December 31, 2012

When It's Time to Say "Good-bye"

We have come to the 11th hour of our dog's natural life cycle. Matisse is 15 years old on Christmas Day. I'm very grateful we made it.

Due to over-vaccination before I knew better, he has lived with multiple chronic conditions for a very long time. Indeed, it's hard to remember when he was ever completely symptom free.

Immediately after his first rabies vaccine, he began to scratch.

In the Dark Ages before the Internet, I asked his first veterinarian why. She shrugged. Dogs do that.

Itchy skin was followed by poodle ear - dark, waxy, discharge. Having it is a function of floppy ears that create a deep, dark tunnel ideal for growing yeast. Not being able to dispatch it is a function of vaccine damage.

We used every ear wash known to the veterinary profession and a few home-made concoctions. All with less than satisfying results - nothing worked to alleviate the symptoms much less cure them.

Eructations - vomiting water-brash, food or bile. Diarrhea. He's had all of it, sometimes more, sometimes less, for his entire life.

For nine years, I was diligent following a conventional veterinary protocol. Annual vaccinations. Antibiotics. Anti-fungal medicines. Neuro-toxic flea repellent. Heart-worm medicine. My dog saw the vet annually when I could not afford to see a doctor for my own wellness.

Regrettably, it took a long time for me to get the information about vaccinosis, then "get" that doing the right thing for love of him was destroying his immune system. By that time, his immune system was damaged beyond repair.

After we lost Aimee in 2007 to rabies vaccine-related illness, we turned to alternative therapies, treating everything with species appropriate diet, exercise, oils infused with organic herbs which I made to control the ingredients, occasional over-the-counter drugs, homeopathy and TLC.

I went through a revolving door of veterinarians before connecting to an understanding and cooperative allopathic veterinarian.

Since then we have coordinated conventional diagnostic testing with a highly-knowledgeable homeopathic vet, managing symptoms with a delicate balance between conventional drugs and homeopathy.

Each has pluses and minuses. Each has a place.

One suppresses symptoms within the body, sometimes driving them deeper or into a more serious dysfunction. The other lets the body express symptoms and works energetically to reverse the course of disease. 

Conventional medicine. Sometimes hit or miss. Good drugs. Bad side effects. Homeopathy. Slow. Hit or miss. Sometimes things get worse, much worse, before they improve.

Before we started homeopathy, his skin erupted with staph outbreaks. He scratched almost constantly. After treatment began, his symptoms went from bad to worse - from itchy to balding; alopecia (patchy hair loss), aural lick granuloma (a bald spot on his foreleg from excessive licking) and thick, smelly, blackened skin of malassezia on the inside of his thighs.

Our first homeopathic vet continued to throw remedies at this until I lost patience. After a year, we had made little progress. When I challenged him, he suggested we needed another practitioner.

All righty then.

By now I was connected with a group of people who are expert at feeding raw.

At the suggestion of one of these people, I stopped homeopathic treatment and began a food elimination diet. As soon as we withdrew chicken from the menu, the skin issues began to reverse. No itching. No licking. No malassezia.

What a relief to him and me to see my dog's coat restored to something close to healthy.

Getting his food right also eliminated much of his gastric upset - diarrhea. But depending on what he ate, we still dealt with mild gastritis - vomiting and borborygmi (tummy talking.)

Some symptoms stayed - waxing and waning with the seasons. Flea-bite allergies, seasonal allergies, environmental allergies.

It was always something.

Matisse developed a pendulous growth on his right eye - a kind of tumor or adenoma that develops from the meibomian gland. It itched. He scratched. It bled. We considered surgery, but these tumors can recur. Multiple surgeries and Elizabethan collars were not acceptable in my mind.

One year, the conjunctiva of his eyelids inflamed, his eyes teared and filled with mucous when the eyelid wart began to rub the cornea. Everything was red!

Treating his eyes with steroid drops caused the tumor to grow humongous. I stopped them immediately and gave him a different homeopathic remedy. The tumor shrank to nothing in less than a month. In an odd combination of steroid therapy and homeopathy - a one-two punch - I finally eliminated it. It was an overnight miracle (if you don't count the four years it took to find the remedy.)

Another period, the hair on his back turned pink and patchy hair loss escalated.

Hyperpigmentation is a symptom of a number of chronic diseases including Cushing's, thyroid or sebaceous adenitis. Tests said thyroid was within normal ranges. Following another dog owner's home-made regimen for sebaceous adenitis, I bathed him frequently in sunflower oil infused with calendula  followed by a very dilute apple-cider vinegar rinse to restore PH balanceto his skin.The hair loss abated. Eventually the pink tint disappeared too.

I never gave up, recording every urp, fart, burp, scratch, head shake and cough in a spreadsheet since we 2007. Selecting homeopathic remedies that fit his demeanor and the symptom picture. Never giving up. We worked through all of it.

But the best we could do was manage symptoms.

Allergic coughs, wheezing and reverse-sneezing diagnosed in 2005 developed into allergic lung disease and bacterial pneumonia in 2009. He hawks up phlegm. As the disease has progressed, he sometimes has difficulty breathing and occasionally awakens from sleep like he's strangling.

