Full Diary Part 9

[Continued from Full Diary Part 8]

Help for dogs with kidney disease means following directions on prescriptions.

To completely tell my story of my care for a dog with kidney disease,  it is late May about a year and a half after diagnosis and I’m always realizing something new and on her last bloodwork, her potassium was closer to the high end of normal so I cut it back a little.  Well, I think I cut it back too much – probably started giving her half what I had been according to the tube dosage instructions.  Well, just in the last week or so, her front leg was not working right after she would be resting for a while, like on my lap while I gave her fruit and veggies so I thought maybe it was going to sleep, so I started working it a little (pulling it in and out while still on my lap) before setting her on the floor.  But then as I watched her every day on walks, and moving around, I just really thought she was just overall somewhat weaker which was puzzling because she is eating so much more tripe, which is top quality protein for muscle support and also counters anemia which would cause tiredness.  Remember, the doctor acknowledged we are treating her based on anecdotal evidence and here is a perfect example.  Then happened to read that muscle weakness is a symptom of kidney failure, which I really hadn’t realized, so researched it more thoroughly this morning and read that is why I should supplement with potassium.  And here I had cut hers back!  So this morning, I returned to the full dosage I was giving her and  I’ll watch over the next few days to see if the front leg weakness disappears.   Bet it will!

May 23 –  Just a mere 36 hours after increasing her RenaPlus potassium gel, she is astoundingly improved!  Hooray!  And I’m thinking I need to give her more calcium for the hind leg weakness that can afflict dogs with kidney disease, so today I started being more generous sprinkling it on her veggie afternoon snack.  That is the snack that delivers all of her vitamins, minerals and herbs so the perfect time to add additional calcium/D3 because calcium blocks iron and zinc as well as phosphorus but with her fruit (raspberries high in iron) in the morning snack, and the honey (high in iron) added to the veggies, and the tripe high and most usuable as animal iron at her morning meal, plus honey on the cabbage at bedtime, those other feedings are when I hope I am getting high iron in her to fight anemia and without added calcium at those feedings so it should not be blocked.  At the last blood work where I had been trying to increase her iron so she wasn’t so anemic, it showed great improvement, just barely on the anemic side.

May 26:  Almost a week since being sure I gave her the increased potassium dosage and she is following me everywhere again and so excited to get her meal, coming to the counter where I prepare it then running to her placemat for me to put her tripe down for her just like she did just 10 months after diagnosis.  Like my vet commented it is all good that I am maintaining the status quo.

But now she is just picking at her trip when before she was eating 5 times more than normal, albeit normal was a small amount. But I had read you can’t feed them too much.  But I have come to realize that as I have increased her potassium dosage, her appetite has decreased proportionately.  So I went online and looked up side effects for potassium, and sure enough loss of appetite was one of them.  So now, I’m going to cut her back to maybe just a little under the required dosage whereas I have been giving her a little more than the required dosage, in hopes now to try to get her appetite back. It is such a balancing act, pros and cons to everthing.  But a half hour went by when I had an idea.  Why not give it to her AFTER she voluntarily eats her tripe, instead of after her first nutrition of the day, fruit at 8:30 am so it doesn’t spoil her appetite?  She is getting her 2nd dose after her last snack in the evening, cabbage/honey/salmon oil/E oil at 10:30–11pm so it would make sense to would be fine to give it to her AFTER her tripe meal at 10:30–11am.  That way, maybe it won’t affect her appetite so much when she eats her tripe – because again she seems so excited to see me make it and run to eat it, then just picks at it.  Hard for me to watch, when she was gobbling it down just a week before – before I increased the potassium and I was giving it first thing in the am after her fruit “breakfast.”  That should help and I certainly WON’t overdue it!!  I know I wrote this early on that more is NOT better, and here is another example.

OK, I must fine-tune my care for a dog with kidney disease.

