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Stage 4 Renal Disease and Pallidia
Hello,
I had to put down my 10 year old Yorkie last night and it was the worst experience of my life. I have a question about Pallidia, oral chemo for mast cell tumors, and its effects on the kidneys. I started Ruby on Palladia and when I went back for her two week check up her kidney values were a little elevated, nothing alarming. The Palladia was working. We had an appointment set up for 4 weeks after 3 doses weekly of Palladia. When we went back Ruby's kidney values were elevated to stage 2 renal failure. However, during that 4 week period I gave her 5 doses of Rimadyl which is hard on kidneys and the combination of everything wasn't good. The question I have is this, I gave her Pallidia a couple of hours prior to her appointment before they checked the kidney values after the 4 week period. Could the Palladia have elevated her kidney levels because it was given to her a couple of hours prior to the labs? I had to take her to the vet this past Monday and because she wasn't eating or drinking. They did more labs and her kidney levels were so high the machine couldn't read them. Once again I gave her Pallidia prior to the appointment. The vet said she was in kidney failure and I needed to euthanize her. I was devastated. She gave her a bupronex shot for pain as she was also suffering with pancreatitis. The shot took almost 24 hours to wear off so I never gave her the gabepentin dose for her nerve pain in her back that evening. She was still feeling punky on Tuesday so I never gave her gabepentin again for her nerve pain. Wednesday she woke up but was extremely tired and wouldn't eat at all. I didn't give her gabepentin again. I had to give her water through a syringe just to try to keep her hydrated. As the day progress her status worsened. She was resting but breathing as if she was in pain with her tongue out. I took her out to go potty and when she stood in the yard her right foot rolled under and her back was hunched. She was also urinating in her bed a bit. As the afternoon went on she began to shake a bit and rarely opened her eyes. She tried getting up once by seemed to be extra weak in the back end. We finally took her to our vet to have her euthanized last night noticing her lip had dropped on one side, but I am questioning everything I did and feeling guilty for giving her Rimadyl or not giving her gabepentin. Does chronic kidney disease cause neurological disorders, such as seizures and possible being wobbly or arched back to the point of her back end would drop or her lip? It disgusts me I allowed her to be in pain if in fact it was just the lack of gabepentin. Or do you think all of these systems stem from CKF? Does CKF happen that quickly? It is almost as if the Monday Pallidia dose pushed her kidneys over the top.
My heart is so broken. She meant everything to me and I just need to find an answer to rid myself of this guilt.
Thank you
I had to put down my 10 year old Yorkie last night and it was the worst experience of my life. I have a question about Pallidia, oral chemo for mast cell tumors, and its effects on the kidneys. I started Ruby on Palladia and when I went back for her two week check up her kidney values were a little elevated, nothing alarming. The Palladia was working. We had an appointment set up for 4 weeks after 3 doses weekly of Palladia. When we went back Ruby's kidney values were elevated to stage 2 renal failure. However, during that 4 week period I gave her 5 doses of Rimadyl which is hard on kidneys and the combination of everything wasn't good. The question I have is this, I gave her Pallidia a couple of hours prior to her appointment before they checked the kidney values after the 4 week period. Could the Palladia have elevated her kidney levels because it was given to her a couple of hours prior to the labs? I had to take her to the vet this past Monday and because she wasn't eating or drinking. They did more labs and her kidney levels were so high the machine couldn't read them. Once again I gave her Pallidia prior to the appointment. The vet said she was in kidney failure and I needed to euthanize her. I was devastated. She gave her a bupronex shot for pain as she was also suffering with pancreatitis. The shot took almost 24 hours to wear off so I never gave her the gabepentin dose for her nerve pain in her back that evening. She was still feeling punky on Tuesday so I never gave her gabepentin again for her nerve pain. Wednesday she woke up but was extremely tired and wouldn't eat at all. I didn't give her gabepentin again. I had to give her water through a syringe just to try to keep her hydrated. As the day progress her status worsened. She was resting but breathing as if she was in pain with her tongue out. I took her out to go potty and when she stood in the yard her right foot rolled under and her back was hunched. She was also urinating in her bed a bit. As the afternoon went on she began to shake a bit and rarely opened her eyes. She tried getting up once by seemed to be extra weak in the back end. We finally took her to our vet to have her euthanized last night noticing her lip had dropped on one side, but I am questioning everything I did and feeling guilty for giving her Rimadyl or not giving her gabepentin. Does chronic kidney disease cause neurological disorders, such as seizures and possible being wobbly or arched back to the point of her back end would drop or her lip? It disgusts me I allowed her to be in pain if in fact it was just the lack of gabepentin. Or do you think all of these systems stem from CKF? Does CKF happen that quickly? It is almost as if the Monday Pallidia dose pushed her kidneys over the top.
