A Tail of One Sick Puppy Dog, "Jake" the Jack Russell Terrier
and Observations of His Owner - Myasthenia Gravis!
by TWA
So, I've just come off the week from Hell and in this Facebook, Twitter, and You Tube share your life NOW world and I thought I'd contribute to a different discussion then what the Enlightened Divorce Blog™ normally covers, although I pander to readers from time to time by sharing cute pictures of my dog - who is what this article is about, but for different aims this time. My hope is that a search engine picks up something that I write and some similarly situated infatuated doggie owner (or even a Vet or two) learns maybe a day or two earlier than otherwise what they might be facing with the small creature placed in their hands by the Divine. And, possibly avoid certain medications and products under relevant circumstances, diagnose his or her condition earlier, save some money, but maybe a dog or cat life or two. Because, a number of things went wrong that possibly wouldn't have had everybody had a little more knowledge. Like so many people I hear from and try to help.
After all, one can aspire to great things with small creatures, and they can teach us more than we anticipate.
Jake is suspected to have "Myasthenia Gravis" - although the blood results aren't back in, but I'm convinced based upon (1) Dr. Julie Stegeman's preliminary diagnosis (Southern California Veterinary Specialty Hospital in Irvine, CA), (b) what I observed with my little guy, not only starting a week ago when he unaccountably collapsed while getting his 400th life-time shower, but based upon a difficult history or auto-immune type disorders that I will share to possibly help other dog owners and (c) what I've read now about the disease/disorder.
Jake is almost nine years of age, but not yet (which is important because the on-line literature speaks to adult spontaneous onsets at between age 9 to 12 years), so maybe he is on schedule and maybe he decided to have an early onset to get the attention needed to hopefully save his sweet little life.
Please note, I am not a Vet - and much of what I say is interpretational from a lay person's point of view. I really hope that, if you searched some of the words in this Blog, that it gives you a pointer you'd not considered.
Jake the Jack Russell has had the following medical history:
- Jake has had long-standing dental issues. He had his first teeth removed at about age 4. Two months ago all his remaining teeth were removed. The doctor opined that he had an auto-immune disorder by which his immune system attacked not merely the plaque on his teeth, but the roots themselves and the surrounding bone. Had the remaining teeth not been removed, there might have occurred a deterioration to his jaw that could be difficult (and far more expensive then dentures) to repair. I thrice asked the Certified Doggie Dentist whether Jake could continue to eat Greenies™ without teeth, something he so dearly begged for and enjoyed, and she said "sure" but "watch him" - and I did. I only gave him a couple dozen of the 'tiny' ones between then and last month, but now I wonder if that was a causal mistake because of the megaesophagus condition discussed in the postscript below.
- Jake has had diarrhea and occasional vomiting issues since he was about 2. He has been on Science Diet ID for many years. His toenails always grew sideways, in bizarre angles that were not normal.
- He was diagnosed with a copper storage disease in June, 2010, that almost killed him before it was fully diagnosed. Dr. Shawn Behringer at VCA Desert Animal Hospital literally saved his life by having the insight to predict the diagnosis and the good sense to refer us on for the testing, after ordering a true-cut biopsy of Jake's liver. I well remember giving him IVs during weekend Collaborative Divorce meetings at my Desert Family Mediation Services' offices, with clients, coaches and lawyers watching. Hence, Jake is a "liver dog". BTW, I have never known whether Jake overdosed on copper or copper chelate's, if indeed he did (that crap is in everything dogs get, from dog food to treats to toys) and apparently there are qualitative differences in these copper compounds in many dog foods and accessories. He was given Cupramine beginning three years ago, and Prednisone (which was titrate discontinued about a year ago) and it probably saved his life. However, the Cupramine continued until recently because no Vet could tell me what his copper toxicity was without another biopsy (true-cut or worse), and anesthesia is a vicious cycle with liver dogs in terms of the harm it may cause to the liver. I am now recently advised that one can take the Cupramine too far and eliminate too much copper. So, that is now discontinued, and he will be started on Zinc soon to block absorption of copper more naturally.
