One frigid Christmas, many years ago, the boys and I were returning home from spending the day at the in-laws. It was just before dusk and I made my way along an abandoned Canal Street. For those not familiar with Manchester, New Hampshire, Canal Street is a street that runs through the mill buildings along the Merrimack River. Elm Street is one block above and runs above the mill buildings. It is Manchester’s version of the quintessential Main Street found in any town. I preferred to take Canal over Elm in order to avoid traffic lights. As I made my way towards the Amoskeag Bridge, I was stopped at a red light. I think the cross street may have been Dow. I could see a cat to the left of me lying still in the intersection. I felt a pang of sadness as I contemplated the violent end, and on Christmas no less.
As I waited for the light to turn green, I couldn’t help but continue to watch and ruminate. Was this a stray? Was there a child waiting for their companion to come home? As I watched, almost imperceptibly, I saw the tail move. I initially thought the wind was catching it, but then a wave a realization washed over me as I registered it was an extremely still day. There was no wind, no breeze, and no external force moving the cat’s tail ever so slightly. The cat was still alive!
I pulled over on the cross street, told the boys to stay in the car in my best stern mommy voice, grabbed some plastic bags, a big quilt I kept in the car just in case we were ever stranded, and made my way across the intersection. I was already crying. I thought my actions were futile, but she was alone and injured in the middle of the road and the least I could do was make sure she died being embraced in a warm car. I discovered she was lying in a pool of frozen blood. I put my hands in the plastic bags and thought about how one shouldn’t move anyone who was injured and tried to be as gentle and steady as possible. I literally had to rip her from the tar because her fur was glued to it by the frozen blood. I couldn’t hear it, but I felt her growl. I wrapped her in the quilt, picked her up, and made my way back to my car. I felt her growl a couple more times, but the sound was not discernable. I put her in my oldest son’s lap in the back seat and I told him to hold her while I drove and figured out how to get her help.
Because this was many years ago, it was before the internet and I didn’t have a cell phone. My mind raced to think about where the nearest pay phone was in order to figure out where there was a veterinarian who was open on Christmas. I recalled seeing a payphone at Hannaford’s on Bicentennial Drive and I made my way to the deserted grocery store parking lot. I pulled my car up to the curb. picked up the heavy, clunky, and icy cold handset, and called information. I was in luck, there was a 24 hour emergency veterinarian on Brown Ave. It was across town, but it was close enough and we headed there.
I braced myself and the boys for the worst during the ride. I prepared their expectations through my tears. I explained we would do what we could. It didn’t look good, but we could give her a better death than the one she was destined for. I constantly checked in on how she was doing, expecting at any moment she would be gone. I was dreading the moment my young son was going to tell me she passed. As we pulled into the parking lot of the emergency veterinarian, he exclaimed, “Holy S*#%!!!” I was already on edge and he startled me. I needed to know, “What, what is it, did she die?” His answer, “She just sat up!” I pulled into a parking spot, turned around to look and there she was sitting up in the middle of the quilt on his lap.
I jumped out of the car, wrapped her back up, and went into the veterinarian’s, bloody quilt, cat, and my kids in tow. I am an ugly crier, I’m sure I was a sight to be seen. There were two women who received me and they took the cat out back straight away. We waited and I continued to try to keep my children’s expectations in check. After some time had passed, the women came out and told me the cat was a female and she was going to be ok. They asked me if I wanted to go back to see her. I was elated. Just a short time before, I thought she was a dead cat in the middle of the road, and instead I was meeting the gaze of an alert little being with lots of shaved spots. The women explained she needed surgery and it would cost $800 and asked me if I could pay for it. I didn’t have $800. Despair began to creep back in again and one of them said, “Hold on, let me see what I can do.”
I don’t know how she did it, maybe she called the animal shelter, but she found the cat’s owner. The cat had been missing for days and the owner had been posting flyers looking for her. The owner arrived and went back to identify her. She confirmed the cat was hers and we hugged and we cried. She wanted to know where I found her, and she was amazed she was found so far away on the other side of town. They lived just around the corner from the veterinarian’s office. The veterinary staff gave me my bloody quilt back and advised me to wash it with hydrogen peroxide. It was amazing, I saved a cat, the veterinarians found the owner, the owner agreed to pay for the surgery, and we all have an indelible Christmas memory.
This is where my story veers from the past into the present. Decades ago, we didn’t have cell phones, social media, or crowd-funding. I have always had a question circulating in the back of my mind: what would have happened if the veterinarian’s office didn’t locate the owner?
Recently, a dog affectionately named “Elvis” was brought to the Littleton Area Veterinary Emergency Service (LAVES) under similar circumstances. We have some wonderful animal advocacy groups in New Hampshire and the search for Elvis’ family was quickly under way. Generous souls began to donate funds to help defray the costs of his medical care. Unfortunately, Elvis’ family was not found and Elvis did not survive. Because the donations accepted exceeded the cost of Elvis’ care, LAVES used the excess funds to start the Elvis’ Hope Fund to help future stray animals who are in need of medical care. This is what we need more of – an infrastructure to help animals who need medical care. I have seen great strides have been made in animal welfare and I hope that trend continues. For Elvis’ Hope Fund, I hope it flourishes and strays in the Littleton, New Hampshire, area are always able to to receive the care they need.
