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Sunday, February 28 2016
Nellie - Part 7
It was a bit longer than a week before the blood test results arrived. They had been extremely thorough, and expensive, and when we read the results we were amazed that it was possible to test for so many things! Of course, we understood little of the technical terminology but in the accompanying email the vet said that the tests hadn’t thrown up anything in particular so we would now need to proceed with the endoscopy of the upper part of Nellie’s gastrointestinal tract along with an accompanying series of tissue samples which would be biopsied to provide further analysis. As the vet was imminently departing for his summer vacation, it was established that the examination would take place three weeks later during the first week of September. During the three week interval Nellie’s health stabilized but she was a little skinny waif of a dog and we started to wonder if we should augment her diet with raw meat. We fixed on raw meat because we remembered that when we had been to the Dog Breeder’s to choose a puppy, the breeder had rewarded the two puppies in the display room, one of which was Nellie, by giving them some pieces of raw meat. We decided to do the same. We opted for pig’s heart, mainly because it was muscle without fat and didn’t cost much! I sliced up the heart muscle very fine and we added it to her diet. Like the yogurt, Nellie quickly took to the pig’s heart and ate it with relish. But when we examined her pooh we saw that it had not in any way been digested. We had never fed our dogs raw meat, always cooking it first. Having grown up in New Zealand in the 1960’s where the predominance of sheep and sheepdogs made hydatids (Echinococcus granulosus) a real problem, I had had it drilled into me that dogs should never, ever, be fed raw meat. The internet, on the other hand, was full of raw-meat-for-dogs enthusiasts on the basis that this was more in line with the wild Lupine diet.
Eventually, the three weeks passed and the morning for Nellie’s endoscopy arrived. We were still full of guests so Luca and Davide, a neighbour’s kid who often helps us out, took Nellie to the vets’ surgery. That morning passed very slowly as I was beyond curiosity by now in wanting to understand just what was causing Nellie’s illness. When Luca and Davide returned I was relieved that Nellie was up and about and glad that she had not died under the anaesthetic! Luca said that he had seen the DVD of the examination and that the vet had said that the gastrointestinal mucus seemed fine, that there was no obvious damage to the small intestine that he could see but that the sphincter between her stomach and oesophagus seemed slack and the muscular corrugations of the tube undeveloped. He said that as the endoscope passed Nellie’s trachea he saw that it was massively inflamed and said that this was almost certainly caused by acid reflux from the stomach. As he said: “This can be a problem in humans who stand vertically, imagine what it is like in a dog where the stomach and oesophagus are horizontal and the lungs lower than both!” Luca said that he had got the idea and, at least the cause of Nellie’s constant cough was now identified. In the meantime, the vet prescribed Nellie omeprazole and antacid drug.
A little later Luca and I watched the DVD of the gastroscopic examination together with Luca explaining to me the various stages. It was true, the mucus coating the stomach and small intestine seemed nice and abundant and clean and sticky. There wasn’t anything except a few pieces of grass in Nellie’s stomach. The point where the endoscope passed the trachea was fairly clear because the tissue was bright red but all in all it looked like a clean and orderly stomach and small intestine. There was no obvious smoking gun and it was hard to reconcile Nellie’s terrible illness and symptoms with some acid reflux! -
Thursday, February 18 2016
Nellie - Part 6
When I had first taken Nellie to the vets’ surgery she had been very relaxed and calm while she was examined. Over time, after numerous visits during which she was prodded and listened to and looked into and having countless thermometers stuck in her backside (only one each time, of course!) she grew very resistent and eventually had to be firmly held if a vet was to examine her or draw blood. The vet asked me to take Nellie and bring her to the x-ray room. I placed her on the table underneath the x-ray generator head and the vet helped me to put on the lead lined protective apron. “Stay there Nellie, stay there” I said as I was placing my arms through the apron, afraid that she might make a run for it. But the room was dimly lit and she stayed where she was. “OK, lie her down and turn her on her side with her legs facing the wall” said the vet. Nellie didn’t want to be pushed down and resisted my efforts. Luckily she is a small dog so I was able to get her in position as the vet prepared the machine. “Now, it is important that Nellie stays still while we take the x-ray" said the vet. He reached over and stretched out her legs and positioned her exactly where he wanted her. “Good girl Nellie” I said. Stay there, stay there, brava!” under instruction from the vet I stepped back and to my relief Nellie lay there and didn’t move as the machine hummed and clicked. “Good” said the vet. Now roll her over to her other side” I rolled Nellie over and she lay as still as a church mouse, barely breathing. “Excellent” said the vet returning to finesse her position once more. And again the machine hummed and clicked and it was all over.
