In case you don’t know:  many brands of sugar-free gum contain a sweetener called Xylitol.  For whatever reason, this stuff makes dogs develop profound hypoglycemia (low blood sugar) and later on rots out their livers. It doesn’t take much gum, and it is often fatal. Is it super creepy to anyone else that we humans are consuming this stuff? 

Anyhow, I got out the syringe of Apomorphine (stuff to induce vomiting) that I keep in the freezer for just these occasions so it could thaw.  Then I called ASPCA Animal Poison Control (I swear they need to just give me a punch card…10th call is free…). 

I had to do a little detective work as the poison control vet needed the brand name of the gum and the wrapper was in slimy pieces.  I assembled what I could and Google Image searched using the key words on the brand name I could make out.  Thankfully, the gum she got did not contain Xylitol. 

Big relief.  I re-froze the Apomorphine.  I shot my husband a probably less than nice text informing him to be more careful with is gum. 

It’s past my bedtime, but I wanted to put this out there as a reminder that sugar-free gum, while good for your teeth is very bad for your dog.  FYI. 

Dr. Shiplov at our other hospital (they got hit yesterday) dreamed that the inspector showed up a day early.  I kept seeing things out-of-place or dirty in my house and immediately thinking “oh crap! I’ve got to clean that!”  Then subsequently reminding myself that she’s not inspecting my house.

Basically AAHA comes up with a list of 200+ “standards” that they think excellent veterinary practices should meet (standards involving everything from surgery and anesthesia, to record keeping and safety to everything in between) If you meet those standards, then you get to be “AAHA Accredited.”  Only 15% of animal hospitals belong to this “elite” grouping. 

Well, after 5 hours of inspection, she finally finished annnnndddd….we passed! 

OK.  We can all heave a collective sigh of relief.  (Do you hear that?  It’s “We Are the Champions”, by Queen.  Oh wait, that’s just in my head). 

Yay us.

The Countertop Criminal...so bad but so cute.

mostly calm.  She’s a brilliant and accomplished counter surfer.  Just this year she has absconded with:  a ribeye steak, an entire pizza, about 6 cinnamon muffins, a bottle of the kids ibuprophen (poison control call + 2 day hospital stay on IV fluids, gastroprotectants, etc.),  a bottle of Vitamin D capsules (poison control call, but fortunately it wasn’t a toxic dose). 

My friend and dog, zebra, exotic animal trainer and bear wrangler (http://www.texasbear.org/)  extraordinaire Jason Mayfield  kindly informed me that Mia’s little “problem” is 100% my fault (http://www.petiquettedog.com/dog-behavior/counter-surfing-wheres-beef/)

The above article says I should teach my dog alternate behaviors to counter surfing like banning her from the kitchen.  This, incidentally would also curb her dishwasher dish licking which would also be a good thing.  I shall add this to my to-do list, right next to “finish 2008 photo album, 2009 album, 2010 album”…you get the picture”.

I tried mouse traps (I wrapped the wire snappy part in double stick tape so it wouldn’t hurt her…don’t get all judgy!) And they worked brilliantly for about two snaps.  Then she figured out what the traps look like and learned to only counter surf in non-trap areas. 

She is astoundingly sneaky.  During the mouse trap period, she casually watched me in the kitchen the whole time I baited them with roast beef, waffles, etc. She was very nonchalant about it, just keeping me in view, out of the corner of her eye.  She even let me leave the room to check my email.  I was beginning to think she had super human intuition and knew the traps were evil.  But no, she waited until the SECOND  I left the house to get something out of the car to strike.  I heard the trap snap and found her looking sheepish under a chair.  The hit the trap one more time later that day when my husband and I were in outside in the patio.  

I had hoped that that would scare her out of covert countertop behavior, but nope.  Our busy, distracted lifestyle lends itself to forgotten food on the counters and it’s just too tempting. 

This Christmas day she hit the mother lode.  We learned that cooking bacon in the oven is by far the best way to make it.  Easy peasy and crispy perfect pig strips (as my family calls them) every time.  We are usually very careful with the bacon grease soaked paper towels and pans, but this was Christmas.

The in-law came over and we got distracted.  The kids got a go-kart for Christmas so we all went outside to watch the inaugural drive.  (During which my 9-year-old son yells “Which one’s the brake!”)

