My Old Sam

[kudzu]

No fever, apparently no pain, he's drinking and peeing normally.

That certainly would make me doubt a kidney infection but it wouldn't preclude some other types of kidney issues. Many have been caught off guard, myself included, when lab work indicated chronic renal failure. He was 7 yo at the time & lived another 2.5 years after that. He only showed classic renal failure symptoms in his last 6 months.

 

If Sam gets that stressed out by the car, the vet can't see him until Monday & the ammonia breath smell has been going on for a little while than I'd say wait until Monday. But do, as you already plan, insist on the lab work. No doubt your vet will be happy to comply. Haven't had one yet to refuse or even argue against that request. Good luck. Hoping this does prove to be something relatively simple & treatable like a stealth UTI.

[galgrey]

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.

This was my thought as well. I just went through this with my boy, Cruz, who was in kidney failure. Sending good thoughts for your sweet boy.

[KF_in_Georgia]

We cancelled Monday's vet appointment and went in this morning. They drew blood for labwork, and we should have results by sometime Monday.

 

They also took a urine sample, but I don't expect much from that. For one thing, they couldn't get a bladder sample (I had to let him pee at home; he never would have held it until he got to the vet's), so even if there are signs of infection, we still won't know where the infection is. Besides that, he's already on an antibiotic. I'm fine with not learning much from the urine sample; I just want to know from the bloodwork that there isn't something else going on that we should be dealing with.

 

Got him home, gave him some Ensure and yogurt for breakfast and he turned his nose up at both after he took a couple of licks. (It may be that the antibiotic is screwing with his tastebuds on sweet stuff. We'll try something else at lunchtime.) Gave him a dental chew, and he happily devoured it. He's sleeping in front of the box fan. It's not hot in here at all, but he often sleeps in front of the fan, and when he laid down there today, I took the hint and turned it on. He also lays in the car so he can get the air from the dashboard AC vents on his face as it blows between the front seats. This morning, when I switched on the AC coming back from the vet's, Sam gave a happy sigh.

 

I do freelance proofreading and editing from home, and I've got a raft of work for this weekend, so Silver and I will skip local meet-and-greets and stay home with Sam. Some of us will work, the rest of us will sleep.

Edited April 20, 2013 by KF_in_Georgia

[Remolacha]

hope you get some good answers from the bloodwork.

[GreyPoopon]

Glad you took him in.

 

Jessie sometimes had terrible breath, but her drinking and peeing was pretty normal until the last couple of months (she lasted almost 13 months post-diagnosis, and was 14 1/4 when I said goodbye).

Edited April 20, 2013 by GreyPoopon

[EllenEveBaz]

Sending our best wishes. Hope his appetite has picked up a little.

[kudzu]

[KF_in_Georgia]

This morning he ate his crushed kibble with Ensure and some blueberry yogurt, so I'm thinking he's feeling a little better. I still want to know what the lab report shows, but I'm feeling less panicked.

 

He's sleeping in front of the box fan again. It's cool here today, but I've left the fan running because he clearly likes it. (I'm in the wind-path of the fan, so I'm wearing a sweater.)

[kudzu]

How is Sam doing?

[KF_in_Georgia]

He seems to be feeling better. He's back to eating his ground kibble with Ensure or yogurt (Key Lime Pie flavor today--I usually offer him the lid to lick to be sure he's going to like the taste before I mix it with his kibble).

 

Vet called late today. Sam's kidney numbers are worse than they were, but not awful. The vet is calling it an increase in kidney insufficiency--not kidney failure. I don't have the numbers, but I'm going by tomorrow to pick up a printout of today's report and the one before this. I'll post numbers then.

 

Meanwhile, we continue the antibiotics for a total of 4 weeks if Sam's stomach can tolerate them. What's strange is that he rarely has a bad gastric reaction to antibiotics. He's on a maintenance dose of metronidazole (half a pill every other day)--been doing that since summer before last because stopping it invariably leads to diarrhea--and his digestive system is more stable than it's been in years.

