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Special Diet for CKF

We were just told our 4 1/2 year old shih Tzu grandpuppy has CRF.  We are looking for help with her diet. She is still in the hospital and we are hoping to bring her home either today or tomorrow.  The vet has prescribed Royal Canin (my daughter has the paperwork so I don't know the rest of this food's name) but this morning she refused to eat.  Please, if anyone has suggestions of what type of things she can eat I would really be thankful  We were told she have to keep her protein intake to under 11.  Thanks in advance.  
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1916673 tn?1420233270
Oh, I am so very sorry to read about Tina. Words are not enough and I wish I was there to give you a hug. I offer you my sincerest condolences. You sure did everything possible to help Tina and tried so hard, but sometimes this horrible disease just takes a hold and won't let go. Please stay with us here. Your input for others going through this with their own dogs would be greatly appreciated, once you have had the time to grieve.

Run free Tina.

Tony x
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Avatar universal
It is with a broken heart that I pass this news on to you.

Tina took a horrible turn for the worse.  Her gums were so pale and she refused to eat anything or even drink. Yesterday I gave her some yogurt with a syringe and water that way also. Today she refused to open her mouth and when I tried to squeeze water through her teeth it just ran out the other side of her mouth. She was so weak she couldn't even hold herself up to pee.

She passed away in my daughters arms on the way to the vet this evening. She was a trooper and tried so hard to fight this. She was such a sweet little girl and now no longer in pain or suffering and in doggie heaven with her mom Gracie.

I want to thank you for all your support and advice. This is a wonderful site.
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1916673 tn?1420233270
Sounds to me like you're doing all you can, given obvious work and other commitments. Keep doing what you're doing. You're doing great.

Tony
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Avatar universal
Hubby can do more then go outside. lol  Tina is much more important right now.  

She did eat a little yogurt and tripe this morning. She has always been an evening eater.  One of our biggest problems is that Monday thru Thursday no one is home during the day to offer her more, and if we leave the food out, Sam will eat it.  So when I get home at night, I try to get something (anything) in her about every 2 hours. Friday and weekends, I don't leave for a long period of time so I'm able to make sure she has food more often (if she is not being stubborn and will eat).
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1916673 tn?1420233270
That's good. Little by little is fine, you should just increase the frequency, so maybe offering her a mouth ful each hour or at least every two hours. On another matter ... tell hubby to go stand outside, Tina is more important right now than his delicate nostrils.

Tony
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Avatar universal
When I got home from work, I offered Tina some plain fat free yogurt. She ate about 2 tablespoons of it. About 2 hours later gave her fluids, then about a hour later, offtered her the tripe. Which she ate.  I gave it to her plan, my husband said I can't warm it up because it stinks.  She seemed to like it, Ate about 1 tablespoon.  I know that isn't much but it's a start, hopefully in the morning she will want to eat a little more.

Thanks for all your help Tony.  
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1916673 tn?1420233270
Oh dear. That's very disheartening. She may well have ulcers, which are nothing to do with the medications, it's the kidney disease that can cause them. The ant-acids and a little chopped cabbage in her food will help this. The cold-like symptoms are very very likely due to her feeling so weak and undernourished ... and this can happen because her immune system is under severe strain from the kidney disease. You might try some probiotics, such as plain unsweetened yogurt, which is said to help.

I'm so sorry, but I feel I'm not able to help much. With the best will in the world, nothing seems to be succeeding. I think your daughter is right to get her back to the vet sooner to reassess and (hopefully) offer some alternative suggestions.

You might ask about supplements, such as a nourishment enhancer suitable for CKF dogs, that you can syringe into her mouth ... the chicken broth will certainly help in the meantime.

All the best. Tony
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Avatar universal
She didn't like it at all, so I force feed her again, just a small portion last night and again this morning. She does like her water, tried to give her chicken broth, refused that also. We are told her heart and lungs are great, just these darn kidneys.  

I'm wondering if her meds have caused her to get ulcers? The vet told us that if she didn't get enough food in her that this could happen.  We are suppose to go back to vets on March 16th but my daughter is taking her back sooner to have her re-evaluated.

She has a cold again which I'm assuming is because her body if weak, our weather has been below freezing along with snow the past 2 weeks. She wears a sweater outside and we wrap her in a blanket when she comes in.

Thanks for all your help and advice.  
Pat
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1916673 tn?1420233270
Let me know how she takes to it ... try a tiny couple of spoonfuls first ... hopefully she'll try it and love it. Tony
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Avatar universal
Yes she is on fluids 150 every other day and the off days 100.  

