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Portions of this article appeared in a two-part series in GREAT SCOTS MAGAZINE, Aug. - Sept., Vol. 13, No. 4 , and in Oct.-Sept. Vol 3., No. 5: "A Stone's Throw: Ripples Across Time with Scottish Terriers." Bonnie Sue: One Scottish Terrier's Experience with Adrenal Exhaustion and SARDSBy Russie McDement-Fogarty Previous | Page 1 2 3 4 5 6 7 8 9 POSTSCRIPT: After several months of steroid injections, we re-ran Bonnie's adrenal panel once more and found that she was still not in balance. We conferred with Dr. Plechner who indicated that perhaps higher doses of injectible steroids, using a different mix, might be indicated in Bonnie's case. Bonnie had two doses of these injections. We observed that she panted a lot and had a little bit of noisy breathing, but nothing serious. However, to take proper precautions, we took her to our local vet, who took x-rays and thought her heart was enlarged and her liver, too. We took her on to a cardiologist in Leesburg, Virginia, who assured us that her heart was not enlarged and that she simply had a "Scottie heart." He said that many broad-chested breeds like Scotties or Boxers have larger hearts simply because the chest cavity makes room for it. Since her liver has been somewhat enlarged for the period we've owned her, we didn't feel we could do anything differently for Bonnie than we were at that time. So, we continued on with her treatment. One night, after dinner, she seemed to have noisy breathing and didn't want to sit or lie down. After a satisfying meal, Bonnie normally goes straight to sleep. I noticed that she went out to potty, but produced bright red bloody diarrhea and seemed very uncomfortable. I gave her some Loperimide (a medicine we had on hand for another Scottie we'd owned who suffered from IBD) and continued to watch her. As her breathing grew more labored, I noticed couldn't and wouldn't lie down. I quickly decided to take her to the Emergency Clinic, where the vet there gave her Cephalexin and was sending her home with me without any other treatment. I explained all about her adrenal exhaustion and offered a CD with all of Bonnie's records, but they weren't interested in seeing it or hearing about her problems. I wasn't with her when they were examining her for the hour she was there because all the client rooms were taken, so they took her to the back where they wouldn't permit me access. I think they left her in a cage while they ran the CBC and she grew much worse during that period of time. Then the doctor trotted out and gave me some Cephalexin and said she'd be fine. I told them I didn't feel Cephalexin was strong enough to handle what I had observed. They reassured me it was and then brought Bonnie out to take home. Obviously they didn't have a good look at her when they tried to give her back to me to take home. Nobody would have let a dog who looked like she'd had a major stroke go home with just antibiotics. She couldn't stand and her head was lolling around, her tongue was dark purple, her gums dark, too. She was gasping for breath and completely out of it. I said, "Hey, wait a minute, she can't go home like this!" The vet tech told me she was so glad I questioned them and brought her back. She agreed with me that she had become much worse and that her gums had been a good color when she came in, but I pointed out they were now blue and her tongue was purple. I will never know why they didn't want to give her oxygen to begin with since she was having trouble breathing. They told me later--after all was said and done--that they "didn't want it to interfere with anything." I wondered later what oxygen could possibly interfere with in a dog that was gasping for breath. It seemed from my point of view, it interfered with her continuation of life! But at that point, she was put on oxygen and in a very short while of observing her, the veterinarian suggested euthanasia. I asked for an x-ray, which the vet said (as did our earlier vet, but not the cardiologist) that she had an enlarged heart. Her lungs looked "crappy" he said, but didn't sound nearly as bad as they looked. The vet felt she had a "cardiac episode." We watched her for about an hour, and she got no better--really much worse. I explained to the vet again all about Bonnie's adrenal exhaustion, her SARDS and her enlarged liver. But the vet had no insight to offer and I felt like she was suffering so there was nothing else to be done. I am all about the ends justifying the means, but looking at her, it didn't seem the end was going to be much to be happy about. So, I chose to euthanize her at about 3:00 a.m.on the morning of November 10, 2008. I am sure, looking back, it was the right decision. Distraught, my sole focus became trying to ensure that whatever could be learned from Bonnie's death would be brought to light. A new vet we had switched to before Bonnie's death, Dr. Clara Mason, agreed to my request to do a necropsy for Bonnie. I actually ended up assisting Dr. Mason during the procedure, mostly labeling the specimens as she worked. I admit it was all a bit surreal and at times, painful to watch. However, knowing we own two of Bonnie's children and this was a heritable disorder kept me motivated to see it through. If there was anything to be learned from Bonnie in death, I felt I had an obligation to find out what it was. I also owed it to her. What we learned was that her liver was huge, with lobes overlapping and some funny little lesions that I've read about on ultrasounds but never had a clear idea of how they might actually appear. Her liver was also quite thick. Dr. Mason said I should think of a normal liver being thin--like a beef or chicken liver. Bonnie's was clearly thin on the edges rising to a very fat middle. Bonnie's gallbladder was one of the biggest