Blue Healer: Ellie’s rough road

So lately I’ve been helping to take care of a dog that has proven to be a remarkable, and damned near heartbreaking, challenge. (Well, considering we all live indoors and have plumbing and electricity and stuff. I don’t want to get too high-flown here. A Jack London story this ain’t.)

Ellie is a 12- or 13-year-old Australian Cattle Dog mix, weighing in at about 60 pounds. (An alternative name for this breed is “Blue heeler.”) I first became acquainted with her toward the end of last year. A friend of mine does a lot of house-sitting and pet-sitting, and I often lurk nearby when she does; Ellie’s family is a frequent client. My initial meetings with Ellie were on the turf of her owner Jil’s parents, who live less than a mile from Jil and her husband and own a similarly aged, better sighted, more arthritic pooch named Mollie. Mollie’s owners are also frequent clients of my friend the sitter. When Jil is out of town, Ellie usually stays at Mollie’s, and when Jil and her parents are both out of town (which happens more often that you might think, not that I’m reading your mind), the dogs and my friend all stay at Mollie’s. Which is a hell of a nice house, since you asked.

With that burst of irrelevant details out of the way, I’ll describe the problem and the (apparent) (re)solution.

Ellie recently spent an uneventful two weeks or so at Mollie’s. Last Tuesday, the day before she was to return home, she started having some physical problems. (She’s almost blind. That’s relevant too.) She let fly with an unusually energetic and disconcerting burst of diarrhea during her evening walk. My friend and I figured that this would be a one-off event secondary to the surreptitious ingestion of some kind of rotten food left near a sidewalk or maybe a drink out of the wrong puddle. But Ellie’s diarrhea persisted into the next day, and this caused serious problems when my friend had to go to work and leave Ellie alone with Mollie, because Ellie promptly shat up the house. We cleaned this up as best we could — Mollie’s owners were scheduled to arrive home in a few hours — and took Ellie over to her own house.

This is where things became grim. The story is, Jil and her husband have a two-year-old son, and for all sorts of reasons he and Ellie cannot safely spend much time around each other. So Jil asked my friend to stay in the apartment over their detached garage for six months and keep Ellie there in the hope that their son would be more prepared to equitably deal with an elderly, neurotic, large and largely blind dog. But not surprisingly, Ellie was a lot more troubled being in this apartment than she would have been if lodged across town out of sight of her usual home — the so-near-and-yet-so-far phenomenon canine-style. So from the second we got Ellie situated in the apartment last Wednesday afternoon, she was a nervous wreck. On top of this she was clearly (to me) ill with some kind of infectious illness that I had begun to suspect was giardiasis or “beaver fever,” an infection with a protozoan (think amoeba, not a really tiny and typical microorganism like a bacteria or a virus) found all over the United States. My friend, who has seemingly lived through every injury and ailment described in Harrison’s Textbook of Internal Medicine, actually had this herself some years ago. as it happens, G. lamblia is often present in dogs, but more often than not causes no problems, rather like E. coli and humans. Given Ellie’s burgeoning stress levels, however, the clinical picture seemed to fit. In any case, she was plainly ill with something.

Wednesday night was a horror show. Neither I not my friend got any sleep to speak of, as Ellie needed to go out every hour to let fly with more diarrhea. Every time we brought her back inside, she mad every effort to veer away from the garage and toward the main house, where she clearly thought she belonged. Despite out efforts she shit on the floor twice, one of those times on a throw rug that still sits unceremoniously out in the yard. She spent the entire night pacing, pacing, toenails ceaselessly clicking and clacking on the floor.

By Thursday morning Ellie had been under the lash of diarrhea for 36 hours. When told that Ellie had vomited and shat at the same time (I saw a person do this once, but I’d never witnessed this gruesome phenomenon in a dog; this seems kind of backward when you think about it) Jil called Ellie’s veterinarian, who said that an examination would not be helpful in the absence of a stool sample. Guess who was seen standing in the general vicinity of downtown Boulder with an empty cottage-cheese container behind and just under Ellie’s squatting form early Thursday morning? (What spilled into the container bore a remarkable resemblance to balsamic vinaigrette dressing, but an accidental whiff of it burst that illusion in a hurry.) So Ellie was seen by the vet later in the day. The stool cultures were negative, but this is often the case even with an active Giardia infection. The vet concluded that Ellie’s main problem was actually stress and that the diarrhea was the result of an opportunistic infection. (This is what I gleaned from what Jil told me — I don’t know what the vet actually told her or what his words would have been had he been speaking untrammeled clinicalese.)

Ellie was thus put on the following drugs:

20 mg/day fluoxetine
20 mg 2x/day propranolol
500 mg 2x/day metronidazole

This is a very interesting regimen. Fluoxetine is Prozac, a well-known selective serotonin reuptake inhibitor used to treat depression and other psychiatic conditions in people. Evidently it is used in dogs to treat anxiety, in particular separation anxiety, so this choice made sense given the variables. Propranolol is a beta-adrenergic blocking agent (“beta-blocker”) that has been around since colonial times, when someone dubbed it Inderal, and is most often used in humans to put a governor on the cardiac engine — it slows the heart rate and eases the force of myocardial contraction and thereby makes the job of a failing heart easier. Because it also has anxiolytic properties, Ellie’s vet added it to the mix. Finally, metronidazole (Flagyl) is a broad-spectrum antibiotic used to eliminate anaerobic bacteria as well as protozoans such as G. lamblia. In dogs, it can reduce bowel inflammation of unknown cause.

Ellie improved rapidly after starting this regimen. At first it was unclear how much of this had to do with the medication and how much was attributable to Jil’s having decided to take Ellie back into the main house in the early stages of her convalescence. But in the days that followed, it was obvious that she was better in every way. Her diarrhea disappeared, as did her pacing habit. She’s been spending increasing amounts of time in the garage apartment, and her behavior has been exemplary. It’s been wonderful to see. My guess is that she already had G. lamblia or some other pathogen in her gut when she started to become nervous over not having seen her owners for a few weeks, and that the organism began causing symptoms once Ellie’s immune system was sufficiently shot by stress. The metronidazole knocked out the infection and hence the diarrhea. Less clear is the role of the psych meds. Since a dog can’t actually “care” about having diarrhea, its presence isn’t troubling to the owner of the affected colon in the way it is in people, so Ellie’s ability to behave in a more relaxed manner in the apartment during her multi-hour stints would seem to be a function of the dope. Then again, maybe she’s simply not miserable anymore because she’s not physically sick and the psychotropics have nothing to do with it. Either way, she’s better, and I now know what I may have subconsciously suspected: Dogs do get antidepressants and anxiolytics.