I have had more than one kidney cat… no kidney dogs. Thankfully only one that progressed to higher stages. As others have said, nausea control (Cerenia, Zofran) and antacids (Omeprazole, ranitidine, etc) are key to QOL and appetite. Glad you’re working on both. When Cerenia didn’t work for my cat, we switched to Zofran.
Sorry to hear that but good that only one progressed to higher stages! I worry about this with my bread addicted cat. He eats a wet, sloppy raw diet full of health…but then will go to extreme lengths to steal bread in any form and while we try to prevent it, his determination is strong. We usually have to lock cooling loaves in the bathroom to keep them safe, but then that bathroom can’t be used because gross.
Do you think the meds helped to stop progression or were you able to use diet to stop the progression?
Also, I thought the zofran was in addition to the Cerenia. Is it supposed to be in addition to the pepcid instead? @Simkie? (I would love to replace the Cerenia)
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Zofran and cerenia are different classes of drugs, and act in different ways. I like using them together, and find that most effective, but if zofran is enough, you can drop the cerenia. Cerenia, in addition to being an anti emetic, treats visceral pain, too. (It’s a substance P inhibitor, and inhibiting substance P does all sorts of weird and interesting things that can be helpful when you’re working on end of life care. Here’s the wiki article about substance P.)
Continue Pepcid regardless of what you decide with Cerenia and/or Zofran. You need to control the acid production in kidney disease, regardless of nausea or how you’re treating it.
In your shoes, I would probably hit her with everything in the toolbox, get the nausea WELL in hand, then decide if you want to adjust anything. It’s a little gamble, because sometimes when you drop a med and see a return of symptoms, starting it again doesn’t provide the same effect. But nausea is such a big hit to QoL, using your entire toolbox to control it isn’t unreasonable.
At some point in the future, once you do have it in hand, control will slip. It’ll be one day where you’re doing everything you’ve done before, but it just doesn’t work. Control seems to come back, maybe later in the day, or the next one, but that’s always my sign to schedule euthanasia. Once the meds stop working, even for a little, that’s the downhill slide. But they can often go for awhile feeling good before that happens 
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Thank you. That’s all very helpful.
I may come off as a terrible person, but if she needs the Cerenia to maintain QOL long term, that may be where we say goodbye. I don’t mind expensive meds for treating conditions that can be cured, and it might be different if she were bonded to me or my husband and we would have solace from extending her life. She’s always had what she needed (ACL surgery, joint supplements, dental work, etc) and we care about her and her well being, but this is a degenerative situation and she’s a bit difficult personality-wise. Like if we sit down next to her on the couch, she will get up and move. She only accepts petting when she wants her face rubbed, otherwise she’ll walk away. If she doesn’t feel like going on a walk, she will plant and not move, then 10 minutes later ask to go outside.
When my husband was going through treatment for a late stage cancer, she became terrified of him and hid from or would run from him if he tried to take her out, while the cats all tended to his emotional needs like good friends (understood this wasn’t her fault. Just didn’t help their relationship). It’s looking like he might need to go back into treatment soon. Money will be tight. The dog will be extra unhappy.
All to say- I’m doing my best with her management right now, but if I can’t keep her comfortable without causing financial discomfort, that will be when it’s time.
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I totally support your thinking.
There comes a time when you sit and realize that this one more Thing (meds, supplements, whatever) is the Thing that tips the scales for a myriad of reasons - financial, disruption to your schedule, disruption to the house - and all it is doing is prolonging the inevitable.
There’s no cure here, just varying degrees of comfort/discomfort for everyone involved, not just your pup.
I was fortunate that I had a dog that had a decent prognosis in the beginning, was showing progress, was extremely engaged in life - not just the treatments, and wanted to interact and love on his people. Had any of those variables changed, euthanasia would have moved to the top of the list for me.
So no, you do not sound like a terrible person. Don’t beat yourself up for knowing where your line is.
