How she came to us
Since we are the owners now we can choose to share this information so here is the story of how Ghost came to us.
Ghost is one of seven sisters, reported to be between 8 to 10 weeks old when my wife was called out for emergency treatment last Wednesday night. A kind and loving couple had somehow found out about this litter of puppies left outdoors in a dog pen. The owners had removed the mother from the area previously and then decided to apparently go away for a week, leaving the puppies outdoors with no one to care for them except for a neighbor tasked to throw food across the fence a couple times per day.
The family had, as my wife referred to it, huge hearts but not a huge pocketbook. They simply didn’t want to see these puppies left to die of starvation, dehydration, or simply exposure. (It’s not exactly cool in North Carolina in August). They somehow managed to get in touch with the owner of the puppies and convince him to turn them over to them.
After getting the puppies home, one little one stood out; the runt of the litter, a tiny, sweaty, skin-and-bones mass smaller than all the rest that appeared on the edge of death’s door. That evening, the owners called the vet clinic on emergency and asked her to come try to see if she could save the pup. Amy arrived and did what on-site diagnosing was possible, but the cause of the distress was obvious. As an 8 week old puppy* (see note below), she weighed a little over a pound. By contrast, an eight week old female German Shepherd is expected to weigh 16.6 pounds at two months of age. She weighed one.
*Author’s Note: Neither Amy nor I have seen the other litter mates except by photograph. Even including extreme malnutrition, it is my belief that there’s no way possible an 8 week old German Shepherd pup could be that small and still be alive. The obvious conclusion then is that the original owners lied about their age. All clinical signs show Ghost to be about 4 weeks, now going on 5. This makes much more sense, but also insinuates the original owners weaned these puppies from their mother almost a month earlier than they should have. So we can either assume extreme dwarfism (not likely) or that she’s only half as old as we were told she is. Personally I’m going with the latter, and assuming her birth date to be around July 1, 2014.
It was quickly evident that the puppy was going to need constant monitoring around the clock if there was any chance at all for her survival. Lifting her own head was about the extent of her physical ability. Standing, walking, wagging her tail, even whining; these were all beyond her ability at this point. She didn’t even have the strength to chew or drink water.
With no in-hospital solution available, she would have to come home with Amy for round-the-clock treatment if she were survive the next twelve hours. We really had no hope she would make it through the night at this point.
You want to see me turn into a cooing, gushing pile of total non-manliness? Bring in a starved puppy ten inches long and lie it on the couch in a towel… that’s it. I’m done for. All the macho bull goes out the window with puppies. I can watch my wife put down full grown dogs, cats, horses, and cattle with a detached and unemotional detachment (you have to acquire it or go crazy) but a puppy? I can’t do it, least of all to a shepherd. I had two twin German Shepherds as a child, so I have a huge soft spot for them anyway.
The first night:
Wednesday night was a long one. We don’t really have many pictures of her that night that show her condition because she was hypothermic, hypotonic, hpyoglycemic.. hell, we should have just named her Hypo now that I think about it.
Her first night of treatment was a long one. Amy eventually slept on the couch with her lying on her chest on a towel so she would wake when she felt her move. We started the night with subcutaneous fluids. Her body was so wan and withdrawn that getting an IV into a vein wasn’t even remotely possible. When that happens, you inject fluids under the skin in small amounts and let it be absorbed by the body. You can compare it to injecting a chicken or turkey at Thanksgiving – the skin swells up with the liquid until it’s absorbed into the body. It’s basically the same process. She could only take about a table spoon at a time. Amy would inject her with fluids, monitor absorption, wait another hour, do it again, etc. She basically repeated this process for three or four hours before we saw any signs of life at all.
One of the signs (which I didn’t know about until now) of severe dehydration is incredibly rapid breathing – which she exhibited. One of the final signs of severe dehydration is the heart increasing in rapidity to compensate for the decreased plasma in the blood and decreased blood pressure. Basically there’s no water flowing through the hose, so the heart beats faster and harder to try to accumulate more pressure to make it flow throughout the body. If pressure was up where it needed to be, it could beat slower and in a more normal pumping rate. By this point, just as in a human, you experience nausea, parasthesia (limb paralysis), delirium, and other symptoms.
One of the strangest things I learned was how in the world a puppy can become hypothermic in August heat in North Carolina. Again, being married to a veterinarian teaches you all kind of useful things. Long story short, when the blood sugar levels drop to critical one of the things a dog loses is the ability to control their body temperature. The brain just stops worrying with that until other things are back under control. Thus, her internal thermostat goes haywire and her temperature plummets. So for most of the night we had her on a heating pad to keep her internal temperature regulated since her body couldn’t do it for her.
