Monday, December 3, 2007

Jaffa/Sunshade Kidney Regime

I know the words, "THANK YOU" from me now might seem like such a cliche, and you're probably all tired of hearing them from me......hehe.. BUT, that's exactly how I feel day after day. I continue to get words of encouragement from people all over the world who have grown to love Sunshade & Jaffa. We have also just started to receive our Christmas cards from the exchange, and they are all filled with words of comfort. So THANK YOU! I am so grateful to have all of you with me on this journey to make OUR Jaffaman the best he could possibly be health wise.

Jaffa is still feeling great with LOTS and LOTS and LOOOOOOTS of energy. Clinically, he shows no signs of being in renal failure. We won't be doing blood work for another few weeks (I'm thinking to wait until after X-mas....) so we have no idea how his kidneys are currently functioning. I will definitely keep you updated tho, so no worries!

A few people have asked me about the renal supportive supplements I've been giving Sunshade and Jaffa, and also about Jaffa's diet. So I will be posting what I've been giving Sunshade for the last five years that's kept her kidneys healthy, and what I'm doing with Jaffa now.

(Sunshade: I think she meant to say, the post gets boring from here on. Not that it was interesting to begin with, it wasn't about the perfect ME.... Nothing is ever about the perfect ME anymore....)



DIET:


Diet restriction only needs to be done when serum Creatinine & BUN are elevated. If done too early, you risk doing more harm than good. This is why even tho Sunshade has compromised kidneys (normal blood work), she has not been on a kidney diet.

(Sunshade: I swear I'm on a restricted starvation diet. I'm literally STARRRRRVED!) That's a weight restriction diet Sunshade, not a kidney diet..........

There is a common misconception that "protein" is bad for compromised kidneys. The truth however, is not actually the protein that is damaging, but the nutrient "Phosphorous". Usually, foods high in protein contains higher amounts of phosphorous. Meat for example is a lot higher in phosphorous content than say vegetables. So you do, inadvertently end up limiting the amount of protein in take per day when trying to limit phosphorous content.

Keep in mind when formulating a kidney diet, you want to feed foods that are most bioavailable (little waste, easiest on kidneys), higher fat content (for extra calories), while keeping the Phosphorous content within the daily allowance. Cooked egg white is the PERFECT type of food for kidney dogs as it contains moderate amount of VERY high bioavailable protein, and is very low in phosphorous.

The daily allowance for dogs in mid-stage to late-stage renal failure is:

11-15 mg of phosphorous/per pound/per day.


According to Jaffa's last blood work, he is in very early stage of renal failure. However because his condition might be acute or reversible, we are treating him more aggressively than we normally would for a dog at his stage.

Jaffa should weigh around 60 lbs, so his diet is based on his daily allowance of 660-900 mg of phos per day.

I use a very useful site called NATS (Nutrition Analysis Tools and System) to formulate his diet.

Sample Kidney Diet for Jaffa (growing, high energy, large breed dog):

  • 50 g Whole Milk Yogurt
  • 1 Cup Cooked Glutinous Rice
  • 1 Cup Cooked Butternut Squash
  • 600 g Regular Ground Beef
  • 4 Large Egg Whites

Once I punched all that in, I get the analysis for each individual food item: (click to enlarge)


I click again, and I get the combined analysis. This is what I'm more interested in because it tells me the total amount of Calories, Protein, Calcium, Phosphorous, etc the diet provides.


From the analysis, I can see that he gets 897.67 mg of Phos/day, which is within the allowance range. He is getting enough calories (Sunshade: waaaaaay tooooo muuuuuuch energy for land sharrrrrrrrrking!), and the protein he gets are in high bioavailable forms (raw meat, cooked egg whites). I divide the diet into three portions and feed him three times a day to make things easier on his kidneys.

I have dropped all raw bones from Jaffa's diet. As nutritious as raw bones are, they are also very high in phosphorous. The Calcium to Phosphorous ratio in the diet needs to be balanced or the body will pull calcium from bones/teeth to try to balance the serum Calcium. Because he is no longer getting calcium from bones, I am having to add a calcium supplement with every feeding.

Ca : Phos ratio in diet should be ~ 1.25 : 1

From the recipe, he is getting 897.67 mg of Phos, and 166.92 mg of Cal.

