Cammie’s Story

This sweet girl arrived just before Christmas from our friends at the Spartanburg, South Carolina humane society. She immediately stole our hearts. Cammie is one of the most loving, affectionate, and smartest dogs we’ve ever known. But her story is a distressing one. So are a couple of the X-ray images in this blog post.

Cammie had been shot in the face, neck and upper body with a shotgun at some point in the recent past. That’s why her eyes look like that in the photo above. When her owner went into the hospital, animal control picked up Cammie and the other three dogs she lived with. Cammie was in bad shape, so rather than put her in the county shelter, the animal control officer took Cammie to the humane society where she could receive medical care. Here are the X-rays the humane society sent us when they asked if we could take Cammie:

You can see all those pellets in her face and eyes, across her back and shoulder, and — most worrisome of all — that clump at the base of her head.

Here’s another view:

(If you’re surprised to see a person’s hand in these X-rays, so were we.  Someone was getting some unnecessary radiation.)

By the time the humane society contacted us about Cammie, the wounds had healed and the only visible evidence of the shotgun blasts was her sunken eyeballs. Even before Cammie arrived, I had forwarded the X-rays to one of our veterinary surgeons and to our veterinary ophthalmologist at Peak to find out what they thought we could do for her. We were worried about all those pellets still lodged inside her. We had consultation appointments scheduled with both specialists.

Our pet transportation company, Royal Paws, delivered Cammie early on a snowy December morning. She was scared, tail tucked but wagging nonetheless between her legs. She cowered, acting as if she had reason to be afraid. When we’d pet her, she’d lean into us and relax a bit, but most of the time her body language was all about fear. It took almost three days for her to relax and realize all she’d get here was love.

Her first couple of weeks were uneventful, and she settled right into the routine. Cammie got along well with everyone, even letting Stella sit on her while she enjoyed laying in front of the wood stove:

First, The Vomiting

Then, on the afternoon of Thursday, January 14th, Cammie threw up in the living room … her entire breakfast, undigested. But later that evening, she wanted to eat dinner, so we gave her a small meal. Overnight, she threw up just a little in her crate, but as soon as we let her outside Friday morning, she vomited again. Then she came inside, went straight to the water station, and began sucking down water. A minute later, she threw it all up. We had some anti-nausea medication on hand, so we called our emergency veterinary hospital — Burlington Emergency and Veterinary Specialists, or BEVS — and asked if we should give it to her, or hold off. They advised not giving it but to withhold food and restrict her water access to small, frequent amounts, see if she could hold it down, and monitor how she did.

Then The Seizures

Cammie was quiet and subdued for the rest of the day. She lay on a bed in the living room and barely budged. Around 7:30 p.m., we were just about to start feeding the dogs their dinner and had put them in their various places. Cammie and our little Chihuahua, Jake, eat in the kitchen. All of a sudden we heard a loud crash. We rushed over and saw Cammie had flipped upside down, head first, and was thrashing on the floor. She was crying out, gyrating, trying to lift herself up, only to smack herself back onto the floor. She was having violent, grand mal seizures. We’ve seen plenty of seizures over the years, but this was the worst we’ve experienced. We pulled her out into the center of the floor and held her as best we could to minimize any injuries to herself.

Once the seizures subsided, we called BEVS to let them know we were bringing her in. Fifteen minutes later, after she had recovered from the seizures and could stand on her own, I lifted her into the vehicle and took off for Burlington.

Just as I was getting on the interstate outside of Montpelier, Cammie started crying from the back seat … piercing, wailing sounds I’ve never heard before. It was ear-splitting and heart-rending. I called Alayne so she could hear it, and asked her to call BEVS to let them know this bizarre vocalization was occurring. I assumed something else was now happening to her, but learned later this was in fact another type of seizure. Fortunately it subsided after several minutes, and she was quiet the rest of the way to Burlington.

At The Hospital

Cammie had another seizure literally seconds after she went inside the hospital doors, and then another a short while later. The emergency vets immediately got anti-seizure meds on board, along with supportive care, but Cammie continued to seizure off and on throughout the night. But finally, around 9 a.m. the next morning, she had one last seizure before the anti-seizure meds took control. Then the emergency vets initiated long-term treatment by starting Cammie on “loading” doses of phenobarbital, which they would taper to a regular twice-daily dose by the time she left the hospital.

When I dropped Cammie off that Friday night, I had told the vet team about the shotgun pellets in her, along with the rest of her history. And when I got home about 1 a.m., I emailed them the X-rays you saw above.

Over the course of the weekend, as each rotating emergency vet came on shift and took over Cammie’s care, we’d ask:  What could cause the vomiting and the seizures to occur almost simultaneously? It just seemed so weird to Alayne and me that Cammie would start vomiting for no reason, and then 24 hours later start having horrific seizures. Was that a coincidence, or somehow related?

No one really had an answer to that question, and the working assumption — because her blood work was otherwise unremarkable, her abdominal ultrasound was also normal, and no other diagnostics turned up anything else amiss — was that Cammie most likely had idiopathic epilepsy and that the vomiting may have been a random event, unrelated to the seizures.

