Searching For Answers Re: Carly's Sudden Death

[galgrey]

I’m sorry this is long and probably not very well worded, but I’m posting here as I try to make sense of the unexpected loss of Carly after an outpatient procedure last week to malignant hyperthermia. I’m hoping one of the vets, techs, or someone with experienced with MH aka Canine Stress Syndrome can offer some insight.

 

I've been reading articles about CMH/CSS since this happened. I only ever really knew about the anesthesia risk part of the syndrome like most greyhound owners. The rest of this was news to me. This article, although written specifically about labs, http://www.labbies.com/css.htm, made me wonder if Carly has had this all along but in a milder form?

 

Carly had a punch biopsy on Monday for a lump/swelling that had come up on her left foreleg a week earlier. It appeared literally overnight. She was not limping, but I feared the worst and made an appointment and had it x-rayed. The bone looked great and my vet was puzzled by the cause. He thought she could have gotten stung or bitten by something and told me to give her some Benedryl and bring her back if the swelling didn’t subside. I took her back in nearly a week later (Saturday) because it was still swollen. She was not showing any signs of discomfort and was not limping at all. He did a needle aspiration and looked at the cells in house and recommended I bring her in on Monday and drop her off for a punch biopsy under light sedation (Domitor).

 

I want to add as background that she was very stressed by these three vet appointments and the car rides to and from the vet as evidenced by panting, pacing, whining, and shaking. Also, two weeks earlier I had taken her and Princess to get their nails cut and they refused to do hers because “she collapsed to the floor” on them. They used to let me stay and hold her while they cut them, but their new policy required me to leave. I felt she must have panicked and fallen on the slick surface. She shook and panted all the way home, but was fine an hour later. She always took longer than my other dogs to stop panting after exercise, heat, or stress, so this was “normal” for her.

 

So after the procedure on Monday, I picked her up around 5:45 pm on my way home from work. She was rather glassy eyed and panting and shaking (typical for her) and jumped into the back of my Honda Element on her own. The AC had not been off long so the car wasn’t really hot when we got in, but her panting became more pronounced and before I got home she starting shaking so hard she couldn’t stand up. I attributed this to the combination of the Domitor, buprinex, and her anxiety. She got out of the vehicle on her own when we got home and walked in the house. I put a fan on her, gave her some water, and misted her with cool water on her feet, legs, belly, etc. She relaxed and went to sleep. I thought she was still sort of out of it from the anesthesia and pain injection (buprinex?) so I wasn’t concerned that she wasn’t active or hungry. I did offer her water periodically and she drank. At bedtime I asked if she wanted to go outside but she didn’t. She woke me up around 1:30 AM to go outside. She was walking normally and not panting. She walked down the back steps and went outside. I went to the bathroom and when I came back to let her in and she had collapsed near the gate and was clearly in distress. She couldn’t bear weight on her legs and it took everything I had to carry her (70 lbs.) back into the house. I got the fan on her, applied cold towels and squirted water in her mouth while frantically calling a friend to come and help me load her in the car and drive us to the E-vet. Her temperature was 106 F when we got there. They got her temperature down a bit but she rapidly developed disseminated intravascular coagulation and her organs were shutting down. I let her go and went home in shock.

 

Do you think she had CSS all along and this was just the “perfect storm” that pushed her over the edge? She had always had these issues and I managed it by not making her do anything she didn’t want to do (unless it was absolutely necessary). She was 11 this year and I noticed she seemed to have less tolerance for heat, but I’ve seen that with my other dogs over the years. She did, however, have less tolerance for stress and it seemed to take her longer to “calm down” once she got stressed or hot.

 

I had read about MH as a new greyhound adopter over 20 years ago, but thought it was only seen in response to anesthesia. I had never heard of Canine Stress Syndrome until now. I’m devastated by this and in my grief am searching for answers and trying to understand it. My vet is also in shock and says he has never seen MH with Domitor. I've not talked to him yet about this article on CSS. I would appreciate any insight from those with knowledge or experience. Thank you.

Edited August 24, 2014 by galgrey

[macoduck]

I have no answers to your questions but thank you for sharing Carly's story.

 

My Mazy will be getting her first dental in a few weeks and I have already been getting worried as she gets upset and worked up at the vet office, more so than any of my previous greyhounds. I've talked with my vet about this and she assures me they will be extra vigilant. But I know that outcomes are not guaranteed.

 

I am so sorry that you lost your beautiful girl.

[tbhounds]

First I want to say that I am so sorry for you loss-what an awful, horrible thing to happen. Most likely your girl did not have MH. If she had surgery in the past (spay) and survived the surgery without special medication she most certainly did not have MH. Sounds to me that she had Non-MH. The combination of stress and the medications she was given and not given lead to her passing. Ghs are a real pita when they need to be hospitalized and or have surgery. I'm a technician at a small animal clinic and consider myself very knowledgable in gh medicine and when I see a gh on the book for admittance I take a deep breath and start to calculate doses and protocols much in advance (I'm actually up half the night running the protocol around). Even then they can throw a curve ball at you. We had a lovely two yr old hound in last week for scheduled extractions. She was a very nervous girl and I knew we needed to really titrate her care and treatment very carefully. Well, let's say she was headed towards a non-mh path. Thankfully we were able to identify the signs and to be able to intervene.