“If she has ingested a piece of wood or plastic which cannot be expelled and hangs around creating inflammation then of course we won’t see it with the x-rays. But you never know, so it is worth having a look in case something show up” the vet said. He helped me remove the heavy protective apron and we returned to his office. He sat at the computer and pulled up the x-ray images of Nellie that he had just taken. He examined the images closely, referencing between the two, looking closer at the screen or enlarging parts that interested him. “No, there is nothing here” he said eventually. “Let’s take some blood”.
Nellie was sitting on the examination table and I was locked in a firm cuddle with her knowing that she had the capacity, if she wanted, to jump like a little black gazelle. As the vet took her leg to shave with the electric razor poor Nellie tried to climb up and over me, anything to get away. She put her front paws on my shoulders and tried to pull herself up and out of my grasp. At this point Luca took her hind part and we laid her down and held her firm while the vet shaved her leg then applied a rubber band to inflate the vein and finally inserted a needle and removed some phials of blood. Being subjected to this procedure certainly caused Nellie some suffering but I felt that, finally, we would begin to get to the bottom of her illness and hopefully from there to a cure so it seemed on the whole completely positive. “OK” said the vet. “It will be a week before we have the results. I will email them to you and your vet once we have them. At that point we will have a better idea of what to do.”
We took poor little Nellie away, a raggedly, rag-like, waif. She was afraid of the other dogs in the surgery waiting room and the city traffic outside with its movement and noise left her uncertain and insecure. She was glad to reach our van and willingly climbed into its familiar interior. The day was sunny and the afternoon warm. On the trip back Nellie vomited as usual but the mountains were majestic in front of us and the evening would be long and we felt better about Nellie than we had for a long time!Photos
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Wednesday, February 17 2016
Nellie - Part 5
In July I was sleeping on the top floor of the barn. The top floor of the barn has a rough wooden cladding with space between the boards for air to pass. The design was to allow grapes to be dried if we wanted to create very dense and concentrated wines. Dense and concentrated wines, however, don’t find a ready market and so we have this great space that turned out to be a wonderful place to sleep. The summer was very hot but the barn was always gently aerated. My bed was hard against the low concrete wall that defined the side of the barn and to which the boards were attached and Nellie slept behind my head on the ledge which was the top of the wall. She would look out of the gaps between the wooden slats until eventually she fell asleep. But she was unwell. Her cough was continuous and she had an unnaturally atrocious breath. She was restless during the night and slept fitfully. I left the low gate to the barn ajar so she could go outside if she needed to and sometimes she did. If dawnbreak was chilly, she would snuggle up against me and gently lick my face. I hated being licked and was terrified of getting some infection from her but in the face of Nellie’s suffering I felt that it was something that I had to endure. I had little to give her and to turn away from her at this time seemed as if it would be an act of unconscionable egoism. When I held little Nellie against me I felt her bones as there was no fat to soften their outline.
