# 5.5 month with Renal issue



## obelinux (Jun 19, 2012)

Crossposting this from the recipes thread.

My puppy has a renal issue ( cause which hasn't been diagnosed yet). We are trying to get a renal diet going for him but our vet is clueless. We have gone to 4 vets in the past 15 days, and the current vet is apparently one of the best. He just recommended us to his shop where the idiot at the shop just threw a pack of Cibau regular puppy food for him. After a huge altercation and constant probing they randomly suggested Hills K/D. 

Now I didn't buy it since they were clueless about dog nutrition. Now being in India, its a tough call to get a dog nutrition expert. I want to home cook meals for my puppy. With his renal issues, he needs a low protein/phosphorous diet, however, with him being in his growing age, he will still need a decent amount.

Anyone here have a similar problem. Any help here would be fantastic.

This is a diet I'm feeding him right now. Would be great if I could get feedback if its good.

Morning : 2 egg whites with a wheat tortilla ( made at home. We call it chapati.

Afternoon:
150g of white rice
30-50g of chicken thigh or chicken liver
a few pieces of pumpkin/carrot/squash/potato : just rotating veggies
1 tsp vegetable oil
1tsp clarified butter
1 pod garlic.

Night : 

Same meal as above, with a change in vegetable. Also mix in 40g of lentils into it.

Does this meal seem wholesome enough, or do I need to feed him more/less or move around any nutrient.

Thanks


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## obelinux (Jun 19, 2012)

To add, he weighs in at 33lbs now. He used to be 39.5 lbs 1 month back, but with the renal issue and loss of appetite, he lost a ton of weight. Finally he seems to have his appetite back, so really looking to help him out.


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## jaggirl47 (Jul 18, 2009)

Is he still receiving fluids?


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## Jax08 (Feb 13, 2009)

Again...he does NOT need low protein! He needs high quality protein and lower phosphorus. You need to figure out how much phosphorus he can have based on his creatinine level and stage of CRF. All that information and recipes for home cooked meals are on the facebook page I posted in your other thread as well as many of the links in Banshee's thread that I posted for you. You can also post any questions to the facebook page and the people with lots and lots of experience in CRF can help you.

What is his CREA and BUN levels right now?


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## obelinux (Jun 19, 2012)

Jax08 said:


> Again...he does NOT need low protein! He needs high quality protein and lower phosphorus. You need to figure out how much phosphorus he can have based on his creatinine level and stage of CRF. All that information and recipes for home cooked meals are on the facebook page I posted in your other thread as well as many of the links in Banshee's thread that I posted for you. You can also post any questions to the facebook page and the people with lots and lots of experience in CRF can help you.
> 
> What is his CREA and BUN levels right now?


Thanks Jax. I did explore a ton of info from that page. Only issue was I couldn't find as much info on CRF for puppies. Possibly I didn't look well enough.

As of Monday his CREA was 2.27 and BUN 54.4. He has a blood test tomorrow, so I'll post the updated values in a couple of days.

He is not on fluids right now. Doctors say if he has a normal appetite let him eat.


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## BowWowMeow (May 7, 2007)

Search for posts by UConngsd on this site. Her Wolfie had CRF and she did a raw diet with supplements.


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## Jax08 (Feb 13, 2009)

Definitely contact UConngsd. She was a great help to me. 

Ask specifically about puppies on the Facebook CRF page. Many members have dogs that have juvenile CRF. If you look in the Notes section of that page, there is a list of supplements to add to their diet including B-Complex vitamins, spirullina (sp?), CoQ10 and others. There are recipes for balanced meals. 

If you want to know how much phosphorus / calcium are in foods go to this site
Nutrition facts, calories in food, labels, nutritional information and analysis – NutritionData.com
I used this site to figure out daily requirements for my dog. 

Also, you need to look into phosphorus binders depending on what stage of CRF your puppy is in. Again, the ladies on the facebook page can help you. 

FYI...the lady running that page is a registered nurse who works with kidney patients, as well has have CRF dogs, so she definitely has the knowledge to help with kidney failure.


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## Jax08 (Feb 13, 2009)

I sent UConn a message for you. She isn't on the board often.


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## obelinux (Jun 19, 2012)

Thanks a ton Michelle. Don't even know how to thank you.

Thanks to you too Ruth!


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## Jax08 (Feb 13, 2009)

If you PM me your email address, I'll send the spreadsheet I set up for Banshee to figure out her daily phosphorus intake. It's not great but did for me just fine quickly. And anything else I can find. Somewhere I have papers from my vet of recipes and a little more info on CRF. I'll scan those in for you.


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## Jax08 (Feb 13, 2009)

oh...NO bones. Bones have far more phosphorus than meat. And save your egg shells, bake them and grind them to supplement for calcium. I know yolks have phos. in them but I think it's more beneficial to feed the yolks 

CRF Facebook page
https://www.facebook.com/CRFDogs?ref=ts&fref=ts
Ground Eggshelle
https://www.facebook.com/notes/crf-...de-pet-food-phosphorus-binder/294260780605680
Notes with recipes
https://www.facebook.com/CRFDogs/notes


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## Jax08 (Feb 13, 2009)

DIET GUIDELINES FOR CRF: Phosphorus, Fat, Protein & Carbs - Very important!


https://www.facebook.com/notes/crf-...-phosphorus-fat-protein-carbs/139973719367721


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## obelinux (Jun 19, 2012)

I've always been feeding Whiskey yolks. Just stopped them for the past couple of days to limit the amount of Ph. Started collecting shells to make a powder of them.


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## Jax08 (Feb 13, 2009)

Just throw the shells in a bag in the freezer until you have enough. I grind Banshee's up in a coffee grinder. You want it finely ground so they can digest it.

The first step is to find out his CREA level to determine how much phosp. he can have in his diet. Then you can formulate a better plan.


