Arno's medical history

anal glands | kidney failure | gall bladder | again | 2 years later | epilepsia | ring worm | arthrosis et al

Arno has always been fragile. The first signs of weak health surfaced when he was about four years old. Below I only mention some of his problems. There is more...

Anal Glands

anal glands

Arno could not empty his anal glands anymore and developed an abscess, which is painful and needed proper care. The same problem popped up a couple of years later and then again maybe two years ago. The third abscess was serious business. His anal glands never functioned well again after that. We had to go to he vet continuously to have the sacs emptied.

That is why it was necessary to have them permanently removed. This procedure is complicated by many local nerves controlling fecal continence, the fact that any change in the local musculature of the anal sphincter area can affect fecal continence, and the fact that with chronic anal sac problems anatomy is distorted. Draining tracts can develop after surgery if the gland is not completely removed. Still, despite these pitfalls anal sac removal is considered a relatievely simple surgery by most certified surgery specialists. That part of Arno is now working well.

What makes a man a man?

A pair of testicles. Arno's testicles had not fully descended. A couple of years ago the vet noticed that his prostate was enlarged. In order to avoid further problems, it was decided to remove his testicles. Arno has gained weight (which is obviously not good).

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Kidney failure

Arno started vomiting gall occasionally around the age of four. I reported this to the vet, who did not pay much attention to it, since it is not uncommon for both cats and dogs to vomit gall. The vomiting got worse though, and I insisted something be done about it. The vet prescribed a food supplement, which partly suppressed the problem. Arno's condition slowly got worse, but the vet I went to never bothered to examine him properly. It was not until he totally collapsed three years later and I took him to the local animal hospital that he was diagnosed with kidney failure.

Kidney, what is a kidney?

The kidneys are organs which maintain the balance of certain chemicals in your dog's blood while filtering out the body's wastes as urine. The kidneys also help regulate blood pressure, help regulate the production of calcium and phosphorus metabolism, and produce a hormone that stimulates red-blood-cell production called erythropoiten. As you can see, a malfunctioning kidney can cause many problems.

Let us picture the kidneys filtering mechanism. There are tens of thousands of microscopic funnel shaped tubes called nephrons. These tiny structures are responsible for filtering and reabsorbing the fluids that balance the body. These nephrons are susceptible to damage due to many causes such as poisons, aging, infection, trauma, cancer, auto-immune diseases, and genetic predisposition. If any of these occur the entire nephron stops functioning. Fortunately, due to both the reserve capacity of the kidney and the ability of the nephrons to grow larger, the kidney can still function. If damage to nephrons occurs gradually and the surviving nephrons have enough time to hypertrophy, a kidney can continue to function with as few as 25 percent of its original nephrons.

Kidney failure

When the number of functioning nephrons drops below 25 percent or when damage occurs too suddenly for the remaining nephrons to compensate, kidney failure occurs. There are two types of kidney failure. Acute kidney failure is a sudden loss of function that is sometimes but not always reversible. Chronic kidney failure is an irreversible loss of function that occurs gradually over months or years.

Failing kidneys can't adequately clear the blood of certain toxins. These include urea (a nitrogen-containing byproduct of protein metabolism) and creatinine (a chemical byproduct of muscle exertion). As a result, when the kidneys fail, there is an abnormally high levels of these wastes products. Other blood components normally regulated by the kidneys - such as phosphorus, calcium, sodium, potassium, and chloride - may also rise or fall abnormally. Failing kidneys may also produce extremely dilute urine or urine that contains too much protein. Healthy kidneys produce concentrated urine that is relatively protein-free.

Diagnosis

To determine the prognosis of kidney disease, blood and urine tests are performed frequently during treatment to evaluate how well the kidneys are responding. It's a good sign if test results swing back toward normal within the first 48 to 72 hours of therapy.