I multiply his Phos number by 1.25 to get how much Cal he should get to get the ratio:

897.67 mg X 1.25 = 1122.1 mg of Cal

Then I take the should get Cal amount (1122.1 mg) and minus the Cal already in the diet (166.92 mg) and I get how much Cal supplement I need to add.

1122.1 mg Cal - 166.92 mg Cal = 955.2 mg Cal to add

Since I'm dividing the recipe into three feedings, I divide 955.2 by three to get how much Cal supplement I need to add per feeding:

955.2 mg / 3 = 318 mg Cal per feeding

I use pure Calcium Carbonate or a veterinary kidney formula Epakitin (Calcium Carbonate + Chitosan) to balance phosphorous.

This is what I give Sunshade too instead of bones on days she gets red meat only. All the white meats Sunshade gets have bones ground in them.

I believe in feeding different varieties. So I alternate meat sources and also buy ground chicken/turkey without bones for him. Yes.... that means a different analysis with each item I changed since they all have different phosphorous contents.

I don't like all the carb he is getting, especially the glutinous rice, but they provide extra calories and are low in phosphorous. Basically used as fillers.... SIGH... gotta do whatever that's best for those kidneys tho..... at least for now.... (can you tell how much I dislike giving them grains?? LOL)


KIDNEY SUPPLEMENTS for Sunshade & Jaffa:


Here are the supplements Sunshade has been getting since I found out about her kidney insufficiency in 2003:

  • Vit-B complex, Vit-C

Both are water soluble vitamins. Kidney dogs pee a lot more, so those get leached out.


  • Fish body oil (highest EPA/DHA)

protect kidneys, and other body organs. The higher the content of long chain fatty acids EPA/DHA are the better. It is also great for Sunshade's arthritis.


  • Vit-E

Fat soluble vitamin. Given to slow down the oxidation process of the high dose fish oil given.




Glandular supplement made from raw bovine kidney tissue. Provides kidneys the nutrients they need. Also cleanses blood.


  • Hawthorne/Milk Thistle/Ginkgo tinctures


Hawthorne and Ginkgo are both to increase blood flow throughout the body. Increased circulation, better for the kidneys. Milk Thistle is detoxing liver. Sunshade usually goes on the tinctures for about two months, then she's off them for three months, and back on two and so on. The tinctures come in an alcohol base, so I pour boiling water over to evaporate the alcohol before giving.


  • CoQ-10 (Coenzyme Q10)

An antioxidant aiding heart health. However, studies have shown that it seems to reduce serum Creatinine reading in human kidney failure patients. It needs to be given in or with an oil base for it to be properly assimilated. Some products come in an oil based Q-Gel capsule,


some come in dry capsules like this,


Dry capsules should be given with fish oil.

Here is a medical journal on the effect CoQ10 has on humans with end stage renal failure - "Randomized, Double-blind, Placebo-controlled Trial of Coenzyme Q10 in Patients with End-stage Renal Failure"

More reads,



  • Probiotic Formula with a Metamucil capsule


I give a probiotic formula that contains a few specific strains of bacteria (Streptococcus thermophilis, Lactobacillus acidophilus, and Bifidobacterium longum) together with a capsule of psyllium husk (Metamucil).

The reason I give the above is based on Kibow Biotech's Enteric Dialysis - "the process by which colon-friendly, non-pathogenic microbes consume uremic toxins or metabolites."

Basically those probiotics work together with a prebiotic (psyllium husk) to form a nitrogen trap, and trap the excess uremic waste the compromised kidneys cannot process. Instead of going through the kidneys and being eliminate via urine, the uremic wastes are eliminated through the bowel. Hence reducing uremic toxins in blood.

You can read more here about Kibow Biotech's Breakthrough Veterinary Product - Using the bowel's capacity to substitute for failing kidney function

If you have a small dog, you might consider buying the Kibow product. It is also being sold under a different name now - Azodyl.

Unfortunately, I can't afford $200 per month on one supplement for the two of them. So I found a probiotic formula which contains the strains I want and just give it together with a Metamucil capsule. I have no idea if I'm giving them at the right ratio for it to work the way the company's product works.... but Sunshade has been doing well so far.... knock wood.





Recommended for dogs in kidney failure to use as a phosphorous binder. It contains calcium carbonate and Chitosan. Company claims studies have shown Chitosan to be effective at lowering serum calcium.

1 scoop = 1 g = 100 mg calcium carbonate + 80 mg Chitosan

With Sunshade, she ever only got this when on days she got red meat only, no bones to balance out the phosphorous.

