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January 2010

The new year began with two seizures, around 4 and 6 a.m.  January 2. There was a lull until January 9, but I knew by then I had to address the seizures and try to give Percy some relief from them. I was in more contact then with the holistic vet, but she was about to leave the country for a few weeks, so back to our regular vet I went and we talked about how to begin introducing the phenobarbital and what to expect. Percy seized again on the 13th and twice the morning of the 15th; I began giving him the phenobarbital January 16, working up within a few days from an extremely low to a low dose.

The difference was nearly immediate and so positive I wished I had begun the medication much earlier. The time between seizures was stretched to nearly every two weeks during that first month, and the seizures seemed somewhat less severe, were shorter, and Percy did not urinate. Percy seemed himself again– I did not realize how much the seizures must have been affecting him until we began the medication. He did not seem lethargic or drugged, a typical side effect, in fact he seemed to gain energy from not having the seizures and also began to exhibit another side effect, ravenous hunger. He would jump up to grab food from counters or put his head in an open frig at every chance, and while with a normal puppy this of course would be verboten I was less dismayed and barely discouraged this behavior in Percy as it represented positive life force at that point. But it was a balancing act, as feeding him as much as he could eat would have strained his kidneys.

Percy seemed more like an almost-normal puppy again, though he remained small– he was not really growing and he gained just a little more weight, eventually nudging up briefly to 50 pounds– and his energy level remained somewhat limited.

January 13 BUN 88 (the lowest we ever saw it for Percy, but still a level that would render most dogs miserably  ill), creatinine 5.2, phosphorus 11.7

November – December 2009

While October had just seemed an unreal series of events, especially after mid-month November began to be more real. Though Percy still seemed healthy and active, I began to see slight differences: he did sleep a little more, perhaps, than what I remembered our other puppies doing. There were moments or days where something seemed a little off. But I hoped I was just looking too hard.

Then, after a respite of almost exactly two months, he had his third seizure, late in the evening of November 18. Then his fourth, around 3 a.m. November 22. Those in the middle of the night were surely the worst– perhaps for Percy, robbing him of rest, but certainly for me, coming up from whatever stage of sleep to the sound of Percy’s howl as he began the seizure was pretty horrific. I began to feel the exhaustion of the months I was a new mother with middle-of-the-night feedings, 20 years earlier, but now rather than nurturing my son into life I was watching my puppy die. All I could do when Percy seized was to witness it: I held him as I could without wanting to get in the way of his body movements, and I always spoke to him, wanting to believe my voice somehow made a difference. The seizures lasted perhaps two minutes, and then Percy would come back, and try to get up, but stumbling crazily he would crash into things and fall over. He did not want to be contained or restrained, though, and I did not want to increase his agitation and possibly provoke another seizure. In those first months he consistently urinated during the seizures so I would change his bedding and try to clean his fur– he didn’t like this– and hold him until he would settle again into sleep. And I would eventually drift off myself, wondering when the next one was going to strike.

A few times Nocci’s behavior told me a seizure was coming: once I woke in the middle of the night to see him pacing anxiously, and within a few minutes Percy seized. This was not consistent, and as time passed I wondered if Nocci sort of turned this off; he too wanted some state of grace, to be in denial and if he didn’t predict what he felt was about to happen, maybe it wouldn’t happen. But that of course is my human analysis, and I can’t know.

From those two November seizures there was a lull of just over three weeks. The lulls allowed me to think that maybe things were getting better, or at least that they wouldn’t get much worse. Our vet had advised thinking of starting Percy on phenobarbital, before the seizures became so frequent and/or severe as to become a determining factor beyond the JRD. But knowing the possible marked side effects, unpleasant especially for such a young dog– lethargy, dullness– I resisted making that step.

In the meantime, Percy was also having digestive issues– he ate well but his stools were consistently extremely loose– like liquid– and voluminous to a point that I wondered if he was absorbing any nutrients. In November, I consulted a holistic vet who practices alternative as well as traditional medicine, and among other supplements we started Percy on powdered colostrum, which healed his digestion almost immediately. Following more bloodwork she also thought Percy could benefit from adrenal cortex injections. I was under no illusion that anything we could do would make his disease go away but I wanted to make his life, what he would have of it, better– more comfortable, more normal, if possible. So I began the injections.  Around mid-December the holistic vet also recommended giving Percy fluids through an IV over several days to help his system beyond what his kidneys were unable to do; we began the series. But after the second day Percy had what was now the fifth seizure of his life, December 16; the following night he had another, the first time he had seized on subsequent days, so I ceased the IV flushes. Though there was no way to know if there was a correlation, and logic said giving him the fluids could only help his system by giving his very weak kidneys a rest rather than overload him in any way, I’d become suspicious of everything. I also stopped the adrenal cortex injections.