I came back inside within just a few minutes because it was flippin’ cold outside.  I swear I could hear the scary “Psycho” knife stabbing in the shower moment music playing overhead.  Scully (my little old lady who is a lower elevation food theif) was maniacally licking the floor.  Mia had “the guilty face”. 

It took me a minute to piece together what was going on, nothing looked amiss in the kitchen.  I wandered into the living room and…(key the scary movie music again, you know with all the screechy violins…or even the music from any JJ Abrams show) …THERE WAS A PERFECTLY CLEAN BACON PAN.

This would probably not strike a cold knife of fear into the heart of a mere lay person, but I know the danger of bacon grease.   Consumption of that much fatty grease is pretty much guaranteed to give the canine consumer a raging case of pancreatitis.  Which can be fatal. 

“Aw Shucks!” I proclaim calmly*

* This is not what happened at all. I actually unleashed a torrent of profanities that would definitely make Santa blush and put me on the naughty list, but this is a family blog.

I then went into problem solving mode.  She had just eaten all the grease, which in this situation is a poison, so I decided to approach it like any other poisoning.  I grabbed my handy-dandy bottle of peroxide (that we use solely for dog inappropriate object ingestions) and proceeded to try to make Mia and Scully (because I wasn’t sure how much second-hand grease she got) puke.  

I waited, and waited (it was old peroxide) and nobody vomited.  Ok. Plan “B”, go to the ER and get the “good stuff”.  Apomorphine, generally always vomit inducing. 

I sped to the ER, just daring a cop to pull me over.  I had my speech all ready, I was going to make him escort me to the ER then back home.   They always ask you if you have some kind of emergency, and dang nabbit, I did.  Pancreatitis treatment is expensive! Even for me. 

I sheepishly walk in, explain the situation and get my Apomorphine and some activated charcoal “to go”.

Of course Mia barfed (a nice greasy pile of Christmas rawhide goo) before I got home so I just froze the apomorphine.  God knows I may need it another time. 

Step 2 is to try to bind up any leftover grease in the dogs so it isn’t absorbed.  That’s what the activated charcoal/UAA (Universal Animal Antidote) gel is for.  It’s got stuff in it to bind all the bad stuff.  It’s black as the night and probably not too tasty.  Scully and Mia both get big fat doses. 

OK, now what?  The pancreas is a squishy little non descript organ that makes digestive enzymes and stuff. My take on why they get pancreatitis from eating fatty stuff is that the sudden deluge makes the gland just start activating digestive enzymes like crazy and it blows itself up.  Not literally, but physiologically, it’s sort of like a little fire, just in the belly. 

Mia's Pepcid/Charcoal/Enzyme Sandwich

I decided to try to make its job easer (after the vomit induction and charcoal) by giving her a cocktail of more charcoal, pepcid (to turn off her digestive acid producers), and digestive enzymes (to maybe do some of the pancreas’ work for it, to ease its burden).  It’s total voodoo that I made up, but I hoped it helped.  I also put both dogs on an ultra low-fat diet, to further aid that pancreas. 

Thankfully, nobody got sick.  I had to board the dogs the next day, as we had plane tickets to visit my brother in San Diego.  (My water heater broke and was leaking onto the garage ceiling on Christmas day as well, thus we had to shut off the water to the house, and subsequently cancel the house/pet sitter).  The AMCOP staff took care of them beautifully, with nary a hiccup.

I supposed I can either attribute it to my stellar intervention or their cast iron stomachs.  Either way, I’m glad they’re ok. 

We’re trying to be more diligent in the kitchen.  I am going to have to start enforcing the “no dogs in the kitchen rule”.  Hopefully it will be more effective than the “no dogs on the couch” rule, or the “no dogs pooping on the dining room rug” rule. 

Sigh.

Anyhow, I arrived at work and my desk contained a pile of this years Christmas cards.  I have to admit, that I got a little warm and fuzzy Reading through them.  There were funny cards, shiny cards, modern cards, vintage cards, hand made cards, photo cards featuring pets and their people, cards where the pets photo was bigger than the kids, cards that featured the pets front and center because they are the kids. 

The stack was a visual reminder of just how big a part of the family our pets are. 

…And how honored I am to help take care of them.

On the first day of Christmas my client brought to me:  a hotspot caused by a flea.

On the second day of Christmas my client brought to me:   two itchy Labs, and a hotspot caused by a flea. 

On the third day of Christmas my client brought  to me:   three blocked toms, two itchy Labs and a hotspot caused by a flea.

