Monday, December 08, 2008

Pepa is a Very Sick Pup...

Today was the day we were to go pick out our Christmas tree, but instead we had a hard slap of reality and a tough reminder of the fragility of mortality as far as it concerns one of the great furry loves of our lives, Queen Pepa.

Part of the reason why I haven't been posting for the past several days was due to excessive work demands, but the more worrisome part I've not wanted to acknowledge just yet was that Pepa became very ill Wednesday night. We kept her under close observation from Thursday through last night, when we called Fernymoss' brother (who is a vet) for a consult as to what we should do. She had started acting oddly Wednesday night, becoming very lethargic and having difficulty breathing. Since it was long after Vet's hours when this began, we had little choice but to keep her under observation for the time being. Because she was obviously in distress in the stomach region, we at first thought that she must have gotten into something that had made her sick (after all, she has been known to scrounge from the compost pile) and hoped that it might just "pass" (so to speak) in a day or so.

Since neither of us was able to get her in to see a vet due to work on Friday and Saturday (and we haven't had a "regular" vet since Aaron got his degree several years ago because he examines the dogs when he's in town every 6 months or so), we knew we had to find a new "regular" vet who could deal with an obviously acute situation. So, we called Aaron last night and described the situation: Pepa was refusing food (but still drinking water), she was frequently gasping for air and coughing harshly and her stomach was distended and working very hard. She was in such pain that she couldn't find a comfy place to lie down and relax, so she spent most of her time on her feet, that is, until she became exhausted and just fell down. We knew this must be something pretty serious, so we sought Aaron's advice. Of course, I was more than beside myself with worry, because she is almost 15 years old, and I imagined all the worst case scenarios, the sum total of which equaled her imminent death. After talking with Aaron, he cautiously reassured us, but recommended we get her in to see a vet ASAP today (since we both had it off) to get advice based on a hands on exam.

So Fernymoss spent the morning combing the Yellow Pages looking for a vet or clinic that actually has Sunday hours, of which, surprisingly enough, there was only one, even in a city the size of Des Moines. Since I was essentially a basket case of worry, stress and nerves, Fernymoss called to inquire if they would take an emergency walk in. Our hearts dropped when the woman on the other end said no. When he asked how soon we could get her in for an exam, fortunately she replied 3:20 p.m. this afternoon. So from then on, we fretted and discussed various theories as to what the cause could be. At 2:40, off we went, hoping that they wouldn't be very busy and could get us in a little early....

Once we got to the clinic (in West Des Moines), they weighed her, took down some information and very quickly got us in to see the vet on duty. As soon as the vet listened to her heart, she asked me, "How long has she had this heart murmur?" I was dumbstruck, because she had never had this condition diagnosed before. She explained to us that Pepa has a quite severe heart murmur --on a scale of 1-6, she said this was a 5-- then my heart sank, and I began to lose it a bit. The vet did explain that heart murmurs can show up later in life in older dogs, and often with no warning, then she explained that she might be suffering from Congestive Heart Failure, but without x-rays and a blood work up, she couldn't be certain. So, once I consented to the tests, a vet tech took our dear pup away from us for about a half hour, one of the longest and most tearful I've had in quite some time.

When the vet returned, she said she was sad to confirm the initial CHF diagnosis and proceeded to show us the x-rays taken from 4 different positions. It turns out that Pepa has a frightening amount of fluid being retained ... from the esophagus all the way down into her abdomen. This is what was/is causing the difficulty in her breathing and has also resulted in a collapsed lung, thus the gasping and trying to breathe from her stomach, rather than her diaphragm. I thought then and there that she would recommend putting her down and started to lose it again.... Fortunately, that was not her recommendation and she explained that we could start her on a treatment that is often successful at managing CHF in dogs, though eliminating the excess fluid was the first, and most crucial, thing we had to address in her current sad state. So there was the glimmer of hope in her diagnosis, and hopefully, since this came on rather suddenly, we're hoping that her heart is strong enough to benefit from the CHF medicine (she prescribed Vetmedin for this) once the fluid retention is under control. She also explained the blood test results: Pepa is anemic, has some elevated liver enzymes, both likely due to the acute stress she is currently under, though her kidney function is very good, so that's a good sign for her being able to excrete the fluid she's retaining.

