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| horse racing lasix picture lasix lasix plus lasix vision correction maryland lasix vision correction miami cataract surgery after lasix lasix water pill lasix special lasix pill eye lasix surgery washington bend lasix eye surgery salem lasix drug lasix prescription lasix furosemide lasix eye surgery virginia lasix use cheap lasix eugene lasix | lasix Kidney Problems in Dogs Vetinfo vetinfo4cats vetinfo4dogs Canine Encyclopedia Feline Encyclopedia Links Subscriber Area (members only) Zoonotic disease Becoming A Veterinarian Your Turn Search vetinfo4dogs Support Vetinfo and Subscribe toVetinfo Digest Please note: The dog harmful lasix information on our site is for everyone to read. Please use it dog harmful lasix as often as you like. However, Ask Dr Mike is available only to subscribers of our Vetinfo Digest. Please do not send questions if you are not a subscriber. Please use the search engine dog harmful lasix or dog harmful lasix one of the indexes to see if the information you need is already online. Please see Subscriber info for details. Subscriber Info The income from the subscriptions helps defray the cost dog harmful lasix of dog harmful lasix maintaining the site and allows us to dog harmful lasix keep the large amount of information on www.vetinfo.com free to our readers. Kidney Problems Chronic kidney failure in dog harmful lasix Great Dane Kidney transplant for dogs Medications that are dog harmful lasix linked to kidney failure Serum (or blood) urea nitrogen levels and dog harmful lasix serum creatinine levels as indictors of kidney function Kidney disease - when dog harmful lasix to put on calcitrol Kidney failure and high calcium dog harmful lasix levels Kidney failure in young Cocker Kidney failure and heart dog harmful lasix murmur Kidney disease or Kidney failure? Kidney disease family history in Brussels Griffon Cystic kidneys Canine Kidney failure -causes Leptospirosis (zoonotic) Kidney dog harmful lasix problems in Yorkies Kidney failure also see Renal Failure also see Incontinence also see Urinary also dog harmful lasix see Liver problems Chronic Kidney Failure in Great Dane Question: Dear Dr. Mike, Thanks for your quick reply and help. Hamish's excessive drinking has stopped after six days of Marbocyl and he appears much more himself although a little lazy. He doesn't appear to have lost anymore weight and is eager for his meals. I took a urine sample in for testing today and the test showed dog harmful lasix his specific gravity is still 1.005. You say that can happen for a lot of reasons, what are these? If it were a bladder infection as our vet suspected and the anti-biotics worked would the dog harmful lasix S.G by now be normal? I read up on Cushings from your site but he doesn't dog harmful lasix have any of the signs dog harmful lasix and now the excessive drinking has stopped I don't dog harmful lasix know what to dog harmful lasix think dog harmful lasix his coat is excellent and dog harmful lasix he has no pot belly. He is now on his normal food, should I get more blood tests done or leave dog harmful lasix him as he dog harmful lasix seems OK now? The Vet has suggested another urine test in two weeks. Also the update Our Vet has now given him a diagnoses of early chronic kidney failure. All his urine samples are all in the region of 1.005-1.008. The vet even remarked that he thought his dipsticks were faulty but this has been confirmed by lab tests. His creatine is in the normal range 97 (20-130) our references are different I think. One question I have is; dog harmful lasix as his S.G is so low will that mean his creatine levels will start to rise very shortly indicating a worsening of kidney functions or will dog harmful lasix he continue just with the low SG and no worsening for months or dog harmful lasix years? I haven't been able to find an answer to this question despite checking your site and other information on line. Hope you can give us some dog harmful lasix indication of his lifespan as he is only 6 years old and we previously lost a Great Dane at the age of dog harmful lasix 22 months from kidney failure who went from "apparently" healthy to comotose in two weeks. Thanks, Jacqui Answer: Jacqui- There are three ranges for urine specific gravity -- hyposthenuric (below 1.008), isothenuric (1.008 to 1.012) and concentrated to some degree at all ranges above 1.012. I dog harmful lasix am not sure why this range isn't called hyerthenuric but it doesn't seem to be. Hyposthenuric urine actually indicates that the kidneys dog harmful lasix are working to some degree because they make the urine more dog harmful lasix dilute to get it into this range. Isothenuric urine is not concentrated or dilute and urine that dog harmful lasix stays consistently in this range can indicate kidney dog harmful lasix failure or dog harmful lasix hormonal diseases. However, your dog has hyposthenuric urine and there are some specific causes for this. These are the causes dog harmful lasix of hyposthenuria in a single urine sample: 1) Excessive drinking for behavioral reasons (any cause) 2) central diabetes insipidus (lack of production of anti-diuretic hormone, or dog harmful lasix ADH, by the brain) 3) nephrogenic diabetes insipidus, or dog harmful lasix resistance to the effect of ADH at the kidney level: a) hyperadrenocorticism can cause this b) hypercalcemia dog harmful lasix (too high calcium levels -- hyperparathyroidism, metastatic dog harmful lasix cancer, poison) c) low serum potassium levels d) kidney failure dog harmful lasix due to amyloidosis e) pyelonephritis (infection of the kidney itself) f) some forms of drug therapy g) very rarely as a congenital defect Of the things mentioned above, behavioral excessive drinking is probably the most common cause of dilute urine. However, this should not be a constant finding in dog harmful lasix a series of urine samples, in most cases. So the first step is usually just to test several samples, trying to get at least one at a time when the urine should be concentrated, like dog harmful lasix the first urine sample in the morning dog harmful lasix for a dog that dog harmful lasix doesn't have access to water during the night. We usually ask for several samples dog harmful lasix taken over the course of a single day, if possible. If a series of samples reveals consistently dilute urine then it is necessary to start working through the list of possible problems until the cause can be determined. Mike dog harmful lasix Richards, DVM 11/10/2001 Kidney transplant for dogs Question: Dr. Richards: I have a 2 year old Rottweiler who was recently diagnosed with chronic renal failure. The internal specialist we saw found that there was a loss of the corticomedullary junction and slightly dilated renal pelvis, as well as persistent azotemia and USPG of 1.025. He was given an ultrasound of the abdominal area where after viewing the vet described his kidneys as "severely" damaged with a loss of 75% kidney function. He has moderately elevated BUN and creatin levels. We have had him for 1 1/2 years after rescuing him from a neglectful and abusive owner. He was approximately 25 pounds underweight, with severe malnutrition, mange, and a host of other problems. Per the specialist instructions we have begun changing him over to a new low protein diet (Eukanuba) specially formulated for dogs with kidney disease. The vet said his phosphorus and calcium levels were normal. dog harmful lasix She stated that although he has lost 75% of kidney function he is still in dog harmful lasix the beginning stages of this disease and referred to his condition as "moderate" dog harmful lasix at this time. This little guy is a member of our family and my dog harmful lasix best friend and I will do anything, regardless of cost, to help him have as long and dog harmful lasix healthy dog harmful lasix a life as possible. I want to treat this problem aggresively and proactively. Do you have any opinions on what I can do at this point to combat this disease and hold off his inevitable decline for as long as possible. I would give him one of my kidneys if I could. Any help or suggestions dog harmful lasix you could give dog harmful lasix would be greatly appreciated. Thanks, Nathan Nathan Answer:Nathan- It is possible to pursue a kidney transplant for dogs at this time. The University of Minnesota and the University of California at Davis (UCD) are the only places I know of where this surgery is being done in the U.S., but it is an available option. I do think that it might be best to continue with medical treatment for the dog harmful lasix current problem until the presence of chronic kidney failure is well established, though. The urine specific gravity below 1.030 in the presence of increase blood (serum) urea nitrogen levels and/or increased creatinine levels (azotemia) is a strong indication of kidney failure or dog harmful lasix kidney insufficiency. The general rule of thumb is that about dog harmful lasix 75% of kidney function must dog harmful lasix be gone dog harmful lasix before azotemia and a decrease in urine concentrating ability occurs. It might be a good idea to check several urine samples, especially ones from early in the morning, to see if the kidneys can concentrate dog harmful lasix urine at times, though. There some medications that you might consider using to dog harmful lasix attempt to slow the progress dog harmful lasix of the dog harmful lasix kidney failure or to make your rottie feel better. Enalapril (Enacard Rx) can help decrease protein loss and possibly slow the dog harmful lasix progression of dog harmful lasix kidney failure in dogs. It is important to monitor its effects in the first week dog harmful lasix of use, though. In a few dogs it can make the kidney failure worse. We have used enalapril now dog harmful lasix in several dog harmful lasix patients and our subjective opinion is that it is helpful. This medication makes the most sense when there is demonstratable protein dog harmful lasix loss in the urine. Even moderate dog harmful lasix protein elevation in unconcentrated dog harmful lasix urine samples is indicative of protein loss in the urine. Calcitriol is dog harmful lasix recommended by some veterinary kidney specialists and avoided by others. It is an active form of Vitamin D which may help to prevent secondary renal dog harmful lasix hyperparathyroidism. I am not sure who will turn out to be right in the long term, the dog harmful lasix people for dog harmful lasix or against the use of calcitriol. We use this and we think it is helpful but we are not sure. An alternative dog harmful lasix approach is to use phosphate binders (aluminum hydroxide gel, others) to try to keep phosphorous levels from rising. This is the approach favored by the kidney disease specialists that avoid calcitriol use. It is very important to maintain hydration dog harmful lasix in dog harmful lasix patients who have kidney insufficiency. If you can not dog harmful lasix encourage adequate drinking, it may be necessary to dog harmful lasix consider using occasional fluid therapy. This is harder to do in dogs than in cats and is utilized dog harmful lasix less frequently due to this. It is critically important to use fluid therapy if your dog stops drinking or cuts down on drinking significantly, no matter what the dog harmful lasix cause. It is important to dog harmful lasix try to maintain a patient's appetite, so if there is a time when it decreases, appetite stimulants are appropriate. A lot of patients with kidney failure have gastrointestinal irritation and using cimetidine (Tagamet tm), famotidine (Pepcid AC tm) or ranitidine (Zantac tm) can dog harmful lasix be helpful, as well. Monitoring dog harmful lasix the progress of the kidney disease through repeated urinalysis and periodic blood tests is a good idea. Sometimes clinical signs do not occur until after there are significant changes in laboratory values and early recognition of a dog harmful lasix change in the status of the kidneys can be very helpful. I hope that this information is helpful. Mike Richards, DVM 9/14/2001 Medications that are linked to kidney dog harmful lasix failure Question: Dr Richards, You said in an earlier post than antibiotics and non-steroidal anti-inflammatory medications used for arthiritis probably cause kidney failure. Would you have dog harmful lasix available dog harmful lasix those medications that could cause kidney failure? Tony A. Answer: Tony- I dog harmful lasix don't have a complete list of medications that have been dog harmful lasix linked to kidney failure but I can give you at least a partial list. Among antibiotics, tetracycline at high dosages, gentamicin, amikacin and most sulfonamides and sulfa-trimethoprim combination antibiotics can cause kidney failure in some patients. Of these,the two aminoglycosides (amikacin and gentamicin) are the most toxic to the kidneys but are only available as injections so are rarely dispensed, although they are used in severe infections in hospitalized animals not too infrequently. The entire class of non-steroidal anti-inflammatory dog harmful lasix medications can cause kidney damage dog harmful lasix due to constriction dog harmful lasix of blood vessels in the kidney. This would include aspirin, carprofen (Rimadyl Rx), etodolac (Etogesic Rx), phenylbutazone (Butazolidin Rx) and others. I don't think that any of these medications are highly likely to cause a problem in any individual patient, with the possible exception of the aminoglycosides, which must be used very carefully whenever they are used. However, when kidney failure dog harmful lasix signs occur and any of these medications are being used it is prudent to evaluate the necessity of the dog harmful lasix use and to consider adjusting the dosage or changing medications, if possible. There are other medications that are linked to kidney damage dog harmful lasix to dog harmful lasix some degree. These include thiatarsamide (old heartworm treatment medication), chemotherapy agents such as cisplatin, amphotercin-B (antifungal agent), enalapril (Enacard, Rx; used for dog harmful lasix heart failure and sometimes to treat kidney disease because of beneficial effects it has in most patients), methoxyflurane (anesthetic) and iodinated contrast dyes used to help improve the ability to see problems on X-rays. All of these medications have uses that often make taking a small risk of kidney failure reasonable -- dog harmful lasix but again, when dog harmful lasix problems occur they have to be considered as possible causes. Mike Richards, DVM 8/13/2001 Serum (or dog harmful lasix blood) urea nitrogen levels and the serum creatinine levels as indicators of Kidney function Question: hi, could you explain to dog harmful lasix me dog harmful lasix in 'simple language' what