On the fourth day of Christmas my client brought to me:   four limping dogs, three blocked cats, two itchy Labs and a hotspot caused by a flea. 

On the fifth day of Christmas my client brought to me:  five jaundiced pets, four limping dogs, three blocked toms, two itchy labs and a hotspot caused by a flea. 

On the sixth day of Christmas my client brought to me:  six cats a’ spraying,  five jaundiced pets, four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea.  (making good use of the cut/paste feature here   )

On the seventh day of Christmas, my client brought to me:  seven Cockers coughing,  six cats a’ spraying,  five jaundiced pets, four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea. 

On the eighth day of Christmas, my client brought to me:  eight Shepherds scooting, seven Cockers coughing, six cats a’ spraying, five jaundiced pets.  Four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea.

On the ninth day of Christmas, my client brought to me:  nine boils for lancing,  eight Shepherds scooting, seven Cockers coughing, six cats a’ spraying, five jaundiced pets.  Four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea.

On the tenth day of Christmas, my client brought to me:  ten roundworms creeping, nine boils for lancing,  eight Shepherds scooting, seven Cockers coughing, six cats a’ spraying, five jaundiced pets.  Four limping dogs, three blocked toms, two itchy labs and a hotspot caused by a flea.

On the eleventh day of Christmas, my client brought to me:  eleven patients barfing,  ten roundworms creeping, nine boils for lancing,  eight Shepherds scooting, seven Cockers coughing, six cats a’ spraying, five jaundiced pets.  Four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea.

On the twelfth day of Christmas, my client brought to me:  twelve  chocolate eatings,  eleven patients barfing,  ten roundworms creeping, nine boils for lancing,  eight Shepherds scooting, seven Cockers coughing, six cats a’ spraying, five jaundiced pets.  Four limping dogs, three blocked toms, two itchy Labs and a hotspot caused by a flea.

Happy holidays folks.  May the new year be happy and healthy for all your critters and people.

This is definitely a delicate topic.  Mucho controversial.  Even here in the practice between us doctors.

I am going to keep my opinion out of this one (yes, it will be hard) and try to stick to the facts as I understand them. 

Saturday we had another angry client yelling at the receptionists.  The reason this time (and several times before) is our policy on online pharmacies. 

Dr. Sharp maintains the policy that we do not write prescriptions for online pharmacies. We will match the prices on items sold at Petmeds.com. 

That’s it.  Non negotiable. 

This particular client was angry that a) we wouldn’t write him a script to buy his heartworm pills online and b) we wouldn’t match the price of the off-brand pharmacy he wanted to buy them at (it was cheaper than our cost). 

At the moment, there is no law (in Texas) that says we have to write the script. 

That could be changing, there is a bill called the “Fairness to Pet Owners Act” , backed by (surprise, surprise: WalMart) that could change that. The law would require DVM’s to provide scripts for all prescriptions for clients to fill wherever they want.

 The AVMA has issued a statement opposing the bill (here’s a VIN article on the topic: http://news.vin.com/vinnews.aspx?articleId=19967 ) 

So, the reasons we give to not write the scripts include

• We don’t know where those pharmacies are getting their drugs (are they the real thing or counterfeit?)
• Drugs may be expired, or from a foreign country and may not be dosed properly
• The manufacturers won’t honor the guarantees on the products

The flip side of that is that clients take the same risks buying their human drugs on-line. 

The biggest threat to the veterinary profession (uh oh, this is my opinion, darnit) comes from something I learned from my human veterinarian.

Well, she’s not a vet, she’s our family doctor, but that is the closest thing to a vet on the human side. 

I love her, she’s a great doc. We have a mutually beneficial relationship, she’s my doc and I’m her vet.  We text each other whenever our “kids” (hers are canine, mine are human) have issues. 

Once, her husband was picking up her dogs after surgery and he about had a coronary over the cost of services.  He said he could do all the same stuff in his office (he’s the office manager) for a fraction of the cost.

This was news to me.  I thought things that happened on the human side (procedures, office visits, etc) were generally exorbitantly expensive.  I thought all doctors were filthy rich. Being unable to bite my tongue, I expressed this sentiment to him.

With much exasperation and hand gesturing (he’s latin American, we are a very dramatic people) he exclaimed that that is not so in family practice.  They have to see hundreds of patients a day to just break even.  Their fee schedule is capped by the insurance companies (or the government?). 

