CRF and overfeeding
February 28, 2008 4:28 AM Subscribe
My dog has chronic renal failure. Are we overfeeding him?
I have a 12 year old chihuahua who I was expecting to have for another five years, but now I'm not so sure. He's been losing weight for a couple of years and has just been diagnosed with CRF. We're aggressively feeding him to get his weight back up (when he was young and muscular he weighed about 7 pounds; he's down to 5 pounds now, the equivalent of a man going from a young and muscular 155 pounds down to 110 lbs at 60 years).
He's getting low-protein dog food and ipakitine/Epatikin (a phosphorus binder). We mix the dog food with a small amount of (no sugar, no salt) peanut butter, add water, heat it in the microwave and add the ipakitine/Epatikin. Five times a day. He does really well on this for a few days then spends a few more days vomiting and not eating. (We've gone through this cycle twice - we're still new at this.) The first time we took him to the vet who prescribed famotidine/Pepcid. The second time we took him to the vet and had a long conversation that ended with "well, he's had a good life."
(We're not ready for the final step yet! I'm hoping that we can stabilise him and that he'll have at least another good year. Even when had been vomiting and not eating for four days and could barely stand up, he still danced his happy dance when I came home. The vet confirms that he's not in pain. And besides, he does go back to enthusiastic eating.)
Ok, back to the question. Is it likely that we've been feeding him too much and that the accumulation of metabolites is what's making him sick? Should we be a little less aggressive with the refeeding regimen?
Any other thoughts?
I have a 12 year old chihuahua who I was expecting to have for another five years, but now I'm not so sure. He's been losing weight for a couple of years and has just been diagnosed with CRF. We're aggressively feeding him to get his weight back up (when he was young and muscular he weighed about 7 pounds; he's down to 5 pounds now, the equivalent of a man going from a young and muscular 155 pounds down to 110 lbs at 60 years).
He's getting low-protein dog food and ipakitine/Epatikin (a phosphorus binder). We mix the dog food with a small amount of (no sugar, no salt) peanut butter, add water, heat it in the microwave and add the ipakitine/Epatikin. Five times a day. He does really well on this for a few days then spends a few more days vomiting and not eating. (We've gone through this cycle twice - we're still new at this.) The first time we took him to the vet who prescribed famotidine/Pepcid. The second time we took him to the vet and had a long conversation that ended with "well, he's had a good life."
(We're not ready for the final step yet! I'm hoping that we can stabilise him and that he'll have at least another good year. Even when had been vomiting and not eating for four days and could barely stand up, he still danced his happy dance when I came home. The vet confirms that he's not in pain. And besides, he does go back to enthusiastic eating.)
Ok, back to the question. Is it likely that we've been feeding him too much and that the accumulation of metabolites is what's making him sick? Should we be a little less aggressive with the refeeding regimen?
Any other thoughts?
maremare: Here's the thing. You need to get some knowledge about the situation first hand. So - I'm going to post this link where other folks are undergoing exactly the same things that you and your pup are. Please. Go to this site and start finding out what is new in nutrition, supplements and generally to get some support and ideas to help you deal with this further down the road.
posted by watercarrier at 4:51 AM on February 28, 2008
posted by watercarrier at 4:51 AM on February 28, 2008
And the link is - http://tech.groups.yahoo.com/group/HolisticPet/
posted by watercarrier at 4:52 AM on February 28, 2008
posted by watercarrier at 4:52 AM on February 28, 2008
Renal failure it's something to deal with and the faster, the less sufferng an animal needs to endure. There is treatment and the outlook need not be grim. Good luck.
posted by watercarrier at 5:57 AM on February 28, 2008
posted by watercarrier at 5:57 AM on February 28, 2008
I am going through the same thing with my 15 yr old cocker spaniel.
As I write this, waiting for his latest blood test results.
After an acute bout, the hardest thing is--as you know--to get the dog to start eating anything again. I agree with biscotti about less food and more frequent meals. Finding what the dog likes has been a challenge for me. He rejected all his favorites from before the acute attack. His vet said "anything" goes foodwise after an accute incident. Baby food did it for a while. Afterwards, it was a lot of experimentation.
I cook a bit of ground turkey for my dog and offer it with broth. No salt. It has gotten to where he vomits after eating only if I have given him a bit too much, or he is too hungry and eats too fast. It's still a worry of course, keeping him hydrated has been a huge challenge.
I can't get him to take the tums or mylanta [aluminum hydroxide] that was recommended.
Like yours, my dog has lost quite a bit of weight, gained some back, but still has a lot of weakness--especially hind leg weakness--and overall shakiness.
Hydration is a challenge too. I did the subcutaneous hydration for a while, then was able to taper off. Still not sure until I get test results back if he is ok with this. Is your dog at least drinking enough?
