Photos courtesy shibaguyz
By Ranny Green
For 16 months, Lucy, a 10-year-old Jack Russell Terrier, battled one ailment after another under the care of Dr. Kelly McCord, at Summit Veterinary Referral Center in Tacoma while her committed owners Lori Massie and Manny Gomez, of Olympia, dealt with a medical travelogue of emotions, ranging from angst and optimism.
“Several times I thought it would be best to let her go,” admits Gomez. “It was never about how expensive it was to keep her alive, it was more because she was such a little fighter. She is a scrapper with a special zest for life, so if she is not willing to give up, we should not deny her the opportunity to live.”
One episode after another they continued to bring her back to McCord, a veterinary internist. But there were many nights the couple, both of which work in the medical field, stayed awake caring for her, attempting to make her as comfortable as possible, encouraging her to eat and drink, then cuddling and holding her, just letting her know they were there.
“There were times when we thought she was not going to make it,” says Gomez, “and we would hold her and cry over her. We did not want her to leave us. She is a huge part of our family, since we do not have children. She is almost like our child.”
Lucy is one of five animals to be featured in Animal Survivor video stories at the American College of Veterinary Internal Medicine Forum June 12-15 in Seattle, which will be attended by approximately 2,500 veterinarians. Each beat the odds because of advances in veterinary internal medicine, thanks to the commitment and efforts of their primary veterinarian, an ACVIM-board certified specialist and owners.Lucy was first presented as a referral to McCord in November 2011 for lethargy and a poor appetite, after her primary veterinarian in Olympia treated her for a fever and swollen lymph nodes. While awaiting results from a variety of procedures, Lucy developed limping in multiple joints, consistent with polyarthritis, another immune-mediated condition.
The owners elected to begin immune-suppressive treatment for a bone-marrow issue (immune-mediated neutropenia) revealed by the tests, which destroys a type of white cells called neutrophils. Within a few days, Lucy’s condition rebounded and her white-cell count returned to normal. When veterinarians slowly tapered down her prednisone dosage, her joint pain and fever returned, necessitating additional immune-suppressive medication.
With medications and recheck visits, Lucy’s condition remained under control, although she was taken to a veterinary ophthalmologist for a cataract issue.
In May 2012, she developed diabetes and was brought to McCord for complications related to this condition. Ultrasound revealed severe pancreatitis. She also contracted a severe skin reaction while on antibiotics for a urinary-tract infection she incurred concurrently. Because of the diabetes and pancreatitis, the medications used to treat her immune-system disorders had to be discontinued.
Sometimes through the complexity of medicine, the most basics prove revealing. For instance, a squeak here and a squeak there told the staff at Summit, Lucy was on the mend. The squeaks from Lucy’s toys were the trigger mechanism to say, “Hey, I’m feeling better.”
“It always correlates to appetite, energy level and the amount of pain or discomfort she is experiencing,” says McCord. “The entire staff can walk in at the beginning of a shift and hear the squeak, squeak, squeak coming from the ICU and know that Lucy Gomez is here. It’s music to our ears.“When I come in for rounds in the morning if she has been there overnight, the nursing staff always makes sure to tell me if Lucy had squeaks overnight or not. Apart from the objective tests we perform, of course, it is an important tool for me to interpret her current health status.”
After five days of hospitalization, she returned home and for a couple of months began feeling better until she developed skin lesions causing thick plaques about her body in addition to enlarged lymph nodes. Through that process, she began losing hair, as well.
To heal the skin lesions and based on biopsy results of the skin lesions, McCord elected to put Lucy on prednisone again. She responded well initially, but diabetes complications recurred, requiring hospitalization for treatment for this and pancreatitis, at which time her medication was changed.
For five months, Lucy was a happy-go-lucky pooch again, but in December 2012 the lethargy and vomiting issues recurred, which were found to be related to “significant liver disease.”
