Old dog, kidney disease, & options
June 17, 2019 7:39 AM   Subscribe

My senior dog’s kidney disease is acting up again. Do I do fluid therapy and hospitalization?

We’ve been managing my 14/15year old Westie’s kidney disease with specialized food. But he’s refused it the past week and the vet says his bloodwork shows it’s his kidney disease. She gave two options:

Hospitalization with fluid therapy to “jump start” or get him comfortable. This is about $1-2k and could work (few more months) or could do nothing. I worry because he was hospitalized a few years ago and not sure I want to put him through the stress though it could make him feel better.

Or, fluids under the skin that we administer. He got the shot a few days ago and it perked him up a little bit, but I’m not sure for how long it’ll help.

Sigh. I’ve read the other related threads but any recommendations or thoughts would help greatly. He’s still eating chicken and other home cooked foods, played ball a little yesterday, so I’m trying to be hopeful (but keep him comfortable).
posted by inevitability to Pets & Animals (18 answers total)
 
My cat has kidney problems and I've given her subcutaneous fluids. It's not that hard once they accept that you're going to do what you're doing, and she's a very willful cat. But kidneys do not regenerate so it will be fatal in the end. I'm sorry to say it so bluntly, but it's the reality we have to accept.

A long vet stay would be very stressful. It's not an easy decision. Generally, the fluids will rehydrate and if no other issues, they'll feel more like eating and drinking naturally. I am in constant hawk mode to see if my cat isn't drinking and I have trained her to always want drinks from the shower or sink so I can keep her hydrated. I've caught her early illness before when this changed and really mitigated the kidney damage that can happen.

But again, it's not fixable only a thing you can slow and manage. I hope your puppy feels better soon.
posted by OnTheLastCastle at 7:50 AM on June 17, 2019 [5 favorites]


I have no personal experience but know of someone that had a poodle x with a similar problem & did the fluids under the skin at home for their dog (I think daily) for around 6 months. The dog always seemed like a happy, senior dog when every I saw her, but it wasn't a cure & she passed in the end.
posted by wwax at 7:53 AM on June 17, 2019 [1 favorite]


He's 15 years old. Please focus on his quality of life and palliative care for whatever time is left to him. He would choose to be at home with his humans and not separated from you in a stressful environment. Obviously, if he was 5, the math on this would be different because you're looking at years of payoff, but for elderly dogs, we always choose to focus on their immediate well being.
posted by DarlingBri at 8:03 AM on June 17, 2019 [15 favorites]


I would try the fluids. I've had friends with cats who did subcutaneous fluids for quite a while and their cat seemed like it was doing OK for an older kitty.

Beyond that, I would not do the hospitalization. I love all my cats dearly, but wouldn't trade the stress to gamble for just a few months. Try the fluids, keep giving him chicken and whatever else he'll eat, and he'll probably make it clear when his quality of life is no longer sufficient.

I hope the fluids do the trick and help him feel better.
posted by jzb at 8:15 AM on June 17, 2019 [1 favorite]


I've done at home subq fluids for an elderly pet and would do it again in a heartbeat. After the first couple of tries, it's not much bother or stress for potentially great return. Making pets comfortable at home for as long as their quality of life stays good is the way to go, in my book.

I hope he's feeling better soon and for a while to come.
posted by Stacey at 8:43 AM on June 17, 2019 [4 favorites]


Your instincts seem correct to me. There is no reason to subject him to the stress of a vet visit or hospitalization. I would recommend doing the sub-Q fluids and keeping a strong eye on things with the intention of pulling the trigger on letting him go with dignity at the first sign that a bad day might be approaching. If the sub-Q fluids don't seem to do much, that should inform your planning.

