Advice Sought

[Guest djenkins99]

My 10-year-old greyhound Allison has kidney disease (glomerulonephritis). The disease began to manifest itself around March this year; since then she's lost nearly 1/3 of her body weight (now about 41 lbs, from a pre-disease 62 lbs), has very reduced appetite, and spends much of the day sleeping. She has to be watched constantly when she's awake to prevent accidents in the house. She's on medication (losartan) that has partially stabilized her condition, although not completely prevented further weight loss, and now is giving her diarrhea, which also afflicted her when she was on enalipril. Her vet says the damage to her kidneys is permanent. Her life expectancy is probably measured in months, and it's terrible to see how a once beautiful, energetic creature could be so horrible diminished.

 

I'm not sure how long to sustain her life at this point. As far as I can tell she is not in pain, and occasionally even shows some energy, running as best she can down and up our sidewalk. She's frequently cold, having no body fat, so I keep her wrapped in blankets when she's resting. An especially cold December hasn't helped; she obviously and understandably doesn't like going outside to relieve herself, and bolts back inside once she has. My wife wants her euthanized now, saying that her quality of life is poor. I'm reluctant to end her life until she's in pain, can't move or eat, or is incontinent to the point where she can no longer live in the house. Still, the strain of caring for her for 8 months is taking its toll. Since she cannot be left alone, without risking an accident in the house, outings involving the whole family have been practically ended. I've tried crating her, but she simply soils the crate. None of this is normal behavior for her--before she became ill, we used to leave her unattended for hours and she was fine.

 

I would appreciate knowing if anyone else has had to deal with this disease in their dog, and how you handled it. Any other suggestions would be much appreciated.

[macoduck]

Dogs don't show pain like humans do. She is most likely in some kind of pain.

Substitute yourself in the description you posted. Is that a kind of life that you'd feel happy in?

I don't mean to sound harsh and you are in a very difficult position. My husband could never sense when it was time to let one of ours go and used to deny that it was needed. I'd rather let one go a day too early than a day too late.

I've been told to make a list of things your dog likes to do. When the majority are physically impossible anymore, then it's past time.

I'm sorry you are having to go through this.

[JohnF]

I've lost 3 to Kidney Failure over the years and the last one was my heart dog 'Angel' at the age of 14. It it really hard to let them go but I think you need to try to rationalize it this way:

You've gotten used to it and developed coping strategies that may be obscuring the key points behind a decision to PTS viz:

 

1) Is the dog free of distress, pain or discomfort, and could the pain be controlled?

2) Can the dog walk and balance fairly well?

3) Can the dog eat and drink without vomiting?

4) Is the dog free of inoperable tumours which are painful?

5) Can the dog breathe without difficulty?

6) Can the dog urinate or defecate without difficulty or incontinence?

7) Does the dog have an owner who is able to cope physically and

mentally with any nursing that may be needed?

 

If treatment is not possible then answering 'No' to any of those questions means there is no blame in having the dog put to sleep.

 

I've always tried to let them go from Kidney disease just before the bad seizures set in or if they give me a sign that enough is enough. I try to think also: if that was me in that poor wrecked body and if I could still think straight, would I be hoping that someone would be strong enough to end my life in a peaceful way.

 

If you talk to human kindey sufferers they'll say that it can feel like an ever-present sick hangover and you have no energey at all.

 

Nobody knows your dog better than you, but just maybe your wife is putting it all together more clearly? Whenever your dog gets to go it will be the last act of loving kindness you can bestow upon them.

 

If not already done so, join the K9 kidney support group on Yahoo and talk it thru with the knowledgable people there.

http://pets.groups.yahoo.com/group/K9KIDNEYS/

[tbhounds]

Perhaps you should have another work-up done. She may have some other health issues that has risen. I don't believe just GN would present with the symptoms you're describing. Depending on the results it might make the decision to go forward with the current treatment or to make another choice.

[EllenEveBaz]

My Scout had glomerulonephritis for years beginning at age 10, but it was evidently more easily managed than Allison's. I've read that there is a rapidly progressive variant of the condition -- perhaps Allison unfortunately has that. Scout did well on enalapril; I'm sorry that Allison hasn't. I also fixed Scout a high calorie diet that was low in phosphorus. Low phosphorus foods can also be high in fat, which later probably contributed to several scary bouts of acute pancreatitis.