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## obelinux (Jun 19, 2012)

Jax08 said:


> Just throw the shells in a bag in the freezer until you have enough. I grind Banshee's up in a coffee grinder. You want it finely ground so they can digest it.
> 
> The first step is to find out his CREA level to determine how much phosp. he can have in his diet. Then you can formulate a better plan.


As of 21st October, his CREA was at 2.29.

We have a blood test due in 10 hours. Should get the results by tomorrow. Hopefully it's better than before.


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## Jax08 (Feb 13, 2009)

Asked for you on the CRF facebook page on how to create a balanced diet for a puppy and below is her response



> It's more complicated that I can answer in a post here. Have her check out our Recipes under NOTES, namely the Meatloaf and Stew. And have her check out this page, which is probably the most comprehensive in terms of diet, that I agree with...
> 
> Sample Homemade Diet for Dogs with Early to Moderate Stage Kidney Disease
> DogAware.com Health: Sample Daily Diet for Dogs with Kidney Disease
> ...


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## UConnGSD (May 19, 2008)

Hi Obelinux, Jax alerted me to your pup's case. I am so sorry to hear that you are going through this with your little boy. I am originally from Calcutta so I understand fully the challenges of finding reliable canine health information over there. I am so glad that you are home preparing Whiskey's meals. Overall, with Wolfie, I pretty much got his bloodwork done once a month. This way, if you make any changes to the diet you can evaluate the impact soon enough. My experience tells me that there is no science to this, unfortunately. As much as I dislike Hills K/D, I also know of at least one CRF dog who is doing very well on that. Would I advise that person to change because of my evaluation of Hills K/D? Never. Because I want to see the dog at least maintain the creatinine level, if not bring it down totally. 

Whereas for Wolfie, he would have rather starved before taking a bite of that food. So even though the Cornell vets highly recommended K/D, we couldn't even start him on that. The Cornell nutritionist drew up a kidney friendly diet. I can PM you about that later, as there might be proprietary issues, I'm not sure. But that was too low protein and Wolfie refused to eat that either. Then I started reading up on holistic books recommended by Ruth (BowWowMeow) and got interested in the raw diet. That worked beautifully for Wolfie, at least for one solid year. Which is remarkable in and of itself, as Cornell had told us we would have him for no more than a year. He passed away this July at the age of 4 (diagnosed Stage 3 CRF at 8 months). Now being in India, I would not recommend a raw diet. I have to attend to an errand now but later this evening I can PM you a kidney friendly diet which will not starve a growing puppy as much, as far as nutrients go.


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## obelinux (Jun 19, 2012)

Jax08 said:


> Asked for you on the CRF facebook page on how to create a balanced diet for a puppy and below is her response


That's of great help Michelle! Thanks a bunch.


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## obelinux (Jun 19, 2012)

UConnGSD said:


> Hi Obelinux, Jax alerted me to your pup's case. I am so sorry to hear that you are going through this with your little boy. I am originally from Calcutta so I understand fully the challenges of finding reliable canine health information over there. I am so glad that you are home preparing Whiskey's meals. Overall, with Wolfie, I pretty much got his bloodwork done once a month. This way, if you make any changes to the diet you can evaluate the impact soon enough. My experience tells me that there is no science to this, unfortunately. As much as I dislike Hills K/D, I also know of at least one CRF dog who is doing very well on that. Would I advise that person to change because of my evaluation of Hills K/D? Never. Because I want to see the dog at least maintain the creatinine level, if not bring it down totally.
> 
> Whereas for Wolfie, he would have rather starved before taking a bite of that food. So even though the Cornell vets highly recommended K/D, we couldn't even start him on that. The Cornell nutritionist drew up a kidney friendly diet. I can PM you about that later, as there might be proprietary issues, I'm not sure. But that was too low protein and Wolfie refused to eat that either. Then I started reading up on holistic books recommended by Ruth (BowWowMeow) and got interested in the raw diet. That worked beautifully for Wolfie, at least for one solid year. Which is remarkable in and of itself, as Cornell had told us we would have him for no more than a year. He passed away this July at the age of 4 (diagnosed Stage 3 CRF at 8 months). Now being in India, I would not recommend a raw diet. I have to attend to an errand now but later this evening I can PM you a kidney friendly diet which will not starve a growing puppy as much, as far as nutrients go.


I'm so sorry to hear about Wolfie. That's indeed very sad. Hope you guys are doing okay.

I do agree on the Hills diet part. My pup hasn't been a fan of kibble at all, and I am scared to give him kibble of any kind. He's been lapping up home cooked food like crazy, so would rather not move him off that. The kidney friendly diet for him would be of great help. As you say, there is no way I can trust a raw diet in India. Even while cooking meat for him, I go buy meat everyday.


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## jaggirl47 (Jul 18, 2009)

So, while I read up on the genetics of the disease, I honestly do not know about the maintenance. Do the dogs need to be on fluids to help flush the kidneys or is it strictly the oral intake?


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## UConnGSD (May 19, 2008)

Obelinux, can you post your pup's phosphorus numbers? To me, that turned out to be the biggest headache of all. The goal should be to try your damnedest to keep it under 6. BTW, Organic India has a very good kidney supplement -- the name is slipping my memory but if you go to one of those FabIndia type stores, you should be able to find it. If you are open to holistic supplements, it would be good to put him on this one. 

jaggirl, of course, sub-q fluids are more beneficial but with large dogs, you can understand how problematic that can become. In the end stages, unfortunately, even this cannot help as we saw with Wolfie. His body lost the ability to absorb even the sub-q fluids (I was doing it twice a day).


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## jaggirl47 (Jul 18, 2009)

UConnGSD said:


> jaggirl, of course, sub-q fluids are more beneficial but with large dogs, you can understand how problematic that can become. In the end stages, unfortunately, even this cannot help as we saw with Wolfie. His body lost the ability to absorb even the sub-q fluids (I was doing it twice a day).


 
OK, I was wondering. He is still in the beginning and his pup is not on fluids. Wouldn't it be more beneficial for him right now?