Percy had the last of this series of seizures December 18. I remember going to get our Christmas tree the following day with one eye on him continually, as there were multiple moments he seemed about to seize. But he didn’t. He was very weak that weekend, not himself– he mostly slept and had none of the puppy energy left, at all. He would go off to the other side of the house to sleep, whether to be alone or because he was hypersensitive to noise and light. But I would continually go to check him, as his going off by himself to sleep could presage a seizure. I feared he would not make it to Christmas. But after a few days he rallied. I continued  to resist beginning the phenobarbital– illogically, it may seem in retrospect, but I simply didn’t want to subject him to anything worse than what he had been born with and had to contend with daily. But he seized twice more before the month’s end, and I realized couldn’t ignore that the seizures had to be treated.

 

November 12 BUN 152, creatinine 4.5, phosphorus 9.8

December 15 BUN 125, creatinine 5.0, phosphorus 13.2

October 2009: diagnosis

It was the second week of October that he had the ultrasound, and the confirmation of the disease was all too visible on the screen. His kidneys were almost not there: there was water where there should have been mass. Seeing this and hearing it described was like a death sentence being handed to me for my adorable four-month old pup. I remember holding him in my lap and simply trying to hold myself together: I don’t cry in public but I could feel everything retract inside me into a protective mode, protective of him, of me. But there was no protection to be had. He would die from lack of kidneys, and all we could do would be to manage his diet and give him supplements to help what little kidneys he had do the job they were meant to do. It would only buy a little time.

Yet he seemed like a puppy of that age would, playful with a good appetite, eating rabbit droppings in the yard with gusto. He and Nocci could graze for hours on them. Since the second seizure in September there had been no more, so I just sort of held my breath, knowing it was only a matter of time before things started to look worse.

Percy’s initial treatment consisted of a low-protein diet with supplements serving to bind phosphates and reduce blood toxins, as well as additional supplements for general health and to address the ancillary issues affecting him. Please see the treatment posts for details.


November 6 BUN 128, creatinine 3.4, phosphorus 11.2. In addition his sodium to potassium ratio had dropped from 27 in September (the low end of normal) to 23, just below normal. As a result the following week we did a test for Cushing’s, just in case, but it was negative.

 

One number would rise, another would go down, but they did not improve significantly.

September 2009: first seizures

As I describe in Percy’s World, the first sign that anything was amiss with Percy was an epileptic-like seizure he suffered early in the evening of September 15. He was exactly three and a half months old. I brought him in for bloodwork the 17th and by the 19th we knew his kidney functions were very abnormal. The following day, a Sunday, Percy suffered a second seizure, again in the evening while he was napping. It was never clear if the seizures were caused by the imbalance in his system due to the kidney disease, or if it could be a separate idiopathic epilepsy. But in terms of his kidneys, the next step was to do an ultrasound to see their morphology. Short of doing a biopsy of the kidney tissue this would give the most comprehensive diagnosis.

There was a delay of several weeks until the ultrasound was done, and in that time I was just in a state of suspended shock about Percy. The numbers could not lie, and they were so dramatically off as to be incontestably bad. But Percy, except for the two seizures, still seemed pretty normal– though I of course began to watch him more closely. Was he somewhat less active than our other pups had been? Was he really drinking more? He was gaining weight and growing the typical Spinone beard. Who could believe this bundle of sweet energy would have a severely limited lifespan?

Towards the end of the month I found drops of blood here and there on the floor and where Percy slept. I looked him over and found nothing external. Then I looked in his mouth, and found what appeared to be an ulcerated abscess on his left upper gum. It was red, inflamed, and bleeding just a little. Though I did not see any foreign body protruding, this was a not-yet four-month old puppy, so I thought he must have chewed a stick or something of that sort and a piece had gotten lodged in his gum. Of course, this was a weekend. Percy did not seem feverish or especially bothered by it, but given everything else that was going on it needed attention. I brought him to the clinic the next day but nothing beyond the ulcer was apparent, so we began a round of Clavamox. The ulcer healed, but a few months later there would be a reappearance.

September 17 Bloodwork results showing abnormal kidney functions: BUN 120, creatinine 3.3, phosphorus 11.6. Normal levels are considered within a range of 7-27 for BUN, .4-1.8 for creatinine , and 2.2-6.3 for phosphorus.

July – August 2009

These were great months as Percy explored and grew. As puppies do he would go and go and then he would collapse in a nap, often in a cool spot in the garden (left, at eight weeks and two days old). Moving house with a ten-week old puppy was a lot of action but a lot of fun as well. The dogs got to know each other and Percy explored the wild perimeter of the yard, where he went out of view in the tall bamboo and brambles. He discovered the tomatoes within reach in the garden– the few that had survived the terrible blight of ’09. Nocci was at the stage of just tolerating this new canine: it was unclear if he actually recognized Percy as a dog, and oftentimes he seemed to consider him simply a nuisance. There were moments he would look at us as if to say, “What is this thing? Is it staying?”

But gradually Percy won him over.

We were looking forward to many years with Percy as we packed up and moved into our new home.