Nikolai's Odyssey
"Nikolai Micha's Legacy" Niki in his prime years
|
|
|
|
Please
Note: This site is not
meant to give medical or veterinary advice. This is simply a
web page documenting the experiences, trials, and daily occurrences that
happened with our family and our Siberian Husky "Nikolai" during his Acute Renal
Failure or Chronic Renal Failure disease. Notes on this page
about consultations or conversations with veterinary doctors or staff are
given one sided (from our point of view and remembrances) and are therefore
subject to accidental omissions or misrepresentations (incorrect or incomplete
memories).
People who undergo such traumatic experiences often make
mistakes in recounting their recent past events. We have tried as much as
possible to recount these events as best as they are remembered, but everyone makes
mistakes.
Please keep this in mind. Whenever dealing with a
pet undergoing such a serious medical condition you should always consult with your
veterinary doctor first and format a plan for treatment of your pet that will meet
both the pet's needs and the family's needs as closely as possible and with
the most hope for a successful outcome. The events we recount here
occurred after careful consideration and veterinary consultation (whenever possible).
We did not make any of these choices lightly and we will have to live with
the choices we have made at this time for the rest of our lives.
At this point in time we have no way of knowing how Niki's at home treatment
will end, whether with success or in failure, but we feel that it is important to
document our attempts at this venture, because no one should be without hope or
feel helpless. There are always choices and possibilities for all
of us.
We can only hope and pray that we make the best of the
choices God grants each of us and continue to have hope and faith for a good day and a
brighter tomorrow. If you have any questions or comments to make about
this web site please contact us via email at Sorry, no longer available for email at this time.. The
Beginning"Nikolai Micha's
Legacy" was born By 2 years of age Niki
was beginning to dominate our little pack of 2 Sibes. He often lashed out both
vocally and physically whenever anyone crossed his domain. Please don't
misunderstand, Niki never bit a human (on purpose) during a confrontation, but he
would posture and growl whenever Natasha or a human pack member confronted
him about anything he was concerned with. That is not to say that he
never did bite a human. I was bitten on the nose and required 2 stitches to seal the
wound, but that was entirely my fault. As stupid as it is true I had
placed myself on the kitchen floor between 2 Siberian Huskies who were
fighting over a rawhide bone and tried to take the bone away from the fighters while
simultaneously being on eye level with both canines! It doesn't take a
rocket scientist to figure what happened next. Being a head wound (the nose is
part of the head after all) blood was everywhere, but funny thing it was all mine
not a drop belonged to either of the fighters. When my little
brother arrived (I called him and asked for transportation to the closest E.R), I thought I was going
to see our youngest Siberian out the door on the quick path to one of the shortest lives you have
ever seen. Needless to say I was able to prevent a 2nd
bloodbath and amazingly enough both Niki and Christopher eventually went on to
become the best of friends. Within a year Natasha
had passed on and a few months after that we introduced yet another new pack member to our
family, Sasha. Sasha and Niki went on to become proud parents of
several litters. Each time we struggled to make Niki adapt to the
role of loving parent (frequently without success) but after many trials and
tribulations Niki did eventually learn to tolerate puppies and even like them at
times. Over time we ended up keeping 2 puppies and our pack grew to a Husky
foursome. We now had 2 female Siberians and 2 male Siberians, all
intact. After a few years of this homemade hell a decision
was made to spay the 2 females and finally a little calm descended on our home
again (after several years of absence). Niki and his son Alec still often
butted heads but bloodshed was minimal (if at all) and time passed. Now
Niki is 8 going on 9 and the pups are 5 going on 6, "Alpha Siberian Pack Leader
Nikolai" has been forcefully retired despite his objections and time goes by. We are now up to mid
March 2008.
