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12 year old purebred female English Cocker Spaniel. General

12 year old purebred female...
12 year old purebred female English Cocker Spaniel. General Health very good. 3 weeks since onset of vomiting of bright yellow bile usually within minutes of ingesting special, low fat canned food (Royal Canin Brand: Medi-Cal "Gastro"). Veterinary recommended treatment: Pepto Bismol (tablet form -refuses liquid). General lethargy. One day, she will eat (hesitatingly) small portions AM & PM with no vomiting. Next day, she will eat hesitatingly and vomit within minutes. Stool is formed but again, bright yellow. Appetite is poor, yet subject initially appears to be hungry.
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Answered in 2 minutes by:
12/13/2009
Dr. Loretta
Dr. Loretta, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28,319
Experience: 25 years of experience in surgery and internal medicine.
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Hi there and welcome to Justanswer!!

Can you tell me if your vet ran any lab work?

Has he had any other problems before this?

Thanks!

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Customer reply replied 8 years ago
Stool sample was examined at clinic - no apparent problems. I assume you mean
"Has SHE had any other problems before this?" ( not the vet.;-) Answer: Positive: inflamed anal "gland" earlier this year treated with anti-biotics. The problem with the gland continues to bother my dog from time to time. Also suffered a very severe sinus infection related to teeth. Profuse bleeding through nose. Teeth extracted about 12 months ago and condition stabilized. However, I have noted a chronic mild redness in both her eyes like conjuntivitis which I have treated with tetrocyline salve. Condition persists but is mild. Some eye discharge daily.
Thanks for the info.

I asked about lab work since at your gal's age, a kidney problem is a possibility. From the symptoms you describe, I worry about either an allergy causing this odd behavior or an Irritable Bowel Syndrome. these are both difficult to diagnose but if this continues, you will have to have further diagnostics to determine what is causing these digestive signs. I say this especially since it appears that she wants to eat but is afraid of the consequences.

Your next step, since the treatment she is on is not helping, is to have a specialist perform an endoscopy and biopsies of the intestinal tract. If she has Irritable Bowel Syndrome, this has a specific treatment. If this is due to an allergic response,. this also has specific treatments.

I know you are very worried and I understand your concerns. Your gal has a very serious condition but this condition has yet to be determined. Have your vet refer you to a Veterinary gastroenterolofist. They have more sophisticated diagnostic tools to get to the bottom of your gal's problems so these can be resolved and give your gal relief.

Good Luck and happy Holidays!!
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Customer reply replied 8 years ago
Agree additional tests and endoscopic examination is necessary. Have difficulty seeing relationship with kidney dysfunction. Hepatic possibly? Atypical Addisons? Possible relationship with chronic anal gland problem. Gland has hardened and is difficult to express. Painful for dog when I attempt. Also see systemic possibility. Anal Gland, sinus problem, conjunctivitis... Realize my dog is old, but past year has witnessed a slow build-up of seemingly unrelated problems with 'common bacterial baseline'. (Sorry. I'm a cardiologist so I am likely talking gibberish). Any final comments appreciated. Thanks for advice, and best wishes to you for holiday season.
I certainly understand your thoughts on a possible relationship between the other issues from the past. I love your gibberish since you are not talking gibberish but an educated guess.

I cannot see the relationship to these other issue except for a suppressed immune system causing your gal to be more susceptible to these problems. the anal gland problems are not at all related to her obvious digestive problem. They are not connected although anal gland problems will make her tender in this area.

Your gal is suffering from geriatric issue although I am not sure of the digestive issue. I do not see a hepatic problem unless this digestive issue is related to a neural component and a hepatic encephalopathy. This is certainly possible but you would see other neurologic signs if this were the case.

Run the other tests and be sure all chemistries have been completed including looking for Addisons which is in the differential list but pretty far down the list. If the chemistries rule out certain issues, then you are looking at a Bowel condition or allergic response.

I hope this helps, Doc! I can tell how much she means to you and I know you will do the right thing for her.,

have a Great Day!!
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Customer reply replied 8 years ago
Dr. Loretta - Nothing worse than an MD as a patient huh? I drive my vet crazy with my ill-informed theories...and of course, let's not forget I am also the typical "crazy dog owner" demanding instant cures!

Thanks for your professional advice - All good. And thanks for your reassurance. A pleasure corresponding with you too Doc! From one MD to one DVM - Seasons Greetings and Best Wishes for 2010.
NO worries!! I LOVED having MDs in my practice. They added a dimention to the diagnostic process that was really informative.

You could never drive me crazy!! I appreciate the input and as far as being a crazy dog owner,....so am I!!

I really hope you get to the root of your gal's problem. This is not an easy case and it will take more diagnostics to find the problem. I can tell you are as stubborn as I am so you will find the cure!!

Happy Holidays, Doc!! Great talking with you too!!!
Dr. Loretta
Dr. Loretta, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28,319
Experience: 25 years of experience in surgery and internal medicine.
Verified
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Customer reply replied 8 years ago
Praise for Dr. Loretta - An intuitively gifted diagnostician! Balanced, well considered advice and guidance were provided. Variety of possible causes offered with professional skill and necessary caution. Felt most reassured. Thank you! Five stars for this skilful practitioner!
Oh MY! I am blushing!!

You are too kind, Doc!!

have a Great Day!!
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Hey Doc!

I had a thought last night and, after reading the signs again,. ask your vet to check your gal for Laryngeal Paralysis. If she had this, it may show these types of signs. She would also have trouble drinkiong water so if this is ok, this is probably not the problem.

Just a thought....

Have a Great Day!!
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Customer reply replied 7 years ago
Hello Dr. Loretta - You are most welcome regarding my comments. They were genuine. Here's the update. Was in touch with our local vet. I am at my country home in Nova Scotia, rather than in Toronto, Ontario. After further consultation with him, he is preparing a Homeopathic Remedy to treat the symptoms of the nausea Clara is no doubt experiencing. She is still refusing all food. However, I am literally out in the sticks right now, and she requires much more sophisticated diagnostics than locally available. I have booked appointment for her at the University of Prince Edward Island Small Animal Vet Clinic. Just a mere 6 hour,*****for me. I am not terribly keen on Homeopathic remedies. But I have to treat the symptoms until I get her to this hospital. She is quite lethargic and refuses all food. Having trouble even with water. If I suspect dehydration, I'll take her in to local clinic and have her hooked up before beginning monumental journey to the clinic in Prince Edward Island. Any additional suggestions of a non-homeopathic nature to treat the nausea; control the bile? I can tell she is under stress. Nothing like nausea in my experience. Give me a migraine (without nausea) any day. So I am quite focussed on just trying to stabilize symptoms right now. Fortunately she likes the car. P.S. I can't prescribe in this province. If you were in my position, what would you be doing? I feel quite out of my depth here which you can imagine is driving me nuts. HELP!
Sincerely ***** ***** MD FRCP(C) FRCS(C). P.S. Thanks for your kindness in extending your service.
Hi Dr. Tim!! It is so noce to get an update.