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Totally reasonable. Not at all a bad place to draw a line. You’re definitely not coming off as a terrible person, and don’t ever feel that way. Much better to have this line, IMO, than to pour all of the dollars into keeping an animal alive even with terrible QoL. Don’t ever feel bad about knowing where your limit is, and have comfort in the fact you’re still making a good call for the dog even with a limit that’s financial in nature. In the end, this is a life limiting condition. She’s going to die. Palliative care is making her death a good one, and no one wins by just spending the most
I’m really sorry to hear your husband is facing another round of treatment, and hope it’s successful. Glad the kitties are there for cuddles!
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Famotidine (Pepcid) is about 2/3 eliminated by the kidneys so if it seems to work, you might run it by the vet. Probably decreasing the dosing to once a day would prevent accumulation of the drug.
Susan
Thank you!
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We have the Cerenia, pepcid, and zofran in the dog. The generic zofran was wild. A two week supply rang up as over $100, then the pharmtech commented that that was expensive and offered me a QR code to find coupons, and then the coupon brought it down to $16. Why…is that how it works?
She is ok. No longer willing to eat the senior baby chicken and noodle meal, but she ate the back-up peanut butter toast for breakfast. Starting to have some anxiety over what to offer for dinner since we have plans and I’ll only get one shot.
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I’m always mystified by those coupons/discounts, etc…
Fingers crossed she’ll eat some dinner. Maybe just try the cottage cheese since that’s been pretty reliable?
I’ve given her two half teaspoons so far today to get the pills into her. Think that’s getting to be a lot of phos on top of regular meals? I could also try very small cubes of bread coated in raw food. She tried to steal a cat’s breakfast this AM and it’s the same brand and flavor…or another jar of baby food. She left some noodles behind last night so I’ll give those a break.
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Oh, well if she was interested in the cat food and you have something close, go with that!
One of our vets told us once that there would be days where we should just celebrate that our guy wanted to eat, and not worry so much that it wasn’t the ideal kidney diet, as long as in the bigger picture we were following her rules.
Oh, yeah, def always look at GoodRX for pet people meds. I actually thought generic zofran was pretty cheap on its own, but I must’ve been remembering something else, sorry for not mentioning. 
It’s always weird how there can be BIG swings between pharmacies:
Super that you’ve been able to get it on board!
Aversion is tough. Even if the drugs kick in and she feels better, she’ll remember that eating certain things made her feel bad, so she may refuse those things. Offering stuff that’s just different from before in smell and taste and texture is generally successful. It sounds like you’re a pro at that!
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Thanks, Simkie. I feel like I’m running out of new foods to try. Even with all the drugs on board I’m having a hard time getting her to eat. Cottage cheese is now a “nah” so getting pills in has been rough. I was going to call the vet this AM to see if I could get her in for fluids to see if that would help, but then she lapped up a nice bowl of warm raw food soup and seems spunky this AM, so we carry on.
She will no longer eat pasta or the 3 types of meaty (but non beef) baby food I can find in stores here. I’m going to try to circle back to some foods I haven’t offered in a while. Yesterday morning I had 5 plates on the ground with a dollop of something on each one as I stood poised to poke her pepcid into whatever she might show interest in 
At least the zofran dissolves in her cheek so it doesn’t require food.
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I’m really sorry, I know how stressful it is when they just won’t EAT 
Something I had luck with, although you’d have to check it out from a kidney diet perspective, is Fresh Pets. It’s a refrigerated fresh food, and they have a few different types. I used the “kibble” for a kitty dying of cancer, and it’s just unlike anything else. Sort of a semi moist fresh kibble. You can find it at the grocery store.
But, if you need to continue offering new things, that’s likely an indication the nausea is uncontrolled despite the meds, and that’s probably a time to call it rather than continue 
One other thing to try would be adding an appetite stimulant like mirtazipine. I’d only do that if you think her nausea is controlled, and she’s just too averse to eat, or if you think it’s an appetite issue (which is separate from nausea.)
Mirtazipine is cheap from a human pharmacy with GoodRX:
https://www.goodrx.com/mirtazapine
And it’s dosed every other day or every third, which is nice.
