My Old Sam

[KF_in_Georgia]

It was great while it lasted (three weeks), but Sam has stopped eating his ground up kibble with Ensure. Or the ground up kibble with yogurt. (He wants the yogurt and the Ensure--just not the kibble.) I did get him to eat a peanut butter sandwich at lunch. He still likes dog cookies, but he won't eat a piece of kibble that's whole, and now he's over it with the ground-up stuff.

 

He does have an appetite--he's hanging over my potato chips--but he clearly doesn't feel well. He's been panting a lot the last week and a half and isn't sleeping well.

 

He's nearly maxed out on his pain meds (he could have two more tramadol a day, but I don't know if that would make him pant even more), but he doesn't seem to be in pain. He gets up after lying down with no outcry, and he's fine lying down without a whimper (when his arthritis is bad, he cries out). The vet said the pain doesn't seem to be as extreme as it has been in the past.

 

He's not running a fever. An in-house urine check at his vet revealed RBC and WBC in his urine, but no sign of crystals, no sediment, and good concentration. No kidney cells visible, and mashing on his kidneys doesn't net any pain reaction.

 

I took him to the vet's about 10 weeks ago when I suspected a UTI. The vet put him on cephalexin for two weeks, and said to try another two weeks if Sam was tolerating it well. Sam didn't improve much until the end of the first two weeks, but he suddenly got better so I refilled the prescription--then refilled it again. Sam was on it a total of six weeks. When I stopped it, he was fine for a week, then started acting as if he didn't feel well. (And his breath has been smelling funky--almost ammonia-like--which is what had me running to the vet in the first place. Sam's got an old dog's teeth, but no gum disease, no sign of serious trouble, and he's happy to eat dental chews.)

 

We went back to the vet on Monday, and this time he was prescribed ciprofloxacin. He's been on it four days and isn't any better. I know that's not enough time for it to work, but Sam's clearly not comfortable, and I don't want to put him through another week of "not comfortable" before things become obvious. And if the cipro works wonders and he feels better--then what? How long can he stay on it safely?

 

Any idea what we're looking at here? The vet is betting against a kidney infection, so we're pretending it's a UTI and treating that. If he gets better, then we know what he had (maybe), but maybe we'll just know what fixed his mystery ailment. Sam is not going to tolerate scopes or xrays or anything like that. (And he's generally a nightmare under anesthesia--ketamine triggers seizures.) Also, at his age and considering his physical condition, we're not going to do anything extreme to him.

 

Sam is three weeks from his 13th birthday. He has arthritis in his spine (takes tramadol, gabapentin, methocarbamol), as well as something weird on old x-rays of his lungs (although his breathing doesn't sound that bad--panting, but not actually gasping for air). He's got some early-stage LP being successfully treated with Doxepin. He has an ulcer (dormant now) and takes Prilosec. He has wobbly back legs and frequently puts a rear foot down wrong when we walk. He takes thyroxine (has for years). Takes a maintenance dose of metronidazole (half a pill, every other day--otherwise full-blown diarrhea within four days). Takes a probiotic.

 

I'm tempted to take him back in on Monday and ask for a full lab panel, just to see if the numbers show something going on. Any other ideas?

Edited April 19, 2013 by KF_in_Georgia

[claudiav]

if you know he's going downhill, why not give him what he will like to eat? Steak, hamburger, hot dog... just so he has some food/nutrition for the meds to do something.... that's what i'm doing with Remy since I know our time is limited...

 

I have no advice about the different options to diagnose what's really wrong... but I pray his remaining time is happy and as painfree as possible.... you are in our thoughts/prayers

[GreyPoopon]

I'd be checking his blood kidney values, if you haven't already.

 

My kidney dog (Jessie, gone now) was very hard to feed because her tastes changed constantly. We eventually needed an appetite stimulant; we used anabolic steroids. I have another one now that may have kidney disease--we're going to repeat the bloodwork next month--and his appetite is increasingly erratic.

