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Dr. B.
Dr. B., Veterinarian
Category: Pet
Satisfied Customers: 21419
Experience:  I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Seeking advice and my Maltese Mooki turned 18 October 30th.

Customer Question

Seeking advice
My name is***** and my Maltese Mooki turned 18 October 30th. I noticed in the past month that he seemed to be displaying loss of cognitive function. (over a year but more so over the past month or two) Signs included walking into a room and standing there, going the wrong way towards a door etc.. Prior to that on Halloween Oct 31st 2015 I helped him to get his bearings but in doing so he twisted slightly and he became very painful. After trying to lift him, he cried out so I rushed him to our vet who has 24 hour emergency. Although the dr on call was not our daytime vet. After 6 hours, pain meds and X-rays (sent out to X-ray specialist readers) they surmised that disco spondylitis was suspected. They noted potential lysis of the bone. He was put on antibiotics twice a day. We visited a neurologist the following week who saw Mooki's X-rays. He admittedly said he saw something but didn't say this is disco spondylitis. I was told without a spinal tap (think that is it) it could not be 100 percent confirmed.
The antibiotics are Clindamycin liquid 1.5 cc/ml and 1/2 of a 150 mg Rilexenne twice a day. December 31st will be two months.
I took him to our veterinarian on Monday Dec 21st regarding the cognitive dysfunction. Our vet decided to have him take the novifit instead of anipryl because if he needed a tramadol (for his occasional bad back pain) there would be no issue with interaction. I asked her about stopping the antibiotic (recheck x-ray) and she said it was too early. I asked her about checking his bloodwork but she choose not to. The next morning I woke up to him gagging and he threw up. I texted her immediately and she advised we come in for blood work. 3 months ago his creatitine was 1.2 and this time his BUN was high and his creatitine was 2.4. ALthough he just urninated she wanted to catch his urine for urine specific gravity. I followed him around for an hour until he peed. His test came back 10:18 this is what she said. The last test months back was 10:22. Afternoon pee catch after a long pee
Obviously very scary and horribly upsetting she decided to give him fluids. Yesterday he also had fluids at the clinic. I have been in a horrible state of anticipatory grief and have even started therapy due to the unimagined pain I am feeling.
For reference, I have Mooki who has been with me since a puppy and Milo who is a morkie and turning 8 in January. I began therapy due to paralyzing anxiety and sadness.
For the past few days I have been researching home cooked kidney diets, supplements and doing overall research. My vet told me Mooki could live a week or several months or stabilize. This unknown pushed me into a state of panic and despair.
Mooki is eating well and has been without complication every day. My vet did mention that the fact he is eating is great. He is a senior, no doubt but other then her diagnosis of kidney disease he is just the same old guy.
He is drinking water quite often and peeing several times as needed outside and on the wee wee pads in the house. He is up and about cruising around. He just ate a meal I cooked for him last night. White rice, grass fed ground beef cooked in coconut oil and egg white. I tried t make a meal based on my research until the Holiday passed and I could get more assistance.
Other meds he takes include standard process renal. He hates it on his food so I mix with water and give with a dropper thingie. I ordered a product called Epakitin yesterday after extensive research. I also orders probiotics and a fiber supplement that is supposed to be helpful.
The most concerning information I came across and why I am reaching out is the antibiotic use. I did read that both should be given with caution to dogs with kidney disease. I decided to stop the antibiotics and demand an X-ray now for Mooki instead of waiting. I have felt and do feel that this overload of antibiotics is too much for his system and now for his aging kidneys.
I know my vet will say otherwise which is why I am seeking another opinion as much as available without knowing Mooki or his history.
You must know I am conservative with my dogs. Meaning I do not always follow what is suggested as far as throwing medications at my dogs. For example the day Mooki went in for back pain and disco spondylitis diagnosis they wanted to inject him with pain meds. I choose to have them give half the tramadol they wanted to give and he was sound asleep in 5 minutes. I am a cautious pet owner. I will follow doctors orders when I feel they are necessary for my babies.
So, a dog with 2.4 creatitine and elevated BUN (do not know number) and 10:18 USG and 2 months of antibiotics. A death sentence of weeks to a few months.
I understand that kidney disease is serious but I do not feel it is fair to give this kind of information to a mom and leave her to her own devices.
Your expertise and advice is appreciated.
Lisa, Mooki and Milo
Submitted: 1 year ago.
Category: Pet
Expert:  Dr. B. replied 1 year ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.

