A common reason for bringing a pet to the vet is because the pet is not his/her normal self. This vague health complaint could signal any one of several potential problems and takes some sleuth work on the part of the veterinary team.
Subtle or gradual changes in health may be hard to detect, but the sooner they are addressed, the better. What happens if you aren't sure there is a problem or not? Better safe than sorry - ask your vet. What happens when you are that vet, and that pet is your pet?
This story is about my beloved dog, Sophie. I first wrote about her on this site, shortly after we adopted her in 2002 from the shelter.
A Healthy Life
Sophie led an energetic life, helping raise our two kids and numerous pets throughout the years. She was healthy and pain-free, her only issues in life being noise phobia and separation anxiety. She taught me lots about those conditions over the years, and together we came up with workable solutions.
Our summer was an active one, with lots of walks and hikes and people-greeting. She was always in the lead, forging ahead of her slower (and younger) Greyhound housemates, Argos and Purl.
Then, A Change
It was a tiny change. The first-morning pee was a little more urgent, not the sniff-sniff-sniff before urinating, like usual. She squatted just a second or so longer than normal for her, too. I pointed it out to my husband while on a walk one day. See that? No, he didn't. But I did, and it was worrisome.
The Workup
I ran some blood tests and collected a urine sample as a first look.
All of the blood tests (chemistry profile, complete blood count) that August were normal, other than an upward trend - but still within the normal range - of the BUN (Blood Urea Nitrogen) and creatinine from blood work drawn in February. These two blood chemistry values are related to kidney function. The urinalysis was unremarkable except for the urine specific gravity - that revealed isosthenuria, poorly concentrated urine.
Was this a case of early kidney failure? More testing was needed. I consulted with my friend and veterinary internal medicine specialist, Dr. Zikes.
Next up, a cystocentesis, collecting urine via a needle directly into the bladder, to submit for a culture of the urine to rule out an infection. That was negative.
Radiographs were unremarkable. Abdominal ultrasound - liver, kidneys, adrenal glands, bladder, intestinal tract and more - all normal. There was one abnormal finding though, the spleen had some lesions. The spleen was of normal size and shape, but there were small irregularities in the tissue of the spleen.
The next step would be a needle biopsy of the spleen, but blotchy bruises, called petechiae, were noticed as Sophie's abdomen was shaved in preparation for the ultrasound. This finding could indicate a bleeding problem, so a needle biopsy was not a good idea until more investigation.
One lymph node (prescapular) was mildly enlarged. We sampled it and had that sample read by two veterinary pathologists. It came back as reactive, no cancer cells found. The node area became very enlarged post-aspirate, though. Bleeding had occurred.
It had been a week and a half since the initial bloodwork. We repeated the blood count. This time, there were virtually no platelets to be found. This is a condition known as thrombocytopenia. Platelets are responsible for blood clotting. Without them, bruising and bleeding (nose bleeds, profuse bleeding with injury or surgery) happens.
Thrombocytopenia may occur for a variety of reasons, sometimes no known reason (called idiopathic thrombocytopenia, more common in young dogs). For a 12-year old dog though, cancer is a common culprit. This was disheartening, to say the least. We needed to bring the platelet numbers up before going further diagnostically.
I started Sophie on prednisone, to control auto-destruction of platelets, and melatonin, which may help bring up numbers. Prednisone is no fun. My mild-mannered, who-cares-about-treats dog was now on the hunt for food, food, food. She was thirsty and needed to urinate more. But her platelet numbers improved. Until they took a dip. I added cyclosporine, a drug to help where prednisone was starting to fail.
Sophie did okay these two months. She still loved her walks, her treats, and being with her family, as always. But she was tired. My dog who seemed to never tire, even as recent as the summer, was tired.
The unofficial diagnosis: cancer, probably lurking in those splenic lesions.
Saying Goodbye
I knew from the start that anything was possible at her age of twelve. And, I knew that I wasn't going to go to extreme lengths to provide us with a few more months with Sophie, only to provide Sophie with a few more months of not feeling great. Deep down, my goodbye started as soon as I knew something was amiss.
Where is that line between feeling okay and feeling really crummy and struggling for a beloved pet? In these cases, it is murky territory at best. The benchmarks of what is normal keep shifting. The new normal might be going for one short walk when before that would not have even counted as a real walk. That's where we were.
Sophie was struggling when not on for the people she loved or out on a walk. Her appetite was waning, sleep was difficult, breathing was becoming labored, and I saw a slight bloody nose, telling me it was time.
The kids had the choice of when, and how, they said goodbye to their first life-long pet. Everyone is different in how they handle grief, and it was hard for everyone. I am thankful for medications to give Sophie a sense of calm, peace, and an easy send-off.
It is always sad. It never gets easier. Goodbye, my friend.