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82861 tn?1333457511

Old Dog - Seems to be Failing

I'm really happy with our veterinarian, but want to run this by you since it never hurts to have another opinion.  :-)

My dog is over 13 (near as we can tell).  She has always had a somewhat touchy digestive system for as long as we've had her.  Every so often, she'd go through a few days of diarrhea and/or vomiting, but never lost her appetitie or energy.  She's always been a "type-A" personality and interested in everything that happens around her.

Four years ago she blew out her ACL and had TPLO surgery.  Recovery went well and she was back on 4 legs again.  Arthritis is a big problem now and she falls down sometimes when that leg just gives out, but generally gets around fine.  Until recently, she has been on Deramaxx since the surgery.
6 Responses
234713 tn?1283530259
The Chinese herb Rehmannia 8 may help for the kidney failure,  Sub-Cutaneous fluids that can be administer at home should help.  Has your veterinarian performed a urine culture and sensitivity?  Are you sure this is not chronic rather than an acute kidney insult?  If you supply all your symptoms and test result I can devise a list of other Eastern and Western herbal remedy's that may help.  
82861 tn?1333457511

Over the summer months, she just started losing energy.  Walks got shorter and shorter, and we put it down to the arthritis.  On Nov. 7, I took her to the vet because she was throwing up a lot (usually during the day and mostly bile).  She also lost complete control of her (full) bladder on our bed a couple times, which has never happened.  No sign of minor leakage anywhere - it just cuts loose when she's fully asleep and relaxed apparently.  Her urine test (dip stick) showed a lot of blood, a little high on the protein end, and a little high on white cells.  Started her on oral baytril twice a day.

The vomiting just got worse, and after 5 days, the vet took her off the baytril.  I stopped the Deramax at the same time.  We added reglan twice a day, which seemed to be a big help, and also tried a wormer just in case.  I can't remember the name of it, but it was yellow liquid in a syringe, and given in 3 daily doses for a possible stomach parasite.  

Nothing helped and she's just getting slowly worse with every passing day.  On Nov. 7, she weighed 52 pounds, down from 60.  On today's visit, she is now 46 pounds.  Did another urine stick test and it's only slightly better.  We'll get liver panel and pancreas results tomorrow.  An x-ray film showed nothing really remarkable other than some pretty obviously thickened intestinal walls.  No bladder stones, tumors, masses, etc.

Pending blood results, she got injections of abx, reglan, and an anti-inflammatory.  Also trying another wormer for whip worms.  She has pretty well lost all appetite now, and I can only tempt her with lunch meat.  She won't even touch white rice any more or her favorite treats.  Since the deramaxx really upset her stomach, I have discontinued it, and am very curious to see what her liver panel shows tomorrow.

After all that - any ideas on what might be going on?  Do dogs get Chrones Disease?  What else can cause thickening of the intestinal walls?  What else can cause blood in the urine?  Are there any probiotics that might help with the appetite and bowel function?  I know she's an old dog, but she's not ready for euthanasia yet, and I just want to keep her as comfortable as possible for as long as possible.  Many thanks!
82861 tn?1333457511
:-(  Well, we got our answer today.  She's going into kidney failure.  Amylase 1718, BUN 84, Creatinine 5.5, TCO2 15, Potassium 3.7

We're going to try some meds and a low-protein diet and see if we can get her feeling better for as long as we can.  I'd appreciate any other ideas you might have to keep her comfy.  Thanks!
82861 tn?1333457511
We're not at all sure when the kidneys began going south, but she's been overall slowing down in activity level, "barfy" and a little off her feed all summer.  The change happened so slowly that I didn't get really concerned until about a month ago when she peed the bed twice and the vomiting became a daily, sometimes 3 times daily, event.

Here is all the lab work:
Alk Phos:      14  (10- 150 u/l)
ALT (SGPT)   31  (5 - 107 u/l)
AST (SGOT)  24  (5 - 55 u/l)
GGT             120 (10 - 200 u/l)
Amylase       1718 (450 - 1240 u/l)
Lipase           399 (100 - 75 u/l)
Albumin         3.4  (2.5 - 4.0 g/dL)
Total Protein   7.3 (5.1 - 7.8 g/dL)
Globulin          3.9 (2.1 - 4.5 g/dL)
Total Bilirubin  0.2 (0.0 - 0.4 mg/dL)
Direct Bilirubin 0.2 (0.0 - 0.2 mg/dL)
BUN               84 (7 - 27 mg/dL)
Creatinine       5.5 (0.4 - 1.8 mg/dL)
Cholesterol     231 (112 - 328 mg/dL)
Glucose           81 (60 - 125 mg/dL)
Calcium         12.9 (8.2 - 12.4 mg/dL)
Phosphorus    6.1 (2.1 - 6.3 mg/dL)
TCO2 (Bicarb) 15 (17 - 24 mEq/L)
Chloride          114 (105 - 115 mEq/L)
Potassium      3.7 (4.0 - 5.5 mEq/L)
Sodium          149 (141 - 156 mEq/L)
A/G Ratio       0.9
B/O Ratio       12/9
Indirect Bilirubin  0  (0 - 0.3 mg/dL)
Triglyceride       66 (10 - 100 mg/dL)
NA/K Ratio       40 (27 - 40)
Hemolysis Index:  + (Index of N, +, ++ exhibits no significant effect on chemistry values)
Lipemia Index:      N (Index of N, +, ++ exhibits no significant effect on chemistry values)
AN/ON Gap       24 (12 - 24 mEq/L)
T4                    1.1 (0.8 - 5.0 ug/dL)   hypothryoid?
WBC                6.6 (5.7 - 16.3 THOUS/uL)
RBC                 6.75 (5.5 - 8.5 MILLION/uL)
HGB               16.0 (12 - 18 g/dL)
HCT                 48.9 (37 - 55%)
MCV                72  (60 - 77 fL)
MCH               23.7 (19.5 - 26.0 pg)
MCHC             32.7 (32 - 36 g/dL)
Neutrophil Seg  67 (60 - 77%)
Neutrophil Bands 0  (0 - 3%)
Lymphocytes     18 (12 - 30%)
Monocytes          7 (3 - 10%)
Eosinophil          7 (2 - 10%)
Basophil            1 (0 - 1%)
Auto Platelet    336 (164 - 510 THOUS/ uL)
Absolute Neutrophil SEG    4422 (3000 - 11500 / uL)
Absolute Neutrophil Band   0 (0 - 300 u/L)
Absolute Lymphocyte   1188 (1000 - 4800 /uL)
Absolute Monocyte       462  (150 - 1350 /uL)
Absolute Eosinophil      462 (100 - 1250 /uL)
Absolute Basophil          66 (0 - 100 / uL)

