end stage renal failure and chf

I apologize up front for having a long post, but I am very anxious for advice. Three months ago Scout, my 15 year old Cocker Spaniel was diagnosed with end stage renal failure. Since then I've tried to get as much information on what to do to make sure she does not suffer. We have a wonderful vet who has worked wonders with the drug cocktails she takes three times a day for congestive heart failure. Our vet is amazed at how she manages to rebound from countless close calls due to chf. He always prepared us for what the end will be like if her heart goes. We have been treating her kidney failure with sub-q injections beginning twice daily and progressing to three when her blood work came back worse than when we started. Now our vet has told us she will most likely succumb to the kidney failure before her heart gives out. My friend is a vet in the town we live in (our vet is an hour away-but worth it) and when I ran her blood work by her she told me to be prepared to make a decision in two weeks. Scout has only very recently become picky about eating. Food is her life. She would eat anything and everything. Now she turns her nose at liverwurst, hamburger, sushi, kobe steak and her all time favorite canned tuna. This is a dog who was restricted to prescription dry food for the past 9 years. She's always been about 5 pounds overweight, and now she seems to be losing weight everyday. Her attitude is still good, she's happy to see us and interested in what's going on about 60% of the time. She is unsteady on her feet and needs to be monitored so that if she falls I'm always there to pick her back up as she is unable to right herself. She is in no pain and still takes all her medication. She has had bouts of incontinence that have become more frequent. I never leave her alone. She is my main concern and has been throughout the past year as her health has deteriorated. She has bouts of vomiting approximately twice a week but has persistent diarrhea. Her last vet visit was three weeks ago and our vet still wanted us to continue with treatment keeping in mind that the end is near. Which leads me to my question; how will we know when it's time without it being too late. We do not want her to suffer after trying so hard to keep her comfortable. Except for her blood work and appetite, everything else is status quo. We have been so completely stressed out mess worrying about her. We do not want to regret waiting too long but some days she seems downright healthy. But as sure as the sun comes up, the only thing we've been able to count on is her unpredictability.
From the posts I've read I am in good company. My heart goes out to all of you. I'd appreciate any advice.
Kathy

[peggy64]

I can't offer you any advice as I am in the same boat with my Sara, a rat terrior, 14 years old with CHF. Sometimes she acts like she is just about gone, and then she will rouse up and bark and act cheerful. At this point I am just doing what I can to keep her comfortable. Until it comes to where I believe there is no hope, we will just keep on this path.

It is very stressful, watching them suffer, and I thought to myself, I don't want to do *IT*because of my discomfort. does that make any sense? But you have to do what is best for you and your whole family, including Scout. You will make the right choice....

Anyways, I do feel your pain. just keep loving and petting and talking to her as long as you have her. Thats what I will do....

[chasha33]

I am so sorry that your baby is ill,But  in your heart you know what is best.I had a little Peke that was almost blind,had a stroke was on subques twice  a day he couldnt walk he was wearing baby diapers he had no lower jawbone due from a previous home where he had been abused They had hit him in his face so hard that he lost his lower jawbone and i had to hand feed him every meal with a baby spoon.I promised him when i got him that i would not let anything or anyone ever hurt him again.He was so sick as he aged,But i could look in his eyes and see his will to live.I kept him as comfortable as possible and i would tell him that he could let go that i would understand,But he wouldnt give up.He just couldnt leave me.The months went by and no one could believe how tough he was.My vet was amazed at what a tough little guy he was.I would hold him in my arms and tell him all the stories of our good times together.He would just listen and nuzzle his head in my chest.Even though he couldnt see,His tail would wag when i would walk into his room.I knew in my heart that my Bernie was content and still happy.One evening i had to run into town 3 days before Christmas,I gave him his meds before i left and kissed him and told him i would be back shortly.I was in a store and i had a strange feeling overwhelm me.I told my husband about it and we headed home.When we got in,Before i ever opened his bedroom door i knew that he was gone.I believe that he held on for a reason.I had just told him earlier that week that he was going to be a big brother,I was expecting and i think that he knew that i would be ok.If you are fine with taking care of your baby and you know that you want him to make the choice of letting go on his on then that is what you need to do.For humans we have Hospice...Why dont people offer that to there on fur babies If a person is fine with offering that care to them.From what i have read of your post it seems like that is exactly what you are doing and i have to praise you for that.It seems like your vet is helping you out tremendously with it as well.So just follow you heart and the rest will fall into place.I promise you that!!! If you ever need to talk,Please dont hesitate to contact me.You are both in my Prayers...God bless you both

[kathycindy]