I really worry about your gal since she will still not eat. In my clinic, I have used metaclopromide to control nausea in in-hosptal patients and I am not sure of this would help in Clara's case.

I have also had good luck with Famotidine or Pepcid AC to control acid production if this is what is causing the nausea.

Hang in there, Doc!! Clara is lucky to have such a great Parent!! I know you will do the best for her.
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Customer reply replied 7 years ago
Hi Loretta - (please call me Tim). Many thanks for your continued advice. Clara has now gone 36 hours plus without vomiting. Remains food shy, but is eating about 4 oz. Medi-Cal "Gastro" canned formula twice diem. Still lethargic but 'appears' to have stabilized. Slow onset with increasing severity now appears to be on wane at 2 week point. Administration of liquid homeopathic remedy (2 ml. of unknown substance) about 36 hours ago seems to have had efficacy. Remains food shy, but also has indicated she is hungry. Appears to have rounded corner. I am wondering if possible pathogen is responsible. Any thoughts on this, given her symptomology? Is drinking water again, so no dyhydration worries. Stool firm, and returning to 'normal' colour. If condition continues to improve in next 24 hr. will order full blood panel (with your recommendations) and cancel trip to major clinic in Charlottetown PEI. This has been a stressful and strange experience - especially considering Clara's constant good health throughout her life. Will remain vigilant and will (if you do not object) keep you posted as to status and results of blood panel. I cannot thank-you enough for your "beyond the call of duty" professional interest and help. All the best Loretta. Sincerely Tim.
Hey Tim!! It is so good to hear from you and Clara!

I am thrilled to hear she has stopped vomiting and has had some food and water. I am still at a loss as to what has caused this. The first thing that comes to mind now would be pancreatitis and be sure to ask the vets to add on the cPLI test along with the chem panel.

I am not convinced this condition is due to a pathogen however, some forms of pancreatitis have been infection so this should not be over looked.

I do agree, Tim, that if Clara were my patient , that I would cancel the clinic and have chemistries run first. If it is available, try to give her Science Diet AD. This is a high calorie food that is used when dogs are debilitated., It will give her more nutrition in a small amount so she can keep her strength up to fight off whatever has caused her illness.

PLEASE keep me in the loop, Tim!! I LOVE to find out more about online cases and I rarely get the chance. Currently, I am on an island off the coast of Honduras running a free clinic for the island animals. My practice of 25 years was sold since I was burned out by the business part of the clinic. therefore, I do not get much of a chance to follow up on interesting cases.

Oh, No, I am rambling! Give Clara a hug from me and my thoughts are with you, Tim, and , of course, Clara!!
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Customer reply replied 7 years ago
Hi Loretta Feel a touch guilty continuing our consult. But as you have requested follow-up info, I will provide it. I anticipated your idea of a blood panel and have ordered blood work, urinalysis and will add screen for cPLI. This is a strange case. She woke up this AM and quickly vomited small viscous blob of clear matter. No food in it. Then she appeared fine. So whatever is going on, it appears to be righting itself naturally. Must find out what was in the homeopathic rememdy. Things did turn around after administration of one dose. I am proud of what you are doing. Good girl Dr! I have recently retired due to diagnosis of MS (recurring remitting). Have had but one serious attack, but right hand tends to have days when it shakes. This shaking has been occuring over last 4 years but never in OR and very infrequent until major attack. Prognosis good, but I am not currently practicing. Am currently pondering what I shall do. Teach? Consult? Diagnostics. Possibly pathology. Nothing is ringing bells at moment but surgical days are over. Cannot risk possible consequences regardless of infrequency and short-term duration. I am very happy to hear of your current work. Am avid animal activist. Provincial government in Ontario recently changed from Conservative to Liberal and enacted new Animal Protection Act (not revised since 1909!) Powerful legislation gives inspectors radical new powers of entry, and heavy fines, imprisonment. Will rid Ontario of loathsome Puppy Mills. Most other provinces now in sinq. with these type of laws except our French Canadian province of Quebec, mired in 18th century. For personal email:***@******.*** - Just for personal stuff, not professional. Would like to get to know more about your work. So feel free. Tim
HI again, Tim! It is so good to hear from you again. Do not ever feel that you are bothering me. I LOVE to hear from you and Clara!

I am so glad to hear she is doing better and I would LOVE to know what was i the holistic med. there was another one that came from Germany I think that cured a dog that was my patient of a very bad odor and they would never give me the ingredients and this is a very common problem in dogs. If you find the ingredients, I would love to know.

The website does not allow us any personal contact so just keep contacting me through here. It is no problem and, as you can tell, I love it!!

I am sad about your condition. That must have been a hard blow, Tim. Especially having to change careers in some way. Remember, this website has many doctors and it is pretty fun answering these questions. It may be right up your alley if you get bored.

OOOH!! Just hearing about Puppy mills gives me the chills !! I see here on Utila many that come from the mainland that are diseased and many have distemper of all things!! I never thought I would have to see another case of distemper until I came here and here in Honduras,. there are no rules. I have done many Femoral Head Ostectomies due to severe inbreeding and rampant Hip Dysplasia.

Keep in touch, Tim!! I am very anxious to know how Clara is doing and now I need to know how YOU are doing!!

hang in there, baby!!! You are doing great so far!!!

Merry Christmas to you, your family , and, of course, Clara!!!
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Customer reply replied 7 years ago
Loretta Whoops! I actually should have thought of the professional nature of the site. Hope it won't cause trouble or concern to you. Just a touch frustrating when a potential new professional friend comes within view. I would of course, not have expected professional advice...but I understand the policy. Do not worry about me. I am one of the lucky ones. It is the unremitting kind that kills. This just occasionally annoys. But certainly being a surgeon under such circumstances would be out of the question. I would feel awkward offering cardiologically-related advice without seeing a patient. OK for general practitioners but specialists, it's a bit dicier. Would imagine many would be trying to get a second opinion,and this is not a good medium for such analysis. Not being "snooty", but feel this site better suited to GP's with broad-ranging, up-to-date, general diagnostic abilities. But an interesting thought! Well, Loretta, signing off for now. Your work really does sound exciting. Love to hear more. Until then, I return my best wishes for the Holiday Season to you and your loved ones. All the best, Tim
No worries, Tim. I think the website is afraid we will go off on our own making money without them. It would never happen from me but not everyone has scrupples.

I certainly understand your concerns about second opinions and fortunateley for me, I am a general practitioner and there aren't as many litigious concerns in Veterinary medicine, although that is changing. The thing I find with answering all these questions is how many "bad" vets are out there not doing justice to the profession. I am afraid you may find the same concerns in human medicine. By the way, my father, grandfather and uncle were all MD's but I wanted vet med instead....go figure!!

Keep the faith, Tim, and feel free to contact me anytime. The whale sharks are back here in Utila so my husband is taking me out in our boat this afternoon. They are quite a sight to see!!!

Give Clara a big hug from me!!!

Happy Holidays!!
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Customer reply replied 7 years ago
Loretta As we agreed, this I consider a professional question for which compensation will be paid. OK?

