Kidney Problems, Deramaxx, And The Vet

[Guest suzye]

Hi everyone. I have posted here a few times, I think, but it was so long ago I couldn't come up with my login information! My girl Jazz is 12 ½ years old, and while she’s had a lot of mishaps, she’s always been pretty healthy (always good bloodwork).

 

On 10/14 Jazz was diganosed with the dreaded kidney disease. She broke her toe about a week before that and was given Tramadol (for pain) and Deramaxx (NSAID). I wasn't offered any info about side effects and I didn't ask (big mistake).

 

A few days into it I googled the drugs. I found some bad stuff about Deramaxx causing kidney problems and even death. I'd had a bad feeling and wanted to stop giving it to her, but I told myself this was rare and the vet would have warned me if I should be on the lookout. After a few more days, Jazz stopped eating. I wasn’t sure if Tramadol was suppressing her appetite or if she was ill. However, she was also drinking a lot of water. I stopped both meds and called the vet. She said stop giving her the medicine -- that’s ALL!

 

I soon decided something was very wrong, so I brought her in. We saw a different vet this time (we're new to this hospital and part of town). Jazz's urine was dilute so they ran full bloodwork. Her creatinine was 2.2 and her BUN was high (I'm thinking ~60 but I'm requesting the records tomorrow for my files). I know 2.2 isn't high for greyhounds, but it's high for *her*. Coupled with the high BUN, I knew we were in trouble. Jazz was hospitalized immediately for an IV flush. The next morning she was already eating again. The morning after that, I waited in agony for the follow-up bloodwork. Her creatinine and BUN came down to normal levels. What a relief. BTW this vet knows what's normal for greyhounds, and she told me exactly what the values were, but I just forgot to ask for a copy.

 

She was discharged that evening with a case of Royal Canin modified diet. I've done some research on kidney diets (I've read this link http://www.dogaware.com/kidney.html#diet -- tons of info to process!) and what my vet says doesn't seem to *totally* line up with what I've read. She recommends low protein and is keeping it quite conservative. I brought up the phosphorus specifically and she said it wasn't a problem. Maybe I didn't explain myself right. All I've given Jazz is RC plus max of 1/2 cup white rice (per day) plus small amounts of baby food (veggie flavor only) plus a spoonful of pumpkin (for soft stools). I asked the vet about green tripe and she said no, that's protein she shouldn't have.

 

Jazz has been home since 10/16 evening and she seems to feel good, she's alert, and she is eating a few small meals per day. She used to eat about 3 cups of dry food per day, and now she's eating about 2 cans of RC per day. Of course, she has fresh water at all times. She pees all over the floor, so the clean-up is getting old. I've ordered some bed pads but it will probably be a week before I get them so we're making do with yucky disposable pads and newspaper until then. I'll be sealing the grout next weekend!

 

Anyway, I'm just wondering if Jazz is getting *enough* protein now. She's a little girl. She weighed 54 a month ago, 52 before the illness, 50 upon entering the hospital, and was back up to 52.2 today at the follow-up visit. She's always been one of the skinniest greyhounds I've seen, so I guess she is doing pretty good. They ran her blood again and the kidney values were normal -- more good news. The vet said if she keeps doing well we might be able to get her partly back on regular food, but now is too soon to tell (and I'm fine with that).

 

The bad news is her fracture has not improved (it's been 3 weeks). Maybe now there is less stress on her body, it will start to heal? I'm really thinking about changing vets for the next dog. A co-worker recommend another place nearby so I want to get prices and ask some non-price questions, too. Isn't $206 for CBC+chemistry high? $50 for urinalysis, $88 for select bloodwork (kidney stuff), $92.50 for single-view x-ray, and $31.50 every week to change her bandage (and that's labeled SMALL!) 2 days of hospitalization with IV fluids was $800.

 

This was probably too much for 1 post... just wondering what anyone with experience thinks about the diet stuff and the prices. Their IV pricing chages when you hit 51 pounds. I'm thinking about asking them to adjust my bill since she fell below 51 pounds that second day! I got a free bandage so I guess I won't say anything.

 

Jazz is gassy, too.... I forgot to mention that so I will call tomorrow. I mentioned to the vet that I was upset about the other vet not being more vigilant with the drug. I was told they are starting to give out the drug info with all prescriptions, so that's a step in the right direction. I forgot to ask about supplements, though. Should I put her on milk thistle, or is that more for the liver?

Edited October 24, 2007 by suzye

[Trudy]

Yes, $206 for a chem panel and CBC is high.

I've always paid about $100 for the combo. The ones we had done at the hospital a few weeks ago came to $103.

