How does she know there's only 15% kidney function remaining? Has your dog had a scan? This would be the only true way of determining this.
I honestly feel your vet is talking nonsense about SubQ fluids. IV fluids are expensive (maybe the reason she's happy to do it for you). And IVs are more extreme, so they are meant to kick-start a fall in creatinine levels, but SubQs are then needed to maintain the treatment. I can only repeat that there is absolutely no reason you cannot undertake SubQ fluids at home, with veterinary support, as this would be far less stressful for your pup. This is very common practice in the UK, USA, and many other countries - so not sure why your vet is being so obstructive.
You don't need a prescription for Milk Thistle. It's a herbal supplement you can get easily at health stores - or just Google it and see if you can get it supplied by mail.
It's worth asking your local pharmacies about cerenia and whether they can compound it and/or supply it for your dog. If not, then as long as there's not a long wait, you may just have to hold on till your vet gets it.
Mirtazipine should be given in a low dose every day - not just every now and then. SubQ fluids are the same - every day - and to the right dose for the weight of your dog. You should not be giving IV fluids yourself, as it is more intense and things can go wrong very easily when you are injecting straight into the bloodstream.
I would tend to consider trying for a 2nd opinion from another vet. You don't have to leave the one you are with, just get a 2nd opinion. Another vet may be more amenable and more proactive.
Tony
Hi. So I went back to the vet this morning to discuss Jabu and what we can and should do.
She's gave me a subscription for Mirtazipine and another for Ondasteron. Cerenia is not available at the moment from their supplier. I don't know if its just in the Eastern Cape or the whole of South Africa. Do you think I should phone a few pharmacies or maybe the manufacturer. The vet did ask for a some as soon as it becomes available. Is there anything else I could ask for?
My vet is also still not budging on the SubQ fluids. She is more than happy to place him on an IV as many times as he needs it, though. I also think I would be able to convince her to let me administer the IV at home if I have to. She says to just bring him in whenever he looks like he might need it. Does he still need SubQ if he is getting a drip? She says no, I just want to double check.
I forgot to ask about the milk thistle. I'll phone and find out if they can give me a prescription or if I can just pick it up somewhere.
She suggested I increase the doses of Ondasteron and will be ordering the injection for me, if he continues to vomit even with the higher dose. She said to give him the Mirtazipine when he looks "off". Or over a weekend when I can't take him for a drip etc.
My vet said she suspects Jabu only has about 15% of his kidney function. She is a great vet, but I'm a little concerned that she might have already given up on him. I'm hoping he'll be around for a while longer.
Thanks so much for all the advice. I really, really appreciate it.
Hello. Your vet seems to be doing all the right things. The metaclopramide and Ranitidine are to deal with nausea and vomiting. This is only one option for this symptom, so if it doesn't seem to be working after a few days, let me know and I'll suggest alternatives.
The Amphogel is basically aluminium hydroxide, a phosphate binding medication that aims to reduce dangerously high levels of phosphorous in the blood.
Did your vet get you to do SubQ fluids after they completed the course of IV fluids? I'm assuming not, but this is necessary to maintain the work done by the IVs. Talk to your vet straight away and ask to start SubQ fluids at home - they will need to teach you how to do it and provide you with the fluids (Lactated Ringer Solution). You should continue with SubQ fluids daily for the next month (at least), having bloods taken every 2 weeks to see what impact the fluids are having on creatinine and other values.
Getting your dog to eat may take a while longer. You can try enticing him with a few tricks ... a teaspoon drizzle of natural honey on the top of the kd food sometimes works, as does a desertspoon of chopped cooked green cabbage, or all natural (unflavoured and unsweetened) yogurt. If these fail, get your vet to prescribe Mirtzapine.
Did your vet take his blood pressure. 90% of dogs with kidney disease also have high blood pressure, and it always seriously and adversely impacts on kidney function. If they didn't take his blood pressure, this is an urgent priority.
I am giving you links to two of my articles on Diet and canine kidney disease, which I would urge you to read.
http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease
Hope this helps.
Tony