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## obelinux (Jun 19, 2012)

Hi Uconn, 

I can't seem to find the Ph content in his reports. Let me just type all the data I have, as of 21st oct 2012. We got another blood test done today and the numbers will be out tomorrow.

Blood Urea - 76.64
Blood Urea Nitrogen - 35.81
Creatinine - 2.29
Total Protein - 5.31
Albumin - 2.22
Globulin - 3.09
SGPT - 40.51
SGOT - 31.82
Blood Glucose - 87.87
Alkaline Phosphatase - 86.51
Bilirubin ( total) - 0.25
Bilirubin ( direct) - 0.14


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## obelinux (Jun 19, 2012)

jaggirl47 said:


> OK, I was wondering. He is still in the beginning and his pup is not on fluids. Wouldn't it be more beneficial for him right now?


He was on fluids from the 11th to the 21st. He got anywhere from 450 - 600 ml of Lactated Ringers solution. On the 21st the vet said that if he has a normal appetite they will take him off IV. He's had a blood test today and the results should be out tomorrow.


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## jaggirl47 (Jul 18, 2009)

obelinux said:


> He was on fluids from the 11th to the 21st. He got anywhere from 450 - 600 ml of Lactated Ringers solution. On the 21st the vet said that if he has a normal appetite they will take him off IV. He's had a blood test today and the results should be out tomorrow.


 
I would worry about the toxins building back up. If he is in renal failure his kidneys are not working which is why he gets the fluids. Even with eating I would think fluids should be added.


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## UConnGSD (May 19, 2008)

The main problem with giving these guys sub-q fluids is as follows: as per our vet, they have to be given twice a day in order to be truly effective, otherwise it is just not worth it. In a 65 lb dog, you are talking 1/2 a bag which might take a while to administer. With an active puppy, I dread to think of the chase involving the needle, catheter and saline bag :crazy:


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## Jax08 (Feb 13, 2009)

The need for sub-q depends on the stage of failure. He doesn't necessarily need it right now.


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## jaggirl47 (Jul 18, 2009)

UConnGSD said:


> The main problem with giving these guys sub-q fluids is as follows: as per our vet, they have to be given twice a day in order to be truly effective, otherwise it is just not worth it. In a 65 lb dog, you are talking 1/2 a bag which might take a while to administer. With an active puppy, I dread to think of the chase involving the needle, catheter and saline bag :crazy:


 
We had to do sub-q on my pup Zeus. It sucked!


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## Jax08 (Feb 13, 2009)

The phosphorus and calcium levels would be in a test called a Chem10. Did they by any chance do that today? If not, you should have that done. Did they check his urine for evidence of protein?



obelinux said:


> Hi Uconn,
> 
> I can't seem to find the Ph content in his reports. Let me just type all the data I have, as of 21st oct 2012. We got another blood test done today and the numbers will be out tomorrow.
> 
> ...


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## Jax08 (Feb 13, 2009)

Also, forgot about this page
http://www.windyhollowvet.com/Document/info/ChronicRenalFailureDiet.pdf

Great source of foods you can feed him and supplements.


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## obelinux (Jun 19, 2012)

Jax08 said:


> The phosphorus and calcium levels would be in a test called a Chem10. Did they by any chance do that today? If not, you should have that done. Did they check his urine for evidence of protein?


Hi Michelle,

I'm not sure if that test was done. Will find out when I go to get the reports today. As of 18th Oct 2012, his urine had 30 mg/dL of protein. Have given his urine for analysis yesterday so will get the reports today. 

Will definitely update.

Thanks again!


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## obelinux (Jun 19, 2012)

His CREA has shot up to 3.37. Going to the doc to give him IV. He hasn't had IV for almost 7 days, however he's had fantastic appetite.

Now the doctor recommends a renal diet. I'm not sure if my diet makes sense for him or not.

Not sure where this is headed. We are really depressed.


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## obelinux (Jun 19, 2012)

Got a confirmation blood test done again . CREA - 4.5 . Gave him Ringer Lactaid 300 ml. Really not sure how this is going to pan out. Very tensed and depressed.


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## obelinux (Jun 19, 2012)

Can overeating cause CREA levels to go up? He has been eating very well for the past 7 days. 

His average diet is ( per meal)

150g uncooked rice ( not sure what the cooked weight is)
30-50g chicken thigh/mutton
1 cup boiled veggies
1 tsp oil


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## Capone22 (Sep 16, 2012)

I have no advice but just wanted to say I'm so sorry your going through this! Your in my thoughts!


Sent from my iPhone using PG Free


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## obelinux (Jun 19, 2012)

Capone22 said:


> I have no advice but just wanted to say I'm so sorry your going through this! Your in my thoughts!
> 
> 
> Sent from my iPhone using PG Free


Thanks a lot!


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## Jax08 (Feb 13, 2009)

Overeating will not cause CREA level to go up. To much phosphorus in the diet will. I'm very sorry his levels went up.  Have to run right now but will find the spreadsheet and send it to you as soon as I get home.


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## obelinux (Jun 19, 2012)

The vet missed the phosphorous test today. He'll do it tomorrow.

From what I'm checking, he has not had high phosphorous over the past 7 days. Barring a total 2 egg yolks over the 7 days, most of the food he's consumed is lower on Ph. THat said we have no idea what his Ph levels were at since none of the vets here test for Ph.


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## obelinux (Jun 19, 2012)

Whiskey's Ph levels are at 9.2 mg/dL. What does this imply? We will be starting Ph binders. I've already started giving him crushed egg shells.


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## obelinux (Jun 19, 2012)

obelinux said:


> Whiskey's Ph levels are at 9.2 mg/dL. What does this imply? We will be starting Ph binders. I've already started giving him crushed egg shells.


Just read that for such high Ph levels, AlOH would be most effective. My vet will start them today. Unfortunately they have never given Ph binders ever, and he wants to get some research done before prescribing them.

Do binders reduce Ph content in the blood or do they remove Ph from the food?

