Our Pug Gigi – True Love, True Grit

We euthanized our rescue Pug Gigi last week. She joined our family five years ago, probably coming from a puppy mill. She was abandoned and left to die in an empty building where she stood at the window and barked until someone finally noticed.

Gigi was fostered by South Florida Pug Rescue and medically treated and rehabilitated. No one knows how old she was. After losing our original Pug to old age, we decided to bring some love to an animal that needed it and to provide our sweet older mixed breed dog Chloe with a friend.

On her first visit in our home, she walked over to a straw basket filled with dog toys and pulled out a squeaky toy and had great fun tossing it around and chasing it. The representative of Pug Rescue said she never had a toy and this was her first. We allowed her to take it with her back to her foster home after the first introductory visit.

The process of adopting a dog is quite lengthy and difficult. There is a home inspection. You fill out an application and need two citizens and a vet to vouch for you. In Gigi’s case, they were concerned about her kidney function. Being a physician, and reviewing their lab data, I was not the least bit concerned, nor were my consulting kidney specialists who reviewed the data with me.

We fought to adopt Gigi and won. Pug Rescue said she was gruff and not very affectionate. It took about 48 hours of play, food, long walks and petting for this formerly abused dog to trot up to my wife and I and I and cuddle and lick our hands. She returned our love, caring and attention in multiples.

We hired a professional trainer to help us teach her obedience and after a few weeks we noticed she stopped jumping onto and off of the furniture, which she was not supposed to be on in the first place. Several weeks later a neighbor noticed she was walking awkwardly having difficulty placing her rear paw. A trip to our vet and a consult to a neurologist disclosed that she had the doggie equivalent of Lou Gehrig’s disease. Genetic testing through the American Kennel Club confirmed that she had both genes for a degenerative neurological myelopathy with a prognosis of 1-2 years. The disease produced no pain, just a gradual loss of muscle function starting in the legs and moving forward. Eventually the respiratory muscles stopped functioning.

My wife and I talked about the poor animal’s horrible luck and decided to make her time on this earth as good as possible. We constructed ramps to make access easier. We did daily physical therapy. Having a swimming pool, we set aside an hour for her to swim most days. When the weather turned cold, we put her in a doggie wetsuit with her name on it and went swimming despite the cold.

Gigi thrived but her muscles continued to get weaker. First, the back legs stopped working. The tail stopped wagging. I had to support her rear on walks and make sure her rear paws were high enough off ground to prevent them from knuckling under and scraping away the skin.

For almost three years we followed this daily schedule of long walks with two dogs and me supporting Gigi’s rear followed by a trip to the pool for more exercises. It reached a point where Gigi’s only real freedom occurred in the pool when I allowed her to swim where she wanted to when she wanted to.

Throughout this process she was pain free, with a great appetite and a love for being with the family. There were some hurdles. She had a stroke a year and a half ago during a hurricane. Her paralysis resolved with exercise. She had several of urine infections too.

When her front paws started to decline, and she started having difficulty swallowing without aspirating, I knew her days were numbered. Despite this we took her and our other sweet puppy on a three-week driving vacation to visit family up and down the east coast of America. Both dogs behaved well.

Upon our return home I tried to renew our pool exercises. Poor Gigi lost her ability to stay buoyant and lost the strength in her front legs to propel herself. Her gag reflex started to decline, and meals sometimes went down the wrong pipe causing coughing. I thickened her meals like we would for a senior citizen and hand fed her. Then, last week, her front legs gave out despite me holding them up. She cracked a nail on her front paw, dropped her chin to the ground and scraped it on the pavement. I took her home, stopped the bleeding, cleaned and dressed the wounds and consulted my wife about her deterioration. It was time to end her battle before she suffered.

We called our vet and took both dogs to his clinic and put Gigi to sleep. As the vet injected a tranquilizer into her she found the strength to lift her head and lick my face with several kisses.

In my profession, I deal with life and death daily. I counsel patients and families on end-of-life issues routinely. You stay a bit detached and objective and professional. When the loss is yours, the grief sits like a basketball in your throat and chest.

We were blessed to be able to provide a loving home for five years to a creature who knew no love or care before entering our home. Despite a genetic degenerative illness, we improvised ways to give this puppy a high quality of life for far longer than the experts predicted. Those facts don’t make the sadness and loss any easier to bear. We miss her and she will always be in our hearts.

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NSAIDS and Heart Failure in Type II Diabetics

The European Society of Cardiology is receiving a presentation on the increased risk of heart failure occurring in Type II Diabetics over the age of 65 years with an elevated HgbA1C level. The mechanism of the heart failure is still under discussion and being researched and it is believed to be beyond the accepted increased retention of fluid that occurs when you take an oral NSAID. The risk of developing heart failure was increased by almost 50% in Type II Diabetics 65 years of age or older. It was clearly not seen in patients with a normal HgbA1C younger than 65 years of age.

The study was led by Anders Halt, MD, a cardiologist and epidemiologist, who accessed the Danish National Health Registry to obtain his raw data. In his study it was clear that older age and elevated HgbA1C were present in those patients developing heart failure and requiring treatment and/or hospitalization. In Denmark patients were using Diclofenac Sodium and Ibuprofen primarily with few using celexocab or naproxen products.

As we age, we develop joint inflammation and aches and pains that make us reach for an over-the-counter anti-inflammatory medication frequently. This study raises the question clearly “If you are a Type II diabetic over sixty-five years of age with poorly controlled sugars should you be looking elsewhere than NSAIDs for relief”. Diclofenac sodium is no longer in oral form in the USA, but ibuprofen certainly is. The study clearly outlines the need for exploration of the mechanism of the heart failure. I believe the reason heart failure occurs must be clarified but until that occurs older Type II diabetics should be wary of reaching for an NSAID for relief of aches and pains.