Anyone reading this knows I don't quilt or sew that often. I hope to soon. I'll be joining a new guild and hope to make new friends and get many projects under my belt.
This past week has been tough. At least every few hours I think of our little dog, Buffy. I wish we had gone on even more walks, had more cuddles, had more playtime and naps together.
She had had several episodes of going limp and fainting. This last time, my son just told me, was the only time she gasped for air. I was there, she only did that 3 or 4 times then her muzzle twitched a little and she was gone. It's good the other times were not as actively stressful. We three were all with her for the last moments. My son and I were on the floor near the pillow she was on so it was easier to pat and talk to her, but my husband bent down to encourage her too.
Recent Medicines
She had been taking several oral medications.These were easy to give with a little tab of Justin's peanut butter. Before she had several eye drops that we administered having to wait 10 or 15 minutes between meds so it took a long time. I can't even remember how we did that now.
9:30am and 9:30pm.
Vetmedin 2.5 mg 1/2 tab
Enalapril Maleate 2.5 mg 1/2 tab
Amlodipine Besylate 2.5 mg 1/4 tab
Furosemide 12.5 mg - this dosage had been reduced from 1 about a week before she passed. It was 3/4 a tab, and was going to go to 1/2 tab and I think to 1/4 tab. A few times a day we would video her sleeping or 15 seconds and my son would count the number of breaths and they were always below what the vet said to look for (under 20?). Because her breaths were not above that number it was okay to reduce the dose.
Hydracare liver flavored liquid supplement was a hit until it wasn't. It was supposed to make her thirsty. But often she would select plain water to drink with out touching the 'liver water'. A few years ago she would lap up the water with such gusto and noise when it was hot or after a walk. Now the licks didn't seem as loud, but still lasted a long time. I changed her water bowls (was kitchen and son's room or my room, but now was kitchen, living room, dining room, and den) every morning and sometimes at night too. Because she had so many bowls it was hard to say how much she was having.
Salmon oil - added about a week or less before. We gave one squeeze around 11am and the second after her fluds in the evening.
9:30pm Red chewy - added just one day before - 1/2 pill in the evening at 9:30pm
7:30am, 3pm, 11pm - There was a new pill added (I think) two weeks before. The dose was 1/2 pill three times a day. We decided to give that at different times than the two time a day stuff - then we would have another timed reason to see and be with her. The RX was issued 01/22/2024 Sildenafil 20mg for 50.0Tablets - so we were given enough for 33 days. She only lived 20 days. What went wrong? Why did she pass away so soon?
Informational Handout from the Vet January 15, 2024
Sad and Angry Note about this Handout: Nothing in this handout gave us guidance on if there was something we could do while this was happening. Only includes additional testing or to take to the vet. There might have been something we could have done if we had known what to do, how to hold her, if moving her head would help. I didn't need to know the names of the two conditions, I needed to know what I could do if/when she was having one.
Syncope vs. Seizure
Syncope and seizures are separate symptoms that are very different, but can look similar and be hard to differentiate. These symptoms are not a diagnosis. Here is some information about each symptom to help determine which your pet is experiencing, and what next steps to take to identify the underlying disease.
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Syncope
What an episode looks like
The animal may appear to suddenly collapse, lose consciousness briefly, then quickly become “normal” again. This looks like spontaneous “fainting” with flaccid muscles, but paddling may occur as they regain consciousness. Exercise, excitement, urination, or defecation may directly trigger the “fainting” episode, but they do not urinate or defecate during their episode. Syncopal episodes last only seconds.
Common Diseases that cause Syncope:
Heart disease:
Arrhythmias causing a very slow or very fast heart rate
Congestive heart failure (CHF)
Heartworm infections
Heart tumors
Other types of heart disease
Lung disease:
Pulmonary hypertension (PH)
Blood clot in the lungs (pulmonary thromboembolism, PTE)
Hypotension (low blood pressure) caused by the following:
Certain stimuli (coughing, defecation, urination, fear, excitement)
Systemic disease (gastrointestinal, lung or neurologic disease, others) can cause this
Additional Testing to find a diagnosis
Blood Pressure
If low blood pressure is identified, further investigation can be performed to look for underlying disease (listed above) that can cause hypotension. Normal blood pressure doesn’t rule out hypotensive syncope. There could be sudden drops in blood pressure causing the episodes.
