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Fourteen-month-old Molly died last week. She’d been an impulsive Valentine’s Day gift from a young man to his girlfriend, which is probably why he’d made the mistake of buying this English Bulldog at a chain pet shop.
Her condition came on suddenly Sunday night and spiraled so quickly that, by lunchtime on Monday, she’d been unable to breathe without a tube and 100 percent oxygen flowing into what was left of her workable lung tissue.
As most Bulldogs are wont to suffer, Molly had severe respiratory compromise even before her crisis began. Brachycephalic syndrome is a big issue among Bullies, and it’s these genetic structural malformations that predispose them to a wide range of upper respiratory ailments.
But that wasn’t what I’d originally been treating her for.
I’d seen Molly for the first time last week for the most dramatic case of demodectic (“red”) mange that I’d seen in over a decade. Her skin was red, raw, ulcerated, crusty, weepy, itchy and hairless all at once. She was miserable.
The dog had been living at a relative’s house for over a month, during which time she’d acquired this often genetically predetermined disease in which the demodectic mange mite manages to colonize the animal’s entire skin. A chink in the armor of the body’s immunological defenses is what allows the mite to rage on a puppy’s skin. While adults can also be affected, most dogs initially present when they're babes with simple hairless spots, which can sometimes progress to the kind of generalized condition from which Molly was suffering.
Luckily, this is a highly treatable condition. Although it’s sometimes incurable, it almost always responds to treatment with antiparasitic drugs or dips, and other medications or shampoos that treat secondary infections.
One of these antiparasitic drugs kills the bugs so that the pet’s immune system can gain enough of an advantage to overpower the invaders. The problem is that some dogs are uniquely sensitive to it — Collie breeds, in particular.
This is partly why I couldn’t believe that Molly (hailing from an unaffected breed) had come down with symptoms consistent with drug toxicity so quickly — especially since I’d been so cautious about increasing the dose slowly over a week’s time to mitigate the risk of any untoward reactions, like vomiting and seizures.
When she died, I was especially shocked. She started with vomiting and seizures, but she died of respiratory compromise. It made no sense. Perhaps she’d aspirated some of the vomit. Maybe the seizures had led to something called neurogenic pulmonary edema. Yet neither condition explained how the chest X-rays looked.
Molly’s heart was probably one and a half times its normal size. Seeing how it was globoid and enlarged, I suspected congenital (born this way) heart disease, which was probably making what should have been a simple, reversible reaction to a drug a terribly life-threatening disaster.
So when Molly died, I wasn’t too surprised. But I was extremely curious. Thankfully, her owners were not only understanding of the anomalous nature of her reaction and her eventual death, they really wanted to know what had ultimately led to her death.
Postmortem examinations are not as commonly undertaken in veterinary medicine as in human medicine. But how better to learn than to explore the rationale behind the outcome of your patient’s condition? So I asked for permission to open her up, retrieving her lungs and heart for close dissection.
In the end, I learned that Molly had died not of her drug sensitivity alone — any similar reaction to a drug, infection or inflammatory process would have led to severe cardiac compromise and death. Her heart was afflicted with a rare genetic disease called tetralogy of Fallot.
In the end, it was sad to see such a sweet dog go. Her Valentine’s Day story didn’t make it any easier. But, somehow, I can honestly say that her underlying cardiac condition made the loss somewhat easier to take; knowing that it was inevitable that she would succumb meant that we were almost relieved to see her go so quickly.
OK, perhaps her owners didn’t see it that way, but knowing how stressfully some dogs can die of a broken heart, I can’t help but take the rational view that a mercifully acute death is preferable to the alternative.
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