Dogs and cats aren't like humans in that they don't have any sense of tomorrow or future tomorrows. They only have now. This is to say that a dog or a cat doesn't have the capacity to appreciate enduring a bad day in order to have more days in the future, or to make that one last Christmas or whatever. Our greatest duty to our animal family is to ensure that they don't have any genuinely bad days, if at all possible. This is especially true when the end approaches, because it's not like it is with, say, a three year old dog that might need to have an unpleasant procedure and a few bad days in order to have a decade of great days. The best we can do for an elderly dog or cat with a terminal illness is hope to follow up a bad day with somewhat-less-bad days. From the dog or cat's perspective those are all bad days, and we should understand that the instinct to prolong things is really for us and not for them. This is all to say that, from the dog's or cat's perspective, leaving this world three weeks too early is better than one day too late.

I'm sorry this is happening. It's so emotionally difficult when these times come, as they inevitably do. I hope you can find some solace in the understanding that managing your dog's ending is one of the greatest responsibilities of a pet owner and one of the greatest acts of love you can give him.
posted by slkinsey at 9:41 AM on June 17, 2019 [10 favorites]


I agree with all who have been recommending doing fluids at home. We have a cat with kidney disease and we've been doing subq fluids for a year and a half now. It does take a bit of practice to get comfortable doing it, and it took a while for our cat to get used to it, but now that it's a routine it's really not bad at all. We do 75ml a night these days, and it never takes more than 5 minutes or so. I can do it solo, but it works better with two people, at least for our cat. My eleven year old daughter has even learned to do it too, so we switch off holding and poking.
posted by Lazlo Hollyfeld at 9:53 AM on June 17, 2019 [2 favorites]


Chiming in to concur with those who've suggested trying the sub-q fluids. It sounds/seems scary at first if you're not accustomed to sticking needles into your pets, and it definitely helps to have another person to assist (one to hold the fluid bag, one to hold the pet/needle), but most pets tolerate it extremely well.

My dear departed Siamese cat, Nikki, received daily fluid infusions for the last couple weeks of her life (when she was having trouble eating and drinking enough due to cancer), and it was *hugely* beneficial for her in terms of comfort. She was extremely willful and stubborn, and for her, the fluids were a breeze compared to, say, trying to give her any oral medications! Given your pup's age and overall health, it definitely seems like he'd get more out of being home with his people and receiving comfort care (fluids and whatever else the doctor recommends) than hospitalization which likely wouldn't buy him much in the way of quality time.
posted by aecorwin at 10:17 AM on June 17, 2019 [2 favorites]


Response by poster: Thank you everyone. I’ve been feeling so guilty about not taking a chance with the hospitalization if that would give him a better outcome. It’s just so hard to come to terms with this.

I will definitely try the fluids at home.
posted by inevitability at 10:20 AM on June 17, 2019 [4 favorites]


I haven’t done subq fluids, but for the last five years of his life we had to give our dog 3 meals a day, and a shot of insulin with each meal, and special meds with breakfast and dinner. It quickly became a routine and was not a huge hassle in an way. I guess my point is that even though it sounds like a major hassle - it really wasn’t. I’d bet that administering fluids at home is much the same.
posted by doctor tough love at 10:24 AM on June 17, 2019 [1 favorite]


I get the guilt. Even though it may seem that taking on the sacrifice of spending a few thousand dollars for your dog is ‘doing more’ for him, it’s actually not. So that can get confusing when you want to do all you can for him because of your love makes you think more is better. In this case, I truly believe everyone above is correct. He doesn’t need to feel afraid and alone anymore. What will be most important to him is as much of a regular life with his loved pack as possible. It sounds like you can give him some good quality time with the fluids. Go with that.
posted by MountainDaisy at 10:58 AM on June 17, 2019 [1 favorite]


One more person jumping in to support your choice to give him fluids at home. We did this with an elderly dog for a couple of months and it was truly not a huge hassle and didn't stress her out much. We would just do it on the sofa or bed in the evenings while we were all spending time together.
posted by assenav at 11:54 AM on June 17, 2019 [1 favorite]


Starting home fluids is probably the easiest next step. If it works for a while and everyone's cool with it, that's great! If it's not good for some reason, you'll have tried it and ruled it out and won't have to wonder what if.

