Posted by: Bob McMichael | August 27, 2010

Old dog

Glenna as a puppy

Glenna in her first spring

When I got my first dog, Glenna, a little over ten years ago I loved her so much that I soon began dreading the time she’d die. It was only when she was seven, when we got our puppy Angus to keep Glenna company after a raccoon killed our cat (Glenna’s only animal companion) that I stopped dreading her death. I transferred that dread to the puppy, where it currently resides. That’s another story.

Glenna is now not long for this world. The dread I once felt for her demise has now turned into what I imagine a parent with a terminally ill child might feel: a kind of tender, loving acceptance of the mortality combined with an anger which cannot be accepted or controlled and pervades every moment of the day and every thought during the sleepless night. Complicating this emotional cocktail is the fact that Glenna is the most sensitive reader of my emotional state that I’ve ever known, and she gets visibly upset when I am angry or sad. Sometimes I don’t realize what I’m feeling until she shows me. So I try to protect her from upset by hiding my emotions, which is basically pointless. She knows.

The illness

Weeks ago Glenna began vomiting white foam. She couldn’t keep any food down. We watched her lose pound after pound while we tried to learn – on our own – what was wrong and how we could treat it. I had developed a strong aversion to veterinarians after what I noticed was a growing trend among them to sell their customers anything and everything they could by more or less frightening them into a purchase or a decision. This is in keeping with the American approach to marketing and American culture in general. I shouldn’t have been surprised that vets became businesses like any other, but the fear factor upset me and made me not trust them.

So we tried Prilosec and Pepcid to control what appeared to us as an excessive amount of stomach acid. Neither worked. She still upchucked her food. Then she ate it, upchucked it again, and ate it again, including the white foam. It was heart-wrenching to watch her gulp down her food with gusto and then stagger around the yard for an hour trying to find the the perfect spot to barf. She was clearly in lots of pain and discomfort.

The vet, part 1

When she lost enough weight that she looked like a furry skeleton I decided to take her to the Humane Society veterinarian, whom I’d heard was a no-bullshit vet, largely because he was so busy neutering and spaying the canine and feline adoptees that he didn’t have time to do “elective” procedures on pets. I described her condition on the phone and they gave me an appointment that morning, telling me I needed to get her in there as soon as possible. After sitting in the waiting room for 45 minutes without a word, watching other pet owners come in, get treated, and leave, I asked when Glenna would be seen. It took the receptionist ten minutes to tell me it would be about another 30 minutes or so. I couldn’t handle this in my state of mind so I left.

The next day I took her to a vet close to our house, a young guy who was very nice and ran a small animal hospital. I described in detail what Glenna had been doing as he examined her on the stainless steel table. When I asked him how she should be treated for this worsening condition, he said that he would need to do blood work, x-rays, a barium study, an ultrasound, and endoscopy before diagnosing her, totaling over $1,000. I told him I’d been unemployed for almost a year and was afraid I’d have to chose between paying my mortgage and doing these tests. He said he understood my situation and was happy to work with me, and prescribed a mild antibiotic which only made her seem worse. After a horrible couple of days I was ready to put her down.

The vet, part 2

I called a friend who told me I should at least find out what’s wrong with her before putting her down, and that I wouldn’t ever rest if I didn’t. Regardless of the expense, it made sense. I called the vet that had seen Glenna most of her life and made an appointment with the oldest doctor there, Dr. Craig Stoenner of All Pet Complex. Although it was his practice that had irritated me with what I saw as an increasingly hyperactive marketing approach to pet care, I knew he’d seen lots of dogs in his career and would be as able as anyone to figure out what was going on.

Glenna hates vets probably more than I do, but for better reasons. All Pet Complex strikes a particularly acute horror in her as she has endured numerous very painful treatments there. The first was when she impaled herself on an exposed screw while trying to scale the fence in our backyard (that was on my wife’s birthday; I’m writing this on my birthday, strangely enough), requiring a bunch of stitches. Next was when she was attacked by an unleashed pit bull on a “leash-only” trail at a nearby park, requiring more stitches, a couple of wound drains, and a big cone around her head. Then she somehow managed to tear every tendon, ligament, and muscle in her left rear leg while our brother-in-law was taking care of her when we were out of the country, requiring a painful exam, a couple surgeries, and a bulky cast up to her hip for six weeks. Then there was the spider bite (probably a hobo) that necrosed most of her left side, requiring more stitches. And finally, while play-fighting with Angus she broke a molar, requiring its extraction and several other teeth that had also been broken. Even the $8,000 in vet bills for these treatments doesn’t compare to the pain she’s been through beyond those doors. But she still goes in the door.

Within a few minutes Dr. Stoenner guessed it was mega-esophagus, in which the esophagus loses its ability to push food into the stomach. The critical distinction, which the other vet and all of the research I had done on the Internet failed to make, was between vomiting and regurgitation. The former is what we described in college as “blowing chunks” from deep in the stomach, and the latter is a less forceful exit of food from the esophagus. The slimy white foam surrounding kibble that we watched Glenna barf up was not excess stomach acid but just saliva. She was regurgitating her food, which never made it beyond her esophagus.

