urine sample and sent it off to lab.
If I had known he was going to say it was a new condition I would have been better off paying him and not making the insurance claim. But I didn't realise at the time.
If I had known he was going to say it was a new condition I would have been better off paying him and not making the insurance claim. But I didn't realise at the time.
So, what was it he did last week that incurred cost?
Sorry Tony, I don't think I explained very clearly - he meant he hadn't given him any treatment for kidney disease last week.
That's ridiculous. Was he not the vet that prescribed Fortekor 2.5mg? What was he prescribing this for, other than as a treatment for renal failure?
Thank you for the link Tony, I will read it later.
My vet phoned me a couple of hours ago and said that he could not put kidney disease on the insurance form because he had not given any treatment specifically for kidney disease. It didn't matter what I said to him, this was his reason and he was sticking to it. The insurance form has already been posted. I will be looking for another vet now.
My vet phoned me a couple of hours ago and said that he could not put kidney disease on the insurance form because he had not given any treatment specifically for kidney disease. It didn't matter what I said to him, this was his reason and he was sticking to it. The insurance form has already been posted. I will be looking for another vet now.
I received the following message from the receptionist this morning, I asked for the vet to ring me back.
....he doesn't feel that this condition can be linked to one of the other conditions he feels its separate he said he's happy to discuss this with you if you want him to call you or you call him ..
....he doesn't feel that this condition can be linked to one of the other conditions he feels its separate he said he's happy to discuss this with you if you want him to call you or you call him ..
2 Comments
Hi Tony, thank you so much for replying so quickly. I am going to speak to the vet today but I don't hold much hope in changing his mind. I agree with you about finding another vet, I should have done this a long time ago.
Thank you again, your advice is very much appreciated.
Betty
Thank you again, your advice is very much appreciated.
Betty
Hi Betty. As far as I am aware (but your vet might want to try teaching me otherwise), there is no illness called "inappetance". The lack of appetite and refusal to eat is a direct consequence of kidney failure, whereby the toxins build-up in the stomach causing nausea, vomiting and/or acid-reflux. This IS a symptom of kidney failure, NOT a second illness.
After your issue with the antibiotics, and now this, I would suggest looking for an alternative vet. It seems to me the one you are currently using has no idea about this serious and complex illness.
Tony
After your issue with the antibiotics, and now this, I would suggest looking for an alternative vet. It seems to me the one you are currently using has no idea about this serious and complex illness.
Tony
Hi Tony,
When I took Graham back to the vet on Wednesday evening he wanted to start him on a course of antibiotics. I asked how he knew if there was a UTI without testing his urine so he took a sample and sent it off. I got the result on Friday, and there was no infection. Graham is insured with Petplan and I thought that last week's problem would be connected with his kidney disease but the receptionist has just told me that it is a separate condition, which the vet has called 'inappetance'. This means I will have to pay the excess of over £100 for a new condition. Am I wrong in thinking inappetance is one of the problems with kidney failure?
When I took Graham back to the vet on Wednesday evening he wanted to start him on a course of antibiotics. I asked how he knew if there was a UTI without testing his urine so he took a sample and sent it off. I got the result on Friday, and there was no infection. Graham is insured with Petplan and I thought that last week's problem would be connected with his kidney disease but the receptionist has just told me that it is a separate condition, which the vet has called 'inappetance'. This means I will have to pay the excess of over £100 for a new condition. Am I wrong in thinking inappetance is one of the problems with kidney failure?
That's good Betty, although giving an antibiotic injection wouldn't have been something I would have allowed. Why? Because unless there's a certainty of infection, all it does is cause more stress on the kidneys (which have to try and remove the by-products and toxins created by this medication). Also, antibiotics are going to be needed at some stage to treat probably infections (particularly UTIs), and if they are used too much without good reason, they may not work when you really do need them.
This disease is a learning curve, isn't it.
Keep me informed how things go.
Tony
This disease is a learning curve, isn't it.
Keep me informed how things go.
Tony
Hi Tony,
After Graham ate the Encore on Sunday he didn't eat anything on Monday and was sick a few times. I took him to the vet yesterday morning and while he couldn't find anything, he said that his stomach was very tense. He gave him an antibiotic injection and also one for the vomiting. Graham seemed a bit better after we got home and after a good sleep he ate some boiled chicken leg and a little sweet potato. He has been his usual self today and had two very small meals of the chicken again. It was lovely to see him clear his plate. I have to take him back to the vet again this evening so he can check on how he is. I mentioned about the mirtazapine and he said he had used it before with good results and would consider it for Graham. He was reluctant to start him on it until his stomach was back to normal.
