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:

http://tinyurl.com/8lyjxnh

Curing Beau's Anxiety

The other day I introduced you to Beau. He had lost his lifelong beagle companion and it sent him into an anxiety-ridden tailspin that led to destroying drapes, crying and whining incessantly. His fears were becoming more diverse, more frequent, and intensifying. He is the poster child for "separation anxiety" as we call it in veterinary medicine. I had met Beau not too long after his best friend had passed away and talked to his family about how to most adequately address Beau's stress and condition.

Beau's fight with the drapes. AKA "I want out!"

The family knew very early on after the death of their beagle that they needed to find another friend for Beau. They had jobs and lives outside of their love for Beau. He was a mess on his own and they couldn't fill the gap that their beagle had.

I saw Beau's family about a week and a half ago on my Sunday walk-in hours. Their chart was in the exam room box and I saw that they had a new pet. I was so excited to see their new addition and to hear about Beau's response to having a new friend that I forgot to actually read the chart's entry for "reason for visit."

When I walked in the room I saw looks of concern and a small Beagle recumbent on the exam table. Within a second my excitement dropped to despair.

The beagle on the table was small, about 12 pounds, and she was laying on her sternum with her head extended, nose pointed straight ahead, and breathing as if every tiny inhalation might be her last.

We didn't need words. We all knew she was terribly ill.

I then turned to read the chart. "New pet, sick."

Why hadn't I suppressed my excitement long enough  read the file? Why had I burst into the room excited when the room contained despair?

They introduced Brea to me and told me that they had just picked her up yesterday from the SPCA. (I quickly did the math in my head. They had only had her 20 hours).

They were told when they adopted her that she had kennel cough but was being treated for it. They then produced her antibiotic, doxycycline. They also told me that she had been given up, and then adopted, and then surrendered again.

When you see lots and lots of animals you get a good 6th sense about them. I could tell that there wasn't a mean aggressive tendency in this small scared and pitiful pup. She is a beagle. And although they are vocal and sometimes their nose forces them unconsciously to wander off for that elusive smelly bunny, they are sweet affectionate dogs. They told me that the second family had brought her back because she ran off and wouldn't come to them when they called. (Do people think that this is abnormal? Especially for a beagle? They are powerless to the nose-brain force that drives them to investigate the scent of any animal that has passed by). All pets need to be trained, and all new pets need to be intensively supervised and also trained. Poor Brea, she was a little beagle in a world that couldn't understand or appreciate her. That was until Beau's parents found her.

They explained that they loved beagle's and knew that another beagle would be perfect for Beau. They were so happy to find her, loved her instantly, and didn't care that she was a little sick, but on the mend.

I looked at Brea, gave her an exam and then notified them that she was "Very, very sick." I suspected that her kennel cough had turned into pneumonia and I was not sure she would live." How else could I tell them? She was less than a day theirs and I wasn't very hopeful that she would live past today.

This is what a dog that can't breathe looks like. Head extended, open mouth, reluctant to move.
Brea is in our oxygen cage. The sides are covered in yellow snot becasue she is so congested.
Pink tape covers her i.v. catheter.

Yellow crusted nose.

They said that they loved her already and they wanted to give her a chance. I told them they could call the SPCA tomorrow and see if maybe they would help with her treatment plan.They explained that they had signed paperwork that clearly stated that any medical conditions were their responsibility and that there was a medical facility they could send her to. But they felt confident that she wouldn't get immediate medical intervention and that the SPCA may elect to put her down. They didn't want to wait for her care and they didn't want to give her up.

We took a chest x-ray and ran some blood work. I reported back to them that the x-ray and the blood work didn't appear to look as badly as she clinically did. I discussed options for them. She could go to the ER until we opened again on Monday at 8 am. I told them that the "average ER overnight stay is about $500-$700." I also explained that they could take her home and monitor her very closely and go to the ER if she worsened. Because her blood work and x-ray weren't as severe as I had thought they decided to go home and bring her back first thing the next morning.

Brea's first three days in the quarantine area of our hospital were "touch-and-go."

Quiet, recumbent, and depressed. In quarantine.
A/d slurry (a high calorie prescription food) in with her, just in case she feels well enough to eat.
Because she hadn't eaten in so long with had to add potassium to her fluids.

She went to the ER every night at 8 pm for overnight oxygen cage therapy and came to us everyday for nebulization, i.v. fluids and antibiotics and prayer.

She had severe yellow thick mucous from her eyes, her nose and her throat. She was as sick as sick can be without dying. We all tried to convince each other each day that she had some slight glimmer of improvement. We were saying things back and forth to each other like, "she will get worse before she gets better," which is a difficult piece of advice to swallow when you look as sick as she did.
At day three her x-rays and blood work looked as bad as she did.

At day 4 we had a tiny interest in food. This was a HUGE milestone!

At day 6 we had a bark! A beagle eats and barks! She was finally classified as "recovering."

At day 8 her blood work worsened. Her white blood cell count had continued to climb every time we checked it. On  days 2 through 8 we had her on 3 different very strong antibiotics. On paper we were losing the war. In person we were beginning to see a real live beagle.

As the staff fretted about her stats I reminded everyone that "the pet tells you the most important information. The pet trumps any number." That first exam she was telling us that she was very sick, and now she was telling us that she felt better. We will treat her until both pet and blood work agree that we can stop.

At day 10 Brea remains with us for the day while her new family is at work. She has yet to meet Beau. It will have to wait until she isn't blowing disease droplets at every sneeze. But she is a bright, happy, wagging, nose to the ground, inquisitive girl who I think will be a perfect buddy for Beau.

Out for a walk in the sunshine! This is how you know a beagle feels better.
They are sniffing, digging, and watching other dogs.
And there is that "happy beagle wag!"

Her new family knows that they single handedly saved her life.

Please rescue, and please be patient if you do. These guys often come from broken homes, and many of them have been shuffled around. They in many cases also haven't been "trained." I know many people are hesitant to adopt because they are afraid of inheriting a pet with problems. I hear many people say to me "I think that Fluffy is this way because she was abused." I know a great number of pets who were adopted at 8 weeks old with behavioral issues that were never abused. Your pet Lives in the now and almost every single behavioral problem can be resolved with patience, kindness, determination and assistance from professionals. Please don't give up your pet without asking for help from your vet, your local rescue organizations, and behavioral advisers. Pets are a life-long responsibility.

It has been two weeks of hospitalization for Brea. I am soo happy to report that she is thriving and happy. I will post pictures of her and Beau soon. She is still being kept away from him for a few more days, while the antibiotics kill the last few bugs of her infection.

Update:
On September 13, 2012 Brea passed away due to a severe infection in her spinal cord. Her parents loved her immensely, fought countless battles with and for her, and in the end, although her time with them was very short, she found a place to call her own and a family that loved her every second of her time with them. We all should be so lucky.

Brea and Beau's family came into the clinic a few months later. At that time we were looking for a home for Pheobe. She was an overweight, under exercised mixed breed dog. She had been scheduled to be euthanized because her mom was entering long term hospice care. Her mom didn't believe that there was a possibility that Pheobe could find another home at her advanced age of 8. I spent 20 minutes pleading with her to let us find her a home. I had to say things that I was dumbfounded to answer. Like promising her "that we wouldn't experiment on her." Or, "that we wouldn't let her suffer in a tiny cage and never be able to go outside or see daylight." I was so disheartened that people could do such things, or even imagine doing such things.

Pheobe in the few months that we had her, blossomed into a happy, playful girl. Phoebe got a second chance at life because Brea's parents understood how important it was for Beau to have a buddy.