Dr. Stoenner took some x-rays, which confirmed his diagnosis. He also noticed a bunch of fluid in her chest cavity, which made it hard to tell if there was a tumor anywhere. So he suggested doing a blood test to rule out hypothyroidism, Addison’s Disease, and myasthenia gravis, three related diseases for which megaesophagus is a secondary symptom. The blood work came back negative, so we scheduled an ultrasound to see if we could identify the fluid and rule out any mass. The ultrasound showed no mass, but they couldn’t determine the source or type of the fluid in her chest cavity, so they took a sample with a big needle.

The fluid was identified as chyle. Glenna has a pleural chylous effusion, diagnosed as idiopathic chylothorax, meaning they don’t know the cause of the leak in her thoracic valve that is responsible for the fluid. Chyle is the fluid vehicle that transports fatty nutrition from the stomach throughout the lymphatic system. Possible causes are lymphoma, AIDS (which I doubt she has) and many other things. Since she’s old and weak, there’s not much that can be done except make her comfortable and do what we can to get her the little nutrition her body is still capable of metabolizing. Dr. Stoenner recommended an herb called rutin that might help reduce the leak.

As far as feeding, now she has to eat in a vertical position so gravity can do the work her esophagus no longer can. The food has to be almost liquefied to make it into her stomach; any chunks just stick to the esophagus wall and create a dam. Yesterday morning I gave her a little canned dog food and missed one chunk that she regurgitated up about 8 hours later. That caused her to have a very bad, uncomfortable day.

What’s left

Dr. Stoenner guessed Glenna might live another six months. When she’s lying on her side at night, breathing hard and looking at me I can hardly take it. Leslie says I have to be strong for her, but I feel so weakened by her pain and even moreso by her normal personality squeaking through her pain. She quickly wags her tail stub like she always has when she sees me after a brief absence. Lying on the grass while trying to hold down her gruel she snaps at a fly that pesters her. A squirrel runs along the fence and her head snaps with the reactions of a younger hunter. Her eyes are still bright and deep. She still issues a big sigh when I rub the warm waxy inside of her ears. I used to massage her hips, but there’s almost no muscle there now and the increasingly apparent bones there make me uneasy. I don’t want to irritate her.

I asked Dr. Stoenner when it will be time to put her down. He told me I would know. How many times can a sane person ask himself that question each day? I don’t want to short-change her, but I already miss her.

Suggestions

I regret how my emotionally driven antagonism toward veterinarians delayed the diagnosis and treatment and – worst of all – prolonged Glenna’s discomfort. There are a few things resembling advice that I want to end with:

  1. To pet owners: find a vet you can trust, be honest with them about what’s going on, and learn as much as you can about the situation so that you can make educated decisions about treatment without unduly extending your pet’s pain or worsening their condition.
  2. To pet owners: consider a vet who is older and seen a lot of animals; this made the difference in Glenna’s diagnosis. All vets start out young, and have received excellent training in school, but I’ve noticed that a lot of younger vets are reluctant to even suggest a diagnosis before doing a battery of expensive and sometimes unnecessary tests. Whether this is by design – to increase the practice’s profit – or a hesitance from inexperience, pet owners frequently get into financial trouble treating their beloved animals. Even worse, many pets are either put down prematurely or not treated for simple problems and suffer unnecessarily because of this dynamic.
  3. To pet owners and vets: if you have a cell phone that takes videos (most do nowadays) or a video camera, take a video of your pet’s problematic behavior; vets should recommend this to their customers. If I had taken a video of Glenna staggering around and barfing and showed it to the first vet he most likely would have known it was mega-esophagus.
  4. To vets: although you are in business to make money, do not alienate your customers by capitalizing on their often irrational emotional attachments to their pets. Do not use fear to encourage treatment, regardless of whether the treatment is critical or preventative.
Glenna's first sibling, Moby

