"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..
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
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 Niki went outside to relieve his self. Unfortunately on 2 different occasions today the lactated ringers leaked from their injection sites. I am uncertain of how much liquid was lost, but any loss of the subcutaneous fluid is not helpful to Niki's condition. On the positive side, Niki is again drinking fresh filtered water today which he had not done on the previous 2 days. I want to make a note here for anyone considering taking on this type of at home treatment for their pet: If you can give your pet their annual shots (or those who give them every few years) then you can do this subcutaneous fluid therapy at home or at least be taught how to do it by your veterinary clinic staff. Doing this is about as difficult as giving subcutaneous shots, with only a few exceptions; you must make certain that the sterilized needle stays in place while the fluids are flowing, you have to watch the fluid out flow to insure it is constant and stable, and you need to monitor the injection site to see if the fluids are becoming encapsulated to an area where pressure could become a concern. In that case you simply need to remove the needle and select a different site for the injection (normally on the neck or shoulder area or the hindquarters). Also you need to check the injection locations after fluid delivery to insure that there is no leaking - and if there is then apply direct pressure until the fluid loss stops. Simple enough.
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.
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)
This page was last updated on April 5, 2008