cush dog with kidney failure please help

[pupdog]

Hi, I have an 11yr old dog and I really need some advice what to do for her. She was determined to have all of these problems by way of various lab tests:
a skin infection, a urinary tract infection that has spread into the kidneys and become pyelonephritis, PDH cushings disease, and an ultrasound showed a possibility of mild pancreatitis.

In brief, my dog was given an injectable gentocin antibiotic for the pyelonephritis, developed acute renal failure due to it and was hospitalized. They told me that she would surely die in a few days and tried to convince me to euthanize her, but she looked just fine to me other than not eating so I had them keep her on IV fluids. She was released about a week later on subQ fluids and has shown good improvement since. But she is supposed to eat KD and she doesn't like it, she has lost a lot of weight and she needs to start eating twice as much as she currently is. She would gladly eat chicken but it's bad for the kidneys... I know that I can give her 15mg mirtazapine to get her eating KD, but I am afraid to do that because I don't want to make her renal failure any worse than it is, and medication is what got her in trouble to begin with.

Her last tested kidney values are: Creatinine 4.9, BUN 71, Phosphorus 6.5


Questions:
#1 My dog is on 500ml lactated ringers twice daily, the vet wants to lower the dose to 300ml twice daily beginning on 11/21, is this advisable? How long and at what dose should subQ ordinarily be given?

#2 I am worried about an edema or other complications related to fluids, especially if this becomes a long term chronic condition, isn't there any way to prevent an edema?

#3 My dog hates the taste of the KD food. I am mixing chicken in with it so that she will eat it. This is barely working though, what can I feed her that is safe and she would like to eat? I couldnt find any dietary intake values for renal dogs online.

#4 Do you think it is safe or would you recommend just giving mirtazapine to force the dog into eating pure KD food? For how long would this be safe, and how do we know it won't damage her further, as she is already on several other medications: epikitin, famotidine,

azodyl, and the lactated ringers solution. Uncleared medication becomes toxic right?

#5 How serious is it if an infection returns to her kidneys now while she has renal failure? Could anything be done to save her if that happens?


History:
[10/01/11] begins amoxicillian for urinary tract infection and skin infection (labs have not shown yet that the UTI is resistant), cushings is confirmed with low dose dex test.
[10/04/11] initial kidney values are slightly elevated: BUN 32, Creatinine 1.0, Phosphorus 5.1, specific gravity 1.007 (she was not concentrating urine.) -- Dr. says the kidneys look fine to him and she is OK to start trilostane
[10/06/11] begins on trilostane (100mg compounded), she weighed 33kg at this time.
[10/13/11] I start to notice a bad reaction to trilostane; hind leg weakness, loss of appetite, lethargy -- I suspect kidney damage or an addisonian reaction, Dr. assures me all is fine and to continue.
[10/18/11] symptoms become more severe; front & rear leg weakness and trembling so bad that she cannot sit, not eating or drinking
[10/20/11] trilostane ends today, ACTH test done and cortisol still high which rules out the reaction to trilostane as an addisonian response. Put on ketochlor shampoo for skin infection, 1 dose of comfortis flea pill given.
[10/26/11] dog begins to eat normally again
[10/28/11] An ultrasound is taken, showing pyelonephritis. Labs say its a resistant strain of ecoli. It's decided to treat this infection before any further attempts to treat the cushings disease.
[10/30/11] begins gentocin injections, which are contraindicated for renal affected patients, described as a little risky but a benefit since the drug will have more effect on the kidney and should rid the infection better, kidney values tested
[11/03/11] dog's kidney values tested again and apparently still look ok, I don't have the lab results for this day
[11/05/11] dog doesn't eat her dinner at 11pm, it goes unnoticed until the next morning
[11/06/11] sunday, vet is closed, not knowing what to do I give another dose of gentocin
[11/07/11] dog hospitalized and put on IV fluids at 4pm, diagnosed with acute renal failure
[11/12/11] dog sent home with 250ml lactated ringers once daily, azodyl, epikitin, famotidine.
[11/13/11] dog stops eating and drinking again, appears lethargic, taken to an ER and an ER doctor changes orders to 500ml lactated ringers twice daily.

