Senior Kidney Failure - Knowing When It's Time

[Guest Bebe]

Hi everyone,

 

I hope this is the right discussion group for this topic. I have a 12.5+ yo Grey and she had kidney failure last week. 3 days in 24 hour care running fluids dropped her BUN and creatnine levels down to just above normal. As I kind of expected, her levels are climbing again...BUN up to 80 and creatnine up to 4 as tested today, 4 days after 24 hour care.

 

I've had Bebe for over 10 years now and my last resort here is to start subcutaneous fluids 500ml on a daily basis which I start tomorrow. I will bump it up to 1,000ml when she gets worse. She won't eat the Hill's k/d diet food so I am doing all I can to get her to eat chicken/rice with k/d mixed in and 80/20 ground beef. I've searched for what is best as far as low phosphorus and it's basically down to whatever she will eat now. She's lost a fair amount of weight while in 24 hour care and is eating *decently* at this time.

 

So here are my questions: Is there anything better I can do about her situation? Suggestions about her current diet? And how does one know when it is that time to make the call. The LAST thing I want her to do is to suffer and I do not want to be selfish by trying to keep her going for my own sake. She is somewhat weak and is still very responsive under her condition. I guess I need some advice on how to tell when it is that time. I know her very well and I think she is beginning to be in some slight pain. She is working her mouth every now and then and I was told this might be a sign of pain.

 

Any advice and suggestions are welcomed. She has meant the world to me.

 

Thanks,

 

Scott and Bebe

 

[RobinM]

I am so sorry to hear that she is having such a hard time. I don;t have any advice, just know that you are in my thoughts and prayers along with your sweet Bebe.

 

[CaliforniaGreys]

I am so sorry you and your girl are having such a rough time. You know her best, and only you can judge her quality of life and if she's in pain. All I can offer is a special prayer for both of you. The love you share will guide you

[MandysMom]

No advice, just sending prayers for your Bebe.

[Tallgreydogmom]

Have you tried her on Azodyl? It helped my greyhounds with kidney disease. I believe Marlyn at Grey Haven also has used it.

 

http://www.vetoquinolusa.com/pages/pro_azodyl.html

Edited December 27, 2008 by Tallgreydogmom

[Bill419]

The sub Q fluids should help. We adopted Susie at almost 14 years old with kidney disease and had her on Sub Q fluids for 13 months. She was past 15 when she died and that was after 2 strokes.

[Batmom]

Can't offer much advice .

 

At this stage, she'll probably feel better on a relatively low-protein diet but there's nothing magical about K/D. Rice with some chicken/beef/egg would do as well. A bit of beef is nice because it has more fat and thus more calories (the K/D gets a fairly high percentage of calories from fat since it is restricted protein; don't want too much fat, but on a rice-based diet you've got room to maneuver).

 

A couple other folks on the board have gotten vet-approved homecooked diets for their kidney dogs; hopefully some of them will see your post.

 

Sending gentle hugs and prayers for your pupper.

[greyhndz]

I have an iggy with chronic renal insufficiency, likely immune mediated as she has polyarthritis. She's had flares of her renal disease, and typically she'll refuse most foods, become depressed, and (so help me) have droopy ears. She's responded very well to IV or Sub-Q fluids under these circumstances. But she fooled us about 3 weeks ago by turning out to have pyelonephritis (kidney infection) which bumped up her BUN/creatinine to 130/4.4. She's followed by an internal medicine specialist for both her renal and autoimmune diseases.

 

Many dogs live a quality life for a good period of time with some dietary changes and regular Sub-Q fluids. A great website is DOGAWARE, which has a lot of good information on protein and phosphorous content of many foods, and also discussed options for home cooking. Lexi wanted no part of K/D, and didn't care for my home cooked kidney diet (I didn't care for it either ).

 

I finally made the decision, together with my vet, that quality of life for Lexi, at 12, is more important than a restricted diet. She needs to eat, and she's been on a reasonably normal diet for the past year. And until the incident of pyelonephritis, her BUN/creatinine remained stable. This was a personal choice, knowing what would make Lexi's life happy for her, and as a food-driven girl, happy = her favorite foods. She's also been on enalapril (just changed to benazepril) which has greatly decreased her proteinuria.

 

I was told by a veterinary nutritionist that the most bioavailable and digestible protein sources are eggs and cottage cheese, and many kidney diets are based on those protein sources. There's also a veterinary out west who has written a book on home cooked diets for kidney dogs (among others): "Home-prepared Dog and Cat Diets, The Healthful Alternative", Donald R. Strombeck, DVM, Iowa State University Press, 2121 South State Ave., Ames Iowa 50014. 1-800-862-6657. www.isupress.edu (ISBN: 0813821495)

 

Here are a couple of recipes that I've used from this book:

 

 

 

Egg & Potato Diet (low-protein, low-phosphorous, high-potassium, normal sodium)

 

1 egg, large, cooked3 cups potato, boiled with skin1 tablespoon chicken fat1 1/2 calcium carbonate tablets (600 milligrams calcium)1/2 mulitple-mineral tablet

 

Provides 600 kilocalories, 15.1 grams protein, 18.5 grams fat.Supports caloric needs of an 18-pound dogProvides phosphorus at 53 percent, potassium at 322 percent, sodium at 114 percent of dogs daily needs. To feed this diet with a normal amount of phosphorus, substitute 3 bonemeal tablets for the 1 1/2 carbonate tablets.

