Little Red’s Miracle Potion & Elixir:?
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The treatment can not cure CKF but could keep him with us 18 months - diet is most important of the ringer's solution to diurese "little red" at home for many weeks. First twice a day, 200 cc, then once a day.
There are mixtures for people "under the
weather " with colds flu - but it's difficult to mix up a
potion for a very sick animal - We plan to sell the product on
the internet to Vets, individuals and health food stores.
Powered Mixture pre-made for sick dogs; http://www.wiredbrain.com/red.htm
The mixture includes the items underlined
below -Tincture and oils, the client adds to Fruit
Juices, barley and produce, meats for flavor - blends to taste.
Little Red
http://www.wiredbrain.com/red.htm I'm looking at our precious puppy Little Red
who is here next to me wearing his new sweater which reads
"4 on the floor" (the sweater is red). Today is exactly
2 months since the Rotweiler attacked Little Red and traumatized
our family. Thank you, Dr. Mike, for your part in keeping us
together and in giving us your sound advice throughout our
ordeal. We are hesitant to say all is well; but all is well at
the moment. Right now, Little Red is our Little Red as we have
always known him. We love our dog because of his character. A
healthy dog is different -- he has a certain bounce -- Little Red
has a special bounce \\ HIS BOUNCE IS BACK!!!! Thank you, Dr.Mike
for your help. This is an amazing recovery. We never will know what happened or why he
got better. But we firmly believe that caring matters. Little Red loves us and we love him. The
personnel at the vet's love him and we didn't give up. With such
a sick dog it is not unusual to give up. We were told his chances
of survival were quite low --. We still don't know -- we are far
from complacent -- Every day that we have Little Red with us is a
special day. Sara, Mary Anne, Blaine, Peter, & Little
Red We have made several trips to the health
store and hours of preparation and hand feeding - maybe Vets
should have products made to treat different conditions - a
general base then for common problems such as arteriosclerosis -
arthritis - diabetes - skin disorders - hypertension - ulcers
even cancer and kidney liver problems Not a regular diet but for treatment of
specific problems ( not as a substitute for medicine but as
support ): We are using the diet from Natural Health
for Dogs and Cats by Pitcairn and Pitcairn. I have blended barley, parsley, yeast, kelp,
parsnips, garlic, whole rolled oats, cabbage, carrots, yellow
squash, apples, strawberries, with raw beef liver or chicken with
cranberry and black cherry juices. Herbs and vitamins
include B complex and C , tissue salts - calcarea phosphorica,
Natrum muriaticum and alfalfa tincture, marsh mallow,
pure water for drinking, honey - that has to be hand fed in a
injector twice a day. He likes the liver and chicken and doesn't
mind the vegetables blended in with juice and broth. Vitamins supplementation should also be
considered to replace those lost in the increased urine flow.
Since kidney disease and failure can alter, among other things,
the blood levels of calcium and phosphorus, medications designed
to keep levels of these electrolytes constant are used well.
Chronic renal failure or CRF, Nepro, a ready-to-feed nutritional
supplement. kidneys' work can be made easier by limiting the
intake of foods that produce large amounts of urea. Vitamins, A, B+1, 2, 3, 6,
12, folic acid, biotin, beta-carotene C, D, D3, E, PABA, Choline,
Inositol, dong quai, bee pollen, royal jelly, Tums, diagel, Pet
Tabs ( Foster Smith ) Electrolyte: potassium, calcium, magnesium,
lithium, iodine * kelp ( yes) Liver: Milk Thistle (yes),
dandelion root (yes), Life's blood; burdock (yes) helps clean the
blood ( black cherry ), Antibacterial; Pau D' Arco (yes),
Goldseal (yes) Kidney, urinary track; Uva Ursi (yes), immune
system; echinacea (yes), digestive; licorice root (yes), slippery
elm bark(yes) Other possible elements: Astagalus, Reshi and
Shitake mushrooms, horehound, ginger, thymus Skin and Coat Food Supplement: linoleic Acid, linolkenic Acid, Olric Acid,
Http://www.wiredbrain.com/red.htm
There are actually a number of premade foods
for dogs that have various illnesses, such as liver or kidney
damage. The problem is that there are a lot of dogs that won't
eat specific diets and so we often end up devising diets that are
attractive enough for a specific dog to eat, anyway. The idea of
a base diet that can be improvised on is a good one. There was a
company marketing a line of diets several years ago based on that
concept but they stopped making dog foods since that time. I am
not sure why. Feb. 7th, Sunday: We have been doing subcutaneous saline,
ringer's solution to diurese "little red" at home for
about a week. First twice a day, 200 cc, then once a day.
