Rolling Dog Farm Blog

This is why we do this.

The eye exam today made clear that Briggs was definitely a dog in pain.  He has been suffering for a long time.  And now he’s finally going to get help.

First, a brief explanation of glaucoma.

The eye is constantly producing an internal fluid called the ‘aqueous humor,’ which normally drains out through a part of the eye called the ‘drainage angle.’  This balance of fluid production and outflow is what maintains a steady pressure inside the eye.  With glaucoma, the fluid can’t drain out and thus continues to build up inside, causing the internal pressure to rise dramatically.  The increased pressure damages both the optic nerve and the retina.  Eye pressure — called intraocular pressure, or IOP — is measured in
millimeters of mercury (mmHG), and the normal range in a dog is 15 to
25 mmHG.

In the photo above that I took this morning, our vet Dr. Brenda Culver is measuring Briggs’ eye pressure using a diagnostic instrument called a Tono-Pen while vet tech Heather holds him.  In his left eye, the pressure was a stunning 80 mmHG.  This was compounded by the fact that his lens had detached and was pressing on the inside of his cornea.  His right eye was 35 mmHG, but Brenda thinks the lower IOP is only because the pressure had been so high for so long that it had finally started to kill the cells that produce the fluid in the first place.

In humans, glaucoma is reported to cause constant head pain as bad as a migraine.  Because dogs with glaucoma typically have higher IOP readings than humans with glaucoma, some veterinary ophthalmologists believe that this condition is even more painful in dogs.  And with pressures as high as 80 mmHG, I can only imagine how much pain Briggs has lived with … and for how long. 

In this next photo, Brenda is looking at his eyes using an ophthalmic microscope called a slit-lamp, which magnifies all the internal structures:

Then Brenda stained his eyes with a dye strip and  turned on the blue light setting on the slit-lamp for another look.  This would reveal whether there were any ulcers or other damage to the cornea:

The condition of his corneas is important to know because of the surgery Brenda is going to perform.  Rather than enucleate, or remove, his painful blind eyes — there’s no way to restore vision, so our only goal now is to eliminate his pain — we’re going to try and save his eyeballs and thus his ‘natural’ look.  This is done with a two-part procedure called ‘evisceration and intrascleral prosthesis.’

In this operation, Brenda will make an incision at the top of the eye, remove the internal contents, and place a silicone ball — the prosthesis — inside the globe.  Then she will suture up the incision site.  The cornea keeps the prosthesis in place.  So the eye will look relatively normal … not compared to a typical healthy eye, but it will still look like an eye.  Briggs will be able to blink, move his eyes around, and otherwise look like himself.  You can read more on this procedure here.

We have done this on several animals, including Widget and Dusty.  There are risks that the body will reject the prosthesis as a foreign object, but so far we haven’t had that happen.  If it does happen and we can’t save it, then we will end up removing the eye after all.  We have not been able to do this procedure on all of our blind dogs who’ve had eyes removed because the cornea has to be healthy and in good condition, and also because some eye diseases make this procedure simply not feasible.

Brenda is planning on doing Briggs’ surgery tomorrow, but only after we get his blood work back and after Brenda’s husband, Dr. Britt Culver (our internal medicine specialist), does a neurological evaluation.  Because of Briggs’ neurological deficits — he wobbles — he could be at slightly higher risk for anesthesia, so we want to make sure we minimize those risks as much as possible before proceeding.

At the top of this post I wrote, "This is why we do this."  But we couldn’t do this alone.  As I mentioned when I wrote about Pepper last week, all of our animals get the best veterinary care possible because of the sanctuary’s amazing friends.  In the wake of Pepper’s loss, we had a number of wonderful gifts to help pay for her care at WSU.  And this afternoon, shortly after I got back from Helena, we had another example of how blessed we and these animals are.  One of the kindest, most generous individuals we have ever known called Alayne to make a gift that will cover the entire cost of Briggs’ surgery and hospital stay.

That kind of compassionate, generous spirit is how we do this. 

