LRVC is so busy these days that a scheduled appointment would be impossible. So Jean and I waited at the front desk; the staff were fantastic. We were told to bring Sweeny early this morning (Wednesday) and leave him there. Dr Russel Codd is well-known to us and he would try and find time during the day to diagnose Sweeny.
We were back home, minus Sweeny, by 8am. At 9:15am there was a call. It was Dr. Russ! Both Jeannie and I took the call.
Sweeny had advanced diabetes. His liver and kidneys were going and he was in pain. He had lost the will to live.
Very reluctantly Jeannie said that Sweeny should be allowed to die at the clinic. I agreed. Dr. Russ then said that that was the best decision and one that he would have taken if he had Sweeny as his own.
Sweeny kissing Jeannie. The year 2018!
But it was a shock to hear of Sweeny’s issues. We had no idea and, as was said, just two days ago Sweeny appeared happy and content.
From time to time I have let it be known that I had a second book stewing on the back burner. The title that had first come to me was: ‘Of Pets … And Of People’. The book idea and initial title had come to me from visits to our local Lincoln Road Vet Clinic where I had sat in on both Dr. Jim Goodbrod and Dr. Russel Codd as they saw pet patients. As I described it in my original post when I introduced the idea in June:
Some time ago, when we were visiting Lincoln Road, it struck me that the detail of what takes place ‘behind the counter’ of a busy vet clinic is most likely not commonly appreciated by those that visit said clinic.
I asked Russel one day if I might be allowed to spend time watching and listening to what goes on behind the scenes; so to speak. Russel said that he would be delighted for me to do that.
Dr. Jim at work
I subsequently started publishing posts under the general title of Visiting the Vet.
Back to the book.
Recently it came to me that the title was wrong. Because it didn’t speak directly to the potential reader about dogs.
So I came up with a different name: An Insight into Dogs and Owners.
Here is the Vision for this next book:
An examination of the world of the veterinary clinic including those who care professionally for our dogs and an insight into those people, from many varied backgrounds and circumstances, who have dogs in their own lives.
The first section, dipping into the extraordinary work that goes on in a modern vet’s clinic, is inspired by my belief that the majority of dog owners have very little idea of such work and the skills displayed by DVMs.
But let me move on by sharing with you the Introduction to the book. Firstly, these paragraphs:
There’s a tiny amount of domesticated wolf in all of us. The relationship between canids and humans goes back nearly 40,000 years, when dogs split away from wolves. With our dogs, we have traveled the ancient track from hunter-gatherers to modern humans. That track that in this 21st century sees us having untold numbers of dogs in our lives. In the USA alone there are: “In 2017, a total of about 89.7 million dogs lived in households in the United States as pets. In comparison, some 68 million dogs were owned in the United States in 2000.” 1
Yet a surprising number of those who have dogs as pets and are lovers of those same dogs admit to not really understanding what goes on behind the scenes in a busy veterinarian clinic. Yes, they know what happens when they take their dog to their vet but that view is almost certainly from the perspective of that dog and the specific reason why that animal had to to be seen by a vet.
An Insight into Dogs and Owners seeks to broaden the understanding of the reader to the range of treatments and procedures that are undertaken in a modern veterinarian clinic.
OK! More or less what I explained earlier on in this post.
But!!
But here’s where I do believe (fingers tightly crossed) many of you dear readers can help.
Back to the remaining part of that introduction:
But just as dogs do not live in isolation then nor do we humans. So the book sets out to explore the range of relationships that humans have with dogs. Perhaps better put as the book exploring the range of human circumstances that have led to people having a dog in their life. The homeless, those disabled persons who care for their dog, the service dogs that are, for example, the eyes and ears of the partially sighted and the hard-of-hearing. But not excluding exploring the relationship between police dogs and their handlers, those who work with cancer-sniffing dogs, and all the way through to Mr. and Mrs. Joe Public having a pet dog or two.
“.. explore the range of relationships that humans have with dogs.”
If, dear reader, you fancy working with me and can comfortably reply to the following questions, then I want to hear from you!
