Akita Rescue Society of America


For Tootsie

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For Tootsie



    "Grieve not, nor speak of me with tears, but laugh and talk of me as if I were beside you...I loved you so…'twas heaven here with you."

Isla Paschal Richardson

Writing this story about Tootsie is probably the hardest thing I've done but it must be told. We all love our dogs and have strong bonds with them but my relationship with Tootsie was different. For the last 19 years I have been secretary of Akita Rescue Society of America. In 1991, Tootsie was one of 126 Akitas taken from a puppy mill in Kansas. The situation at the puppy mill was inconceivable. Tootsie was one of 6 Akitas brought to my group in Southern California.

Within three months, I lost both of my Akitas to age-related health problems. The day my female Akita died I was visiting the small kennel where Tootsie was living. During her free exercise time, Tootsie came running over to me, placed her big head on my knee and stayed like that. She knew she was meant to be mine but my male Akita would not accept another dog and so she had to wait.

I began visiting Tootsie every day and soon she trusted me enough to allow us to begin taking her to vets seeking treatment for her mangled right rear foot. We will never know how it happened but 9 bones had been torn from her foot. When we found a surgeon who agreed to do more than amputate her leg, she underwent surgery with the agreement she would come to my home for recovery. He removed the bone fragments, cleaned out as much infected bone as possible, created a soft-tissue prosthesis and did a dorsal pad graft. After months in a cast and a period of toughening, Tootsie had a new foot. That was August, 1992. Her courage throughout the ordeal was incredible. During the next 5 years, my poor Tootsie had surgery for bloat and 3 benign tumors plus four root canals because of malnutrition. Tootsie had bonded only to me. She accepted my husband but was never comfortable being alone with him. I was her "soul mate", her reason for always getting through these trials. Her foot needed daily tending to keep it moisturized and often when a small area tore, she would require bandages covered with a ladies sock and matching vet wrap. Without being asked, Tootsie would simply settle into her customary spot, lay back and enjoy the attention as I tended her foot, brushed her, loved her.

This new medical crises was the same--she trusted me totally. In early June 1998, Tootsie underwent x-rays for a limp that turned out to be osteosarcoma--bone cancer. A blood panel done at this time showed she was in excellent health--no abnormal blood values. Luckily, we were able to get Tootsie into a clinical study using samarium-153, a radioactive isotope that targets rapidly growing bone cells. About 65 dogs had undergone the treatment at UCLA and the University of Missouri. The majority of those dogs were surviving the odds and the size of Tootsie's lesion was one of those most responsive to samarium-153. The treatment itself consisted of an injection of the isotope followed by a bone scan and 48 hours of monitoring by the staff. After her samarium treatment, the bone scan showed Tootsie had one area of osteosarcoma with no further signs of cancer and her chest x-ray was clear. We were filled with hope--there was a good chance for Tootsie.

I had her medical treatments planned to give her the most comfort and the best chance of beating the odds. The only danger-facing Tootsie after the samarium, would occur at 3 weeks and 6 weeks following treatment when her white cell count would drop. I was prepared. At the recommendation of the samarium tech at UCLA, once her white cells returned to normal after the 6th week, she would undergo a few treatments with carboplastin. I fully understand the seriousness of osteosarcoma but this canine samarium study partially funded by DuPont and the University of Missouri was increasing the odds for the dogs.

Following the samarium treatment, when she returned home her appetite and attitude were good until the patch was used. Five days after her treatment when she seemed to favor that leg a little more, the oncologist wanted to do an x-ray. If I had my wits about me at the time, I would have realized an x-ray would not show anything but the bright light of radioactive samarium! Following the x-ray that was inconclusive because of the samarium, the oncologist said there was little more to be done, just keep her comfortable and wait. She said a "pain patch" would keep Tootsie comfortable, providing a prolonged analgesic. They planned to shave a spot on the back of her neck where the patch was to be placed.

When they brought her out to the van I was amazed at the size of the shaved area but struck dumb by the application of the patch. Yes, there were two 50mcg patches on her skin, covered with long strips of tape adhering to her fur to keep them in place. Within 10 minutes the whole mess fell off. If only, if only, if only!! If only I had left them where they lay. If only I had thrown them out the window or trashed them. I did none of those things because I loved Tootsie. The thought of her in pain was unimaginable. After talking to the oncologist by phone, we reattached them and secured them with a strip of ace bandage wrapped once around her body.

