The vet called today to follow up on her visit with Spark yesterday. Lucky for us, this home-visiting vet will come to our house while we're at work. Lucky for Tina, she didn't need any bloodwork or shots this time.
It appears that Sparkey now has End Stage Renal Disease (ESRD). This means that his kidneys are irreparably damaged (which we already knew) and that the damage has worsened since April (which we suspected). For those of you medically-minded readers out there, his BUN in April was 87 and his creatinine (the best overall measure of renal function) was 4.9. Now, his BUN is 115 and his creatinine is 7.2, a considerable increase. Although protein is difficult for his kidneys to break down and process, and his muscles can no longer build mass with dietary protein, his carnivorous diet is still the best for him at this late stage. All that protein is bad for his kidneys, but the poor guy has to eat something and his disdain for carbs is now legendary (at least in this house).
On other fronts, he is now anemic (due to the kidney's role in the production of erythropoietin, an essential element for the production of red blood cells) and his phosphorus levels are high at 9.4, showing even more clearly that the kidneys are very damaged and extremely compensated. His thyroid function is quite high, meaning that his voracious appetite may be due to the revved-up metabolism, overall not necessarily a good thing as it causes him to want to eat even more protein-rich foods which further compromises his kidneys.
So, as waste products of metabolism build up in Sparkey's blood (this is called "uremia"), Sparkey may begin to experience nausea, vomiting, and anorexia (lack of appetite, not to be confused with anorexia nervosa, an eating disorder). When these symptoms begin to occur, we'll manage them as best we can, keep him comfortable, and weigh his quality of life closely and as objectively as possible.
In terms of medication, we are cutting back his thyroid medication in the hopes that his metabolism will be more normal for a dog his age and condition, and he will eat moderate amounts and not experience such intense hunger. His pain medication---Tramadol---is a good non-narcotic analgesic but also takes a toll on the kidneys, so we will begin to cut those in half and see if his pain control is good enough with a decreased dose. If there's any signs of pain or discomfort, we'll go back to full dose and keep him comfortable at the expense of his poor kidneys.
I told the very kind vet that he is sleeping alot, and she responded by saying that any 13-year-old dog will sleep "24/7" if given the opportunity, and that should not be a cause for concern, unless it seems that pain is decreasing his ability to rest comfortably.
She praised us for all we're doing, and encouraged us to continue to use the booties to protect his hind feet while walking. The 500 mL's of IV fluid every night is essential right now in order to replace some of the electrolytes he's losing in his urine and not absorbing into his tissues. Even though I sometimes grumble about doing the IV (this was the 85th night) and its cost ($13 per day!), it's the least I can do for this creature who has lived in our home, helped raise our boy into manhood, protected our property, ate off of our plates, and loved us unconditionally for thirteen-plus years. Even as he begins to withdraw somewhat and becomes less demonstrably affectionate (a normal occurence for a dog--or human--approaching death), we know he loves us and appreciates our love and care. This animal's beautiful soul has danced with ours for more than a decade, and we will dance with him (in the flesh) until his flesh grows tired and releases his spirit into the night sky.
And now we dream.......