Elke’s passing has given us all pause. Not only is there the missing of who she is -- her apple core eating and play-spinning ways -- but it also makes me examine the purpose of our pen pal blog. Being “real” about dogs and being “science” about dogs are not separate from one another; they are part of the same coin. Maybe that’s obvious, but I’m very happy (if that’s the right word) that you shared Elke’s life and passing here on Do You Believe in Dog?. From the feedback on Facebook, others agree.
I used to have conversations with my childhood dog, Brandy. We would lie next to one another as if we were girlfriends at a slumber party, and I would explain to her that if she ever died, I would kill her. I wanted her to understand that death wasn’t a viable option for her. She would have to find something else to do when she got old.
Playing, "Find the real dog" with Brandy
Death is universal. It is not unique or unordinary. We bring companion animals into our lives knowing that there is a finite time we will be together. But what I do think is notable about Elke (and Brandy’s) deaths, is that they were "good" deaths. They didn’t experience prolonged discomfort or drawn out pain and suffering. How animals die is part of end-of-life care, regardless of whether we are talking about companion animals, lab animals or farm animals. This is why, when I heard about the work of Dr. Stephanie LaFarge, I paused and took interest.
Advice on dealing with children, the elderly or disabled individuals who are facing a death of a companion animal.
Helping the surviving animals in the household to cope.
Assistance in establishing a relationship with a new pet.
The first area, “Assistance with the decision to euthanize” is incredibly important. They explain: “Coping with the impending loss of a pet is one of the most difficult experiences a pet parent will face. Whether your furry friend is approaching his golden years or has been diagnosed with a terminal illness, it’s important to calmly guide the end-of-life experience and minimize any discomfort or distress.”
Nowadays, it can be possible to extend a loved pet's life, which can be awesome! But sometimes the question becomes, "Are there any costs? Are we minimizing discomfort and distress?"
There is nothing easy about end-of-life decisions, but a good death is as important as a good life.
I have an 11-year old small (20 pounds) male dog of mixed breeding. In preparation for a routine dental procedure, he had a blood panel done, which showed that two of his liver enzymes are high. The serum alkaline phosphatase was 617 U/L (normal < 100 U/L), and the serum alanine aminotransferase (ALT) was 172 U/L (normal < 100 U/L). He was placed on Denosyl (SAMe) at the daily dosage of 90 mg for 6 weeks. Repeat serum chemistry testing at that time revealed that his liver enzyme levels were slightly decreased, with an alkaline phosphatase value of 426 U/L and an ALT of 115 U/L. My vet then changed his medication to Denamarin (a supplement containing both SAMe and milk thistle) and suggested retesting in 4 weeks. When I brought my dog in for that recheck, however, the vet did an ACTH stimulation test instead of running the liver enzymes! The results of the ACTH stimulation test were normal, with a baseline cortisol value of 2.1 µg/dL and a post-ACTH cortisol value of 14.1 µg/dL. Despite the fact that both of those cortisol levels are within the normal range, the vet is now telling us he thinks our dog has Cushing's disease and wants to do an ultrasound at a cost of $300! My dog is COMPLETELY asymptomatic, and he has no signs of Cushing's disease (normal thirst, appetite, and hair coat). I would have never known he had high liver enzymes without the dental blood panel. Now I feel like I'm being taken for a ride. He has not been rechecked for liver enzymes so I have no idea if the medication he's been on has been working, and we're chasing this test result that by the vet's own admission can be greatly skewed by stress. Finally, he still needs the dental! Am I wrong for declining the ultrasound and seeking a second opinion or am I missing something here? What would your recommend?
My Response:
What you're describing in your dog is a common scenario that we see frequently in every day practice. The increases in the liver function tests that are present in your dog could indeed be due to Cushing's syndrome, which is a common disease in older dogs (1). Dogs with Cushing's disease tend to develop a characteristic type of hepatopathy, which frequently helps lead us to the diagnosis (1-3). However, the liver enzymes may be high because of primary liver disease too (2).