The
First Signs of Trouble
The Diagnosis
Dr. Coakley goes on to
say that with acute care there is only a 10% chance that Niki will survive his current
condition. She palpitated Niki's chest and abdomen and took stool
specimens, nothing of significance was found. She points out that in
recent times acute renal failure in dogs (especially in our area) has been
brought on by Canine
Leptospirosis which can be treated with antibiotics. The problem
with treating a dog with this infection is that it takes a minimum one
week administration of Clavamox 375 mg given twice daily to clear the
infection, and possibly a 2nd week's treatments (or longer) to be
certain of beating back the infection completely. Unfortunately Niki's
kidneys are in all likelihood not functioning at all at this point in time and
even if they are it is still unknown how much permanent damage has been
done. Dr. Coakley points out that even with aggressive treatment only 25
% of dogs with this infection survive. To make matter worse I am
currently unemployed and desperately trying to find work, which makes
financing any in-clinic treatment virtually impossible. Dr. Coakley
leaves the examination room to check on some further information leaving Anya,
Niki and myself alone again for a while. At this point I am nearing the
breaking point. Nine and a half years of life and love (not to mention
fights) is hardly enough time at all. I don't know what I can do this
time. Years past Natasha (our former Siberian family member) had
developed terminal breast and skin cancer. Even in those days of a steady
job money was always tight, but after a lot of hours of research our family
learned of alternative at home treatments for terminally ill humans with
cancer, which had on rare occasions been adopted for use with pets, and we
jumped on this information. To make a long story short we managed to get
Natasha into remission and she lived a blessed 2 more years with us before
finally succumbing to the disease near age 14. Micha another past
Siberian near age 12 had developed abdominal cancer and renal failure and we
had also researched how best to treat renal failure in dogs at home at that
time, so this situation was not something that our family was totally
unfamiliar with. By the time Dr. Coakley had returned to the examination
room I had pretty much made up my mind on what we might do and had pulled
myself back together again. Dr. Coakley asked me how we wanted to proceed
and how far we wanted to go if we decided on treatment. Dr. Coakley is a
wonderful vet, she has always been sensitive to the financial state of her
clients and at the same time able to take in the best approach for the
continued health of her patients. I told Dr. Coakley that we wanted to do
everything possible to fight for that chance that Niki could overcome this
illness while realistically holding down costs. We needed to buy Niki
time to allow the antibiotics to do their job while preventing a complete
shutdown of his body from the fragile condition of his kidneys. The
only option is subcutaneous fluid therapy, administering 1000 ccs of lactated
ringers daily to flush the toxins out of Niki's body, mimicking the functioning
of his kidneys while the kidneys are attempting to heal and while the antibiotics
are doing their job. Dr. Coakley went on to prescribe, 1/2 cc of
Vitamin B12 daily to boost energy and stamina, 1000 mg of Basaljel to bind
phosphates, 10 mg of Reglan twice daily to stimulate appetite, 50 mg of Novox
or up to 150 mg of Tramadol daily to manage pain as needed. Niki
would need to be on a kidney diet, one which is higher in fats and
carbohydrates and lower in proteins. On such a diet you need to decrease
the quantity of proteins in the diet while increasing the quality of such proteins
and serve more calorie dense carbohydrates and fats since most dogs with ARF or
CRF have substantially reduced appetite if any at all. However you have
to be careful not to change the diet so radically that the patient loses even
more interest in eating. We have decided on using white chicken breasts
as our protein source and per past experience we are also going to feed Niki
flaxseed oil mixed with cottage cheese to boost Omega Fatty Acids and as an
alternative protein source. This means that I will be administering the
subcutaneous fluid therapy of lactated ringers daily to Niki to keep the costs
in check, and also to keep Niki at home with the family he loves. At
home treatment will help to keep Niki's spirits up and help with motivating him
to drink, eat, tolerate the daily needles and pills, be able to urinate and use
his backyard facilities as he is comfortable with and continue the force
feeding of Pedialyte Solution as well as a vitamin / mineral
supplementation. I have informed Dr. Coakley that during my college years
and for several years afterwards I was a practicing orderly in West Texas and
so using Ringers and needles isn't something that would scare me off, even
though I have never administered lactated ringers to a dog before, though I had
seen the procedure done hundreds of times on humans and assisted as
needed. This seems like the best game plan we can come up with. I
can tell that Dr. Coakley, while encouraging the entire time, doesn't seem over
confident that this plan will work. When Anya, Niki and I leave the
clinic several staff members say goodbye and wish us well, and I likewise
think to myself that several of those clinic staff members are also thinking
there goes the crazy pet owner who thinks he can take on this job at
home. Please don't misunderstand, if I had the money I would spend every
dime to insure that Niki was treated by experts in their field and not a novice
who is going to attempt the improbable and maybe impossible at home. I am
certainly not a certified veterinary health professional, but after having a
younger brother who owns and runs a small ranch on his own I understand the
meaning of self-motivation that often comes from those working with financial
restrictions who are at the same time trying their best to save animal lives
whenever they can. Home Treatment
Begins in Ernest
We make it home,
through a horrendous watery March downpour. Niki is unable to stand up in the back seat of the car
and walk out by this time. I can almost see him deteriorating by the
minute. I setup a mat and work area in the comfortable back living area
with my family and prepare the B12 injection, pills, drinks, lactated ringers,
etc. I carry Niki back to the area and after a few minutes of consoling
him I administer the first round of medications and fluids. Then I setup
a sterile field (as best as I can with a dog that has so much fur) and begin
introducing the IV fluids just under the skin on the back of his neck and
shoulders. I keep adjusting the IV flow repeatedly and on more than one
occasion I have to remove the needle and move to another site on his neck of
shoulders because the fluids and not dispersing well at the current
injection site (they are building up, making a knot of fluids). It takes
over an hour but eventually we get the full 1000 cc bag of fluid in Niki.