All in all, the prognosis is cautiously optimistic at this point, and given what a strong spirit Pepa has (not to mention her past excellent health --this is the first serious problem she has had), we're hopeful she will pull through this current acute crisis and we'll be able to stabilize her and manage the CHF from then on, through the use of diuretics (she's on Lasix now, just like many humans) and the Vetmedin. They gave her an injection of the Lasix to get her started (it's faster acting, of course) and instructed us to start her on the Vetmedin tonight and the oral Lasix tomorrow morning. They also gave us a couple of cans of a prescription very nutrient dense food to help her start getting her strength back to combat the anemia. We're to take her back in on the 15th for follow up, at which point the vet will re-assess her condition and see where we go from there with regard to further treatment. We're hopeful that the fluid will be greatly reduced by then (Lasix is apparently a very powerful diuretic) and that she will have gotten through this acute phase, but only time will tell....

Before we even left the clinic, we thought Pepa looked perkier and more alert than when she came in, but we were of course desperately looking for any sign of improvement compared to the last few days. To accomplish one of today's errands (and to take my mind off the situation a little bit), we made a quick visit to Big Lots to stock up on some food items (they have had some real deals on Campbell's Chunky soups lately) and other stuff we knew we'd find there. I was a bit worried about leaving her in the car for a half hour or so (it was chilly today), but we had an old comforter in there for her to lie on, and when we came back, we found her sitting up, checking things out, and best of all alert, with her ears up where they haven't been the past few days. Then back home to get her started on the Vetmedin and the new food ... happily, she was all "Oh yes!" on the food that I mixed in with her regular dry food, and probably would have eaten the whole can, but I was instructed to start her on half a can with the dry for the time being. Then I gave her the pill, concealed in a "Greenie" (a stinky play doughy type stuff) which she wolfed down eagerly.

Then we called Aaron to give him the report ... he was relieved to know that we had found a good vet who gave a comprehensive and thorough diagnosis and said that many dogs are very successfully managed on this regimen and that the injectable Lasix has excellent results in decreasing fluids in even just a few hours in dogs he has seen with CHF. He also echoed what our new vet said, that the next few weeks will be crucial to the eventual outcome ... if Pepa responds well to the medication, she may well have a few more good years with us. That's all and more than I wished for when I got up this morning, when I feared that she wouldn't still be with us tonight.

Of course, where diuretics are involved, there is a great deal of thirst and peeing involved, but I care little about that, as long as Pepa is able to get that excess fluid out of her lungs and body cavity so that we can work on getting her heart function improved. I can say that we have already seen some promising signs tonight ... her breathing is much less labored (though far from normal) and she has taken a few quick naps from which she has woken up more alert and interested in things around her. She's even started going back to some of her old ways such as scrounging around in the kitchen for anything that may have fallen on the floor while we were making dinner ... a small sign, sure, but something we haven't seen her exhibit since she started refusing food on Thursday. Baby Pepa steps, I know, but we've both decided that we have to focus positive energy on her so that she doesn't pick up on too much worry (that's going to be tough for me, less so for Fernymoss).

Interestingly, one of the questions on the form I had to fill out today was something to the effect of "Where animals are concerned, do you think 'a pet is just a pet' or do you think 'my pet is a very loved member of the family?'" Of course, you all know how I answered that one ... Pepa is my little girl and has been for the past 13+ years since she came home with me from the Animal Rescue League of Iowa, near the end of my previous dog Coco's life in 1995. We've had our ups and downs over those 13+ years, but we both cherish her as much as any human child we could have had during that time (and didn't have to go through puberty!) and we're going to do everything we can to make sure that her time left with us is as good as it can be. With any luck, as soon as this acute phase is stabilized, the prognosis on Quality of Life will be positive, but again, only time will tell. I feel much better at this point about that issue than I have in days, and I instinctively feel that Pepa has the fighting spirit to get over this hurdle so that she can remain with us for some time to come.... I really hope that I can see her help us celebrate the now even more meager (I'm $530 poorer today) holidays to come, and believe you me, she's going to be pampered and treated royally as befits her status as the one and only Queen Pepa (approximately).

A final note: I apologize for the length of this post, but there was a lot to report to explain what has happened recently with Pepa, and though I know there are some real Pepa fans out there, I didn't want this to become a maudlin plea for sympathy, at least that's not how I intended what I just wrote. I deliberately did not include a photo at this point because she really does look sad at this point, and that's not the Pepa we all know and love ... when she starts to improve and demonstrate her usual peppy attitude, I'll update with those pictures, but for now, she needs her rest and time to start recuperating. I'm sure you'll all understand.

Thanks so much for reading and understanding where I am emotionally right now. It means a lot to us.


Gail said...

Dear IVG,

I am so sorry Pepe has been ill! We love our pets and they are our children...It sounds like she is well on her way to being her 'young' self and you and Fernymoss will have more good times with her!