Really depressing situation to be in. I've read the cases of Wolfie and Veeru too. Still keeping positive thoughts going!


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## Jax08 (Feb 13, 2009)

Binders will attach to the phosphorus in his system and flush the phos right through the kidneys. Calcium is a phos. binder. Many people feed Tums as a binder. Or there are other binders. Banshee doesn't need them yet so I don't know much about it. Hopefully UConn will see this and have answers for you.


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## UConnGSD (May 19, 2008)

Michelle, we have been communicating mostly via PMs. This is the link I sent him on the phosphate binders: http://www.dogaware.com/health/kidne...html#phosphate
At least, the eggshells option is there. The mint-flavored Amphojel we used on Wolfie -- he detested that taste! I'm thinking the eggshells might be easier to administer.


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## Jax08 (Feb 13, 2009)

I mix the ground eggshells right in the food for Banshee. I would think if a gravy of some sort it made of the food is ground, even mixed in the rice, that he will eat it. Will the eggshells be enough for the level of phos?


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## UConnGSD (May 19, 2008)

At that phosphorus level, it's anybody's guess. Unfortunately, canine renal research is not as advanced yet, so this is still uncharted territory. When Wolfie's phos levels crossed 10, our vets pretty much said give him as much amphojel as he will tolerate. There didn't seem to be any upper limit per se. Only bounded by the dog's nausea factor. Amphojel is supposed to be a more effective phosphate binder but dogs HATE the taste. I did get Wolfie to take it by following up immediately with some tripe or a little piece of raw meat.


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## obelinux (Jun 19, 2012)

We've been recommended a Calcium Carbonate based tablet called ShellCal. However from the article Uconn sent, I believe Calcium won't help reduce phosphorus at such high levels ( 9.2). We couldn't find AlOH powder in this entire area. I'll probably try to look for AmphoGel and try mixing it with his food.


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## UConnGSD (May 19, 2008)

If you do get hold of the Amphojel, I would recommend just squirting it in the back of his mouth with a needle-less fat plastic syringe and follow it up immediately with a yummy treat. You have to give a pretty large dose and if you mix it with food, it will turn Whiskey off the food.


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## obelinux (Jun 19, 2012)

So I found one chemist with AlOH powder. However it doesn't come in a sealed pack with an expiry date. Just a powder packed into a pouch. For what it's worth the pharmacist is very reputed, but he mentioned that since companies don't market these powders, that's all he could give.

I also found Q-Bind from Kuemen,Gurgaon,Haryana,India,ID: 1979043130 as an option. Does it make sense to try it out?


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## obelinux (Jun 19, 2012)

My vet hasn't administered binders before so we are not sure what dosage to give him. He weighs in at 16.8 kg with a Ph level of 9.2.


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## obelinux (Jun 19, 2012)

Next Ph test done yesterday shows it to be 5.7

Can Ph values vary this much? For what it's worth, he's been getting IV + sub-Q everyday for 4 days.


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## Jax08 (Feb 13, 2009)

The sub-Q should bring it down at least temporarily. What is his calcium level? Was that checked?


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## obelinux (Jun 19, 2012)

Calcium hasn't been checked. Only phosphorous. Among standard tests, they do Sodium and Potassium. No Ca/Ph. We have to send the blood to a different lab for Phosphorous. I can check for Ca tomorrow. Now we aren't sure if we should use AlOH or stick to a Calcium binder.

Secondly he's also getting some allergic reactions to his antibiotics. His face starts getting small red swellings as soon as it's administered.


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## UConnGSD (May 19, 2008)

My vote would be to try the AlOH. For his weight, try 500 mg per day. If you are feeding twice a day, split it into 2 doses and give it right after you feed him. Give it at least one week at this dose before testing -- the numbers won't stabilize before that. If it is still not sufficiently down, you can then increase the dose.

You can add baking soda (sodium bicarb) to neutralize the pH levels. At his weight, the dose will be very small -- less than 1/8 teaspoon, I am thinking. If I remember correctly, Wolfie (about 30 kg) was being given less than 1/2 teaspoon. Anybody else have more accurate info on the dosing?

I agree with Michelle about the positive impact of sub-q fluids on the pH levels. The levels can bounce around -- Wolfie's did.

What antibiotics are these and what are they for?


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## obelinux (Jun 19, 2012)

He's getting augmentin for possible infections.


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## UConnGSD (May 19, 2008)

What are the potassium and sodium numbers like?


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## obelinux (Jun 19, 2012)

Whiskey is slowly improving. His phosphate is back to normal, and so is his BUN and Blood Urea. His Creatinine is now down to 3.23. Hopefully it keeps improving.


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## Jax08 (Feb 13, 2009)

Thinking of you this morning. Glad to hear good news.


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## obelinux (Jun 19, 2012)

Jax08 said:


> Thinking of you this morning. Glad to hear good news.


Thanks so much Michelle. Your help with this is something invaluable!


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## UConnGSD (May 19, 2008)

Very happy to hear that the phosphorus is back in normal !! 

The reason I asked about the potassium and sodium level readings (preferably from the first bloodwork done during this health crisis) is I am wondering if this might be Addison's disease... I am dealing with this myself right now with Foxy. Apparently, a badly impaired adrenal gland can mimic renal failure, among other diseases. I remembered last week that very early in Wolfie's diagnosis we did the ACTH test to rule out Addison's.


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## obelinux (Jun 19, 2012)

UConnGSD said:


> Very happy to hear that the phosphorus is back in normal !!
> 
> The reason I asked about the potassium and sodium level readings (preferably from the first bloodwork done during this health crisis) is I am wondering if this might be Addison's disease... I am dealing with this myself right now with Foxy. Apparently, a badly impaired adrenal gland can mimic renal failure, among other diseases. I remembered last week that very early in Wolfie's diagnosis we did the ACTH test to rule out Addison's.


