Goodbye

I said "Goodbye" to my best friend last Thursday. Most of you will likely understand that having multiple kids doesn't mean you love any less but there are probably those that are "special".

Rusty was special. I adopted him on February 28, 1998, officially although he and I had been sharing a clandestine relationship in the clinic kennel where I worked for a month or so already. He had been left there by a lady who said she had 14 dogs, had brought 7 with her on a trip to visit family and been told by her husband that if she wanted to come home, she should do so without the dogs. We took in a couple to find homes; Rusty was one of those because he was a Bichon frise and we had some clients that seemed to be a sure bet for a good home. But we didn't know Rusty...

We were told he had been found wandering the streets of Florida and was at least 2.5 years old, already neutered and on heartworm prevention. It is still unclear how many homes he had already gone through before arriving in northeast Alabama. He had a mature cataract in the left eye, luxating patellas with arthritis already, a small depression in 2 of his ribs on the left side, and a painful left shoulder. He also hated kids with a passion. His personal opinion was that all children (and any loud, busy adults) should be on a leash or in a kennel at all times.

Rusty went to his new home with the aforementioned clients after a haircut and bath; it failed to work out because the clients' dogs did not like him (so we were told). He went to another home that also failed. We showed him to numerous people who thought he was "sooo cute" until he hid behind me growling because they got too loud or reached over the top of his head too quickly. One weekend I had kennel duty and was once more berating his habit of pooping all in his kennel then walking over it until it became a solid mat of poop regardless of how much he did outside when I discovered that all he wanted was to be held. Since my car had broken down and I was waiting for a ride, I indulged him for an hour or so. They said I created a monster that weekend.

Shortly after, Rusty went home with me to "go to my cousin" ostensibly but the truth was he had already wormed his way too deeply into my heart. Rusty became my best friend and closest confidant. He was a shoulder to cry on, a friend to depend on, always ready to go on an adventure or to just sit at home in my lap while I indulged in a good book. Rusty was my rock when my brother died and I had to be the rock for everyone else. Countless nights he soaked up my tears and was there just to listen.

Rusty went to work with me daily for a long time. He had severe separation anxiety and each time he had to be groomed, it worsened, probably because he associated that with being thrown away again. He always fit in easily with the herd and loved other dogs. When he decided that Choo Choo was his special girlfriend, he sometimes stayed home because he was more comfortable being in a safe crate with her than he had been alone. He hated being alone...

One Halloween, a friend and I had a brilliant idea that Rusty should dress up as the Grinch since he "hated the noise, noise, noise" and was otherwise Grinch-like. We dyed his hair with green kool-aid and conditioner, I made him a Santa coat and hat, put his ear hair up in a topknot, and velcroed a stuffed dog Max to his back. It was hysterical and he had a blast. My boss's dog kept stealing the stuffed toy from his back but it was overall a riot. Until I discovered that kool-aid and conditioner apparently does not was out of white Bichon hair... He was a shade of green for 3 or 4 months until I was able to cut his hair. It was rather fun though when clients asked about the green dog to deny any knowledge. "You saw a green dog? Really? That's weird. Are you feeling okay?" If a straight face could be maintained it was best.

Later, Rusty went with me through both undergraduate and vet school; I often said he was smarter than I and should have taken my tests for me, then I would have aced them all. There was the time during the first year of vet school when I was wondering why he kept having diarrhea and vomiting to the point that I was getting really worried until I discovered he had figured out how to open the cat food storage container and was sneaking in to take little bites here and there. Or the many times when Choo Choo turned over the garbage to get some choice tidbit only to find her on the couch innocently sleeping and him caught in the act.

In 2005, Rusty lost his left eye. I had been poorly advised that the cataract would not hurt him, leave it alone. He developed uveitic glaucoma and I failed to be able to control the progression and pain therefore we enucleated the eye. This became the subject for my senior presentation in vet school (Rusty came through for me yet again!) In 2006, he had to have surgery to remove bladder stones. Both times, I was a nervous wreck and stretched rules to the limit including insisting on scrubbing in even though I wasn't on the surgery rotation and taking him home on the same day because I knew how stressed he would be without me.