Symptoms of neurological degeneration began to emerge in 2009 - rear-end weakness, random lameness in his front legs, twitching and paddling feet in his sleep, difficulty getting up and lying down, difficulty jumping in and out of the car, difficulty navigating stairs. His toenails sometimes scrape when he walks. Sometimes one of his back legs kicks out spasmodically. He lost his voice so long ago. I can't remember the last time I heard him bark. Stridor on exhalation. Breathing like a freight train.

Our veterinarian suggested the possibility of laryngeal paralysis and referred us to a veterinary surgeon.

The surgeon was eager to scope him to rule out the disease and identify another cause. I have no doubt she'd have found something. But I wasn't buying it.

Surgeons. Rock stars. She evaded answers to direct questions and walked out of the examination room in a huff when I challenged her.
"Most people don't ask me these questions; their dogs are turning blue."

Matisse would have to be sedated for the procedure and my research in peer-reviewed medical studies indicated that dogs with existing respiratory disease rarely survived the sedation required for it. I wasn't willing to let him go like that. 

An extended course of antibiotics prescribed in 2010 to tamp down bacterial pneumonia left him with chronic suppuration in his right ear. Pus flows like a river. He's deaf. He's blind in at least one if not both eyes. He vomits more and more often - water-brash, phlegm, food, bile. He has a heart murmur.


Yet, through it all, he's been a happy boy with a bright disposition. Always eager to socialize with other dogs. Always up for a game of "smell it find it." Always ready for a road trip whether around the block or 2000 miles. Always happy to play with his puppy. Always game. 

Early in 2012, neurological symptoms characterized by rear-end weakness and lameness grew more pronounced and took on yet another dimension.

He began to miss easy jumps - the step up from the sunken living room to the landing, the ottoman, the sofa. His back legs would simply not do what they were told. This quickly degenerated from missing a jump occasionally to missing them 90 percent of the time. He'd trip and splay all fours out.Or he'd fall backwards, not fully able to right himself. He's beginning to walk flat footed, another stage of degeneration. Occasionally, his rear right leg kicks out uncontrollably, randomly, spasmodically. And though it wags randomly, spasmodically, his tail doesn't wag for joy any more.

Many neurological diseases fit the symptom picture including Degenerative Myelopathy.

There are no tests to diagnose it; it can only be ruled out. This means we could spend several thousand dollars and not really get an answer.

I'm not doing that.

Regardless what we call it, conventional medicine offers good drugs, bad side effects. It's possible to relieve his symptoms, but at the expense of his internal organs - heart, kidneys, liver.

Homeopathy offers us partial relief. It makes him feel better; it never heals.

 He had a rough night Thanksgiving weekend, waking me in the wee hours with an urgent need to evacuate his bowels. Outside, I watched as he squatted and fell, squatted and fell, unable to bear his own weight and unable to produce anything from his effort.

My heart spoke what my eyes saw:

"I see."

Life is the path; we choose how we walk it. How I dreaded this path.

I have let go two dearly beloved cats. It was merciful. But it was unbelievably hard. Second guessing. Could a. Should a. Would a. Do we really have the right to take the life of another sentient creature?

I swore that I would not make this call for Matisse. I could not. He's my whole heart. But watching him in the wee hours of the morning, squatting urgently all over the house, outside struggling to stay upright, straining to defecate without result. Inside again, finding sputum coughed up everywhere and feces on the kitchen rug - an incident he could not control, I had to consider this option.

Yes, I can control his symptoms with drugs. It's possible that a short course of Prednisone would give him mobility a little longer. If rear-end weakness were his only issue, I'd take that route. But we have an aggregation of chronic disease - layers on layers of immune mediated disease related to over-vaccination.

Past the point of healing, we merely chase symptoms - cough, nausea, constipation or diarrhea, anxiety, inflammation, pain. Many are caused by the drugs themselves.

Who am I sparing when this graceful creature must be drugged to the gills and asleep all the time to live? With all these symptoms swamping him, how does it feel to be him?

We have agreed that when the time arrives, we will say "good-bye" in a peaceful setting. Knowing that time for sure is another matter.

I don't trust myself. I don't trust Stuart. We are so deeply in love with our dog, I don't trust us to step outside our emotional investment to see the situation clearly. So day by day, we evaluate Matisse's condition by objective criteria established by canine hospice care professionals

Dr. Villalobos utilizes a scale called “HHHHHMM” (Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, More Good Days than Bad Days). Patients are scored in each category on a scale of 0-10, with 10 being best. In general, a total score of 35 or higher is indicative of a continuing “good” hospice experience but use your dog’s veterinarian as a sounding board. It’s important to have an ongoing dialog with her about what you’re seeing, so don’t try to go it alone.
As long as we are having more good days than bad, as long as he has an interest in food and can walk, as long as he stops to read pee mail and plays with his toys, I will continue to manage his symptoms with homeopathy supplemented with allopathic drugs.

Days. Weeks. Months. Who knows?

Since I started this post three weeks ago, the HHHHHMM score has dropped below 35 on only one day. Matisse is still very much present, a study in adaptation and the absence of vanity.

He doesn't feel well, but he feels well enough to take a walk around the condo development, four square blocks. He can't jump onto the sofa any longer; but he can lift his front legs up and ask for a boost. And more often than not, after supper, he gives his stuffed puppy a good shake and looks appealingly at me - just in case I want to play tug or chase.

Life, such as it is, is good.

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