Hey, sorry for not posting Pot/Sod. They have always been normal. Now creatinine is at 3.2 while the rest of the parameters are normal. However I noticed a lump on his back today. Checked with the doctor and he says it's lymph node inflammation which should subside in a few days. However, it just got me worried again. Right now, anything odd on his alarms me.


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## UConnGSD (May 19, 2008)

Hmm... is the lump near the spot where the sub-q fluids are being given? Does it feel squishy? Like a little water balloon? Is he still getting sub-q fluids?


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## obelinux (Jun 19, 2012)

UConnGSD said:


> Hmm... is the lump near the spot where the sub-q fluids are being given? Does it feel squishy? Like a little water balloon? Is he still getting sub-q fluids?


It is near a sub-Q spot, but it's not squishy. It's pretty hard. He is getting 350ml through IV and 150ml through sub-Q everyday. I initially thought it was a sub-Q fluid bag, but this seemed much harder. It's similar to how it was yesterday when I found it. Hard & lumpy...like a swelling.


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## obelinux (Jun 19, 2012)

His Phos is back up to 6.2 now. Not sure why there is so much fluctuation.


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## UConnGSD (May 19, 2008)

I guess I should have asked before... are you fasting for 12 hours before the bloodwork? Otherwise, it gets very hard to read the numbers. Phosphorus can be affected by what he has eaten recently. 

And are you continuing with the phosphate binders?


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## obelinux (Jun 19, 2012)

UConnGSD said:


> I guess I should have asked before... are you fasting for 12 hours before the bloodwork? Otherwise, it gets very hard to read the numbers. Phosphorus can be affected by what he has eaten recently.
> 
> And are you continuing with the phosphate binders?


We've just taken one reading on fasting. The remaining have always been on a reasonably full stomach. He has breakfast - one egg + rice + veggies at around 7-7:30 am. Blood test usually at 10 am. We figured that getting a non fasting blood test 'might' give us a better idea of how things would be normally for him. I could be wrong though.

We are giving him Calcium Carbonate as a binder for now. Not tried AlOh.


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## obelinux (Jun 19, 2012)

Another question I had was about supplements

Whiskey is on 
1) Fish Oil
2) Vit E
3) Vit B
4) CoQ10
5) Glucosamine ( weak hind legs)
6) Spirulina
7) ShellCal ( CaCO3 for binding Ph)

I've been mixing all this with his food. Is it recommended to mix with his food or give it separately?

Thanks


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## Jax08 (Feb 13, 2009)

You have to give CoQ10 with an oil in order for body to process it but is fine to give with food. The vitamins are fine with food as well as the glucosamine and spirulina.

UConn will have to address the calcium binder. I would assume you would want to give it with food but we are not at that point with Banshee so haven't had to deal with that yet.


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## UConnGSD (May 19, 2008)

Anytime you are feeding a meal that has significant quantities of protein, you need to add the phosphate binder. So if both meals include protein, then the dose should be split across the 2 meals. And yes, it can be mixed in with the food.

Yes, there can be big differences between fasting and non-fasting because depending on what you have eaten, certain values can spike into the abnormal range after food enters the bloodstream, even though the body might be otherwise fine. The normal range for all the bloodwork metrics is designed for fasting, as there can be enormous variations in people's diet and no lab can figure out what's "normal" if you throw this randomness into the mix. What was the reading from the time you fasted him? Our vet always insisted on fasting bloodwork, as otherwise it turns into a guessing game and unnecessary worries. Maybe for the next bloodwork, try to fast at least 12 hours (but provide ample water, otherwise BUN will get screwed up). I find those numbers much more reliable.


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## obelinux (Jun 19, 2012)

His fasting creatinine was 4.3 . This was ~10 days ago or so. His creatinine had shot up to 3.36 and 4.56 going from 2.2 when he was off IV/SubQ for 5 days. 

I'm still restricting his protein intake. He gets 1 egg + 100g of mutton/lamb through the entire day split over 2-3 meals. The rest of his food is rice/sweet potato and some fat/vegetable. I'm not sure if I should up his protein or reduce it.


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## UConnGSD (May 19, 2008)

Since his creatinine is now down to 3.2, I would say stick with your current diet. Controlling the creatinine is the first priority at this stage. How is Whiskey's water intake? Does he drink lots of water on his own?


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## obelinux (Jun 19, 2012)

UConnGSD said:


> Since his creatinine is now down to 3.2, I would say stick with your current diet. Controlling the creatinine is the first priority at this stage. How is Whiskey's water intake? Does he drink lots of water on his own?


He doesn't drink water AT all. Right now he's getting 500ml of Ringer Lactate every day through a combination of IV and Sub-Q. I add a decent amount of water to his food ( ~ 1 litre over the entire day). However he has not had just plain water voluntarily for over 10 days. He does urinate a ton though - almost 10 times a day. 

Not sure what the reason is, but it started getting really cold here around the time he started recovering.


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## UConnGSD (May 19, 2008)

Well, he is getting a lot of fluids (which is great, as they will flush out his system), so he will pee a lot.

That is kind of strange that he doesn't drink water on his own. Not even when you don't add water to his food?? Usually, kidney failure dogs drink tons of water. Wolfie used to get up at night to drink water.


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## obelinux (Jun 19, 2012)

UConnGSD said:


> Well, he is getting a lot of fluids (which is great, as they will flush out his system), so he will pee a lot.
> 
> That is kind of strange that he doesn't drink water on his own. Not even when you don't add water to his food?? Usually, kidney failure dogs drink tons of water. Wolfie used to get up at night to drink water.


I tried not adding water once. He still didn't have water. On his off day from IV, he still had no water. Haven't risked not adding water though. As you say it does seem strange.


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## obelinux (Jun 19, 2012)

Had a quick question about these supplements I'm giving Whiskey. Do they slow down creatinine reduction?

Whiskey has a creatinine of 2.96 as of today. Down from 3.19 on the 7th. I also wanted to find out when I'll get to know his norma. How long should we keep continuing IV/Sub-Q?


