What is the typical path for Renal Failure?

[MollyOllyDoodle]

My darling Labrador girl, Molly, is 10.  She was diagnosed with kidney failure on July 1.  Usual symptoms: vomiting, excessive drinking, weight loss, etc.  Turns out she also has advanced Lyme's, which is probably what triggered the kidney failure.  

She started off wolfing down rice and canned K/D, and accepting vitamins, antibiotics, other meds, and alternagel.  After a week, she stopped eating the K/D and switched to pasta and soft-cooked eggs and fought me over taking her meds.  Then, she stopped eating anything at all, except hamburger rolls and organic dog biscuits.  I want you to understand that I offered her every good thing I could think of - all her favorites - but she doesn't want them.  Now, she barely eats anything.

I started subq fluids right away, and she tolerates that very well.  She has some edema in her back legs, so I've been propping them up with a pillow when she lies down and also massaging them.  This helps some, but she has progressively losing the ability to walk.  I've been carrying her up and down steps for a few weeks now, but as of last night, I'm also carrying her outside to the lawn.  

We've been seeing a gradual inability to do the things she loves: swim in the Delaware, swim in our creek, swim in the pool.  She still wants to: if you say, "Want to go to the creek?" (or a ride or the pool) her ears perk up and her eyes shine.  She thumps her tail like mad when she hears you - I don't think she can see very well now - and loves to be petted and fussed over.

Just today she has started bleeding lightly from the nose.  It is a very watery, pinkish tinged dribble and seems to come when she exerts herself.  Is the blood something I need to fret over?  

Is this the typical course for renal failure?  A gradual slowing down?  She doesn't seem to be in pain; just lethargic and quiet.  I don't sense fear, either.  

My inclination is to let her go when she is ready, providing we don't see suffering.  I keep her clean, hydrated and loved.  She is in a comfy place where she can see everyone in the house.  Is it wrong to think that she is content simply because she's not moaning or clearly in pain?  When I sit with her, I get no vibes except fatigue.  I think I'd feel it if she was hurting, don't you?

If I sound composed and matter-of-fact, don't believe it.  I have been crying pretty much steadily since July 1.  I cannot imagine our home with our beloved "doot" tracking in mud, making a racket with all her goofy "bwufs," and insisting on climbing onto your lap so that she can lick your face (and fart on you).  What will we do without her?

[MollyOllyDoodle]

Bless your heart for answering me so candidly.  I'm so very sorry for your loss.  I love that the last thing your sweet Chica knew was the comfort and love of her own home and her family.  That is my hope for Molly, too.

Since my original post, Molly has moved into a very quiet state of being.  She is still in her comfy spot, where she can track the family and also see our front yard (and all the evil squirrels, deer and other critters she used to chase).  She is not vomiting, but she's not eating much, either.  She lets me give her liquid vitamins and Alternagel, and Enalapril (most of the time).  I keep her hydrated with the subq.  She seems content, and happy to be with me or my husband or the kids.  We are still getting the tail thumps and perky ears, but she is definitely fading.    

I'm very grateful to you for letting me know about the dementia; I think my heart would break if I wasn't prepared.  Molly is the sweetest girl.  I pray that she goes quietly while one of us is sleeping beside her, or that I have the wisdom to know when she has had enough and needs our help and the strength to help her.  

Thanks again for your kind words.

[Jaybay]

I completely understand your position.  I lived it last Fall when our dog was diagnosed with severe kidney failure.  By the time the dog has severe enough symptoms to prompt a vet visit, it's usually too late.  Once vomiting begins, that means the kidneys can't filter out toxins which results in nausea, lack of appetite and vomiting.

Like your dog, we went through the KD food, the special homemade diets, etc., until Chica just had no appetite at all.  During the last month, ANYthing we could get her to eat was a victory.

One thing you can do to make your dog a bit more comfortable is to add a lot of calcium.  Pill her twice a day with a plain Tums tablet (read the label - most Tums preps are only calcium).  Calcium binds to phosphorus and removes it from the body.  Since phosphorus is deadly to animals in kidney failure, removing it can help the symptoms.  

Are you using anything to help Molly's nausea right now?  Reglan is an old standby for nausea, but it's processed in the kidneys. We were able to avoid the extrapyramidal reaction in our dog by doing injections at home instead of using pills.

The "textbook" case of kidney failure goes along just as Molly's case is.  At the end, the toxins that can't be filtered by the kidneys flow from the blood through the blood-brain barrier and cause dementia.  Molly may not recognize you in the last hours.  

In our dog's case, that never happened and it made our decision to euthanize so much more difficult.  She never gave up.  Not in the face of terrible nausea and vomiting and literal starvation to the point that her hair fell out in her last week.  Chica's decline and death was the worst pet death my husband and I have ever experienced.  I'm so thankful our vet gave us heavy-duty sedatives for Chica before she ever left our home for the last time.  The last thing she knew was being stroked while laying on her favorite couch.

I am so terribly sorry that you have to lose Molly to such a long, drawn-out illness.  It isn't particularly painful, but it's extremely miserable with all the nausea and vomiting.  All you can do is monitor her condition and use your best judgment as to when to end her suffering.  Blessings to you all.  :-(