 

Fees are odd - we were charged a "Multiple Injection/day" fee of $72 and $8 for 90mg of phenobarbitol - a half day supply (I can get a 45 day supply for $15), along with some nursing care and professional treatment fees - things I'd think would be part of the hospitalization fee, but weren't.

 

 

Depending on where you are, these might be normal charges.

[Guest suzye]

Yes, $206 for a chem panel and CBC is high.

I've always paid about $100 for the combo. The ones we had done at the hospital a few weeks ago came to $103.

 

Fees are odd - we were charged a "Multiple Injection/day" fee of $72 and $8 for 90mg of phenobarbitol - a half day supply (I can get a 45 day supply for $15), along with some nursing care and professional treatment fees - things I'd think would be part of the hospitalization fee, but weren't.

 

 

Depending on where you are, these might be normal charges.

Thanks for the reply, Trudy. The other hospital I am thinking of switching to also provides emergency support for established clients, so I'll be curious to see if their prices are just as high.

 

[Guest LynnM]

Dunno about all the charges....

 

The progress on her fracture... is that according to x-ray or by feel? If you x-ray a leg at that time, oftentimes, you'll get a picture of what looks like a busted up leg. *THEN* you remove the splint and have a feel and it's not as bad as you thought. Callouses take some time to calcify, and take some time after that to be visible on x-ray. At 4 weeks, there should be a good callous there that is palpable, even though there might not be a darn thing visible on x-ray.

 

Lynn

[Guest suzye]

Dunno about all the charges....

 

The progress on her fracture... is that according to x-ray or by feel? If you x-ray a leg at that time, oftentimes, you'll get a picture of what looks like a busted up leg. *THEN* you remove the splint and have a feel and it's not as bad as you thought. Callouses take some time to calcify, and take some time after that to be visible on x-ray. At 4 weeks, there should be a good callous there that is palpable, even though there might not be a darn thing visible on x-ray.

 

Lynn

The vet took an x-ray because she said Jazz was bearing a lot of weight on the leg. She didn't say anything about feeling it. I will ask her about this next time. For what it's worth, it was a nasty break.

[Guest Greensleeves]

Oh, poor girl! But it sounds like her mommy is on top of things.

 

She may not be getting enough food. Remember that kibble is *all* solid food, but canned food is about 70% water, so she might be getting less actual food than it seems like. Is she still hungry? You might try adding another half to a whole can. My guys, who top out in the 70s, get 3 cups of kibble per day--so I'm wondering if she's just a dog who needs to eat a little more to maintain a good weight.

[Guest ss556]

When Alan was diagnosed last June w/ KD, it was recommended I put him on Hills K/D dry and canned. Well that didn't work - he didnt like the kibble and canned gave him the big D. He got skinny quickly. I started him back on a regular kibble and added some boiled chicken and he was feeling better, acting better and looked better. Maybe your grey isn't getting enough food.

[Batmom]

Isn't $206 for CBC+chemistry high? $50 for urinalysis, $88 for select bloodwork (kidney stuff), $92.50 for single-view x-ray, and $31.50 every week to change her bandage (and that's labeled SMALL!) 2 days of hospitalization with IV fluids was $800.

 

Where are you located? That can be a big factor in pricing. Here (mid-sized city) I would pay less than half for the individual items you listed but probably about the same for hospitalization.

 

Good for you for recognizing that something was wrong and stopping the meds! It sounds like that was the problem, or at least the main problem. I do think your vet is right to be conservative with the food for a time, tho; it won't hurt her; the veterinary kidney diets are designed to be easy for the kidneys to deal with. Once she's got a good record of normal blood values, then you can start metering other foods back in.

 

Again you are right that the current thinking points more to phosphorus than protein being the issue with kidney problems. The difficulty is, animal proteins come with lots of phosphorus -- hard to have one without the other.

 

Do you know the calorie content of the canned food? Might be worth giving her another can per day if she'll eat it, if you want to see a bit more weight on her. 'Course you don't want her to get fat but healing is going to take some extra energy.

 

Hugs and luck with your pup! Wish all doggies had such a diligent momma.

[Guest suzye]

I offer her as much as she will eat. She's doing good to eat half or 3/4 can at once. The only thing she'll eat after she's stopped eating the canned food is baby food. Last night she acted a little funny. She ate more than usual at 4:15 PM and then didn't eat anything for the rest of the day. This morning she ate a normal amount. On the plus side, she didn't "go" last night.