After Graham ate the Encore on Sunday he didn't eat anything on Monday and was sick a few times. I took him to the vet yesterday morning and while he couldn't find anything, he said that his stomach was very tense. He gave him an antibiotic injection and also one for the vomiting. Graham seemed a bit better after we got home and after a good sleep he ate some boiled chicken leg and a little sweet potato. He has been his usual self today and had two very small meals of the chicken again. It was lovely to see him clear his plate. I have to take him back to the vet again this evening so he can check on how he is. I mentioned about the mirtazapine and he said he had used it before with good results and would consider it for Graham. He was reluctant to start him on it until his stomach was back to normal.
Hi Betty. You are very welcome. Coconut oil ... less than a teaspoon is all you need. Also, I know it's very tempting to let Graham eat everything and anything when he seems hungry and willing to eat, but large meals (as in a full tin of Encore chicken) could cause problems. If possible, feed very small amounts more often, say 4 to 6 times a day. This places less stress on the kidneys.
Also, talk to your vet about adding Mirtzapine. This is both an appetite stimulant and deals with nausea caused by the toxins.
Tony
Also, talk to your vet about adding Mirtzapine. This is both an appetite stimulant and deals with nausea caused by the toxins.
Tony
Thank you for that information about Fortekor. I suppose the next step would be for Graham to have his blood pressure taken, and urinalysis done?
Thank you for the information about food. I have briefly looked at your website because it was getting late last night, but I will definitely try some of your recipes.
His appetite was quite poor over the weekend. He seems to be hungry but just sniffs his food and walks away. He ate nothing all day yesterday but then I gave him a tin of Encore chicken and he ate all of it. I do have some pure coconut oil at home and will try a little of that on top of his next meal.
Thank you so much for all the help and advice.
Betty
Thank you for the information about food. I have briefly looked at your website because it was getting late last night, but I will definitely try some of your recipes.
His appetite was quite poor over the weekend. He seems to be hungry but just sniffs his food and walks away. He ate nothing all day yesterday but then I gave him a tin of Encore chicken and he ate all of it. I do have some pure coconut oil at home and will try a little of that on top of his next meal.
Thank you so much for all the help and advice.
Betty
Graham's latest urine test was on 16/9/15.
Creatinine 194 umol/L
Urine protein 150 g/l
Urine creatinine 2986 umol/L
Urine protein:Creatinine ratio 0.44
UP:C 0.2 - 0.5 are considered borderline proteinuric
Creatinine 194 umol/L
Urine protein 150 g/l
Urine creatinine 2986 umol/L
Urine protein:Creatinine ratio 0.44
UP:C 0.2 - 0.5 are considered borderline proteinuric
I wanted to add this as a separate message, because it has a great deal of relevance. Fortekor is a good and useful medication in kidney failure - and also for blood pressure and cardiac problems - as it dilates the blood vessels, allowing more oxygenated blood to flow around the body and, importantly, through the kidneys.
However, it does have certain effects which may be relevant. It can LOWER blood pressure significantly, which is good if a dog is hypertensive (common in kd dogs), but when blood pressure is actually normal, it can lower it to become dangerously hypotensive. It's crucuial your vet keeps a regular and close eye on blood pressure for this reason alone.
Also, interestingly, it can raise potassium levels. As Graham has high potassium in his blood readings, this may well be part of the cause.
It can also have side effects that cause gastro-intestinal upset such as vomiting, diarrhea, lack of appetite and possibly weakness. These are also common in kd dogs, so it's a bit of a double whammy. While I am not suggesting the Fortekor is stopped, it does demand a little more cautious and careful monitoring by your vet.
While his appetite remains good, there's no need for adding an appetite stiumulant or anti-nausea medication. But if you think these symptoms are starting to creap in, let me know and I'll advise the best remedies for kd dogs.
Tony
However, it does have certain effects which may be relevant. It can LOWER blood pressure significantly, which is good if a dog is hypertensive (common in kd dogs), but when blood pressure is actually normal, it can lower it to become dangerously hypotensive. It's crucuial your vet keeps a regular and close eye on blood pressure for this reason alone.
Also, interestingly, it can raise potassium levels. As Graham has high potassium in his blood readings, this may well be part of the cause.
It can also have side effects that cause gastro-intestinal upset such as vomiting, diarrhea, lack of appetite and possibly weakness. These are also common in kd dogs, so it's a bit of a double whammy. While I am not suggesting the Fortekor is stopped, it does demand a little more cautious and careful monitoring by your vet.
While his appetite remains good, there's no need for adding an appetite stiumulant or anti-nausea medication. But if you think these symptoms are starting to creap in, let me know and I'll advise the best remedies for kd dogs.
