Jasper (12 yr old Mini Schnauzer) is now at peace

[Trish]

Hi Tina
Has Jasper's appetitie gone off only since the enalopril started? I wonder if that is making him a bit queasy? Is he doing any lip smacking that could indicate nausea? Maybe it is the pill upsetting him. Be good to hear what your vet says tomorrow about this, can you try putting something nice and smelly on it to make it more tasty for him, like tuna juice? Or on second thoughts that could be too salty.

Jasper, now you be a good boy and go eat your dinner!!!

Have a good night you two!

Trish xxxxxxxxxxxxxxxxxxx

[Tina]

Well this morning now he won't eat at all. Took a couple of kibbles from my hand and that is it.

Trish, yes, it seems that his appetite issues this go around have started since we started the Enalapril, but he was switched to the prescription k/d kidney diet around the same time also. He started the Enalapril at half dose on 1/31, and was transitioned to the k/d beginning 1/26 and was on full k/d diet by 2/1 pm meal. He first started acting finicky with the food on 2/5, with the walking away behavior. It has been intermittent since that time, where some meals he will eat normally, but even when hesitating, etc., he would always finish. The last couple of days the problems have increased, and now this morning won't eat at all. He has not been doing any lip smacking that I have noticed.

When he went out this morning, he had a poo that was partially weird looking with some mucous. So I wonder if he is starting with colitis. I think that would surely affect the appetite. I gave him a dose of metronidazole that I have on hand, and will talk to the vet today to see what she thinks. I sure don't want him to break with full on colitis. I held the Enalapril this morning also, not sure if I can give it on an empty stomach. Thank goodness he isn't scheduled for his Dex today. He seems to be drinking ok.

Thanks for your feedback Trish. I will check in later after I talk to my vet.

Tina and Jasper

[addy]

Tina, will Jasper eat other foods? If you cooked up some chicken and rice would he eat that? Is it just his the kibble or all food?

[SoggyDoggy]

Wondering the same thing now too. is it maybe just that he hates the K/D? especially if he is drinking fine. Sometimes the mucousy stools can be just not enough food/bulk in the system. A bit of chicken breast might be worth trying.

[Harley PoMMom]

I would definitely try the chicken/rice mixture or any other foods that you think he will eat.

Hoping Jasper's appetite picks up real soon.

[lulusmom]

Hi Tina,

I have been so out of the loop here, I had to go back and refresh my memory on what's been going on with Jasper. So much has happened that I'm still not sure I understand everything, like why is Jasper taking Enalapril and why is he on a seriously protein restricted diet? It looks like Jasper has normal, normal BUN, creatinine and phosphorus levels but because the protein creatinine ratio was much higher in January, she put Jasper on K/D food which he doesn't seem to like too much. I can't say that I blame him. I'd be very concerned about putting my dog on such a very low protein diet without knowing that his kidney function is seriously impaired and if I were at that point with one of my dogs, I'd try to make my own food as opposed to the crappy quality ingredients Hills uses. Please check out these excerpts as well as others on the Dogaware site. Lots of excellent information there.

Pet Food Safety: Dietary Protein by Dorothy LaFlamme, DVM, PhD, Dipl ACVN
"Summary and Conclusions: Based on a comprehensive review, there remains no evidence that dietary protein causes kidney damage, or any other adverse effects, in healthy dogs. Even in dogs with chronic kidney disease, dietary protein does not appear to contribute to kidney damage. However, in chronic kidney disease, there can be an accumulation of byproducts of protein metabolism, which may contribute to uremic signs. Hence, in those patients, dietary protein restriction may be of benefit. On the other hand, dietary protein is important to support normal protein turnover and maintain lean body mass. Healthy, aging dogs have an increased requirement for dietary protein. When insufficient protein is provided it can aggravate the age-associated loss of lean body mass and may contribute to earlier mortality. Unless medicatlly indicated, intake of dietary protein should not be restricted."

The Mythology of Protein Restriction for Dogs with Reduced Renal Function by Kenneth C. Bovee, DVM, MMedSc
"Morris subsequently developed, produced, and sold a low-protein diet, KD, for dogs with renal failure. He and others were influenced by the erroneous work hypertrophy concept for urea excretion advanced by Addis. While experimental or clinical data were never published to support the value of this or other diets, the concept was broadly accepted without challenge in the veterinary literature." This article talks about the history of protein restriction, and about 10 recent experimental studies that have failed to provide evidence of the benefit of reduced dietary protein to influence the course of renal failure.
Also see Influence of Dietary Protein on Renal Function in Dogs by the same author, which concludes, "These results do not support the hypothesis that feeding a high protein diet had a significant adverse effect on renal function or morphology."

http://www.dogaware.com/health/kidneyprotein.html

You mentioned that a urine culture was done on January 25th which was several days after the protein creatinine ratio was done. This is a bit ass backwards since you want to make sure there is no active urinary inflammation/infection before doing a UPC as that would falsely elevate the ratio and I'm not talking small numbers. Unless I missed it, and that's completely possible, I don't see where you ever posted the results of the urine culture. Can you post those results now? If there was any blood/bacteria identified in Jasper's urine, you might as well throw out the last UPC and maybe even ask for your money back.

Glynda

[Trish]

Darl what has the vet said? Hopefully they will allow you to give her some tastier food. Mr Flynn would turn his nose up at a kibble diet too! Fingers crossed to hear good results tonight xxxxxxxxxxxxxxxxxxxxxxxxx

[Tina]

Hi Everyone,

Sorry to follow up so late, the evening got away from me. I forgot to say in my last post that I considered giving Jasper the bland hamburger or chicken and rice diet, but wanted to check with my vet first to make sure it was ok with the kidney issues. I figured he would probably eat that. She verified tonight that it was ok.