 

And to make things more interesting, my widowed 79-year-old mother went in the hospital today with a case of--heaven-knows-what. She's never shown any signs of dementia or Alzheimer's--and we have no family history of it--but she's suddenly confused and hostile (and dehydrated). Supposedly, one doesn't leap full-blown into Stage 6 Alzheimer's between lunch and dinner, so the doctors are trying to figure this out. Since January, she's been living here with my sister and her husband. My sister says it's as if Dr Jekyll went out to dinner last night (with some people from their church), and Mr Hyde came home. And Mother doesn't think anything is wrong. She fought my sister about going to the doctor at all. Now she's in the hospital, following a CAT scan that showed nothing and an IV (for fluids) that hurt like crazy, and she's absolutely furious about the whole thing. It's a mess, and I'm keeping my head down, fussing over Sam, and trying to stay out of the way. I've told my sister I'll back her up with Mother if she needs me to. Until then, I'm staying out of it because I don't want Mother to think we're piling on.

[Guest Adrianne]

Wow! That's a whole lot on your plate. I have no advice on any of it, but I am sending you good thoughts, and I'm here if you need to talk.

[kudzu]

Sad & scary news about your mother. You've got too much going on in your life right now. Sending my best to your family.

 

Sounds like Sam is improving or at least holding his own & that's good news. Renal insufficiency can mean the same thing as "chronic renal failure". Have never understood the failure part. My dog had chronic renal failure for 3 years so clearly his kidneys were still working even if at less than optimal capacity. In recent years they seem to be finally using "insufficiency" in place of "failure" & I think it's high time. With both my cat, who was 17 yo, the process moved faster. My dog though seemed to show no symptoms until much later on. Even then he would seem unwell for maybe a week & then rebound, holding at that plateau for months. It is like their bodies adjust to the newer state of affairs.

 

Whatever is going on with Sam I hope things continue improving.

[KF_in_Georgia]

Sam's lab results. Red are the numbers from the recent test; blue are numbers from last August.

 

 

 

I have no clue what's what on here.

 

 

In other news, Mother is home from the hospital and much better--although not entirely back to normal. The doctors are blaming it on dehydration and stress (there are contractors remodeling my sister's house--Mother doesn't have to deal with them, but she gets nervous while they're there; and Mother was glued to the TV last week--Boston and West--and that didn't help her stress levels).

[4My2Greys]

I'm glad your mom is doing better and that doctors feel her symptoms were caused fby dehydration and stress and not the onset of alzheimer's. Good news too about Sam eating his kibble again.

[silverfish]

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.

 

Sam has so much going on, and he is a very old dog, bless him. I can't make a diagnosis for you, but I can tell you that Cipro and Cephalexin are both powerful antibiotics and both can seriously upset a dogs gut. When Sid was put on one of them (can't remember now which without looking it up) he developed bloody colitis and was literally screaming every time he pooped. The other just upset his gut 'normally' and both made him feel crappy and put him off his food - no easy feat with Sid! He's OK on Tramadol, but Vetergesic actually sends him completely paranoid. Many of these strong opioid type painkillers can have some very strange effects on individual dogs, and while I don't doubt he needs them, I would be watching carefully to see if he is any better at all when he's due for a dose rather than when his blood levels are high... though some do take a couple of days to get out of the system.

 

I would have to agree that if you can possibly do without the antibiotics - and anything else you consider non-essential - you might see a big change in Sam. It doesn't have to be a raging attack of colitis which shows they don't suit: simple loss of appetite can be a big concern, especially in an old dog.

 

Ammonia breath can indicate a lot of different things and has actually been implicated in candida albicans infections - which are very common with over-use of strong antibiotics.

 

And to make things more interesting, my widowed 79-year-old mother went in the hospital today with a case of--heaven-knows-what. She's never shown any signs of dementia or Alzheimer's--and we have no family history of it--but she's suddenly confused and hostile (and dehydrated). Supposedly, one doesn't leap full-blown into Stage 6 Alzheimer's between lunch and dinner, so the doctors are trying to figure this out. Since January, she's been living here with my sister and her husband. My sister says it's as if Dr Jekyll went out to dinner last night (with some people from their church), and Mr Hyde came home. And Mother doesn't think anything is wrong. She fought my sister about going to the doctor at all. Now she's in the hospital, following a CAT scan that showed nothing and an IV (for fluids) that hurt like crazy, and she's absolutely furious about the whole thing. It's a mess, and I'm keeping my head down, fussing over Sam, and trying to stay out of the way. I've told my sister I'll back her up with Mother if she needs me to. Until then, I'm staying out of it because I don't want Mother to think we're piling on.

 

Oh gosh, how awful for everyone. You know, it could simply be the dehydration, as they say. It can and does cause confusion especially in senior citizens. I hope she makes a full recovery.