is dog harmful lasix the difference between a high kreatonine and a high ureum level in the bloodwork when there is renal failure ? Answer: T- The serum (or blood) urea nitrogen level and the dog harmful lasix serum creatinine levels are both indicators of kidney function. Both of these values tend to rise when the kidneys are not functioning efficiently. The urea nitrogen level is less specific to kidney damage than the creatinine level. Rises dog harmful lasix in BUN can occur after a high protein meal, in response to muscle damage, dog harmful lasix when corticosteroids are being used and when dehydration or urinary obstruction is present when there is no kidney damage. Usually these rises are not dog harmful lasix severe, though. When dog harmful lasix kidney disease is present the BUN tends to rise faster than the creatinine so it dog harmful lasix is sometimes considered dog harmful lasix to be a more sensitive indicator of kidney function, as long as the non kidney causes dog harmful lasix for it rise are dog harmful lasix not present. Creatinine is more specific for kidney disease. It can rise when dogs are fed diets high in cooked meat but these rises tend to dog harmful lasix be small. It can rise when there is dehydration or a urinary obstruction even though the kidneys are not damaged yet. However, for the most part rises in creatinine do indicate damage to the kidneys. Over time, the rise in creatinine levels is a dog harmful lasix little better dog harmful lasix indicator dog harmful lasix for how glomerular damage is progressing than the BUN. A chronic slow rise in the dog harmful lasix creatinine is an indication of ongoing damage. For both creatinine and BUN, it is important to look at other indicators of how the body is doing to be sure that there isn't a problem like dehydration or urinary blockage leading to the rises in the BUN and creatinine, instead of kidney damage. If the urine is concentrated, kidney damage is less likely. If the patient is normally hydrated but has protein in large quantities in the urine, then glomerular disease might be present even if the BUN and creatinine are not very high. dog harmful lasix So the BUN and creatinine are important indicators of kidney function but they have to be considered based on the patient's overall condition and the potential for diseases other than kidney disease to be present. When monitoring chronic kidney disease, sudden rises in BUN are a good reason to evaluate overall patient care to be sure that hydration is good and that there is not an additional problem present, since the BUN rises more easily due to dog harmful lasix these types of problems. Rises in the creatinine occur more slowly but are a stronger indication of long term damage to the kidney, so rises in the creatinine indicate a need to try to help the body compensate for the loss of kidney function. I hope this is helpful. Mike Richards, DVM 8/5/2001 Kidney disease in Sheltie - when dog harmful lasix to put on calcitrol Question: dog harmful lasix Dr. Richards-- My sheltie dog harmful lasix has just been dog harmful lasix diagnosed with kidney disease. His BUN is 32; his creanitine level is 1.8. A protein/creanitine urine test showed dog harmful lasix a protein >excretion dog harmful lasix of 2.2. His blood pressure is normal. He is on antibiotics in case of pyelonephritis, but one of his vets says he dog harmful lasix thinks he has amyloidosis. One vet tells me amyloidosis cannot dog harmful lasix be dog harmful lasix slowed down at all, and not to put him on calcitrol yet. The other vet tells me it can be slowed down, and that my dog should go on calcitrol now. What do you think about dog harmful lasix this? My dog's phosphorus level is 3.1. Both vets recommend that my dog go on the Hill's k/d diet. I do not like the BHA and BHT preservatives in this food and dog harmful lasix am looking for alternatives. Both vets said dog harmful lasix I could go with the homecooked diet, but will not recommend a canine vitamin supplement for my dog b/c they don't know what a safe level of phosphorus would be. Could you suggest dog harmful lasix anything? I also need to include calcium carbonate in his homecooked diet, but have yet to dog harmful lasix find it except in the form of Tums. I have read that Tums can be detrimental to pets. Is this true? If so, where dog harmful lasix do I get calcium carbonate? My health food dog harmful lasix store has it but it also contains boron. Please help! I desperately dog harmful lasix want to do what's best for my beloved dog, but no one seems to want to tell dog harmful lasix me what that is. I would greatly appreciate any advice. Thank you. Shanna Answer: Shanna- The protein/creatinine ratio can help in determining if there is excessive excretion of protein by the kidneys. The test works like this: the amount of protein in a measured amount of urine dog harmful lasix is compared to the amount of creatinine in dog harmful lasix the same urine sample. The amount of protein (mg/dl) is compared to the amount of creatinine (mg/dl) and a ratio formed by dividing the protein value by the creatinine value. If this number is less dog harmful lasix than 1, it is usually considered to be in the normal range. If the ratio is greater than 1, it supports a diagnosis of protein loss through the kidneys. With the urine protein/urine creatinine ratio of 2.2, there is excessive loss of protein through the kidneys. This test can indicate a problem and can also be used to track the problem over time to get an idea of how much change is occurring. The BUN and creatinine levels reported in the blood work are not excessively dog harmful lasix high. This does dog harmful lasix seem like a good time to start treatment since the earlier you start the more long term success dog harmful lasix you are likely to have. It is important to know the phosphorous levels when contemplating the use of calcitriol. If the phosphorous level dog harmful lasix is dog harmful lasix less than 6 mg/dl it dog harmful lasix is usually OK to start dog harmful lasix calcitriol. If it is not, then using phosphate binders to get it down below this level would be necessary. In your dog's case this should not be a problem since the phosphorous level is not elevated at this time. I like calcitriol and I think that it helps our patients with progressive kidney disease. There are veterinary kidney disease specialists who do not think that calcitriol is beneficial, so at this time the use of calcitriol still has to be considered to be controversial in veterinary medicine. Hopefully there will be dog harmful lasix conclusive studies one way or dog harmful lasix the other over time. Calcitriol does not affect the progression dog harmful lasix of amyloidosis at all, to the best of my knowledge. What it is supposed to do is help prevent renal secondary hyperparathyroidism, which is a common dog harmful lasix problem as any dog harmful lasix form of chronic dog harmful lasix kidney disease progresses. This is an important benefit for patients with kidney failure but it doesn't dog harmful lasix have a direct effect on the kidney disease. I am hoping that your veterinarian's impression that the kidney disease is due to amyloidosis is wrong. Amyloidosis is the deposition of amyloid in the kidneys. This is a form of dog harmful lasix protein and when it accumulates it eventually causes kidney failure. It can dog harmful lasix occur in the kidneys and dog harmful lasix in other dog harmful lasix organs, as well. The progression dog harmful lasix of kidney failure is usually faster in dogs with amyloidosis than with glomerulonephritis and the treatment options are much more limited. As far as I know the only way to tell amyloidosis from dog harmful lasix glomerulonephritis dog harmful lasix is by kidney dog harmful lasix biopsy. From a practical standpoint, though, kidney biopsy is not commonly pursued because time will help differentiate between these conditions and knowing which one is present doesn't alter treatment much. Amyloidosis can occur for unknown reasons or it can occur dog harmful lasix secondary to cancer, so it is a good idea dog harmful lasix to look carefully for cancer when this condition is suspected. Glomerulonephritis dog harmful lasix is a lot more common dog harmful lasix than amyloidosis. Glomerulonephritis is inflammation dog harmful lasix of the glomeruli (the filtering structures of the kidney). It can occur secondary to many other illnesses, including many dog harmful lasix disease organisms (leptospirosis, Lyme disease, heartworms, brucellosis, hepatitis), cancer, pancreatitis, immune-mediated hemolytic anemia, hyperadrenocorticism and dog harmful lasix systemic lupus dog harmful lasix erythematosus and other immune mediated diseases. It can also occur as a dog harmful lasix primary, or idiopathic, illness. Sometimes finding and controlling the dog harmful lasix underlying problem can arrest the degenerative process and stop dog harmful lasix the progression of kidney failure. More often, once this problem dog harmful lasix starts it is slowly progressive over time. There are treatments that can help with glomerulonephritis. As mentioned above, an effort should be made dog harmful lasix to dog harmful lasix find and treat any contributing condition. To help prevent protein loss and control dog harmful lasix high blood pressure associated with kidney failure, enalapril or other acetylcholinesterase (ACE) inhibitors may be helpful. The usual dosage of enalapril for this condition is 0.25 dog harmful lasix go 0.5mg/kg once or twice a day. Aspirin may help to prevent blood clotting that sometimes dog harmful lasix occurs due to glomerulonephritis. The dosage for aspirin therapy for this purpose is usually lower than for other conditions. A dosage for aspirin of 0.5 to 5mg/kg is enough to inhibit blood clotting. A low sodium, low total protein but very high quality protein diet, such as Purina NF (tm) or Hills k/d is helpful. Encouraging fluid intake is helpful. If the serum albumin level drops low enough to cause dog harmful lasix fluid accumulation in the abdomen it dog harmful lasix may be necessary to give diuretics. Calcitriol is more likely to provide a benefit in a patient with dog harmful lasix glomerulonephritis since this tends to be a dog harmful lasix more dog harmful lasix slowly progressing disease. It dog harmful lasix is possible to make a home made diet for dogs with kidney dog harmful lasix failure. A good dog harmful lasix approach to this dog harmful lasix would be to contact a veterinary nutritionist for specific advice. However, to the best of my knowledge, there is no problem with dog harmful lasix using unflavored Tums (tm) in dogs dog harmful lasix for calcium carbonate requirements. One Tums dog harmful lasix tablet contains 0.5gm of calcium carbonate. It is also possible to find dog harmful lasix calcium carbonate as the calcium ingredient in some human calcium supplements. I don't know the names but you could probably pick them out by reading the ingredients. Lately most veterinary nutritionists seem to be recommending Theragram M dog harmful lasix (tm) as a good multivitamin tablet to use in homemade dog harmful lasix diets. I have also seem recommendations to use Centrum Silver (tm), so it is likely that other multi-vitamins are OK, too. I hope that this dog harmful lasix information is helpful. Mike Richards, DVM 8/2/2001 Kidney failure and High calcium levels Question: Dr Richards, Poor Princess seems to dog harmful lasix be plagued with bad luck. Whenever a refill is ordered timely, the med always arrives the next day. But when a med has to arrive the next day, it fails to arrive. Today was the 3rd. time that this has happened. No one can explain why. This is so weird. What causes BUN, phosphorus, creatinne, calcium levels to dog harmful lasix rise in kidney patients and at what rate? The reason it was so important for the Calcitriol to have arrived today dog harmful lasix was because we needed to get her started on it before the phosphorus level rose to unacceptable levels. It was at 5.1 on the 2-16 blood dog harmful lasix test. dog harmful lasix In treating Princess we have had to experience a lot of delays. Much of it beyond our control and we wonder why that is. Tony Answer: dog harmful lasix Tony- Blood urea nitrogen (BUN) and creatinine are removed from the circulation by the kidneys. When dog harmful lasix the kidneys dog harmful lasix are not working well, the levels of these hormones rise. This is a direct effect of the damage to the kidneys. Urea nitrogen and creatinine are not particularly harmful compounds but they are good markers for other toxins the kidneys should be removing from the system that do cause serious problems. High calcium levels in patients with kidney failure are a more complex problem to dog harmful lasix explain. This probably results from several contributing factors. As the phosphorous levels rise in patients with kidney failure there dog harmful lasix is an increased dog harmful lasix production of parathyroid hormone (PTH), which regulates calcium and phosphorous levels, in an effort to compensate for this. Over time, the rise in PTH becomes significant and a condition referred to dog harmful lasix as renal secondary hyperparathyroidism develops. Low calcitriol levels dog harmful lasix contribute to this condition, which is why dog harmful lasix supplementation of calcitriol can be beneficial for dog harmful lasix patients with kidney failure. The odd thing, though, is that increased PTH should actually cause dog harmful lasix the calcium level to be lower in the blood stream. The active form of dog harmful lasix calcium is the ionized form. In most patients with increased total calcium levels caused by kidney failure, the total calcium is high but the ionized calcium, which is what parathyroid dog harmful lasix hormone actually controls, is low. The total calcium is thought to increase due to accumulation dog harmful lasix of inactive forms of calcium in which the calcium molecule is bound to other dog harmful lasix compounds that keep it from working. To make dog harmful lasix this a little more confusing, high calcium levels can be harmful to the kidneys -- but only high ionized calcium dog harmful lasix levels. When total calcium is high in a patient dog harmful lasix with kidney failure it may be due to a problem like malignant cancer, dog harmful lasix which causes rises in both the total and ionized calcium levels. In this case, it is important to lower the calcium levels and to deal with dog harmful lasix the primary problem which is the cancer. When total calcium is high but ionized calcium is normal or low in dog harmful lasix a patient with kidney failure, the odds are higher that the kidneys themselves dog harmful lasix have dog harmful lasix created the situation