 

Chicken and Potato diet (low protein low phosphorus, high potassium, low sodium)

 

 

 

1/4 cup cooked chicken breast3 cups potato, boiled with skin2 tablespoons chicken fat1 1/2 calcium carbonate tablets (600 milligrams calcium)1/2 multiple vitamin-mineral tablet

 

Provides 689 kilocalories, 18.9 grams protein, 26.8 grams fat.Supports caloric needs of a 21-22 pound dogProvides phosphorus at 45 percent, potassium at 301 percent, sodium at 54 percent of a dog's daily needs. To feed this diet with a normal amount ofphosphorus, substitute 4 bonemeal tablets for the 1 1/2 calcium carbonatetablets.

 

 

You obviously have to pro rate the quantities in the recipe according to Bebe's weight.

 

Wishing you and Bebe well.

Jordan

[greysmom]

I'm so sorry for what you're going through. I had this happen with our Libby last February, only she went into kidney failure and was gone in a matter of weeks. I would have done anything to keep her with us as long as possible - cooking whatever food she would eat 2-3 times a day, sub-Q fluids, a stomach acid reducer to help make eating easier. As I'm sure you know, pain meds are hard to administer due to how they're metabolized, but keeping her comfortable may become more important as the end comes closer.

 

As someone said, you know your girl best. When she's not eating and seems to be not enjoying life anymore - those were what we looked for as our sign posts. Know that many here have gone through what you're experiencing and feel your sorrow both for your baby and our own.

 

Peace and White Light, Good Thoughts and Prayers

greysmom

[Guest vahoundlover]

My thoughts and prayers are with you

[Guest greyscot]

I'm sorry about Bebe and I understand what you are going through. I've been through this twice - once with a cat and once with a non grey. According to my vet the 'best line of defence' is the kidney diet. There are various types on the market - do an internet search. If she will not eat one type she may eat another. I was told to mix it with a little boiled chicken if needed. One of the best things for me was adding nutritional yeast to the food. This stimulated my dogs appetite and I honestly believe it bought her more time. I am eternally grateful to the folks here on Greytalk who suggested it.

As to your question about knowing when it's time in both cases with my animals I knew. For them the change, as I call it, came rapidly. One day they were managing to have a decent quality of life and then the next day they had changed and it was time. I hope you have many more good days with your Bebe.

[Guest ss556]

I have a kidney dog, not in failure, he eats boiled beef (chop meat) with rice or boiled chicken with rice daily - with K/d kibble. I put tums in his food and he gets pepcid twice a day. Bebe needs to be comfortable - I'm sending my prayers.

[Guest argolola]

Your precious baby will be in my prayers.

[Guest MorganKonaAlex]

My Kona went through kidney failure. She got fussier eating as her numbers got worse. We finally started administering SubQT fluids 2x week at home. I was amazed at the difference the fluids made. She acted years younger. She started eating regular dog food again. We got several quality months out of SubQT fluids.

 

Re: Bebe working her mouth: Have you checked her teeth?

[Guest suzye]

I am sorry that Bebe is in kidney failure. My Jazz made it 11 months with that diagnosis and it was her back problems that took her, not her kidneys. You might consider joining the yahoo group http://pets.groups.yahoo.com/group/K9KidneyDiet/

 

There are a lot of recipes there, but it's all copyrighted to the group so I cannot post here. You're doing a lot of the right things already but that's another resource you can try.

 

Of all meat, egg whites have the highest protein/phosphorus ratio, so they are a wonderful food. You can include some of the yolk but when I fed them I tried to use only 1 yolk or fewer per 2 egg whites. You might also try finding glutinous rice (mochi gome) -- it's a special rice with opaque, round grains that is very low in phosphorus.

 

I was frustrated for a few months after starting subQs. It took a few months before her numbers went down again, but 11 months later, her numbers were essentially the same as they were when she first got sick.

 

Check blood pressure, too. There are a few choices of meds (Benazepril, Amlodipine, and others) if your dog's blood pressure is high. I never really got to the bottom of that with Jazz, though. Her BP was high at the vet every time we went, even when she was on 3 doses per day. Maybe she was just scared at the vet and OK back at home.

 

I was prepared to let Jazz go when she would no longer eat much and wasn't interested in going outside. Kidney disease is extremely frustrating because of the appetite problem.