 

I have to take her to the vet again this morning to get the bandage redone. She's been licking it like crazy, and it's all wet. After they change it, I'm wrapping it in PACKING TAPE! I don't see why that would be a problem. That way it won't get wet through any normal means. I'm going to ask them if they have a frequent buyer discount program for the bandages. Ha ha.

 

Jazz has never been a big eater. I wish she'd eat more, but she doesn't want it. I don't know the calorie content. The 70% water probably partly explains why she is peeing so much. Maybe tonight I can give her some sweet potatoes (plain, canned) and she'll eat a little more. I'll mix kibble in it, but she spits most of it out. The good news is she gained 2.2 pounds since she left the hospital.

 

Maybe I will call this other place and see what they charge for bandages/splints, bloodwork, etc. I like the doc we're seeing now, and I hate to switch vets during this problem, but if it's significantly cheaper, I might.

Edited October 24, 2007 by suzye

[Guest LynnM]

When I have boys in front leg casts, I use duct tape along the back of the cast, so I can just wipe it off if they pee on their leg.

 

Head to a pet supply store and get some Fooey, Bitter Apple or other similar product and spray the splint with it. If the top of the splint is binding or rubbing, you can take a soft, old sock, cut the foot part off, and use it to make a "cuff" at the top of the splint. Even doing this, I have had dogs that required a muzzle with a stool guard for the majority of their time in bandages.

 

Lynn

[NeylasMom]

My guess is it was the meds that caused the problem. Hopefully there wasn't any damage to her kidneys and she'll recover fully. The normal bloodwork levels sound very promising to me and honestly, if it were my dog, I wouldn't wait a terribly long time to switch back to normal food if they stay that way.

 

I think those prices are really high, particularly the bloodwork. I live in the DC metro area, where everything is ridiculously expensive and I still pay around $100 for a full blood chem/CBC (that also includes a urinalysis). The lab my vet uses charges that for a senior profile, but we run the "senior" profile on both of my dogs (Zuri is 3) b/c it's cheaper that way. If you were to run the 3 things individually it would be much more expensive. Since your dog is already a senior, you would think your vet would be choosing that option regardless, but it may be something to ask about.

 

I hope your girl feels better soon. I went through this with Neyla when she was about 5 and she did recover. We didn't get to the point where we had to put her on fluids, although we did do an ultrasound that showed acute kidney failure and she was peeing about once every hour. She's 8 1/2 now and kidneys have been fine since. We feed a raw diet.

[Guest suzye]

Thanks for the replies everyone. After her bandage change today, I asked if they had a bootie or something and they brought one without giving me the cost. They said it was $21 so I said no thank you. Then the vet wrapped the sandwich bag that I brought and taped it at the top. I'm going to keep doing that from now on. I will get some spray too in case she keeps after it -- thanks Lynn!

 

NeylasMom, I'm glad your dog made such a good recovery from the kidney problems. Maybe Jazz will be just as fortunate, despite her senior status.

 

I stopped by the other vet and their bloodwork is half the cost, running along what y'all have reported. Unbelievable! I'm going to call that vet today or tomorrow and ask some questions. I might have her records transferred right away, if they can see her next week for a new bandage. I definitely think we should re-check her kidney values in a few weeks to see how she's maintaining, and at this place it will cost ~$40 instead of ~$80. I'm sure the x-ray will be less, too. I'm in Sugar Land TX, BTW.

 

Her creatinine was 2.4 pre-hospital and went down to 1.4 right after the flush (before all this it was about 1.0). BUN was 46 pre-hospital, 21 after (16 before all this). UGH I just realized I still didn't get everything -- I don't have the values from yesterday -- maybe because I got it for free. The vet just said they were normal.

 

I'm suddenly really depressed knowing how much extra this place charges. I just feel... violated!

[Batmom]

Don't feel too violated or depressed. There is a vet here that charges a good bit more than mine for the basics, but they have some specialized equipment and capabilities that my vet doesn't have. I have had some things done there when needed and been very pleased with the service. So it could be yours is just a different sort of practice, not trying to take advantage.

 

FWIW, if I have to keep a foot dry I often use the brand name ziploc bags and just cut the zip part off. They seem to be sturdier than other bags. You can also put some duct tape on the outside of the bag in the foot area -- that'll help keep the bag from getting holes in it from toenails, the great outdoors, etc. so you don't need a new bag as often.

 

Best luck.

[Trudy]

Ask for an IV bag - that's what we are usually sent home with when somebody has a bandaged foot.

[Guest Greensleeves]

I offer her as much as she will eat. She's doing good to eat half or 3/4 can at once. The only thing she'll eat after she's stopped eating the canned food is baby food.