If I can answer any more questions or you just want to talk please feel free to pm me. Again-I'm so sorry-what a tragic loss.

Edited August 24, 2014 by tbhounds

[mychip1]

I lost my Jack to anesthesia complications......different initial symptoms than M H, but ultimately spiked 108 and died 18hours after surgery. We don't know what happened. I still grieve and beat myself up four years later.....I am so sorry for you......

[Houndtime]

Someone is our adoption group had her dog suffer from canince stress syndrome due to a long car ride. She almost lost the dog and won't travel any where with him anymore.

 

I don't know how common this is, but, Paul was terrible in the car. He once collapsed after a 25 minute car ride and we didn't take him in the car during his last year with us. I am so sorry for your loss.

[GreytNut]

Geez, that's awful.

 

Raven went into malignant hyperthermia while having a hematoma removed, but it happened while she was on the table and they were prepared with lots of ice packs just in case. They threw those on her to cool her down. She came out of it OK. I was of the understanding that once they came out of anesthesia they were no longer at risk.

 

Can your vet do a necropsy to determine the cause?

[tbhounds]

Folks please understand the difference between malignant hyperthermia vs Non Mallignant Hyperthermia.

[Guest normaandburrell]

My first grey developed a mild temperature elevation and what may have been a seizure after an xray which was done to rule out osteo. The xray was negative but my dog ultimately died of a pathological fracture. Like you, my husband and I replayed everything we did and did not do, over and over again. I am not a vet or a vet tech but I am a nurse practitioner, and I have observed that we don't always know why things happen, and we can't always prevent them. You did everything you could for your beloved Carly.

[GreyKarma]

I am so sorry for your girl's passing. MH is always a worry for us Grey owners. I too thought it was only from anesthesia. In my first greyhounds adoption package was a paper about a drug called "Dantrolene". Thankfully I had put a copy of it in her chart.

 

In my 20 yrs in the Vet field I saw a non-anesthethic event on a Grey who was 10-11 with a bad mouth...he was very stressed when he came in and before we could even think about the dental he started to go downhill.

 

Dantrolene is not something a Vet (or ER) usually keeps on hand but I was able to call the local hospital and they sold us some to give IV. While I went to get it the Drs and staff kept him on the traditional cooling protocol. The old guy survived and lived the rest of his life with bad teeth.

 

This spring Molleigh was schedule for a massive dental...she ended up having 25 removed. The dental specialist I used actually had the drug on hand in case needed, she had worked on a lot of greys and I grilled her on her protocols. The fact that she had it made me feel much better.

 

Even with a necropsy an answer might not be there......I just wanted to share this info on Dantrolene because I saw it save a life. It can be given pre surgerical in tablet form for highly stressed animals. It is the same drug they would use on a human if MH occurred.

 

Again I am so sorry about your loss.

Carol

[galgrey]

Folks please understand the difference between malignant hyperthermia vs Non Mallignant Hyperthermia.

I didn't realize there was a non malignant hyperthermia. I thought the E-vet said MH, but I was in such shock I could have misunderstood. I walked out of there and left all the paperwork on the counter so I can't even check that.

 

I just found this article by Dr. Bill Feeman on non - MH: http://vet.osu.edu/sites/default/files/greyhound_pdfs/faq/AnestheticMalignantHyperthermia.pdf

[tbhounds]

A good read regarding MH vs Non MH...

 

http://vet.osu.edu/sites/default/files/greyhound_pdfs/faq/AnestheticMalignantHyperthermia.pdf

 

Ha-we posted at the same time :-)

Edited August 24, 2014 by tbhounds

[Guest alannamac]

Thank you for educating us about these two conditions....I had no idea....

 

I am so sorry for your loss. You did everything you could...that one came out of left field...no way you could've seen that coming and very unlikely you could have

stopped it when it happened at home especially in the middle of the night.

[galgrey]

I have no answers to your questions but thank you for sharing Carly's story.

 

My Mazy will be getting her first dental in a few weeks and I have already been getting worried as she gets upset and worked up at the vet office, more so than any of my previous greyhounds. I've talked with my vet about this and she assures me they will be extra vigilant. But I know that outcomes are not guaranteed.

 

I am so sorry that you lost your beautiful girl.

Thank you. Please make sure they have Dantrolene on hand and that they monitor body temperature throughout the procedure and have a cooling protocol in place. I was told my vet knew how to manage greyhounds and anesthesia, and he's seen my greys for twenty years, but I never knew the specific questions to ask until now.

[BatterseaBrindl]

So very sorry for the unelected loss of your Carly

I have no advice....but want to say thanks to you ... and TBHounds ... for all this information. GreyKarma, too!

 

I am going to print it all out to keep on hand.

[galgrey]

Perhaps this information could be pinned so everyone will have access to it. I want everyone to learn from this tragedy so no one else to has to go through this.

