Affaire's Tail of the Storm "Tailor"

Tailor was lost to a massive liver infection. We do not know the specifics of what caused it or made it so incredibly aggressive. The necropsy results, tissue pathology and report of the first ultrasound is below. The sequence of events is as follows.

This all started Friday, Jan 30, 2009. I came home and she was lame on her right front leg. She would not stand on it, but when she put the leg on my shoulder, she would put her full weight on it. So it appeared to be from the pastern down to the foot, but there was no swelling and no pain response. I thought that if she was not dramatically better on Saturday, I would take her in. But she was dramatically better on Saturday, so I dismissed it. Whether or not this had anything to do with the series of events that followed, may never be known. But, if it does turn out to be significant, you will want to take note.

Tailor seemed fine on Saturday, Jan 31st, but on Sunday night, (2/1) she did not finish her food immediately. This was something to make note of ­ this girl was a very good eater every day of her life. When I came by her, she immediately went and finished up the food, but I knew something was amiss.

On Monday morning, Feb 3, she ate her breakfast like nothing was wrong, but I still had this nagging feeling in the back of my mind. So I came home from work at lunch to check on her. She was laying in the sun and did not come in to greet me immediately. I took her temp and it was 104.7 and the thermometer had not started beeping to signal it was done yet. I called the vet and told her I was bringing her in.

While I was waiting for them to come out and see us, I noticed a swelling on one mammary gland. She had been in a pretty intense false whelp on her last cycle, but had been out of it for about a month, so I thought this was odd. My vet did not think the timing was odd, but she did not get much of a pain response when examining the swelling and mastitis is usually very painful. By the time they took her temp at the vet, she was up to 105.8. She responded well to antibiotics ­ her fever was down to 103 when I came to get her. So we thought it was odd ­ me with respect to the timing and my vet with her lack of pain in the area, but did not have any real reason to think there was anything more to it since she was responding to antibiotics. But there was this nagging feeling that something wasn't right here.

Monday night seemed to go well, but on Tuesday, she was not interested in food. Her temp was normal so this was a big red flag. I waited to see if she would get her appetite back on Wednesday, but she did not, so we went back to the vet. She was drinking a lot of water, so I was wondering if she might have a case of closed pyometritis. My vet took an xray, but there was no real definition on the xray ­ the image was very "mottled." My vet got us over to the local ER/specialty clinic for an emergency ultrasound.

The ultrasound showed that she did not have any reproductive issues, but had significant swelling of the internal lymph nodes and remarkable changes in her liver. There was some sort of inflammatory/infectious process going on. Her blood work was not surprising ­ there were elevations in her white count and in a blood protein that indicates chronic inflammation and infection and her liver values were a bit off, but she was not in liver failure. Her kidney function was normal.

She stayed in the ER on IV fluids, antibiotics (Baytril, Ampicilliin and Clindamycin) and pain meds (Buprenorphine). She was clearly in bad shape and the vets made it clear that this was a very dire situation and her prognosis was not good. The vets and I wracked our brains trying to figure out what could have triggered this ­ was she exposed to something, was there an injury, what was she eating before this all started ­ playing back the "tapes" over and over again. Nothing significant was recovered from our memory that would help Tailor fight the horrible infection that was consuming her internal organs.

On Thursday, Feb 3, she started having bloody diarrhea. I got her to eat a bit in the morning, but she threw it up after I left, so they recommended not tempting her with food until they could see if she continued vomiting. They started her on Pepcid. She did not, but I could not get her to eat another bite of anything ­ I had tried pork, cheese and cottage cheese. That night I cooked her beef and yams and took an assortment of biscuits ­ she seemed to want to eat, but sniffing the food made her nauseated. Later that day the vet called to tell me she started to dribble urine.

The pathology on the tissue samples from her liver and lymph nodes indicated a massive chronic infection/inflammation. There was also indication of necrotic tissue. The vet took a sample from the swollen mammary gland and it was full of pus as well. The fluid from her liver also contained pus, but the preliminary results from the culture on it did not grow anything.