[KF_in_Georgia]

Food isn't actually the issue. He can live on potato chips and peanut butter sandwiches, if he wants. Scrambled eggs. Chicken and rice. Ice cream. (Any/all of this as long as it doesn't trigger diarrhea that would make him feel worse.)

 

But he doesn't feel well, and that's the bigger issue for me. If we can't figure out what's wrong and turn things around, I won't make him keep going.

[IndyandHollyluv]

Hi there. Not exactly sure what is at issue but I have had two kidney hounds. Lost Holly to PLN (btw, she also had a duodenal ulcer but refused all meds after a few days on prescription meds. So I went the Manuka Honey route - which she was fine with.). Currently, my Lucy, a 13-1/2 yr old female grey, has mildly elevated kidney values that fluctuate. Not unlike many dogs with kidney issues, she is on prescription renal kibble and canned - but she will not eat a prescription renal diet exclusively. So what can you do? I want her to eat - so you compromise. You can't be a purist.

 

At this point, I would offer Sam some very yummy canned food and eliminate any added carbs. I mix stew-like canned food (beef, chicken, venison, whatever. Wellness, Evanger's, Merrick, etc.) in with my girl's kidney kibble. IMPORTANT: Warm the slop in the microwave - which will soften the kibble, release the yummy aroma and make it more palatable. And my Lucy is a VERY, VERY picky eater which makes it even tougher (not to mention she is missing quite a few toofers.). But I have learned she is a TOTAL carnivore. Some hounds will eat vegetables, etc., but not my girl. I also add canned white meat premium chicken or salmon to her meals (depending on what canned food I'm serving). Rinse and squeeze canned meat to flush excess sodium. So I serve a combo of warmed kibble, canned dog food, and a few spoonfuls of canned (human) meat (tuna, chicken, salmon).

 

With all due respect, perhaps fewer meds might make Sam feel better. At 13-1/2, my old girl is not on any meds. Sam might feel a whole lot better with less medication. I had Lucy on an anti-anxiety protocol and it turned her into a zombie dog. Discontinued all that junk and she is sooooooooo much brighter and happier.

 

Hugs to you and Sam.

Edited April 19, 2013 by IndyandHollyluv

[Batmom]

Has he had bloodwork? I'd do that ASAP, and get another urine sample.

 

There's no reason he'd need anaesthesia to do a quick x-ray or ultrasound -- even for a dog that freaks, a little valium or similar would usually be enough. If he did need anaesthesia for a procedure, wouldn't need to use ketamine.

[KF_in_Georgia]

Sam needs the pain meds. Otherwise, he'll cry out (actually, scream) when he stands up or lies down. He's been on most of them for several months. They haven't made him groggy or anything like that. He actually sleeps less than the unmedicated 8-year-old. They're the same meds that many of the dogs suffering from osteosarcoma are taking. (X-rays have shown he has a slightly herniated disc as well as arthritis in his spine. We tried a chiropractor, but it was immensely painful and he was back in severe pain in less than two weeks.) It's clear he has felt worse since we stopped the NSAID, but we had to do that in the face of his ulcer.

 

The Doxepin, which actually is an antidepressant for people, keeps him from choking with LP. The metronidazole keeps him from having blow-out diarrhea. I might stop the Prilosec on the grounds that his ulcer is pretty much under control (I hope). The only other med that isn't immediately necessary is the antibiotic we just started to deal with the fact that he's not feeling well. Oh, and I could stop the probiotic. Also, several of his meds are the sort of thing you can't just stop without bad consequences.

 

He's got a vet appointment for Monday at 11:30 to have blood drawn for lab work. I'll ask them to do their usual "senior panel"--that's blood and urine.

Does the ammonia-smell of his breath suggest anything? Even my vet can smell it. It's why I originally thought kidney infection...

[krissn333]

No exceent advice, but, my coworker was just on cipro for an ear infection and it took a good 5 days-a week before she even started feeling better while on it. Might be worth continuing it for a while longer and see if that does it?

