The Food Battle

When we first decided to do the homemade diet, I was so scared. Everything I read stressed the importance of balance. I also had to worry about the amount of protein...and that it was high quality protein. Then there is concern about the amount of Phosphorus, and that you should make sure that the Calcium/Phosphorus intake is balanced. Many have it on a 1:3 ratio. We are on a 1:1 ratio, particularly since her phosphorus levels are still within normal range.

We take all of this into consideration, that is, when we actually have the opportunity to worry about it. Generally speaking, though, the concern is more that she eat something...anything(although preferably something that still fits into the right parameters.

To make matters more difficult, Gabby has always been a picky AND an unforgiving dog when it comes to food. Picky speaks for itself, but unforgiving probably deserves some explanation. Seven years ago, Gabby was sick. Our vet at the time wanted us to put her on a bland diet of either cottage cheese or plain rice. We tried the cottage cheese first, which she gobbled down happily...and then threw up a couple of hours later. She refused cottage cheese after that. Ok, rice. Same experience. "Yummy. Gobble. Puke. Get that rice away from me." Now, seven years later, she still refuses cottage cheese and plain white rice (rice with something done to it she has been willing to take).

Unfortunately with this disease, eating often leads to not feeling well. I think this may be why she only likes foods once or twice, but refuses them after that.

The thing I find most funny about this is that I now cook more for Gabby than I do for myself! Some of the foods we have been successful with, even if it was just once:

• Tapioca and ground beef


• Ground beef only


• Egg white omelet with touch of bacon


• Egg white french toast


• Just plain ol' toast


• Poptart crusts


• Malt-o-Meal and chicken


• Sliced ham


• "Meatloaf" of ground beef, egg, pumpkin, and glutinous rice
  
• Spaghetti noodles and ground turkey, with a hint of parmesan cheese


• Shredded wheat cereal

And here's what I've learned so far:

• She seems to prefer her eggs over easy, then egg whites cut up with the egg yolk stirred up giving everything a nice coating.


• Things that I think she might not I should go ahead and try. This was how we discovered that she actually likes shredded wheat cereal.


• She doesn't seem to like things that are gelatinous in texture. Tapioca and glutinous rice are 2 things that many of the homemade diets you find online call for. The rice she ate in something, but never by itself. I couldn't add enough water, chicken broth, etc to get it less sticky enough. Same with Bob's Red Mill Tapioca. No matter how much water I would add, it never was quite right for her. Minute Tapioca, on the other hand, she has eaten willingly.

Helpful Groups and Websites

Fortunately early on I discovered 2 Yahoo groups that have been very helpful.

K9Kidneys There's a lot of information in their files about the disease, medications, treatments, blood tests, supplements, diet, SubQ fluids, where to buy supplies and so on.

K9KidneyDiet As the title implies, there's a lot of information here regarding homemade diets and supplements.

More importantly, both of these groups provide helpful answers to questions you may post...and I've posted a few. There are members in the groups who have been dealing with kidney failure with multiple dogs and/or for long periods of time. Some have medical training. The environment is incredibly supportive. No question too simple.

I've learned, sadly, that it's more uncommon than not with this disease that we have to make the decision about quality of life. That's one of the downsides of this group. The reality of the disease is always at the surface. It seems on a regular basis someone writes struggling with making the decision, or writes to say that their battle has ended. As is the nature of the group, there are no judgments when someone gives up the battle only an outpouring of caring and support.

Other informative and helpful sites:

• http://www.dogaware.com/ There's a section on kidney disease which provides some good information on diet and the disease itself. They have information on other conditions as well.


• http://www.thrivingpets.com/ Good source for supplies, particularly needles and IV kits.

Numbers still climbing

It has been 1 month since Gabby was hospitalized to get 48 hours of fluids, so it was time for another blood test. Unfortunately her numbers (Creatinine and BUN specifically) are continuing to rise. Going up about 75% from where they were when last checked. We had hoped they would level out because we started the fluid therapy, but the dr. said that they are actually going up at a rate a little faster than typically seen. We've increased her fluids from 3x a week to every other day. Not a drastic increase, but if you ask her it is. I don't think I would much care for being poked with a needle every other day.

I have to remember...Here and Now

I have to remind myself to live in the present. Sometimes this is the hardest thing for me to remember. She can't be cured and I can't make this go away for us. Her death is inevitable, but, really, it always was. Up until the diagnosis we lived life without being consumed by that. Sometimes it seemed like she was so healthy she'd live forever. This diagnosis brought the reality that she wouldn't to the forefront. It's even possible that this disease may not be what she dies from, especially if she does well with the treatment plan. She'd do better if she at the special diets, but I'm doing what I can to make sure that what she does eat is in line.