Would you believe the old boy never flinched once, never cried out, just lay
there docile the entire time while I held the needle in place with one hand
while stroking and petting his head with the other. Halfway through the
treatment Niki began lifting his head up, opening his eyes full and looking
straight into my eyes. I think he was feeling better for the first time
in half a dozen days and this was his way of telling me. We finished the
treatment and I was able to coax Niki to walk back down the hall to the great
room where I had prepared a cozy nest on one of the sofas for Niki. With
the rest of the pack watching I then tried feeding Niki a freshly roasted
chicken breast (from the microwave, after cooling but still warm). Would
you believe he ate the entire breast! I also gave Niki a 1/4 cup dose of
cottage cheese blended well with a tablespoon of flaxseed oil (he wasn't as
pleased with this as he should have been). After several "pony"
shots of Pedialyte Solution (Bubble Gum flavored) I served Niki a treat of
several spoonfuls of vanilla ice cream I had saved for the occasion. Niki
then managed to go outside to the backyard and take care of business and then
came back indoors and resumed his place on the sofa. Bedtime is
next. We have survived Day 5 of the acute illness and what is also now
Day 1 of treatment. We have friends and family (several called tonight
while Niki was getting his IV solution) that have all called to say that they
are keeping Niki and all of us in their prayers and thoughts. I don't
know what tomorrow will have in store for us, but I have to have faith that we
can continue to hold on just as we have for today. One day at a time. I was able to reach Dr. Coakley by
mid-morning to again thank her for all her help yesterday and to give her an
update on Niki's current condition as of today. She was encouraged that
Niki had indeed had a comfortable night and was showing some signs of increased
activity and not exhibiting any nausea or gastric distress. I went on to
voice my concerns of swelling under the skin at injection sights for the lactated
ringers, but Dr. Coakley said that this was a common occurrence during
subcutaneous fluid therapy and that my response to periodically move the
injection location when the swelling seemed to be of discomfort was the
appropriate choice. Dr. Coakley mentioned that if Niki was going to
respond to the antibiotics we could see improvement as soon as 3 to 4 days
after starting treatment and that if he was able to overcome the renal failure
it would most likely take 3 to 4 weeks before we might be able to consider discontinuing
the subcutaneous fluid therapy. We have enough lactated ringers to last
10 days , the period Dr. Coakley thought was critical and would indicate
whether or not Niki would be able to rebound from his illness. As I
mentioned earlier, Dr. Coakley did state yesterday that if Niki seemed to
respond to the antibiotic treatment she would likely recommend a 2nd
round of antibiotics to insure that all the infection was eradicated. Next we administered
Niki's morning round of 500 ccs of lactated ringers. Last night being the first night of home
treatment we used a full bag, 1000 ccs of lactated ringers, to start Niki's
subcutaneous fluid therapy. Dr. Coakley advised going to 500 ccs twice
daily from this point forward because it would be easier for Niki's system to
absorb the fluids if we spread the dosage over 2 applications daily instead of
1. Niki tolerated the therapy well and immediately was able to get up and
go outside to relieve himself. I did not see him defecate, which has concerned
me, since we haven't seen him have a bowel movement in the past few days.
If this continues to be the case I will consult with Dr. Coakley again.
The outside temperature is in the high 50s today and Niki wanted to stay
outside, so we let him remain outdoors with the rest of the pack for several
hours before coaxing him inside late this afternoon for a late lunch.
Niki ate another dose of flaxseed oil blended with cottage cheese and managed
to finish off most of a baked chicken breast (skin included) and a 2nd
round of Pedialyte before retiring for the afternoon. Early this evening we
administered Niki's 2nd
round of subcutaneous fluid therapy and gave him his afternoon dosage
of antibiotics, Basaljel, and Reglan. Having carried out further
research on the internet for Niki's condition I have decided to add B
Complex, Ester C (2000 mg) and Potassium (100 mg) supplements to Niki's daily therapy. Vitamin D is also
frequently recommended, but we have none on hand and I want to discuss this with our vet before
administering it. Water soluble vitamins (B Complex and C) should not be an
issue. Shortly after receiving this 2nd
round of fluid therapy for today Niki again had little difficulty walking outside to relieve
his self and then coming back indoors. I am truly encouraged that Niki
has continued to be fairly mobile during his current treatment; if his
mobility were declining I would be more concerned that the home therapy wasn't
working. Niki has continued to be able to mount the sofa and
bed (which is fairly high) to rest and to walk outdoors and indoors with little
assistance. I have needed to occasionally guide him when
preparing for fluid therapy sessions, but I think that is more a case of reluctance
on the part of the patient for the treatment rather than an issue of failing
mobility. We will see what tomorrow brings us. We
received more encouraging emails and calls from friends and family
today. Niki weighs 45 lbs.
