We lost our most precious dog, Crystal on May 15 2006 at the

We lost our most precious dog, Crystal on May 15 2006 at the UM vet teaching hospital. Crystal was undergoing treatment for lymposarcoma, that we discovered in January. Her condition originally masked as Cushing like symptoms. Crystal underwent Chemotherapy (Wisconsin protocol) from 1/31 until May 03rd (her last treatment). We took Crystal to the UM Veterinary Teaching Hospital on April 06th (?) I think) and had them due tests on her at that time. They thought at that time that her Lymposarcoma had gone into remission. UM Vet hospital sent their findings to ouor vet. On May 08th at 1630, Crystal begin vomiting ferociously, approx 8 times. She then refused to eat or drink. We monitored her the next day and notified her vet, who was giving her chemo. He said he thought her vomiting was related to her chemo treatment. However, she had never vomited at any other time. We took Crystal in to him Thursday am, for we feared she would dehydrate. He put her on IV's during the day and since he doesn't care for dog's overnight, we took her home each evening. He got blood work back and it noted that her ALP was very very very high and so was her ALK. Our vet said he didn't think it was anything serious, that sometimes those levels can get high in a sick dog. On Thursday pm, I spoke with the oncologist at Mizzou who handled Crystal in April. I described Crystal's syptoms and she said that whatever was happening had nothing to do with the cancer or the chemotherapy treatment. She suggested that her vet explore other issues. She said that unfortunately, it was graduation weekend coming up on campus and a bad time to come down. She said if Crystal got worse we could admit her through emergency. We took Crystal back in to our vet on Friday and the vet continued the IV's. My wife brought her home at about 1600 and called me to say Crystal looked "better" and was now in the backyard checking out her rabbit friends (one of her favorite pastimes). 10 minutes later, my wife called to say Crystal had burrowed under our deck (the deck is only 12-14" off the ground and Crystal weighed 16 pounds). Crystal wouldn't come out. I came immediately home and my neighnors and I began dismantling the deck to get her out. Finally, we managed to get enough boards off that one of the neighbors grabbed Crystal. She had her by her back leg and I asked her to let go of her leg for fear she would break it. She got a hand around her belly and then all hell broke loose. Crystal bit the neighbor, me and my wife. She had never, ever done that. We got Crystal inside and put her on our bed (where she always liked to sleep). Her breathing was rapid and shallow, which it had been for about 4 days. Again, our vet thought it may be due to the chemo treatment. At 01:30 am on May 13th, Crystal's breathing had worsened. We then drove the 120 miles to Mizzou to have Crystal looked at. They drew blood and engaged a whole series of tests. They performed an ultrasound on her abdomen and x-rays. They concluded that Crystal had a "very, very large liver (they said that it was as big as a german shepards should be, and Crystal was half chihuahua and half terrier, 17 pounds) and that her primary condition was pancreatitus.
Now for my questions. They told us that unless Crystal began eating food within 4-5 days, that she was destined for a poor prognosis, as they claimed that the cells in the stomach begin to die(?) and this creates problems. I don't understand this, as on Animal Planet you see starving dogs and they don't seem "doomed". Or is it a different circumstance in Crystal's case because she was undergoing chempotherapy and the chemotherapy made her condition more complicated.
Question 2: Crystal did ok on Saturday and perked up somewhat on Sunday. The hospital said that one of her major problems was the pain caused by the pancreatitus.
They had placed a catheter into Crystal's jugglar vein to administer fluids and pain medication and antibiotics. They said this was necessary because Crystal's veins were in poor condition because of the chemotherapy. On Monday am May 15th, they called and said she did well overnight. 30 minutes later, they called to say that "somehow Crystal's catheter had "come out" sometime after midnight and the staff didn't catch it. They said that they were going to have one of the "experts" replace the catheter. My wife was already planning on driving down. 30 minutes after that, they said Crystal;s condition had worsened "severely" and that we had best get there ASAP.
We drove through heavy rain and thunderstorms 120 miles. When we arrived, they had Crystal in an humidified oxygen tent / preemie tent. Crystal was having trouble breathing very badly. She was laying down when we first came in the room, as she couldn't see us. The very second she seen us, she got up and tried to lick us. She wanted to come home. The vet hospital at Mizou said that there was nothing they couild do, that in their estimation Crystal was now terminal.
Next question: They said that what was happening to Crystal, based on the bloodwork they drew when they found the catheter out, was that Crystal had likely "thrown a clot" that had traveled into her lungs and basically she was not getting any oxygen as a result. I guess I can accept this educated hypothesis, but my question is what made the clot in the first place. Was it the replcement of the catheter? The fact that the catheter came out in the first place?
Final question: Because Crystal was sick with the Lymposarcoma and we were told that Crystal had maybe a year to live, maybe two if we were really lucky, we began feeding her and our other doc, Bonnie, a 15 year old Corgie-beagle mix, chicken thighs and crummies for their meals, with a little dry dog food mixed in. Crystal had lost her appetitie for dry foods when the chemo began and her vet said that she needed to "keep her weight up" whiuloe she underwent chemo. She actually had gained 2 pounds. Anyway, on Sunday night, May 07th, our neighbor had given us some steaks that he didn't want. (these were small steaks,)We grilled the steaks and had given both Crystal and Bonnie each a steak. They were both fine all day Monday and all day Tuesday, until Tuesday at 1600 when Crystal began vomiting.
Question: did this have anything to do with Crystal getting pancreatitus? My wife thinks it may, but I ahd to remind her that the whole week before, Crystal was only eating 1/2 of the amount of food she was eating previously.
sorry that this is so long, but you needed the background.
Your thoughts??

