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.

• Renafood by Standard Process

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,

• Coenzyme Q10 Beneficial for People with Kidney Failure

• Coenzyme Q10 Good for People with Kidney Failure

• 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.

• Epakitin

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.

• Canine Renal Support from Standard Process

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

• Canine Hepatic Support from Standard Process

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

• Denosyl

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

• Rehmannia 8

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....