After a couple hours, the pup started to want to vomit, which in itself was a good sign, but in a battle like this any little thing that takes energy from the body’s other energy-crippled systems is a bad thing too. She’s like a battery with just energy to turn on the headlights really dim.. you know if you try to start the car and it doesn’t start on the first try then you’re battery is going to be completely dead and no amount of hoping is going to make it start. It’s the same with her body at this stage. She has so little energy left in her body for it to operate than every little exertion is draining her energy reserves, and the poor baby had very left in her to give.
Over the next half hour, she vomited up almost 50% of her body mass. Amy and I monitored her closely and cleaned her mouth out after each renewed session. She didn’t have enough energy to work her mouth properly and could very well have aspirated on her own vomit without help.
She made it through those first few hours, shaky and feverish, but still alive. Throughout the night Amy injected enough subcutaneous fluids that she her heart rate eventually slowed and she exhibited the traditional slow deep breaths you’d expect to see in a sleeping puppy.
The next triage to address was her hypoglycemisa. In short, her body has no sugar. We make energy by processing sugars and without any, she can’t make more. Vets keep a variety of substances for treating this sort of thing. Basically Amy has a compound that looks like gel from a toothpaste tube, except it’s full of sugars and protiens the body can use to heal and start converting to energy. The best sign we saw that first night was the pup’s ability to try to lick it from her fingers, and swallow it when she put it on the roof of her mouth. As far as actual food went, we fed her liquified food through a syringe throughout the night.
Day Two: Thursday
It’s probably very fortunate that she came to us on a Wednesday night. Amy’s day off each week is Thursday. It’s safe to assume she didn’t really get a day off this time. I pretty much blew off my work too and we both traded turns with the pup throughout the day. By early afternoon on Thursday she was showing great promise of improving. She was able to whine, lick her lips, turn her head to see you, and even try to stand. She had the muscle coordination for it, just not the energy to do it too well yet. She was fed more, given more water, more sugars, and more proteins. By thursday afternoon she was able (with help) to stand to pee and poop. Thus far she hadn’t voided anything from her body yet, so peeing was a good sign. Her body has excess water (which is great) and her kidneys are functioning to process it (which is also great.)
My Mom even came over to spend some time with her on Thursday, offering to help babysit her while Amy and I did things we had to do.
The middle of the evening on towards later evening were a challenge with her. Every hour she expressed the need to go to the bathroom so someone would have to pick her up, take her outside, and hold her steady so she could stand. With that deed complete she felt compelled to examine her surroundings – which is a great sign, but also depletes her energy. Again you could picture a human patient that just had a chemo session… they want to do something different, but their body isn’t necessarily up to walking around and exerting itself. Unlike a human, you can’t explain it to a puppy. “No, go lay down, honey. You need your rest” don’t mean much to her. It was really heartwarming though to see her standing on her own for brief moments, walking around the patio a little, then falling over too tired to get back up, but still wanting to. Her puppy curiosity was fully intact but she didn’t have the strength to make her body keep exploring like she wanted to, but she was reluctant to give up. She’d roll and whine and work at it, trying to get back up on her feet again. We’d carry her back to the bed made for her, sit with her until she relaxed again, and she’d eventually drift off to a restless slumber again between meals bathroom breaks.
Thursday night was my turn to watch over her. I offered to let Amy sleep and I’d put together a cardboard box from a Dell computer we’d received a few days ago for a customer to put her in. I lied down on the couch with her in the box beside me so I could see, hear, and reach her if needed. We all tried to rack out around 11:30 that night, knowing Amy had surgeries to do at 7 AM the next morning. It was almost 1:30 before she would stay settled. Every time I’d put her back in the box, she’d yowl and whimper to get out. (I know how that wasn’t what it was she was yowling about.)
At 3:45 she woke me up again. (Two hours and fifteen minutes of restless sleep… looks like that’s all you’re getting tonight, Bucko. Sigh.) I sat her on my chest and laid there with her for half an hour or so. She had developed the shakes again; her head quaking back and forth like a patient’s hands with Parkinson’s. I remembered from earlier that Amy told me that was another sign of her hypoglycemia. Again, an analogy: Her body was shaking like a car running out of gas will sputter before it dies…sputter, sputter, sputter, then just silence… She was giving me that whining sound I’d previously understood to mean “I gotta go potty” so I took her out to go the bathroom.
My heart sank…
She couldn’t stand.
I’d put her on her feet again, like I’d done previously, and she had been OK with that. She’d walk forward and around for a bit then sit down. Now, she’d try to move one and they would cross, fold under each other, or simply fail to maintain balance and she’d fall over sideways. I got down on the concrete with her, and kept trying with her again and again (which in hindsight was probably just stupid, but I didn’t know what else to do. There was no need to wake Amy up at 4 AM because there’s nothing she can do other than what we’ve already done.) It occurred to me later, once I understood her condition better, it probably wasn’t the desire to go pee that had her upset and whining. It was likely her neurological condition causing her distress. She wanted to sit up, but her feet had stopped working. They just worked a few hours ago. Why won’t my feet work? I want to look around. Why don’t my eyes open? Why can’t I see? I’m thirsty. Why can’t I make my tongue work to drink anything? He’s giving me food. I know its there. I just can’t open my mouth or swallow it. This is probably what went through her little brain during those hours of confusion before she passed out into comatose.