When I got up, Nellie often stayed in the barn and would only come down to the house later. I would give her a big bowl of yoghurt which she would wolf down. Nellie loved the children who were staying at La Faula and was very caring and gentle with babies. In front of the house is a large pergola and in front of this is a little sandy football field. The field is tiny but it has goals and is fenced off to keep the dogs outside. Hector, in particular, our oldest dog and father of Annie and Rett, has never been trained to play with soccer balls so the first thing he does when he gets one is to destroy it. This can happen surprisingly fast so we have this little field where the dogs are kept outside and small kids can play football without it all ending in tears. Whenever kids were in the field, Nellie was on the outside tracking the ball as it moved too and fro. Sometimes, overcome with excitement she would leap gazelle-like over the fence and carry the ball away to cries and shouts of concern and dismay. Luckily, this was all happening outside the kitchen where I spend a lot of time in the summer so I would sprint outside aiming to get the ball before one of the dogs destroyed it. If Nellie had it still, the ball would be in perfect condition as she would carry it gently in her mouth to no ill effect. If Hector had got to it, however, it was often a case of tears and disappointment! But very quickly Nellie learned not to remove the ball from the field. Instead she would jump the net and race between the players before jumping out and over the net on the opposite side. This became her great game and she would do it for hours. Her illness, eating only yogurt and running for hours reduced to to skin and bones and we felt sure that she was really at the end. By the evening she would be exhausted and spent. Waiting for me, she would lie drained on the half landing between the dining room and the kitchen where the stairs go up to the first floor looking out the window to what was going on under the pergola. I felt terrible not knowing what to do with her. Sometimes I felt myself emotionally drawing away from Nellie in preparation of her death. But for this I felt terrible: to pull away from little Nellie at this moment, to leave her to face this time alone just to protect myself from inevitable hurt seemed like gross selfishness. And yet it was a recurrent instinct that had to be overcome.
Towards the end of July Nellie developed another infection and Luca took her to our vet. Our vet prescribed a course of antibiotics and arranged an appointment with a vet gastroenterologist at the nearest pet hospital. We took Nellie to the specialist and he said that the first thing he would do was arrange a series of exhaustive blood tests. While we were there he would x-ray Nellie to see if there was anything obviously untoward. Then if it was necessary, the next step would be a gastroscopy with tissue biopsies from her small intestine. The problem was that it was August and he would be on holiday for two weeks towards the end of August. The specialist explained that in Udine there was only one other vet who conducted gastroscopies. He asked us if we were prepared to wait or would like him to contact the other vet. At this point a distinct play of the human mind kicked in. Being with this vet who had the means and ability to see what we had all been guessing at for six months was like, in a way, being saved. Probably the rational thing to have done would have been to see the other vet. But we were so relieved to be in the presence of this specialist that we were reluctant to give him up for some unknown quantity. So, “yes” we said. “We would proceed immediately with the blood test and x-rays” and would wait for him to get back for the gastroscopy and biopsies.Photos
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Sunday, February 14 2016
Nellie - Part 4
Nellie started on a 20 day course of doxycycline the powerful antibiotic. The vet said to return at the end of the 20 days. Almost imperceptibly, Nellie began to improve. She continued to eat little but the quality of her coat improved and incrementally, in the smallest way, she began to put on weight. Over the days, her constant cough became intermittent and eventually disappeared. She was active and playful and although she remained skinny she was looking good. We were of course pleased but it was hard to credit that all these months of problems could have been due to a bacterial infection, especially as no one seemed to know where it could be. Previously, Nellie’s reluctance to eat and her cough had endured even when she was between courses of antibiotics. Plus her intermittent anemia seemed to be a sign hard to reconcile with a simple bacterial infection. Somehow it didn’t all hang together but here she was, under our eyes, measurably getting better. At the end of the 20 days we returned to the vets’ surgery. “I’ve got some bad news” said the vet. “Nellie hasn’t got lyme disease. The blood test is negative so we are back where we started. At least if she had Lyme’s disease we would know where we stand.” I was disappointed. It felt strange to be disappointed that Nellie didn’t have Lyme disease. Normally one is pleased to discover that a feared illness is not present in fact. But to be pitched back into the uncertainty and doubt regarding Nellie’s health, to live with the hope of cure but the reality of decline, was becoming interminably oppressive. “I’m going to put Nellie on another 20 days course of doxycycline” said the vet. At the end of this any bacterial infection, no matter where it is, must be eliminated.”