My heart is so broken. She meant everything to me and I just need to find an answer to rid myself of this guilt.
Thank you
Thank you so much--it helps me to know that are experiencing this loss in similar ways.
Hank was quite the little character--his full name was Runaway Hank, and he came into life running loose in the neighborhood, bearing a heart shaped tag that read: "Runaway Hank, Escape Artist, Car Chaser, My Friend". Long story short, I met his owner, and we combined efforts to keep him safe until he convinced me that he and I were meant for each other. He was 9 or 10 years when he moved in, and he made it to the ripe old age of 18. He enriched my life more than I can say, and I absolutely loved taking care of him, especially the last few months.
I also have the devastating sense of feeling as if I've disappeared (thank you for mentioning this). A few days after Hank died, I took a walk on the old trail he and I used to frequent before his illness prevented these outings. People didn't recognize me without him. I don't recognize me without him!
I believe that one reason the bond we have with animals is so powerful is because our communications depend on cues that are more subtle, and often more true, than verbal language. The down side of this is that they can't tell us specifically what is going on with them, so we depend on trial and error to get it right. It's complicated with dogs because they always want to please us, so they may not show us how they feel when they are ill. So it's pretty difficult to know what's best and when.
The Yorkies I've known have an adventurous character similar to Hank's--I can imagine what Ruby must have been like! I'm so sad that you have lost her.
So time will have her way with us-- I don't expect the power of this loss to diminish for quite a while, but you have brought me some comfort--I am grateful.
Take care--
Hank was quite the little character--his full name was Runaway Hank, and he came into life running loose in the neighborhood, bearing a heart shaped tag that read: "Runaway Hank, Escape Artist, Car Chaser, My Friend". Long story short, I met his owner, and we combined efforts to keep him safe until he convinced me that he and I were meant for each other. He was 9 or 10 years when he moved in, and he made it to the ripe old age of 18. He enriched my life more than I can say, and I absolutely loved taking care of him, especially the last few months.
I also have the devastating sense of feeling as if I've disappeared (thank you for mentioning this). A few days after Hank died, I took a walk on the old trail he and I used to frequent before his illness prevented these outings. People didn't recognize me without him. I don't recognize me without him!
I believe that one reason the bond we have with animals is so powerful is because our communications depend on cues that are more subtle, and often more true, than verbal language. The down side of this is that they can't tell us specifically what is going on with them, so we depend on trial and error to get it right. It's complicated with dogs because they always want to please us, so they may not show us how they feel when they are ill. So it's pretty difficult to know what's best and when.
The Yorkies I've known have an adventurous character similar to Hank's--I can imagine what Ruby must have been like! I'm so sad that you have lost her.
So time will have her way with us-- I don't expect the power of this loss to diminish for quite a while, but you have brought me some comfort--I am grateful.
Take care--
Hello--my name is Wendy, and I'm so sorry that you're going through this. I have great empathy for you, as I am experiencing similar emotions after losing my little dog companion, Hank, two months ago.
I can tell you that it's common for a person to enter into a state of shock in such an emotionally charged situation--it is indeed a protective mechanism that can help us act when needed. Unfortunately, it appears that things were progressing rather rapidly with multiple disease processes for Ruby, leaving you and your veterinarian with very few options for treatment, and little control over the outcome. It is clear to me, after reading your posts, that you did everything you could to help her, and I'm sure she experienced great comfort in your efforts.