One of the most rewarding things resulting from Johnny’s Journey has been when folks have reached out to share their personal stories in order to educate others. It is especially rewarding when their stories have a happy ending. Too many don’t. This is Emma’s story, and luckily, she is still with us! <3
Last month, I received a message from Lynne O’Hare letting me know she was a longtime follower of Johnny’s page and that she recalled we had shared some posts warning followers about the symptoms of bloat, or in scientific terms, gastric dilatation volvulus. I recall sharing this video with Johnny’s followers. Unfortunately, Lynne was already familiar with bloat and its devastation because her aunt had a Great Dane who died from bloat previously.
Lynne describes the day started with Emma having some gastric discomfort during the early morning hours, which wasn’t unusual. Emma ate breakfast, however, she vomited it back up. In the past, Emma would rest and fast and her tummy would settle. This time was different, and in the afternoon, Emma began to retch but she was not producing vomit. She was drooling, foaming at the mouth, and pacing in obvious discomfort. Lynne made an appointment with her local veterinarian to have Emma seen. As soon as Lynne hung up the phone, she realized Emma’s stomach was swollen. Lynne called the veterinarian back immediately who instructed her to bring Emma in right away. The ride was 20 minutes.
Within 4 minutes of arriving, Emma collapsed and was in severe shock. Two veterinarians worked on Emma for an hour to relieve some of the gas and fluid in her stomach and stabilize her enough so she could be brought to an animal hospital for surgery. Emma had surgery to untwist her stomach, and she also had a gastropexy done (tacking of the stomach) to prevent recurrence.
Any dog can develop bloat, however, large, barrel-chested dogs are more at risk. It isn’t known why some dogs develop it, but the veterinary community has identified some items that may increase risk and have made recommendations to help prevent it. The current thought is pups shouldn’t eat from a raised food bowls, that pups should have multiple small meals per day instead of having one large one, that pups should be prevented from eating quickly or eating or drinking too much, that pups shouldn’t run or play heavily right after eating, and families should try to prevent stress. Bloat appears to run in dogs who are related to each other.
Symptoms include indications of pain like restlessness and pacing, drooling, retching without vomiting, retching producing small amounts of foamy drool, and swelling stomach. As bloat progresses, additional symptoms may include weakness, collapsing, pale gums, rapid heartbeat, and shortness of breath.
Bloat is an emergent situation. I’ve heard surviving surgery is about 50/50. It is an extremely painful condition and horrific way for your beloved companion to pass. Be alert. Emma is still with us because 1) Lynne contacted her veterinarian in time, 2) her veterinarian agreed to see her right away, 3) her veterinarians were able to relieve the pressure and stabilize her in order for to obtain life-saving surgical intervention. Dogs are resilient, but they are also fragile. This was a very close call! By being educated and aware of the danger, pet parents can ensure their dogs get the intervention they need.
Lynne took a series of photographs of Emma and has posted them on Facebook and shared them with us so we can see how quickly and severely the abdominal area swells when a pup is afflicted. The first photo was taken at home after the call to the veterinarian. The second photo is about 20 minutes later when Emma arrived at the veterinarian’s office. The final photo is about 4 minutes later when Emma collapsed in the reception area.
I’m so glad Emma is still with us and this is a happy story instead of another sad one. <3
Emma upon arriving at the veterinarian’s reception area
Emma at home before leaving for the veterinary clinic
Before Wishes, Maxie, Johnny, and Zuchie, there was Papa Bird. It hasn’t even been three weeks since we had to say goodbye to Maxie and our family is mourning another loss.
It was years ago when I was walking from my workstation to another part of the building when I passed a woman from customer service. I had seen her around the building from time to time, but I didn’t know her. I made eye contact and said, “Hello.” She responded with, “You. You will take them.” Needless to say the exchange caught me by surprise and I stopped in my tracks. She explained either her son and his girlfriend or her daughter and her boyfriend had a pair of bonded cockatiels that needed to be rehomed and she just knew I would take them. She had them at her home and we made arrangements in a very small, quiet, rural community for me to follow her to her home to get the birds.
They were in two cages. She explained they needed to be separated because they were male and female, but they needed to be with each other because they were bonded. She said she thought the one in the wire floor cage was the male and the one in the solid floor cage was the female. I asked her their names and she didn’t know, but then she said she thought the male was “Sunny.” On bright blue summer day, she helped me load two bird cages and two birds into my car for me to bring home.
We set them up in the dining room close to each other so they could see each other, but separate. Sunny would stand at the closest point to the other cage and scream. He did not think the living arrangement was ideal. It broke my heart to see the star-crossed lover pining for his love that he could never touch. I also felt they were captive in their little cages, so I soon allowed them to be free. Sunny hung out at his love’s pad rather than his own.
