Dr. Pam and others, thanks so much for being here and sharing your knowledge. I’d welcome your thoughts on BUN levels being elevated and possible kidney issues.

Snapshot: Lexie is very young-acting almost 14 y.o. 27lb mix; aggressive STS front leg tumor*; amp 4/10; lung mets present and growing but aren’t out of control yet; some short course oral chemo (Cytoxan; later Leukeran – details in signature) but onco not convinced it helped.

Post amp: She developed arthritis and hip issues, and she is having physical discomfort due to a lot of stairs in our home and being a front leg Tripawd, and still wanting to go up and down/in and out, etc.

On the plus side: She still loves life most of the time thanks to meds. She still attempts to chase squirrels, is eager to go for walks, loves going outside to the back yard, going to the dog park, etc. (and when people meet her they can’t believe she’s 14).

We’re doing physical therapy at home and seeing a PT vet monthly. Except for some muscle spasms and breakthrough pain she is still enjoying life very much with the help of meds. Her eating and drinking is normal.

Latest blood work:

CBC: no anemia, platelets fine and white cells normal range.
     Ht 42.9%, plt 390K, N 6.76K
Chemistry panel: elevation of BUN, concern that is is caused by NSAID: renal disease vs GI irritation, risk for possible intestinal perforation if GI ulceration worsens- recommend stopping Rimadyl and giving he carafate to help her intestines heal. LIver values and creatinine fine.
     Glu 85, TO 5.9, ALb 3.5, Glob 2.4, Tbil 0.1, GGT 1, ALT 29, ALP 28, AST 25, BUN 54 (high, but better than last month), Creat 1, Phos 3.4, Mg 2.3, Ca 10, Na 146, K 4.8, Cl 113

Current meds:

Gabapentin 100 mg 2 occasionally 3x/day; Tramadol 50mg 2-3x day (sometimes half-dose); Rimadyl 25mg 2x.day; Pepcid 10mg 1x day; Trilostane (for Cushing's) 55 mg 2x/day; Yunnan Baiyo herb as needed; K9 Immunity Plus; GlycoFlex III for arthritis (1/2 tablet).

Before the BUN news I was going to ask about adding Robaxin for muscle issues given her spasms (if she didn’t hate needles I’d consider acupuncture, but she’s a total needle phobe).

Her Cushing’s disease, along with pancreatitis which has been controlled with low fat diet, are both well-managed. Post amp we started her on grain-free high protein low fat kibble plus some chicken or turkey.

Questions:

*Which of the meds and/or supplements are most likely linked to high BUN?

*Should I switch to low-fat moderate protein in the grain free kibble since I'm adding chicken/turkey?

*How worried should I be about kidney function or other issues with her numbers– and is the fact that the BUN went down a bit from last month something of a positive?

*Given her arthritis, hips, etc., how would you prioritize which meds to consider swapping out if you think it’s necessary? And should I add Sucralfate/Carafate back in for possible GI issues given the meds she's on?

*How is Robaxin processed, and is it advisable to add given current scenario?

*Any other pain med suggestions? Alternative therapies?

*Should I consider adding Apocaps since we're not pursuing other chemo options at this stage?

*Re. further testing/eval -- should I follow up with her Internal Med vet? Primary care vet? (We won’t be seeing our onco as often since we’re in the palliative stages.)

*Are there other things I should be concerned about? Are there things you would consider exploring, tests you would do, etc. if Lexie was your dog?

Obviously I want us to enjoy as much time as we have left together with good pain management and not put her through more tests unless they're necessary. On the flip side, I don't want to compromise her overall health and vital functions like the kidneys.

Thanks very much for your wisdom and insight.

Deb and Lexie