So here I am at 4 in the morning lying on my porch in the dark with this puppy, talking to her. Had anyone been awake to see me, I’d probably have been visited by the people from the loony bin.
Anyway, lying there on the ground, I made her a promise. I was out of ideas and I figured Amy would be too. I told her she was like a Ghost almost; one foot in this world and one foot in the next, and that she had to decide which one she wanted to be in. If she decided she wanted to be in this one, I promised to make sure she was cared for, loved, and that she’d be raised with a family that would treat her right and that we would find a higher purpose for her to serve – a way to be more than just any other dog. I asked God to make a decision for her… I really think everything in this world happens for a reason. I told God that I didn’t think he would intentionally let an innocent animal like this stay here on this earth if there wasn’t a reason for her to exist and that he wouldn’t have put her here if he didn’t want her to do something in this world. She was here, she had been found and brought to us, and she was alive, which was already way beyond expectation, so I hoped he wanted more for her. I certainly did.
Not knowing what else do really do, I held her up while she went to the bathroom, cradling her by her scrawny ribs so she wouldn’t get any on herself. When I thought she was done I took her back inside. Her paroxysms (tremors all over) had resumed, so I tried to give her some of the good tasting sugary stuff Amy had for her to eat to bring her sugar levels back up. She reached her head forward, but couldn’t open her mouth to eat it. With tears in my eyes, I opened her little mouth to put it on her tongue so all she’d have to do was swallow it. It sat there on her tongue, making a mess of her muzzle while she whined at her inability to even eat. With nothing medically left to do at 4 AM I had only prayers and good thoughts to give to her as I put her back in her box and laid down on the couch beside her.
Sometime before 7 AM, Amy woke up, saw her condition, and left with her for the clinic without rousing me. When I awoke she was gone, but I know my wife. If something definitive had happened she would have let me know. The fact that I had no missed calls and Ghost was gone meant she was doing something with her. I still had little hope based on how she’d been two hours earlier, but not being there in the box wasn’t necessarily a bad sign either, right?
I woke up and called Amy at the animal hospital as I brewed a pot of coffee, trying to work the kinks out of my back and neck and get the cobwebs out of my head.
I could tell when she answered the phone the news wasn’t good. Amy just has that tone in her voice that not everyone that knows her gets to hear. When she talks to clients, even when it’s bad news, she tries her best to remain professional – for the client’s sake, not for her own. It helps the client’s mental state to feel that there’s someone that’s “grounded” in the situation, no matter how bad it might be. Your animal’s doctor needs to be strong, to be a rock, so you can be a horrible mess on the other end of the phone that can’t make decisions and can’t answer questions past all the tears and sobbing. And other times, she needs to be the advocate for the animal when it’s too late to help and sometimes it’s better for the animal to be put down. It’s a burden most of us will never know and I’m thankful for that.
She’s never been that way with me. I get to see the moments when Dr. Jordan takes off her scrubs, comes back out of the bedroom in a t-shirt and jeans, and she’s just “Amy” and can be human and upset and tired and exhausted.
When she answered the phone on Friday morning, it was Amy I was talking to, my wife, not Dr. Jordan. That immediately freaked me out… there was this really sad tone to her voice that I don’t often hear. I won’t pretend to remember everything she said. Most of it was buried in an emotional wave that hit me. Ghost wasn’t going to make it. She’d fought that hard, that long, and wasn’t going to make it. Amy was going to put her down, or already had, and she was trying to find a way to break it to me.
The long and short of it was that Ghost, that was the name I’d given her by now, wasn’t doing well. She was neurologic (I’ll explain that in a minute) and fading. Amy didn’t think she’d last much longer. She’d put her on an IV pump to keep her fluid levels ok and she wanted to know if I wanted to come see her, and possibly say goodbye.
I told her I couldn’t do it… that I’d seen her show so much improvement that I couldn’t stand to see her in worse shape that I’d seen her in hours before. If we were going to lose her, then I’d choose to remember her walking around and making funny growly noises, not lying dying hooked to a machine in a stainless steel box. I asked what the prognosis was and she told me, though I don’t remember it now. I just remember buzz words; neurologic, can’t see, cant’ stand up, and things of that sort.
