Daisy in final stage

[KrissyM87]

About three weeks ago found out my best friends numbers were off the charts. First vet suggested euthanasia, second gave me some options. I have been researching like crazy and trying everything possible, hollistic and prescribed by the vet. My Daisy, who will be 17 in April has been fighting hard. We have been doing SB fluids twice daily at home, along with many other things around the clock. I allowed my hopes to get to high. She has been so happy and alert, earing again (though still reluctantly) then the last couple days has started to refuse food again. Ive bought every option available and cooked many other options, she just won't eat it. She still keeps sniffing around looking for "junk" food dropped by my little ones. Today she stole a doughnut! Why would she be so drawn to eat junk food? I'm considering adding sugar to her food even though i know it is bad for her. I feel i have nothing to lose. She is waisting away and i can't watch her starve to death.

Another question. Does anyone have some great tips for giving the sb fluids? She is starting to fight me and it's breaking my heart, lately she is jerking around so much i end up having to stab her multiple times. I cannot keep doing this! I know if i stop the fluids she will get worse quickly but am not ready for that decision. I don't want to.be selfish and keep making her fight but i don't want to give up too soon as she is so happy agin, following me around again. How can i ever decide when she has had enough? This emotional roller coaster is killing me. I have had daisy since i was 11! She got me through soooo many hard times, now it is my turn but i feel i am not being strong enough for her. Please help

we are retesting her bloodwork tomorrow and im overly anxious. Her numbers about three weeks ago were crazy high. Bun off the charts >180  creatine 6.5  phoshporus 16 something. (she is sleeping on me or id go grab tge paper for reference)

Thanks for the support, no one in my life can understand right now, so im thankful to have found this group!

[KrissyM87]

Ok got my print out
Bun >180
Ca 12.6
Phos 16.4
Cre 7.5

Retest tomorrow, she is obviously feeling better so im very anxious to find out. She just got so bad so fast :( with her being 16 we lean towards chronic, but just a year ago her bloodwork was good enough to do a dental, no probs. She does have recurring UTIs and we are currently treating another. Is it possible to be Acute due to infection?

Ive just never seen any others with values this high, but she is strong and even seems happy again. I think she is enjoying mons undivided attention. No vomiting or diarrhea as of yet.

[tonyb286]

Hello Krissy. I'm pleased you found us here, though obviously not the reasons why you needed to. I really doubt this is acute kidney failure. You know your dog better than anyone else, so have a read of this article ...

http://veterinarymedicine.dvm360.com/differentiating-between-acute-and-chronic-kidney-disease?

It's a long and complex piece, but you may find some of it refers to your observations and experience. At worse, it should give you some insights and provoke a few questions you may wish to raise with your vet.

I would also urge you to read one of my own articles on Diet and Chronic Kidney Failure, which you can find here:

http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease

It should give you some ideas on feeding and, please, read before you think about changing the diet to anything like scraps or sugars. If you want to try it, you can add energy-giving food supplements to an existing kd specific tinned diet (hopefully this is what you are using now), such as a teaspoon of all-natural honey, unsweetened and unflavored yogurt or pure salmon oil. These all help flavor unpalatable foods and give very useful nutrients, probiotics, and essential vitamins and minerals.

Urinary and other infections amongst CKF dogs are very common. But these are likely to happen after the onset of kidney disease, which lowers the ability of the immune system to fight such things.

I need to check her blood values properly, so thanks for giving them to us. I'll check them out and get back to you when I can.

In the meantime, I'm hoping others will reply with some practical advice about administering fluids. I know it's hard going, but it's also very necessary in giving your best friend a fighting chance.

At 17, it may be an uphill struggle getting the blood values under control ... but I can tell you really want to give it your best shot ... and it sounds like your dog also still wants to stay around, so let's see if we can support you as much as we can.

Stay strong.

Tony

[tonyb286]

Hi again. Just been checking a couple of things regarding your blood panel results ... the BUN is extraordinarily high and I'm tempted to say this should be the priority. BUN levels can be reduced by restricting the intake of protein (hence the useful impact of renal specific dog food for chronic kidney failure dogs) and by increasing the intake of fluids (the administration of IV fluids is particularly effective). What this means is you need to pay close attention to diet - and maintain the fluids. As you are experiencing some issues with administering the fluids, which will help flush the toxins from your best friend's body, I have sent messages out to the Group asking them to offer any suggestions.

Creatinine is also very high. When BUN, creatinine and phosphorus levels are all high, it suggests the kidney disease is longstanding and may have been slowly occurring for a substantial period of time. The level you have given suggests she is in stage 4, the final stage of kidney failure. The prognosis is very poor, so this may best be a day-by-day assessment. If she deteriorates suddenly, then maybe I would opt to consider euthanasia - not something easy to consider, I know, but it might be appropriate if things get worse.