I am asking the impossible. But your personal advice (heart) may help me to determine through your experience (head) whether my course of action seems correct and something you would consider given the circumstances. Clara has taken a turn for the worse since we last spoke. The brief interlude of relief she appeared to experience - a bit more animated and ate a bit of food - lasted but a day. By the following day she awoke and again vomited a small amount of clear, viscous liquid. During the day she was in and out of the house trying to defecate, with no result. Just the urge to evacuate her bowels. She also was wretching (nausea?) but had nothing to bring up. Now as you know this condition has been going on now for 4 weeks, with the first symptoms being a hesitation in eating, followed by not eating, followed by watery stool, followed by bright yellow bowel movements and vomit (with food undigested in her stomach - no smell). This progressed to complete refusal to eat, yet seemed as if she wanted to eat something. It was a this point I took her to local vet, who suggested a holistic treatment for the nausea. Because my country home is in a poor section of Canada - the Maritimes - (how I wish I was in Toronto!) the facilities to do endoscopic work, Ul.Sound, Scanning etc. are a 6 hour treacherous winter journey away and the weather has been BAD. So I have ordered the blood panel with your recommendations to be performed. What I am trying to determine is if the blood work will indicate either a specific possibility, or be so out of whack as to indicate a general "shut down" of Clara's major organs. Basically, is this dog likely suffering from cancer or equally fatal condition? Now here comes the question. I have always tried to approach the end-of-life period for my many past dogs by asking myself several questions. If a curative treatment is available, I will act agressively to see the dog gets the best medical care promptly. If the dog is suffering, and there is an iffy prognosis, I take my dog's age into consideration. If the treatment is elaborate, requires surgery, has an uncertain prognosis, and the dog is suffering, I elect to have my dog put to sleep. Now I am in a situation, I have never been in before. Clara is still mobile, still comes when called, still follows me around, still drinking water. Introduce food and it will either be expelled through the bowel or she vomits. Food is not digesting. She does not appear to be seriously nauseated once the food is out of her. I am in an area of the country where it will require a considerable land trip in very bad weather to take her to another province to receive full testing. She is 12 years and 4 months old. What I am driving at here, is do I go to heroic means, make this uncomfortable journey, have her thoroughly tested, only to be left with the same diagnosis surmised by blood tests which indicate a likely cancer or life threatening disease with a poor prognosis? (Naturally if the blood test indicates a problem which is likely curable, I would immediately make plans for the trip to PEI.) I have never been in a position where I have been in an area of the country where major veterinary facilities are hundreds of miles away. I simply do not want to drag Clara through a six hour voyage, uncomfortable and foreign surroundings, only to be told she is dying. She is old. Right now she is apparently comfortable. If the blood test indicate a serious condition, do I put this poor soul through surgery at such an elderly age, only to have her live a few mediocre months before death comes knocking again? I am really at loggerheads over this. You must understand Clara means a great deal to me and I deeply love her. However, if I look at the facts, she has now been ill for 4 weeks, she cannot keep food down, she is certainly suffering bouts of nausea. As for the level of pain and discomfort she may be in, I don't know. No routine treatment has had any effect. She grows a little thinner and lethargic with each passing day. However, when she follows me or goes outside there is the usual spring in her step. It is simply NOTHING will stay down, NOTHING is digesting, and while she will eat very tasty food, she throws it up within an hour or so undigested entirely. The yellow bile has disappeared entirely. She absolutely refuses any tasteless therapeutic food. Christmas arrives Friday. If I have a crisis, I am without medical assistance for Friday until at least Monday. Test results may not be ready before the local clinic closes. I am seeing the vet today -Tuesday - Eastern Daylight Time + one hour. It is currently 13:40 hrs here. I am feeling very "out of control" here. A sick elderly dog and I might as well be on the moon. Very nerve-wracking. Should I equip myself with palliatives? And what should those palliatives be, should she really sicken when no medical assistance is at hand? I know I am all over the street here, but hope you can give me some guidance. Thanks Dr. Loretta. Dr. Tim
Oh my, Tim!! I am so sad to hear what has been going on with Clara. I was hoping every day to get good news but I am not surprised at your email.

I certainly understand your predicament and it is a tough decision to make the trip or not. I find myself in very similar situations here on this island since the closest veterinary care besides me is in the states and it is a very long trip.

My gut feeling, Tim, from 25+ years as a practice owner of a $2million dollar a year facility, is that Clara has inoperable cancer. I say this by the typical cachectic appearance of Clara due to her not being able to eat. I have seen this many times especially with pancreatic cancer. I am hoping I asked you to makes sure the lab did the cPLI test(serum pancreatic lipase immunoreactivity concentrations) because this is a pancreas specific test.

I wish I could tell you more and your description of how you have made your decisions in the past is very reasonable but does not really fit this situation that you are in.

PLEASE email me as soon as you get the results of the blood work and I may be able to help you a little better. Unfortunately, I feel there is something very serious and most likely inoperable that is affecting Clara and most likely a trip to the specialty facility will only stress Clara only to find bad news.

Before you make any decision, Tim, talk to me about the lab work. I am very happy to help and I feel sooo bad for what you are having to go through!!

I am not sure of the time change but it is about 1PM in the afternoon here and I will be here all day. Don't do anything rash until you talk to me, OK?????

hang in there , Tim!!! I am here to help!!!
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HI Dr. Tim.

I have been worried about you and Clara. I hope things are going better. let me know if you have a chance. I know you are busy. I will be gone for a few hours but I will check later to see if you had gotten the lab results.'

My good thoughts are following you over the ocean for you, Dr. Tim and of course, Clara!!!

Loretta
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Customer reply replied 7 years ago
Dear Loretta - Many thanks for your very obvious and kind concern. I was waiting until I got the test results before contacting you. Basically Clara's kidneys are failing - one of your first thoughts! As we began to discuss, we appear to have gone away from our professional instincts. However, as I recall you went straight to the kidneys which I hadn't even thought about. Why I got stuck on the liver, I don't know.

Here for your consideration are Clara's test results along with a Reference Range.
I'll name the test, then result, then normal ranges. I will also tell you what I am currently doing.

