EPI

[EDIT: Quick reminder that is related to this post — voting is still going on to support EPI research. Please consider clicking over for the five seconds it takes to add your vote!]

If you’ve been following my semi-constant whinging on about Yara on Facebook and/or Twitter, then you’re well aware times is not good.

Basically the positive news we got from her last round of tests at the vet in July isn’t lasting. Since her major rebound of SIBO last month she’s been on-and-off sick. It’s incredibly inconsistent and until yesterday hadn’t manifested into accidents in the house. Her stool would be somewhat soft one day and then the next it’d be fine.

Anyway, over the last few days she’s had very loose stool and then yesterday morning she had a middle-of-the-night accident in the house that was very close to the “cow plop” type stool that is a trademark of pancreatic issues. And it was quite a somewhat larger amount of fecal matter than is her normal; another hallmark of EPI. So, I called in.1

The vet and I are kind of stumped. All things considered I’m doing pretty much everything I can to keep Yara healthy with regards to her EPI. But the research the both of us have done basically seems to suggest that sometimes dogs just have issues and there’s no rhyme or reason as to what works for one dog and doesn’t for another. But given Yara’s results from July, we’re going with the assumption the current issues are stemming from low B12 levels. She has B12 added to her food,2 but we’ve decided that isn’t enough and so for the foreseeable future Yara’s now back on weekly B12 injections. You can imagine how much I’m looking forward to this.

We’re trying to avoid putting her back on Metronidazole, the antibiotic she was just on for the SIBO incident. She’s been on it now three different times and while it’s helpful, it’s a bit on the aggressive side. However, given the loose stool her vet is concerned that she might develop another bought of SIBO, so to offset that possibility she’s put Yara on Tylan Powder for two weeks. Because of that I’m giving her Forti-Flora, which is a bit of a stronger pro-biotic than those found the cultured yogurt I generally add to Yara’s food.

Hopefully she’ll improve. She did get sick again last night, which I only discovered as I was headed out the door to work, so we’re home for the day again just to be on the safe side. Yara has an appointment on November 11th for her rabies shot and I’ve now amended that to include a full exam to check up on her. That is if we don’t end up going in before then.

As for me? I’m very torn by all of this. I can’t help but think how I’d have given up long ago if this were just a pet of mine dealing with this. And then I feel horribly callous for thinking that.

I’m just worn out, I guess.

  1. Well, actually the fact that my para-transit bus rolled into my driveway at 5:45 a.m. (35 minutes before it’s scheduled pick up and an hour ahead of it’s “usual” time) had a bit to do with this, too. Since I’d spent the majority of my awake time cleaning up after the dog, I was hardly ready. In fact, I was still in my jammies!
  2. Along with her enzyme supplements, omega-3 fatty acid and probiotics.

Health and “Hunger”

So, after an absolutely hellish Saturday morning and three more days of being woken up at oh-god-thirty to clean up a diarrhea accident and spending roughly $150 at the vet Tuesday, I am happy to say that Yara is doing pretty much fine. Yesterday she had her first formed stool. It’s still very soft, but is a nice, normal color which means she isn’t reacting to the prescription food.

As for me, I caught a stomach bug and spent Wednesday morning having my own issues at oh-god-thirty. Thankfully, I didn’t have to clean up after myself, though.

On a similar topic, epi4dogs.com is hoping to raise some money through Pepsi Refresh for EPI research and a general information/awareness campaign. I’m fully in support of this and hope that you’ll take the few seconds out of your time to click over to that there link and cast your vote. There are some other very worthy causes that you can also vote for, too. I’m sure I sound like a broken record and it’s hard not to after all of our struggles with this horrible condition, but there really needs to be more awareness of EPI. GSDs are the most common breed of dog to be afflicted, but it isn’t a condition solely limited to them. The belief is that EPI is caused through genetics and the aim of the research going on at Clemson University, which is where these funds would go, is to determine the exact genes that create this abnormality.