Initial test results can be remarkably similar for both forms of kidney failure. The diagnostic challenge is to determine whether the dog has acute or chronic kidney failure. Making the distinction between chronic and acute failure is crucial because the prognosis and duration of treatment for the two types of kidney disease are different (although some treatment procedures may be similar). At our practices, we recommend yearly base line lab testing starting at age 3. This protocol allows us to help determine if we are dealing with acute or chronic disease.

Acute kidney failure occurs so suddenly surviving nephrons don't have time to compensate. This abrupt failure can occur if the kidney is damaged by an infection, or harmful substances such as antifreeze and rat poison; or certain medications, including some antibiotics and chemotherapy drugs.

Many cases of bacterial kidney diseases can be successfully treated. Leptospira is one bacterium that can cause acute renal failure. Other bacteria can also cause kidney infections, invading the urinary tract, the bladder or prostate for example, and ascending up to the kidneys. With proper diagnosis and treatment these infections can be treated effectively with antibiotics and, in most cases, result in complete recovery.

Ingesting as little as a teaspoon of ethyleneglycol-based antifreeze, which forms crystals inside the dog's nephrons and shuts down kidney function is usually fatal. Unfortunately, this product has a sweet taste which attracts pets to drink it. (Propylene-glycol-based antifreeze is a safer way to protect your car and your dog.) Another potentially lethal substance is rat poison. If a dog eats rat poison containing calciferol (a form of vitamin D) the calciferol pushes up the dog's calcium level, causing mineral deposits, inflammation, and other damage within the kidneys.

Treatment

Ironically, treatments for some nonkidney diseases can jeopardize the kidneys. Although most antibiotics cause no harm to the kidneys, practitioners should closely monitor patients on certain antibiotics - gentamicin, for example - because of potential damage to nephrons. Cisplatin (an anticancer drug) and amphotericin B (a drug for serious fungal infections) can also cause acute kidney damage. In general, before you decide on a course of treatment for any condition, ask your veterinarian about the benefits and risks of all available options.

Chronic kidney failure, CIN, is the most common form of kidney disease in dogs and among the most common causes of death in older dogs.

Unfortunately, chronic disease progresses over a period of years and often goes unnoticed by even the most vigilant owners. When signs finally appear, the disease is often well-advanced. But, with proper treatment and monitoring, some dogs with chronic kidney failure live comfortably for years after diagnosis.

Dogs with the chronic disease, CIN, tend to produce large amounts of dilute urine (polyuria), because there aren't enough healthy nephrons to properly filter and reabsorb excess water back into the bloodstream. Consequently, dogs with chronic renal failure drink lots of water (polydypsia) to maintain the right volume of internal fluids.

CIN can lead to the progression of acute kidney failure or result in the destructive diseases that slowly destroy nephrons. One such long-term condition is glomerulonephritis, in which immune-system proteins damage the glomerulus (the tuft of blood vessels at the entrance to the nephron). But, more often than not, it's impossible to identify the exact cause of CIN.

Intravenous fluid therapy can temporarily help dogs that have acute or chronic kidney failure. Other medications may also be used in the treatment of renal disease. When kidney failure occurs, many other organs are affected by the increased toxins not effectively eliminated by the kidney. One major organ is the stomach. The stomach lining becomes inflamed and ulcerated due to the increase in urea nitrogen in the blood stream. H2 blockers, such as cimetidine, assist in reducing the stomach irritation. To help keep levels of phosphorus under control, phosphate binders are given orally. These include aluminum hydroxide, aluminum carbonate, calcium carbonate, and calcium acetate. One produce we use is Alternagel, available at most pharmacies located where the antacids are kept.

Renal failure can also cause hypertension or high blood pressure. Sodium restriction is the initial step in the management of this disease. Drugs may be incorporated if hypertension is not controlled by dietary management.

We also recommend B-complex and vitamin C to help the well being of your dog and also replenish the vitamins lost due to the inability of the kidneys to recycle and retain the nutrients in the body properly. Sodium bicarbonate may also be of use to aid in controlling the changes in the acidity of the blood. If hypertension or heart failure are present, we avoid the use of this medication.

