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LRS Treatment (Kidneys)

Ericmpls
May 8th, 2011, 07:09 PM
My Shih tzu (around 9 years old)quite eating for abt 5 days and was diagnosed with Chronic Kidney disease Wednesday, he is back from the Hospital and his levels dropped from
BUN from 97 to 50
CREA from 4.7 to 2.9
PHOS from10 to 4.8

****He still doesn't have his appetite back as of today, he's on the KD renal food now and is taking a appetite stimulant???

Back in November he was diagnosed with Hip Disp. and his Kidneys and Liver were tested for Meds and they were fine.

My Vet said ongoing treatment for the Kidneys(not including his Hip meds) will be arnd $230 month - I'm trying to drop that by buying some of the meds online IE Azodyl / LRS treatment 2-3 times weekly. I noticed there are a few sites online selling the LRS solution for about 75% less then my Vet.
***Any recommendations on which company to buy from??

***Also what size(gauge) needle?? My vet gave me a 1' needle with a blue hub but I don't know the gauge???

growler~GateKeeper
May 8th, 2011, 07:50 PM
Welcome to the forum, nice drop on the numbers :thumbs up, now the trick is to keep them around that level without shooting up too high again.

Have you tried anything other than/or in addition to meds to stimulate his appetite? Does he have a favorite food/treat he goes nuts for? Freeze dried treats such as Pure Bites (http://www.purebites.com/) is a healthy option that will not affect the phos levels too much, especially the chicken, this can be crumbled & sprinkled on the food to entice him to try it.

Sitting beside him while he eats may also help, hand feeding if necessary - the most important thing at this point is getting him to eat.

Is he nauseous? Licking his lips often? Standing over the water bowl but not drinking?

What is his energy level like? Still want to go for walks?

For the fluid supplies have you checked the prices at your local pharmacy/walmart?

Have a look around for a local medical supply company, one that supplies hospitals/pharmacies/doctors offices etc some will do in house sales when they know the purpose or if you have a prescription from your vet. That is where I purchased my fluid supplies from, the company I used allowed off sales for CRF clients and is listed on the site below under Canada, of course it would be cheaper for you to find a company in your area to save on the cost of shipping/hassle of customs importing across country borders.

This is geared towards cats w/CRF but the supplies pages applies to both cats & dogs http://www.felinecrf.org/obtaining_supplies_cheaply.htm

Be sure that if you do purchase fluids online that you get the exact same solution as from your vet, there are many types of fluids that are used for subq injections and some have additives that may not be appropriate for your dogs' situation.

The Blue Hub needles would be 23g you can verify this by looking at the side of the hub it should be printed right on it. 23g is a good size for a dog of that size, though you could go to a slightly bigger size if you feel this is flowing to slow for his liking (if he squirms too much, gets restless during the treatment cuz it takes too long), I was using a 21g Ultra Thin Wall from Terumo on my cat.

Ericmpls
May 8th, 2011, 08:09 PM
Thank you for your reply, he was licking his lips alot b4 I took him in - but now not at all - he drinks water alot - no problem with that - they think but not sure he may have an ulcer so he is on pepcid ac and Sucrafate. (he is not nausea) Vet told me no more of his favorite soft treats - so I got milkbones - he is eating them -

For appetite he is on 7 grams a day of mirtazapine as a slurry

His energy level is up and down - today / yesterday I gave him 250ml of LRS and his energy level was way down all day.

I boiled chicken breast with rice today and he ate about 8 oz of the chicken - he is acting like he is hungry (he goes to the KD food and keeps smelling it but walks away - he was eating it on Friday - He has always been very picky on dog food b4 the kidney problems

hazelrunpack
May 8th, 2011, 08:10 PM
Welcome to the board, Ericmpls. I don't know a lot about kidney disease, but I know a little about hip dysplasia and some of the meds frequently prescribed. Which meds is he on for the HD? If he was/is on NSAIDs did your vet say anything about stopping them? Some of them can be pretty hard on a dog's kidneys... :o

Sending along good wishes for you and your dog! :goodvibes:

Ericmpls
May 8th, 2011, 08:14 PM
it was a green hub - it said 18 on the side

Ericmpls
May 8th, 2011, 08:19 PM
he was on carprophen and switched it to tramadol / also he is on Dasuquin and Wellactin for hips but I am not given him anything for his hips until he starts eating more

hazelrunpack
May 8th, 2011, 08:27 PM
Both carprofen and tramadol can cause kidney problems, so make sure you talk to your vet about starting them up again.