By the second day she began behaving as if she were coming out of an anesthetic. She had difficulty walking was not interested in food and could not seem to relax. I called the oncologist. She seemed unconcerned by the symptoms. By early evening Tootsie started showing signs of respiratory distress and I phoned the oncologist again. I had a long discussion with her about the Akitas' sensitivity to drugs. She said she understood.

At this point, we removed the patch. To ease my increasing anxiety I phoned Janssen Pharmaceutica, distributor of the Duragesic patch. After explaining that Duragesic was not a veterinary drug therefore very little information on its use in dogs was available, Janssen's pharmacist said the drug should be filtered from her system within 17 hours. We removed the patch thinking that was the end of it.

I was so convinced we would come through this together, I could not accept any other outcome. Watching the clock, waiting for the 17th hour to pass, I lay on the floor with Tootsie massaging her muscles. I stroked her head, talked to her, told her we would come through this as we had everything else. I kissed her inhaling her scent that I loved so much. Finally she began to relax and pushed her head up under my chin. I saw she was asleep. Relieved, I drifted off believing the drug was decreasing. In the small hours of the morning she died, I could not believe she was dead. After all she had endured, to lose her because of a drug reaction that could have been prevented, if only someone had listened.

Was it unreasonable of me to expect the oncologist to be aware of possible side effects from a prescribed drug? . I've been feeling that somehow I failed to communicate the seriousness of drug reactions in the Akita to the oncologist and perhaps that's why she didn't listen. Today I learned that another Akita died from an anesthetic reaction a few weeks before Tootsie. Both dogs were patients of the same oncologist. Will she pay attention to the next Akita?

I am not a veterinarian but I am an observant owner. I trusted these highly educated, board certified professionals to assess the seriousness of her symptoms. If they had asked me to move heaven and earth for Tootsie, I would have found a way! An hour after we removed the patch, the site erupted into large purple blisters. I was told to use cortisone cream. I carefully explained Tootsie's symptoms each time I spoke with these people but they did not appear alarmed at my description of her difficulties.

What is so horrible about this story is the total ignorance of a Board Certified Oncologist using a drug without any knowledge of its side effects. Tootsie died a prolonged and terrible death because of Duragesic, a pain patch that uses the drug fentanyl. Worse still, her pain was a weight-bearing pain only, not a reason to use an opiate. I had no idea what this patch was foolishly, I trusted a veterinarian.

After Tootsie died, I phoned the oncologist to inform her I had lost Tootsie. She was shocked. Her words implied Tootsie should not have died, that the cancer could not have killed her. The samarium did not kill my Akita. Samarium emits beta rays for 6 weeks following treatment but the medical radiologist at UCLA did not believe her death was caused by samarium that has a half life of 47 hours. She was kept at UCLA during that time. The samarium can cause delayed kidney damage if not properly flushed after treatment. My understanding is only one dog died from renal failure 7 months after treatment but the dog had some loss of kidney function before the treatment. Samarium has been used for metastasized cancer in humans for a few years with no loss of life. Based on extensive research I have conducted, I have so much faith in the safety and success of samarium-153, I would do it again and recommend it for any dog with osteosarcoma.

She looked so at rest lying there. When I bent to kiss her face as I had so many times before, I saw bloody fluid coming from her mouth or nose. I asked my general vet why, what caused the discharge of bloody fluid? Her answer continues to torture me--damage to the lungs can and does cause this to happen. Page after page of articles I obtained mentioned the danger of respiratory distress from transdermal fentanyl. Now, not even the oncologist doubts Tootsie died from an adverse reaction to the drug. If Tootsie is the first dog to die from transdermal fentanyl, let her be the last.

The information I found online about the Duragesic patch was available to the oncologist. The drug has never been approved for veterinary use. It's called an "extralabel" drug because it is used by veterinarians without FDA approval. There are many drugs out there like that. Few studies have been done on dogs, therefore no database is maintained about its effects on dogs. I'm not against extralabel drugs used for our dogs but to use the drugs without learning about adverse reactions in humans is irresponsible and unethical. I understand that, in medicine, desperate situations can require desperate chances but in this case the situation was not desperate. The patch was used much like a "take two patches and call me in the morning--I'm busy!"

Many articles published in scientific journals stated the Duragesic patch was implicated in preventable human patient deaths by causing respiratory depression, muscle rigidity, and renal and liver dysfunction. Meaning, the drug could not be filtered from the body since the two primary filters, kidney and liver, were not functioning because of the drug. In a 1995 study at McGill University, "of 14 subjects receiving transdermal fentanyl, 3 had clinically significant fentanyl toxicity, mandating early removal of the device."