Tony
There's always something I mean to ask, and it slips by me as I'm typing (and then remember when I'm reading my reply back to myself) ... has your vet undertaken a urinalysis recently. It would be interesting to see whether there is any protein leakage in the urine, as this would cause something called Proteinuria, which is indicative of later stage kd. I would say there's every likelihood Graham is in stage 3 or 4, but protein leakage could suggest stage 4 rather than 3.
Knowing probably isn't terribly helpful, as the recommendations regarding diet and management are the same. It just makes diet control that much more important in stage 4. Specific gravity is another useful indicator in a urinalysis.
Regards
Tony
Knowing probably isn't terribly helpful, as the recommendations regarding diet and management are the same. It just makes diet control that much more important in stage 4. Specific gravity is another useful indicator in a urinalysis.
Regards
Tony
Hi Betty. Thanks for getting back. As I said before, Cushings is not my area of knowledge and I am a little uncomfortable answering anything about it. Frankly, you probably know more than I do about it, having read up on the subject and having joined and no doubt taken some interest in the Cushings group you mention.
There are so many good canned kd foods, but quite often they are very unpalatable. I have heard good things about Hills kd, if you can get a tine it would certainly be worth trying. One good tip is to drizzle a teaspoon of something really tasty and quite good for kd dogs on top of the food, so they get a sniff of that first before the actual canned food itself. All natural honey is good - so too is pure coconut oil, which almost all dogs love the taste of.
Unfortunately, although my healthy dogs do like Butchers too (particularly the tripe variety), it does contain a lot of phosphorus, which really needs to be restricted as it will adversely affect any dog with kidney disease.
The dental chews can be problematic as they have a large amount of animal derivatives in them (this means the worst parts of carcasses not considered suitable for human food, such as beaks, feet, intestines, etc.). They are also consequently high in protein, but not high quality protein, which make them difficult for the kidneys to deal with. All that said, hell, if Graham likes and enjoys them ... who am I to say he shouldn't have them.
Ipakitin is good and will help keep the phosphorous levels in check and add a little nourishment too. The phosphorous level is still a little high in his blood levels, so it's worth keeping an eye on it.
Potassium is also moderately high, so you may want to avoid treats and foods really high in potassium. Unfortunately, carrots are high in both phosphorous and potassium. Try him with some crunchy raw cucumber, to see if he likes it, as that has about half the amounts and has the advantage of having a lot of water content too.
If you can get over to my website at www.tonyboothwriter.com you'll find a whole host of articles there (by me), some of which you may find helpful.
Tony
There are so many good canned kd foods, but quite often they are very unpalatable. I have heard good things about Hills kd, if you can get a tine it would certainly be worth trying. One good tip is to drizzle a teaspoon of something really tasty and quite good for kd dogs on top of the food, so they get a sniff of that first before the actual canned food itself. All natural honey is good - so too is pure coconut oil, which almost all dogs love the taste of.
Unfortunately, although my healthy dogs do like Butchers too (particularly the tripe variety), it does contain a lot of phosphorus, which really needs to be restricted as it will adversely affect any dog with kidney disease.
The dental chews can be problematic as they have a large amount of animal derivatives in them (this means the worst parts of carcasses not considered suitable for human food, such as beaks, feet, intestines, etc.). They are also consequently high in protein, but not high quality protein, which make them difficult for the kidneys to deal with. All that said, hell, if Graham likes and enjoys them ... who am I to say he shouldn't have them.
Ipakitin is good and will help keep the phosphorous levels in check and add a little nourishment too. The phosphorous level is still a little high in his blood levels, so it's worth keeping an eye on it.
Potassium is also moderately high, so you may want to avoid treats and foods really high in potassium. Unfortunately, carrots are high in both phosphorous and potassium. Try him with some crunchy raw cucumber, to see if he likes it, as that has about half the amounts and has the advantage of having a lot of water content too.
If you can get over to my website at www.tonyboothwriter.com you'll find a whole host of articles there (by me), some of which you may find helpful.
Tony
When Graham was diagnosed with kidney failure three years ago the vet advised me to give him Royal Canin renal food. Graham would not eat it, neither the tinned nor dry. I have tried to get him to eat it but he just won't. He has never had a massive appetite for any sort of food and has never wanted to eat dried food. I usually feed him Butchers tinned because he does eat that, but not very enthusiastically. I am willing to get anything if he will eat it. For treats he has a small piece of dental chew (Asda) every day and raw carrot. I sprinkle Ipatikin on his food.
