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Chronic Kidney Failure in Dogs Community
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Avatar universal

Stage 2 chronic kidney disease in 18 year old rescue terrier

Hello--thank you for providing some of the most comprehensive information on managing chronic kidney failure in dogs that I’ve been able to find.  I have an ~18 year old terrier mix rescue dog who developed chronic kidney disease--stage 2, about 2 weeks after an episode of acute pancreatitis—now about 7 weeks ago.  He had been on metacam for degenerative joint disease (elbow, spine, hips) for about 2 years, so we have been monitoring his blood work at least every 6 months.  His creatinine had been creeping up slowly, but entered the abnormal zone at 1.8 after (but not during) the pancreatitis, BUN was 76 (BUN/Creatinine ratio 42), potassium 5.6, sodium normal (148), phosphorus not tested.  Urine was tested only for infection (no protein other analyses done).  Blood pressure not tested. Radiographs revealed an enlarged liver (present for several years) and kidneys at lower limit of normal size (new finding).  Prior to the pancreatitis, he sporadically leaked urine at night, but about a week before his pancreatitis emerged, it progressed significantly to every night, and during the day during long periods of sleep.  This has naturally persisted, along with classical symptoms of increased water intake.  To address his pancreatitis, he was placed on a low fat prescription GI diet (Royal Canin), which I have maintained, but I supplement with canned food (fat < 5%, protein 5-10%) and home cooked food (chicken/sweet potato/pumpkin/green beans/mixed vegetables/rice/flaxseed meal).  Although he seems to have recovered from the pancreatitis--he is active, enjoying his daily short walks, OK appetite (this fluctuates—I rotate his food to avoid associations with feeling sick), he has also developed sporadic episodes of trembling that seems to be increasing in frequency over the last week or so, which I assume will worsen as his disease advances.  My vet has discounted the trembling in spite of the high potassium at diagnosis, but I have made an appointment for 2 days from now for blood work and re-evaluation (hate to subject him to another urine test, which my vet does by cystocentesis).  He was prescribed subcutaneous lactated ringers solution 3 x week at home, but is not tolerating this well—it stresses him out.  Once the new blood tests are done, I will definitely follow the advice in this forum to deal with the issues with diet (and will post again), but I am struggling with the stress he experiences with administration of subQ fluids.  I know it is supposed to delay progression, but it is difficult to balance the stress against the suffering caused by kidney malfunction, and I do believe that he suffers with it.  He has also developed extreme restlessness in the evening before settling down to sleep (perhaps driven by hunger, but he often won’t eat additional food after his evening meal—I feed him a small meal in the morning/larger meal in the evening), and sensitivity to sudden exposure to light (such as when we walk into the sun).  His musculoskeletal pain seems controlled with 25mg tramadol twice a day.  By the way, he has too numerous to count skin tumors—mostly sebaceous adenomas—but had a malignant melanoma removed about 3 years ago—it doesn’t appear to have spread, unless his enlarged liver is an indication.  I would like to limit any procedures/trips to the vet to only that necessary to reduce his discomfort.  I am very afraid of him dying without me in the vet’s office—I prefer home euthanasia when the time comes.  Like others in this forum, I struggle with not knowing how long he will last in this state, and with identification of when the bad days outnumber the good.  Do you have a sense of what I might expect from my description? Any advice about management (I know this is a long thread) would be greatly appreciated. Thank you for reading through all of this!  
19 Responses
1916673 tn?1420236870
Hi. I can empathise with your concerns. It really is a balancing act trying to work out what is the best management/treatment for an older dog's group of health concerns. Often, helping one condition simply antagonises another, so all you can do is work on priorities and quality of life.

You may already know that the pain meds will cause some deterioration of the kidney disease and increase the toxin build-up in the blood stream. But, if giving the meds seems to reduce any pain your dog is experiencing, then it's a valid choice to make.

I am amazed your vet has not undertaken phosphorus testing - or taken a blood pressure reading - or checked urine for protein leakage. These are fairly critical tests and should be performed. Without them, you and your vet are working blind and not getting all the information you need to help your dog.

The other thing I would mention is about feeding. If you can arrange it, try to feed smaller meals more frequently - the ideal is every 2 to 3 hours - but with each meal being a tiny portion (so total daily intake meets guidelines for the breed and size of your dog). These smaller but more frequent meals reduces the workload and stress placed on the kidneys and helps to minimise any nausea. It also reduces toxin build-up and encourages appetite and eating.

Pancreatitis is a common problem and you are right to reduce fat intake to help guard against it happening again. To do this, you will need to ensure the normal fat content is replaced with viable carbohydrates. Sticky white rice, sweet potato and couscous are useful ingredients you can use in rotation.

