Some days, there are just no words. Some days, the pain wells up inside you until you feel like you are going to cry or scream or both, but you do neither, because no outward expression of the inward misery will suffice, and you don’t have the energy to try. Friday was one of those days, today is one of those days.
When we found out Dusty had megaesophagus, it hit me right away. I remember breaking down in the vet’s office when we got the news, even before I knew how bad it was, even before we had any idea that she wasn’t going to make it to her first birthday, which would have been Friday.
I don’t think Smokey’s sickness hit me until this morning. Friday I was numb, because I didn’t know what was going on, and though I tried to keep myself from thinking the worst, I couldn’t help it. One side of my mind was saying that our luck couldn’t be that bad, that of the three dogs we’d owned since we moved in together, it couldn’t be that two of them were seriously ill. A 66% serious illness in your dog rate just didn’t make cosmic sense. Then the other half of my mind kept reminding me of that sick feeling you get in your stomach when you have to put a 10 week old puppy in the ground. I kept thinking about Smokey and his life and how horrible it had been before us and how it just wasn’t fair that we weren’t going to be able to have enough time to make it up to him. At least Dusty knew only kindness in her short life, Smokey has known 50% hatred and fear and pain and 50% love and devotion. It seemed to me that we should have enough time to make his life better than just half and half.
Of course I was assuming he was going to die young. Unfortunately, that has become the natural assumption in our lives.
And of course when I got out of work on Friday, Dusty’s would be first birthday, and called Joe to find out what the vet had said, I sat in my car and listened while he explained that the vet was almost positive Smokey had an auto-immune disease. But it didn’t hit me then. I just said, “Well, that doesn’t sound good.”
“No, no it doesn’t. They’re doing blood work, they put a rush on it and it will be back tomorrow.”
We had a yard sale on Saturday, the first measure to raise money for Smokey’s vet bills, which we can only assume will be colossal. At this point, we know how quickly you can fall down that rabbit hole. At 10:30 I called the vet, the blood work wasn’t back yet. At 11:00 they called me, the fecal sample was negative but still no blood work. At about 1:00, they called us again. Joe took the call, and I heard him say, “How bad?” And then he walked inside. When I went inside to check on him, he looked like he was about to sob. My hands were shaking, but I went back outside and smiled at the strangers gathered on our lawn and acted like nothing was wrong.
As it turns out, Smokey has Immune-Mediated Thrombocytopenia (ITP) as well as Immune-Mediated Hemolytic Anemia (IMHA). The combination together is called Evans’ Disease. Long story short, Smokey’s immune system is attacking both his platelets and his red blood cells, bringing his platelet level down to about 4.6% of normal and his red blood cell count far below normal. As the vet explained, our 95 pound German Shepherd has the platelet and blood cell count of a sick Chihuahua.
As I sat on the porch and listened to Joe convey to me what the vet had said, I just sighed. I thought I’d accepted it. When people told me I was acting so calm, they followed it up with, “Well, I guess you’ve gotten worse prognoses before.” I laughed and agreed. But does that really make it better? Oh well, this horrible thing isn’t so horrible, because it’s not as horrible as the most horrible thing which has already happened to you. My dad asked how old Smokey was, and then said, “Well, that’s four years more than Dusty had.” I know he was trying to make me feel like we hadn’t failed yet another dog, but when I look back on that statement, it just makes my heart hurt.
I can’t blame anyone who is saying this. I can’t blame the people who are telling me that we need to draw a line in the sand when it comes to the financial reality of this very expensive and consuming disease. I understand where they’re coming from. To some extent, I agree with them, but right now, I just can’t think about it.
One step at a time. One step at a time.
The first step was to start him out on a high dosage of prednisone. Prednisone is a steroid which imitates the body’s stress hormone cortisol. Prednisone serves to suppress the immune systems in dogs with self-destructive immune systems like Smokey’s. Prednisone is sort of a miracle drug when it’s used properly, because you see almost instant results. Within the first twelve hours of his first dose of prednisone, Smokey’s temperature had gone back down to 101.4 where it belongs, he was eating again, drinking again; he seemed to have a little more spring in his step. His gums stopped bleeding; he even got up the energy to play a little tug. Unfortunately, those results were only temporary and superficial. As of this morning, his temperature was back to 103.6, and he wasn’t eating. He is no longer bleeding orally however, so hopefully that means his platelet levels are going back up, and he is able to clot blood again.
The long term use of prednisone can be dangerous in and of itself, however. Prednisone use over time can cause digestive ulcers, diabetes, muscle degeneration, behavioral changes, inflammation, Cushings Disease and Addison’s disease, not to mention serious damage to the internal organs most notably the kidneys and liver. Without the prednisone, Smokey’s platelet levels could drop, and he could start bleeding internally. If his ability to clot blood is dramatically reduced, he could bleed into his brain, which would kill him very quickly, and we may never even know it happened. Without the prednisone, Smokey’s red blood cell count could drop, and he would lose his ability to transport oxygen to his organs, essentially suffocating him from the inside out.