Glenna's first sibling, Moby

Glenna used to finish Moby's food for him

Glenna used to finish Moby's food for him

She used to jump for scraps

She used to jump for scraps

Glenna and Moby liked each other

Glenna and Moby liked each other

After Moby died, we got Glenna a dog-brother

After Moby died, we got Glenna a dog-brother

Glenna taught Angus lots of things

Glenna taught Angus lots of things

Like how to chew on sticks

Like how to chew on sticks

And how to hunt quail

And how to hunt quail

Glenna loves going to the cabin

Glenna loves going to the cabin

She loves going fishing

She loves going fishing

She loves to canoe

She loves to canoe

She loves to hike along the Snake River

She loves to hike along the Snake River

She likes sleeping in and looking out

She likes sleeping in and looking out

She likes cooling off in the garden

She likes cooling off in the garden

She likes the Sawtooths a lot

She likes the Sawtooths a lot

She likes hiking in the winter

She likes hiking in the winter

She likes running on snow

She likes running on snow

She collects snowballs

She collects snowballs

She loves her Natuzzi sofa

She loves her Natuzzi sofa

She's done plenty of time at the vet - left leg cast

She's done plenty of time at the vet - left leg cast

See the drain in her neck after nearly getting killed by a pit bull

See the drain in her neck after nearly getting killed by a pit bull

Glenna's failing esophagus

Glenna's failing esophagus

Some food makes it down

Some food makes it down, but it must be almost liquid

Now she must eat in a vertical position

Now she must eat in a vertical position

Angus is a little confused by this

Angus is a little confused by this

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Responses

  1. Bob–I have had a lot of pets, and it is terrible to go through the final life stages–BUT the greatest kindness we can do, and one we should be able to do with the people we love too, is the spare them the pain and loss of dignity at the very end. If you think Glenn is still enjoying her life, even with the limitations, then keep her comfortable. The minute you suspect that she is not (and it is very hard to tell because our dogs want to please us and they are happy when they are with us) then you have to take her to the vet and take away her pain. It’s hard–very, very hard. But even worse is not figuring it out soon enough and regretting that you let you pet suffer. I had a terrible experience with a cat–Lili was dying, but I didn’t know. After several vet procedures she ended up at the emergency animal clinic, and died there in the end–in a cage and not at home. I will regret that for the rest of my life–and I will never let that happen again. Right now we have two older dogs, and one has cancer–I won’t go into all the involved details here–but I am watching and waiting to see when it is time. She is going to be as happy as I can make her until the end, and then the end will be quick and painless, and I will be right there. It’s all we can do.

    • Dear Evelyn,
      Thank you for your great comment. I really appreciate everything you say and am comforted by the support and advice. I hope your puppy goes as pain-free as possible when it’s the right time. It sounds like you know. It’s a kind of knowledge I’m ambivalent about obtaining but it seems worth it at this point. I was at the Baker City Highland Games yesterday and there was a vendor there who breeds Irish Wolfhounds. She had six of the big beautiful beasts there. I asked her what their life expectancy was, and she said about six years. I nearly choked. She’s bred them for 12 years. She said you never get used to putting a dog down, but that fortunately these big dogs go very quickly.
      Thanks again for your nice words.
      Bob

  2. Dear Bob,
    A wonderful testament to a lovely, dear dog. She is lucky to have had you as her dad. We will be remembering you in this hard time. Rub her ears and tell her that Grandmother Susan loves her!
    L/Susan

  3. She has had a great life. Longer than some. Shorter than others. I don’t think the exact moment she goes down is all that important. You’ll know and it will be OK. I feel for you brother. It’s very hard to lose a dog.

  4. My 12 yr old heeler was bitten by a rattlesnake and after leg rotten and many weeks of treatment at vets it was healing. He was finally ex rayed and finally found mega esophagus. What they said was vomiting was not really vomit, after I could not stand his dislike of cages I brought him home, 17 lb weight loss. Even then more tests were recommended, I declined. Finally went to head vet. Older as you said. Said it was too much of a coincidence but snake bite may or may not have caused it. Vet came here and put him down at our home. No more cold cages and collars. Thanks for your article. Neta Pooley

    • Neta, thank you so much for your comment. I am, as you might imagine, very empathetic and feel bad for your loss. It really sucks. When I read your message the first thing that came to mind was that Glenna had gotten a bad bite from what I speculated was a hobo spider, and experienced major necrosis not long before she started the symptoms of mega esophagus. I’ll mention this to my vet and see if he can dig up anything linking the two. If so, I’ll let you know. Take care, and thanks again for your comment.

      • My vet says strange coincidence Talked to another vet that is a friend as well and he said he would post my info on a web site for vets only and see what if any any association of bite and horrible necrosis and then mega esophagus We are still grieving for our loyal farm dog that always alerted us to snakes, but one slipped up on him while he slept in bushes,, We killed him. Lots of problems here in south Texas this year with rattlesnakes. Killed 10 in our immediate area last 3 mo, creepy. Thanks for your input. Neta Pooley

  5. […] Glenna and Angus have increased my predisposition toward morbid thoughts, but I came to dogs late in life and am regularly felled by the ineffable and ephemeral connection I feel with them. As I write this, I’m home for the weekend and Angus is bored and playing with his toys. Serial goofiness: rubber ball, shrieking monkey (three of them, in various states of dismemberment), Nylabone, then his chin rests on my knee. He wants to get out, and so do I. It’s these rarer moments of down time together that allow me this reflection and time to wonder if he’s reflecting on anything or just thinking of his next half-cup of kibble, or of nothing at all. Maybe he feels something like comfort having me nearby for a change. I hope so. I know I’m comforted by his presence, even while dreading the end of that. […]

  6. […] Glenna and Angus have increased my predisposition toward morbid thoughts, but I came to dogs late in life and am regularly felled by the ineffable and ephemeral connection I feel with them. As I write this, I’m home for the weekend and Angus is bored and playing with his toys. Serial goofiness: rubber ball, shrieking monkey (three of them, in various states of dismemberment), Nylabone, then his chin rests on my knee. He wants to get out, and so do I. It’s these rarer moments of down time together that allow me this reflection and time to wonder if he’s reflecting on anything or just thinking of his next half-cup of kibble, or of nothing at all. Maybe he feels something like comfort having me nearby for a change. I hope so. I know I’m comforted by his presence, even while dreading the end of that. […]


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