The Denosyl and Denamarin can't hurt your dog and may help some types of liver disease, but they probably aren't going to change the clinical course if he does have Cushing's disease.
Testing for Cushing's disease The finding of normal results on an ACTH stimulation test certainly goes against the diagnosis of Cushing's disease. However, the finding of normal results would not be all that unusual in a dog with early or mild Cushing's disease. For that reason, the ACTH stimulation test is not my test of choice for screening dogs with possible Cushing's syndrome. I'd rather do a low-dose dexamethasone suppression test, which is a more specific test since it evaluates the entire pituitary-adrenal axis (1,4-6). But that's an 8-hour test and more money, so you might want to either just continue to monitor the liver tests or go straight to an abdominal ultrasound at this point.
Why do an abdominal ultrasound in this dog? In my opinion, performing an abdominal ultrasound this time is not a bad idea. Doing an ultrasound examine would allow us to take a good look at the liver to determine if the liver is small or large in size, as well as to look for any obvious pathology (e.g., liver nodules or tumors). Dogs with Cushing's disease tend to develop liver changes that have a characteristic appearance on ultrasound, so that can also help us in the diagnosis (1,7).
In addition to just examining the liver, performing an ultrasound examination will also allow us to look at the entire abdomen, including the adrenal glands. If both adrenal glands are large, that can be consistent with pituitary-dependent Cushing's disease, the most common type of this disease in dogs. On the other hand, if one adrenal gland is very large and the other is very small, that would be consistent with unilateral adrenal tumor (1,3,8). Since half of adrenal tumors are malignant (1), it's always a good idea to locate the adrenal tumor and remove it as soon as possible.
Now most likely, your dog does not have an adrenal tumor, and he may not have Cushing's disease at all. If both adrenals are enlarged (consistent with pituitary-dependent Cushing's disease), I certainly wouldn't start treatment immediately since your dog is not showing any clinical signs. None of the medical treatments we use for Cushing's disease, including trilostane (Vetoryl) or mitotane (Lysodren) actually cure the dog — these drugs only act to lower the cortisol values and control the clinical signs (1). Again, if you dog has an adrenal tumor, I'd recommend removing it because of the risk of malignancy.
If your dog does have mild Cushing's disease, it is likely that clinical signs will develop at some time in the future. This could be in a week or a year or more, and may never happen.
What about the dental procedure? If the abdominal ultrasound rules out significant liver pathology (i.e., no hepatic tumors or cancer) and both adrenal gland are similar in size (i.e., no adrenal tumor), then I would definitely recommend having the dental procedure done. Some dogs with severe dental disease can develop high liver enzymes secondary to the oral inflammation, so a good dental procedure may actually help to lower the liver function tests.
References:
Pérez-Alenza D, Peterson ME. Hyperadrenocorticism in dogs In: Ettinger SJ,Feldman EC, eds. Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat (Seventh Edition) Philadelphia, Saunders Elsevier, pp 1816-1840, 2010.
We have been overwhelmed by the response of the Do You Believe in Dog? community to the death of Mia's dog, Elke. It's obvious this has struck a chord because so many people can relate to this emotional time of losing a much loved canine companion.
Thank you all for your messages of sympathy and support.
We decided to compile some resources to help you, or a friend, prepare for and cope with this difficult (and inevitable) part of sharing our lives with dogs.
Understanding Grief: The Australian centre for grief and bereavement offer excellent information on their website. We have included some key excerpts and links. About Grief Suggestions to help you get through this difficult time:
Create a memorial - do or make something to honour your loved one.
Develop your own rituals - light a candle, listen to special music, make a special place to think.
Allowing yourself to express your thoughts and feelings privately can help. Write a letter or a poem (or a blog post!), draw, collect photos, cry.
Exercise - do something to use pent-up energy, walk, swim, garden, chop wood.
Draw on religious and spiritual beliefs, if this is helpful.
Read about other people's experience - find books and articles.
Do things that are relaxing and soothing.
