Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.
Now as I am sure you can appreciate, we can see anorexia in dogs be caused by a range of issues. That said, if your lass has chronic kidney issues then I would be suspicious that her lack of appetite is linked to nausea secondary to this. The reason we can see the two linked is because if the kidneys are filtering poorly, toxins/metabolites/waste products will build up in the blood and this can lead to GI upset and gastritis.
First, since she is refusing food despite the Omeprazole, it would be ideal to ring her vet about stronger anti-nausea/vomiting treatment. You could of course try other antacids like Famotidine/Pepcid (More Info/Dose), or Ranitidine/Zantac (More Info/Dose). But we may need a true anti-vomiting medication like oral or injectable Metoclopramide (More Info/Dose) Ondansetron (More Info/Dose) or Cerenia (More Info/Dose). So, I would consider first making sure that if she is suffering with underlying nausea that we are addressing it and ruling it out.
Further to this, we need to tempt her to eat (as I know you are). Favourite foods are allowed or you can tempt her with a light/easily digestible diet. Examples of this would be boiled chicken, boiled white fish, scrambled eggs (made with water and not milk), meat baby food (do avoid the ones with garlic powder in the ingredients) or there are also veterinary prescription diets that can be used here (ie Hill’s I/D or Royal Canin’s sensitivity.) And if tempting doesn’t work, then we do have to consider initiating syringe feeds to get food in. In that case, we can use preparations like Hill's A/D (LINK), Royal Canin Recovery (LINK) or Clinicare Canine/Feline Liquid Diet (LINK). Though as she has underlying kidney issues, it may be best to make a gruel from a kidney support diet (ie HIll's K/D, Royal Canin Renal, etc) to get nutrition in without over burdening her kidneys.
Further to managing the nausea secondary to her kidney disease, we do have to consider trying to support the kidney itself. I see that Shawna is on a phosphate binder (Renalzin) but you have not listed any other kidney specific medication. Therefore, in this case I would just note that you may want to speak to your vet about Fortekor (Benazepril) as this medication works to increase blood flow to the kidneys, which can help the kidneys to function more efficiently. So, this would be a consideration for her.
Further to this, if she is very nauseous with her kidney disease and/or her blood values are severe, then you may want to consider having her admitted to the hospital for IV fluids. These are a good way to flush out those toxins building up in her blood which can then reduce nausea and get her feeling better. Otherwise, since this is a chronic issue, you may also want to consider regular treatment with subcutaneous (SQ) fluids.
This is a supportive measure that I tend to use in my kidney patients as standard (As long as the owners are comfortable doing this at home or visiting regularly). The nice thing about SQ fluids is that they are quite non-invasive and can just support the kidney on a daily/weekly basis to keep the metabolite levels from reaching a severe state where we do have signs like you are seeing. Just in case you are interested, I do want to leave a good guide (HERE) and a very good video on giving SQ fluids HERE.
Finally, if you find the above doesn't get her eating, then we can consider one other trick up our sleeves. Specifically, some vets do carry appetite stimulating medication (ie Mertazipine/mirtazapine (LINK)) and these could be potentially of use here.
So, this could also be something to discuss with your vet to see if we can just give Shawna a bit more "encouragement" to eat again.
Overall, with Shawna's history of kidney issues, we do have to be highly suspicious that the metabolite/toxin build up from her kidney struggles are playing a role here. Therefore, we'd want to consider an alternative antacid +/- anti-vomiting treatment. Furthermore, we need to tempt her to eat or consider syrining nutrition into her. And if she is very poorly with this, then we'd want to consider checking her kidney values by blood sample +/- starting fluid therapy to reduce those effects that her kidneys are having on her stomach. Hopefully by addressing the nausea and the kidney's struggles head on, we can manage her kidney disease for her, reduce the nausea associated, and get her feeling better.
I hope this information is helpful.
If you need any additional information, do not hesitate to ask!
All the best,
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