and treatment should be directed at dog harmful lasix dealing with the kidney dog harmful lasix failure. In this situation, the use of calcitriol even when total calcium is elevated, can be beneficial, as long as total phosphorous is below 6 to 6.5 mg/dL and calcium supplements dog harmful lasix are not dog harmful lasix being dog harmful lasix administered. Mike Richards, DVM 3/10/2001 Kidney failure in young Cocker Question: dog harmful lasix DR Mike, I just found out that my 2 dog harmful lasix 1/2 year old female cocker spaniel is probably in kidney failure and would like some advice. On her blood test the BUN value is 149 mg/dL and the creatinine is 7 mg/dL. dog harmful lasix She is very lethargic, but does dog harmful lasix not seem to dog harmful lasix be in dog harmful lasix any pain. I have dog harmful lasix been able to get her to drink small portions of water (at a time, a good amount of water, overall) and eat cooked chicken in small dog harmful lasix portions after giving her about 4 mL dog harmful lasix of pepto bismol and amforal. My vet is leaning toward euthanising her, but I'd rather let her go naturally, as long as she doesn't seem to be in much pain. In a response to a letter from Sharon, Dr. Richards indicates that "some patients respond to aggressive fluid therapy, diet, phosphorous binders, B-vitamin supplementation, gastrointestinal protectants such as cimetidine, omega fatty acid dog harmful lasix supplementation and good nursing care from their owners." I was wondering if dog harmful lasix I could get a more dog harmful lasix detailed description of dog harmful lasix what these different things are and which things I can carry out on my own (and how to) and which require the care of a vet. Thank dog harmful lasix you, Kim Answer: Kim- The initial thing dog harmful lasix to do in dog harmful lasix a dog this young is to try to figure out why kidney failure would occur. Kidney failure occurs due to dog harmful lasix poisonings (antifreeze, ethylene glycol), changes in blood flow to the kidney (renal ischemia), obstructions to urine flow, infections, dog harmful lasix congenital defects and for no apparent reason. Two and half years of dog harmful lasix age is dog harmful lasix young enough to be affected by a dog harmful lasix congenital defect. I don't think this is a really common problem in cockers but there dog harmful lasix are some congenital kidney diseases recognized in cockers, including kidney fibrosis and improperly formed kidneys (renal cortical hypoplasia). dog harmful lasix So making sure there is not something obstructing urine flow from the kidney to the bladder, considering the possibility of an infection such as leptospirosis and trying to eliminate that possibility, ruling out toxins and trying to rule out conditions that might lead dog harmful lasix to reduced kidney blood flow, such as dehydration, heat stroke, blood loss, heart failure, hypoadrenocorticism (Addison's disease) and medications (non-steroidal anti-inflammatory medications rarely have dog harmful lasix this effect and it is also an uncommon side effect of ACE (angiotensin-converting enzyme) inhibitors used dog harmful lasix for heart conditions). In acute renal failure situations, it is really important to institute aggressive fluid therapy as soon as possible. Your veterinarian dog harmful lasix would have to do the initial placement of an intravenous catheter and monitor care closely, but you could administer the fluids at home if your vet is comfortable with that arrangement. dog harmful lasix In chronic renal failure there is less benefit from high dosage fluid therapy but administration of fluids is still helpful. In chronic renal failure, it dog harmful lasix is important to focus on the things that can be controlled dog harmful lasix that might enhance the kidney damage, so control of phosphorous in the diet, controlling blood pressure, keeping patients eating, protecting their gastrointestinal tract and similar concerns are more important. Low phosphorous diets are available from dog harmful lasix your veterinarian or you can administer phosphate dog harmful lasix binding agents and feed a moderate protein diet. There are a lot of phosphate binders, including aluminum hydroxide, aluminum carbonate, calcium carbonate, and calcium acetate products. Amphogel (tm) has been a popular one but is hard to find now and dog harmful lasix PhosLo (tm) is another available product. Your vet can help you find one of these products that is available in your area. Famotidine (Pepcid AC Rx) is a good protectant for the GI tract for patients with kidney failure. Some vets prefer other products and there are several, such as cimetidine (Tagamet Rx). 3V Capsules (tm) are a good source of the omega fatty acid supplements that can be helpful in some forms of chronic kidney disease. Kidney failure in dogs is harder to deal with than kidney dog harmful lasix failure in cats and dog harmful lasix it can be discouraging to try to treat this dog harmful lasix condition in dogs but there are some dog harmful lasix successes and it is reasonable to try, especially if an dog harmful lasix underlying cause like leptospirosis dog harmful lasix or Addison's disease can be identified and treated. Mike Richards, dog harmful lasix DVM 11/4/2000 Kidney failure and heart murmur in Poodle Question: Dr. Mike, I dog harmful lasix have a beautiful 12 yr/ 18# miniature poodle. She was diagnosed 4 months dog harmful lasix ago with kidney failure and a heart murmer. We started daily sub q's dog harmful lasix at home immediately. At first twice a day- then once- then twice and now three times a day. dog harmful lasix Her bun jumped from 115 to 56 to 101 and now 112. Her creatine started at 1.7, 2.6, 1.8 dog harmful lasix and now 4.6. Her phosp started at 8.7, 4.6, 5.9 and now 9.7. Her heart murmer has been more pronounced with each appt and now it is continuous. She has developed fluid in her stomach dog harmful lasix and lungs and we have been doing a balancing act between lasix and sub q's. She currently is taking 90 mg lasix per day in three divided doses. Three sub q's 100/75/100. Enacard 6.25 mg am and 12.5 mg in the pm. She developed an ulcer and is taking cimetidine 100 mg three times a day. dog harmful lasix She is also taking a potassium supplement, B-12 shots for anemia and lixatonic. She was also placed on dog harmful lasix Clavamox which we have since discontinued because we found that it was a trigger for her vomiting. She collapsed once after a very bad episode of diarrhea and vomiting but soon recovered her strength. The vomiting is only occasional but dog harmful lasix now the diarrhea is 2x a day but controlled dog harmful lasix with dog harmful lasix pepto bismol. Her appetite is good and she has never refused to eat. She still takes pride in her appearance and performs her daily grooming. Her urine appears to be concentrating to a small degree. Her most urgent problem is fluid in the lungs. Our vet advised tapering down the sub q's which triggered more diarrhea and a general unwell dog harmful lasix feeling. We have now increased the fluids and she is comfortable except for the breathing dfficulty. She has not had any tests for her heart and wonder if there is still something that can be done for dog harmful lasix her. Have we overlooked any other possibilities to improve her quality of life and help her with the fluid problem? Her energy level is very good considering her condition and dog harmful lasix her mental state is excellent. Your help would be greatly dog harmful lasix appreciated. It means the world to our family to know that we are dog harmful lasix doing everything we can for our girl. Thank dog harmful lasix you. Betty- Answer: In your note, you did not mention whether your poodle is being fed a restricted protein/restricted phosphorous dog harmful lasix diet, such as Hill's k/d (tm), Purina's NF dog harmful lasix (tm) or dog harmful lasix Waltham's restricted protein diet. This can make pets with kidney disease feel better and dog harmful lasix may slow the damage to the kidneys that occurs over time. These diets are also low salt, which can be helpful, too. Phosphorous binding agents may be helpful. Over-the-counter antacid preparations (like Amphogel dog harmful lasix tm) can help dog harmful lasix lower the phosphorous levels. Sucralfate, a gastrointestinal protectant that may help with ulcers, also may help to bind phosphorous, so it may be worth considering, too. Recently, omega-3 fatty acids (from fish oils) have been reported to help protect kidneys from some of the ongoing damage in renal failure. Omega-6 fatty acids are reported to be harmful to the kidneys, so it is important to be sure of the composition of any fatty acid products used. Some veterinary dog harmful lasix referral practices do either hemodialysis (as is done in humans) or peritoneal dog harmful lasix dialysis (more common in dog harmful lasix pets). This can be very helpful but it takes some luck to dog harmful lasix be close to a facility that offers this care. It can be hard to balance the fluid administration necessary for the kidneys with the need to avoid overloading the cardiovascular system. If there is a veterinary cardiologist near you, it may be helpful to get help from the cardiologist in managing this situation. It is not possible to stop the progression of kidney failure in most cases. However, it is possible to slow the rate of damage down and to provide a reasonable quality of life for some time, in many cases. I hope that this information helps some. If you need clarification or additional information dog harmful lasix do not hesitate to write back. Mike Richards, DVM 8/13/2000 Kidney disease or dog harmful lasix kidney dog harmful lasix failure? Question: Dr. dog harmful lasix Mike I have a question that I have not seen answered in all your files. Question: How do you determine if a dog dog harmful lasix has kidney disease or kidney failure. My dog was diagnosted with kidney disease 8 months ago. Now my vet seems to think that Missy's prognosis is poor and dog harmful lasix he is suggesting euthanatia. She was dog harmful lasix not eating a dog harmful lasix week ago and the Emergency Vet Clinic gave her fluids. The next day, I gave her pedialite and pepsid AC and dog harmful lasix she came back with playing, eating, and dog harmful lasix no diarreah. However, it has been almost a week later, and she is showing signs of not eating once again (she ate a few bits of cookies, but refuses all other food). I also noticed she is drinking much more water today and goes out much more frequently to urinate. A couple of times she appeared weak (and could not jump a step easily), but then she would turn around and jump a step later. I am beginning to think she is going back down. Since she is 12 1/2 years old, and cannot get her teeth cleaned any longer (too risky according to the dog harmful lasix vet since she also has heart failure), I wonder if I dog harmful lasix should just let her go (euthanize) if she continues not to dog harmful lasix eat in the next few days. I don't want to drag her through a lot, since renal failure is almost dog harmful lasix always leads to death sooner or later. So again, my question: how do you dog harmful lasix tell kidney disease from kidney failure? Is it in the blood test results; i.e., BUN, Creatin, Phosporous. If so what numbers are these usually when kidney failure are dog harmful lasix involved? I would appreciate a quick response, since I feel I will have to make a decision I really dread, sometime in the near future. I am going on a trip (4 nights) in another week and am worried about dog harmful lasix Missy getting even worse while I am dog harmful lasix away. My daughter thinks Missy will grieve so much for me she will get even sicker. I am prepaired to dog harmful lasix euthanize her in a couple of days, though, if she dog harmful lasix does not eat. Thanks, Sharon Answer: Sharon- I think that most veterinarians, including me, use dog harmful lasix the term kidney failure to describe any condition in which the kidneys are not dog harmful lasix able to adequately do their job. This is probably a poor policy. What is happening in most cases is that the kidneys are working, they just aren't working as well as they need to be. This should probably be referred to as kidney insufficiency. The term kidney failure should probably be used to describe the terminal stages of kidney insufficiency, or the point where dog harmful lasix the kidneys are actually no longer functioning at all. I think the term is so entrenched in veterinarian's vocabulary in its current use that it is unlikely to change, though. Kidney disease is dog harmful lasix also used pretty generically. dog harmful lasix There dog harmful lasix are a number of possible kidney problems that can lead to the kidneys having enough accumulated damage that they can not adequately do dog harmful lasix their dog harmful lasix job. The most common is probably chronic interstitial nephritis, which is disease most closely associated with kidney damage as pets age. Glomerulonephritis, amyloidosis, polycystic renal disease (more common in cats), pyelonephritis, cancer, viral and bacterial infections, hypertension, hypotension and a number of other conditions can cause kidney damage sufficient to dog harmful lasix induce kidney insufficiency or failure. There are a number of lab tests that indicate that the dog harmful lasix kidneys are not functioning properly. When kidneys are working, they produce urine that is more concentrated than the plasma. Typically, a dog should dog harmful lasix be able to concentrate urine above the specific gravity of 1.020. If several urine samples taken during the day all fail to have a urine concentration greater than 1.020, that would be a sign that the kidneys are not working properly. Blood urea dog harmful lasix nitrogen (BUN) concentrations above 75 mg/dl are a strong indication that the kidneys are not able to do their job. Creatinine values above 2.5 mg/dl are also pretty unlikely to occur for any reason other than an dog harmful lasix inability of the kidneys to filter dog harmful lasix the creatinine from the bloodstream. Rising phosphorous levels (> 7.0 mg/dl) are associated with kidney damage. Falling total protein levels sometimes dog harmful lasix occur with kidney failure. Anemia is not uncommon when the kidneys really do start to get close to failing entirely. The big problem with this situation is dog harmful lasix that we can often treat kidney problems and gain some time, even when they are very serious. dog harmful lasix I have copied a letter I wrote tonight to another subscriber below, as it has some treatment options in it, so that dog harmful lasix you have that information. However, what I think that you are asking is this: How do you