This July 4th was a holiday we'd like to forget.
The previous afternoon, about 4 p.m., we had just come inside from afternoon chores to get something to drink before heading out again. Alayne and I were in the kitchen when we heard Pip, the tyke who had only arrived in mid-May, crying out from down the hallway. Pip was always a vocal little guy, but we could tell this was a distress call. We ran down the hall and found him on the floor of the laundry room, lying on the ground, head turned at an odd angle and pressed against the floor while each of his legs went out in different directions. We realized he was having a seizure.
We stayed with him until it was over, then put him on a bed in the dog room to monitor for a bit while we sat with him. We'd never seen him seizure before. Just a few weeks ago we had him checked out by our internal medicine specialist and he received a (mostly) clean bill of health, so we were alarmed by this development. Still, we've had plenty of dogs over the years who experienced the occasional seizure, never needed treatment and never had it get progressively worse. We hoped Pip would be one of those.
The seizure had really knocked him for a loop, and he was very quiet and still. We finally put him in his crate in the dog room while we went back out to finish chores. When we returned, he was sitting up looking at us, but not interested in leaving the crate.
We were having dinner around 6 p.m. when we heard Pip crying from the crate. We dashed down to the dog room and found him having another seizure. At that point our hearts sank. We knew something major had happened. I called the emergency vet clinic in Littleton, New Hampshire -- they handle the after-hours calls for our primary care vet and other clinics in the area -- and told them I was coming in with Pip. Before I could even leave, he had a third seizure. I put him on the front seat of the truck in a small crate and raced to Littleton, about 30 minutes from here.
At the clinic, bloodwork immediately told us what the problem was: his glucose was 13. The bottom end of the normal range is 70 and the top end of normal is 143. The emergency vet told me that a reading of 13 "was not compatible with sustaining life." The body runs on glucose, and without enough, things go haywire. He was surprised Pip was even alive. But what was causing the glucose to disappear from his body?
The vet gave Pip glucose via an IV, but as soon as they stopped administering it, his glucose level would plummet again. Why?
The vet worked through some differential diagnoses and one by one, ruled them out. In the end, he found that Pip had an insulinoma, or pancreatic tumor. These are very small and often impossible to see on ultrasound (not to mention on a very tiny pancreas on a very tiny dog), which is why it wouldn't have been seen during his abdominal scan a few weeks ago. (And his glucose levels were perfectly normal on his bloodwork in mid-May!) Essentially the tumor causes the pancreas to overproduce insulin, even when the glucose level in the blood is low. Pip's body in effect was gobbling up its own glucose, leaving nothing to run on. (This is the opposite of diabetes.)
I left the clinic at 9:30 that night, with Pip continuing to receive glucose injections and supportive therapy. The next morning, on July 4th, I called the clinic at 7 a.m. to find out how Pip had done. The news was not good. The vet told me that he had to continue providing Pip with glucose throughout the night to keep him alive. He said the insulinoma had probably started to interfere with Pip's glucose at some point in the past week, so the descent was gradual until it reached a critical stage and then crashed -- which is what we saw on Tuesday afternoon. Indeed, Pip had seemed his usual self right up until we found him on the floor having a seizure.
Given the advanced nature of the insulinoma, along with Pip's age and frail condition, the vet didn't think we really had any good options. He said, "I hesitate to say anything is untreatable, but this is as close to untreatable as they come." I told the vet that Alayne and I needed to talk about it some more. He was going off-duty at 8 a.m. and I told him I'd follow up with the relief vet mid-morning. About 11 a.m. I spoke with that vet, who said Pip's condition hadn't changed at all and he concurred with his colleague's assessment. He said Pip was living from glucose injection to glucose injection.
Alayne and I had already reviewed the veterinary literature on insulinomas, and found that even the Veterinary Society of Surgical Oncology said that "a surgical cure is not expected" and that 52%-100% of dogs have a recurrence within 60 days. And those are for younger, healthier dogs with insulinomas not nearly as advanced as Pip's.
We knew we were going to have to let our little guy go.
At 1 p.m. on the 4th, I made the drive back to the clinic to be with Pip, fighting tears the entire way. By the time the vet tech ushered me into an exam room, I was crying. She brought Pip in, wrapped in a towel, and handed him to me. She put a box of Kleenex on the table behind him. She knew I'd need them.
That's when I took the photo of Pip above. You know, we only had him in our lives for not much more than six weeks, but we had so fallen in love with the little character. I was overdue on a blog post about him. I was going to tell you how he'd go through a door after we opened it for him, then turn and look up and bark at us. We weren't sure if that was a "thank you for opening the door" or "let's try to open it a bit faster next time."
I was going to tell you how he surprised me several days ago by wanting to roughhouse with me -- he'd bark and run around in circles at my feet, trying to get me to play with him. (How do you roughhouse with a 3.5 lb dog?) So I'd get down on my knees and run my hands around him on the floor while he tried to avoid them, barking at me the entire time. He loved it.
And I wanted to tell you how he figured out he was tiny enough not only to get through the gates at the end of the ramps, but also the doggie gate that closes off the kitchen and keeps it a dog-free zone. But not a Pip-free zone, as he proudly found out.
In the clinic exam room I sat and held him in my arms, while he lay against my chest and settled in for a nap. He loved to be held and cuddled, and he was so relaxed and content as he lay on me. I watched his little body move up and down with every breath. We stayed like that for 15 minutes or so, until the doctor came in. He asked if I was ready. I said I was ... but of course, you never are.
Pip was gone before the vet had finished pressing the plunger on the syringe. I bent over his tiny little body and cried.
This has been a bad year for this sort of thing. Pip was the sixth animal we've lost so far -- almost one a month. Samantha, aged 14, died in her sleep in January; the same month we lost our own Libby (14) to lymphoma; in February we lost Avery to congestive heart failure; in April we lost dear old Cedar (15) to a ruptured spleen; and in May we lost our own beloved Goldie -- the queen of the minion brigade -- unexpectedly to complications from what was supposed to be routine surgery that turned out to be anything but routine. Goldie was the last of our personal dogs, the last of our "Seattle six-pack" who moved with us from Seattle to Montana way back in 2000, so that loss was particularly devastating.
Yesterday (Saturday), we had the first of our scheduled visitor days this summer, and hosted a wonderful group of people from Delaware, Rhode Island, New Hampshire and Vermont. As they were in the living room meeting some of the dogs who have taken over the the "people wing" -- Widget, Wilbur, Madison, Dexter and Holly -- I looked over and saw Pip's basket sitting there, empty. I had a lump in my throat.