Visiting Veterinarian : Saving Camille
They're called the Spanish Virgin Islands — Culebra and Vieques, two small municipalities off the east coast of Puerto Rico. Ten years ago, on vacation there with friends, my first impression of the place was driving at dusk along the rutted dirt road to our rental house. Bouncing up the hill, my headlights caught a furry black creature slowly crossing the lane. "Is that a kitten?" I exclaimed, stopping the car to allow it to pass safely. "Um, well, I think it's a tarantula," my husband ventured. Yup. A really big traffic-stopping tarantula. Once the critter had cleared our path, we drove on to the house, perched on a cliff overlooking the water, to find a scorpion in the living room. Nice.
Camille, born on Vieques, is definitely cuter than the scorpion, though not as furry as the tarantula. She's a Sato — that's Puerto Rican slang for street dog. Stray and feral dogs are a big problem down there so when two young Vineyarders traveled to Vieques, they couldn't resist bringing this adorable pooch home with them. Barely 18 pounds, the shelter there assured them she was healthy, more or less, and had been vaccinated, but soon after coming north, Camille developed vomiting and diarrhea.
"I think it might be a reaction to some peanut butter she ate," her owner said. "Or stress from travel," I suggested. "I'm also concerned there's no written proof of vaccination for distemper or parvovirus. Let's start with testing for intestinal parasites and a bland diet."
Not surprisingly, we found Camille was infected with hookworms and whipworms. Look at an adult hookworm under the microscope: you'll understand the name. The mouth cavity is rimmed with three pairs of sharp teeth to latch onto the lining of the host's intestines and suck blood. Your basic sci-fi nightmare. Pups get hookworms by nursing on an infected mother or ingesting fecal-contaminated material. Microscopic larvae can even burrow into their feet if dogs stand in infested mud. As few as 50 to a 100 hookworms can kill a puppy. Whipworms are also blood-feeders that can cause severe diarrhea and weight loss. We have both these nasty worms here, but they are even more abundant in the Caribbean where the tropical weather provides their ideal breeding climate.
We de-wormed Camille, tested for heartworm and tick-borne diseases, vaccinated for Lyme, but something still wasn't right. The vomiting and diarrhea resolved but her appetite was poor. She was lethargic and losing weight. We rechecked fecal samples. Nothing. The diarrhea recurred. We ruled out the protozoal intestinal parasite Giardia. She developed bald patches on her legs. Skin scrapings ruled out mange. The diarrhea continued.
"She looks pale to me," I said at yet another recheck. "Let's run more blood work." As the blood swirled into the tube, my concern intensified. Even a casual glance told me her blood was too watery, not the expected deep, robust red. Camille was anemic. Seriously anemic. Ten minutes later I perused the official test results. Our little Sato was in big trouble.
Anemia is defined as an abnormally low number of red blood cells. By placing a few drops of blood in a tiny tube the size of a toothpick and centrifuging, we determine what percentage is cells versus fluid. This is called the packed cell volume or hematocrit. A normal canine hematocrit is roughly 37 to 55 percent. Below 15 is a life-threatening situation. Camille's hematocrit? Nine percent. She needed a blood transfusion. Fast.
Now in the old days we didn't think much about canine blood types. We'd grab any available donor, usually the vet's personal pooch, and hope for the best. Transfusion reactions are relatively uncommon in dogs as long as you only transfuse once. Nowadays, veterinary transfusion medicine has come a long way. Emergency referral centers have blood banks. They can cross-match blood and choose from a variety of transfusion products.
"I'm not sure what's causing her anemia," I said, "but the best thing would be to go off-Island immediately to a facility with specialists and a blood bank for a transfusion and round-the-clock nursing."
Her family hesitated. Couldn't I do it here? I haven't had to do a transfusion in a long time. We used to use a synthetic blood called Oxyglobin, which made treatment in these situations easier, but the company folded years ago. "I can't provide 24-hour intensive care," I responded, "but I guess my dog Flower can donate blood." I started fishing around frantically for transfusion equipment. As I pulled dust-covered bottles and tubing from the nether regions of my cupboards, Camille's owners reconsidered.
"If you really think it's best for her to go off..." they sputtered. I did. Flower breathed a sigh of relief.
Camille survived. The specialists determined she had a chronic Ehrlichia infection acquired in Vieques. It didn't show on our initial diagnostics because her weakened immune system was not producing the antibodies our in-house test measures. She stayed hospitalized for days and remained fragile for weeks. The infection affected her bone marrow's ability to make all kinds of blood cells, not just red ones. Extremely low white blood cell counts put her at risk for dangerous infections. Low platelet counts affected her clotting ability, putting her at risk for hemorrhage. "Treat her like a hemophiliac, " I warned. "And avoid exposure to any type of infection. She needs to be like the kid in the bubble."
A recent letter to the editor suggested that owners whom I appreciate for "going that extra mile" must all be wealthy. Not so. Most are regular folk who often have to make difficult economic choices about sick or injured animals. Everyone does the best they can, but I am always touched by people like these two hard-working young adults, not rich in dollars, but rich in love. They saved Camille once, rescuing her from the shelter. When her life was on the line a second time, they came through yet again. Camille is not only off the streets but she's finally out of the woods.