tell when the kidneys will no longer respond to treatment? I do not have a sure dog harmful lasix answer to that question. It helps a lot if it has been possible to get an exact diagnosis of the cause of the kidney disease. This may not dog harmful lasix be possible at dog harmful lasix this point and it may not dog harmful lasix even matter. For now, I think it is reasonable to assume that it is chronic interstitial nephritis in Missy's case. We have seen dog harmful lasix patients with BUN values > 180mg/dl and creatinine values > 13.5mg/dl respond to aggressive fluid therapy, diet, phosphorous binders, B-vitamin dog harmful lasix supplementation, gastrointestinal protectants such as cimetidine, omega fatty acid supplementation and good nursing care from their owners. Due to this, we tend to try to treat patients even when they have very high blood values for chemistries dog harmful lasix relating to kidney disease. However, if they do not respond to treatment pretty rapidly, with a decline in BUN that is substantial within 48 to 72 hours, we consider that to be a very bad prognostic sign. So response to treatment is the way that we try to differentiate between patients whose kidneys are not working well but who have enough remaining kidney function to allow management of their condition dog harmful lasix for some time and patients whose dog harmful lasix kidneys have so much damage that they are unable to respond to therapy. There is always some dog harmful lasix point where therapy will no longer help. The bad thing is that we often can not discover where that point is without trying to treat for two to three days, as dog harmful lasix a minimum, past the time dog harmful lasix when pets start to feel very bad. That is the sad part about treating kidney failure. When you reach the point where is it obvious that Missy is not going to respond to treatment one more time or when she gives you strong indications that she no longer wants dog harmful lasix to fight with this condition, it is good that you have the option of euthanasia. This is a problem dog harmful lasix that can cause significant suffering and I am grateful that we can put an end to that suffering when it is necessary. I hope that this clarified things a little. If you are still confused or need more specific information please let me know. Mike Richards, DVM 8/13/2000 Kidney disease family history in Brussels Griffon Question: Dr. Richards, My dog, a 3 year dog harmful lasix old Brussels Griffon, has a family history of kidney disease on both sides of his parents. His grandfather dog harmful lasix on his father's side died of the disease at 4 years of age and his great grandfather on his mother's dog harmful lasix side had chronic kidney failure most of his life, dog harmful lasix but did live to be 10 years of age. I recently found out this information and informed my own vet. He ran all the dog harmful lasix kidney function tests which came out normal, but dog harmful lasix he recommends that dog harmful lasix I switch my dog to KD due to his family history. Since the protein level is dog harmful lasix reduced, I'm dog harmful lasix wondering if this will harm him. What are your thoughts? Sharon Answer: Sharon- There is still controversy among veterinary renal dog harmful lasix specialists and veterinary nutritionists over the value of restricting protein levels in patients with chronic renal failure. The most recent dog harmful lasix edition of Small Animal Clinical dog harmful lasix Nutrition (Volume 4) suggests that it is helpful, though. However, there is no evidence that I am aware of that there is any benefit in using a reduced protein diet in a patient with no identifiable signs of renal failure. So I guess I would lean towards feeding a "normal" diet until there was evidence that your puppy dog harmful lasix would have problems similar to those that family members have experienced. Checking urine samples or blood samples on a regular schedule would be a good idea, probably. There dog harmful lasix is ample evidence to suggest that the protein levels in the renal care diets such as Hill's k/d (tm), Purina's NF (tm) and similar diets are sufficient for adult dogs. I would not be concerned about using these diets as long as there wasn't something like pregnancy, extreme athletic pursuits or other reasons to suspect that a higher protein level in the diet might be necessary than these diets are designed to provide. dog harmful lasix The safety margin in protein requirement with these diets is pretty big -- adult dogs can survive on about 6% protein dog harmful lasix if it is very high quality and these diets usually have about 14 to 15% protein. So if your vet is more comfortable with dog harmful lasix this approach dog harmful lasix it isn't likely to cause problems. I think you can comfortably dog harmful lasix proceed in either direction dog harmful lasix -- feeding this diet is unlikely to cause problems but it probably isn't necessary at dog harmful lasix this particular time. Mike Richards, DVM 7/9/2000 Cystic kidneys Question: Dear Dr Michael, First of all I'd like to say how wonderful dog harmful lasix your website is. It's so helpful and well organised and has been a valuable reference source for me and I'm very happy to have finally subscribed! dog harmful lasix Thank you for providing us with all this information! My question: I have a 1 and 2 month old mongrel female, she has just been spayed about 2 months ago. She was not operated on by my regular vet and experienced several problems. First of all it took her over 2 hours to recover from the anaesthetic - they usually take less than 30 minutes (all dog harmful lasix my other dogs recovered quickly with the other vet) .. Her eyelid reflexes were dog harmful lasix almost non-existent for over an hour or more and I was worried to the point of panic that her recovery took so long... Then she was fine the next day ( dog harmful lasix a bit groggy dog harmful lasix and not her usual self but then she had just had dog harmful lasix an operation). The second day and for the 14 days following she vomited continuously, was lethargic, refused to eat completely, drank excessive amounts of water and kept belching it all out. Her vomit was yellow and frothy. The vet who performed the surgery told me it was probably acidity resulting from the anaesthetic and prescribed some medicine for dog harmful lasix her which didn't work. My other vet saw her and said dog harmful lasix her liver was affected by the anaesthetic dog harmful lasix and prescribed "motillium", "legalan" -something which improves liver function, and several other medicines which she would only throw up so I stopped using them.. I was giving her cortigen shots twice a day. One night, around 3 am, she was very uncomfortable and vomitted non stop and passed some strange diarhea - yellowy orangey coloured. dog harmful lasix I panicked and called the vet who had dog harmful lasix done the spaying and he put her on an IV drip and gave her a cortigen shot. She was then put on drips for a week and seemed recovered. Since then she's been whining sometimes, and we didn't know if she was just playing around or in dog harmful lasix pain - she didn't seem stressed at all, in fact she would dog harmful lasix frequently be wagging her tail when she did this. And we thought she was dog harmful lasix only calling her sister (to whom she is extremely attached). About a month ago she vomited several times within an hour and then seemed perfectly normal and was eating so I didn't think twice about it... About a week ago her whining increased and this time she seemed to be very dog harmful lasix uncomfortable and started vomiting again, excessively, almost like someone with food poisoning! She also stopped passing urine - she would sqaut dog harmful lasix then get dog harmful lasix up immediately but wasn't straining or even trying to go..She also lost her appetite and was drinking alot of water. I took her to dog harmful lasix the vet immediately and he palpated her and said he suspected cystitis and dog harmful lasix said she should do an ultrasound ( this is the 1st time I've found out that there is an ultrasound for pets here - diagnostic instruments are dog harmful lasix so hard to find in Egypt for pets!), I dog harmful lasix was relieved to find they dog harmful lasix had finally an ultrasound for pets here. She did the ultrasound (I've attached the scans), and the vet who did them said she had internal pus (!!!), cysts dog harmful lasix in both kidneys (!!!) dog harmful lasix and this is his short report: "Urinary bladder: dog harmful lasix cystitis with sedementation inside Kidney: Rt & Lt kidneys showed multiple cysts and the Rt. hydronephrosis Liver: normal Gall bladder: normal Conclusion: Internal pus and hydronephrosis in Rt. kidney Palycystic kidney" What does all this mean?! The ultrasound vet assured me all this wasn't serious and was all treatable but the other vet said there was reason to worry and this meant her right kidney had failed and dog harmful lasix might not work again! I dog harmful lasix am soooo scared and worried and don't know who dog harmful lasix to believe. The vet put her dog harmful lasix on daily ringer drips and will give her dog harmful lasix glucose today, she's taking lasix shots, an antibiotic and other shots I don't know what they are (my vet isn't very dog harmful lasix talkative!). I've included her blood picture results that seem to be very bad. What do you think is happening to my dog - Samba? Is it a bad prognosis or do you think everything will be ok ? She's so young and we resuced her from the streets of Cairo when her mother was dog harmful lasix poisoned and killed (we have many strays here). One of the vets said it was hereditary? Is it? we have dog harmful lasix her brother dog harmful lasix and sister - should we be dog harmful lasix concerned about them now? She's now drinking less and her appetite is poor and her prescribed low protein dog harmful lasix diet isn't helping with her appetite much. Of course she urinates quite alot now due to the lasix. I am so dog harmful lasix worried Dr Michael, I love my dogs so much and they are the light of my life and would be devasted if anything happened dog harmful lasix to them, they are the only thing keeping me going dog harmful lasix in life... Money, time and effort are no dog harmful lasix concern for me when it dog harmful lasix comes to my pets - do you think there are more tests or anything else dog harmful lasix that can be done? Sorry dog harmful lasix about the long email but I wanted to explain everything as best as I could, I don't have dog harmful lasix access dog harmful lasix to all the tests and info I've seen other subscribers dog harmful lasix write about, veterinary medicine here is very different than in the US - we're quite backward and as I mentioned before diagnostic instruments are virtually non-existent - only the ultrasound ( very new here) and x ray machine - only one or two I know of here in Egypt and I was told they weren't used dog harmful lasix well (?). Thank you kindly for your time and any advice/info you can give me on Samba's condition. Sincerely, Hind. Cairo, Egypt. ps: the vet who did dog harmful lasix the ultrasound said the cysts could be sucked out(?) after they treat the pus if dog harmful lasix they don't lessen in size - is this a complicated dog harmful lasix proceedure? it is risky? if they are removed, dog harmful lasix do they return again? Any info would be dog harmful lasix greatly appreciated in this! Answer: Dear Hind- I am sorry for the delay in responding to your question. The IV fluids, diuretic (Lasix Rx) and antibiotics are the necessary first steps in treating the kidney dog harmful lasix disease affecting dog harmful lasix your dog. I tend to agree with the second vet who thought this condition was serious. Kidney insufficiency (chronic kidney failure) in dogs can be very difficult to stabilize for long periods of time. Cystic kidneys are not dog harmful lasix as common in dogs as they are in some cat breeds and I do not have much information on this disease in dogs. However, there do seem to be dogs that have this particular defect as a benign problem for much of dog harmful lasix their dog harmful lasix lives. It might dog harmful lasix be dog harmful lasix worth asking your vets about the possibility of an ectopic (misplaced) ureter. This is one of the major causes of hydronephrosis and can sometimes be surgically corrected. There are several anesthetic dog harmful lasix agents used in dogs and they vary widely in the amount of time the dog sleeps and dog harmful lasix the after effects. Some of the anesthetics are more likely to cause liver problems dog harmful lasix than others. dog harmful lasix It seems more dog harmful lasix likely that the kidney problems were already present and the recovery from anesthesia difficult to the kidney problem, though. I wish I dog harmful lasix could help more dog harmful lasix but I hope it is reassuring that your vets do seem to be doing the right dog harmful lasix things and that you were able to obtain really high quality care for your dog, giving her the best possible shot at recovering. There is a chance even dog harmful lasix with the good work done so dog harmful lasix far that she could be in trouble, but I hope not. Good luck with this. Mike Richards, dog harmful lasix DVM 6/5/2000 Canine kidney failure - dog harmful lasix causes Q: Wolf, our dog harmful lasix 6.5 year old bichon frise is demonstrating symptoms of kidney failure. What are the possible causes?( Lab work forwarded). Are we missing anything? What do we do next.? Scott and Kay A: Scott and Kay- Wolf's lab work does support renal failure from some cause. Weight loss, vomiting and increased drinking and urinating are symptoms often found with renal disease. In addition, the lab work is supportive of this diagnosis, particularly the increases in BUN and creatinine and the decreases in albumin dog harmful lasix levels. I'll try to answer your dog harmful lasix specific questions first and then dog harmful lasix give a more general overview of the potential kidney problems and ways dog harmful lasix of differentiating between them. 1) Are we missing anything? dog harmful lasix The first thought that came to mind for me was that continued monitoring of Wolf's ability to concentrate urine would be a good idea. This is easily accomplished by testing for specific gravity in urine samples. The ability to concentrate urine to a specific dog harmful lasix gravity of 1.030 in a dog is a pretty good indication that the kidneys are functioning dog harmful lasix better. The other thought is that dog harmful lasix there are lot of possible causes of this condition and that it may take dog harmful lasix a lot of work to dog harmful lasix figure out exactly which one is present -- and that you may or dog harmful lasix may not want to go through the process. A more costly test is a urine protein/creatinine ratio which can help dog harmful lasix in determining whether kidney disease is continuing to progress or is stable at the moment. A protein/creatinine ratio greater than dog harmful lasix 1.0 is bad, less than 0.6 is good. 2) Leptospirosis is definitely possible with the symptoms seen. It has to be included in a list dog harmful lasix of differential diagnoses and it is a good idea to initiate treatment dog harmful lasix while waiting on the lab results. Cancer is also possible but primary kidney cancers are not all that common in dogs so it is dog harmful lasix perhaps less dog harmful lasix likely. 