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Avatar universal

My dog has CKD! Prognosis "poor"


I have a 12-year old Poodle/Maltese mix (33lb) who was just diagnosed with Chronic Kidney Disease, stage 4 to 5, prognosis poor. She has been slowly declining for a few months, getting more lethargic, sleeping more, back end trembling, lumps on her belly, appetite has slowly been decreasing, etc. I chalked all of this up to old age. Especially since I took her to the vet a few months ago for the lumps and the vet didn't raise any flags.

I decided to take her to the vet last week after she had blood in her diarrhea. She hasn't eaten much or drank much all weekend. Her appointment was today. I wanted to get blood work done. It came back with very high CKD levels: 12.9 creatinine, 117 bun, 11.9 phosphorous.I didn't know anything about any of this until today.

-He said she's stage 4 to 5. There is no "stage 5". The stages come from The International Renal Interest Society (http://www.iris-kidney.com/guidelines/en/staging_ckd.shtml). There is no stage 5. Does this affect his credibility?

-Vet was wishy washy on what to do. He said her chances weren't good, but they could do an IV overnight to see if levels would improve, if I wanted ($200 for one night). I got a sense that he was trying to sell me services opposed to having her best interest truly at heart. There was no recommendation, just left it up to me to decide what to do (as in IV overnight with Science Diet k/d diet vs plan for euthanasia), with no urgency to go one way or the other. He said she probably has "days" left.

I've spent the afternoon reading all about this. I know based on her numbers that it's bad. But, I don't know how bad, exactly. On one hand, her test levels are extremely high, she mostly stopped eating/drinking this weekend. She's got several CKD symptoms that I previously thought were just old age. I know she'll continue to get worse rapidly. I know there is only one outcome in the end. Part of me thinks it's the humane thing to do just to let it play out, so that she can go (hopefully peacefully) in her own home, where she's lived a long, happy life. Or that I may need to help her along if her quality of life drastically goes down. This seems like the most likely route, based on her test results alone. She could go this week? I also don't have the money to rack up a ton of vet bills right now. I would make it work if I thought I could help/save her. The potential cost of doing IV treatments looks like it will be expensive, and I want to make sure the vet isn't taking advantage of me at a time of weakness, especially if it's not really going to accomplish anything. I just didn't get the assurance I needed of that from the vet. I don't want to be one of those owners who prolongs their pet's suffering unnecessarily.

On the other hand, some say to "treat the dog, not the numbers". Based on that, I feel like she may have some hope. Her behavior is a little better than her test results would indicate. I got some Science Diet canned food today (not the k/d, but one lower in phosphorous). I mixed it up in some water and and she woofed it right down. Wouldn't drink plain water, won't eat her dry food. But devoured the Science Diet. She's definitely lethargic, but did follow me around outside, slowly climbing the steep trails in the backyard and back again. According to what I've been reading, with levels as high as hers, she should be vomiting and having seizures. She has only vomited once, and I know it's from not eating for a day or two this weekend. I've also read some pretty amazing turnaround stories today for dogs and cats, when they start fluid treatment, and I wonder if she's got weeks or months left in her, if I commit to treating. Then again, if she does, I wonder if she will have any quality of life during that time.

My head is a mess, and I'm hoping to get some guidance/sense from others that may know more about this than me. Is there hope for her? How do you know when to fight and when to let nature take its course? I don't know what to do and I know I've got to make a decision ASAP.

9 Responses
1696489 tn?1370821974
Hi Emma.  I am sorry about your fur baby.  I worked with a vet for 8 years.  I have watched dogs with this very thing suffer needlessly for long periods of time because the owners couldn't bear to euthanize.  Please consider that it's time for this most loving last thing you can do for your fur baby.  I'm sorry.  Blessings - Blu
462827 tn?1333168952
1832268 tn?1326816010
Hi Emma's Dad....
As you said, "My head is a mess"  with this statement in mind, I urge you to not make any decisions "ASAP."
I made the decision to have my dog euthanized, when my head was a mess, and I still regret it to this day.
My TwoBits was diagnosed with kidney failure. I will tell you that the one thing that I wish I would have done, before I had her euthanized, would have been to try an IV flush.  I chose not too, because it would have meant that she would have had to spend 2 days at the vet's office, and she was always terrified at the vet's, so I didn't want to put her through that.  
You know your dog best, so, if she is OK with the vet, I would really consider giving it a try.  It may help your dog feel better. It also sounds like it is time for you to talk to your vet about medication to control your dogs nausea, as well as some anti-ulcer medication. ( Blood in the stool is a sign of ulcers )
You will also need to consider giving Subqutaneous fluids to your dog. Your dog is small, so the cost for the fluids and needles may be something you can afford. The medications are also inexpensive.
If your dog is still willing to eat, then I would say that it is not time for her to leave you.  When she quits eating and drinking, I think she will be telling you that it is time for her to go.
Please don't make your decision too quickly....give yourself time to check out your options, and then decide what is best for her.
My thoughts and prayers are with you and Emma....I know how much you love her.
Hugs to you both....Connie
Avatar universal
Hi, thanks for the replies. Ultimately, I decided to give IV therapy a try. I didn't want to live with knowing that there was something I could do, but didn't. Spending the money was hard, since the odds of helping were low, but I did it for her. That being said, I wish I hadn't. I brought her home this morning and she's in worse shape than when I took her, even less stable and confident on her feet. Her nose is scratched up from the kennel (she does that when she's stressed and wants to get out of a cage). And apparently she tried to get the IV out in the night. I consoled myself throughout a very lonely night thinking that she was curled up asleep (she sleeps a lot) and comfortable, getting the fluids that her body needs, and cleaning out the poisons.