Where were you born?
Were there dogs in your family home from an early age?
When did you first have a direct relationship with a dog?
Describe that relationship.
Do you presently have a dog in your life?
And if so, what is the name of your dog and how did this dog come into your life?
Finally, can you articulate more or less in a single sentence just what having a dog in your life means to you?
These questions can apply equally to persons who have a dog in their life as part of the family and to those who work with dogs in their professional lives, those who train dogs, hunt with dogs, and those who care for dogs.
If all of this hasn’t put you off then email me at paulhandover (…at…) gmail (…dot…) com putting ‘Book Two’ in the email title. I will then contact you directly looking at the best way to listen and record your answers to those questions.
Dear people, again I must say this: CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
Back on the 4th May I posted the results of Hazel being scanned ultrasonically in a post Hazel’s Sonogram. Here’s a tiny extract:
Dr. Parker, who is a board-certified veterinarian doctor, came to the conclusion that the most likely cause of Hazel’s illness was the fungal lung infection, as Dr. Codd and the radiologist supposed.
But still Hazel showed too many signs that there was no improvement. Her eating was pitiful and the application of the Fluconazole (anti-fungal) medicine was not helping, bearing in mind that she was first seen by Dr. Codd over a month ago.
Dr. Codd’s advice was that we seek specialist help and yesterday morning Hazel was seen by Dr. Kimberly Winters, DVM, of Southern Oregon Veterinary Specialty Center (SOVSC) who, in addition, has a further qualification (Diplomate AVCIM) in Internal Medicine.
Based in Medford, about a 40-minute drive South from home.
oooo
Waiting to be seen by Dr. Winters.
Jean and I were impressed by the way we were received and noted that the clinic, Southern Oregon Veterinary Specialty Center, offered a 24-hour emergency service. Here’s a piece from their home page:
At Southern Oregon Veterinary Specialty Center, we understand the special bond between a pet and their human family. Our team of highly trained doctors, certified technicians and support staff partner with your family veterinarian to provide specialized diagnostics, surgery and emergency care for your pet upon a referral or emergency basis. Our clinic is staffed 24 hours-a-day, 7 days a week, to receive emergency cases and to monitor our critical care patients. The clinic’s board-certified veterinary specialists and staff are committed to providing exceptional compassionate care utilizing state-of-the-art technology and treatments.
Then we were called in and first seen by one of the technicians to record all the details.
Pulse and body temperature normal.
Then a short while later in came Dr. Winters.
Dr. Winters listening to Hazel’s rather laboured breathing.
Dr. Winters recommended a further xray of Hazel’s lungs and some blood work.
An hour later we had her analysis.
Dr. Winters said that while the condition of Hazel’s lungs could be an indication of a fungal infection she had her doubts. Or, in the words of her subsequent report:
There are several things that are not consistent with fungal infection – no high globulin level, no elevation in white blood cell count, no fever, negative titers, progression despite fluconazole treatment.
But the most important indicator of it being something other than a fungal infection was that the xray showed Hazel’s lungs to be worse.
My photograph of the clinic’s screen display.
This can be more readily seen if I publish the xray image of yesterday and the image taken on the 15th April; see below.
Xray image as of the morning of May 12th, 2016.
One of the radiographs taken of Hazel 15th April, 2016.
Despite not truly understanding these images both Jean and I quickly thought the top one, taken yesterday, showed a decline in Hazel’s lungs compared to the lower one, taken on the 15th April.
It was then time to seek Dr. Winters’ opinion.
Essentially, she said that she doubted the diagnosis of it being a fungal infection especially as lung fungal infections were very rare in Oregon. When I queried the fact that it might have been dormant for some time Dr. Winters thought that doubtful because the lungs, even a month ago, were displaying advanced disease.
Dr. Winters couldn’t be sure without a physical examination of the lung tissue but on the balance of probability she believed Hazel was at an advanced stage of cancer with the tumor somewhere in the body and that her lungs were showing that the cancer had metastasized!