(20.5 kg) so he should require 21 ounces of water (615 ml) daily (see Recommended Daily
Allowances for Canines, dogs require approximately 1/2 oz of water per lb. of body weight or 30 ml
per kg of body weight, from research I have found on the Internet).
Since he is receiving 1000 cc of lactated ringers (1000 ml) plus 14 ounces of
Pedialyte Solution (414 ml) that means his total liquid intake daily is 48
ounces daily (1,414 ml). This is 2 1/3 times the minimum daily
requirement. We have consulted with our vet regarding Niki's fluid intake
requirements. Here are some other sites that discuss CRD,
CRF
and ARF in
canines. In canine patients with CRF protein reduction is often recommended
but is controversial; see studies: Diet and Renal
Failure, Nutrition
and Chronic Renal Failure, Kidney
Failure in the Dog and Cat, and
Chronic Renal Failure. After discussing protein intake with Dr.
Coakley we agreed to restrict Niki's protein intake sources to chicken breasts
(with skin) and cottage cheese. We are currently feeding him one small to
medium sized chicken breast daily, but we do not force him to eat the entire
breast - only the amount he is interested in. So far he has been
finishing off at least 75 % of each chicken breast we feed him. We administered Niki's 2nd
round of subcutaneous fluid therapy with a small amount of leakage around the neck
injection site. Around Well I am not
encouraged by Niki's behavior at supper. He refused anything at all to eat, so he was force
fed 1/4 cup serving of flaxseed oil / cottage cheese mixture and 3 tablespoons of
Vanilla Ice Cream plus about 4 ounces of chicken breast and skin.
Not a lot of food, but then any nourishment during this period is better than none.
The Reglan was supposed to stimulate his appetite, but that apparently
isn't working. His energy levels appear stable at the moment - although
on the low side, but there is non of the dreaded vomiting that we were told to
look for if his ARF/CRF took a turn for the worse. Also he is drinking water
which is likewise a good sign. My family has asked me how I think he is
doing and I can only answer honestly that I am getting mixed signals.
Niki is always alert and awake, does not appear to be in any pain or
discomfort at this time, he has low energy and little motivation, but is still
able to urinate and walk and his ears and eyes are almost always erect and
alert. The rest of the pack fawns over him as if they expect him to die
at any moment, which also concerns me because dogs often seem intuitive.
For now he is stable and Dr. Coakley said that each day he remains so is
progress since the road back (if any) from ARF/CRF is a long one. We need to start
thinking of a wider variety of calorie dense foods to feed Niki. Dr. Coakley mentioned vegetables,
but with the exception of avocados those are all calorie lean not dense.
On the Internet I have seen Rice and Pasta mentioned often in homemade
Kidney Diets, but I worry that these in any bulk might upset Niki's stomach and
cause him to start vomiting (he has vomited Rice dinners in the past when he
had an upset stomach). Any vomiting at this point would be extremely bad
for his condition, not only for the loss of nutrition, but also because gastric
bleeding is a strong possibility with Renal Disease (at least according to the
research I have found on the Internet). Dr. Coakley did not mention
ulcers or gastric bleeding during Niki's exam (that I remember), but she did
ask about any blood in the stool or any vomiting - all of which I informed her
were negative. She also did a stool check and found no indication of
bleeding there, which was good. Still it left a great deal of doubt about
exactly what was causing the severe anemia which Niki certainly has and which
often occurs in ARF/CRF patients - although gastric bleeding is often found to
be the cause, it is not apparently so in Niki's case. I checked Niki's gums earlier tonight and
they appear to have some pink coloring back in them which would be a good sign.
We still have one more round of 5 "pony" shot glasses of Pedialyte Solution to go before bed, then it's another night passed us
and tomorrow to wait for. Niki just got up from the sofa and walked into the
kitchen to lie in his favorite crate for a time, a good sign I hope.
I am glad for this web page, it gives me a chance to review our day at the end of
each day and put all the emotions and choices into perspective.