One problem with my CRF dog is his bowel movements. Usually he is ok, but there is periodic constipation. When that happens he is less interested in his food--or insanely ravenous. In either case, he vomits and is generally miserable. The next thing I know it, he has a semi-diarrhea and needs a bath afterwards. Pretty disgusting, I know, and he is upset by it too.
I'm sorry this is all pretty anecdotal. The vet is not terribly optimistic for the long run--in any case I think 15 is advanced for a cocker. But in the short run, my dog has recently overcome acute renal failure and come back from the brink of death. His resiliense surprises everbody.
Taking it day by day sounds nice, but it is taxing. At least a few times a month--when he's constipated or who knows what-- he wakes me up 3 or more times at night to let him out! But I do love him. And he does seem happy.
This illness and the experience of nearly losing him during an acute attack have given me time to consider the inevitable, and I have talked with my family and our vet over what to do when our dog's time finally comes.
In the mean time it's nice to be able to take short walks with him and to catch glimpses of the healthy dog he once was. Then I forget that he has CRF, and we both enjoy any fleeting illusion of health, though momentary.
posted by subatomiczoo at 6:59 AM on February 28, 2008
As I write this, waiting for his latest blood test results.
After an acute bout, the hardest thing is--as you know--to get the dog to start eating anything again. I agree with biscotti about less food and more frequent meals. Finding what the dog likes has been a challenge for me. He rejected all his favorites from before the acute attack. His vet said "anything" goes foodwise after an accute incident. Baby food did it for a while. Afterwards, it was a lot of experimentation.
I cook a bit of ground turkey for my dog and offer it with broth. No salt. It has gotten to where he vomits after eating only if I have given him a bit too much, or he is too hungry and eats too fast. It's still a worry of course, keeping him hydrated has been a huge challenge.
I can't get him to take the tums or mylanta [aluminum hydroxide] that was recommended.
Like yours, my dog has lost quite a bit of weight, gained some back, but still has a lot of weakness--especially hind leg weakness--and overall shakiness.
Hydration is a challenge too. I did the subcutaneous hydration for a while, then was able to taper off. Still not sure until I get test results back if he is ok with this. Is your dog at least drinking enough?
One problem with my CRF dog is his bowel movements. Usually he is ok, but there is periodic constipation. When that happens he is less interested in his food--or insanely ravenous. In either case, he vomits and is generally miserable. The next thing I know it, he has a semi-diarrhea and needs a bath afterwards. Pretty disgusting, I know, and he is upset by it too.
I'm sorry this is all pretty anecdotal. The vet is not terribly optimistic for the long run--in any case I think 15 is advanced for a cocker. But in the short run, my dog has recently overcome acute renal failure and come back from the brink of death. His resiliense surprises everbody.
Taking it day by day sounds nice, but it is taxing. At least a few times a month--when he's constipated or who knows what-- he wakes me up 3 or more times at night to let him out! But I do love him. And he does seem happy.
This illness and the experience of nearly losing him during an acute attack have given me time to consider the inevitable, and I have talked with my family and our vet over what to do when our dog's time finally comes.
In the mean time it's nice to be able to take short walks with him and to catch glimpses of the healthy dog he once was. Then I forget that he has CRF, and we both enjoy any fleeting illusion of health, though momentary.
posted by subatomiczoo at 6:59 AM on February 28, 2008
Best answer: I don't know much about canine renal failure, but in people they do lose weight and they have to restrict their total caloric intake. It's not just about protein - the kidney is critical in metabolism and homeostasis. When the kidneys start to fail you can't just go into an anabolic state by eating more; the failure of the vital metabolic organ is a bottleneck.
So yeah, don't overfeed your dog. He's not going to get back to his fighting weight unless you really box his kidneys, in which case it'll all be water weight and that's something you really don't want.
posted by ikkyu2 at 10:07 AM on February 28, 2008
So yeah, don't overfeed your dog. He's not going to get back to his fighting weight unless you really box his kidneys, in which case it'll all be water weight and that's something you really don't want.
posted by ikkyu2 at 10:07 AM on February 28, 2008
I have a corgi who has renal failure and he's managed to stay fairly active for 2 years now because of subQ injections. At first he spent a week in the vets constantly being flushed by a drip and that got him better for a couple months without treatment, but I have been continuing the treatment at home for quite a while and besides the usuals (bad back leg control, sleeping, old dog stuff) he's doing quite well.
There was a period when he got very bad and wouldn't eat. He was on fluids but they weren't helping- he wasn't eating and that was the main problem- he had a seizure and the vet put him on phenobarbital- which has a side effect of increasing my dogs appetite, and we were able to get him to regain his weight fairly quickly. Maybe this is something you should look into, our vet remarked it was interesting and that he wouldn't have considered it normally.
posted by Large Marge at 2:06 PM on February 28, 2008
There was a period when he got very bad and wouldn't eat. He was on fluids but they weren't helping- he wasn't eating and that was the main problem- he had a seizure and the vet put him on phenobarbital- which has a side effect of increasing my dogs appetite, and we were able to get him to regain his weight fairly quickly. Maybe this is something you should look into, our vet remarked it was interesting and that he wouldn't have considered it normally.
posted by Large Marge at 2:06 PM on February 28, 2008
Response by poster: Thanks, ikkyu2. What I suspected. I was particularly hoping for your input.