 

This was how Whistler was, too. We found we were able to get him to eat more by:

 

-- offering at different times of the day (which is how we found out he got really hungry around 1 am. He also ate really well very early in the morning, but not as well later in the morning or late in the afternoon)

 

--changing how we fed him (he would barely touch canned food in a dish, but could eat a whole can if we fork fed it to him straight out of the can)

 

--offering food all day long. She may have a small stomach and feel full after 3/4 of a can... but maybe she'd be hungry again for the rest an hour later? Whistler would have been the perfect candidate for free feeding, if we hadn't had ten other dogs in the house.

[Guest suzye]

Don't feel too violated or depressed. There is a vet here that charges a good bit more than mine for the basics, but they have some specialized equipment and capabilities that my vet doesn't have.

OK. I think once I get Jazz to a new vet and spend a little less, I will feel better. So far I reinforced the bottom of the bandage area with tape but for the next bag I'll use the better one.

 

Ask for an IV bag - that's what we are usually sent home with when somebody has a bandaged foot.

The vet offered that the first day we went home with the bandage, but the bag was really stiff and it had a tall edge along the bottom, so that didn't work too well. I think the sandwich bag reinforced with tape will do OK, but thanks for the suggestion!

 

This was how Whistler was, too. We found we were able to get him to eat more by:

 

-- offering at different times of the day (which is how we found out he got really hungry around 1 am. He also ate really well very early in the morning, but not as well later in the morning or late in the afternoon)

 

--changing how we fed him (he would barely touch canned food in a dish, but could eat a whole can if we fork fed it to him straight out of the can)

 

--offering food all day long. She may have a small stomach and feel full after 3/4 of a can... but maybe she'd be hungry again for the rest an hour later? Whistler would have been the perfect candidate for free feeding, if we hadn't had ten other dogs in the house.

It's funny, Jazz is just the opposite. After a few days I caught on that she needed to eat several small meals a day like you said -- usually it takes her a couple of hours between. This is hard because no one is home during the day, but I work close enough to come home at lunch. I also realized that she might not eat straight from the can, but if I put it in her bowl and leave, she will. Go figure! Sometimes when I realize she is ready to eat I will stand there over her bowl, spooning out chunks of the canned food, while she eats it. When she stops I stop because once she does the only thing she'll take is baby food or something she thinks is a real treat. She also likes to eat later at night. That's actually not a new thing with her. We used to cut her off at 8 PM (to keep her from getting us up at night) but now we cannot cut off her water so I may as well try to feed her late, too!

 

I have decided I'm never free feeding a dog again. It's too hard to track what they're eating and then when you need them to eat, like for some medications, they won't.

 

Thanks for all the replies and good thoughts. Y'all have provided some good info and suggestions.

Edited October 25, 2007 by suzye

[Guest suzye]

At this point Jazz's bigger problem seems to be her foot. She saw a bunny 2 days ago, ran after it, and has been limping worse than immediatelyafter they bandaged her foot in the first place. I had 2 Tramadol left so I gave her those but they don't seem to help the pain. I'm hesitant to give her any drugs now and of course anti-inflammatorys are out of the question. The good news is she's staying off it a lot more now. I just hope she isn't suffering too much. Poor thing. I'm going to put some ice on it now.

[Guest suzye]

I "interviewed" the new vet and he passed my test, so I'll call Monday to make an appt. for Wednesday or so. I "borrowed" the x-rays from our current vet so he can look at them. They made me sign a form and I didn't read it but they're MY x-rays. I paid a lot for them so I think I should be able to do whatever i want with them. If I end up having her records transferred they better not give me any trouble about taking the x-rays. If they want copies they'll have to pay for that themselves! I think the form just said I would return them but if I quit the hospital I don't see why they'd care.

 

If we do end up switching her over to regular food, even partially, I really wish we could get her back on dry. She's spoiled now so I don't think she'll eat dry food. I guess you could say if she's hungry enough she'll eat, but what if it takes 2 days or more? I don't think I can stand doing that. I have probably 20lbs of Innova Senior and don't know what I can do with it! BTW I don't think I will use senior good with a senior greyhound anymore, unless I ever have one prone to gaining weight.

 

Any tips on getting her to eat dry food? If I mix it, she's VERY good about eating around it -- even spitting it out if she gets it in her mouth.

Edited October 27, 2007 by suzye

[Batmom]

Re dry food: If you have an Osterizer or Cuisinart or similar, you could try grinding up a bit of dry food and then making a gruel out of it with warm water or low-salt chicken broth.

 

But.

