| Digger's Fatal Illness
|from an E-mail written on November 27, 2001:|
I had to have Digger put to sleep today.
His throat was swollen and he was having a lot of difficulty in breathing. The swelling was likely aggravated by him being taken off the cortisone tablets he had been getting, but even while taking the tablets the swelling had been slowly getting worse. He had a massive bacterial infection, and a continuation of the cortisone, which suppresses the immune system, would have caused him to die of sepis. His leg was still swollen and was an open wound, but that was a secondary problem, even if a potential source of further infection. The main problem was that he could hardly breathe anymore, and the infusion he was getting with antibiotics was not enough at this late stage to stop whatever was causing the swelling in his throat. His chances of survival were slim at best, and he was already in a lot of discomfort. They would verly likely have had to perform a tracheotomy - put a tube in his throat so he could breathe. That would have been yet another potential source of infection, close to his lungs, it would have added to his discomfort, and he still wouldn't have had a very good chance of surviving the infection.
For those who don't know the situation, what follows is a long and depressing story, but maybe somebody will learn something from it which will prevent them from making the same mistakes if they are ever confronted with a similar situation.
It started with Digger getting some fleas, I assume from another dog he met on a walk, and me trying progessively more ways to get rid of them. I gave him a couple of flea baths, which killed all the fleas currently on him at the time. Of course that never solves the problem completely as there are always some which have jumped off somewhere and which jump back on. My understanding is that fleas cannot breed without a host - like a mosquito, the female has to obtain blood in order for the eggs to be viable. The eggs hatch into larvae, which eat the feces left by the adults. The eggs and larvae can fall off the dog, live in the bedding or carpet, and eventually jump back onto the dog as adult fleas. An adult flea can live for about 100 days. This was apparently happening, because I'm pretty sure that I got all the fleas on him each time I bathed and/or groomed him. So I started him on a program of tablets which break the breeding cycle - the active ingredient is absorbed into the fat, from which it is slowly released back into the blood stream over the next month. It is a chitin formation inhibitor, which is injested by the fleas when they bite the dog. It either prevents the eggs from hatching or else prevents the young from developing, so after the current generation of fleas expires, there are no more. I kept finding the occasional flea, so I put a flea collar on Digger, and sprayed his bed and other places he liked to lay with a flea spray designed for that purpose - it kills the fleas, larvae, and eggs. I didn't like the smell of the first flea collar, so I got a different one which didn't smell. It worked to the extent that the fleas I found on him from that point were all down on his tail end. I sprayed under an on the sofa as well, determined to get rid of all the fleas.
Shortly after this - a day or two - Digger got a lot of swellings, particularly near his neck which led me to believe that he'd had an allergic reaction to the second flea collar. I took it off him, washed all his bedding, and did what I could to get rid of the remnants of spraying, but from that point on things went all wrong.
The swellings were quite large and hard cyst-like accumulations of fluid, which didn't go away so easily. He had them in his cheeks, on his shoulders and neck, and even on on his rib cage. The vet gave him a shot of dexacortin, a strong cortisone, which overnight significantly reduced the swellings, especially the ones around his mouth. Over the next couple of days, the swelling around the mouth slowly came back, and his hind legs, abdomen, and testicles became very swollen and red. I took him to the animal hospital, and based mainly on the evidence that the first shot had helped, the doctor gave him another shot and prescribed some prednisolon tablets. This seemed to help, but after a couple of days the tablets didn't seem to be working very well. Since the most dramatic improvement had been after the shots, I asked the vet what the difference was between it and the pills, and the vet agreed to switch to dexacortin tablets, which he said were about 6 times stronger. Unfortunately, even though I knew that cortisone is great at relieving inflammation and quieting an overactive immune system - i.e. one undergoing an allergic reaction - the danger of getting an infection due to suppression of the immune system wasn't clear to me. I didn't think about it, but if I had, I would have assumed that cortisone suppressed the overreaction and not the normal reaction. For his part, the vet was perhaps a bit too willing to go along with my suspicions and suggestions and didn't make that particular danger clear. Having been prescribed cortisone myself for mononucleosis, I was aware that it had to be tapered off, and that prolonged use can cause the body to quit producing its own.
