Support needed please

[Lilahs_mom]

Hello- I'm new to the group. My 14 y/o Maltese Lilah was diagnosed with severe kidney failure. Background- she has had glomerulonephritis for 3 years which has been maintained wonderfully with enalapril (2.5mg BID). She also has autoimmune liver disease (multiple liver bx's with no real diagnosis). Her ALT runs in the 300's and has been like this for 4 years. Liver function has been maintained with denamarin and ursadiol. She has been symptom free. December 27th she ruptured a disk (degenerative disk disease) and was hospitalized. Pumped full of steroids, robaxin and tramadol. She was completely paralyzed. Against all odds, she regained full function. At this time, I had a full chemistry panel run just so I had a baseline. Her BUN/Creatinine were mildly elevated. On March 2nd she ruptured a 2nd disk. We were back at square one with the same treatments. She regained full function again and was placed in a stablizing brace. Since December she has been urinating a lot. I contributed it to the steroids. I expected it to get better since she has been off the steroids for 7 weeks but it did not. Last week she started shivering had vomiting and diarrhea. My vet put her on flagyl and a nausea med. I did that for 2 days. The N/V/D stopped but she had no energy. I brought her into the vet on Monday and had a full chemistry and metabolic panel run. The BUN was 115, creatinine and phos was too high for the machine to read. Vet started fluid to flush the kidneys and started a phos binder. Lilah started eating a little yesterday and perked up a little. Today the BUN was 98, Creatinine 4.5 and phos 14.9. Labs are down but still crazy elevated. All other lab values are totally normal. I'm at a loss and don't know what to do. I do not want her to suffer and am trying to determine if I should bring her home or put her down. I don't want to lose her but I also don't want to keep her alive for selfish reasons. With these labs does anyone have in site from their own experiences how long she has? I know every dog and circumstance is different. I need encouragement from what will be inevitable. Thank you in advance. Rachel

[tonyb286]

Hello Rachel. I'm pleased you joined the group, but saddened that you needed to. There's a lot of conditions there and, frankly, I'm fairly amazed Lilah has made it this far. She must be an extraordinary dog. I can only really comment about the kidney disease, as I really don't know enough about the other issues to give advice. The kidney values are bad. I would say the only way of bringing them back into line (quickly) is by having fluid therapy, which you might want to talk to your vet about. I have no doubt the kidneys have deteriorated partly through all the medications she's been on, as there would have been a huge toxin build up from both the metabolising of the drugs and from the by-products of the drugs themselves. If she isn't currently on a canned kidney dog food (such as Hills kd), then she needs to be, as that will help reduce both protein and phosphorus intake. The alternative is to home cook - but that's a decision only you can make. As to whether the time has come, well, again that's a decision only you can make. You know your dog better than anyone else. Is she happy? Is she in any pain? Is she suffering? Is she still enjoying  more good days than bad ones? These are things to think about while making a determination.

How long ... it's what everyone asks in these situations, and there's rarely an easy or accurate answer to provide. I doubt more than a year and, if things deteriorate rapidly, maybe only a few months. If I were in your position, I would take it day-by-day and assess on an "as-needs" basis.

I don't know if that's helpful, but one thing's for sure ... you are in my thoughts.

Take care

Tony

[tonyb286]

I meant to say, about fluid therapy, talk to your vet more about ... assuming the course has been finished. You could keep doing this at home using SubQ fluids, but your vet would need to instruct you how to proceed.

Tony