Knott’s heartworm test and 4Dx snap heartworm test.
Both of these tests are useful to identify a heartworm infection.
A cardiologist appointment
The cardiologist will perform an echocardiogram (ultrasound of the heart) to evaluate the heart structure and function. During this appointment, they can look for the heart diseases listed above, as well as pulmonary hypertension. They may run additional test based on their findings.
Chest X-Rays
These can help identify an enlarged heart, congestive heart failure, a collapsed lung from a pulmonary thromboembolism or other lung disease. However, CT/MRI scan are more sensitive to evaluate the lungs.
Abdominal ultrasound
This can help to look for gastrointestinal disease and is indicated if there are clinical signs pointing to gastrointestinal disease (decreased appetite, vomiting, diarrhea, etc.)
MRI
This is useful to evaluate the brain, brainstem, and spinal cord to look for neurologic disease that could be causing hypotensive episodes. Evaluation of the lung is also possible to help identify a collapsed lung from a potential PTE (blood clot).
Seizures
If the seizure lasts for 5 minutes or your animal has more than one seizure in 24 hours, this is an emergency and they need to be seen by a veterinarian immediately.
What a seizure looks like
Seizures always have 3 stages; Pre-Ictal (Pre-Seizure), Ictus (Seizure), and Post-Ictal (Post-Seizure).
Pre-Ictal (Pre-Seizure):
This stage lasts hours to days preceding the seizure. During this time, animals can have changes from their normal routine behavior. Changes may include anxiety, restlessness, hiding, withdrawal, increased affection, contact-seeking behavior, aggressiveness, and vocalization.
Ictus (Seizure):
This is the seizure event itself. Most seizures last 60-90 seconds. Different types of seizures can present very different. Seizures are not triggered by activity or excitement. If it truly is a seizure, you will not be able to distract your animal out of the episode because it is involuntary. If you are able to distract your animal out of the episode, most-likely it’s not a seizure.
Partial/Focal seizures affect only one or a few portions of the body. Examples include abnormal involuntary rhythmic contractions of the lip, whiskers, eye or ear on one side of the face or of one leg twitching/contracting repeatedly, “fly biting” where the animal is biting at a phantom object in the air repeatedly, or a sudden behavior change such as extreme unprovoked aggression or irrational fear, running in circles, or floor-licking. With partial seizures, the animal may retain consciousness or have impaired consciousness. A seizure can start as focal and become generalized.
Generalized seizures involve the entire body causing muscle tremors, possible paddling motions of the legs, or rigid stretched out legs that will not relax. With this type of seizure, the animal typically loses consciousness. You are not able to rouse them out of their state. Animals may drool, urinate or defecate.
Post-Ictal (Post-Ictal):
This stage may last several hours after a seizure. Animals recovering from a seizure can be confused, delirious, lethargic, restless, aggressive, have vision loss, thirst, hunger and inappropriate urination.
Common causes of Seizures: There are many. Your veterinarian can help narrow down this list.
Extracranial causes (outside of the brain)
Toxins from
Ingestion
Ammonia from Portosystemic Shunt
Organ failure (liver or kidneys)
Low blood sugar
Low blood calcium
Thiamine Deficiency
Inborn errors in metabolism
Intracranial causes (in the brain)
Idiopathic
Stroke
occlusion or rupture of blood vessel in brain
50% from systemic disease
Infections (bacterial, fungal, protozoal, viral)
Autoimmune Diseases
Cancer
Congenital abnormalities (birth defects)
Trauma
Additional Testing to find a diagnosis
Blood pressure
Complete Blood Count, Chemistry, Urinalysis
Bile Acids level before and after eating
Ammonia level
Toxin tests
CSF (Cerebrospinal fluid) sample for cytology, culture, PCR
MRI
Apequel 5.4 mg - as needed. 1.2 tab a day max She hadn't had that for a few weeks. She had a monthly injection of ________ that did a good job on controlling her need to scratch or bite herself. Why can't I remember the name? It's cytopoint. I remember now. We'd have her nails trimmed during the monthly injection.