At stage 2, protein isn't a huge issue (though more recent bloodwork results will be helpful to confirm it). You can provide up to 15% protein content in the food you provide, although low-fat protein sources would be advantageous. The protein you give should be high quality (human grade meats and poultry). Once the kidney disease moves into stage 3, then protein restriction becomes more important. However, what IS important right now is to restrict phosphorus. Phosphorus build-up causes huge problems in kidney disease. If phosphorus shows abnormally high in blood work results, then a phosphorus binder will be necessary.

Hope this helps.

Tony
3 Comments
Thank you Tony--you are really quite amazing!  He resists eating more frequently, though he will eat spoonfuls of his favorite foods (mostly chicken--always human grade, though I'm not sure how good any of our meat is anymore--I do my best to select reputable organic sources--I'm a vegetarian myself). There seems to be a volume threshold for nausea upon eating, and he is highly sensitive to pain or discomfort under the best circumstances.  Your answers on this forum have really helped me identify the information/practices needed from my vet--I will be requesting a complete blood panel when I take him in tomorrow, along with more complete advice for treatment based on the results.  It has bothered me too that we don't have the information needed to make the best decisions, and I'm really worried about his trembling--he wakes up during the night with it, and seems uncomfortable.  It's great to know that up to 15% protein is OK at this stage, and I'll be working to fill in with carbs.  Is there a maximum amount of phosphorus I should feed, or should I just try to keep it as low as possible, with guidance from blood levels?  I do think the tramadol is necessary, since we stopped the metacam as soon as he developed pancreatitis.  It's a real culprit for the kidney.  Finally, do you think that stopping or reducing the frequency of the subQ fluids is really not advisable?  It is tough on him, especially because of the need to maintain healthy skin around his skin tumors.  He sleeps about 21-22 hours a day but is mostly engaged and alert otherwise, so I don't think we are looking at letting him go yet.  Thank you again.
Thank you Tony--you are really quite amazing!  He resists eating more frequently, though he will eat spoonfuls of his favorite foods (mostly chicken--always human grade, though I'm not sure how good any of our meat is anymore--I do my best to select reputable organic sources--I'm a vegetarian myself). There seems to be a volume threshold for nausea upon eating, and he is highly sensitive to pain or discomfort under the best circumstances.  Your answers on this forum have really helped me identify the information/practices needed from my vet--I will be requesting a complete blood panel when I take him in tomorrow, along with more complete advice for treatment based on the results.  It has bothered me too that we don't have the information needed to make the best decisions, and I'm really worried about his trembling--he wakes up during the night with it, and seems uncomfortable.  It's great to know that up to 15% protein is OK at this stage, and I'll be working to fill in with carbs.  Is there a maximum amount of phosphorus I should feed, or should I just try to keep it as low as possible, with guidance from blood levels?  I do think the tramadol is necessary, since we stopped the metacam as soon as he developed pancreatitis.  It's a real culprit for the kidney.  Finally, do you think that stopping or reducing the frequency of the subQ fluids is really not advisable?  It is tough on him, especially because of the need to maintain healthy skin around his skin tumors.  He sleeps about 21-22 hours a day but is mostly engaged and alert otherwise, so I don't think we are looking at letting him go yet.  Thank you again.
Hello Tony--Again, I appreciate your help.  Just to let you know, I just returned from my vet, who was very receptive to all of my questions and concerns.  Hank's blood pressure is slightly elevated, but not to a threshold that triggers treatment.  Phosphorus, potassium, calcium, sodium levels all within normal limits.  We don't have an explanation for his trembling, but I'll keep an eye on it.  In spite of his age,  he's doing remarkably well, and since his disease is in the early stages, I can concentrate on his diet as treatment, with a goal of delaying progress and keeping him comfortable and as stress free as possible.  I really appreciate your advice.  I'll be following this user group regularly and will post what we experience.  Hopefully it will be helpful to others too.  Take care--
1916673 tn?1420236870
Hi. There isn't a marker for phosphorus reduction and it would actually be really hard to achieve one, even if one existed. Phosphorus is in all foods, so it's just important to try and restrict the intake by choosing the appropriate foods. There comes a point in kidney failure when diet restriction of phosphorus doesn't work and a binder is then required, in addition to diet restriction. The blood tests you are having done should prove interesting, so please post them once you have a copy of the results.

The trembling is almost certainly associated with muscle wastage - but it could also include some neurological changes. Again, the blood test results are crucial, because they will show if some of the essential nerve transmitting minerals are abnormally low or (more usual) abnormally high. These will include sodium, potassium, magnesium, calcium and others. When the blood numbers become askew, the kidney disease deteriorates, and the trembling can develop into small seizures. It's therefore worth getting things under control as much as possible, as this will help reduce the symptoms.

SubQ fluids are useful in helping get the blood levels under control, so I would try to keep going with it, at least for the time being. The blood test results will tell you whether it remains necessary. SubQ fluids also help deal with any dehydration, which is very common in kidney failure dogs and causes lots of problems - and can even by life threatening if not dealt with.