May 29 – Well here is yet another example that more is not better.  I let her eat all the protein she wanted about a month ago, and at lease doubled the amount of Brie I was giving her and in the last 36 hours she has behaved very bizarrely and had me SO puzzled.  Called and discussed the symptoms with her doctor, dazed, confused, lost, has forgotten all routines, location of water bowl and where the wee-wee pad outside where she knows to pee and poop- she was just leaving it wherever she is as she is walking around.  But it had me so confused because she is NOT vomiting, her stools are firm and normal, her coat is shiny…what’s going on?  So she had me take a urine specimen this morning, first catch, thinking she might have a low grade urinary tract infection but her lab results came back normal – clearer and more normal that ever, although her specific gravity was down just slightly.  So she recommended a one week regimen of a broad spectrum antibiotic, Amoxicillin and to watch and see if she improves.  The doctor made the comment that if her urea was unusually high that could have caused those symptoms too.  So I gave her one dose of amoxicillin, then read on the internet about high urea and I had forgotten that it is totally linked to protein and I found a great article on limiting protein, being sure what is given is high quality and low phosphorous – recommending it to be only 10 – 15% of total calorie intake.  So I totaled the foods I was giving her (tripe, brie cheese, mango, pineapple, blueberries, raspberries, pumpkin, sweet potato, parsnips, banana, cabbage, Stauffer’s animal crackers crushed to thicken the parsnips and pumpkin, honey, salmon oil) and their calorie content and the Brie cheese accounted for 27% with the tripe already at 15%.  So I see I have to up the fruits and veggies to get increased calories in her and reduce the tripe a little and the Brie a lot if not altogether.  So after seeing this and thinking I have let this problem manifest over the last month by encouraging and giving more and more protein, I called the doctor with my belief that her urea comment was correct and a result of my protein increase so should I still give the amoxicillin?  Her assistant called me back to go ahead and give it anyway.  But after I hung up I got to thinking if I reduce the protein and start the amoxicillin at the same time, I’ll never know which caused her to improve (and she seemed a little improved just over yesterday when she got very little tripe, and I gave her no Brie – I just let her sleep through dinner.  So I called the animal hospital back and asked how long the Amoxicillin would keep in the refrigerator and my idea of reducing the protein to see how she responds and if after a few days – maybe four total-  there is no obvious improvement I could then start the amoxicillin. Then I would know which helped her – if either.  That was fine with her.

Well, after the 4/11/13 bloodwork,  I reduced protein, and never did use the amoxicillin because her 5/30/13 urinalysis just didn’t warrant it in my opinion – that we were just kind of throwing something at her to see if it helped and she responded to nutrition and vitamin/mineral/herb therapy so well that I didn’t want to use the antibiotic unless it was clearly indicated.  She stayed pretty much the same then after 3 – 4 weeks she got considerably weaker in her legs, especially her front left as there were times she couldn’t use it all – it was useless and just hung there.  Actually saw her gimping along on just three legs!  Amazing, since her back legs are so weak from luxating patella.

Because then she had two “episodes”  right after the urinalysis.

I thought maybe I had been giving her too much protein, so had cut Brie out entirely – and since she had no appetite she didn’t eat any tripe that first day, Thurs. 5/30 and I didn’t finger-feed her. She had only had one .4 mil dose amoxy drops first day I picked it up although urinalysis best ever when I decided to stop it.

That night around 10:15 climbing up ramp to couch, a little slow but made it OK, went to lay down by my feet, settled with a leg over my ankle which I thought was sweet, covered her, and moments latter two cries as if in pain, whipped off the covers, she was flat on her side. Alert, not panting, sweating or gasping or otherwise stressed in any way, just on her side and looking somewhat frightened and no more cries. Petted her, told her it was all right and she got up, settled down and all was usual the rest of the night.

Friday ate fruit breakfast fine, after routine walk where she sniffed odors, did fine, offered tripe at lunch, sniffed but didn’t eat any, so finger-fed her a very small amount to introduce some animal protein. Dinner 7:30, offered tripe, expected her to sniff and not touch but she ate half of very small amount offered. Was serving my husband’s dinner so not watching constantly, when I hear two cries, looked over and she was flat on her side legs straight out. No panting, sweating, or gasping for air, no incontinence. 30 seconds passed she got up and went and laid down and all was well. Showed an interest in wanting her usual treat from dad while he ate. Refused it but was alert and aware of usual routine.