 

Two things you might want to ask your vet about, if you haven't already, are 1) low dosage of aspirin that may help with platelet damage; and 2) azodyl, a bacterial supplement that sometimes helps bring down toxic waste levels.

 

After Scout began to be incontinent, I bought lots of sturdy pee pads (permanent ones, made for human beds). At first he refused to use them, but gradually I had so many that the floor was covered with them. They absorb a large amount of urine, and you just toss in the washer. He wore washable pajamas all the time, even as the weather got warmer.

 

Those last few months were bittersweet. Scout enjoyed huge meals even though he was losing weight quickly. He wore a harness so I could help him stand up and go up/down steps. I was sleep deprived from multiple late night potty trips, but it seemed worth it when he obviously enjoyed being out and taking in the night scents. He had a kleenex fetish, and his last few weeks he had a bonanza of used tissues to tear up because I was crying over him every night. He would get up, stagger over to the wastebasket, and start shredding, giving me his patented "Lady, what is your problem?" look when I protested.

 

I literally waited the one day too late. I had arranged for in-home euthanasia on a Monday, hoping for a last few days together and a gentle death, but Scout had 2 violent seizures on that Sunday, so I took him to the e-vet. Looking back, I wonder if I was holding onto his life more for me, or for him.

 

Uncertainty is normal at this stage, but disagreement can only make things worse. Sending my best wishes to you, your wife, and Allison.

Edited December 26, 2010 by EllenEveBaz

[NeylasMom]

I won't give any advice on when to let her go or quality of life, but want to reiterate the suggestion to join the kidney yahoo group first and foremost. If she is in the advanced stages of disease, I can tell you that they would recommend daily sub-q fluids - you would learn to administer them at home. It's the closest you can get to dialysis with a dog and I have read on the board how helpful it's been in prolonging the lives of their pets. My vet recommended Azodyl as well when Neyla recently developed kidney issues and while she wasn't on it for very long, I do think it helped some, as did switching her from a raw fed diet, which is high in phosphorus because of the meat and bone to a cooked diet lower in phosphorus. If your vet has recommended a kibble for kidney issues, I would suggest considering switching to a home cooked diet that is higher in protein but lower in phosphorus and with the right balance of calcium. All of the info on how to do that is on the yahoo group. If she's very far along in the disease, then lowering her protein is also appropriate, but you'll have to read through the info to make that determination.

 

On the accidents, I had been using the incontinence pads, the washable kind for humans and they are a huge help. I had thrown them over all of teh dog beds and the couch and my bed, but eventually because I wasn't getting any sleep at night, I tried diapers. I thought Neyla would hate wearing them but she actually took to them okay. It took a little while to find what worked for her, but once we figured it out, they saved us! I settled on the size 6 Pampers baby dry (they're the overnight ones). I would cut a hole for her tail and then because the diaper is filled iwth gel beads to absorb liquid that would fall out, I would use pieces of cloth medical tape (Nexcare brand I believe) to tape closed the edges of the hole. I generally just made a few at a time so I had them on hand. I had also bought the large cloth washable diapers at Petsmart so I would put that over top as an extra protective barrier although Neyla never bothered with them and the Pampers never leaked. Instead of lying in her urine, Neyla would wake up DRY! The diapers are amazing, they completely absorb the pee and the lining of the diaper kept her dry. I honestly was astonished, but tehn I've never had kids so am oblivious to the miracle of diapers.

 

Anyway, Neyla was only 60 lbs, closer to 55 at the end and on the petite side and size 6 is as large as they come and they barely fit her. Otherwise, I guess you have to move into pull ups, which I didn't want to do b/c it would mean lifting her legs to get them on, but for you that might be an option if the size 6 don't owrk.

 

I'm sorry that you're dealing with this. I hope some of those suggestions are helpful.

[MaryJane]

I would suggest getting your vet's opinion (or another vet's) as to whether there are better ways to treat this like a "home-cooked diet" (along with the medicines of course). Also, has a full blood work-up been done to see whether there could be another underlying issue that is causing the kidney problem to be worse.

