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Rusty’s Emergency

Kidney Surgery

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On July 1st, 2021, a sweet Lab puppy came into the care of Collie Rescue Network. He was an 11-week-old visually impaired boy (now named Rusty) who was cute as a button, full of life and love, but very stunted mentally (slow to learn, acting younger than his real age), with droopy eyelids and rotational nystagmus (involuntary movement of the eyeballs).

Rusty was placed into a foster-to-adopt home with the intention that once he was old enough to neuter (later than the normal 6 months in Rusty's case), the family would adopt him and become his furever family. However, before that could happen, the following happened:

(From Rusty's foster mom):

Wed., April 27th - the day started normally with Rusty's walk, doing his business, eating his breakfast etc. Mid-morning the dogs get a treat, a small dog biscuit. Immediately after eating the biscuit Rusty vomited up the biscuit and some fluid, then a 2nd vomit but only fluid (it was on carpet so the fluid looked like dissolved kibble or dog biscuit). He 'asked' to go outside, so I went out with him; he proceeded to vomit a small quantity of fluid and then had a very normal BM. I called the regular vet to see if I could get him in, we got an appointment for the following morning @ 9am just in case the vomiting continued. Later in the afternoon (around 2pm) Rusty vomited, after drinking water, fluid onto hardwood and then a 2nd smaller quantity. Using a paper towel to blot, the vomit was red. Rusty started to retch, heave and attempted to vomit again - it was red but he somehow 'sucked it back in'.

o    I contacted our regular vet to send his files to VCA Alta Vista (7x24 Emergency Hospital) and drove him to VCA Alta Vista. Rusty was taken by a vet tech almost immediately as I waited. At 4pm, I was told to go home as it would take some time to examine Rusty.

o   The Emergency Vet called around 7:30pm to advise that Rusty was resting quietly, had a small vomit while in their care and asking permission to run a complete blood panel and an x-ray. After that was done, around 11:15pm the vet called to state they had started Rusty on IV fluids as well as 'drugs' to keep him comfortable. The x-ray showed 'something' in his stomach, & that his stomach was 'larger' than she expected, and he would stay the night, repeating the x-ray in the morning in case it was 'gas'

Thurs., April 28th - morning x-ray still showed his stomach as 'larger' than expected, bloodwork all normal. Option of performing ultrasound or exploratory surgery. Opted for ultrasound prior to surgery (better idea of 'what' they are 'dealing with')

o   Ultrasound performed in early afternoon, shadow in stomach (unclear) but discovered right kidney was 'architecturally unsound', very enlarged as was right ureter - suspect congenital issue. Recommend transfer to DMV Montreal (Lachine) where Board Certified Internal Medicine Specialist & Surgeon were available. Drove Rusty from VCA Alta Vista (Ottawa) to DMV – Montreal (Lachine) with paper records from VCA Alta Vista (in case the electronic files were not received by the time we would arrive). Rusty was immediately admitted though we had to wait to speak with an Emergency Vet to confirm details etc

Fri., April 29th: The DMV Lachine called with an update on Rusty. The right kidney has a major accumulation of 'fluid' and there is not much tissue left to the kidney itself. The ureter is enlarged as it is filled with 'fluid'. Kidney function measured by blood work and urine are all within normal thresholds. According to IMS (Board Certified), the options are:

1.       attempt to identify via exploratory surgery if:

a.        ectopic ureter or sphincter related function *but* to correct Rusty would need to be referred to another specialty hospital and require additional surgery.

2. Surgical removal of the right kidney & ureter.

The recommendation is the surgical removal of the right kidney & ureter for the following reasons:

1. Exploratory surgery may identify ectopic ureter or sphincter related issue but the DMV-Montreal (Lachine) is unable to perform 'attempts' to correct which would necessitate additional surgery at another facility. These additional surgeries have very low probability of success.

