pet connection

I’m going through a rite of passage, of sorts. Or it might be two, depending on how things go. I’m looking for the breeder of my next dog.

You might think I’ve been through this before, but I haven’t, really. I’ve written about it lots, but I’ve never had to go through the process from the beginning. Savanna came from a Greyhound rescue group. We visited the kennel where she was being kept, picked her out (she stuck by us while the other ones ran off) and drove home with her. We received a follow-up visit from two people from the organization to make sure she was settling in and answer any questions we had, such as “How do you get them to sit?”

When Savanna died and I decided we needed a smaller dog for our condo, I got introductions to several Cavalier breeders from my colleague Allan Reznik, who’d had Cavaliers himself. I also joined a Cavalier mailing list (this was in the pre-Facebook and blog era…also known as the Dark Ages) and got to know the people on it. Joanne Nash was one of those people, as well as someone recommended by Allan, and she lived only a few hours away. When she heard about our losing Savanna and that we were looking for an adult Cavalier, she got in touch with us. Long story short, we drove up to meet the Nashes and their dogs, passed their test of not panicking when they let a gang of Dalmatians and Cavaliers mob us, and drove home with Bella. I met Darcy’s Irish (not puppymill) breeder on the same email list, got Twyla from Cavalier rescue, and bought Harper from Bella’s breeder.

But this time I’d like to try my hand at a different breed. I’m interested in a smooth-faced Pyrenean Shepherd. I like the size, I like the look, and the temperament does not appear to be all that different from Twyla’s (extremely smart, not interested in outsiders, funny and loving with family and a very few friends). I’m okay with the potential health issues. I think I am capable of keeping up with the activity level. My plan is to get a Springer for my bike, as well as to re-find all the dog-friendly hiking areas in Orange County. I’m not interested in agility (no sense of direction) but I’m willing to give flyball, nosework and rally a try, and opportunities to learn herding exist within an hour’s drive. We’d do puppy classes and obedience with Liz, natch. Who better to teach me how to navigate life with a herding dog?

So far I’ve contacted several breeders with a little about us and what we’re looking for in a Pyr Shep (smooth face, don’t care about color or gender, not crazy high drive). I haven’t heard back from the grande dame of the breed. She probably thinks I am the world’s worst potential Pyr Shep owner. One advised me that Pyr Sheps weren’t much like Cavaliers. The other didn’t have any smooth puppies and didn’t expect to any time soon. I think maybe there’s one other person who hasn’t responded yet. Luckily, I’m not in any hurry. I fully expect this to take a year or more, and I have no illusions that being a dog writer will help speed the process. Besides, I have concerns that Harper and Twyla’s noses will be out of joint, so there’s that to consider.

I’m debating whether to contact French breeders in advance of our trip to France next month. It would be a bad idea to bring a puppy home from that trip if one were even available, but it couldn’t hurt to get to know some people. And I need to put a dog show on my calendar after we get back so I can see if I can meet some Pyr Shep people there. I’ve only seen the dogs at the Eukanuba Meet the Breed booth or in the agility ring, so I’d like to meet some in a home setting if possible. I also have a couple of backup breeds in mind if we get to know the Pyr Sheps better and decide they’re not right for us.

I said earlier that we might experience a different rite of passage. If it looks like a Pyr Shep won’t work out or won’t be available for quite awhile, I may be keeping an eye out for a dog at our local shelter. I’ve had dogs from breed-rescue groups–and I may go that route again–but I’ve never adopted one from a shelter.

Whichever way it goes, wish me luck!

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Palliative care does not always mean death is nigh.

Oreo is staying at my hospital this week, but not because she’s having a medical crisis. Her family is out of town and they simply won’t allow her to stay anywhere else. Oreo is a lovely tuxedo kitty, 16 years old, and she is a palliative care patient.  In fact, she has been a palliative care patient for a staggering two years.
Palliative care is defined as patient-centered care that focuses on symptom alleviation rather than curative strategies. It is often aligned with hospice and end of life care, and implies the pain management and “comfort care” are leveraged to assist the dying during the relatively short period preceding death. While palliative care in the final time is a critical element of what we call good death, much about palliative care and its application is misunderstood and often overlooked.