[labblab]

I want to welcome you to our forum, but I am so sorry about your dog's kidney problems! We do have some members who have battled renal failure, and I hope that they will be by today in order to offer some thoughts or suggestions. Perhaps there may even be an internet forum similar to ours that is dedicated more specifically to canine renal issues. In the meantime, I just want you to know that we are here to offer our support in whatever ways we are able.

Sending many hugs to you and to your girl,
Marianne

[Harley PoMMom]

Hi and welcome from me as well!

My boy, Harley, had kidney issues too. I joined a K9kidney forum which provided me with a lot of information, here is the link: http://pets.groups.yahoo.com/group/K9KIDNEYS/. I really do recommend that you join there as well.

Since your furbaby has pancreatitis along with the kidney failure, watching the fat intake is important. Skinless, boneless chicken breasts that are at least 95% fat-free would be a good protein food source. Any white fish such as talipia and or eggs are also good protein sources. I would suggest feeding white rice, cooked very mushy and serving the rice with the protein. This dogaware link can help you with determining what food is best for a dog with kidney issues: http://www.dogaware.com/health/kidney.html but keep in mind that your furbaby has pancreatitis.

Another medication I would recommend is either Pepcid AC or slippery elm bark. Dogs that have kidney problems and are not eating properly accumulate excess acid in their stomach and the Pepcid AC/slippery elm bark will help with that. Here is a link about SEB: http://www.littlebigcat.com/health/slippery-elm/

I am so sorry about the circumstances that brought you here but glad you found us and we will help in any way that we can. Please ask any and all questions that you have.

Love and hugs,
Lori

[pupdog]

Hi, thanks for the welcome. I am really worried for my dog I still don't know if she's going to live or die or get better or stay sick. I do have her on pepcid, famotidine is the generic name for it, they told me it was to prevent ulcers. My baby hasn't shown signs of pancreatitis for at least 2 years so I'm not too worried about that, I think maybe she does need the fat right now to get her weight and strength back up. I did have her on g/d food which was lower fat for pancreatic dogs but its also higher in phosphorous so I put her on k/d, she hates both either way. I am trying to get her creatinine and BUN to go lower so I guess we need to remove protein from the diet to accomplish that.

[lulusmom]

Hi and welcome to the forum.

I only have a second but wanted to provide you a link to some good information on kidney diet.

http://dogaware.com/health/kidneydiet.html

I'll check in on your thread tomorrow.

Glynda

[Harley PoMMom]

I wouldn't recommend eliminating all protein from her diet, but since she is uraemic (high creatinine + high BUN) a reduction might be warranted.

If her phosphorus is elevated a phosphorus binder is necessary since high phosphorus accelerates renal failure and makes the dog feel nauseated thus not wanting to eat.

In humans the supplement CoQ10 has lowered levels of serum creatinine and BUN (blood urea nitrogen.) Here's a link about this study:http://www.rejuvenation-science.com/n_coq10-kidney_failure.html

Please keep us posted.

Love and hugs,
Lori

[Skye]

hello!!!! welcome!!!!
I am not sure how much I can offer to help but i will toss a couple of thoughts your way.
i would speak to a specialist...a nutritionist. (sorry i may have spelled wrong) If she doesnt like the food suggested, THERE IS ANOTHER OUT THERE that will work. BUT be careful they dont trigger another response. I learned that one the hard way.....My vet wants mine on prescription hills....we have been on 4 or more in less than 6 months.........the nutritional value truly lacks. General vets are not very educated at all in nutrition, but a specialist will be. And one had so much fat content in it she landed in icu for pancreaitic attack. One of them even had saw dust as a filler. There are some decent foods out there, and some that claim they are all that when they are not.
Low protein diets can be harmful and must be carefully done and same for grain free diets.

[pupdog]

Hi skye, I have heard that they have nutritionists at hills you can talk to for free at the 800 number, I haven't got a chance to call them up yet myself. My pup was on their prescription i/d food for a while which is the one for pancreatic dogs and she really liked it.