Tony

I have just caught up with your 2nd message, so some of what I have said above may no longer be relevant. What were the creatinine and BUN levels like? I am posting you a link about tremors and shaking in canine kidney failure. This is one of my own articles and I think it will be of value to you. http://www.infobarrel.com/Tremors_and_Shaking_in_Dogs_with_Kidney_Failure
Avatar universal
Thank you again Tony.  Sorry for the delay in my response--I am discovering that this forum isn't optimized for Mac/iPad/Safari users, so I am now using different devices and browsers.  

Anyway, the vet did not repeat the BUN and creatinine, and didn't believe that they would change much in such a short period of time.  Exam included blood pressure and ocular pressure measurements, along with testing electrolytes/minerals.  She didn't think that the trembling was due to kidney issues, since he only recently converted to a 1.8 creatinine level after several years of monitoring every 6 months.  In addition, his trembling appears to occur primarily during sleep at night, and continues after waking for several hours.  He is unsteady upon waking, but that resolves during the day.  I read your article (thank you) and it focuses a bit on trembling in later stage kidney disease, so she may be right.  However, I will be monitoring and documenting to see if the trembling is associated with something specific, or has a trigger of some sort.

I read the other articles you've posted on infobarrel and find them very helpful--you distill information to the most essential points in a kind way.  I feel that I now have the information I need to move forward with my little Runaway Hank--especially with your recipes.  I will focus on limiting both phosphorus and sodium, and will try to balance high quality protein with vegetables with his low-fat food for his pancreatitis.  

I expect to be back to the forum on a regular basis.  Thank you again, and take care--
Avatar universal
Oh, and I meant to indicate that I will be requesting follow-up blood and urine testing on a regular basis to make sure I'm on track.  It will help me cope with the relative unpredictability of his kidney disease, and as you say, will make me less blind!  Take care--
1916673 tn?1420236870
Hi. I'm very pleased you found the articles of some value ... I try my very best to give all the info necessary, but in a fairly straightforward and easy-to-digest manner.

I am a little surprised your vet doesn;'t think creatinine (even more than BUN) is a necessary test to be included. To be honest, I find it extraordinary. Creatinine is THE key test for degenerating kidney disease. It can also change dramatically and very quickly over a very short period of time. Without this test being done, you nor your vet cannot gauge whether the disease is under control or deteriorating. Personally, I would absolutely insist on the test being done.

Feel free to come back any time ... ask questions, contribute to others that post and need support or just keep us updated with any changes that may occur.

Regards

Tony
Avatar universal
Sigh--I know, it was surprising to me again.  Apparently they run some blood panels in house and some are sent out, and it doesn't appear that any one of them has all the measurements we need.  By the time I figured out that they didn't add the phosphorus, sodium, potassium etc to an existing panel that also included creatinine and BUN, they were already finished with him.  Next time I will ask to go over all the panels available (I would think that they would have a kidney specific panel, with such a high prevalance of kidney disease in older dogs) and make sure all the right measurements are done in the future.  

I have access to scientific journals and found a trend toward the use of serum SDMA to detect kidney disease prior to elevation of creatinine.  It doesn't look like it will be useful for monitoring progression though.  In addition there are some recent studies of commercial kidney diets, typically limited in scope, but they basically confirm the benefit you've indicated.  If you'd like, or you don't have access to journals yourself, I'll be happy to either provide pdf copies of papers or a list results from a search. Not sure I can do that in this forum.  

Hank woke up very sore from his arthritis this morning, mostly in his right elbow--it's been most affected these last 6 months. I'll probably need to give him an extra dose of pain meds, but I'll know more after we are up and moving. He had a subQ LRS treatment Thursday, so he is feeling better from the kidney point of view.  

Just another day in the life of a geriatric dog. It's a roller coaster.

Thank you again--

Wendy
1916673 tn?1420236870
Hi. Yes, SDMA was invented about 3 years ago and it was rolled out across most of the USA and UK last year. It's a good test for diagnostic purposes, but panel testing of creatinine, BUN and other elements remain crucial. Blood pressure and urine testing are also fragments of the diagnostic testing for kidney failure. It take all of these tests to make a valid diagnosis.

I do have access to most journals, but thanks for the offer. In fact, I read hundreds of journal entries each week, from universities and researchers all over the world, just to keep up to date.

Tony
Avatar universal
I figured you had access!  I have only begun to sift through the literature, but I am now acutely aware of the need to monitor the factors you've indicated.  It will be interesting to see how long we can keep Hank going . . .

Take care, and thank you--
1 Comments
You may find some of my articles of value, if you haven't sifted through them yet. I try to write about canine kidney disease from an owner's point of view and try to keep them easy-to-read and up-to-date. You can find links to them on my website at www.tonyboothwriter.com

Tony
Avatar universal
Thank you Tony--I did read them and have found them very useful -- I believe that they contain the most comprehensive, up to date and user friendly information one can find.  I will continue to use them to manage Hank's kidney issues as well as my emotional reactions as we face this stage of his life.  I am greatly relieved to have a better understanding of what I can and can't control, and to have clear guidance for what needs to be monitored as he progresses.  The rest is up to Hank and mother nature!  