Blood transfusions, which he will most likely need over the course of his life now that the Evans’ Syndrome has been triggered, have complications of their own, including fever, shock, septicemia, vomiting, cough, hypothermia and heart failure. The complications only increase as the dog gets older and the complexity of the blood transfusions increase due to the frequency of the mixing of blood.
It’s hard not to let the guilt get to you. Joe says we’re bad dog parents, because we let it wait too long. Smokey started acting strange a few weeks ago. We couldn’t quite put our finger on it. If we’d gone into the vet’s office, and they’d asked us to explain his symptoms, we probably would have fumbled around, trying to put words to, “He’s just not quite right.”
The first sign of his not-quite-rightness, was that he started sleeping in Shelby’s kennel. Smokey almost never seeks out a tightly enclosed spot to rest in. He doesn’t like kennels or corners, probably because he had to live in them for so long. So it was strange when he stopped sleeping on our bed and chose to huddle in a corner of the room instead, and even stranger when I walked downstairs each morning only to find him sleeping in Shelby’s kennel in the kitchen. Something about that made me anxious. I just kept thinking about those stories of dogs who try to find solitary places to die.
The next sign was that he stopped taking an interest in Shelby. He didn’t want to play with her, he didn’t want to sleep with her; he just didn’t want to be near her. Every time she play bowed and ran toward him he tucked his tail, turned his body and started screaming before she even got to him. When Joe and I felt him over, he didn’t cry. There was no sign that he was in pain, and while we worried, we thought we were just being paranoid because of the rabies vaccine scare we’d just had.
A couple weeks ago, he started limping in his front. First it was his left paw, which we poured over, looking for any signs of fractures or cuts or maybe a thorn stuck in his paw. After a day or so, the limping went away, and we thought, “Well, maybe he just got stung by a bee or something bit him or Shelby stepped on him the wrong way or…” Then the limping started again, but this time in his right.
Everything started spiraling downward after that. His limping got worse, he started panting, he got incredibly lethargic, he couldn’t keep up with me on our short bike ride, and I actually had to turn around and walk back when I was only maybe a sixteenth of a mile in, because I was essentially dragging him behind my bike. His temperature started slowly rising, he stopped eating, and then he stopped drinking. Not even the sound of the clicker seemed to wake him up, and instead of trying to get in on the training exercises I was working on with Shelby, he just laid in the corner and stared. On Thursday night, his temperature hit 104.4, and we started to get very worried. All of our little excuses didn’t seem to be working anymore. The not-quite-rightness had evolved into something else. We discussed calling the emergency hospital. Joe opened Smokey’s mouth to see the color of his gums, looking for any indication of what was wrong. When he did, we saw that it was full of blood. At first, we’d thought maybe he’d lost a tooth at some point, and maybe it had gotten infected. After a thorough examination however, we realized the blood was simply pouring out of his gums. As he’d been so lethargic, we knew he’d just woken up from a nap and hadn’t been chewing on anything, so there was no way he could have cut his mouth open.
We did the obvious thing and called the emergency hospital. They told us to keep an eye on him and monitor his temperature and that if it went above 105 to bring him in, but since we already had a vet appointment for the next day, to save ourselves some money and wait for that.
Friday, when Joe got home, the spot where Smokey had been laying was soaked in blood. Joe took him early to his appointment and called me on the way. I sat at work and tried not to panic, but all I could think about was my Smokey Dokey dog, lying on the floor all alone, slowly bleeding.
Smokey goes in for a PCV (packed cell volume) test today. The test will let us know how badly his red blood cells have been compromised and whether or not he will need an emergency blood transfusion to stay alive. Fortunately, the test results are instant. Unfortunately, we may be forced to make some tough decisions. No matter what we do, we’re going to have to choose the lesser of two evils. No matter what we do, Smokey is going to suffer.
When we asked the vet whether or not he thought the rabies vaccine that Smokey was given in error caused this, he said that he believed it triggered it, yes. We don’t have the luxury to look back now, we have to keep looking forward. Forward is scary, forward could be xrays and biopsies, bone marrow aspirations and blood transfusions. The financial consequences pale only in comparison to the suffering that may be ahead for our family.
I sat on the floor with Smokey this morning while he struggled to breathe, and I thought back to Saturday, when, despite how sick he was, he visited with the neighbors at the yard sale and kissed a seven year old autistic boy on the face. The boy laughed in delight and cried, “Doggie!” while his parents stood back in shock. They explained that they were working with a speech therapist to help their son vocalize better, so we took the boy’s hands and touched Smokey’s ears, “Ears.” “Ears.” He repeated. He tried to grab onto Smokey’s tail which was wagging furiously and clapped while saying, “Tail!” Then said, “I want to pet the doggie.”
I buried my head in Smokey’s fur and cried for the first time.