"Can I ask you a question?" said a man the other day when we were on our walk on a busy road side. I stopped and turned back, after moving Penny to a safe spot near a row of cars parked on the side of the road.
I said yes.
He said, how would the dog protect itself in case of an attack by another dog? He was pointing to the muzzle my dog was wearing and went on to say that he can understand why people make their dogs wear muzzle but they never think about how the dog feels about it.
My first response to him was that when I am with her then I will save her. And being a dog who stays inside a human home, the dogs cannot really defend themselves.
He went on saying how it hurts him to see a dog with their mouth clasped shut with a plastic cage, which is what a muzzle is.
So does my heart, I said. I have to do this each time we go out for a walk but this pain is nothing in comparison to the one that we, she much more than me, endured in the past. It is a miracle that she is still alive.
It started with vomiting. Seems pretty much usual for dogs. Just that the final diagnosis happened only after a month long trauma followed by an endoscopy and the wait for biopsy before a major surgery after which came the diagnosis. Although there were signs all along which we all missed partly due to ignorance. It was fortunate in our case that the diagnosis could happen and we could save her because this is a fatal infection which gets unnoticed unless you decide to get an autopsy done. This is why there is so little information out there and that is another reason for the delay in the diagnosis.
The trauma that my dog endured, was of first not being given food and then not being able to eat. This is what was visible to us, it was only later that we would find her real trauma inside her gut. We watched her from begging for food, when she had to fast for her stomach to recover which usually takes a couple of days during which only fluids through IV are given and later for her ultrasound and Barium X-rays for the treatment and management of an undiagnosed condition, to not wanting any food because even water or her saliva could not find passage to pass through her food pipe into the stomach.
Regurgitation and foamy vomits happen in that case. Saliva pools inside the food pipe when the body is in a lying position and so she would have to cough it out. In her attempts to cough out, she would make sounds that we had never heard but could see and feel that it isn't a regular cough.
Megaesophagus, a condition where the esophagus or the food pipe becomes larger in diameter and loses its ability to move the food to the stomach, was the first diagnosis. Whether it was a foreign object or some unknown reason, the Vets could not tell without an endoscopy.
It was hard for me to explain what the coughing and wheezing which was doing looked like. It was only on one occasion that she coughed in the presence of a Vet but those doctors just ignored seeing her in that state while standing a few feet from us while saying they cannot do anything for this case, as only endoscopy can help. They were obviously right and maybe apathy is needed in their profession.
This was the first time that I had given up. Instant diagnosis of pancreatitis to ulcers, flatulance on ultrasound, damage to food pipe (megaesophagus), all that was bearable, but the repeated desensitisation and apathy of the Vets we visited was not. This was the first time that I regretted adopting her for I could not give her proper medical care.
And then from two different places, we heard of a very experienced doctor's name and an animal hospital's name. As I realised those two are connected, we took her there. A repeat X ray told us that there is a tumor blocking the food pipe. A similar diagnosis of blockage and megaesophagus due to it was explained by the doctor with patience, empathy, and reassurance along with the bare truth of the complications during surgery because of the location of the tumor. The tumor was at the junction of the esophagus and stomach. There is a sphincter at this junction, which acts as a gate to keep stuff inside the stomach and not spill into the food pipe. Without it, things would keep on leaking out causing acid burn, regurgitation, and vomiting and a scenario/condition which isn't going to be manageable. We scheduled the endoscopy for the next day.
After this enlightening visit to the Vet, Penny and I went for a walk in the park. While I was on call with my sister, Penny started eating grass. I don't know why I let her eat, knowing well that there isn't enough space for the blades of grass to enter her stomach. We had not been giving any solids to her. Doctors had advised for semi solids and here I was joking on the phone with my sister about my sick dog eating grass in the park. That was me giving up on her the second time. Soon, she started to choke and cough. I wasn't sure whether to take her again to the hospital. I wasn't sure of what to do anymore. She coughed for some time after which the grass came out. It seemed that she wasn't going to give up and would not even let me do so!
The next day we went for the endoscopy to a different hospital where we were referred to by our new Vet. At this hospital, the surgeon asked us about the deworming of the dog, before beginning the procedure. He said that the tumor could be because of a worm infestation -Spirocerca lupi. The new vet had also mentioned that as a possibility. Hearing it again, raised our hopes because a worm infestation can be treated.
