Violet - Rhabdomyolysis, Update: Vet Recheck (#183)

[Remolacha]

sounds like she is making excellent progress! I hope she gets to come home tonight

[NeylasMom]

I also wanted to post now that I have some time in front of a computer what I think happened since quite a few people have mentioned how scary it is that this happened without her even running (I agree!). I was starting to formulate a theory based on a few things I read and then I got my hands on a copy of The Care of the Racing Greyhound and Teri also shared her experiences with Blu and that sealed the deal for me.

 

Right there under the list of 4 or 5 precursors to the acute (middle severity) from of ER is stress/anxiety/panting. I don't remember all of the details, but when the dog spends time anxious and panting there are changes to the blood pH and the body releases sodium bicarbonate to address that. Unfortunately sodium bicarbonate is what helps the body rid itself of the lactic acid and hydrogen ion buildup that causes ER. Heat/humidity (especially in an enclosed environment) are also precursors.

 

Ever since Violet had her near death strangulation episode in the car (yes, I am apparently trying very hard to kill my dog) she VERY occasionally will have a day where she won't lay down in the car, or might be reluctant to get in. It's so infrequent that I hadn't really worried about it. Except that Saturday morning was a day where she did that and she stood panting for an hour and 15 minutes of the hour and a half car ride. She wasn't obviously super anxious, panting wasn't really horrible, eyes weren't showing signs of stress, etc. so I wasn't too concerned. I asked her to lie down a few times and eventually she did, but 10-15 min later she popped back up.

 

I've gone over the circumstances of our hike over and over. We were out in the sun where it was warmer than I would have liked for a few tenths of a mile. The minute we were in the shade of the woods, we stopped for a long water break and to let the dogs calm down. We then continued slowly and at 8/10 of a mile in, we discussed our route and decided to be safe we'd cut our 6 mile hike down to 3 just to be certain we didn't run out of water for the dogs (we had 3 1/2-4 liters between the 2 of us). In the mile and a quarter that we went before her urine turned red, we stopped multiple times for water breaks. Zuri (who actually has a history of overheating) was if anything dragging a little behind Violet, but aside from them both panting and walking more slowly as you'd expect there was nothing to indicate that something was wrong with Violet until I saw her urine. The fact that we were only a little over a mile in when she was sick enough to have that much myoglobin in her urine despite our hydration efforts says to me that something had already got the ball rolling earlier and maybe that short hot uphill just set it fully into motion. To give you another clue about how easy we were taking it and how often we were stopping, it took us 3 hours to hike those 2 1/2 miles.

 

This terrifies me, especially because I've heard that once a dog has an episode they're more prone to future episodes. The fact that some seemingly mild stress in the car before what would have otherwise been an uneventful hike could have caused this terrifies me. She's more likely to be stressed in the car when I'm taking her somewhere before I head out of town - most likely because that's when the incident in the car happened, but probably also in part because she knows I'm leaving. What if that sets off the process again and then I drop her off with someone who isn't as alert as I was? You can inform people obviously of the seriousness and what to look for, but in my experience people just don't get it until they experience it. Heck, the vets and vet techs both on the phone on the hike and then in the vet's office were all telling me she just probably had a bad UTI. It just scares the crap out of me. I guess I should just keep focused on getting her home and fully recovered before I start stressing about the next thing, huh? But I have a good bit of travel in the next 2 months so it's on my mind.

Anyway, I'm rambling , I mostly just wanted to share how I think it happened so other people could be aware.

Edited September 2, 2013 by NeylasMom

[KF_in_Georgia]

She's more likely to be stressed in the car when I'm taking her somewhere before I head out of town - most likely because that's when the incident in the car happened, but probably also in part because she knows I'm leaving. What if that sets off the process again and then I drop her off with someone who isn't as alert as I was? You can inform people obviously of the seriousness and what to look for, but in my experience people just don't get it until they experience it. Heck, the vets and vet techs both on the phone on the hike and then in the vet's office were all telling me she just probably had a bad UTI. It just scares the crap out of me. I guess I should just keep focused on getting her home and fully recovered before I start stressing about the next thing, huh? But I have a good bit of travel in the next 2 months so it's on my mind.

 

Consider delivering her to her temporary home-away-from-home 24 hours early. You may pay for an extra day of boarding, but you can deliver her and keep in close touch in those first few hours with whoever's keeping her. And if you deliver her before you do obvious packing and stuff at home, you might be able to head off the whole thing if she stays calmer to start with. And you can tell the person keeping her about restricting Violet's activity, especially for the first several hours.

