Timber, How could the 2nd dog be more tragic than Ruger?

I introduced you all to Ruger a few days ago. I told you about the long difficult road it was to finally get him a diagnosis, and then the incredible struggle it was to keep him happy and functional once we got it.

In the end, after his struggles with finding his disease and watching him through his ups and downs, he died of malignant lymphoma 2 months after his first sign of illness. His story was agonizing to watch and heart breaking for his parents. Through it we became friends and allies in a war against the disease in Rugers body. He was an "incredibly sweet loveable dog, and he can't ever be replaced."

So were the last words I heard from Rugers parents. They said that Ruger was "one of a kind" and that they "could never replace him," and I knew the pain of losing him would take a long time to heal.

I wished them well, told them to call me anytime, and that they were great parents who had a dog that loved them.

A few weeks later I was elated to see Ruger's dad in the waiting room with a rambunctious bouncing curly locked Golden Retriever puppy. I was so happy to meet that little boy they named Timber. Timber's dad was all smiles as we smothered that puppy in kisses and compliments. I asked how his wife was doing? He said he had surprised her with the puppy and she was feeling better now that he was in the house. They were healing and moving on. But they did have lots of questions about whether Timber was a "normal" puppy. They just didn't remember Ruger being so energetic when he was Timber's age. I told them that "all puppies are diferent, and that he did seem a bit more energetic than the average Golden." Secretly, I thought that he was just what they needed. The busier that Timber kept them, the less time they would have to mourn. But it was apparent to everyone that they loved this pup to pieces.

At Timber's first visit he was 8 weeks old. We started him on his first set of puppy vaccines, flea & tick preventative, ran a fecal to check for intestinal worms, and started him on heartworm prevention. We also spent a great deal of time going over our puppy instructions. These help owners understand what we do, what we recommend you do at home, feeding guidelines, and lots of helpful hints.

I saw Timber every three weeks from 8 weeks to 17 weeks old. He grew into a beautiful bouncy adolescent. He was one of the few puppies who was always happy to come in and visit us. Which is quite a big compliment when you are getting multiple vaccines at each visit.

For his last puppy visit, at 17 weeks, I spoke to Timber's dad about what the recommendations for Timber's next few months would be. I gave Timber his last puppy examination and then vaccinated him for his last puppy distemper combination shot, and his last Lyme disease vaccination. I then asked the technician to bring Timber back to the treatment area so he could have his blood taken for his pre-op neuter check. Timber was in the back with the technician for about 5 minutes. While they were in the back I stayed in the exam room because I wanted to ask him for his permission to write about Ruger in this blog. He said that it would be fine. Timber was brought back into the exam room as we were talking about the magnificent dog Ruger was. Out of the corner of my eye I saw Timber squat and urinate on the floor..I thought that this was odd, he never seemed scared or nervous around any of us before. Then within 10 seconds his back end went limp and he sort of fell/fainted. Timber's dad said, "Oh, he must be tired?" But my gut knew better. I lept to the floor, put my hand around his heart, and looked at his gums. His gums were pink, but I'll be damned I couldn't feel a heartbeat. Without any word to his dad I picked up his lifeless 30 pound body and ran through a packed reception/waiting area. I looked like a t.v. show, and I was wishing that this was one. I placed Timber on the surgery table, and got my stethoscope on his heart immediately. Nothing. His gums were now purple. I started CPR and swearing. How could I possibly face these owners? God, the devastation of losing Timber would be too much for them. I was thinking all of this and barking orders at my petrified staff. Within 1 minute we had 2 i.v. catheters in. I had him intubated, and I was shoving massive amounts of life saving heart starting drugs in his veins. Yes, a flashback of Pulp Fiction ran thRough my head. I never stopped the chest compressions and his color very quickly became pink again. Within 3 minutes he had fluids, a drug to increase his heart rate (atropine, see Pulp Fiction) and oxygen. Within 1 minute I felt his heart flutter under my fingers gripping his chest. I was determined and desperately pleading to coax him back to consciousness. I was continuing his CPR and then his heart stopped again. I gave a HUGE dose of atropine in his i.v. catheter. It was my last hope and I was losing all hope. Within 30 seconds his heart regained life and started beating fast and furious. Ok, I did get really nervous here. His heart went from zero to 200 beats per minute. But he was alive! Oh! I could breathe again. Within a minute or two he was conscious.