 

From your description, it does not sound like she is in pain and it also sounds like she might still enjoy life. Do you have close friend that you trust that you can talk to about this and get their point of view?

 

The "hygiene" situation does seem to bother your wife (as it would most people) so you will need to address those concerns and as NeylasMom suggested, use pee pads and diapers. If your dog can tolerate diapers, then you might be able to leave her alone and continue to have your family outings. You can also use baby gates and put pee pads down. Another alternative .. do you have a friend with greyhounds that could "watch" your greyhound for a few hours and you can reciprocate that favor later.

[GeorgeofNE]

Merely sustaining her life is probably not what she'd want.

 

For me, and my whole family, it's always been about quality of life. It's a decision only you can make, but if you just re-read how you described her to us, you might see that it doesn't sound very happy or enjoyable for her.

 

Having had to make some very hard choices on when it was time myself, I know how painful and difficult it can be. Sometimes the kind thing is to let go.

 

Best wishes to you in making the tough choice for your girl.

[Guest djenkins99]

Thank you to everyone who replied. I will find out about azodyl, and about changing her diet to reduce phosphorus. (BTW, she's had 2 full blood work-ups since this started, plus x-rays and ultrasound, and everything came back normal except high protein in the urine.) The larger, quality of life issue is the toughest decision I've ever had to make. I work from home; she's been my constant companion for 4 years. I owe her whatever is best for her.

[NeylasMom]

Thank you to everyone who replied. I will find out about azodyl, and about changing her diet to reduce phosphorus. (BTW, she's had 2 full blood work-ups since this started, plus x-rays and ultrasound, and everything came back normal except high protein in the urine.) The larger, quality of life issue is the toughest decision I've ever had to make. I work from home; she's been my constant companion for 4 years. I owe her whatever is best for her.

Her creatinine and BUN aren't elevated???

 

What is her protein level in her u/a's? How many +'s? What about her specific gravity?

 

Did you confirm the glomerulonephritis with a biopsy, or did you at least do an abdominal ultrasound?

 

What about testing for tick born diseases, lepto, heartworm, etc.?

[Guest courser]

Read the BEST advice on knowing when the perfect time is to put a dog to sleep. The vet in the book wrote that people always ask him when the right time was. He said that is impossible to pick the perfect moment in time to put a dog to sleep. The one thing everyone wants to avoid is waiting too long and having the dog suffer unnecessarily. That leaves a little too early as the best option.

[duncan41]

Thank you to everyone who replied. I will find out about azodyl, and about changing her diet to reduce phosphorus. (BTW, she's had 2 full blood work-ups since this started, plus x-rays and ultrasound, and everything came back normal except high protein in the urine.) The larger, quality of life issue is the toughest decision I've ever had to make. I work from home; she's been my constant companion for 4 years. I owe her whatever is best for her.

Her creatinine and BUN aren't elevated???

 

What is her protein level in her u/a's? How many +'s? What about her specific gravity?

 

Did you confirm the glomerulonephritis with a biopsy, or did you at least do an abdominal ultrasound?

 

What about testing for tick born diseases, lepto, heartworm, etc.?

 

[Guest zoolaine]

no advice just

[brandimom]

I am sending no advice but I am sending prayers for the family and your grey. It is such a personal decision to make that only you can make. I had one grey with renal failure. I made the decision the day she could not stand up and she was shaking so bad as her system was starting to shut down. When I got to the vet he said I waited to long.

[kudzu]

Am sorry to read of all you are going through. I have been in a similar situation with a dog & a cat. Though I had a dog with neprhitis it was tuhular in nature not glomerular so a somewhat different approach used. Do you have a copy of the latest urinalysis? If so what is the protein level & the urine protein:creatinine ratio (UPC)? Have they done any blood pressure readings? I echo the question about screening for tick diseases. Lyme nephritis is a form of glomerulonephritis. Is your dog getting therapuetic doses of Omega 3 fatty acids, usually given in the form of fish oil?

