One Sick Pup

This post has been over 4 months in the making so I'm certain I will forget some details, but here's a little of what our life has been like with Puddin Pop.  It's one of those cases of life going just great and then boom one day it all changes out of the blue.

I work from home on Fridays and on Friday, August 1, as Puddin was happily roaching I noticed a huge dark area on the inside of her thigh.  She hadn't had any troubles, no injuries, nothing out of the ordinary so it was very strange.  I took a picture of it on my phone and sent it to my husband at work and followed up with a phone call.  I had never seen anything like it before on her and my thought was that it was perhaps some type of skin irritation like some sort of rash.

I had to go to California the following week for work and since Tracy was going to be on his own, we agreed that I should contact our vet (which is over an hour from our house) in case we needed to bring her in - it was already nearly 4 pm on Friday.  Earlier this year, we switched vets based on a bunch of recommendations from other VAGA members.  Our vet is the owner of the practice and doesn't work on Fridays and the person who checks the email account had left early that day.  So, I turned to Facebook and sent a private message to our vet (whom we had only seen a few times prior to this incident) with the above photo attached.  Thankfully, she responded within a half an hour.  The bad news was her response "That is bruising and very abnormal. I would get her to an emergency vet tonight. It looks like your dog is bleeding under the skin. This could be from trauma or because there is some sort of clotting disorder."

I went into panic mode of course and waited for Tracy to get home so we could take her to the ER.  Not knowing just how serious this was or what the outcome might be, we decided that he would take her and I would stay home with Buford and our girls and pretend like everything was okay.  I'm really not sure how Lauren is going to handle it when something does happen to her beloved Puddin Pop and I tear up every time I think about it.

Anyway, as it turns out she was indeed bleeding and her platelet count was so low that the results came back at ZERO!  The normal range for dogs is listed as anywhere from 148,000-484,000.  She was diagnosed with idiopathic thrombocytopenia, or platelet decrease due to unknown cause.  The two most common causes are either tick-borne illness or immune mediated which means that her body's own immune system is destroying the blood cells - unfortunately, the latter is the case and I hate that there is no known trigger so we can't fix it, all we can do is react.

She came back home several hours later from the ER, they put her on prednisone, doxycycline (in case it was tick related), and an anti-nausea medication.  Since that day, we have made countless trips to the vet.  Puddin has to get her blood checked every 2-3 weeks and the last several months have been a roller coaster of ups and downs while trying to get the medication regulated.  Fortunately, she is very relaxed at the vets office (complete opposite of Buford whom really looks like he could have a heart attack every time we're there ). 

Her initial response to the prednisone was favorable and we were able to quickly get her platelet count up to a good range.  I had high hopes that we were in good shape at that point, but that was just the beginning.  As soon as we decreased the dose on the prednisone, her platelets dropped to dangerously low levels again.  She was also showing some of the side affects from the prednisone such as increased thirst, which meant increased urination, which meant several accidents in the house.  After a couple months of this up and down business on the prednisone dosing, our vet added melatonin and a drug called Atopica to our arsenal.  Atopica is approved to treat severe skin conditions, but has been shown to help with thrombocytopenia.  It is supposed to be easier on the dog's system as compared to prednisone, but reading the literature on it and all of the other problems it can trigger is scary too!  And at $88 for a box of 15 (she now takes them twice a day by the way), it's an expensive treatment option too! 

Some changes we've noticed since all the medications are that she has a new found love of the kids' crayons!  She actually seeks them out now...the kids have a tub of crayons downstairs and a basket with them upstairs and Pud actually digs the crayons out with her paws every chance she gets.  I've had to clean up a lot of this:

She also started eating poop in the yard every chance she got.  Totally disgusting, I know!  Thankfully, she rarely gives kisses :-)  I think this poop eating desire has waned recently though.  And since we're on the topic of poop, let's not forget to mention all of times that she has pooped in the house since all this started - ugh!  The girl who never had an accident in the house, now has them a couple times a week...often times within an hour of just going outside.  We mentioned these things to our vet and she said they were all due to the meds!  Great!  Especially considering she has to be on them for the rest of her life!

As if all of this wasn't bad enough, there's more!  I was on travel to CA again for work the first week of November.  Tracy sent me these photos of what he woke up to and asked how my morning had been so far.  That's piles of throw up in the bedroom - and there was poop in our bathroom. 

I guess he thought it was an isolated event at the time.  However, Puddin had started vomiting and unfortunately continued to so every 20 minutes or so for hours.  She was shaking, had a fever, and had trouble walking.  He took her the vet and she was so completely out of it that Dr. Grissom was worried that she had started bleeding into her brain.  It was that bad - while I hated to not be here for her, I'm actually really glad that Lauren and I didn't have to witness the whole series of events.  Tracy told me on the phone that he wasn't sure Puddin was going to make it through the day. 

She was referred to Veterinary Referral and Critical Care (VRCC), a 24 hour critical care hospital in Richmond.  She ended up spending four days there.  Puddin was diagnosed with pancreatitis.  All food and water was withdrawn for 48 hours to give her body a rest.  She was put on IV fluids and a catheter.  Tracy took this photo of her when he dropped her off.

