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What else can we do with our Bassett in Stage 4.
Our Bassett Lucy was diagnosed exactly 4 weeks ago. BUN 114; CREA 8.6. She was eating the first 2 weeks, KD Hills and specially prepared diet, however the past 2 weeks she hasn't ate a thing on her own. She is currently on Damestron,Cerenia, Mirtazapine, 500ml of fluids SUBQ daily and we also give her a vitamin B, TUMS and 20mg acid reducer daily. I have been grinding the dry Hills food into a finer texture and mixing with water or honey and feeding her 3-4 tablespoons a couple times a day. She is an excellent patient and never fights us. She is still drinking water, urinating, drools, mostly lethargic, walks around unsteadily, but still responds to commands. Any suggestions, advice, or comments appreciated. We are heartbroken but grateful our girl is hanging on.
Just adding that she was on 3 full days of fluids at the ER after her crisis
I just wanted to chime in on my experience and what is working. Tony is correct about the phosphorus. My dog had an Addisonian crisis and acute kidney failure mid Nov 2016. 3 full days at the ER and all numbers were normal except an elevated BUN. It only took about a week before she started acting tired and became finicky eating. Back to the vet's, and all her numbers were elevated including her phosphorus...8.8. They actually put her on 3 more days of IV fluids....so that's another option. The fluids brought her numbers back to normal, except the BUN. I was sent home with lactated ringers, K/d diet, and aluminum hydroxide (phosphorus binder). I know it's expensive, but can you ask to have your dog put back on IV fluids?
Hello. Welcome to our group of friends, although I'm sorry there's a need for you to be here.
A few questions ...
Has Lucy had any IV Fluids? While SubQ fluid is a good primary treatment, helping get creatinine down, it take much longer than IVs and isn't quite as effective. So, if you stay with SubQs, it could take quite a while to see any great improvement. Also what type of fluid is being given? The ideal would be lactated ringer.
While talking about fluids, what weight is your dog? The dosage is crucial and it depends on the weight of your dog as to how much can and should be given.
Mirtazipine is a favorite medicine of mine that I recommend often, and I do believe it helps a huge amount. Cerenia is good alongside it to help with anti-nausea. I haven't heard of Damestron? Can you check the name again. Do you know what it is being given for?
TUMS are okay, but do be careful of adding too much calcium - they are beneficial, as long as calcium blood levels don't climb high. The calcium will also help keep phosphorous under control - which is a crucial thing - but if both calcium and/or phosphorous blood levels start climbing, it would be better to add an alternative phosphate binder to the medicine regime. If this happens, please ask me about it. Monthly blood checks are important at this stage of management, so you and the vet knows what's changing and when.
You didn't actually list phosphorous levels in the bloods. Can you let me know if it has been recently tested and what the level is.
Helpful supplements you might consider include pure organic salmon oil (rich in omega-3 fatty acids), rhemania-8, CoQ10 - these can be given in rotation, so salmon oil (with a Vitamin E canine capsule, as salmon oil depletes this vitamin in the canine body) on day one, then rehamania-8 on day 2; then CoQ10 day three. These help boost the kidneys, improve the immune system and reduce inflammation. All quite helpful.
In terms of eating, I'm hoping the Mirtazipine helps encourage Lucy's independent eating over the next week or so - it would also be helpful to increase the frequency of "meals", so up to about 6 meals a day, with 2hrs or so between meals. This reduces stress on the kidneys (dealing with smaller volumes of food being processed) and reduces the volume of toxins released into the bloodstream caused by metabolization.
Hope this helps.
Get back when you can.
Tony
A few questions ...
Has Lucy had any IV Fluids? While SubQ fluid is a good primary treatment, helping get creatinine down, it take much longer than IVs and isn't quite as effective. So, if you stay with SubQs, it could take quite a while to see any great improvement. Also what type of fluid is being given? The ideal would be lactated ringer.
While talking about fluids, what weight is your dog? The dosage is crucial and it depends on the weight of your dog as to how much can and should be given.