The phosphorus is also high, and this might be best reduced by controlling diet - mainly by opting for foods that do not contain any phosphorus and/or by maintaining a kd specific manufactured canine diet.

It would be useful to introduce a phosphate binder, but first the phosphorus level needs to be brought under control. It may be worth adding a desertspoon of chopped cooked cabbage to the daily diet. This can act as a natural phosphate binder and also helps prevent stomach ulcers forming. It's worth trying, if nothing else.

Okay. there's enough for you to think about and read there. Let me know once you've absorbed this info.

I know this is a very traumatic and stressful time for you. I hope this Group gives you some useful info, good support and - if not much else - someone to talk to whenever you need it.

Best wishes,

Tony

[KrissyM87]

Tony, thank you so much for taking the time to read about my girl. Let me give you a little more info, since i was kinda all over the place emotionally with my first post. About a year ago her kidney values were very slightly increased, we treated for a uti and they returnes to normal. A little over a month ago she suddenly lost her appetite and was just looking like she wasn't feeling well. I had made an appt with the vet but ended up taking her on a sunday when she suddenly becme lethargic. The other symptoms of excessive drinking/urination/incontinence she has had for a couple years but i do blood work often and never showed signs of kidney disease. We tested for cushings and the vets could never find a reason, but she was still energetic and happy so we just dealt with the incontinence issues.

So when she suddenly becane so ill three weeks ago, i knew it was her kidneys from the smell on her breath :( . She still is not vomiting, no diarrhea. Bp, liver all that is good. Just an ecoli uti we are treating.  Three weeks of around the clock care;
Fluids twice a day
Azodyl
Aluminum hydroxide
A variety of essential oils for kidney health and digestion
Antibiotic
Slippery elm bark for digestion
Naturally alkaline water
Low phosphorus diet
Now cutting protein and increasing cals as much as possible
Pepcid once a day
Wild alaskan sockeye salmon oil
1/2 a B50 vit
1/4 of a renal essentials vitamin
Seacure added to one meal daily (powder for underweight dogs)
Also a goji berry blend i use once a day helps with her energy too

I have tried every royal canin and hills variety for kidney disease, and the lowest phos commercial canned stuff available. ( got values from emailing companies.) Ive been offering two or three options about four times a day.
Originally i.had to puree and feed off my fingers. Now she is turning down pretty much everything. She used to be on raw and homemade food so i think nothing seems higher value to her. Im cooking new things constantly trying new stuff, always choosing the lowest phos options, adding calories through coconut oil and butter. Have tried green trip, cooked, raw, pureed. Ive been adding the cabbage to my purees as i read that about stomach ulcers. Also add ginger to everything i cook. She seems only interested in bread type stuff. Which i am becoming desperate for.calories at this point. Diet has always been very important to me, im just so confused because she is alert, happy following me around. Running outside, and she acts like she want to eat but then turns away or.drops it back out of her mouth :(

I know this is.very long and thank you so much for taking the time to help me and Daisy. The links you posted are not working for me, perhaps because i am mobile but i will try retying into.my browser. Thanks again

[KrissyM87]

Another thought i had from reading, is that she used to get bladder stones, but if there was a blockage she would not be passing so much urine i assume. It's just in all my reading i have never seen numbers so high and it had to of happen in less than ten months (since last bloodwork was great)

I guess im still blaming myself for not getting her to a vet sooner but there were no new signs until a month ago.

It's nice to just talk to people who understand, so thank you . I know im writing a lot :/ but it's hard to talk through this stuff with people who haven't reaearched the topic. Or think she is just a dog and i shouldn't try just because of her age, but if there is a chance... She deserves it.

[KrissyM87]

Read your article again Tony. I do remember reading this one before i even found this forum. Very informative! You taught me about nitrogen trapping and the cabbage before i even met you (:.

It is also your article that made me think about how her urine output decreased the week she was the worst, leading me to wonder about acute/chronic. At this point i guess it doesn't really matter :/
Thanks for the great read.

[TinasGrandma]

I'm so sorry you have to go through this with Daisy.  This is a wonderful site and Tony has so much information and help to give.

I would like to let you know what we did to give our Tina her fluids. We only had to give them once a day.  Maybe they will help you in some way. My daughter was the one who gave them, and I was there holding her so she would sit still. My daughter (as far as we know) never stuck her in the same spot. She was always moving to another area of her back, upper, lower, side to side so she wouldn't get poked in the same spot.  

Also, on feeding, when she was refusing her food, I had a very large dropper, like an eye dropper, and would give her food, yogurt that way. Sometimes she would start eating on her own other times I just feed her that way until she refused that also.  

My thoughts and prayers are with you. This is a very frustrating disease. Just keep doing what you are and loving Daisy everyday.