Edited April 24, 2013 by silverfish

[tbhounds]

Here's my take on your boys blood work results--his hct is pretty low for a gh. 45% would be considered anemic in a gh---is your vet sure his GI ulcer is healed?? Also, did see where his renal values are elevated slightly but, his USG is pretty good at 1.027 so, he's concentrating his urine. The urinalysis looks ok too-no bacteria, no protein, no reds--not sure why the antibiotics--did you ever culture the urine???

[kudzu]

Urinalysis looks good which is important. Renal values look like kidneys are declining but nothing scary considering this was a known issue, especially for a dog his age. It isn't at a level I've seen associated with ammonia breath, though all dogs are different & my experience with it is limited. BUN could be contributing some to him feeling poorly but I wouldn't look to that as being the actual cause. With chronic renal insufficiency most dogs seem to adjust to the slowly elevating BUN levels, at least up to a point.

[KF_in_Georgia]

Originally, we did Cephalexin because there were some white blood cells in his urine, making my vet think there was some sort of infection, and Sam clearly wasn't feeling well (which was why I took him in--not feeling well and the ammonia-breath). Sam was on the Cephalexin for nearly two weeks before I saw a change, but then he felt much better the rest of the time he was taking it and for about a week after he finished it.

 

Then he went downhill again: not feeling well (restless, not sleeping soundly or as much, panting--but without signs that it's his arthritis that's bothering him, as he sprawls in his sleep and doesn't appear to have to lie down a certain way to get comfortable). He also peed in his sleep a couple of times in one 24-hour period (not a little leak, but not a full flood; he slept through it the time it happened while I was at home). And the white blood cells in his urine, again (or, still). So we put him on the Cipro. The peeing in his sleep stopped. About four days into the Cipro was the day he didn't eat and didn't feel well (last Friday), but he perked up by Saturday evening, ate all his dinner, and he's feeling better (and still hasn't peed in his sleep since we started the Cipro). It took about 5 days from the time he started the Cipro until he started feeling better and eating well again: he hadn't felt well on Friday, when I set up the appointment for the bloodwork, but he was feeling better by Saturday night (and eating all his food again). We talked about culturing his urine if this antibiotic didn't make him feel better or if, after he finishes the Cipro, he starts feeling bad again.

 

We aren't positive the ulcer is healed. He was taking Prilosec until last weekend. No noticeable signs of blood in his poop. It's darker than Silver's poop, but it always has been--probably because of his usual meds. His gums are all nice and pink. He gets all his pills on top of food (usually 3/4 cup of kibble plus half a bottle of Ensure or three heaping tablespoons of yogurt--but no dairy with the Cipro). He's not taking an NSAID of any kind, no supplements beyond the probiotic.

 

 

ETA: I've realized that what I thought was generic Prilosec I was giving Sam is actually generic Prevacid--different ingredients, but from what I've read online, equally effective (or perhaps the Prevacid has a slight advantage). Should I change to the Prilosec? He hasn't had either one since Friday, but if we think his ulcer may be bothering him... Also, I think the Cipro may be supposed to be given away from antacids and such, so maybe stomach pills in the morning (with the yogurt or Ensure meal) and Cipro in the evening (with the non-dairy meal).

Edited April 24, 2013 by KF_in_Georgia

[KF_in_Georgia]

I stopped by Sam's vet's office. Wednesday is the vet's surgery day, so I didn't expect to see him. I just left a note about the HCT values on Sam's last two tests, reminded him of the ulcer, and asked what we should do.

 

I just got an email from Sam's vet. He says this:

 

 

I thought that I would reply with an e-mail, since the answer gets fairly technical. I had noticed that his red blood cell count had dropped, normally referred to as Packed Cell Volume (PCV) or hematocrit (HCT). Since he is no longer on the meloxicam NSAID--and that is why I double-checked with you before assuming anything--then the chance that he is having an ongoing GI bleed is very low. Also, his reticulocytes (immature red blood cells) are fine, and so his bone marrow has not been stimulated to replenish any blood loss, either. Therefore, it is by far more likely that he is finally showing mild signs of Anemia of Chronic Disease (ACD); and in this case, the "chronic disease" may simply be age.