Her numbers didn't improve at all. I was trying to help her and I feel like I took a step in the wrong direction and caused her unnecessary stress. She is so tired and depressed. She's going downhill quick, but at least she's back in her home with the people that love her most.
1436598 tn?1332896533
So sorry to hear the IV therapy didn't help. Please don't beat yourself up for trying. If you hadn't tried, you may have had a lot of 'what if' thoughts as well.

I'm sending thoughts and hugs your way, and I'm sure she knows that you were trying to help her.
1832268 tn?1326816010
Hi Emma's Dad...
Everything I have read, and been told, is that Fluids and diet are the most important things you can do, to help manage and slow down chronic kidney disease. I'm sorry to hear that the IV flush did not help. If Emma tried to, and succeeded at removing her IV, ( or chewed the line )...there is no telling how much fluid she really received.
I know you feel like you took a step in the wrong direction, but, knowing now, that Emma did not fair well with the procedure, tells you that it is not an option in the future. You may be having second thoughts about it now, but, you know you were just trying to help her, and I think she knows that too. I still wish I would have tried the flush with TwoBits...because I didn't, I feel like I let her down. You will never have to feel like that.  
If Emma is still eating and drinking, I don't think she is ready to leave. In the mean time, do the best you can to manage her symptoms, with diet and medication. ( Meds are inexpensive )  Do some research on Subqutaneous Fluids...It requires that you learn how to insert an IV needle under your dogs skin..( not into a vein )
again, you need to decide if this is something Emma would tolerate on a regular basis. I did try it with Twobits, but after a week, I decided that it was just not something she wanted to deal with on a daily basis.
Trying to help a dog with kidney disease, will require a lot of decision making on your part. You know Emma best, I am sure you will do the best you can for her.
My thoughts are prayers are with you both.

Avatar universal
I know exactly how you feel. It's been 2- weeks now since we had our Jack Russell who was almost 15 euthanized because of chronic kidney failure. Like your Emma it came on suddenly, first excessive drinking and then he started coughing up blood. We immediately brought him to the vet which I was trying to prepare myself for what I thought would be the end. She kept him overnight and gave him 4-fluid infusions, we immediately started on the daily infusions at home, KD diet, dry and canned. For the next 2-weeks he was himself, energy level was high and was very happy. He then slowly started to decline, didn't want to eat the KD food or take his meds. No matter what I wrapped the pills in he would try and spit them out. By his 1-month follow-up with the vet, he lost 4-lbs.(originally weighed 22 lbs.) and the blood results now showed his kidneys were  severely compromised with high levels. She suggested giving him a a boiled egg once a day if he refused to eat. I was able to give him usually 2-eggs a day and increased his infusion treatments to twice a day when he was very lathergic. He would sometimes pace at night, go outside and just stare off. He was having trouble controlling his urine and bowels having daily accidents in the house. Originally when we started the treatments the vet advised us he could live another 6-months, it was only 6-weeks when we made our decision to put him down. I kept asking myself if I was prolonging his life for him or me? I could see he was getting weaker, sleeping more and more during the day and at night sometimes up every hour to go out. The last week of his life I would take him for his daily walk he loved but could only make it mauve 10 minutes before I woul have to carry him. His belly was so tender I would have to carry him holding his bum and support under his front paws. If I accidentally held his belly he would mouth my hand to get down because of the discomfort in his abdomin
Avatar universal
Continued . . .abdominal area. The vet gave me several recipes to mix with the kd food to get him to eat which sometimes worked and other times didn't. The last night he was moaning while he slept, his breathing was labored and I stayed up with him and applied a hot water bottle to his swollen belly to comfort him. That last day he eat very well but that does not excuse all the other symptoms. I keep asking myself maybe I acted too soon? Up several times at night, the confusion at times staring at walls and outside, the labored breathing and the lethargy he was displaying made it obvious he was very uncomfortable and was only going to get worse. I have a broken heart letting him go . . . But my heart was breaking every day to watch him deteriorate. I guess what I'm trying to tell you is that it comes down to a quality of life issue and you know your beloved pet better then anyone. You will know when the time is right. A tough decision I know only too well. I try and remember all the joy he brought us and are thankful for those memories. Good luck to you and a big hug!

Avatar universal
Hello everyone,

Thank you for all your thoughtful responses. Emma continued to decline over the next couple of days. She was less and less interested in food and water, even with the smelly Science Diet food & water soup that she was eating for a while. I continued to wrestle with the decision on when the best time for her to pass was. On Sunday afternoon, it became more clear. There wasn't any incident. She just continued to get more lethargic on Sunday, to the point that she seemed only half-conscious when awake. I made the call and the vet came to the house and helped her pass on Sunday night. It was very difficult to let her go, but I felt like I'd made a good decision for her at that time. She was getting uncomfortable, but I didn't let her suffer. And she passed surrounded by the people that loved her most, in the comfort of her home.
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