Friday, September 14, 2012

Baby Brea

I received a text message last night that Brea had passed away very early this morning at the veterinary neurology facility.

She had been referred by us to a neurologist because she had been experiencing some severe back pain that had progressed to her not wanting to move. She had come in last week with reluctance to move and we quickly thought that it might be her back.

Back pain is rather common in dachshunds and beagles. But based on Brea's recent history of illness I was concerned that she might have meningitis.

Meningitis is inflammation of the meninges. In veterianry medicine we usually mean inflammation of the covering of the spinal cord. It is very painful and usually the result of an infection, although many times we don't know how or why it decided to land there. It is a very serious disease and can be very difficult to treat. You see your brain and spinal cord are protected by a protective tissue that keeps the bad stuff out of our most important and most valuable place, our brain and its peripheral extension, our spinal cord. When disease gets in it is now sealed in. There aren't the same super effective defense mechanisms in place here so the infection can lie undetected by our body, but wreak havoc on our primary nervous tissue. To diagnose this disease we need a spinal tap. This is not a procedure general practitioners do. We like to send these tests to the neurologists. (Something about a big long needle piercing into the spinal column gets us spooked, although all of the neurologists I know tell me it's actually easy to perform. I'll take their word for it).

Brea's arrival with yet another disease had us all scared. It was just a few weeks ago that she left the hospital after a 3 week stay from one of the worst cases of pneumonia that I had ever seen. Now she has severe pain that seems to be coming from her spine? OMG! How can 1 little sweetest-dog-ever, have another terrible affliction? My first thought is that this episode MUST be related to her last episode. We ran blood work, took her temperature and looked for any sign of progressive infection. Everything in the infection category was negative. Yet her exam still looked like spine, inter-vertebral disc disease, (IVDD). I called the neurologist to ask for his opinion. I didn't want to deal another crushing blow of devastating and expense to treat disease to Brea's family.

He agreed that she probably wasn't a meningitis case, but also agreed that we probably shouldn't start her on a steroid initially. We sent Brea home last week with lots of pain medications and a plan that if she wasn't better in 2 days, or if she worsened that she would go to the spine center.

Two days later she was not better, and she was sent to the neurologist to try to identify her source of pain and to try to figure out how we could lessen it.

Brea had a myelogram and it identified a disc in her spinal cord at the level of her cervical spine at C2-C3. The "higher" your disc disease is the more paralysis it usually causes. A disc at the cervical area will affect all four legs, versus a disc at your lumbar area affects your rear limbs. Also the nerves that control your vital organs live high up to. If you injure your spine at the very top (high cervical area, right by the base of your brain) it can actually stop your ability to breathe.

At 3 am Brea died. The consensus is that she must have extruded more disc material or she was so pyrexic (elevated body temperature, can happen from pain), that her breathing stopped. She had done fine during her myelogram, and was at the hospital for observation and pain management, but slated to be discharged for home care in the morning.

As soon as I heard about Brea I called her family. They are wonderful, kind people who have done more for any dog than anyone I have ever met. The first time I saw Brea was within 24 hours of them adopting her. They knew she was sick, but they adopted her anyway. And even though I wasn't sure that she would live through the day from her pneumonia they decided to try to save her. They stuck by her despite needing three weeks of hospitalization. As she got better she blossomed into a happy energetic inquisitive beagle. They had gotten her to help ease the anxieties of their other dog, Beau. Beau only knew Brea for a few short weeks. Between being quarantined for her first and last illness Beau and Brea only had a few weeks together.

There wasn't anything I could say to comfort Brea's parents. All I could say is how sorry I was, and how incredibly unfair it all seemed.

I sat on the phone trying to hold back tears and telling them how wonderful little Brea was and how incredibly lucky she was to have found them. What I really wanted to say was, "How can this have happened?" Not to place blame, because I just don't think there is any to point at, but how can that little bundle of baby beagle who was so adorable, so irresistible, abandoned, almost died a few months ago, have died from this? How could she be so young, and have been dealt such a shit hand?"

I told Beau's family that we would help them find a new friend for Beau. That I know they are shell-shocked and don't even want to think about it, but I will help them find and foster a healthy friend for Beau, who still needs someone to keep him from being alone and afraid.

I know I get too emotionally involved with my patients, but "Why?" I just don't have the answer to "Why?"

I am heart-broken for baby Brea and her family.

Such is medicine, I just doubt I will ever stop asking "Why?" It happens when you get emotionally involved, but I guess I will never stop doing that either.

To read Brea's blog please go to:

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