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
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. :’(