 

As for quality of life & when it is the right time, only the owners can decide. Sometimes your vet or people who have known your dog but do not see her on a daily basis can also help just by pointing out how much things have changed. I am personally of the opinion that I would prefer to let go a week or even a month too soon rather than a day too late. I also have come to feel that it is easier for most dogs & most definitely for someone like myself if the departure is planned in such a way as to be calm, peaceful & loving rather than during an emergency situation. However, I do not give up lightly & with fight my hardest to the end if the dog is happy, comfortable & might remain so for some time. Sometimes that balancing act works. Others it does not. We do the best we can. For many though, there seems more pain involved in looking back & regretting they did not let go sooner. These are my personal beliefs, opinions & preferences. I am not saying you should feel the same.

 

Does the good still outweigh the bad? You could try the approach of picking 3 things she loves most. Can she still do those & enjoy them? Can she still do/enjoy two? Are the humans able to still cope? There is more than just the dog involved as much as we hate to put ourselves before them it must be considered. When we are going to great measures to prolong life we must consider all the lives involved. With the ability to extend life comes the responsibility to know when to quit.

 

Most of all I wish you were not having to ask this question or needing folks help.

[duncan41]

"Most of all I wish you were not having to ask this question or needing folks help." Amen to that.

 

At some point during Nikki's chemo for lymphosarcoma, I had the presence of mind to speak to my Vet about the inevitable. Since I knew that we would be seeing a lot of each other, I asked him to tell me when it was time to let her go. I know myself too well - I will fight so hard that I lose perspective - I would have done ANYTHING to cure her. Nikki gave me some subtle signs that she was letting go and I didn't "get it". Fortunately, she developed a problem that necessitated an unscheduled visit to the Vet and he took one look at her and told me that she would be in serious trouble in a matter of hours. It was a shock but I chose to let her go right then and there rather than risk having to make the decision in an emergency situation. My motto: Better a day (or days) too early than an hour too late. I would never have forgiven myself for making her suffer because I wasn't ready to give up. It wasn't my fight.

 

If you have a good relationship with a Vet that will be or has been seeing a lot of Allison, you might want to consider enlisting his/her help in making the decision while keeping Allison's comfort and quality of life as priorities.

 

In the meantime, please feel free to lean on us. As you can tell, many here have walked in your shoes. :grouphug

[Rickiesmom]

There is an extremely helpful and knowledgeable group on Yahoo - I strongly recommend you join. They require that you provide your hound's blood and urine test results so they have a picture of what is going on:

 

Kidney Diet List

 

Let me know if this link doesn't work. While it is a diet-oriented list, the moderators in particular are very, very knowledgeable regarding treatments as well.

 

Best of luck to you.

[Guest Diablo]

I've recently lost 2 of my girls, Zigane had hemangio and Sabrosa renal failure.

In may Sabrosa's weight dropped in 3 weeks from 22.8 kg to only 16kg. She was allways a petite and very slim dog, when I adopted her she was 10 and was incontinent, which was well managed with Propalin and she almost never had accidents in the house (we have a doggy door)

When the renal failure was diagnosed, she went to the vets every 4 weeks to check up her blood and urine. Was on tons of meds (vasotop, rubenal, etc) and special diet (Hills K/D and Eukanuba renal). She was eating like a horse but didn't put any weight on. My vet told me she only had 20% of her renal function left. But like Duncan41 I would've done anything to help her. So I went back to my old vet at the end of november cause I saw no improvement at all.

On december 7th he did additional x-rays, test etc and also diagnosed her with massive heart failure and a bp of 22. If I would've listened to the vet he would have let her go that day. but I wasn't ready. I only had her for a bit over 2 yrs. So he told me that if she reacted well on the meds to get her bp down, maybe we could have a slim fighting chance.

When I got home the 9th from work. Sabrosa was in really bad shape. She couldn't lay down, cause she had troubles to breath. I was up with her the whole night, my poor girl was in so much pain, so the first thing in the morning I called my vet, and let her go.

If I hadn't been so damn stubborn, my girl wouldn't have had, that last horrific day. I could kick myself in the a** now for putting her through this.

