When Midas, a 2 year old terrier mix, came to BRVC he was not acting himself – he was depressed and lethargic, wouldn't jump up on the couch (one of his favorite activities), wouldn't go outside to go to the bathroom unless encouraged by his owners, and most telling of all – he was not interested in eating. While nothing drastic seemed to be wrong, all of these things together were unnerving for the little dog's owners and they followed their intuition to bring him to BRVC.
Initially back pain was suspected but when Midas's symptoms did not improve Dr. Wong recommended some investigative diagnostics. Midas was quiet and subdued upon examination. He was licking his lips, indicating nausea, and his abdomen was painful when palpitated. Blood work and x-rays are the classic first step when attempting to diagnose an ill pet and that is where Dr. Wong started with Midas.
His x-rays were not very illuminating –his stomach was filled with gas which indicated an upset stomach but that was it. The blood work was much more revealing, and alarmingly so. Midas had extremely high kidney values, something which is incredibly abnormal in a normally healthy, young dog.
The sudden spike in kidney values such as was present in Midas's lab work made Dr. Wong suspect acute kidney failure. Acute kidney failure is a sudden onset condition where the kidneys cannot properly perform their function of filtering toxins and waste from the blood. Some common causes of acute kidney failure are:
Bacterial infection or urinary tract infection (UTI)
Anything that restricts or decreases blood flow to the kidneys e.g., severe dehydration, low blood pressure and heatstroke
Leptospirosis (a bacterial disease that chiefly affects the liver and/or kidneys)
Dr. Wong sent out a urine sample to be cultured in a lab. This test would reveal whether a UTI or bacterial infection was present. But the results can take 3 to 5 days to return. Confirming what was causing Midas to suffer from acute kidney failure was important but it was imperative for therapeutic treatment to begin immediately. After speaking with his owners, Dr. Wong admitted Midas to BRVC Patient Care for at least 48 to 72 hours of hospitalization for intensive treatment.
He was started on IV Fluids to flush the kidneys of toxins. He was also given medicine for his nausea and upset stomach and started on ampicillin, an antibiotic to fight any potential infection that might be causing his kidneys to shut down. While he was undergoing treatment, Midas would need to have his kidney values rechecked every 24 hours by his Patient Care team.
The next morning Midas was still not interested in eating – and still more alarming was the fact that his recheck lab work revealed his kidney values were even worse! He also had an elevated potassium level; high potassium levels are very dangerous for the heart. The even higher kidney values combined with the high potassium indicated that Midas was entering either oligric or anuiric kidney failure – decreased or absent production of urine.
This is a dangerous stage; it is what occurs right before the kidneys start to shut down and die. The prognosis is very grave if the kidneys begin to shut down completely. Dr. Wong and the Patient Care team kicked Midas's treatment into high gear – it was time to do all they could to try and bring this little guy back from the brink!
An abdominal ultrasound was performed and it revealed fluid accumulating around the kidneys – a classic sign of acute kidney failure, but little else. It was still a mystery exactly what could be causing Midas's illness. In her initial examination Dr. Wong gathered information from his owners but there was no indication that Midas had been exposed to any poisons or toxins and he had not been hiking or in the wilderness recently.
The latter would be classic risk indicators for leptospirosis. Lepto is found in the urine of undomesticated animals and is present in the Bay Area. Dogs can contract it when hiking off leash, swimming in or drinking from standing pools of water, lakes, ponds or streams. Because Midas did not go hiking or live near open space he was not vaccinated for lepto.
Even though Midas did not meet any of the risk factors, Dr. Wong decided to send out a titer for lepto. Again, this test takes at least 3 to 5 days for results. In order to aggressively respond to Midas's worsening condition Dr. Wong increased his IV fluids and started him on lasix – a diuretic to help him produce urine.
The lasix was delivered via CRI (Constant Rate Infusion) meaning small doses of it were continuously administered. A urinary catheter was placed so his Patient Care team could monitor and quantify how much urine Midas was producing. Dr. Wong needed to make sure that the fluids coming out matched the amount of fluids going in. Producing the correct amount of urine would be a sign of recovery.
Midas spent several days in the hospital receiving this treatment along with antibiotics and daily recheck blood work. Finally his kidney levels began to mildly improve and he started producing adequate quantities of urine. This was cause for celebration! Midas was making his way slowly out of the woods.
He continued to improve daily with his kidney values dropping significantly. At last he was able to go home with his grateful and loving family. He still needed to have fluids given subcutaneously once a day for two weeks as well as continue on antibiotics, but he was alive and well! The day after Midas went home, after 7 days of hospitalization, his lepto titer results came in. It was positive – somehow Midas had contracted leptospirosis!
Midas's mom was thankful for how transparent and present Dr. Wong and the rest of the staff were throughout the entire process. She also appreciated the daily medical and financial updates. More than ever she feels the importance of families making sure their pets are vaccinated – you just never know how or where they may contract a disease. In hindsight she also believes pet insurance would have been incredibly helpful.
Thankfully, Midas's family followed their instinct and acted quickly to get Midas the care he so desperately needed. Time was of the essence in this case and this, along with the superb medicine practiced by Dr. Wong and the BRVC team, helped save Midas's life. These days he is back to 100%!