I tried not to break down, but Amy could hear that I wasn’t successfully managing it. I begged her to try everything humanly possible, for me, to try to save her. I think she knew I’d ask that… I try not to ask my wife to do more than she has to. She already gives up so much of her life, her income, her time, and her heart in ways those not married to her will never know. I didn’t want to ask her to do more just for me. That day I did though. I asked her to do it for me stressing the “me” part of that as much as I could. I told her that I thought Ghost had enough fight in her to want to live, I KNOW she wants to live, but she just can’t do it on her own.
Amy promised to do all she could to save her, but warned me that if it became where she thought it was putting Ghost through more pain than it was worth, that she’d have let her go and put her to sleep. She asked if I wanted to come visit, encouraged me to change my mind about not coming. I really think she thought Ghost wasn’t going to be coming home again.
My final request was that if she had to be put down, to bring her to me. I had a place. deep back in the woods to bury her. There is this glade way back on a neighboring farmer’s land that I explore from time to time where the sun shines just enough into this area to create the most beautiful grassy bed surrounding by some sort of willow tree on all sides. It looks like something out of a Tolkein novel and that was where I’d take her and put her to rest if it had to be done. She agreed and promised to do everything in her power to help Ghost fight if she had it in her to do so. We hung up and I spent the remainder of the morning going through the motions of working, but my head wasn’t really in it. I don’t even really remember what I did the rest of that day to be honest…
Meanwhile at Bear Creek
The problem with an animal in Ghost’s condition is that they’re too small and frail to work on much. Their immune systems haven’t developed enough yet to fight off things that wouldn’t bother a larger animal, so treatment options are limited due to that. Her veins are so small that running an IV catheter is almost impossible.
Amy and the girls at the clinic scoured the hospital to find a catheter needle small enough to work in her veins and eventually found one they thought would work. The next challenge is administering drugs once they determine what to give her. You have to remember, even at full health, this animal has a total of maybe 1 pint of blood in her body. A solution that would work for a grown dog, or even a normal healthy puppy, will be too strong to use on her. There’s no way for a human hand, even with the best training, can deliver a dose of 2 parts per million because even one “drop” is a way higher dose than that. Thank God Dr. Preston asked to get that new IV pump awhile back – for administering drugs to small dogs and cats!
Amy and the girls at the clinic came up with some concoction of drugs they put together to hopefully combat all the things failing in Ghost’s little body. Intravenous fluids, proteins, sugar, antibiotics and a lot of other stuff went into that pump, to be administered in incredibly tiny doses throughout the next 24 hours. With that done, there was nothing left to do but wait, pray, and hope that Ghost’s body had enough life left in it to process these things and put them to use.
Understanding her condition at this point is important. You can’t fathom how tiny and sad she looked. As the body becomes hypoglycemic, many things start to go wrong. The eyes get glazed and milky, and they lose the ability to focus. Ghost could hear you and would turn her head, but you knew there was nothing going on behind them. They didn’t track objects and for the most part just blinked occasionally.
Her legs had become completely useless. She couldn’t even keep her hind legs underneath her body sitting on a towel. If she rolled to one side due to shifting her weight, they would just twitch out to the side. Her front legs almost constantly remained crossed, another bad sign and she didn’t have the mental ability to uncross them.
She stayed on the IV pump for the next 36 hours straight, getting all her nutrients from the tubes going into her tiny bony forearm. Amy, Dr. Preston, Samantha, and the rest of the girls at the clinic kept an eye on her during business hours. Amy and I took turns going up at night to feed and check on her. We posted a video on the 3rd that some of you saw (video below) of her first real visit outside her kennel.
As of Tuesday, August 5th, Ghost had made profound progress and was taken off the pump. Her vision had unclouded some and she was showing improvement being able to track sounds and faces again. Her back legs show signs of strengthening, but she still doesn’t have fine motor control of either front or rear legs yet. For the next couple days she’s staying at the clinic during the day and coming home with us at night. Amy and I took another video of her last night to share with those on Facebook that have taken an interest in Ghost and her progress.
Last night, Tuesday, we brought her home from the clinic and made the video above. I went out to Tractor Supply to get her some basic things; puppy food, a bed to sleep in, etc. She spent the night lying on the floor between us in the living room and beside my side of the bed last night. Today she was back at the clinic for observation, but I picked her up at 3 PM and brought her home for the evening.
Given the opportunity, I’ll update this blog post more as time goes on to keep you guys informed about her progress. Thus far all I can say is that she continues to show improvement each day. My wife and I thank you all for your kind words and comments, prayers, and continued support! We’re hoping Ghost will make a full recovery very soon!
Me and my Analogies: Pardon the analogies and don’t criticize the accuracy of them if you’re a veterinarian. They’re for those of use who aren’t so medically inclined as to know things like paroxysm mean… just a tool to put some of these concepts into perspective others can relate to. If one or more of them are medically inaccurate, forgive the transgressions of a layperson, ok?
Update on Ghost: August 9, 2014
Rather than amend this post with all the new info, I wrote a second article on Ghost. You can read it here.