Fluids and Time Together
In the eevening my son and I brought her upstairs to my sewing room with the variable height cutting table and hook to hang her fluids on, and we gave her 200ml fluids. At first this took 40 minutes for the set up and giving it to her. It took days before we figured out the right way to set things up. At first I put a little peanut butter in a bowl for her to lick, then put it on the back of the bowl for her to lick. Then we decided to put her wet food in the bowl with a little peanut butter. Boy she liked that! She would eat that as her main meal. Sometimes I even brought more up as a back up, but after the first bowl was gone she rarely if ever eat from the second.
The lines on the fluid bags were uneven and we spent a bunch of time trying to figure that out. Even getting a scale that my son would hang the bag to try to get it perfect for little Buffy. The bottom line was a 9 then there was a space that seemed to be double the distance between the other lines. It was confusing.
Every 4 or 5 days my son would change the bag out and put in a new prepierced Y-Site 80-in 15 drops per mL. I tried to insert this a few times, but always had to give to him to finish. She finished a bag the day before she died.
My son would hold her while I inserted the 19-gauge thin walled needle. He would then put his finger on the needle to keep it in place so I could hold the food bowl or look at the level of the fluids going down. At first he stood at the other end of the table, but at the end he was at the end nearer to the bag. That made it easier for me to insert the needle. I would use three fingers to tent the skin before inserting it. At the end it took less than five minutes to insert and withdrawal the needle. And even when the fluids did not drip and I had to withdraw, put a new needle on and try again it was like six or seven minutes.
For a few days, I don't remember why, my son was gone so my husband held her gently while I inserted the needle. He needed more practice to hold the needle down. I did it and it was scary as I didn't know if he or I would move and the angle of the needle would change and damage her. But we didn't move and she was okay. I only knew my part of the job so was a lousy instructor. My husband doesn't like seeing or being around needles so it was very nice that he stepped forward to help when needed.
Buffy only very rarely made a noise or moved to tell us the needle wasn't placed correctly - meaning we did it correctly. It never seemed to hurt her, even the three times when she was clearly bruised and had blood show when the needle was removed. After the first time that happened, I usually had washcloths in the room so we could cover her after the needle was removed. I would cover her side with the needle underneath and pull the needle back carefully. It seemed to help ensure I took the needle out so it was flat against her body and not pulling it out at an angle. My son and I got used to talking to each other during these times. I looked forward to the chat - and the hug of thanks he would give me. We would thank Buffy too and tell her how good she was.
Fluids and Eating and Treats
Since her January 12 episode she was sometimes not eating when we gave the fluids. I brought up washcloths so I could wipe my hand before removing the needle, and I would heat the food before we came upstairs then offer it to her in my hand after I had put the needle in. I wrote last week how she was so gentle while eating from my hand, she would sort of suck the food by putting her mouth around each finger. She seemed to like that most of the time - she would eat all but a teaspoon of food that way. At the end I wrote down the start and end time, where I put the needle, and if she ate or not.
At some point we were weighing the food we offered and taking notes on that. Then we started using a little scoop and give her two of those. We weren't used to wet food so when she would eat, usually we would only put out one scoop of food.
We got some stuff that was supposed to make her eat more and gave that to her a few days, but she started eating on her own again so we stopped that.
She liked carrots. Oh she liked carrots. I used to hide pieces under towels and she would have so much fun finding them and eating. (We never thought about giving her carrots until I had visited a friend who showed me how she hid carrots under towels for her hamster to find, and a different friend showed me how she gave her dog carrots to eat. It's good to visit other people and learn things!) Once she lost her eyes though it was easier for her to smell them when they were just on the floor. Sometimes I'd toss several at a time and let one of them brush her back or side as it slid down to the floor so she would know to look for something, but most recently I'd drop down one at a time and wait for her find it before putting another one out.
She used to like Zuck's treats too - we'd cut one up or break it apart with our fingers so she could find them on the floor or in the towel too. Those Zuck's dried out quickly if no sealed up, so i would empty them in to a left over sauce jar - then they were easy to break apart and give to her. Once she was prescribed kidney diet food Hills Beef and Vegetable Stew we didn't get those for her anymore. The Hills Diet had some Prescription Diet Original Crunchy treats that were really large and hard - she never enjoyed them as much as Zuck's but would eat them. Usually I cut in at least 10 pieces for her.
