That illness Roo went through didn’t so much end as taper off. The course it ran was an example of how confusing diagnosing and treating a sick dog can be. This post is for those of you who’d like to hear the whole story.
Her trouble started in early November. My buddy, Rockin’ Dr. Jim Raker, and I were hiking Roo on a lakeside trail in Maine when Roo, who was running around like her usual mad dog self hunched over and released an explosive bang of a poop. Someone once joked that if aliens were examining the Earth from a distance, they would conclude that it is run by dogs who lead human servants around on strings to clean up after them. Though this was in the woods where no scooping was necessary, of course I had a look at it. This was not your grandfather’s diarrhea. This was a noxious mixture produced by a disturbed gut.
“I don’t know,” I said to the Doctor. Dr. Raker is in fact a real doctor, but in reality he only practices medicine in order to finance his alter-ego, who is a bluegrass guitar picker. “That looks like she might have picked up some giardia.”
“Could be,” the Doctor said. “Or just a bug of some kind.”
We continued our walk. Roo started digging for a mouse at the roots of a tree, bringing Dr. Raker closer to murder than ever before in his life. Years of abiding by the Hippocratic oath won out in the end, though, and he spared us.
Now, every dog picks up a stomach bug from time to time. A day or two of diarrhea isn’t anything to get upset about. I expected it pass. For the next couple of days, Roo had to go urgently three or four times a day. It’s a lucky thing our security state hasn’t yet advanced to the point where you have to go through bomb sniffing machines to go outside, because whatever the chemical reaction inside Roo was would have gotten her placed in a steel canister and detonated in the middle of a closed-off street. She seemed to be carrying a load of cherry bombs around. Roo always resists going out after dark, preferring to hold everything in from sunset to nine or ten in the morning when she finally feels like rolling out of bed. If I could spare her I would loan her Science to be studied at a veterinary college for her ability to do this. But for a couple of days, she had 3 AM emergencies.
At first, I gave her Pepto-Bismal and fed her white rice and cooked chicken or ground meat and after a few days she was back to normal. But then, some days later, out would plop another wet stool or two. Then she would get better again, then worse, and back and forth like that it went. Her loose stool was the only problem. She never lost energy or appetite or seemed to feel at all bad. So, I didn’t pay much attention to it.
Up in Maine, winter held off for an unusually long time, but when a week of temperatures in the single digits was predicted we headed south and then west to Oklahoma. The pattern with Roo stayed the same. Soft stool came and went but she was otherwise fine. She didn’t slow down at all or want to exercise less or bother me less about being taken for walks or getting her treats. And, as will be clear to forensic biologists monitoring mouse populations in the future, her crime wave never let up at all.
A few days later, after an accidental overnight at a nudist colony in Georgia, we were in Oklahoma. Roo was again putting out the occasional loose stool, and even though there was no sign of worms, I dewormed her for good measure. That just added to the confusion about her growing sickness, because at first it seemed to return her to normal.
But then there were the first signs that something more was going on. It was subtle. She was happy and interested and hungry, but I started to wonder if I was watching her start to slow down a little, that perhaps I was just noticing her start to act her age. She didn’t seem sick. She just wasn’t running around as crazily as she always had.
And then, damn it all if after a few days her diarrhea was back.
This is one of the confusing things: if a dog appears to be healthy, and the only thing that’s off is loose stool, and then it goes away, was it a mistake not to have gotten her to a vet sooner? As it turned out, bringing her in wouldn’t have changed anything, but it wouldn’t always be that way. It didn’t matter because even after the many vet visits and treatments she was about to have, no amount of diagnostics would ever determine what had happened.
I took Roo to see Dr. Randolph Stokes, who, thankfully, turned out to be a thorough veterinarian of the old school, the kind who takes his time and discusses everything with you. I would see over time that even dogs who don’t like going to the vet seem relieved when they find out it’s going to be Dr. Stokes at the controls. He gave Roo a good once-over and found nothing wrong with Roo. Her fecal exam was clear. Everything else about her looked healthy. Glowing coat, clear eyes, pink ears, good weight, even an extra pound or two. I told him that there had been a small change in her appetite, which amounted to her putting breakfast in ed off until she reached the dining room, but in itself that wasn’t much. There had been other times when she didn’t eat in the morning. She didn’t seem to be exhibiting any signs of discomfort, so there wasn’t a sense of urgency. He listed several things that could have been the cause. The only ones that I could do anything about right away were pancreatitis and irritable bowel disease. Even though nothing showed up in the fecal exam, we agreed on a course of metronidazole to kill giardia or other canny parasites that might have been holing up and keeping quiet with guns drawn in her gut to avoid detection, what with the way this might have started in Maine (another possible source of confusion—that might have been when it started or it might have been coincidental).
