Farewell to Reo

February 16, 2015

Thanks, everyone for your comments, messages, and thoughts in the wake of Reo's passing.  We still miss her every day - some more than others.  I know she is with us all of the time, and she occasionally will "possess" one of our other Min Pins, which always makes us smile.

I have been meaning to write a post about what I feel are the contributing factors to Reo's decline, in the hopes that they might help another dog owner out there. I've been putting it off because of my own personal pain - I just wasn't ready.  Of course, hindsight is 20/20, and it wasn't until her final weeks that I was able to put all of the pieces together.  I still carry a huge burden of guilt for not seeing this sooner and being more proactive about getting her in for blood testing sooner than I did.  At the end of the day, she was a nearly 14-year old dog, with several health issues, and we knew we couldn't keep her forever, BUT I am her mama who loves her very much, and it's hard not to blame myself for things related to her health. 

At the beginning of 2014, we reduced her T4 supplementation dosage from 0.1 mg BID to 0.05 mg BID (we did this because she was showing clinical signs of too much thyroid - couldn't keep weight on her despite healthy appetite, restlessness, etc. - and her bloodwork showed her in the upper 50% of the reference range).  When we reduced her dose, she seemed to return to normal/stable and so we thought it was the right decision for her.  We also made the switch from Medrol to prednisolone liquid, because this was easier for me to adjust her dose when she needed a little more.  We were only able to get 4 mg Medrol tablets, and it was too difficult to make adjustments when needed.

As you might recall, Reo had a dental in July.  She had an abscessed tooth along the gumline.  We had tried different antibiotics and mouth treatments to get it to abate, but it just wouldn't go away.  So, she got a nice cleaning and a few extractions.  Her pre-surgery bloodwork looked great, and we had the anesthesiologist custom-tailor a plan for her based on her medical history (as well as monitor her surgery).  She was only under for about 45 minutes, and they let me be there and hold her/talk to her for her recovery to help reduce her stress.  It was kind of incredible the difference it made in her disposition after the surgery.  She was much more happy and energetic, and way more playful, too.  I regretted waiting so long (over a year) to get this surgery for her, and wished I did it sooner, because it was clearly bothering her!

At the end of August, we traveled back to the east coast with Reo and Leigh for my sister's wedding.  It was a stressful/busy time for all of us, and that was when we started to notice Reo's waning appetite.  She was still eating, just more slowly, was more picky about what she was eating.  This went on for weeks - somehow not severe enough for me to bring her to the vet, but somehow not quite right, either.  Clinically, she seemed to be doing ok - drinking her normal amount (which was always a fair bit), urine and stools normal to my eyes.  She was just slightly "off".

Around the end of September, I was at the end of my rope with the eating games.  She still would eat, but smaller portions, and I was using a rotation to keep her interested.  I noticed she was getting up earlier and earlier for a drink of water and/or potty.  So finally I made an appointment with my vet for a booster injection of DepoMedrol, an EI-1 panel, and regular bloodwork.

Nothing could have prepared me for how poor her bloodwork was.  Just two months ago, her blood chemistry looked great!  Now she was in kidney failure - BUN and creatinine were highly elevated, phosphorus, very high, and electrolytes out of balance.  Some liver enzyme elevations, too - but we were mostly concerned about the kidneys.  The CBC showed an infection, as well - very high white blood cells.  The EI-1 panel came back and her levels were awful - high estrogen, low cortisol, low T3 and T4, and low immunoglobulins.  I was hoping that the DepoMedrol injection would perk her up while we could get her infection under control.  We also did leptospirosis serology, which came back negative.

She had a week of IV fluid flush at our vet's - I would drop her off in the morning, and pick her up in the evening - to try and get her BUN down.  She had two different antibiotics (which I know did NOT help her appetite because they upset her stomach), as well as Denamarin for her liver.  Her appetite was extremely poor, and I tried to get her to eat absolutely anything she would (but tried to keep low phosphorous foods in mind).  We were also doing sub-cutaneous fluids at home, to try and keep her hydrated, and to help her body flush out the toxins.  I also joined the (incredibly wonderful, helpful, and knowledgable) K9 Kidneys Yahoo Group, who truly helped educate me, in a very short period of time, of everything I needed to do to help Reo's kidneys.

We had an ultrasound, which confirmed a kidney infection as well as mild pancreatitis (no doubt from letting her eat whatever she would eat over the past couple of weeks).  So now I had to find something low fat and low phosphorous that would entice her - not to mention all of her medication.  It was nearly impossible!  We had an absurd feeding and medication schedule, that occupied my whole day, essentially.  She was being fed every two hours, and many of her meds couldn't be given together and had to be spread out.  Reo HATED all of this, and started rebelling at all of the meds.  So, I began using a syringe to help feed her.  I would make organic baby rice cereal, and mix it with beef and veggie dinner baby food and syringe it small amounts at a time, mixed with some of her meds.  She would eat this way, but not on her own.  I even gave her "dessert" of baby food fruit, mixed with aluminum hydroxide powder to try and mitigate her phosphorous levels.  

There was no doubt we were scrambling, and very far behind, to try and help her.  I told her every day that I was paying attention to her, and she had to let me know if/when she was ready to stop fighting.  What I feel were contributing factors to Reo's decline:   

1) Reducing T4 dosage without running a re-check EI-1 panel a few months later to see her levels

2) Switching to prednisolone over Medrol without running a re-check EI-1 panel a few months later to see her levels

3) Anesthesia from her dental affecting her kidneys (could catheter insertion contributed to her kidney infection?)

4) Not running a re-check blood chemistry a month or so after her dental, which would have helped us pick up on the infection/kidney failure earlier

5) Some stressful travel events

Essentially, this was a "perfect storm" of events, that I feel all together contributed to her decline.  How could I have been so blind to not pay attention to all of this together?  She was just doing so well with everything until all of a sudden she was not.  *kicks self*

We were repeating blood chemistry and CBC many times to see where she was, and the disturbing thing was that the infection was not going away.  Some improvement in BUN and creatinine, but not enough to make her feel better.  There was slight improvement in white blood cells, but the infection was still strong, despite two different antibiotics (she was on oral, but we had also done injectables as well).  We were using Cerenia to help with her nausea and encourage her appetite.  I began to feel like we were fighting a losing battle.  

One morning, I had just syringed Reo's breakfast into her and had her all set up on the couch.  I went upstairs to get my coffee, and when I came back, she had thrown everything up everywhere and was just sitting in it, looking like she was in a daze.  It was at that precise moment that I knew it was her time.  I exploded into tears and lovingly cleaned her up.  The fire and spark in her was gone and she didn't want to fight any more.

We spent a day celebrating her - thanking her, loving her, cuddling her, kissing her.  We sang her song, 'Rio" by Duran Duran, and danced around with her.  We sat in the sun for hours, in the unseasonably warm October for Denver.  I fed her vanilla ice cream.  We cried rivers of tears.  We laughed at stories we shared of her antics.  I fed her more vanilla ice cream.  I made an appointment with one of my veterinary friends, who came to our house to help her earn her angel wings.  We sent her off with love, gratitude, and comfort.  All of our dogs were there with her, and she took her final, shuddering breath laying on my chest.  I can still feel the weight of her there, against my heart.

She was a once-in-a-lifetime dog, and a very special little girl.  She is profoundly missed by her family, including her "online extended family" of SARDS dogs and their owners.  I will continue SARDS education and group maintenance in her honor!  From my family to yours, thank you for your support.