Mirtazipine is a favorite medicine of mine that I recommend often, and I do believe it helps a huge amount. Cerenia is good alongside it to help with anti-nausea. I haven't heard of Damestron? Can you check the name again. Do you know what it is being given for?
TUMS are okay, but do be careful of adding too much calcium - they are beneficial, as long as calcium blood levels don't climb high. The calcium will also help keep phosphorous under control - which is a crucial thing - but if both calcium and/or phosphorous blood levels start climbing, it would be better to add an alternative phosphate binder to the medicine regime. If this happens, please ask me about it. Monthly blood checks are important at this stage of management, so you and the vet knows what's changing and when.
You didn't actually list phosphorous levels in the bloods. Can you let me know if it has been recently tested and what the level is.
Helpful supplements you might consider include pure organic salmon oil (rich in omega-3 fatty acids), rhemania-8, CoQ10 - these can be given in rotation, so salmon oil (with a Vitamin E canine capsule, as salmon oil depletes this vitamin in the canine body) on day one, then rehamania-8 on day 2; then CoQ10 day three. These help boost the kidneys, improve the immune system and reduce inflammation. All quite helpful.
In terms of eating, I'm hoping the Mirtazipine helps encourage Lucy's independent eating over the next week or so - it would also be helpful to increase the frequency of "meals", so up to about 6 meals a day, with 2hrs or so between meals. This reduces stress on the kidneys (dealing with smaller volumes of food being processed) and reduces the volume of toxins released into the bloodstream caused by metabolization.
Hope this helps.
Get back when you can.
Tony
11 Comments
Do NOT give the steroid. Who suggested this? Although steroids can help a more healthy dog with poor appetite, they should not be given to kidney failure dogs. They have potentially life-threatening side effects, which include liver and kidney failure.
Tony
Tony
Thanks for the feedback. Lucy was initially in the hospital for 5 days and received IVs (diuresis?) and flushed her kidneys and her BUN went from over 130 to 110 and CREA 8.2 to 5.7. Two weeks later it was 114 and back up to 8.6....we were sent home with SubQ fluids (Sodium Choloride) and Ondansetron (nausea/vomiting). Her bloodwork did not include phosphorus or calcium. She has lost 15 pounds, has not ate in 20 days. Our vet suggested last week to increase fluids to 500ml (I understood her to say you can't really overdo the fluids) and we added the mirtazaphine and cerenia. That increased her mood and activity, but she still hasn't ate. At this weeks consultation we decided to add the steroid only because we feel at this point it's better to try and make her feel better and stimulate an appetite than to worry about kidney management. We don't have any plans for further blood work unless we can get her eating. Since we work unfortunately it's hard to get the food in her during the day.
If we can get her eating, we will definitely start monitoring phosphorus, specific foods and additional supplements. Just praying her time is not up quite yet. Let us know if you have any other suggestions. Thanks again!
If we can get her eating, we will definitely start monitoring phosphorus, specific foods and additional supplements. Just praying her time is not up quite yet. Let us know if you have any other suggestions. Thanks again!
A vet that doesn't include phosphorous in the bloodwork doesn't understand kidney failure at all. Phosphorous is perhaps THE major problem of all canine kidney failure issues, as it sends calcium levels out of synch. Calcium is the most important mineral to all mammalian life on the planet, and the canine brain will make any change it can to preserve calcium - including dragging it (disastrously) from bone and teeth if it feels there is a deficiency. High phosphorous causes the brain to "think" there's a deficiency, when in reality, there isn't.
So, phosphorous blood levels MUST be checked, urgently.
The other thing that makes me wonder about your vet is the fact they have given sodium as a fluid. This is not good (unless sodium is very low in the blood tests, which is unlikely). Sodium is basically salt - and this has bad effect on canine kidney failure, as well as affecting blood pressure adversely.
Fluid should be Lactated Ringer, as this is a canine balanced fluid (the same as the fluid in a healthy canine body).
I can't advise on fluid dosing, as you haven't told me the weight of your dog.