Longer term, full-borne kidney failure and shrunken kidneys can cause anemia d/t a lack of a stimulant hormone (erythropoeitin); but his kidneys are functioning too well for that. He could also have a tumor somewhere that is bleeding, and/or interfering with other hormones; but again, he appears to be too healthy for that, and we would be unlikely to treat it if we did find cancer.

So, this is one area in which Greys--by virtue of starting off with such a high PCV--have so much extra leeway, that I would not recommend further work-up at this time. Let me know if this is too complicated; but again, it is not yet serious enough to worry.

 

 

[greyhead]

Kathy, when Shane's BUN and creatinine elevated and his specific gravity declined, similar to Sam's, we'd treated him for a UTI for months, and he was still leaking urine. An internist inferred that he had kidney disease and wanted us to put him on Proin and Elavil (for BP) as well as a low-protein food. That didn't feel right at the time -- and hasn't since -- for a couple reasons. Anyhow, we put him on prescription Royal Canin Medium-Protein Renal Food (as opposed to their low-protein version), and the leaking stopped. Every time I'd try to feed him some of Spencer's food (Natural Balance venison & sweet potato), including the last couple weeks mixing it in with his RC food, the leakage returns! So he basically does fine with no meds, just that special food. (We do make a gravy for it with canned food too.) I gather there can be too much salt in some forumals and even human foods. Wish I could be more help, but it might be worth a try. The food is pricey, but it saves us a lot on vet bills.

 

With that very sudden change in your mom, I'd suspect an underlying physical cause, and I hope they find it. You're right, people don't develop true dementia overnight. A friend's grandma, for instance, became disoriented and ultimately comatose. Turned out she'd been on a no-salt diet, and her sodium level was so low it was going to kill her if they hadn't figured it out. While it was scary, it was an easy fix once found.

 

Holding the best hopes for you and yours.

[KF_in_Georgia]

With that very sudden change in your mom, I'd suspect an underlying physical cause, and I hope they find it. You're right, people don't develop true dementia overnight. A friend's grandma, for instance, became disoriented and ultimately comatose. Turned out she'd been on a no-salt diet, and her sodium level was so low it was going to kill her if they hadn't figured it out. While it was scary, it was an easy fix once found.

 

Mother's problem turned out to be dehydration. She was a bit dehydrated, then started hallucinating that things were in the water glass, which made her even less willing to drink. She's home and I saw her today. Occasional fuzzy memory about stuff (which actually is normal for her, but now she's not sure whether something happened or she hallucinated it), but she's all sane, sensible, and even-tempered.

 

And drinking water often.

 

I'll keep Shane's special diet in mind if the peeing resumes with Sam.

Edited April 24, 2013 by KF_in_Georgia

[greyhead]

Reading back, I see about your mother. I got so fixated on Sam's blood work that I'd missed it! So glad to hear it.

[KF_in_Georgia]

I can certainly understand the getting fixated on one issue. This week, I've had three areas of worry--Sam, my mother, and work (I've been slammed with a lot of extra freelancing, which is good for the wallet but bad for sleeping). I've tried to concentrate on one area at a time--clear out everything I need to deal with on Sam and my mother, then get to work on the freelancing--and flinch every time my email dings, because that's how I've been getting bad news or news of something else I need to deal with or a freelancing job that takes precedence over the freelancing job I was working on that interrupted the job before that one. So then it's go off to focus on whichever problem has popped up, then go back to the freelancing and try to figure out where I left off, and the email dings again...

 

Things are better now. Mother is stable and sane and we know what was going on. Sam isn't quickly and quietly succumbing to a major ailment. And I got all the freelancing out the door--at least for a day or two.

[Guest 2dogs4cats]

From the tests, the kidneys look pretty good for his age. Sounds like he has a bit of pain, a bit of just not feeling well and a lot of my greys got picky with food when they were old. Some things I tried to help them feel better in old age were Vitamin E (max dosage for weight, helps mobility), Traumeel (liquid, by mouth) for pain when they maxed out on Rx pain meds, homemade diet and Chinese meds.

 

Hope he feels better soon.

[Batmom]

I disagree with your vet and some others. A BUN of 55 -- that is not normal for an elderly dog and it is about the level that you can indeed start to see changes in appetite and feeling well. That is also a level indicative of sufficient kidney impairment to begin seeing anemia. I would want to keep a close eye on the BUN and HCT. Those are big changes in a fairly short period of time. You might not be able to do much to control them, but knowing what they are could explain any further symptoms he might have. I hope he continues to do well for a long time to come.