Sort of a side issue right now, considering the kidney management takes precedence, but how severe was the HD? It might be that the Dasuquin, Wellactin, and moderate exercise (esp. low impact exercise like swimming) will be enough to keep your boy limber. Weight is likely not an issue right now, but if you can keep him on the light side of normal, that will also be beneficial for his hips. With luck, maybe the HD can be managed from here on out without having to resort to the meds that might further impact his kidney function. :fingerscr

Ericmpls
May 8th, 2011, 08:35 PM
http://www.freeimagehosting.net/uploads/ff3b06cb50.jpg (http://www.freeimagehosting.net/)

hazelrunpack
May 8th, 2011, 08:40 PM
:laughing: Now that's one cute Santa Paws!!! :flirt:

Ericmpls
May 8th, 2011, 08:42 PM
I never gave him much of the Carprophen b4, i never gave him the dosage they suggested ( 25mg morning and night) Igave him abt 12mg once a day maybe twice a day if I noticed him favoring his hip(very seldom)

The Vet said the Trymadol would be better on his Kidneys, I will ask her if there is another pain med.

growler~GateKeeper
May 8th, 2011, 08:47 PM
It sounds like you are using Monoject brand needles? - a green hub is 18g. For a Shih Tzu you could use anything from 18-23g the 23g are about 1/2 the diameter of the 18g so the flow is much slower.

As mentioned I used Terumo (http://www.terumotmp.com/productdetails.aspx?categoryId=1&productId=443) Ultra Thin Wall 21g for a cat, the gauge you use depends on the comfort of your pet when the needle is inserted and how well your pet tolerates the length of time it takes for the fluid to flow.

If you find your dog flinches constantly when the 18g is inserted try a 20g or 21g, the flow rate will be slightly slower, but hanging the LRS bag above your head helps the flow rate.

Switching to Terumo Ultra Thin Wall will also reduce the discomfort of needle insertion because the walls of the needle shaft are much thinner than regular needles. This allows for both for faster flow and less of a pinch to the skin, the beveled edge aides in piercing skin smother and faster. Because the walls are so much thinner on the Terumo UTW the flow rate on a 21g was about the same as a Monoject 18g, but I didn't feel like I was stabbing my cat for each treatment.

He's probably not too interested in the smell of the KD food & that's why he's walking away from it. What food was he on before the kidney issues? Have you tried crushing a bit of milkbone ontop of the kd?

Ericmpls
May 8th, 2011, 08:47 PM
I found him about 4 years ago in a bad neighborhood - he was stuck in the street in a snow drift. his hair hadn't been cut for atleast a year and was covered with about 200 burrs - vet said he was around 4-5 years old - he was not potty trained and hid under my bed for 5 weeks then one morning i woke up with his paw in my face - he didn't start barking until almost 2 years.

Ericmpls
May 8th, 2011, 08:55 PM
When I get more needles I will get the 18g 1" Terumo ultra thin -
He was on moist food he didn't like dry food, Chicken flavor (hates beef flavor dog food) Alpo / mighty dog /nutripet.

I will try crunching a milkbone over the KD food

Sat morning was the first time I did the LRS at home - he did great, he laid there and almost feel asleep - me on the otherhand, poked my thumb and finger.

growler~GateKeeper
May 8th, 2011, 09:21 PM
Have a look in a local pet supply store for food from By Natures Organic, Innova Evo 95%, Wellness, Taste of the Wild, Evangers they may be a bit more expensive but are healthier options than what he was previously eating. The k/d is super low in phosphorus, but also fat & protein making the food not that appetitizing. A higher quality meat sourced food will go a long way in improving his health, it won't cure the CRF or HD but will provide for a better energy base, muscle mass and immune system.

What you want in a kidney friendly dog food is moderate to high fat, moderate protein, low phosphorus, not low everything such as the kd - there is very little actual meat protein in the kd. When you have a higher quality protein source the phos levels are lower than a poor quality source.


Stabbing yourself does tend to happen on occasion when preparing injections :). Sounds like he tolerated the treatment quite well :thumbs up

Ericmpls
May 8th, 2011, 09:45 PM
This link http://www.felinecrf.org/obtaining_supplies_cheaply.htm
was very helpful. found out where to get LRS solution, needles, Azodyl cheaper.

Ericmpls
May 9th, 2011, 10:43 AM
I will go to Petco/Petsmart today and look for the food u mentioned. They let me do the LRS when he was in the hospital and he took it well then, I was syrprised, he takes 3-4 techs at the vet to hold him to take blood samples. He doesn/t like having pills shoved down his throat(Azodyl), I stuck myself twice when I was trying to pull the needle off to throw it away(it didn/t want to come off.

