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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 14880
Experience:  Over 20 years of experience as a veterinarian.
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Our lasapoo was adopted from a shelter 4 years ago. He

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Hi, our lasapoo was adopted from a shelter 4 years ago. He showed signs of abuse, and we were told he was around 4 years old. He had 13 teeth pulled the day he came home. Since then he progressed slowly and became friends with his 2 male family members and all was well. One day he fell down uncarpeted stairs and i thought he just lost his footing. Months later, he fell down 13 stairs and was in a ball by the door, and we rushed him to the emergency dr. The Dr. took xrays and said nothing was broke, but thought something neurological happened, such as a stroke. He was kept overnight and returned home. Fast forward to this past Thursday evening, he ate dinner and an hour later vomited. I thought it might be the flu . Friday he would not eat or drink. He just slept all day. I called the vet, and brought him in Sat. morn. He kept him, and gave an i v. , forced food from a stick or large spoon. BB was use to eating from a small fork. I tried to feed him, but he had no interest. He stayed there sat sun mon tues, with no improvement. We picked him up yesterday for Thanksgiving, with the promise to bring him back Friday morn. Being with him and he knowing he was home, stopped shaking but just layed in my arms and still no interest in anything. He wobbled over to the water bowl but just stood there. He didn't know to drink. He would walk away some, walk back and stare at the bowl. I gave him water from a dropper, and had to force that. From the blood tests his levels were high, and he is in kidney failure. Having him home, and seeing how he has no will to stand up, no knowledge of why hes at the waterbowl, and no excitement to see the other 3 dogs, i can see no future for him. The vet runs bloodwork every other day, and when we stop in to visit, i am always wondering why we are leaving him there. He calms down when i hold him, and then falls asleep. He has been relaxed in our bed, or in his bed on the couch downstairs. The only time he yelps is when he wants to go outside to the bathroom. So we carry him out because he can no longer figure out how to go thru the doggy door. I feel there is nothing any of us can do for him, and have been thinking we have to let go. Any hope for him
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Customer: '
JA: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about the?
Customer: I don't know right now, but i get my husband

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

I am sorry to hear that your fellow is in such a condition even with hospitalization and fluid therapy.

My understanding is that he has very high kidney enzyme blood levels despite intravenous fluid therapy, a complete loss of appetite and mental confusion because of the effects of those high enzyme levels on his brain, and you are wondering if it is fair to continue trying to treat him when it seems he is no better with therapy.

If I am reading your question correctly then I do think that you are right to question further treatment, and it may indeed be in his best interests to let him go via humane euthanasia.

Kidney failure prognosis will depend upon several things including the cause (toxins or infections causing acute failure tend to be more responsive and lead to a better long term prognosis if the dog responds well to fluid therapy), his degree of failure (mildly elevated enzymes have a better long term prognosis then very high values), whether he is still eating or not (dogs that don't eat have a much poorer prognosis) and his response to therapy. Other complicating factors are if he has hypertension (high blood pressure) and whether he is spilling protein in his urine (which indicates more serious disease).

In your fellow's case he is not eating, his blood values appear to not be coming down and it sounds he now has evidence of the effects of high enzymes on his brain.

I understand that you are struggling with whether it is appropriate to consider letting him go via humane euthanasia now. I try and guide clients on this very difficult decision by asking them if they believe they would want to live the way their beloved pet is.

I ask if their pet is still able to do the things that they have always enjoyed (albeit for a shorter period of time).

I also ask if they believe that their pet is comfortable most of the time and is living with dignity.

Is he eating and drinking normally?

Is he interacting with the family normally?

I ask if there is a reasonable chance of him recovering to the point where his quality of life will be good again.

If you honestly answer these questions I believe you will come to the best decision for your fellow.

I believe humane euthanasia is a gift we can give our pets when their quality of life is poor.

Although he is trying to behave normally, and he certainly takes comfort in being with you, he is unable to do so.

I think that you are asking this question because logically you know he is uncomfortable, but your heart doesn't want to lose him. That is very understandable with a well loved pet.

Euthanasia is not painful.

It is simply an overdose of anesthesia. All your pup will feel is the placement of an intravenous catheter or the pinprick of a needle.

They get very sleepy, become mentally unaware and then their heart stops, which leads to low oxygen and brain death.

I do think his quality of life isn't very good now. From what you are describing he must feel extremely nauseous and confused. But you have to be able to reconcile that decision. Be honest in your assessment and I think you will make the right decision.

I have had to make this decision too. It is heartrending. But I was able to let go when I put myself in my dog's shoes. I didn't want her to be uncomfortable any more.

I can give you some tips that may make things easier for her at the appointment. If you feel it would be stressful for him you can ask for a tranquilizer before the procedure.

And if you wish staying with him while he goes can be very helpful for you and him, IF you can be gentle and reassuring for him. I find that dogs with owners who can be relatively calm and loving let go much more peacefully.

But if the owners are upset then they tend to fight the effects of the overdose of anesthesia and it is rougher for them, and then of course for you.

If you feel you cannot be calm and reassuring for him don't worry that he won't be well loved and taken care of. We are gentle and hug and speak softly to them as they pass. They do not pass alone and afraid.

If you can, you should make his appointment for the first or last appointment of the day so there are no distractions and the clinic is quiet.

Please let me know if you have any further questions.

Hello, I wanted to check in and see if you had any further questions after reading my response. If you do please feel free to respond with them. If not I would appreciate an update on your pup, thank you, ***** *****

Customer: replied 3 days ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.

I am sorry I cannot help with a phone call. The states/province I am licensed in do not allow me to communicate via phone calls, unless I have previously physically examined a pet. I could lose my license for doing so. If you would like you can ask any follow-up questions here & I will be happy to respond here.