Did you catch that? It may not have actually been hundreds of patients a day (we latin Americans tend to exaggerate).  OK, just texted my doc: she said 26-32 patients.  Given her work schedule, that averages to about 5 patients an hour.   

I generally see two patients an hour. 

Point is:  in family practice, in order to make money they have to see a large volume of clients.  No pharmacy revenue in human med to offset their fees.  They can’t raise their fees, so therefore they have to see more clients to make up for it.

Here’s the thing, if everyone starts getting their drugs from sources other than the vet, the vet will lose a huge chunk of his or her revenue. 

(Duh)

However, the vet still has to make a living, pay his staff, pay for the overhead, etc. 

I don’t know what percentage of our revenue comes from pharmacy sales, I’m going to guess half.  So say we lose half our revenue.  What do you think we will have to do to make that up?

Raise fees.  A lot. 

And if that’s not enough, perhaps be forced to see more clients.  Office visits will become our main revenue source.  Those leisurely hour-long visits when your pet is sick could likely be replaced by brief 15 minute problem-oriented ones.  Just the facts please…

I don’t know about you, but one of my favorite things about the job is spending time, getting to know the pets, clients etc as individuals.  Running clients through like cattle does not appeal to me. 

Will the quality of care suffer? Probably. 

I’m all for getting a good deal, I know times are a changin’  and in all likelihood I think our pharmacy as a revenue source may very well go the way of the dinosaur. 

Are cheaper drugs worth the cost of more expensive office visits and fees in general?  Less personal care?  Possibly less thorough care? 

Seems like a lot to pay.

Classic X-Ray of a GDV, see the Smurf hat?

You will have to bear with me, I started this new exercise program and I may die while typing this blog.  If I die it will be from sheer lactic acid buildup. Otherwise, I could possibly get hit by a car because I physically can’t get out of the way of a speeding car or projectile because I am so stiff and sore I can’t move that fast. 

My first class was on Friday.  Saturday I had to work, walking around like an old person.  I felt like I could barely hold up the little 1/4 ounce  bottle of microscope oil. 

An Actual Smurf Hat.

Anyways, as I was hobbling around, the receptionist runs back and announces that there is a new client in the lobby and she says her dog is bloated.  “Yah right” I think, clients always think their dog is bloated, but they never are. 

Bloats only happen at night…. (key the ominous music)

The staff rushes the dog back, its a beautiful Springer Spaniel, it’s flat out on its side, it’s gums are white and it’s stomach is totally distended and tight as a drum. 

Holy crap it IS a bloat! 

I immediately panic (on the inside, I was cool and calm on the outside, because that’s how I roll), and summon Dr. Rogers who has worked at the emergency room and loves this stuff.  Subsequent to that, I quickly absconded into the nearest exam room to deal with the appointment side of things while Rogers swooped in to the rescue. 

Bloat is the mother of all emergencies.  AKA Gastric Dilatation and Volvulus (GDV).  It’s when the dogs stomach twists around itself.  Whatever food material is in the stomach immediately starts to ferment and produce gas and the stomach swells.  The stomach loses blood supply because it’s twisted, often the spleen goes along with it and gets compromised as well.  The rest of the GI tract starts to lose blood supply when the stomach gets so distended. 

All that blood supply loss quickly results in the buildup of toxins and the death of tissue (very often the stomach or spleen). According to the (brand-new version of)  The 5 Minute Veterinary Consult, the overall survival rate from bloat is around 84%.  Dogs with stomach necrosis seem to have around a 66% survival rate. 

The reason I said bloats only happen at night, is because in a total of 20 years in the vet biz (13 of those as a practicing vet), I’ve never actually seen a bloat case.   I’ve only ever worked days.

Even in vet school, when I was on emergency duty I never saw one.  I’m not sure I ever saw any  emergencies, actually, when I was in vet school.  Generally regular people didn’t come to the vet school for run-of-the-mill things, they took that stuff to their regular vets.  We pretty much just stayed up til 10 or whenever our shift was over and answered the phone and ate pizza.  Somehow the real emergencies went to the live-in vet students who did the late night calls.  Rumor has it that Texas A&M has a pretty awesome critical care facility now, so things have changed from the late 90′s when I was there.

Back to the present, the treatment for bloat is to decompress the stomach as quickly as possible by passing a stomach tube while concurrently treating the patient’s shock and circulation issues with aggressive IV fluids.  I know this because I memorized it in vet school, not because I’ve actually done it.  I did pass a stomach tube once my first year out of vet school on a dog that had been poisoned with sleeping pills by an angry neighbor (two of the client’s other dogs had died, but we saved that one). 