- So, other than all his remaining teeth being removed in June, 2013, we seemed to be good to go for summer vacation. Not to be - something was going on inside him that was ready to erupt. We spent a week up in Cambria in a "dog-friendly" rental, which had that obvious urine odor. It has since occurred to me that Jake was bit by a tick - ticks are common along the Big Sur coast, and as I've tried of figure out the events of the past weeks, that made sense for a moment as a cause of what happened a week ago, when Jake become paralyzed during a shower and flopped on all fours. He has since been tested for tick-borne illnesses and that test was negative.
- Anyway, Jake began behaving weakly in Cambria about 15 days ago. He'd torn off his 10th nail or so over the years, running wildly down some stairs while he explored our temporary digs, which resulted in another trip to a vet for a wrap up (please, save yourself some money and learn doggie ER). But nothing presaged his utter collapse last Saturday (July 27) in the shower.
- As I said, Jake has had some 400 showers, assuming he is almost 9 years of age and has gotten washed down once each week over these lovely years (52 x 8.5 = something like that). But, it is true that he hasn't had 400 showers without whatever it is like to try to breathe through a mouth recently stripped of all its teeth. During that shower, he just collapsed and dropped, palsy-like, and let go his bowels. I could tell something was desperately wrong immediately, so I carried him out, wet and cold with Palm Springs A/C on full-blast, and worried he had aspirated water. It was obvious we were heading to the Vet, at once. I had to get dressed, calm myself, and return to the bathroom. In the meantime, Jake is sitting on his side, unable to stand.
- So off to Desert VCA we sped, Jake shivering still wet from the shower but too fragile now to wipe off, and unable or unwilling to move on the car-seat. You know that smile of your dog, "hey, I'm fine, I love you Pop." The VCA staff was warm and concerned, as always, and Jake was whisked away behind closed doors quite fast. Put on oxygen I was told, and an IV. "Leave him with us, and the doctor will call shortly". I went to my office and tried to work.
- About five hours later the kind doctor called to say - essentially, I thought, "he's okay" - you can pick him up at 4:15 p.m. And so I worried, and worked, worked and worried - but then I thought "hey, this is going to resolve." It would be too surreal otherwise.
- I went to pick him up that afternoon. The Vet appeared and carried and handed Jake off to me, whom I soon realized still could not walk. I didn't even know what tests had been done, or that chest-rays had been taken. Maybe I was told, though, I was in trance. But Jake and I discovered that when we got home, when he kept falling and sitting on all fours when he tried to walk the 50 feet from car door to gate, that this situation was just beginning.
- He ate a bit on Saturday night - everybody I know was texting me about what to do, "it must be a hypoglycemic attack, give him honey." Or "try some scrambled eggs, Enzo loves scrambled eggs." Jake did eat some scrambled eggs that night, and I gave him honey and even trauma emergency sucrose from my camping medical kit the next day. But, every time he tried to stand he fell on his chin and forelegs, and then the hind legs buckled too.
- Sunday was no better - now we were not eating. Or drinking water. Pretty much both of us. Instead, we were just sitting in the dough-net bed, looking miserable. And Dad was not well, undoubtedly causing some emotional hyperventilation (does your animal watch you ALL THE TIME to make sure that you that you are okay?) Jake does that, constantly. That is why he is such a great prop for divorce mediations. Pick him up, roll him on his back, stroke his tummy - and everybody de-escalates. But not today. On Sunday, Jake's human mother weighed in on this crisis, recommending who I should consult and which Vets were best in the area. I decided that the doctor I saw on Saturday sucked, and I was going somewhere else on Monday if I couldn't reach Dr. Long at Desert VCA, who, like Dr. Cutler and Dr. Behringer, and have demonstrated their competence time and again to me - and their bedside manners. Attitude matters. Especially when you are paying big bucks for the best care. To Vets - and OMG, to lawyers too!