I can tell you from my experience with Hank that is not easy to find a pain medication that works consistently without side effects, or that won't contribute to kidney disease, or any other disease activity that might be going on. Hank did not do well on gabapentin--it made him anxious and unsteady, and as far as I could tell, it didn't seem to help his pain. It is possible that it might not have worked for Ruby either.
I also entered what I call "constructive" shock on the day I made the decision to let Hank go. It helped me remain as calm as possible then, though I felt as if it couldn't all be real--especially because the euthanasia process did not go well. As time has passed, the shock has gradually been released, along with all the emotions that it kept in check! There is absolutely nothing wrong with wishing to hold Ruby again, or with feeling her loss so deeply. To me, it is a reflection of the importance of the bond we have with our little companions. The people who post on this forum understand this (not everyone does)--you are not alone.
I don't know what might bring you comfort at this time--it's different for everyone. Hank was pretty much everything to me, and I am quite lost without him. Some days it helps me to look at photos and videos of him, or to spend time with people who also knew and loved Hank--it keeps the connection alive. Sometimes I find this too painful, and prefer to trace the steps we used to walk together. Still other days I find myself reviewing all the actions I took, especially the last day--while difficult, this has helped me realize how impossible it was to know what to do all the time, and that I also did the best I could. My sense is that I will continue going through this for as long as it takes. I try to be kind to myself--just like Hank was with me--the little rascal chose me to live with so many years ago. He knew I was the right person for him.
Tony described how the years of good memories gradually outpaced the difficult ones at the end for the companions he has lost, and I comfort myself knowing that the painful experiences with Hank are a tiny fraction of all the wonderful times he and I spent together. My emotions are not quite on board with this knowledge, but as you indicated in a prior post, I am taking it a day at a time, grateful that he is no longer in pain.
I am thinking of you and giving you a virtual hug as I write--
Take care--
I can tell you that it's common for a person to enter into a state of shock in such an emotionally charged situation--it is indeed a protective mechanism that can help us act when needed. Unfortunately, it appears that things were progressing rather rapidly with multiple disease processes for Ruby, leaving you and your veterinarian with very few options for treatment, and little control over the outcome. It is clear to me, after reading your posts, that you did everything you could to help her, and I'm sure she experienced great comfort in your efforts.
I can tell you from my experience with Hank that is not easy to find a pain medication that works consistently without side effects, or that won't contribute to kidney disease, or any other disease activity that might be going on. Hank did not do well on gabapentin--it made him anxious and unsteady, and as far as I could tell, it didn't seem to help his pain. It is possible that it might not have worked for Ruby either.
I also entered what I call "constructive" shock on the day I made the decision to let Hank go. It helped me remain as calm as possible then, though I felt as if it couldn't all be real--especially because the euthanasia process did not go well. As time has passed, the shock has gradually been released, along with all the emotions that it kept in check! There is absolutely nothing wrong with wishing to hold Ruby again, or with feeling her loss so deeply. To me, it is a reflection of the importance of the bond we have with our little companions. The people who post on this forum understand this (not everyone does)--you are not alone.
I don't know what might bring you comfort at this time--it's different for everyone. Hank was pretty much everything to me, and I am quite lost without him. Some days it helps me to look at photos and videos of him, or to spend time with people who also knew and loved Hank--it keeps the connection alive. Sometimes I find this too painful, and prefer to trace the steps we used to walk together. Still other days I find myself reviewing all the actions I took, especially the last day--while difficult, this has helped me realize how impossible it was to know what to do all the time, and that I also did the best I could. My sense is that I will continue going through this for as long as it takes. I try to be kind to myself--just like Hank was with me--the little rascal chose me to live with so many years ago. He knew I was the right person for him.
Tony described how the years of good memories gradually outpaced the difficult ones at the end for the companions he has lost, and I comfort myself knowing that the painful experiences with Hank are a tiny fraction of all the wonderful times he and I spent together. My emotions are not quite on board with this knowledge, but as you indicated in a prior post, I am taking it a day at a time, grateful that he is no longer in pain.