Sometimes it goes well, but sometimes it is very difficult. On
Wed. we stopped and cut back on treatments because he seemed so
much better and we were having such a hard time sticking him. He
is running up stairs, trots on his walks, and seems almost
normal. We are still using Prednisone every other day or third
day, and making him eat the "gruel". He has lost a lot of fur, mainly on his
tummy. The skin looks fine. As you know poodles don't shed so he
is doing something odd. The vet doesn't think the liquid between
his coat and inter skin could cause this but the fluid did
accumulate on his tummy. He looked like he was nursing. Fuss is
growing back so we don't think it's a long term problem. e kidney
failure in which ua little suffy but not very sick. Jan 24 th It seems like he feels "almost "
fine - We will pass your suggestions to Dr. Jill ( Bates ) in the
morning, ( since we are in there twice a day ) It seems the color of his gums gives a good
indication of the BUN level - they had returned to pink, then
went sort of dark - a little gray. We thought he was better
and he was very hungry - so we let him eat - pro plan - eggs -
and even a little cheese - Now I'm afraid we over pushed
the system - so he back on daddy's gruel. We agree that given time he can recover - We
have thought of doing the treatments a home - I have held him
while they put the fluid between the skins. If he has to do this
for a month or more - we can learn to do it. Dr. Jill still
thinks about Addition's and is using the Steroid's I am concerned
about long term use ? His BUN had dropped to 75 but now is back up
to 140 - We restarted the Subcutaneous saline. Is there anything
else we can do ? In the last week he has been much better. He
almost has his trot back and is alert and active. He gained
weight up to 9 lb. 4 oz. We were surprised and disappointed
by his production is Testing Urine: If we do this - so what ?
Will it give us information to do something we are not doing ?
The problem is now his mouth and tongue - he
has lost 1/3 of his tongue due to decay and has sores. It's hard
to eat. Subcutaneous saline is used to diurese dogs
with renal failure. Dialysis is not commonly used in pets due to
the expense and lack of treatment facilities. Diuresis offers a
lower tech alternative. Fluids are administered to force the
kidneys to remove them and to drag some of the accumulated toxins
out with them. As long as it is not overdone (this rarely
happens) the more fluids that are administered, the better. We are now using subcutaneous saline twice a
day for several days to diurese dogs with renal failure, there is
a marked improvement. BUN was at a very dangerous 140 or higher
now down below 75 It is a tough choice but when BUN and
creatinine levels fail to respond to diuresis and total
inappetance sets in most people elect to euthanize rather than to
let a pet suffer. Dear Peter and Mary Anne, Subcutaneous fluids are an effective way to
aid the kidneys when renal failure is causing inadequate
excretion of waste products. I prefer to use a buffered fluid
such as Normosol or lactated ringer's solution over saline. It
may be necessary for us to check the site and correct this
statement if I have stated that saline is better somewhere. It is worth monitoring something to evaluate
whether or not the kidneys are responding to this therapy. In
some pets it is easiest to monitor the urine and in other pets it
is easier to monitor the blood values for things like BUN,
creatinine, potassium and phosphorous levels. Monitoring urine
protein levels, urine/creatinine ratio and specific gravity of
the urine can all help in evaluating how the kidneys are doing.
Sometimes we reach a point where we realize that a dog or cat is
simply going to require daily fluid therapy in order to maintain
adequate kidney function. Once we reach this point then
monitoring becomes less important as a means of determining when
to consider treatment. It still provides prognostic information,
though. Dietary control of protein and phosphorous
levels using diets like Purina's NF and Hill's k/d can be
helpful. Phosphorous binding agents (diagel) can be useful
if phosphorous levels are rising. Potassium supplementation seems
to help delay the progression of renal failure, especially when
the values are lower than normal without supplementation. Some
dogs will need to have gastrointestinal protectants such as
cimetidine (Tagamet Rx) and others need appetite stimulants at
times, although these work better in cats than they do in dogs.
Control of high blood pressure is helpful if it is present. It is really important to have a good
working relationship with your vet in order to have the best shot
at good long term control of kidney disease in dogs or cats. Keep
talking to your vet and keep working with your vet. If it becomes
financially difficult to do everything your vet would like to do
then tell your vet and try to work out a plan that will provide
the maximum benefit for the amount you can spend. Most dogs can adjust to the loss of a third
of their tongue. It may take a little more time but I really do
think that he will adjust to this loss. One thing that you have to remember is that
everyone who is giving you advice who can not There may come a time when you know that the fight is not worth
it or when your vet tries to tell you that there is not much hope
for stabilizing this condition anymore. Please trust your
instincts when this happens. In the end you know Little Red
better than anyone else. I am not sure if I am typical of
veterinarians but sometimes I don't know when to give up,
especially when I am dealing with conditions that appear to have
a traumatic origin, which always makes me think that the body
will be able to repair itself if I can just help the pet fight
long enough. I will continue to hope for the best for
Little Red. Mike Richards, DVM I am not sure that I know exactly what
information you are looking for in the note below so please feel
free to send a clarifying note, if necessary. I am willing to
talk to other veterinarians or correspond via email but it is
important that everyone understand that I am not a specialist in
any discipline. I am simply a general practitioner with twenty
years of experience in private practice who is reasonably adept
at finding information for people. There are two good options for
veterinarians seeking help with cases from veterinarians more
expert than I am. The first is the Veterinary Information
Network, which is an online service. For information on this
service call 1-800-700-4636. The second is the AVMA's information
service, NOAH. The AVMA has a web page at www.avma.org, I think.
The history provided on "Little
Red" is unfortunately not an uncommon scenario for little
dog/big dog attacks. While the exact details often vary it is not
unusual at all for little dogs to have extensive and
life-threatening damage that is inapparent until days after the
initial attack. It is also not highly unusual for a trauma to
occur in a dog that is harboring an inapparent illness and for
the illness to surface during the treatment and rehabilition of
the little dog. Attacks by a big dog on a small dog have the
potential for injuries to the kidneys to occur in a number of
ways. Big dogs often shake little dogs during an
attack. This may fracture a kidney or disrupt its blood supply,
although this is unusual. The tooth may penetrate into the kidney
or into the tissues surrounding the kidney and cause damage.
