I wish I had better news.

[Sue R]

Do you have the option of consulting with a specialist? It can involve travel to find someone who does specialize in kidney failure but you may also find a specialist vet who has more in his/her toolkit than your general vet.

[GentleLake]

NSAID, and I suspect that may have contributed to the rise

 

NSAIDs can not only contribute to failing kidney function, they can cause it!

 

Several years ago I was hospitalized with acute renal failure brought on from years of NSAID use to manage chronic pain.

 

Other meds are cleared through the kidneys as well, so you do have to be careful about any warning of potential for renal failure, especially if a dog (or human) has already experienced renal insufficiency.

[kingfisher7151]

Sue,

 

We may have the option of seeing a specialist. I'm interested in getting a second opinion. The only thing we have to consider is whether or not a specialist could really tell us anything that we don't already know. We have friends who blew through thousands of dollars going through different specialists trying to find another answer when the conditions were obvious. If it's not going to get us anywhere, I'd rather spend the money on things to keep him comfortable. But a second opinion is very likely on the menu.

 

I've been given a LOT to chew on from many different people, I think I'll have a game plan once I've had a chance to really process it!

[kingfisher7151]

If there's anything good that has come from this, it's that I'm trying to make every day special. We had to put down our spaniel just a couple weeks ago at 8 years old, so this is just pouring salt into the wound. I took a few family photos today:

 

 

And I think we've decided to go ahead and do the ultrasound. It may not give us any more info, but we're thinking knowledge might be power.

[Maralynn]

Lovely pictures

 

If you're considering a specialist then I'd consider getting the U/S done there.

[kingfisher7151]

I just got his blood work results, and he is in Stage 2. I might as well post his results, it's good for record keeping if nothing else.

 

[gcv-border]

What a lovely canine family. I don't know much about canine kidney issues (but have had 2 senior cats with kidney issues) so I am learning.

 

Best of Luck going forward.

[Blackdawgs]

My old dog was diagnosed with Stage 3 renal failure in March. I'm pretty sure that she was stage 2 in the previous June and the vet missed a red flag....so I proceeded to give her daily NSAIDS which may have contributed to the renal decline.

 

Anyway, second opinions aside, management of renal failure is potentially very complicated. You need to preserve the remaining function and you need assistance from the most knowledgeable person, who is probably not the average generalist vet.

 

I use a board certified veterinary internist for the kidneys. Although it is expensive (blood work, urinalyses, blood pressure monitoring, anti-hypertensives), the specialist is actually pretty conservative about ordering tests and is very generous in answering emails.

[carolync]

NSAIDs can not only contribute to failing kidney function, they can cause it!

 

Several years ago I was hospitalized with acute renal failure brought on from years of NSAID use to manage chronic pain.

 

Other meds are cleared through the kidneys as well, so you do have to be careful about any warning of potential for renal failure, especially if a dog (or human) has already experienced renal insufficiency.

He was borderline before the NSAID, but at 15+ years of age we felt it was worth for a quality of life standpoint, especially since some of his kidney #s were normal, and to check blood work prior to continuing the intial trial. We had him on a relatively lower dose, too. He's on tramadol now, which won't have adverse affects and he's got a swing back in his step.

[carolync]

GentleLake, I am indeed a raw feeder. 3 dogs are partial raw, but Trooper is full raw. I'm glad to hear it's worked for some people, he does SO much better on raw with regards to his autoimmune disease and suspected pancreatitis. I'll be researching away what the best diet will be for him!

 

I read somewhere along the line that dogs that are feed a raw diet tend to have a higher BUN. Couple vets have also told me that it's the creatinine & urine specific gravity numbers that are the most important.

 

Was the urine sample the first of the day? - that also makes a difference.

[kingfisher7151]

Interesting about the potential raw/higher BUN correlation, I'll have to find some info about that. Either way, his creatinine was high and his specific gravity was low. He's pretty textbook. The urine sample wasn't the first of the day. But they used a catheter into the bladder, so it was a pristine sample.

 

Ultrasound is scheduled for Monday, teeth surgery on Wednesday. I'm scared to death about putting him under anesthesia, but it has to happen.

[carolync]

Interesting about the potential raw/higher BUN correlation, I'll have to find some info about that. Either way, his creatinine was high and his specific gravity was low. He's pretty textbook. The urine sample wasn't the first of the day. But they used a catheter into the bladder, so it was a pristine sample.

 

Ultrasound is scheduled for Monday, teeth surgery on Wednesday. I'm scared to death about putting him under anesthesia, but it has to happen.

Hero's latest workup was the first time his specific gravity was low; when scheduling the appointment I asked the tech if the sample needed to be first thing and she said not this time around. Speaking with the vet later I should have gone with my gut - she said it does make a difference, taking a random sample can vary the results depending on how much they drank during the day, and suggested I drop off another sample to get a true reading.