Mike Hannemann
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First let me say how terribly sorry I am that you lost your dear friend. Your post speaks volumes to what wonderful care you've provided her and how much she meant to your family. I hope that I can help you to sort out some of the things that went on in the last few weeks of her life.
There's obviously no way for me to know for certain what precipitated the pancreatitis. There may have been something brewing, a low grade inflammation of the pancreas several days prior to the onset of the vomiting since you mentioned her appetite had been decreased during this time. The decreased appetite might also have been related to the last dose of chemotherapy she received on May 3, as this is a common side effect in the week following chemo. Unfortunately, it's also possible that the steak that was given on May 7th played a role. The cause of pancreatitis is not well understood but it is often associated with ingestion of a high fatty meal. Now whether the steak was the primary cause or just tipped the scale from a low grade to a full blown pancreatitis, we'll never know.
It was reasonable for your vet to initially believe that the vomiting was related to the chemotherapy, even if she hadn't experienced this as a side effect before. However, once it was determined that her liver values were extremely high another cause should have been investigated. Dogs with intestinal upsets of many causes will commonly have mild elevations in liver values, but when they begin to get to 3x or more than normal, then something else is usually at work. Usually in cases of pancreatitis, a value called the amylase level is elevated; but this isn't always the case. If Crystal's amylase was not elevated, that may be why your vet did not immediately look to the pancreas as the source of the problem. In dogs with lymphosarcoma, if the liver is involved in this disease process, then values can also be quite high. The oncologist believed that Crystal's cancer was in remission- what sort of testing had they done to confirm this? I must say that, while it is common in cases of pancreatitis to have secondary involvement of the liver and intestinal tract, I've never seen a case in which the liver was so markedly enlarged or the liver values were off the charts. So I have to wonder if there wasn't more to the liver changes than just the pancreatitis; perhaps the lymphosarcoma wasn't truly in remission and thus complicated the pancreatic issue.
As to your question about cells in the stomach beginning to die if she went for X number of days without eating- this isn't exactly correct. In fact, in cases of pancreatitis enforced fasting of the patient is the recommended treatment. Pancreatitis occurs when the pancreas inappropriately releases digestive enzymes into itself instead of into the small intestine. It, in effect, begins to digest itself. Intake of food or water by mouth stimulates further release of these enzymes- so fasting is needed, often for 3- 4 days, in order to allow the pancreas time to quiet down. The biggest risk here is that the inactivity and inflammation of the intestinal loops associated with release of pancreatic enzymes can result in ileus, in which the intestinal loops come to a standstill. So it's a race between resting the pancreas and not giving the intestinal loops too much of a vacation so that they stop contracting all together.
It's very common in cases such as Crystal's to have to use a jugular catheter, both because of scarring of the leg veins as a result of the chemo, and also to facilitate administration of multiple medications. It is unlikely that the blood clot occurred as a result of the jugular catheter getting pulled out. The major complication in that situation is usually bleeding, which Crystal apparently did not experience. I think that the more likely cause for the formation of the clot was an end- stage complication of severe metabolic disease (pancreatitis can cause it but so can others, such as liver disease or cancer) was disseminated intravascular coagulation. DIC involves a cascade of events in which the clotting pathways are activated- it can lead to the formation of clots in various organs of the body, as well as to bleeding because the clotting factors are being used up at a phenomenal rate. Once a patient starts down the path of DIC, the condition is rarely reversible.
I hope that this information addresses all the concerns you have about what happened with Crystal at the end of her life. I know that sometimes filling in the blanks helps to bring a little more sense to events that seem to spiral out of control. Please take comfort in the fact that you provided a loving, wonderful home for Crystal in her 10 years. You did your best to extend her life, in comfort, in the face of devastating illness. Something that the majority of people could not, or would not, do. Her death has no doubt left an enormous hole in your lives. I can only hope that in time you will be able to let go the pain of the circumstances of her passing, and embrace the joy and friendship she brought into your home for 10 years. Share stories of her with one another, remember the silly things that she used to do or how her presence helped to ease the load of a long and hectic day. Her memory and her life should be celebrated. If you allow yourself only to dwell on the last few weeks, you are doing yourself a terrible disservice.
Please let me know if you have any further questions.

pancreatitus, embolism, background and questions

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