Retroperitoneal abscesses occasionally occur after dog attacks
and may surface weeks after the initial attack as the infection
slowly builds in intensity. Big dogs have tremendous crushing power in
their bite and they may crush tissue such as muscle or skin and
cause it to die. When large amounts of tissue die in the body it
is hard on the kidneys and the other organs as they try to aid in
the cleanup of the dead tissue. Organ failure during this process
can occur. Shock or blood loss from an attack can lead
to hypotension (low blood pressure). When blood pressure is low
enough, the kidneys are damaged. In a pet with marginal kidney
function prior to the attack shock can be enough to set off full
blown renal failure. Infection of the kidneys from bacteria
introduced into the bloodstream or other tissues at the time of
the bite and then spread to the bloodstream can lead to kidney
failure days after the initial bite. A dog with hypoadrenocorticism (Addison's
disease) prior to the initial attack that has not been diagnosed
previously may die or suffer aggravated secondary effects such as
kidney failure due to the pre-existing disease. Addison's disease
can have very subtle signs in many dogs and it is not unusual for
it to go undiagnosed until a crisis occurs. Blood clots formed due to trauma may break
loose and damage any organ. The kidney is pretty susceptible to
damage by blood clots due to its rich blood supply and the way
the blood flow is directed through the kidneys. Bleeding
disorders associated with major trauma or shock may lead to
kidney damage as well. Due to the potential for severe internal
damage even in bites that do not seem to be especially serious
based on the initial signs or skin injuries there are
veterinarians who advocate surgical exploration of every puncture
wound found after a dog attack. This is expensive and it subjects
the dog to anesthetic risks which may also be higher due to
trauma so there are also a number of veterinarians who feel that
it is better to try to stabilize the patient and assess the
damage more as signs develop. We have had success and failures
using both approaches and I honestly do not know which is best in
the majority of cases. When bite wounds start to develop secondary
complications it is not unusual for a case to go from bad to
worse to really awful rapidly. Attacks by big dogs on little dogs
are true nightmares from a diagnostic and treatment standpoint.
This attack should be reported to the animal
wardens or appropriate authorities, as you indicate. I believe
there as to be two confirmed reports of attacks before any legal
consequences are possible. Since there is the potential for this
to occur again it is important to report this instance. I wish that I could offer a treatment plan
that has consistently worked for us but there are so many
variables in the complications that can develop from bite wounds
that we are often forced to react to the symptoms rather than
being able to prevent all of them. I hope that Little Red has survived the
complications that have occurred so far. If so, experience tells
me he is very lucky and that he has benefitted from caring on the
part of his owners and veterinarians. Mike Richards, DVM Testing for renal (kidney) diseases can be
done with a number of tests, some of them relatively simple to
perform and some of them quite complex. Obtaining a good medical
history is important in making a decision about what tests to
perform, as well as aiding in evaluation of the test results.
There are a number of disorders that are not directly related to
the kidneys that produce changes in lab values associated with
kidney function. It is important to keep an open mind when
thinking about the results of any lab tests but this is
particularly important when evaluating tests related to kidney
function. It is easy to be led astray by normal values when renal
damage is present and by abnormal test values normally associated
with changes in renal function that are being influenced by
another condition, such as dehydration. The simplest method of evaluating kidney
function is to perform a urinalysis, if it is possible to get
urine without too much difficulty. If urine is not being
produced, there is obvious evidence of severe kidney disease or
obstruction of urine outflow. If urine is being produced it is
usually possible to get a urine sample by catching urine in a
container as the pet urinates or by cystocentesis --- inserting a
needle into the bladder
and withdrawing urine. This is a fairly safe
procedure that most veterinary hospitals can perform when
necessary. Urine contains a number of substances that the body
wishes to excrete and some substances that the body wishes to
conserve but that the kidneys can not completely resorb during
the filtration process. As blood flows through the kidneys it
passes through a filtration system that relies on both passive
filtration mechanisms and active (selective) filtration or
reabsorption mechanisms. The passive filtration works mostly by
osmosis. When the concentration of a substance in the blood is
higher in the bloodstream than it is in the urine being produced,
it passively moves from the blood into the urine. This is a good
system for things that the body wants to be rid of. The things that the body wishes to preserve
tend to follow the same path, though. Protein, potassium and
other valuable substances to the body would be lost if only
passive filtration was possible. These things are excreted into
the urine and then recaptured by the body through active
mechanisms such as ion "pumps" or through attraction to
membranes that have electrical charges that are opposite of the
desired substance. The effectiveness of many of these processes
can be evaluated by measuring the amount of various substances in
the urine. Most veterinary hospitals use a
refractometer to measure urine specific gravity. This is the
concentration of solutes in the urine. When the kidneys are
functioning normally urine usually has a higher specific gravity
than plasma. This is referred to as hyperthenuric urine. For
cats, a urine specific gravity above 1.035 is usually thought to
indicate that the kidneys have normal urine concentrating
ability. For dogs, a value of 1.020 to 1.030 (depending on the
references cited) is usually high enough to indicate normal
concentrating ability. Urine that is within the normal range of
concentration for plasma is said to be isosthenuric. If several
urine samples fall within this range and a dog or cat does not
have any samples of a higher concentration there is reason to
believe that the kidneys can not adequately concentrate urine and
may be damaged or may be influenced by other systemic illnesses.