Other medications that may be used are androgens or erythropoiten (hormones to help reduce the anemia associated with kidney disease), and calcitriol, a substance which helps regulate the levels of calcium and phosphorus.Some urologists are now recommending treating with calcitriol as soon as kidney disease is diagnosed. The dose is 2.5ug/kg every day. If phosphorus levels are above 6, this drug should not be administered. ACE inhibitors, such as enalapril are also recommended in early stages of kidney disease as long as renal functions are monitored. Additional vitamins or nutritional supplements for slowing the progression of CIN may be beneficial. These products are fish oils containing the Omega 3 fatty acids in conjunction with vitamin E which may help reduce kidney inflammation. Omega 3 oils slow may slow the progression of renal failure. Vitamin E acts synergistically with the Omega 3's. Also, omega 3 fatty acids may deplete vitamin E in the body, another reason to supplement this vitamin .Veterinarians sometimes resort to more intensive treatments. For example, veterinary specialists can perform dialysis (artificial blood filtering) and kidney transplants. However, dialysis and transplants are labor- and technology-intensive - and therefore very expensive. Dialysis requires several hours of treatment several times a week - on an ongoing basis. And canine kidney transplants have produced few long-term survivors, probably because the genetic diversity among dogs increases the risk of organ rejection or some other factor that we do not understand at this time. Future advances in anti-rejection drugs may make kidney transplants a more viable option for dogs, although cost considerations may still limit this practice.

The key to ongoing CIN treatment takes place at home, where owners can take several steps to help their dogs. Make sure a dog with CIN always has access to fresh water. To encourage the dog to drink and eat, maintain a steady, stress-free daily routine. (Stressed-out dogs often stop drinking and eating, further jeopardizing kidney function.)

Dietary management can also help your dog. This consists primarily of restricting the amount of protein, phosphorus, and sodium in the diet, while providing adequate amounts of non protein calories, vitamins, and minerals.

Arno gets a proper diet, pills and regular blood tests. Until the end of last year he was doing well.

source: Pets Health - Columbia Animal Hospitals (Maryland)

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Gall bladder infection

gall bladder

At the end of 2007 Arno got seriously ill. He stopped eating, was visibly ill and in pain. Because of his kidney situation he was hospitalized straight away. Various examinations and tests (including surgery) revealed that he had a gall bladder infection. His liver and lymph nodes were also affected. Arno received intravenous solutions for eight days. He had refused every food for a period of ten days. Because it was impossible for the vet to keep him going like that, it was decided to bring him home on Christmas day in a last attempt to make him eat. A continued refusal to eat would mean the end of his life. As soon as he arrived home, we offered him a piece of food, and he ate it...

He needed several months to recover. If everything goes well, Arno will celebrate his tenth anniversary in August. Unfortunately, The gall bladder problem has weakened him further. He is old and slow. What matters is that his condition is reasonable and stable and that he is still with us. Although it can be assumed his organs are not functioning as they should, his appetite remains good. To give him the opportunity to take part in the daily walking routine I have bought him a pet stroller. It allows him to spend time outside and feel part of the family.

Special thanks to Joke and Els who look after Arno the way it should.

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Again

At the beginning of July 2008 Arno was ill again. He was clearly in pain. Off we went to see the vet. She kept him one day and allowed him to come home with us in the evening. His blood tests did not reveal anything truly shocking. He was given Flagyl, Buscopan and Tolfedin first, but it became obvious he was probably dealing with gall/liver issues again. So then he had to take Baytrill 50 mg in combination with Finidiar. That seemed to help somewhat, but his feces remained questionable. Tests showed that he had salmonella. So he is now taking Tribissen. It is a mystery how he got that. He is slowly getting better, eating two meals a day as usual.

We hope to celebrate his tenth birthday on 10 August.

