Jack is my 15-year-old Jack Russell. He is incontinent and has kidney disease, but it’s not the end of the world.
Figure 1 shows his average drinking peaked at over 500ml a day in late 2022 into early 2023. His overnight nappies were pretty wet during this time, and he wasn’t always dry during the day. He topped the 600ml mark 20 times and his highest ever water intake was 670 ml in one day – excessive for a 7.5 kg dog.
Supporting Jack with his incontinence and kidney disease has been significantly helped by integrated vet care which treats him as an individual with his own specific needs. As well as a mix of conventional and complementary treatments such as herbs, homeopathy and nutraceuticals, this individualised medicine approach has included tailoring his diet. By October 2023, Jack’s monthly drinking average had significantly dropped to 90ml a day. His incontinence was also much reduced as evidenced by nearly if not dry overnight nappies and barely any leaking during the day.
As a family we have also incorporated several tricks into making life as easy as possible for him and for us.
He is living a good life. This blog explains why and how we went about things with the help of our lovely vets, nurses and their staff from Sue Armstrong Consultancy, Crieff Vets and Companion Nutrition as well as Honey’s Real Dog Food.
Summer 2022 – an unexpected damp patch!
It was a lovely sunny day, and I was trying to convince myself that I could work in the garden without nodding off. Jack is a heat seeker by nature. Consequently, he was alternating between roasting on his bed in the full glare of the sun and heaving himself into the shade for temporary respites when it got too hot.
As he staggered up puffing and panting, I did a double take. Was that a damp patch? I spent the next few minutes observing him only to confirm, that yes, there was a very occasional drip of urine emerging!
Well that was a surprise! But at 14 Jack was officially elderly so maybe incontinence was on the cards at some point.
Urine and blood tests
I thought maybe it was a one off as it didn’t happen again until couple of weeks later. And then it became gradually more frequent, and his drinking increased. After the second dribble incident, on the advice of our vet Dr Sue Armstrong, I took a urine sample into our local vet Dr Fern Fraser at Crieff Vets and a blood test was done.
An infection was ruled out, but Jack’s urine was very dilute, and his glomerular flow was compromised. This could have been due to high blood pressure, chronic kidney changes, an incompetent sphincter or a combination of factors.
Jack’s blood pressure was fine. Regarding his kidney parameters, his SDMA was up although this can be a marker of inflammation elsewhere. His creatine, urea and phosphorus levels were all OK. At this point we were looking at Jack having an incompetent sphincter causing urine to leak which was accompanied by increased drinking to make good the loss. He wasn’t quite at the stage of kidney disease.
Facing up to reality
When something goes wrong like this, especially if it worsens gradually, it can take a while to accept and deal with it. For example, Jack sleeps on our bed and it took me a few weeks to put a nappy (belly band) on him. He wasn’t leaking every night, and it was only ever a few drips at this point. I would wake up in the morning and hope for the best, washing bedclothes as necessary as I tried not to be disappointed when there was dampness. Seems crazy now! Once you acknowledge and embrace something, it becomes a lot easier to deal with. Pretty soon the nappy went on every night, and it was a bonus if it was dry! As the incontinence got worse, we later added a (fragrance free) Tena lady pad (other brands are available) to reduce the amount of nappy washing.
Monitoring changes in drinking and urine
I began to record his drinking and how wet his overnight nappy was each day. I felt it was really important to keep a careful note of this as I never remember exact details as much as I think I do! It turned out to be very useful in tracking overall changes. Figure 2 shows how his drinking changed from August 2022 to October 2023.
Some initial treatments
You can see from Figure 1 in the introduction that from a pre-incontinence level of around 150 ml a day, Jack’s drinking had gone up to an average of 250ml in August and 300ml in September. This is reflected in Figure 2 above.
Propalin Syrup and a couple of homeopathic remedies were tried but weren’t useful in Jack’s case. It might have been possible to help his incompetent sphincter, but he had a history of neuromyopathy, so the muscle weakness was likely to be the result of nerve degeneration which vet Sue Armstrong had diagnosed some years before. In other words, it was always going to be very difficult to treat.
The Propalin Syrup was used to try and get another clue as to what was going on. It works by tightening up the muscles, but of course it doesn’t just target the bladder sphincter. Poor Jack became wired within a couple of hours of the first dose followed by vomiting. Trust us to have one of the very few dogs it doesn’t suit! It can, however, be a useful tool for most dogs with this diagnosis.