Urine that is more dilute than plasma also
requires the kidneys to be functioning and is usually a sign that
hormonal diseases are influencing renal function. The specific
gravity of urine is easy and relatively inexpensive to monitor.
Testing for concentrating ability is a good way to monitor
progression of kidney disease as well as to monitor recovery from
acute kidney damage. It is important to remember that a single
specific gravity test has little value in many instances. The
specific gravity changes under normal circumstances in response
to the water intake and other factors influencing hydration. This
test often has to be repeated several times or monitored over
time to be really meaningful. *values based on results in our lab and
those reported in "Small Animal Clinical Diagnosis by
Laboratory Methods" by Willard, Tvedten and Turnwald There
are a number of urine test strips available to veterinarians.
They may contain as many as 12 individual tests on each strip,
each for a metabolite found in urine under normal or under
abnormal circumstances. Of these tests, the urine pH, glucose,
protein and blood tests are probably the most useful. Glucose should not be found in the urine
under normal circumstances. When glucose is found in the urine it
indicates a possibility of diabetes mellitus. There are other
conditions that can cause glucose to show up in urine, such as
Fanconi syndrome and in some urinary tract infections. False
positive tests for glucose can occur when antibiotics are being
administered. Antibiotics which may cause false positive tests
for glucose include penicillins, cephalexin, chloramphenicol,
tetracyclines and streptomycin. Some other medications can have
this effect as well. It is important to be sure that your
veterinarian is aware of any medications your pet is taking in
order to be able to properly evaluate the urinalysis results.
This is especially important in emergency situations when your
pet's veterinary records may not be available to the
veterinarian. Urine pH should be about 5.5 to 7.0, meaning that
most pets have slightly acidic urine. There are metabolic
disorders that can lead to pH changes in the urine but this test
is most commonly used to evaluate for the possible presence of
urinary tract infection. Several species of bacteria cause the
urine pH to be higher when they are infecting the bladder or
lower urinary tract. Cats who suffer from recurrent bouts of
lower urinary tract inflammation (LUTI) seem to do much better if
their urine pH can be kept below 6.0. A number of special dietary
foods are available to aid in keeping the urine pH low. In severe
cases of LUTI it is a good idea to monitor the pH of the urine at
home to be sure that control of urine pH is successful. In older
intact (not castrated) male dogs high urine pH values can be
indicative of prostate infection. Protein is normally lost in the urine in
very small quantities. For this reason, it is important to
consider the protein value from a dipstick in conjunction with
the specific gravity of the urine sample taken. A small amount of
protein in a concentrated urine sample is normal but even a low
protein level in very dilute urine may be important to consider,
especially in a patient suspected of having kidney failure. While
a trace of protein may not be as important in a pet with highly
concentrated urine the protein level should not exceed 100 mg/dl
in any sample. Persistently high urine protein values
should prompt a search for an underlying cause, especially kidney
damage. Infection and inflammation of the urinary tract may lead
to high urine protein values, too. Measuring the urine
protein:creatine ratio is helpful in deciding if protein loss is
significant. This is a test that can't be accomplished with just
dipstick analysis, though. Blood in the urine normally indicates
urinary tract infection or inflammation. It can be associated
with cancers of the urinary tract and with bladder stones, kidney
stones or stone formation anywhere else in the urinary tract as
well. It is possible to have blood in the urine as a direct
artifact of the way in which urine was obtained and it is
important to consider this possibility when evaluating the
significance of blood in the urine. Catheterization or aspirating urine from the
bladder with a needle can result in urine contaminated with
blood. Prostate infection in intact male dogs is also a potential
source of blood in the urine. Injuries to the vaginal or
preputial region may also lead to blood in the urine, so it is
important to be sure that there is no damage to these areas.
Bleeding disorders can lead to blood in the urine and it is not
unusual for clients to mistake urine contaminated with hemoglobin
or myoglobin as "bloody". These contaminants produce a
"port wine" colored urine and are associated with some
bleeding disorders and with severe heartworm disease in dogs.
Urine can also be evaluated microscopically for the presence of
crystals, bacteria, unusual cells and other visible contaminants
that can be useful in making a diagnosis. Crystals are common in
lower urinary tract inflammation affecting cats and are seen in
some instance with bladder stones are present. Struvite crystals
are not unusual in urine, especially if it is not acidic. It is hard to evaluate the importance of
finding a few struvite crystals in the urine due to this. Calcium
oxalate crystals are also not highly unusual and ammonium urate
crystals occur frequently in dalmatians where they may or may not
be indicative of problems with urate stone formation. Bacteria
can often be seen in the urine if they are present. If cancer is
affecting the urinary tract it may be possible to detect this by
examining cells in the urine microscopically. Large numbers of
white blood cells indicate urinary tract infection or
inflammation. A very useful urine test is the
protein:creatinine ratio. This test is usually has to be sent to
a reference lab but it is a good way to monitor for the presence
of excessive protein in the urine which helps a great deal when
monitoring chronic renal failure, especially when conditions such
as amyloidosis or glomerulonephritis are present. The total
protein and creatinine levels are measured in the urine by the
lab. These numbers are then compared in a ratio made by dividing
the protein level by the creatinine level. If the value that
results is >1.0 it indicates that an abnormal amount of
protein is being lost in the urine. Monitoring the protein loss in this
manner is a good way to evaluate the success of treatment
programs for chronic renal failure. This test is also useful when
repeat urine tests are difficult to obtain as it more accurately
reflects the amount of protein loss than comparing urine specific
gravity to the protein levels reported on a dipstick evaluation.