2. Rusty's right kidney is non-functional (the left kidney is doing all the work) and even if the additional surgery required for ectopic or sphincter repair are successful, the kidney is not viable (the kidney has no regenerative ability). If the additional surgery is unsuccessful, it would necessitate the removal of the right kidney & ureter.

3. 'Fluid' build up in the kidney & ureter increases potential for serious kidney infections (eg., pyelonephritis).

4. Rusty can live a normal life with only one kidney (and they suggest, as this is a congenital condition with which he has already been living - only one fully functional kidney - he has already demonstrated living a full life with one functioning kidney). Annual blood & urine tests recommended to ensure the remaining kidney is functioning properly.

I agree with the removal of the kidney and ureter to avoid additional complications which may result from additional surgeries to attempt to correct ectopic or sphincter related issues.

At the same time as the kidney & ureter removal, they will examine his stomach as it still appears slightly large on imaging. I have requested they perform gastropexy ('stomach tack') while they have him open (this procedure is to prevent GDV).

Estimate for the surgical procedure is $6,000.00 and aftercare (at least 48 hours in hospital) is a further $2,000.00.

Friday April 29th 2022: Rusty underwent surgery sometime between 4 & 6pm. The surgery went well. The surgeon stated that it was fortunate the kidney issue had been identified as it was severely distended with significant 'fluids' contained therein ~ the possibility of the kidney rupturing in the short term (upto 6 months) was significant and was potentially life threatening. The surgeon stated it was a congenital condition and more than likely the kidney never functioned properly, continuing to degrade over Rusty's short life. Rusty will remain in hospital for at least 48 hours to monitor for bleeding or leakage.

A feeding tube was inserted, this morning, as Rusty has been refusing to eat offered food (can't blame him), has had diarrhea and they are concerned about his protein levels. A further update is expected later this morning or early this afternoon.

Sunday May 1st, 2022: Rusty is discharged with ‘at home’ instructions and prescriptions.  Activity restricted to leashed outings for potty only for the next 14 days.  Staple removal and post-surgical renal function testing to be scheduled for 10-14 days from date of surgery with Rusty’s regular vet.

May 4th, 2022: Rusty is eating his gastrointestinal canned food, tomorrow dinner we will start adding his regular food and slowly transition him over ~ the discharge recommended 5 - 7 days of gastro, I prefer a gradual transition. He is much 'brighter' and 'alert', wanting to play 'tug' with his leash when taken outside (we discourage it). We are taking him out every ~2 hours for toileting ~ unfortunately, that includes overnight as it appears he needs to urinate frequently & in great quantity. Last night he soaked the bedding in his crate (after 3 hours - I missed an alarm) and the night before he started to pee as soon as he was out of his crate but before the door opened. I suspect I might be giving him too much water, considering he is currently eating canned food, so I've cut back on his water allotment. I, also, have questions in at DMV - Montreal about how much water he should consume daily and the frequency/quantity of urine.

Rusty Update (May 19):

Rusty weighed in at 29.6kgs on May 12th, down 4kgs from his weight at time of admission to VCA Alta Vista.

The results of Rusty's post-surgical renal profile have been received (a copy is attached). Our regular vet called, yesterday afternoon, to 'explain' the results, discuss her concerns and next steps.

In summary, all the kidney 'markers' are elevated (SDMA, Creatinine, Urea/BUN), his 'free catch first urine' sample is not concentrated (gravity 1.016)) and his Eosinophils are elevated. The immediate recommendations are: (1) administration of phosphate binders daily; and (2) transition to renal (kidney) diet. As per our regular vet, under IRIS staging for Chronic Kidney Disease (CKD) Rusty is 'stage 2'.

Next steps include referral to Dr. Dunn (IM - Renal specialist) at St. Hyacinthe Animal Hospital (link to website: https://chuv.umontreal.ca/english/small-animal-hospital/small-animal-hospital-services/) as our regular vet has significant concerns over Rusty's remaining kidney (left).

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