He ate some more boiled chicken breast around midnight - 4-5 ounces. He seemed energetic last evening and night.

Ericmpls
May 9th, 2011, 12:39 PM
This morning after I gave him his meds -Azodyl, Sucrofate, and appetite stim, he ate abt 8 oz of boiled chicken and then he proceeded to grab chunks of the wet KD food sprinkled with milkbones and hide them throughout the apartment?

He's never done that b4?

His energy level is good this morning, about 70%.

http://www.freeimagehosting.net/uploads/0168da70fe.jpg (http://www.freeimagehosting.net/)

Ericmpls
May 9th, 2011, 04:49 PM
He was out chasing birds today when I took him for a short walk. energy level abt 70%

Found Wellness - turkey & chicken(no luck eating it) And Innova chicken (not opened yet)

found Pure Bites chicken freeze dried - he likes it.

hazelrunpack
May 9th, 2011, 05:25 PM
Sounds like he's feeling a bit better! :goodvibes: Not sure what the food stashing was all about, but he sure does sound and look like a sweetie!! :D

Ericmpls
May 9th, 2011, 07:06 PM
He is on 3 pills a day on Azodyl. permanently, on internet a bottle of the same quanity (60) is abt $12 a bottle cheaper. Does anyone know if it is the same as what I get from the Vet? The bottle looks different

growler~GateKeeper
May 10th, 2011, 01:22 AM
I stuck myself twice when I was trying to pull the needle off to throw it away(it didn/t want to come off.

Try twisting the hub counterclockwise as if you were opening a bottle of pop. Twist clockwise to tighten the needle onto the drip line when starting a fluid session to be sure the needle won't accidentally come off.

Found Wellness - turkey & chicken(no luck eating it) And Innova chicken (not opened yet)

found Pure Bites chicken freeze dried - he likes it.

It may take a little while for him to try the new foods because it smells different that what he's used to, try offering him a tiny bit on your finger see if he'll lick it that way.

You can also try crumbling a little bit of the PureBites onto the food, you don't want to put too much treat on the food though, the idea is to tempt him into trying something new not just covering it up otherwise he might try to just eat the treat on top & leave the rest.

Have you tried mixing a little bit (start tiny 1/4-1/2 teaspoon) of canned food in the dish with the cooked chicken? Will he eat it that way?

Not sure about the hiding food, did he go back for it later?

He is on 3 pills a day on Azodyl. permanently, on internet a bottle of the same quanity (60) is abt $12 a bottle cheaper. Does anyone know if it is the same as what I get from the Vet? The bottle looks different

I would be very wary if the bottle looks different, it is possible that is a different product. Even though it was a bit higher I always purchased Azodyl & other supplements from my vet, I was assured of the quality that way.

Ericmpls
May 10th, 2011, 11:50 PM
I tried putting in chicken breast and pure bites chicken treats in the food - he picked it out, Tomorrow Vet is going to give me dry KD food and she told me to soak it in low sodium chicken broth.

He did come back for the food he hid but only carried it to another spot,

- Sat was the first time giving him LRS at home(no problem)today was the second time I gave him LRS - not good - he fought me trying to put the needle in I put a cone on his head and it still was VERY difficult 3-4 times he jerked out the needle, finally got it to stay in, once in he laid down very calmly - called Vet, not much help, and asked her about Temuro thin walled needles - said she never heard of them - said all they had was the monojet 18g or 27g - I think Temuro 19 or 20 might work better than the monojet 18g they gave me,

I've been on the internet and calling pharmacies around Mpls for about 6 hours today to try and find some(I don't want to wait to get it online his next LRS treatment is Thursday - and the Vet said they can only hand write a perscription and not fax or call it in, so for the internet I will have to mail in the perscription.

growler~GateKeeper
May 11th, 2011, 12:55 AM
I tried putting in chicken breast and pure bites chicken treats in the food - he picked it out, Tomorrow Vet is going to give me dry KD food and she told me to soak it in low sodium chicken broth.

He did come back for the food he hid but only carried it to another spot,

Did you put the whole treat in or just crumble a tiny bit?

- Sat was the first time giving him LRS at home(no problem)today was the second time I gave him LRS - not good - he fought me trying to put the needle in I put a cone on his head and it still was VERY difficult 3-4 times he jerked out the needle, finally got it to stay in, once in he laid down very calmly - called Vet, not much help, and asked her about Temuro thin walled needles - said she never heard of them - said all they had was the monojet 18g or 27g - I think Temuro 19 or 20 might work better than the monojet 18g they gave me,

An important thing to remember is to be as calm & stress free as possible yourself before giving fluids as your dog will pick up on your emotions. If he is resisting, struggling & trying to run away, let him go calm down for a few minutes before trying again - we want to try to keep this as relaxed an experience as possible for him & you.