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## UConnGSD (May 19, 2008)

obelinux said:


> Had a quick question about these supplements I'm giving Whiskey. Do they slow down creatinine reduction?


You meant "slow down creatinine increase", I'm assuming? If so, yes, they will help. Of course, each dog is different in their response to the supplements. My view is that at the very least, they will not hurt him. 

On to your second question, which is the more difficult one. IMHO, there is really no way to know what would be Whiskey's normal, as in will his creatinine plateau at some point. I am afraid that at this point, with Whiskey you might never see his creatinine fall within the normal range set for dogs  But from what I have heard of Whiskey, he will live his life to the fullest and that attitude, believe it or not, will pull him through a lot. Regarding the sub-q fluids and how long to continue... this is the reason why many of us ultimately learn how to administer sub-q fluids at home. Once you have one of the vet techs show you how to do it and you do it under their watch a couple of times, it is pretty easy, so long as the dog remains calm. This way, you can do this therapy for the long term. 

Another possibility is to go for a supplement called Azodyl. This was extremely helpful for Wolfie, in extending his life and more importantly, in improving his quality of life. It is expensive though, at least here. Azodyl is considered to be like a "dialysis in a pill". Also, Epakitin will help support the kidney function and reduce the phosphorus levels better.


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## obelinux (Jun 19, 2012)

Thanks a ton Uconn. I think I just got hopeful after the 4.5 to 3.3 drop. It's still scary to think his creatinine might not drop at all, but that's how it goes with renal failure. 

As far as Azodyl goes, I've read it needs to be refrigerated. Unfortunately we don't get it here in India so will look for refrigerated shipping options.

A new development has come up. He had some papaya as a snack two days ago which he threw up. Last night he threw up a little bit of sweet potato from his food. He still eats a fairly large amount of food 3 times a day, but doesn't puke that out. Is there any reason why this is happening?


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## UConnGSD (May 19, 2008)

Unfortunately, yes, renal failure is a progressive disease. We measure victory slightly differently in these cases. Victory is when you can get the creatinine level reduced so significantly (like you did with Whiskey). Victory is when you can get the creatinine to stay more or less steady for a decent length of time. You and Whiskey should be proud of what you have achieved together.

Here is another very good kidney supplement: Herbal Supplements - Registered and Licensed Ayurvedic Medicines

No idea why he might be puking out the veggies... any other veggies? Or only those kinds? Sweet potato is great for kidney failure! Are the papaya and sweet potato cooked? Pureed? If they are left chunky, maybe that could be a possible reason??


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## obelinux (Jun 19, 2012)

Hi Uconn

They are chunky but cooked. He's been having them this way for almost a month now, which is why we weren't sure what's happening . I also realised we haven't been giving him any antacids. He's been doing well without it so we've ignored it. Maybe that might help? 

Thanks so much for your help Uconn.


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## obelinux (Jun 19, 2012)

I also bought those kidney supplements after you told me about them. Didn't give them since he hated them. Guess I should ensure he has them
Now.


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## UConnGSD (May 19, 2008)

He's not vomiting out anything else, right? Other than papaya and sweet potato? In that case, antacids may not be needed at this point. At some point in the future, you will surely need to put him on antacids. But at this stage, I am not sure if this is needed. _Unless_, the vomiting increases.

I would suggest just omitting the 2 culprits for a few days and observing. If the vomiting goes away, you could try to re-introduce a small portion of either (mashed up with other foods) and see if he holds it down. If the issue re-occurs, I say skip those veggies altogether. With a kidney failure dog, I would be extremely careful about avoiding anything that induces nausea. 

Yes, unfortunately, many of the supplements don't taste good. What I do in that case is put a dab of soft cheese or other yummy gooey treat on one of my fingertips, open their mouth, place the supplement in the back of their throat and follow up _immediately _with the treat. The licking induces them to swallow the supplement.


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## Wolfgeist (Dec 4, 2010)

A client of mine has a dog with renal failure, at 10 years of age. She switched to this diet and has seen some pretty incredible improvement. Can't tell the dog is in renal failure.

Take a look. I know she adds egg shell for calcium / low phos. 

Product Listing

The kidney support formula.

EDIT: She also adds more protein... it was a significant amount but can't remember.. you do NOT need low protein for renal issues.


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## obelinux (Jun 19, 2012)

Thanks Wolf. Unfortunately I stay in India, so won't be able to order that. However, I could try to use the same ingredients and make something similar.

On another note, we got a blood test done today. Creatinine up to 3.8. We're guessing/hoping it's just an abnormal spike due to his puking.

As far as puking goes, we seem to have found a theory. People here can verify if it makes sense.

On Friday he had a biscuit with cashew in it. He puked his papaya some time after that.

On Sunday he had one almond. I've been reading about almond toxicity in dogs. Maybe that caused him to vomit.


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## Jax08 (Feb 13, 2009)

Almonds are not toxic to dogs.

ASPCA | Almonds

Toxic Nuts
http://www.petinsurance.com/healthzone/pet-articles/pet-health-toxins/Nut-Dangers-to-Dogs.aspx


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## UConnGSD (May 19, 2008)

Interesting, Obelinux!

Michelle, I am wondering if some dogs can be allergic to nuts the way some humans are allergic to them and whether that can cause GI upset like vomiting??


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## Jax08 (Feb 13, 2009)

Both links say they can cause gastro issues because they aren't digested well and the fat in them. I would think it's more that than allergies?


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## obelinux (Jun 19, 2012)

Jax08 said:


> Almonds are not toxic to dogs.
> 
> ASPCA | Almonds
> 
> ...


Interesting! Now it's back to square one. Not sure what caused him to vomit, and if that was the reason his creatinine shot up again. By the time we could digest his reducing creatinine, it goes back up again .


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## obelinux (Jun 19, 2012)

Whiskey's creatinine dropped to 3.08.

His weight though has been a bit off.