Some days are better than others
In common with many diseases or conditions, some days are better than others. However, there was an overall increase in terms of drinking and urine leakage over time as you can see in Figures 1 and 2.
Jack has never continuously dribbled. He remains dry for a period of time before starting to drip. This length of time varies. During the day I aimed to let him out into the garden or walk him roughly every two hours. This seemed to suit his dribbling pattern most days. Sometimes he would remain dry over the two hours but two or three days a week he would dribble before the two hours were up, occasionally within 20 minutes of being let out for a pee. I just kept more of an eye on things and put a nappy on him if I had to go out on those days.
To begin with, every time this additional leaking happened, I would think “This is the start of a deterioration, he’ll have to wear a nappy all the time…”. But actually it never got to that stage, and I learnt to accept his new normal. We always have a waterproof mat covered by vet bedding and a towel or blanket wherever Jack is likely to lay in the house to preserve the furniture! I also got into the habit of feeling for damp patches every time he gets up. It simply became our routine.
We took blood tests again in November, March and June. (I have to say here that vets Fern, Lucy, Trevor and locum Tamsin plus the nursing and admin staff at Crieff Vets are marvellous with Jack who doesn’t exactly enjoy going to the vets or being examined).
Urea and creatinine levels were a little above normal, but they can be affected by other factors such as recent meals. He could have been Stage 2 according to the creatinine levels, but the SDMA was down to normal. This put him in pre-renal failure indicating that his body was managing OK at that point.
If the SDMA is repeatedly up and / or keeps going up, then you need to do something. It is also important to keep an eye on phosphorus levels. If urea is normal it suggests the animal is fine with protein levels.
Jack’s drinking levels kept on rising with the following averages per day:
- October – 400ml
- November – 490ml
- December – 510ml
- January – 520ml
- February – 520ml
There was no appreciable worsening of Jack’s kidney parameters. The SDMA was still good, creatinine and urea were raised but the ratio was still normal. If he had a problem, the SDMA would be going up much more rapidly. Phosphorus was still normal. Furthermore, vet Fern Fraser was pleased to observe that Jack remained clinically good.
Jack was still drinking in the 500mls plus range. It was important that he was seen to be passing plenty of urine (overnight nappies definitely proved this!) indicating that he was still processing things. His kidneys were coping at that point. You would expect / want a heavy overnight nappy if he’s drinking 500ml plus a day.
- March – 520ml
- April – 530ml
- May – 450ml
June 2023 – kidney disease raises its ugly head
As you can see above, Jack’s drinking had gone down in May for some reason. I was therefore a bit surprised at his blood results. Later I wondered if it was because we had stopped lighting the fire and the house was cooler. The SDMA was creeping up slightly, but more concerning was that creatinine and urea were both up. Phosphorus levels were OK. Fern felt Jack was going into Stage 1 renal failure which was not surprising given his age. He’d been hovering on the edge since November. She suggested adjusting Jack’s diet to something more renal specific.
We altered Jack’s diet over the following few weeks. Vet Sue Armstrong suggested reducing the load on the kidneys at any one time by dividing his daily food ration into 4 or 5 little meals a day ensuring at least three hours between meals. She also suggested adding a little water or bone broth if needed. Although Jack’s drinking stayed roughly the same (480ml in June and July), his overnight nappies became a bit drier. Presumably he was able to pee out a higher percentage when he wanted to rather than it dribble out overnight . He was also able to last all day without dribbling, and to be left up to three hours without a toilet break on most days.
At that point, Jack was eating Different Dog, a top of the range gently cooked and species appropriate fresh food diet. I also took advice from their vet, Dr Alison Lambert. She suggested that since protein by-products might be building up it was advisable to reduce the protein content. She also emphasised keeping a particular eye on phosphorus and reducing that before it became a problem. All their recipes are high in protein, so we initially diluted the protein by replacing 10% of the Different Dog with butternut squash and sweet potato.
On incorporating this into his diet, Jack’s drinking began to go down – see Figure 3 further below.
July 2023 – not the best of months!
Henry my son was on the phone – “Jack’s having trouble weeing and he’s crying!” On rushing home, I saw he was also passing blood so off to the vets we went!
The trouble with Jack spending some of the time in a wet nappy during the night is that he was in contact with stagnant urine – prime breeding territory for urinary tract infections, UTIs. It was bound to happen sooner or later I guess. Jack was prescribed a broad-spectrum antibiotic. The pain passed almost immediately.