9pm fed her half of her veggies, did fine, followed normal pathway in from outdoors, came to couch, walked up ramp, laid down, napped. But earlier, husband thought she had a poop accident by the door and I didn’t see anything. Later when coming in after veggies, ran my foot over something soft and there was a little ball of firm poop – but very dark, almost black which is why I didn’t see it on the black carpet. But then I remembered Amoxy drops and figured that was why it was so black looking because Sat. morning’s poop was light again.

1. Took normal walk with just a few rest stops, sniffing though and then ate increased amount of fruits, gave RenaPlus like former plan. 12:30pm lunchtime, ate small serving of tripe and 3 more smaller servings but after eating had a useless weak front left leg and back legs so weak as to be almost useless as well. Napped 1 – 2 hrs in dining room then found her sitting behind me in the den and she climbed right up her ramp to get in a cozy cave to rest in the same room as I.

But then another episode happened 6/11 at 10:30 in the morning so I scheduled an emergency appointment with her doctor and she was seen that afternoon because the vet thought perhaps she had arthritis and maybe a spur that would pop out in the shoulder causing pain and leg weakness and although she probably couldn’t take the normal analgesic there may be something she could prescribe to bring her relief.

But, at the examination no arthritis was found, Pnut walked for them and they saw the pronounced weakness and the doctor expressed great concern about the loss of muscle in her legs and body in general. I reminded her [105]she had asked me to cut back her protein after the last blood work in April as her BUN had gone up (although only 8 points over the cut-off I have read necessitating a cutback in protein and 2/3 of what it had been a year before.)   But then I considered that her Creatinine had gone up to 3.0 too, highest it’s ever been, so I had agreed to go for the reduced protein.

Upped Pnut’s Ginko/Hawthorn drops to two twice daily for hopeful improved circulation 6-15-12 – realized also I am feeding liver which is high in phosphorus and I see on her blood work from 4-11-13 that her phosphorus is already higher than it should be for a kidney dog even though it is actually only high normal. The IRIS guidelines states blood plasma phosphorus readings should be no greater than 4.5 and hers was 6.1 with the high end of the range at 6.2. So I have increased her calcium as a blocker and feed it in her veggies within an hour of the liver, although I have read two opinions on WHEN it should be given to be effective, one stating immediately and the other within two hours.  So I’m hoping the 2 hrs is effective because I do so love it when she is excited to eat the liver treats. And they have to be simmered fresh – no leftovers will tempt her.

BUT….STOP the presses – liver was providing too much phosphorus and she started feeling poorly so I have read more that many sites say to NOT give liver whatsoever so I’ve stopped that – and she cooled on liking them anyway so I have ordered a multivitamin with iron and NO phosphorus (the two I was giving her now both contain phosphorus and I’m just re-acquainting myself how really bad phosphorus is for her.)

Because yesterday, 6-27-13 her left front leg didn’t give out on her until around 4pm – she was underfoot ALL day. So I think the Taurine, and her appetite for tripe plus the little Brie I give her for her evening meal is working and I can’t wait to get the Fosfree in tomorrow so she starts getting more iron, although I must be conscious of the fact that it contains iron gluconate which is considered toxic by many and dangerous (especially an overdose) but I have read a study advising its use so I am trying it. I’m a little concerned about the calcium in it blocking the iron absorption and there is triple calcium in this multivitamin but I do believe I read somewhere that calcium might only block 50 – 60% of iron intake so at least it will be an improvement.[106] And I just read that “foods rich in vitamin C can triple the bioavailability of iron”.   I looked on my Excel nutrition chart of the foods I’m giving her and she is already getting 495% of the daily vitamin C intake she needs, so at least that’s in my favor and there is a high amount of vitamin C in this new Fosfree complex vitamin-mineral. So I’ll be sure to adopt what they speak of and give plenty of Vit. C to counteract the calcium when offering iron.  [Continued Full Diary Part 10]