I took a deep breath and walked back to the exam room. I tried as calmly as I could to explain what had just happened. I brought Timber's dad in the back to sit with Timber so I could keep monitoring him. I begged them to stay another hour, until we closed because I was so afraid I would lose him. Within 30 minutes that puppy was up and jumping around like nothing had ever happened.

I went home that night feeling as if I had just lived through one of the most scary, nail biting, near death experiences of my career.

Timber is doing great. Although it has been too long since I ran that pre-op blood work. I bet they are afraid to come back and tempt fate again. I better call them tomorrow.

Ruger's Ominous Mystery Illness

Ruger’s story began in April 2010 when he came into JVC (Jarrettsville Veterinary Center) because he had a decreased appetite and was vomiting. Ruger, a 7 year old Golden Retriever, is owned by two of the nicest people and they adore him. He is a 70 pound gentle, docile, affectionate boy. He is charming and irresistible.

On his first visit we treated him like we do many acute gastro-intestinal disease dogs. We took a full history, gave him a thorough physical examination, offered to run some basic diagnostics, (but didn’t force because he was “acute”) and treated conservatively with anti-nausea drugs, subq fluids, and gastro-protectants. Three days later his owners called back to say he had begun to vomit again and now his stool was loose. This time his owners elected to run the recommended basic diagnostics. 

We ran bloodwork, took x-rays, and went over the history again to make sure nothing had changed or been overlooked. This time we learned that his food had recently been changed, and he wasn’t on heartworm preventative. So we ran a heartworm test, it was negative, thank-goodness, and put him on a bland commercial diet. We also learned that Ruger had had seizures in the past. His bloodwork came back inconclusive (a nice way to say, thanks for paying for this but saddly it didn’t really help us get an answer). But a day later Ruger was feeling better.

10 days later and Ruger was back. OK detectives here where the years of sleuthing pay off! So let’s go back over his history so far. Because we now have all of the clues we need to help steer us in the right direction.

·         7 year old Golden Retriever; unfortunately for Goldens this is the time we start looking for cancer. These guys are cancer factories. They all die of cancer!

·         Waxing and waning disease. Big red flag. There is something going on. The dog knows it, so you better start digging, it is there lurking somewhere.

·         Vomiting and loose stool/diarrhea means you have something going on in the gut. These cases frequently wax and wane so take serial weights. The scale doesn’t lie. He was 70 pounds his first visit, 68 the second, and 64 the last.

He now needs to be watched very closely. Any small note of concern is reason for discussion with the Vet.

He returned 4 days later, now it was 2^nd of May, with the complaint “still not eating or drinking.” His stools were getting even looser. His owners were offering anything and everything to peak his interest in food, but very little of the offerings were being contemplated or taken. We recommended they repeat the blood work and radiographs but they declined. (I think that initially this was acceptable to decline but now it should have been repeated. Just because the blood doesn’t indicate something on the first try doesn’t mean that it won’t later. I say this a lot; “Your body knows there is something wrong before the lab does.” Trust the dogs word over the labs!) We also recommended an ultrasound.

Ultrasounds are a much more sensitive way of looking inside the abdomen. Radiographs (slang = x-ray) are great for bone, but an ultrasound allows you to see the internal soft tissue architecture that is the contents of your belly. That’s why we use ultrasound for fetuses, and x-ray for broken bones.

The May 2^nd examination also revealed a depressed and dehydrated Ruger. I think most people significantly underestimate how important good hydration is. A day of not eating or drinking normally or a few episodes of vomiting can cause significant dehydration. Once the dehydration snowball starts every hour makes it exponentially and significantly worse. This is why we Vets tell owners to bring your pet in when you call and tell us your pet has been vomiting and/or having diarrhea. The Vet who saw Ruger on this visit had only two rule outs for his possible diagnosis; gastrointestinal disease and cancer.