In veterinary medicine, palliative care in the end of life context is only now being explored as a viable option for keeping animal patients both comfortable and with their owners for a bit longer as the time for euthanasia approaches. The International Veterinary Academy of Pain Management is emerging as a resource for both pet owners and veterinarians better to understand comprehensive, multi-modal pain management options.
End of life palliative care is both fascinating and an amazing gift we can give our dying pets, but we need to expand our consciousness about who among our patients needs and deserves palliative acre. There is so much we can do for so many of them.

Back to Oreo’s story.  Two years ago, having lived with chronic renal disease for several years, Oreo had a “crash and burn” event with her kidneys. We still do not know precisely what caused her kidneys to fail at that moment, but they stopped filtering waste products from her blood. She was still producing a very small amount of urine, but the laboratory values were off the scale. Her prognosis was grave. Yet, as subdued as she was, she was still engaged with her family. She still had a spark of life. When we hospitalized her, we did not know if Oreo had any kidney function in reserve that we could tap into. We knew she would never return to her pre-crisis status, but we knew that we had palliative care options available to give her a little more time with her family, and we knew we had to try.

Oreo spent a week in the hospital with intensive IV fluid therapy. Her family was with her in the hospital every day, rotating through family members so folks could get their daily activities done. It was inspirational to witness her restoration. At the end of a week, with kidney blood tests still in the “terrible” range, but with her appetite and attitude returned, she went home. Her palliative care consists of a dose of fluid delivered each day under her skin because she physically can’t consume enough water to support her remaining diminished kidney function. She sits quietly while her fluids are administered. She takes potassium each day. She eats a kidney-support nutritional profile. She loves her family, and she loves her life!

Oreo lives a delicate daily balance. There will be no heroic interventions in her future. The symptoms of her kidney are disease relieved through palliative care. At the two year mark, it is safe to say that Oreo’s palliative care did not portend imminent death (though that is what we were worried about at the time). Without her everyday support, surely she would die quickly. But she doesn’t have to die, at least not yet. This is the beauty of palliative care.

Do you know any animals who have benefited from symptom management through palliative care?

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There are all sorts of pluses and minuses to the world of veterinary medicine when compared to human medicine, but in one arena veterinarians come up clear winners. In all but the most vanishingly rare situations, dogs don’t get heart attacks.

Dogs almost never develop the same sort of hardening of the arteries (known as atherosclerosis) that makes middle-aged men and women clutch their chests, drop the 3-wood and shuffle off this mortal coil. Human medicine has all the shiny toys, insurance money and human-life-is-so-important stuff going for it that make veterinarians green with envy, but I thank my lucky stars every day that I don’t have to deal with heart attacks. The canine equivalent, at least in my opinion, is probably a phenomenon known as ‘spontaneous hemoabdomen.’ Your average veterinary ER probably sees two or three of these types of cases a week, and as the pet population ages they are bound to become even more common.

The thing about hemoabdomens that makes them so frightening for pet owners is that they seem to come out of nowhere, and they hit like a random, unforeseen lightning strike on an otherwise sunny day. One moment their dog may be happily cavorting in the yard, and the next they’re lying on gurney in a veterinary ER fighting for their lives.

In most cases, a tumor on the spleen (which may have been growing for weeks in the abdomen without being detected) ruptures and starts to hemorrhage internally. Dogs can bleed to death within a few hours if the bleeding continues unchecked. They can be quite literally felled in their tracks.

The bleeding is internal, and there is no evidence of bleeding that can be seen externally by the pet owner.  All they know is that their dog was fine one minute, then collapsed and couldn’t get up the next. No blood in the stool, none in the urine, none anywhere; just a big pool of blood building up inside the abdominal cavity.  Blood that should be circulating and bringing oxygen to tissues is suddenly pooling in the abdomen. Shock and low blood pressure set in almost immediately.