When Janssen Pharmaceutical assured me the drug would be filtered from my dog's system within 17 hours, that was not accurate. The half-life of fentanyl administered by the transdermal patch is "relatively long, indicating ongoing absorption from a subcutaneous depot." The drug pockets under the skin where it continues to be released into the tissues. Removing the patch did nothing! She needed the antidote.

Another article stated the 100 micrograms transdermal patch was "too potent for routine postoperative pain relief due to a risk of respiratory depression." That was the dose used on my 104 pound Akita. Veterinary oncology seminars throughout the country are recommending this high dose but scientists using the drug with humans recommend beginning treatment with a 25 microgram patch, then closely monitoring the patient for depressed respiration and other side effects.

The drug insert included with the patch contains a warning if the oncologist had taken a moment to read it: "As with other CNS depressants, patients who have received fentanyl should have appropriate surveillance. Resuscitative equipment and a narcotic antagonist (e.g. naloxone) should be readily available to manage apnea."

Further: "In the presence of hypoventilation or apnea, administer oxygen and assist or control respiration as indicated."

Also available to anyone interested in the information, is an article published in a Japanese medical journal (April 1998 ), detailing a fentanyl study conducted on 12 dogs at Saitama Medical School. "Hepatic blood flow and oxygen metabolism did not change after administration of 3 micrograms. Kg-1 of fentanyl, but mean arterial blood pressure, cardiac output, hepatic arterial blood flow, portal venous blood flow and hepatic oxygen delivery were significantly suppressed by 30 micrograms.kg-1 of fentanyl." Tootsie was killed by 100 micrograms of fentanyl.

The Duragesic patch is not used solely for cancer patients. It is widely used for orthopedic-surgical cases. I know there are responsible, caring veterinarians out there but as lay people we have no way of knowing if their assurances are based on knowledge or attitude. To protect our pets, we can't simply accept and trust. We must all begin to question and demand.

To Janssen Pharmaceutica and the oncology group in Southern California, she was just another dog. To me Tootsie was what humans should strive to become: courageous without complaint, loyal without demanding, an unselfish friend and a loving companion. Losing her is unbearable but losing her to negligence is a real nightmare. When I say I loved this dog more than anything on earth, I mean it with all my heart. She was a gift I was allowed to have for only a short time. To honor her, to make her life and death have meaning, I wanted dog owners to know why she died. Please, let this serve as a warning: Akitas are fragile when it comes to drugs. Don't assume your vet knows this fact. Demand to have it written in red ink, underlined, on your dog's medical file. Remind your vet every time a new drug is prescribed. If you have any doubts--don't allow the drug to be used.

Losing Tootsie has been one of the hardest things to endure and almost impossible to accept. I know time heals but until the time passes the pain is unbearable. It's made even more painful for me because Tootsie was the best ambassador for the breed I've ever known. Wherever we went, and we went everywhere together, Tootsie's presence attracted people, even those people who disliked Akitas because of a negative past experience, felt utterly comfortable with her. Her large size and fierce look belied the gentle reassuring qualities Tootsie demonstrated to everyone.

Last week at one of our neighborhood parks, I had baby Jazz with me for one of her first socialization outings. Little Megan, a 3 year old child living across from the park stopped to pet the puppy. I recognized her and said "hello, Megan." Megan's mother did not recognize me until I reminded her I was the lady who was always with Tootsie. I told them Tootsie died last week. Megan stopped petting the puppy and sadly, asked if she could play with her tomorrow. She left with her mother. Tootsie was Megan's favorite dog. She watched for Tootsie from her front window and always had her mother take her across to visit Tootsie. Megan would end each visit by wrapping her slight arms around Tootsie's neck to hug and kiss her goodbye. They were good friends.

It's like that wherever I go now. People ask for Tootsie and so many of them cry when I tell them she died. She never produced a Champion; she never won a dog show but Tootsie touched people's hearts. She made real friends along her way. As time passes, when those friends hear the word "Akita," it will be Tootsie they remember and they will think of our breed with fondness.

When you think of Tootsie, please let her death remind you that ultimately, YOU are in charge of your dog's medical care. A title on a veterinary/medical license does not bring with it additional common sense or superhuman powers. There are over 150 breeds in the United States. It is not possible for any veterinarian to claim expertise with each of these breeds, but you as owners and breeders know the idiosyncrasies of your breed. There should be a mutual exchange of information between you and your veterinarians for the sake of your dog. If that respect is not reciprocated, find a vet who cares enough to listen.

© 1998 Barbara Bouyet