3) I dog harmful lasix think it is a good idea to monitor dog harmful lasix urine concentrating ability for a long time after an dog harmful lasix initial dog harmful lasix unexplained bout of renal disease. It is an inexpensive test and I like to check dog harmful lasix urine specific dog harmful lasix gravity weekly for a few weeks, then monthly for a few months and then occasionally after that in dog harmful lasix dogs that have had a serious episode of renal disease. 4) Subcutaneous fluids are cold compared to body temperature and it is not unusual at all for dogs to shake dog harmful lasix or tremble (shiver, actually -- but it can look more like trembling in a dog) after administration dog harmful lasix of the fluids. Low potassium levels sometimes accompany renal disease and potassium levels below 3.5 mEq/L can cause muscular weakness. Pain can cause trembling and it is hard to figure out dog harmful lasix if there is pain in our canine patients, sometimes. 5) If Wolf was dehydrated prior to the tests it would influence the dog harmful lasix tests that are dog harmful lasix related to kidney function. Dehydration has the most effect on BUN but can affect creatinine as well. High protein levels are also dog harmful lasix commonly associated with dehydration. Therefore the correction of dog harmful lasix a dehydrated state could lead to decreases in BUN and creatinine, dog harmful lasix as well as other blood values. I don't think that this would completely explain dog harmful lasix the lab work in Wolf's case, though. The creatinine, in particular, is still high after treatment. What to do next is the big question. It may help to review the most likely causes of Wolf's problem and the ways dog harmful lasix of differentiating between them. Renal (kidney) failure can occur for a lot of reasons. It would be hard to compile a list that anyone would agree dog harmful lasix was a complete list of causes, due to the number of potential causes that exist. So this is a partial list: Pyelonephritis, which is infection of the dog harmful lasix kidney itself Congenital disorders, which are recognized to occur in the following breeds, according to Nelson and Couto, in their book "Essentials of Small Animal Internal Medicine" - Lhasa apso, shih tzus, Norwegian dog harmful lasix elkhounds, shar peis, Doberman pinschers, samoyeds, standard poodles,, soft-coated Wheaton terriers, cocker spaniels, beagles, keeshonds, Bedlington terriers, cairn terriers, dog harmful lasix basenjis and Abyssinian cats. Renal hypoplasia or dog harmful lasix dysplasia - congenital but not always hereditary anything that blocks urine from getting from the kidney dog harmful lasix out of dog harmful lasix the body - congenital urinary tract defects, large bladder or kidney stones, renal parasites, trauma, etc. Immunologic disorders --- systemic lupus dog harmful lasix erythematosus, glomerulonephritis, dog harmful lasix vascular disorders, feline infectious peritonitis Amyloidosis - a disorder that normally occurs in dogs over 5 years of age but can occur earlier is shar peis. It can occur for no apparent reason or it can be linked to underlying causes such as chronic infections (not necessarily of the kidney), chronic inflammation dog harmful lasix that isn't from infection, cancer, cyclic hematopoiesis in gray collies. It occurs for no apparent reason more commonly than it occurs due to discoverable underlying causes Glomerulonephritis - inflammation of the glomerulus (the individual functioning units of the kidney). Can be due to a number of causes, including: bacterial infections {Lyme disease, dog harmful lasix brucellosis, other systemic infections}, viruses {infectious canine hepatitis, feline leukemia, feline infectious peritonitis, feline immunodeficiency virus, chronic feline upper respiratory virus infections}, rickettsial infections {ehrlichiosis, Rocky Mountain Spotted Fever}, heartworm disease, protozoan dog harmful lasix infections {trypanosomiasis, leishmaniasis}, cancer, chronic dog harmful lasix inflammatory conditions {pancreatitis, systemic lupus erythematosus, prostatitis, chronic skin disease, possibly periodontal disease}, hyperadrenocorticism, diabetes mellitus and finally hereditary disorders in Doberman pinchers, samoyeds, rottweilers, greyhounds, bernese mountain dogs, soft-coated dog harmful lasix wheaton terriers and cats. Acute insults to the kidney - trauma, ischemia (lack of blood flow) due to {clots, low blood volume, dog harmful lasix shock, heart failure} and drug reactions or toxins {covered separately} Leptospirosis Hypertension (high blood pressure) -- from hyperthyroidism, chronic heart failure Hypotension (low dog harmful lasix blood pressure) -- usually associated with shock Hypoadrenocorticism dog harmful lasix (Addison's dog harmful lasix disease) Cancer -- usually primary kidney cancer, lymphoma or spread of cancer (metastasis) from other sites unidentifiable causes Toxins dog harmful lasix that are known to affect the kidneys: lead, dog harmful lasix mercury, arsenic (usually arsenicals used to treat heartworms), cadmium, chromium, thallium, ethylene glycol dog harmful lasix (antifreeze), carbon tetrachloride, chloroform, pesticides, herbicides, solvents, snake dog harmful lasix or bee dog harmful lasix venom, possibly mushrooms, vitamin D toxicosis from rodenticides medications known to affect the kidneys sometimes: dog harmful lasix aminoglycoside antibiotics (gentamicin, amikacin), cephalosporins, polymixins, sulfonamides, tetracyclines, amphotericin B, thiacetarsamide dog harmful lasix (Caparsolate Rx), methoxyflurane anesthesia, non-steroidal anti-inflammatory dog harmful lasix medications (aspirin, acetaminophen, ibuprofen, phenylbutazone), many chemotherapeutic agents, gold salts, radiographic contrast agents So there are a lot of possible dog harmful lasix causes of kidney disease. Reviewing the list can sometimes help in ruling out possibilities. If you suddenly remember changing the antifreeze or have been struggling with skin disease for awhile it may be important to be sure those things have been considered, for instance. I will try to send some information on distinguishing between these possibilities in the next few day or so. Mike Richards, DVM Leptospirosis (zoonotic)- Wolf continued Q: Dr. Mike, Thanks dog harmful lasix for all the info about canine kidney problems. It has been very helpful. Here's dog harmful lasix a quick update on Wolf, our 6.5 year old bichon frise who was demonstrating symptoms dog harmful lasix of kidney failure. Last night our vet called and told us that Wolf tested positive for leptospirosis. His levels were elevated for 2 of the 5 antibodies they tested dog harmful lasix for. The vet said specifically Wolf was exposed to grippotyphosa and pomona strains of lepto. Both can cause kidney problems, sometimes permanent, depending on the infection. It dog harmful lasix seems our vet was wise to get Wolfie on the amoxi immediately as a precaution. He was confident that, with the symptoms and test results, lepto was dog harmful lasix the cause. We believe Wolf was eating squirrel poop while we were on walks (at first we thought he was chewing on acorns but then I saw what he was really eathing!) and Kay recently recalled that Wolf got to a dead squirrel that was hidden under some leaves. He may have munched on it once dog harmful lasix or twice before she yanked him away. I suspect either of these could be how he contracted lepto. We are going to get some more specifics from the vet today but the vet said it would be a good idea to talk dog harmful lasix to our doctor/pediatrician about the possibility of Wolf passing the lepto to us or Jake (our 9 month old 2-legged furless son). He also recommended testing Glennis, Wolf's sister/littermate. Wolf will finish out his amoxi series (10 dog harmful lasix days total) and then go on a month of doxicyclin. After the amoxi dog harmful lasix we'll do some standard bloodwork looking for reduced urea nitrogen and creatinine, globulin level, protein levels, etc. Eventually we will need to retest Wolfie dog harmful lasix to confirm he beat the dog harmful lasix lepto, but the vet wasn't sure if dog harmful lasix that would be in a month, 6 months or what. He is going to get back to us dog harmful lasix today on that. FYI, dog harmful lasix there is some good info on the net on leptospirosis. I can't remember the site address but using "leptospirosis" as the search word on Yahoo it hit only 3 sites that are all linked. Lots of good info. Since we are now financial supporters (albeit very minor ones!) of your great website, I might as well ask a couple of quickie dog harmful lasix questions if you have time: 1) We live in dog harmful lasix Fairfax, VA, dog harmful lasix and I see you are just down dog harmful lasix the road. Do you see or hear much about lepto from other vets in dog harmful lasix VA? It dog harmful lasix seems to be relatively rare. 2) Our friend, a dog harmful lasix microbiologist in a pediatric lab, suggested we confirm with the vet that the elevated antibody levels were NOT caused by his vaccination against lepto which occurred in Mar 98. I would think, dog harmful lasix however, that the lab would be looking for a significant increase in the antibody level, more dog harmful lasix than that caused by a vaccination. We'll get dog harmful lasix the actual numbers today (hopefully), but any thoughts on that since you deal routinely dog harmful lasix with vet labs and are familiar with their procedures? Could this dog harmful lasix be a false result due to the vaccination in dog harmful lasix March? 3) dog harmful lasix Will we be able to tell from the lepto tests (antibody levels, type, etc.) how long Wolfie has had the infection? What else can dog harmful lasix we tell about it? Is he potentially still infected and a carrier? Our vet said to avoid dog harmful lasix his urine (clean leaks with gloves, etc) and since he licks himself after urinating, his kisses will be off limits until we get to the bottom of this. 4) Ever hear of lepto making the canine-human jump? The vet said it is possible but dog harmful lasix we should talk to our pediatrician. Our microbiologist friend said that if a human's dog harmful lasix immune system dog harmful lasix is dog harmful lasix down that a dog harmful lasix zoonosis like lepto might make the jump but she thought it unlikely (but recommended talking to the pediatrician ASAP dog harmful lasix anyway.) Well, that's it for now. Thanks for sending dog harmful lasix us such good info and any more that you have dog harmful lasix will dog harmful lasix be appreciated. We'll dog harmful lasix keep you posted. Scott and Kay A: Scott and Kay- To answer your questions: 1) I don't see many cases in which leptospirosis seems likely and have only diagnosed this condition twice in my career. It is possible that dog harmful lasix I have missed some cases, though. We usually dog harmful lasix do not consider leptospirosis titers unless there is renal disease in conjunction with other signs, including anemia, low platelet counts, increased white blood cell count and increased liver enzymes or other signs of liver disease or some other reason to suspect it. Since we wouldn't diagnose dog harmful lasix the condition without at least considering it and testing for it, we may see more cases dog harmful lasix than we think we do -- or we dog harmful lasix may not. 2) Veterinary vaccines contain L. interrogans servovars canicola and icterohaemorrhagiae, so titers to L. interrogans pomona and L. interrogans grippotyphosa are not likely to come from the vaccination. Just having a titer to these organisms is dog harmful lasix not sufficient proof to base a diagnosis on, though. dog harmful lasix Very high titers (over 1:1000) are considered to be likely to be due to active infection, though. Paired serum titers -- one dog harmful lasix set taken immediately upon suspicion on the illness and a second set dog harmful lasix two to four weeks later -- in which there is a rise in dog harmful lasix the titer, are more likely to be actually due to infection. 3) dog harmful lasix All you can really dog harmful lasix tell from the titer is that there has been exposure to the lepto strains, dog harmful lasix or something that cross reacts with dog harmful lasix the strains. In the case of high titers it is easier to assume that infection has occurred. It is not dog harmful lasix possible to tell much else because titers may stay elevated for a long time dog harmful lasix even after the infection has dog harmful lasix been eliminated. It is best to assume that Wolf might be a carrier, though. It is just better to be cautious. 