ALB = 28g/L - 22-29
ALKP = 507 U/L - 23-212
ALT = 131 U/L - 10-100
AMYL = 1942 U/L -(###) ###-####br />UREA = 46.4 mmol/L Right off the scale! (2.5-9.6 is normal)
Ca = 2.39 mmol/L -198-300
CREA = 839 umol/L Wow 44-159
GGT = 3 U/L - 0-7
GLOB = 46g/L -25-45
GLU = 5.91 mmol/L -3.89-7.94
LIPA = 850 U/L -20-1800
TBIL = 10 UMOl/L - 0-15
TP = 74 g/L -52-82

Na = 156 mmol/L - 144-160
K = 5.8 mmol/L -3.5-5.8
Cl = 113 mmol/L -109-122

T4 = 7.7 nmol/L Scary - she's given up

Canine:
<10 nmol/L Low
10-20 nmol/L Borderline Low
21-64 nmol/L Normal
> 64 nmol/L High
39 -77 nmol/L Therapeutic Range

Diagnosis: Renal Failure /unknown agency

Current treatment
- hypothroid - Synthroid 300 oral tab. 2x diem
- hydration NaCl 0.9% IV 250ml 2x diem
-diet/homemade 1/4 lb. ground steak (hamburger), 2,3/4 cups enriched rice, carrots, corn oil 2 tbsp.,salt .25 tspm. Cooked mixed together.
Dog Multiple Vitamin 2 per day

Observations from me: Clara has lost about 6 lbs in last 4 weeks. Since commencing this regimen, she received 250 ml NaCl (in H2O) IV Tuesday night, 1 synthroid pill, one vitamin. She hesitatingly ate small amount of food at 6 pm last night. She ate another small portion before bed at 11pm. Sometime in night, she thrw up what appeared to be second portion (undigested). Hydrated again at 10 am this morning, took synthroid tab. Refused food. At vitamin. No oral drinking. Very sleepy, eyes half open when awake. Makes effort to stay with me, including ride in car. Slept most of day. Now 6:10 my time. Am going to hydrate her again. Will try food again but am not sanguine, she'll eat. Will administer 2nd synthroid tab around 8 pm. No bowel movement yet today, Peed in AM but hasn't since. Sleeping now on her bed by my home office desk. I can't determine if she is suffering, but seems more to be just profoundly tired. Felt hopeful last night that she would respond to meds, diet and hydration, but frankly she seems to be even more listless today. With T4's so low, I suspect she is past the point of no return. Wish I could determine whether she is suffering, but there are no outward signs.
So here's my situation. All vet care disappears at 12 pm tomorrow afternoon. Do I continue treatment and let her sleep away at home, or do you suspect she is suffering and should be put down at clinic? I only ask because it will be too late for any medical intervention after 12 noon tomorrow, and then we're on our own for 3 and a half days. Have lots of IV solution and meds. What would you do under circumstances? Only concern is possibility of onset of terrible pain, but if she just sleeps away, I have no problem with her dying in her own bed. Tough question - not knowing underlying cause. I know there is no way out of this. Clara is dying. It's a question of how, when and where. It's the unusual circumstance of a major holiday that complicates this. Please give this some serious thought and let me know your reaction. Quite the dilemma. I will look forward to your thoughts. And thank-you for being there. Sincerely Tim
Good MorningTim.

Sorry it took me so long to get back to you. I had to gather my thoughts. I cannot figure out the time change but I hope I am not too late.

I am still surprised that Clara's illness turned out to be renal failure. I guess I got away from the renal failure idea and got stuck like you on either liver or digestive involvement.

Probably you realize that Clara may have permanent kidney damage. If this were treatable, I would have thought diueresing would have eased her symptoms. We vets run into this often that we do not know how many functioning kidney cells remain so it is tough to give a prognosis. It could be that the renal failure, like I have said before is secondary to something else also.

I just hate to see you giving Clara fluids all weekend only to find that she has permanent renal failure but, on the other hand, this may not be permanent. Its very difficult to tell but I would have hoped to see some relief from her symptoms after a few days of diueresing.

If this is permanent renal failure and the waste products are building up in her circulation, Clara will be just like a human in renal failure that decides to deny dialysis. They become ill from these causing the vomiting and listless. This is most likely what you are seeing in Clara now. Whether she is in severe pain or will become in severe pain is also really tough to know. I do not believe that dogs is severe renal failure are suffering since they become depressed but do not appear in obvious distress.

It just does not sound like you are ready, Tim, to let Clara go at this point. I am afraid you may get into a predicament that you will want to put her down and may not have the clinic available to you until Monday.

I guess what I am trying to say is that Clara most likely is not suffering but is uncomfortable. Another day on IV fluids should tell you more so it would not hurt to wait to see. If she is in obvious distress today, Tim, she may not make it through the weekend but it seems that you are prepared for that. make your decision on your gut feeling on how she appears today. If she is very depressed even after fluids., then it may not be the best thing for Clara to keep her going. You may be keeping her going for yourself and not for Clara. If she seems to have given up. do the right thing for her and make that hard decision. Often , we try to keep our dogs here with us too long for ourselves without taking what is best for them into consideration.

I just want you to think about that , Tim. I cannot tell you if it is best to put her down now or not because I cannot examine her to tell you if she is responding to treatment or not. Use your gut feeling to tell you what to do. The holidays is the worst possible time to have to make this horrible decision and I certainly understand that. Look into your heart, Tim and do the best for Clara. She may not be suffering but if she is not comfortable and it appears that she will not get any better and may get worse, you have to listen to this.

I hope that makes sense to you. I will be at the computer all day Tim, so please give me your thoughts.

Sincerely, Loretta
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Customer reply replied 7 years ago
Dear Loretta
This morning, Christmas Eve Day, at 12:10 p.m. Atlantic Time, Clara peacefully died in my arms. She was 12 years, 4 months and 7 days old.

I cannot begin to tell you, Loretta, how comforting were your words, and how supportive you were in bringing me to the right decision. We are the guardians of all living creatures, and it is our duty to keep them safe from harm, comfort them when they are ill, and see them to their rest in timely fashion. Clara, I know, wanted to go.

You helped her. You helped me. And we are both grateful.

With my heartfelt thanks and good wishes.

Tim.
Oh, Tim! I was afraid of this but on the other hand, I am relieved.

I know how tough this can be and I know you have made the correct decision for your precious Clara. It seems that sometimes we keep them with us for ourselves and not for their own good.

The holidays are the worst for veterinarians. I say this because I have euthanized more animals during the holidays than any other time of the year. This is because of the stress on the older dogs and lots of other variables that make this so sad.

I know Clara was probably ready and being with you at the end made this process extremely important and calming for her.

It has truly been a pleasure helping you through this difficult time and I feel privileged to have gotten to know such a compassionate person from across the ocean.

Please keep in touch and I am always happy to help if you need someone to talk to. This will make the Holidays sad for you. I am always a cyberspace away.....

My thoughts and prayers are with you, Tim, and your precious Clara!! She will be missed!!
Dr. Loretta
Dr. Loretta, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28,319
Experience: 25 years of experience in surgery and internal medicine.
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Customer reply replied 7 years ago
Dear Loretta - Your kind words about me can, as easily, be attributed to you. You are a kind-hearted person, Loretta, and it is quite remarkable how we "bonded" in cyberspace. In a way, it is a friendship similar to those that occur when two people find themselves in a crisis mutually shared - like two individuals who become close friends after surviving a ship sinking, or the countless people who today share friendships forged in the ashes of 9/11. In this case it was a person trained to cure or extend or improve the quality of another person's life, reaching out in desparation hoping someone could help me in a complicated illness for which I was frustratingly ill-equipped to understand and provide a solution to his best friend. Clara shared a time in my life when I was myself facing an unexpected and radical change in how I would be spending the rest of my career. You have no idea the number of times I sat and talked to her about my dilemma as if she were a talented therapist. Of course, it was simply the totally unqualified love she provided when I was feeling rather useless. She reminded me I had a purpose - if nothing more than to make sure she was safe and happy. So, Clara will always be remembered by me as the dog who kept me from slowly melting into a mound of self-pity. She was certainly the dog who spent the most time with me. I took her everywhere with me, after I ceased to work. We became fused at the hip, and I know that it is going to take me some time to go through the grieving process.

