Signalment
- Age: 6 years
- Sex: male
- Breed: Minature Dachshund
- Species: dog
Disease Notes
- Certainty: confirmed
- Final Status: Deceased from this disease on day 15
Treatment and Outcome
Problem Notes
- Dehydration: Dog was slightly dehydrated on initial exam: 1.5 seconds on skin turgor test.
- Elevated BUN: On 10/1/14, BUN= 85 (7-27)
- Elevated Creatinine: On 10/1/14, CREA = 2.6 (0.5-1.8)
- High Blood Pressure: Combination of renal insufficiency and over-hydration?
- Positive Lyme Test: Snap ELISA test positive. Would like to get Cornell multiple-titre test, but client has limited resources.
- Proteinuria: Measured at 156 on 10/15
- Retinal Detachment: With hyphema, dog was thrombocytopenic at hospital
- Seizures: 3 seizures while being observed and hydrated after 2 episodes cardiac arrest, post Advantage II. Clinician claimed he had another so upped the dose. Suggested to client that he has brain damage from sz
- Vomiting: Owner presumed vomiting was from Dewie, but this was not observed. Both dogs are on doxycycline for Lyme, so could be gastric distress related to AB.
- Weight Loss: Owner says formerly was 13+ pounds. Weight loss started end of July, accelerated end of September.
Treatments
- Phos-Bind
- Canine Renal Support
- RxBiotic
- Azodyl
- Essential Fatty Acid Supplement
- Vitamin E
- Canine Renal Support
- Beta-sitosterol
- Alpha-lipoic Acid
- Nettle Herbal Tincture
- Multiple Remedy Homotoxicology Tincture
- Apis Homaccord--Ubichinon
- Diazepam
- Crot-h 30C
Notes:
Dog was diagnosed in renal failure via quick pre-anesthetic panel on 10/1. This was second vet to see dog, previous one found blood and glucose in urine dip stick test when dog was presented for weight loss. Referring vet told owner her dog would probably not make it until Christmas. Phosphate binders were discussed but not dispensed. RV suggested famotidine for stomach acidity. Dry K/D was dispensed. On owner's request both her dogs were tested for Lyme and were positive. Doxycycline was dispensed for both dogs. On morning prior to my seeing him, at least one of the dogs was vomiting.
On this visit, urine was collected via fresh catch for urinalysis, Owner was advised on benefits of feeding raw, high quality digestible fresh food rather than dry K/D, and sent home with both samples of Darwin's Pets beef, and Honest Kitchen "mix-ins" to combine with fresh meat. Owner advised to use beef only for now, as it is lowest in phosphorus. We will investigate Darwin's Pets Rx Kidney diet.
Diet is largely canned or kibble
Acupuncture points were stimulated
Notes: Urinalysis results: SG= 1.014, Protein= 100, RBC 5-20 hpf, trace glucose. Discussed results with Cornell pathologist, who felt profile was consistent with renal tubular rather than glomerular damage, which puts Lyme nephritis less likely on differential list. Referred case for fluid diuresis at Cornell Companion Animal Hospital on 10/8. Supportive meds and diet change will probably be discontinued while dog is hospitalized.
Notes: Referred patient to Cornell Companion Animal Hospital for intensive care on 10-8. At that time BUN and Cre were much higher than on 10-1. They initiated fluid therapy, found many casts in his urine via cystocentesis and established that his left kidney especially was enlarged. He also had thromocytopenia and phosphotemia. They concluded he had an acute kidney injury, possibly infectious or toxic. Leptospirosis titre was negative. Because client had limited funds, they kept monitoring and testing to absolute minimum. After a day on 2x fluids, he developed high blood pressure, then subsequently detached retinas, hyphema, ascites and increased respiratory effort. So then they were treating him with two blood pressure meds, plus famotidine. When they discharged him on 10-12, they recommended SQ fluids every other day, and K/D diet. Owner reports he is eating, defecating, drinking and urinating normally. His vision is still impaired. He will be rechecked at Cornell on 10-15 for azotemia and blood pressure. At time of discharge, his urine was free of casts.
Notes: Report from Referral Clinic: Dewie went for recheck and was BAR, ascites resolving, retinas reattaching. Then, they overruled client's objections and gave him Advantage II. She brought him home and he suddenly collapsed as if dead. When she revived him, she tried wiping off the Advantage with a washcloth, and took him back to referral clinic and insisted he be readmitted. They denied any possible connection with flea meds, suggested she imagined it and reluctantly took him in. He repeated the episode at 4 am. I didn't hear about any of this until next day (10/16). He remained under observation. I sent her with some Nux 200C to give him when no one was looking.
Notes: Dewie had 3 seizures at referral clinic in the evening, put on IV diazepam
Notes: Patient released from referral hospital this AM, despite recommendations to euthanize. Owner sent home with prescriptions for phenobarbitol and liquid diazepam to be administered rectally when dog has seizure, instructions to express bladder. Catheter was retained in case needed for euthanasia. Dewie heavily sedated and unresponsive. Intermittently vocalized and paddled hind legs. Hydration was adequate after 3 days on IV. Treated GB 20 dry needles for 20", GB 34 until pulse softened, <3", injected BL 19 w Spascupreel. Sent home with homotox tincture including protocols for epilepsy, renal injury, glomerular nephritis and Body Pure.
Acupuncture points were stimulated
Notes:
Report from Dr. Dayon, who saw him this AM: Previous night he urinated without expressing bladder. This AM, Dewie presented seizing...many small tremors, owner reported vocalizing off and on all night, sometimes face in rictus. Gums greyish yellow and tacky, eyes not responding correctly to light..very slow, Blink reflexes not consistent. slight paddling motions of feet, heart sounds strong and steady, pulse rate normal. Lungs, some noise mostly upper respiratory inspiratory snorting sounds, rate slightly elevated. Abdomen within normal limits, but doughy, skin also seems very dry, some stool in blanket, T 102.5. Dog did whine and bark when owner went to car, but unsure if was coincidence or reaction. Was not repeatable after crot.-h dosing.
Plan, discuss poor prognosis but owner would still like to try. Gave crot -h. 30c and fluids. Immediately after remedy and fluids, gums changed from greyish yellow and tacky to pink and moist. Waiting on tinctures from Dr. Marsden's recommendations-- Settle the Yang and Quell Fire have been ordered in tincture form overnight, will be administered rectally.
12:30 pm..still no seizures! Has been about 1.5 hours, longest so far and no more valium was given.
Notes:
Patient was largely unchanged in mentation (remained unresponsive) all week, although seizures became less severe. Started treating with Chai Hu Jia Long Gu Mu Li Tang and
Long Dan Xie Gan Tang, given rectally, yesterday, as per Dr. Marsden, but no obvious response. When my colleague examined him earlier, he was moribund and he passed away a few minutes ago.