Generally dogs that bloat have severe dry-heaves and their bellies swell, then they pass out/go into shock.  Diagnosis is confirmed with a right lateral x-ray where the stomach takes on this characteristic “smurf hat” appearance.  

Dr. Rogers’ patient had all the signs and the tell-tale x-ray.

Back in the ER: there was a moment of panic when Dr. Rogers couldn’t find the stomach tubes (because we never use them!), she had to call Dr. Sharp in Michigan so he could tell her where they are.  She quickly sedated the patient with Propofol (she is a trained professional and is very capable of using this drug without killing her patient, unlike Michael Jackson’s doctor).  It took her two tries to finally get the tube passed, because of the severity of the twist. She let out the air and flushed out as much food and debris from the stomach as she could. 

The next step in this process, once the patient is stable is to take them to surgery to attach the stomach to the body wall so it can’t twist again.  While in there, you have to also check for organ damage secondary to the twist (generally in the stomach and spleen).  This dog ended up going to the emergency clinic for surgery (so she wouldn’t have to be transferred post-op as we would be closed for the weekend, Dr. Rogers is a very capable surgeon, it was just a logistical thing).  They ended up taking out her spleen as it was damaged, and her stomach was heavily bruised but ok. 

The post twist and post op periods for a GDV case are the most critical.  Remember all that tissue that lost blood supply?  Once blood starts flowing back into those areas, all kinds of nasty toxins get released and wreak havoc elsewhere in the body.  The biggest problem is that it cause cardiac arrythmias.  Many dogs die post op because of this complication. 

This dog spent the weekend in the ER, and went home from the hospital on Monday minus her spleen, but doing great. 

Dr. Sharp, the old guy said he’s only seen a handfuls of daytime bloats in his 40+ years in the day-practice biz, so hopefully we won’t see another one for a long time.  One is plenty.

I was stumped. I went back to the drawing board.  The facts were these:

1. I had a young beagle, with apparent severe generalized pain that responded exquisitely to Rimadyl.
2. She maintained a high neutrophil count for months despite 4+ rounds of antibiotics.
3. Ultrasound, X-Rays were basically normal.
4. She still has nose worms.

I decided to look into this nose worm thing.  When stumped by parasites, talk to the parasitologists. 

Parasitologists are a very interesting species of veterinarian.  They dedicate their lives to the study of creepy crawly disgusting creatures.  Subsequently, they tend to be a bit odd.

Tom Craig, the venerable parasitology teacher at Texas A&M University College of Veterinary medicine definitely was odd.  He used to sing us a song about a sheep parasite.  He is rumored to have infected himself with tapeworms just to see what it felt like. Needless to say he knows his parasites. 

I decided to give him a call to see if the Eucoleus boehmi parasite was the cause of all of Lucky’s woes. 

Dr. Craig said “absolutely not”.  The worm was a red herring.  He said that based on Lucky’s muscle pain, high white count, and the fact that she’s from Oklahoma made him strongly suspect a parasite called Hepatozoon. 

I informed him that I tested for Hepatozoon waaaay back at the beginning of this saga (when Dr. Nitsche laughed at me for thinking  it could be that).  The test was negative. 

He informed me that unless I did the PCR test 7 times, on 7 different days and got 7 negatives then he didn’t put much stock in my test result.  He said that the test is very accurate for detecting those little pieces of DNA, but the amount of actual DNA floating around varies immensely from day-to-day.  The gold standard test for this disease is a muscle biopsy.

He told me I needed to call Susan Little, DVM, apparently one of the foremost experts on this disease who happened to live in Lucky’s home state of Oklahoma.  Dr Little is on faculty at the Oklahoma State College of Veterinary Medicine. 

She is the rare “cool” parasitologist.  I actually had the pleasure of attending a lecture (well, if you call attending a lecture on parasites a pleasure, maybe it’s a vet med thing) given by her a few weeks ago.  She is totally normal, she just love, love, loves ticks and other parasites.

Turns out Oklahoma is a hotbed for ticks and tick borne disease.  I had no idea, you should have seen some of the slides she showed, ticks swarming like fire ants.  She said she has to check her kids for ticks DAILY!