Our new arrival, little blind Briggs, is having a terrible flare-up with his eyes today.  We had noticed yesterday that he was sleeping a lot, more so than the other dogs, but we thought it was probably just because of the trip.  Yet this morning it was clear his eyes were suddenly very painful.  He was squinting a lot and had a lot of tearing, sure signs of ocular pain.  I called our primary care vet, Dr. Brenda Culver, first thing.  She suspected, as we did, that he’s going through a pressure spike with his glaucoma, so Brenda had me put him on some pain and anti-inflammatory medications.  I took that photo above of Briggs this afternoon, and you can see how painful those eyes look.  I bet he was probably sleeping a lot and was more subdued yesterday because he felt the pressure spike coming on.

In this next photo he’s not sleeping but actually rubbing his eyes repeatedly:

I had earlier scheduled an appointment for Brenda to see Briggs tomorrow morning in Helena, so we’ll have a much better idea then of what’s going on with him.

As much as his eyes were hurting, it didn’t keep him from looking forward to his dinner tonight.  While I was writing this, Alayne was in the dining room filling the 23 dog bowls, and Briggs heard the food being stirred and came to life.  He raced into the dining room and stood next to Alayne, baying at her until she finally gave him his bowl.  A hurting Beagle is still, well, a food-motivated Beagle!

(In case you’re wondering, the 23 bowls are for the dogs who stay with us in our house and the cottages next to our house; the rest of the dog family is over at Widget’s House.)

Speaking of Beagles, here are a couple of lunchtime photos I took of deaf Stuart on the left and blind Widget on the right, snoozing together next to the dining table.  Oddly — especially for Beagles — neither one got up to demand our lunch.

At some point their noses must have alerted them to the presence of nearby food, and the Beagles stirred … yet not too much:

But, realizing that lunch was now over, there was nothing left to do but settle back in and resume their nap:

That’s Daisy the miniature Dachshund poking her head out from her pillow bed behind Widget.  The contingent of Dachshunds — seven strong — have noted with growing alarm the increasing number of Beagles here.  More worrisome, the Dachshunds have overheard the servants talking about how fond they are of the ranch Beagles, and in little Doxie voices they whisper to each other, "What’s up with that?"

Alayne and I spent the weekend trying to recharge our emotional batteries after losing Pepper on Thursday, and here’s one thing that really helped — wobbly blind Briggs arrived at the ranch this afternoon.  He has a true Widget-certified Beagle personality, and Widget’s same bossy, insistent, pay-attention-to-me-now attitude.  Stuart the deaf Beagle is not nearly as bossy (oh thank heavens) but has more than his fair share of Beagle spunk.

Morgan S., who runs Atlanta Beagle Rescue, had pulled Briggs from a rural Georgia shelter where he had been turned in as a stray.  We first learned about Briggs on the day we lost our beloved old Dillon.  Morgan had earlier sent us both blind Widget and blind Willie, and we were delighted she’d been able to save this little guy, too.  You can read Morgan’s write-up on Briggs on her blog here. 

So this morning she put Briggs on a Delta flight leaving Atlanta at 6:50 a.m., and after making his connecting flight in Salt Lake City, he was at the Missoula airport by noon.  Alayne drove in to pick him up, and I took the photo of the Alayne holding Briggs this evening when they got back to the ranch.  When Alayne got to the ticket counter at the airport to get Briggs, she could hear a Beagle baying from the cargo area in back.  The airline staff were only too happy to hand him over and send him on his way!

Briggs is definitely a wobbler, too, although more stable than our other wobblers.  I can’t tell if it’s cerebellar hypoplasia or not — he can maintain his balance better than our animals with that condition typically can — but he’s just like them in one respect:  when you hold him in your arms, he goes absolutely still and just melts. 

His eyes really bulge, and we suspect he has glaucoma.  I went to take his eye pressures this afternoon using our Tono-Pen but the batteries had died — and of course they’re a fancy, medical device kind that has to be special ordered.  (On Monday’s to-do list now.)  We will take Briggs to see our vet, Dr. Brenda Culver, this week for an eye exam when we go to pick up Trooper and Popeye.  (Trooper’s hip surgery went well, by the way, and Popeye’s eye is healing, too.)  I worry that we will probably have to remove both of his eyes, given their appearance and the tearing and discharge we see.  In fact, they bulge more than any glaucoma eyes I have seen in a dog, and if the intraocular pressures are as high as I think they are, his head is throbbing. 