The other dramatic thing about Rusty was his compassion and understanding. He hated his tail and feet touched yet my 90+ year old grandmother could pull on the tail with impunity. Or the time my co-worker's child (remember, he hated kids) was crying and sitting in the floor and he climbed into her lap to comfort her. Similarly, he had not accepted Can'tSpell until she sat in my floor crying and he climbed into her lap. If anyone was upset, Rusty felt that he needed to help.

Rusty traveled to 25 states with me; I had hoped to make it to all the lower 48. He dealt with long intern shifts, emergency overnights, and countless nights and weekends on call. We lost his little girlfriend in 2008, and we comforted each other in our mutual grief.

Over the past several months, I've watched Rusty begin to show signs of growing old. He started to slow down, his arthritis worsened, his sight worsened, and his hearing virtually disappeared. I pulled out all the stops to try to slow the process and keep him comfortable and happy; it seemed that all he needed to keep him happy was to touch me. He's had a lot of dental problems and I have had to extract several teeth to keep him comfortable. On July 11, I took another out. I wound up only using the induction dose of ketval and not even needing more anesthesia because it hit him so hard. He was really slow to wake up and had what seemed to be a short, focal seizure the following morning; by afternoon (time to get off work, he reminded me adamantly) he seemed fine.

We left for AVMA and a short vacation the following Friday. Going out on the pavement seemed really hard for his arthritis and the heat was very bad on his breathing therefore I started letting him wear a diaper and not go out while we were in the city. On the last night there, he awoke in the middle of the night, vocalized and had another episode similar to the first. Very short, tremors involving the front of his body with almost a Schiff-Sherrington position other than his back legs not being stiff. He responded instantly to my touch therefore I was unsure if it was really a seizure or if it was anxiety since he was in a strange place and covered up with a blanket. Afterward, he seemed fine. Over the course of the next 5 days while I visited my friend who lives near, he had a total of 5 episodes, all very similar, all short, and each time he responded to my touch immediately. On the Monday following my return home, he walked down our couple of porch steps then seemed weak in his hind legs, postured to urinate and collapsed onto his side in what appeared to be a true seizure. In the middle of it, he stopped breathing and I felt his heart stop. He then came out of it and had what appeared to be a post-ictal period. Through the course of the day, his breathing became very labored.

Radiographs of the chest that day showed a mixed interstitial / alveolar pattern. I was confused: pulmonary edema or pneumonia? There had never been evidence of heart disease, no murmur, a rather slow resting heart rate for a small breed dog historically, nothing abnormal. I ordered a Holter monitor, set a medicine / neuro consult at the vet school as soon as possible, pulled blood, and had an echo / abdominal ultrasound done. (I had done radiographs and bloodwork just before the tooth extraction, all were dead normal.) The abdominal ultrasound was normal. The echo showed elevated pulmonary arterial pressure with very mild mitral regurgitation, normal left heart size and pump quality, mild right sided dilation with good pump quality, i.e. no reason for heart failure. The CBC showed a mild leukocytosis with lots of band neutrophils, there was a technical error with the chemistry therefore I was unable to get values.

During the time the Holter was on, Rusty began to have more small seizures and each time his breathing became more labored. He was on nasal oxygen and IV fluids, antibiotics for presumptive pneumonia, and I was holding him when he arrested while defecating. He came back but his breathing deteriorated rapidly and he continued to have seizures even with diazepam. Finally, he just stopped. Throughout the time I wrestled with the guilt of stopping and letting go versus not stopping and seeing him suffer more. He died in my arms but I'm not really sure he knew...

I regret deeply the small things. I wish I had made him some homemade biscuits, his favorite, like I promised to do the next day. I wish I hadn't gone to AVMA, maybe if I had been where I could have gotten help quicker, it would have changed things. I wish I had not been working on the day he decided to go; I hated being torn between him and my obligation to the other pets that needed care. Most of all, I just miss my best friend.

I still don't have answers. Maybe the Holter report will tell me something. A brain tumor maybe? He didn't act like a dog with increased intracranial pressure. Neurogenic pulmonary edema doesn't make sense. Maybe PTE's, especially at the last when he deteriorated so quickly? Maybe he was throwing clots because of cognitive dysfunction syndrome... In some ways, having a name might help but the reality is that it won't bring him back. Rest in peace my Rusty-dog and know that you are missed and always will be.