A later discussion with Dr. Russ Codd and Jim Goodbrod confirmed this analysis with Russ thinking that the primary tumor might be in Hazel’s arteries. To a very great extent, it has become academic as Russ believes that Hazel will not have that much longer to go and that our main focus should be on keeping her quality of life as high as we can, for as long as we can.
Jean and I are devastated as you can imagine and later on when writing this post my thoughts were on some of the words added to the post Embracing Those Senior Years just last Wednesday. These words:
Hariod, your comments to Paul about your GSD really touched me because I myself am in that same space now with my almost 17 year old shih-tzu. We have always had a special connection but in the last year, as her age has progressed with it’s usual complications, our relationship has moved to another level – becoming even deeper than anything I have ever experienced; so powerfully in tune with each other, it’s incredible.
As I write this, every day she is with us is a precious bonus.
Our aging pets can be very troubling. I ‘ve been there and done that many times in about 60 years and even in my years before I left the farm to attend school. It doesn’t get easy and I always hate watching my pets age. It is devastating to lose them.
Then my words:
There are no favorites in our ten dogs but there are some that are more open in expressing and returning affection. It seems those dogs in particular tear us apart when they die.
I’m writing this post at 5pm yesterday (Tuesday) shortly after we returned home from collecting Hazel from Lincoln Road Vet Clinic following her earlier examination by Dr. Parker using his mobile sonogram.
Hazel at the clinic shortly before she was taken in by the staff.
The good news is that Dr. Parker did not find any sign of trauma or life-threatening illnesses in Hazel’s body especially focusing on her abdomen.
Dr. Parker to the left being assisted by clinic staff as he examines Hazel ultra-sonically.
(I should be quick to say that I left my camera with one of the technicians and wasn’t present. Indeed, Jean and I did not get to meet Dr. Parker.)
Dr. Parker, who is a board-certified veterinarian doctor, came to the conclusion that the most likely cause of Hazel’s illness was the fungal lung infection, as Dr. Codd and the radiologist supposed.
Nothing frightening seen!
To try and narrow down the exact fungal infection a further blood sample was taken and the lab results should be known in three or four days time.
Dr. Codd, in his briefing to Jean and me when we collected Hazel late afternoon, said that his recommendation based on the lack of any notable findings from the scan could be summarised as follows:
Regard treating the fungal infection as the number one priority,
Hold off from treating the tick fever in the interim,
Dose Hazel with 100mg of Fluconazole twice a day even if she is eating hardly anything,
The measure is whether Hazel, with a very small food intake, can take that dosage without vomiting,
Add a B12 tonic to her diet with immediate effect,
Give Hazel appetite stimulant medicine,
Consider the hemp oil (as queried by me) if the proper dosage can be determined.
(Petspeopleandlife: Hazel’s current weight is 53 lbs (24 kg). Any advice?)
Back home again albeit still feeling a little drowsy!
Thus while we have not yet got to the bottom of what precisely is the nature of Hazel’s infection at least we know there isn’t anything else silently killing her.
Thank you so much, dear readers, for taking so much interest in Hazel and for sending your love and caring wishes – it’s working! 🙂
Still a long way from getting to the bottom of what is ailing Hazel.
In my last post about Hazel I opened by saying:
In the last post on Hazel’s condition, back last Thursday, I passed on Dr. Codd’s observation, “… that by not having Hazel on her meds we were, of course, letting the fungal infection continue its damage.”
Dr. Codd also recommended reducing the dosage of the Fluconazole to lower its side effect of suppressing appetite.
So since then, with outstanding care and patience, Jean has been coaxing Hazel to eat just sufficient food for Hazel to be able to take the Fluconazole, for her fungal infection in her lungs, and Doxycycline, for her tick infection. (Mind you, Hazel is still a long way from eating reliably.)
That was a week ago and while, at best, Hazel is just eating sufficient to take her meds she is far from improving to any noticeable degree. But she is not eating enough food to stabilise her weight and yesterday morning Jean was worried we might lose her if we didn’t rethink what was going on.
Jean is attempting to get Hazel to eat many times each day.