On Feb 6, she started to bleed from a needle stick from 36 hours prior. The vet checked her platelets and they were low. We discussed putting her on plasma and replacing the Baytril with another antibiotic. They also did another ultrasound ­ checking her heart for endocarditis or other heart infection that might account for this and taking another look at her abdomen.

Her valves were normal, but her pericardum (sp) muscle looked a bit "suspicious", but not immediately recognizable as a cause for what they saw in the abdomen. The liver changes in 48 hours were extreme in the most negative way. All her internal organs and tissues were horribly inflamed and her liver had huge abscesses all over it. What looked moth eaten on Wed ­ looked like swiss cheese on Friday, if you can picture this on ultrasound. She would not even consider the lamb chops or whipped cream that we offered her.

The vet said that the only treatment they could suggest was to perform surgery to remove all the diseased tissues, but that her condition was so serious, it was a losing battle. They felt that we could spend a whole lot of money trying to save her, but her chances of survival were so extremely low that they were recommending we let her go.

So it goes ­ my beautiful Tailor went to her join her grandparents, Conner and Cody and is no longer in pain. She went very easily and peacefully with the people she loved at her side.

The treating veterinary asked the medical director at the veterinary hospital where Tailor was treated to call me. She reviewed all the results with me and said that her opinion was that Tailor got a bacterial infection and this all resulted from that. Nothing grew on the cultures at the lab, so we would never know what the bacteria was, and even if we did, we would not necessarily know how she got it. Her thought was that Tailor went into a cascading set of syndromes resulting from this initial infection.

The first she mentioned was Systemic Inflammatory Response Syndrome (SIRS). From her description it seems like this is a syndrome where the body mounts an inflammatory response to an infection, for example, and the inflammation triggers another and another so that the response just snowballs out of control. Given the gross findings on the necropsy and tissue samples submitted, this is pretty consistent.

She then mentioned Disseminated Intravascular Coagulation (DIC). Those of us who have heard of this before often refer to it as, "Death Is Coming" because so few dogs survive it. I personally do not know of any who have. This is also consistent as Tailor developed bloody diarrhea and started to bleed from a spot where blood was drawn 36 hours previously.

The last syndrome she talked about was Multiple Organ Dysfunction Syndrome (MODS). In looking into SIRS and DIC, they typically lead to MODS. Her notes indicate a diagnosis of, "sepsis/endotoxemia, likely bacterial (possibly secondary to foxtail migration as pathologist suggested) » SIRS/DIC/MODS » death."

None of this was particularly satisfying because I did not get any information about what Tailor had or why she had it. When they did the necropsy, they did not find a foxtail or any other foreign body. I do not know if Tailor has ever been close enough to a foxtail for this to even be possible.

But what the vet did tell me is that there is alot of research going on in the area of this set of syndromes to try and detect the problem before they start. Once the series of syndromes begins, there is no way to save the patient. She told me that even if we had gotten some results from the cultures that told us what bacteria she had and what antibiotics it was sensitive to, we would not have been able to save her.

The research being done is focusing on how to stop the syndromes from ever starting because once they start, there is nothing that can be done. This was a bit helpful because I had been thinking over and over and asking myself what we could have done differently that might have saved her. Now it is pretty clear that nothing would have made a difference.

So the report from the first ultrasound, the pathology report on the tissue samples that were sent in and the necropsy report are here for whatever value they might have. I've also compiled a glossary to help with all the medical terms.

Other than this episode, the only other health issue that Tailor had was a sensitivity to poultry. That started when she was just under 2. It took a while to figure it out. She started breaking out in hives when she got excited. When we would go to a show, she would get hives. When we got home, they would go away. Then when people came over to the house, she'd be excited to have new company, and break out in hives. Pretty soon, this turned into a staph infection on her skin that we could not get under control.

My vet sent her to a dermatologist and after several weeks, she determined that it was food allergies. Tailor was on a poultry diet (chicken & turkey), so we put her on a prescription salmon diet for several weeks. Between this and the medications, the staph infection cleared up. We stopped the meds and I kept her on a fish based diet. The problem never recurred.