Bran of Caber Feidh
Acute Renal Failure
Note: This page originally contained a tribute to Bran written immediately after his death. That tribute can be found here: Bran: The Sweetest Boy.
When Nothing Works
I'm a lucky dog owner. I've worked with vets for years, and so I have many excellent veterinarians to consult with. Because I have been involved in holistic pet care since 1986, I've built relationships with some excellent holistic veterinarians. I live in the Bay Area, where we have access to topnotch facilities such as UC Davis, excellent vet specialists, and a whole array of experienced holistic veterinarians. I'm informed, I'm pushy, I'm smart. So you'd think unless they were shot in the heart, most likely my young dogs would never die.
Of course that's a delusion. Probably most of you know that death trumps every hand, and there is no specialist, no herb, no magic that can beat death in the end. You'd think I might have seen it coming, that I was going to lose the fight for Bran. But I didn't. I walked into this one absolutely sure he was going to come home with me again.
My friends KT and Reina came to visit me in August, bringing their two Rhodesian Ridgebacks Sirene and Savannah. The weekend they were here, my 4-year old Scottish Deerhound Bran, the son of my Rosie and a third generation dog of my own breeding, didn't want to eat his dinner. But when I hand-fed him, he gobbled it up. So, given that Bran had been a singleton puppy in his litter and somewhat spoiled (OK, I'll admit it, incredibly spoiled) by everyone in his life from his dog mother to me to my mother, I thought perhaps he was just a little jealous of the visiting dogs and the attention I was paying them.
The next morning he seemed fine, and ate normally, but that night he was back to wanting to be hand fed. After my friends left, just as I'd suspected, he was back to normal on Monday. But Tuesday morning at sunrise he started throwing up and didn't stop until I'd gotten the vet on the phone at 8 AM. I ran him right over there, and they hooked him up to IV fluids and took blood. I left him there all day on fluids, and he only threw up one more time. I brought him home that night, and he threw up once or twice but that was all. Otherwise he seemed pretty well. We were thinking pancreatitis as the most likely cause of his problem.
But the next morning the vet phoned me and said that Bran's bloodwork was back, and he was in kidney failure. I felt my heart hit the floor, because I knew this probably meant he had leptospirosis, a bacterial infection that affects the kidneys and sometimes the liver, depending on the strain. While I was frightened, I also knew that it responded to antibiotics, and I knew many dogs who had, with varying degrees of veterinary care, survived lepto infections. Bran also had very low platelets, but it was assumed to be a mistake (fairly common) because they were so low, he'd most likely have bled from the catheter they put in the previous day.
I immediately took Bran to the veterinary practice of my friend Helen Hamilton, an internal medicine specialist in Fremont. Helen is a greyhound breeder, has cared for dozens of deerhounds, including mine, over the years, and is the veterinarian I trust more than any other. She used to practice in Santa Cruz, but even after she relocated to Fremont I continued to bring my dogs to her when they needed expert care, or to her colleague Dr. Brown when they needed surgery. Dr. Brown had, in fact, brought Bran into the world four years before, when his mother Rosie had needed a C-section.
Helen did more tests but she agreed we were most likely looking at lepto. We hospitalized him and put him on fluids. At this stage he was lively, active, and still eating, although he threw up most of what he ate. We started him on IV antibiotics, including some to cover other possible causes of his symptoms such as tick borne diseases. The test for lepto takes a couple of weeks to run, and so when you suspect this disease, you have to treat it before you know for sure that the dog has it. In addition to antibiotics, careful management of IV fluids, plus the administration of diuretics, is necessary, as well as urinary cathertization, so you can ensure that the kidneys do not stop producing urine. If they do, the dog's prognosis is very grave.
The first couple of days Bran was in the hospital, we assumed he'd be OK, although the low platelets turned out to be real. However, with treatment they were going back up rapidly. In fact, I woke up on the morning of the third day thinking I might be bringing him home that evening. But when I went to Fremont (a three-hour drive from my home in western Sonoma County), Helen was deeply worried. Although his platelets were improving, his kidney values were worse. She had run some more tests, looking for a variety of possible causes for his condition: Addison's disease, thyroid disease, tick disease, food poisoning, toxic exposure. She had been juggling fluids, anti-nausea and anti-vomiting medications, different antibiotics, and diuretics, but nothing helped.
It was day four.
Helen suggested I take Bran to UC Davis, but I was reluctant. I'd heard many stories of owners who had their animal swept away into the nether regions of the teaching hospital, not allowed to visit except for a few moments, and not really knowing what was happening with their dog. Was he being treated by a student or an expert? How could I, who was sitting with Bran for hours each day and into the night at Helen's 24-hour hospital, going to deal with turning my baby over to a bunch of strangers? Helen's facility was a state of the art speciality practice; what could UC Davis do for him?
I talked to a friend who is a veterinary kidney specialist. She talked to Helen. Helen talked to the nephrology department at Davis. We changed a few things, ran a few more tests. We gave him plasma, hetastarch, we even put in a catheter to give him IV nutrition. I cashed in my 401K, I drained my savings account, I borrowed from my family.