 

Over the last four years Hero's numbers have gone up and down, but stayed pretty stable. His creatinine was at 1.9 at one point, and then dropped to 1.6 a year ago, and his BUN has been trending downward, so try to keep as optimistic as possible if you can, I know it's hard. 4 years ago I wouldn't have believed my guy would still be around.

 

Best of luck next week.

[GentleLake]

IIRC, both BUN and creatinine can be higher in raw fed dogs. Would be a good idea to confirm, especially creatinine as I'm not positive about this.

 

Vets should be aware of this, but I'm not confident all are.

[Sue R]

When testing for urine specific gravity,"pristine" is not important. First catch of the day is best because that's when the urine should be most concentrated and lack of concentration due to kidney failure will be most obvious and consistent.

[kingfisher7151]

Is that something that should have been taken into consideration? Or possibly a retest?

 

Now, feel free to tell me if I'm being THAT owner. I know vets hate when clients come in thinking they know what's going on. I just have a little voice in the back of my head that won't shut up.

 

I just feel like we're missing something. Trooper would have to have the sh*tiest luck to have immune mediated polyarthritis AND pancreatitis AND renal failure. He just has way too many gastrointestinal problems for it just to be IMPA. I just feel like there has to be something connecting all these things. I could be wrong, he could just be the prime example of natural selection. But I'm getting frustrated with the vets looking at the papers instead of the dog.

 

I hate complaining about vets. I look up to them more than almost any other profession. But the clinic we moved to has had us shuffling between 3 different vets. I feel like none of them know his full story, they're just familiar with one portion of his problems.

 

I might be wrong, but it feels like the prednisone plays some part in this. First, it's very well known for causing polyuria and polydipsia. But second, is it just a coincidence that his kidneys start failing as we start taking him off the pred? Could he have Addison's disease? Or something similar?

 

I spent hours mulling over all of his blood results since we got him. He had very low creatinine and BUN levels in January, and now they're mildly elevated. His BUN is definitely his worst level. Everything else falls on the "barely high/low" side. One thing that I think is weird is that he's been consistently anemic since we brought him home. Is that just a sign of chronic illness? He was negative for immune mediated hemolytic anemia, but he's still anemic. Could mean something, could be nothing.

 

I don't know, I could totally just be grasping for straws. But I can't look at him without wanting to fight to know just what's going on. We still have the ultrasound scheduled for Monday, unless we decide we need to take him elsewhere that'll perhaps get us started.

 

I don't want to be THAT patient, but I'm going to do right by this dog. I couldn't live with myself if we just said "well, that's it" when it could be something treatable.

[Jim Kling]

I couldn't live with myself if we just said "well, that's it" when it could be something treatable.

 

I would encourage you to think in terms of managing, rather than treating. Trooper sounds an awful lot like Rodeo, who has immune problems as well (IBD, a chronically inflamed nail that had to be removed).

 

I know that you're an advocate of raw feeding, but I'll just put it out there that we've had great luck feeding him Hills Z/D and similar brands, along with a supplement of psyllium powder (the main ingredient in metamucil). He also has severe reactions to flea bites, and based on observations I think it may trigger his IBD, so I'd encourage you to be diligent about flea preventives.

 

Those steps have basically eliminated his auto-immune problems for the past few years. I honestly don't expect him to live a full life given his history, but he's healthy now and we're grateful for every day.

[Maralynn]

A couple questions -

 

Why do you feel that they are looking at the paperwork instead of the dog?

 

Is it possible to request to work with one vet primarily as opposed to all three? I would rather work with one primary vet for anything beyond the basics.

 

To me this sounds like a situation that, for your peace of mind, a specialist is in order.

They may not be able to give you any better answers but you probably won't be second guessing yourself as much.

[Sue R]

You mention "suspected" pancreatitis. Did you actually have a blood test run to conclusively determine whether or not he was experiencing that? Pancreatitis is very serious but from what I have read, it is can be either misdiagnosed or not diagnosed. I don't remember the name of the test and it could be expensive, but it is (as far as I understand) pretty accurate.

 

Any time I hear of a dog with gastrointestinal issues and anemia, I think of our Bute who had IGS and died from it just the weekend that we got a diagnosis, at three years of age. There is a blood test for it now and I sure wish we'd had been able to test for it when he was young as his disease would have been easily managed. He also had issues with immunity, with small skin injuries becoming infected when on a normal dog, they would not have.

 

I am grateful for a vet that is glad that I am trying to learn about Megan's kidney disease and how to manage it. She respects my opinions, is willing to talk to me on a level that I can understand and yet not talk down to me, and will also do additional research if need be when I raise a question. I feel like we are a team on this (and any other issue I have with my dogs) and I am grateful for her willingness to have me as a partner in my dog's care, as I am grateful for her (and other care providers who are involved in any way).

 

I arrange my appointments so that I see the one vet, and I have a vet that is recommended by her and other staff should I not be able to see her for unavoidable reasons. I think that when you have something that is chronic, like Megan has, consistency in evaluation and treatment is a big plus if it is possible.