My Zigane's hemangio was also comming back in full force, and although I wasn't ready again to let another one of my girls go, together with my vet,I made the decision on december 21st to let her go to the bridge. And though I am a wreck since the 21st and my heart is bleeding, deep down I know I did the right thing for her

 

Sending good thoughts to you

Isa

[Guest djenkins99]

Thank you to everyone who replied. I will find out about azodyl, and about changing her diet to reduce phosphorus. (BTW, she's had 2 full blood work-ups since this started, plus x-rays and ultrasound, and everything came back normal except high protein in the urine.) The larger, quality of life issue is the toughest decision I've ever had to make. I work from home; she's been my constant companion for 4 years. I owe her whatever is best for her.

Her creatinine and BUN aren't elevated???

 

What is her protein level in her u/a's? How many +'s? What about her specific gravity?

 

Did you confirm the glomerulonephritis with a biopsy, or did you at least do an abdominal ultrasound?

 

What about testing for tick born diseases, lepto, heartworm, etc.?

 

I don't have (but could get) the exact lab analysis numbers, but everything came back within normal ranges except urine protein, which was 3 times normal. We didn't do a biopsy, but did do an abdominal ultrasound (preceded by x-ray), which also revealed nothing out of the ordinary except a slightly enlarged spleen, which the vet wrote off to the effect of anesthesia. She was also tested for common parasites via stool sample which came back negative. Also a thyroid test, again normal.

 

Not being a vet, but having read a bit on kidney disease, her symptoms (excessive drinking/urination, extreme weight loss, loss of appetite and energy, occasional disorientation) seem consistent with kidney problems. Mainly, I'm going on what the experts tell me.

Edited January 1, 2011 by djenkins99

[kudzu]

Not being a vet, but having read a bit on kidney disease, her symptoms (excessive drinking/urination, extreme weight loss, loss of appetite and energy, occasional disorientation) seem consistent with kidney problems. Mainly, I'm going on what the experts tell me.

Those symptoms could also be many other things. I would be strongly tempted to ensure bloodwork was sent out for a tick panel & assuming that comes back negative then do an ACTH stimulation test to check adrenal function. Addison's disease is frequently misdaignosed as renal disease especially if serum electrolyte levels are not out of line. And it is not too unusual for electrolytes to be normal.

[SAVED2]

Merely sustaining her life is probably not what she'd want.

 

For me, and my whole family, it's always been about quality of life. It's a decision only you can make, but if you just re-read how you described her to us, you might see that it doesn't sound very happy or enjoyable for her.

 

Having had to make some very hard choices on when it was time myself, I know how painful and difficult it can be. Sometimes the kind thing is to let go.

 

Best wishes to you in making the tough choice for your girl.

I agree with the above , we lost our Maggie yesterday to this its better to be early than late.

[mychip1]

Many thoughts coming your way as you make the hardest decision that any of us ever have to make. But remember, we make that decision out of love - and try to take comfort in that fact when you come to that point.

 

 

[AEB]

I'll share our story and maybe it will be of some help to you. We lost our Sadie in July after battling kidney disease for two years. We discovered her values were off by accident (a bout of the big D that wouldn't go away). We began by monitoring her values frequently. We gave her baby aspirin. But after some research I decided to stop. Medication (Enalipril) was eventually added, and eventually increased. Eventually our vet suggested we needed to adjust her diet. We chose Iams early stage renal. She was 11 when all of this began. We cooked the wet portion of her diet.

 

She did well until sometime last year, early 2010 when things changed. At first the changes are subtle and we didn't notice because we lived with them everyday. She had lost some weight but it started going down steadily despite her eating (she was a picky eater though) about 4 cups a day. She stopped running and would just sometimes trot on her long walks around our property. She started getting up in the middle of the night to go outside. Sometimes more than once. Eventually she was no longer phased by loud noises that used to scare her so. Gunshots in the area from hunters didn't phases her nor did fireworks (but thunderstorms still made her a little nervous). I chalked it up to old age. She shortened her walks but still took them. She stopped greeting visitors. Barely acknowledged them. She was a people dog. She was having this twitching through her whole body. A shivering. But she didn't stop when we kept her in PJs. It was neurological.