Some holistic or self care ideas that may assist include meditation, distractions, relaxation, massage, aromatherapy and warmth.
To help with sleeplessness: exercise, limit alcohol, eat well before sleeping, and try to have a routine.
Sharing with other people can reduce the sense of isolation and aloneness that comes with grief.
Allow people to help you, don't be embarrassed to accept their help. You will be able to help someone else at another time. It is your turn now.
Talk to family and friends; sharing memories and stories, thoughts and feelings can be comforting and strengthen our connection with our loved one.
Consider joining a support group to share with others who have had similar experiences.
Talk with a counsellor to focus on your unique situation, to find support and comfort, and to find other ways to manage, especially when either your life or your grief seems to be complicated and particularly difficult.
Advice from the Australian Centre for Grief and Bereavement:
Our journeys with dogs are incredibly personal. End-of-life feelings and decisions can have similar elements. We hope these resources prove useful.
Mia and Julie Further reading:
Fuhr N. & Ruthven I. (2012) Grieving online: the use of search engines in times of grief and bereavement, Proceedings of the 4th Information Interaction in Context Symposium, 120. DOI: 10.1145/2362724.2362747
Planchon L.A. & Templer D.I. (1996). The Correlates of Grief after Death of Pet, Anthrozoos: A Multidisciplinary Journal of The Interactions of People & Animals, 9 (2) 107-113. DOI: 10.2752/089279396787001491
Packman W., Field N.P., Carmack B.J. & Ronen R. (2011). Continuing Bonds and Psychosocial Adjustment in Pet Loss, Journal of Loss and Trauma, 16 (4) 341-357. DOI: 10.1080/15325024.2011.572046
"On Sunday I sat outside in the sun, stroking Elke's so-soft ears, while my husband patted her long, sleek back, and we farewelled our first girl. We learned on Friday that her liver and spleen were full of cancer. We are so grateful to have shared 12.5yrs with her and will miss her dearly." is what my Facebook status update said. But let's start at the beginning...
Little Elke-Moo and her cow hips, at RSPCA
I met Elke (pronounced Ell-kee) when I was in my third week of employment in the RSPCA shelter. What a sucker I was! She was seized as part of a cruelty case from a property where an elderly man with dementia had over forty dogs. Because of the dementia, the dogs weren’t receiving proper care and he sometimes fed them chicken pellets. Of her litter, Elke was the only survivor. She looked like a 5 week old puppy but she was actually 12 weeks old.
She was always small. Our ‘bonsai pointer’, we called her. We joked that she was little, but could lay a good egg. My boyfriend at the time and I had been speaking about getting a dog, and pointers had come up as a breed we were interested in – he wanted a dog to run with him. After three weeks of rehabilitation at RSPCA, she came home with me. I was 23 years old. Since then, she has been a fixture in the landscape of our lives - through house moves, our engagement and marriage, the death of my father, the arrival of our daughter, the comings and goings of oh-so-many other dogs (occupational hazard!).
Elke and my daughter - a fantastic introduction to dogs
Elke was energetic, excitable and hilarious. She wasn't perfect, but neither were we. We were a perfect match. She realised, as a young dog, that she could redirect attention to herself if visitors were over, by trawling our dirty clothes basket for recent underwear and then parading it through the lounge room for everyone to see.
Post-beach snooze with our other dog, Caleb
She didn’t like thunderstorms or fireworks. She loved running off lead at the park, the beach or through the bush and she adored retrieving. She would regularly throw herself into water without stopping to check for a way out. One time I had to walk along a river back for about 500m while she swam and we looked for a place where she could scramble up the riverbank to get out again! We took Elke to obedience training and she taught us so much. Elke was also more than our pet. She helped as a friendly adult dog at puppy preschool classes, she posed as a jaunty model as Australia legislated for the end of tail docking, she tried to distract trainee guide dogs and she visited nursing homes as a certified visiting therapy dog. They were all things we did together, my spotty dog and I.
