January 22, 2013

A Lifetime of Symptoms

Since Matisse's death last week, I have been coping with the many faces of grief. Anger is chief among these.

What is the name of the thief that stole his good health in middle age and plagued his old age with so much debility? What part did I play? Was my faith in energy medicine well founded or merely stubborn? What information could I have gained from diagnostic tests that would have changed the outcome?

At least I'd have a name to curse. Chronic bronchitis. Sebaceous adenitis. Laryngeal paralysis. Degenerative myelopathy. Cushing's syndrome. Cancer.  

I don't know. I can't say.

Something racked his respiration with coughs, wheezing and exhalation stridor. Something robbed him of agility and wrecked his balance, coordination and strength. Something wicked, insidious and progressive ultimately cost him comfort and ease in his senior years.

I reviewed his entire medical record since we relocated to Austin in 1999. Twelve years of vet visits, shots, tests, drugs. I racked my brain for clues that foreshadowed the debility he suffered at the end of his life. What was consistent? When did it begin? When treated, did the condition resolve permanently or merely subside to re-emerge in another form? When untreated, why? What would I do differently knowing now what I didn't know then?

Post-mortem forensics. All I have to go on is a lifetime of symptoms. It's a long list.

Mind -  Temperamentally, the standard poodle is a great dog. Bold, intelligent, athletic. As a puppy, they can be a hand full - demanding attention. Play. Walk. Play. But generally, they are affable if you don't.Easily trained, they work for treats and love performing for an audience.Overall, I'd say that Puppy Matisse was more submissive than dominant, more fearful than aggressive, but he matured into a fairly balanced demeanor. Easy going. With other dogs, he accepted whatever role worked - alpha, submissive - as long as he got to play. Bred with a very high prey drive, he chased cats, rabbits and squirrels. Also trucks and little boys on bicycles. He habitually nipped people in the behind as they were leaving. this was puppy play. I could only forestall it, never break him of it. Fortunately, this only happened at home. In public, he was an extremely well-mannered citizen. In his declining years, he began to react strongly to thunder. Disturbingly strong. A Thunder Shirt seemed to help.

Face - Nose color changed about age six; face looked caved in (neuralgia).

Ears -  Dark, waxy discharge in the left ear from puppy-hood had been treated with many prescription ointments as well as antibiotics to no effect. Xymox Otic, an enzymatic solution that dissolves the discharge deep in the ear canal cleared the left ear once and for all in 2009. Regrettably after an extended course of antibiotics for bacterial pneumonia in 2010, his right ear joined the party. Chronic inflammation, suppuration, pus are characteristic of otitis media, a progression of otitis externa. There were no good (read risk-free) medical solutions so we soothed and cooled it topically, searching for a homeopathic remedy. According to the Merck Veterinary Manual, chronic pathologic changes in the ears may also reflect a generalized systemic or skin disease. In the last year, he lost his hearing completely.

Eye - After many years, we resolved a meibomian-gland tumor on his right eyelid with homeopathy. During the time it was growing, there was considerable mucus in his right eye. The tumor itched. He scratched. It bled. In another period, the conjunctiva of both eyes became swollen and inflamed. We tested for Keratoconjunctivitis sicca (KCS) or canine dry eye. Negative. Inflammation, swelling and discharge resolved - along with the tumor - using homeopathy and irrigating with saline solution. At the time of his death, another meibomian-gland tumor was developing on the left lower lid. There was mucus in is right eye. He had cataracts and may have been blind.

Mouth - Offensive breath, calculus on teeth

Nose - We first noticed that the color changed in 2006. It was drippy with mucus in his final days. But he never lost interest in reading pee mail!

Skin - Lots of skin issues beginning after puppy shots. Over a period of many years, itching progressed to eruptions - staph outbreaks on his belly. Eruptions dried up and scaling commenced along with patchy hair loss. At its worst, the skin inside his thighs was blackened, oily and smelly - malassezia dermatitis He had aural lick granuloma on his foreleg. Eliminating chicken from the menu reversed this disease. Later, his skin began to form scales and lose patches of hair. In time, the hair on his back turned pink. A thyroid workup by Dr. Jean Dodds, Hemopet was in the normal range. I treated this as sebaceous adenitis using regular oil baths to manage symptoms. Hyperpigmentation as well as hair loss resolved. He continued to sprout small, black scabs on the crown of his head along with red lesions (hot spots) and thinning hair. At his death, the symptoms of sebaceous adenitis were re-emerging.

Growths - Papiloma warts on feet. Lipoma on his leg, breast bone and flank. Small hemotoma on the pinneal of his right ear; resolved with homeopathy.

