All the dogs I have owned have a place in my heart, but a specially large one is reserved for one Edward Bear, who died at age 12 this past July.
Bear was a magnificent red and gold retriever. I know he was magnificent because I overheard a French dad say so to his family –“C’est un chien magnifiique!”– as he watched him admiringly (the French have high standards when it comes to dogs).
He was the sort of Bear who stayed close at hand and took it as his sworn duty to tend to our family in sickness and in health. He would stand watch (either on the bed or close by) over whichever child or adult happened to be laid up with this ailment or that. He was a constant companion of days, a quiet and happy presence–the soft thumping of his tail when he sensed I was in a particularly good mood was a rhythmic accompaniment to my writing, working, and of course, on walks. When I was sitting or even cooking, his head, often as not, rested on my foot. He was as sunny and friendly in disposition as a dog sired by Summer Bear and whose dam is Buttercup (truly her name!) would be expected to be.
The illness that took him started subtly. At first, we noticed that he fell over easily when he had a bath. His bark became raspy, and at the end he had no bark. He started to have difficulty jumping in and out of the car. I bought a ramp to help him because at 75 pounds, he was a lot to lift.
1. Lesson 1: the importance of the small stuff (ramps!) and learning from the experience of others
I ran into a nice man in the woods, who looked sharply at the way Bear was walking. His dog, he said, had started to walk the same way with that same weakness in his hind legs just a few months before he died. I should treasure my time with my old dog, he said; he still missed his canine companion. The worst thing was–his dog was so beautiful up until the time he died. Putting him down broke his heart.
“Does that ramp work for your dog?” he asked me.
“It got terrible reviews,” I said, “but one person wrote that if you put a towel on top of the ramp, the dogs could get a fine grip.” It was the only thing for sale close by, and I wanted to be able to return it easily if it was no good.
“Oh,” he said. He had bought the same ramp but he hadn’t known about the towel. His dog slipped. The ramp had been useless to him.
2. Listen to the clues: keep a record of what works and treat what is treatable
A few weeks later, Bear’s hindquarters became suddenly weaker, and he couldn’t use one of his legs to walk at all. I worried he might have hip dysplasia–or worse, cancer. There is some data suggesting that aspirin can help arthritis and prevent cancers in humans–so I gave him a tiny dose of this anti-inflammatory. He started walking again. I called the vet to share this turn of events; she was mystified.
Then Bear got a bad case of diarrhea–we thought he had been socializing too much with our backyard bunnies– so we took him to our vet, Dr. Stills (not her real name). He had lost 10 pounds and he had muscle wasting in his hind legs. She felt his spine: maybe he had a tumor in there, she said. Did we want to do some x-rays? “Yes if it is treatable,” I said–but if it would require surgery or chemotherapy, no. She didn’t do the x -rays.
The vet ran some blood work: she found a low functioning thyroid; and his liver enzymes were a little off, as was his kidney function. She said she was pretty sure he had cancer.
“Can we treat his thyroid?” I asked. “Let’s treat what is treatable,” I continued. “It might help.”
“OK, I will treat his low thyroid,” she said, clearly humoring me; “but we both know it is cancer.”
Bear’s hindquarters became stronger. She started him on an antibiotic and we gave him chicken and rice. His diarrhea improved but wasn’t gone.
3. The importance of the second opinion
Several days later, Bear stopped eating his dry food and again couldn’t move one of his back legs. We called our vet. She said it was time to put him down. Dogs can die screaming with pain, she said. It is a terrible way to go. I scheduled an appointment with her for euthanasia the next morning.
But my husband firmly refused–he wanted a second opinion. “We old guys have to stick together,” he said.
So a second vet came to see Bear. We decided on a house visit because it was hard for him to walk. When the vet arrived at the house, we were shocked to see Bear spring up and somehow make it to the door. She greeted him warmly and came into the kitchen to look him over. She palpated his spine very firmly: no, she didn’t think there was a cancer there. He didn’t even flinch, she noted. Highly unlikely to be cancer.
She thought Bear might have the same condition her own dog had had, and eventually died of: a neurologic disease. Her dog had the same weak hind legs; the funny raspy voice; the difficulty eating.
4. Euthanasia isn’t necessarily the only answer
She could see how beautiful Bear looked overall and sympathized with our difficult decision. We did not have to put him down now, she said. It would be work for us, but Bear could keep going for a while. I could put a pair of jeans as a sling underneath him to help him walk to the door and go out and pee. I could put rugs across our wood floors to help him not slip when he walked. She had used yoga mats for her old Shepherd, she said. I would know when it was time. She would feel comfortable putting him down now if we wanted that; but if I wanted to put him on “doggie hospice,” she was comfortable with that, too. She would be available to us if we needed her.