It is because of the unusually close bond which Clara and I shared, that I feel a sense of tremendous respect and fondness for you! Here I am, stuck out in the sticks, about 1,000 miles from Toronto where vet services were sophisticated and instantly available. You, Loretta, became a vital source for me. You knew the questions I should be asking and the possible conditions from which she might be suffering. You also provided the all important service of human kindness and thoughtfulness.

I am sure, that in your many years of clinical practice, you not only significantly helped animals in distress - but PEOPLE in distress. You understand the sometimes profound psychological bond that some people form with their 'pets'. Not all pet owners have this intimate bond with their household pet(s). You, I think, possess the talent to 'read' when the PERSON attached to the pet, is one of those who develop the powerful bond between themselves and their dog or cat or bird etc. And even though you never met me, nor examined Clara, you did clearly identify me as possessing that special relationship. And that helped me tremendously. You not only treated Clara, you treated me. That's a gift, and I am sure many other former clients would say this about you.

I hope it does not sound too theatrical for me to say that you have been a critical component in facilitating the proper outcome. It lessened Clara's suffering, and it comforted and supported me in making decisions which were naturally repugnant to me. I did not want to part with that little girl, but I also knew that critical decisions had to be made. You provided me with the extra energy I was lacking, to form the right decisions on how I should proceed. Clara, as a result, benefited through you. You drew the map with the critical path that was the quickest route to giving Clara all the opportunities without dragging her half way across the Maritimes. Given the circumstances of being in a region of the country with few readily available facilities, you encouraged me to maintain vigilance in a pragmatic way. For that, you have my deepest respect and thanks. I have only begun the grieving process. Right now, I am numb. So I will take you up on your invitation to send you a note now and then. I wish you and your husband (and family???) a Very Merry Christmas, and all the best in 2010. My wife and I are going to attend the midnight service at this wonderful church in Chester Bay. It is a classic "Christmas Card" type of church, built in 1812, and -remarkably- it is the original structure. It's tower still contains the original bell (along with a great many more added later in its history). What is interesting about this bell is that it was rung during a raid of the town by Americans during the War of 1812. It is white clapboard in construction, with wonderful stain-glass windows throughout. The interior is finished in this rich, reddish coloured mahogany with magnificently carved detailing. Unfortunately as we are destined never to be able to communicate as friends, I cannot send you a photo. Tomorrow, we plan to go on an excursion to Lunenburg where the famous "Bluenose" schooner was built. (it appears on the back of our Canadian dime). The town is right out of the early-mid 19th century. It has been virtually taken over by wealthy Canadians and Europeans, many of whom are retired. So it should be a fun day. Well, it's time to reward you for all your kindness and, again, thank-you for being there when Clara (and Tim) were in urgent need of help. Best wishes Tim (and my wife sends her thanks) and Natasha.
Merry Christmas, Tim and Natasha!!

Tim, you are too kind! Thanks you so much for the $...it was totally unnecessary but much appreciated! I did not continue communication for that. I was just very concerned about you and Clara. I am very sad how things turned out. I always wish the outcome could have been better. It seems, though, that for Clara, this was a blessing and she was even more blessed to have such a caring and compassionate "parent".

I had tears in my eyes this morning, Tim, because I was sincerely ***** ***** your email. It was the best Christmas present I could have ever gotten. It really feels good to have helped someone like you. As you probably know as a doctor, not all people appreciate your efforts and it can be frustrating at times.

I certainly understand your connection with Clara since I have been there myself with my own dogs and with countless clients over the years. I am very glad, though, that you have a very positive attitued about this situation and I am sure it has helped strengthen you for the long road you have ahead of you with your own challenges.

Just know I am thrilled to have gotten to know you and have made a connection with you and Clara for some unknown reason and I feel priveledged to have had this opportunity.

If you and Natasha ever want to get away, we have a second home here on the beach in Utila called Las Brisas which you can see on aboututila.com and you would be our guests. It would again be a priveledge.

Have a Great Day and take this time going to see the schooner to celebrate Clara's life and I will do the same here on my island. By the way, this church you described sounds so great!! I bet the mass was spiritual!!

My thoughts will remain with you, Tim, and Natasha and, of course, Clara.
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Customer reply replied 7 years ago
Dear Loretta - Sadly, in our culture, a person's worth is measured in dollars. Do not think for one moment, I hold the belief that your interest in my case was predicated upon the anticipation of the number of dollars involved. So let me hear no more of that!
I could lie to you and tell you that under the circumstances, we made the best of Christmas. I broke down in Church. (incidentally, I should tell you I am Anglican - I think Americans call it Episcopalian or as Robin Williams once hilariously observed: Catholic Lite. The services today between Roman and Anglo Catholic are remarkably alike. We part company on the issues of transubstantiation and, of course, the concept of God's supreme representative and divine lineage to St. Peter, the Pope - although I must say that John-Paul II was possibly the greatest Pope in the history of your (I am assuming you have some relationship to Roman Catholocism) church. Anyway, without warning, and much to the alarm of Natasha, I utterly broke down when the choir ( and this little church has a remarkable choir) sang from the Messiah. (Handel's). That did it for me, and the tears just streamed down my face. The end of this particular stanza did not end my sudden plunge into grief. Realizing that I was rapidly nearing the boundaries of social propriety, I told Natasha, I would excuse myself until I could bring myself under control. I quietly exited - fortunately I was near a side isle and could leave without too much commotion. I exited by a side door of the Narthex, and found myself right smack in the ancient churchyard. What a scene. The weathered tombstones angled this way and that, a wind off the ocean, a moaning sound from the tree-break along the shore. Just the ideal place for someone trying to manage their grief attack. (NOT). I attribute my ability to recover to the sharp wind. Otherwise I think I could very possibly have begun keening. Clara's death represented a climax to my ability to hold back the floodwaters of 3 years of trauma which I have been going through. My personal life has suffered some very severe blows which I will not burden you with. Let's just say it has been very tough on us, and losing Clara - truly unexpected given her otherwise very hardy health and robust personality and "animation" - was like the proverbial last straw.

However, thanks to the North Atlantic "breezes" I was literally smacked back into sobriety and was able to soon return to my seat in Church and to take Communion.

Natasha and I forced ourselves out on Christmas Day, and I am glad we did. Otherwise, I fear we would have both sunk into some kind of morbid depression. Today, I am just taking a day to reflect and consider. I will bury myself in a book, and just let life pass over me.

I want you to know Loretta, that from across the ocean you brought solice, understanding and most importantly compassion to a complete stranger. You and your husband's kind invitation is overwhelming in its generosity. What truly remarkable people you must be. I'm sure "Just Answer" never anticipated such an extraordinary result to a site dedicated to giving professional advice.