Pat

[tonyb286]

Hi Krissy. Never worry about writing long posts. I will always read them ... and the more detail the better. I am now slightly more curious about the diagnosis, particularly as the blood results a year ago were okay. While symptoms don't necessarily appear until kd has developed into stage 3 or 4, the blood panel should have shown some elevations to BUN and creatinine a year ago, if this is a chronic condition.

The biggest problem with kidney disease is trying to identify what causes it, because it is very often a secondary disease, brought about by something else. Sadly, it doesn't always make any difference to how it is treated, but obviously, occasionally, finding the source of the problem and solving that can impact positively on the kidney disease itself. In Daisy's case, given her age, I am doubtful you or your vet will be able to discover the onset cause, because things have clearly progressed quite a long way.

You are therefore in a very tricky situation, where all you can truly do is treat the kd and the symptoms, and hope she rallies. You have done an amazing job with her so far. The fact she has energy and interest in things going on around her is very positive. The long list of supplements and alternatives you are providing may have some benefit, though many supplements (in my opinion) don't do very much. I think the salmon oil, azodyl and pepcid are the important ones. If she is still refusing food, the pepcid may need changing to something else, because it clearly isn't solving the "sickly" feeling she is experiencing. Talk to your vet about this.

When are the next blood tests going to be done? I think it would be useful to see some updated results. If the values have gone even higher, then that would be a great concern, given all the treatment and management she is receiving. If however the results show improved levels, even just slightly, then you just need to maintain the regime and keep fingers crossed.

You are in my thoughts. This is hard, but you truly are doing everything right and to the best of your ability.

Tony

[KrissyM87]

Thank you for the kind words Pat, it really helps just talking to others who understand.

Tony, i took her to the vet yesterday blood tests should be back by tomorrow. We did a more complete panel so it had to be sent off. Im very anxious...

In other news, she gained a whole POUND this last week! I cried, lol . She was running around and even jumping up on people to be petted! It was an amazing day. No one would have known she is even sick. The vet and vet tech were pretty surprised. (the vet tech told me three weeks ago she wouldn't put Daisy through any treatment as there really wasn't a chance of getting quality of life back, so i think Daisy was showing off for her (:  )

I will post again once i get the results, thanks for the help all... Gotta go check my green tripe mixture treats baking, they smell wonderful (;

[KrissyM87]

Oh and we started cerenia for nausea, so hopefully that helps, she does seen to be eating with less dancing on my head tricks today (:  so im hoping she feels better.

Does anyone used cerenia? Pros/cons? Im just worried about the workload on kidneys...

[tonyb286]

Oh wow, that's great news. Truly, great news. Of course, it's only one day, but every good day is a bonus, right? Cerenia is an unusual choice of drug, but an interesting one. It is generally only prescribed for motion sickness (for dogs that suffer when in cars), but has become more widely known for its many other uses. It is relatively new and more complex in its actions than most anti-nausea meds. Importantly, it should be administered every other day - or alternatively 5 days on, 2 days off. The reason is that a dog's anatomy gets used to the drug, and consequently it stops doing what it needs to do. Has your vet talked to you about this (known as depleted substance "P").

Tony

[KrissyM87]

He has not, he only gave me a four day dose but it has three refills available. He said it also has anti inflammatory properties, that it's used for a lot of off label reasons that may help her too. ??  I will have to look into it :/

[KrissyM87]

So the vet called me and her numbers are so so much better! No one seems to understand just how excited I am about these numbers!

Bun 3weeks ago >180 now 97 normal 7-25
Ca was 12.6                 now 10.8 normal 8.6-11.8
Phos was 16.4            now 8.7 normal 2.9-6.6
Cre was 7.5                  now 3.98 normal 0.3-1.4

I have one strong baby girl! Can't believe it, i didn't dare hope for such a huge change. That being said there is one problem, her blood concentration is getting dangerously low. We are down to 23.9% and i guess emergency level is below 20? I don't know much about it yet. I guess it could mean she is losing blood somewhere in her body or the kidneys are not bouncing back in that area yet. We are going to keep an eye on ot. Does anyone have experience with this kind of anemia? I know it's common with kidney failure. Thanks all! (:

[tonyb286]

Great news, and honestly, just what I was hoping for. The fluid therapy is clearly kicking in, along with other remedies. Yes, the slide downward is small, but it's heading in the right direction. Things are improving!!! It is very common for dogs with CKF to develop anaemia. It means the bone marrow is unable to produce enough red blood cells. And in turn, this is caused by an inability to produce erythropoietin, one of the hormones involved in red cell production. Your vet needs to undertake a blood test for levels of erythropoietin. Replacement therapy is the standard treatment, but also keeping the CKF under control will certainly help more long term, unless the anaemia is caused by other factors (possible, but less likely).