Thank you for your kindness and encouragement. It amazes me that total strangers are in sync with what Scout, Cindy (my partner of 20 years) and I are going through yet I feel criticized and judged by some members of my own family. Cindy and I really don't talk about what we are going through with many people because of the stigma that we are keeping Scout alive out of our own selfishness. Our next door neighbors didn't even know that Scout was sick until yesterday. We still bring her outside to do her business every two hours as she is usually able to walk for a couple of minutes slowly. (This is not to say she does not have accidents. My house is one big wee-wee pad, literally). My neighbor and her little boy stopped to chat and during the 10 minute conversation Scout fell four times while sniffing around. This family of four has seen us every day, several times a day since Scout was a baby. Therein lies the rub. She looks too good to be this sick. After speaking with our vet yesterday we have some definite cues as to when she may be ready to go. As soon as she goes more than 24-36 hours without eating, won't take her meds or her bouts of vomiting become persistent in their frequency and/or intensity. Does this sound about right?
PS after lamenting about her waning appetite yesterday morning, she made a liar out of me by eating like a freaking horse for the rest of the day. I'm pretty sure that she is just messing with our heads sometimes :) I'm going to the bakery now to get some crumb cake for our Sunday morning treat. Here's hoping she eats more than I do.
Thanks for listening. Have a great Sunday.
Kathy

[Thomas Dock, CVJ, Vet. Technician]

Just a thought...you might want to visit the Ask a Vet Forum and look for Dr. Jim Humphries.   He has a great blog article about hospice care for pets

[chasha33]

Please dont get down about what others say.People want to pass judgement on others so easily,But just because you dont want to let your baby go does not make you selfish.It only means that you love him with all your heart.Look at it like this if it was someone elses baby they would want to keep them as long as possible...Right.Just from what you have said about Scout,I wouldnt give up on that baby.The two of you just give him all the love that you can and cherish every moment that you have together.Give him his meds to ease any discomfort and let him decide when the time is right and he will do what is best.You are in my prayers.

[kathycindy]

I posted yesterday but I don't see it here. We had to bring Scout to the emergency hospital on Sun afternoon. She stabilized and we took her home. I talked to my vet yesterday and he was very concerned about her most recent lab tests that were done at the hospital. She fasted yesterday but got meds and subq. She looks a little better today and is hungry which is good. Vet said that we might want to make a decision this week if she does not improve. We'll see how today goes.
Thank you for listening and for your support and encouragement.

[chasha33]

I am so sorry about Scout getting sick over the weekend.I was just wondering are you considering taking care of him all the way till the end and letting him go on his on?With my Peke that is what i did.I gave him subques at home and handfed him and when he was unable to walk any longer he wore his baby diapers and i would take him out several times a day and let him use the bathroom that way as well.I kept him medicated and comfortable and made sure that he wasnt suffering.He was respondent all the way till the end.I am at peace with the choice i made.I had alot of people criticize me for it.But i knew him better than anyone.And i believe what i did was the right choice for him.So if that is what the two of you want then i support you with your choice.Either way you know in your heart what is right and you will make the right choice for your baby.Just dont let anyone pressure you into something that you dont feel is right in your heart.I am sure that your vet will help you either way.If you need to talk anytime i will be here.God bless you two.I am praying for you both.Chan

[kathycindy]

to chasha33
thanks for your support. scout did not have an appetite yesterday and refused her meds though we wore ourselves out trying different ways to disguise them. she is still able to go on short walks to go to the bathroom. we take her outside every 60 minutes for as long as she wants. our first priority is to get her to take her meds and then to get her to eat something. if she refuses then we have a problem. we are heartsick. we would love to let her die at home but we don't want her to suffer any pain. how did you manage keeping your dog comfortable? also, what was it like during your last days with your Peke? we know exactly how you feel about being criticized and judged. that is one of the reasons i decided to join this forum - to be with like-minded people.
hopefully, i'll have better news later.
kathy

[ziggystardust]

My heart and prayers go out to all of you. I lost my beautiful australian  at the age of 11 to renal disease three years ago and prayed I would never have to loose another pet to it only to find out in May that my 9 year old ginger has it due to lymes disease.She has seen numerous specialist and is undergoing acupuncture with a great vet. She receives iv fluids at home and is also on traditional medications for nausea and lack of appetite although she has not been vomiting for except one small episode. her labs were not that impaired but the irony is she has stopped eating except for small bites of this and that here and there and that is with being on medications and treatments. she has had other tests including an ultrasound that was negative> When people see her they say she doesnt look like a sick dog but no one can diagnose why she will not eat. Im astounded that she still has energy and goes out t greet and bark at people with her tail wagging although she has stopped playing with the other dogs. I feel so hopeless and helpless. When is it time to let go.  Last week I thought we hit the jackpot with a new medication because she started to eat like her normal self but this lasted only four days.  A good book for anyone who believes in alternative medicine in addition to traditional is Diane Steins alternative care book for pets.