While the endoscopy was being performed, I read about the worm and this deadly disease. I could not stop blaming myself as tears ran down my cheeks. I failed to take care of her. I failed to keep her safe. It was because of me that she had become a scared puppy who kept hiding from me. Her fear came because of the syringes filled with medicines that I would hold in hand while trying to catch hold of her. These medicines would make her vomit again at times. Or I will carry her to the tables, on which needles will be injected in her limbs that were still sore from the last puncture.
As the endoscopy got over, we followed the surgeon who was rushing out without meeting us. He turned on hearing his name and said casually, 'Ohh, it is a tumor', as he entered the lift which closed in front of us. Was I relieved on knowing that it was not my fault?
We had to now wait for the biopsy results before the surgery could be performed. This was the most difficult ten days of our lives. Daily visits to the hospital for IV fluids were traumatic (and transformative). I kept asking myself, will I be able to do all this again for Penny on seeing so many senior dogs spending the last few months of their lives on stainless steel tables hooked to IV fluids. Some were so calm and others quite aggressive. Penny was brave. The senior most Vet would often look at her and say, it is not even possible to imagine by looking at her that she has such a big growth inside her. Her body language, her stature, they all deceive us of the suffering she has been enduring. He was so right. Penny would still go on walks both times. We would walk on the side of the road, opposite to the direction of the moving cars and two wheelers, and everything appeared to be usual, normal, and regular. It would feel like an ordinary day. She was a healthy pup and I was a guilt free dog parent.
After a week of waiting for the biopsy reports, it was her body that started to give up, not me, and not her. We suggested of not waiting for the biopsy report but the doctors advised against it. She could hardly sleep by now, saliva would keep drooling out. I remember once stealing (not exactly, but taking on the insistence of one of the para vets) half a tissue roll from the hospital for our auto ride back home, because we had forgotten to take a towel to keep under her mouth for cleaning the constant drip of drool. The happy puppy who would not want to sit in the auto, would choose to now sit. The walks were getting shorter now. She would sleep on the floor and so would I. After every one or two hours she would wake up and cough out the saliva that pooled inside her food pipe, not finding a way to her stomach. At times, she would sleep on the sofa with her head resting on the high back rest and it was then that she would get a little more sleep.
Finally, the day of the surgery arrived. It was Doctor's Day. The biopsy report had indicated a benign growth but the size and the location of the tumor made this a complex surgery. I remember of not being sure if I will be taking her back with me from the hospital after the surgery. No, I had not given up now but I was prepared for the worst.
I was elated and relaxed. I smiled and thanked the doctor. The storm had passed.Spirocerca lupi worm is carried by the dung beetle. When a dog eats the dung beetle (along with the dung), these worms go to the stomach just like all the food goes. From the stomach, the worms enter the blood flow reaching the major artery of the body that is directly connected to the heart. I start to shudder while imagining 5 - 7 cm long worms moving inside the artery of my baby. The worms move further and settle in the wall of the esophagus (food pipe). That is where small masses called as nodules form as the worms breed and reproduce building their nest and villages inside the gut.
In Penny's case, there was a single large nodule present at the junction of the stomach and food pipe. This huge size suggested that it would have taken more than a year or two for the worms to have settled and forming a civilization inside her gut. And during these last two years, there were multiple signs that we all missed.
The most crucial was this exchange that I had with Penny's Vet of 4 years, a couple of years back when she was healthy but may be not spirocerca free.
I told the Vet that she is always hungry when we found that she had gained 2-3 kgs more than her ideal body weight. The doctor remarked, "She is turning into a Labrador from an Indie". I further added with concern that eats cow dung. No special remarks were made this time, but yes, we also got deworming done.
On hearing about a dog eating dung, some people say yuck, others say how stupid dogs are and then there are some who would say they might have some dietary deficiency.
My answer now is please take them to the Vet and get them dewormed and tell your Vet about the dung and spirocerca if they don't bring it up themselves so that they use the specific drugs which kill Spirocerca lupi in addition to the regular deworming regime.
Penny was given four doses of Doramectin followed by Assurity Plus. The whole treatment regime was for months, but she was back to being her happy and active self within a few days after the surgery.
Now we make sure to get the deworming done regularly.
And the muzzle stays with us on the walks, at times on her mouth and at other times hanging in my hand, when she cannot bear it any longer. Yes, making her wear it does break me but not as much as the reminder of what she went through because I would just laugh when she would eat cow dung.
Here is a video for those who would like to understand how the worm infests the body of the dog. It might raise your anxiety but kudos to the Vet who has made it for helping you calm down when those panic moments will hit you.
P.S. I would not want to name all the doctors that we went to but would want to express my gratitude for Dr Aradhana Pandey and Dr SK Pandey (of Doggy World) who saved us.
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