Since most clients can obtain urine samples (it takes about a
teaspoonful to run this test) it is a useful way to monitor the
progress of renal failure conditions or to check to be sure that
acute kidney diseases such as leptospirosis or antifreeze
toxicity have not led to longer term kidney damage without having
to continually bring a patient to the office to have blood drawn.
Since the kidneys are supposed to remove
toxins from the bloodstream and to conserve important substances
such as sugar and protein, it is also possible to check the blood
to be sure that these substances are within normal ranges. For
some reason, it often seems more convenient just to draw blood
and run kidney evaluation tests than it is to obtain urine from a
patient already in the office. I tend to do this and from the
letters I receive I am pretty sure that most vets have similar
tendencies. Many of my clients are almost unaware of the
possibility of making important evaluations from urine and accept
blood testing more readily. While there is no particular problem
in making evaluations of kidney function from blood it is
important to remember that using blood tests in conjunction with
urine tests is more accurate in many instances and is preferable
when possible. The two blood tests that most people are
familiar with are the blood urea nitrogen (BUN) and creatinine
tests. Some labs are picky about nomenclature and report a serum
urea nitrogen (SUN) level instead of a BUN, since this test is
almost exclusively run on serum by reference labs. Whenever
possible it is best to evaluate these two tests together to gain
a better understanding of the kidney function. Urea nitrogen is a
normal byproduct of protein metabolism. It does not cause harm to
the body but evaluating the levels of urea nitrogen in the blood
stream is a good way to evaluate whether the kidneys are
functioning properly. There is some controversy over what
constitutes a normal BUN level for a cat, with values of 5 to 35
mg/dl being most commonly reported but some labs considering BUNs
of up to 50 mg/dl to be normal in cats. In dogs the level is a
little less controversial, with values of 10 to 25 mg/dl being
most commonly reported as normal. Creatinine is normally 0.5 to 1.5mg/dl in
dogs and cats again have a more variably reported upper range
with values as low as 0.5 to 1.5mg/dl being reported by some labs
and as high as 0.5 to 2.1 mg/dl being reported by others as
normal. The BUN value is very sensitive to dehydration. It is
important to evaluate low level BUN rises in conjunction with the
state of hydration. An elevation in BUN is less likely to
indicate kidney damage in a pet with a high urine specific
gravity and other signs of dehydration than it is in a pet that
appears to be well hydrated and has a low urine specific gravity.
There are other reasons for falsely elevated
BUN levels, as well. The BUN rises with dehydration, excessive
dietary protein, corticosteroid therapy, muscle damage and
chloramphenicol administration. Many people are confused by BUN
rises associated with corticosteroid administration, assuming
that this is a result of kidney damage when it actually is a sign
that the corticosteroids are causing muscle wasting which causes
protein rises in the blood stream and consequently causes rises
in the BUN. The kidneys are functioning normally, there is just
more urea nitrogen in the blood than is normally present. When the BUN rises above 75 mg/dl it is
unlikely to be due to dehydration or other factors. Evaluating
the creatinine level in conjunction with the BUN can also help in
determining if there is kidney damage or non-kidney causes of BUN
rise. If the creatinine and BUN are both elevated the likelihood
of kidney damage rather than other causes of BUN rise is very
high. However, the BUN rises more rapidly in response to kidney
damage than the creatinine level so it is possible for the BUN to
be high and the creatinine to be normal and for the cause to be
actual kidney damage rather than non-kidney causes. Whenever it is unclear whether a rise in BUN
is actually due to kidney damage it is a good idea to correct any
possible dehydration and recheck the BUN and creatinine values to
see if the problem persists. The BUN also falls more rapidly than
the creatinine during treatment for kidney problems, making it a
little better for evaluating initial response to treatment. The creatinine level is less likely to be
affected by factors other than that actual is slower to rise when
kidney disease is present. Knowing this, it is sometimes possible
to evaluate whether a rise in BUN is due to a non-kidney related
cause or whether kidney damage is acute rather than chronic. In
addition, the creatinine levels may be a slightly better way to
monitor the kidney's response to treatment over the long term
than BUN levels. When both the BUN and the creatinine kidney
disease is present and kidney disease is present and that further
diagnostic efforts should be directed at finding the cause of
kidney disease rather than trying to establish whether or not it
is present. Potassium levels usually fall with chronic
kidney disease but may rise with extremely acute kidney failure
in which urine production is decreased, such as ethylene glycol
(antifreeze) poisoning. In cats, the potassium level may fall
prior to any other indication that chronic kidney damage is
occurring. It is unclear whether this fall in potassium is
harmful in some way to the kidneys and leads to further kidney
failure or whether it is just an early warning sign of damage to
come. Most vets agree that potassium should be supplemented when
serum potassium levels drop below 3.5 mEq/L, especially in cats.