Have a lovely day--

Wendy

1 Comments
Thanks Wendy. If there's anything you are uncertain about or need to ask a question that the articles don't cover, feel free ... if I have an answer, I'll be happy to respond. And do keep updating this post about how things go with Hank's kd management. I like to think no matter how hard this disease sometimes is, none of us in this Group are alone in trying to battle it.

Tony
Avatar universal
Thank you!  

In addition to managing the veterinary and diet issues, what I've mainly been dealing with is Hank's urinary issues.  He is not continuously incontinent (yet), but has significant leakage during sleep or rest.  If he finds himself wet, he will try to lick it clean, which I imagine can't be a good thing.  So in addition to getting him outside on a regular basis during the day (usually every 3 hours), I've purchased washable waterproof (whelping) pads and placed them in all the places he's chosen to rest (on his beds and under my beds) -- it's less expensive than disposables, which he hates anyway.  At night, I use disposable male wraps that usually need to be changed once (sometimes twice) during the night.  I don't like to use them much more than at night, as I worry that they may lead to bladder infections or skin issues, even with frequent changes.  

I try to make sure that my sleep conforms as much as possible to a normal human sleep cycle, which is on average about 1.5 hours.  This means that I try to get Hank up at night every 3.0 or 4.5 hours.  So far, this is working OK--it means I'm not as tired as I could be.  

Hank is also a very restless sleeper--he gets up and moves from bed to bed, place to place, all night.  I think it indicates pain (arthritis), but it may also be due to other forms of discomfort. It's funny, he woke up this morning acting like a puppy--very happy and animated.  Some days it seems as if he's immortal, but other days, I worry that he won't be with me long.

I think that Hank's breath may be a good indicator of worsening--it was absolutely terrible when he had pancreatitis.  It is mostly OK now, but I noticed that when he has a subQ LRS treatment, it improves.  So I'm hoping I can use it as an indicator of the need to treat, or the need to make another trip to the vet (absent other signs).

I hope this information will be helpful.  

Take care--
1916673 tn?1420236870
Hi Wendy

Yes, fluid therapy, additional drinking and CKD all contribute to bladder issues. You seem to be coping extraordinarily well, although I'm sure it must be stressful for you. Frequent urinating can also actually be a significant symptom of bladder and/or urinary tract infection, so it's worth you trying to catch a sample (first one of the morning is best), and ask the vet to do a culture and sensitivity test on it. Any glass jar will do, just boil it in water to sanitise it, then dry it and allow to cool. It may be purely due to the CKD, but it's worth checking and could solve at least one problem if an infection is discovered.

Tony
Avatar universal
Thank you Tony--I'll do that--I'm glad you are OK with the catch method.

Managing all of this can definitely be stressful, especially when my work commitments and deadlines loom-- the routine helps.  But the little guy had quite an adventurous, troubled (and often notorious) past before he landed on my doorstep at the age of 10, bringing a lifetime of stories with him--mostly entertaining, but some not so pleasant.  So I want to make the rest of his time on this earth as good as it can be for him.

Not too long ago I caught him on video (nanny cam set up) unplugging a lamp while I wasn't home, then looking up at it as if he knew he had turned it off.  Needless too say I immediately dog proofed all the outlets. So he is a handful.

All the best--Wendy

5 Comments
Ha. Yes, rescues come with their own set of baggage, that's for sure. Our dogs have all been rescues for the last 30yrs and our latest, Sally the greyhound, is also a handful ... bulging with psychological problems from her racing days.

Let me know what happens with the urine sample. Hopefully, no infection, but you never know.

Tony
Hello Tony--I'm sorry, I didn't see your post until now.  I'm still having trouble using this website, but it seems to be working fine for me now.

It's lovely to know that all your dogs have been rescues--they are the best.  

Hank has escaped infection, thank goodness.  And actually, he has rallied quite nicely--he's active; engaged, eating well and his water consumption has decreased.  I think I have a good balance between low fat food for his pancreatitis and lower phosphorus protein for his kidneys.  I mix low fat prescription dog food (Royal Canin) with food I prepare myself with guidance from you in your articles and on this forum).  He enjoys his walks and has adjusted to our routine of incontinence management (frequent trips outside, use of male wraps at night, washable pads placed in his beds and favorite resting spots).  If he didn't have the incontinence issues, one would never know that he is ill.  However, his separation anxiety has worsened considerably, so I am working to help him (and me) with that.  