I wish I had gotten pet insurance before my cat, Coal had aged and developed some health issues! I wonder if it is helpful to have?


Roses and Lilacs said...

IVG, I'm sorry. My beloved old cat is going thru kidney failure. Heartbreaking times. I hope your vet can control this and you can have a couple more good years.

FARfetched said...

Good thing her kidneys are good… Lasix stresses them quite a bit. That's what nearly whacked my father-in-law a couple months back (he also has CHF). But like you said, it works FAST and Pepa shouldn't have to be on it very long.

Also good to hear she's recovering quickly!

olivia said...

Sending positive vibes toots. I'm glad to hear that she's improved w/ the medication and back to a few of her old mannerisms. Give Ms Pepa some loving from me, and xoxoxs to you and FernyMoss and Rolly.

boran2 said...

IVG, I'm glad that you were able to get some good medical care for Pepa. Hoping that she is well soon.

NDD said...

Sorry to hear of Pepa's health challenge.

Let's hope the medicine does the trick.

Happi sends best wishes to Pepa, you, FernyMoss and Rolly too.

Iowa Victory Gardener said...

Hi Gail,
Thanks for the kind thoughts ... yes, she is truly our little girl, complete with the independent spirit and even petulance at times, lol. I don't think she'll recover to where she was in terms of energy, but as long as she can regain a comfortable quality of life, that's good enough for me.

I know of pet insurance, but as for the details, nothing. I do know that the dogs are covered by our car insurance if they should be injured in an accident, and that's just an extra perk they give us. I hope we never have to use it though....

Iowa Victory Gardener said...

Hi Marnie,
Thanks, because I know you have had loss of your animals recently, and you know exactly what it all means. It's Voodoo who is sick, right? (I think you mentioned it a while back.) Kidney failure is heartbreaking, no matter the animal involved. Thankfully Pepa does not appear to have that issue, and the vet considered that a very positive sign as well.

Good luck with your cat, and I know you will give him all the love and the best care he deserves, because I know you are truly a kind soul. :-)

Iowa Victory Gardener said...

I remember you talking about your FIL (he's the O'Liely watcher, right?) Pepa can be stubborn, but I think he's got her beat and so far she is being the best little patient, taking her meds and getting her rest (no O'Liely for her, it would likely finish her off!)

I thought I had read that Lasix was a bit tough on the kidneys (too much Pharma market research I've done over the years), and I know that the worst thing for cardiac patients is to have kidney issues along with the heart, so we're hoping for the best!

In the long run, it's the success of the Vetmedin that has me concerned ... I did read the clinical trial info in the package insert and they reported 70+ % success rates, so I read that as 50/50, given Pharma companies' history of reporting. Still, that's better than a lower number!

Iowa Victory Gardener said...

Oh Olivia,
Thanks so much. It means a whole lot to us ... I already told her several times tonight that her aunt Olivia in Ottawa was sending her hugs and kisses. :-)

Iowa Victory Gardener said...

Hi B2,
We were so lucky to find this vet, and on a Sunday, no less. Pepa is in good hands and we both thought that everyone at the clinic emanated good vibes. It's clear they take a personal interest in the animals they treat, and that's comforting for us as well as her!

She'll never be "well" due to the nature of CHF, but if we can get her past this crisis and into a managing situation we'll all be much more relieved. Right now it's getting rid of that fluid that is the big issue before we can address longer term issues, but she's only had 2 doses of the heart med so far, and it does take some time to kick in....

Iowa Victory Gardener said...

Good to see you venturing out of the wilds up there. :-)

Thank you so much for the concern, and I know it's sincere given your long years with dogs ... you're a true dog person.

So far the Lasix seems to be working on the fluid issue ... we'll see how the Vetmedin does over the next few weeks as well.

We send our smiles, love and best wishes back to you, Ms NDD and especially Happi!

Annie in Austin said...

Best of luck to Pepa on gaining some strength and my sympathy to her dogparents...don't forget to breathe once in awhile, Fernymoss and IVG.

When our daughter's cat was deathly ill my husband chose saving her cat over getting a badly needed kitchen floor - I understand the financial aspects, too and you get my sympathies for the vet's bill.

Annie at the Transplantable Rose

Shady Gardener said...

IVG, What a traumatic situation you and Fernymoss have been through with Pepa's health. It's so very difficult, isn't it? Every parent can identify with the helplessness one feels when their child is enduring health problems. I'm relieved to read that she is feeling some better and hope it continues!