Phosphorous levels in the serum are another
indirect way to measure kidney function. Rises in phosphorous
levels occur as kidney function deteriorates. Measuring
phosphorous levels can help in making decisions about control of
dietary phosphorous intake and are particular important when
calcitriol therapy is being used to help in the treatment of
chronic renal failure. There are many more specialized tests that
are used to aid in the diagnosis and management of renal disease
in pets. Creatinine clearance is a test in which the
total amount of creatinine in the urine (collected over a 24 hour
period) is compared to serum creatinine level taken during the
same time period. This test is a good way to monitor response to
therapy and to figure out if kidney disease is present when there
is some indication that it is but the BUN and creatinine levels
are not high enough to be sure. Biopsy of the kidneys is often
the only way to accurately determine the cause of kidney disease.
While this can be important in some cases in managing long term
kidney diseases such as amyloidosis or glomerulonephritis there
are risks involved and they must be carefully weighed prior to
making a decision to biopsy. Ultrasound exam of the kidneys can be very
useful, especially in helping to determine if conditions such as
polycystic kidney disease are present. X-rays of the kidneys can
be valuable as well, helping to evaluate the size of the kidneys,
presence of kidney stones and when combined with dye techniques
to evaluate kidney function. Serologic information may be
necessary to rule out causes of kidney disease such as
leptospirosis, feline leukemia virus infection or other diseases.
Sometimes it is necessary to test for other
organ system or hormonal disease, such as hypoadrenocorticism,
hypertension (high blood pressure) or liver failure, all of which
can influence the results of laboratory tests that are used to
evaluate the possibility of kidney damage. The major fault in
veterinary medicine in evaluation of kidney disease and in
monitoring progression of treatment is a lack of aggressiveness
in collecting laboratory data. This is understandable, since lab
tests can add significant costs over and above already expensive
treatments. This is true of both acute kidney disease and chronic
kidney disease conditions. In the acute disease situations having good
information on the status of the kidneys may be the difference
between life and death. In chronic conditions, especially in
cats, monitoring kidney related lab values on a periodic basis
may be the difference between a life span of several comfortable
years managing the kidney disease or discomfort and a shortened
life span for the patient. When kidney disease is suspected or after it
has been confirmed, periodic lab tests are necessary to manage
the kidney failure effectively. Successful management of kidney
disease is best accomplished when an informed client works
closely with their veterinarian to provide all the information
and care necessary to keep a pet comfortable. As always, we
sincerely appreciate your support of the VetInfo Digest and the
VetInfo Web Site. It is much easier to provide these services
with your help. The opinions expressed in this newsletter
are solely those of the author, Michael Richards, DVM, unless
otherwise noted in the text. Michal Justis is our web designer
and graphic artist. P.S. We are sorry for the delay in getting
the VetInfo Digest out this month. Seven days without power due
to the ice storm in Virginia put us a little behind! HISTORY: It was Friday the 11 Th. of December, I was
walking with "Little Red" on the road from the lake (
The Steeles and another neighbor were also on the road ) when
"Edward" a large rottweiler, trotted out of a
neighbor's Little Red ran up for a smell. The large dog grabbed
him and Little Red screamed. I ran up and grabbed Edward's collar
which came off, but separated the dogs. I held our small dog
while the neighbors kept the big dog away. There was no growling
or signs of a fight before the attack. The owner's wife, Doreen, came out the
driveway and we hurried to my house to check injuries. Little Red
had a long laceration on his back and two puncture wounds on his
neck. We all went to Edgewater Animal Hospital where they kept
him. The next day they stitched his back up but left the
punctures open to drain. The stitches were in for 11 days from
Saturday the 12th to Wednesday the 23nd. To control the infection he was given
antibiotic Baytril, a wide spectrum drug, to control the
infection. He came home on Monday the 14th. Wednesday the 16th he
was back because the neck was quite swollen. The puncture in the
lower neck remained infected so they took x-rays then a brillium
x-ray to check on the windpipe (or trachea). We saw the x-rays on
Thursday the 17th. It was not punctured but infected and bruised.
Little Red continued to weaken. He got more and more depressed. A
drain was added in his neck to keep the swelling down Monday
21st. They drained the neck and added Amoxi ( a penicillin ) to
try to reduce the infection. We took him back to get the drain taken out
on the 23rd. He could not keep water down and refused to eat so
we don't know if the medicine had a chance to work. He was home
only briefly after the drain was taken out. Thursday the 24th
early in the morning we thought he was dying and took him to the
Daytona Emergency Vet Hospital then back to Edgewater (for the
fourth time) where he still is. He had not eaten since Monday and
had problems keeping water down. They stabilized him and put on a
IV tube. The report on Dec 26th was he was doing better, had
eaten a little, had barked and seemed more himself. The whole family has been
through a trauma now for three weeks. People are completely responsible for the
behavior of their pets and any damage they cause, so the owner
has directly done all this harm because he knows the danger yet
he keeps a dangerous animal. We informed Animal Control because
it's likely he will strike again and it needs to be known that
the owner was warned. If Little Red dies -
he is beloved family pet and very valuable to us - a great harm
has been done. If he lives (we all pray) it's been a trauma for
all of us. 12/28/98 7:10 PM Little Red in Back
in Hospital - emergency almost died. Turns out he had kidney
failure and was near death. The doctor gave thyroid steroids and he
pulled through. It was possible he has Addison's disease that
interferes with production of hormones that stimulate the adrenal
glands. Adrenal insufficiency can be primary or secondary.
Primary adrenocorticism affects salt/potassium balance in the
body and glucorticoid as well. Secondary adrenocorticism usually
only affects the glucocorticoids. It is not known why primary
adrenocorticism occurs but it may be an immune mediated process.