5. The little things again: the importance of the proper treatment
Bear was still having diarrhea so we asked about that. We were doing something wrong, the vet said. When you give chicken and rice for doggie diarrhea, the chicken has to be boiled; and the ratio of chicken to rice should be roughly 20% chicken to 80% rice. The purpose of the chicken is just to make the rice taste better.
Bear’s digestive issues would have recovered a lot faster if we had known that at the outset. I had been giving him rotisserie chicken. Fat is not good for upset doggie stomachs; they can even develop bloody diarrhea, which he did before we made the change our new vet suggested.
For a few days, supporting him with the jeans or sling and the better diet worked; then Bear started to go downhill again.
Again my husband and I discussed putting Bear down; again my husband said no.
6. The importance of a diagnosis: putting the puzzle pieces together
But then an interesting thing happened. I said to my husband–but with Bear’s hip dysplasia, or cancer, or whatever it is–he isn’t going to get better.
Then my husband said: but the vet didn’t say that (I had been in so much shock that day I had hardly heard what she said). He told me he was sure that she said it was a neurologic disease of some sort.
This is why it is always so helpful to have a second pair of ears in the room at an appointment–including a veterinary appointment!
I looked back at the vet’s clinic note, which she shared with us. There was NO diagnosis listed.
The note read:
“ASSESSMENT: Bear is such a beautiful, sweet boy.
I am sorry that he is struggling with his mobility.
PLAN:
Keep supporting him as you have been doing as long as he is showing you that he is happy.”
But the physical exam said:
GENERALIZED MUSCLE WASTING. SEVERE ATAXIA
HIND LEGS.
On his respiratory exam, she said that everything sounded good, but noted he was PANTING –written in all capital letters.
I thought about that; and about Bear’s difficulty swallowing food–he clearly was HUNGRY, he just had a hard time swallowing–as if he had laryngeal paralysis.
So I gave some deep thought to the condition. If this was a neurologic condition–it must have a name. What was going on here?
I googled laryngeal paralysis; panting; hind quarter wasting.
An instant hit. Many. They all said the same thing.
The syndrome is called GOLPP, a relatively recently described disease; GOLPP is short for geriatric onset laryngeal paralysis and polyneuropathy. When I asked Bear’s vet, she confirmed the diagnosis. It is often accompanied by thyroid disease, and can improve when the low thyroid level is treated. The laboratory abnormalities on his blood tests were typical of this condition. These dogs have a hard time eating, so they can lose weight, just as Bear had. It seems to especially affect the hind quarters with weakness and muscle wasting–thus Bear’s “muscle wasting and ataxia”; and it also affects the lungs–they have a hard time getting a full breath–thus the panting.
Knowing Bear’s diagnosis was such a huge relief. This wasn’t cancer; it wasn’t hip dysplasia; it was a relatively new neurologic disease in dogs and cats that prevents them from breathing properly.
7. Understanding the cause of disease can suggest effective treatments
In many ways, I thought, it was like my mother’s Parkinson’s disease, where soft voice, poor balance and weight loss is also seen. I googled tracheal/ laryngeal paralysis in humans; I wondered–could this be due to pesticides? Yes. Another hit: tracheal paralysis in humans can be due to organophosphate poisoning.
That, I thought, was interesting, because 1/ a lot of pesticides are used in my neighborhood; and 2/ organophosphate poisoning can be treated. So perhaps, I thought, if we tried to treat Bear’s laryngeal paralysis in a similar fashion–that might work.
I asked Bear’s vet: is it possible to measure organophosphate levels in dogs? Is there a lab test for organophosphate poisoning?
No, she said.
But the knowledge was helpful and inspired us to try several medications. Miraculously, Bear start to walk again.
We knew when he was really getting better when Slikke, our other Golden, who had ignored him when he was sick, started to groom him again. In a few weeks, we took away all of the rugs that lined the hallways and kitchen floor like a jet runway–he could walk so well he was no longer slipping and falling. When Slikke started to bound into the middle of our new ramp to get into the car (just to show off)–Bear could now follow suit. We started to go on real walks again. One month led to the next. My daughter came home to see him; then my son. I finished a manuscript I was working on, with Bear’s head resting on my foot, as always.
Bear was doing so well that we paid a social visit to Dr. Stills just to say hello– she was a bit incredulous to see him walking, and the office staff was so thrilled to see him–they were big fans of his.
8. When it is time for euthanasia
But eventually, all of his symptoms returned. I was heartbroken. He needed the jeans for support again. Then one morning, he couldn’t use his front legs. He gave me a look: “I am done with this,” it said. I called my husband and told him. Yes, he said, “I noticed that he couldn’t walk on his front legs either when I took him out this morning.” I told him I thought it was time to put him down–because this time, Bear clearly was in pain.