The meds did nothing and Roo kept losing energy. This is a dog unsatisfied with a hard run of an hour, but now she began to ask to end her walks after only a few minutes, employing her signal of asking to carry her Flexi leash or my hat after only a few minutes. She started to dig the occasional hole, but lost interest in them and the bounty of mouses they promised, and then stopped digging entirely. Even jumping in the lake lost its appeal. She just wanted to lie on the floor looking miserable. Once in a while she moaned, and then began to grunt. She was having a godawful stomach ache. For a dog as tough as Roo to express discomfort it had to be bad. Then she began to emit a constant, sick-smelling, gas, which I at first didn’t recognize as coming from her because it smelled more like something chemical.
One morning, Roo woke with a terrible bout of acid reflux. She’s always had a bit of a sensitive stomach, and her cure has always been to jump up and down to be let outside so she can eat grass to make herself throw up. Usually I let her, though on the occasions when she takes it too far I stop her, worrying that if she ingests too much some won’t come up and will only make her feel worse. And there have been times when that’s happened and some strands come out the other end. There have been times when I’ve had to fashion a forceps with a pair of sticks to help pull a few particularly long strands out of her butt when one is stuck half in and half out and she tries to force it out but it is too small an item for her machinery to expel. It’s one of the funnier instances of human-canine cooperation, though not much of one to look forward to.
When the acid first hit that morning, I let her eat out to graze on the Oklahoma pasture grass. But this time it was obvious that this was different, because she didn’t just eat a little—she tore at the grass feverishly, and when that bucketful came up, it did nothing to help her and she wanted to get right back to it and I stopped her from eating more. Pepto had been relieving her but now it did nothing, and Nexium, which usually helps her quickly, wasn’t relieving her, either. We were back at Dr. Stokes’s office within the hour.
Though a lot of confusion ensued over the next weeks, none of it was because of any lack of attention, thoroughness or competence on the part of Dr. Stokes. I’ve only had total confidence in a few vets over the years, but Stokes is one of them. He’s one of those smart, caring top-rate vets. He did everything possible and warned me from the outset about further steps that might be necessary if his testing didn’t yield a diagnosis. It’s just a fact of medicine that not everything shows up on bloodwork or imaging.
The first thing that was different on this visit was that Roo reacted ever so slightly to having her belly palpated. She didn’t do that on previous visits. Dr. Stokes explained that a dog should show no response to the pressure at all, and though I couldn’t see it, he said that Roo was reacting. He guided me through it, and even then I couldn’t really tell. But I’m not an old pro like Stokes. The needle went in Roo’s neck for blood, and the results from what they could do in the office lab were all normal. The next day the results from the lab the rest had to be sent to came back. All of that was normal, too, with the exception of an ever so slightly elevated indication of pancreatitis. That number, however, was so minimally out of range that it wasn’t at all definitive. It was a number that appeared often on dogs with no pancreatitis at all. But as the only lead, we followed it.
First things first, though, and the immediate goal was to get whatever was going on inside Roo to calm down. She was suffering. Her gut was churning. The vomiting had to stop. Her insides had to be given a chance to relax so they could try to get back to work. Dr. Stokes prescribed Cerenia, an anti-vomiting med, and, in conjunction with the Nexium and Peptos, she began to feel a little better right away. The key to her relief was ending the nausea, and the Cerenia did that effectively. Roo was exhausted and couldn’t do much more than lie around, but at least she wasn’t gulping in pain from the acid or vomiting any more. In the meantime, Dr. Stokes got to work on the next step of diagnosing Roo, which would be a visit to an internal medicine specialist. The closest one was in Tulsa, 140 miles away.
Now, I never knew the first thing about pancreatitis before. The main thing that provokes that is fat. And carbohydrates, which dogs don’t need to begin with, don’t help, either. Roo wasn’t getting a lot of fat to begin with, but she did get some. A few pieces of cheese, a little half-and-half when I made coffee. A piece of pizza on the rare occasion when I bought some or a small burger on the even rarer emergency occasions when we stopped for fast food. And those of you who have been reading about Roo for a while might remember her love for things like the tortilla she scarfed up in the parking lot of a Nogales Motel 6 and bread, like the garlic toast that someone happened to knock off an outdoor restaurant table and into her path in Asheville once and that she pounced on instantaneously. I never stuffed her with bread, but I always gave her a little. I’ve always said that Roo is like Tony Soprano—she always got a taste of everything. No more, though. Sorry, Bearface.