I left the vets’ surgery strangely disheartened. Nellie was in pretty good condition. Her cough that had been right from the beginning was gone. Her atrocious breath had improved. She was skinny but had added a little bit of weight. She didn’t show obvious signs of sickness. Since being on the antibiotic Nellie hadn’t vomited or had night fever. But the cure still seemed too simple for the extensive symptoms she had exhibited. It was like repairing a broken down car by cleaning the spark plugs! By now the routine was well established. From the vets’ surgery I returned home. Nellie suffered from car sickness so by the time I arrived at La Faula she had vomited mucus and the grass that was always present in her vomit (another bad sign). I departed immediately to get to the pharmacy before it closed at midday. If the pharmacy didn’t have the particular medicine it would be ordered by the pharmacist and I could pick it up in the afternoon. This time the antibiotic was in stock. I already knew the price and gave thanks, yet again, that at least for human medicines there was a national health service to cover most of the cost of medical treatments. Between the vets’ visits and medicines, Nellie was costing us a small fortune. Of course we paid willingly but not blind to the weight it was putting on our financial resources.
For the next 20 days it was possible to say that Nellie was OK. Gradually it seemed to be the case that she was cured, if only because the cure was so long that we got used to a healthy - if food adverse - dog. It became possible to convince oneself that the nightmare for Nellie, and for us, was perhaps over: that things had been restarted and could now proceed smoothly and without difficulty. As it seemed that the antibiotic had produced the cure it was obvious to think that the infection was gone and that Nellie was now free of whatever parasite had been ruining her health previously. It would be true to say that we approached the end of the course of antibiotics without trepidation and with a confidence that she would proceed healthily as all our other dogs did.
For a week or two once she had finished the antibiotics Nellie’s health stayed stable. But then the cough returned. And then over time she showed an aversion to eating that seemed wholly inimical to living. We tried different brands of dog food. Soft and crunchy, all flavours, all guaranteed to be perfect for one’s pet. At first, for a day or two, Nellie would eat the new food she was introduced to. Then after a couple of days she would definitively refuse it. She only ate when she was starving. She lost weight precipitously. I moved to sleep in the barn with Nellie so that if she needed to be sick during the night she could get to the grass. Nellie would sleep in the ledge that runs down the inside of the top floor of the barn looking out through the slats in the wooden cladding to see what was happening below. Normally I rose at around 05.30 in the morning and then went down to the main house but when Nellie was poorly she would stay up there barely moving. Eventually we knew that Nellie could not survive if she didn’t eat. Normally it is advised not to give dogs cows’ milk products as dogs are lactose intolerant and can also be allergic to the casein protein that it present in cows’ milk. But one morning I was putting the yoghurt that I make at home in the serving jugs and I decided to try it out on Nellie. I got a bowl and put some yoghurt in it. I put the bowl near Nellie. By now, Nellie showed such aversion to what we offered her to eat that she would approach the bowl of food as if it would do her mortal harm. Normally she would sniff then not eat. This time she sniffed and sniffed again. She gingerly gave a lick to the yoghurt and stopped. Then she licked the yoghurt again, and again, with an enthusiasm that I had never seen and in a flash the yoghurt had disappeared. I gave her more and she gulped it down.Photos
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Monday, February 8 2016
Nellie - Part 3
The month was May. Spring was ripe, the mornings started early and the sun was warm already by 6.30. The light was fresh, the air limpid. Winter was but a shade of the past; plants were reborn with bright new foliage and the birds happy and noisy in their courting. At 7.00 a.m., as promised, the vet arrived. I took him into the staff room. Nellie was on the bottom bed of a bunk bed set and her little head was abjectly poking out from a blanket. She looked so sad and pathetic the vet’s heart went out to her immediately. “Oh you poor little thing” he said “And they’ve covered you with a blanket to keep you warm” he reached in and rolled back the blanket. He looked at Nellie’s gums, around her eyes. He gently got her to stand up and took her temperature. He took out his stethoscope and listened to her heart and breathing. “Well he said” what she has is not going to kill her immediately. What I mean is, she is not going to die now but there is something wrong here, something not right.” He went on “It’s clear that she hasn’t ingested rat poison, but there is something not right about her. Something underlying that is provoking these recurrent illnesses.” He lifted his head up with a start and caught it on the wooden frame of the bunk bed above. It was a good whack and must have hurt. I felt terrible. Here he was, disturbed from his sleep, helping our little dog and he got a whack on the head for his efforts! “Oh, I’m sorry” I said not knowing what else to say. “It was nothing” he replied and began to pack his instruments back into his vet’s bag.