"You can't overdo he fluids" is not quite true Aggressive fluid therapy is sometimes necessary to help bring creatinine down. It is only a danger if there are signs of fluid build-up or in the case of congestive heart failure.
There are also questions I asked in my first reply that you have yet to answer. I realise this can be very stressful, but please try to reply to my questions if you want me to offer some guidance.
I know you don't plan doing more bloodwork. If you don't, then you don't, but that means you are accepting your dog will deteriorate rapidly - and you won't know what to do to help her.
Regards
Tony
So, phosphorous blood levels MUST be checked, urgently.
The other thing that makes me wonder about your vet is the fact they have given sodium as a fluid. This is not good (unless sodium is very low in the blood tests, which is unlikely). Sodium is basically salt - and this has bad effect on canine kidney failure, as well as affecting blood pressure adversely.
Fluid should be Lactated Ringer, as this is a canine balanced fluid (the same as the fluid in a healthy canine body).
I can't advise on fluid dosing, as you haven't told me the weight of your dog.
"You can't overdo he fluids" is not quite true Aggressive fluid therapy is sometimes necessary to help bring creatinine down. It is only a danger if there are signs of fluid build-up or in the case of congestive heart failure.
There are also questions I asked in my first reply that you have yet to answer. I realise this can be very stressful, but please try to reply to my questions if you want me to offer some guidance.
I know you don't plan doing more bloodwork. If you don't, then you don't, but that means you are accepting your dog will deteriorate rapidly - and you won't know what to do to help her.
Regards
Tony
Lucy is down to about 34 pounds...I think I answered everything else. The reply we got from our vet is that we know her kidneys are failing, we don't need to do more bloodwork to figure that out...we need to get her eating and then we can worry about more bloodwork.
It's hard to question the vet, but I'll do my best.
Thanks
It's hard to question the vet, but I'll do my best.
Thanks
Your vet is fobbing you off. Sorry, I believe in speaking bluntly. Yes, the bloodwork has already told you the kidneys are failing. That's true. But more bloodwork is needed for comparison to assess what diet and medication changes are and become onwardly necessary, and without that bloodwork being done, it is all going to be guesswork. Guesswork can adversely affect your dog's health, kidneys, longevity and quality of life.
Personally, if I were you, I would look at finding an alternative vet for a 2nd opinion - and one that is more familiar with canine kidney disease and more amenable to good pro-active management and testing.
I need to ask again about blood testing of phosphorous? Has your vet tested for this yet? This is crucial.
Has your vet performed a blood pressure check? This is also crucial.
Has your vet changed the sodium chloride for lactated ringer fluids?
500ml a day SubQs are the very top of the maximum level for fluid therapy (for a 34lb dog). This needs to be undertaken with some caution, as it can have an adverse effect on the heart and electrolyte balance. I would not keep it at that level for more than two weeks - and both blood and blood pressure tests need performing weekly to guard against problems arising
Tony
Personally, if I were you, I would look at finding an alternative vet for a 2nd opinion - and one that is more familiar with canine kidney disease and more amenable to good pro-active management and testing.
I need to ask again about blood testing of phosphorous? Has your vet tested for this yet? This is crucial.
Has your vet performed a blood pressure check? This is also crucial.
Has your vet changed the sodium chloride for lactated ringer fluids?
500ml a day SubQs are the very top of the maximum level for fluid therapy (for a 34lb dog). This needs to be undertaken with some caution, as it can have an adverse effect on the heart and electrolyte balance. I would not keep it at that level for more than two weeks - and both blood and blood pressure tests need performing weekly to guard against problems arising
Tony
Phosphorus and calcium were never tested. I don't think BP was checked. I have not ask about the Lactated Ringer, I'll call Monday. The last time she was at the vet was 12/16. The general consensus from both local vets is that Until we get her eating (over 3 weeks), Everything else is a non-issue. Do you have any suggestions to encourage eating or food combinations to try? Nothing we've tried has been successful. We have declined the suggestion of a feeding tube.
