Bruno update--am I missing out on any options?

[Astahr]

Bruno was diagnosed with CKF last May and has been holding his own but has since slipped.  His bloodwork in Dec was BUN 125, Creatinine 7.3, Phosphorus 11.2 SDMA-49 and Potassium 5.2  His last BP was 240.
He is currently taking 5mg Amlodipine, Metoclopramide 10 mg 3x day, Enalipril 30 mg (split into 2 doses per day) and Aluminum Hydroxide 350 mg 2x day  He is also taking an Antacid 2 x day, Azodyl ( 2 in am , 1 pm) and I have put Epakitin on his food. And a capsule of organic salmon oil in the am. Wow! Thats a lot!
Just started Sub-Q 2 days ago because his appetite went to almost nothing.  I make him homemade dog food ( usually beef with mixed veggies and rice--really doesn't like rice anymore) He used to like green tripe but isn't touching it now.  The Sub Q seems to have brought his appetite back a bit--hes about 42 lbs ( has lost 30+-he was a pudge!) and is eating a total of a cup of food a day.  Still loves hard biscuit treats although Im trying to keep him from eating so many because they are dry.  Even those he sometimes just sniffs and walks away.  He is still happy and chasing birds but does spend a lot of time laying around with "weird eyes" --closing them as if he has a headache??  I know we will lose this battle but as long as he is comfortable I will do anything to keep my little buddy around . He is 8 1/2 years old -mixed breed ( saw online-maybe mostly Hovawart? Which I have never heard of here in the States!) Am I missing anything? are the dosages appropriate?  How long can we keep up the Sub Q? I like my vet but I know I am my pets biggest advocate and want to make sure that we are doing everything possible for my baby! Thanks so much!!

[Astahr]

Thanks again for all your kind words. Your support through this has been invaluable.  It's even helping now that he's gone, to hear of similar experiences, and endings. All the best-Amy

[tonyb286]

Hi. I am really sorry for your loss. Losing a dog (best friend, companion and soulmate) to this disease is a dreadful journey. You did all you could, so try not to feel bad ... it's the way of things and you took the decision to help Bruno in his best interests, not yours. Remember, the last few weeks and the final days were only a tiny part of his life. Think of all those times you shared together, the adventures you provided him with, the love, care and attention you gave him. He was a lucky dog to have such devoted parents and not all dogs are nearly so fortunate.

Kindest regards

Tony

[tonyb286]

You need to feed small quantities of food ONLY, not meal-size, and then feed this once every 2 or 3 hours. Large meals will make Bruno sick, and then he will associate being sick with the last food he ate - and then won;'t eat that food for a while. So you end up in a vicious circle. A small handful of food at one time may stay down, but don't be tempted to give more, just because he wants to eat. If possible, stick to the canned kidney food and nothing else.

Tony

[Astahr]

Sadly we lost Bruno on Saturday.  I am heartbroken but he was in so much misery we had to make the hard decision. 48 hours of constant vomiting, bloody diarhhea, shaking uncontrollably, no food, no water and he wasn't sleeping ( nor was I) He spent his last hours outside trying to dig a hole to go die in-yet was so weak all he could do was scratch a bit at the ground.I can't even begin to describe the grief but I know so many here know what I am going through.  I had an intense connection with him and I feel like Ive lost one of my children.  In the end -he declined so so rapidly and  the vet confirmed we had reached the point of no return. The small comfort I found was reading online about euthanasia and that there is general thought that "better a week too soon that a minute too late"  in order to reduce the suffering that these poor pups go through with this devastating disease. Weeping as I type this-I would give anything to have him back and healthy but I knew that it was cruel to keep him around for me when he was suffering so much.  Weirdly-I widh the end had been slower so I had time to prepare, but having just lost my mother 6 months ago-I know there is no real preparation for the end. Thanks for all your advice and kind words. You helped me help Bruno make it as long as he did.

[FawnT]

I just posted about the treats, but only read your original comment.   I am sorry your dog has taken a turn for the worst.  I hope you are able to find suitable vet care during the holiday weekend.  I know how you feel, my Sheltie had an episode of shaking and swaying when we were having a massive snow blizzard on the East Coast in January and I couldn't get her to the emergency Vet.  It was a very scary time.  I hope Bruno will rally and feel better soon.

[FawnT]

I was able to find kidney treats (hard dog bone shaped biscuits) and ran it by my Vet, which he ok'd.  They are called Matties Kidney treats and I get them from amazon online.  This is the only KD specific treat I have been able to find.  My dog loves them.