The signs are typically a sudden onset of weakness and inability to get up. These can happen in any breed of dog, but the majority are in dogs that share a genome with German Shepherds. Golden Retrievers, sadly, probably take the #2 spot. Any dog over eight years old that’s related to a German Shepherd or Golden is potentially at risk for a a spontaneous hemoabdomen, and this disease should be considered in any dog of this type who has a sudden episode of unexplained weakness.  If you check their gums, they are often as white as a sheet.

In about three quarters of the cases, the ruptured mass on the spleen is due to an aggressive malignancy called a hemangiosarcoma, a really nasty cancer that grows out of blood-forming organs (the spleen is a tongue-shaped, flat organ that sits on the left side of the abdomen, all snuggled up to the kidneys and other giblets). Hemangiosarcomas love to grow rapidly, spread to other parts of the body and, worse, they usually eat powerful chemotherapeutic drugs for lunch. They are just a miserable type of cancer to have, and most patients with them are not around for long, even with a full-court press of medical intervention. I hate making the diagnosis of hemangiosarcoma because it usually means I have just completely ruined someone’s day and pronounced a death sentence for a patient.

For that lucky one out of four that doesn’t have a hemangiosarcoma, they likely have a benign and slow-growing tumor called a hemangioma that just decided to break open and start bleeding (we keep the names similar to confuse the tourists).  These, fortunately, can be completely cured through surgery.  You still have to deal with all that life-threatening hemorrhage and accompanying scariness, but at least you get good news when the biopsy comes back.

The survival rate for dogs with hemangiosarcoma is, on average, about 3 months (with emergency surgery to stop the bleeding). That time span can be doubled with the help of powerful chemotherapy, which is an option that all owners should be offered. We tend to not be as aggressive with chemo for our pets as they are with people, so that can mean fewer side effects. For some folks, six months of good quality life is a blessing, while for many that is nowhere near enough to justify the medical high-wire act that must happen to even hope for a little survival. The word ‘cure’ is almost never uttered in the same sentence as the word ‘hemangiosarcoma.’

To be honest, many owners decide to not pursue surgery when we make the diagnosis of hemoabdomen, and I can’t blame them.  They are usually looking at a 75% chance that their dog has a disease that will very likely kill them inside of 90 days. The alternative is a fast and painless euthanasia, or, in some special cases, a death at home.  Despite all the drama of this disease, it is usually totally painless and I will honor requests to take pets home to die if the owners are educated about what may happen. For those that elect to pursue treatment (I would say about 1/3  opt to treat), the goal is to take them to surgery as soon as they are stabilized. This means blood transfusions and other methods to try and make them the best anesthesia candidate we can.

All of this comes at owners with dizzying speed. I am often in the unenviable position of trying to get them to make a timely decision on a very expensive, delicate matter with little information and no guarantees. As I hinted at (and took some heat for) in last week’s post, lengthy Q & A sessions in the middle of this type of crisis only makes the prognosis grow more dim for the patient as their lifeblood seeps into their abdominal cavity.

However, I recognize the need for people to feel that they have made the best and most informed decision that they can in this scenario. I try to answer as many questions as time permits for the patient, and steer them to make a decision if we start covering the same ground repeatedly. I want to note one important point right here. This is an excruciatingly difficult point in the lives of pet owners, and it becomes a critical juncture for me to talk to the owners, hear their concerns, and help them make the best decision we all can, given the imperfect information we have on hand. Unfortunately, in this case the patients simply don’t have time for anything but a rapid decision.

The cost for surgery and ICU aftercare can easily run into the thousands (many will hit the $5,000 mark before discharge), and many will have post-op complications that can escalate that amount even higher.

I had one case several years back where post-op complications kept the dog in the hospital for a week, at a cost of over $10,000. The biopsy came back shortly after discharge and was what we all feared worst: hemangiosarcoma. The dog, owned by a very nice and caring MD, lived for another month before the cancer grew back and caused more bleeding. For most of us, $10,000 for another month of life would never fit the budget (or, for some people, their concept of what is right), but for this man, he assured me it was the best month he ever had with his dog. They hiked, they fished, they lounged on the couch eating Doritos and drinking Yoo-Hoo. They did everything but go 2.7 seconds on a bull named Fu Manchu. They lived like the dog was dying, and got everything out of it they could. He was happy with his initial decision and told me, as I put his dog to sleep, that he would have made it again.