 

Jazz was also on Sucralfate for acidity, to prevent ulcers. I don't know if she really needed it, but it's on the $5 drug list at HEB. If her phosphorus level is elevated, you can also add a phosphorus binder to the food. Alternagel is a gel and has a flavor (I think it's minty, which is odd) but there is also flavorless powder but you have to get a prescription for it. Regular drugstores should be able to order it.

Edited December 26, 2008 by suzye

[Guest Bebe]

Thanks to everyone! I have received nothing but love and support from everyone on here and also great advice during tough times in the past. Today was my first giving her sub Q fluids and it was tough but I know it has to be done. When she first has her blood work done, her BUN was around 300. Two days of daily fluids at the vet followed by 3 days of 24 hour care dropped it to 37. So I know how important the fluids are.

 

Thanks for the link houndznigz and this was one of the links that came up when I searched on the net. It is my main source for referencing about her diet and is loaded with info on kidney disease. The good news is that she's eating better than two days ago and putting a slight bit of weight back on. She was rail thin from not eating in 24 hour care. I read that giving them smaller meals several times a day helps. She doesn't like Purina NF and not much on the k/d. I will try some others listed on Dogaware.

 

She's on Pepcid 20mg and with the vets advice, I plan on keeping her on it. She's also at the end of her Baytril so I hope her appetite gets better once that wears off in a few days. I'm moving into a single story home with a nice backyard this weekend and leaving this one with stairs that she had to deal with. I've been carrying her up/down for almost 4 weeks now. Bebe's teeth are clean and the vet said maybe she's working her mouth from pain, but I don't know.

 

suzye, thanks for the group suggestion and I just put in a join request.

 

She's carried me through some really tough times and I am willing to do everything I can to make her as comfortable as possibile.

 

Thanks again to everyone who replied. This site has always been one that I can count on for Greyt advice!

Edited December 26, 2008 by Bebe

[Guest Greensleeves]

I'm so sorry. We just went through this with Nelly (two hospital stays with IV fluids, home-cooked diet, sub-cu fluids twice a day, etc). It sucks. I never want to hear a vet tell me a creatinine reading again as long as I live.

 

When she was first diagnosed, we asked our vets what to expect when it was "time."

 

They told us to prepare for uncontrollable vomiting, and most of her care was to prevent that (Pepcid, metaclopramide, Tums, baking soda dissolved in water, etc). What we actually saw were neurological symptoms--pitting edema in her legs, falling and knuckling under when she walked, head-bobbing (those were in her last 24 hours). She had also started to develop canker sores in her mouth, one of the signs of end-stage renal failure. I feel blessed we were spared the worst of the stomach upset, but do wish someone had mentioned the neurological issues to us beforehand (they were scary and confusing, and kind of went undiagnosed at first). Nelly also got very reclusive and depressed, and spent a lot of time trying to find places to hide.

 

We spent weeks struggling to get her to eat, and in her last 10 days, finally just fed her the KD by syringe. I truly wish we had done that from the beginning, because she didn't enjoy the daily diet battle any more than we did, and because wondering whether she was getting the right balance of calories/nutrients/protein/phosphorus was completely overwhelming.

 

Hugs to you both, and hope you have many months yet together... but make sure you spend as much time as possible loving on her. We lost Nelly a lot sooner than we expected, but we absolutely packed her last months with stuff she loved.

[Guest IrskasMom]

Hi Scott .... I really don't have any Advice but your Story is thou Touching . I will pray for your sweet Bebe and hope you have

many more GOOD Days with her.

Edited December 26, 2008 by IrskasMom

[Guest suzye]

I read that giving them smaller meals several times a day helps.

I had to feed Jazz 3 meals per day after she got sick. She was not a big fan of the rice, so getting her to eat as much as she needed to required a 3rd meal. I work only 15 minutes from home so I was able to come home at lunch to feed her and let her out. If I didn't work so close... well I can't even think about what would have happened. Jazz got meals at 11:30 and 5:30, and a slightly smaller one between 7 and 8 PM. She was always hungrier in the evening (always a night dog anyway).

 

suzye, thanks for the group suggestion and I just put in a join request.

I hope the group helps you. They will require you to fill out a very long questionnaire, but all the info helps them help you. It's a very busy group, so it might take a few days to get the ball rolling. But once you're in you can look at all the files and do searches on past messages. I'm still a member, but I don't post anymore and turned off the incoming emails.

 

If you're desperate for snacks, Nilla Wafers are a semi-low-phosphorus snack, as are animal crackers. Jazz got 6 Nilla Wafers every day. I gave her the reduced fat kind only because I was really worried about her lipase level. We never really determined if she had a problem with fat or not. Otherwise I would have given her the regular ones.

 

Suzy

Edited December 26, 2008 by suzye

[crazygang]

Sending prayers that you have a lot more time spent together..........strength and courage

[patricia]

Sending my prayers. We lost our Angel Queenie with Renal Failure. I will say...she had some pretty bad days...and would bounce back. Hoping this is just a bump in the road.