- 2:00 a.m. Sunday. Jake is at the foot of my bed, in his dough-net thing. Coughing. Arrrrgghhhhhing - something is up with his esophagus! He is retching water. Half dead, I suddenly remember the "baby benedryl" that I got for him years ago when he chomped on his first bee sting, and when he then began to foam at the mouth. I don't know about paramedic care - I cannot hold that stuff in my head, but I remember that antihistamines deal with toxic symptoms (like bee stings - who knows, a Black Widow bit him?) involving the throat. I give him a half a baby benedryl, but he continues to arrggghhhhh. At 3:00 a.m. he gets another half, and then we - mercifully - sleep, for a few.
- So, back to VCA on Monday to visit with Dr. Pat Long, who was terrific and available and very smart. The probably perfectly competent but not-so personable young doctor from Saturday had ordered chest X-rays, and by Monday Dr. Long ordered that Jake have another set and suspects something quite new in his medical history - aspirational pneumonia. "This is weird" she says, "this just doesn't look right. Its so fast." She does a neurological test and drops Jake to his knees and paws by pressing on his cervical spine - "maybe there is a bulging, or herniated, disc" she says. I used to do personal injury cases before juries, and some of this makes sense to me. But what she really notes is the aspirational pneumonia, and that is the key symptom as it turns out. She also notes problems with Jake's throat, which is the "argghhh" I was hearing. She recommends I see a doggie Internist, thank God, and gives him some injected painkillers and steroids, and he does appear relieved and better for awhile. But not for long.
- I make an appointment at Southern California Veterinary Specialty Hospital, for the following Thursday and the first day I can get Jake in - it is Monday afternoon.
- By Tuesday Jake hasn't eaten since Saturday night, and his pneumonia is progressing. He can't keep any pills down. Dr. Long agrees to a walk-in and another pain shot plus something for nausea. SCVSH calls to confirm the appointment for Thursday for Dr. Berry, but I tell them "I don't think he is going to make it to Thursday." We negotiate for an earlier date - which turns out to be Wednesday instead.
- In the meantime, some of my family law and divorce clients have figured out that I've cut my vacation short. Some need immediate attention. I try to respond to them all, plus the daily Internet distress calls I receive from perfect strangers. I have a new view of how vulnerable they all feel, even if imperfect. I am caught up in my own crisis, as are each of them. Who can blame any of us?
- A buddy drives Jake and I on Wednesday to the Irvine doggie hospital. My friend has seen Jake paralyzed on Monday (and me too, now) and I figure he is a support person who can help to accurately, and unemotionally, convey and express what Jake has evidenced. Please feel free to bring your support people to me, when you need them to help interpret your marital strife experiences! They are not only welcome, but useful grounders!
- Dr. Berry quickly sizes the situation up as not orthopedic, and we are not in need or safe to have an anesthetized doggie MRI - so he orders up another chest X-ray, and then advises the aspirational pneumonia is getting out of hand and there is an esophageal problem too, and he hands us over to Small Dog Internist, Dr. Stegeman. She says she is stumped, but she has a theory she wants to investigate - I can barely hear her words, with the Latin phrase I now know to be "myasthenia gravis". We talk about ticks - we talk about other possibilities, but his AP needs to be controlled. And so we leave Jake behind, and I leave a credit card number that has not been recently abused for the estimated costs of the next few days.
- Jake is to be released four days and three nights later. I realize how exhausted I am. I wonder whether Jake needs a break from his panicked father, as much as I need a good night sleep and a break from "my child". The Universe doesn't answer that question, but I continue to obsess and worry about this tiny creature that is my responsibility. I am so grateful I have not had children with medical issues. I am so sorry for those of you that have - I hang my head to you.
