Gracie, ready with a ball, as always
(Originally posted to Hawksbill Cabin September 25, 2009, by Jim) Â Readers of the blog already know this, but Mary, Sofie and I lost our beloved friend Gracie a few weeks ago. Gracie, the Border Collie we adopted from relatives in 1995, suffered canine renal failure for about two years, entering the final stage in approximately January of this year.
Mary took on the primary care giver role for Gracie as the disease progressed.  She compiled a series of previous entries on the disease (they’ve also been published here on the WordPress blog in a digest format); since Gracie passed away she put together her records from the last three months, July to September, 2009.  On the Hawksbill Cabin blog you can follow the story by clicking on the “canine renal†label in the index in the right hand column.
Even as I am consolidating and editing these posts in October 2009, it is still hard, and perhaps too early, to look back at these events for us (note: re-posting this here, four months later, it’s still hard).  We definitely still feel the emptiness of loss.  But we wanted to publish these notes on the blog and elsewhere for other owners who may be just receiving the diagnosis.  I hope that in some way these posts will help prepare those owners for what’s ahead and the decisions that will need to be made along the way during the course of the disease.
For my part, I thought I might have more to add after reading Mary’s eloquent posts, and preparing them for the blog. It’s still too early for that, like it is for Mary and Sofie, although I find that now, sometimes my thoughts are turning to fond memories:
- Â Playing soccer with Gracie on the hillside near the grade school in Adams Morgan, or at several of the other parks there in the District.
- The fun times we had when we first moved to Alexandria, when Sofie and Gracie would play up at the Masonic Memorial.
- A special cove that both dogs liked at Great Falls, their anticipation picking up as soon as they got on the trail to it. During the summer, they would lie down in the shallow water to cool off.
- Our vacations in the Outer Banks and later at the Hawksbill Cabin, where the girls delighted in exploring the outdoors with us, an alternative to our urban environments – the city wasn’t a bad place for dogs, just necessarily constrained because of the confined populations.
Our vet sent a condolence card after Gracie died. As a near final note, her words:
“Gracie was truly a special patient and I will share your loss. Her tenacity to forge ahead and live life to the fullest was admired by all. Your dedication to her these past nine months has been dearly recognized. Thank you for allowing me to be a part of her life all these years. My thoughts are with you, Fondly, Donna.â€
Thanks to everyone for the kinds thoughts and comforting words. We lost a good friend in Gracie.
12/27/1994 – 9/7/2009.  Â
Monday, September 7 (originally posted by Mary to the Hawksbill Cabin blog)
After our visit to the vet last Thursday, Gracie seemed to perk up a bit, finding a tennis ball under a table in the sun room and bringing it to me for some play. Months ago, we modified the game to one where she lays down and I roll the ball to her, which she then traps between her front legs and bites soundly to stop.
She seems so happy during these moments, recalling perhaps the more rigorous games of fetch we played in her younger days up on the hill at the Masonic Temple here in Alexandria, or, later, the “stairmaster†game when she would stand or lay at the top of the stairs and I would toss the ball up to her, which she would catch, then roll back down the steps to me to start the game all over again. However, this burst of energy and interest is short-lived and she grows weaker.
We are out at the cabin in the Shenandoah for the Labor Day weekend. On Saturday, she had enough strength to walk with Jim around the house, sniffing and enjoying being with him as she explored some of her favorite bushes and trees. During the night from Sunday to Monday, Gracie woke me up and I took her outside to pee. She sniffs in the dark for awhile then returns to me but has a difficult time walking over the black drain pipe leading from the downspout that crosses the back path. I also help her up the step to the side porch and into the house. She wags her tail as I pat her now boney back.
As I clean up the kitchen this morning, Jim has Gracie outside and later tries to give her the semi-weekly dose of calcitriol.  She is suddenly drastically weaker and can no longer lift her head and can’t seem to swallow. She can no longer stand-up.  We’re not sure if she’s had a stroke or not.  She’s conscious and continent but we realize that the time has come to end Gracie’s fight against the disease that has taken her strength and dignity.
We return to Alexandria and take Gracie to the vet, which we have called ahead of time. Jim carries our girl into a pleasant green-painted room with some comfortable chairs and plants and an examination table covered with towels.
After a brief consultation, the vet agrees that to continue Gracie’s life in this way would be cruel and we begin the process that we have been dreading for so long. We have a chance to hold and kiss her before they administer the sedative and she is unconscious when the last medication is given. She leaves us quickly and peacefully, a gentle, loving companion to the end. She was three months short of her 15th birthday.
