Thursday, August 27, 2009
A Big Dog With a Big Problem
Kodi was a BIG dog-a gorgeous 120-pound Malamute- who had a very big problem-his kidneys weren't working like they should. For him, this meant the waste products of every day metabolism that build up in the bloodstream just kept rising, unable to be filtered by those failing kidneys. Now, Kodi wasn't an old dog as you would have expected. Older patients get things like organ failures-they just wear out after years and years of use. Sometimes they get cancer in those organs. This just wasn't the case for Kodi-he was only 4 years old. As we attempted to treat Kodi for the obvious problems resulting from his kidneys not working, we also had to go on a hunt for possible causes of their failure-or we might not be able to stop it from happening again.
Since kidneys are a filtering organ, anything that travels in the blood stream and accumulates in the kidneys could potentially casue those organs problems. Drugs like non-steroidal anti-inflammatory medications can do this, especially ibuprofen, a drug really meant for human, NOT canine use. Other medications humans routinely take could have renal toxicity problems in dogs, but Kodi's owners were fairly certain he didn't have access to anything like that. They hadn't given him anything as some people do, "just to make them feel better" before resorting to a veterinary visit. We couldn't think of any plants or yard products/chemicals he could have eaten, and they hadn't changed their anti-freeze in their cars recently. Anti-freeze is a well known kidney toxin.
There are, of course, primary diseases of the kidneys themselves-infections like pyelonephritis which can develop from bacteria that travels up the urinary tract from the bladder to the kidneys when a pet has a bladder infection, often unnoticed by owners. The blood work we did on Kodi did not indicate any infection in his body right then, but it was still a slight possibility.
Leptospirosis is a bacterial disease that can affect the kidneys of dogs, as well as humans. Wild critters such as possums, racoons and rats can be the carriers, spreading the organism through their infected urine. The disease can be serious for both humans and animals. In people, the symptoms are often like the flu, but sometimes leptospirosis can develop into a more severe, life-threatening illness with infections in the kidney, liver, brain, lung, and heart. Because we had put many of the other possibilities for Kodi's kidney problems lower on the differential or "rule-out" list, leptospirosis worked its way higher up the list. Testing for the disease is done via a blood sample, but results often take 10 days to get back. Since the treatment for the leptospirosis bacteria itself is done with antibiotics, we decided to start Kodi on these right away rather than wait for the test results to come in.
Leptospirosis is one of the "big" diseases we usually vaccinate at-risk dogs for every year, but unfortunately the vaccine does not provide 100% protection. This is because there are many strains (types) of this bacteria, and the vaccine does not provide immunity against all strains. It is important to get your pet vaccinated again even if it gets leptospirosis because it can still get infected with a different strain of leptospirosis. Kodi was vaccinated each year for 4 different strains of lepto, but his test came back positive for another strain, one for which a vaccine is not available. It was a good thing we had started him on antibiotics when we did. when we got the test results back, we also started his house mate, Kiona, on a prophylactic course of antibiotics. She wasn't showing any symptoms of the disease, and we certainly wanted to keep it that way.
As mentioned, treatment for the leptospirosis bacterial infection is antibiotics, specifically those in the penicillin family. These will arrest the on-going infection, but dogs can remain carriers of the disease unless a second antibiotic from the tetracycline family is used, often for 6 weeks, to break that carrier state. Kodi was initially put on injectable ampicillin since he was so nauseated and anorectic from the kidney disease that resulted from the infection. And this was the big problem: we had a handle on the disease and could get it treated, no problem. But the damage it had already done to Kodi's kidneys was severe-he was hospitalized multiple times, once for 4 days in a row for 24 hour a day IV fluid therapy in a attempt to diurese his blood and get those kidneys working again. It never worked. His owners were terrific. They did everything we asked of them, bringing him in for testing, for hospitalization and treatment despite the considerable time they had to take off work and expenses they incurred. He spent a lot of time with us and in the emergency hospital when we weren't available.
We really expected such a young, big, strong, dog to turn the corner any time and make a full recovery, but it was not to be. Kodi's initial bloodwork showed just how poorly the kidneys were doing, and his first retesting of their values showed good improvement. Kodi was given very aggressive care, including those antibiotics, fluids, anti-vomiting medications, prescription renal diets to require less work on the kidneys while providing good nutrition for healing, antacids, appetite stimulants, phosphate binders (phosphorus levels go sky-high in kidney failure patients, making these patients very weak and wobbly, and Kodi was no exception)-you name a drug in our pharmacy and he probably was on it at one time or another! Subsequent testing showed no changes in those kidney values, and his phosphorus levels worsened, making him even weaker. His owners were reaching their limits of what they wanted to put him through, and frankly, what they could afford to spend. When Kodi finally became painful-his kidneys evidently swollen and tender-he was crying out as only a 120-pound Malamute can-his loving owners made the choice to end his suffering and said goodbye. It was a terrible tradgedy-his owners did everything right, loved him, fed him right, provided him with good preventive health care-and it just wasn't enough. They unselfishly did the right thing for him that weekend, as hard as it was on everyone involved.
Kiona is still symptom-free, and we fully expect her to stay that way. We had a little scare when one of out veterinary technicians became ill this week and made sure to alert her physician about her exposure to leptospirosis. In fact, we were required to report Kodi's case to the state veterinarian, that's how serious this disease is.
Definitely get your pet vaccinated for leptospirosis (the "L" part of a typical DHLPP vaccine) if he or she is at risk, and do your best to control the rodent/small animal population to minimize their urine in your pet's environment. Leptospirosis is out there, but is not a very common disease, thank goodness. If your pet has been confirmed by your veterinarian as having leptospirosis, don't despair. Early, aggressive treatment usually brings about good results. Kodi's case was rare and tragic.