For now, although his eyes bother him, he’s still a very happy boy and his baying has announced to all who can hear it that another Beagle has arrived.  It’s Beagle mania at the Rolling Dog Ranch.

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Thank you to everyone who gave us such wonderful emotional support in the past few days after we lost Pepper.  We read each of those blog comments and emails, and believe me, it makes a difference.  It’s not just our grief but shared grief.  And there is strength in that.  It really does provide comfort and solace knowing so many incredible people care so much about these special animals and what we’re going through when we lose one.

Hope did not prevail in the end.  Our little blind Shepherd, the girl with the "perpetual puppy" look, died this afternoon.  We made the decision to let her go gently and with dignity. 

The MRI images showed that a tumor at the base of her brain had obstructed the flow of the fluid that normally bathes the spinal cord.  With nowhere to go, the fluid had backed up inside her brain, creating a large reservoir and causing intercranial pressure to rise dramatically.  Although the neurologists have seen this type of tumor before, they have not seen a dog in as bad a condition as Pepper.  Usually the dog is showing much milder symptoms.  In Pepper’s case, she had somehow been able to compensate incredibly well while her brain was being flooded.  Yet when her brain finally was tipped over the edge, she had nothing left to give … which is why, even today, she had yet to come out of her coma-like condition.

Dr. Wininger explained that while it would be possible to do surgery and remove the tumor, we had only a 20% chance of her surviving the operation.  Those are terrible odds but one we’d be willing to take if she could beat this thing … but Dr. Wininger said the tumor would, in fact, come back.  Even if she survived surgery and then completed a month-long radiation therapy, the tumor would still come back — in a year at the outside. And at that point we would have no other treatment options — a second surgery is not feasible — and Pepper would be right back where she is today. 

There are two possible types of tumor causing the obstruction — a choroid plexus tumor or a meningioma.  The first one, the choroid plexus, is the worst of the two, and after surgery and radiation it would be back within months.  The meningioma is the "nicer" tumor that might allow a survival time of up to a year, but it too would still come back to kill her.

That one-year time frame is a median survival rate, so if you imagine a bell curve, a year would be at the top or center of the curve.  A few survive longer and would be on the right side of the bell curve, and a few die sooner, putting them on the left side of the bell curve.  In Pepper’s case, given the severity of her symptoms, Dr. Wininger said she would already be starting out on the left side of the curve … if she could survive surgery.

And that was only if it was a meningioma.  It was more likely — in fact, a 50% to 70% greater likelihood — to be the choroid plexus tumor, meaning the survival time is measured in only a few months.

I talked through all this several times with Dr. Wininger this afternoon after reviewing the MRI images.  Then I called Alayne to tell her everything I had learned.  After three long, painful and tearful conversations, Alayne and I finally decided we wouldn’t put Pepper through this.  We don’t mind the 20% chance of surviving the surgery, but then only to have the tumor come back … we just couldn’t see doing that to her.

Dr. Wininger said the surgery, intensive post-operative care, and month-long radiation therapy would have cost between $8,000 and $10,000 … but I can tell you that the cost did not factor into the decision.  Had it been a $2,000 operation, we would have reached the same conclusion.  Because of the sanctuary’s compassionate and generous donors, we are blessed that we don’t have to make medical decisions like this based on cost — only on what is best for the animal.

I told Dr. Wininger that we would let Pepper go.  He left me alone in an exam room to cry while they went to get Pepper and wheel her in.  When I saw her on the gurney, I knew we had made the right decision.  She was still comatose, and more than two hours after the MRI, she still had not recovered from the anesthesia.  In fact, she was unable to breathe on her own.  I don’t know if she knew I was there, but I stroked her face and held her paws in my hands while I cried over our little blind girl.  And then I told her how sorry we were.  I was still holding her paws when she slipped away.