This led to the next level of confusion. Roo was now on the anti-vomiting meds, the omeprazole and Pepto for the acid. Her diet went through an immediate change. So, with so many things being thrown at her, it’s impossible to know which one might be doing the trick. And maybe it was none of them. Maybe, given the chance to stop the nausea, she was just mending as she would have anyway. Who knows.
It’s amazing how Roo understands the relationship between pills and feeling better. After all, a dog can be bitten by a rattlesnake and swell up in agony half an hour later and still not connect the snake to the pain and go after another snake the next time they see one. But to this day, if she shows any sign of stomach discomfort and I take the bottle of Nexium from the drawer, she wags and comes right over and sits down to let me jam it down her throat. She is such a good girl about taking her pills, which was lucky, because what with food being an iffy proposition to begin with and her having to take so many of them, feeding her a constant stream of delectables while treating a digestive problem was something I preferred not to do.
Relieving Roo of her pain helped Roo quickly. Though she was weak, she was resting more easily, and, within a few days, she started to show signs of wanting to go out more. I didn’t wait for her to nose me for the Flexi, instead I kept her walks short just in case. She started to notice with a combination of frustration and glee that the mouse and rat populations she thought she had wiped from the face of east Oklahoma were beginning to reestablish themselves, and that interest was a good sign.
The earliest appointment the internal medicine clinic had been able to offer was a week after the last visit with Dr. Stokes. They said I could bring her in any time as an emergency, but, as Roo was starting to feel marginally better and they were 140 miles away and the staff had warned me that it wasn’t ideal to come in as an emergency, I called Dr. Stokes for his opinion. He recommended against it. He said that while they would work her in, they would be rushed and she might not get thorough attention. And there was always the option to bring her in if she got worse.
In the course of that week, she started to feel better. Her energy began to improve, she started exercising more and sleeping better. The Cerenia completely knocked out the nausea and her reflux was abating. By the time her appointment for the ultrasound in Tulsa rolled around a week later, she was starting to feel pretty good. Nowhere near her old normal, but not bad.
The most worrisome thing was that she was still only dropping cow patties, which meant that her small intestine wasn’t functioning properly and wasn’t absorbing water properly. And the mystery surrounding that was troubling. Something inside wasn’t working and none of the things that would usually account for anything like that weren’t evident.
The internal medicine clinic in Tulsa was a big, new, state-of-the-art facility with granite countertops and three receptionists with a small decorative waterfall behind them and sparkling new electronic gear all over the place. I warned the vet about Roo’s fears and that she was terrified of flashlights, so to make sure they covered her eyes if they had to use one. She didn’t want to go in back with them, and I had to perform a minor betrayal by pretending to go through the door with her and then doubling back through when she went, which is something no dog would ever stoop to doing. When she saw me turning back, she lay down on the floor with her head flat on the linoleum to refuse to go farther. But once I got her up and told her there was nothing to worry about, as I have to tell her about 20 times a day and which she usually believes when I tell her, she went quietly.
After the ultrasound the vet came to brief me. Roo was still in back in the examination room. Now, I’m sure this vet was a competent clinician—and he had a soothing and caring touch with Roo—but he had no capacity for communication. He volunteered only the basic outlines. Everything had to be extracted from him under interrogation. I considered strapping him to a chair and shine the exam light in his eyes to make him talk. A vet like that makes you appreciate one like Stokes all the more.
The ultrasound had only added to the confusion. Nothing obvious appeared. The only thing was that Roo’s pancreas appeared to have been only possibly and ever so slightly swollen, so little that they might not have been swollen at all. They were in the range of what a dog could have been naturally endowed with. The vet said he saw this all the time. And there are colors that appear on the ultrasound to indicate pancreatitis, and none of those showed up. So, more tests were prescribed: a better, more conclusive blood test would rule pancreatitis in or out and another test for Addison’s disease, a hormonal problem originating in the pituitary gland in the brain that also could have accounted for her symptoms. He returned to pull the blood and I waited for Bearface in the reception area. When she came out, she wasn’t in bad shape at all. She was a little on the disoriented side but she didn’t appear to have been frightened so much as stressed. She was of course as glad to get out of there as any regular dog would have been and didn’t see the point of my taking the time to pay the bill, but otherwise she was fine. I walked her, she dropped a cow patty, and we drove the 140 miles back to were we started and waited for results.
We were taking a walk the next day when Dr. Stokes called with the results. I was glad it was him and not the name-rank-and-serial number guy. Roo was actually running around and chasing someone when the call came. Nothing at all on the pancreatitis, with numbers smack in the middle of the range. That was ruled out. But the numbers for Addison’s suggested she might have that.
