I’m sure you’ve all heard of pancreatitis—the notoriously painful inflammation of the pancreas that occurs commonly in dogs. This organ is so sensitive that swelling in the stomach, intestines, or any other abdominal organ can make it swell, too. And when the pancreas swells, things can get very complicated very quickly.
Here's a pic of a pancreas nestled between a slice of small intestine and that olive-like thing we call the gall bladder:
Lizzie was a nine-year-old Boston terrier—until a couple of days ago. She was euthanized at the internal medicine specialist’s hospital after she suffered unexpected complications in the progression of her disease.
Sometimes we vets get in a little over our heads. And here I refer not to the complexity of the patient care involved (though this happens too, as it did with Lizzie) but primarily to the phenomenon of personal attachment.
I call it a phenomenon because I don’t understand why it happens. Occasionally a patient comes through my doors and inexplicably works his or her way into the very personal, emotional part of my psyche. It’s like the chemistry between lovers. You can’t really explain it or stop it. It just happens.
Lizzie was like that. Ever since the day I first met her (last week) she’s been in my head non-stop. I only knew her for a week but somehow she’s affected me more deeply than pets I’ve known for years. It was an instant connection. She and I got along as if we’d always known one another.
The first day I met her she had been vomiting all night and I determined that she had a significant amount of belly pain. She had been to the emergency room earlier in the week with an anal gland abscess and had been on antibiotics ever since. After running bloodwork and taking some X-rays it seemed obvious that we were dealing with pancreatitis.
Some breeds are predisposed to pancreatitis. Usually, it’s the small breeds like Yorkies and Poodles. Bostons fall into this category as well. Lizzie had always suffered from a sensitive GI tract. Nothing but a stable, unvarying diet for this girl lest gas and diarrhea disturb her quiet family life. This is a pretty common history for pancreatitis patients. They don’t exactly have stomachs of steel.
I assumed that Lizzie’s aggressive, multi-antibiotic protocol (not easy even on the steeliest of stomachs) was the cause of her pancreatitis. I changed her over to an antibiotic less gastrointestinally aggravating and hospitalized her for fluid therapy, nausea relief and pain control.
When our patients get pancreatitis the mainstay of treatment is supportive. This means that our job is to keep up with what her body is doing. Unfortunately, there’s no specific treatment for these cases. A vet has to tailor his or her treatment to the specific needs of the patient. Usually, that means addressing her physiologic needs (fluids, glucose, protein and electrolyte imbalances) as well as her comfort level (reducing fever, pain and nausea).
After a day I knew I was in trouble. Lizzie wasn’t responding well. Her pancreatitis seemed better (if the numbers were any guide) but Lizzie seemed sicker. After a weekend with me (getting round-the-clock home-style care) I transferred her over to Dr. Allison Cannon, internal medicine specialist extraordinaire. (I would have transferred her sooner but the weekend was upon me before I’d realized the sorry state of things.)
At the specialty hospital she rallied a bit. They confirmed my diagnosis with an ultrasound and made her more comfortable with a continuous infusion of pain meds (better than my every-four-hour protocol) and more effective anti-nausea medication combinations.
After suffering through a weekend of feeling stressed out and helpless with Lizzie in her little doggie bed beside me I felt tremendous relief that she would be well-attended to. So I kissed her on the forehead, leaving a little lipstick kissy mark, and went off to my conference with a good feeling about the whole thing. Lizzie would be fine and I’d come back to see her in great shape.
The next day she improved some more. And then came the day after. I’d called from Orlando to see how she was doing and I knew by the tone of the receptionist’s voice that I was about to get some very bad news. Sure enough, they’d euthanized her…after she’d gone blind.
How could she have gone blind? What happened? The internist was also stumped (Lizzie’s parents had declined a transfer to a neurologist for an MRI) but had to assume that Lizzie’s pancreatitis was more than just a manifestation of a simple antibiotic reaction. Pancreatic cancer spread throughout her central nervous system (or vice versa) was more likely the cause. Sure, the antibiotics probably hastened it, but one off meal or a little extra stress could have done it, too.
So here I was, in public on a balcony in an Orlando hotel, trying hard to control my emotions and feeling for all the world like the owner who needs to be consoled by a doctor on the other end of the line. Most of the time my compassion in times of death is so client-focused that I forget how it feels to actually mourn a pet. Lizzie brought it all back. I wish I could thank her.