We discussed what we were going to name the birds, but we really couldn’t think of anything. While Sunny came with the name Sunny, it just didn’t stick. We found ourselves calling them “Momma Bird” and “Daddy Bird.” Being the parent of two children, I knew a little about the birds and the bees, but I did not literally know about the birds. My goodness, these two little birds had birdie sex constantly. There is a distinct sound they make and soon we would recognize when they were having sex from other rooms. They were adorable. They’d groom each other and were very affectionate. Momma Bird would sidle up to Daddy Bird and tilt her head begging him to primp and preen her, and he would. As lovey dovey as they were, they also had squabbles quite frequently. They had a volatile and passionate relationship. We were entertained.
Daddy had the cat call whistle down pat and would whistle whenever anyone removed clothing. Seriously. He was vocal. Whenever we used the microwave, it went beep, beep, beep as we pushed the buttons and Daddy beeped, beeped, beeped back. If he heard whistling on a TV show or if we whistled or even if a bird whistled outside, Daddy whistled in return. Daddy was a talker.
Hanging out on a wreath
Daddy Bird was more timid around humans than Momma Bird, and he appeared to be a bit less coordinated too. He was extremely dependent on her and if she flew away from him, which she did frequently, he’d panic and scream for her to return. We spent time after time trying to coax him unto us so we could return him to her location. We joked that we thought Momma Bird did it deliberately to get some alone time. We never understood why he had such a hard time navigating back, but he did, and he was also not quite happy with our assistance whenever he lost his way. This was our routine, however.
It didn’t take very long for Momma Bird to start laying eggs, cementing her name as “Momma Bird” and his as “Daddy Bird.” She laid the eggs on the solid floor of the cage. I read up on egg-laying and learned it was not healthy for hens to continuously lay eggs. I also read the eggs would need a nesting box in order to incubate. I let her tend to her clutches to discourage more egg-laying and then I would throw the eggs out after a couple of months and the cycle would start again. She had a clutch of two eggs she was caring for when on an early December morning my son called out to us from the Momma’s bird cage. He pointed out that one of the eggs was chirping. Low and behold, it was! We were going to have a hatchling. I was stunned. Both eggs hatched a day apart and Wafer and Cookie came into the world. I set up a little bowl as a nest and both Momma and Daddy took care of the little chicks. It was an amazing experience.
Our baby birdies
When the chicks’ pin feathers began to poke through, Momma Bird became obsessed with trying to rip them out. She was hurting the baby birds and we made the decision Momma needed to be separated from the family. Momma went to the wired-bottomed cage and Daddy became a single parent. He was an excellent parent. He fed and raised those baby birds and was just as attentive to them as he was with Momma Bird before they became parents. We allowed Momma visitation under supervision. The baby birds fledged and soon we had 4 cockatiels flying around the house. Sometimes Daddy Bird would still get stuck alone in another room and we would have to help him return to the flock.
Daddy Bird and Momma Bird began having birdie sex again and I conducted more research on how to discourage hens from laying eggs and soon Momma and Daddy were living in the wired-bottom cage and the babies were in the solid-bottom cage. That worked. Momma and Daddy returned to their passionate and volatile relationship, with Daddy giving his full attention to Momma, preening and primping her, interrupted only by their vociferous squabbles. They were incredibly amusing.
We lost Wafer to an accident, so Cookie was all alone. Soon I switched jobs and moved. When I did, I looked for a large wire-bottom cage that would be roomy enough to house all three remaining birds. Oddly enough, Momma Bird laid one more egg in the food dish, but that was the last time she laid an egg. Due to Wafer’s accident, and the fact we couldn’t trust Wishes with the birds like we could trust Zuchie, we confined them to their cage.
Momma was injured once and had to be in her own cage to heal for a time and Daddy returned to pressing himself against the cage as close as he could be to her and screamed. Once she could hold her own, she returned and all was right with Daddy again. Somewhere along the way and over time, Daddy Bird became Papa Bird. I’m not really sure how it happened. I noticed months ago his feathers around his eyes were thinning, similar to how I noticed grey coming in on Max’s muzzle – and dare I say my own head. Papa was aging.
He still chirped and climbed around. His squabbles with Momma Bird was replaced with squabbles with Cookie. He and Momma slept on a perch, Cookie slept on top of the water dish. If we sat near him and weren’t paying attention, he would throw seed at us. He was very skilled at tossing seed. He was curious and loved interacting with us, he would chirp away, tilt his head looking at us, and squawk anytime I tried to touch him. He had a strict look but no touch policy.
Yesterday was a day like any other day, the birds were chirping and squawking and doing bird things like they do. I heard fluttering in the afternoon, which isn’t all that unusual and didn’t alarm me as the birds will fly here and there in the cage. The fluttering stopped and didn’t escalate. When I stepped into the room a few moments later, however, I was shocked to see Papa Bird on the floor of the cage belly down with his wings spread. I swear I saw his eye open and I thought he may still be alive. I retrieved him from the cage; he was warm, but I didn’t feel a heartbeat. Papa Bird was gone. I cradled him and I envisioned Maxie was there to greet him and he traveled away on Maxie’s back.
On January 1, 2019, the Journal of the American Veterinary Medical Association (“JAVMA”) released a study assessing suicide rates for veterinarians. The sample for the study was obtained by the American Veterinary Medical Association (“AVMA”) obituary and life insurance databases as well as internet searches for deceased veterinarians. The authors of the study were three veterinarians and two medical doctors associated with the Centers for Disease Control and Prevention (“CDC”). The overall sample was reviewed by the three veterinarian authors for inclusion within the study. Out of the 11,620 veterinarians included, 398 veterinarians were determined to have died from suicide between 1979 and 2015.