A Sunday morning call to Dr. Jim Goodbrod brought us the advice to re-think the evidence.
The titre results were negative but because there are so many variants of fungal infection that was discounted.
The film of Hazel’s lungs show what the radiologist described as a clear case of fungal infection.
However, if that infection had been in the past, before Hazel was taken in by us down in Mexico, and that infection had ceased, that film could be showing scarring in the lungs.
The positive result for Tick Fever showed evidence of antibodies not antigens. That might be interpreted as a previous incident.
Jim liaised with Dr. Codd and it was agreed that further examinations needed to be conducted to obtain a clear, unambiguous diagnosis and that in the interim we stop giving Hazel any medications and offer her body systems a bit of a rest.
One option being discussed is to call in a mobile sonogram or ultra-sonic scanner. There is a very expert doctor in the area who uses such a mobile device and scans can be taken of Hazel’s abdomen and lungs here at home.
Because we will do everything to try and return Hazel to good health.
More information will be passed to you just as soon as it is to hand.
The powerful combination of good medicine and unconditional love.
In the last post on Hazel’s condition, back last Thursday, I passed on Dr. Codd’s observation, “… that by not having Hazel on her meds we were, of course, letting the fungal infection continue its damage.”
Dr. Codd also recommended reducing the dosage of the Fluconazole to lower its side effect of suppressing appetite.
So since then, with outstanding care and patience, Jean has been coaxing Hazel to eat just sufficient food for Hazel to be able to take the Fluconazole, for her fungal infection in her lungs, and Doxycycline, for her tick infection. (Mind you, Hazel is still a long way from eating reliably.)
Yesterday, (Saturday) Hazel was showing clear signs of feeling better but still having to be hand-fed by Jean.
Then this morning (Sunday) she really was perky and readily came out for a walk with the other dogs.
First time in recent days when Hazel has shown an interest in the world around her.
oooo
A return of a head gesture unique to Hazel that we haven’t seen in ages! 🙂
More generally, Dr. Jim was trying to track down supporting details to the observation made by Dr. Russ:
Namely, that there was evidence that fungal infections can lay dormat for quite long periods of time.
Jim sent me the following email:
Paul …
The following article is the one and only reference I have found so far that refers to the possible dormancy of this fungal infection. In paragraph 2 (Clinical Disease) I have highlighted it in red. I have to admit, I was skeptical.
Jim
The article was:
Coccidioidomycosis (Zoonotic) Last updated on 2/4/2011.
Contributors:
Rhea V. Morgan DVM, DACVIM, DACVO
Synonyms:
San Joaquin Valley Fever
Valley Fever
This is that domancy aspect from that paper that Jim highlighted (in red):
The incubation period in the dog is 1 to 3 weeks.1,2The organism can remain dormant, with exposure preceding the onset of clinical signs by 3 years or more.1,3 Although people may acquire the disease from the same sources as domestic animals and the mycelial forms are highly infectious, with one exception the disease has not been transmitted from animals to people. One published report exists of transmission to a veterinary assistant via the bite of an infected cat.15
Meanwhile, over in Brandy’s corner, he has very quickly healed after his neutering operation last Thursday. It was fair to say that he was not a happy chappy when he arrived home that day.
Didn’t like that!
oooo
And I can’t even lick my balls!
But his cone was off by Saturday and he is back to the wonderful, bouncing dog we all love so much. (Can’t believe that last Saturday was only the second week that Brandy had been with us; he has so quickly woven his way into all our hearts.)
Checking out the stables yesterday (Sunday) morning.
oooo
Behind that placid expression is the most docile, loving brain and heart one could ever wish for!
Returning to Hazel we are still some way from knowing that she has returned to a fully fit dog but the love and caring sent her way by all of you out there has been precious beyond imagination.
So said Sophocles. But too slow a decision, or no decision is, of course, a decision in its own right.
Last Tuesday in my update on Hazel Of art, and science I wrote:
It seemed to make sense that until we had confirmation of whether or not Hazel had a lung fungal infection, for which taking Fluconazole would be an excellent course of action, we should pause in her dose until the results were in.