From what I've read on the K9KidneyDiet list, Epakitin should NOT be used if the serum Calcium is elevated. Also, it is NOT an effective phosphorous binder *if* the serum Phosphorous is elevated. An aluminum based phosphorous binder (ie, Amphogel) is required then. Some suggested buying Chitosan alone and give it on its own if it does indeed lower serum Creatinine reading.

Right now with Jaffa, I alternate Epakitin with pure calcium carbonate. Because his serum phosphorous level is normal, he does not need an aluminum based phosphate binder.


SUPPLEMENTS for Jaffa only:


Here are some supplements only Jaffa is taking because he needs all the help he can get right now. His liver was also effected, so he is on some liver supplements as well.


Kidney glandular supplement with some herbal ..... stuff... LOL. Prescribed by Janice


Liver glandular supplement with some other herbal... stuff. Prescribed by Janice


Sam-E or S-Adenosylmethionine. Protects liver cells from cell death, useful in cell repair and healing.


Ummmm..... eight different kinds of chinese herbs combined. Aids dogs with kidney failure. Prescribed by Janice.


FLUID THERAPY:

Jaffa gets 500 ml of Sub-Q fluids a day. I know some feel since he is in an acute stage, I should be treating him more aggressively with anywhere between 700 - 1300 ml of Sub-Q per day. However, the truth is, I can only get about 500 ml in him in one spot, and I really DON'T want to have to poke him twice a day with those HUGE needles. I'm not sure if you can tell how big that needle is beside a ball point pen..... but it scares me..


He has been so good, so co-operative with me poking and giving him fluids. The first time I poked him, he turned and gave me that "Why did you hurt me mummy?" look, and followed by a few kisses.... almost made me cry (but I didn't!). Then I told him to lie down and stay, and he fell asleep with his head on my lap. My Jaffaman!!

Here are a few pictures of Jaffa getting Sub-Q,




And some loving!! It takes about 15-20 mins to give him 500 ml.



Oh, and he looks like he's got a big growth on the side with all that fluid inside him.....



I do get at least another 500 ml of water/broth in him be it through mixing with food or syringe.
(Sunshade: mum, are you gonna talk about ME?? How perfect I am??)

Ok ok, here is a little brag about the perfect Sunshade.. hehe. Since I found out about her kidneys back in 2003, I knew keeping her hydrated was very important. She never drank enough water (I felt), possibly due to the moisture from her raw diet. So I, of course, was worried.........

(Sunshade: so you know what SHE did to the perfect ME???

Teeeeeeelllllllll them mum, about how you've tortured your perfect Airedale TERRRRRRRRRIERRRRRRRRRRRR!!)

Hmmmm...... I trained the perfect Sunshade..... to um.... drink on command LOL. Yea... so everyday, I tell her to "GET WATER" and "FINISH IT UP" anywhere between 1 Litre to 1.5 Liters of water throughout the day.... for the last almost 5 years....

(Sunshade: you keep saying I'm over weight, I eat too much, you cut my food portion down. I bet you anything, I'm made up of ALLLLLLLLL water!

HMMMMMMPH!
)


Sunshade really is a good girl. I by no mean "forced" her to drink, not even by syringe. I started out by making her broth, and gave her full strength broth while adding in a command like "GET WATER" while she was drinking. She associated the drinking action with the command. Then I started to mix half broth half water, slowly cutting down the broth while upping the water. Used the same command, and she learned from drinking that "GET WATER" meant to finish the bowl of broth/water put in front of her. So now she knows the command even when I give her plain water.

I do get that "I'm really NOT thirsty!" look from her a lot of the times, but if I tell her to, she will finish up the bowl for me. This is the dogter that would walk through fire for me. My fully hydrated, Perfect Sunshade!

Anyway, so this is what I've been doing for Sunshade and Jaffa. Jaffa has not shown signs of any acid reflux problems, and he is not anemic, so I haven't had to give him those meds yet. Hopefully, he really is only in acute renal failure, and his blood work will return to normal by the next testing....

33 comments:

jaffeboy said...

Jaffa Jaffa, I'm glad you are still good good! U have to stay good good ok!

Listen to mommy & take all the vitamins & supplements so you will be strong strong again!

MayB you are so strong strong, you can run all the way to TO next year to visit me?!

KaylieGirl

Putter said...