Ten days later and Jack really wasn’t well. He barely ate, if at all, for a few days. It may be that his kidneys were struggling a bit, making him feel uncomfortable and putting him off his food. Either way, another UTI was diagnosed so he had another course of antibiotics. Integrative vet Sue Armstrong prescribed a short course of Thuja 30 to help fight the infection and a Berberis / Taraxacum kidney support remedy to be used daily from then on. Jack’s bloods showed him to be in stage 2/3 kidney disease. For the first time his phosphorus was too high.
Thankfully he rallied round and was soon back to normal in terms of eating and general health.
Mid August 2023 – another UTI!
Vet Dr Lucy van Zwanenburg could see rod bacteria in Jack’s urine under the microscope, so she sent the sample away for culturing. E coli, typically, was the culprit. More antibiotics and Thuja for Jack.
Mid September – here we go again!
Yet another infection! This one was caused by a different species which is what can happen with repeated infections and antibiotics. Antibiotics and Thuja came out again. If there are repeated infections, it can get harder to tell if there is an infection as the dog may not show symptoms quite as much. A home urine testing kit proved useful to help monitor things.
With Jack it was getting to the stage where we may have had to consider long term low dose ABs every day. In the meantime Sue added Urinaid ( D-Mannose, Cranberry, Pomegranate, Ashwagandha) as a daily supplement to try and avoid this prospect. We haven’t had an infection since this.
The fundamental effects of diet
As highlighted above, we had observed several key changes as a result of changing Jack’s diet. Figure 3 below highlights the significant relationship between specific dietary changes and Jack’s drinking habits from July 2023 when we started changing his meals to the end of October. Measuring how much he drinks every day to make this observation is pretty accurate.
However, it’s harder to quantify how much urine leaks into his overnight nappy. I used a relative scale to help with observations ranging from very heavy through heavy, quite heavy, light, very light, a few drops to dry. I’m the only one monitoring this so the relative assessment remains fairly constant. I’ve not shown daily changes on a graph, but I feel confident in giving an overall assessment of key changes here.
Smaller and more frequent meals
When Jack first went into kidney failure we changed from feeding him twice a day (plus a mouthful for supper to prevent hunger pukes at 4am) to five smaller meals in order to minimise the load on his kidneys. We observed that:
- He more or less stopped dribbling during the day and was able to last longer without a toilet break. As Sue Armstrong observed, being dry during the day shows that by reducing the amount of protein in any given meal, his kidneys’ ability to handle the by-products of protein metabolism is not exceeded. Furthermore, his brain still had the control function.
When we started to dilute his food and reduce the protein content by adding sweet potato and butternut squash:
- His drinking went down even further
- Overnight nappies were lighter on average
A more radical change in diet – Honeys Real Dog Food
Honeys is one of the best raw food companies in the UK in terms of the quality of their ingredients (top of the range and organic) as well as their ethics toward the animals they feed and their owners; their staff; animal welfare and the environment. They started a special bespoke service in 2023 which included gently cooked options.
Discovering this was a godsend. I booked a consultation with one of their in-house nutrition team, Vet Nurse Francesca Cates. We went through Jack’s history in great detail. Kidney disease and acid reflux / laryngeal paralysis are the main factors driving Jack’s dietary requirements along with a brief bout of (mild) acute pancreatitis four years ago. Francesca was very thorough. As Jack is a relatively complex case, she also referred me to one of their canine nutrition specialist vets, Dr Charlotte Gray of Companion Nutrition with whom I had a very detailed consultation.
Key points included
- Getting phosphorus down to a normal level was key. This is particularly important for reducing the rate of calcium phosphate deposits. If it proved impossible, then the use of phosphate binders would have to be considered.
- Reducing meat levels whilst retaining high quality protein content and replacing with ‘beige’ foods that are inert for the kidneys (such as rice) is important
- Sweet potato, rich in beta carotene, is good for dogs with renal disease
- Vegetables and fruit can be used for antioxidants, fibre, water, reducing inflammation and to support the gut microbiome
- For special conditions like renal disease, extra supplements are needed such as water-soluble B vitamins and high potency omega 3
- Any vitamins and minerals should be in a highly bioavailable form
- Lower fat meats are needed for a dog that’s had pancreatitis
At this stage it was important to go with a single recipe in order to ascertain the exact effects of diet on his kidney parameters. Another recipe could be added at a later stage if required. However, it won’t matter if this remains Jack’s food for the rest of his life if it works.