The study cites several limitations, including information on non-decedent veterinarian populations from 1979 through 2015 was unknown. Lack of denominator data prevents the calculation of standardized mortality ratios, which are statistically stronger than the proportionate mortality ratios (“PMRs”), the methodology used. The study cites PMRs may be skewed by the high ratio of suicide within the sample population or by the low cause of death by other causes. For example, if fewer veterinarians in the sample die from heart disease than the general population, then the suicide rate for veterinarians may reflect higher rates. The study noted that for females, deaths by suicide was stable from 2000 through 2015 but the number of suicides “subjectively” increased with each 5-year period.
The purpose of the study was to conduct an updated assessment of PMRs for suicide among male U.S. veterinarians and to investigate PMRs for suicide among female U.S. veterinarians for the first time. Demographics within the profession has changed significantly over the past three decades. The study notes the profession has moved away from the agricultural based practice to companion animal based practice and that since 2017, larger than 75% of veterinary practices focus care on companion animals. The study also notes that since 2017 the number of practicing female veterinarians surpass the number of practicing males. The authors propose success of incorporating suicide prevention strategies may be evaluated by future studies of PMRs.
In November 2018, prior to the JAVMA publication of the veterinary specific study, the CDC released its analysis of suicide within occupations in one of its Morbidity and Mortality Weekly Reports(“MMWR”). The MMWR report noted during 2000-2016, the suicide rate among the U.S. working age population increased from 12.9 to 17.3 per 100,000. The CDC analyzed suicide deaths by Standard Occupational Classification major groups for decedents aged 16-64 years from 17 states participating in both a 2012 and 2015 National Violent Death Reporting System (“NVDRS”). The purpose of the analysis was to better understand suicide among different occupational groups in order to inform suicide prevention efforts.
According to the MMWR report, In both 2012 and 2015, the occupational groups with the highest suicide rates for males and females remained consistent. More males commit suicide than females, however, the highest percentage for suicide of 29% for both years was for females who were in unpaid occupations. The largest percentage of male suicides (19-20% of decedents) were in the Construction and Extraction group. The largest percentage of females among classifiable occupations was in the Office and Administrative Support group (15%). The highest male suicide rate was Construction and Extraction (43.6 and 53.2 per 100,000) and the highest female suicide rate was Arts, Design, Entertainment, Sports, and Media (11.7 and 15.6 per 100,000). The largest rate increase for males was in Arts, Design, Entertainment, Sports, and Media (from 26.9 to 39.7 per 100,000). The largest rate increase for females occurred in the Food Preparation and Serving Related group (from 6.1 to 9.4 per 100,000). None of these occupational groups include veterinarians.
The Health Care Practitioners and Technical Occupations group, which includes doctors, nurses, dentists, pharmacists, paramedics, veterinarians, and other medical and technical professionals, had a rate increase from 20.8 to 25.6 per 100,000 from 2012 to 2015. This group’s ratio in comparison to the total for all occupations for males remained consistent at 2%. The rate for females fell from 14% to 12% because even though suicides increased slightly for this occupational group (from 220 to 225), suicide rates have increased overall and at a higher rate for other occupational groups. The CDC has remarked there is limited data in determining veterinarian suicide rates in an earlier MMWR published February 13, 2015. Merck and the AVMA have also released a study in 2018 finding the veterinary profession did not have a higher rate of mental illness in comparison to the general public, but did have a lower sense of wellbeing.
The CDC noted in the November 2018 MMWR the etiology of suicide is multifactorial and identifying occupational factors that contribute to suicide is complicated. Both work and nonwork factors are associated with psychological distress and the relationship between occupation and suicide may be influenced by access to lethal means on the job. For example, law enforcement has easy access to firearms while doctors, nurses, and pharmacists have access to lethal drugs. The CDC’s veterinary specific report published in JAVMA attributed veterinarian suicide rates to a specific combination of factors unique to the veterinary profession that highlight a need for comprehensive suicide prevention strategies. Some of those factors included recognizing veterinary students are selected with certain personality traits, such as perfectionism, which has been associated with higher risk of mental illness such as anxiety and depression. The authors theorize occupational stressors, such as long working hours, client expectations, unexpected outcomes, communicating bad news, poor work-life balance, high workloads, rising veterinary care costs, professional isolation, student debt and lack of senior support may contribute to veterinarian suicide rates. The study recognizes the knowledge and acceptance of euthanasia as an acceptable means of ending suffering may influence veterinarians’ perceptions of suicide. In addition, the authors acknowledge veterinarians have easy access to lethal pharmaceutical products.
The authors suggest incorporating a subset of suicide prevention strategies recommended by the CDC in Preventing suicide: a technical package of policies, programs, and practices by Stone DM, Holland KM, Bartholow B, et al such as creating protective environments, teaching coping and problem-solving skills, and identifying and supporting people at risk. The authors proposeincorporating healthy work design and well-being concepts in the clinical environment to address compassion fatigue and occupational stress and offering continuing education on managing occupational stressors might help to reduce the number of suicides among veterinarians.
A number of media outlets have covered the JAVMA report. In my opinion, the focus on veterinarian suicides has been disproportionately covered. In light of the #MeToo movement, where are the articles discussing the suicide rates for unpaid women, the group with the consistently highest suicide rate across all other groups? While some articles covering suicide by veterinary professionals have been responsible, like this article published by Alex Johnson of NBC News and this article published by Katelyn Newman of U.S. News and World Reports, others have published articles blaming “misguided” clients and social media for an increased rate of suicide by veterinarians. While one might expect an inferior level of journalism from a website called cracked.com, I was surprised to see it in reputable publications such as the Washington Post in an article written by David Leffler and in a similar article written by Sy Montgomery published by the Boston Globe in 2016. The CDC studies do not support the conclusion clients are misguided or that cyberbullying has directly impacted the suicide rates of veterinarians. In fact, since suicide rates peaked prior to and remained stable throughout the evolution of the internet, the studies suggest cyberbullying is not a factor. I have heard the refrain clients are causing veterinarians to commit suicide for years now, I suspect there is a campaign to keep this narrative front and center.
The three articles attributing veterinary suicide to disgruntled clients and social media heavily feature the story of Dr. Shirley Koshi. Dr. Koshi committed suicide in 2014 during a custody dispute over a cat named Karl. The authors rely on an anecdotal story sympathetic to Dr. Koshi. The authors point out Dr. Koshi was subjected to internet scorn, but neglect to mention Dr. Koshi’s supporters also engaged in cyberbullying. The absurdity can be fairly summarized by an example of one of Dr. Koshi’s supporters wishing for pack of feral dogs to eat Dr. Koshi’s detractors. The comments directed at Gwen Jurmark, the woman on the other side of the controversy, on a YouTube interview are simply put, mean. The merits of the controversy was never decided as Dr. Koshi died prior to a hearing on the matter. There were no winners in the courts or on social media, yet, mainstream media is citing Dr. Koshi’s suicide as a talking point to undermine the credibility of those who would speak out on social media about their terrible experiences at the hands of veterinary professionals. Individuals like Corey Dafnis, who’s dog Milly bled to death after a receptionist at a veterinary practice botched a spay surgery, and Madeline Kayser, who’s dog Betsy died strangling herself after being left alone overnight after surgery after assurances Betsy would be supervised, are being discredited by national news organizations dismissing them as “misguided” clients.
Dr. Koshi’s suicide is tragic, as is Dr. Sophia Yin’s, or even Dr. Valerie McDaniel’s. I encourage the profession to incorporate some of the strategies recommended by the CDC to help mitigate suicide risk within the profession instead of projecting blame on clients. I also encourage the profession, in light of the evolution of the industry, to consider and revisit some positions, policies and practices contributing to rifts between veterinarians and clients, especially if the profession believes social media may contribute to veterinarian suicides. While maligning clients may have been effective in the past, in the age of social media, more and more clients will be able to set the record straight. The profession is quite lucrative, to the tune of $18 billion in revenue in 2018. Consumers and their companion animals deserve high quality and compassionate care at reasonable prices. It is time for the profession to be proactive, not only about suicide, but also quality care, affordability, and client relations.
I encourage news organizations like the Washington Post and the Boston Globe to refrain from discrediting consumers who have been victimized by the veterinary profession. I imagine if anyone did a study on victims of veterinary malpractice, it would yield pet owners who decided to end it all because they trusted the wrong professional to care for their beloved family member. There is nothing quite like the feeling of betrayal and guilt of entrusting your family member to the wrong practitioner, only to learn soon after the profession has successfully lobbied for extraordinary protections for veterinarians who harm pet after pet, family after family. Suicide is a serious matter impacting all demographics; it is not exclusive to veterinarians. Those who fall victim to its grip have lost hope. Please don’t contribute in taking away hope from victims of veterinary malpractice that one day their voices will be heard. It is commendable to want to help a profession prevent suicide within its ranks, but it is not admirable to do so by stepping on the necks of the victims who have been betrayed by members of that profession.
TL;DR – Dogs get better right away or not at all. There was a small study done on dogs that determined if the glucose level in peritoneal fluid is lower than the glucose level in blood by over 20 mg/dL, it is 100% indicative of sepsis.
Maxie lounging and relaxing on the sofa
I have lost a second dog, Max, to post-operative complications after a foreign body was removed from his intestine.
Our family lost our first dog, Johnny, just over 2 ½ years ago. He was young and an avid chewer. I had bought him toys, including rope toys for Christmas. At the time I didn’t know obstruction is a leading cause of accidental death of dogs. I thought it was a rare freak accident. I thought Johnny was good about spitting everything he chewed out. The combination of some plastic pieces from toys and string from the rope toy was fatal. The string became entangled with a couple of plastic pieces that stayed stuck in his stomach as his intestines stretched and pleated to try to move the string through and Johnny’s intestine tore. Johnny’s symptoms were vomiting, being less energetic, and decreased appetite. At times he shook. In retrospect, I remember him stretching his abdomen. He continued to defecate. He was sent home from the veterinarians multiple times. Johnny had surgery, but he succumbed to septic shock 17 hours later. I learned too late that continued vomiting, especially in young dogs, is indicative of obstruction. The veterinarians involved didn’t educate me until it was too late.When Johnny passed away, all I could think to do was educate and warn other families so that they would never experience what we experienced, and yet here we are, experiencing it again.
Maxie, looking stunning as always
Unlike Johnny, Max was an older dog and he was not healthy. He was diagnosed with Lupus when he was six. Max was trustworthy before Lupus. He didn’t chew on shoes, he didn’t get into the trash, he didn’t eat socks, and he hardly played with toys. After Lupus, however, Max became compelled to have something, anything, in his stomach. I don’t remember if we discovered he was eating socks or shoes first, but we realized we had to take the unmatched sock basket from under the settee in our living room and secure it in a bedroom. We realized we could not leave shoes by the door. Max had his first obstruction November 2016. I came home from work to find several spots of bile on the floor and Max lying down without greeting me at the door. I immediately brought him to the emergency hospital where he had X-Rays showing folds of fabric. Max had his first surgery to remove a sock.
Because Max had Lupus and was on a pretty significant dose of steroids, the veterinarian obtained special suture material from another veterinary hospital to increase Max’s odds he didn’t leak. Up to 15% of intestinal surgeries will leak. With Max’s weakened immune system, she went the extra mile to try to protect him from that devastating complication. Luckily, Max recovered without any complications, or so we thought.
After Max returned home, I put up a baby gate in front of the boys’ room to make sure Max wouldn’t go in there anymore. When we left the home, we secured our other dog in my bedroom with the hamper, closed the bathroom door, and Max stayed out in the living room/kitchen area after we surveyed and removed anything we thought he might decide to chew on and swallow.
Over Christmas 2017, I returned home and saw Max had gotten into the trash. Max had never got into the trash can before. If I threw out anything that would be particularly tempting, I took it to the outside bin to reduce temptation. I had company over and the lid wasn’t secured and Max could not resist the opportunity. I saw cut food bags, paper towels, and a plastic shopping bag with a hole in the bottom. The bag was dry; I was sure he must have ate the contents, but I couldn’t think of what was once there. A few days later, Max began vomiting. We went back and forth to the veterinarians a few times and eventually Max passed a sock. I wondered if the plastic bag that had a hole was a dirty clothes bag from our guest and didn’t come from the trash at all. Socks come in pairs, and Max only passed one.
Max finding some shade amongst blueberry bushes
A couple of months later, I recall coming home and finding Max had broken through the baby gate and was in the boys’ room while I was gone. I added an ex-pen outside the baby gate. Another time, I went out to shovel snow and when I returned I saw Max had broken through the ex-pen and baby gate and was in the middle of the living room, eating a sock. I reasoned he broke into the room because I was outside in that area and Max has severe separation anxiety. But after that I came home from work another time and found he had knocked over the ex-pen and the baby gate yet again. We adopted a new rule that the boys’ room door was to be shut at all times so there were always three barriers between Max and the room.
Max began to vomit again in May 2018. He had lost significant weight in the preceding months. Foreign objects can sit in the stomach for months before causing issues. I wondered about that missing sock from Christmas. I also had no idea what he may have eaten when he broke into the boys’ room those times. When the X-Ray was inconclusive and Max refused food, we got an ultrasound. The ultrasound revealed Max had something(s) in his stomach which could have been scoped out, but of greater concern, it appeared Max had a hernia and severe inflammation at the previous surgical site. Max had a second emergency surgery. The surgeon called me in the middle of the procedure to tell me Max had severe adhesions. Some of them could be broken down, but a lot of them would need to stay for risk of damaging Max’s intestines. Max did not have a hernia; he had a major abscess and a chronic inflammation. The veterinarian speculated Max had a reaction to the suture material used during the first surgery and she said she removed the prior suture material and used a different kind. She removed socks from Max’s stomach. The discharge papers were clear the adhesions were of great concern. They may strangulate the bowels at any time and Max could obstruct very easily.
Max gained weight back and recovered without incident. I am clear with guests no suitcases, bags, or dirty clothes can be accessible, no shoes can be left out. I heard noises coming from the kitchen area in the middle of the night over Christmas 2018. I got up to check on Max and found my son. I commented I came out to make sure Max wasn’t getting into the trash or anything. I saw the lid of the trash was ajar, but Max never got into anything when we were home, only when we left. I didn’t grab the trash and put it outside. Previously I did do that once, and Max ripped it apart when he was let out. I trusted Max didn’t get into things when we were home and went back to bed. Except this time he did. When I woke in the morning, I saw he had pulled a few items out of the trash.
Max, hamming it up
Max began vomiting on the overnight of December 30th. He vomited several times in less than an hour and then stopped. He appeared to have trouble defecating on the 31st. He was drinking water, but was reluctant to eat. We took him for a couple of walks to see if that would help him poop, but it didn’t. We went back to the emergency hospital.
The X-Ray was suggestive Max had ingested fabric. His blood work was good. Max had slightly elevated liver values, but at his age, it wasn’t concerning. The recommendation was for Max to have another surgery. The good news was Max’s clinical symptoms had only been exhibiting for one day. On New Year’s Eve, Max had his third surgery. A piece of fabric (a small dishcloth I had thrown out) was removed. The veterinarian said Max’s intestines looked healthy aside from the adhesions. He said if he was concerned if he tried to break the adhesions down, they would grow back twice as bad. Max was discharged the following day. He was eating, drinking, alert, and doing well.
Max continued to recover the next couple of days. The redness and swelling of his abdomen went down significantly. His incision was healing beautifully. I was impressed with the workmanship this latest veterinarian had done. The staples were evenly spaced and close together. It was clear this veterinarian was meticulous. Max defecated. I was over the moon that Max was sailing through this latest episode.
Max asked to go outside on the morning of the 4th. He peed like usual. He appeared to try to defecate but wasn’t able to. I noticed he didn’t seem very excited to eat and he was shivering. I put a blanket on him and I gave him his pain medication and antibiotics. He stopped shivering. It could have been from the cold or pain. I tried to feed him again in a couple of hours and he wasn’t interested. I called the veterinarian. I was told Max was at the early stages of healing from major surgery and I had only just fed him a couple of hours before and he could be full and I should wait a couple more hours and try again. He ate a couple of hours later. He drank. He followed me around the house wherever I went. He looked comfortable most of the time. He defecated in the afternoon. His stool was very loose, but he was defecating and he wasn’t having explosive or uncontrollable diarrhea.
Max wading in a local pond
Max would eat when food was offered but he still wasn’t very excited about it and he continued to drink. He continued to have diarrhea, but not a lot of volume. When my son fed him his afternoon meal, I asked him to feed Max a little bit more than what we had been. Max ate it. Max rolled over on his back with his legs in the air asking for a belly rub and I was encouraged he was feeling better. Shortly thereafter, Max came over to me and I began to pet him. I realized he looked off and then he vomited. Inappetance, diarrhea, vomiting… these are all signs that something is seriously wrong. We went back to the emergency veterinarian. My sister gave us a ride and commented how perky Max looked to her as Max climbed up the ramp into her vehicle.
The veterinarian examined Max. She took his temperature, normal. She checked his heart rate, normal. She checked his respiration, normal. She inspected the incision, which was healing beautifully. It was remarkable how nicely Max’s incision was healing. She listened to his abdomen and could hear bowel sounds. She did a flash ultrasound and nothing appeared to be out of the ordinary, there did not appear to be any obstructions. She could see solid fecal matter, she said she thought he would not have diarrhea the next time he defecated. Max was responsive and did not appear to be in distress. She commented that he still had food in his stomach. She noted there was a small amount of fluid in his abdomen, but that could have been attributed to the suction not getting all of the fluid out when he was lavaged. She thought perhaps he was having a side effect to gabapentin and we stopped it. She gave him alternate pain meds, cerenia, and stomach protectant. I was to give him his dose of antibiotics when I got home. She was confident Max was not leaking. He would be much sicker if he were. His abdomen would be hot and irritated. He would have a fever. When we returned home, Max refused his antibiotics.
I called the veterinarian again the following morning. I let them know that Max had refused his antibiotic the night before and he was refusing to eat again and I was concerned he was missing his antibiotics. I was told to try again in a couple of hours. When I attempted, Max ate and took his medication. However, a saying I’ve heard once began to echo in my mind, “Dogs get better right away or not at all.” I called the veterinarian again. I let them know that Max wasn’t recovering like he should and he needed to be seen again.
Max and I were in the waiting room when the veterinarian called to check on him. She saw us and did another examination. Temperature, normal. Heart rate, normal. Respiration, normal. Max was responsive. She was concerned. She said Max would need to be hospitalized and given intravenous antibiotics. We would take another full panel of blood work, we would do another ultrasound, we would take a sample of the fluid from the abdomen. She reviewed his blood work taken before and after surgery. Maybe this was related to his slightly elevated liver and gallbladder values he had prior to surgery. He was anemic, probably due to the Lupus, but not to the level where he required a transfusion. There is something is definitely wrong, but we don’t want to open him up again without justification. She listened to his abdomen again. She listened where she had seen the fluid the prior night and Max slightly vocalized. Pain. She listened again, he slightly vocalized again. I heard her say she wasn’t hearing anything. Dread. Pain and she didn’t hear noise where she should be hearing his bowels. I asked her to measure Max’s glucose as she was about to take him out back. She looked at me strangely and asked why. I said it will tell us if he is septic, right? I remember this from Johnny’s ordeal. Johnny’s glucose level dropped because he was septic. She agreed it would and she told me that the blood work we were already planning to do would show it. She took Max with her and he trotted along side her to the back room.
Yes, please. Max enjoying a snack on a hike.
A little while later a technician brought Max out to me in the waiting room. After a bit, the technician came out again with an alcohol bottle and needle and said she needed to take blood. I was surprised and asked hadn’t they already taken his blood. “Yes,” she said, “We need more blood to measure his glucose and compare that to the glucose in the fluid taken from his abdomen.” After she left, a man in the waiting room commented on how good Max looked, how responsive and intelligent he seemed.