[tonyb286]

Hi. One quick thing - check the salmon oil capsules you are giving. Does it say anything about Vitamin E being included in the capsule? If not, you need to start giving it as an additional supplement (salmon oil depletes vit E in the canine body).

With phosphorus so high, there is something in the diet you are giving that is sending things out of control. I would say that while SubQs are okay, it will take too long to get things back to where they should be, so I would approach your vet and get them to give Bruna at least 3 days of IV fluids - then carry on with the SubQs.

Amlodipine is a calcium channel blocker and Enalapril is an ACE converter. Does your dog have high blood pressure or are these being given to improve blood flow/volume? Ask your vet if you aren't sure and let me know. I'm fairly sure Bruno must have had high blood presure - so the next question is, have these drugs now brought the blood pressure under control? When was the last blood pressure check done?

Metoclopramide is an antiemetic, so if Bruno is no longer vomiting or maybe never has, this can be stopped altogether.

Good diet control is crucial right now - and you need to be feeding a suitable canned kd dog food such as Hills renal or a very carefully put-together home-cooked version. I'm sending a link to one of my articles that I would request you read on diet changes.

http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease

Tony

[Astahr]

He does have high BP (240 at last check) so that is why the 2 BP meds. I am very reluctant to bring him in for in-house IV because he is so terrified and neurotic about the vet that it takes him a couple days to recover from a visit there.  At this stage in the disease im not sure its worth the trauma to bring him in.  Ive been following your advice and diet suggestions very closely since he was diagnosed.  The only thing I can think of-other than the fact that CKF raises phosphorus on its own-is that these darn biscuits that he craves are not good for him! Ive made homemade ones and he won't touch them. Yesterday all he wanted was green peppers! Any suggestions for a hard treat that is low in phosphorus?  And he has been vomiting (1-2 x week) so thats why the anti-nausea med although I am interested in the other one you have mentioned. Wont touch the canned KD and nibbled at the dry KD (against my common sense that the kibble is inherently not good I bought some and he ate a little for a couple days-but not any more) Cut-up steak was his breakfast this morning with a little rice mashed with baby food.  Barely touched the rice. But ate the steak very happily.  Sigh--this is heartbreaking!

[tonyb286]

Okay. Thanks for getting back. I would talk to your vet about SubQs and (as Bruno stresses on IVs at the vets), ask them about increasing the fluid regime. SubQs do work, but they take much longer and it might be another several weeks before any real benefit starts to show.

I would certainly talk to your vet about trying Ondanestron (zofran) as an alternative antiemetic.

The BP check is a real priority, because high blood pressure seriously undermines anything you or your vet might do to bring the blood levels down. Getting the BP back down to a healthy level is crucial. If the current drug regime isn't bringing the BP down, it's time to try a different approach (there are good combinations that can work, which your vet should know about and should be trying).

As a hard treat, try chunky slices of sweet potato brushed with a little unsalted butter, bake in the oven until they are hard (can take a good hour at medium heat), let cool and then give a couple a day. Other alternatives are rice bones - you can make them yourself or buy in (I use Goodboy varieties and my dogs love them).

Which canned kd food did you try? Have you tried Hills renal? Most dogs will eat it. It's more palatable than many. And you could drizzle a teaspoon of organic honey on the top, just to entice him. The point is, canned renal dog food does all the work for you - being low in phosphorus, moderate high quality proteins, low in sodium, etc and it also has 80% water, to help hydrate). Given in tiny amounts more frequently during the day, this really will help the blood numbers come down.

Tony

[eckhout]

My sheltie had hi BP as well but she had seizures the last 6 months of her life. the diet is very important. I know it is heartbreaking when they will not eat. Tony really knows his stuff so listen to him. The more "bad foods" your dog eats the higher the numbers go. It is a vicious circle. i know you wish your baby could talk.  libby, emma's mom

[Astahr]

Bruno has taken quite a turn the last 24 hours.  He has vomited a lot and has a lot of tremors-almost constant. I had scoured the pet food store and found a "natural" chicken and salmon food that he devoured! I mixed in some KD because otherwise he won't touch it I was so pleased! He hasn't done that in months( he would eat but not with gusto) he vomited 12 hours later.  Gave him same food mixed with KD yesterday and we were up all night.  Lots of vomiting, tremors , some panting.  This morning he won't even sniff food let alone take his pills. Of course my vet is off ffor Easter weekend. I'm not ready to throw in the towel- he was looking for chipmunks and pooped/peed/drank so he's got a bit of life in him.  Suggestions? I feel that somehow this food -however delicious it was to him- triggered a major setback.  Don't know the vet that's on call very well and she's booked.  Reaching out here- I trust tony and all his experience with this terrible disease. So sad :(