Toward the end of October 2014 our dog Sally was diagnosed with mild kidney disease. Sally has battled three cancers too. In fact, it was at the time of diagnosis of her third cancer that the kidney disease was discovered.
Sally’s first cancer led to an amputated toe. She recovered from that like a trooper. She never really missed a beat being her silly self while her foot healed up. We have always referred to her as our endless source of entertainment.
After the cancer in the area of her toenail that led to a toe amputation, I noticed two nodules in her neck that started to grow. They grew to the size of golf balls. She started to snore more and seemed to have a very slight amount of labored breathing. We took her to Pittsburgh Veterinary Specialists and Emergency Center on Camp Horne Road in Pittsburgh, Pennsylvania. Sally saw Doctor Rebecca Newman who also treated our Lucy.
Sally was diagnosed with canine lymphoma in 2012 and put on the COP protocol to treat it. She went in for regular IV chemotherapy, taking oral chemo agents at home. Her lymphoma shrank and stabilized. It turned out to be an indolent rather than aggressive form of lymphoma. It did not get any smaller, and it did not get any bigger after initially shrinking greatly during the IV part of the chemo protocol.
After Sally finished the IV portion of the protocol, she was supposed to stay on an every other day dose of a chemo agent at home. It was in short supply for a time. This is actually a problem for different chemo agents that have a low profit margin for the pharmaceutical companies. Human beings suffering from various cancers have difficulty receiving steady treatments due to some of the medications becoming more difficult to obtain.
We stretched out Sally’s medications to once every three days then waited longer between doses so we would not run out. We noticed her lymphoma was not getting worse. We eventually took her off of the chemo at home and her lymphoma never worsened. It has been more than a year with her lymphoma remaining stable. The nodules in the lymph nodes of her neck and back legs can be felt, but they are very small. Things were going along great. We had a fun summer of 2014 with her, and then a small cauliflower shaped bump began to grow on her left rear foot. Doctor Newman told us it is a soft tissue sarcoma.
Sally started a metronomic medication protocol to slow blood vessel growth in hopes of retarding the growth of the cancer on her foot. We could not afford surgery and radiation treatments. It was blood and urinalysis testing on the day of diagnosis for her third cancer that she also was diagnosed with mild kidney disease. The drug protocol to treat the foot cancer was to be three drugs—doxycycline, cyclophosphamide (Cytoxan) and piroxicam. The doctor suggested we only give her the doxycycline and Cytoxan because piroxicam would be tough on her already failing kidneys.
We had not missed a dose from the first day of giving her two of the three chemo agents. Not until late in January of 2015 anyway. Sally started to act like she was sick for the first time in her life. We were ready to schedule her followup visit to see if the tumor was growing and to check her kidneys when she started to not want to eat or drink much and was throwing up. The visit showed that her kidney disease had greatly worsened. The normal treatment is to hospitalize a pet in her condition for a few days. We did not have the money for that. Sally is terrified of the vet’s office anyway, and I believe she would have declined even if we could have afforded to leave her there.
My wife and I believed that Sally would do best being treated at home. Going all the way back to when I had to learn how to survive with diabetes and no insurance when I was a young man, I had picked up plenty of skills along the way. Some of them were from training, others learned out of necessity. Plus, it is not difficult to give subcutaneous fluids to a dog. It is common for pet parents to administer them at home. It takes about 10 minutes of training for someone who has no experience but is willing to do it.
With her kidneys not efficiently removing the toxins, she needed to have more fluid moving through her system, not less. As long as she is urinating, she needs to keep the toxins in her system from building up. Since dogs with kidney disease start to drink less and eat less, supplemental subcutaneous fluids are a necessity for them to live. However, it is only a temporary measure. Pets will rally for a short time. If the kidney disease is caused by something that is correctable, then they may fully recover. The cause of Sally’s kidney failure is not known.
We got a call from the vet’s office in the late afternoon after we got back home with Sally, her new medications and a box of IV bags, tubing and needles. Sally’s urinalysis came back indicating she had a urinary tract infection. This was a good thing actually. It meant that her sudden decline in kidney functions might be at least slightly attributable to the infection. The degree would not be known until she was on an antibiotic for a few days. We started her on her prescribed 750mg of ciprofloxacin right away. Fortunately, the antibiotic was free at our local Giant Eagle pharmacy.