 

Here's an article from NGAP that explains their protocol for anxious dogs: https://www.ngap.org/malignant-hyperthermia-y608.html

[Batmom]

My heart goes out to you in your loss and in your struggle to find out what went so horribly wrong for your darling girl.

 

 

 

(I had a dog whose temperature could easily shoot up 3 degrees in any waiting room or pre-surgical situation. We were able to manage procedures with careful timing (whisked her in and started induction agent as soon as we arrived) and monitoring. For non-surgical things, we tried to do @ the same thing and keep any exams, x-rays, etc. as short as possible. Our dumb luck that she was usually OK once something other than waiting was happening.)

[PatricksMom]

I'm so sorry you lost your beloved Carly. I have a hyper-anxious dog, Leo, and will be reading all of the posted info, thank you for sharing your experience.

[galgrey]

I am so sorry for your girl's passing. MH is always a worry for us Grey owners. I too thought it was only from anesthesia. In my first greyhounds adoption package was a paper about a drug called "Dantrolene". Thankfully I had put a copy of it in her chart.

 

In my 20 yrs in the Vet field I saw a non-anesthethic event on a Grey who was 10-11 with a bad mouth...he was very stressed when he came in and before we could even think about the dental he started to go downhill.

 

Dantrolene is not something a Vet (or ER) usually keeps on hand but I was able to call the local hospital and they sold us some to give IV. While I went to get it the Drs and staff kept him on the traditional cooling protocol. The old guy survived and lived the rest of his life with bad teeth.

 

This spring Molleigh was schedule for a massive dental...she ended up having 25 removed. The dental specialist I used actually had the drug on hand in case needed, she had worked on a lot of greys and I grilled her on her protocols. The fact that she had it made me feel much better.

 

Even with a necropsy an answer might not be there......I just wanted to share this info on Dantrolene because I saw it save a life. It can be given pre surgerical in tablet form for highly stressed animals. It is the same drug they would use on a human if MH occurred.

 

Again I am so sorry about your loss.

Carol

Thank you for sharing this information on Dantrolene.

[EllenEveBaz]

 

Perhaps this information could be pinned so everyone will have access to it. I want everyone to learn from this tragedy so no one else to has to go through this.

 

[Bogangles]

We are so sorry to hear your heartbreaking news of your loss of Carly. Thank you for sharing this important information. It is very relevant at this time for my little girl.

Our thoughts are with you and Carly.

[JJNg]

My condolences on your loss of Carly. I agree with tbhounds that this probably wasn't a case of malignant hyperthermia (MH). From your description, I'm wondering if it was even non-MH that resulted in her passing. The fact that she settled down, went to sleep, and walked outside normally without panting all point toward her temperature having returned to normal. It's possible that the collapse wasn't directly related, and she may have thrown a clot or suffered a stroke. The stress from that episode would have been enough to cause her temp to be elevated again by the time she got to the e-vet. Maybe the preceding events and stress contributed, but that may not have been the direct cause of her sudden death.

 

A bit more about MH... It's a genetic condition and extremely rare. Dogs with MH die *during* the stressful event or anesthesia, and often do not survive if they aren't given Dantrolene. Most greyhounds that develop an elevated temperature with stress or anesthesia have non-malignant hyperthermia, as described in the article by Dr. Feeman mentioned in previous comments. Dantrolene will not help with non-MH.

 

Excerpt from Dr. Feeman's article:

"Many anesthesiologists believe that if the animal survived and did not receive an injection of Dantrolene, MH was not the cause for the elevated temperature. If your pet has ever had a previous uneventful anesthetic procedure, it is most likely not MH. Animals affected by MH are always affected by MH and cannot have an anesthetic procedure with gas anesthesia without triggering the hyperthermia. If your Greyhound was neutered with no report of problems with anesthesia and subsequently developed hyperthermia during an anesthetic event, it is unlikely to be MH."

[tra708]

I'm so sorry for your loss. It's a terrible feeling to have lost your girl, and on top of that, wondering if you did all you could. I have been reading these posts and articles with much sadness, but also to learn for the future. I went through a similar experience with Jackie 3 weeks ago.

 

After xrays were pointing towards bone cancer on her wrist, the vet did a fine needle aspiration to get a confirmation. When I picked her up that afternoon, she was a total mess....panting heavily and shaking uncontrollably, and seemingly disoriented. She was in so much distress, I thought she might collapse and die. To make matters worse, it was well into the 90's and humid here. Long story short, I was up til 4am with her, trying to get her cool and calmed down and able to rest and sleep. It was horrible, and I was in tears the whole time with regret for agreeing to the prodedure in the first place. Her condition improved, but we ended up letting her go later in the week because the test came back positive, her wrist looked like a golf ball, and she couldn't walk.

 

We give our greyhounds wonderful retirement years, and they give us so much joy during that time. It sucks that many of us are left with regretful memories of the end that we can't get out of our heads. For Carly, it may have been a combination of things going on in her body. You definitely did all you could for her. No matter how hard we try to be in control and have a plan, things often don't go the way we planned. Thank you so much for sharing your story so that readers can learn more about the condition. I am so, so sorry again for your loss and hope this wasn't too long but I wanted to share my similar story with you.

tracy

Edited August 25, 2014 by tra708