Goodbye, Pepper.  We love you, honey.

I met with Pepper’s neurologist, Dr. Fred Wininger, at WSU’s veterinary teaching hospital a short while ago to review his initial assessment of Pepper. She is, he said, “a very sick girl.” Dr. Wininger spoke this morning with our primary care vet, Dr. Brenda Culver, about the sequence of events leading up to the seizures, the diagnostic tests Brenda and her husband Britt, our internist, had conducted, and the nature of the seizures they witnessed Pepper having. As a result, we are going to proceed with an MRI today at 12:30 Pacific time, and Dr. Wininger will have the images to evaluate about an hour later. He will also do a spinal tap to see what her cerebral spinal fluid tells us.

However, because she is already suffering from significant neurological deficits, she is at risk from the anesthesia required for the MRI and spinal tap procedure. Yet without doing those, we won’t know what she has and what we can do for her, so it’s a risk we have to take.

He said there are a number of things that could be causing Pepper’s problems, and even an intercranial tumor might be operable … but it’s just too soon to know. Although we can’t get our hopes up, given her condition, Dr. Wininger said it’s not hopeless or he wouldn’t recommend moving forward with the MRI.

Dr. Wininger was also the neurologist who last year worked on Claude, our blind Great Dane puppy who had wobblers syndrome, so we know him very well and were very happy to see him take on Pepper’s case. I took the photo this morning of Dr. Wininger with Pepper in the ICU.

I’ll post more when we have more information on her condition.

I arrived at Washington State University’s veterinary teaching hospital at 2:30 a.m. last night. When I had picked Pepper up at our vet clinic in Helena about 8 p.m., she was completely out of it … from a combination of the drugs to control her seizures and, I’m afraid, from what the seizures have done to her brain. She was still completely gorked when we got to the hospital in Pullman. She continued to twitch throughout the trip, not quite real seizures but still evidence of misfiring in her brain. In Kellogg, Idaho, I pulled over at 1 a.m. to give her one of the injections of valium that our internist in Helena, Dr. Britt Culver, had equipped me with for the journey.

It was a beautiful night for a drive across the Rockies … clear skies, stars, and the snowy mountains glistening in the bright moonlight. Yet all I could think about was the blind dog laying on the stretcher behind me, with her life teetering in the balance. As the miles wore on, I continued to reach back every ten minutes or so and touch Pepper to see if she was still breathing.

A fourth-year vet student, Alaina, helped me carry Pepper in from the truck on our stretcher when I got here. That’s Alaina you see in the photo above, along with Dr. Chad O’Brien, the emergency vet on duty last night. Her vital signs were not good … rapid heart rate and a temperature — again — of 105. Dr. O’Brien’s goal was to get Pepper stable once more and get her through the night until the neurologists could assess her this morning.

Dr. O’Brien just called and said Pepper’s temperature has come down but she is still essentially comatose, which he felt by now could no longer be explained by the medications she is on. So I am heading over to the hospital to meet with the neurologists. This is where I will be spending a good part of the day … in the lobby of the teaching hospital while I wait to see how our girl is doing. Please keep her in your thoughts. It doesn’t look good at the moment.

I’m leaving right now for Helena this evening to pick up blind Pepper at our vet clinic and rush her to Washington State University’s veterinary teaching hospital tonight.  Pepper began having seizures yesterday about 6:30 p.m. — this after healing up from her abscess and being ready to come home.  Pepper seemed to respond to medications last night but the seizures resumed today and have been uncontrollable.  Brenda kept me posted throughout the day, and this evening called to say that Britt had consulted with neurologists at WSU and they recommended we bring Pepper over as fast as possible.  So I am heading to Helena first to get her, then turn around and drive over to Pullman.  I won’t get there until 1 or 2 a.m., so I will post another blog update tomorrow as soon as we know more.

Please keep our sweet blind Shepherd in your thoughts.