 

I know many vets (and many clients) do not make it easy to work together, and I hope you can resolve that.

 

By the way, I did not feed Megan raw prior to her diagnosis other than as supplemental feeding. Now that I understand what her diet should be like for her stage of CRF, I feed her a combination of raw beef, cooked green veggies, cooked glutinous rice, and certain supplements, keeping in balance her needs for protein, energy, minerals, etc. Whatever works best for your dog is what is best.

[GentleLake]

Is that something that should have been taken into consideration? Or possibly a retest?

 

Sorry. I'm not sure if you're referring to the BUN and creatinine levels here or not.

 

But, imo it's always a good idea to bring things you're aware of or have been made aware of up in discussion. There's been more than one time I've known something the vet(s) didn't or just hadn't thought of yet.

 

One example was a friend's dog. I suspected his aggressive outbursts might be the result of low thyroid. She mentioned it to the vet. They were skeptical since he didn't have a weight issue, but they tested and said he was fine. I still wasn't convinced, so I talked her into sending a sample to Dr. Dodds. Sure enough, he was pretty darned low. Her vet hadn't done a full panel and missed it. She got him on thyroid meds and he's been fine ever since, though I still had to tell her that the meds needed to be taken on an empty stomach. And this is a generally good vet practice.

[kingfisher7151]

Hi all, I'm at work so I'll have to make it quick.

 

Maralynn, I feel like they're just looking a the results because they've never done anything more than a quick exam and pulled him back to draw blood. I don't think we've ever had an appointment longer than 15 minutes. We'll try to explain what's going on and we only get "interesting, we'll draw blood and will get back to you in a week" as a response. It's just kind of a gut feeling.

 

Sue, we have done a blood test for pancreatitis. He came back right on the cusp of normal and high. The blood was taken when he was in a good spot, rather than when he would be in a crisis. We have enough to believe he has had bouts of pancreatitis. It's very scary, and we've made alterations to his diet. Another clue was that he started to spiral and instead of upping his pred I decided to withhold food for a day and a half, as is protocol with pancreatitis. It stopped the attack in its tracks, something we'd never successfully done before.

 

I know we considered IGS when we were first finding a diagnosis. Perhaps it's time for a revisit...

 

GentleLake, I was referring to the "first catch of the day". I wasn't sure if that's something the vet should have mentioned, or even ran a retest knowing the sample wasn't collected at the optimum time.

[GentleLake]

I can't recall if you've done this, but with all the problems Trooper's had in the past and now this if he were mine I think I'd be taking him either to a university vet hospital where there are lots of specialists to consult with or at least a board certified internist who could be looking at all of these things in relationship to each other (within what I could afford, of course. I know we don't all have unlimited resources). It just seems a little hard to imagine that all his problems are happening completely independently of one another.

 

Even though your reply was to someone/thing else, I'd still think a vet should know and tell you if there's an optimal time for the urine catch. But there's nothing wrong with your asking if you're not sure they didn't miss something, if nothing else but for your peace of mind. If nothing else it'll let the vets know that you're intelligent and informing about his health care.

 

I wish I had something really meaningful to add to the discussion. Still keeping both of you in my thoughts.

[Alfreda]

I'm with you and Gentle Lake- pretty crappy luck for one young pup to have all that going on! As someone already said, Trooper is aptly named and I'm rootin' for both him and you! -loved the video and pics BTW...

 

I think you're in Colorado? I don't know what part of the state you're in, but I'd definately consider going to CSU, and/or the Vet Specialty practices in either Wheatridge or Longmont (Aspen Meadows is where I've been for oncology, cardiac, and knee surgery with 2 older dogs).

 

I've been in the same boat as far as thinking different diagnoses *must* be related... my mind usually goes to diet and/or drug reactions... I guess because those are the things (inputs) I can actually control...

 

Just an anecdote: A friend of mine had an older BC with kidney failure related to a chronic (but unrecognized) botched early spay. She lived an active life for more than 4 yrs after diagnosis, (til age 12 I think), mostly on Hill's prescrip diet...

 

just sending you and Trooper good wishes!

Rebecca

[kingfisher7151]

Thank you both!

 

I am indeed in Colorado. A good friend just graduated from CSU's vet program, and she said the hospital there is really no different from any other hospital. We know lots of people who bring their horses up there, but not as many dogs. With the horses, it's usually a last ditch effort. But we're pretty much there with Trooper....We're only about 2 hours from Ft. Collins, I'd easily take him up there. Maybe I'll give them a call and see what they say.

 

I've heard some great things about Aspen Meadows! That might be an option as well.

 

I'm starting to figure that repeated vet visits (to no avail) quickly add up to be comparable to one specialist visit.

[Liz P]

http://www.petmd.com/dog/conditions/endocrine/c_dg_amyloidosis#

[kingfisher7151]

Thank you Liz, that would certainly explain the correlation with the autoimmune. It looks like going forward with the ultrasound is a good way to go, then.