Elke loved playing swim-retrieve in the water
She and our other dog Caleb were very close. They had a silly play ritual they indulged in every day. Twice a day. A close-quarters mouthing and growling game that ended in howling calamity. It was sometimes annoying (working from home, it wasn’t always compatible with work-related phone calls!), but always made me smile. But now our house is very quiet.
We all loved time at the beach
We didn’t know Elke was sick until a week before she was euthanased. We took her to the vet, her temperature was up, a blood sample was taken, antibiotics were commenced. We didn’t know just how sick she was until two days before. What we did know, was that she was getting older, slowing down, not hearing the thunderstorms any more – and we knew she wouldn’t live forever. But 'that day' always seems - in the future.
Instant couch-rights
When the vet rang me on Friday (the 13th) to advise that the ultrasound showed Elke’s liver and spleen were full of cancer, I was interstate at a conference aiming to eliminate the euthanasia of healthy and treatable pets in Australia. I was told that there were no options. Elke was comfortable, but at risk of bleeding internally and needed to be kept quiet with minimal activity. Euthanasia was not required immediately, but certainly the recommended course of action to avoid a slow and painful death by haemorrhage. I made the appointment for the day after I was due home and cried in my hotel room until there were no tissues left.
Sunday morning was a beautiful morning in Melbourne. The sun was out. I sat with Elke and my just-turned-3-year-old daughter in our garden. We talked about Elke being sick and that she was going to die. She asked hard questions. I did my best to answer them. We weren’t able to play retrieve, but passed Elke little sticks and she crunched them in her teeth. I took some last photos of the two of them – my girls – who have enjoyed a calm and positive relationship. Then Pete and I took Elke to the vet. She was given a mild sedative and we walked outside into the vet clinic’s garden (she never really liked veterinary consult’ rooms). We placed her bed on the grass in the sun, while she walked and sniffed. As the sedation took effect, I helped her settle onto her bed and she relaxed, dozing in the sun. Pete gently stroked her back. I had her relaxed head cushioned in my lap, savouring the sensation of her silky soft ears against my fingertips, one last time. She didn’t even notice the needle that entered the vein in her leg with the overdose of anaesthetic. It really was the perfect euthanasia.
Elke was doing selfies pre-Facebook - circa 2003
Now Elke is gone, and we’re adjusting to this changed landscape of our lives.
Despite all the dogs that have lived in our home, for days or for years, Elke is the first dog that we have owned from puppyhood through to old age. In some ways, this is helping me cope with her death. With other dogs I think I’ve felt an element of anger that we had met too late for them to live their best life, or been robbed of time together through unexpected illness taking them too soon. But today, I’m trying to take comfort in the fact that Elke lived a fabulous and full life with us; her passing was as peaceful and stress free as any of us could hope for. I’m so grateful that our daughter had Elke to share her infancy with.
It still hurts. In ways that bubble up unexpectedly. And I know that’s OK. Grief is messy. It’s individual and it takes as long as it takes. Time plays a critical role and will not be rushed.
Spooning in 2003.
Still besties in 2013.
Research over the past 25 years has shown us that grieving for a pet follows the same reactions and involves the same emotional responses as dealing with a human loss. People who have lost a pet commonly experience intense feelings such as sadness, anger, anxiety, disbelief, depression, panic, relief or even numbness. The act of consenting to euthanasia has been found to be particularly disturbing for some owners, who feel they have betrayed a trust by choosing death over life. Of course, grief responses to death of companion animals is linked to the strength of attachment we have with them, but we should not trivialise, nor brush aside our response to the death of our pets.
Animals are important to us and the grief we experience when they die is real. We should be gentle to ourselves.
Acknowledging this and permitting ourselves to react (however we need to) is important. Letting our support networks (friends, family, colleagues) know how we feel and letting them help us in return is also important. If time isn’t helping, or you lack a support network, seek further help, from your doctor or a professional counsellor. The Australian Centre for Grief and Bereavement has helpful information about grief here. The number of friends who have sent me kind messages, called to see how we're doing this week or even driven over just to give me a hug has shown me that a) Elke was a dog whose reach was long, and that b) I have amazing friends and family!