I can assure you that you went far beyond the call of duty with this particular client and his beloved dog. Clara will be individually cremated, and returned to her native soil in Toronto. As promised, I will from time to time, send a note. I noticed that you actually can send pictures on this site, so when I am ready, I shall send you a picture or two of my dear old Clara. Please do not feel obliged to return this note. It really is just a final thank-you to a very, very kind individual. You brought peace to Clara and much needed sympathy and warmth to this old guy. You have not heard the last of me however. Natasha has her own, rather complicated veterinary problem regarding a cat she rescued about 2 years ago. She has been so impressed by your help, she will be contacting you through me, shortly. Until then, the blessings of the coming year are sent to you by us both.
With the most sincere respect,
Tim and Natasha Laurence.
Tim and Natasha!!

I am so glad you shared with me your Christmas Eve. I know this was hard on you but I also know we all need to grieve in our own ways. I cannot even imagine hearing Handel's Messiah without breaking down in such a setting. By the way, Tim., you have quite a way with words and you should consider writing as an alternative. You are very good and I love reading about the church and the graveyard.

My husband would LOVE to talk with you about the religion issues. It appears you know what you are talking about.

I would LOVE a picture or 2 of Clara. I was actually going to ask but I did not want to be presumptuous.

Hang in there, Tim!! You are doing great and I feel privileged to get to know such a fine person. You and Clara will be remembered in my heart for many years to come. I am feeling a bit melancholy today so don't pay attention to me if I seem sad.

Tell Natasha I would be happy to help with her cat at any time.

Until we meet again, you guys are in my prayers...I am actually sad to say Good bye!!!

So....until we meet again..Hasta luego!!!
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Customer reply replied 7 years ago
Dear Loretta - Just a brief note to let you know that Clara's ashes came home today (January 11th). What a sad little urn - I suppose there really isn't anything that would please me. The "classic urn" seems to come down through the ages. But whoever decided that this was the appropriate shape to contain one's mortal remains, certainly didn't have much of an imagination. It looks like a flower pot - the only difference being, of course, it has a lid. For the moment it will have to do, and we placed poor Clara's earthly remains on a cabinet. Beside it I placed a small, framed picture of Clara, taken about 5 years ago at our home in Toronto. I always noted that Clara never photographed well. Her unusual coat colour - I think it is referred to as "roan?" is a mixture of black, silver, grey and white. Apparently quite a rare colour and difficult to breed - that is that often only one of the litter will carry the recessive gene. However, in photographs her colouring (note my English spellings - sorry I am a Canadian) seems to trick the camera lens. The subtle blending of the greys and silvers and blacks and whites act like camouflage and so you end up with an image that makes her handsome lines disappear. Just a blob of black with a handsome head. I have slowly collected a few pictures and now am trying to figure out how I convey these to you without using too much bandwidth for this site. As I would imagine you and your husband have both experienced, when a family dog suddenly is no more, it leave us with a period of adjustment. They become such a integral part of our daily lives, I find myself talking to her out of habit. Clara really did capture my heart in a way none of my other dogs did. That is not to say I did not love them all, but Clara was a part of an 'era' in my life where there were great changes, and she became a mentor. Whether she understood or not, did not matter. It was some who would listen, and I found that therapeutic. It is interesting you should note my writing. As a matter of fact I LOVE to write. And in a different life, there is a good possibility I would have become a writer. I have written many short stories and 'opinion' articles. And I must say I became a favourite writer to the editor of the Arguements and Opinion page of Canada's largest circulation newspaper - the Globe and Mail. Out of 21 submissions, over a period of 5 years, I was accepted 19 times. I never wrote on medical subjects - save one article on depression - . I am afraid the Black Dog and I have had a very close (too close) relationship throughout my adult life. A terrible blight is depression. No one, especially shrinks, really understand the mechanisms. And as far as my personal research has gone, these newer SSRI and SSNI drugs have no greater efficacy than earlier drugs - just fewer side effects. I, unfortunately fall into the category of 'drug resistant' and none of these so called drugs bring me much relief. I simply have to tough it out. Unfortunately the more 'acute' attacks one experiences in life, the greater becomes the likelihood you will suffer another attack of longer duration and deeper impact. I have had 6 such episodes in my life, the last occuring in 1996, about 6 months after the death of my first wife, Anne. Anne and I were true soulmates, and had started dating when only 15. Unlike most early romances -leading-to-marriage, ours worked and if anything, grew in intensity as the years went by. Anne was born with scoliosis in 1949. It was a strange case, in that the skeletal deformity was not profoundly noticeable. Yet in wreaked havoc on her rib cage, and eventually she underwent a major operation to try to straighten her spine in 1969. It was the first such operation of its sort, so doctors came from all over the world to witness this 18 hour operation. The result stopped the progression of the deformity, but alas, enough damage had been done that she developed many respiratory and heart problems. Heart failure became a constant challenge. We were able to just keep up with the progress of science to keep her alive until 1995. When she died, a large part of me died with her. I thought I had handled the situation well, but one day, about six months later I began "keening" in the shower. This went on for nearly 10 hours. I had to call in and cancel my appointments. I was a mess. I have never experienced such a bizarre emotional reaction, and fortunately I had a friend who was an excellent psychiatrist. He was unconventional in his therapy - I would call it "early cognitive therapy" with a strong emphasis upon relaxation exercises and breathing exercises. In 1995, cognitive therapy was just beginning to become the fashion, and my friend had developed his own, unique blend of therapeutic procedure. Whatever, it worked for me, and within 2 months I was able to cope with a full day of work. However, I elected not to perform surgury for about a year. Fortunately, the hospital administration and my colleagues were sympathetic. I maintained a full schedule and always attended in OR, but just did not feel confident to lead. Within a year, I returned to full practice, and much to my relief, I found -just like learning to ride a bicycle, I had no difficulty returning to surgery. But, I also found that I was more prone to emotional ties to my patients, which of course, we a rigorously trained to avoid. The bout with depression had left open a gate directly to my heart, and I had to really watch myself and strictly monitor how I was 'feeling' about certain patients. And I am not just speaking of the usual vulnerabilities of a beautiful young lady patient. This ran the whole spectrum. Young to old, male, female, and child - some patients just effected me. By maintaining a therapeutic relationship with the shrink, I was able to control these feelings and to carry on without allowing myself to become too attached. I recall you mentioned your husband expressed interest in my 'religious' beliefs, and I will tell him that my faith did help me through these dark times. Should he ever wish to discuss the topic, he is free to do so. It is just I do not know the boundaries of tolerance this site would have for such dialogues. Do they monitor your correspondence? I noted when I attempted to leave my personal email the system struck out the information. Perhaps I could suggest you try Facebook. I am there, but I do not reveal who I am professionally. I made up an interesting profession to avoid the classic free medical advice problems I encounter with all sites where I have joined a list. Unfortunately, this once backfired, when someone recognized me (on a Maritime History List) where I had used my brother's career as a cover. In this case I was publicly chastized for misrepresentation, by the moderator. However, when I explained the ruse, he understood and I was permitted to maintain my membership. I now avoid saying anything much about who I am. I figure those who know me, understand why. However you might try face book as a means for us to maintain a friendship.