 

When my Batman was ill, he couldn't have any chunks and soon lost interest in soaked mooshy kibble. So I cooked for him. All his food had to be ground up, which made it a bit more of a production, but it only took a couple hours every @ 5-7 days. The time and extra $ for chicken breasts, ground beef, ground turkey, etc. were really no big deal for one dog and the $ was less than buying canned. My dogs all eat some homecooked now; I often use just meat/eggs/a little veg but sometimes add cooked rice or barley and freeze the extras. The most labor-intensive part is cooking the rice/barley. I use my biggest pot and cook as much as I can at once; again, freeze the extra for next time.

 

Hugs and luck.

[Guest Greensleeves]

Whistler was on and off kibble, but we had *great* luck by soaking the kibble in chicken noodle soup (low sodium). I'd take the leftovers from a can I'd fix for myself, add a little more water, and then dump in as much kibble as I could, and still have all of it submerged. If you wait overnight, it will soak up all the liquid and become soft and mushy (but still formed), and it will take on the yummy salty flavor of chicken broth.

[Guest suzye]

Thanks for the ideas! She only ate one can of food today (plus some pasta, sweet potatoes, and a little bit of kibble). Right now I'm afraid to give her any additional protein, but if she doesn't eat better tomorrow I will. It's most important that she eat, even if it's a little extra protein. I'm definitely going to talk to the new vet about the more recent ideas of it being more about low phosphorus. I feel like the vets at the other place are too by-the-book (those being old books). I printed an article for him.

[Batmom]

The trouble with low phosphorus is, meat has lots of phosphorus! So it's hard to get more protein without also getting more phosphorus. I wouldn't think a little extra protein would be harmful in your situation, but I'm not the vet. Have you tried a little canned fish (jack mackerel, tuna, salmon) and some of the oil from it? My mom (who lives here and feeds in the afternoon) threatened to move if I ever bought another can of mackerel for the dogs. Dogs, of course, loved it.

[Guest suzye]

The trouble with low phosphorus is, meat has lots of phosphorus! So it's hard to get more protein without also getting more phosphorus. I wouldn't think a little extra protein would be harmful in your situation, but I'm not the vet. Have you tried a little canned fish (jack mackerel, tuna, salmon) and some of the oil from it? My mom (who lives here and feeds in the afternoon) threatened to move if I ever bought another can of mackerel for the dogs. Dogs, of course, loved it.

I was going to brave the green tripe, but the (current) vet said no. The problem is she says low protein and it's not because pf phosphorus, there's no way around it. I just don't know what to do. I'm reading this stuff online (and from y'all) that says she should have high-quality protein yet I'm afraid to go against the vet's orders. I'm hoping the new vet will be more open.

 

I just gave Jazz half a can of tuna with a little canned food and she lickd the bowl clean!

Edited October 28, 2007 by suzye

[Guest suzye]

Why can't I edit my last post? That's weird. Anyway, that dogaware link says Royal Canin modified is a late stage renal disease diet. Jazz's creatinine was only 2.4 and BUN was 46. I know those are high (moreso the BUN however Jazz's creatinine has been low at this lab for a greyhound, running about 1.0) but they're not way off the charts. I dug up some old bloodwork from 2001, 2002, and 2004, and her creatinine ranged from 1.8-2.2. Each test was only run once per lab. I guess the current place just runs lower. BUN was higher at most of these other places as well but less so.

 

What I was trying to say about the vet is she just said low protein is what's needed. I asked about phosphorus and she said that wasn't the problem. She didn't elaborate and say some proteins are better than others.

 

I still have so many questions.... If her kidney values are going down does that mean her urine specific gravity should go up? Or will that always be a problem, and that's likely since she is still drinking and peeing so much? Would she pee less and therefore drink less if I transitioned her to the RC modified dry food? I wonder why the vet didn't even suggest the dry food. Granted, it might be tough to get her to eat it, but the vet wouldn't know unless we tried.

[Batmom]

Hoping the new vet will be of help to you.

 

Drinking a lot, peeing a lot, specific gravity issue can be related to kidney problems ... or not. For specific gravity, you always want to check the first urine of the morning, after pup has been without a drink overnight (or several hours, anyways). Specific gravity will always be low if pup has drunk more than she needs to; that's not necessarily a sign of kidney issues. The first-of-the-morning-after-night-without-water shows you if kidneys *can* concentrate the urine. If they *can*, then you may want to look for other issues, including "psychogenic polydipsia" or "I drink a lot 'cause I want to, so there!"

 

The creatinine from your old bloodwork is in line with what my hounds' always is. You can also check BUN:creatinine ratio from the results you have. I forget what it's supposed to be but you could google that.

 

Hugs.