Determining that, however, required more testing, so we went on the next tangent, a glucose stimulation test. I’ve had those when two out of five lab results came back when I was sick a couple of years ago and my doctor sat me down to tell me to pick out a brain surgeon before they figured out that the whole two-month-long brouhaha had been caused by a miscalibrated machine in the lab. They pull some blood to get a baseline, then shoot you full of glucose. That, in turn, makes some hormones secrete or not, and if they don’t, presto. So it was back to Dr. Stokes’s office for that the next day. Though Roo was not pleased, she accepted her fate with considerable dignity.
It was odd having a few hours without Roo around. A definite step down. When I went back to get her, she was again glad to get out of there, but again surprisingly unbothered by her solo at Dr. Stokes’s office.
The Addison’s test came back negative and Dr. Stokes had conferred with the internal medicine vet. As Roo’s primary veterinarian, he relayed the internist’s recommendation for the next step, which was to run an endoscope run as far down both ends of her as it would go. For this she would need to be under general anesthesia. There was a caveat, though: the endoscope can not be routed into the tight windings of the small intestine, which was the very organ under suspicion for Roo’s persistent cow impression. And Stokes said that because of that, if they didn’t find anything, the next step the internist wanted to take would be exploratory surgery. I told him that in view of Roo’s improvement, that sounded extreme and he agreed. Dr. Stokes was careful to provide me with all the information necessary to make the decision. The risk was that Roo could get worse later on account of something that could only have been determined by opening her up, though no one seemed to have any idea of what that might have been. But she didn’t have cancer. Imaging had turned up no masses or any sighting more untoward a large pancreas. She had been imaged everywhere but up the Kahoo wazoo.
In a case like this, it was important to rely on my own understanding of Roo as much as the veterinary input. Roo’s illness seemed to have been progressing along a smooth curve. First she got sick and the curve went down, then more sick to the point of seriously ill, where it bottomed out, and then the curve started trending back upwards after she passed through her crisis. Had the trend not improved—had she remained as sick as she was at her nadir—I would have gone along with more extreme measures. But not now. No way. Even the endoscopy sounded like a long-shot and unlikely-to-succeed prelude to elevating the case to perform abdominal surgery. Though whatever it was that was making Roo sick would never be determined, it seemed to be a problem in the one organ—the small intestine—that wouldn’t be viewable endoscopically.
And slicing a good dog open without clear need doesn’t seem like a wise thing to do. Though anyone worries about the worst happening when their dog becomes too sick to move for a long time, she was on the upswing. Her energy wasn’t where it had been two months earlier, but she was getting stronger every day, feeling better, smiling more, interested in hunting again, reminding me again when it was time for her jerky and biscuits. If it wasn’t for the cow patties she was leaving in her wake, and if I didn’t have her previous energy levels to compare her to, it would have been hard to tell there was anything wrong wth her. And what about Roo’s view of the whole thing? All the work she had done to rid the Arklahoma border area of mouses might have been undone with the snap of a vet’s fingers. Perhaps new dog-resistant breeds would evolve, mouses with the jaws of chupacabras or who swam in boiling packs like pirañas might appear. They might never be conquered again. The psychological impact of seeing her life’s work disrupted like that that might have been too much to expect even a brave and singleminded dog like Roo to take. And what about the swimming problem? Under no circumstances would Roo give that up. She would have to be encased in a bathysphere and lowered into the water by a crane. No. I’m sure that if I cold have gotten her opinion, it would have been that.
Within another couple of days, Roo left something firmer than a cow patty in her wake. Not much firmer, but firmer. And within another week or so, the only thing she left behind were her days as a cow. She was back to normal. It’s been nearly two months now, but I still check her production every time and no one has ever been more glad to see a good, solid dog turd than I.
I was worried that all the downtime would be hard for Roo to recover from, and so I was careful to limit her walks for a while even though she wanted to do more. But finally, she was clear of whatever it was that had been ready to nail her, and all that was left of her recovery was to regain the rest of her strength, which she has. She’s as good as new. It’s once again certain that she will kill me with the amount of exercise she requires.
And here’s a confession: in the period before she got sick, when she was still running around and raising hell, just not as much hell, and it seemed possible that she might just be slowing down after crossing the five-year line, I found myself thinking, a little guiltily, that that might not be the worst thing in the world. I mean, the amount of wear and tear on me from making sure she gets all the exercise she needs is pretty bad. By the end of her walks all I can think about is washing my next dose of Aleve and Tylenol down with some strong coffee.
But I knew the answer as soon as the question occurred. Of course it was no. No part of the answer was yes. I wanted her to get back to the way she was. She’ll get old too soon as it is. She gave up enough of her turn on the planet when she was a puppy.
I wanted Roo to be Roo again, and as soon as she was, I let her fly.