On the advice of the vet, I tried reducing the cortisone, but after two days the swelling around the mouth got worse, so I went back to the original dosage. The swelling in one leg went down, and the swellings around the neck and shoulders and on the rib cage went away, but the swelling on the left hind leg just would not go down. The vet and I tried massaging it to get the lymph fluid to drain, I tried a warm bath to improve the circulation and then some cold cloths to reduce the swelling. Nothing helped. The skin was very raw by this point from Digger licking due to the discomfort, most of the hair gone. Lymph fluid was leaking out all over through the skin. The vet tried bandaging it snuggly to put some pressure on it, and along with the medication, this may have backfired. The swelling did go down, but the skin on the lower leg got hard, died, and began to slough off, leaving an open wound.
However, even on his chin, which he could not scratch but merely rub back and forth on the carpet, the skin began to ooze lymph fluid and turn red and scabby, though not nearly so bad as the leg.
Digger had long since stopped eating normally, and was very thin and weak by this point. I took him to the vet a last time, who noticed that he was now anemic in addition to everything else, as evidenced by his gums being very white. This was something I hadn't known to look for, and another thing I learned too late. Since this was hard to explain as the result of an allergic reaction, which was the premise we had been going on the whole time, I was referred to an internist in the animal hospital. That was yesterday. Digger stayed the night there, was taken off the cortisone and given intravenous antibiotics. He had been having a mild bit of difficultly breathing before, manifested as snoring during the previous night, but this morning they had to clear his throat of mucus so that he could breathe, and his breathing was very labored. The internist called me in, and when I saw him I knew that he shouldn't be put through any more.
The cause of the original swelling has not yet been determined. The internist suspects that there was some other problem, such as a tumor, which was primarily responsible for his lymph system becoming inflamed. It cannot be excluded that he had a toxic reaction from the flea collar or flea spray or something else. It could be that it was a combination of both - an underlying problem which had not yet manifested any symptoms, but which made his immune system overly sensitive and susceptible to an allergic reaction which he would not have otherwise have had.
I asked the internist to do some further test to try to determine if there was some other problem. If Digger indeed had cancer or some other tumor, there may or may not have been anything one could have done in the long run, but in the short run, it seems that what I and the vet did and did not do resulted in his death. Confronted with something he had never seen before, the vet should probably have referred me to a specialist a lot sooner. I should have had the sense to ask for that myself just to be on the safe side. No blood work was ever done until the end, and a blood sample taken sooner would have shown the infection, since his white cell count was six times the normal.
The problem with allergic reactions is that any number of crazy symptoms can occur, which may or may not seem to have anything to do with the source of the allergy. Knowing that, and when there is a strong circumstantial indication of an allergic reaction, it is easy to attribute everything to the allergy and overlook other problems.
The internist extracted a sample from one of Digger's lymph nodes and it turns out that he had lymphosarcoma, a cancer in the lymph system. The internist said that it was a bizarre kind of cancer he'd never seen before, with the cells strung together. This explains why the leg remained stubbornly swollen and the lymph fluid would not drain properly. The only possible treatment for it, had it been detected earlier, would have been chemotherapy, and if that had worked (and the chances that it would are probably less than with a person, which means not great) he would have gotten probably another year to live. It was not anything which could have been detected directly from a blood sample. Even the biopsy in this case was a long shot.
As it happens, cortisone is part of the chemotherapy treatment, so the cortisone did help, at least up to the point where the skin sloughed off his leg and let him get a massive bacterial infection in spite of the antibiotics he had been getting.
So his days were numbered, regardless of what we did. It could have been a pure coincidence that he swelled up at the same time that he was getting the flea treatment, but I still suspect that the reaction of his body to the toxins pushed him over the threshold. Something would have happened eventually in any case.
* * *
Thomas Meyhack reminded of something which I forgot to mention in the tribute to Digger: dog farts. Digger's farting under the sofa and stinking out Elizabeth, when she was an au pair, resulted in me learning my first two words in Polish, namely for "dog fart". Since I never actually looked them up, but only know them from conversation, I'm sure that the spelling won't be correct, but it's something like "piez piergi" spoken pee-EZZ pee-AIR-gee.
Digger aided me in my weekly Magic card games by sitting under Thomas' chair and farting him out. Also, while we would be playing and quietly concentrating, he would hear some noise only discernable to a dog, leap up, and give out a BOW-WOW-WOW-WOW-WOW intruder red alert, which would invariably startle the hell out of all of us and make us jump half out of our chairs and fumble with our cards, even though he'd already done it to us many times in the past.