my patient Shep is a very nice german Shepard, diagnosed with PLN in November 2022 and 5x 7 isoechoic Liver mass (r/o hepatoma vs carcinoma).
At the time values were: Sdma 34, Crea 3.2, Bun 81, Phos 4.9, Alb 1.8, UPC 6.5
He was started on Enalapril
1/13/23 Sdma 38, Crea 3.5, Bun 85, Phos 7.8, UPC 11
Appetite has been very finicky at the time and due to worsening of UPC, Enalapril was traded for Telmisartan, which O quickly also discontinued due to appetite being even lower on it.
I saw Shep first time End of January, his appetite has been extremely finicky
(eating Tripe, Darwins RX rarely, canned kidney diet and sausages (low sodium), egg yolks).
He still had pretty good energy and spirits, normal stools.
Tongue Lavender, Pulse slippery/wiry strong.
I started him on: Slippery Elm, Standard Process K9 renal support and Renatrophin PMG, Gastrex, XCHT 1 tablet bid to start, then 2 bid, B12 and B complex added to 500 ml LRS SID.
Appetite seemed to be improved in first week.
2. Visit 1 week later : We added 1 bid XFZYT. After the visit DNAP Bl 18, 20, 21, 23, St 36, Gb34 r, Ki3, Shan Gen. Same day appetite got much worse and remained poor for remainder of the week.
3rd visit 1 week later: Shep was low energy, less happy and more vocal/groaning during exam.
BCS 4/9, MM dry, mild abdominal discomfort, cold ears, warm paws.
Recheck blood showed much worsened Azotemia: BUN 129, Crea 6, Sdma 37, 11.8, Alb 2.1, Phos 11.8, Ca 11.6, Chol 443, Plt 473, UPC 8.9.
Increase XCHT to 2 TID and stopped XFZYTmodified because O is somewhat overwhelmed with his care.
Decided to hospitalise 2/14, was released by specialty place after 24 hours due to values not improving. Received Doxy, Baytril, the whole battery of acid blockers, also started on Amlodipin and Clopidrogel because his BP went from 154 when admitted to 240 and then 190, he did not eat at the hospital.
AUS showed bilateral severe degenerated kidneys.
Was released home for Hospice/Euthanasia.
Continued Wednesday with XCHT 2 tid, Slippery elm bid, Renatrophin, started on Arsenicum homeopathic, Charcoal binder at night. Cerenia, Entyce.
Friday added Cleavers, Parsley, Marshmallow tea and chopped Ceavers/Parsley in food .
He is eating treats and sausage, but appetite is finicky, he wants food and he doesn't, turns his head, low energy, quivering when sleeping. I was unsure if this means he is cold but O reports he prefers cool, so maybe just crummy feeling? O is forcing kidney diet. LRS 500 ml bid.
My questions are:
Should I stay with current dose XCHT or increase.
How can I help his appetite, nausea, Gi ulceration? Add San Ten Tang, Rehmannia 8, 6 Gents?
How can high Phos be helped in natural ways, I have not gotten myself to add ALOH...
What else?
Any other thoughts are much appreciated.
Thank you
Final Status: much worse as of day 18 of treatment