Anyhow, prior to actually seeing her in person, I spoke with her via phone.  She does extensive research on Hepatozoon, and maintains a colony of Beagles that are actively infected with the disease so that she can study them.  Turns out that the drug of choice to make these dogs comfortable and happy is Rimadyl (and no, I’m not getting any money or kickbacks from the Rimadyl people, it just happened to be the drug the first vet put her on and it’s a decent drug so I kept her on it). 

Dr. Little echoed what Dr. Craig said: this dog sounded like a textbook Hepatozoon case. 

I pulled out my trusty Greene’s “Infectious Diseases of Animals”.  In my world, the Bible of infectious disease.  The article on Hepatozoon was like a play by-play of Lucky’s case:

• Generally causes back pain (usually in the lumbar area)
• Usually dogs have undergone several rounds of antibiotics to treat for fever of unknown origin.
• Waxing and waning signs.
• Back pain often mistaken for diskospondylitis or meningitis.
• Sometimes mistaken for pyometra.
• Most consistent lab finding is an extremely high neutrophil count ranging from 20-200K cells.

For all intents and purposes, it looked like I found my diagnosis.  To prove it I needed a muscle biopsy.

I called her owner and relayed what I learned.

She was leaning towards euthanasia.  Lucky was young and she had already been through a lot.  The owner had been diligently trying not to get attached.  If we could cure the disease that was one thing, but if she had to live a truncated life, chronically infected, and that was not an option.  They had some personal issues and just euthanized a chronically ill dog a year or so ago.

They asked me to look into her treatment options.

Back to the books: turns out that there is no cure for Hepatozoon.  (In case you starg Googling, Hepatozoon americanum is the strain I’m talking about.  Hepatozoon canis is generally a mild self-limiting disease).  The organisms form thousands of little cysts inside the dogs muscles and you can’t get rid of them. 

To control the disease you give an initial round of:

•  Ponazuril (a drug used to treat protozoal infections in horses, I think I knew about it in vet school)
• Or “Triple Therapy”, a combo of Trimethoprim Sulfa, Pyrimethamine (another large animal drug I had to look up), and Clindamycin. 

This treatment is supposed to basically put the clinical signs of the disease into remission.  However, this only lasts about two months or so.  In order to keep the pets in remission, you have to give a drug called Decoquinate for the rest of the dog’s life.  You can never get rid of the tissue stage of the disease. 

Decoquinate (pronounced de-cock-quin-ate) is a sheep anti protozoal.  I had to do a lot of searching to find this stuff.  There are not many sheep in the Plano, Texas area (we’re pretty urban, contrary to popular Texas stereotype) so the feed stores around here do not carry this.  On the internet I found it in 50 pound bags for around $500.  Lucky needed maybe a half a teaspoon twice daily. 

I reported this to the owner.  We had a long talk.  She decided to euthanize Lucky.  A lifetime of muscle cysts that were constantly straining her immune system and would ultimately shorten her life was not what this client could contend with.  At this juncture, she needed a healthy dog.  I couldn’t argue with her. 

Despite the fact that Lucky was happy and wagging her tail and playing, it was smoke and mirrors.  She was really sick. 

She died in my technician Kim’s arms.  We sedated her first to make it easier on her (and us). 

Despite the fact that I was thrilled at the discovery of a rare and unusual disease, it was a hollow victory.

The voice was speaking again though.  I never got the biopsy.  What if I was wrong and I just condemned this dog to death mistakenly?  Another voice said that the client had already spent a ton of money and the dog was still sick, ultimately she would have been euthanized regardless.

I ignored the second voice, I needed to know.  I took a muscle biopsy. 

I sent it to Dr. Little at OSU. 

About a month later she gave me a call: classic Hepatozoon.  The doc who looked at the samples took photographs to show the students. 

I passed the info along to the client, for what it was worth. 

This was such a bittersweet moment for me.  I love, love, love diagnosing rare and unusual diseases. I live for the zebra cases (if you hear hoof beats, think horse not zebra, a well-known tenant in medicine: look for the obvious diagnosis, not the obscure disease). But in the end, like in any good dog story, the dog died.

I can’t tell you how grateful I am to her and her owners though for the volume of knowledge that I gained from this case.  I can’t think of one in recent memory where I’ve learned more. 

That’s got to count for something.   