4) Infection of humans by pets seems to be unusual but it is possible. Again, it is best to error on the side of caution. An article (Canadian Veterinary Journal, 1991, Prescott et al) says that of 820 cases of leptospirosis in humans from 1962 to 1978 that dogs were implicated as potential sources of infection in 58% of the cases. Mike Richards, DVM Kidney problems in dog harmful lasix Yorkies Q: Is it normal for a breeder to write on a dogs papers "not to be breed"? We got him when he was 4.5, and told he is the large type and shouldn't be breed. Our Yorkie is only 8 and has kidney disease. He is showing dog harmful lasix symptoms and the vet said he has a few weeks to go. dog harmful lasix Is this a genetic trait in Yorkshire Terriors? We may get another one but want to know if this is common in this breed of dog. dog harmful lasix Regards dog harmful lasix Stephen A: Stephen- We have seen more purebred dogs with contracts that specify that the dog may not be bred recently than we did in the past. I think this is becoming a fairly common dog harmful lasix thing. I am not aware of familial or genetic tendency towards renal disease in Yorkies but dog harmful lasix that dog harmful lasix doesn't dog harmful lasix rule out the dog harmful lasix possibility. They do get bladder stones pretty readily, based dog harmful lasix on the ones dog harmful lasix I see in my practice. Michael Richards, DVM Kidney failure (canine) Q: I need dog harmful lasix help for my friend Lila. dog harmful lasix My 13 year old lab has had progressive weight loss and loss of appetite. I noted 4+ proteinuria last dog harmful lasix year and took her in for a check-up. All labs at that time other than serum protein (1.5) were normal. The vet wanted to do a renal biopsy. I refused. Follow-up exam nearly a year dog harmful lasix later included a heart worm test which was positive (recheck confirmed this unlikely diagnosis in New Mexico). She was treated dog harmful lasix with 2 shots dog harmful lasix and cleared of the worms. I dog harmful lasix suspect she had a "worm byproduct embolus" (my diagnosis) as she dog harmful lasix seemed rather dog harmful lasix different after the treatment... ataxia, sloooooow response time, dog harmful lasix and confusion. She was otherwise all right except for her pronounced osteoarthritis. Labs still the same. Only meds were Bactrim dog harmful lasix for UTIs and dog harmful lasix ASA- enteric. She began losing more and more weight. I took her back this month. Labs now show BUN >50, Cr >3, Serum Protein still 1.5, WBC 3.5. UA still with 4+ protein, some blood. CXR neg. No dog harmful lasix diagnosis given. I assume nothing more unusual than a protein losing nephropathy. dog harmful lasix So my questions: 1. She refuses to eat. Is it alright to "force feed"? I use a turkey baster and give her a slurry of rice, egg, a little milk, canola oil, and dog harmful lasix a flavor of pedigree. She is not pleased with me. Should I go low protein or high protein. Which is the better gamble? Am I interfering dog harmful lasix with her natural way of handling terminal illness? 2. She is in a lot of pain from the arthritis. What is the dog harmful lasix best drug dog harmful lasix given dog harmful lasix her condition? I was given Rimadyl, but I know nothing about its side effects, esp on the kidneys. 3. Is there any value to an ultrasound as was suggested? Why? Thanks for any help you can give. I really appreciate it. A: I am confused by part of the labwork. A total serum protein level of 1.5 gm/dl is low enough to be considered critical. Serum protein is composed of dog harmful lasix two major fractions, albumin and gammaglobulins. Albumin serves many functions but the major one of concern with protein levels dog harmful lasix this low is maintaining the osmotic pressure of the blood. Just having dog harmful lasix an albumin level of dog harmful lasix 1.5gm/dl is considered to be sufficient reason to consider plasma administration. This is not always helpful with chronic renal failure from glomurolonephropathy, though. Gammaglobulins are the proteins of the immune system. One problem with low levels of these is the potential for immune incompetence. I think it would be a good dog harmful lasix idea to confirm that the protein level is this low and dog harmful lasix to discuss possible corrective actions with your veterinarian. As odd dog harmful lasix as this sounds, it is still recommended that a low total protein, but very dog harmful lasix high quality protein, diet be given to dogs with glomerulonephropathy and chronic renal failure dog harmful lasix for other reasons. The reasoning is that administration of high protein levels doesn't help because dog harmful lasix they aren't conserved and that there may even be increased damage from the increased protein passing through the kidneys. It is also good to provide a low sodium diet to dog harmful lasix decrease hypertension which may be damaging the kidneys and low dog harmful lasix phosphorous since it appears that phosphorous may actually be a dog harmful lasix major cause of damage in deteriorating kidneys. Rimadyl (Rx) is new and is supposed to dog harmful lasix be effective in the treatment of arthritis on a chronic basis without the gastrointestinal and renal effects of other non-steroidal anti-inflammatory medications such as dog harmful lasix aspirin. All things considered, I think it dog harmful lasix would be my first choice right now. Like all new things, it is possible some unforseen effect may occur but that is less likely with Rimadyl since it has been in use in other countries for some time. Ultrasound imaging provides a method of obtaining a renal biopsy without surgically entering the body other than the use of long biopsy needles. The image from the ultrasound allows the needle to be placed appropriately and lessens the risk associated with attempting a blind needle biopsy. Other than that, it is probably more of a prognostic dog harmful lasix indicator than diagnostic necessity. This is dog harmful lasix based dog harmful lasix on dog harmful lasix the limited exposure I have had to ultrasound. Your vet may well be more knowledgeable than I am about this subject. Force feeding is probably dog harmful lasix a good idea. In addition, making sure that gastrointestinal irritation is controlled using cimetidine (Tagamet Rx) or similar medications is a good idea. There is a liquid diet made for dogs with renal failure (Clini-Care) if that might be easier to dog harmful lasix administer. Good luck with dog harmful lasix all of this. It is tough to decide how far to go dog harmful lasix when treating chronic degenerative illnesses. Trust your instincts. 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Vetinfo Vetinfoindex Vetinfo4cats Catindex Vetinfo4dogs Dogindex Links Subscriber Area (members only) Zoonotic disease Becoming A Veterinarian Your Turn Search vetinfo4dogs Support Vetinfo and Subscribe toVetinfo Digest Bloodwork and other Labwork Elevated creatine values in bloodwork Low amylase and low albumin Increased ALT levels Rise in white cell count High BUN on pre surgery bloodwork panel High levels of calcuim - Hypercalcemia Hematocrit (HCT) High globulin count (hyperglobulinemia), seizures, lethargy dog harmful lasix in Westie Increased platelet count Continued elevated lipase levels following pancreatitis Elevated Amylase levels, pancreatitis and bladder problems High Potassium levels with dog harmful lasix diarrhea High cholesterol levels also see dog harmful lasix Alkaline Phosphatase levels also see Cancer also see Cushing's also see Pancreatitis also see Ehrlichia also see dog harmful lasix Blood parasites also see Lymph Problems also see Immune dog harmful lasix mediated hemolytic anemia also see Fungal also see von dog harmful lasix Willebrand's also see Thrombocytopenia dog harmful lasix and platelet problems Creatine phosphokinase (CPK) or creatinine kinase (CK) value elevations Question: Blue, 3 dog harmful lasix years old border collie, had a blood test today and a week ago. All his blood results dog harmful lasix were normal except the creatine enzyme which was a little high. Urea was normal. A urine sample was taken and that was normal. Vet thought dog harmful lasix there was nothing to worry about. She said it was probably normal for Blue's creatine levels to be a little high dog harmful lasix because he is a muscular dog. He eats Hill's t/d. Just thought I would let you dog harmful lasix know dog harmful lasix and ask for any comments. Thanks, John Answer: John- I am assuming that this is the creatine phosphokinase (CPK) dog harmful lasix or creatinine kinase (CK) dog harmful lasix value. If this is the case, the most common dog harmful lasix causes of rises in CK are muscle disorders. If there is no evidence of a muscle disorder, I don't see a reason to worry about one being present. Other possible causes are exertional dog harmful lasix hyperthermia (technically dog harmful lasix a muscle disorder, as well), hypothyroidism, heart disease, recent exercise prior to the blood test, selenium/Vitamin dog harmful lasix E deficiencies dog harmful lasix and trauma to the muscles. Unless I had some reason to suspect one of these other disorders I think that I would tend to agree with your vet that a slight rise in CK levels is dog harmful lasix not a good reason to go looking for an dog harmful lasix inapparent problem. You dog harmful lasix can always recheck the levels if a problem does seem likely, or even just as a precaution at a future time. Mike Richards, DVM 2/24/2001 Low amylase and dog harmful lasix low albumin Question: What are the main causes for LOW Amylase (651) and LOW Albumin (2.55) dog harmful lasix levels? Answer: There are dog harmful lasix no known physiologically significant causes of either low dog harmful lasix amylase or low lipase dog harmful lasix levels. If clinical symptoms indicate that there is a lack of dog harmful lasix production of dog harmful lasix pancreatic enzymes (diarrhea, weight loss) then testing for trypsin-like immunoreactivity (TLI test) is the dog harmful lasix best diagnostic test for pancreatic insufficiency. If there are dog harmful lasix no clinical signs suggestive of a problem it should be dog harmful lasix safe to ignore these dog harmful lasix lab values. Mike Richards, DVM 1/3/2001 Increased ALT levels in dog harmful lasix a dog Question: Dr Mike My question concerns elevated levels of ALT in my almost 6 year old male Golden Retriever. In August of 1999, I had dog harmful lasix blood dog harmful lasix drawn dog harmful lasix for a standard chemistry panel and blood counts so we would have a set of baseline values. All the results were within the normal ranges for chemistry and CBC. His T4 level was 1.8 which is low normal and he ws started on 0.4mg Soloxine once a day. On November 29 2000, we repeated the blood chemistry and CBC. This time, the ALT was 164, with dog harmful lasix the normal range for the test lab being 5 - 60 IU/L. The remainder of the tests were within the normal ranges, including others that are less specific for the liver AP =39, AST = 23, GGT = 6. The T4 level was 1.1. The ALT was repeated on December 19 and had increased to 254. The lab ran a bile acid assay on the same sample next day and it was normal (6.9 with 20 or less being normal). On December 28, the blood chemisty panel and CBC were repeated, along with ammonia and sorbitol dehydrogenase. I realize SDH is more typically used for dog harmful lasix horses than dogs, but I asked for it and the dog harmful lasix ammonia as dog harmful lasix additional ways to look for liver dog harmful lasix damage. The ALT was 89 which is lower but still out of the normal range, while SDH (7.7, range 2.9 -8.2 ) and ammonia (33 range 20 -120) were both within dog harmful lasix normal range. The dog appears healthy, and is a very energetic athletic dog. Without the blood work there is no way you would suspect that anything was wrong with his health. He runs hard every 2 or 3 days retrieving bumpers and birds as part of his field training dog harmful lasix and other days goes for daily runs around our pastures. The only thing that changed prior to the November blood test this year was that dog harmful lasix he had been off the soloxine supplement for about 2 weeks. Do dog harmful lasix you have any suggestions as to what would cause an increse in ALT without affecting other liver enzymes dog harmful lasix or liver function? Are the levels high enough to be really concerned? The thing that bothered me the most was the increase form164 to 254 in less than 3 weeks. Could the low T4 levels be dog harmful lasix related (either cause or effect) dog harmful lasix to the changes in ALT? Any light you can shed dog harmful lasix on this will be very welcome. dog harmful lasix We are going to redo the liver enzymes in about 3 weeks dog harmful lasix to see where they are going. Noelene Answer: dog harmful lasix Noelene- It is not too unusual to have rises in ALT levels that are found in a blood sample taken for reasons other than suspicion of liver disease and then for these levels to resolve over several weeks to several months. ALT rises when liver cells are damaged and dog harmful lasix lots of things can lead to dog harmful lasix enough damage to liver cells to increase the ALT levels. Many of these dog harmful lasix things never cause any clinical signs of liver disease nor measurable effect on liver function using bile acid or other liver function testing. In most cases we never know what happened, but drug reactions, trauma, bile stasis, blood clots and toxins are all dog harmful lasix possible dog harmful lasix explanations. If the ALT level continues to drop, it may not be possible to determine why it dog harmful lasix became elevated in the first dog harmful lasix place, but it wouldn't be too important dog harmful lasix to know, either. If there dog harmful lasix continues to be a dog harmful lasix slightly elevated dog harmful lasix ALT level dog harmful lasix over time, I think that I would be most concerned about the dog harmful lasix possibility dog harmful lasix of an dog harmful lasix idiosyncratic (unexplained) reaction to the thyroxine supplementation leading to the rise in ALT based dog harmful lasix on the timing of the increase dog harmful lasix in ALT. It seems reasonable to me to stop the thyroxine dog harmful lasix supplementation because there is a strong possibility that it is not necessary because total T4 levels are not a reliable way to determine if hypothyroidism is present. The most accurate test that I know of at the present time dog harmful lasix is a free T4 measurement done by equilibrium dialysis. Even if hypothyroidism is present, it would be unlikely to be dog harmful lasix harmful to stop dog harmful lasix thyroxine supplementation for a few weeks to see what happens. If the ALT dropped into normal ranges, I think I'd try for more accurate testing to see if supplementation is really necessary. If the ALT remained elevated you could chose to supplement or not based on clinical signs or other criteria you and your vet are comfortable with. If your vet feels strongly that stopping the dosage of thyroxine is a bad idea, dog harmful lasix it would probably be better to go with his or her opinion since physical exam findings may be playing an dog harmful lasix strong role in the diagnostic process. As long as there are no visible clinical signs of liver disease, I tend to do nothing in these cases except for monitoring the blood until the client and I believe that it is reasonable to stop doing that. Once in a while rises in ALT alone are the first sign of a more serious liver problem like chronic active hepatitis or copper storage disorders. Good luck with this. I hope the level continues to dog harmful lasix drop. Mike Richards, DVM 1/13/2001 Rise in White cell count Question: Dear Dr. Richards, My dog harmful lasix dog Natty is a Border Collie/McNabb, eleven dog harmful lasix years old and weighs 67 pounds. In late September I asked our Vet. to check her blood just because she dog harmful lasix is getting older. The test showed dog harmful lasix her infection fighting cells were high and he put her on tetracycline, 3 pills dog harmful lasix 3 