As for me, you can tell by my babbling, that I am not entirely "intact" from this latest blow. So we shall officially call this grief counselling Dr. Loretta. I did however want to let you know that my little girl is home again. I must tell you something amusing however. Being as this area of Canada is somewhat poor, and the people less well educated, Clara's Individual Cremation, sponsored the suppliers of such services to enclose - not a nicely engraved card of condolence (as occured with my other dogs) but a "anything but subtle" bad, colour-photo-copy, on a cheap piece of 8X11 paper. On this 'sensitively worded' document it stated that Clara Belle Caerfax Laurence had been individually cremated. However, it then went on to laundry list a series of additional services for which the dear-departed might be more greatly honoured. There followed a list of differing "cremains" containers (each more ghastly in appearance and price), internment in the Eternal Wall of Remembrance (picture included) where one's beloved pet would reside in perpetual care (or as long as the mortar and brick wall held up). There was also the Eternal HALL of Remembrance - A Nova-Scotian interpretation of a neo-classical Greek Structure featuring pillars with Doric capitals, and classic pendament. Here, you could enter a building, which appeared to have taken its decorating cue from a government washroom design. One's beloved was placed in the wall with suitably area for an engraved name and short statement of rememberance. Either the wall or the hall came with a guarantee of perpetual care. Prices were listed for all. There was also the Rainbow Meadow, where one could have either the body (casket required) or ashes of ones beloved interred. I really feel like writing to these people and suggesting that perhaps combining the urn with a flyer was not the most sensitive way to gain additional business. Perhaps, a nice card expressing their condolences would suffice, and then perhaps a few weeks later they might send a second "sales-oriented" letter. I also saw no reason for listing casket prices and bodily remain burial considering that the beloved pet had already been cremated. All in such innocent BAD TASTE, but still, who wishes to be accosted at such a time with a combo condolence/sales pitch letter. Anything for an extra few dollars. As for the guarantee of perpetual care - well by the look of that Wall and Hall of Remembrance, I have a feeling a building inspector would likely rate the life span of the structures at about 25 years.

Well I hope I have provided a bit of levity. Naturally there is a very noticeable hollow in my heart right now. And I have yet to stop involuntary reactions and calling her name out when I am going out in the car. She loved going for "Rides in the Car!" and I find myself automatically grabbing the keys and calling out "Clara - Rides in the Car". What can I say? I have always preferred the company of animals to that of most humans. Natasha calls me a misanthrope from the get go. It is not so much that, as that in this area of the country there is a dearth of intellectual stimulation. I'm not too good on the usual topics of conversation around here which primarily consist of weather (an enormously important topic in these unpredictable climes where a snowstorm may cut you off for days at at time); how much wood you have (very important because most homes here are heated by wood stove and a minimum of very expensive electricity); where one can find a carborater for a 1978 Ford 150; septic tank back-ups; frozen plumbing and exploding pipes; and whether it might be wise to put the "chains on" - meaning chains on the wheels of your vehicle in case of heavy snow. Of course we drive a sissy city sedan instead of a truck, so we're the laughting stock of everyone around here. No BMW's Mercedes or Lexus in this area - accept in the summer when the wealthy come to enjoy their summer homes in Canada. Then the place is inundated with the sports car versions of BMW etc. After Anne's death, and my kids at school, I bought a BMW Z3. In the city is was perfect all year round. I bought another one in 2002, when I heard they were about to radically change the original design. But Natasha hated it - (she has arthritis) and convinced me to buy an American BOAT she liked. The latest Chrysler 300. I hate the damn thing. It's a huge, gas guzzler, and has every electronic do-dad you could imagine. I feel like the car is driving me, not the other way around. Just ludicrous - if it rains, the wipers go on automatically...and not just that they adjust to how heavy the rain is so they will automatically go from intermittant (10 settings) to full wipe (4 speeds). Lights go on and off automatically. High beams go on and off automatically - the minute another car is seen coming towards you, the high beams switch off. GPS Navigation tells me where to go, warns me if I am going to fast. The BMW was positively basic in comparison, but I felt totally in control on this small, powerful and very navigatable car. Now I am fighting horrible blind spots, and one is never quite sure where the front or back of the car is. (an extra $3000.00 option would have told me, but I declined.)

Anyway from ashes to grieving to religion to cars. Just excuses to stay in touch. You must let me know if I am crossing the boundary here, as I do not wish to get you in trouble with Just Answers. I'm afraid we have "bonded" as friends due to the circumstances of our meeting. I am still feeling moments of guilt over whether I should have tried longer to keep Clara alive, but these are only momentary. Your suggestion that the dramatic onset of the symptoms may well have been predicated on an underlying disease. When I look at her drug panel - which is different from a human one in so many subtle ways - I do believe that the renal failure may indeed have been secondary to a far more sinister illness. Cancer was never far from my mind. I am reminded of a famous line from Richard III "If it t'were done; when t'is done, it t'were well it t'were done quickly". That line passed through my head as I took Clara on her final "rides in the car". Do let me know if this letter is out of line. Boy, I wish there was a way to maintain contact. It is not every day -especially when older - to make friends. I'd love to know of your work, and to even have a dialogue with your husband. But this site, which was such a blessing, is now become a curse. So let me know whether I should cease communicating. I am trying to keep it to a minimum, but today, I was thinking of you and just could not resist the urge to write.
Take care Loretta and Mr. Loretta (is he a DVM as well?) Let me know if I am crossing the line.
Best wishes to you both
Tim (and Natasha too) Laurence.
HI again, Tim!!

It is so good to hear from you. I was actually thinking of emailing to see how you were handling this whole situation--great minds think alike, I suppose.

I know how you feel about the urns they have for our precious old friends. They all seem a bit tacky and adding in some advertisement seems very tacky. I guess you just have to over look the outside influences because, as we both know, a Rose by any other name is ***** ***** Rose.

I was saddened t hear about Ann and I of course send my sincere condolences a little too late. This must have been very difficult for you and it seems it had taken you a long time to regroup. Thanks goodness for Natasha to bring you back to life.

I know it is sad that we cannot communicate outside the service but they are quite strict on this. I am happy to help or just listen whenever you feel the need to write. You are VERY good at it. I have been trying to get a book published about my first year in practice but have been turned down by the best of them. Currently, I am revising my proposal and then sending it out again. You are much better than I at description.

Mr. Loretta or Rodg as most people call him, owned a software company for 30 years and sold it recently. Now he is a jack of all trades here on the island and is my anesthesiologist on most of my procedures. The only one he cannot do is when we have to do a procedure on my baby, Jackson, a miniature schnauzer(love of my life) because he cannot handle it well. In practice I would never do surgery on my own animal but here I have no choice.

Keep the faith, Tim. You and Natasha seem to be such great and caring people and I do not want to lose this connection. PLEASE keep in touch!!