That’s blind Babe on her favorite spot in winter, atop the snowbank that forms from the snow sliding off the Widget’s House roof.  We turn the dogs out for exercise in small groups in several different yards adjacent to Widget’s House; in Babe’s yard you see blind Allie the black Lab, Shiloh in the center and Libby on the right.  Now, Babe is one of those dogs who would rather be wherever she’s not, so the yard in front of her is always more exciting than the yard she’s in.  (Kind of like the "whatever is in their dog food bowl is more exciting than what’s in my bowl" line of canine reasoning.)  So Babe loves it when we open the gate and let her charge through. 

What she doesn’t realize is that she could very easily just walk across that wooden fence, using her snowbank, to get to the next yard.  But she doesn’t, and instead she stands there … and often sits there … barking at the dogs in the other yard and enjoying her perch.  Maybe she just likes the king-of-the-hill feeling.

Libby, who can see, does use that snowbank to get out of her yard and mingle with the guests on the other side. 

And speaking of Shiloh, he has now finished all of his chemotherapy treatments for his hemangiosarcoma and is doing amazingly well.  There is nothing more we can do at this point other than wait — the prognosis is typically for a survival period of 6 to 9 months with chemotherapy — but so far he is physically looking really good.  We know that some folks with animals who develop hemangiosarcoma don’t enjoy as much time as we’ve had with Shiloh since his diagnosis, so we are very grateful for every day.

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I wanted to let you know how much we appreciated the wonderfully supportive comments and emails about the very sad ending for Luke the blind hound.  Those incredible sentiments meant a lot to us.  Thank you!

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Spellchecker weirdness:  Just ran the blog’s spellchecker and it helpfully suggested "humanism" instead of "hemangiosarcoma."  Hmm.  Who are those guys who program these things?

Trooper, the adorable Lab/Hound mix who arrived from Louisiana back in December, is finally ready for surgery.  Judging from the number of emails I’ve received from people asking how he’s doing, I realize I have been remiss in not posting any updates on him since he came.  But he is doing just great, and that emaciated dog in December is now completely filled out.  We had to hold off on surgery until we could bring him up to normal weight. 

I drove Trooper over to our vet clinic in Helena this afternoon, and took the photo of him in the back seat of the truck when I got there.  (Actually, we removed most of the back seat to make room for dogs!)  This photo makes him look both more serious and more sad than he really is.  Trooper is a complete goofball, in fact.  He’s a happy, bouncy, funny guy who loves nothing more than to wrestle with Travis, he of fused-jaw fame.

Despite his twisted front leg and his obliterated hip joint, Trooper is one of the fastest dogs we have.  We were completely amazed at watching him race across the yard at Widget’s House.  His front leg doesn’t seem to bother him at all.  When he runs, he simply pulls up the back leg to get it out of the way, and then he just holds it there as he zooms along.

This surgery will be on that hip joint, which you can see in the left of this X-ray (it’s his right side, where the ‘R’ is on the image):

Just compare that hip joint to the other, normal side, and you can see the difference.

The procedure is called a femoral head ostectomy, an operation we have had done on two other dogs at the ranch, Pappy and Chelsea.  Our internal medicine specialist in Helena, Dr. Britt Culver, does this surgery.

It will take months for Trooper to fully recuperate from the hip operation, and then we will make a decision about the surgery on his front leg.  To be honest, we are not sure about proceeding with that operation after watching how well he gets around.  The surgery is very complex, involves lots of rods and pins, and makes the FHO procedure look simple by comparison.  Our veterinary surgeon in Spokane who would do the operation on Trooper’s front leg considers the outcome to have only a "fair prognosis."  So now that we see the front leg doesn’t seem to bother Trooper, and doesn’t seem to cause him any pain, we are beginning to wonder if we really need to — and should — put him through that.  So I’ve asked Britt and our primary care vet, Dr. Brenda Culver, to also evaluate Trooper’s front leg while he’s at the clinic and to let us know what they think.

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In the crate behind Trooper is blind Popeye the cat, who’s had another setback with the operation to remove a painful eye.  Over the weekend the eye socket started opening up again, so back to Brenda he went!