I truly hope that other families who find themselves presented with similar
circumstances will be able to glean something useful from our experiences; at
least in that sense this will have some value beyond our own needs. Today Niki will receive
Clavamox 375 mg (twice daily), Reglan 10 mg (twice daily), Lisinopril 10 mg (once daily),
Basaljel 500 mg (twice daily), Ester C 1000 mg (twice daily), B Complex (1/2
tablet twice daily), Potassium 50 mg (once daily), Subcutaneous Vitamin B12
1000 mcg/ml (1/2 cc injected into the 1000 cc Lactated Ringers which are given
daily). Niki has no appetite
again today. I force fed him 1/4 cup of flaxseed oil / cottage cheese
mixture, 1/4 cup of vanilla ice cream, 75 % of a baked chicken breast and 6 ounces of
Pedialyte Solution. Niki drank fresh water twice this morning that I witnessed.
If he continues to not eat I will begin pureeing the chicken breast and
adding in some steamed pureed vegetables (like broccoli or carrots).
It is easier to force feed pureed foods than solid ones because when placed on the
back of a dogs tongue he is more likely to swallow it than spit it out as he
can do with a mild gag reflex when swallowing solid foods. I hate to
force feeding, but once again I am confronted with the need to see Niki through
this first week of antibiotics and subcutaneous fluid therapy.
If there is any hope for Niki this is it. At the worst we are simply buying extra
time with Niki and (except for the force feeding) making him more comfortable. I know many people
wouldn't think of multiple daily subcutaneous injections as
"comforting", but in all honesty Niki doesn't seem to mind these
sessions and he always feels better afterwards. I know most people
would simply give up and euthanize their pet when faced with these
circumstances, but I believe life is worth fighting for and only agree with
euthanization when the animal is in constant pain or the quality of life is so
poor that it is hopeless. Except for the force feedings Niki still
seems to enjoy his days and nights. Yes he is very lethargic (some would
read this as depression), but I watch his interest in all the things going on
around him and his attention to our family and so I judge his quality of life
as good at this time. With Natasha, one of our past Siberians, when her
cancer remission failed and she was again being ravaged by the disease she got
to the point where she no longer showed interest in anything and would attempt
to sleep constantly - she didn't appear to be in pain she just no longer cared
about life. At that point we agreed it would be best for her to pass on,
and so we euthanized her after spending an entire Saturday surrounded by her
family. Niki isn't to that point, though he may be at some time in the
near future. Niki took his first
daily dose of subcutaneous fluids without problems and without any leakage this
time. However an hour after his therapy Niki choked and threw up a small
spot of bloody spume. Then 10 minutes later he threw up the chicken,
flaxseed oil / cottage cheese foods he had eaten earlier - there was no blood
in evidence in this food mass. This is the first time Niki has vomited
anything and greatly concerns me. I have been reading on the Internet
about frequent problems of gastric upset and bleeding in ARF/CRF patients.
I have plenty of Nexium here at home and have found several references to
its use (and testing) in dogs. I am thinking about giving Niki some
Nexium in hopes of heading off any stomach ulcers or bleeding and also hoping
to prevent further vomiting. Nexium is apparently
safe for patients with Renal problems or Hepatic (liver) issues.
In an Astra
Zeneca publication (on page 33) they said that .5 umol/kg dose of Nexium
inhibited histamine-stimulated gastric acid production in dogs for periods up to one year. By early evening
Niki received his 2nd round of fluid therapy which he tolerated
well. I gave him his 2nd round of medications and supplements
(including a Nexium capsule) and force fed him 6 ounces of Pedialyte Solution.
Afterwards Niki went outside to relieve his self.
We let him stay outdoors for an hour or so before bringing him back inside.
Per my earlier comment I pureed a whole chicken breast, added 1 cup of Cream of Rice,
added 2 cups of chicken broth (no salt, no garlic) then pureed the entire
mixture again, after the mixture cooled I added 1 cup of flaxseed oil / cottage
cheese mixture and pureed the entire mixture one last time. I force fed
Niki 1 cup of this pureed mixture then refrigerated the remaining mixture for
use tomorrow. I managed to hold Niki in my lap for about 10 minutes
before he insisted on getting down and then went to lie down in the kitchen
with the rest of the pack. Tomorrow I will attempt to give Niki a coffee
enema. Coffee enemas are excellent for cleaning toxins out of the body (I
have successful used this treatment with other sick pets).
