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CHANCES FOR A MIRACLE
One of the hardest decisions owners often face is, knowing when to "pull the plug". It is a human invention, of course. We almost never pull the plug on animals. We let them die on their own or they die because we euthanize them. Euthanize literally translated means "good death". Sometimes, however, I feel we don't give our friends a chance to perform miracles. A miracle being a healing or outcome that is rare and one we just don't understand or expect. And, believe me, we don't understand as much as we would like to think we do when it comes to medicine. Although we have had our share of disappointments, we have had a few "miracles" and below are a couple of their stories.
"Abbie" is a cocker that developed a tumor on her lower jaw. It was early when the owner noticed it and we diagnosed it relatively easily with a biopsy. It was the type of tumor that wasn't likely to spread to distant parts of the body but it was locally aggressive. If we didn't remove it soon, Abbie would slowly lose the battle because the tumor would take over her whole lower jaw. Abbie's owner was understandably upset but was willing to do what it would take for her girl to pull through this. What we needed to do was pretty gruesome. We needed to remove part of her lower jaw, the part that was between her two bottom canine (Fang) teeth. This would guarantee her survival to a ripe old age but it would mean some rehabilitation on Abbie's owner's part. Abbie would take days to learn how to hold food in her mouth to eat properly again, and perhaps weeks to learn not to drool all over mom's floor. Abbie's family was up to the challenge.
We removed the tumor and sufficient tissue around it to ensure we got it all. Abbie pulled through the surgery like a trooper. The next morning we greeted Abbie and she was bright and alert, ready to go for a walk and eat breakfast. She went out, peed, came back into the hospital, walked into her cage, and as we were about to give her medication and food, she collapsed. Not so much as a whimper or whine. One minute we were saying she was a good girl and the next, she was comatose. And I mean that in the medical sense. Abbie's body was there but nobody was home mentally. We couldn't figure out what happened and Abbie wasn't talking. At a human hospital CT scans or MRI's would have been run of her brain and perhaps her whole body to determine the cause of this. We don't have that luxury and even if we did, it would be cost prohibitive for most people. So we did what we could. Physically, we knew that there was nothing wrong. To stimulate her mentally, we all took turns going in to her, rubbing her body, massaging her, moving her legs, talking to her. Nothing helped.
Her owner called to check on her and we told her that there had been a setback. That perhaps she should come down and visit Abbie because we thought that Abbie might not make it. Her owner came and tried for over 30 minutes to get in touch with the dog we knew was there somewhere and we had to face all the tough questions. Why, and how, and what do we do now? I couldn't answer any of them. I didn't know. What could I say, I'm sorry, the surgery was successful but your dog may die anyway? There was nothing to say. The owner left and I went to grab some lunch with Mike.
When we came back 30 minutes later, there was Abbie, lifting her head up off her pillows. Not really responsive yet but she was moving! And over the next hour she gradually "woke up" from her coma. We kept her for another day just to make sure but for all outward appearances when Abbie left us, she acted like there had never been anything wrong with her. Now, months later, she's still fine, still cancer free and not even drooling that much anymore. Do we know why she went into a coma...no. Do we know why she came out of it...maybe our efforts at constantly trying to stimulate her, maybe hearing Mom's anguished voice trying to make contact with her, maybe only Abbie knows and she won't tell.
"Lacy" is one of those cases that you wish you could have the experts watching because it is so weird. She underwent a surgery that is considered routine. The surgery went well and immediately post-op everything looked good. Then about three days after surgery something began to go horribly wrong. If Lacy could have talked she would have complained to Mom and Dad, who were doting parents, that something was wrong and they would have listened. But only when her owners noticed a bad odor and a strange redness near the surgery site, did Lacy come back to the hospital. It had been six days. and it was almost too late.