Jaffa! Sunshade!

You have the goodest ever Mum in the whole universe! Sunshade, we have decided that your Mum should be come a vet ... Ask her what she thinks, okay??? Talk to you soonest!

Your Friend,

Putter ...:)

Maggie & Mitch said...

Wow - that's a LOT of information, Jaffa! Good thing your mom knows exactly what she's doing because my mom would stink at something like this! You're looking real good, Jaffa! Keep up the good work! We think about you and Sunshade and Elaine every single day and pray that you're all doing well!

Love ya lots,
Maggie and Mitch

Snowball said...

Thanks for all the information. I sure learn a lot from this post.

Yes. Jaffaman's blood result will be back to normal soon but it might take more than a month so get yourself prepared for that.

Sunshade is always the perfect airedale and will always be.

Luv,
Snowball

Charlie Kelley-Church said...

Wow- you guys are wonderful. I don't let my mom or dad do that kind of stuff on me. Mom was really interested in Sunshade and the pack thing. Even tho I am completely inside and can't see anything, I know when one of my pack enters the yard. I start doing the barking whining thing and when they let me out I chase after the stranger. My kitty sibs can be in the yard and I don't pay attention to them- just strangers. I'll keep checking back for updates. Give your mom and Sunshade hugs and kisses.

C-K-C

Noah the Airedale said...

Gosh there is so much work involved. You're so in control Elaine. Good for you! Jaffa and Sunshade are very lucky dales, I can't say that enough. Jaffa looks so happy through it all.
We think about Jaffa all the time and come to his blog to see how he's going everyday.
Stay strong!

Denise, Noah, Willow, Tess & Lucy

Anonymous said...

Elaine, you are the perfect dog-mom. Don't let Sunshade tell you any different! I can't believe all the time and effort you put into ensuring Jaffa (and Perfect Sunshade) get the just-right diet. Just awesome, in the true sense of the word.
I know Jaffa will be fine because of how much love you have invested in him.
xoxox,
Ellen

Joe Stains said...

wow I learned a lot! sunshade and jaffa are in good hands for sure. we are still keeping our paws crossed for jaffa, good luck getting that crazy character to drink on command!

Gus said...

We're glad that Jaffa is cooperating, and can sympathize with him about the subQ fluids. We had an older Siamese cat and muzzer and dad gave her fluids for more than a year. She was almost 18 when she died, so it was old age type renal problems, not like Jaffa. But the cat gradually got used to it, and though muzzer says she was never as good as Jaffa is, they did get to the point where she "tolerated" it, to the point that she would sit in Dad's lap and let him stroke her while the fluids went in.

Gussie

Scruffy & Lacie said...

Jaffa...ur mumsie has acquired an amazing amount of knowledge about renal disease...we think med school or vet school too...WOW!! Our mumsie's a nurse and knows some renal stuff, but nuthin' like this!!!!! Scruffy will NEVER need subq fluids...he drinks like a fish....and pees like one too...

Sunshade... u really are perfect....and so good for ur mom...we know she's showering u with attention too....perhaps a bit of exagerating on ur part??????

Healing barks....Scruffy and Lacie

Stanley said...

Hey, sweet Elaine!

JaffaMan looks like he's just happy to be with you and Sunshade, no matter WHAT you have to do to him.

It sounds like you're doing everything you can to help our buddy out. Thank you so much for being so dedicated.

My girl & I are tired just looking at the list of supplements and all of the figuring you have to do to make sure JaffaMan is getting what he needs. Be sure to TAKE CARE OF YOURSELF, PLEASE!!

All of our love & healing goober smooches,
Stanley & Lisa

happy said...

Stay strong! That's quite a lot of info there. Thanks for sharing it here. Keeping you in my prayers.

Bogart said...

Jaffa I know I say this a lot, but you're a really lucky boy to have such a GREAT mama - stay strong my friend!!!

Big Aire Kisses
Love,
Bogart

River said...

Jaffa & Sunshade your mum is absolutely amazing! It sounds like she's just about got a degree in canine nutrition and she has covered everything to make sure you both live happy, healthy and long lives together!

River

eliza said...

jaffa, good to know you are in good spirits and health. keep it up! sunshade, you are so clever to drink on command!
elaine, keep up the good work! :)

PreciOus said...

