Cardiac Catharsis

Tam​ showed me the quote from this story a little bit ago, and I thought it was cute. Children frequently give us a fresh, innocent, view of the world, something many of us have long lost the ability to do. Often they give us a whimsical observation (I saw someone mention their daughter proudly exclaiming that she “farted in [her] butt”), but there are times where the youth and innocence of the observer belie the wisdom and depth of their comment. I thought the quote was cute, at the time I didn’t realize how poignant it would turn out to be.

I’m not sure who originally wrote this, I saw it credited to a Dr. Robin Downing, but I can’t confirm that. Anyway, here’s the story:

Being a veterinarian, I had been called to examine a ten-year-old Irish Wolfhound named Belker. The dog’s owner, his wife, and their little boy were all very attached to Belker and they were hoping for a miracle. I examined Belker and found he was dying of cancer. I told the family there were no miracles left for Belker, and offered to perform the euthanasia procedure for the old dog in their home.

As we made arrangements, the owners told me they thought it would be good for the four-year-old boy to observe the procedure. They felt he could learn something from the experience.

The next day, I felt the familiar catch in my throat as Belker’s family surrounded him. The little boy seemed so calm, petting the old dog for the last time, that I wondered if he understood what was going on.

Within a few minutes, Belker slipped peacefully away. The little boy seemed to accept Belker’s transition without any difficulty or confusion.

We sat together for a while after Belker’s death, wondering aloud about the sad fact that animal lives are shorter than human lives.

The little boy, who had been listening quietly, piped up, “I know why.”

Startled, we all turned to him. What came out of his mouth next stunned me. I’d never heard a more comforting explanation. He said, “Everybody is born so that they can learn how to live a good life – like loving everybody and being nice, right?” The four-year- old continued, “Well, animals already know how to do that, so they don’t have to stay as long.”


On Friday, I learned that Penny has Pulmonary Hypertension, which is elevated blood pressure in the lungs. She also has Congestive Heart Failure caused by Degenerative Valve Disease. Her heart is severely enlarged, and 2 of her heart valves aren’t properly closing. This reduces the heart’s efficiency when pumping blood, and causes blood to leak past the valves, leading to other issues.

One Sunday in December I took Milo and Penny down for their walk, everything seemed fine, but when I got to the top of the steps, Penny collapsed. On the inside I started freaking out, on the outside I remained calm as I picked her up and brought her inside the apartment. After a few minutes, she seemed to return to normal, eventually sitting up, and then walking around like nothing was wrong. The next morning she collapsed when she got inside the door, first sitting, and then falling over. I carried her up the stairs the rest of the day, and first thing on Monday I called the vet to bring her in as soon as they could fit us. She was examined, but his findings were inconclusive. He recommended X-Rays, but suggested my best option was to take her to a cardiologist for a consultation.

I love my dogs, but the unfortunate truth is I’m not in a situation where money is no object, so I had to leave the vet without any further testing, and without scheduling a consult. He did say that if she could manage climbing the stairs slowly, then I could just carry on with that… So that’s what I did, I would control her climbing the stairs, keeping her to a slow pace so she didn’t overexert herself, and she seemed fine.

But things changed this past Thursday. As she was slowly climbing the steps in the morning, she stopped between floors, abruptly sat down, looked up at me, and then collapsed. I carried her up to the apartment and immediately looked up and called the area cardiologist. They setup the appointment for the following day.

She was clearly getting worse, I was also beginning to notice her mouth and tongue were turning purple with even a small amount of physical exertion, her breathing was consistently heavy, she was panting often, her temper was much shorter with her brother, and she was reluctant to play, typically just sitting off to the side and watching if I was playing with Milo. I knew something was wrong, so I began bracing myself for what I would likely hear at the appointment. I had a hunch as to what was going on, so I began educating myself on the possibilities, fighting back tears as I read. But I had to know for sure.

Typically, I take both Milo and Penny to any vet appointments, just because they’re basically inseparable, but I knew Penny would likely be tested a lot, and I didn’t want Milo to wind her up around all the new people, so I left him home. I took her in, and in typical Penny fashion she quickly befriended anyone and everyone in the room. We were led to an exam room where a technician took some measurements and asked me loads of questions. She asked for details about her collapsing, her attitude, her appetite, her water consumption, her breathing, etc, etc. She told me it was likely that an echocardiogram was needed, I said that was fine, she told me the cost, I agreed, and they escorted Penny away.

The doctor, and two student cardiologists, arrived shortly after. She asked more questions: did she seem confused when she collapsed, describe her breathing, does she seem more lethargic? She explained they’d like to take a chest X-Ray to make sure there weren’t any masses or nodules in her lungs, and that they’d also like to do a blood pressure test. If the echo was still needed, then they would do that as well, with my permission. The tech returned to break down the costs of everything, which, again, I agreed to, and I was told I could wait in the lobby and watch TV, or grab a cup of coffee. But I wanted to be alone, so I stayed in the exam room.

The doctor returned some time later and broke it down. The X-Ray showed fluid buildup in Penny’s lungs, as well as excess fluid in her abdomen. She diagnosed Pulmonary Hypertension during the echo, and she was also able to observe the deteriorating condition of her heart and its valves. She explained the medical science behind everything, how her heart was severely enlarged, how the thickening of the valves prevented them from forming a tight seal, how the back flow, regurgitation, of blood was likely causing the hypertension. She pointed out how Penny’s mouth and tongue would quickly turn purple when stressed (“excited”), even just a little, and explained her collapsing was syncope, which is the medical term for fainting, due to a lack of oxygen to her brain. She told me Penny’s heart is no longer able to properly supply her body with the oxygenated blood it needs.