I wasn't sure how to do the tripe last night and she has turned her nose to anything I have tried to give her, so I force feed her about 1 tablespoon plain. She did walk over to the water bowl and drank on her own and does go from one doggie bed to another.  I carry her outside because we have steps, but she does walk around the yard to go potty.  

Just no interest in food.  We give her 1/4 tablet of 15mg Mirtazapine every day, 5 mg Pepcid twice a day and a phosphorus binder twice a day. And tons of Prayers.  

Will microwave and mix with rice and see what happens.  I might have to get a blender and puree it, so if she doesn't eat it on her own, it will be easier to give then shoving it down her throat.  
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1916673 tn?1420233270
Meant to ask ... is she on fluid therapy? I couldn't remember whether you had started this or not, but I think now is the time, if not.

Tony
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1916673 tn?1420233270
Hi. That;s great news about the green tripe. With the frozen blocks, I cut them into quarters, then microwave them for 12 minutes on 30% setting. You'll probably need a strong serrated knife (like a bread knife) to cut them. Once cooked, break up into a kind of mince texture. Keep the juice from cooking (it looks and smells dreadful, but it contains nourishment) and pour over a little boiled white rice, which you can mix into the green tripe.

The chances are, she will eat this ... but I'd give really small portions every couple of hours, which will help her gut and kidneys deal with it.

Fingers crossed! Well done on finding.

The best thing to do with eggs is use three egg whites to one egg yolk and mix together. The yolk gives flavor, but it's high in phosphorus - while the egg whites have the highest and best quality protein of any other food. You might try missing out the egg yolk completely, but she may turn her nose up at just egg white on its own. Worth a try though. One egg every three days is enough to give some very useful energy and beneficial omega 6 fatty acids.

Tony
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Avatar universal
I found a store about 12 miles from my home that sells All Natural Frozen Green Tripe. They are a specialty grooming shop and I called just on the chance they might have some. They are holding a 2 lb. package for me. I'm getting on way home from work tonight. Hope she wants to eat some.  Can this be cut into smaller sections so I don't have to thaw it all at once?

I hope it isn't to late. She's only ate a little on Saturday and Sunday. Just has no interest. She likes her water, but I have to force anything else into her and I just hate that.  She's done this before but since she has lost weight it really worries me.

You mentioned an egg, would that be the whole egg or just white? yolk?  
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1916673 tn?1420233270
Hi. The blood in her stool is almost certainly down to gulping the alternative food from Sam's weight-loss bowl ... because it would have given her some serious stomach upset and potentially excessive protein issues for the gut and kidneys. Hopefully, nothing too serious ... but a lesson learned there I think. BUN is still the biggest problem in her bloods. Fluid therapy remains the most essential part of her treatment, as this will help bring the BUN down. Smaller portions of food more frequently will also help, and it remains crucial to limit the amount of calcium, sodium (salt), phosphorus and poor quality protein. You could also maybe give one egg (cooked or raw) every 3rd day, mixed in with the food. While the egg has protein, the kidneys don't need to work at all to deal with it because of the type of protein it contains. I would also urge you to get/try-to-get all natural frozen blocks of green tripe from a good quality pet store, as this will help her put some weight on without affecting the kidneys.

Tony
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Avatar universal
Well Tina's counts are still coming down, little at a time. BUN only dropped from 173 to 172, phosphorus dropped .6 to 15.9, Creatinine dropped .7 to 8.3.  Her weight also dropped 1.5 lbs.  Had a bad week with eating, Someone left Sam's food down which is a weight loss food because he is over weight and she ate all of it. Throw it up the next day (Wednesday) and hasn't wanted much since then. I gotten a little broth down her everyday but I know she needs more. Also she is drinking okay.

Today I noticed there is blood in her stool, I'm sure not a good sign. Daughter will be calling the vet for advice.
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1916673 tn?1420233270
Great stuff. Yes, it's always worth rotating the foods, because dogs are great at forgetting what they didn't like (purely due to psychological association with feeling sickly). And they can sometimes suddenly woof down things they earlier refused to eat. So, it's trial and error much of the time. Human grade chicken with the fat on is good, but like all things, in moderation because there is still some phosphorus in chicken - and just so you know, dark meat chicken is better than white meat parts.