The other portion of the raised funds will be used towards an ongoing awareness campaign to spread knowledge and information about EPI. While EPI is manageable with proper treatment, there are dogs that die from the extreme effects. Diagnosis can take a long time, especially if the vet you are working with is ignorant of EPI and the symptoms. Without proper treatment, these dogs are literally starving to death. Sadly, some dogs are diagnosed too late and the malnourishment they suffered from EPI has done permanent damage to vital organs. Having a support system during the initial diagnosis and treatment process is absolutely invaluable. I can’t tell you how thankful I am for both of the vets that Yara has seen over the last three years; they’re informed about this illness and better yet they are both invested in Yara. But unfortunately there are still so many vets out there who have never heard of EPI (it’s only been recently it’s been taught in vet school, and I’m not even sure every school covers it) and that leaves a lot of dogs in a very scary place.

Somewhat related to the above in the sense of starving to death at least, I just finished reading Hunger, which is a fascinating young adult novel by the phenomenal Jackie Morse Kessler. (Otherwise known as Jackie Kessler, author of the Hell on Earth series.) It’s the story of Lisabeth, a seventeen-year-old anorexic who is one of the Four Horsemen . . . the Black Rider, Famine. Really, that was all I needed to know to pique my curiosity, which was good because that’s about the extent of the blurb.

Book cover

I feel I should have so much to say about Hunger because it is such a powerful read. Instead I’m left completely blown away and nearly speechless at this terribly short, yet incredibly intense novel. Kessler has managed to take eating disorders and weave a fiercely unrelenting story without being the tiniest bit preachy on the subject. She doesn’t shirk away from the pure physicality or raw emotion and presents Lisa’s suffering in a tangible and gripping way.

What initially piqued my interest in the book was the vague description I’d had of it. I’m sure if I’d really searched I could have found out more, but I was thoroughly intrigued by how the author would intermingle these two ideas. (Turns out, as she explains in notes at the back of the book, this isn’t exactly a foreign concept in literature . . . or at least comics.) It’s a truly fascinating juxtaposition and, aside from the uncompromising nature of Lisa’s (and Tammy’s) struggles with food, was the main force compelling me to read on further.

Basically, I’m left kind of bereft of words. It really is a fantastic book.

And the Weekend Begins…

[Note: This is probably TMI for anyone adverse to bodily functions or the like. You have been warned.]

The other day I posted about Yara’s continuing health issues. Talked with the vet Thursday afternoon and she agreed with my desire to “nip this in the bud” as it were. Since I still have meds from the last time, she suggested putting Yara on a very short course of the Prednisone and then tapering it off with increased allergy medicine. Of course, Yara’s still basically refusing to eat…

At roughly 2:30 a.m. I was startled awake by the sound of gushing water followed shortly thereafter by lapping sounds that were unmistakably Yara.

I leaped out of bed and rushed over to her crate and saw the product of some very explosive and runny diarrhea. And, of course, not only was my lovely companion laying in the mess . . . in an obvious effort to hide what was technically a no-no she was trying to eat it. Don’t you just love dogs?

I suppressed my own desire to make an accident of my own and dragged her straight to the bathroom to rinse her off. Not before she scooted passed me and plopped her mess-covered self on her bed. While she was drying off a bit in the tub — and looking terribly pained by this — I bundled up the blankets from the crate and inspected the necessary cleaning. At first glance it didn’t seem too bad and so I left that chore until after I got Yara outside to potentially empty herself out.

Because she’s Yara, of course, she just stood out there and stared at me like I was a complete moron for taking her outside.

So, back inside I tossed the blankets into the washing machine and set about cleaning off her bed and crate. Yara took the opportunity while I was cleaning her crate to spend some time in the living room vomiting up an entire river of bile and water right by her bed. Seeing a theme here yet? If not, I’m sure you will soon.

Out comes roll number two of paper towels and I busy myself with cleaning up the vomit. Yara’s being super cooperative and won’t get off her bed, which is right in the path of the spreading liquid on the floor. After physically manhandling her away so I can move the bed, she pees on it.

And in the kitchen.

Where she continues to throw up.

And then step in it.

I’m on my last roll of paper towels at this point and moving onto any available rag I can find.

I drag her outside again — along with two rather foul bags of garbage. This time she relieves herself and manages to drag her tail through it while waddling around. This happens shockingly often since her tail is about as long as her entire body.

Back inside she lays down on her bed with messy feet and tail before I can even turn around to shut the front door. This time it takes four tries to call her off the bed — she keeps coming over to me about halfway and then running back to the bed, walking in a circle on it and laying down. Anyway, I rinse her off in the tub again. She’s looking quite morose at this point because, I think, getting sprayed with the shower attachment is akin to being beaten alive.

