What More, Verbal Dog?

Regular readers of this blog (and anyone who knows me AT ALL) know all about Verbal. She has been my constant companion since she joined my life over 11 years ago, an adorable, 4-week old yellow puppy. This tiny, broken thing was presented to the hospital where I was then working by a supposed "breeder." I use the word loosely-what kind of breeder would cross a Golden Retriever with a Yellow Lab, and do absolutely no pre-breeding health or temperament testing on the parent dogs? As much as I love this dog of mine, I have had numerous times called her "my genetic disaster," referring to her terrible hip and elbow dysplasia, her numerous bouts with cancer (yes, debatable whether genetically linked or not) and her, at times, questionable temperament.

Anyway, this little puppy had been attacked by her daddy dog-evidently she got too close to his food dish and he mauled her. 4 weeks old and he broke her jaw and ripped her tongue off. The "breeder" brought her in to be euthanized-they couldn't justify putting any money into this one puppy when they had 8 others at home, and it was pretty obvious how they felt about spending money on veterinary care.

Well, I would have euthanized the dog that did this to the pup in a heart beat-what would stop him from turning on a child someday? But there was no way I could end the life of this innocent little ball of joy, wagging her tail despite the terrible pain she had to be in. My husband and I had just happened to purchase our first home literally one month prior to meeting this wayward puppy, and we knew that adding a dog was in our future.....Can you see the big word "sucker" tatooed across my forehead? Well, there's worse things, for sure. We had the owner sign over the rights to the puppy, and we did surgery to fix her up right then.

Her lower jaw was broken, so we placed a pin through the length of it. Her tongue was reattached, and we could only cross our fingers and pray that it would be functional after such a dramatic injury. To this day, she has a huge scar on the back of her tongue, and when she yawns, her tongue curls up, almost touching her right ear. I doubt it has much feeling on that side, so accounts for even more dribbling than usual after drinking water (but what labrador anywhere drinks neatly???) It isn't perfect, but at least she has a tongue, and that goofy sideways grin gives her even more character than the usual smiling, happy water dog that she is.

4 weeks is awfully young to wean a puppy from its momma, but this just wasn't a normal situation. We did our best choosing some pain medication for her, but were limited due to her age. It didn't seem to matter, though. She was up and eating that first night after surgery, and was carrying a frisbee that was bigger than her later that week. Eating and carrying something, Frisbee, tennis ball, stick-SOMETHING-have been THE themes of her life ever since! She was our first (and so far only) dog in the family, but not the first pet. Flake was our "top dog," even though she happened to be a Maine Coon cat. She was bigger than the puppy at the time, and even though not exactly thrilled with the new addition, handled her just fine. The curious puppy couldn't help bouncing up to the giant cat asking her to play, and came away more times than not with a swat on the nose but hardly humbled at all. To this day, Verbal goes up to the various kitties in her life a bit cautiously, fully expecting to get whacked, but unable to resist-she just loves them so much!

Since I brought this broken little thing home kind of unexpectedly, I thought it would be best if I let Michael name her. We had just seen a great movie, "The Usual Suspects," one of Michael's favorites, and the main character, played by Kevin Spacey, actually had two names. "Keyser Soze" just didn't seem like a good name for a little girl puppy, so "Verbal" it was. We kind of thought it would be a joke, too, since how could a puppy whose tongue was ripped off and jaw was broken be very talkative? Ha! The joke was on us! Verbal more than lived up to her name, and very few people who meet her know the source of her name-they just assume it is because of how darned much she likes to talk.

Since she had no trouble eating, she began growing like a weed. It was only two weeks before we realized that pin in her jaw would have to be removed. I took her to work, anesthetized her, and pulled the pin, but during her recovery, Verbal's heart stopped! I went into emergency doctor mode, performing CPR, injecting epinephrine into her heart, and sure enough, that plucky little puppy came back to us. I got the job of reviving her done-then went and puked my guts out. Being mom and doctor at the same time is really hard to cope with, but it was good to know that I could automatically go into emergency mode when needed-and deal with the emotions of the situation later. Verbal actually suffered hypoxia during her cardiac arrest. The lack of oxygen to her brain resulted in her being very wobbly and unsteady when walking for a few days-and scariest of all, she was actually blind for a day! Of course, we didn't know it would only be 24 hours, and it was a horrible time when we didn't know what was going to happen to her. Michael was adamant-we were NOT getting a seeing eye dog for our puppy! Thankfully, she regained her sight the next day, and gradually got more steady on her feet. An anesthesiologist I consulted with thought her blood glucose might have been too low during her procedure, resulting in the hypoxia. While adult or even older puppies can be safely fasted prior to anesthesia, it just isn't safe to do so in these neonates or very young puppies for just this reason. This was just one of so many things Verbal has since taught me about medical issues that I would be able to use for my future patients. I know she came into my life for a reason, making me a better veterinarian, despite what people say about how lucky she has been to have me (a vet) for her owner. She has given me far more in my life than I could ever have given her.