This is what his weight gain over the past month looks like

21st Oct - 15.1 kg
26th Oct - 15.7 kg
28th Oct - 16.2 kg
2nd Nov - 17.3 kg
8th Nov - 18.3 kg
12th Nov - 17.5 Kg
18th Nov - 18.3 kg

We think the drop on the 12th was possibly due to his vomiting and slight stomach upset. We are not sure if we are feeding him enough.

This is what he gets through the day 

80-100g of mutton ( goat meat)
400g of uncooked rice ( cooked quantity might be 3x that)
100g Sweet potato
2 egg whites

Is this diet sufficient for a 6 month puppy or should I increase something? He gets a 2 mile walk every day, and some ball play, otherwise no other physical exertion.


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## vom Eisenherz (Feb 13, 2012)

Don't give antacids to a raw fed dog. Unfortunately, it's one or the other. If the dog really needs them, feed food slightly cooked or choose a dehydrated food, etc. DogAware.com Health: Non-Prescription Commercial Diets for Dogs with Kidney Disease but in this case, you can't have your cake and eat it too. Sadly, many vets don't understand this and many owners don't think about how important those acids being blocked are to the safe and thorough processing of raw food.


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## obelinux (Jun 19, 2012)

vom Eisenherz said:


> Don't give antacids to a raw fed dog. Unfortunately, it's one or the other. If the dog really needs them, feed food slightly cooked or choose a dehydrated food, etc. DogAware.com Health: Non-Prescription Commercial Diets for Dogs with Kidney Disease but in this case, you can't have your cake and eat it too. Sadly, many vets don't understand this and many owners don't think about how important those acids being blocked are to the safe and thorough processing of raw food.


I'm sorry. I should've mentioned. We cook the meat before giving it to my puppy. Problem in India is, you can't rely on the quality of raw meat.


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## Jax08 (Feb 13, 2009)

obelinux said:


> Whiskey's creatinine dropped to 3.08.
> 
> His weight though has been a bit off.
> 
> ...


How does his weight look? What is the phosphorus content of that per day?


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## obelinux (Jun 19, 2012)

Jax08 said:


> How does his weight look? What is the phosphorus content of that per day?


Weight is as per the table I've put up. I'm not sure if he should be gaining more weight or not. He's 14 lbs short of his ideal weight . Phosphorous is usually between 100-125 mg a day ( max ), else it's pretty low Ph.


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## Jax08 (Feb 13, 2009)

How does he look? that's how I should have phrased it. If his body condition looks like, then i think the caloric intake is good. 

At his stage of CRF, what is his maximum PH supposed to be?


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## obelinux (Jun 19, 2012)

Jax08 said:


> How does he look? that's how I should have phrased it. If his body condition looks like, then i think the caloric intake is good.
> 
> At his stage of CRF, what is his maximum PH supposed to be?


His spine is visible. Ribs normal. However, we keep seeing him everyday so am not sure what to make of it. Let me try to get a picture of him tomorrow.

About Ph, not more than 500-600 mg IIRC.


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## Jax08 (Feb 13, 2009)

Ask UConn but I think if his CREA level stabilizes perhaps find a way to add more protein to his diet? I did read somewhere that egg yolks, while high in PH, are good to add to the diet in moderation. Once or twice a week, maybe?


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## obelinux (Jun 19, 2012)

Jax08 said:


> Ask UConn but I think if his CREA level stabilizes perhaps find a way to add more protein to his diet? I did read somewhere that egg yolks, while high in PH, are good to add to the diet in moderation. Once or twice a week, maybe?


That's a good idea Michelle. Hope we can slowly peg his CREA on something. With so much variation, we aren't sure what to do. We want to increase his protein but are scared it'll mess up his CREA.


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## Jax08 (Feb 13, 2009)

I know! My vet did say that CREA could go up and then stabilize but Banshee is only Stage 1. UConn would now more about this than I so definitely talk to her.


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## obelinux (Jun 19, 2012)

Is Glucosamine Sulfate okay for my pup with a renal condition? He has weak hind legs and was wondering if I could use it.


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## Jax08 (Feb 13, 2009)

I'm checking on that for you but I wonder if his hind legs are weak because of the low protein which would affect his muscle growth rather than a joint issue?


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## obelinux (Jun 19, 2012)

Jax08 said:


> I'm checking on that for you but I wonder if his hind legs are weak because of the low protein which would affect his muscle growth rather than a joint issue?


He hasn't had the strongest hind legs since he was a baby, but we just ignored them as puppy legs. It's highly possible what you say is causing it. Reason why I want to try glucosamine is, if it'll help with the low protein. I'd love to up his protein but again am scared if it'll mess up his values.


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## Jax08 (Feb 13, 2009)

CRF page says they use it and are confident it's ok. What about an alternate source of protein like blue/green algae as a supplement? You would need to be aware of the phosphorus level in it but it also has calcium which may offset the ph.


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## obelinux (Jun 19, 2012)

Jax08 said:


> CRF page says they use it and are confident it's ok. What about an alternate source of protein like blue/green algae as a supplement? You would need to be aware of the phosphorus level in it but it also has calcium which may offset the ph.


I am giving him Spirulina everyday. Is that the same thing?

Thanks Michelle.


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## Jax08 (Feb 13, 2009)

yes. there is another one too. I'll look it up. One has more phosphorus than the other.


ETA: chlorella is the other algae


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## obelinux (Jun 19, 2012)

Whiskey had slightly low hemoglobin, so we started giving him a little iron. However, with iron, his appetite seems to be off. Are there any natural iron sources I can mix in his food which might help?


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## Jax08 (Feb 13, 2009)

spinach
Cooked vs. Raw Spinach for Iron Content | Healthy Eating | SF Gate

Here is a list of iron rich foods
Iron in the Vegan Diet -- The Vegetarian Resource Group

You might want to check these for phosphorus levels but I think spinach is probably the best.