I realize that this period of stability will change so I will be monitoring closely with my vet, doing urine and blood testing every 4-6 weeks, depending on his symptoms.  The unpredictability of this disease is tough.  However, he has been highly intolerant of the summer heat for the last 2 years, so I am anticipating worsening as the temperatures rise to their peak from August-October.  I am not looking forward to it.  

I so appreciate your help.  

Take care,

Wendy
Hi Wendy. That's great news.

Sep anxiety is truly a nightmare to deal with - and hard to manage and change. The thing that will almost certainly make it worse is the level of attention you need to provide to keep up with kidny disease management. You are caught between a rock and a hard place.

On the plus side, you seem to be doing so well and clearly there are positive effects from your interventions. Just keep doing what you are doing.

Regards

Tony
Thank you Tony--
I will keep you posted as the story progresses--your articles, and your responsiveness on this forum have been essential to my understanding of the choices available to me, and I appreciate your support.
Take care,
Wendy
Any time. Feel free to ask any questions as they arise (I don't have all the answers but I can usually find someone that does), and yes, please do keep me posted about how things go.

Tony
Avatar universal
Thank you Tony,

I do have questions about the use of medications for separation anxiety--do you have any experience with them, and if some are less deleterious to the kidneys?  It's been recommended that I give them a try in an effort to alleviate Hank's suffering when I have to leave him alone.  I'm a little reluctant for obvious reasons, but also because he is only anxious when I leave him, and he doesn't always tolerate medications that act on the central nervous system very well.  Any insights would be greatly appreciated, though I know this is a tough subject.

Thank you,

Wendy
11 Comments
Hi Wendy. It is a tough subject, you're right. Sep Anxiety is truly a very difficult behavioural and sometimes physical (neurological) condition. Some dogs respond well to behavioural techniques (but this demands persistence, continuity and dedication by the whole household of humans) - and can take many months to have any effect. A mixture of traditional medicinal treatment AND behavioural techniques can work slightly faster, as it puts a dog in a calmer place in his or her head to start with. However, there are no medications that are safe for the kidneys - sadly, all of them will adversely affect the kidneys to one degree or another.

I have seen some miraculously good changes in sep anxiety dogs - but I have also seen dogs that do not respond well regardless of the input. Indeed, I once had a dog that I spent thousands on with different canine behaviourists, even one being a police dog trainer, and to no avail.

All you can really do is try your best and see what happens.

I would however certainly suggest giving he Plug In calmers a try. The Pet Remedy Plug in Diffuser uses all natural herbs and natural oil extractions and therefore is not harmful to the kidneys at all. Worth giving it a few weeks trial maybe.

Tony
Thank you Tony,

I was afraid that the meds would be tough on the kidneys.  I know there is a lot of trial and error wit them, even when paired with behavioral interventions.  I guess I have to decide what is reasonable for an 18 year old complicated dog.  

We do have a plan for very detailed tracking of his behavioral patterns and cues (he only exhibits anxiety and obsessive behaviors when I leave--otherwise he is very chill and content to spend time in a room away from me while I'm home), and will develop an intervention plan after that, with or without meds.  

I have tried diffusers and calming sprays on a short term basis--they didn't seem to do anything, but maybe I didn't use them long enough.  It's indeed worth a try.

Take care--
Wendy

I am currently using the one I mentioned, mainly for a slightly anxious rescued greyhound who is over-protective and guards constantly. They do actually work, but it does take several weeks before any effect is seen. A month's trial would be a good idea.

Tony
Thank you--I just ordered it.  I've used Comfort Zone Diffuser with DAP (smelled bad and became very hot), then the spray, and finally Bach's Rescue Remedy drops.  No harm in trying one more!

Several people in my area rescue greyhounds--they have all been very sensitive to stress, but otherwise lovely and interesting dogs.  In the U.S., greyhound racing is losing ground, but not fast enough, in my opinion.  

I'll let you know how Hank does with Pet Remedy--

Take care-
Great ... yes, do let me know. Greyhounds are fabulous dogs, and I wholeheartedly agree with you, dog racing should be resigned to history. My own dog, like thousands of others, was abandoned at 3yrs old, after her racing money-earning potential career was over.

Tony
Money . . . we owe the animal world so much.  
Hello Tony--

I wanted to let you know that we've tried Pet Remedy--it's been about one month--and I think it takes the edge off of Hank's separation anxiety, which is an improvement.  

His arthritis has unfortunately progressed though, to the point that he is having difficulty getting up and limps on 3 legs until he is brave enough to try setting his foot down---it affects his front elbow most, and it rotates laterally when he walks. Although he has had acute bouts of this trouble on both right and left elbows, it's his right that shows consistent pain.  Interestingly, once he gets up and braves putting his foot down, he improves and is able to walk short distances.  So our priority now is to manage his pain, perhaps at the expense of his kidneys, which seem stable.  So far, I don't think he's responding much to the pain meds, but my sense is that his pain is worse than he exhibits, so I think it's best to err on the side of caution.  