And it might not work out. Don't frogboil yourselves or him if it's a miserable process or if it works for a bit and then slowly stops working. My husband and I spent about six weeks not really sleeping, increasingly unable to leave the house for any length of time, and then it was a single room in the house that was the only place our dog could ever get comfortable. That was my home office, which at least meant I could care for him during the workday but by the final two weeks I was barely working and having to catch up when my husband got home from work - with everybody here in my office with me, and then my husband sleeping in here, and then me waking them up to work in the morning. In the final two weeks, I had my husband turn down freelance work to stay home and help. If my husband had not gotten a call about a full-time gig he could not turn down, I don't know how long we would have carried on hand-feeding and helping the dog walk before we came to our senses.

Once we agreed to palliative care with the vet, about 8 months before we let him go, we stopped taking him there (it was so hard on all of us, just the transportation) and they were pretty amenable to just having us come pick up pain meds and antibiotics when he needed them. We had a home service come when we let him go.
posted by Lyn Never at 12:04 PM on June 17, 2019


Our 13 year old dog also has chronic kidney disease and we faced a similar decision a few months ago.

We opted for a few full days of IV fluids at the vet where we brought him in in the mornings and picked him up in the evenings - no overnight stays. He was calm during it or we would have stopped it. The jump starting did seem to help him feel more comfortable faster, and now we manage it with subcutaneous fluids at home, which, as others have said, is super easy/almost a non-issue after the first few times.

(On preview - I reread your question and saw the “few more months” part - if that means your vet thinks your dog only has that much time left, then please disregard the below. It’s not the case for our dog.)

Honestly, I’m a little surprised at everyone talking about end of life issues. Yes, kidney failure is eventually fatal, and obviously I have no idea where your dog is on the spectrum, but if he’s playing ball and eating chicken and generally seeming happy, it seems like this is something that could be well managed for months or years with diet and SC fluids at home. I certainly expect/hope my dog will live another 2+ years with excellent quality of life. He’s super happy, seems comfortable, and also wants to play ball/go on walks. Totally agree that letting them go gracefully is the right thing to do when the time comes, but the time hasn’t come for my dog yet, and it doesn’t sound like it has for yours either.

All this to say - try the IV fluids or not, definitely try the SC fluids at home, but don’t panic just yet. This may be just a blip and he may have another couple great months to years on the right regimen.
posted by bananacabana at 12:05 PM on June 17, 2019


Also, it won't hurt to give fluids beyond the initial prick. There aren't nerves in that zone (again, so I was told about cats and also she only dislike the initial prick even if the needle moved a bit). You're between the skin and the muscle. I just read this article and it was comprehensive and accurate from all I know.
posted by OnTheLastCastle at 12:44 PM on June 17, 2019 [1 favorite]


Not doing subcutaneous fluids with our elderly (19) cat with kidney disease, who was diagnosed two years ago. Instead, we kept her eating, on the vet's recommendation, and that worked well. I don't know what people do to encourage dogs to eat, but cats react well to getting parmesan cheese (or nutritional yeast) sprinkled on their food.

She's close to the end now, but I'm not doing fluids because I'm not about to add one more annoyance to her goofy little life. We're giving her a boatload of gabapentin, though, and while she staggers when it kicks in, she's clearly happier and eating up a storm when the pain is managed. As long as she can get around, that's what we're doing.
posted by Peach at 1:10 PM on June 17, 2019


I’ve been feeling so guilty about not taking a chance with the hospitalization if that would give him a better outcome.

What are your criteria for "a better outcome"? More weeks/years of life, or fewer weeks/years with higher quality of life, or a balance of the two, or some other factor(s)? Make certain you're not thinking "more time = better, full stop" without looking at the bigger picture.
posted by showbiz_liz at 1:43 PM on June 17, 2019


Response by poster: Thank you all so much for your advice and stories. It means a lot. It’s been a lot of tears. We ended up doing the subcutaneous fluids and he has perked up—including eating his kidney diet food again! We’re going to keep him comfortable at home.
posted by inevitability at 5:45 PM on June 21, 2019 [1 favorite]


« Older Birthday getaway within 5-hour drive of Philly   |   Going to Umbria to lie in the sun and forget all... Newer »
This thread is closed to new comments.