|Norton's always had some health issues. He came with worms and fleas. He's had emergency surgery for a punctured intestine. But nothing prepared us for the fall of 1999, when we nearly lost him to leptospirosis. Here's the history of what happened to us:|
Before you read this, remember what we said in the beginning - we're not experts. If you read this and want to know more, I've included a couple of sources that gave me a lot of information and hope while we were struggling to save Norton, but nothing ever replaces discussing your dog's health with your veterinarian.
In late July of 1999, Norton quit eating. Several trips to the vet, with x-rays and blood tests led our vet to believe Norton was suffering from arthritis in his hips. The vet did note that Norton appeared to have enlarged kidneys, but blood tests showed normal kidney function, so that was ruled out as the cause of Norton's pain (now we're not so sure). He responded quickly to steroids, and remained healthy when we switched first to buffered aspirin and then to glucosamine.
In early September of 1999, Norton quit eating again. I had noticed the week before that he had been drinking a lot of water, but decided it might be related to the glucosamine. When he hadn't eaten in a week, we brought him to the vet. She felt Norton was suffering from an intestinal bug, and sent us home with anti-nausea medicine. Norton didn't improve. He developed incredible bad breath - as if he had eaten something dead. Two days after seeing our regular vet, we decided that something was really wrong with Norton, and we took him to the 24-hour emergency vet hospital.
Blood tests revealed he had extremely high levels of BUN (blood-urea-nitrogen) and creatine in his system, which indicated kidney failure. An ultrasound revealed enlarged kidneys, but no tumors, blocked blood vessels or any other abnormalities. The size of his kidneys, the lack of eating (technically called anorexia), the BUN and creatine and the bad breath led to the diagnosis of acute renal failure (ARF).
ARF is treated with IV fluids. The vet put Norton on an IV, and then told us the grim prognosis - the most important thing was to find what was causing the renal failure. Many dogs die before a cause is found, and many dogs die even after the cause is found because the kidneys are too far damaged to allow recovery.
Norton was switched to the care of an internal medicine specialist. They drew blood and urine for a variety of tests to search for the cause. The first several tests came back negative. We agreed to a kidney biopsy because even though the anesthesia might further damage his kidneys, it would tell us where the damage was (which could help determine the chances for recovery), and might give a clue as to the cause. Norton developed several other problems - an irregular heartbeat, vasculitis (leaky blood vessels), edema (fluid retention) phlebitis (inflammation of the vein the IV was in), and became very depressed. Although these new problems were bad, his BUN and creatine levels were coming down. The irregular heart beat required an ultrasound of his heart, which revealed that one of his heart valves wasn't closing properly, which was letting blood flow both ways. This required lidocaine to correct. To deal with the vasculitis and edema, Norton was put on a very low dosage of steroids. The phlebitis was treated by moving the IV to another leg, and warm compresses were applied to the swollen area.
The vet began to suspect Norton might have leptospirosis, a fairly uncommon infection. Because the symptoms of lepto are similar to many infections, a blood test is the only way to be positive. The results of that blood test would be back about the same time as the kidney biopsy (3 days), but the vet worried that might be too late to begin treatment. He started Norton on the appropriate antibiotics - amoxicillin to kill the infection, and doxycycline to keep the infection from being shed in his urine (to keep him from spreading the disease). The biopsy results showed that the damage to Norton's kidneys were in an area that could recover to a certain degree. It also indicated a strong suspicion of lepto. The blood work confirmed that Norton was infected with leptospirosis. When the vet went to tell Norton the good news, Norton tried to swipe the bagel the vet had in his hand. This was the first food Norton had tried to eat in 15 days.
Norton's BUN and creatine values continued to decrease. He began to eat a bit. He came home with 10 days worth of antibiotics and a special diet (Hills k/d, which is low in protein and phosphorous), 12 days after entering the hospital.
Norton's recovery has not been uneventful. We returned to the hospital 24 hours after leaving with an infection. He was running a fever, shivering and had a rapid heart beat. His kidney function values were up a bit, but not enough to cause these symptoms, so they added Baytril, another antibiotic, to deal with this secondary infection. He returned home, only to have them find a "fluid filled mass" 5 days later, which required exploratory surgery to remove. The pathologist says that the mass was a hematoma, or a cluster of blood vessels surrounded by fluid and tissue. They aren't sure why it formed - it may be pure coincidence or it may be a result of the stress on Norton's body/immune system from the kidney failure and leptospirosis. The hematoma wasn't on the many ultrasounds they had done on Norton during his stay at the vet hospital, so it may have been the cause of the infection that caused his relapse. The day of surgery, Norton's BUN and creatine values were just 1 point above normal, which completely stunned the vet. He had hoped they would fall somewhere close to normal, but he never expected them to drop back to normal.