Oh Jaffa,

I am sorry to hear about your incident. I pray that you'll be well in no time bcos you are a good and very sweet boy and deserve only good things. Hope your Mum gets enough rest too while taking care of you. *Hugs*

Snuggle,
Precious

Toby said...

Oh Jaffa, you're such a brave boy!! And you're Mommy is like the bestest Mommy on earth!

We can't wait for the next batch of super good news!!

Toby

Shannon said...

Hi Elaine,
Wishes to you for continued strength as you continue in this journey to get Jaffa better.
Shannon

jaffeboy said...

Jaffa Jaffa, R U still keeping happy? Did you give mommy that killer begging look so you get to open all the packages?

MaMa stripped my fur fur yesterday & Jaffe says I look like a boy boy. I'm so sad sad. I told MaMa not to do too short short next time.

Licks & Kisses... KaylieGirl

T-man said...

Mr Jaffa and Miss Sunshade,
You are so lucky to have such a smart mom!! Tell her that she should become a vet, and that she should make sure to look after herself as well during this stressful time.

Just listen to everything mom says, and I'm sure your kidneys will be strong again.

T-man

CASPER AND PALS said...

Hey Jaffaman and Sunshade, your Momma is so smart! Keep getting better!

Woofs Casper ,Buddy and Nikki

Kirby said...

Jaffa,

You've got the bestest mom in the whole wide world! You are getting the best care anywhere! You are looking great, which makes mom and I quite happy. Not a day goes by that we don't think of you, your mum and Sunshade. Every night you are remembered in our prayers. Keep up the good work Elaine and Jaffa you keep getting better. We want excellent blood results next time! Sunshade, once Jaffa is better, you will resume your position of the world revolving around you! He he he!

Your pal,
Kirby

Ben_Benjamin said...

Thinking of you Jaffa, and also Elain & Sunshade

Lacy said...

woofies Elaine, Sunshade and Jaffa!!! Jaffa always lookies like a sweetiepie to me...i dont know how ya do it, hmmm i can c me having to give lacylulu anything, she fights like a demon dog just gettin her ears cleaned..he looks at sunshade like me me cant wait wait till me me gets to to play wiff u again...ur all still in my thoughts and prayers....

b safe,
;)lacylulu

Ume said...

hi Jaffa,
you're such a good boy. i'm sure with all the efforts dat your mum has put in, you will soon be a healthy boy again!

Lorenza said...

Hi, Jaffa
We all know you could not be in better hands!
Still paws crossed for you.
Kisses for you, Sunshade and your mom
Have a good night
Lorenza

Opy - the Original GruffPuppy said...

Hi,

You have been nominated for Post of the Month over at the Bone Zone - head on over and cast your vote :-)

Love
Opy

wally said...

Jaffa, pal! So glad to hear you are perking up and your mom is taking such good care of you. I have something to add to your routine that may help you feel better---WALLYSMOOCH!

wally.

Asta said...

Hi Jaffa
I've been thinking of you lots and haven't heawd anything, but now i see how vewy busy youw Mom is and what wondewful cawe she is taking of you and Sunshade and that explains it..I hope you'we both feeling good ..I know Santa will know how good you've both been and youw Mom too
I hope you get to have some fun duwing the holidays
smoochie kisses
Asta

Ricky Pepper said...

Glad to hear that Jaffa-man is still feeling great! That Christmas magic is very special!

xoxo,
Ricky

Jan said...

Hey, We found you by accident and are fascinated with the kidney knowledge you have. We don't see any posts since December, but we hope you are doing well.

Jan's Funny Farm

Jeannie and Marvin said...

just always wondering about you, it has been so long without a post, I think perhaps you don't even look or think about these blogs any more,

which is cool, each to his/her own, but I cannot believe you just left it like this.

I so so so so wanted Jaffa to get well, and now we don't know anything, because you never post anymore.

We have deleted and come back again in the time you were away.

I just hope you are all well and Jaffa is ok.

lotsaluv, Jeannie and Marvin....

we keep you all in our hearts. You were so good pals to us when we began blogging.

Jeanne said...

Jaffa and Sunshade,
You DEFINITELY have been blessed with one ANGEL of a "mommy" ..and you sound like you are just as sweet! Praying for you always and Maggie sends you licks and wags and she sure knows how it is to get those darn fluids, but she too gets lots of tummy rugs and ear massages making it alot easier. Take care to all of you! Your airdale buddy in PA, Maggie and Mum - Jeanne