We walked outside, the vet and me. The morning was by now warm and beautiful. The wonder of the morning and reassurance of the vet’s intervention had removed the desperation and panic that we had suffered earlier when we saw that Nellie was, yet again, rapidly declining into illness. “Bring the dog to the surgery at 10.00 a.m. when we open. I’ll tell my colleagues what has happened. We need to examine this matter more deeply. The dog is suffering from some underlying condition and we need to work out what it is. My heart sunk. By now I knew that this dog had a problem, a defect that couldn’t just be cured with an 8 day course of antibiotics. “What do you think it might be?” I said. “I don’t know” replied the vet. “It looks a bit like leukemia. But I really don’t know. But maybe leukemia is worth considering”. I bade the vet farewell, his car tires crunching on the gravel of the carpark and with an unhappy heart returned to the house. I knew that if it was leukemia Nellie was finished. But somehow leukemia seemed unlikely. Her sickness up until then had been a series of cycles with illness followed by a period of normality followed by illness. Not knowing anything, I felt sure that if it was leukemia the decline would have been more linear, irreversible and distinct. But for the first time I was presented with what happens when a living creature is sick and the cause of that sickness is a mystery. In our normal life up until then symptoms are followed by diagnosis and treatment. Relatives, people we knew, people in the village got sick. If the illness was serious like an aggressive cancer they were treated and either got well or died. But everyone knew what the stakes were. People had heart disease. They either got treatment or had a heart attack and, often, died. It all seemed very clear. But here we were with little Nellie, a fur covered, bundle of sick medical mystery.
I went back into the staff room. Nellie was sleeping. I sat there with a heavy heart gently stroking her little head.
At 10.00 a.m. Nellie and I were back at the vet’s surgery. She had improved a little. As she sat on the examination table the vets gathered around her discussing the case amongst themselves. Leukemia was ruled out more or less immediately because if this was the problem she would already have been dead. They took blood samples. Prepared slides. Finally Nellie’s principal vet said to me. “I’m going to test for Lyme’s disease”. In the meantime I’m going to put Nellie on a course of doxycycline, an antibiotic that can penetrate the blood brain barrier. If we are lucky, we’ll find out that she has Lyme’s disease although her symptoms are not a perfect match. Otherwise, we will have reached the end of what we can do here and she will require a gastroscopy and biopsy carried out by a specialised vet.” By now the uncertainty and open questions were starting to weigh a bit. Seeing Nellie sick was dispiriting and the mystery of her condition portended more problems, more trips to the vets and more expenditure, because by now the vet’s interventions and treatments, especially out of hours, were starting to build up. The story was becoming heavy and tiresome and we dreamt of it having a happy ending although the difficulty to get even this far was starting to create a grain of doubt in our mind as to whether there would be a happy ending. At the edges of our thoughts the possibility that she might die hovered, still inchoate, but its outline indistinctly beginning to take form.Photos
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Wednesday, February 3 2016
Nellie - Part 2
When we began life at La Faula in 1995 Wikipedia didn’t exist. The Internet did but only for those in the know. So we brought up our first dogs - Maremmano Sheepdogs - using general books about owning a dog, advice given us by our vets and stories and legends absorbed over our lives up till then. As knowhow, true or false, was so rare and difficult to access, it tended to stay in one’s mind. When someone recounted a story that could be relevant to one’s life, one tended to remember it. It happened that early on in our time at La Faula the dog of someone we knew ate rat poison. That person called the advice line on the poison packet and was told not to worry as the poison was warfarin based and a small amount ingested by a medium sized dog wouldn’t do any harm. Of course, by 2015 the first thing that I did when I got home with presumptively poisoned Nellie, was to access Wikipedia and look up “warfarin poisoning dogs”. Rather to my horror I saw that life in the rat poisoning business had not stopped still in the 1990’s but like everything else had moved on. The tolerance of rats to even higher doses of warfarin had led to the development of even more effective anticoagulants that were combined with warfarin. These anticoagulants do not have an antidote.
