Saturday, June 1, 2013

Myrna and her Lady



Myrna first brought in Lady back in 04 when the pup was 6 months old. She had some itchy eyes from allergies or from the oppressive wind that blows its brains out every day in the summer around here, or both. That one was easy, and the drops helped. Two weeks later, I spayed the young Lady, and then I didn’t see her again until summer of 09.

Sometimes when the females have been spayed they begin leaking a bit of urine in their sleep. They tell me this happens often in the physicians’ patients, and we certainly see this in some of ours. It’s more common in the larger breeds, and it shows up more often as these girls age a bit. Lady was a German shepherd, and now she was 5 years old, so she fit the profile. We have meds that usually stop the leak, but most often this is a life long deal, so the meds go on forever. They are not resoundingly expensive, these meds, but one person’s pocket change can be another’s small fortune.

Myrna has a fortune in good spirit, but she’s not what ya might call wealthy in the traditional sense. She did find a way to pay for continuous meds, for Lady was an indoor dog, and that was just that. But it clearly wasn’t easy for her. Myrna lives alone, having been widowed some time ago. She has adult children, and some young adult grandchildren, but it is mostly a few friends who help her out. Myrna doesn’t like to talk about it, but it seems that her children and grandchildren steal from her from time to time, which is the kind of help she doesn’t need.

So a year later, when Lady began having trouble with her anus, well that’s when things got real tough.

The condition is called perianal fistulas. These are rather large holes that erupt in the tender skin around the anus. Deep under the skin a problem arises, an inflammation that becomes a pocket of yuck and this eventually burrows out to the surface, breaks open, and then you have a hole you can stick a finger in, which discharges mung and fungu and various bloody pussy stinky sticky substances. Forever.

Perianal fistulas hurt. They hurt when you poop. They hurt when you sit. They hurt when you lick yourself, if you are the dog. For the owner, they stink, they leave stuff all over everything, and they make you hurt for your dog. They often accompany chronic diarrhea, for reasons we don’t really need to consider here. They happen mostly to German shepherds. And of course it was happening to Lady.

So for the owner there is cleaning that must be done, to the dog and to the house. Cleaning of awful stuff. This presents a problem to any owner. It provided an even more difficult problem for Myrna.

Oh, did I mention that Myrna is blind? Yeah, totally blind. Myrna needed to clean Lady’s painful bloody stinky pussy shit covered anus without being able to see it. And she would smell the diarrhea, and she would go find it in her house, on her hands and knees, and she’d call to tell my just how bad it was that day after doing a digital appraisal. And no, her family was not helping.

The doctors know that perianal fistulas show up due to some crazy hiccup in a dog’s immune system, for when we are successful using the drugs that suppress the immune system, some of these dogs get better. But this condition has expensive tastes, preferring only the most costly immunosuppressive drugs. The best choice is an oral med that costs multiple hundreds of dollars a month to maintain a shepherd size dog. We also do better when we can restrict the dog’s diet, since food sensitivities also may be a trigger for the disease, and thus we need to try the expensive foods, too.

Myrna vowed to find a way to pay for all this. We shopped around for the best prices, and since I’m the boss, I cheated myself by letting Myrna buy these things from me at just about my cost. I don’t even want to know what Myrna cut out of her spartan lifestyle to support her beloved dog. Sometimes I’m a sucker that way.

Lady couldn’t tolerate the oral meds. She vomited, and even when we gave it the time you need to try before you finally give up on that med, she still threw it up.

So drug choice number two was ordered, an expensive cream made from a different but similar drug that is rubbed into the skin around the anus twice a day. This one we got through a pharmacy, so I had no way to subsidize the cost. This did work, and eventually Myrna started getting it through some Canadian pharmacy, and this brought down the cost to merely backbreaking. And Lady did much better. The sores never completely healed, but much of the stench and yuck went away, and this little blind lady was able to keep things tolerable for three years.

One morning a couple of months ago, Myrna called asking about arthritis drugs, for Lady was having trouble getting up. Myrna needed to borrow friends and cars and other people’s time to bring Lady in, so we decided to try something simple, a drug that wouldn’t conflict with the ones that were keeping Lady’s anus tolerable, and I postponed that chance to examine her. And the drug seemed to help, although at least one of the grandchildren was stealing them for his own use. Apparently, it’s easy to steal from a trusting little old blind lady if you are truly scum.

The second phone call came some weeks later. A leg was swollen and Lady couldn’t use it at all, and the big sinking feeling settled into my gut. This time we needed to take a look.

The tumor was almost softball size, tucked in behind the knee, hidden under the hair, hard to spot when you are blind and you mostly concentrated on the anus. All those parasitic offspring folks who should have seen this, never noticed.

I tried a few things to help Lady stay comfortable, but not long later Myrna and I came to the wall where we knew we had to stop. She wanted to remain with Lady when I did the last part of my job. The injection went smoothly, and Lady slipped into sleep and out of life. And since Myrna couldn’t see what was happening, I needed to tell her when this all happened. And then all that was left was the grieving.

Perhaps Myrna had more pent up inside that just the loss of her precious Lady. Certainly, from outside looking in it seemed to me she had that right. After Lady breathed her last, Myrna let some of it go, and it filled my hospital and took with it all of us here. Myrna’s heart was truly broken. There was nothing we could do save to hug her and try to convey our own sadness.

So no, I couldn’t fix that, either.


4 comments:

  1. Beautiful, and such a great representation of the emotions we vest in both our patients and our clients. Well done.

    ReplyDelete