When Organs Go Bad

Hi all, Remember me? I haven't been able to blog for quite awhile-we have been busy at the hospital and extra-curricular "stuff" has just left me tired and uninspired for writing. I hope those times are behind me now!

We had a very sick patient the past couple of days that everyone on the staff worked very hard for. Jericho was a sweet, older dog who could barely walk in to the hospital yesterday-he was just way too weak and disoriented. He was constantly vomiting and had severe vomiting. Worst of all, these symptoms had likely been going on for 10 or more days with no treatment! He was beginning to show signs something was wrong almost 2 weeks ago, but then the owners had to leave town for vacation. Their dog sitter didn't provide any care for Jericho while they were gone, so he just continued vomiting, not eating, and got weaker and weaker. The dog we saw just wasn't the same dog they knew and loved.

Of course we wanted to know if he could have gotten into anything, eaten poisonous plants, swallowed a rock or bone or some other foreign object, causing an obstruction in his GI system and thus the signs we were seeing. Other possibilities were eating a toxin of some kind, antifreeze for instance, or being fed a poison by a disgruntled neighbor. You hate to think that way, but it sure can happen. He was an older dog but not geriatric, so we didn't really think organ failure was high on the list of rule-outs, but we put them on the list any way-kidney and liver insufficiency, pancreatitis, enteritis. Jericho was not current on his vaccinations, so parvovirus was possible. No matter the cause, this boy was SICK. He was dehydrated from the loss of so much fluids and inability to keep anything down, and the weakness and disorientation could have been from electrolyte imbalances or toxin build up in his blood stream. His prognosis or ability to recover from this problem wouldn't be able to be determined until we identified a cause.

We gave Jericho's worried owner a treatment/diagnosis plan, starting with a parvo test-it was negative, thank goodness. We then did a complete blood count and general blood profile and there we learned the source of his symptoms. Blood Urea Nitrogen or BUN and creatinine are two blood values that are normal by-products of metabolism and excreted by the kidneys. Our "normal" values for BUN are 7 - 27 mg/dl-Jericho's value was over 130! It was so elevated that the machine couldn't give an accurate value. The creatinine was similarly increased. The two values being elevated together is called azotemia-a strong indication that Jericho's kidneys had failed. The other major problem was the phosphorous level, a product usually eliminated from what we eat, again by the kidneys. When they aren't functioning, it becomes elevated and makes the patient weak and ataxic or wobbly, just like Jericho was. His phosphorous level was sky high.

Jericho's owners couldn't think of anything he could have gotten into that could have caused this to happen. They said they have good neighbors that love dogs-very unlikely to poison him. There are some diseases like leptospirosis as we have discussed in the past that can cause kidneys to fail. Of course, being an outdoor dog, he could easily have found something bad to eat, so we may never know what did this to him. The most important thing was-could he recover?

The answer to that question is never easy. Dogs are individuals, and sometimes those with very severe symptoms and lab values recover uneventfully and go on to live long lives. Some with minor changes will suddenly worsen and die despite aggressive treatment. Only time and treatment will tell. Often that means spending a lot of money, unfortunately without a guarantee of success. I felt Jericho's chances to survive were very poor, but his owners felt they owed him at least a chance. Our whole team came together for him and initiated an aggressive treatment plan. We sent in an ethelyne glycol test. This would tell us if he had been exposed to antifreeze or not. If he had, his chances would be next to zero and I told his owner this. In the mean time, we placed an IV catheter to administer fluids, gave him pain relief medications, anti-vomiting medications, and antacid medications-all by injection as he wasn't keeping anything down orally. He was so much more comfortable right away-just taking away the pain and vomiting reflexes was enough to allow him to sleep comfortably and allow his body to start to heal-or so we had hoped.

Jericho received IV fluids and medications throughout the day. We aren't a 24 hour hospital, so we could have sent him to one for round the clock observation if I had thought he needed that. His pain level seemed OK, his fluids were running well and all he was doing was sleeping so I thought he would be fine. I offered to check on him later that night and his owner agreed that should be fine. Around 10:30pm he was QAR (remember our abbreviations?-quiet, alert, responsive), he walked very slowly outside to urinate, but I had to carry him back in. He just got tuckered out. He hadn't vomited but his heart rate had increased and his pupils were dilated so I thought his pain level might be rising. I gave him another dose of a narcotic and made sure he was toasty warm and that his fluids were running well.

This morning Jericho was again QAR. The ethylene glycol test came back negative. I was considering running a test for leptospirosis, an infectious cause of kidney damage, and would discuss that with his owners later. We again gave him pain meds and some anti-vomiting medication as he had started to lick his lips and drool a bit. Today, though, his drool was quite bloody-I was very worried about gastritis from the uremia that had developed from the kidney failure. His owner came to visit him and spent about half an hour with him. He seemed to perk up a bit while she was here which was good for both of them. Literally a few minutes after she left, Jericho stopped breathing. The nurses called me back to see him, but it was usesless. He had made the decision about whether or not to fight this horrible disease. At least we know he wasn't in pain and his owner and he got to spend some nice time together right at the end.

I feel so bad for the family-I know they will hurt over Jericho's loss for a long time to come. It was great, though-his younger owner came right back into the hospital holding on tightly to a very scared brown tabby cat she had seen running wild behind the strip mall where our hospital is. She was worried the cat was lost, not eating, and possibly reproducing out there on her own. We scanned the kitty for a microchip-none was found. We will notify her if anyone calls missing their cat and she will foster it until then. This kitty is redirecting some of her grief energy into something more positive. Animal lovers through and through. Rest in peace, Jericho.

Peace,
DrReneigh