I took a chance last night and made some food from that dogaware site lulusmom posted, i made up rice and hamburger and she ate a whole pot full of rice and about 1lb of hamburger mixed in! Not the most nutritionally balanced meal but she was happy and ate without a fight. I'm going to try potatoes instead of meat next time, if this works not only will it be a good way to cut out the protein but also very economical compared to the prescription diet food. I got a 10lb bag of rice for $13, and a 10lb bag of russet potatoes on sale for $1.

I'm interested to know if anyone has tried using CoQ10 for their dog, how did it work out?

[Squirt's Mom]

Hi,

A word of caution about diet - we can really mess up a dog's system by feeding unbalanced foods and we can do that quickly. If you really want to help your baby fight via nutrition, you need a nutritionist or nutritional consultant to work with. They will take all your baby's health issues, environment, age, activity level, breed, etc into consideration when designing a menu. There are several good people out there who can help you with this. Learn from my mistake - after a pancreatic attack I decided it was best to remove as much fat as possible from the diet and that was so wrong; it made my baby sick. If you want to add the beef and rice to the prescription feed to encourage her to eat it, that is ok, but to give her that alone over a period of time will lead to worse troubles than she already has. Monica Segal is one I would recommend you talk with. I don't recommend any diets you find on the web. For a healthy pup, it might be ok but for one with a compromised system it is like taking someone else's medicine just because you both have stomach aches tho you may each have very different conditions. You dog is a unique biological system, unlike any other, and needs to be treated as such.

And don't waste your time calling the "nutritionist" at Hill's or any other dog food manufacturer. They won't be able to tell you anything other than how wonderful their feed is - they are being paid by that manufacturer after all. They could care less about your dog or any other - they only care about selling their product regardless of how worthless it may be. ;) I met a "nutritionist" from Hills just a couple of months ago at our local PetSmart. Her training? A two day seminar given by Hills. :rolleyes:

Renal failure is serious business and should be tackled by experienced professionals who are working for YOU and YOUR baby.

Just my 2 cents worth. :)

Hugs,
Leslie and the gang

[Skye]

Exactly my point about Hills...............and so many others. I am sooooo looking forward to seeing a nutritionist after my girl is through her surgery and recovery. A REAL one.
GREAT post Lesile. Wish more people could know about this.

[addy]

Hi,

The only diet I ever saw on line that seemed we could trust was from Dr. Jean Dodd- the thyroid expert. it is a liver clensing diet so not sure about kidney failure, maybe Lori would know. Dr. Dodd is adding a supplement to it.


Liver Cleansing Diet

•White potato + sweet potato (50/50) cooked
•White Fish lightly cooked eg: cod, halibut, mackeral, smelt, snapper etc
Ratio is 2/3 of potato mix with 1/3 of fish . Season with mixed Italian Herbs or fresh parsely, salt and pepper. Later chopped carrots and green beans ( both cooked) can be added as can scrambled eggs. Yellow squash can also be added. Give a liquid childs multivitamin or a supplement such as Missing Link ( source of calcium)

Note from Dr Dodds :- I have some patients that have been on the diet for 7 years now-- that were near death before-- and are thriving ! Testimonials are numerous, without one negative comment other than some won't eat fish and so we give chicken to them.


Hugs,
Addy



W. Jean Dodds, DVM
Hemopet
938 Stanford Street

[Squirt's Mom]

FWIW, I would never give a mixed Italian herb to my dogs nor would I ever use a human multivitamin....and I respect Dr. Dodd's a great deal as an endocrinologist. Dogs don't need seasoning and many of these premixes will contain onions. Humans and canines have vastly different vitamin and mineral requirements so to use our multivitamins for them is risky. There is no indication if the veggies are canned or not - canned human foods for our dogs can also contain seasonings and spices that are not good for canines.

A well designed home made menu will be very specific in the ingredients to use (not a list of meat and veggies to choose from), exact measurements of each (usually in grams not ratios), and detailed in how to prepare (lightly poached liver has a different nutrient profile than well boiled liver for example). Then individual supplementation is added to bring it all into balance; ie if the calcium is a bit low for that dog, you will be told exactly how much calcium to add, not a supplement that contains calcium along with other things - which would throw the balance out. ;)

Another 2 cents...;)

Hugs,
Leslie and the gang

[pupdog]

Tonight I tried giving her k/d with rice and she didnt want it, then i put hamburger and potato in with it and she still didnt want it so I dumped it all out. After that I gave her just plain rice and she ate a few bites then walked away, put some hamburger on top and she still wasn't interested. Either I scared her from eating hamburger now with that k/d or she just isn't a big fan of hamburger and was hungrier yesterday than today. I'm going to try chicken and rice tomorrow and if she won't eat that then I'm going to force her to eat with mirtazapine because I don't know what else to do. I weighed her again today and she's lost nearly 10lbs. The vets and internal medicine people tell me just get her to eat anything at this point its better than nothing.