At 08:45 this morning we had to take Brandy in to Lincoln Road Clinic for his neutering operation (that we heard a short time ago has gone well with no complications – he will be collected in about an hour). Dr. Codd asked after Hazel and we said that she was brighter but still not eating sufficient for her to be taking her medications.
Dr. Codd then made the eminently sensible observation that by not having Hazel on her meds we were, of course, letting the fungal infection continue its damage.
In response to the query as to why a fungal infection from either Mexico or Arizona had taken so long to appear, Dr. Codd added more sense to the situation. Namely, that there was evidence that fungal infections can lay dormat for quite long periods of time. Possibly in Hazel’s case the trigger for the infection becoming active was the additional stress on Hazel’s body systems from her recently contracting an Ehrlichia Infection from a local tick.
The final element for the argument of not delaying any longer Hazel’s healing medications was that the titre results would only be a result of one particular ‘brand’ of fungal infection. Dr. Codd said that it may well have been one of many other fungal infections that took hold of Hazel’s lungs.
So the decision was made to try Hazel on an oral anti-nausea med that would be much easier to administer. It is Ondansetron Orally. Also to cut down the dosage of the Fluconazole so that it doesn’t dampen Hazel’s appetite for food, a known side effect of Fluconazole, in quite such a dramatic fashion. (Note: Fluconazole is the least appetite suppressant compared to alternatives.)
So there we are.
We hang on to the fact that Hazel is still with us and coping with what is ailing her, albeit with a heightened stomach sensitivity that is complicating eating. Time is on our side.
A thousand thanks to all of you that have shown so much love and concern for our dear hazel.
Dear people, I must add this: CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
Finally, Mike Shannon is my guest blogger with a lovely post for Earth Day 2016 that will be published in a little under 10 hours time. That is why this post has been published now.
The learning and healing journey continues with Hazel.
The title to today’s post came from Dr. Jim Goodbrod, DVM. When he and I were taking a walk yesterday Jim mentioned that diagnosing exactly what an animal is suffering from is as much an art as it is a science.
Jim and Janet are close friends and neighbours who live a couple of roads away. Jim also attends the Lincoln Road Vet Clinic on a part-time basis. Off his own volition he has been speaking with Dr. Codd (Russ) about the situation with Hazel and the pair of them are showing incredible devotion to getting to the bottom of what is happening.
So, like yesterday’s post, today is being offered to you in the spirit of information. Forgive me if I repeat the caution from yesterday. (This is being written at 4pm on April 19th, 2016.)
CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
Late on Sunday afternoon Hazel was becoming so weak and lethargic that Jean and I feared that she wouldn’t make it through the night. So it was wonderful to see that she was alive and still connected to the world at 6am yesterday; Monday. Nonetheless, Hazel had not eaten since Saturday afternoon and was only drinking very small amounts of water. We made the decision to ring the Clinic as soon as they opened on Monday at 8am. They recommended that Hazel be brought in to go on to an IV drip to boost her anti-fungal intake and also to receive an anti-nausea intake to help her regain an appetite. But there was the question hanging over everyone that if this was a fungal infection, as in Coccidioidomycosis, that is not present in the Oregonian soil but is found in the drier parts of the USA and Mexico then why had it been such a long time before it brought Hazel down?
Jean also had this suspicion that Hazel might be suffering from a form of ‘Tick Fever’ that is very common in Mexico.
So off we went to the Clinic again. There were discussions about the whole situation.
Dr. Codd (RHS) speaking with Jean at the Clinic.
Dr. Codd took a quick blood test and, bingo, it revealed that Hazel was showing that she had, or had had in the past, an Ehrlichia Infection; a tick-borne infection.
The lower of the left-hand spots is the indicator of a past or present Ehrlichia Infection.
The cure for that was a course of Doxycycline.
So now we are looking at battling two separate diseases.
The blood that was taken from Hazel last Friday, when she also had radiographs taken of her lungs, had been sent for a ‘titre’ that would confirm one way or another if her lungs were suffering from a fungal infection. Those results will be available on Wednesday or Thursday of this week.