Dr. Mason had ever seen in a dog. She was sure there would be stones, but there were none. Just a huge gallbladder. Bonnie had been diagnosed with gallbladder mucocele dysplasia and Dr. Mason saw no signs of that, but did say the gallbladder was grossly abnormal in size.. However, when she opened it up, it had all of this sludge in it that I also read about on our ultrasound reports for every Scottie we've owned. It looked like big pieces of black pepper. I had no yardstick for knowing whether it was a little or a lot, but Dr. Mason said in 20 years of practicing, she'd never ever seen that much in a dog or even heard of such a thing. She was at the top of her class at Michigan and won awards for her necropsy skills, so I suppose she is in a position to comment. I know the sludge is common in Scotties, but isn't supposed to be good. Kind of an indicator that the liver isn't working as well as it should. One of my big regrets is that we forgot to get a bladder sample. A ridiculous omission in a Scottish Terrier, but I wasn't thinking well that day. Bonnie is even part of a special Ostrander Bladder Cancer study, searching for a genetic marker for transitional cell carcinoma, so it would have been good to have a sample to get a final determination on the status of her bladder. As it stands, her blood was sent in to several years ago to represent Scotties without bladder cancer. Her heart was large, but showed no visible problems. Dr. Mason agreed with the cardiologist in Leesburg, VA, that her heart was just large because she is a Scottie, not because it was diseased in any way. Her kidneys looked okay--not great--and her adrenals were small and hard and had an unusual texture, which really interested Dr. Mason. I had read before this could mean that they weren't working well, but she said she'd rather wait and get the report back before she made any comment about that. Dr. Mason said--perhaps to make me feel better--that it appeared Bonnie had other issues going on that would have compromised any treatment plan to jump start her adrenals and that perhaps it was more merciful she died when she did. I don't know about that. I just know I miss her a lot. She was one of those dogs you get really involved in caring for; it's kind of like a job. Most days revolved around what she needed or what help I could provide for her. That night before I took her to the Emergency Clinic, I prayed with Bonnie at my side and asked God to heal her, to end her suffering, to delay it for another day. He answered my prayers, but not how I thought. Now, the hard part is accepting that He knew best. NECROPSY RESULTS: When we got the necropsy results back, I was surprised, to say the least. She had a lot of problems going on, but in the end, Bonnie died of end-stage kidney failure. But clearly, we were on the right track in believing her adrenals were a big part of the problem. A summary of the results:
The pathologist indicated that the "The kidney would be considered an end-stage type of kidney." I found that surprising in that we never saw any indication of this in Bonnie's behavior. More significant and heartbreaking was the pathologist's last comment of all, which echoed quietly what Dr. Plechner has been preaching for years about the body-wide impact of adrenal failure. The pathologist simply wrote "Changes in the organs may be related to the adrenal atrophy." So, we are left with proof through necropsy, not just blood work, that Bonnie did indeed have adrenal failure. When discussing these results with Dr. Mason, she tried to give me insight into the situation when I blamed myself for not being able to help Bonnie. She said that although we had made a valiant effort to help Bonnie's body heal, perhaps we were not successful simply because she was too far into the process to be able to receive that aid In effect, she said that to be able to regenerate and restore the body, the process has to begin before the end-stage, when the body is able to accept rejuvenation. LAST THOUGHTS Despite our best efforts to help Bonnie, we were unable to stop the degenerative process that caused her SARDS. However, we did give her a great year of limited vision with lots of love and attention and were able to learn a lot about how to help other dogs that were bred from her. I believe our experience with Bonnie will benefit her two offspring living with us, and hopefully, others. My deep desire is that owners with pets suffering from adrenal exhaustion will draw from our experiences and find motivation to seek treatment. Dr. Plechner's mechanism--his recognition of adrenal exhaustion--is the cornerstone of treatment of pets with adrenal exhaustion or SARDS, and I suggest to any owner seeking help for their pets suspected to suffer from these diseases to contact him immediately. His deep love of animals and his willingness to help owners goes above and beyond the average call of duty and I will be eternally grateful to him for his insight and aid in our time of need. RESOURCES: If you are concerned that your pet might be suffering from endocrine-related disorders such as those described in this article, you may find your vet or specialist to be unacquainted with the diagnosis process or treatment information. Therefore, you may find the following web links and titles useful. For better endocrine testing with tighter "normal" ranges, Plechner and Levin recommend: National Veterinary Diagnostic Services (NVDS)29620 Ashdale Way Quail Valley, CA 92587-9511 Phone: 951-543-4678 Web: www.national-vet.com Email: info@national-vet{dot}com Caroline D. Levin, R. N 18709 S. Grasale Road Oregon City, OR 97045 Phone and fax: (503) 631-3491 Lantern Publications online resources for SARDS Iowa State University Veterinary Teaching Hospital Previous | Page 1 2 3 4 5 6 7 8 9 Copyright ©2009 TOP OF PAGE |