Tony

[Dkomoro]

So sorry about your struggles with Daisy.  Celebrate the good days and every small victory with this disease.  RE: Fluids. My vet trained me to gently pull up the skin on the neck with your thumb and first finger.  You'll feel what forms is almost like a "V" in the raised skin fold.  This is where to insert the needle.  Then I released the skin and let the appropriate fluids flow.  I used this process with my Teagan.  She never flinched or fought me.  So I hoped that meant it didn't hurt that much.  Good luck.

[Misfits4Me]

My Vet always uses Cerenia for nausea.... Not only for Kidney disease, but also any kind of nausea.....For anemia, I was able to change those low red blood cells by feeding RAW, ORGANIC Calf's Liver....If you must cook it, it can only be seared or you are defeating your purpose.....My 8 lb. dog can have about 1-2 teaspoons daily....We chose not to do fluids, because it upsets her so.....My Vet will give her Sub-q's only if she is in danger....Otherwise , he doesn't want her upset & waste energy on being upset instead of using the energy on healing.....Yes, he practices alternative medicine along with Chinese & traditional...Best of all worlds and obviously thinks outside the box....

Good luck to you and Daisy, I'll be praying for you....Karla

[KrissyM87]

Thank you all for the tips and support. Ive ordered a blood and energy supplement of liver and herbs to help red blood cell production. We are still doing fluids once a day but the better she feels, the less cooperative she is. Now that she has put a lil weight back on i am able to move around a little more. The using up so much energy fighting us is definitely bothersome and i just don't want to add to her distress. However, after fluids she always gets a good boost in energy/mood. We will just keep trying to make it as easy as possib.

She started a new med to coat the stomach in case of bleeding ulcer, but her stool has been great. Perfect color and consistency still, so i really don't think she is bleeding, but rather be safe i guess.

The cerenia doesn't seem to.be having any effect on her that is noticeable. What are some anti nausea meds you all would recommend?

will keep you updated, thanks

[KrissyM87]

Oh, one more question!

She has developed a soft cough that only happens at night?? The last few nights but gone during the day. It's almost like a gentle hacking. Just one soft hack, like something is stuck in her throat. Any ideas?

[tonyb286]

Yes, liver and herb supplements can have a small desired effect, but it's inconsequential to replacing the erythropoietin professionally. Please do talk to your vet about this. The hacking could be due to dehydration. I know that seems unlikely, due to the extra fluids being given, but kidney failure and dehydration tend to go very much together. I would try feeding some simple chicken broth (no salt or additives) in between meals, just to see if she will lap at it. The other possibility is kennel cough, particularly as she has probably come into contact with other dogs at the vets on prior visits. And it could also be the progression of other problems, such as heart disease or an infection (the latter is far more likely, if white blood cell counts are low).

We have previously discussed anti-nausea meds on the forum where owners have given alternative suggestions. Here's a link to that post:

http://www.medhelp.org/posts/Chronic-Kidney-Failure-in-Dogs/Anti-Nausea-Medication/show/2202286

Tony

[Dkomoro]

My vet also prescribed cerenia.  Teagan never vomited after she was put on Cerenia.  I don't know if it actually settled her stomach though.  I could never find any foods she would eat.  But, by then she was in late stages.  

[KrissyM87]

Has anyone been prescribed carafate? It is supposed to heal any existing stomach ulcers but i am concerned with the added stress on her kidneys. The smell on her breath is returning since starting it and the manufacturer states to be sure and let doctor know if you have kidney disease before taking this product. The vet is wanting to be sure she isn't bleeding in her stomach because of her anemia. :/ i just don't know if it's worth it. I mean wouldn't there be signs in her stool. It is not dark at all. What do you all think.

[tonyb286]

Hi Give Carafate away from meals (at least one hour before or two hours after), and Pepcid or Zantac at a different time, such as half an hour before meals (half an hour after the Carafate) if used together. Carafate has been used and is advised for CKF dogs with ulcers. Once the anaemia is under control, she can be taken off the carafate.

There is also a natural cure and preventative remedy for ulcers - cooked cabbage - which you can add to her meals at the rate of a desertspoon (chopped) for one meal given each day. Don't be tempted to give too much.

I think, on balance, it's worth sticking with the carafate for now, as it's better to be cautious about ulcers.

Tony

[KrissyM87]

Ok thanks, i have. The dose drops tonight but i know her bun is going up :(  the uremia is returning. She is still happy but the smell is getting stronger on her breath. :(

[tonyb286]

The fluid therapy is going to be key to solving things initially. I know you are having "issues" doing this, but please persevere. It may be that you will need to increase it to twice a day, if things don't improve. The other option would be to have your vet insert a canulae, as a short term measure, but this would be even more stressful. Is she taking the fluids any easier now?

Struggling dogs can be a nightmare, when we are only trying to help them. Of course, they simply don't understand. One of my dogs struggles every time I cut their nails (monthly) and I always need a second pair of hands to help.

Tony