I taught a “Positively Perfect Patients” workshop at the Randolph Animal Hospital on March 10th.

When I was planning the workshop, one thing I hadn’t planned on was the opportunity to practice all of the skills I intended to teach – over and over again, with a dog who once had to be sedated for anything more than the most basic of vet exams.

But a couple of weeks before the workshop, our dog Nico got sick. Very sick. In less than a week, he went from feeling “Not Quite Right” to being barely able to stand, with lumps all over his neck and sides that were necrotizing (the tissue was dying) and bursting. We thought we were going to have to put him down that weekend — without a diagnosis, as every test we’d run had come back negative, or at best with only a clue or two about what was going on (”there’s inflammation in his tissues….”).

The vets at the Randolph Animal Hospital decided it was best to treat it as an autoimmune disease, and put him on massive doses of prednisone that Friday evening (three days after I’d presented him with “back pain” and “just not himself”). It was a calculated risk, as prednisone is counter-indicated in infections and cancer, the two other suspected culprits we were trying to track down. But an infection or cancer wasn’t likely to kill him in just days if we’d guessed wrong, whereas he was very likely to die if we couldn’t get the inflammation under control.

We took Nico to the Animal Emergency Center at the New England Animal Medical Center in West Bridgewater, MA and left him overnight that Friday for observation.

By Saturday morning he was already showing signs of improvement. By Monday all his lumps and bumps were gone (although some had left holes in his skin, including one patch on his left hip where several square inches of skin had to be removed entirely).

The next week we received a diagnosis from the biopsy done on one of the enlarged lymph nodes on his neck – Idiopathic (unknown cause) Sterile (not caused by microorganisms) Nodular (if you’d seen his lumps and bumps you’d know exactly what this means) Panniculitis (inflammation of subcutaneous fat tissue).

(Want to know more about Idiopathic Sterile Nodular Panniculitis? Do a Google Search! There are no good summaries, but there are some technical papers available…. It’s quite rare, but then so is Nico!)

In the first nine days of this whole journey with Nico’s mysterious disease, we took him to at least one vet’s office each day. In that time he had the following done:

• Blood draws (daily)
• Physical exams
• Shaving (to remove hair from around the nodules, and also to prepare for ultrasounds and surgery)
• Anaesthesia
• Surgery (to remove a lump for biopsy, and later to remove necrotized portions of his skin, and later still to suture up that area where the skin was removed)
• X-Rays
• Occular Pressure checks (by tapping an instrument against the corneas of his eyes)
• Ultrasound
• Temperature taken anally (twice a day for most days)
• Pills (really easy with Pill Pockets!)
• Lots more I’m sure I’ve forgotten, and I hope he has, too!

Since then he’s had several more vet visits, several more x-rays, another ultrasound, and a lot more poking and prodding and blood-drawing.

And all that time the vets and vet techs marvelled at how good he was. He allowed himself to be handled, poked, prodded, manipulated, shaved, stuck with needles, and more. The only thing he had any trouble dealing with was the x-rays — not the x-rays themselves, as I’d already taught him to “lie flat” for earlier x-rays, but being repositioned onto his back freaked him out a bit.

He’d stand still for blood draws, shaving, ultrasound, exams, and even having his eyes poked with the occular pressure measuring device.

All this, from the dog who turned out to be fear-aggressive towards strangers and panicked if restrained or handled when we first adopted him five years ago.

If I hadn’t done some work with Nico over the years, getting him more comfortable with strangers and especially at the vet’s office, the stress of it all would have been overwhelming. As it was, Nico was able to handle everything well, and that made things much easier on me, Paul, and certainly on the vets, nurses, and vet techs.

In fact, last week when I took Nico to NEVOG (New England Veterinary Oncology Group - in all of this we discovered a small lung tumor that may have nothing to do with the panniculitis), he took one look at the building, which he’d never seen before, and started pulling me towards the doors. I can only imagine he was thinking “Hmmm, I’ve got my harness and leash on, and Mom’s got treats, and that sure looks like a vet’s office, let’s go!“….

I took Nico to NEVOG several days before his appointment, in part to drop off his very thick file but mostly to do some training with him in the lobby so he’d be more comfortable there on the day of his appointment. (Plus I had just dropped off one of our cats at Radiocat in the same building, to be treated with radioactive iodine for hyperthyroidism – yup, it’s been very interesting around here lately, we now have a radioactive cat who needs to be semi-quarantined for two weeks!) And I’m glad I did, although I’m sure he would have been fine going in there “cold” (no practice visit beforehand) and even without food treats (There are times when I can’t use treats with Nico at the vet’s office, as he needs to be fasting before anaesthesia….).

So to sum up: The work I’ve done with Nico sure has paid off, big time! And it wasn’t really hard. There were several visits to the vet’s office between vet appointments, where we did training or just hung out and ate treats. There was some counterconditioning and desensitization and training around his handling issues. And there are some specific behaviors I’ve taught (to stand or lie down on a towel, to lie flat, to stand still, to move to where I indicate with the palm of my hand with hand targeting, and similar stuff).

All that makes vet visits much easier on the patient, and obviously much easier for the vet staff as well!

And Nico? He continues to improve, although he’s still weak (lost all muscle tone between inactivity and the prednisone) and has been having problems with intestinal gas (see my post on Bloat). He doesn’t seem to realize he’s still sick! Which, of course, is a good sign….