A laparoscopic liver biopsy – a relatively minimal invasive procedure – revealed a suspected toxicity reaction to cyclosporine and the drug was discontinued. “By this time,” McCord explains, “the skin, white cell, joint and lymph nodes immune-mediated reactions had been in remission for about five months so we decided not to start any other medications because of her history of sensitivity to many classes of drugs.”
Lucy’s up-and-down health journey bottomed out again in late January with all-too similar symptoms of poor appetite and vomiting. Her blood work indicated gallbladder obstruction, prompting removal of the organ.Since that surgery the incredibly resilient 13-pound (she dropped as low as 9 pounds when she was ill) animal has been the healthiest and perkiest she has been since November 2011, according to Massie, meaning she is in a full squeak mode. Her health improved enough last month to allow her to accompany her owners on a well-earned road trip to the California coast.
Through the 16-month medical odyssey, the busy owners altered their schedules to attend to Lucy’s needs, but friends often stopped by mid-day to check in on her two. “At one time, she was on eight pills at various times of the day, plus insulin and eye drops twice daily,” recalls Gomez. “Lori became very proficient at getting pills down Lucy’s throat.”
Missing a day of work, staying up all night to care for her (they alternated that duty), shared medication responsibilities were all part of the “I Love Lucy” protocol that prompted multiple hospital stays ranging from a day or two to seven or eight days. “We lost count of the number of stays,” says Gomez, “but she was in the hospital so often that we jokingly requested that Dr. McCord name the new hospital addition after her, ‘The Lucy Ward.’ “
McCord says cases like Lucy’s involving multiple disease processes are not unusual in a specialty referral practice, which unlike a general practitioner’s hospital, is equipped to handle advanced diagnostic testing, access to multiple specialists where many minds can collaborate in complicated cases.
Reactions to medications are not unusual. “We were able to document in Lucy’s case,” explains McCord, “at least a couple of reactions that were unexpected.” Lucy was placed on prednisone, a steroid that has immediate immune-system suppressing activity. It was chosen, says McCord, because it works quickly, which was a necessity at the time; however it antagonizes insulin, and for patients like Lucy who are diabetic, it can cause problems. Monitoring for complications related to medical therapy is an essential part of treating patients with complex diseases.
Cyclosporine, another immune-suppressive drug, helped control Lucy’s diabetes and clear up her skin condition until she developed suspected liver-cell toxicity from it several months later. “She was lucky that there had been enough time on the two drugs that the multiple immune-mediated diseases went away completely and no longer required therapy,” adds McCord.Lucy and her owners deserve plenty of credit for her survival throughout this trying process, says McCord. “It is amazing to see a family so committed to its pet’s health care. Lucy has been close to death many times, yet today is vibrant, energetic and loving life.
“Lucy is one of Summit’s most well-recognized and loved patients. She is typical of most dogs that come in for treatment in that she tends to be very trusting. I think most patients know that we are trying to help them, especially when they are critically ill.”
Asked if he had specific concerns for Lucy’s health going forward, McCord replied, “If she becomes ill again with a new problem, we will need to make certain that we are being as safe and conservative with her treatments as possible so as not to cause any new issues like we have seen in the past.
“Lucy’s immune system is very sensitive and I will always worry that medications might cause havoc again, which, of course, will be unpredictable. She is a special little girl and my life is better for knowing her.”
Lucy is almost completely blind with inoperable “immune mediated cataracts.” She is completely blind in her left eye and has at most 20 percent vision in her right eye. She receives eye drops twice daily to keep her eyes comfortable and two ointments daily to keep her corneas from ulcerating and to prevent infection.The couple does not treat her as handicapped, emphasizes Gomez. She has learned to use her hearing and amazing sense of smell to compensate for her lack of vision.
Her veterinary costs are in the neighborhood of $20,000-$25,000, but, says Gomez, “You can’t put a monetary value on life. Having her as part of our family has been an enriching experience. She has taught us what is really important in life, which is a lesson money simply can’t buy.”