[kathycindy]

it sounds like we are in the same boat in that our dogs that are extremely ill but don't look sick. as far as knowing when it is time to let go, i think that it depends on whether it's possible that your dog will get better with time and medication. with scout we knew that any medical intervention would only delay the progression of the crf. we were told by our vet that if she goes more than 48 hours without wanting to eat we need to make a decision.
we had taken her down to our summer house on the nj shore on tues hoping she would perk up bc she loves it there. we came back home today bc she is really not interested in food and won't take her medication. also, she had another bad case of diarrhea and soiled herself bc she has trouble getting up. she is very lethargic. cindy and i both agree that her quality of life will only get worse so we made an appt with our vet for tomorrow. we are going try to enjoy our last night with her.
kathy

[ziggystardust]

DEAR KATHYCINDY; I AM SO SORRY TO HEAR THAT SCOUT IS NOT IMPROVING. TO HAVE TO EUTHANIZE YOUR PET IS ONE OF THE MOST HEARTBREAKING THINGS A PERSON CHOOSES EVEN WHEN THERE IS  NO DOUBT IT IS THE RIGHT DECISION IF QUALITY OF LIFE IS NOT THERE, I  HAVE UNFORTUNATELY HAD TO MAKE THIS CHOICE SEVERAL TIMES IN THE LAST 12 YEARS AND IT DOES NOT GET ANY EASIER. AS A LAST TRY YOU CAN TRY ALTERNATIVE MEDICATION WHICH HAS NO SIDE EFFECTS AND IS NOT EXPENSIVE. THERE ARE SEVERAL PELLETS YOU CAN PURCHASE FOR DIARRHEA AND VOMITING AND EVEN INCONTINENCE . IF YOU GO ON LINE OR HAVE A HOLISTIC VET NEAR YOU OR EVEN CALL NUTREE PHARMACY IN JACKSON NEW JERSEY KEVIN THE PHARMACIST CAN  GIVE YOU A CONSULT OVER THE PHONE WITH NO CHARGE AND HE IS WONDERFUL.  732 367 0688. HE  
MAY SUGEST SOMETHING THAT YOU CAN PURCHASE LOCALLY AT WHOLE FOODS OR A HEALTH FOOD STORE. IT CANT HURT. LOVE AND PEACE ROBIN. I WILL PRAY FOR YOU AND SCOUT

[kathycindy]

i appreciate your concern for our baby. unfortunately she is in a severe azotemic state. even if we could control her diarrhea and vomiting, she still falls over constantly when she tries to walk and can't get up from a seated or lying position without us picking her up. for the past three weeks either cindy or myself have always been with her. she has never been left alone in the house. however, even if we walk out of the room for two minutes, we often return to find that she has urinated or pooped without even knowing it (sleeps through it). all that combined with the fact that she won't eat, take her meds, and only has 15% use of her kidneys. basically, we would be very selfish to continue trying to keep her alive although it breaks our hearts. we go this morning at 10:30am. we know that we are doing the right thing but we can't stop crying when we think about coming home without her.
i feel hollow inside.

[ziggystardust]

MY HEART BREAKS FOR YOU AND I TOO OFTEN HAVE COME TO KNOW THAT HOLLOW FEELING. EVEN THOUGH MY PRECIOUS GINGER IS STILL WITH US AND BARKING AND CONTINENT SHE STILL REFUSES TO EAT EVEN BEING ON WHAT HER VET CALLS THE SILVER BULLET PREDNISONE  WHICH IS THE THIRD STIMULANT WE TIRED. IT IS EVEN MORE HEART BREAKING THAT MY DOG HAS COME TO ASSOCIATE ME WITH TREATMENTS AND SO WHEN I GO TO GIVE HER FOOD SHE REFUSES IT AND WILL ONLY TAKE TREATS FROM THE MAN NEXT DOOR AND THAT IS NOT ENOUGH TO SUSTAIN HER. SHE EVEN REFUSED STRAK FROM HIM. MY PRAYERS FOR SCOUT AND MAY HE BE WAITING FOR US ON THE OTHER SIDE OF THE RAINBOW BRIDGE WITH MY OTHER LOST FRIENDS.

[kathycindy]

we had to have our beloved Scout euthanized yesterday morning. she passed on peaceful.  there was no question that it was time. it was emotional for everyone. all the vet techs cried and our stoic vet even had tears in his eyes. he said that she was being spared the worst part of the disease. i was shocked at how fast her condition worsened. any further intervention on our part would have been selfish. we did all we could not to cry in front of her so she wouldn't get nervous. we held her until little heart stopped and then broke down. it was so hard to walk out the door without her. we are struggling today. our two cats and houserabbit are looking around for her like crazy.
thank you for support and kindness.
kathy