By May 5^th  Ruger still wasn't eating or drinking. At this point everyone at the clinic was worried enough to start talking about referring Ruger to a specialist. This and repeating the bloodwork was declined. We also scheduled them for an ultrasound in 2 days, (the soonest we could get it) and we added medications for diarrhea. We offered to run the diagnostics as soon as the owners wanted. We received a few phone calls updating us on Ruger. He was doing better, eating better, and his owners believed he was back to normal: disaster averted, and ultrasound cancelled.

On May 20^th Reuger vomited bile. His parents scheduled an ultrasound for ASAP, which was 5/25. The ultrasound finally hit pay dirt! Thank goodness, after all of this it was time to start finding a villain to point the finger at. The ultrasound found “the mid to distal (away from) small intestine revealed a significant infiltrative pattern with loss of detail, (something is there that is mucking up the normal architecture).. strongly suggestive of lymphoma or carcinoma (bad and worse cancer). Intraoperative ultrasound would be warranted." Another word’s the Internal Medicine Specialist reading the ultrasound thinks that the abnormal tissue won’t be seen grossly during an exploratory surgery. He recommends the surgeon be ultrasounding their way through the abdomen so we don’t miss the abnormal spot. Problem with that is it is waay expensive! I discussed the ultrasound findings and suggestions with Ruger’s parents and they decided to have me just go in and do the old fashioned exploratory surgery. (Ok time for my personal admission, I LOVE EXPLORATORIES! I love the whole treasure hunting, never know what your-gonna-find mystery, so fun I can’t even stand it!)

One big deep breathe and all doubts of ability cast aside the ext day Ruger was in surgery. I made my midline ventral abdominal incision and entered Ruger’s belly. Lucky for all of us I found a big abnormal mass in the area of the stomach. It was easily removed and Ruger’s worrysome surgery ended quickly and without fanfare. His intestinal culprit was put in a bottle and sent off to be fixed in formaline, shaved into little slivers, and scrutinized under a microscope. 5 days later we had a diagnosis for Ruger. It was lymphoma. His biopsy report read “intestinal mass: malignant lymphoma..the long term prognosis is poor.” With these words Ruger was taken to an oncologist for a treatment plan and a miracle.

Getting the already not eating Ruger to eat after having been opened and explored was not happening. He protested for days, and refused every morsel offered. We were also struggling with keeping his total protein, (specifically albumin, the tiny very important vital to life protein so that your blood actually stays in your vessels) in the normal range. He became so weak and lifeless that we were forced to give him a plasma transfusion. As happy as I was to have a diagnosis I was concerned I might lose my patient before we got to the treatment part. Even with the transfusion he wouldn’t resume eating. So we turned to drugs, and within a day those drugs had him eating. Ruger took his second wind and ran. He did great for a month. During this time he started his chemotherapy and we all regained our hope for his recovery and conquest of cancer. Because he was doing so well and because there are detrimental adverse effects to long term drug use we started to taper his drugs. But unfortunately as we started to taper him off of these drugs he started to turn his nose up to his food. Within a few days we ended up right back at transfusions and those same steroids and appetite stimulant drugs.

Ruger spent his last three days at the emergency hospital. They were suggesting he continue with the transfusions. His parents called me in deep despair seeking advice for what they should do. I knew by their voices that they wanted Ruger to be cured, but understood he wasn’t going to be. They wanted someone to give them advice based on what was right for Ruger and not what was right for the cancer. I told them that Ruger had given up a long time ago, and that keeping him alive in a hospital wasn’t what he wanted. He was weak, and tired and ready. They were so grateful for the permission to let him go. They just couldn’t say it and they didn’t want to admit it.

There were many conversations exchanged between us after Ruger passed. There were words of sorrow, acceptance, and grief, and many, many tears. I was sad to say goodbye to Ruger, but I was more saddened by the thought of not seeing his parents, or worse yet, not seeing them and knowing that they didn’t want to love another dog, or love anything again, because it hurts too much to lose a pet.

A few weeks later Ruger’s dad came in with an eight week old Golden that they named Timber.
Oh, Timber, you are another story! Cutest puppy ever, but his story, that’s another tale of drama and…oh, its too good to leak..stay tuned!