“I will be right home,” my husband said. I called my daughter to let her know, since she lives far away.
Then I called the vet, who said he would be right over. Then I went to chat with my son. “It’s your decision, mom,” he said. “You are doing all of the work taking care of him. It’s up to you.”
When the vet rang the doorbell, Bear wagged his tail; but this time, he could not get up and go to the door. “That’s some dog,” the vet said. “Wagging his tail when he must be in a lot of pain.”
“You did a really really great job taking care of him,” he added. “Three months with that diagnosis at that stage of this disease is impressive; and I have never heard of these dogs being able to walk again.”
It is important to know that dogs can suffer tremendously at the end of life; that is why euthanasia is often recommended. I would also suggest that, if you choose to pursue doggie hospice as we did, you consider asking the vet for pain medications just in case they are not available to come quickly when your dog is nearing the end. We ended up not needing these; but the medications offered us peace of mind.
While Bear’s breathing was labored and his heart rate fast, he was calm and did not appear to be in pain as long as he didn’t try to walk. My husband got home just in time to say goodbye. The vet gave Bear a medication to relax him, then one that would stop his breathing. He told me to put a towel under Bear in case he had an accident, which I did–but it wasn’t necessary. Bear rested his head on my lap. The vet listened to his heart. “He’s gone,” he said. I know, I said. I took a few of Bear’s glorious locks of hair. They would comfort me, the softness and beautiful color, in the weeks to come.
This is a photo of Bear, six months before he died. I will put this up in my living room–just as I found a picture of a friend’s fine hunting dog who had recently died, in a place of honor in his living room in Iceland. Bear would be honored like my friend Bjorn’s Hera.
Lessons learned: the angst of an incorrect diagnosis
Looking back on our journey, one of the most difficult parts was when the veterinarian, Dr. Stills, told us that our dog had cancer. I am not sure why, but the idea that Bear was dying of cancer caused me particular anguish. I didn’t think it was true– but the vet must know–right? It also caused a lot of angst in our household. I told my daughter what the vet thought. We grieved. Should I tell my son? He had a big race coming up at college. Was that fair to tell him just before a race?
I shared with Joan, my mother’s good friend, the huge loss that I was feeling. At 96, she said, she had lost many a dog and cat. “And the funny thing is,” she said, “in a way we love them more than our own kids.”
Anticipatory grieving that comes with seeing an illness through may ease the pain of loss
Another important part of this story: Bear himself was part of our healing. Even when he was sick–the extraordinary thing was that Bear–always the greatest source of comfort in the face of any trial or tribulation in our house–helped us grieve his own passing. The time spent sitting with him, watching over him, hugging him–the joy of seeing him recover almost back to his baseline, the agony of watching him get sick again–it seemed like it helped ease the pain of his loss. At the end–there was no question that he was dying, that he was in pain, that he was ready to leave us. At the beginning–when this illness had come on suddenly, his coat was beautiful and the only thing was the wasting and weakness in his hind legs–it was a hard decision.
My daughter said to me–”I am so shocked–and almost guilty–I grieved for Bear for a day–and then it eased off. It is as if I did all the work of grieving up front–anticipatory grieving. Like I have worked through it all already. How can that be?”
I wonder if we aren’t a bit quick sometimes to put animals down. I thought of how awful and unresolved my grief would have felt if I had put Bear down right away–when his coat looked brilliant and beautiful and the only thing wrong was that his back legs didn’t work.
Urgent need for further research into cause of GOLPP–and effective treatment options
Another lesson: might there be a potential treatment that might work for other dogs, especially if given to them early? We acted on a hypothesis; and the medication cocktail worked, although the effect did not last. Maybe finding a better combination of medications could be an important area of veterinary research. Sadly, testing for pesticide exposure was not available for Bear, so the hypothesis could not be proven. But since pesticides have profound neurologic effects– shouldn’t we be testing for this in our pets with unusual neurologic diseases, and in humans also? We are all exposed to these neurotoxicants, and tracheal paralysis, which is what Bear suffered from, is well described in humans as a serious complication of pesticide exposure.
We should be working harder on therapies in general for this illness–and to prevent this disease in the first place. The only treatment offered for GOLPP is a surgical procedure; but that is like treating a bacterial pneumonia with cough syrup instead of antibiotics: it treats the symptom (cough) but not the disease. It is time to start doing a better job of figuring out the etiology of–and then preventing–this terrible disease that takes the lives of some of our dogs. Our best dogs. Like Bear.
Takeaways:
- Ask for a diagnosis; does the diagnosis makes sense?
- Treat what is treatable
- Caring for your sick dog can ease the grieving process
- Know your own truth when is it time to seek help in saying goodbye
- New diseases require more research into cause and treatment