And so, my friend, I’m off to give Caleb a big hug. Because amongst all the other sad (for Elke, for my daughter, for me) I’m sad that he may never get to do this again:
Mia
Do You Believe in Dog? will place further helpful resources about dealing with the grief associated with pet loss online soon.
My submitted proof that the sun did shine out of...
Further reading: Weisman A.D. (1990). Bereavement and Companion Animals, OMEGA--Journal of Death and Dying, 22 (4) 241-248. DOI: 10.2190/C54Y-UGMH-QGR4-CWTL Archer J. & Winchester G. (1994). Bereavement following death of a pet, British Journal of Psychology, 85 (2) 259-271. DOI: 10.1111/j.2044-8295.1994.tb02522.x Podrazik D., Shackford S., Becker L. & Heckert T. (2000). The Death of a Pet: Implications for Loss and Bereavement Across the Lifespan, Journal of Personal and Interpersonal Loss, 5 (4) 361-395. DOI: 10.1080/10811440008407852 Smith A. (2012). Pet Loss and Human Emotion: What's New?, Death Studies, 36 (3) 292-297. DOI: 10.1080/07481187.2011.590443 Field N., Orsini L., Gavish R. & Packman W. (2009). Role of Attachment in Response to Pet Loss, Death Studies, 33 (4) 334-355. DOI: 10.1080/07481180802705783 Crossley M. (2013). Pet Loss and Human Bereavement: A Phenomenological Study of Attachment and the Grieving Process., PhD Thesis, NC State University: http://www.lib.ncsu.edu/resolver/1840.16/8451
I have a 5-year-old female DSH cat that has recently been diagnosed with hypothyroidism. This diagnosis was based on a low serum T4 value that was detected during a pre-anesthetic workup for a preventative dental procedure. She had been looking unthrifty and "off" to me at home for a while, but has had no other signs of illness. Her appetite remains normal with no signs of vomiting or diarrhea.
We sent out a complete serum thyroid panel two weeks after the initial low T4 value and the results were as follows:
Total T4: 0.3 µg/dL (reference range, 0.8-4.7 µg/dL)
How would you interpret this panel? Should we treat her as being hypothyroid? She has never been hyperthyroid and has never been treated with methimazole or radioiodine.
Is there value in trying to use one of the herbal remedies for thyroid support (e.g., Thytrophin PMG) or should we just start her on thyroid hormone? If you think we should use thyroid hormone, which product is best to use (L-T4, L-T3, or a combination)?
My Response:
Based on your cat's serum thyroid panel, the results are not supportive of primary hypothyroidism. As the thyroid gland fails in hypothyroidism, the pituitary would respond by increasing the secretion of thyroid stimulating hormone (TSH) (1-4). In your cat, all of the serum thyroid hormone values (T4, T3, and free T4) are very low. However, the serum TSH level remains well within the reference range limits, not high as would be expected with primary hypothyroidism.
Again, the result of this thyroid panel goes against a diagnosis of primary hypothyroidism. Spontaneous hypothyroidism (i.e., not secondary to treatment of hyperthyroidism) is extremely rare in the adult cat, with only a few cases reported (4,5), so I'm not surprised that the serum TSH value is normal in your cat.
The most likely explanation for these serum thyroid results is that your cat is likely suffering from another illness. It's well known that any nonthyroidal disease can act to lower circulating T4 and T3 concentrations in cats (6-10); thyroid hormone replacement in those cats would unlikely be of any benefit.
I'm assuming that you did routine blood work (CBC, serum chemistry panel, urinalysis) in addition to the T4 for the pre-dental panel. Were there any abnormalities on this blood-work or urine? If not, a chest radiography or abdominal ultrasound may be indicated as the next step to search for the underlying problem. Once we determine what's wrong with your cat and treat the primary problem, the serum thyroid values will likely normalize.