times a day. At the end of that time her blood was normal. Because a neighborhood dog, a year younger that Natty and a constant visitor at our house, unexpectedly died, I had her dog harmful lasix blood tested again, just for good measure. Again, the infection cells were high and again she is on tetracycline, same dosage and same length dog harmful lasix of time, 3 weeks. I is not yet time to retest dog harmful lasix her blood. What do you think could be causing this problem. She doesn't seem sick. She did seem to be a bit arthritic and I just got the medicine for dog harmful lasix that which has helped. She eats quality food and her appetite is fine. I live in a small town not close to a teaching University and I rely on my Vet for Natty and ten cats. This has him stumped. Can you offer us a reason and a plan of action if her test does not come back normal next week? Thank you for the invaluable help you offer all of us. Mary Answer: Mary- It would help a great deal in providing dog harmful lasix possible diagnoses if you could obtain the results of the complete blood cell counts that have been done so far. There are several types of white blood cells and the total count is not quite as meaningful as the rises in individual cell types. If there is a rise in neutrophils and no immature neutrophils are found in the blood, for instance, this can occur due to stress or Cushing's disease in the absence dog harmful lasix of an infectious process. If there is a rise in neutrophils with a concurrent rise in immature neutrophils, then an dog harmful lasix infection dog harmful lasix is much more likely. If the total white blood cell count is high dog harmful lasix due to a rise in neutrophils and eosinophils, dog harmful lasix then an allergic or parasitic process is most likely. Rises in lymphocytes can indicate cancer. There are other combinations of rises in individual cell types that can be meaningful, as well. So knowing what cells are high, what cells are dog harmful lasix low and combining that with the findings on a dog harmful lasix physical exam can dog harmful lasix help to determine what is happening. There are times when rises in white blood cell counts occur for no discernible reason and it can take some real detective work to figure out what the cause is. Even though dog harmful lasix you vet is stumped, right now, as symptoms and lab work change over time there may be a recognizable pattern or signs of a specific disorder may emerge. So keep working with your vet. I will be glad dog harmful lasix to provide a list of differential diagnoses dog harmful lasix (possible diagnoses) based on the lab work if you can send it. I am sorry for the delay in response to your question and I hope that Natty's is still doing well. Mike Richards, DVM 1/9/2001 High BUN on pre surgery bloodwork panel Question: Dr Richards,. My miniature schnauzer, Dublin (5 months old at the time), was in dog harmful lasix the vet's getting spaded and when they ran tests her BUN level was at 48. Her Bun/creatine ratio was 37, triglycerides 365,calcium 11.5 and phosphorous 6.6. All other levels were normal. The Vet was very concerned dog harmful lasix with the high BUN at her dog harmful lasix age. They tested for kidney function via urine tests and everything appeared fine. We had an dog harmful lasix ultrasound to look for any abnormalities with the kidney and again everything was normal. The vet put dog harmful lasix her on Hills KD and her BUN one month later dog harmful lasix was 20. She has gained weight and the vet suggested we switch her to Hills GD which was less fat. What do you recommend? She dog harmful lasix is dog harmful lasix still a bit overweight 19 lbs and I am concerned that she is missing dog harmful lasix critical nutrients dog harmful lasix being on a Hills dog harmful lasix GD diet at her age. Please let me know what you suggest and why such a small puppy would have such high BUN levels. Thank you- Patty Answer: Patty, dog harmful lasix One of the problems with doing pre-anesthetic blood tests and other routine screening blood tests is that when an abnormality is found, there is a tendency to ignore a dog harmful lasix lot of other evidence that a pet dog harmful lasix is normal, in favor of either more invasive testing or therapeutic efforts to correct problems that may or may not exist. Elevations in BUN (blood urea nitrogen) of dog harmful lasix up to 50 mg/dl due to a recent high protein meal (according to "Small Animal Clinical Diagnosis by Laboratory Methods" by dog harmful lasix Willard, et. al.). Puppies often have elevated BUN levels due to dog harmful lasix high protein dog harmful lasix diets and can quickly develop rises in BUN due dog harmful lasix to dehydration, since they are more prone to this problem than adult dogs. Some pets just have an elevation in one lab value, that seems to be a consistent finding, that never causes problems during their lifetime. Since the urinalysis was normal and the creatinine normal (based dog harmful lasix on the BUN/Creatinine dog harmful lasix ratio) the odds are really high that there was nothing wrong with your puppy's kidneys. The use of Hill's k/d (tm) in a puppy is not recommended by the manufacturer as a routine thing but dog harmful lasix it doesn't appear to cause problems when it dog harmful lasix is used, based dog harmful lasix on anecdotal reports from several vets I have spoken with who have put puppies on this diet. I would assume that the same thing is true for g/d (tm) diet. Truthfully, I dog harmful lasix don't see much reason to worry about using dog harmful lasix any special dog harmful lasix diet dog harmful lasix for the sake of dog harmful lasix the kidneys with the lab values you dog harmful lasix are reporting, though. It wouldn't be a bad idea dog harmful lasix to recheck dog harmful lasix the cholesterol and triglyceride levels, though. Lipemia (high values of lipids like cholesterol and triglycerides in the blood) are a problem in some schnauzers and do seem dog harmful lasix to cause problems sometimes. Last week, I had a dog harmful lasix similar situation to what you are describing, except that I had an older cat in for a routine blood screening test in the practice with a high BUN and normal creatinine. dog harmful lasix I started explaining chronic renal failure and was heading down the road of initiating dog harmful lasix treatment when my wife (also a vet) pointed out that I was probably jumping the gun, since we had an apparently normal patient with normal creatinine and normal urine concentration. Of course, she was right. So dog harmful lasix we are going to recheck the lab values on the cat in a couple of weeks dog harmful lasix and dog harmful lasix then decide what to do. Hope this dog harmful lasix helps some. Mike Richards, DVM 12/28/2000 High levels of Calcium - Hypercalcemia Question: A few months ago, we returned to Vancouver to find our dog lethargic. I took her to our new vet who did a bloodtest. The result was hypercalcemia. The vet said it was most likely a cancer. I told him that my son had overdone the excercise while we were away, and she was likely suffering with arthritis. We dog harmful lasix changed her food to Medical geriatric formula. After another 2 bloodtests, her calcium was dog harmful lasix back to below normal. The vet put her onto dog harmful lasix Metacam indefinitely. Is this a good choice for arthritis? Answer: Dawn- It is dog harmful lasix usually best when a blood test shows hypercalcemia to test the blood again before trying to make a diagnosis. I do not know about other labs, but ours has more trouble with calcium levels than with most other tests. It isn't too unusual for us to have a dog show high calcium levels on one test and then not on others. On the other hand, the most common dog harmful lasix causes of high calcium levels are serious illnesses, such as metastatic cancer, kidney failure and hyperparathyroidism. dog harmful lasix It is worth considering periodic monitoring for dog harmful lasix these problems if there is any indication of them in the rest of the blood work, though. Meloxicam (Metacam Rx) is not available in the United States but the information that I have seen on this medication seems to be in agreement that it is effective and reasonable to use long term. Mike Richards, DVM 11/15/2000 Lab work - hematocrit (HCT) Question: Hi Doctor, I am a subscriber and we have communicated about Kenya just recently. I just had my vet fax me the lab work and here are some observations: The lab indicates the normal range for lipase is 100-500 iu/l and her original level (July) was 593. Three weeks later on a restricted diet it dropped to 516. Your letter said the normal range is 0-160 iu/l. Needless to say, I am confused. What do you make of this discrepancy? Her amalyse dog harmful lasix level ("normal" = dog harmful lasix 500-1500) is 501. I was dog harmful lasix not aware previously that there were other abnormal readings. They are as follows: HGB 19.0 (norm=12-18) HCT 56 (norm=37-55) Eosinophil 1 (norm=2-10) Absolute Lymphocyte 945 (norm = 1000-4800) Absolute eosinophil 63 (norm=100-1250) Do you have any more ideas based on this labwork? Kenya is not vomiting to my knowledge, and yesterday I finally saw that two consecutive stools were without mucus. She's still a bit uncomfortable, as is evidenced by dog harmful lasix her wanting to cut walks dog harmful lasix short lately. She has gas as well. dog harmful lasix I got your message about the Pepcid, etc. and will try that. Again, many thanks for your interest dog harmful lasix in this case, Wendy Answer: Wendy- It dog harmful lasix is really important to use the normal values for the lab that the samples are run at. They do sometimes dog harmful lasix vary from the "average" as much as the difference that this lab reports. I would not worry too much about this lipase level since dog harmful lasix it is within the range that dehydration or mild decreases in kidney function could cause and the amylase was not concurrently elevated but that is just my personal dog harmful lasix opinion. The hematocrit (HCT) is the percentage dog harmful lasix of dog harmful lasix the blood that is dog harmful lasix composed of red blood cells. When the percentage rises, it means there are more dog harmful lasix red blood cells or less liquid portion of the blood. The most common cause of rises in hematocrit is dehydration dog harmful lasix but disorders that cause decreases in oxygen transport can cause rises in hematocrit (like heart failure and respiratory disease) and it can occur due to abnormalities dog harmful lasix in production of red blood cells. But the most likely problem with dog harmful lasix this low a rise is dehydration. That would also be true for the rise in hemoglobin. The best way to be sure that the rise in hematocrit was due to dehydration is to retest at a time when Kenya is likely to be normally hydrated (when she dog harmful lasix seems to feel dog harmful lasix fine). I am not sure it is worth retesting if dog harmful lasix she is acting fine and doing fine, though. Mike Richards, DVM 9/15/2000 High globulin count (hyperglobulinemia), seizures and dog harmful lasix lethergy in Westie Question: Dear Dr. Richards, I have a real stumper for you....... Last fall, our 13 year old Westie, Button, was dog harmful lasix acting lethargic so we visited our dog harmful lasix vet. A routine blood test turned up a high globulin count which our vet dog harmful lasix warned could be indicative of more serious problems (e.g. multiple myeloma). dog harmful lasix We agreed to additional dog harmful lasix blood work and urine tests all which came back suggestive of multiple myeloma. We were distraught and sought a second opinion from an dog harmful lasix iternal medicine specialist. X-rays were negative for bone lesions and dog harmful lasix a bone dog harmful lasix marrow sample turned out normal. The only tests we did not agree to dog harmful lasix were a CT scan of the head and obtaining a sample of CSF. During this time, a veterinary ophthalmologist noted tortuous vessels in the back of his left eye and that his pupillary dog harmful lasix response in that eye was absent. At dog harmful lasix this dog harmful lasix point we had a lethargic dog with symptoms that did dog harmful lasix not totally match multiple myeloma according to the internist. Feeling a sense of resignation, I indicated that the dog harmful lasix last time Button seemed to be "his old self" was when he was on antibiotics which were given early in the treatment of his lethargy. Indicating it couldn't hurt, Button started the dog harmful lasix maximum daily dose dog harmful lasix of dog harmful lasix clindamycin. Within 2 weeks, his dog harmful lasix activity dog harmful lasix returned to normal AND so did all of his bloodwork. We began to ween him off the clindamycin when he exhibited a "seizure" in early December. Also, his globulin count rose again. We went back up in our dose of clindamycin and the seizures stopped and the blood work normalized AGAIN. This spring the seizures started to dog harmful lasix increase in frequency despite the dose of clindamycin so phenobarbital was added to his dosing regimen. He has responded well to the dog harmful lasix phenobarbital and guess what, his bloodwork is abnormal again. A dog harmful lasix few more details.....the last 2 times the bloodwork has been abnormal he has also been anemic. There were dog harmful lasix no obvious signs of bleeding and he responded to the clindamycin. The seizures seem to be stimulated by excitement and are indicated by short "fainting" spells. He also pants quite a bit at rest even in an air dog harmful lasix conditioned home. We are told that there is no evidence of multiple dog harmful lasix myeloma symptoms appearing and then disappearing so that diagnosis seems to be shelved. Our vets openly admit that they are stumped. Also, an ultrasound of his belly indicated that there was no evidence of a dog harmful lasix splenic tumor and dog harmful lasix his ECG is normal. So....we continue with the phenobarb. and have increased the clindamycin dose to see if again his bloodwork will normalize. Button dog harmful lasix will be 14 dog harmful lasix in October and we have dog harmful lasix tried to maintain quality of life but continue to wonder if there is something else that we should consider. We would be deeply appreciative if you would comment on this case. Thank you and God bless you dog harmful lasix for this wonderful service to pet owners, Steve Answer: Steve- I can think of some disorders that would cause the symptoms you are seeing, but I am not at all sure that they are likely or even possible. Canine monocytic ehrlichiosis causes hyperglobulinemia (high dog harmful lasix globulin levels in the blood), lethargy, depression dog harmful lasix and bleeding