Thanks, subatomiczoo and Large Marge. We've been doing a lot of thinking about what we will and will not do when the time comes. For the moment hydration is good. He got subcutaneous fluids once, that time he'd been vomiting and not eating for four days, and then the vet prescribed the antacid. He's been much better since. I've told her that we won't hospitalise him, meaning IV fluids are out, and she's ok with that. He has a chronic illness. if he's too sick for us to look after him at home, then he's too sick. And I don't think subcutaneous fluids are going to be a big part of our future either. He's skinny, which makes it painful and difficult. He raised a real ruckus when he got that bolus in the vet's office.
watercarrier, thanks for the tip but I won't be joining the group. 1539 people contribute to that list, and I will have no way of knowing which ones know what they are talking about. Chronic renal failure is not something that can be reversed, though some of the symptoms can be alleviated with an understanding of physiology. It's pretty complicated chemically and hormonally, and I have most trust in someone with a grasp of the whole picture. Pet owners have experience of what worked for them, and that can be valuable, but vets have experience of what has worked (and not) for many, many pets. Pepe is well loved and I will be making sure he has the care that is right for him.
Thanks biscotti, yes I think we will be trying lots of different diets. Nausea is common in CRF which leads to hospital food syndrome. We are biologically wired to be disgusted by food that makes us ill, which is very useful in keeping us healthy. The problem is that we don't actually know if it's the food that's made us sick or whether we were just sick: we just get disgusted by any food that we were eating when we got sick. In the case of a person who is nauseated because of a chronic illness, anything they eat when they are not feeling well is likely to disgust them even when they are feeling well. (Meaning that no matter what is served in hospitals, patients are going to find that it's awful. To keep this effect to a minimum, a good hospital kitchen tries to offer a wide variety of food.) I suspect the same principle applies in dogs - like us they are scavengers, so like us they need to be able to learn from experience what is good and what is going to make them ill. Right now I'm flavouring his kidney diet with peanut butter, but I expect next time he gets sick he's going to decide that peanut butter is disgusting. The vet gave us a recipe for rice, eggs and fish oil which is going to be our next line of attack; when that becomes disgusting too, we'll try flavouring it with broccoli. Then back to a commercial diet, but a different brand than before. And so on.
posted by maremare at 3:51 AM on February 29, 2008
Thanks, subatomiczoo and Large Marge. We've been doing a lot of thinking about what we will and will not do when the time comes. For the moment hydration is good. He got subcutaneous fluids once, that time he'd been vomiting and not eating for four days, and then the vet prescribed the antacid. He's been much better since. I've told her that we won't hospitalise him, meaning IV fluids are out, and she's ok with that. He has a chronic illness. if he's too sick for us to look after him at home, then he's too sick. And I don't think subcutaneous fluids are going to be a big part of our future either. He's skinny, which makes it painful and difficult. He raised a real ruckus when he got that bolus in the vet's office.
watercarrier, thanks for the tip but I won't be joining the group. 1539 people contribute to that list, and I will have no way of knowing which ones know what they are talking about. Chronic renal failure is not something that can be reversed, though some of the symptoms can be alleviated with an understanding of physiology. It's pretty complicated chemically and hormonally, and I have most trust in someone with a grasp of the whole picture. Pet owners have experience of what worked for them, and that can be valuable, but vets have experience of what has worked (and not) for many, many pets. Pepe is well loved and I will be making sure he has the care that is right for him.
Thanks biscotti, yes I think we will be trying lots of different diets. Nausea is common in CRF which leads to hospital food syndrome. We are biologically wired to be disgusted by food that makes us ill, which is very useful in keeping us healthy. The problem is that we don't actually know if it's the food that's made us sick or whether we were just sick: we just get disgusted by any food that we were eating when we got sick. In the case of a person who is nauseated because of a chronic illness, anything they eat when they are not feeling well is likely to disgust them even when they are feeling well. (Meaning that no matter what is served in hospitals, patients are going to find that it's awful. To keep this effect to a minimum, a good hospital kitchen tries to offer a wide variety of food.) I suspect the same principle applies in dogs - like us they are scavengers, so like us they need to be able to learn from experience what is good and what is going to make them ill. Right now I'm flavouring his kidney diet with peanut butter, but I expect next time he gets sick he's going to decide that peanut butter is disgusting. The vet gave us a recipe for rice, eggs and fish oil which is going to be our next line of attack; when that becomes disgusting too, we'll try flavouring it with broccoli. Then back to a commercial diet, but a different brand than before. And so on.
posted by maremare at 3:51 AM on February 29, 2008
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posted by biscotti at 4:40 AM on February 28, 2008