Yorkie Poo - Dior - 3rd or 4th Stage CKF

[Lindsey0203]

Hello Tony,

I am so excited to have joined this group. It makes me feel better to talk to other people that understand what I am going through. I wanted to ask you about the pain medication my little Dior is taking and if you think it's a good idea for him to continue using the medicine. Dior is a yorkie poo and he is 9 years old and will be 10 on May 4th. He is my little baby and just like others on this site, I love my dog sooooo much! Dior was diagnosed with Chronic Kidney Failure in January 2016, his vet kept him in the hospital for 3 days until his levels went down (they went down, but they never went back to normal). I decided to switch vets because one of the nurses recommended that I think about putting Dior to sleep. This was so devastating because Dior was still eating, running around, and still had so much energy. I would have never known anything was wrong with him if it wasn't for his blood results. I only went to the Vet this day because Dior was having dental work and I decided to do the pre blood work before his dental surgery and that’s how I found out he had Kidney Disease. Well, I decided to try two other vets because I was so hurt by what the nurse said. The second vet did a blood test and confirmed that he was in 3rd to 4th stage Chronic Kidney Failure, his blood results were so high because he was vomiting about three times a day because the original vet gave him a medication called Clavamax (for his UTI infection), which ended up being way too strong for him. Once I discontinued the medication, he was somewhat back to normal. The second vet also did a needle aspirate on this bump he had and the results confirmed that Dior had a testicular tumor. Dior was neutered 8 years ago but for some odd reason the vet that performed the surgery did not remove all the tissue and this tumor formed (sad news!!!!!). So I went to a third vet and he also recommended that I remove the tumor once Dior’s blood levels go down.  Once the blood levels lowered, the vet performed the surgery. The vet did not give full anesthesia, he did local anesthesia in just the area around the tumor. Dior had the tumor removed two weeks ago and the same day of the surgery, he was running around and playing as if he never had surgery. The doctor gave me Tramadol for his pain and an antibiotic. After about two days, Dior was vomiting and I was told to discontinue both medications. I stopped the medication and he seemed to have been doing better. A couple of days ago, I called the doctor and told him that Dior was playing with my other dog and is now limping and does not have any energy at all. He told me to give him the Tramadol again. I started to monitor him and noticed that he wasn't getting better and that he was just laying around. He could barely walk! I took him to the doctor this morning and he recommended that they keep Dior until Wednesday so they can perform fluid therapy. They also noticed that Dior shoulder was swollen and dislocated.  He did a blood test today and the blood results were BUN  102 and CREA  4.3. I do not have the other results, but about a month ago, his BUN was 72, CA 13.0, PHOS 8.4, CREA 3.4. He was taking aluminum hydroxide last month, but he is now taking Epakitin. I give him 100mg of SUBIV every other day. I have cried so much because I don't know if the surgery was the right thing to do, but since two different vets told me it was the best thing to do, I did what they said. I also don’t know if I should continue with the medication.
I have done soooooo much research on this disease and I have tried so many things,  I give him half of a B 50 Complex vitamin (I read that this is great for dogs with Kidney Disease), I also give him a fish oil pill everyday, I give him Dr Harveys Coenzyme Q10 vitamin, and I give him a Pepcid, and I make sure he has fresh water everyday. I get him back on Wednesday and if there is anything you think I should stop doing or start doing, I would love to hear your advice.  I know its not time for Dior to leave us, I know he has more time with us and I just want to make sure I am doing everything right. Thank You.

[tonyb286]

Hello. Well, you and Dior have certainly been through a tough time, haven't you. It's always difficult to say whether or not to go through with surgery for a tumour, because there is a question over the stress and pain associated with surgery (and the potential for infection and fatigue afterwards), balanced against the quality of life and repercussions of not going ahead with it. Sometimes, particularly with very early caught cancerous tumours, surgery is pointless, because the likelihood of a dog surviving the kidney failure long enough for the cancer to become a really big issue is slim. I guess it's a very individual situation for each dog and each owner - and the vet's advice is the best to go with, because they will know the urgency requirement to treat or not.

I think, on balance, you seem to doing pretty much all the right things in terms of the chronic kidney failure (CKF). Hopefully the fluid therapy will bring the numbers down and you can then continue with SubQs at home for some more weeks to help stabilise things even more.

Did the vet say why they changed from Aluminium Hydroxide to Epakitin? Epakitin can be a good choice, as it helps nourish a dog that is under-nourished and can lead to a slowing of the renal disease's progress.

I am now wondering what you are currently feeding Dior? As it's stage 3 or 4, you need to be on a kidney specific diet - low phosphorus, restricted protein, low sodium. Canned varieties of manufactured foods are better than dry dog foods. One of the things it's quite hard to control, but nontheless very necessary, are treats (all the extras we give between meals). Many treats contain high phosphorus and various unwanted chemicals and preservatives, so pay particularly close attention to these potential problems.

Tramadol is okay short term, while Dior is getting over the pain of surgery, BUT it is absolutely essential that a lower than recommended dose is given for any dog with kidney failure. The reason is the drug's byproducts have to be processed and excreted by the liver and kidneys, and this will add stress to them.

The supplements are fine, although if you are giving fish oil do check that the supplement you are giving includes vitamin E (some fish oils deplete this vitamin in the canine body and it therefore needs replacing with another supplement).

The next stage is really to have post-surgery blood checks done in another week or two. Once you have these results, post them here.

I also have an article of mine you may find of value, which explains the changes in diet necessary for stage 3/stage 4 ...

http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease

Regards,

Tony

[jm0203]

Hi Lindsey,
I totally understand how you're feeling... My dog's doctor said he would need to be put down, but I switched to a specialist, and he is very optimistic about my dog's recovery. I am so glad to see that you took Dior to multiple vets! Please check out my posts; one is Emotional Support and Joshua Update. I hope that info can help... Let me know if there's any way I can help!
Jasmine

[pepsibaby]

I too have a Yorkie with Kidney Disease (and Heart Murmur). At first his numbers were so scary I thought he would go very soon. I got his BUN to go from 224 to 93 in 2 months and started to relax and enjoy him again. Now that his numbers have gone up again (BUN 258 Creat 2.9), I am terrified all over again. He is taking similar meds as your baby. Sometimes I think my Pepsi gets depressed so yesterday my sister visited and brought her Yorkie. My Pepsi barked and chased and ran, actually ran, with the other dog. Even after they left, he was so excited he could not sleep, and this morning he ran to the kitchen looking for his new friend. I was so happy to see the old Pepsi again. There will be good days ...sometimes only a few good hours... and very bad days but I noticed that when I was depressed he seemed to sense it and was depressed too...
wishing you and Dior the best, I so totally understand...

[Lindsey0203]

Thank you so much for responding. You are so right, I've noticed that some days are good and some are bad. The bad days hurt so much, but I try to stay positive. Yes, I think Dior senses when I'm depressed also and then he gets depressed. I try to stay upbeat on his bad days but its so difficult for me. I look at him and just start crying. Thats so good that you were able to get Pepsi numbers down. It was so sad to hear the doctor tell me that so many people give up on their dogs when they are diagnosed with kidney failure, but he told me that dogs can live for years if the owners just stick to the right diet and SubQ Fluids. I wish you and Pepsi the best also! Thanks again! Happy Easter!