There is something peculiar to cats called fat necrosis. It is when body fat, usually in the belly area where it hangs down, starts to die off. Sometimes we know the cause, other times we don’t. In either case, it is quite similar to the flesh eating bacteria horror stories in human hospitals. The fat just begins to decay providing a great food source for whatever bacteria may have gotten in there accidentally. The treatment is to get rid of all the dead fat, put them on antibiotics and cross your fingers. So we sedated Lacy and did just that. Again, the surgery went well until the end when we were already done and waiting for Lacy to wake up. And Lacy died. First her breathing stopped and then within about a minute her heart stopped. A minute seems like such a short time but when you’re watching an animal and taking pulses and watching breathing, it seems like forever. When this happens, out comes our "crash cart" which contains epinephrine and other resuscitation medicine. Quickly, one person begins breathing for the animal and the other person performs chest massage. And although Lacy's heart began beating again and Lacy turned from blue to pink, Lacy was not responsive to us. Lacy's pupils were dilated and she did not respond to any stimulus.
Lacy had only been clinically dead for about 90 seconds. Would she come back any further than this? This had all taken place at the end of the day. So there it was, closing time, and I had what seemed to be a comatose animal. Would she make it? The owners wanted to know. The chances were 50/50. To ensure that someone would be watching Lacy all night long, Mike and I drove her to the animal emergency center when she was stable. Just as we arrived, Lacy went into a type of position called opistotonus. This is when the front legs extend straight forward and her head pulls straight back like she was trying to look at the stars. Bad sign this star-gazing appearance. It means that her thinking brain, the forebrain, had disconnected from her primitive brain, the hindbrain. Her chances just went down dramatically. I left the emergency center very depressed and confused. When an animal gets sick or dies, it’s never easy but knowing WHY it happens makes it manageable for us. The not knowing WHY is what really drives us nuts because if you don’t know why something happened, that means you can’t prevent it and it can happen again. I called the center about 9 p.m. to find out that Lacy was unchanged. Still disconnected.
The next morning I arrived at the emergency center to pick Lacy up for what I thought would be a sad day of baby sitting a coma case at the hospital only to find an awake and slightly responsive Lacy waiting for me. The emergency vet told me that Lacy's owners had visited just after I called and to everyone's amazement, Lacy woke up. She definitely was not "normal" but she was awake! She couldn’t see very well, and she certainly couldn't walk yet but she held her head up and meowed when Mom came to visit her later that morning. Over the next few days, she learned how to eat, drink, and walk all over again and now is a happy normal cat.
The last story will be brief because it's a lot like Lacy's. "Bobby" got overheated. Bobby's body temperature was 110 degrees when he arrived at the hospital, his pupils were fixed and dilated. You hear that in hospital dramas all the time and it IS a bad thing. It means that that portion of the brain that controls simple responses, like pupils contracting in response to light, is no longer working. If this is not working, then higher brain functions definitely are not working and it is rare for them to recover. In essence nobody was at home in Bobby's brain. We did what we were supposed to do to treat him but I had to be honest with the owners. Even if Bobby lived through this horrific event, his brain may literally be fried and he may be brain damaged. There was also extensive damage to his liver and to his skin from the elevated temperature.
The prognosis for a normal life were not good, I told them MAYBE 10 % max. Bobby recovered and went home four days later, acting as if nothing had happened. The only lasting scars were elevated liver enzymes on his bloodwork that were amazingly coming down to the point where they would be normal in another week and an area of hair loss on the left side of his body where the hair follicles were damaged. The hair would regrow within a matter of months. In all of these cases, the owners decided not to euthanize. There was that nagging doubt in all of their minds: Am I allowing my pet to suffer? And yet do we really know what our pet wants? No. In all of these cases, the owners decided to let their pets have a chance...to not pull the plug too quickly. And in these cases, miraculous, unexplained recoveries, did happen. It had nothing to do with religious belief or lack thereof. It had nothing to do with our skill in healing (although I wish it did). Sometimes I do believe in the will to live and the power behind the pet/owner bond. In both Abbie's and Lacy's cases, they began recovery during the owners visit or shortly thereafter. Sometimes I think we could learn alot from our four legged companions about what it means to live. And sometimes, when we give things a chance, just a wild shot in the dark, miracles do happen.