At this point I had given up any pretext of a normal life. I lived, ate, and breathed for my dog, who was now depressed, sick, and miserable. It was the hottest time of the year in Fremont, but at night it cooled off enough that I could take him outside and let him lie on the hospital's patio on a quilt from home. I sat next to him holding him while he slept, still hooked up to fluids and catheters, shaved and bony from a week without eating. I told my boss what was going on, and he told me to do what I had to do. But if it had cost me my job, I'd have done it anyway. Some nights I went home to feed and check on my other animals, but my mother was staying with them so some nights I slept at a hotel or caught a fast nap in my car. I could barely swallow. I could barely breathe.
And his kidneys got worse.
I took him to Davis. We were hoping that kidney dialysis would keep him alive until we could understand what was causing his kidney failure. Everyone still believed we could save him, sick as he was. There was no reason to doubt it; he was young, strong, had never been sick a day in his life. In the car on the way to Davis, I called my credit card company and negotiated an increase in my credit limit, to cover the cost of dialysis.
Let me say right now that everyone at Davis was wonderful. They gave Bran the best of care and treated me with great respect and compassion. Dr. Rosalind Chow, the veterinarian who admitted him through their ER, is one of the kindest people I've ever met. Their emergency and nephrology departments took over his case, and told me that Helen had done the best job on a dog being admitted to their hospital they had ever seen.
One test we hadn't run was a kidney biopsy, because when his platelets were low it would have been too dangerous. They were normal now, so the vets at Davis wanted to anesthetize him to do that, as well as put in the dialysis catheter. It was dangerous given how sick he was, but we had no other choice at this point. We had to know what was going on. They brought my mother and me in to see him before he went for the procedure. I knew it was possible we would lose him under anesthesia, so I said goodbye to him and told him how I loved him. He was in an oxygen cage (the fluids from his failing kidneys were affecting his lungs and his heart), lying on a pile of soft fleece pads.
We waited until he came out of anesthesia. It had gone well. We waited four more hours to be sure he'd be OK. It was 8 PM, so when they assured us he was in recovery and sleeping peacefully, we headed out to eat dinner, and then went home to the other dogs. They expected to have the biopsy results the next day by noon, and he was scheduled to start dialysis in the morning, so I intended to be back by noon.
At 1 AM my phone rang. It was Dr. Chow. At first I didn't understand what she was asking me. I was groggy from sleep and she was being a bit too cautious in how she explained things. She was talking about putting him on a respirator to help him breathe. Why was she even asking me first? I wondered. Having gone this far, did she think I'd hesitate now?
"The thing is," she said, "If he goes on this machine, it's very unlikely he'll ever come off it."
There was absolute and total silence. I am not entirely sure, but I think that for that one moment my heart didn't beat and my blood didn't flow. It was just perfectly still.
"You're telling me there's no chance?" I asked.
"We don't like to ever say there's no chance," she said. "But I think we have done everything we can do. He's suffering now. His lungs are filling with fluid and we can't stop it. He is struggling to breathe. We can put him on the vent to keep him alive until you get here to say goodbye, but he's suffering."
Writing this now makes me want to live this moment over, to tell her to put him on the damn machine and race out and get in my car and go to be with him. But thankfully some merciful angel took over my powers of speech at that moment, and asked, "If he's on the vent, will he still be suffering?"
"We can put him on so much morphine he won't know," she answered.
"No," the angel using my voice said. "That would be cruel. Let him go. Do it now."
I'll tell you about Bran. He was my baby. I was there, knee deep in a January snowbank in Ontario, Canada, when he was conceived. His mama and daddy found the moonlight on the snow and the 20 degree temperatures romantic.
I was there when he was born. Dr. Brown put him into my hands the moment he was taken out of his mother. He told me that Bran wanted so much to be born, he was scrabbling at the inside of the uterus during the procedure. I held him against me while Rosie came out of anesthesia, and the first time he nursed off her, there in the hospital, he stood up on his hindlegs and pumped at her side like a week-old puppy.
I was there when Rosie didn't get enough milk in, to rush him to the hospital with hypoglycemic seizures, and then to tube and bottle feed him every two hours until finally, after five long days, she was able to nurse him.
I was there when he grew up into a strong young boy, racing around with his "harem," splashing in the creek, napping on the sofa.
But I couldn't ask him to wait, suffering, while I drove back the 3 hours to be with him when I let him go.
Sometimes nothing works. Not even love.
Note: We never did find out what Bran died of, although I had them do an exhaustive necropsy. They couldn't completely rule out tick borne diseases, including a rare condition, never seen at Davis, called Lyme nephritis. But no cause of death was identified, although we do know he did not have leptospirosis.
Additional update: As of two years after Bran's death, most of us who were involved with his case now believe that Lyme nephritis was the cause of his death, although we were not able to confirm that by necropsy.