After that I can give Niki a bath, and then I plan on taking him down to the local park for
an outing. Niki always loved outings in the park in past days - I am
hoping this will revitalize him. Then after a brief rest
Niki was given his morning fluid therapy. He tolerated it well as usual. In the early
afternoon I administered the coffee enema to Niki which he didn't
really seem to mind as much as I thought he would. I know most
people would be squeamish about administering an enema to their pet,
but if done correctly it can be very beneficial in riding the body of
toxins. This took about 45 minutes and Niki slept soundly for
about an hour afterwards (which is normal) - his first real rest in the
past 24-48 hours as far as I can tell. Afterwards I gave Niki a
bath, which he didn't want but needed. Then we went down to the
park and stayed there for about an hour and a half. Niki was
chilled (from the bath) and so I wrapped him well in a coverlet - he
kept his head up most of the time and frequently lifted his nose to
smell of the things going on in the park. I think he had a really
good time. We
came home and administered Niki's evening fluid therapy, medications
and supplements. At this point Niki appears very tired. His
energy levels have been steadily dropping all week although he is still
able to stand and walk on his own. I don't think the medications
are working at this point and I have to agree with Dr. Coakley that it
looks like we are merely buying time. Niki still takes interest
in things going on around him and at least that is encouraging. I
will try force feeding him a half cup of the strained pureed food
mixture before bed, maybe he will tolerate it better than the feeding
this morning. From now on I want to make certain that the
medications and supplements are always given at a time several hours
different from the feedings - so that if Niki does throw up the meds
will not be wasted in the process. If he doesn't eat something
soon I am very concerned that his time remaining will be very short.
As far as I can tell he has never thrown up the Pedialyte
Solution after it is administered. Niki has left the Great Room
and gone to his crate in the kitchen - he has done this more frequently
of late and I can only think that this is a protective action.
Niki has always felt safe in this particular crate in the kitchen
and I think in his present condition he feels vulnerable. Non of
the rest of the pack has threatened Niki since his illness started
although the pups (Alec & Anya) have attempted to play with him
(which he ignored). I have tried to keep Niki close to me most of
the time, but when he is insistent on something like this I am not
going to force him to do something he doesn't feel comfortable doing at
this point.
Later I found Niki in the crate with a small amount of regurgitated
liquid food in front of him - on close examination I found no traces of
blood or clotted material this time. At least that is one
possible indication that the Nexium is working now. After I
cleaned things up we went to bed. Christopher
dropped by this afternoon. While he sat down in the Great Room I
went into the back living area to get Niki. We walked down the
hall, then when Niki entered the Great Room and saw Chris sitting there
he almost ran (as best he could) to get over to the love seat and
climbed up next to Chris and lay down. Chris immediately started
petting and talking to Niki, then just closed his eyes and almost
looked like he was actually sleeping he was so content. I don't
know why Niki has always preferred my little brother to me, but such is
the case. As much as Niki loves me he absolutely adores Chris.
This was exactly why I asked to Chris to drop by if he could.
For a few hours Chris stayed and we watched T.V. and talked while
he stroked, petted and talked to Nikolai. A few times Niki
actually turned over or on his side to better expose areas he wanted
Chris to scratch. Niki was on cloud nine. At one point in
time Niki got down and tried to go into the kitchen. Thinking he
wanted to go outside, Chris and I walked him outback but nothing
happened so we brought him back inside and got him to lie back down on
the love seat on an old towel for comfort. The only let down came
when Chris left of course. After that Niki just lay around the
house - all the earlier energy was gone. I came to pick up Niki
and take him back to the back living area and noticed that the towel I
had left under Niki while Chris visited was wet. On closer
inspection I realized that Niki had been incontinent. This was
most likely the reason he had gotten down earlier - he must have
realized he needed to go but was unable to pass fluids outside.
Poor old boy knew he didn't want an accident around Chris - and
luckily for Niki that didn't happen until after Chris had left. By
early evening I gave Niki his next round of medications and supplements
and a second dose of 6 ounces of Pedialyte Solution. This was
again followed by 500 ccs of subcutaneous lactated ringers. I am
starting to realize that Niki is heavily retaining fluids - I would
image so since he is urinating less. I examined him thoroughly
and noticed that his testicles are extremely swollen, I think the
fluids are infiltrating into his lower extremities. I will try to
reach Dr. Coakley tomorrow and ask about this. Several veterinary
sites have discussed the use of diuretics to attempt to restart the
kidneys to function. I am wondering if this can be attempted in
Niki's case. If the kidneys have totally stopped functioning (as
they appear to be) and Niki is running out of time then I don't see how
trying this treatment could be any worse for him than what he is going
through right now. Again I need to ask Dr. Coakley about this
too. I am already giving Niki Lisinopril (without the diuretic)
10 mg daily. I could start giving him Lisinopril hctz instead
(with a diuretic - 12mg) but I am uncertain if that would be strong
enough or not. We also have Furosemide 40 mg (a straight
diuretic) in the house. Scrutiny of the Internet found that
Furosemide is the diuretic most likely used (if any at all) during
episodes of ARF, but is apparently not recommended for CRF.