While these tests were running, I placed a call to my local internal medicine specialist Dr. Kelly Nitsche to discuss the case.  I told him I was running the “big” tick panel looking for odd diseases and he said “Ha! Like you’re gonna find Hepatozoon or something! Those are so rare, don’t get your hopes up!”.  Ha ha I joked back…secretly thinking “Just you wait Mr. Specialist guy…I AM gonna find some rare disease and be a hero”. 

Granted, half of those organisms I was testing for, I hadn’t heard of or knew as some other name (microbiologists seem to like changing the names of organisms alot, not sure what that’s about other than to confuse me). But that wouldn’t hamper the rush of discovery I’d get from diagnosing one of them.

Oh and did I mention that on fecal exam, Lucky tested positive for nose worms?  Eucoleus boehmi.  I 100% forgot that one even existed! She was treated with two injections of Ivermectin for that.  Can you even imagine having WORMS in your NOSE!  Super gross, but apparently they are fairly benign in dogs.   

Anyhow, the test I ran for the tick borne diseases was a PCR test which essentially looks for tiny pieces of DNA from the organisms in the blood.  As with any test, there is fine print: a positive means they’ve got the bug and it may or may not be making the pet sick and a negative just means there wasn’t enough DNA to pick up but the pet could still have said organism.   

Everything on Lucky’s test was negative. 

Boy was I bummed. 

I called the client to tell her the test results, and she said it was a miracle:  Lucky was a new dog.  She was playing, crazy and wild.  She was eating like a pig. 

I felt like a hero.

I wanted to rest on my laurels.  My novel antibiotic had cured this dog.

However, there was a little treasonous scratchy voice in the back of my mind that said: really?  What if you’re masking something with the pain pills? 

I wanted to ignore it, but couldn’t. 

I did what I always do when I’m stumped, I pick up the phone and call people who I think are smarter than me.

First I called Dr. Monica Bungee, she works for our outside lab.  She practiced most of her career in the deep South. Louisiana, Mississippi, etc.  She’s my go-to person for weird infectious or parasitic diseases.  (Somehow I had this gut feeling that whatever was going on with Lucky was of that nature, since she was young, maybe 2 or 3 years old so cancer and organ failure, etc are less likely to blame here).

She said what I was thinking: maybe the pain pills are masking our symptoms. 

I hoped she (and that stupid voice) were wrong, but when I rechecked the white blood cell count, it was still high.  Granted it was less high, down from 25K at last count to 21.  Maybe it was a step in the right direction.  Lucky was still wild and happy.

The plan was to continue my miracle drugs and recheck the white count in two weeks.  With one caveat:  (reluctantly, because I part of me didn’t want to know…) I had the client wean the dog off of the pain pills.

Like clockwork, two days after stopping the Rimadyl, Lucky was back to being miserable.  She stopped eating, playing, moving.  She just curled up into a ball. 

Her white count was up to 30K.  Her urine was pretty normal (we were wondering kidney infection). Now she has a fever though. 

We referred her to the specialists for an ultrasound to definitively rule out pyometra (infected uterus) or some other internal organ issue. 

Her ultrasound was normal, and the only new information we got was that the specialist felt like she was painful in her lumbar area.  He wondered if maybe she has some variant of “Beagle Pain Syndrome”, meningitis, or discospondylitis (infection between the vertebrae.)  She needed an MRI to be sure, but the client wasn’t going for that financially. So they put her back on the Rimadyl, changed her antibiotic again, and hospitalized her for the night. 

Beagle pain syndrome AKA Steroid responsive arteritis: another disease I’ve never heard of.  Thus, I hit the books and the internet….  Basically it’s an immune mediated disease that causes neck pain, a high white count, and is steroid responsive. 

It sounded good, but a) Rimadyl shouldn’t be enough to totally mask the symptoms, these dogs scream in pain. b) this dog has back pain not neck pain c) the white cell was higher than typical for this syndrome.  Still I figured it was certainly possible, but the voice in my head didn’t think that was it. 

The voice made me refrain from “trying” her on steroids.  Steroids could maybe repair that beagle pain thing but it would supress her immune system and be a disaster if Lucky had an infectious disease. Plus she was back to feeling stupendous on the Rimadyl.

She came in for a recheck.  I rechecked her blood, her urine and a fecal.  The urine was normal.  White count still high at 28K.  The fecal recheck was still positive for those blasted nose worms.

I’m literally scratching my head, now what?

To be continued…

However, all my former heroes are now retired with bad knees.  I subsequently lost interest, all those over-tattoo’d young whippersnappers who dominate the sport now with their giant shorts just don’t seem to compare. 