[Squirt's Mom]

Hi Sweetie,

Your vet is right - at this point getting her to eat period is the main thing. One of our members here went through the same thing as you and your baby. The only thing she could reliably get Pallie to eat was Kroger rotisserie chicken. She would have Kroger cook a chicken for Pallie using no seasonings, spices, etc.

If you would like to read about their journey, Pallie's kidney story starts on her thread here -

http://www.k9cushings.com/forum/showthread.php?t=353

I still strongly recommend the assistance of a nutritionist if you can. But I don't doubt you are doing and will continue to do all you can for your pup. Know we are all here for you to offer our ideas, knowledge and support.

Hugs,
Leslie and the gang

[pupdog]

Thank you so much for posting that link, pallies story is almost identical to mine, we also have a UTI that the vet wants to treat with nitrofuranton. It appears that pallie died from complications of using that drug within only 17 days of starting it :( this doesn't look good for us, I don't think there is any other drug or procedure we can use, and if the UTI gets bad she can die of that. Now I am really worried.

[addy]

I am so sorry you are going through this. At this point, in my opinion, you just want her to eat something, who cares if it is balanced. When I looked at a novel protein diet for my pup, they were talking about home cooking a protein and carb, feeding for 6-8 weeks and they did not care if it was balanced. Long term is another story and then I agree with Leslie.

I have tried a product called Seacure. I don't have the link handy but you could google it. It is smelly fish supplement originally developed for malnorished children. I wonder if the fishy smell might get her to eat her hamburger and rice again. Just a thought. When they are not eating, I don't see why you can't pull out all the stops as your vet already stated but that is just my opinion.

As for the meds, I can't help. I am hoping Lori may stop by. Otherwise try sending her a private message.

Try to keep you chin up and remember to breathe:)

hugs,
addy

[Harley PoMMom]

One of the possible side effects of Pepcid (famotidine) can actually be inappetence so I would urge you to try the slippery elm bark. Slippery elm bark (SEB) soothes the stomach and helps to diminish the accumulation of acid in the stomach plus it is contains many nutrients and it may stay down when other foods are not tolerated.

SEB info:http://www.littlebigcat.com/health/slippery-elm/

Baby food, but nothing that contains onions, is another possible food you could try.

Keeping you both in my thoughts and prayers and sending lots of hugs and love, Lori

[Bichonluver3]

A big welcome from us too! My diabetic dog, at one poiunt, was refusing his food. I think it was someone on this forum that recommended a slight sprinkle of parmesan cheese. Worked like a charm. Even my cush pup insisted on it!!
Don't know if that is an option for you.
Carrol & Chloe

[pupdog]

Now that I have seen pallies story its like I am able to see into the future: if I put my dog on antibiotics ever again she will die of renal failure within 2 weeks flat. And I know for certain that her infections will return since she is a cushing dog. I guess all I can do is just leave them untreated and hope they take a long time to kill her, is that what you guys would do? I am so depressed now, I thought I had saved her and now this.

I left the rice/hamburger in her bowl and she ate it for breakfast at least.

[corgipallie]

Pallie died of a pulmonary embolism, not related to antibiotics in any form or fashion.
She went into acute renal failure due to so many chronic renal issues from her Atypical Cushings. Her Creatinine was up to 7.3. She was in the ER for 3 days, her regular vet for a few more on continuous IVs. Her creatinine went down to around 4, and then I did sub-q fluids every day. On the day she passed away (earlier in the day she had a blood test), her creatinine was 1.8. Her kidneys recovered.