The reason nothing has been successful is because nothing is being done about abnormal blood levels (except fluid therapy) ... which I suspect include phosphorous. Abnormal phosphorous causes abnormal parathyroid hormone levels, which in turn cause the kidney disease to cycle into decline. Your dog needs to be on aluminium hydroxide (if phosphorous levels are as I strongly expect, abnormally high).
90% of dogs with kidney disease have high blood pressure. A good vet will recognise this and test for it at diagnosis. High blood pressure causes damage to the kidneys and makes the disease deteriorate more rapidly than it would otherwise do. So, getting blood pressure down to near-normal levels with an appropriate medication (benazepril or enalapril would be my choice) is a priority.
One of the main reasons your dog isn't eating is because she is feeling constantly sick and her brain is telling her that food will make her vomit. Anti-nausea medication is the way to deal with this right now. Cerenia PLUS mirtazapine will help. Ondansetron (Zofran) should certainly be given to help even more.
If your dog really hasn't eaten for 3 weeks, then I would definitely use a tube for feeding as a temporary measure - even as a one-off, just to get nourishment into her. A very temporary alternative would be to cook up a broth of human-grade chicken (high quality protein), one cooked potato (carbohydrate) and some green beans (good vitamins) - strain this after cooking and cooling, so it looks like a clear(ish) soup.She may lap at it - she may not.
The longer these issues are left, the worse your dog will become. I am concerned things are now critical.
Tony
90% of dogs with kidney disease have high blood pressure. A good vet will recognise this and test for it at diagnosis. High blood pressure causes damage to the kidneys and makes the disease deteriorate more rapidly than it would otherwise do. So, getting blood pressure down to near-normal levels with an appropriate medication (benazepril or enalapril would be my choice) is a priority.
One of the main reasons your dog isn't eating is because she is feeling constantly sick and her brain is telling her that food will make her vomit. Anti-nausea medication is the way to deal with this right now. Cerenia PLUS mirtazapine will help. Ondansetron (Zofran) should certainly be given to help even more.
If your dog really hasn't eaten for 3 weeks, then I would definitely use a tube for feeding as a temporary measure - even as a one-off, just to get nourishment into her. A very temporary alternative would be to cook up a broth of human-grade chicken (high quality protein), one cooked potato (carbohydrate) and some green beans (good vitamins) - strain this after cooking and cooling, so it looks like a clear(ish) soup.She may lap at it - she may not.
The longer these issues are left, the worse your dog will become. I am concerned things are now critical.
Tony
So Lucy went back to the vet today and we had a lengthy consultation. She is 34 pounds. Heart and lungs sounded good. CREA had decreased to 6.8 (down from 8.6, 4 weeks ago), BUN had increased > 130 (114, 4 weeks ago). CA was 10 (normal), and everything else was normal except Phosphorus (16) and RBC (2.9). Did not take BP due to difficulty obtaining.
We are currently on Cerenia, Mirtazapine, Omedanestron. We traded the predisone (since it not had stimulated appetite) for Valium. We also got the PH binder (3 scoops daily). We also received the Lactate Ringer and are increasing her fluids to 760 cc daily. Both vets said as long as her body is absorbing the SUBQ, that there is no chance of overdosing (IV is different story). They suggested we try to feed her a cup of the food I'm "forcing" down her daily. If she should start eating on her own, we could give a shot of EPO? to deal with low blood count, although it could be pricey. We are continuing with the B vitamin, TUMS and acid reducer. We have quite the regimen but hopefully it will be worth it.
We are currently on Cerenia, Mirtazapine, Omedanestron. We traded the predisone (since it not had stimulated appetite) for Valium. We also got the PH binder (3 scoops daily). We also received the Lactate Ringer and are increasing her fluids to 760 cc daily. Both vets said as long as her body is absorbing the SUBQ, that there is no chance of overdosing (IV is different story). They suggested we try to feed her a cup of the food I'm "forcing" down her daily. If she should start eating on her own, we could give a shot of EPO? to deal with low blood count, although it could be pricey. We are continuing with the B vitamin, TUMS and acid reducer. We have quite the regimen but hopefully it will be worth it.