After that anesthesia fiasco, I swore I would make her suck it up and just stand there for her spay. Not really, but I sure was holding my breath during that surgery when she was about 6 months old. I think the anesthesiologist was right about that low blood sugar as a neonate-she has never had anesthetic complications again-and she has had a LOT of surgeries in her life.

Verbal was only about 2 months old when I began noticing how she ran with both of her hind legs kind-of "rabbit-hopping" together. Normal dogs have hind legs that move independently of each other; this rabbit-hopping gait was indicative of pain, discomfort, or at least some limitation of movement in her coxofemoral (hip) joints. We took some radiographs of her hips and found out that she had a terrible case of hip dysplasia. I probably blogged about it before, but where there should be nice deep sockets or cups, Verbal's hips had flat plates. There was no where for the round heads or balls of the femurs to fit. Her right side was much worse than the left, and unfortunately, surgery was in her very near future. I took her x-rays and visited a surgeon I respected and trusted. He told me that the "usual" surgery to repair hips in such a young dog, a TPLO or triple pelvic osteotomy (breaking the hip in three places and plating them together in alignment for the femoral heads to seat better) just wouldn't work because of her particular anatomy. We would have to wait and do at lest one if not two total hip replacements. Since these surgeries can't be done on growing dogs, and since she was already showing signs of pain, we decided to do an FHO or femoral head osteotomy on her right hip. This involved removing the ball and neck of the bone so it would no longer cause bone-to-bone contact and therefore no more pain. Read the blog on 3/24/09 about Quik and his screening for hip dysplasia for more info.

Her hip surgery went well, and so did her spay, thank goodness. She was pretty much pain free-and she went everywhere with me. I was so lucky! I had a small mobile (house and farm call) practice at the time, so she hopped in and out of the truck, waited patiently while I doctored any sick animals, and looked forward to getting on the way again. Well, there are a few things she isn't so "patient" and good about. When she sees cows, for example, she just has to let them know who's boss. She doesn't do this for any other animals, unless a dog is obviously challenging her, jumping up and growling at "her" car-then it is only natural that Verbal gives them a piece of her mind. She also loves to "attack" the scrubbers and brushes when we go through automatic car washes. I really don't think she is afraid or anything-I think it is a big game and she is just having fun. But boy! Those windows get all steamed up and drool-y by the time we are driving out the other side. Nice and clean on the outside-pretty much a disaster on the inside. Oh well, simple joys in life....

I said she went everywhere with me-she really did. When I was doing some relief work, working for other veterinarians at their hospitals or clinics when they were taking vacations or going out of town for some reason, Verbal would always come with me, even when we had to stay in motels. In fact, we became "regulars" at one motel. Verbal and I stayed in the same room on the top (3rd) floor. She would often wake up before I really needed to and wanted to go outside to do her business. I REALLY didn't want to get dressed just to do that and then come back to go to bed again, especially on those cold, rainy, wintery days. I would just open the door, Verbal would run down the three flights of stairs, run to the back of the motel, pee really quickly, and come running right back up to our room. What a good girl!

So, I mentioned that the FHO surgery went well and she had no pain in that hip. This was so evident that she put most of the weight on her hind legs on that leg, and subsequently, one day, playing Frisbee (of course) came down from way too high of a jump and blew out her anterior cruciate ligament (ACL) I've blogged often about ACL injuries-Verbal's was no different-except for the fact that she had surgery on her blown knee 3 times! It now has severe degenerative joint disease, an "end-stage knee" according to the orthopedists, and she will always have pain there. We manage it the best we can using multi-modal analgesia (again, a frequent blog topic) and of course, no more high flying Frisbee games. And now at her age, a couple of tosses and chewing some of the cheap Frisbees to shreds is just fine by her!

Swimming is such good exercise for bodies, human and animal, as it allows working muscle without too much stress on the joints. Now, our hospital is in a community called Lake Stevens-and yes, there is a nice lake here. But do you think we could find a place to swim anywhere on that lake? There are "no dogs allowed" on the public beaches, and I just didn't have any friends who owned property with beach access. I was reprimanded by a "lake cop" one day while walking Verbal on an empty beach; we were standing by some HUMAN'S discarded dirty diaper. I mean, gross. We always carried baggies for "accidents," but there is just no reasoning for some things. I decided to write a short letter to the editor of the Lake Stevens Journal, our local little paper, asking if anyone would be able to offer their yard access to my gimpy yellow dog who needed swimming for physical therapy. The response was just amazing! We have a terrific community of pet lovers, that is for sure! I got over 30 responses offering Verbal a place to come swim any time she'd like. I can't help but wonder how many I would have received if I had asked for a place to swim for myself-a gimpy HUMAN! Another story there....One wonderful lady named Jo actually called me the day BEFORE the paper was released. I was really surprised by this until I learned that she worked part time for the Journal, stuffing inserts in it before delivery the day before release each week. Jo lives alone, her husband had died and her children had moved away. She has a very cute home and a secluded back yard right on the water. Jo offered it up to Verbal and me any time we wanted to come over....She is so sweet, Verbal just adores her, and the little steps going down into the water are perfect for my gimpy old lady. She goes crazy when we are driving up to Jo's house-she can smell the water and it just makes her day! We never stay very long, and I always have to make sure I hose her off really well after the swim. Lots of duck poo and other fun things growing in the water usually give my disaster dog a lovely case of pyoderma (skin infection) if I fail to do that. I never knew a dog could wag her tail while swimming and retrieving. I wish I could take her to the lake every day-such a simple thing makes her so darned happy. It's the least I should do for her.