Sally has had 6 of 10 doses of cipro as of Super Bowl Sunday. She took a slight turn for the worse from the time she got up that morning. She ate a burger the night before, and she had chicken soup earlier that Saturday. She has not been eating as much as she normally does, but on Sunday she did not voluntarily eat anything. The only caloric intake was the little bit of ice cream I put her pills in.
Breyer’s Natural Vanilla does not have any artificial ingredients. It is just milk, sugar, tara gum* and natural flavoring. Sally used to go crazy for ice cream. Now it is just a vehicle to get her to swallow pills. I form it into a small ball with the pills inside and place it in her mouth. I gently try to keep her from spitting it out. As the ice cream melts, she begins to naturally swallow. The liquefied ice cream helps the pills go down smoothly. The only risk is an ice cream headache as the small ball of ice cream is melting in her mouth. Well, the giver also has the risk of an accidental or even intentional bite depending on the dog. Sally is a good girl who cooperates with just a little coercion.
Sally vomited in the late afternoon. She had vomited about five times in a little more than a week. She was declining. However, the majority of her days since the advancing or progression of kidney disease has been spent wagging her tail, playing out in the snow—as much as an old lady dog can anyway—and hanging out on the couch watching TV with her mom and dad. Sally also continued to enjoy bedtime. She likes to knock the pillows around and settle into a spot that is inconvenient for her humans that share the bed with her. She is still the same old Sally except for eating and drinking less and the infrequent vomiting.
The Super Bowl is being played as I type this section. The multi-billion dollar NFL is oblivious to the battle our little Sally is going through. The game is just noise coming from the television set. Sally is asleep on her couch and snoring lightly. She seems perfectly normal.
We do not know how much longer Sally has. Maybe a day or maybe a week. Kidney disease is insidious, and she may hang on being almost perfectly normal for weeks. The subcutaneous fluids help immensely. Why would we not treat her according to our means if her quality of life is close to what it was without kidney disease? I realize that there are those who wonder why we just don’t euthanize her. We took that route twice over the years we have been together. Both experiences were awful and not remembered with any peace for us. We leave the choice up to other families with pets to decide for themselves, and we expect the same respect be given to us.
For those reading this who have a dog with end-stage kidney disease, it is not written to fix anything. It is just an account of what we are all going through. Some moments seem like everything is perfectly normal. Then we remember this is the end of her life. It is heartbreaking. Yes, we know the bible does not say that pets go to heaven. It also does not say they do not. In fact, it is silent on the matter because the bible is for humans, not pets. If you are interested, you can view our Two Minute Bible segment “Do Animals (Pets) Go To Heaven” for more information. My favorite verse that gets you thinking about all life being under the control of God is Job 12:7-10.
If your beloved pet is suffering from end-stage kidney disease and you are willing to give some oral medications, fluids under the skin and be patient in trying to get them to eat and drink, then you may extend time with them. Depending on your viewpoint, it may be good for children to see the lengths human beings should go through to help those who cannot help themselves. Seeing their beloved pet pass at home also lets them see and know the truth about death, negating all the misinformation of how movies and books portray it. Life is filled with horrible and traumatic things we all eventually will experience to one degree or another. Learning strong examples of how to give all that you can to help is a good thing.
*As with most any food ingredient, some pet owners are not comfortable even with tara gum present in anything fed to canines. I advise researching anything and everything and making an informed decisions when it comes to any risk whether suspected or known. At the point of Sally’s kidney disease she was in, the ice cream was not an issue.
DO NOT ACT on any information in this article without seeking advice, training and specific instructions from your pet’s veterinarian. The purpose of this article is not to train to treat but to advise what can possibly be done with a sick dog and with cooperation from a veterinarian. Just like people, no two pets are exactly alike and are very likely to need different treatment plans for even the same diagnoses. Also, different states may have different rules as to what treatments a pet owner can provide at home. This article was written by a pet owner, not a veterinarian.