9 yr old Lhasa who has been happy and healthy up to this point,

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9 yr old Lhasa who has been happy and healthy up to this point, just stopped eating last Wednesday. She started to become lethargic, so Friday I took her to vet, where she is still receiving IV Fluids. They flushed her kidneys and are giving electolytes. I'm confused...She had no fever, no vomitting or diarrhea. Her blood test results came back Saturday. High BUN/Creatinine Levels, but the ratio was normal. Akaline Phosphatase was 601 (very high), but ALT and AST in normal range. Glucose was 40 (low) and Sodium and Potassium were normal. Phosphorus was 6.2 (high) and Globulin 4.2 (high). Blood count was normal. Total Bilirubin was 1.5 (high) - Any ideas? How do we get her to eat? She wasn't feeling all that bad, just turned to nose to everything, including her most favorite treats!

Optional Information:
Age: 9; Female; Breed: Lhasa Apso

Already Tried:
IV Therapy - flush kidneys & given electrolytes

Customer (name blocked for privacy)

Status: Closed Value: $9

The bloodwork results you can read about here
http://www.cpvh.com/Articles/42.html
and in more detail here
http://home.gci.net/~divs/disease/lab_tests.html
It sounds like there are issues with the liver and kidneys and might be an adrenal gland issue.
An adrenal gland issue called Cushings disease is seen in the breed and your vet can test for it. http://www.marvistavet.com/html/hints_of_cushing_s_disease.html
If she has dental disease the bacteria from that can migrate to other areas of the body including liver and kidneys.
You should work with your vet on treatment and nutrition for her. If your vet is not sure what is going on you may want him or her to consult with a small animal internal medicine specialist or to bring your dog to such a vet yourself.
This site may help you locate one
http://www.acvim.org/Specialist/Search.aspx
You may find that NutriCal a sticky supplement you put right in the dog's mouth will help perk up appetite. Pet supply stores usually carry it.
Hope this helps you!

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Reply to Nancy Holmes's Post: Dental disease wasn't discussed. What do I ask my vet? I'm picking her up ths afternoon. He ruled out bacteria, I believe since she did not have a fever or any signs of tooth decay. Her gums look good.

OK if the teeth and gums are good then that isn't the likely issue. With this age dog its always a possibility though so that is why I mentioned it.
I would ask about possibilities of Cushings disease, ask if she was tested for a tick carried disease (as they can impact many of the organs), ask about a home cooked diet for a bit to help her get back on eating or using Nutrical.
I would expect if I was picking up a dog the vet would have a pretty good diagnosis and treatment plan in place for me to continue with home care.
Sometimes I take a list of questions with me just so I remember to ask them. Including - what should I watch for at home? and when should I update you on progress or lack of it?

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Reply to Nancy Holmes's Post: Brought Lilly home. She's still not eating. Vet gave me all the k/d stuff, which is a waste since I can't get her to eat. He said she doesn't have any infections. How does he know? He said dogs really don't get fevers. She's drinking a little water, a couple licks of nutri-statin (which vet said not to give, but I was desperate & bought some). I don't want to lose her this way. She went outside and peed last night. I can't get her to do much this morning. Is there anything I can do? Her eyes look red, is she just tired? Sleeps soundly, hardly moves.

Poor little one! Sounds like if he gave you KD he thinks the problem is in her kidneys.
Dogs do get fevers so not sure what your vet meant to say. One check for infections would be that bloodwork which should have white blood cells high if there was infection.
Its good that she urinated. Key thing is to keep her taking fluids.
If the vet gave you no diagnosis or treatment plan other than nursing you could let them know that the dog is not doing well or eating for you and see what the response is.
Alternatively you could get a copy of the testing already done and see another vet. Perhaps one who specializes in small animal internal medicine as they handle tricky cases all the time.
This site might help you find one as I listed above
http://www.acvim.org/Specialist/Search.aspx
There is an inherited kidney disease in the breed which you can read about here
http://www.lhasa-apso.org/health/hrd.htm
If your vet gave you no diagnosis, no home care info, no prognosis then you can ask about that over the phone and see what they say.

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Reply to Nancy Holmes's Post: Vet said kidney failure. I can pick up some prednisone pills if I want to try - possibly that will help her want to eat? It's a last ditch effort, but is it worth the try? I don't want to make her more miserable... She's still drinking a little, and will go out to pee when I take her. At what point do I give up? Her CBC is normal. BUN = 50, Creatinine = 4.5, Phosphorous = 6.2, Alkaline Phosphatase = 601, ALT & AST normal. Total Protein normal. Globulin 4.2 (high). Everything else is normal. She just feels bad, lost weight, weak, has red eyes.

If she is in kidney failure fluids should help her.
You may want to ask the vet about how to give fluids under the skin at home.
You can check out this site for a home made diet for kidney issues
http://www.2ndchance.info/homemadediets.htm
The second diet down.
But depending on how bad the kidney failure is she may not get to where she is comfortable.
You can read about kidney failure here
http://marvistavet.com/html/chronic_renal_failure.html

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Reply to Nancy Holmes's Post: Ok. Thanks. By the way, I couldn't see the internist unless approved by my vet's office. I didn't want to offend my vet because he's tried so hard to help. I guess it's not a free country? Why does the Internal Med Vet have to have a referral?

Many of the specialists do this to ensure their time is 'wasted' seeing patients that are not suitable candidates for them - think of it like weeding out the people who would take a simple common cold to the emergency room for help instead of seeing their doctor.
As your vet has tried hard they might be willing to consult with a specialist for you too.
You might try the pred pills and ask if the vet is willing to teach you to do fluids subcutaneously at home or to consult with a specialist in case there are newer treatments out there that a specialist would be familiar with. Depending on how far you want to go I have heard of dogs getting kidney transplants for example. Its not common and its not inexpensive but it has been done with the right candidates.

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Reply to Nancy Holmes's Post: I don't want to go too far, I just want to keep her comfortable. I hate to see her starve & I didn't want to use pred if it makes her feel worse in any way. Based on her blood work, do I need a 2nd opinion? Do I just accept that it's kidney failure and not question the diagnosis? She is still drinking, she doesn't seem dehydrated and she'll still go out pee. She'll letme put a little Nutri-Stat gel on her tongue. It's a high calorie supplement w/ vitamins.

The supplement may help her keep her strength up. If she keeps up with her fluid drinking OK then ask your vet about adding plain pedialyte to the water to help with electrolytes.
See if the home made kidney diet appeals more than the KD or if you got dry KD try the canned.
Your vet is likely right as to what is wrong after all he or she can see the results of testing and see your dog.
You could ask if the vet has any estimate on how much damage was done or any suggestions on getting her to eat for you other than Pred.
You might see if some plain chicken meat will tempt her into eating. Sometimes once you start them eating something you can convince them they should be eating again and get on the better diet.

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What is wrong with my Lhasa and what should treatment consist o

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