Now kidney disease is a common issue for dogs Mooki's age.

First, in regard to what you have reported on prognosis, please know that your vet isn't trying to scare you but as this is very much a disease of the individual, there is not way to predict if a dog will have a slowly progressive loss of kidney function or a rapid one. That said, given his mild signs, great appetite and borderline urine specific gravity (normal concentration is anything great then 1.015...so he is just in the normal range there which suggests the kidney dysfunction is very mild just now) he sounds like a dog with low grade slowly progressive disease and will likely be one that will manage with kidneys for longer then a few weeks to months. And with your care, he will likely be one that can go years with this.

Now I would just note, since you didn't mention an elevated phosphorus (a change we see as this becomes chronic), if his phosphorus levels were normal then we'd not necessarily need a phosphate binder like Epakitin at this point and Azodyl (which may be the probiotic you got) may be a better option here. As well, if you are keen to give fluids, I do want to include a reference for you to read HERE. And if you are keen to offer a low protein/sodium/phosphorus (what we need to reduce to reduce kidney strain) homemade diet, then you can find some good recipes HERE.

Otherwise, in regards ***** ***** question, I do think it is reasonable to give him a break from the antibiotics and reassess those bone changes with xray here. If he is to continue on these, we may need to consider reducing the Clindamycin dose to reduce strain on the kidneys. Otherwise, the Rilexine is a safer choice as its actually an antibiotic we use with kidney infections and thus well tolerated.

Overall, you are right to be concerned and give the time frame he has been on the Clindamycin, it would be reasonable to have an xray, reassess that situation to ensure we aren't unnecessarily treating when we have those wee kidneys to focus on.

All the best,

Dr. B.

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Expert:  Dr. B. replied 1 year ago.

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Customer: replied 1 year ago.
Hi Dr. BI did read your response! I have been so busy caring for Mooki and his brother Milo. I am so grateful to announce that Mooki had blood work again yesterday. His Creatine went down to 1.5 from 2.4 and his BUN from 115 to 43. His USG is at 1016Dr said he had an acute on chronic episode. His X-rays for disco spondylitis showed no worsening and improvement in***** said she could not medically recommend I stop the antibiotics but I could decide. I decided to stop for one month and to recheck his X-rays then. I will monitor him closely as usual during the next month.I wonder what caused this sudden spike?In the meantime, he is eating great and will continue fluids. We are seeing a very well know homeopathic vet today to help with supplements and diet!Happy New Year!!Lisa, Mooki and Milo
Expert:  Dr. B. replied 1 year ago.

Good afternoon,

I am glad to hear that Mooki's kidney values have improved with your care. In regards ***** ***** acute on chronic episode, it could have been related to the strain the Clindamycin put on his kidneys or anything that would have inflamed the kidneys (ie infection, ingestion of kidney unfriendly plants, etc) or increased their workload (ie increased protein intake, etc). Still, in any case, it is positive that he is responding to treatment and hopefully will continue to do so as this kidney insult passes.

Take care & happy new year to you all,

Dr. B.

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* Please remember to rate my service once you have all the information you need as this is the only way I am credited for helping you. Even after you have rate, we can still converse as needed. Thank you! : )

Customer: replied 1 year ago.
I know! Those were my thoughts exactly. For some reason my vet is not willing to admit that! However, I trust my intuition and 2 months on that drug is too much for a dog Mooki's age. I understand the disco spondiylitis is serious but one must assess the patient and not always the paperwork.Just curious? are you a retired veterinarian? How does one work on this site?Lisa
Expert:  Dr. B. replied 1 year ago.

Hi again,

Some vets on our service are retired but most of us are practicing vets that share our time between our own patients and the ones here. So, in my case, I do both as my time allows. :)

Otherwise, I agree that it is always keep to assess our patients and balance our treatments to do as much good as we can without causing any issue for them.

Take care,

Dr. B.

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* Please remember to rate my service once you have all the information you need as this is the only way I am credited for helping you. Even after you have rate, we can still converse as needed. Thank you! : )