Tony
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Avatar universal
After I posted this yesterday, I went out and looked up peas to make sure they were okay to feed to dogs, especially since Tina seems to love them. I read about the phosphorus in them.  I'm going to hold back on the amount she was getting. I was giving equal parts chicken and peas. Now it will be chicken and green beans (today I'm going to try sweet potatoes also) and if I offer peas, it will be in a very small dose.  Since she seems to be wanting to eat more often, I'm going to try some of the things she refused at the beginning of this roller coaster ride with her.
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1916673 tn?1420233270
Hi Pat. I would use the frozen peas in small quantities, perhaps only as an encouragement to eat the other k/d foods. Green peas have an amount of phosphorus content, but not as high as some other peas and beans. There is a balance to be made here between eating anything and eating nothing ... the peas may be getting some very useful nutritional content in her, but they are not the ideal food for a CKF dog because of the smaller phosphorus content AND sodium (particularly high in frozen peas), which puts more stress on the kidneys.

Phosphorus comes into the body via the diet and leaves the body via the kidney, only in renal failure phosphorus is not well removed as it is supposed to. Obviously using less phosphorus in the diet may be adequate to keep the blood phosphorus levels normal, thus balancing the intake with the output, but sometimes addition of medication (i.e. a phosphate binder) is needed to further reduce intake. Restricting dietary phosphate has been shown to slow the progression of renal disease.

So, be cautious with the peas - don't make them a major part of the meal or feed too much all at once.

Tony
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Avatar universal
Just an update on Tina.  We have seemed to found a food Tina likes. She likes the grilled chicken and frozen green beans, but seems to love frozen peas.  She eats the peas before anything else when she gets her little plate of food, and seems eager to eat every time we offer her food. Hopefully next Saturday her blood results will still be heading down.

Pat  
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1916673 tn?1420233270
Hi Pat. That's really good news and shows you are indeed on the right track. The crucial thing now is to keep to the plan and don't be tempted to waver from it. When CKF dogs start improving, even a little, we sometimes think it's okay to give them one of their old treats or favourite foods, but this can be he trigger that sets them back down the deteriorating path again. Just keep doing what you are doing and hopefully things will continue along the right path. Well done on getting this far. Tony
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Avatar universal
We received good news and not so good news today.  
Tina has maintained her weight. She has stayed at 14 lbs. Still down from original weight of 17.2 but she is maintaining.
Her BUN was down from 180 to 173. Creatinine was at 11.1 now down to 9 back to were we were 2 weeks ago, and Phosphorus was 18.4 now down to 16.5  I know everything is still way to high but she is heading in the right direction.
Not so good news is her red blood cells have dropped from 20 to 18. Vet didn't seem to concerned as of yet, but I know that's not a good sign either.  
Bright side again, Tina seems to be more alert and active for the most part. Greats us at the door when we come home, waits at refrigerator for her meals, likes to be outside. Also, we don't go back for blood work for 2 more weeks unless we see a decline.  
Thanks again for all the well wishes and support.
Pat
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1916673 tn?1420233270
Hi Pat. I love hearing news that gives hope, because hope is a quality we cling to here. Tina running around, chasing squirrels and playing with Sam paints a wonderful picture, despite the obvious concern about her eating. I think you just have to keep trying, even tiny amounts, hand-feeding (offering by hand) when absolutely necessary. A tiny amount every hour will sustain her ... whereas a full bowl will just cause a higher toxin build-up, more gastric issues and the psychological aversion to food. I know it's hard, but keep persevering, because you actually doing really well and certainly the best you can.

Tony
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Avatar universal
Thank you all for your thoughtfulness. Tina's counts were still up on Saturday, the BUN was down by 10, but other two went up by 1 each when we went for follow up.

We are giving her fluids 150 every other day, then 100 off days.

She had 2 really good days (Monday and Tuesday) with eating, I kept her portions small so she would be able to process it, this morning she didn't want anything, so she is resting.

She has played outside with Sam the past few days since it has been warmer and even chased the squirrels that run along the top of our fence. Which made me happy to see her acting like her old self.

Hopefully tonight she will have her appetite back just a little.  I really worries me when she doesn't eat but I know this is part of the process.  

Thanks again, we go back for more blood work on Friday. Will keep you posted.

Pat
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9214378 tn?1408881584
Hi:)

I'm going to hop in quickly as I feel you are going thru a difficult time. Many of us on the board have struggled thru such horrible times trying to achieve some common ground when our pups begin to thrive. It's a great balance. I believe less is more. I say this as we must find that graceful space keeping our pup hydrated and finding a balanced diet. Out of fear we may overcompensate ....I did, but I never lost hope. Please stay hopeful and understanding and subtly incorporate changes in diet.

You are in great care with our friends here:) Tony is my family as he has saved my beloved Darbie in the worst of times. I truly hope everyday gets better.

Fondly,
Lynne & Darbie:)
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