One of the radiographs taken of Hazel.
Back to Hazel’s lack of appetite. One of the side-effects of Fluconazole is that it depresses appetite. Getting Hazel eating again was becoming a priority. It seemed to make sense that until we had confirmation of whether or not Hazel had a lung fungal infection, for which taking Fluconazole would be an excellent course of action, we should pause in her dose until the results were in. To speed up the return of an appetite Dr. Jim prescribed a short course of Mirtazipine.
So that’s about it for the time being. Except for Jean and me to say how much we appreciate the art and the science that is being so skillfully offered by the Clinic. (As of 19:00 PDT yesterday Hazel was eating again! 🙂 )
Great team effort!
Their “Special Love of Animals” comes over in spades!
CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
About three or four weeks ago we noticed that Hazel’s bark was changing, almost as though she had a sore throat. In every other way she continued being the happy, lively dog that she is.
Then very suddenly last Thursday she started sicking up white, foamy bile and went off her food. Hazel rapidly became lethargic and lacking any vigour. Last Friday we took Hazel to our local Lincoln Road Vet Clinic and she was seen by Dr. Russ Codd, DVM. He took xrays that showed that Hazel’s lungs were far from being as clear as they should be. Potentially, Dr. Codd said that we could be looking at one of three things:
Some form of bronchial pnemonia,
A fungal infection of the lungs,
Cancer.
In view of the fact that Hazel hadn’t been coughing that ruled out 1.
Dr. Codd forwarded the xray pictures to a specialist. Later came the information that the spherules in her lungs, as seen on the xray pictures, were not as would be expected with a cancer diagnosis. Dr. Codd concluded that Hazel was indicating a fungal lung infection. Especially as this is commonly found in hot, drier parts of the USA and Mexico. Hazel was an ex-rescue from Mexico and for a couple of years we lived in Payson, Arizona.
The medical term for the disease is Coccidioidomycosis and I republish a little of what may be read over on the Pet MD website:
Coccidioidomycosis in Dogs
Mycosis is the medical term for any disorder caused by a fungus. Coccidioidomycosis comes from inhalation of a soil-borne fungus which normally affects the dog’s respiratory system. However, it is known (even likely) to spread out into other body systems.
The fungus spores begin in the lungs as round spherules, and live in a parasitic stage in the lungs until they grow large enough to rupture, releasing hundreds of endospores, which then begin a parasitic stage in the tissues, growing and rupturing, spreading out (disseminating) into the body perpetually. Endospores can also take a faster route through the body by way of the lymphatic and blood vessel systems, resulting in systemic infection — meaning the entire body will be affected. Coccidioidomycosis sets in from 7 to 20 days after exposure, though some dogs can develop immunity and never show any symptoms, especially younger dogs.
Dogs that are susceptible to the infection can become ill from only a small amount of the Coccidioides fungus, and fewer than 10 fungus spores are needed to cause the disorder. And though uncommon, Coccidioidomycosis is a deadly disease that originates mainly in the arid, hot regions of the western and southwestern regions of the U.S., and in several Central and South American countries. Coccidioidomycosis affects many different types of mammals, but tends to occur more commonly in dogs than cats. This infection is also known as valley fever, California fever, Cocci, and desert fever.
The condition or disease described in this medical article can affect both dogs and cats. If you would like to learn more about how this disease affects cats, please visit this page in the PetMD health library.
Dr. Codd recommended getting Hazel on a course of antibiotics with Fluconazole being his first choice. That commenced on Friday afternoon.
Early today (Monday) Dr. Codd will be seeking to narrow down the diagnosis with further analysis of Hazel’s blood being undertaken because while he was confident that it is a fungal infection he wanted to confirm precisely the nature of the infection.
I will publish more information as it comes to hand and close with these photographs taken yesterday afternoon.
Hazel taking a very slow walk outside.
oooo
But most of the time she just wanted to be left on her own in our bedroom.
We are holding Hazel very close to our hearts just now.
Learning from Dogs 