Hydrochlorothiazide (hctz) is not recommended for dogs. I
don't want to do anything that would accelerate Niki's deterioration or
cause him any pain, but I feel the urgent need to try something more at
this time. One other point I have found articles that state that cimetidine can control vomiting caused by uremic gastritis. Administered the last round of Pedialyte Solution (6 ccs) before going to bed.
Niki
had the usual medications and supplements plus the Pedialyte Solution
as we have been administering it. Once again he ate nothing at
all today because of the severe nausea. Niki also had a diarrhea
attack just after his morning subcutaneous fluid therapy. We also
managed to get in the coffee enema treatment. Niki is stating to
show signs that he doesn't appreciate the enemas, but he is always more
alert, energetic and active afterwards so I am reluctant to stop them
at this time. I called the pharmacy around 6 pm. They did not have the prescription, but said they would call me once it came in. Around 8:30 pm I called them back (it is 30 minutes before they close) - they still had no prescription and suggested I call the veterinarian tomorrow. By late evening Niki was exhausted so I put him to bed, but he is not sleeping nor resting well at all. Perhaps things will improve once we get the anti-nausea medication. I
had also been able to give Niki another cleansing coffee enema today as
well as his normal medications and Pedialyte Solution. It has
been 3 days since Niki ate anything and so I decided to try the
powdered protein/carbohydrate mix in skim milk. I administered
another Hyoscyamine pill before giving Niki the protein drink.
Niki still made several attempts to vomit, but each time I held
his mouth gently closed and stroked his stomach - attempting to calm
him in order to keep the only nutrition he had been able to eat in 3
days down. Eventually Niki was able to relax and did not throw up
this meal (not even during the night). Niki had developed a light
nose bleed earlier in the evening which disturbed me, but I decided
that since his nose had been dry for several days - that perhaps his
nasal passages likewise had dried out and that was the reason for the
bleeding. I applied Vaseline to his nose and will continue to
monitor this. At on point during the evening I had placed Niki on
the sofa to rest while the rest of the pack was likewise resting in the
Great Room. I left the room briefly and then came back and a
resumed my place in my recliner to watch T.V. I suddenly felt
something by my hand and when I looked down Niki was lying next to the
recliner. How he had managed to get from the sofa across the room
to the recliner I have no idea, I never saw him move. The last 2
days Niki has still been able to stand, but could only walk short
distances and even then with some assistance. I was amazed that
on his own he had moved his self off the sofa and across 15 feet of
room to get to his current location. I proceeded to pet him and
gave him words of encouragement. Just
before turning in Niki was able to go outside and urinate on his own.
When we finally went to bed Niki appeared fairly relaxed and
slept well most of the night. No vomiting, no incontinence.
Niki
did improve after the enema, but unfortunately his weakness and
lethargy did not improve to any great amount. Niki started
moaning faintly earlier today and has continued to do such from time to
time. I gave Niki the maximum dose of Tramadol and Hyoscyamine
both. That seemed to stabilize his episodes of moaning but now he
has episodes where he sits up suddenly as if startled and looks around
like he is disoriented. I feel certain that his time is running
out. We managed to give him 800 ccs of his subcutaneous fluid
therapy - but he kept getting up which almost jerked out the needle
several times so I was unable to complete the therapy for today.
Likewise I did not give him his full complement of medications
and supplements for the evening because he kept having periods where he
was choking and almost vomited everything up. I did manage to get
12 oz. of Pedialyte Solution in him today - but that was all.
Niki's breathing has become shallow and labored at times.
His heart beat is somewhat rapid (though all dogs heart beats are
rapid compared to a humans) but the heart beat is also faint/shallow. By late evening Niki appears to be sleeping, his eyes are closed and his breathing is more stable. I am worried about his blood pressure because I was unable to give him the evening dose of Lisinopril. At this point I am reluctant to disturb him since he is finely sleeping well. Our out of town relative, Sarah, had a good visit with Niki as well as the rest of the pack - Niki still enjoys being the center of attention. Sarah remarked several times that as I was speaking to him - Niki's eyes always tried to locate me and follow me, even when I was behind him and he could not turn his head around. I also noted that Niki frequently closed his eyes gently when Sarah was scratching his ears and rubbing his head - his favorite things to do. Never let anyone tell you that in these dire circumstances dogs no longer enjoy life. I am certain that Niki very often feels gravely ill, but at the same time I am also certain that he finds times when he is still enjoying life and living, whether in a stoke of the ears, a gentle afternoon breeze caressing his face or being embraced by a family member. I have no idea how tonight will go or whether or not there will be a tomorrow with our beloved Nikolai, but all things considered we still enjoyed many moments of the day we had today. We can only wait and see what tomorrow brings. I
have managed until now to hold it all in, except on occasion, now I
can't seem to hold anything back. It feels empty inside, this
loss, this loneliness that nothing can fill. Nine and one half
years wasn't nearly long enough a time to have spent with our Niki.