TH Plus with UA and Spec cPL
Color                       Yellow
Clarity                      Clear
Spec Gravity             1.010
Glucose, Bilirubin, Ketones: all negative
Blood                       Trace
PH                           6.0
Protein                     Negative-trace
WBC                       2-5  (0 - 5 HPF)
RBC                        0-2 (0 - 5 HPF)
Bacteria                   None seen
Epi Cell                    2+ (3-5)
Mucus, Casts, Crystals:  None seen
Other:   Amorphous debris present
Urobilinogen              Normal
SPEC cPL               134 ( - ug/L)  normal range
82861 tn?1333457511
The question limit has been reached for the past 2 days, so I hope you might see this additional post on Chica.  

Thursday evening, she began trembling, and had very fast and shallow respiration.  It worsened Friday morning, and our vet had us bring her in yesterday afternoon.  He said these symptoms really had nothing to do with her renal failure, so we re-ran her bloodwork.

Friday evening after her round of meds with food, she got noticeably worse.  The only thing I could think of was that the reglan was causing the trembling and new symptoms.  I looked up reglan toxicity, and it appears I was correct.  Chica's latest results were faxed to us, and in 4 days, her BUN went from 84 to 148; Creatinine from 5.5 to 7.2.  Since Reglan is processed in the kidneys, and her kidneys are so much worse, I'm assuming she built up toxic levels of reglan and experienced an extrapyramidal result.  I gave her one benadryl last night, and that helped calm down the trembling.  By this morning, it was all gone and her breathing is normal.

We are taking her on one last road trip tomorrow for a week at a river house.  This dog just loves to travel.  Our vet gave us a referral to another doctor in that area in case we have an emergency or need to euthanize in the next week.

Since reglan obviously won't work for Chica, and Pepcid doesn't seem to make any difference, what else can I use for nausea?  I have plenty of phenergan, but don't know if dogs can take it.  I can't reach my vet today or I'd ask him.  We left him a message, but the idiot at the front desk fouled up the communication and he's gone for the weekend.  I'd really appreciate any advice you can give on nausea meds that aren't processed through the kidneys.  So far, she is still eating well on the renal diet of hamburger, rice and a small amount of egg.
234713 tn?1283530259
Sadly kidney disease is the most frustrating problem in medicine, and I am sorry Chica has renal failure!  

There is a new anti-nausea medicine called Cerenia which would be worth a try.  Benedryl also has an anti-emetic effect and she seems to tolerate it.  She should also be on Sucralfate and Tagament (one hour post Sucralfate).  Her kidney enzymes are getting worse, but she doe not have anemia yet.  Dogs with kidney disease can become anemic because the kidney produces enzymes necessary for the production of blood.   There is also a possibility that she may be hypothyroid, to confirm your vet could perform a free-T4.  However, it could be low secondary to disease.  Has she ever had Lyme disease which could have caused nephritis?

Have you been giving sub-Q fluids at home?  Have you had a cystocentesis to acquire urine for a sterile culture and sensitivity?  You cannot use a free catch urine since it will give false positive results due to contamination from bacteria on the surface of the urethra, etc.  Also a bladder, kidney, and  abdominal ultrasound is important because it shows much more than an X-Ray.  Some bladder and kidney stones can only be visualized via ultrasound or other, more complex diagnostics. The very low specific gravity found in the posted urinalysis could indicate pyonephritis, which is a infection of the kidneys and much more difficult to treat.  

Unfortunately, she may have more than one problem occuring, one in the digestive tract and another unrelated problem occuring in the urogenital tract, and due to the severity of the symptoms she could also have something significantly wrong, such as cancer.  If all else fails I would seek the assistance of a holistic vet, which you may be able to find at your travel destination or on the way.  Please check with the American Holistic Veterinary Medical Association website for a holistic vet.  When all else fails in traditional medicine there may be an answer in holistic medicine.  Please let us know how it goes!
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