Gracie’s status (originally posted by Jim, September 5, 2009)
Not to be too much of a downer today, but since I am going to be off-line for a few days, thought I would give a quick update this morning. We’ve had another setback, a complete food boycott on Thursday. Plus, she was visibly weak from not eating. These are typical symptoms of end stage Canine Renal Failure.
Off to the vet for a consultation. We’re told that finally, the effects of the disease are piling up, getting quite strong, and the nausea and other symptoms may be just overpowering her.
It’s most important that we continue to get her to eat. Mary has been so diligent about this – trying something new and different almost every day. We are having success with freshly cooked hamburger right now, and the vets gave us some food that is used to help get dogs back on track after major surgery – very much like chopped liver, with a strong smell and overwhelming deliciousness for canines. To our surprise, during this visit’s weigh-in, Gracie had gained back 2 pounds!
The advice from the vet was to keep an eye on things, and recognize that there is not a lot left that can be done. Quality of life is the key now, and with a chronic disease, the one benefit you do get is to spend that much more time with your pet.
It’s day to day now, and we are a little more flexible with the meds understanding where we are with this – sometimes she’ll take them and sometimes not.  Of course, a visit to the vet was enough to give us a rally. When we got home, she ate very well – and she brought a tennis ball to Mary for a toss.
Thursday, September 3, 2009 (originally posted by Mary)
Gracie seems so much weaker today that both Jim and I take her to the vet. I am steeling myself to the possibility that the doctor may advise us to put her to sleep today.
After the exam, the vet advises us that Gracie is in decline and that she probably only has about a week or two left at the most. As the disease progresses, she may suffer a stroke or go into a coma. The vet also gently answers our questions about the process of euthanasia and also tells us that today isn’t Gracie’s time, that we should enjoy her last days but to prepare ourselves.
When the time comes, we have decided that we want her sedated before the administration of the medication that will cause her heart to stop. We don’t want her to know what is happening and we also don’t want her – or us – to experience the involuntary twitches or vocalization that may occur as that medication takes effect.
Thursday, August 27, 2009 – Originally posted by Mary to Hawksbill Cabin
Gracie and Sofie on August 27 before the vet visit
Gracie’s test results came back and her numbers have risen. Her BUN has gone from 82 to 117, creatinine from 3.5 to 4.3, but most troubling, her blood pressure has risen from 160 to over 200. In response, we have increased her amplodipine dosage from 1 tablet to 1.5 tablets every 12 hours for the high blood pressure, and will begin daily administration of 500 ml of fluids. The doctor has advised us that at this point it is probably best to let her eat whatever she wants just to keep her from starving, even if the food isn’t on the strict diet. The vet also advised stopping the AlternaGel dosages with her food since forcing the liquid medicine down her throat with the oral syringe at meal time is probably not helping her at this point.
I have begun to feed Gracie grilled or fried hamburger, about 4 to 6 ozs. per meal. She will sometimes take penne pasta cut up in small pieces. I also try to entice her with some “maximum calorie†dog food provided by the vet that they give to sick dogs recovering in the hospital. Everything must be hand-fed or given to her in small amounts on the floor as she lies in the kitchen. She will no longer stand and eat from a bowl. Chicken, rice, baby food, even bread are no longer palatable to her. She will still accept small bites of Iams weight control dog biscuits, but it is now a struggle to get her to take her meds in the pill pockets or in the G3 Chews. She seems to have the most problem with the tramadol tablets; I have to break them up and put the pieces in separate pill pockets so she doesn’t have to chew them – their taste is something Gracie definitely does not like.
This situation is not good and I am trying to accept the fact that our long journey with Gracie along this difficult path of canine renal disease may be coming to an end. I will work hard to keep her with us but the disease can not be reversed and it is taking its toll on our dear girl. She still seems engaged and happy and not in pain but she is losing strength by the day.
Wednesday, August 26, 2009 – Originally posted by Mary to Hawksbill Cabin
I was away last weekend working on chores at the cabin; Jim had to stay at home to catch-up on some office work. We decided to leave the girls with him to reduce their travel stress and to give me a break from the demanding routine of caring for Gracie. Jim administered the correct meds, fluids, and food but Gracie started to refuse food by Sunday, August 23rd. For probably more than a year she has howled on occasion if I have left her even to run errands and she has always been very close to me, following me from room to room and being my constant companion as I work in my home office.
I was able to get her to eat a small bit but her appetite had definitely fallen off to almost nothing. I decided to take her to the vet to have her blood tested to see what we were dealing with and if her meds needed to be adjusted. We saw the vet today. Gracie seems fatigued but her weight seems stable, which may be the result of being weighed in a different exam room.