For a bad outcome, that’s a pretty good way to look at it.

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It was time. We let Bella go a few hours after we got home from visiting my sister in Santa Fe on Tuesday. I had scheduled an appointment for her with our veterinarian for the following morning, based on what the pet sitter had been reporting to me about her condition, but she was clearly unhappy, so we went ahead and took her in late that night.

She had been slowly deteriorating. I almost euthanized her last week before we left, but she rallied–again–and I couldn’t bear to do it. I am sad that I was gone those last few days, but in a way I wonder if it was necessary. Maybe my absence helped her to detach and to be ready to go. Maybe I am just trying to make myself feel better. It did help to have the neutral opinion of the pet sitter, someone who didn’t know Bella except from staying with her for a few days.

It was a gentle passing. I held her in my arms while the very nice veterinarian administered the injections. Jerry was right by my side.

Twyla seemed upset after we got home and the next morning, so I called to see if Bella’s body was still available for viewing. I’ve heard that it helps some animals to realize why the missing one is gone, so I took her and Harper in to say their farewells. As it turns out, they were completely uninterested, giving a quick sniff and then retreating under the chairs in the exam room. It was therapeutic for me, though, to get to see her one last time. They brought her in arranged as if she were in a bed and it just looked like she was asleep. And at peace. Before we left, I tucked a treat inside the blanket with her.

Good night, sweet Bella.

Photo and painting by Terry Albert.

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Greetings, dear readers. I’ve missed you. I’ve missed writing. I’ve missed our interactions.

May 15th was the one year anniversary of my mother’s death. In the weeks leading up to that date a cloud of gloom descended over my world. I was suddenly moving under water, slow motion, akin to when the “6 Million Dollar Man” would kick into bionic body-part mode.

Intellectually, I knew to expect grief bursts to increase in frequency and ferocity as her death date approached. But knowing something in the brain doesn’t really prepare the heart for the experience. I could feel this hard something growing right in the middle of my chest. I couldn’t relax. I couldn’t breathe deep, chest-expanding, lung-filling breaths. I couldn’t concentrate. I had some really not so nice moments. I lost touch with my always threadbare patience. And (probably the hardest for me during that time) I couldn’t write a single creative word.

For me, writing is truly an integration of head and heart. The inspiration enters through the heart, and the head (with my years of didactic training including my English degree) filters and refines those creative impulses. Writing is an outlet, a way to educate, and an instrument through which to help pets and the people who love them.

My heart was frozen by my grief.

Mind you, I couldn’t even articulate this frozen heart conundrum in the moment. I just knew I wasn’t right and that I had this crazy lump in my chest.

But my pets knew…our beautiful Golden Retriever, Farrah, went out of her way to sit right beside me on the sofa (she rarely gets up on the sofa with a human).

Tommy, our mischievous Cavelier King Charles Spaniel took it upon himself to ensure that my lap was never empty. Columbo, the one-eyed Ocicat, made it his job to “make bread” on my back as I fell asleep each night, purring so loudly that I didn’t need the white-noise machine.
Opus, our genetically deaf Aussie/Corgi snuggled even closer to me throughout the night. And Payton, our sleek Great Dane, made sure to encourage walks every day.

Their combined efforts paid off! They really did thaw my grief-frozen heart. The hard lump in my chest is gone. And only from today’s perspective do I understand and appreciate the magnitude of what they have done for me.

T.S. Eliot said,

“Animals are such agreeable friends – - they ask no questions, they pass no criticisms.”

Ain’t that the truth!

P.S. One of my favorite books on this very topic is our own Dr. Marty Becker’s book, “The Healing Power of Pets.”

Photo credit: Dr. Robin Downing

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