- Fast-forward to today. I drive out to pick up Jake. Its Saturday, two hours each way, a week after "the shower." I'm advised his pneumonia is better and he can take pills. He has eaten since Wednesday, when he'd not eaten for about three days before (and could not keep food down). But when he is brought into the room, within ten seconds, I know he is messed up again. He cannot stand. The Internist says that its the slippery floor. It isn't. I take him for a walk, and he collapses within four minutes. Same thing as a week before. I know he isn't coming Home. Dr. Stegeman appears from nowhere - on her weekend off, she has evidently snuck back in to see her patients, and she is a doll. We walk Jake together, and she mentions that when he was walked every four hours as part of his routine, those walks were quick. Too quick for identifying these presenting symptoms. I hand over my credit card again, and head back home. I have a mediation client at 3:00 p.m. to meet back 100 miles away back in Palm Springs, who expects me to finish the parties' Stipulated Judgment - they are both chomping at the bit to conclude their matter notwithstanding my issues, which I understand. I comply, and am glad that her (their) lives are moving forward, even if mine is on hold. Pain is a solitary thing.
- So, now I've read about the presumed diagnosis, Myasthenia Gravis, and it all makes sense in terms of what I've watched over the past week. Dr. Stegeman can't know for sure without further tests, but after reading twenty blogs on the subject, I feel better. I only hope that the Blogs I write sometimes have a similar effect.
Life hurts. Choices are usually screwed up. We all take too much responsibility for things we cannot control and did not cause. We don't investigate the laws that affect marital rights and nobody gives us instruction books (though we might seek them out, as I am learning) about life or raising kids or maintain intimate human relationships, and we think that dogs will take care of themselves. The mind struggles to comprehend how we find ourselves where are. Guilt is toxic. And it is too easy to think that we suffer alone (often we do, depending upon who we've surrounded ourselves with as times like this bring into focus), and that everybody wants to rip us off.
The truth of it all seems more complicated, and challenging ....
________
Post-script three days later (8/7/13) - the answer may have been staring me in the face. Turns out cupramine (penicillamine) is associated with the spontaneous onset of MG. No vet ever mentioned this to me before, and had I researched the drug's side effects, I am not sure whether I would have recognized this danger. While this is my working hypothesis, the current Vet can't say it is for sure. Myasthenia gravis remission in humans and dogs that used cupramine is thought to be 70% within four months. One looks for hope wherever one finds it.
To the liver-dog owners out there, especially who are administering pencillimine - there are now better drugs for copper storage disease.
________
Post-script 8/11/13 - Jake comes home last Wednesday, with tons of med's to be administered once daily, twice daily, and three times daily throughout the day and night. I live alone, and am becoming sleep deprived. He is diagnosed as "borderline MG" (myasthenia gravis), which may be the cause of the real problem that threatens to radically restructure our lives - megaesophagus, a condition where the muscles of the esophagus muscles cannot move food to the stomach. If food or water does not move to the stomach it comes back up, and can easily be aspirated into the lungs, hence aspirational pneumonia - a certain killer if not treated aggressively. To my amazement I find it is not uncommon in many breeds, and that there are thousands of people out there with suffering "ME" dogs (and cats). The Megasesophagus Yahoo Message Boards are filled with weekly new admittees.
Solution to megaesophagus: Gravity.
ME dogs have to sit vertically for at least 30 minutes so that gravity can carry food, water and medicines to their bellies. And they need to eat and drink in small amounts, four times or more a day. I quickly learned my low back (and arms) cannot take feeding Jake and trying to carry and prop him up (now six or more times a day given everything that he is being administered) for as long as I can, which is becoming hard to do at even 20 minutes.
Enter the "Bailey Chair". We built one yesterday, and this is what it looks like.
"Daddy, please ...."
"Wow, it was good to get some food - see you in 30 minutes!"
8/12/13 - This chair is turning our lives around for the positive!
8/24/13 - Mega-E Dogs know how to party!
Postscript 9/8/13: He didn't make it. His body failed him, after aspirational pneumonia attacked again.
He died in my arms. I know he wishes the same for me, with someone or some puppy one day,
when my time comes.
Oh, and the MG was confirmed by blood tests.
Blessings to you other Mega-E parents, and I hope your hearts don't explode like mine.
May you have a better outcome!
TWA