[greyhead]

Thanks much for that info, Jen. Shane has been easily stressed since Spencer died, pants easily, and produces long ropes of saliva when in playgroups. (He got his confidence from being with Spencer, and now he has reverted to the less confident dog he was on arrival.) I've lost a lot of confidence in our vets so I haven't even consulted them, and most fellow dog owners say it's "just stress" and I shouldn't worry so much! So it's good for us to have a better idea of what's really going on. Thanks to you and Violet, we'll be more attentive going forward.

[kudzu]

Am so glad things are going well & she may get to come home tonight. Even if they play it safe & keep her another night this is still great news.

 

It sounds logical that some physiological episode was already ramping up before you started hiking. Am trying to pull a term out of the many long forgotten medical terms I once knew. Is it respiratory alkalosis? Are you thinking that could have been a trigger? My chemistry days were long, long ago & I remember none of it but I think the body uses increased respiration to combat hyperphosphatemia. So if she was panting enough to cause respiratory alkalosis her body would be lowering serum phosphorus levels? And somewhere in all of that sodium bicarbonate is related but this all goes back to my CRF dog days. Stupid brain can't pull that info up right now. I think there may be a link between hypophosphatemia & rhabdo. Again the brain fails me.

 

Well anyway... stress panting does give the body quite a workout, changed the serum & body tissue chemistry & raising body temp. That much is easy to understand. So your premise seems sound. Do you remember about how warm it was in the car?

[NeylasMom]

 

Consider delivering her to her temporary home-away-from-home 24 hours early. You may pay for an extra day of boarding, but you can deliver her and keep in close touch in those first few hours with whoever's keeping her. And if you deliver her before you do obvious packing and stuff at home, you might be able to head off the whole thing if she stays calmer to start with. And you can tell the person keeping her about restricting Violet's activity, especially for the first several hours.

Thanks, these are good suggestions.

 

Am so glad things are going well & she may get to come home tonight. Even if they play it safe & keep her another night this is still great news.

 

It sounds logical that some physiological episode was already ramping up before you started hiking. Am trying to pull a term out of the many long forgotten medical terms I once knew. Is it respiratory alkalosis?

Yes! That's what Care of the Racing Greyhound was referring to. And obviously, if the panting in the car started it, the panting on that brief hot part of the hike would have added to it.

 

As for the temp in the car, I had windows up and AC on and had specifically made sure the vents were pointed up and back so the dogs were getting airflow in the back so I don't know the actual temp, but it was cool. Zuri was laying further back where it would have been the warmest and he was sleeping, not panting at all so it wasn't warm.

[Kestrel]

Glad to hear she's doing better this morning. Sending you continued good wishes for sweet Violet!

[teri_d]

so glad to hear that violet is doing well!! stress rider/rhabdo is very rare syndrome - but it is quite serious. i do have to tell you that we try to avoid taking bleu in the car at all ever - we have found a wonderful pet sitter thank goodness, and bleu is most happy staying at home. we did take her this summer on a four hour road trip and she did ok - but we stopped every 45 min and made them get out and walk around a bit and examine her pee and have a big drink in the process. it does, and always will weigh on your mind when you get her in the car. bleu's first episode (there have been 3 total - two involving car rides - one involving depression after losing her best buddy, win, to osteo suddenly) was by far the worst....is that the norm??? and i wonder if her reaction of acting completely lethargic & unable to move is the norm or just her reaction or her bouts were really really bad? am so very interested in totally comparing notes with you, jen, and hearing your doctors advise, etc. - we did have awesome vet/internist/neurologist in Kansas city at the e-vet - and teddy palmer has also been a huge help to me - but we still have many questions! would love to know if your vets advise giving anything (benedryl, etc) before a car ride??? we have heard very mixed advise.

[tbhounds]

To be completely honest I assumed a uti also-mostly because you had mentioned that you were only one mile in on your hike-seemed too premature to see rhabdo-makes sense that she was already working up to it. You might need to medicate before trips from now on to keep her stress level down. My own girl, Shannon is an anxious dog and really winds up in the car-its like driving with a caged lion in the backseat. I have resorted to giving her Xanax prior to traveling from now on.

[MaryJane]

I just wanted to say thank you for sharing how you think this situation may have occurred. I for one, even with all my years in the medical profession, would have never made the association with panting and a subsequent change in the body chemistry such that it would precipitate this attack.