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## obelinux (Jun 19, 2012)

Jax08 said:


> spinach
> Cooked vs. Raw Spinach for Iron Content | Healthy Eating | SF Gate
> 
> Here is a list of iron rich foods
> ...


Thanks a ton Michelle. 

We also found a Vet who has Azodyl. It comes at a premium though ( 100$ for a 60 tablet bottle), but anything we can try to help the poor puppy.

Happy Thanksgiving everyone!


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## obelinux (Jun 19, 2012)

Sad news with Whiskey. His hemoglobin is dropping. It was 10.9 last week. It's 9.8 now. Vet has given 2000IU erythropoietin as in injection. Unfortunately he was very upset, and we don't have a positive prognosis for the puppy. Hoping for a miracle. It's not done till it's done.


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## Jax08 (Feb 13, 2009)

:hugs: You'll be in my thoughts


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## obelinux (Jun 19, 2012)

Whiskey is doing okay. Eating well/playing well. Creatinine is still in the 2.7 to 3.2 range. We've started Azodyl.

He's also been diagnosed with Babesia Gibsoni blood parasite. We are not giving him medication just yet because we read that Imizol is nephrotoxic.

In other news, I brushed his teeth today and found a slightly rotten molar. It has a black spot in it and his breath is horrid. Also I'm not sure if that is his adult molar or baby molar since all I saw fall off over the past couple of months are his incisors and canines. Hopefully it's not a big deal, but reading the forums, it does seem like one.


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## Jax08 (Feb 13, 2009)

So glad to hear from you! I was just thinking of you yesterday.

You definitely need to get the teeth looked at. Bad teeth put bacteria into their system and can cause CRF so it is certainly an issue given his already damaged kidneys.

A quick google search seems to show a correlation between Babesia (a tick disease) and CRF. Did your vet discuss that with you? Is this the cause of his CRF possibly?


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## obelinux (Jun 19, 2012)

Jax08 said:


> So glad to hear from you! I was just thinking of you yesterday.
> 
> You definitely need to get the teeth looked at. Bad teeth put bacteria into their system and can cause CRF so it is certainly an issue given his already damaged kidneys.
> 
> A quick google search seems to show a correlation between Babesia (a tick disease) and CRF. Did your vet discuss that with you? Is this the cause of his CRF possibly?


We did talk about Babesia being a cause. Of course, there is no evidence to say that caused his kidney issue. 
That said, I'm scared to get the drug administered since the drug ( Imizol) hasn't been tested on puppies, and also needs to be used with caution in kidney failure cases.


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## UConnGSD (May 19, 2008)

I am so sorry to hear that Whiskey's blood values have dropped. Few thoughts:

1) Darbepoetin is thought to work better than erythropoetin, in terms of its effects lasting longer. This is what we used for Wolfie.

2) You are continuing with the iron capsules, right? It can help prolong the time between the injections. I know that people worry about iron toxicity but from what I have heard from human doctors, that you need to be taking very high doses for a very long time in order to end up with toxic levels. Apparently, we absorb only 20% of the supplemental iron.

3) Is it possible for the drop in hemo to be on account of the Babesia infection? If the hemoglobin levels can get back to normal after the Babesia is treated, maybe it's worth giving Imizol a shot?? Of course, this is a calculated risk but given the progression of the disease, maybe worth thinking about...

4) The horrible oral stench goes with advanced kidney disease, unfortunately. It's the toxins building up inside the body. You could try adding pureed parsley to his food to help flush out the toxins.

I'm sorry I couldn't respond sooner -- traveling for work and family visits and broken laptop while traveling doesn't make for a happy traveler.


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## obelinux (Jun 19, 2012)

Sorry for the hiatus here. BEen dealing with Whiskey. 2 weeks ago his creatinine went up to 4 - coupled with a loss of appetite. As of 2 days ago it had come back down to 2.7. However, we are still dealing with severe appetite issues. He's been rejecting food except meat. The temperature has dropped significantly in our city over the past week, but I'm not sure if that has caused his appetite loss. He is looking to sleep a lot, except when he wants to play ball. Hopefully it's just a small phase .


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## msvette2u (Mar 20, 2006)

I'm sure you know the symptoms of kidney failure; because of the toxins circulating in the bloodstream, they often lose their appetite and feel ill.
Just try to change up the foods, we used all sorts of safe "toppings" to try to entice our senior that was in failure to eat.


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## obelinux (Jun 19, 2012)

msvette2u said:


> I'm sure you know the symptoms of kidney failure; because of the toxins circulating in the bloodstream, they often lose their appetite and feel ill.
> Just try to change up the foods, we used all sorts of safe "toppings" to try to entice our senior that was in failure to eat.


Could you please tell me what all you tried.

Today we tried some mincemeat( mutton) fried/roasted in saltless butter. That seemed to work.


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## msvette2u (Mar 20, 2006)

Well we tried things like "gravy" made for dogs, but you could try eggs (scrambled or boiled), any variety of canned food, cottage cheese, yogurt, anything safe you can think of, to just kind of "coat" the kibble.


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## UConnGSD (May 19, 2008)

I am baffled by how his creatinine is bouncing around like this... Any news on the Babesia infection?

As for the non-meat toppings, what temporarily worked for Wolfie were yogurt, cottage cheese, scrambled eggs. But mostly, he just wanted his meat. How about if you just give mashed potatoes (sweet or white) mixed with meat? Does he eat that? In the end, that's the only thing that Wolfie wanted to eat. I am sorry but it's really all trial and error with this disease. The food-related struggle was really hard to deal with.


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## msvette2u (Mar 20, 2006)

> I am sorry but it's really all trial and error with this disease. The food-related struggle was really hard to deal with.


Exactly this. And they'd eat it for a few days and that was it. 
So you had to change every day or so.


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## UConnGSD (May 19, 2008)

msvette2u said:


> And they'd eat it for a few days and that was it.
> So you had to change every day or so.


Oh yes.

I eventually learned to do small batches and not mix in the meat until it was meal-time. Threw out enough food and learned the hard way.


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