My vet is concerned about doing too many procedures with him, so we are limiting kidney disease testing only to that necessary, and I agree with this for now.  Avoiding stress seems best for him.  He enjoys eating the meals I cook for him, but he doesn't eat very much.  I have him on a low fat (for his pancreatitis), moderate protein (~15%--your advice), limited phosphorus diet--small meals whenever he will accept them.  He is alert when he's up, but he sleeps or hides most of the day and does get cranky when he's disturbed, unless I approach with special care.  His incontinence is worsening, but gradually.

It is hard to know what's best for him overall--I plan to bring in a home vet to help me assess his quality of life.  My sense is that he is in a slow decline, and that it might be necessary to let him go sooner than I wish.  Tough decision ahead!

Thank you for sending the article on phosphorus--it was very informative.  Oddly enough, I think I know the work of the vet you mentioned--Andy Mellor.  Small world!  Anyway, thank you for all of your help.  I'll keep you in the loop as things progress with my sweet little dog.

Take care--

Wendy
Hello Tony--

I am sad to say that my little Hank deteriorated significantly over the last few weeks--not from kidney disease, but to severe and painful arthritis, and probably something else--we didn't want to subject him to additional diagnostic procedures at his advanced age.  So yesterday I let him go, using a home euthanasia service.  I am devastated, but grateful for the time I had with him, and grateful I could help him end his suffering.  

I learned a lot from you and this forum that I will be sure to pass along as opportunity presents.  Thank you for your help!

Take care,

Wendy
Hello Wendy.

I am so very sorry.

I've been so busy over on the Chronic Kidney Disease User Group and on the FaceBook Group that I've not been able to call in here over the last few days, so I missed your updates.

I do tend to think something more was probably going on with Hank, as you suggest. Plus, I guess, 18 is a fabulous age for any dog, but it also made him quite an old boy in doggy years.

I think you did the right thing at the right time, even though I'm sure the decision was a really tough call.

I hope, despite the sadness and dreadful feeling of loss, you also feel a little relieved, knowing he's not in pain anymore.

Take care

Tony
Thank you Tony--

He was such an integral part of my life that I am rather lost without him.  But I am grateful that he is no longer in pain and doesn't have to deal with the challenges posed by the summer heat--that has been tough for him in the past.  

All the best--keep up the amazing work!  

Wendy
The loss of a dog is, for some (and certainly for me) a deeper felt sense of loss than any other. As our dogs are our family members, friends, children, loyal companions and soulmates ... and as they share so much of our lives ... our world is completely disrupted when they are no longer at our side, sharing everything we do. It's little wonder then that we feel so sad. And while some friends and family may not understand (particularly if they do not have dogs themselves), we "doggy folk" do.

So, if you feel the need to talk to someone over the coming days, weeks or months - feel free to call back. I'm here along with others for friendship and support.

Tony Xxx
Avatar universal
Thank you Tony,

My belief is that non-verbal communication and the dependence on subtle cues to guide our interactions with our pets (and humans, for that matter) create a much more powerful bond than those that require words (though as a writer, I'm sure you know how powerful words are).  The loss of that kind of relationship is truly profound.  Most of the people in my life recognized the bond Hank and I had, and didn't think of him as "just a dog" for me.  I'm grateful for that.  

But the home euthansia procedure went poorly--as required by law, the vets are required to ask about bite history, and when I made the appointment, I told the vet that Hank could be nippy if approached wrong, especially since he was in so much pain.  In spite of telling her that I knew how to deal with that, this disclosure led to him being labelled a "fractious" dog, and without my knowledge, the vet who came to the house chose a different protocol than was described over the phone (sedative was supposed to be given subcutaneously before the iv injection to stop his heart).  At the time, I didn't know what vets consider to be a fractious dog, or I could have prevented what the vet did without describing it to me--she chose to inject the sedative i.m. in a surprise, tentative approach, which, as you can imagine, did not go well--it required two injection attempts.  Once she finally got all the sedative in, he collapsed very rapidly, but not before we were both traumatized. I blame myself for not insisting that she go through the protocol with me, but the vet I spoke to on the phone was very clear, so I was taken by surprise.  Death can be quite the trickster, and in spite of all of my preparations for what I thought was going to be a good death, it found another way to fool me.

I comfort myself with the knowledge that it was just a few minutes out of more than 8 years (I got him when he was 10) of a fantastic, loving partnership and excellent care, but my emotions have not caught up with that yet. At this time, I doubt they ever will, though I hope my sense of failing him in his last moments on this earth, will diminish with time.  

I know you understand, and I'm grateful for that.

Take care,

Wendy
1916673 tn?1420236870
Hi Wendy

It is so hard for us, when things in the end don't go how we had planned or hoped. I empathise completely.