It is now 7:30 am and I can hear some of the family rousing in
the house. It's going to hurt all over again each time I have to
tell someone else that Nikolai is gone. He was an obstinate, pig
headed, bully of a dog at times, who was likewise so intelligent and
protective at other times. So many unique qualities that I can
see in his offspring from time to time. Our little Princess
Anastasia Alexandra (Anya) is the spitting image of her father.
She has his intelligence and keen eye; she is also a grey &
white like her dad. She keeps walking up to me this morning and
looking sadly into my eyes. When I had let the pack back in the
house - it was Anya who first search all the rooms looking for her dad.
I just patted her on the head and explained that he was gone now.
Sasha jumped up on the bed and put her head down on Niki's spot
as if waiting for him to walk back in. Alec just sniffed
everywhere. When I finally took down Niki's harness (the one he
has been wearing these past days to help him walk or to carry him as
needed) I let Alec sniff the harness. He made several passes over
every inch, and then he went back to the hallway and laid down - no
longer interested in sniffing anything else. Nana
just came in. She asked where Niki was, and I told her he was
gone. We held each other and cried for a while. As much as
the old folks won't admit it - the Siberians are special to them in
their own way. They have always said there were too many and that
caring for a pack of 4 was an unnecessary burden. All the same
every night before be either Nana or Poppy would be there in the
hallway to give every one of the pups a bedtime treat. I have
sent text messages to Chris and Camille inquiring about what time they
think I can come down with Niki. Chris has kept a special area at
the ranch with several trees around it where rests Micha, Natasha,
Kodiac and Avalanche and a few other pets of family members and
friends. Camille has told Chris that it is getting crowded and
she feels they should stop taking any more pets other than their own.
However when Chris came by on Sunday he told me that Nikolai was
very special to him too and would be welcome at the ranch when the time
came. Now is the time. I
am sure that there are people who will read this account of Niki's last
days and think that we failed to do the right thing. Many people
would have chosen to prevent any possibility of discomfort and would
have chosen euthanization over home hospice care. Looking back
now I can honestly say that yes there were times when Niki was in
discomfort whether or not it was painful, but still I believe in my
heart that staying here at home with his family these last 14 days of
his life is what he would have wanted to do. This was his life. Poppy
just came in. He was hardest hit of all I think. He
couldn't even speak - he just stood there, bent over me in my chair and
cried. I got up and we held each other for a while and let go of
the pain. Then was sat back down and talked about Niki's life
here at home. On 2 occasions Niki had bitten Poppy - once on the
leg and once on the foot. On both occurrences Poppy had been
trying to intervene in a dog fight, one involving a bitch in heat of
all things, the other just a simple fight. Both times neither dog
was injured and Poppy's injuries were very minor (some broken skin,
nothing more - no medical treatment needed). Funny how even after
that Poppy had grown very attached to the old dog. Niki's passing
has hit him hard - both Nana and Poppy are suppose to be going on a
trip starting today to visit with relatives in Mississippi, but Poppy
wanted to hold off going for a day. I told him that there was
nothing for them to do here and that it would be best if they went
ahead with their plans as they were. The
pain is still there deep and abiding, but it is easier to tolerate now
after sharing it with family. There are things still to do today.
More family to see and one last trip to take with Niki. For
those that find this site I can only hope that you find the
documentation here of some help. When Chris and I started these
web pages we just wanted to help other people enduring the same
hardships with their animal family members. I know that Niki's
Odyssey was a story that from the beginning was doomed to end sadly,
looking back as I am able to now. Still it is a story of what our
family chose to do in the final days of our loved one, and who knows;
maybe the paragraphs here will be of some help to others who are
enduring the same tribulations. It is our way to try to bring
some sense of purpose and some benefit out of a devastating loss and
emptiness. God bless you and yours, Ron Conley & Family (including Sasha, Anya & Alec)
|
||
Natasha's Cancer Fight Newsletter
Shilo's Tale | Jesse's Story | Misty's Journey | Doggie Dinner | CRF Canine Renal Failure | Vaccinosis Story
Sasha & Nikolai | Sasha Blows Coat | Niki Turns Five | Our Past Siberian Huskies
This page was last updated on April 5, 2008