We had a long talk after I got home from work. Before I even mentioned that he had an episode of mucous in his poo, she questioned whether he might be getting ready to break with colitis, as poor appetite and going off his food has happened in the past before colitis has reared its ugly head. After I told her about the icky poo, she immediately agreed that this was what was likely causing the lack of appetite (rather than the Enalapril or something else), since it has happened before. She said it was perfect that I started the metronidazole this morning, that is exactly what she would recommend. (Yay, I made the right decision after I debated about it this morning!). She also said to give him a dose of Cerenia to help with the nausea and then feed him the bland diet for a couple of days.

His follow up kidney profile was all within normal limits, which was a relief. So we will continue the Enalapril at 1/2 tab twice a day.

So I ran out to the store to get some chicken breasts to cook up for his dinner. In the past I have always fed him hamburger/rice mixture, but since everyone on the site has mentioned chicken, I figured I would try that. My vet said either would be ok. It was snowing here during the evening, and in the few minutes that I was in the store, my whole vehicle was covered and the roads got a little dicey!

He ate the chicken and rice just fine tonight, so hopefully we have nipped the colitis in the bud.

Glynda, thank you so much for your post and all of your information and feedback. I will need to do some checking and try to answer your specific questions/concerns tomorrow, I am pretty tired right now. I will say that the urine culture was negative, I probably just forgot to post that. The k/d food and the Enalapril were prescribed in agreement with and based on the recommendations of the IMS that my vet has been consulting with. They have diagnosed Jasper with PLN, protein losing nephropathy.

I had read a bit about the diet recommendations that you posted from the dogaware site, I believe Lori provided the link previously. I got pretty overwhelmed reading everything, along with trying to understand all that is going on with Jasper now. The excerpts that you have posted have made me feel quite worried about it all now. I agree, I don't like the ingredients in Hills and have told my vet that on more than one occasion. She said she doesn't necessarily like Science Diet, but said she feels strongly about the science behind their prescription diets. She has been pretty firm about that.

Again, I will do the best I can to answer the rest of your questions and clarify things better tomorrow. Things have been quite complicated for Jasper, there has been a lot going on. Thank you all for the support!

Tina and Jasper

[labblab]

Hi Tina,

I'm so glad that Jasper is eating again, and hopefully things will remain settled down for you and your little guy!

Boy, the topic of canine renal management is definitely a contradictory one. And one of the chief difficulties is the lack of controlled experimentation. There have been lots of studies on humans and rats, but not so many on dogs and cats. So it is difficult to find substantiated evidence. However, here are some links that I had found a couple of years ago and kept bookmarked. I do think the sources are quite credible. And if I'm understanding the discussion correctly, the opinion among many specialists is that from a physiological standpoint, treatment (dietary and/or drug) really does seem warranted for dogs exhibiting persistent levels of high proteinuria on the basis of UPC results, regardless of whether or not they show other symptoms of renal disease. The first link is to a "2004 Concensus Statement of the American College of Veterinary Internal Medicine: Assessment and Management of Proteinuria in Dogs and Cats." Even though this statement is now almost a decade old, I still see reference made to the recommendations:

http://cms.evsrl.it/SocSpec/SiteTail...y.aspx?id=2200

The second is a round-table discussion among veterinary renal experts ("Proteinura and Renal Disease") sponsored and published in 2005 by IDEXX Laboratories. This is a most informative "read," and further endorses the basic recommendations of the ACVIM Concensus Statement. It has an especially interesting section re: the advisability and degree of dietary changes depending upon patient symptomology.

http://www.idexx.com/pubwebresources...ound-table.pdf

Lastly, here's a 2009 article from the "DVM360" magazine that discusses diagnostic and treatment issues associated with hypertension and proteinuria in dogs with renal disease:

http://veterinarynews.dvm360.com/dvm.../detail/591639

Here's a quote from this last article that is a pretty good summary of the train of thought represented in all of these links, and I will look for even more recent articles when I get the chance. But for what it's worth, I think your IMS has a significant amount of professional support regarding the advisability of dietary and/or drug intervention in the face of persistent proteinuria to the extent that Jasper has exhibited. However, I don't know the specific profile of the food you're giving Jasper. As Glynda says, it may be that it is more severely protein-restricted than these panels would recommend in his situation. I especially encourage you to read the IDEXX round-table discussion in that regard, because I believe they suggest only mild/moderate protein restriction early on for a dog without other symptoms of renal disease. It's a fine line because you want to keep up with the protein that is being lost, but you don't want to cause additional renal damage from excessive protein leakage into the kidneys.

In addition to being a diagnostic marker of the severity of renal disease, renal proteinuria may be a mediator of glomerular and tubular injury. Recent findings have demonstrated that proteinuria is associated with increased risk of developing progressive CKD in dogs.

In addition, studies have shown that therapies that reduce the magnitude of proteinuria often are renoprotective. Proteinuric renal disease is often associated with systemic hypertension, which can conversely exacerbate renal proteinuria and therefore, it is difficult at times to separate the effects of high systemic and intraglomerular pressures and proteinuria.

Marianne

[addy]

Sweetie, you have a lot on your plate and I dont want you to now get stressed out about having to think about cooking every day for Jasper. So maybe we can find a different solution for you.

I do know that when Zoe first had her outbreak of colitis years ago, we tried the dry prescription ID kibble. She hated it and it made everything worse. The ingredients in the canned ID were a tiny bit better so I switched to the canned and she did better on it, not perfect but much better.


So my question is, does the KD come in canned food? If not is there another kidney type food that might come in canned?

So, I am off to check out that old website of Hills and I'll be back