She improved a little every day and began to come back to life - I never did see her in this state, but from Tracy's and the doctors descriptions it was bad.  So, what caused the pancreatitis?  The prednisone of course!  Here's a paragraph out of the very lengthy and detailed report from Dr. Harpold at VRCC.

"Pancreatitis appears to be the cause of most of her current signs. Pancreatitis can occur spontaneously, due to changes in food, increased richness (fat) in food or can be triggered by medications such as steroids. I suspect the prednisone played a role in her pancreatitis. This is a condition which results from the digestive enzymes made in the pancreas become active in the pancreas and it begins to digest itself. This leads to damage and inflammation and even destruction/necrosis of the pancreas as well as surrounding tissues if the enzymes leak outside of the pancreas. It can result in anorexia, vomiting, diarrhea, abdominal pain, changes in liver values, and even blood clots or bleeding."  While there was at first a concern over bleeding into the brain, in the end they believe her blank stare into space, difficultly walking, etc. was due to the abdominal pain, dehydration, and a drop in her blood sugar.

While trying to figure the cause for the immune mediated thrombocytopenia (IMT), VRCC also ran an in-depth tick analysis.  One of the thoughts was that it may be babesia which apparently can lie dormant in dogs for years and go undetected.  She was put back on round 3 of doxycycline (round 2 was for a scrape that she got on her leg and wouldn't heal) while they waited for the results of the tests, but all tick borne diseases came back negative and the test they ran is supposed to be highly accurate and does not present the level of false negatives that is found in the standard tick testing.

On day 3, they began to give her water and on day 4 they re-introduced food, 1 tablespoon at a time!  She was starving and ate it well and kept it down so she was released. The girls and I arrived back home the same day as Pud and while I did explain to Lauren that Puddin was in a doggie hospital, it was nice that we could all be back home together at the same time (this picture was taken before her hospital stay).

Due to the pancreatitis and increased risk of re-occurrence, we've had to switch Puddin's food to a low-fat prescription diet.  Two brands were recommended to us and we went with Royal Canin.

Let me tell you though that it was heartbreaking at feeding time!  When she came home, we were only allowed to give her THREE TABLESPOONS of food at a time, 4-5 times per day.  This after having not eaten all week, and throwing up everything that was in her system prior to that.  I truly wanted to cry watching how desperate she was for food and at the same time having to literally hold her back from Buford's food.  

In the past, we have always just left their bowls down and let them graze whenever they wanted.  They rarely ever ate when we first put their bowls down before and it was never an issue until now.  Buford has also had to go through a big adjustment because he's had to learn to eat when we put his bowl down - or just not eat.  The new diet is too low fat for him (not to mention even more expensive than the already expensive food we were feeding) so it's not like we can just easily switch him over.  Having to feed two different foods and try to monitor the bowls so they don't eat each other's (of course now that's all they want to do!) has not been fun.  We spent a week slowing getting Pud back up to a normal size meal and now they are back on their normal morning/evening schedule.

Since the meds have changed so much over time while trying to treat multiple issues and regulate the platelets, we've marked the calendar (some weeks the pred was every day and other times every other day, sometimes twice a day, other times once a day, etc) and had to make lists of all of Puddin's medications.  Here's what she came home from the hospital on:

We're down from 6 to 4 now, but I believe these 4 (Atopica, Prednisone, Melatonin, and Pepcid) will be for the rest of her life.  We've gone up on the Atopica (100 mg twice a day) and down on the prednisone (10 mg once a day) and she's had two good check-ups in a row so I'm hopeful that we may be getting to good place now as far as meds go.

So, I know this is long and probably too much information for my readers, but I wanted to do my best to document our experiences as much as I could...believe me, there's more that I could write, we are talking about over 4 months of change.  There have been times that I've wondered if we are doing the right thing.  There have been many days where Puddin just seemed mopey and depressed, now I know that part of that early on was simply due to the decrease in energy levels from her blood count being so far off - and of course now that she takes melatonin twice a day, I think that has some affect on her too.  However, I have never once wanted to give up on her simply because it was too hard or too expensive (Tracy is a little more concerned about that last part - ha!).  Our vet has never once mentioned anything about her quality of life other than the fact that it would take some time to get the meds regulated and once we reached that point, there was every indication that Puddin would lead a completely healthy and normal life.  She still greets us at the door with her tail wagging every day, she still craves attention and paws at us for more loving if we stop petting her, she is eating well most days, and is her normal happy loving self on most levels.  Yes, there are still some noticeable differences in her and we have had to adjust to the new normal.  The most frustrating part is frequency of accidents in the house (both pee and poop).  I am not naïve though and Puddin will be 10 years old on Dec 26 and I realize that she has a serious life-long condition.  Since all of this started, my short term goal has always been to get through the holidays and her birthday and then see what 2015 has in store for us.  I am trying to prepare myself that our time with Puddin may very well be more limited than I had once hoped...one of the hardest parts though and one that I have no idea how to handle is how do I explain it all to my Lauren??!!  I don't post often anymore, but if you follow my blog at all it's clear to see the deep connection Lauren has with Puddin.  Kids are resilient, but it will certainly be a very difficult transition when the time does come.  Feel free to send your happy, healthy vibes our way!