I have been thinking about this case, despite it having ended several months ago. It still eats at me, so I considered not posting about it at all. Puppies and kittens are not all smiles and joy in a veterinary office, much to the surprise of the general public.
Lucy came to us as a puppy for her initial set of vaccinations and the owners noted that she had soft stool. She was routinely dewormed and vaccinated.
Throughout her puppy series of vaccines, the consistency of her stool never improved. Her littermates of her sex were close to 40 lbs. while Lucy weighed in at under 8 lbs. She was skeletally thin, her limbs proportionate, her hair coat rough. Out of context, you would have thought she was an abuse/neglect case. Her fecal consistency ranged from watery to pudding consistency daily. Her appetite was poor, though her owners reported that she played at home.
She was tested for Giardia, intestinal parasites both in-house and sent to reference laboratories. We tested her for pancreatitis, B-12 deficiencies, folate abnormalities, pancreatic enzyme deficiencies. We dewormed this puppy multiple times with broad-spectrum dewormers. Pre and probiotics made no difference, antibiotics made no difference. We supplemented her with parenteral B-12, anti-diarrheal medications.
Eventually when I had run the gambit on bloodwork, x-rays that I was able to do in-house for this sad puppy, we referred her to an internal medicine specialist. With an abdominal ultrasound and intestinal biopsies, all that was found was eosinophilic inflammation throughout her small intestine and stomach which was interpreted as inflammatory bowel disease. The internist began Lucy on a dose of prednisone that was immunosuppressive. The steroid helped her stool a little, but it never became formed, but was not watery. It also helped her appetite some.
So, I set out to a forum of veterinarians and specialists online to try and help this poor puppy because I felt that I had run out of ideas, run out of plans for her. We were making no headway, no weight gain for her. We switched her to a hydrolyzed diet, but she had no interest in it and had to be put on appetite stimulants. I wanted to test her for congenital Addison’s disease (a lack of steroid production within the body), but the owners could never wean her off the prednisone for me to test her.
Lucy continued to struggle and consulting with specialists had given me more ideas, but I could not make the puppy eat the food they recommended, nor could I make the owners compliant with staying off of steroids in order to do additional diagnostics. When Lucy was 11 months old, her littermates were weighing close to 50 lbs and she never managed to beak 8 lbs. She stopped feeling playful at home, she had no appetite even with medication to help, her stools were never normal and never had form to them. Her owners had become financially restricted and could not pursue a second opinion referral after their first one.
They asked me to evaluate Lucy and asked me what I would do if Lucy were mine. I hate that question most of the time because while I have usually seen similar cases, I am never in my client’s shoes. I do not have their house payments, their debt, their children, their own health issues, their employment status, or their life experiences. I told them what that what they needed to keep in mind was her quality of life, not her quantity of life. I asked them to consider what her favorite things to do were, did they see signs of pain at home, to think about what her future may look like because with the diagnostics so far, the tentative diagnosis and treatment were not improving her physical condition.
Perhaps a week later, about 2 weeks before Lucy would have been 1 year old, her owners elected humane euthanasia. I have never faulted them for this decision. Their puppy was suffering and they were suffering just trying to keep her going. They asked me if they should do a necropsy, what was involved in it, if they should spend the money to try and get an answer. I told them it may not give them an answer, that necropsy does not always reveal the underlying pathology. Ultimately, they elected not to pursue necropsy and had her privately cremated.
This case was one where I felt like I pulled out all the stops, did everything I could think of, referred as soon as the owners were on board with it, and when that got us nowhere, I turned to a forum of experts. Even then, it felt like I failed this puppy, like I failed their family. I will never know what the true underlying disease was or if I could have even fixed it. My boss still tells me that we did everything we could within our means and the clients’ limitations, but I can tell you that it still eats at me. I do not know that it will ever go away.