When we ate them I would give her a teaspoon of peas, cooked zucchini, or egg. She mostly had 'dog' food and carrots though. Sometimes my husband would heat the carrots and she liked that. I started doing it on a regular basis this year.
She loved hard boiled eggs. One time though - during the start of pandemic she ate a whole one after eating regular food. We got afraid and rushed her to the ER. Luckily nothing was wrong, they just looked at her and returned her to us in the car (we weren't allowed to come in). They did not charge a fee for this service.
A mystery is that the last few days she was eating 4 or 5 scoops of the food, drinking water, and she would get up at night and eat the dry food we had out just in case she wanting it. My friend gave me a puzzle dish I think it's called and Buffy seemed to always eat the Hill's Kidney Care with lamb dry food from that first, then from the bowl! I took to measuring how much she had eaten every morning. I used a pill bottle as a measurer. We tricked ourselves into thinking the medication changes we making her feel better and she would be with us for longer.
Dried Food and Kidneys and Pumpkin our cat
Before the kidney diagnosis Buffy ate Natural Balance Limited Ingredient Grain-Free Salmon and Sweet Potato Small Breed Bites.
Our little kitty, Pumpkin, had AIMS dry cat food and also was diagnosed with kidney trouble. She was much younger. The vet said the dried food wasn't good for her. I remembering briefly thinking Buffy shouldn't have dried food, but then thought the food wouldn't matter for a dog. (AIMS was the brand they gave us at the shelter when we adopted Pumpkin.) We had a much harder time giving her fluids. We gave her fluids while she was on the ironing board. I hung the bag from a hook on the bathroom door. I think at the end we switched from a bag to somehow filling a tube and then putting the fluids in her. I can't remember. But I know we used to have lots of those things in the house. My son used to tape them together, to create toys with them. I can't remember. That's why I want to type this out.
I think perhaps little animals should have wet food all the time, not just when they are ill.
Once she became ill I used to get little cans of different flavored food for Pumpkin and arrange it on a plate as her tastes would change every day. Just please eat something, Pumpkin. As Pumpkin grew more ill she stayed very distant to us. I was the only one home when she died. She was upstairs by my son's bedroom opened door. I was working downstairs. She let out a loud meow. So loud that I left my computer and went upstairs to see what had happened. But she had passed by the time I went up. She looked so pretty sitting there. Her eyes were open though. I called the vet and they said to use glue to close her eyes before my son saw her. Instead I put her on a yellow towel and then put her in the basket he had for his first year at Waldorf and covered her up with the towel. I called his school (he was in first year of high school) to ask the secretary to put him on the phone, but she said to wait to tell him until her came home. Somehow I picked him up at the regular time and told him. Or maybe someone it was the day for him to be driven back by someone else. I can't recall now. He didn't want to see her, but I think he came with me when I took her to the vet for cremation.
When Buffy was first diagnosed with kidney failure, the vet gave us a prescription for wet food. Buffy loved it for about two days, then she would eat all except the rice and then the rice and carrots, and then she would pretty much not eat it. When we went to Petco, my son happened to find the Hills Kidney diet and she preferred that for two years? I'll have to check to see how long.
We ordered from Chewy's since March 27 2020 so I have those records to refer to. We have all or most of the logs of her earlier medicines and foods. My son has been collecting them in his room.
There is more to remember, and I will organize this later. I've gotten all clinical tonight - I think it's too sad to recall the little daily joys of being with Buffy. But now this is enough even for me!
It has been a week now.
Oh I discovered that Frosted Faces Foundation, in Ramona, https://frostedfacesfoundation.org/ will accept her opened medicine and all the unopened things we have for her, and the girl who does the manicures has dog who takes some of the same meds too so I will bring her the bottles next this coming week. Frosted Faces can use the beds, little blankets, sleeping bags, pillows, toys, pens, crate, and more too. We will start with the items that will expire. We got a lot of things for our little Buffy. The house is still full of those things, but not our little Buffy. The house seems empty now.