Respiration - In 2005, he coughed so relentlessly that we saw the vet for kennel cough. She found no specific cause. This disease progressed to chronic dry, barking cough and occasional reverse sneezing. Homeopathy had no effect. By 2009, after a bout of bacterial pneumonia, he was diagnosed with chronic bronchitis. Nebulizer treatments that used antibiotic saline to avoid the negative side effects to his kidneys.

Merck Veterinary Manual says, "Unchecked chronic bronchitis damages the airways and leads to the accumulation of infected mucus and pus in dilated bronchi. This is called bronchiectasis. Chronic coughing can also lead to enlargement of the alveoli (lung air sacs), a condition called emphysema. These two diseases are not reversible and gradually progress to chronic lung disease and congestive heart failure."

There is no "checking" chronic bronchitis; that's why it's called chronic.

In a follow up appointment, our veterinarian noticed that he breathed "like a freight train" with a whistling exhale (stridor) when he was excited. She suggested laryngeal paralysis which we kept at bay with hydrocodone cough syrup. 

In his last month, coughing dramatically increased along with hawking up phlegm. Nebulizer treatments. Hydrocodone, Benadryl, Arsenicum 30C. Temporary relief. But in the end, coughing at its worst. 10 on a scale of 0 to 10. 

Digestion - From puppy days, he often had signs of gastritis - burping, eating grass and vomiting water-brash. When we eliminated chicken, he rarely ate grass. He continued to vomit - water-brash or bile - in no particular pattern. He also regurgitated entire meals. According to x-rays, there were no visible signs of megaesophagus. This symptom waxed and waned with no apparent pattern. Another nameless, faceless enemy of good health.

Elimination - As a young dog, his stool was chronically loose. A change of diet to raw meaty bones firmed it up  We learned about raw food diets by trial and error. Too much organ meat, diarrhea. Too much fat, thick, tarry stool. Too much bone, dry, white, powdery stool. After he began to take hydrocodone, his stool became hard, knotty. He was often constipated. A touch of fish oil or olive oil in his food helped to soften it. In his final days, he drank more water and urinated more often, including in the house. A homeopathic remedy and more frequent walks resolved the problem. His urine was copious, yellow, clear of mucus or blood, with no particular odor.

Neuro-Musculature - In 2008, Matisse yelped when Stuart gave him a sharp tug on his flat collar. He yelped suddenly when he yawned. He also jumped away from his food when he tried to eat. He refused to play with his puppy. All these signaled pain - "my jaw hurts when I open wide." Along with other routine blood tests, we ran a test for masticatory myositis. While we waited for results, the correct remedy had an immediate effect. Matisse relaxed, curled up to sleep, snoring slightly for the first time. Moving in the direction of a cure. Later he ate the meat I fed him from my hand, then gingerly picked up his puppy using only his front teeth. He ate and played normally in short order. The test results were negative.

In 2009, along with the dramatic freight-train sound of his breathing and exhalation stridor, he also showed marked rear-end weakness. He had difficulty jumping into the back seat of the car. He had trouble climbing stairs. He twitched in his sleep, his feet paddling as though he were running. His back toenails occasionally scraped when he walked.He lost his bark completely.

By early 2012, the progression was marked. He walked slowly, stiffly, periodically lame but never favoring the same leg. He had difficulty standing, sitting. His right left leg shot out randomly, spasmodically. His gait was often exaggerated - high stepping on his walks. At the end of 2012, this incredibly athletic, agile dog began to miss jumps onto the furniture, maybe one out of 10 times. Soon, his back legs wouldn't follow. He missed 90 percent of his jumps. He began to trip, stumble, occasionally fall, tumbling onto his back with difficulty righting himself. His tail wagged randomly, spasmodically. In the end, he asked for a boost. He was fearless jumping down. Progressive, degenerative neurological disease? You tell me. They are legion.

Heart - In 2011, Dr. Bouloy noticed a low-grade heart murmur.

Now I am not a veterinarian. And playing Dr. Google only serves to a point. So I ask you. In this lifetime of symptoms, did multiple diseases develop concurrently or was their a common thread?

Don't get me wrong. I clearly see my participation.

I fixated on one disease, one cause rather than keeping an open mind. I sought medical diagnosis, but when the answer wasn't readily available, I didn't pursue it further. I waffled between conventional drugs and homeopathy. I selfishly kept him alive long past the time when other people would have let him go.

This does not negate the other factors which contributed to his lack of robust health, not the least of which was an inherited predisposition to skin, ear and heart diseases.  

But if I had to put my money on any one thing, here's what I think.

Multiple, chronic symptoms. Possibly multiple concurrent syndromes. Inherited predisposition. When it's idiopathic (no known cause), chronic or the name ends in "itis," it's allergy.

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