[IndyandHollyluv]

Poor old houndie. Well, you know Sam better than anyone. Just fyi - the ER doc who dx'd Holly with PLN also prescribed Prilosec for her ulcer -- but Holly refused meds which is when I tried a daily spoonful of Manuka Honey for her ulcer - and she was okay with that. So just saying ... you may be able to swap out the Prilosec for a more holistic Manuka Honey.

Edited April 19, 2013 by IndyandHollyluv

[Remolacha]

Poor Sam, I hope the tests on Monday give you some answers. My first grey died of kidney failure, and I didn't notice any odor, but her's was acute kidney failure. OTOH, a cat I had with chronic kidney problems did have an odd, different odor toward the end.

[KF_in_Georgia]

I do have some honey, and I know he's taken it okay in the past.

 

I once had to take Ciprofloxacin for two weeks when I had a bronchial infection. I'd wake up in the middle of the night trying to spit out my tongue because Cipro left such a vile taste in my mouth. And if I remember correctly, it was sweet stuff that tasted the worst. (I'm a Diet Coke junkie, and I had to abandon it while I was on Cipro.) Although a dog's taste buds aren't like ours (thank heavens--really! rabbit poop?), maybe I just need to try Sam on food that isn't sweet. Peanut butter would be fine. I remember that salty and/or spicy worked well for me. Chili was fine (although perhaps not for Sam and his ulcer). Chicken soup was good. (I think we're doing chicken and rice tonight.) Tuna might be okay, too. (Normally, he likes tuna.)

 

I'll also try some sweet stuff without the kibble and see how he feels about it, on the off chance that sweet is still tolerable. (I just bought a 30-bottle pack of Ensure at Costco yesterday.)

[kudzu]

Does the ammonia-smell of his breath suggest anything? Even my vet can smell it. It's why I originally thought kidney infection...

Yes, it does. Hate to say it but that's a very disturbing thing. I would want blood work & urinalysis sooner rather than later.

[KF_in_Georgia]

Yes, it does. Hate to say it but that's a very disturbing thing. I would want blood work & urinalysis sooner rather than later.

 

Okay. Ignore my PM. I just Googled it. Would we see something besides what we smell? He doesn't seem to be in any pain when the vet feels his kidneys. Sam was lying on his side, and the vet was able to get his hand well up into the tuck-up and press and Sam totally ignored it. (Sam didn't ignore a little pressure on his sore back--gave the vet a dirty look.)

 

Anyway, I know what might show up in the lab work and urinalysis.

 

 

ETA: Wouldn't kidney cells show in the in-house urine test for kidney failure? Sam's had two tests, now: both were RBC, WBC, no crystals, sediment, or kidney cells.

Edited April 19, 2013 by KF_in_Georgia

[Batmom]

You wouldn't necessarily see kidney cells in the urine in kidney failure. Or any other cells. Urinalysis can be normal in kidney failure -- there's more than one kind. And the dog's kidneys may not feel painful.

 

RBC & WBC points to some type of infection or trauma (due to a mass, possibly, or stones). The ammonia-like breath suggests malfunctioning kidneys although dogs can have bad breath for other reasons.

Edited April 19, 2013 by Batmom

[KF_in_Georgia]

The vet also wondered if maybe Sam had a sheath infection, since neither sample has been from his bladder. We may need to aim for that on Monday.

 

The ammonia breath is definitely not Sam-normal. The first time I smelled it, I started looking around for the source because I wasn't expecting it to be him.

[Guest june]

No advice, but just want you to know I'll be keeping you and Sam in my prayers.

[Batmom]

Any chance you can get him in this evening or tomorrow rather than waiting for Monday?

[KF_in_Georgia]

Any chance you can get him in this evening or tomorrow rather than waiting for Monday?