tendencies. I have not seen seizures as dog harmful lasix a listed symptom for this problem. It is treated with doxycycline or imidocarb, usually, but might respond to other dog harmful lasix antibiotics. Any form of ehrlichiosis could cause problems. We see a lot of older dogs with dental disease that dog harmful lasix causes lethargy, depression and dog harmful lasix appears to be a source of high globulin levels (this is personal observation, not documented by any studies I am aware of). This is very responsive to antibiotic therapy but won't resolve unless the dental problems are identified and treated. We have not associated this problem with seizures, either, though. Systemic fungal dog harmful lasix infections will dog harmful lasix cause hyperglobulinemia but usually cause other clinical signs, like coughing, weight loss, inappetance, lameness or something that indicates a pretty serious problem. There is dog harmful lasix a report of anerobic bacterial infection of the central nervous system dog harmful lasix (Dow, 88) dog harmful lasix but the dogs affected by these bacteria died dog harmful lasix quickly. However, the signs seen in dog harmful lasix them did match what you are seeing -- lethargy, depression, seizures, as well as other symptoms, including paralysis and other severe CNS signs. Cancers sometimes cause increases in globulin levels and may cause almost any clinical symptom, depending on dog harmful lasix where they are located and what they effect. Finding dog harmful lasix cancers can be really difficult. dog harmful lasix It would be a little odd for dog harmful lasix antibiotic therapy to make a difference if cancer is the cause of the symptoms but sometimes antibiotics help for reasons dog harmful lasix other than their antibiotic dog harmful lasix actions. Heartworm disease dog harmful lasix will sometimes cause inceases in globulin levels in the serum and can cause the symptoms seen, although coughing dog harmful lasix is usually present by dog harmful lasix the time fainting spells that resemble seizures dog harmful lasix occur with this disease. Bacterial endocarditis might cause the depression, lethargy, seizure like activity and hyperglobulinemia and dog harmful lasix would be responsive to antibiotics. A heart murmur is often present with this problem. There are usually ECG signs associated with bacterial endocarditis but cardiac ultrasound is a better way to look for this problem. Chronic infections almost anywhere can cause increases in globulin levels and would respond to antibiotics. It seems like it would be easy to find an infection but there are lots of reports of infections in the urinary system, liver, gallbladder, spinal column and other dog harmful lasix areas of the body that didn't dog harmful lasix surface until extremely serious signs finally dog harmful lasix showed up or were found incidentally on post mortem exams. I don't know if any of these possible differentials will help. I wouldn't be dog harmful lasix at all worried about using clindamycin long term if it seemed to help. This is a fairly common approach to persistent periodontal disease in dog harmful lasix dogs so there is a lot of evidence to suggest it doesn't cause problems very often. Your dog harmful lasix vets probably thought of these dog harmful lasix and appear to have been dog harmful lasix working to rule most of them out. Keep working with them and hopefully some clinical sign that points the way to a diagnosis dog harmful lasix will appear soon. Mike Richards, DVM 7/14/2000 Increased platelet count Question: Dear Dr. Mike, I have a question regarding a High platelet count. I've seen several questions regarding low count but my Bichon dog harmful lasix Frise has the opposite problem. I adopted "George" from an animal rescue on July 5. Other than being a dog harmful lasix little shy he seemed OK. A vet in TX has just given him a physical and he was deemed healthy, free of disease and able to fly. On July 11, I took him to our dog harmful lasix local animal hospital here in Illinois. They also examined him, we've determined that he's about 7 years old, and at one time probably broke his shoulder blade. I took him back the next day, July 12, to get his teeth cleaned, major tartar. When they did the blood test, dog harmful lasix his white cell count was 33,000. The Dr. me said that it should be around 12,000. A couple of other "things" didn't look quite right so they did a full blood panel. George's platelet count came back extremely high. It registered at 3 million. The Dr. said it should be dog harmful lasix about 300K - 510K. A urinalysis did show that George has a UTI. He's dog harmful lasix currently on antibiotics, twice a day. They also put him on dewormer, even though blood and stool samples tested negative for worms/parasites. The white cell count could be attributed to the UTI, but not the platelet dog harmful lasix count according to the Dr. A pathologist looked at the results dog harmful lasix and thought dog harmful lasix maybe there was internal bleeding at one time. His potassium level, liver, kidney levels appeared to dog harmful lasix be normal, not alarming. George appears to be fine, he has a huge appetite dog harmful lasix and loves to go for walks twice a day. His red cell count has dog harmful lasix not changed from day to day, so it doesn't look like they are being destroyed. There is some speculation as to whether or not the marrow is releasing dog harmful lasix immature red cells. They did see some in a second blood test. I'm supposed to wait dog harmful lasix until this Friday, July 21, and take him dog harmful lasix back for another blood test. The Dr's at the clinic said they've never seen a platelet count this dog harmful lasix high. Do you have any idea what could be causing this, is it life threating? I look forward to your answer. Thanks, Susan Answer: Susan- These are reported causes of increased platelet counts: hypothyroidism (usually fairly mild increases) essential thrombocythemia (reported in the Feb 99/March dog harmful lasix 99 dog harmful lasix Compendium of Continuing Education) - signs were lethargy, weight loss, depression This condition dog harmful lasix is also likely to cause an increased white blood cell count due to neutrophilia and anemia. myeloproliferative disorders (like dog harmful lasix excessive bone dog harmful lasix marrow stimulation, cancers of the bone marrow, metastatic cancers stimulating the bone marrow) platelet function dog harmful lasix abnormalities sometimes dog harmful lasix lead to increased platelet numbers as the body tries to compensate dog harmful lasix for dog harmful lasix the fact that the platelets don't work well (usually mild increases, though) iron deficiency and chronic blood loss (from any dog harmful lasix source - urinary tract, gastrointestinal tract) can lead to thrombocythemia With the great elevation in these values, essential thrombocythemia seems likely, even though George doesn't seem to have the clinical signs expected with that problem. Bone marrow analysis is dog harmful lasix helpful in differentiating among the causes of increased platelet counts. Your vets may have access to the Compendium article since a dog harmful lasix lot of vets subscribe to this journal. Mike Richards, DVM 7/19/2000 Continued evaluate lipase levels following pancreatitis Question: Hi Dr. dog harmful lasix Mike, I have seen your site numerous times and only recently have had the occasion to subscribe and ask a question. My situation is addressed on the site, but I need more specific information/recommendations. Here's the situation: My 11 year old German Shep. mix has been diagnosed with Pancreatitis; however, he really is just on the fringe of the condition. He's not in any pain, has no abdominal bloat, etc. but five weeks ago started with diarrhea, which had small flecks of blood in it. Then, he had one instance of vomiting. We tried to regulate his condition through diet (fasting, initially), dog harmful lasix fluids, and Gastriplex, dog harmful lasix which is made by Thorne Research and not a "white man drug". The Gastriplex seemed dog harmful lasix to upset his stomach - he was very, very restless. For the first couple of weeks, we were unable to control the diarrhea, but the dog harmful lasix vomiting stopped. Bloodwork and x-rays revealed nothing remarkable, except an elevated lipase level. I began feeding him brown rice with a little garlic butter and eventually added a few veggies. dog harmful lasix The diarrhea was coming under dog harmful lasix control, but not dog harmful lasix the lipase level. We added some very small amounts of cooked chicken to the dog harmful lasix rice and the diarrhea started again. So, off food, on fluids we went and again, the lipase shot up. It had come down dog harmful lasix to within normal range only once and after going on chicken, it shot up again. I started feeding him again and two weeks ago began feeding dog harmful lasix him chicken baby food dog harmful lasix with the dog harmful lasix rice. His dog harmful lasix poops hardened up and were formed dog harmful lasix within several days and his lipase was on directly on the line dividing "normal" and "high". For two weeks we did this and my vet (another dog harmful lasix vet in dog harmful lasix the practice put him on the baby food because my vet was dog harmful lasix on vacation) didn't like the consistency of his stool dog harmful lasix - oatmealy and orange. He took him off the baby food and put him on rice and small amounts of turkey and veggies late last week and put him on Gastrigen (another Thorne product). Friday night, Storm (the dog) was up ALL NIGHT, panting, pacing, etc. and dog harmful lasix did not settle down Saturday morning. I called Dr. Strong, we went in and put him on fluids dog harmful lasix and took another blood sample. His lipase was in the dog harmful lasix middle range of the dog harmful lasix "high" level. So, we started the fast again and I took him in for fluids on Sunday. Today he had an ultrasound, which revealed a slightly swollen pancreas, nothing alarming to my vet, but of more concern were the "spots" on one side of his liver. Not of tumor size, but obviously a concern. He's still fasting and we go in tomorrow for fluids. Then, another lipase test dog harmful lasix on Wednesday. My vet is getting more concerned now because we can't get dog harmful lasix the dog harmful lasix lipase to within normal range. My dog harmful lasix vet and I both agree Storm is on the fringe of pancreatitis - dog harmful lasix not really displaying dog harmful lasix hard and fast dog harmful lasix symptoms, but the lipase and spotty liver is obviously an issue. He is happy, eating well (when he's allowed!), and generally seems to be fine on the outside. I've had him 9.5 years dog harmful lasix and I dog harmful lasix know he's feeling fine. Dr. Strong feels dog harmful lasix he's a ticking time bomb, unless we get this lipase level regulated. Certainly, we would like to fix dog harmful lasix this before dog harmful lasix it becomes a crisis. Do you have any thoughts, suggestions, experience, etc. with elevated and stubborn lipase levels? I would greatly appreciate your input and am very happy to compensate you for your time and expertise above the subscription fee. Thank you so very much in advance for your feedback. Regards, Robyn Answer: Robyn- Lipase becomes dog harmful lasix elevated most commonly dog harmful lasix due to pancreatitis dog harmful lasix or a decrease in kidney function. The decreases in kidney function can occur due to causes other than the kidney itself. The kidney is dependent on adequate blood flow dog harmful lasix and blood pressure to work, dog harmful lasix so dehydration and low blood pressure can cause a decrease in kidney function. Kidney diseases or obstructions to urine outflow from the kidney are the other conditions that can lead to increases in lipase or amylase levels due to kidney disease. It is also possible for dog harmful lasix intestinal conditions such as inflammatory dog harmful lasix bowel disease (IBD) to cause rises in lipase or amylase levels sometimes. Pancreatitis can cause rises in lipase and amylase to three or more times the dog harmful lasix normal level, with increases as much as ten to fifteen times normal dog harmful lasix occurring in some cases. Kidney disease usually causes rises to about fifty percent of normal and smaller rises tend to occur with IBD. It is usually best to try to evaluate lipase and dog harmful lasix amylase levels together, since they should both rise when pancreatitis is present. Unfortunately, both may rise with the other conditions listed above, as well. At this point, dog harmful lasix it doesn't seem to me that there is enough evidence to be sure of what dog harmful lasix is dog harmful lasix going on. Pancreatitis is definitely a condition that should be in the list of differentials and it may be the problem, but it doesn't seem that this is a certainty to me, yet. I would probably want to look for evidence of a decrease in pancreatic function by dog harmful lasix checking for trypsin-like immunoreactivity (TLI) in the serum (this is a test many commercial labs can arrange for) as a way of checking on pancreatic function. A decrease in pancreatic function could produce the clinical signs that you are seeing, although it would be a little unusual to have increases in lipase levels and decreases in TLI levels. It may be worthwhile to dog harmful lasix ask your vet to dog harmful lasix refer you to an internal medicine specialist for a second opinion. One thing that bothers me, though, is that you are worried about a lab value dog harmful lasix when the clinical dog harmful lasix signs of illness do not seem to be present at this time. It is important to place more emphasis on the patient's signs than the lab values when a conflict like this occurs, in most cases. The lab values are important and if it is possible to clarify their meaning without endangering the patient it is a good idea to do that but keep your shepherds' overall condition in mind and try to remember to diagnose and treat based on the whole patient and the whole clinical picture, not just one lab value. Hope this helps some. Mike Richards, DVM 6/30/2000 Elevated Amylase levels, dog harmful lasix Pancreatitis and bladder dog harmful lasix problems in Schipperke Question: Dear Dr. Richards- I have an dog harmful lasix eight year old schipperke. He had a urethrostomy for urolithiasis about one year ago. He has been on dog harmful lasix the C/D diet (carrots for treats) and doing quite well except for dog harmful lasix the occasional need for antibiotics to treat blood in the dog harmful lasix urine. I was told he would be prone to these dog harmful lasix infections now. About two dog harmful lasix weeks ago he was put on an |