I am thinking of you and giving you a virtual hug as I write--
Take care--
1 Comments
Hi Wendy,
Thank you so much for such a heartfelt message. I am very sorry for your loss of Hank. I love his name by the way! Time will help both of us but for now I am working to keep Ruby's spirit alive. I still talk to her everyday and have been doing what you said about walking the steps you took together. We have lost our soul mates and as difficult as it is, they loved us and still do unconditionally. They are like children and when you have that special bond they become even more important than yourself. I honestly feel like I disappeared when she passed. My heart goes out to you and I am very grateful for your enormously kind message. Hugs to you and Hank.
Thank you so much for such a heartfelt message. I am very sorry for your loss of Hank. I love his name by the way! Time will help both of us but for now I am working to keep Ruby's spirit alive. I still talk to her everyday and have been doing what you said about walking the steps you took together. We have lost our soul mates and as difficult as it is, they loved us and still do unconditionally. They are like children and when you have that special bond they become even more important than yourself. I honestly feel like I disappeared when she passed. My heart goes out to you and I am very grateful for your enormously kind message. Hugs to you and Hank.
Hi Tony, It was a month she passed on September 10th. I am struggling with so much grief that I have considered going to counseling. Ruby and I were soul mates and losing her was like part of me disappearing too. I have received wonderful support from Ruby's vets and specialists, but nothing seems to comfort me. We were together 24/7 for a little over ten years since I work from home. The thing I am struggling with is my emotions or lack of emotions during those final three days. I spoke to someone who indicated I may have went into shock or had some mental breakdown which protected me to help me get through losing her. I don't know but sometimes I feel like I am going crazy. I know her spirit is with me but I just want to hold and love on her one more time. Thank you from the bottom of my aching heart.
Hello. There were so many things going on with your little Yorkie that I really cannot answer your questions. Sadly, it could have been a long-term kidney issue - or a short-term one. Long term if it was CKF, and dogs don't show symptoms of it until maybe only 25% of the organs remain unaffected. What this means is the disease could have been progressing for a year or even two years without you or the vet knowing about it. By the time it is diagnosed, it's already late into the disease in most cases.
If it was acute renal failure, the multiple medications could have been the cause - but they were clearly necessary to relieve pain and treat the other conditions. It's always a risk with any medication, but sometimes the risk is necessary.
Palladia is a very powerful and effective drug used to treat mass cell tumours, but it is also problematic. It can cause pulmonary thromboembolism, which may be one reason why your dog was struggling - and it can also cause ulceration of the stomach lining and internal bleeding. Dogs in renal failure often have digestive issues, including ulcers, so the Palladia may have exacerbated it. The hunching of the back may indicate something of this nature was happening.
It sounds like your dog may have had a stroke at some stage, hence the partial one sided issues. This would indicate something was happening to circulation and/or the heart.
I rather feel there was a cascade of several very serious conditions occurring, and they all came to a head at once. There would have been nothing you or the vet could have done to prevent the inevitable.
I realise you feel guilty. This is very natural and very common, despite you having no reason to feel this way in reality. You did your best, and that's all anyone can ask.
I am very sorry for your loss.
Tony
If it was acute renal failure, the multiple medications could have been the cause - but they were clearly necessary to relieve pain and treat the other conditions. It's always a risk with any medication, but sometimes the risk is necessary.
Palladia is a very powerful and effective drug used to treat mass cell tumours, but it is also problematic. It can cause pulmonary thromboembolism, which may be one reason why your dog was struggling - and it can also cause ulceration of the stomach lining and internal bleeding. Dogs in renal failure often have digestive issues, including ulcers, so the Palladia may have exacerbated it. The hunching of the back may indicate something of this nature was happening.
It sounds like your dog may have had a stroke at some stage, hence the partial one sided issues. This would indicate something was happening to circulation and/or the heart.
I rather feel there was a cascade of several very serious conditions occurring, and they all came to a head at once. There would have been nothing you or the vet could have done to prevent the inevitable.
I realise you feel guilty. This is very natural and very common, despite you having no reason to feel this way in reality. You did your best, and that's all anyone can ask.
I am very sorry for your loss.
Tony
2 Comments
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