While I was frightening myself with the internet, Luca did the rounds of the rat bait boxes. They were all in place and intact. One tends to take the advice of one’s Vet as being authoritative so the whole thing just became a mystery. Immediately after Easter we took Nellie back to the Vets’ surgery where we found Nellie’s normal vet. He read Nellie’s notes prepared by the emergency vet. He noted that her gums were grey and eyelids lacking bright red colour and the tongue a mild pink. He also saw that she was running a temperature so ran a blood test and saw that she had an elevated white blood cell count. He extended the course of antibiotics and gave us a further prescription for vitamin K the warfarin antidote. We took poor Nellie home and she was a vision of abject suffering.
Over the next week Nellie perked up. We obsessively checked her gums and tongue which remained an obstinate gray. By now we knew that it was best to avoid calling the vet after hours if we wanted to finish the year with any money left, so when Saturday came we decided to take Nellie to the Saturday morning surgery. I pointed out that although Nellie had improved, her gums, tongue and eyelids remained grey.
“OK” said the vet “We’ll do another course of vitamin K, it’s a vitamin after all, it won’t do her any harm”
but by now I think that the vets were starting to doubt that rat poison was the problem.
The weeks passed and Nellie perked up but she refused to eat and became thinner and thinner. By now we had a fair number of guests and Nellie loved playing with the kids. When the smaller kids were playing with a soccer ball in the little fenced soccer ground (fenced low, but enough to keep the dogs out) in front of the pergola, Nellie would run around and around the exterior perimeter tracking the movement of the ball. Sometimes in a fit of enthusiasm and excitement she would leap, gazelle like, over the net into the soccer ground then leap out again. Sometimes she was tempted to take the ball with her but cries of alarm from children and parents would quickly dissuade her. The combination of all this activity and Nellie not eating started to convince us that maybe we would lose her.
As Nellie was unwell, we were reluctant to leave her by herself during the night incase she needed to be taken outside or helped in some way. I moved down into the little room we have in the services area for volunteers to sleep in during the summer. Nellie took to sleeping at the end of the bed snuggled up to my feet. I was always alert for strange movements or restlessness on Nellie’s part and one morning, very early, around 4.00 a.m., I became aware that Nellie was shivering. With the light on I saw that she was listless and clearly ill. Shivering passed in waves over her. I woke up Luca and we decided that we would wait and call the vet at 6.00 a.m. We covered Nellie up and waited. The time passed very slowly but eventually it was 6.00 a.m. and I called the vet.
Calling a vet at night or early in the morning is a funny thing. On the one hand, it seems a big thing to disturb a sleeping vet for a dog and until Nellie we had never done it. On the other hand, we had learnt with the death of Little Fritz (I’ll write about this at some later time) that waiting can be fatal for an ill animal. The sleepy vet - the one who had seen Nellie on Easter Sunday - answered the telephone. I heard a female voice complaining nearby. I apologised profusely, explained who I was and who the dog was, and said that I was afraid for the dog’s prospects if I waited for the surgery to open at 10.00 a.m. The vet remembered little Nellie and said that he would be at La Faula at 7.00 a.m.. Nellie lay on my bed, covered but shivering. It seemed like a story without end!Photos
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