Along with living in the present is to understand that the efforts I am making right now are to give her good quality of life for as long as possible...to fight the disease for more precious moments together. I was, am, depressed. I cried for days in a row, and still cry now. I can be afraid, guilty, angry, depressed but I can't let it consume me. And, more important, I can't let it affect Gabby. She's always seemed to be "in tune" with me, I have no doubt she's picking up on those feelings and that's not going to help her. Besides what sense does it make to squander that time mourning her when she's still here and very much alive?

Bumpy Road

The road to today has been a bumpy one. I'll simply summarize it here:

She has refused all of the special diets. We've tried: k/d, Royal Canin LP and MP, and Purina NF. There were a couple she sort of ate, but now she refuses them all. She still seems hungry...she'll walk up to the bowl, sniff it and then walk away. She lost a couple of pounds in only a couple of weeks, and she only weighed 19 to start. The vet gave us a handout that suggested Tapioca and Beef. She ate that for a few days and gained 1 lb back. Unfortunately over the last couple of days she's not been interested in what we've given her. Including the Tapioca & Beef. So it's been another game of figure out what Gabby will eat today.

She's also started having incontinence issues (it began last Thursday). She had 6 accidents between now and then. Usually when she's laying down relaxing. She seems to have no idea it is even happening. She's taking DES and hopefully we will get that under control. I've also ordered diapers, someone recommended Female Pet Bloomers from Drs Foster & Smith. I also ordered a waterproof pet pad to put on the couch. Not the most fashionable thing, and I'm sure there are some people who would say "don't let her get on the couch". I guess that's just not me. I'd rather her be able to be on the couch and be comfortable.

Her neck injury seems to be all better, so that's good.

Christmas Eve, 2008

We picked Gabby up from the hospital on Christmas eve.

Her treatment plan:
Fluids 3x a week - 250ml. We could do this at home or bring her into the hospital.
Benazipril for hypertension
Prilosec

We were going to wean her off the Prednisone earlier than originally prescribed, but she seemed to be doing better. We still had to limit her activity for 2 weeks, including no jumping on and off the couch. That is much easier said than done. Especially with a little dog who sometimes forgets her age and really tries to fly.

That's when the dr. said she could have a couple of months or a couple of years. He wasn't overly encouraging on the "years" part, but I guess it's better not to sugar coat things.

Little things that are said do stand out. The vet tech gave us (well, Cori) a demonstration on how to administer fluids. I can't bring myself to stick Gabby with a needle, so thank goodness for Cori! They gave us needles, but only a few. I asked about getting more, if they could be purchased in bulk. She said they could, but that they would come in a pack of 100. Maybe my grieving mind read too much into it, but the thought ran through my mind that she was discouraging the purchase of that many needles for a reason I didn't want to think about.

So for two weeks we took the couch cushions off the couch and put them on the floor. We have a sectional and it happens to have 2 cushions total, each of which are fairly long so it turned out it was actually fairly comfortable to sleep on. And that's where I slept.

December 19, 2008

For a while we had wondered if Gabby was getting doggy dementia. She had started to bark or wag her tail at people, animals (or things?) that didn't exist. Sometimes she would stop in the middle of the hallway and stare off or run outside and seem to forget why she was there. On Tuesday of this week she had gone outside, but when it was time to come back in she ran head first into the door as though she thought it was open. She bounced off, but didn't yelp and didn't seem to be in any pain at all. We thought she was ok. The next evening she started yelping in pain. On Thursday morning I called the vet to make an appointment that day. 15 minutes later I was calling the vet back to see if I could take her there immediately...the occasional yelp had become screaming.

He did x-rays and say that there were 2 points in her spine. One in her neck, the other in her back, where she was showing signs of degenerative disc disease. Based on the exam, he said that she was likely suffering from a slipped disc as a result of the impact with the door. He gave her steroids, muscle relaxer and pain meds.

She was due for her semi-annual geriatric blood test, so we had that done as well. On Friday I missed the vet's call, but he left a message. The radiologist had confirmed his theory regarding her xrays, but there was a problem with her bloodwork. Please call back. He called again later, this time giving his cell number because he was leaving work. When the vet leaves a cell number, it's probably not good news. As soon as I got the messages I called him back.

I've had to stop writing this entry a few times, because I've started to cry...

He told me that her bloodwork indicated that she was in kidney failure. He said that we should give her fluids. We could either do that at home, or at the hospital which would require a 48 hour stay to be most effective. Obviously I was having trouble processing it all, because he said if it were his dog that's what he would do. I wish I could give more information here, but I can't remember any more of what he said. It felt like my heart stopped. My eyes welled up with tears (like they are now yet again). I've never been through this before. I had no idea what it meant, what would happen. I am still learning what it all means. He said to bring her in on Monday and she would come home Christmas Eve.