The doctor recommended a cocktail of drugs to attack the symptoms and improve her quality of life. A diuretic to help clear the excess fluid from her body, and an ACE inhibitor and inodilator to make her blood flow more easily and reduce the demands on her heart. I was asked to monitor her breathing: count the number of breaths in 15 seconds, multiply by 4. The doctor was hopeful that her breathing rate would dramatically decrease as the drugs helped her heart and lungs become more efficient. She gave me documents to log the breaths, as well as a comprehensive packet that explained the conditions, the medications, and symptoms to keep an eye out for. She also recommended a blood test so they could set a baseline and monitor the drugs effect on her kidneys (the blood tests came back good). I once again was shown a price sheet, which I agreed to, and Penny was whisked away for the blood test while I was led to the waiting room to wait for the prescription to be filled. A short time later she was returned to me, we collected our meds, paid the bill, made the follow up appointment, and left for home.

Penny started the meds that night, and considering they get wrapped in delicious pill pockets, Milo immediately became jealous. She gets 4 “treats” a night, a giant pill in one pill pocket, two smaller pills in another, a liquid shot of a tasty med for her Cushing’s, and a regular treat with some supplements to help her joints, which her brother also gets. I also began counting her breaths: 56 breaths per minute the first night. The next evening they dropped to 40, then down to 32, and then down to 22. The meds are doing their job.

But the meds are not a cure. They do not fix the valves in her heart, or reduce its size down to normal. As time passes, her heart condition will continue to deteriorate. The meds will mask the symptoms, but eventually they will no longer be able to keep up. She will likely once again begin fainting, panting easily, coughing. She will eventually pass. The average prognosis for dogs with Congestive Heart Failure is anywhere from a few months, to a few years, but the doctor told me we will talk long term at her follow up appointment. At this point the goal is to improve her quality of life, and prolong her time as best we can.

The child in the story above speaks about how people must learn to love, learn how to lead a good life, learn how to treat others with kindness and respect. He speculates that dogs, love and devotion incarnate, are born with those lessons already ingrained so they don’t need to spend as much time on this planet as we do. They show up in our lives, a whirlwind of fur, and wet noses, and sloppy kisses, and wagging tails, and destroyed shoes, and accidents in the house, and eating snacks we forgot were in bags, and goofiness,  and playfulness, and love. A purity of love humans may never understand, a willingness to confront certain death to protect their family, a devotion to our well being so unwavering, so complete, it makes you wonder if they see us as their deity.

Penny is a lover, more so than her brother. Where he wants to play with everyone, she wants to cuddle up to a nice back rub. She’s never met a person she didn’t like, and it’s rare for her to encounter one who doesn’t succumb to her “would you like to pet me?” face. Penny is happy, she’s always been happy. She’s blissfully ignorant of her illnesses, or why she was tired walking down stairs last week, but can almost run up them today. She doesn’t know what I’m saying when I pet and talk to her about her health issues. She doesn’t know why I’ve looked at her, crying, as she sits next to me, ears at attention, nub wagging as fast as she can move it. She has no concept of her own mortality, and she doesn’t care what happens when her time is over. She just knows how to be happy, and how to love, and she’s extremely skilled at both. Penny is 10, she will be 11 in August, and I fully expect her to be around then, but how much longer after that I do not know… It would appear she’s moving on from this life at a relatively young age for a smaller dog, but perhaps it’s because she was already so accomplished at kindness and love when she arrived.

I’ve met people who don’t understand why others own dogs, or even pets in general. Why we allow ourselves to become so smitten with a creature we know will be with us for only a fraction of our lives. Why we would willingly put ourselves in a situation where we will be heartbroken. “Isn’t owning a dog just guaranteeing misery, heartbreak, and tears in a handful of years?”

The answer is simple: no amount of pain, grief, or sadness can overshadow the years of warmth, joy, and love a dog provides. When Penny moves on, I’ll be an inconsolable mess. I know it, and I’m proud of it. But when I recover, I will eventually allow myself to be chosen by another dog, and I will happily allow the cycle to repeat itself.

This isn’t goodbye, she’s laying in the hall as I write this, waiting for me to step away from my computer. Her health is improving, and she’s still the infinitely chipper, happy, goofy little Penny she’s always been. She still loves to curl up next to us on the couch, nudging a free hand up onto her head for a neck rub. She still snores loud enough to wake me up from a dead sleep. She still snorts, and rapidly trots around the house when she’s excited. She still orbits me, and the couch, and the bike trainer, and everything. She still knows the most effective way to get me out of bed when it’s time for her walk. She’s still everything that makes her my little Penny.

This is catharsis, a chance for me to open my emotional taps, and allow myself to come to grips with the shrinking timeline of her life so that I, so that we, can move on. So I can stop feeling sad that Penny will be leaving, and start feeling happy that she’s still here. So I can enjoy our remaining time together, not dread the day it will end. So I can stop crying when I think about it… at least for now.

So I, in some little way, can try to show Penny love like the love she’s shown me all these years.

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