 

Our vet said it was a race between her kidneys and weight. We could no longer keep the weight on. She was dropping it like crazy. Eventually She had lost so much muscle mass that she was having trouble standing and would be weak in the rear like a German Shepherd. But, she seemed happy to come down the driveway, she would stand as best she would and get excited. She liked her walks, even though there was no more running or trotting. She had not messed in the house. She was still eating. She seemed to still be having some enjoyment. And she seemed aware. But we knew the end was near, just not when exactly. We weren't going to put her through anything diagnostic because we wouldn't put her through any procedures to prolong her life. She was 13 and we wanted her as happy and comfortable for as long as possible. When she was no longer, then we knew it was time.

 

We kept visiitng the vet weekly for weight checks. When she got to 50lbs (from 65lbs 9 months before) we stopped. She had lost as much as 5lbs in a month. It was getting too upsetting. For her and for us. She would panic at the vet's even though everyone liked to see her and she wasn't even poked or prodded anymore. The vet gave her prednisone to help with her ability to stand. It did help. That was June. July 10 she had probably gotten down to 45lbs, maybe less. We had fenced the top part of the yard that day to restrict her movement because she could no longer walk up/down the bank in the yard. She pooped that afternoon. She was just staring, not evening blinking. Just waiting for something. Her breathing was even strange. July 11 she would not settle down. Her front legs looked swollen. I feared edema.

 

We called the vet the next morning. We took her in that afternoon. He always would roll his eyes at my millions of concerns - but this time his say his face said it all. He was stunned at the change in her in a month. He examined her quickly and said it was time to discuss euthanasia. But we already knew and had come prepared with questions. He was leaving for Europe on Wednesday. It was Monday. He had Tuesday off. We asked if he could come to the house. It didn't seem real. But she hadn't eaten anything but hand fed scrambled eggs since the 10th, and hadn't defecated since the 10th. She had lived 13 good years.

 

I do not pray. But I did that morning- for a sign I was doing the right thing. And she went happily for her walk. She moved better than she had in weeks. Her tail was curly and she sniffed and enjoyed herself. I saw the vet pull into the driveway, wondering where we were no doubt. I decided to go tell him to leave. Then she had a bowel movement. It was black and tarry and gooey. She was bleeding internally. I knew it was time. We brought her into the backyard. We said goodbye. It was as peaceful as you could hope for. Awful of course. But I am glad that we spared her any horrible days. She had only days left. I struggled though in the beginning that we did it too soon. But I talked to the vet and to many other dog owners. My vet believes she had some type of cancer as well. I am at peace with our decision.

 

And we recently adopted a red boy we named Kevin.

 

 

My advice is do whatever it takes to keep/put weight on. Ultimately that may take her. Take her to another vet if you are unsure about any part of the diagnosis. But you know her best. You know when she is no longer herself and is no longer enjoying anything.

 

My sympathy to your family as you face each day determining your next steps.

 

Also, my condolences to Maggie's family.

[Guest 2dogs4cats]

I have a 14 year old greyhound with kidney disease. Her UA is abnormal, but her blood work is normal, like your dog. Despite the disease and age,s he is doing very well and you wouldn't even know that she is sick. My vet says if it doesn't show in the blood work, it is still the early stages and they can be fine for months or years. It's a disease that is unpredicatable.

 

My dog also starting losing weight and urinating more frequently just like what you are seeing. However, after I changed her diet, she is a different dog. She has steadily put on weight and is her old self again. I noted on another thread what I feed her along with the fat ball recipe. For the fat balls, use fatty ground meat and don't cook the ingredients. Your dog will love it and put on weight. Ask your vet how many calories your dog needs per day to put on weight, not just maintain it.

 

I thought my dog was at death's door and thought about putting her down, but she has rebounded to her old self in just a few weeks. I am also going to try Rahmennia 8 . It's a Chinese treatment for kidneys, used in people, but I have heard it also works for dogs. I have ordered it and will post if it makes a difference.

 

You can't cure the disease, but it seems to me it can be managed. You will know in your heart when it is time. I had another grey that I put down in 2009. It is extremely hard and no one can tell you when the time is. You need to be at peace with it.