Make this a real Happy New Year for your family!! Good things will come to those that are patient!!!
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Customer reply replied 7 years ago
Hi Loretta - As I suspected, your association with the site preempts the possibility of personal dialogue. To tell you the truth it annoys me. I understand that the site does this to protect its financial interests, and therefore must lay down a guideline which prevents a practitioner of any profession from using the site for personal gain. I wonder what would happen if you were to ask your employers if you might establish a personal contact with a former client? Unfortunately it is difficult to justify our correspondence as my vet requirements have been resolved by a force mightier than the letters which appear after our names. Mind you I have known some MD's in my time who would dispute this observation. Unfortunately the profession of medicine still does contain a few individuals who seem to think they are god. I am going to try to send you a close up picture of Clara. It's one of my favourite shots of her. If I am successful, let me know, and I shall send a few others. Note the unusual colours of her fur...especially the near white nose. She was only 5 when this picture was taken, so you will understand my point about why so many people thought Clara was very old when she was actually in her prime. I hope the bandwidth isn't too large for the system to accept. Well, good friend, I'll drop a line from time to time to let you know how we are faring. Thank-you for your kind words about my Anne. It's been many years now, but my memories remain sharp and clear. Well here goes with the picture. Let me know if it gets through to you successfully, or whether I have blundered it.
Best wishes to you and Rodg. (he sounds like a true Renaissance man - a master of many skills. Just the type of person one would prefer to be stranded with on a desert island. I'd be hopeless!) Take care and let me know about the picture! Tim & Natasha.graphic
HI again, Tim!!

YES!!! I got the picture and it is GREAT!!! I am soo glad you remembered to send one. It is so great to put a face to a very special "person" that I feel I know all too well. I am hoping to get it printed and put Clara up in my little clinic here on the island. She would LOVE the view!!

I understand your concerns about the website but they are quite strict on this and I will certainly ask about this. It would be nice to keep in touch.

Give your lovely wife a hug from us and be sure you will not be forgotten!! I will miss our correspondence!!

Thank you so much Tim for giving my life something very special!! We must remember the things that are important and communicating with you has been pure pleasure!!
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I have a 10 year old miniature schnauzer who has frequent
I have a 10 year old miniature schnauzer who has frequent diarrhea today. She had blood in her diarrhea earlier and has vomited (all inside our home which she never does). She is panting and is not in… read more
Scott Perry
Scott Perry
Veterinarian
Doctor of Veterinary Medicine
1,358 satisfied customers
My 11 week old miniature schnauzer ate half of a KC M20
My 11 week old miniature schnauzer ate half of a KC M20 potassium pill. Is this dangerous for her? … read more
Scott Perry
Scott Perry
Veterinarian
Doctor of Veterinary Medicine
1,358 satisfied customers
My 5 mon old miniature schnauzer ate either a baby wipe or a
My 5 mon old miniature schnauzer ate either a baby wipe or a small amount of toilet paper about 24 hours ago. He is asymptomatic, eating and drinking as usual. He's had 3 normal bowel movements since … read more
Dr. Bruce
Dr. Bruce
Veterinarian
Doctor of Veterinary Medicine
9,077 satisfied customers
My miniature Schnauzer who is 14 years old is experiencing
Hi My miniature Schnauzer who is 14 years old is experiencing kidney failure. … read more
Scott Perry
Scott Perry
Veterinarian
Doctor of Veterinary Medicine
1,358 satisfied customers
I have a 2 year old 10 pound miniature schnauzer who had her
i have a 2 year old 10 pound miniature schnauzer who had her distemper shot this afternoon at 3 now she cant jump up on my lap so i tried to pick her up and she screamed is this normal? … read more
Dr. Peter
Dr. Peter
Doctors Degree
14,317 satisfied customers
My miniature schnauzer is stumbing and jumps when he is
my miniature schnauzer is stumbing and jumps when he is touched.. he was fine earlier today, however he does not want to eat, which is unusual for him … read more
Dr. B.
Dr. B.
Veterinary Degree (BVMS)
3,442 satisfied customers
My 7 year old Miniature Schnauzer out of no where started
My 7 year old Miniature Schnauzer out of no where started squinting first in one eye this morning now its both eyes. We took her to vet this AM and they stained both eyes and there were no scratches U… read more
Dr. Michael Salkin
Dr. Michael Salkin
Veterinarian
DVM
3 satisfied customers
My 22 pound miniature schnauzer mix ate baking soda (it fell
Hi, my 22 pound miniature schnauzer mix ate baking soda (it fell from the cabinet.) I estimate he ate about 2 teaspoons of it before I was able to get it cleaned up and he seems fine, but is there any… read more
Dr. Beth
Dr. Beth
Veterinarian
Doctor of Veterinary Medicine
311 satisfied customers
Has bone tumour on nose and now has frequent nose bleeds.
Has bone tumour on nose and now has frequent nose bleeds. Told vet but not getting clear answer. When is nose bleeds too much?? She had 3 today … read more
Joan
Joan
Private
353 satisfied customers
One of my Miniature Schnauzers has pulmonary hypertension is
One of my Miniature Schnauzers has pulmonary hypertension is on sildenafil 10mg every 8 hours. I have another Mini Schnauzer that is on 25mg Hydroxyzine 2 times a day. I accidentally switched their me… read more
divealot1
divealot1
DVM
6 satisfied customers
My 12 lb miniature schnauzer ate my 22 lb miniature
my 12 lb miniature schnauzer ate my 22 lb miniature schnauzer's trifexis. Will it make her sick? … read more
Dr. Michael Salkin
Dr. Michael Salkin
Veterinarian
DVM
3 satisfied customers
My miniature schnauzer puppy is drooling excessively, won't
My miniature schnauzer puppy is drooling excessively, won't eat and is lethargic. He recently had a tick and we were unable to remove the entire tick until tonight. We live in Kentucky, near Louisvill… read more
Dr. Drew
Dr. Drew
Emergency/Critical Care Veterinarian
Doctoral Degree
9,710 satisfied customers
English cocker spaniel extremely listless.. 7 yrs. Had blood
Harry. 7 yrs. Had blood & urine tests & scan for intestinal blockage. All results satisfactorily … read more
Dr. Michael Salkin
Dr. Michael Salkin
Veterinarian
DVM
3 satisfied customers
Yellow Lab Female, 13 YO. DX: Laryngeal Paralysis and
Yellow Lab Female, 13 YO. DX: Laryngeal Paralysis and Arthritis Meds: 3-6 enteric coated Baby Aspirin, daily.Q: At her age, any med or pulmonary Treatment other than Tie-back procedure you would sugge… read more
Dr. B.
Dr. B.
Veterinary Degree (BVMS)
3,442 satisfied customers
I have a 14 month old English cocker spaniel who was fine
Hi I have a 14 month old English cocker spaniel who was fine this morning but seems unwell now it's all been so sudden and I don't know what's wrong … read more
Pet Doc
Pet Doc
Senior Small Animal Veterinarian
BVSc
2,782 satisfied customers
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Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

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