She’s dry heaving at this point and making a weird clicking/chomping noise with her teeth that I think was her attempt to hold the heaving in? I’m taking this as a good sign, as pathetic as that may seem, because I’ve now run out of rags and am on to clean towels to clean up things. And honestly, at this point I can’t believe she has an ounce of liquid left in her stomach to discharge in either direction. Somewhere in here I cleaned off her bed for a third time, which required basically pulling it out from under her to achieve.

Yara fell asleep soon after I finished cleaning her bed the last time. I plan to try and get her to eat some plain rice later on this morning but I’m not confident she’ll cooperate. Poor thing. All I can say is how happy I am to be living where I do right now. If I were at the Elouise, I’d have little ability to bathe Yara beyond a sponge bath since the tub there was so archaic. Not to mention at this point I’d be looking at at least $10 to do all the laundry that’s accumulated.

Last Vet Visit

Saturday Yara had what was hopefully her last visit to Parkside Vet. Because she was still suffering from her allergic reaction last month when she had her annual checkup, I didn’t fast her and have the blood work done that was needed for some of the tests we wanted done.

Since her diagnosis in November 2008, Yara hasn’t had her TLI, folate or B12 levels checked. Her vet just called and informed me that, obviously, her TLI level shows that she’s EPI. But her folate is normal and her B12 is at 228, which while quite lower than normal is still significantly higher than it was when she was diagnosed. Given that she weighed in at 64 lbs, the highest she’s ever weighed, and is doing so well, the vet and I both agree that B12 injections aren’t necessary for her unless she starts exhibiting severe EPI symptoms or drops her weight drastically again.

So, basically, yay!

Yara

While I don’t feel the need to share every last detail of my life with the whole of the intarwebs, I’m not exactly a private person. So, the fact that this announcement is not news to a mere five people is saying a lot.

On June 17th I started the process to retire Yara and obtain a successor guide dog from Fidelco. It still feels incredibly surreal to me. Many of you who know me off the web and probably a good portion of you who do not but are familiar with service animals and our particular health struggles are most probably not surprised that this has been a decision I’ve mulled over for quite some time. Actually making the final decision and going forward from there was hardly easy. Not that retiring a guide dog is ever easy.

Aside from her health issues, I sincerely have no complaints about her as a guide. I won’t say that she never has a moment of distraction or doesn’t make a mistake now and again, but from that very first day in frigid downtown Schenectady when we took our initial steps together she has always been my partner. I don’t think I can adequately express it in words without sounding like I’m exaggerating or being boastful so you can believe me or not. So far as I’m concerned, she is without a doubt a wonderful match for me and constantly proves that she’s practically precision in harness and it is because of these things that retiring her nearly breaks my heart.

One thing that I have mostly kept to myself was how rough that first year was while we tried to diagnosis her weight-loss and assorted health issues. There were days that I would just break down and cry because here I had this amazing working dog and for whatever reason she was having accidents all over my apartment on a daily basis. I felt like a failure as a guide dog user because I couldn’t figure out what I was doing wrong that was affecting her so adversely. Worst of all, I felt I was being selfish for wanting to keep her as a guide and cruel for doing so when the reality of it could have been that she just wasn’t cut out to be a guide dog. At least not for me. I was so very near calling Fidelco and begging them to take her back at several points that I remain to this day shocked it didn’t happen. Especially when as I explained once before how she is when she’s being particularly stubborn about not eating.

In fact, it was only a few short weeks before she was ultimately diagnosed with EPI that my paranoia over being the cause of her issues was set to rest. I won’t say that the circumstances were especially ideal, but it was such a relief to voice the fear that Yara was possibly too stressed by the job and have a guide dog instructor calmly reply, “She doesn’t look stressed to me,” without missing a beat. And if my own inner-battle as a competent handler wasn’t enough to drive me towards the idea of giving up on our working relationship, there was also the months of going between Fidelco’s suggestions and my vet’s as to Yara’s health.1

Somehow, though, I muddled through it because I just kept coming back to the fact that she’s such an awesome guide dog. And, perhaps naively, I felt that things would get better. She would always have EPI, but once she was recovered and was back to a healthy weight it would no longer rule my life. Except, it totally does. The fact is I have taken off twice as much sick time from work because of Yara than I have for myself. Rather than call in sick, I went to work all five weeks I suffered from a horrendous viral cold last year because of the pressure from my superiors to not use my paid leave. I’ve gone to work with migraines because I have practically exhausted all of my accruals, which only serves to make the headaches worse through strain and stress. I don’t blame Yara in the least for this; she can’t help being sick. But that fact doesn’t make it less frustrating when she stubbornly refuses to eat for days on end and then is sick from not eating and not getting the proper dosage of enzymes in her system.