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Yesterday eating was a bummer and she just seemed unwell-- vacant and had the little bit of kidney pain hunch to her back and even when she was laying down, it didn’t seem like she was restfully sleeping. More of a blank stare. I was feeling ready to take her in for fluids to see what that did and call it if that didn’t help turn her around.
This morning she hopped off the couch looking for breakfast and ate two (small) bowls of warm soup and was ready to go for a walk. I don’t know what to think about her nausea and appetite at this point. I ordered her some salmon, which she hasn’t had for a while…maybe that will be a good test.
I’ll look for the Fresh Pet. I’ve been wary of it since my MIL’s dog has a violent allergic reaction to it, but that’s just one data point. I’d just want to make sure it doesn’t have added phos
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During the last months of my dog’s life, I resorted to cat food. Overall, feeding a dog cat food is not a good idea, but when it comes down to cat food or nothing, he got the cat food. It smells better and has good protein levels. It kept him going for a while.
Dogs with Kidney failure in old age don’t do as well as cats. You can manage a cat for 3-5 years, for a dog it’s more like 6 months. You are doing great and if you decide it’s not working and the dog does not have QOL, that’s OK. Eating is good indicator of how they feel. Having kidney disease makes them nauseous. Once you can’t control that, it’s hard to maintain QOL. My best to you. So hard to lose our friends.
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Sorry, I’m late to the party!
I’m currently managing my 14-year-old Basset/Lab cross (yes, she’s adorable!) for early kidney disease. Will share some things:
- Sweet potatoes: She loves them! I mix sweet potato baby food with her Rx canned food and she scarfs it down. She also gets various dehydated sweet potato treats - some I buy and then I’ll slice up and dehydate sweet potato in the oven. These never get old for her. She’ll eat as much as I’ll give her. Her poops have lots of orange in them, LOL.
- I give her a 10 mg Pepcid AC morning and evening. I hide it in a treat.
- CBD. I give her bacon flavored CBD on a sweet potato chip every night. Helps calm her and helps her sleep.
- Royal Canin has a Rx kidney disease food - Renal Support S. The S stands for savory. My girl scarfed it down when I first got it. She’s slowed down a bit on it but seems to like it better than anything so far.
- Carrots & blueberries are two more things my girl loves.
Best of luck in managing your dog!
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RJC, I’m sorry. We’re also in this club with our 15 yr old. I wouldn’t hesitate to do the stimulant. Give it & then offer her something she likes. IMO, it won’t make them eat what they don’t like, but it helps them to eat a larger quantity of what they do like.
Ours swore off kibble as of Friday & has been existing off boneless skinless chicken breasts, lean ground beef & her low sodium hard treats. Can you explain your balanced diet adding fat & oil? Sadly ours hates rice/potatoes & never met a vegetable she liked. The vet said today that she wasn’t in pain, but euthanasia was a strong consideration. I couldn’t do it, mostly because my dog wanted out of there, desperately. Like she kissed my face for a minute straight when we got in the car. I’ve decided on in home euthanasia, but I’d still like to try different foods. I’m unsure how to build a balanced diet around her 2 proteins. She has zero vomiting & normal bowel movements, albeit small. She’s maintainined her weight the last week & still enjoys her walks, massage time & playing with her cats. She ripped around the house with joy when I got home from the stable tonight. It’s so very hard. I don’t wish it on anyone. Best of luck to all those going through this. <3
Sorry you’re here too. I used the table below to calculate the grams (for large values) and mg for Phos/Potassium/Sodium for her 350 calorie/day needs. Then I used a recipe calculator (https://happyforks.com/analyzer/result) to figure out different combos and fill in fat needs with butter or oil.
The best way I found to get veg into her (since she stopped eating pumpkin, sweet potato, or carrots) was to chop cabbage very finely and cook it with her rice so she hardly knew it was there. Until she stopped eating rice.
(ETA: I followed the Therapeutic CKD values)
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