I honestly am questioning my faith in your vet. They seem to be approaching this very wrongly. She doesn't have to eat KD. You can give her homemade meals of chicken, ground turkey, rice, and some supplements. Stay away from beef as it's high in fat and can cause pancreatitis.

I know getting her to eat is a problem. Some of her meds can also change the way things taste. There are some antibiotics that do that too. Dogs are so smell-sensitive that if it doesn't smell good, they may not touch it.

I really don't have more answers for you. But overall, unless you love your vet, I'm seeing a lot of red flags.

[lulusmom]

If your dog is not being treated by an internal medicine specialist, I would highly recommend that you get a referral from your vet asap. If you let us know what city and state you reside, members may be able to give you a name. You can also do a search for specialists in your state using the link below:

http://www.acvim.org/websites/acvim/index.php?p=3

[pupdog]

how was it determined that pallie had an embolism and what caused it? i have been worried about an embolism too, i don't know how much subq fluid to give or if i should reduce the amount, i have heard that giving too much fluids is a risk for causing an embolism. my vet has basically left it up to me how much fluids to give, i tried asking a few other vets on the phone and they won't tell me how much is recommended.

so much of what you wrote about pallie after starting the nitrofurantoin appeared to be renal failure coming back, even though the kidney values didn't go up on the test it just had all the same signs. I think maybe these kidney profile tests aren't entirely accurate, they didnt detect my dog getting sick until she was already half dead and she was being tested every couple days.

im in los angeles and am considering to go see david bruyette i have heard he is one of the better internal medicine people here. cost is an issue though, i probably wouldnt be able to go see him more than a few times

[corgipallie]

Embolisms are unfortunately a complication of Cushings. It's not as common as other problems, but it was associated to her Cushings.

Your vet telling you how much fluid to give is another red flag to me. Fluids are based on body weight and what the need is for. Your vet should be telling you exactly how much fluids to give and how often. Some need fluids every day. Some every other day. Some once or twice a week.

Renal disease doesn't show up on blood work until the kidneys are only functioning at 25%. That is why you may be getting mixed results.

Please seek out vet recommendations in your area who know about Cushings and kidney disease. An IMS would be a great start but Cushings and kidney disease are common enough that a good, well trained vet can do both and an IMS may not be necessary.

What part of Los Angeles are you in?

[lulusmom]

I heartily recommend that you have your dog seen by Dr. Bruyette as soon as you can get an appointment. I am in Southern California and drive 50 miles to a specialty VCA facility in Fountain Valley. If I was closer to West L.A., my two cushdogs would probably be treating with Dr. Bruyette. It may be that you will only need to see him once or twice to obtain educated and experienced answers, as well as clear direction on treatment options.

[pupdog]

I'm right in west la so getting the pup there is no problem. Shes been happily eating rice and chicken, but she doesn't like the rice all by itself when the chicken is gone, I don't blame her it tastes really blah. I found a low sodium broth to go with but its got onion in its ingredients, is that ok?

Today I cut her subQ fluid down to 250ml, nobody has given me guidelines or anything scientific to go by, but the feeling I am getting is that the fluid should be reduced now. She drank a whole lot more water today because of it, I don't know if that is good or bad but I think I am going to put her back to 500.

Any ideas on where to get deals on medications needles and tube sets?

[labblab]

ONION IS NOT OK!!!! Onion in any form, including as a flavoring in broth, can cause a life-threatening anemia in dogs.

It is so good that you checked the ingredients of the broth. It is important to check the ingredients of any "people food" that you give your dog, to make sure that onion is not included in any way.

http://joybutler.suite101.com/onion-toxicity-in-dogs-a40917

Marianne

[mytil]

I am really concerned you received no instructions on the amount of fluid for your dog as others mentioned above. Possibly it was written down on the paperwork you were given on how to administer fluid.

Why do you have the feeling the amount should be reduced? Have you talked again with your vet and insisted on an amount you need to give, when, and for how long while you are waiting to see another specialist.

Please do seek out Dr. Bruyette as soon as possible.

Terry

[Harley PoMMom]

The amount of fluids to give absolutely should be determined by one's vet. It is based on the dog's dehydration status and weight.

One of the guidelines is to never give sub-q fluids if the prior injected fluids have not been absorbed completely, are you seeing this?