Balance and safety
For a typical dog with no real health issues, achieving balance with a varied and species appropriate diet over two to four weeks is sensible. As long as there is an overall balance during this timescale, varying the ingredients and specifically not feeding the same thing every day is the best approach to optimise health, safety and effectiveness.
However, Jack is no longer a normal dog. He is elderly with serious issues to battle with. He therefore needs a very specific and balanced diet every day to suit his individual needs. Balance and safety in this way is essential every single day in order to optimise his health and well being.
Jack’s diet plan
Charlotte followed up with a very detailed and comprehensive recipe for Jack which also took account of the supplements he was already on (Adored Beast Apothecary Gut Soothe, Superflex Dog Deer Velvet and digestive enzymes). I could have sourced the ingredients and cooked the recipe myself. However, I chose to get Honey’s to make it as they have guaranteed high quality organic food suppliers.
Jack’s special recipe is a mixture of organic chicken thigh; lean beef mince, kidney and liver; sweet potato; a mix of seasonal veg; sardines; and organic white rice along with several key supplements specific to Jack. It has since been given DEFRA approval!! I like to think there is a file saying Jack Hunt’s Special Recipe somewhere in an official building!
I introduced the new diet gradually over ten days in September and oh my goodness, the results have been amazing!
- Drinking went down even more
- Overnight nappies became even drier if not dry
Blood test 20 October ~ renal parameters were all down and phosphorus was significantly back within normal range
As vet Dr Lucy van Zwanenberg at Crieff Vets said, it isn’t just about the blood results. They also look at overall health and well being. Jack had remained fit and bouncy throughout (apart from the blip in July). However, I can’t tell you how pleased I was when Lucy called me with the above results! He was considered to be in lower stage 2/1.
It’s worth noting any other changes in day-to-day life such as additional times of stress or changes in the environment (like the weather) and so on. For example, Figure 3 shows that Jack’s drinking began to slightly increase again towards the end of October. This was not surprising and seemed to be a direct response to us lighting the wood burner for the first time on October 26 making the house considerably warmer. At the time of writing he remains stable in terms of overnight nappies and drinking.
Several key observations have become apparent as a result of supporting Jack with integrative vet care including a radical change in his diet:
- He is drinking a lot less – at the time of writing it’s roughly the same as his pre-incontinence diagnosis levels
- Overnight nappies are significantly much drier, if not dry
- There’s virtually no urinary incontinence during the day
- Environmental factors are important
- Kidney parameters have gone down
- He continues to be clinically well
Top tips to make life easier for you and your dog
Obviously it isn’t Jack’s fault that he became incontinent and as I highlighted, it took a while for me to get my head around having to deal with our new normal. Along the way there have been many things which have made life easier for us and Jack – things that have become second nature. There are no doubt more tricks, but this is what works for us.
Thank you very much to the following people who keep Jack and the rest of us going. Their care, expertise and dedication has enabled us to make full use of truly integrative veterinary care for Jack and optimise his health and well being:
- Integrative vet Dr Sue Armstrong and Jane Young of Sue Armstrong Consultancy
- Vets especially Dr Fern Fraser and Dr Lucy van Zwanenberg, all the nursing staff including Jack Russell wrangler Mhairi Townsend and everyone on reception at Crieff Vets
- Dr Charlotte Gray of Companion Nutrition
- Francesca Cates, Jonathan Self and Dan Archer at Honey’s Real Dog Food ~ Honey’s Bespoke Service
- Dr Alison Lambert of Different Dog
Mention should also be made of veterinary cardiologist Dr Craig Devine of Borders Cardiology who we saw at Broadleys Veterinary Hospital. Fern referred us to Craig when Jack began to have fainting episodes including one at his June blood test. Thankfully Jack has no cardiac issues aside from having the heart of a senior dog. Craig diagnosed vaso-vagal syncope due to a combination of kidney disease with times of high anxiety or over excitement. Jack was prescribed Propentofylline.
Other useful links
Blogs mentioning kidney disease
Senior animal blogs
Isobel is a Co-Founder and active CAM4animals supporter along with her Jack Russell who has integrated veterinary care. She has a background in wildlife conservation and writing, and is passionate about the importance of addressing animal welfare and environmental issues.
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