Our other dog, Willy, was tested for lepto the day Norton's tests came back. Willy tested positive as well. Willy is a 6-year-old West Highland White Terrier. He showed no symptoms of the disease, but took a two-week course of antibiotics to keep it that way. Humans can also contract lepto, so I was tested as well. My test came back negative.
Leptospirosis is an infectious disease. The Merck Veterinary Manual says that "infection is commonly acquired by contact of skin or mucous membrane with urine and, to a lesser extent, by intake of urine-contaminated feed or water." The vet says that squirrels, opossums and dogs can carry the disease without being affected. They shed the disease in their urine, and that a dog that licks grass that has been urinated on by an infected animal, drinks from an outside water bowl that an infected squirrel or opossum has urinated in, or had contaminated urine splash into their eye can contract the disease. We live in an older neighborhood with plenty of squirrels. The neighbor across the street had an opossum get into her basement, and the neighbor behind me said opossums have been destroying his garden. We had an outside water bowl, easily accessible by the squirrels and opossums. Norton has to smell everything, and I've seen him get really close to Willy when he was peeing, so urine could have been splashed into his eye, and I've been totally grossed out by watching Norton lick wet grass in the park before he decides to pee on it, never realizing that it was more than gross, it was potentially dangerous. The disease can live in water for months, unless the temperature gets too cold. I had been spilling out the water bowl every day, but I was rinsing it out, not using bleach. The vet said some dogs pick it up from drinking out of puddles, stagnant ponds, rain gutters and from killing and eating infected squirrels or raccoons.
The symptoms include vomiting, anorexia (refusing to eat), fever, depression, and dehydration. These are symptoms of many other infections as well. Lepto continues on to invade the kidneys and sometimes the liver, which then adds other symptoms. As the kidneys and liver fail, new problems occur, similar to what happened to Norton. This adds to the difficulty in making the diagnosis. It's difficult to determine what is causing which - in the beginning, they weren't certain if Norton had a heart problem that was causing kidney failure, kidney failure causing a heart problem, or an infection causing both. The vasculitis seemed to make the vet happy - although it further complicated treating Norton, it helped point a direction for the cure - kidney failure doesn't usually cause that, but an infection could cause both.
There is a vaccination for leptospirosis, but it only covers two strains. My understanding is that there are 8 that commonly affect dogs. Norton and Willy tested positive for three, none of them would have been covered under the vaccine. The vaccine is thought to be related to many immune-mediated problems, and under the advice of our vet, neither dog had that vaccine since 1997.
Norton recovered well. He came back to his regular weight, and his goofy personality returned. His kidney values remained a bit high, and his thryoid function a bit low, so we kept testing to keep an eye on both. He ate a special prescription diet to help manage his kidneys. The outdoor water bowl was removed. We went back to our normal life - if you can call life living with a coonhound normal. Norton returned to his favorite pastimes of chewing on tennis balls, hogging up the bed and couch, and begging for dog cookies.
In February of 2003, Norton fell ill again. He quit eating, seemed generally disinterested in doing things and began to cough. We put him on a broad spectrum antibiotic, but he didn't respond. He began to walk with a very stiff gait, and couldn't pull himself up from a sitting positon, or climb onto or off of the couch by himself. Blood testing showed that his kidneys were failing again, and he wasn't producing enough red blood cells. The anemia was causing him to be very weak, and the kidney failure was shutting down other major organs, so we hospitalized him again. Fluid therapy and antibiotics brought his kidney values back to acceptable levels, and we were able to bring him home after 7 days. Although he was happy to be home, he still couldn't bring himself to eat. Additional blood testing showed a new problem with his liver, and after many days of hoping, crying and talking with him and the vets at the hospital, we concluded that Norton was not going to recover. After years of bringing us happiness, teaching us humor and humility, we paid back our enormous debt to Norton by releasing him from his pain. He will live in our hearts forever.
I own the Eighth Edition of the Merck Veterinary Manual, which I bought on Amazon.com for about 36 bucks. It's hard to read (lots of big words, and darn it, I nearly failed college biology), but if you reread it a couple of times with a dictionary, you can figure out what's going on.
http://www.petinfocenter.com - Drs. Foster and Smith's web site has a lot of articles about dog health. Excellent information about Kidney Failure and leptospirosis are here.
http://www.vetmed.wsu.edu/boeing/small_animal_medicine/arf.htm - this is a web page of lecture notes from a vet school class on acute renal failure.
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