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2 years later

Arno is still with us! It is unbelievable, but true. He has gained weight, which is partially responsible for his walking problems, he is taking food supplements, pills, and so on and so forth. His skin is itching, and he is complaining every now and then. A couple of months ago he had to spend another day with the vet, becauese he kept vomiting. But in the end, nothing serious was going on. He is a good boy, doing his best.

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Epilepsia

This page keeps on expanding.... On 9 March 2011 Arno had his first seizure. It lasted quite long, and initially we did not know what was happening. We took Arno to the vet straight away. By the time we got there the seizure had stopped. The vet explained there are two types of epilepsia: primary epilepsia, which is caused by a problem in the head, and secundary epilepsia, which is basically caused by a malfunctioning organ in the rest of the body. Blood samples were taken and have shown that Arno's organs are OK. This means Arno might have primary epilepsia. Medication will only be given if the seizures return on a regular basis, because the drugs have a big impact on the body. At the moment we only have to keep records of the attacks. I prey this was just a stupid incident.... The worst case scenario is a brain tumor.

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Ring worm

In June 2011, Arno was diagnosed with ring worm. God knows how he got it. According to the vet he was weakened. One of my major concerns was that Nero would also become a ring worm victim. Arno's treatment consisted of Imaverol and medication (Nizoral 200 mg and Ketofungol 200 mg). Approximately two months later he was declared clean. At the moment (August 2011) I still use Imaverol twice a week to make sure he stays clean. Ring worm is a fungal infection that invades the hair and hair follicles. Most cases are caused by Microsporum canis. Ring worm in dogs is primarily a disease of puppies and young adults. Typical areas of involvement are the face, ears, paws, and tail. Ring worm is transmitted by spores in the soil and by contact with the infected hair of dogs and cats, typically found on carpets, brushes, combs, toys, and furniture. Humans can acquire ringworm from pets, and vice versa. Children are especially susceptible.

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Arthrosis et al

Arno's saga continues. During minor surgery the vet established hyperlipidemia in September 2011. The lipid levels in his blood appeared to be extremely high. Former blood tests had always produced good results. There seemed to be no reasonable explanation for it, although his diet Hill's and Science K/D was a possible culprit. This type of food is low in proteins, but contains lots of fat. The vet told me a couple of other patients were coping with the same problem. As a result, Arno was put on a Royal Canin Gastrointestinal Low Fat diet. I was allowed to combine it with high fibre fruits and vegetables. At the same time Arno had to lose weight, for he had turned very obese. The latter proved to be very difficult, because Arno had/has an additional problem: arthrosis. His joints and legs are letting him down more and more. At the moment (July 2012), Arno can hardly walk. Each time he takes a few steps, he has to rest. He spends his days sleeping in my bed, eating and taking very short walks in the garden to do this thing... When I walk Nero, Arno joins us in his pet stroller. Mentally he is still in prime shape. In order to keep him going he gets the following medication and food supplements: Fortekor 5 mg, Trocoxil 20 mg, Prednisolone Kela 5 mg, Viacutan Plus, Seraquin Dog 2 g, VT Phak, Optimmune Canis. Cortisone (Prednisolone) is not to be given simultaneously with Trocoxil, but since the dose is so low, I am allowed to do it anyway. Despite various examinations and tests the prime cause for Arno's hyperlipidemia has not been found yet. The new diet has brought about some improvement, but the blood lipid levels remain too high. Arno has lost weight though: some 4 pounds!

Arno died on 6 December 2012. During the Fall he sort of managed to recover and walk more again. He remained in good spirits and loved being with his family. I started hoping that he would survive the cold months lying ahead. Then, on 6 December, all went wrong. Arno was in a lot of pain for unclear reasons and had to be taken to the vet. The pain medication did not make a difference. Since his condition remained critical, it was decided the best thing to do was to let him go. He left us peacefully. We will remember him as the gentlest dog ever.

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