12/30/98 12:18:33 PM Prednisone seems
to have done it. Little Red is much better and we hope for good.
There are several theories about what happened - some underlining
thyroid problem brought on by toxic shock or drug interactions
with suspected molds, yeast or fungus from Edwards mouth and/or
soils it is possible that Ed was infected by squirrels could be
how he contracted leptospirosis. Thursday, January 07, 1999 Tuesday he
went back in because of a very bad mouth, gray tongue and the
skin over the punctures on the lower neck ( throat) was all
unattached. He had to have a third of his tongue removed and
there were sores in his mouth. The universal conclusion was
chronic kidney failure. The uric acid was n his blood - a count
of 120, while 30 is normal and anything over 80 is very
dangerous. He was given Winstrol in addition to Prednisone (
steroids ) and continues on Baytril. We have a diet from Natural
Health for Cats and Dogs, Pitcaen D.V.M. low demand on
the kidneys. Reports from the web: http://www.vetinfo.com/drenal.html
Renal (kidney) failure can occur for a lot
of reasons. It would be hard to compile a list that anyone would
agree was a complete list of causes, due to the number of
potential causes that exist. So this is a partial list: Pyelonephritis, which is infection of the
kidney itself Congenital disorders, which are recognized to occur
in the following breeds, according to Nelson and Couto, in their
book "Essentials of Small Animal Internal Medicine" -
Lhasa apso, shih tzus, Norwegian elkhounds, shar peis, Doberman
pinschers, samoyeds, standard poodles,, soft-coated Wheaton
terriers, cocker spaniels, beagles, keeshonds, Bedlington
terriers, cairn terriers, basenjis and Abyssinian cats. Renal
hypoplasia or dysplasia - congenital but not always hereditary
anything that blocks urine from getting from the kidney out of
the body - congenital urinary tract defects, large
bladder or kidney stones, renal parasites, trauma, etc.
Immunologic disorders --- systemic lupus erythematosus,
glomerulonephritis, vascular disorders, feline infectious
peritonitis Amyloidosis - a disorder that normally occurs in dogs
over 5 years of age but can occur earlier is shar peis. It can
occur for no apparent reason or it can be linked to underlying
causes such as chronic infections (not necessarily of the
kidney), chronic inflammation that isn't from infection, cancer,
cyclic hematopoiesis in gray collies. It occurs for no apparent
reason more commonly than it occurs due to discoverable
underlying causes Glomerulonephritis - inflammation of the
glomerulus (the individual functioning units of the kidney). Can be due to a number of causes, including:
bacterial infections {Lyme disease, brucellosis, other systemic
infections}, viruses {infectious canine hepatitis, feline
leukemia, feline infectious peritonitis, feline immunodeficiency
virus, chronic feline upper respiratory virus infections},
rickettsial infections {ehrlichiosis, Rocky Mountain Spotted
Fever}, heartworm disease, protozoan infections {trypanosomiasis,
leishmaniasis}, cancer, chronic inflammatory conditions
{pancreatitis, systemic lupus erythematosus, prostatitis, chronic
skin disease, possibly periodontal disease},
hyperadrenocorticism, diabetes mellitus and finally hereditary
disorders in Doberman pinchers, samoyeds, rottweilers,
greyhounds, bernese mountain dogs, soft-coated wheaton terriers
and cats. Acute insults to the kidney - trauma,
ischemia (lack of blood flow) due to {clots, low blood volume,
shock, heart failure} and drug reactions or toxins {covered
separately} Leptospirosis ( see note below ) Hypertension (high
blood pressure) -- from hyperthyroidism, chronic heart failure
Hypotension (low blood pressure) -- usually associated with shock
Hypoadrenocorticism (Addison's disease) Cancer -- usually primary
kidney cancer, lymphoma or spread of cancer (metastasis) from
other sites unidentifiable causes Toxins that are known to affect the kidneys:
lead, mercury, arsenic (usually arsenicals used to treat
heartworms), cadmium, chromium, thallium, ethylene glycol
(antifreeze), carbon tetrachloride, chloroform, pesticides,
herbicides, solvents, snake or bee venom, possibly mushrooms,
vitamin D toxicosis from rodenticides medications known to affect
the kidneys sometimes: aminoglycoside antibiotics (gentamicin,
amikacin), cephalosporins, polymixins, sulfonamides,
tetracyclines, amphotericin B, thiacetarsamide (Caparsolate Rx),
methoxyflurane anesthesia, non-steroidal anti-inflammatory
medications (aspirin, acetaminophen, ibuprofen, phenylbutazone),
many chemotherapeutic agents, gold salts, radiographic contrast
agents So there are a lot of possible causes of
kidney disease. Reviewing the list can sometimes help in ruling
out possibilities. If you suddenly remember changing the
antifreeze or have been struggling with skin disease for awhile
it may be important to be sure those things have been considered,
for instance. I will try to send some information on
distinguishing between these possibilities in the next few day or
so. Mike Richards, DVM Subcutaneous saline is used to diurese dogs
with renal failure. Dialysis is not commonly used in pets due to
the expense and lack of treatment facilities. Diuresis offers a
lower tech alternative. Fluids are adminstered to force the
kidneys to remove them and to drag some of the accumulated toxins
out with them. As long as it is not overdone (this rarely
happens) the more fluids that are administered, the better. 1)
The most common clinical signs associated with renal failure are
weight loss, increased drinking and increased urination. 2)
These occur early before much damage is done and are pretty
consistent signs. The subsequent signs can be almost anything
since renal failure has so many side effects involving other