One of my dogs many years ago now, had to be euthanised. Meg was a lurcher and the most extraordinary dog I have ever owned. Incredibly intelligent, intuitive, always at my side and a lover of getting into mischief. She lived to the ripe old age of 20, but by that time she had gone completely blind and deaf - and her quality of life had been swept away. It was only when her back legs started to give way due to arthritis (meaning she could no longer enjoy her daily walks) that I decided that time had come, even though it was impossible for me to even contemplate.

I decided to have our great and compassionate vet come to the house, so Meg could die peacefully in her own home. Sadly, the injection for muscle relaxation and the sedative made her yelp - she had lost so much muscle tissue. Although her passing came swiftly after that, I cannot help but remember that yelp and it haunts me to this day. The last thing I wanted was to inflict any more pain.

So, what am I saying ... well, the end is just a few seconds in a long life of happiness and contentment. You were doing all you could to the best of your ability and by the end time, things were really out of your control. You certainly have absolutely nothing to feel bad about (yeah, easy said, right).

You did not fail him. You gave him all you had and more, you helped him take his final journey and you brought him peace. If Hank could, he would be saying thank you ... right now.

Run free Hank.

Take good care of yourself Wendy. Come back and chat any time.

Tony
Avatar universal
Thank you Tony!

Twenty years!  That's amazing--you must have provided such good care, and a happy comfortable home.  I can see that you put a great deal of thought into relieving Meg's suffering, until, and after the end.  Although the final decision is excruciatingly difficult, it is honorable and kind.  I feel for you, for the image that lingers.  I know that you are right, that we didn't fail Hank or Meg, and that Hank would forgive me, not only because dogs live in the moment and because of the merciful passage of time, but also because of the close bond we had.

I love her name--Meg--it brings an image of friendship to mind.

It's interesting that you mentioned loss of muscle as a factor -- I suspect that this contributed to Hank's response.  I also think that a lipoma he had on his hip may have been compressing his sciatic nerve, unfortunately on the side that was injected.  So many factors!  

Your response brings me great comfort -- thank you!  I am thinking of you, and the experiences you've had that have led you to offer such sensitive support.

Take care,

Wendy

1 Comments
We try to live in our dogs' worlds ... and I believe we only ever manage it by about 10%. They live so much in the moment (as you have said) and we could learn a lot from them on that score.

Hoping day by day, things get easier.

Take care

Tony
Avatar universal
Hank had "projects" along the trails we walked close by-- one involved digging a hole underneath a specific bunch of bushes--he worked on it every day that we took that route, until he had a hole at least one foot deep and a few feet wide.  Leaves would fill the hole in between his work days, and he matched the vigor of his excavation to the amount of leaves he found. I think he was after rodents in the beginning, being a typical terrier--an earth dog--but perhaps there were other scents to chase.  When he was done, he would emerge from the bushes with a wild and wonderful expression of joy on his face and then let out a satisfied "ha!" as he turned his attention back to the walk.  But the last few times we hiked the trail, a few months before I made the fateful decision, it seemed as if he was digging to bury his pain, circling as if he planned to lie down, like he did when he made a bed for himself out of blankets.  Then he would become aware of me, aware that I was watchful, and he would stop, and join me, still somehow satisfied.  

I returned to this project a few days after he died, and took a look at the hole, almost totally concealed by a new collection of leaves.  Oddly enough, I was trying to live a little in his world, as you described.  I'd love to know a bit more than 10%, but I did indeed learn so much from him--and what a world he occupied.

It will get better--

Thank you,

Take care,

Wendy


3 Comments
Hi Wendy. Those are stories and experiences we remember, eventually fondly and with a smile. BB was a rescued lurcher that passed away of kidney disease a few years ago and one of the "walking" events came to mind as I read your post.

She loved to chase squirrels and seagulls ... never actually catching any of them (I'm not so sure she would know what to do with them if she had). We would take her either to the local beach or to a local park for her walks. One day, at the park, we let her off her leash as usual so she could have a good run and go and meet other dogs. This particular day, we believed we had lost her, because she wasn't her usual 10ft away from us. We searched and searched and my partner and I were starting to get quite frantic.

Then we heard her barking and ran towards the sound. She was sat at the bottom of a huge oak tree, just sat there, barking. We managed to work out that she had chased a squirrel, who had then climbed this tree. But BB wasn't giving up and stayed there for what must have been 20 minutes, just sat, quite happily barking up at the squirrel.

Take care

Tony
Hello Tony,

What a patient character!  There are some things in a dog's life that are worth challenging zones of comfort, or worth a possible correction.  I can imagine BB's concentration, but I bet somehow she had you two in her sights.

I am waiting for a flight home, having taken a trip to see family-- the first time in quite awhile, as I couldn't, and didn't want to leave Hank behind.  It will be the first time I will return home without him, one of many firsts that mark the transition to life without him.  