The veterinarian returned and we went into an examination room. She let me know one of her colleagues had come across a white paper describing if a comparison is done between the glucose level in the blood and the abdominal fluid and if there is a difference of over 20 mg/dL, the abdominal fluid being lower, then it is 100% indicative of septic peritoneal effusion. They measured Max’s levels twice. His blood glucose level was 105/106, the fluid was 77. Max was septic. She said it was strange, she had spun the fluid, smeared it under a microscope, looked for pathogens and didn’t see them. The volume of the fluid didn’t look like it had increased from the prior day. However, the study said it was 100% sensitive and 100% diagnostic. Hospitalizing Max with IV antibiotics was off the table, he needed to be explored again. I consented.
I am an over-thinker. While I was sick with worry waiting for a call, I vacillated between positive and negative thoughts. Max’s blood glucose was normal and Max’s vitals were normal. Max had a history of chronic abdominal inflammation. Maybe the infection was localized. Peritonitis has a significant mortality rate. Max’s immune system was compromised. The most likely source of infection was a leak. Sepsis killed Johnny. The veterinarian said she wasn’t hearing bowel sounds in one area, which could mean the intestine was dead. The phone rang around 10:45 pm and I pleaded for it to be good news before I answered. She told me Max was in surgery and she removed some pus. On top of the infection, Max’s adhesions had strangulated part of his intestines and the tissue was not healthy. It was dark purple instead of rosy pink. When she was trying to break down the adhesions to find any more unhealthy tissue and potential sources of infection, she was damaging his intestines. The adhesions were so severe, she couldn’t ensure the tissue underneath them was healthy. She couldn’t see. She said she could spend another couple of hours trying to detangle everything, but she didn’t see a happy ending. She said in her nearly 40 years of performing surgeries, she had never seen intestines that looked like Max’s before. She said she consulted with two other veterinarians at the hospital and they both agreed surgery was futile. I asked her for odds. She said that she thought there was a less than 10% chance Max would survive and if he did survive, his quality of life would be negatively impacted. She recommended, as did the other two veterinarians, to stop the procedure and to euthanize him. She spoke to my son and explained this to him as well. He agreed it would be kinder to stop. We wanted to cling to that 10% chance of hope, but that meant there was a 90% chance we would cause Max to end up suffering a horrific and painful death because we weren’t willing to let him go. We agreed to euthanize him.
My intuition that Max was not recovering was spot on. The expectation is animals should consistently improve after surgery. Setbacks, even those that seem minor or temporary can be indicative of major complications. Both Max and Johnny did not appear to be as sick as they really were. The study on comparing glucose levels between blood and fluid was able to give us the justification to open Max up again. When peritonitis/sepsis is involved, early diagnosis and treatment is often the difference between life and death. I would have requested the test earlier if I had known about the study. I’m confident the veterinarian would have done it earlier if she had known too.
Maxie, up close and personal
We are heartbroken. This was a bad outcome. With that being said, it is important for me to share the experience we had with Max’s veterinarians was very different than the experience we had with Johnny’s. Even in Johnny’s case, I have different feelings about each veterinarian that was involved. Max’s regular veterinarians as well as his emergency veterinarians were responsive, compassionate, patient, thorough, kind, and gentle. I recall one of his regular veterinarians telling me after Max was diagnosed with Lupus that the idea wasn’t to prolong Max’s life, but to give him the best quality of life possible while he lives. He did that for Max. Max survived two obstruction surgeries because two veterinarians at two emergency hospitals helped him. Two veterinarians attempted to save him this last time. They weren’t successful, but they tried. Even though I had consented to spend thousands of dollars on Max’s last surgery, we were given the choice to stop when it made sense to stop.
Ever since Johnny died, I’ve educated families about obstruction and how it is a leading cause of accidental death of dogs. The most common symptom is vomiting, other symptoms can be diarrhea, difficulty defecating, painful abdomen, shaking, and lessened energy. Some dogs will stretch their abdomen, and sometimes bowels will be loud – I recall hearing both Johnny’s and Maxie’s bowels. The outcome of surgical intervention is very good if obstruction is diagnosed early. X-rays, followed by ultrasound should be taken if the X-rays are inconclusive. Sometimes X-rays can show soft material like fabric or plastic, however, X-rays cannot be relied on to rule obstruction out as they do not show less dense material like these very well. About 5-15% of dogs will develop leakage after surgery. Early detection and intervention is key to having a good outcome should leakage occur. Comparing the glucose in blood and peritoneal fluid is a diagnostic tool that may allow prompt diagnosis of peritonitis, which may allow sepsis to be addressed in its early stages, giving patients a chance at the best possible outcome.
I have also been educating families about the lack of accountability within the veterinary profession. I have advocated for families to be diligent in selecting veterinary care, to not only be confident with the skill their regular veterinarian has, but to also be confident where emergency care may need to be rendered. Families should have this plan in place prior to any emergency as not all animal hospitals are equal. Having competent care doesn’t guarantee there will be a good outcome, but it gives our pets a fighting chance.
Fly free Maxie. <3 We love and miss you beautiful boy. :’(