In any case, supplementation with thyroid hormone or any one of the herbal remedies are unlikely to be of any use and have the potential to do harm (11,12), depending on the underlying cause of your cats problems. If your cat was indeed hypothyroid (which she isn't!), we generally use twice daily L-T4 replacement, but some cats do appear to respond better to combination L-T4/L-T3 therapy.
References:
Baral R, Peterson ME. Thyroid gland disorders In: Little SE, ed. The Cat: Clinical Medicine and Management. Philadelphia: Elsevier Saunders, 2012;571-592.
One of the questions that came up a few times during the live chat sessions with student classes was about communication between dogs and people. I was asked "Do you think dogs will ever be able to talk to humans?" and "Why don't dogs talk? Why do they only bark?", as well as "Do dogs understand us? How?" and "Could we use technology to communicate with dogs?" - you see? They kept me on my toes!
My initial reactions were to say, "Dogs DO talk to us! They use their body language and their vocalisations extremely well, it's just that people aren't always fluent in listening to what they're telling us!" I also told them all about Chaser and her 1,200+ words, about the fact dogs' senses are different to ours (a much less visual, much more sniffy kind of a world).
Then one student said, "But what about this?":
Now Julie, I don't know about YOU, but somehow, I missed out on this 'BowLingual' device when it was launched in the early noughties. It's a:
"computer-based dog-to-human language translation device developed by Japanese toy company Takara and first sold in Japan in 2002. Versions for South Korea and the United States were launched in 2003. The device was named by Time Magazine as a "Best Invention of 2002." The inventors of BowLingual, Keita Satoh, Dr. Matsumi Suzuki and Dr. Norio Kogure were awarded the Ig Nobel Prize for "promoting peace and harmony between the species.
The device is presented as a "translator" but has been called an "emotion analyzer". It is said to use technology to categorize dog barks into one of six standardized emotional categories. BowLingual also provides a phrase which is representative of that emotion. The product instructions clearly state that these phrases "are for entertainment purposes only" and are not meant to be accurate translations of each bark."
I totally endorse all those disclaimers, especially after reading this review by Dr Sophia Yin, but also can't help thinking if this 'toy' device can register a dog's bark and then categorize the dog's mood as happy, sad, on guard, assertive, frustrated or needy - couldn't we just listen and do the same ourselves? I mean, you know that, right? You recently covered the latest scientific findings regarding what dogs' barks are telling us, over at Scientific American and The Bark (ha!).
So why can't we just listen? Learn? I certainly know the difference between my dogs' barks as to whether there's someone strange approaching our front door versus a family member or if they're just playing when I'm down the other end of our house. I'm teaching my daughter to tell the difference too. She's learning and she's just turned three.
So is it really that hard? Or are people just lazy?
FIDO works by giving a service or detection dog a special sensor that can attach to its collar of a vest. The dog can interact with the sensor by biting, tugging or touching it with their nose and the handler will receive a corresponding signal ("bomb ahead", "hurricane alarm sounding" or "you have pancreatic cancer" are all examples given for different working dog contexts) as an audio or display cue. You can read more about FIDO in an interview with the professor from Georgia Tech here.
What do you think? Gimmick or something that has the potential to actually reduce separation anxiety in dog when their owners are away? Think dogs could potentially be remote trained by professional dog trainers? I wonder how well the dogs can actually SEE the display and whether they would respond differently to different people who 'dial in'.
Very interested to hear your thoughts on this - hope you're well!
Mia
Further reading:
Tan D., Fitzpatrick G., Gutwin C., Begole B., Kellogg W.A., Paldanius M., Kärkkäinen T., Väänänen-Vainio-Mattila K., Juhlin O. & Häkkilä J. (2011) Communication technology for human-dog interaction: exploration of dog owners' experiences and expectations, Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2641. DOI: 10.1145/1978942.1979329 Kerepesi A., Jonsson G.K., Miklósi Á., Topál J., Csányi V. & Magnusson M.S. (2005). Detection of temporal patterns in dog–human interaction, Behavioural Processes, 70 (1) 69-79. DOI: 10.1016/j.beproc.2005.04.006