I received a lovely card from a neighbor who wrote that I shouldn't be surprised if Hank pays me a visit soon.  I would like that--any form will do--an image in a dream, the jingle of his tags when he gets up to change position, his image in the window, watching me make my way up the walk to our door.  I'll take anything ....

Take care Tony, thank you for your kindness.

Wendy

Hi Wendy. Yes, the "firsts" are always tough. I recall weeks after BB passed, I would find myself preparing her breakfast when I got up in the morning - after doing it every day for 12 years, that routine happened automatically, until I remembered I didn't need to do it. Don't be surprised if you dream about Hank - I certainly did about BB, and still actually do every now and then. It's very normal and quite satisfying and part of the grieving process.

Time will make this traumatic event easier to live with.

Tony
Avatar universal
Hello Tony--

I know--the automatic routines will indeed take time to fade--I'm still waking up several times during the night to check up on him and like you, I have to remember not to prepare his food.  

I'm surprised that Hank hasn't visited me in a dream, but it might be because I'm still on what I call emergency emotion--a state of emotional distance that allows me to remain calm enough to act constructively when challenged by tough circumstances.  Although it does protect me from a lot of the immediate impact of shock, clarity of thought in the moment is affected.  Otherwise, I'm sure I would have done better for Hank on that day.  

As I write this, I'm so aware of how tough we humans can be on ourselves--I'm sure Hank would have long moved on to enjoy the here and now!  That's one of the many lessons from him that I would be wise to incorporate into my daily life.

I will try.

Take care,

Wendy

4 Comments
Yes, day by day is a lesson we can all learn from our dogs. Tony
Thank you for allowing this dialogue Tony--not only is it helpful to me, but I'm acutely aware of the fact that we tend to revisit our own losses when faced with those of others.  I know you are touched, and I am, in turn, touched by what you've shared about Meg and BB.  

I received a sentiment, author unknown to me, from a friend.  I'm sure you know it:  

"On the day you open your heart to a dog, don't be surprised when the whole rest of the world starts to fit in there too."  

Take care--

Wendy
Hi Wendy. Yes, although I haven't heard the saying before, it kind of fits.

I know it's been just over a month for you since Hank passed away. I found this is about the time when "others" start to forget - they themselves have busy lives, so that's no surprise - but for those grieving, it can be a difficult time after the initial flurry of kind sentiments.

Others have also said that this can be a time when day-to-day routines start to become well adapted to a different routine, but then - out of the blue - we can suddenly find ourselves with tears in our eyes, with no apparent trigger having started it. Again, I feel, this is all very natural.

If you are still having tough days or times when things seem to be getting on top of you ... come and chat. Just letting it out (even just writing stuff down) is therapeutic.

Take care

Tony
Hi Tony,

Thank you, you are on the mark!  I am indeed struggling--some of it is the unmasking of emotion when the shock wears off, but also, I haven't really adapted to new routines, and I am still experiencing physically painful distress from the knowledge of his pain, especially in the moments before he died, but also for the last few months as he declined (boy do I miss caring for him!).  I find it necessary (or perhaps I'm compelled) to take very long walks in the early morning and late evening, and my awareness of Hank's importance to me has never been more acute.

It feels like I'm at the beginning of a long lasting pattern of storms repeatedly sweeping the continent. What comes to mind at this moment is a classical guitar piece called Cuban Landscape with Rain, composed by Leo Brouwer and recorded by the Los Angeles Guitar Quartet.  It starts with a very gentle raindrop sound on a single guitar, and builds gradually into a full rainstorm played on four.  Eventually the storm resolves, returning to the soft sound of single drops.  

It seems right to feel lost and devastated, and healthier not to fight it and to allow it take its course.  It may take a bit longer than I (or others) like to recover the emotional energy needed to function in the real world, and to seek new meaning in my life.  

I know you know this territory ...

Give yourself a hug for me--

Wendy
1916673 tn?1420236870
Hi Wendy. Thanks for the hug. It took me a while to figure out what was staring me in the face while grieving ... those last few horrible periods of life were but a moment in the long life shared. And slowly I started to remember the happy times, the wonderful times, the times I had happy tears rolling down my face because of what she had done or the expression she had given me, and the love, the warmth, the loyalty ... the sheer fact that almost every waking moment of her life had been a shared experience. The Christmas Days, the impromptu walks, the holidays, the times she welcomed our guests to the home and their dogs too. The point being, those were the important times, not the last short phase of life.

I hope, in time, you can remember those days with Hank, because if Hank was able to, those are the times he would remember fondly.

Tony
1 Comments
Thanks Tony!  

You're absolutely right--the important times greatly (and phenomenally) outnumber the last few tough moments.  I do remember them, quite prominently in fact, along with so many years of hilarious stories that came with him and were generated anew with me. I imagine that he has some stories of his own about me and all the other silly humans in his life.

Not to mention his sense of humor.

I'm glad you gave me this important reminder!

Take care--
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