Winter 1993. My husband and I had rented a house in Vermont’s Northeast Kingdom for a budget vacation. We had borrowed snowshoes, packed skis, puzzles, and books, envisioning snowy days outside and cozy evenings with hot cocoa and jammies. It was snowing on the long drive. Halfway there, the heat in our Isuzu Trooper quit. We bundled up and kept driving. Then the Trooper started making weird noises and losing power. We drove slower and slower but kept going. The snow stopped. We kept driving. When we finally arrived at our vacation rental — no snow. Not one flake anywhere. “I need to get my Visiting Vet column written anyway,” I said cheerfully. “Maybe it will snow later.”
That evening, in jammies and with cocoa, I wrote my column longhand on a yellow legal pad. The next morning we walked into the tiny town in search of a fax machine so I could send the article to my editor. Yup. A fax. We went to breakfast at the Route 101 diner. I love diners. Over eggs and hashbrowns I asked the waitress where we might find a fax machine. I might as well have asked for a time machine. The waitress looked flustered, refilled my coffee. Anyone know where this lady could find a fax machine? Someone suggested driving fifteen miles to the library. Yeah, no. The Trooper was already en route by tow truck to the garage for repairs. Eventually we were steered to a ramshackle house with a lawyer’s office where I was able to use his fax.
Exactly thirty years later I am again writing from off Island, this time sitting at my mother’s table in Connecticut using a laptop borrowed from my daughter. No fax needed. I will simply share this Google Docs when I am done. It got me thinking about how much technology has changed things. Take Pearl, the sweetest Jack Russell terrier. When Pearl was almost fifteen, she started having vague signs of not feeling well. We ran blood tests, essentially the same ones I would have run in 1993. We took radiographs. I still only have old school film X-ray but sometimes refer patients for digital ones. Pearl had some form of liver disease. Nowadays there are so many advanced diagnostics available. The best next step was a referral to a large veterinary medical center where specialists could choose between CT-scan, MRI, ultrasound, liver biopsy, and so on.
Pearl was diagnosed with copper storage disease — an uncommon syndrome, often with a genetic component, in which excessive copper accumulates in and damages the liver. Symptoms may include poor appetite, vomiting, diarrhea, increased drinking and urination, lethargy, abdominal pain, and jaundice. It generally affects, but is not limited to, middle-aged dogs and breeds such as Bedlington terriers, Skye Terriers, and Westies. There is no cure. Mild cases are managed with a copper-restricted diet. More serious cases need chelation therapy — medications that bind excess copper and help the dog excrete it.
Pearl’s case was mild and controlled with diet. She did great for a year, then suddenly had an episode of collapse. She staggered, fell over, and just laid there for a few minutes, after which she rallied and returned to normal. Pearl was seen by the veterinarian on emergency call. At that time, she seemed fine. Blood tests were not significantly abnormal. Understandably, they sent her home with nursing instructions and medication for pain that also has anti-seizure activity, and advised evaluation by a neurologist and cardiologist. When I saw her for a recheck, she still looked fine, but the episodes at home were increasing and worsening. “Is she convulsing, like an epileptic seizure?” I asked. No, Pearl seemed conscious throughout. “Is she sliding on the slippery floor?” No, episodes were happening outdoors on good footing. At my request, the owner monitored Pearl’s heart rate at home and sent videos of the episodes, which I posted online to show cardiologists and neurologists. Technology. Amazing. But everyone concurred Pearl still needed to physically go for advanced testing if we wanted definitive diagnosis. We couldn’t rule out cardiac-related collapse due to severe intermittent arrhythmia, but the owner’s monitoring did not support this. We couldn’t rule out primary neurological disease but it didn’t look like classic seizures.
Several docs mentioned pulmonary hypertension (PHT), a syndrome of high blood pressure in the blood vessels in the lungs. PHT often occurs secondary to conditions such as heart or lung disease, heartworm infection, even pulmonary thromboembolism. But sometimes it occurs spontaneously. Affected dogs can appear sleepy, short of breath, and have fainting episodes. In mild cases symptoms may be vague. Severe cases may result in sudden death. Definitive diagnosis requires cardiac ultrasound. Treatment includes addressing underlying diseases and giving sildenafil, commonly known as Viagra. That may seem funny but PTH is no laughing matter. Prognosis is often poor and treatment frustrating. Although those that survive the first few weeks sometimes live six months to a year or more, many dogs may die or be euthanized due to poor quality of life soon after diagnosis,
While discussions were going back and forth between specialists, the owner, and me, Pearl died at home. We will never know for sure if it was PTH, her liver disease, or different cardiac or neurological problems. Unlike the days when I had to go looking for a fax, technology has enabled us to send videos to specialists. If she had been able to travel for advanced imaging, we might have pinned down the diagnosis, but her condition deteriorated so rapidly it is unlikely that would have changed the outcome. For now, I am glad Pearl lived as full and happy a life as she did, but I also envision a future where technology advances even more, where every little country veterinarian will be able to do every conceivable test remotely.
It finally snowed in the Northeast Kingdom. Not enough to ski but we built a snowdog, then walked to town for the meatloaf special at the diner.
