Multiple Organ Failure and Acute DIC

Lisa and Ballyhara Danny 2018

Sadly, we lost our much loved Danny several weeks ago at 9 years 11 months of age. Though we did not perform a post-mortem, the suspected cause of death was multiple organ failure and possibly acute DIC (disseminated intravascular coagulation). My primary vet believed it to be Hemorrhagic Gastritis as it had a very sudden onset with black tarry sludge pouring out of him. This color is caused by iron in the blood becoming oxygenated when it passes through the ileum and colon. One minute he was healthy, running around the paddock and he came into the house to rest, slept soundly, and when I entered the room again, he had just gotten up and had black sludge flowing out of him. I had never seen anything like it and can best describe it as turning on a faucet. There was no vomiting, and his gums were very pale. The quantity was so vast that I had to hose the lawn down where the black coal revealed itself as blood with a foul odor. Danny was rushed to the veterinarian, and we ran bloodwork diagnostics on him. His red blood cell count was low, and his white blood cell count was very high. Generally, with Hemorrhagic Gastritis, the red blood cell PCV (Packed Cell Volume) is elevated and often they have normal or low blood protein levels. As a result, this diagnosis was set aside. My gut feeling was that an organ(s) was shutting down as a result of the heart medications and nerve pain medication he had been taking over several years, on a daily basis.  He had been taking 1500mgs of Mexelitine 3x daily; 80mgs Sotalol 2x daily; Pimobendan 40mgs daily; Enalapril Maleate 40mgs daily; Gabapentin (for his Cervical neck injury see other posts) 400mgs 2x daily.

Ballyhara Danny

I must deviate here to point out a relevant topic. All novices and students of Sighthound breeds should be acutely aware that CBC (complete blood counts) and blood chemistry as related to Sighthounds, in general, are different than other breeds. Typically, Sighthounds have WBC (white blood cell counts) values usually at the very low end of the normal range. So, for example, IDEXX Laboratories values state that average WBC counts (Reference Interval) are 5.05 to 16.76. Danny's was 17.23 which indicated either extensive inflammation, infection or other stresses. Typical Sighthound WBC should range from 5-6, and everyone should be aware of this idiosyncrasy. If their sighthound's WBC is elevated above this 5-6 range then, indeed, a WBC of 8 is considered raised for this genre of dogs and should be of concern.

Even if my gut feeling were correct, there would be no hope for Danny, but my vet wanted to proceed if he had a massive infection, though he had no temperature. We started with an injectable Baytril along with an intervenous dosage of Metronidazole (Flagyl), and IV fluids over the course of several hours after which I brought him home. That early evening as he relaxed in the shade on the patio he again had a small amount of black stool leach out of him. I take great care in making sure that my hounds are well-hydrated; therefore, I gave Danny an organic low-sodium warm chicken broth (8 ounces to start) via an oral syringe to provide him with energy and nutrients. The next morning, I began organic baby food purees such as simple chicken and rice along with small amounts of applesauce and yogurt but he would not freely eat it, and I had to hand feed it to him. This was entirely out of the ordinary as in the past when he had a bout of diarrhea after picking some virus up at a dog show he would still freely eat food if it were offered to him.

Note: On the topic of diarrhea and fasting, I DO NOT subscribe to the notion of fasting a dog who has diarrhea. I especially do not Fast an Irish Wolfhound, even more, a 10-year-old male weighing 173 pounds (without an ounce of fat on him!). Many of today's mainstream vets still recommend fasting the animals for 24 hours. Nonsense I say, as this only enhances the misery, it weakens them further and makes them feel even crummier. More shamefully, some Internet columnists recommend no water which is dangerous as diarrhea causes dehydration and the loss of electrolytes. Also be aware that there are one or more studies that show that Microbiota modulation changes occur due to a negative impact on gut physiology from fasting. The loss of microbiota is very concerning, and in my considered opinion, it is JUST ONE of several determinants in Gastric Torsion or Bloat (I have no data to prove this, but it has been a theory of mine for decades). Additionally, I also give raw honey -- NOT honey purchased in a supermarket but unheated, unprocessed raw, pure honey.

Despite my efforts, it was evident to me that a much more serious underlying issue was occurring. Though Danny's gums regained some color, they remained paler than usual and his Capillary Refill Time was prolonged. Though he was not lethargic and lying on his side, he still remained in the prostrate position up on his elbows which is another sign that seasoned breeders look for depending on the issue we are attempting to detect or determine. He had fight in him, but he was not interested in the food I was giving him which again was remarkable for him. The end of the third day brought no improvement, despite his antibiotic regimes as he, again, had small amounts of the black coal leaching out of him where he lay. By the morning of the fourth day Danny still had black feces coming out of him, albeit in much smaller amounts, and still had no interest in food. It was then that we knew that we had to help him pass on as fluid began accumulating in his abdomen.

Here I must tell the Reader as to how Danny chose to pass on because it was quite extraordinary. At 10 years of age, Danny had always been very astute and had learned that unfortunately on a few occasions, our longtime primary veterinarian's appearance at our home coincided with the loss of one of our wolfhounds. I have always insisted that my hounds leave while at our home where they are comfortable and not frightened. Over the 10 years of his life, he had noted the loss of litter sisters, as well as his Dam and Uncle, and his partner Jane. He also learned very early on to identify our veterinarian's car so that in the past, whenever Darcy arrived for annual exams, blood draws, Rabies vaccinations or Titers, even before she exited the vehicle, he would bark at her with an unusually high pitch. A bark that was nothing like how he barked when a stranger arrived, or at the neighbor's dogs when they walked by the house, or while trying to play with the other hounds. On the 4th day, as Darcy arrived for the euthanasia, we were outside in the garden that he loved, resting on a blanket as he was up on his elbows, and as she drove in the lower driveway, he watched her carefully and silently. He did not attempt to bark, he did not try to raise himself up to greet her, just silence. It was not because he was weak or sickly as he lay there proudly arching his neck with the most magnificent gaze while watching her enter through the gates to examine him. He simply knew it was his time to leave us. He was not frightened, but instead, he was ready. And as he looked me in the eyes for the last time, he licked me and said farewell and was gone within a few brief seconds. He was a remarkable animal, and my exceptional friend, one I will never forget.

Danny died 4 weeks short of 10 years of age and 10 days before his grandchildren being born. We would have loved for him to have been able to be here for his grandchildren as we have Danny's mate and the pups Grandmother, Kennedy, still with us who is 10 and a half years of age. I firmly believe that the organ failure was due to the extensive medications he was taking for his late onset, adult Ventricular Tachycardia heart disease, without  Dilated Cardiomyopathy. He had undergone a final echocardiogram four months earlier as well as a 24-hour ambulatory Holter monitor in which the Cardiologist had increased his Sotalol to 80mgs 3x daily. Some forms of heart disease are considered a chronic disease in which some dogs can live for years on medications, but there are consequences to this. I believe there are long-term effects from the drugs that develop over time and can result in organ failure. 

Ballyhara Cinneide (Kennedy) 10 yrs 4 months with grandpup