 

They've already closed, but I'll call them first thing tomorrow. Technically, I only need a tech visit, I think, to draw the samples...unless they want to draw urine from his bladder, and even then the tech might be OK to do that.

 

Chicken and rice, tonight, and I'm letting the cooked rice sit a bit in the water to get fat and soggy so Sam gets extra water. At least the rain is over for today and tonight, so we won't be freezing and wet from multiple trips outside.

 

(Meanwhile, our little invalid is standing behind me--I'm on the floor with my laptop--reaching over my shoulder to steal a Frito.)

[IndyandHollyluv]

Just trying to be helpful. Has Sam had an abdominal ultrasound? That how the ER doc dx'd Holly's ulcer and evaluated her kidneys ... (in addition to blood work).

 

Rice. I dunno. My dogs always had diarrhea or the squirts when I fed them rice. Haven't served it in years. What about potato or added canned food???

 

P.S. Oh, neither of my kidneys girls have had ammonia breath (for what it's worth).

Edited April 19, 2013 by IndyandHollyluv

[Guest Scouts_mom]

When my sweet Lizzy died of kidney failure, the last few days her breath did smell of ammonia and her skin texture was strange. She also was not at all interested in food. The vet used ultrasound to see what shape her kidneys were in (not good). It did not need sedation.

[kudzu]

If you could get a tech visit tomorrow that would be best, I think.

 

(Meanwhile, our little invalid is standing behind me--I'm on the floor with my laptop--reaching over my shoulder to steal a Frito.)

Go Sam!!

[KF_in_Georgia]

Sam doesn't have a problem with rice (except that sometimes he got bored when it was the bland food he ate for his ulcer--also got bored with potatoes and oatmeal; never was bored with the chicken). He devoured all the rice tonight.

 

Sam usually is fine at the vet's--loves everyone there--until you need for him to lie down on equipment or be still. On x-rays a couple of years ago, he fought so much he hurt his back even more. If they'll do an ultrasound with me right there, he might be better about the procedure.

 

But we'll wait to see what the labwork and urinalysis give us--esp. bun and creatinine.

 

(My previous two dogs were excellent at the vet's. You could tie the girls into knots, and they'd just lick your face. My current two--not so much. They love the people but hate the machines, needles, etc. Silver will kiss the vet, scream over the needle, then kiss the vet again.)

[Batmom]

Give him some scritchies (and another Frito) for me, OK? Hope he just has a nasty UTI or sheath infection and will be over that soon.

[greyhead]

Every profound good wish for you and Sam. Maybe you could ask for the vet to take a wiff of Sam's breath while he's there, so he'll know what you're talking about and perhaps be inspired to take it more seriously. And, yes, with 20/20 hindsight I'd suggest you do stay with him if he needs an ultrasound. (I can tell you're a calm person, which the staff should have noticed by now too.)

[KF_in_Georgia]

I think the vet has dismissed the idea of kidney failure because he can't see any sign of it in Sam (beyond the breath). No fever, apparently no pain, he's drinking and peeing normally.

 

This may all be true and fine and dandy. I just want the lab work anyway.

 

And this vet knows me well and knows I'm calm. I was there when Sam had staples removed and screamed bloody murder. I was the one who suggested we put Sam's muzzle on him because we'd look like a couple of fools if Sam took a piece out of one of us while the muzzle was sitting right there. (And I'm the one with enough sense to put a muzzle on my high-prey senior citizen when we come in the office, because Sam hasn't noticed how old he is and can still move fast when he wants.)

 

What I hate is that Sam gets so stressed on car rides. He starts panting and drooling even before you start the engine.

 

 

Sam has been getting four small meals a day. Tonight's chicken and rice was the equivalent of two small meals in one. All that extra food is sitting well in Sam's stomach, and he's sound asleep. (It's also much cooler tonight than it has been. Tonight's temps are supposed to drop to 38F. Last night was nearly 70F.) He'll get another round of meds before bedtime since stuff like the gabapentin will wear off long before morning.