organ systems that almost any symptom can occur. Shaking may be
directly related to drops in potassium levels in the serum since
the kidneys do not preserve it well when renal failure is present
or they can be the result of hyperphosphatemia and secondary
renal hyperparathyroidism. In addition, hypertension is common in
renal failure and it can lead to tremors and neurologic damage is
not unusual in renal failure patients, either. Hypothermia can
occur with chronic renal failure and it might produce shaking
behaviors (shivering) too. Labwork to check phosphorous and
potassium levels should be done, probably. 3) Most of the
patients I have treated for chronic renal failure have been
euthanized prior to a terminal event because they stop eating at
some point and most owners give up after a few days of
inappetance. I have seen bleeding disorders such as DIC force
people into making the decision to euthanize in chronic renal
failure and have had several clients wait until their pet was
comatose before giving up. 4) I think that is covered
above. It is a tough choice but when BUN and creatinine levels
fail to respond to diuresis and total inappetance sets in most
people elect to euthanize rather than to let a pet suffer. 5)
I think it is very important to treat as many of the side effects
as can be treated, as aggressively as possible, in order to
prolong life and to make the lifetime remaining as comfortable as
possible. Using medications such as cimetidine (Tagamet Rx) to
ease nausea from gastric irritation, blood pressure medications
if necessary, potassium supplementation, phosphate binders,
subcutaneous or intravenous fluid diuresis and whatever else
seems necessary can all help. I know it sounds like a lot to do
but each medication has a specific purpose in the process. Feed
her what she wants to eat if she won't eat the renal diets. Try
to find low phosphorous, low salt items that she likes, if
possible. Avoiding high protein foods helps in this situation. It
is better that she eat than that she eat what she
"should". If she gets stabilized at some point, work
harder to get her to eat the renal diets. 6) There was a
recent "Clinics of North America" on renal disease. If
your vet or your mother's vet subscribes to this journal it would
be worth taking a little time to read it for further discussion
of this whole issue. Unless he is in the last stages of failure,
he still can live some more years. Did the vet give you any idea what caused
kidney failure in a 5 year old dog? Heat stroke, heart disease,
auto-immune diseases are some conditions which can cause it in a-
younger dog. Therapeutic drugs, such as, aspirin, and certain
antibiotics, can be damaging to the kidneys if used
indiscriminately. Antifreeze or ethylene glycol is deadly to dogs
when ingested because of the profound damage to the kidneys it
causes and also periodontal disease, with its associated
complications, can predispose dogs, both young and old to kidney
problems in the future. : : Stress reduction is vital in dogs with
kidney disease/failure. Unlimited access to clean fresh water
should be provided at all times. Special diets that are low in
protein should be fed to help reduce toxin build up within the
bloodstream. Vitamins supplementation should also be considered
to replace those lost in the increased urine flow. Since kidney
disease and failure can alter, among other things, the blood
levels of calcium and phosphorus, medications designed to keep
levels of these electrolytes constant are used well. If your pet is having trouble with vomiting,
human antiulcer medication such as cimetidine can be used to help
settle the stomach. You would need to discuss dosage with a vet.
Finally, since kidney disease/failure places a burden on the
immune system, all underlying disease processes and disorders
need to be taken care of with the necessary treatments. Don't
forget to give your dog a lot of love and time spent together.
Most important find a vet who is willing to
work with you in helping your dog be more comfortable for the
rest of his life. I wish you good luck and enjoy the time you
will have together.....which can be many more years with proper
treatment and care. Deborah Leptospirosis (zoonotic)- Wolf
continued The future of established institution to
control economic, social and political events. http://www.altavista.com/cgi-bin/query?pg=q&kl=XX&q=disintermedation+middleman+intermediaries+intermediary&search=Search
The History
of the Future: Three central concepts: "Punctuated Equilibrium" 421 matches were found in Altavista
In Action! Complex system are slow when
adapting to changing environments and subject to periods of rapid
degeneration and extinction. Inter-connections: Direct
connection on complex networks. The number of connections
increases exponentially on a global basis. What you see is that
the most outstanding feature of life’s history is a constant
domination by bacteria. The Internet Revolution: The future of established
institution to control economic, social and political events. hhttp://www.nzii.org.nz/Staff/Frank_March/disintermediation.html
Date:
Thu, 11 Feb 1999 21:27:20 -0800
From:
"Dr. Peter E. Pflaum" <wiredbrain@earthlink.net>
Reply-To:
pepflaum@bellsouth.net
Organization:
GlobalVillages
To:
"merzet@inna.net Dr Mike" <merzet@inna.net>
Dear Dr. Mike: SUCH AS:
HISTORY:
Report on Little Red: a 8 Lb. four year old
Poodle attacked by 160 Lb. Rottweiler around the neck but
develops Kidney Failure - WHY ? and what can be done if anything
?
Medicines:
cortico steriod Florinrocortisone ,
finished the antibiotic Baytril 30 days, now finished using
amoxicillin, still using Prednisone, stopped the winstrol
Dr. Pflaump-
evaluate your dog in person is missing part of the picture.
Testing Urine:
Urinalysis Values
Testing Blood:
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