Crap, got sidetracked again.  I was supposed to do a baseball analogy, hence the title.  Especially since our own Texas Rangers are playing in the World Series (AGAIN).  My husband  is not overly sporty himself. He does follow any home team that is winning, and the Texas Aggies and Dallas Cowboys no matter Anyhow, he keeps me abreast of major sports developments. 

Apparently I’ll get to the sports analogy at the end of the story.

Todays story is kind of a mixed bag.  The ending is sad, I’ll go ahead and give it away, for as you know any dog story worth its salt ends with the dog dying.  Just ask Marley, Ol’ Yeller, those dogs in “Where the Red Fern Grows” that made me cry in the middle of class in 7th grade, etc.  I pretty much avoid dog stories because I don’t need any more stress in my life. (Although I recently read “The Art of Racing in the Rain”, on a plane where I cried like a baby next to some pimple faced teen stranger. The book was brilliant.)

This story involves a beagle named Lucky.  As an aside, some of the most complex and educational cases in my career have involved beagles.  Hm, maybe that’s why they use them as lab dogs? 

Anyhow, Lucky was found running along a highway in Oklahoma.  She was plucked from the traffic and that’s how she got her name. However, as I alluded before, she didn’t live up to her name. 

She belonged to an old client whose previous dog (another beagle), Millie taught me almost everything I know about glomerulonephritis.  She was such a great, sweet girl, I did every exam on her while she lay on her back simultaneously getting her belly rubbed. 

Millie passed away about 2 years ago.  I was elated when her owners called that they had gotten a new dog (they were wonderful, wonderful clients).  I was a little deflated when I learned they had started using a vet closer to their home. It was walking distance, and much more convenient than my place.  However, given our previous history with Millie, they wanted a second opinion from me.   I swallowed my pride and she told me the story of their new dog.  At the time she was acting healthy, but had a problem.  They had wanted to get her spayed, but she kept running a high white cell count. 

Her white count generally hovered around 35.  That’s a significant elevation.  I see a lot of slightly elevated white counts, in the 15-17 (thousand) range, usually that’s due to stress, and I don’t get too excited, but when they pop up over 30 like that, I definitely take notice.  Something big is going on. 

White blood cells are the cleaning crew and defense system of the body.  They generally clear out dead or diseased stuff and attack bacteria, fungi, viruses, etc.  Lucky’s white cells were on high alert.

Pre existing infection is a contraindication to surgery.

Thus, her other vet had run a battery of blood tests, and tried her on multiple antibiotics to no avail.  That white count wouldn’t budge. 

I offered some suggestions and we ended the call hoping for the best.

A few weeks later, I got to meet Lucky in person.  Her new vet wasn’t having any luck, so her owner wanted me to take a crack at it. 

One of the good things about being the second opinion vet is that a big pile of the work on a particular case has already been done.  I get to look at that stack of information with new eyes and new perspective.  On a brand new case you have to figure out which tests to run and treatments to try.  On a second opinion, you just have to interpret and sort through all the stuff that’s already been done and go from there. Sooo much more information to base clinical decisions on.  It’s like a gift, a puzzle, all that free info! I LOVE it. 

The only thing I saw missing, test-wise was testing for tick borne disease. 

So I sent out a super-duper tick PCR profile to look for the DNA of every tick-borne disease that we can test for. 

The owner said her main clinical sign was anorexia and reluctance to move around.  She just laid in her bed.  On physical exam, the only place I was able to elicit pain was at her temporal muscles around her head.  Otherwise she was pretty normal. 

I took x-rays to look for a pyometra (infection of the uterus, #1 cause for a 30K white count in an intact female dog) and for any weird lesions in the bones, muscles, organs or elsewhere.  X-rays were unremarkable, no giant uterus.  We would need an ultrasound or exploratory to know for sure about her uterus and innards though. 

Meanwhile, I started her on Doxycycline (antibiotic effective against most tick diseases) and Rimadyl (for pain).

Since I haven’t published anything in a while, and it’s almost time for me to go home, I’m going to publish this one in installments (it’s a long story). 

To be continued…

And forgive me my grammatical errors anyone who’s followed me over here from Pet MD.  I had an editor there to keep me grammatically honest. Now it’s just me by my lonesome and it’s been too many years for me to remember proper sentence structure and punctuation.  I do miss the editorial help, I admit.  But not the deadlines