(Originally posted by Jim, August 25, 2009, to Hawksbill Cabin)
Last weekend, Mary went out to the cabin for an errand or two, leaving me and the dogs home in Alexandria. Mary has been mainly working from home the last few years, and the dogs have gotten very used to that routine, so we had some worries about what might happen with “mom away.â€
There was howling and anxious panting. And then, there was a food boycot that started the morning after.
With canine renal failure, this is a sign that you keep an eye on…dog’s gotta eat, and if they don’t it could signal that something is going wrong.
I tried all the tricks – smearing turkey baby food on some wonder bread (surprisingly looks like peanut butter). Gracie has taken to eating Greek style organic yogurt with honey in a pinch, but that didn’t work this time either. At least she was still taking her meds.
By Monday, she was even spitting out the treats that we use to hide the pills, and she’d grown a bit listless. I was worried, and when Mary got home we talked about next steps. We already had a vet appointment to get the dog checked out.
Turns out, Gracie’s blood pressure had spiked, and that might have caused a little nausea, keeping her from eating. There are a few new meds to get us through this episode, and we’re going to daily sub-Q fluids for the rest of the week, but everything seems to be working and hopefully we’ll be back on an even keel by Saturday.
As far as a diet update, we’ve had to make some changes…this week, there are grilled hamburger patties and ziti pasta on the menu. It doesn’t have everything in it we’d like to see her eating, but the important thing is that she is getting some food in her.
The number of posts we put up at Hawksbill Cabin (and now here, on the Gracie Dawg Blog) about Gracie’s Chronic Renal Failure (I’ve also used ‘kidney failure’ to refer to the condition, and notice that that is one of the web search terms readers frequently use before arriving at the Hawksbill Cabin blog) is up in the teens.
We certainly appreciate all the interest that was shown in Gracie’s progress – by the time this post was originally written in July 2009, she was pretty stabilized for the moment, getting about a half liter of sub-q fluids every other day, along with all the other meds, and the special diet.  I also hope that readers who find these entries on the web find some useful, or at least, reassuring information here on the Hawksbill Cabin blog.
One thing I wanted to be sure to highlight is a comment that reader “Linda†left on Hawksbill Cabin – it was reassuring and provided additional resources that readers may want to check out. A quote from her comment:
“I have been dealing with my dog’s renal disease for three years. I was wondering if you had found the website http://www.dogaware.com/? It has a lot of good articles…â€
I’ve spent some time on that site, and there is plenty of useful information here. To get right to the point on canine kidney failure though – follow this link: http://www.dogaware.com/kidney.html#protein .
(originally post
ed July 2009 by Mary to Hawksbill Cabin)
Late last month, Gracie had another blood test to see how she’s doing. Her numbers indicate that she’s stabile:
- creatinine at 3.5, down from 5 at the last test;
- BUN at 82, which is a little high but acceptable; and
- her calcium level is at 11.7, 1.2 for the ionized test.
This is all very good news. Â The vet said to do a retest in three months unless she seems to be declining. Â We have our fingers-crossed that she will meet this milestone.
Gracie remains alert and interested in her toys and walks. She gets a little sleepy from both the arthritis medicine and the blood pressure medication but is still willing to roll the fuzzy soccer ball for a little game of easy fetch. Meal times are still trying – she needs incentives in her food and she has a tendency to spit out the rice as she walks away from her bowl. Grains of rice can be found all over the house.
Mealtimes are time-consuming. She gets her pills first thing, then her food, but she can’t be fed too close to the time she has her pills because the AlternaGel she must receive shortly after eating to coat her stomach must be given at least an hour after she receives her meds. Warming the subQ fluids, then administering them to her takes another 20 minutes or so in the morning every other day. So, her morning meds-meal-and fluids routine can take about 90 minutes to complete. She needs a mid-day dose of AlternaGel with some food, again to coat her stomach and protect against ulcers. Evenings repeat the meds-meals-AlternaGel routine.
My wife Mary and I lost our Border Collie, Gracie, to Chronic Renal Failure in September 2009. She had been diagnosed with the condition early in 2008, and our vet told us she entered the final stage of the disease in January 2009. Like many pet owners, we immediately went to the web for insight on the disease, and to learn about other owners’ experience treating their pets. We found some comfort there, and I decided to keep a little track record on my blog (the original posts may be found at: http://hawksbillcabin.blogspot.com/search/label/canine%20renal ). A couple of sources have picked up the blog feed or have referenced these posts – we very much appreciate the opportunity to honor our pet this way, and hope that our experience can help other owners prepare for the experience.
C
