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Linda Simon
Linda Simon, Veterinarian
Category: Vet
Satisfied Customers: 2444
Experience:  MVB MRCVS
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I am reporting back on Charlie the ^who has kidney disease,.

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Hello Linda. I am reporting back on Charlie the Jack ^who has kidney disease,. If you recall, he went for IV fluid therapy nearly 3 weeks ago. He coped quite well for the 48 hours and stats did come down. Crea from 261 to 212 and Urea from 42.2 to 11.8. No SDMA done. He was very perky after but when isaw the vet 2 weeks ago, she has given him just weeks to live as the figures not low enough and it hasnt restored his appetite.
Since then, he has been enjoying his walks, playing most nights, occasional zoomy and sleeps well. Only up once in the night after 6 hours. So not much change, given poor calorie intake. I must admit that I am giving him a bit of a high calorie supplemet called Vet Miracle as its truly horrible to have the prospect of him starving whilst quite good in himself. The appetite thing is so strange. He'll suddenly fancy something - treat, chicken, chips (all the wrong things!) - and then eat loads. Next day, it would be something else that takes his fancy.
I think over here , we treat dogs att this stage more conservatively maybe than in US - which I'm fine with. But if you have any thoughts. I will look at your form about decisions at some points but he shows no sign of suffering at all at present. It's a horrible illness. Thanks for reading!
Hi! Thank you so much for this update. Chronic kidney disease does progress differently in every patient which makes it quite unpredictable! I'm really glad that in Charlie's case he seems to be coping really well at the moment.
It sounds as though the fluids were absolutely the right choice for him and it may be that if he were to go downhill again in the future, they would be worth trying again.
A variable appetite is not surprising as he may be feeling nauseous at times and not others.
I do feel that the most important thing is that he eats something and that is calorie intake is sufficient to prevent muscle and weight loss. However, if we could tempt him to eat the prescription kidney food (far easier said than done!) this would be the ideal scenario.
From what you've said, it really does sound as though he is coping very well and long may it continue :D
Customer: replied 5 months ago.
Well, yes, but the appetite issues don't make it seem that he's doing that well plus the prognosis given of weeks to live?

Unfortunately we know that he has a chronic and progressive illness so we can expect the waxing and waning of the associated symptoms such as inappetence, nausea, vomiting etc. It is 'normal' that his appetite will not be as it used to be but it is reassuring that it is sometimes very good.

A prognosis is a 'best guess' based on lab results, symptoms, experience etc. It is really difficult to predict how long any animal has left but many owners find it useful to get given a rough estimate in order to better prepare themselves for what may come. We can prolong life expectancy by managing symptoms as best we can and providing i.v. fluids for as long as they cause a positive effect.

Customer: replied 5 months ago.
It's just a worry that he's likely to die from malnutrition rather than the actual kidney disease at the moment as the good moments aren't sufficient to feed him properly. I understand that the lack of appetite is caused by the disease of course and we're coming to terms with the fact we don't have him for very long, but it's horrible to see him starving. He'll wag his tale for food then drop it down. Terrible. Anyway, thanks for your perspectives.
Bless him, it is such an awful disease.
Is he already on anti nausea medicine? And an appetite stimulant? If not, both can improve appetite significantly. Anecdotally, vitamin B12 injections can also help some.
Customer: replied 5 months ago.
PS He has not vomited for 3 months and then it seemed like a bug going round.
Customer: replied 5 months ago.
No, anti nausea medications didn't work and vet thinks appetite stimulants only last as long as you take them.
Fair enough if the nausea medicine didn't help, although it may be worth trying again in future as his toxin levels build.
Absolutely, appetite stimulants are onto effective for a day or two after being given, however they still have their place as if we give them on the days he is not hungry, at least we should be able to get some more calories into him on those days and prevent further weight loss. In the days he eats well, they would not be needed.
Customer: replied 5 months ago.
Can you suggest an appetite stimulant? Some seem to have nasty side effects? Sounds a great idea. This new vet is more amenable to ideas than the other! Will probably be in touch again. Thanks for help again this time?
No worries!
I always use Mirtazapine as find it works very well for most.
Linda Simon and 3 other Vet Specialists are ready to help you
Customer: replied 5 months ago.
One last question. I have some 15mg tablets of Mirtazapine which I am to divide into 4. When you mentioned, just trying on days that he's not hungry, does that mean the reaction to the medication is instant rather than building up over a few days? I forgot to ask the Vet - the beauty of this Just answer service is that you can ask things that occur to you later. And are there side effects? I hadn't expected to write again so quickly?!
Happy to help! You will normally find it kicks in quite soon and lasts for a minimum of 24 hours although this is quite variable from patient to patient and effects can last a day or two longer than this.
Side effects are rare but can include lethargy and behavioural changes so it's always worth keeping a close eye, particularly the first time the medicine is given.
It does tend to sork well when given for several days in a row, but play it by ear.
Of course, with any medicine it needs to be prescribed and approved by your dog's own vet (online vets cannot prescribe medicine as we have not examined the patient), which I presume is the case here.
Customer: replied 5 months ago.
That's helpful thanks. Yes, the vet here prescribed it and was happy to do so but these questions occured to me later! She was also supportive of me giving him calorie supplementation, especially as not high in phosphorus and based on fish oils.
I agree, it's always better for a dog with kidney disease to eat something rather than refuse their kidney specific diet and go hungry!
Customer: replied 5 months ago.
Thanks again. That's all for now!