So, life went on pretty fine for Verbal, normal aging stuff, an occasional lipoma (fatty lump) but nothing too awful. Then came a day when I noticed she was chewing at one of those apparent lipomas on her elbow-she just wouldn't leave it alone. I was constantly telling her to stop it-anyone with an itchy dog knows the lip smacking sound-it can drive you crazy! Then the light goes off in my head-duh! That is what I have clients monitor lumps and bumps for....does the pet "care" it is there? Licking and chewing at a lump is a tell-tale sign that we should remove it, or at least biopsy the thing. Verbal had quite a few lumps at this point, and needed a bit of some dental work, so we went ahead and removed it and sent that elbow lump in to the lab for analysis. Wouldn't you know it? It wasn't just a lipoma, it was cancerous. In fact, it was a type of cancer, hemangiopericytoma, that is very aggressive where it occurs, so much so that the oncologists recommended amputating her leg to control the disease. Ugh.

I already mentioned her terrible hips and the blown apart knee; amputating a front leg would have just been cruel. So, removal of the mass and follow up radiation therapy at the tumor site was the best treatment choice for my Verbal.

I can't remember if I have blogged about radiation therapy in pets yet. If not, I'll go into more detail some other time-it is pretty fascinating! But suffice it to say that Verbal had her treatments-15 of them!-and was cancer-free for 3 years-pretty awesome! Then another tumor popped up at a different site on the side of her chest-totally unrelated to the first one. My girl is just a tumor factory. This one was able to be removed with a very radical surgical procedure, cutting wide and deep margins around it and having those margins evaluated for sneaky little cancer cells. The margins were deemed "clean" by the pathologist, and now, 1 year later, there is still no evidence of regrowth of that tumor, thank goodness. I watch her like a hawk, of course, and every lump or bump she gets is tested with an FNA (fine needle aspirate) while I hold my breath and pray.

Last week we did Verbal's yearly blood panel. I certainly had been noticing her change in eating and drinking habits over the last year-she has been ravenous! She practically takes your fingers off when you give her a treat, and, as gimpy as she is, has been finding ways to get up on the table and counters to scarf up food (especially the cat food) left there. She would drain her water bowl dry on a regular basis, and even raid the toilet for more water. These were behaviors she had never done when she was younger, and I was oblivious, attributing them to being a bad old lady dog, losing her manners or something. Well, the bloodwork showed that she has a very specific reason for these changed behaviors- Verbal has hyperadrenocorticism, or Cushing's Disease. Dang! What more does this sweet thing need to deal with???

I'll blog specifically about Cushing's later on, but basically it is an endocrine (hormonal) disease, caused by too much cortisol in the body. It can occur for various reasons-Verbal's is caused by a tumor on her pituitary gland triggering her adrenal glands to produce too much of this hormone. Cortisol mimics stress in the body, and we all know how much havoc stress can play on our bodies. I guess it is good because we have an answer to why Verbal is behaving the way she is, and can now go about the process of getting her treated for it. As with so many diseases, Cushing's cannot be cured; it will be a condition we have to manage for the rest of her life. Monitoring that treatment is particularly important because over-treatment can be very dangerous; hypoadrenocorticism or LOW amounts of cortisol in the body is Addison's Disease and can result in weakness, collapse, shock or even death.

Whew! That was some blogging I did there, huh? Can you tell Verbal is a "subject" I feel passionate about??? I love that dog, and was just talking the other day with my friend, Valerie, about this very thing. Some times we are lucky enough to have one special dog in our lives, our "heart dog," the love of our life-however you refer to the relationship, if you are fortunate enough to experience it, you just know what I am refering to. This new diagnosis of Cushing's Disease is awful, but we will fight it as we have every other battle in her life. She hasn't stopped wagging her tail, smiling, and just generally goofing around. I saw her upside down, rolling back and forth in the newly cut lawn on Sunday, just reveling in the feel and smells and all. You make what you will of life, and Verbal sure has made hers full and happy, despite all the challenges along the way. Yep, she has taught me so very, very much. I love you, Verbal dog.
Peace,
DrReneigh