Customer: replied 3 days ago.
Oh, i understand. BB is doing better. He is eating a recipe the Dr.gave me. He gets in there with the others when it's treat time. He gets pedialite mixed in his food. From his bloodwork last Thursday, the vet said BB should go to a specialist, and gave me a card. Our vet is on vacation for a month now, and of course someone is there in his place. I just feel care and love from you, that i know you will continue to be honest with me. I have read about otc meds that can possibly help, subcutaneous injections we can give at home, and of course the diet he now gets to make it easier for his kidneys. We are willing to bring him in for bloodwork. My husband and I don't understand what else a nephrologist could do. BB is not going to get a transplant or dialysis. I know in my heart i will continue to be here for him and do what i need to do. I am worried about the treats, and would like to make my own. Haven't seen a recipe yet. The Dr. said try carrots and beans. The 4 of them look at me like I'm kidding right? They will eat some carrots and still wait for treats. Right now Bb is on the bed attacking the treat jar. He does feel much better. If we could just stabalize him maybe he could be with us for awhile longer. We are both retired now and the income we need when things like this happen we don't have anymore. Yet, if you thought it was absolutely necessary, i would take him to the specialist. I appreciate you, and am glad God gave me you. You are worth so much more than money.

Thank you for the update on BB, I am pleased to hear that he is feeling a bit better.

The most important thing for a dog with kidney failure is that they are eating and still enjoying life. Everything we do for them is to keep their quality of life as great as possible for as long as possible, as we will not win the war against failing kidneys.

A specialist may talk to you about further testing and possibly a biopsy, and that may tell you why kidney failure occurred and possibly change treatment a little, but not likely much.

I'll give you my thoughts on treating kidney failure (having been through it with my very beloved shepherd mix.

It may help you to look at this website which explains how kidney failure is staged in cats and dogs. The higher the stage the more severe failure is present and the more guarded his prognosis is: http://www.iris-kidney.com/pdf/IRIS2009_Staging_CKD.pdf

This may help you ask your veterinarian the right questions that will allow you a reasonable estimate of his prognosis.

Ideally he would eat a diet balanced for kidney failure such as Hills k/d, Hills g/d or Purina Veterinary Diets n/f. I understand that he wasn't eating well for you thus you are feeding a homemade alternative diet.

Animals with kidney failure need high quality but limited levels of protein. The kidney is responsible for filtering and keeping proteins in the bloodstream. If we overload them on lots of low quality proteins then we over-work already damaged kidneys. We also need to stay away from foods high in phosphorus as the kidneys are responsible for getting rid of excess phosphorus.

I understand he may not be eating well at this point. Things you can feed to perk his appetite are green beans, peas, squash, mashed potatoes, sweet potatoes, rice, noodles, and carrots. Small amounts of cantaloupe or watermelon are fine too. If he won't eat his dog food small amounts of white chicken, cottage cheese and boiled or scrambled eggs can be added to boiled rice, noodles or mashed white or sweet potatoes. It is very important that he eat but we do want to move him towards eating dog food balanced for his condition if we can. So mixing some things in with his dog food initially if he won't eat it is fine. Just try and limit the amount of protein and make it very high quality.

Stay away from fatty meats, lunchmeats, organ meats and salted meats. Organ meats in general are high in phosphorus. Phosphorus is an electrolyte that failing kidneys have difficulty removing. If the blood levels of phosphorus are too high calcium is leached from the bones leading to weak bones and calcification of the kidneys.

As far as beneficial treatments fluid therapy to keep kidney waste products at a low level by flushing them out is often beneficial. Usually we start with intravenous therapy at the veterinary clinic then use subcutaneous fluids long term to manage the levels. You can learn to do this at home.

Supplements such as Azodyl to change gut bacteria to help decrease urea in the gut which would be absorbed into the blood, and epakitin to decrease phosphorus levels can be very helpful.

Medication (such as enalapril) to control secondary hypertension and protein loss into his urine via leaky kidneys may help.

If he isn't eating well and ulcers are a concern then sucralfate, a coating medication, can help heal gastrointestinal ulcers which will improve his appetite.

Acid reducers to try and settle his stomach and improve his appetite are also useful. Either:

1) Pepcid-ac (famotidine) at a dose of one half of a 10mg tablet per 10 to 20 pounds of body weight every 12 hours.

OR

2) Prilosec (omeprazole) at a dose of one quarter of a 20mg tablet per 10 to 20 pounds of body weight every 24 hours.

These medications are quite safe and can be used for several days if necessary or for as long as necessary.

I also recommend an omega 3 fatty acid. These are natural anti-inflammatories and have been proven helpful in dogs with kidney disease. Reputable brands are 3V Caps and Derm Caps.

Finally if bringing down his waste product levels and controlling stomach upset and hypertension isn't enough to keep his appetite up we can use appetite stimulants. Dogs that eat and maintain body weight are proven to do better in the long run. Mirtazapine or cyproheptadine are both worth trying. They have different mechanisms of action so if one doesn't work try the other.

If you find that he will not eat the kidney diets and you need to feed a homemade diet all of the time I recommend consulting with a veterinary nutritionist to design a diet for him. There are recipes available but a recent study found that none were balanced appropriately.

Here is a link to help you find one in your area:

http://www.acvn.org/directory/

Another option is a company called BalanceIt. They sell trace mineral and vitamin supplements to add to homemade diets to make them balanced and will help you formulate a diet for her. Here's a link to their website:

https://secure.balanceit.com/

Best of luck with your boy, please let me know if you have any further questions.

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