Did our vet mess up?

[billfaith2]

We lost our little Jasmine on Monday night.  She was a 14.5 year old Jack Russell.  She has been in kidney failure for about 6 months, at least diagnosed for 6 months.  She was on subq fluids for once a week for about 5 months until her numbers spiked, creatinine to  7.1 and phosphorus to around 10.  We increased subq to everyday and her numbers came down fast.  The vet was very pleased and had us stay on daily subq.  She saw a different doc at this clinic after some vomiting a week later.  She said though the creatinine was down, the phosphorus was still at 10 which causes the upset stomach, and to keep the subq up and see if the phosphorus comes down. NOTHING else was offered.  A week later, the vomiting was worse and I took her in on Friday to see a different doc.  He again did a blood test and found the levels basically unchanged.  I was estatic because the creatinine was holding steady.  He gave her a anti nausea shot, some pills for nausea to take home and some antacids.  He finally recommended a aluminum hydroxide powder.  I ordered it that night.  Over Christmas weekend she was the same.  The little she ate came back up almost right away and after all that was up, lots of foamy white and yellow.  I called immediately Monday morning and had her in within the hour.  Her creatinine spiked, higher than the in house blood test could register.  They put her on an IV.  In the meantime we found about a place that mixed aluminum hydroxide in house.  We drove 125 miles to pick it up while she was on an IV at the hospital.  During that time they did an xray an determined that she had fluid around the heart backing into the lungs and diagnosed heart failure as well.  This was news to us as she has never had heart issues before.  They did an EKG and blood pressure which were normal.  By the time we got back to pick her up and transfer her to a hospital with overnight staff they told us she likely would not make it through the night.  They could not stop the vomiting.  She went from 10 pounds a week before to 9.  I asked a million questions and was told her prognosis was grim at every turn.  2 different docs saw her that day.  We held her and cried as the doc helped her go to sleep shortly after.  

I am already upset with myself that I didnt take her home and let her go with us, in bed, in comfort but I am also feeling like her docs dropped the ball a bit.  Why didnt they tell us about a phosphorus binder long before Friday?  Her phosphorus has been elevated for months.  Why didnt they offer an IV before this?  We never got a chance to use the aluminum hydroxide, it is still sitting on the counter with her name on it.  Why didnt they offer more?  I really feel like we failed her in the end.  

Has anyone seen their dog go down this fast?  Decent numbers on Friday, and numbers horrible on Monday.  It happened so fast I still havent fully processed it.    

[tonyb286]

Hello. I am so very sorry about your loss. Losing a family member and loved best friend is bad enough under normal circumstances, but canine kidney disease is among the worst of conditions to deal with - and yes, it can deteriorate alarmingly fast.

My initial involvement in this disease - and indeed this very forum - began after I lost my own beloved BB (a lurcher) to this horrible illness. At that time, I too was very ignorant. My own vet - who I trusted implicitly - also proved to be unfamiliar with the condition. My dog was diagnosed on Friday as she was off her food, on Saturday she became extremely lethargic and refused all food - and she passed away on the Sunday. It was a devastating three days.

After that, I vowed to learn more about the disease. That was 5yrs ago - and I now operate this forum and others (including some on FaceBook), passing on my own knowledge and gathering together knowledge and experience from others. I also write exclusively and professionally (without charge) for this forum and other doggy sites about canine kidney disease, having read thousands of study papers, research documents and so on. This is my way of paying BB back for the years of love and loyalty she gave me - it's her legacy.

I rarely blame vets for their lack of knowledge or experience. They have a huge task learning about hundreds of different illnesses, diseases and physical ailments, and for lots of different animal species. They cannot know everything, though some are more knowledgeable than others.

It would probably have been better to start a phosphate binder earlier. Of that there's little doubt. But that could only be confirmed by knowing the blood values at an earlier stage. It's the blood values that determine the best time to start a binder.

There is also nothing certain about managing canine kidney disease. Some dogs rally with good support - yet others fade away, even with exactly the same support. We can only do our best. You should have no regrets. You did your best. And more than that, you offered your dog a great life, lots of love and security, warmth and so many happy years. The end period was a very small part of your dog's long and contented life. Try to remember that.

Tony

[billfaith2]

Thank you Tony.  Looking back, I thing she probably had some kidney troubles for alot longer than 6 months.  She has been "off" for at least a year if not a little longer.  She has had a ton of bloodwork in that time but perhaps she should have had more tests.  I also think the phosphorus binder would have been very helpful but we will never know now.  She had some back issues and was on some medicines in the last 2 months that I am sure were harder on her little kidneys.  

On the flip side, she has never had kibble in her 14.5 years.  We always made her meals.  She also drank filtered water for the last 10 as it was just something we did, so I like to think those things helped a bit.  

And thank you for the kind words.  She really was a best friend to my wife, my kids and myself.  We have been looking back at the literally thousand pictures we have of her and the many adventures we been on.  It was a crazy 14.5 years that we will never forget!

[tonyb286]

Sadly, kidney disease in dogs rarely shows as symptoms until the kidneys are substantially damaged. And dogs are great at coping with and controlling symptoms. This is in their nature. A dog does not show that it is injured or ill while in a pack (including a human family pack), in fear of being cast out and abandoned as it would be in the wild.

So it's likely this was probably going on for maybe 2 years and maybe more than that. But it wouldn't have shown in blood tests until the kidneys had dropped to around 30% of normal function.

I actually undertake annual blood tests on my dogs, just because I am now quite paranoid about wanting to start treating anything that shows as abnormal as early as I can. But even that doesn't guarantee success.

Great that you didn't feed kibble (I hate the stuff and seem to be always saying so to other dog owners). And filtered water is the safest for dogs. I'm sure those two actions did help.

Take care,

Tony