On top of this she’s also developed some severe allergy issue. My best assumption is that she’s reacting to something at my grandparents’ house, since both of her major attacks have manifested after we’ve spent extended time there. I realized after our most recent trip to the vet that I can no longer risk her health and can’t bring her to my grandparents’ any longer. And the moment that thought passed through my mind, I quite literally had to catch my breath. Many times through the years I have come across two major situations with my guides in terms of taking them places: I didn’t feel comfortable bringing them with me; or, I’ve been told that I can’t bring my dog to such-and-such place. With the first, it’s always been my own initiative to determine this and has more to do with my willingness to subject them to an uncomfortable environment for them (e.g., a loud concert) or me (e.g., a job interview) or a situation where I wouldn’t feel safe working them (e.g., Friday nights during college wherein I’d most assuredly get drunk while clubbing). On the second, I usually find myself responding that I most certainly can and am eagerly waiting for someone to try and argue differently. But never have I been limited by my dog itself in where I could take her. It was with this realization that I came to the conclusion that this partnership isn’t working.

There’s a lot of good, but the few negatives that exist are far too much to handle. If she were a pet, I think I’d feel differently, but because she is a working dog her health issues greatly impact my own ability to use her as a guide dog. I certainly can’t work a dog that is displaying signs of being ill, but as I live alone I have no one else to step in to care for her and I definitely can’t leave her alone for a day while she’s sick. Frankly, I don’t want to not work her and use a cane instead or leave her in someone else’s care since as her handler that really is my responsibility. Still, the fact is that when I made the decision to work with a guide dog I signed on for a healthy animal. The expectation is that the dog will be as dependable as a white cane. And while it’s not out of the realm of possibility that a guide dog will become ill anymore than a white cane being unbreakable, the reality here is that I have gone above and beyond a bit of give-and-take in this respect. I don’t regret any of that; not the money spent or the time off work or the endless hours stressing myself sick. But it has gotten to a point where I have given as much as I can and it’s time to admit there is no more left. And so, the best alternative is for both of us to move on.

This is a bittersweet event, though, because there are many things I am truly happy about. One, I will be working Yara until Fidelco finds a match for me and as it stands currently the earliest they will call is December.2 So, while her retirement is pending, it is still quite a ways off. I plan to soak up as much enjoyment from this fleeting time we have as I can. Two, while there is no firm answer as to where she will go once retired beyond the fact that I am not keeping her3 there are two very viable options for a superb post-retirement home. Either of which will allow for us to remain connected! I’ll natter on that later. Most probably when there is solid news to share. And, third, as difficult as it is to let go of a guide dog, it’s hard to not be excited about getting a new dog. Even if that is still a ways off, I’m still a bit giddy about the prospects of my next guide and making a new friend.

I was going to get into the specifics on the retirement/reapplication process, but this post has gotten a might long, so I’ll save that for a subsequent post. Instead, I want to end this with a very heartfelt thank you to the handful of people who have been “in the know” about this entire situation. I was hardly in the best frame of mind before this became official. I had many qualms about this and a list as long as my arm of questions that I wasn’t sure I’d ever get answered. And without those few ears and shoulders I probably would have shattered into pieces. But just as important was that these same glorious people were around after the decision was made to listen intently to my play-by-play of the most finite details and reassure me. Everyone should be so fortunate to have such a great support system as you. <3

  1. I won’t even get into the aftermath of her diagnosis here because just thinking about it sets my teeth on edge.
  2. I am not entirely happy about the very real possibility of training during the winter again.
  3. Much as I would love to, keeping her as a pet wouldn’t alleviate the issues of her health impacting my life. Also, as spacious as my apartment is, it’s not an ideal home for two big dogs.