That's a good start. I would say a definite NO to valium. It will damage the kidneys even more than they already are. You do not need another appetite stimulant. Mirtazipine will stimulate appetite and reduce nausea. Give it a chance to work (several days to a week). Once Lucy is eating reasonably well, you can reduce and stop the Ondansetron over a few days. That will help reduce the by-product toxins caused by metabolising it.
You are now on the right track. Have bloods done in 2 weeks time and compare with the last set of results. Always get copies of all blood and urine tests and start keeping a file for them. It would also be useful to start a diary, recording medicines that have been prescribed, when they started, what the results of taking them were and when they stopped. Also, keep a record of weight and food intake.
The anaemia is not uncommon. But so much depends on why it is happening. It could be due to blood loss through a haemorrhage (often of the intestines), or an ulcer in the stomach, or due to poor red blood cell production. Does your vet have any idea which of these it is? To offset the chance of ulcers causing issues, start giving cooked chopped green cabbage (about a desertspoon full) every 2nd day mixed with the food. This will help prevent ulcers forming.
If it is poor red cell production, then EPO is a good idea - along with an iron supplementation (canine formulated). If it's a haemorrhage, check stools for colour (dark almost black stools indicate blood loss). This is more serious and may need further consideration from your vet. If the next blood tests in 2 weeks show RBC levels at the same or worse than currently, then it will become a priority to treat.
Tony
You are now on the right track. Have bloods done in 2 weeks time and compare with the last set of results. Always get copies of all blood and urine tests and start keeping a file for them. It would also be useful to start a diary, recording medicines that have been prescribed, when they started, what the results of taking them were and when they stopped. Also, keep a record of weight and food intake.
The anaemia is not uncommon. But so much depends on why it is happening. It could be due to blood loss through a haemorrhage (often of the intestines), or an ulcer in the stomach, or due to poor red blood cell production. Does your vet have any idea which of these it is? To offset the chance of ulcers causing issues, start giving cooked chopped green cabbage (about a desertspoon full) every 2nd day mixed with the food. This will help prevent ulcers forming.
If it is poor red cell production, then EPO is a good idea - along with an iron supplementation (canine formulated). If it's a haemorrhage, check stools for colour (dark almost black stools indicate blood loss). This is more serious and may need further consideration from your vet. If the next blood tests in 2 weeks show RBC levels at the same or worse than currently, then it will become a priority to treat.
Tony
Update on Lucy is that she still hasn't showed any interest in eating, except for a few small bites after we give her the Valium. We did cut the dosage in half. She has Taken a few bites on her own 2 times in 4 weeks. She's pretty much the same....lethargic, gets up to urinate, a little fresh air, maybe for a little attention and then back to her bed. We manage to get about a cup of food down her every 2 days. No vomiting, no diarrhea...still hanging in there.
Medications at this point are:
Ondansetron, Mirtaziphine, Celenia, the Valium, Phosphorus Binder & Cinnamon mixed in food which is the KD Hills dry/wet mix, Vitamin B, Tums, Acid Reducer and Lactated Ringer, all of which has been adjusted to 34 pounds
Medications at this point are:
Ondansetron, Mirtaziphine, Celenia, the Valium, Phosphorus Binder & Cinnamon mixed in food which is the KD Hills dry/wet mix, Vitamin B, Tums, Acid Reducer and Lactated Ringer, all of which has been adjusted to 34 pounds
Lucy is taking a few bites more often, however the only thing we found she will eat is chicken, cheese and egg. Basically it can't have a strong smell...
So sorry that you are going through this :/ I don't have a lot of advice, as I'm pretty new on this kidney disease journey myself, but just wanted to let you know that you're not alone. My dog Spirit was diagnosed in October, though she seems to be crisscrossing between Stage 2 and Stage 3. Tony will probably chime in soon, though, and he has a lot of advice.
1 Comments
Thank you for your concern. We have also added a oral steroid....Good luck with your fur baby.
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