[kathycindy]

i don't know if this will help but when we starting administering subq fluids we would reward  Scout with some to her favorite foods. soon she began associating the treatments with the reward. when she would see me begin to warm up water for her iv bag she would go to her bed and wait for the injection. this worked until she began refusing food.
would it be possible for you to skip treatment for a day or two. if so, maybe you can trick her by going through the motions of treatment but give her a reward instead of an injection.  also, we had some success with Hill's Prescription Diet a/d canned food. it is prescribed for dog/cats with cancer who are trying put on weight while going through treatment. it is very rich and you only give about a teaspoon mixed with water over whatever your dog will eat. when Scout refused everything else that was our last resort. after she ate it her appetite increased dramatically for a day or two. however, her digestive system couldn't handle it and her diarrhea worsened.
my heart goes out to you.
kathy

[chasha33]

I am so sorry for the loss of your baby.My heart breaks for you.I will keep you in my Prayers.You did what you knew in your heart what was right.You never let anyone pressure you into anything.I will continue to pray for you and your loss...                                                                  God Bless...Chan

[kathycindy]

thank you for your support. it has been tough not having Scout around. we miss her terribly. we still cry every day. however, we know that she had a great life and we were very lucky to have had her for as long as we did. our vet said that we did everything we could medically. after all she went through we didn't want her to spend her last days in pain. it was obvious even to us that she was close to death. during the last 24 hours she could not walk more than one or two steps before collapsing. it was heartbreaking to see her like that.
we were so lucky that we were able to afford her medical care. it has opened my eyes to the fact many people delay going to the vet because of the cost. we have a couple of neighbors with pets who lost their jobs so we try to help them out with their vet/medication bills as much as we can. animal lovers need to look out for one another.
kathy

[chasha33]

I know that you loved her dearly ,I can tell just by the way you speak of her.Just always remember she will never leave you as long as you keep her memory alive in your heart.July 31st i took my little girl Peke and her brother to the vet to have there nails done and an hour later they called to tell me that she was gone.She was just 7 years old and in good health.They used Telazol on them to relax them enough to do there nails and shave there feet.Her heart stopped within 3-4 minutes of the med and we dont know why.I had her sice she was 4weeks old.She was my daughter and my best friend.I never imagined that when i carried her in there that day how i would leave there with her.I have tried finding out more about anyone having side effects like that with the med,But nothing has really helped to  explain this for happening.I had planned on her before her biological mommy was even pregnant with her.I feel so empty,But just like i was telling you as long as there memories lives we never be alone.Love ,Chan

[baileykari]

Tag: End stage renal disease with stones and CHF

I read your post about your little Peke. My Jake is 12 years old and had been having Congestive heart failure with MVD and PAH for several months and was on medication. At the hospital the internist said that he was in endstage kidney disease.
He has severe hydronephrosis and a 5mm stone is stuck at his aclyceal ureteral junction. His bladder, and both kidneys are full of stones.
All his kidney labs were normal in June. His BUN now is 130-140 and creatinine 10-12.
They wanted me to euthanize him as they said nothing can help. We are both Physicians and we contd. his IV fluids from 1/19 till this morning(10/26). He has recvd his first SQ. this morning. He is 17 lbs. Another vet also called me selfish and told me that he needs to be put down. He has improved, and eats some chicken and I give him all his meds. He is very patient and very good and allows us to help him inall ways without making a single sound. His eyes follow me around all day long.
Because of the CHF and kidney disease and lithotripsy not being  available for dogs
they feel he is at a dead end. They also said that nephrectomy was not an option as both the kidneys were so bad.

Euthanasia is not an option. he seems quiet and walks OK and sleeps a lot.
I am giving him aloe vera with honey and water through a syringe as my Japanese friend said that it is very helful. I just put the syringe through the side of the mouth and gently push the syringe. He eats chicken and sometimes rice and cottage cheese(low fat).
Please tell me what foods I can give him that he will like and any treatment you know taht can dissolve his stone. Otherwise, I just want to love him and keep him comfortable till he dies. He seems tired but walks well and has a regular bowel movt. No diarrhea or vomiting. Pees every 2 hours.

Please help me with advice. Thanks

Shari

[KatrinaSirju]

I am going through the same tough time. Today I took my 4 year old dog hope to 3 different hospitals because she had been in the hospital for 10 days for kidney failure and their was no progress. She is only getting I broke down and started crying when the doctor told me she is not optimistic about her getting better. Im only 18 and I thought she was going to live a long and healthy life with me. It's very hard to say goodbye but the doctor made it a option. I just picture all the times I had with her and imahining her big brown eyes looking up at me when she takes her final breath.I don't want her to suffer anymore. Tomorrow I get the results to make the hard decision. I pray that I don't have to say goodbye so soon

[chulai]

I am so sad that my 12 year old sharpei has renal failure i feel helpless as he would just not eat.he is on Iv weekly im giving him holistic meds trying everything i just lost my 5 yr old sharpei to cancer  2 weeks ago. What more can i do.Brian South Africa