 

I'm also thankful that your sweet girl is doing well enough that they're talking she might come home soon. It sounds like you acted quick enough that there is likely no damage resulting from this.

[o_rooly]

Echoing the above in saying THANK YOU for sharing what likely led to the episode. And, I'm so glad to hear that things are going swimmingly

[NeylasMom]

Just got the PM update. She's been doing well overall but when they checked her temperature a little bit ago it was 103.3. They're going to recheck that in a little bit so the current plan is for me to go around 8:30 and we'll reevaluate when she can be discharged, but it's sounding like there's a decent chance she'll be staying another night. Which is fine, that temp is just freaking me out.

 

They ran another CBC when they saw that and WBC/RBC were good, nothing alarming there, electrolytes look good. X-rays were good, no obvious bone lesions, they did see some inflammation around the joint on the right leg that had been bothering her. They'd already been doing warm and cold compresses there and said they'd have me continue cold if she comes home.

That's about it on the update. I'll head out around 7 or 7:30 to get see her and see if there have been any changes.

[greysmom]

You should talk to the vet about the best thing to give her for anxiety before car rides and other stressful events. It sounds like you'll want to keep her as calm as possible in the future.

[NeylasMom]

We are headed home!!!!!

[ramonaghan]

:yay

[o_rooly]

All thanks to your watchful eye, Jen. Awesome mom!!

[Riverhound]

Fantastic!!!!

[teri_d]

Great news Jen!!!

[gracegirl]

Yay. Hope everyone sleeps well tonight.

[cmc333]

Jen,you know what is very scary to me is: if this could happen to you, who know so much medical stuff and knows your dogs so well and are so careful about all aspects of your dogs' care, how easy it would be for me to let my dog die from some seemingly innocuous little illness? Your saga makes me feel like I need to wrap all the dogs - including my tuff little westies - in bubblewrap just to try to save them from my killing them.. God, if something like this can happen to you, I hate to think how easily I could let my dogs die. Both Neyla and Gypsy were diagnosed w/ osteo about the same time and you managed to get almost a year of good life for her? I managed to keep Gypsy alive for 10 weeks and I can't say it was "good life".

 

Instead of paying for training advice, what we should all do is pay you for medical advice. Your research and your passion to get the answers are amazing.

 

So glad Violet is coming home tonite. There's no place like home....

[snowjay]

 

 

[greyhead]

Hope you'll let us know when you've gotten home safe and are settled! It's still early out West.

[NeylasMom]

Last update before bed. We're home. Violet had a meal, got her meds and drank a good bit of water and is now sound asleep in my bed

 

Her myalgia is noticeably improved from last night, which is a huge relief and helped me feel more comfortable about her being ready to come home. She's on Tramadol (2x50mg every 8-12 hrs) and Gabapentin (2x100mg every 8-12 hrs), as well as Flagyl, a probiotic, and Pepcid. She was very relieved to have the catheter removed and for the most part isn't limping anymore. I'm still to keep up with cold compresses though. And she's still on the canned K/D. I need to start transitioning her back to her normal diet, although I think I may do cooked meat and sweet potatoes or pumpkin first, rather than going straight back to raw. I'm afraid to bombard her system with protein and more importantly phosphorus even though there have been no signs of kidney issues.

 

Incidentally, I did more research today and found a few journal articles that found that CK levels >5000 tended to be correlated with kidney disease; when CK levels were lower than that and the person got treatment they tended to recover without kidney issues. Violet's max (at least that was measured) was 1400 I think and it was down to 770 this morning so that makes me feel better.

 

So we'll head out for one last potty break shortly and then I'm setting the alarm for 6 am to give her meds and holding out hope that she doesn't need to potty in between.

 

Connie, I feel the same way as you right now regarding the bubble wrap. I thought I would just feel relief having her home, and I of course I am SO happy she's here, but the worry has not lessened much. We need to get through tonight and tomorrow, her first night and day without fluids without any sort of relapse, and then we have several more days for the myalgia to clear, and then there is the issue of how to prevent this in the future and specifically how to address potential anxiety in the car or other situations. I am certainly not special, I have nearly killed Violet twice due in part to my own stupidity. And please don't compare Gypsy to Neyla, that was most likely just timing in diagnosis. You did everything you could for her.

 

Okay, exhaustion hitting. Going to try to get some sleep.

[maggiespet]

^{So glad she's home with you!!! Hope it's a quiet night.}

[BootsyCollins]

Glad she's home. She's very lucky to have you.