If you have any suggestions about food which may be more palatable than the Royal Canin I would be very grateful.
I understand about giving him the best quality of life, that is my main concern too.
Many thanks for your replies.
Betty
If you have any suggestions about food which may be more palatable than the Royal Canin I would be very grateful.
I understand about giving him the best quality of life, that is my main concern too.
Many thanks for your replies.
Betty
Thank you so much for your replies Tony.
Maybe a little background information would be helpful -
My other dog, Vera, also had Cushings for three and a half years until she died in July this year, aged almost 18, not related to Cushings. She had pituitary dependant, Graham's is adrenal. Vera was only diagnosed because I heard of another dog with the same symptoms and asked the vet to test her. I don't think my vet has any experience of Cushings, but the good thing is that he is willing to listen to me and does whatever test I ask for. The bad thing of course, is that I cannot ask his advice!
I suspected that Graham also had Cushings and asked for the test.
He did fairly well on Vetoryl to begin with, but then I noticed that he was not his usual self and had stopped eating. I asked for an ACTH and the result was pre 8.3 and post 95.9. I asked about this on a Cushings group I belong to and was advised by a vet on the group to stop the Vetoryl immediately because he was in danger of becoming Addisonian.
The vet checked his blood pressure about a year ago and told me it was normal, although I do not have the result here. I will ask him to do it again now you have mentioned it. If his blood pressure is high, what medication do you recommend?
I will reply to your other posts separately.
Betty
Maybe a little background information would be helpful -
My other dog, Vera, also had Cushings for three and a half years until she died in July this year, aged almost 18, not related to Cushings. She had pituitary dependant, Graham's is adrenal. Vera was only diagnosed because I heard of another dog with the same symptoms and asked the vet to test her. I don't think my vet has any experience of Cushings, but the good thing is that he is willing to listen to me and does whatever test I ask for. The bad thing of course, is that I cannot ask his advice!
I suspected that Graham also had Cushings and asked for the test.
He did fairly well on Vetoryl to begin with, but then I noticed that he was not his usual self and had stopped eating. I asked for an ACTH and the result was pre 8.3 and post 95.9. I asked about this on a Cushings group I belong to and was advised by a vet on the group to stop the Vetoryl immediately because he was in danger of becoming Addisonian.
The vet checked his blood pressure about a year ago and told me it was normal, although I do not have the result here. I will ask him to do it again now you have mentioned it. If his blood pressure is high, what medication do you recommend?
I will reply to your other posts separately.
Betty
I was just looking a little more into Cushings and the ACTH test. It seems there is just the possibility that treating the Cushings could indeed cause complications to the kidney disease, so stopping treatment is a valid idea. However, treatment is best recommensed immediately symptoms or test results show Cushings is re-emerging. This stop-start process may need to be continued for the remainder of Graham's life. It's very Catch-22, unfortunately.
Tony
Tony
Ok, so now I've had a chance to look at those blood levels. Potassium is moderately high. Cholesterol is very high. Phosphorous is moderately high. Creatinine equates to being high, but not alarmingly so. Can I ask you what you were feeding before diagnosis of kidney failure - and whether you have changed the diet since in any way?
The ACTH relates mainly to the Cushings, and the post value is elevated, which suggests the Cushings is still very evident. Obviously, a repeat of this test would be interesting as you have stopped the treatment. In theory, the post result will increase.
The real complication in all of this is that Cushings and kidney failure do not go well together. They can affect each other in many ways, making prognosis very poor. At 16yrs, Graham is an elderly gentleman, and if I were in the same position I would concentrate on giving him the best quality of life for as long as possible, without too much stress from invasive treatments, trips to the vets, etc.
I think there may be things you can do with diet to help, but I will await your response on past and current diet before I comment further.
Please make a point of including whatever regular treats Graham gets in your diet descriptions.
Thanks.
Tony
The ACTH relates mainly to the Cushings, and the post value is elevated, which suggests the Cushings is still very evident. Obviously, a repeat of this test would be interesting as you have stopped the treatment. In theory, the post result will increase.
The real complication in all of this is that Cushings and kidney failure do not go well together. They can affect each other in many ways, making prognosis very poor. At 16yrs, Graham is an elderly gentleman, and if I were in the same position I would concentrate on giving him the best quality of life for as long as possible, without too much stress from invasive treatments, trips to the vets, etc.
I think there may be things you can do with diet to help, but I will await your response on past and current diet before I comment further.
Please make a point of including whatever regular treats Graham gets in your diet descriptions.
Thanks.
Tony
You must join this user group in order to participate in this discussion.
You are reading content posted in the Chronic Kidney Failure in Dogs Group
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