You should always try to keep a hand on your dog to steady the needle in place during the injection, sometimes the skin may bleed a bit if the needle is jerked out.

Warming the fluids before hand is also recommended so there isn't a big shock of cold LRS under the skin for your dog - very uncomfortable. Put the entire LRS bag & drip line inside an extra large ziplock bag & place it in a sink of warm water for a few minutes - be sure the water is not too hot as you don't want to scald your dog either. Testing the temp can be done either by placing the bag on the inside of your wrist or running a small amount of the fluid out onto the inside of your wrist - should be lukewarm to warm never hot. If it's too hot wait a few minutes to allow it to cool a bit.

Have a read through this page, it's also geared towards cats but the same principles apply for a dog: http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html

I've been on the internet and calling pharmacies around Mpls for about 6 hours today to try and find some(I don't want to wait to get it online his next LRS treatment is Thursday - and the Vet said they can only hand write a perscription and not fax or call it in, so for the internet I will have to mail in the perscription.

Did you ask your local pharmacy if they can special order in the Terumo needles for you? Sometimes if you just ask if they have them & they don't the person doesn't bother to ask if you want to order them in - you have to ask for it yourself.

Did you contact the ones on the list here: http://www.felinecrf.org/obtaining_supplies_cheaply.htm#needles_usa


Did your vet advise you on how to properly dispose of the needles? Because of the potential bio-hazard danger and also safety issues of sharp objects the needles must NOT be thrown in the garbage, instead they must be recapped & disposed of into a proper Bio-Hazard Waste Container either at your vets office or the pharmacy.

What I did was took an empty vitamin bottle (any thicker plastic bottle will work) & dropped all the used re-capped needles in there, and when it was full or on the next appointment I brought it into the vets office & emptied into their Bio Hazard Waste Container, got my bottle back to re-use the next time.

Ericmpls
May 11th, 2011, 05:48 PM
I'm a single person, and basically I've been spending 24/7 with DJ since he got out of the hospital Thursday night. If it happens to be his time to go shortly, I will be at peace with it as long as I do everything I can to give him a fighting chance.
I've been on the internet researching, and found another support group Friday and found this one last night. I AM SO THANKFUL someone from this group suggested Royal Canine LP and to try different Petsmarts to get it.
Between 3pm - 8pm yesterday I thought I was going to loose DJ, I took him outside to go to the bathroom for about 10mins arnd 3pm, 86 degrees and humid, he collasped out side, I had to carry him in. I put him on my bed and turned on the air conditioner, he lay there with his eyes shut not moving then he had the "runs" on my bed without moving, it looked like his body was shutting down and he was giving up. About 5 pm he lifted his head up and tried to sit up, his front legs gave out, he finally started to come around around 8pm last night. Today he is better - about 50% energy level ( Sunday - monday and Tuesday he was at about 75% energy level.


I told the Vet yesterday if still wasn't eating their K/D or A/D brand moist food. the Vet said come and get the fry KD and soak it in low sodium chicken broth.But if he doesn't eat the KD dry food I was going to get this morning(the only brands the Vet Clinic offers KD and AD) then his Kidneys are probably to far gone - they NEVER OFFERED TO TELL ME there were other brands of perscription kidney food out there. Late last night I found another support group for CRF Canines on Yahoo, they suggested another perscription Kidney food Royal Canine LP and that certain Petsmarts carry it. Well I drove to the Vet got the perscription for that and needles and LRS and found a Petsmart that carried it - As soon as I opened the can DJ started wagging his tail and Eating......
When I got the perscriptions from my Vet today they said that they were vwrong and did carry smaller gauge needles and they gave me some 20g to get me by till I can oder some online .
I will try calling local pharmacies agn to see if they can order it, I found a Costco Branch that has the LRS much cheaper.

growler~GateKeeper
May 12th, 2011, 01:30 AM
Sorry you're having such communication issues w/your vets, but good to hear you are on the right track now. I'm glad to read DJ is eating, no matter what it is he needs to eat.

Since you are having trouble finding the Terumo right now, see how it goes for the next fluid treatment with the 20g Monoject - you might find that to be okay, I still preferred the Terumo UTW 21g over the Monoject 20g but used them when I was out.