Those Shotgun Pellets

But we kept thinking about all those pellets. On Sunday afternoon, Alayne started looking up “lead poisoning” online, and learned that possible symptoms of chronic lead toxicity included both vomiting and seizures, among many other awful things. We found multiple reputable sources that cited vomiting and seizures for lead poisoning, compiled them into an email, and sent it to the ER doctors. We asked if they could test her blood for lead exposure, just in case those pellets were involved.

They reviewed the material we sent and agreed that it would be a good idea to test for lead. But it wasn’t at the top of anyone’s list of presumed culprits because lead poisoning typically occurs from the lead being ingested into the gastrointestinal tract. There is almost nothing in the veterinary or medical literature (we looked for hours) about lead poisoning caused by pellets in soft tissue or under the skin. We found only a couple of medical references that even mentioned “lead pellets” in a long list of bullet points as a possible source of exposure, but we couldn’t find any actual documented cases. And we didn’t even know for sure if the shotgun pellets were made out of lead — they might have been made of steel or even tungsten.

Moreover, Cammie hadn’t vomited since Friday, another sign it may have been unrelated.

Coming Home

The ER team at BEVS took amazing care of Cammie over the weekend, calling us with regular updates on her progress. On Monday morning that week, one of the internal medicine specialists at BEVS, Dr. Bryan Harnett, took over Cammie’s case. He agreed it made perfect sense to test her blood for lead poisoning. It’s a complicated assay that needs to go to an outside lab, and it takes 5 to 7 business days to get the results. So Dr. Harnett told me he’d send out the blood test and that I could head over to Burlington to pick up Cammie.

When the veterinary nurse brought Cammie out to me, I could tell she was a little wobbly on her back feet because of the phenobarbital. At first she didn’t know who I was, so she hid behind the nurse with that cowering body language we had seen when she first arrived. I was kneeling down, talking to her, trying to reassure her. When she finally realized it was me, she came over, pressed herself into my chest for a few moments, then tried crawling onto my lap and then onto my shoulder. At that point the only thing left to do was to stand up, holding her tight, and carry her over to the vehicle.

She was relieved to be back home, and she went right back into her routine here. The only difference is that she is more subdued, and sleeps more, because of the twice-daily phenobarbital. But her appetite’s been great, and she’s had no more seizures or vomiting.

The Diagnosis

Dr. Harnett called the following Monday, having just received the lead test results. Not only did Cammie have lead poisoning, she had — literally — off the charts lead poisoning! On this particular assay, the threshold for lead poisoning was 60, and the high end stopped at 120. Cammie’s results simply said, “>120”.  This level of extreme lead poisoning astonished everyone, because no one expected lead pellets to produce that degree of toxicity.

Later that day, Dr. Harnett spoke with a veterinary toxicologist about Cammie’s findings to discuss the best mode of treatment. He also posted Cammie’s case and lead blood test results on a listserv for veterinarians to see if anyone else had seen something similar. A number of veterinarians commented, and all were surprised by Cammie’s results. One of the vets was located in Mississippi, and tongue-in-cheek noted that half the hunting dogs in Mississippi are carrying some degree of shotgun pellets in them … and said that while he hadn’t seen signs of lead poisoning, no one was actually testing these dogs for it. He suggested that Cammie’s case may make them consider doing so in the future.

The Treatment

After consulting with the toxicologist, Dr. Harnett started Cammie on a chelating medication called Penicillamine that binds to metals like lead and gets them out of the bloodstream. (This particular drug is used in the treatment of other unrelated diseases and conditions, too.) We had it specially compounded at Wedgewood Pharmacy in New Jersey, and by Thursday Cammie had taken her first dose. It’s given three times a day, eight hours apart. So far she’s tolerated it well.

But the problem is that the source of her lead poisoning remains in her body:  all those shotgun pellets. It is extremely difficult to try and surgically remove hundreds of tiny pellets scattered across different parts of her body. They’re hard to find, you have to make incisions to look for each one, and it can be very challenging for both the patient and surgeon.

Nevertheless, tomorrow morning, Monday, February 1st, Cammie will be going in for surgery at BEVS. The surgeon there, Dr. Jacob Helmick, will concentrate on removing that big clump of pellets in her neck first, and then removing whatever else he can. The goal will be to reduce her lead exposure as much as possible, but knowing we won’t be able to get it all out. We will see if the surgery can reduce her lead poisoning to a low enough threshold that ongoing chelation therapy can keep her from having chronic lead toxicity. But we don’t know how this will turn out.

Finally

Last week I emailed the Spartanburg humane society folks to let them know what had happened, and I wrote:  “Cammie is one of those dogs we just instantly fell in love with. Because of her adorable personality, she’s what we call a ‘once-in-a-lifetime’ dog. We feel so lucky to have her.”

When Cammie hears Alayne or me speak — to each other, or to another dog — she happily thumps her tail on the floor. Whenever we walk by her, she starts wagging her tail. She really is this incredibly sweet dog who wants nothing more than to love and be loved. She has endured unspeakable abuse at the hands of humans, and yet keeps giving people another chance.

Please keep her in your thoughts this week.

And to end on a happy note, here’s a photo I took of Cammie several days ago: