living with canine addison's disease: kermit's story, part four (the disease and the end)

So what is Addison's Disease, exactly? PetMD describes it:

Mineralocorticoids and glucocorticoids are hormones normally produced by the adrenal glands, which are located near the kidneys. Both of these hormones are critical to the healthy functioning of the body, and an abnormal increase or decrease of either of these hormones can lead to serious health problems if not addressed in time. Hypoadrenocorticism (Addison's Disease) is characterized by a deficient production of glucocorticoids and/or mineralocorticoids. Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration, low blood pressure, depression, heart toxicity, vomiting, blood in feces, and weight loss...

A sudden and severe (acute) episode of hypoadrenocorticism is a medical emergency requiring immediate hospitalization and intensive therapy...

After the initial recovery, your veterinarian will calculate the dose that will balance your dog's hormone deficiency. The dose of these hormones may need to be increased occasionally, especially during periods of stress like travel, hospitalization, and surgery. 

After being diagnosed with Addison's Disease at the age of four, Kermit did quite well on his meds. The vet would adjust them up or down depending on what his blood work said. Giving Kermit meds became part of our routine. The same time every morning, and the same time every evening. 

When we knew he would experience stress, we gave him half a dose more leading up to the event and during the event. The stress could be positive or negative. Having out-of-town guests stay with us for a few days was always a happy, exciting time for Kermit. But the thrill of it all could send him into an Addisonian Crisis, so we'd have to up his meds a bit. Overall, his quality of life was great for a couple of years. We could do this thing.

We thought all was as well as it could be, but then Kermit suddenly collapsed one day. We initially thought it was an Addisonian crisis, but this time, it was different. His body stiffened, his mouth froze open in an ugly attack-like position, and then he started convulsing. It seemed to go on forever, but he came-to after a few seconds, stood up, wandered around a bit, pooped, then drank a ton of water. Then he ran around, perfectly happy. 

We rushed him to the vet, despite his seemingly perfect appearance. Seizures are not normally a symptom of Addison's Disease, so they ran test after test. They found no cause of the seizures, so on top of the Addison's Disease, Kermit had "Non-specific Seizure Disorder," which is a fancy way of saying "we don't know what the hell is wrong with your dog." They speculated that the seizures could be his body's way of reacting to the toll the disease was taking on him, but they couldn't be sure. They said he might never have another seizure. Or he might have many. They couldn't predict what would happen. They kept him on his course of meds and said that if his seizures became unmanageable, we could look at treating them, but that treating them would be invasive, likely consisting of regular injections. 

Over the next couple of years, Kermit's seizures were inconsistent. He would have one every now and again. We'd call the vet, and they would tell us there was really nothing we could do besides comfort him, unless we felt it was time to treat him. We didn't want to subject him to the treatment, and since his seizures were so sporadic and he seemed fine, otherwise, we opted to leave him untreated.

 N.A.S.H.A. would often keep Kermit company when he wasn't feeling well.

N.A.S.H.A. would often keep Kermit company when he wasn't feeling well.

As his life progressed, the seizures became more consistent. Unpredictably, he would have cluster seizures, a group of seizures that would occur over the course of a couple of days. We couldn't understand what would set these off, but we noticed a pattern. N.A.S.H.A. would stick to Kermit like glue periodically. And she wouldn't stop licking his eyes, but only sometimes. When we started to really take notice, we recognized that she exhibited this behavior for a day or so only just before a seizure cluster. N.A.S.H.A. could predict Kermit's seizures! 

Still, there was not much we could do, but at least we knew, and there was some comfort in knowing what was coming. And I'm sure Kermit was somewhat comforted by N.A.S.H.A.'s care. He always tolerated her eye-licking, and even seemed to enjoy it. A little love goes a long way.

Kermit's seizures also followed a pattern: He would suddenly drop to the ground, stiffen, seize, then moan and lay there for a minute and wet himself. Then he'd get up and wobble around a bit, falling a few times, then he'd walk around in a daze (the seizures caused temporary blindness for a few minutes), and then he'd poop, drink water, and be fine again. Our role: to keep him from hitting objects that could cause injury, comfort him, and then try to escort him toward the back door so he could relieve himself outside rather than inside. The seizure clusters happened approximately monthly, and he would have five or six seizures over the course of two days.

Kermit would occasionally hit something on the way down and bleed from the mouth...his gums had begun to deteriorate, and the vet advised us not to put him through the anesthesia it would take to treat it. His tooth decay was likely a result of his weakened immune system.

So why did we choose to prolong his suffering? Because other than the two days he was having seizures, his quality of life was wonderful. He was normal Kermit. He ate and played and cuddled. It was really hard to think about euthanizing him when he was seizure-free. 

Kermit started to show signs that his mind wasn't all there. After so many seizures, his brain was damaged. We affectionately called him "mashed potato brains." Perfectly potty-trained Kermit would now stare us straight in the eye and lift his leg on the corner of the couch as if it was a fire hydrant. He had just lost his mind. We purchased him some reusable belly band "diapers," and after hearing our story, the lady who made them sent Kermit a custom band with Kermit the Frog on it. Kermit wore a belly band all the time to prevent our house from becoming a urinal. He came to enjoy the attention a diaper change brought, and when we'd release him from them for a naked romp outside, he'd prance around, free. Kinda like taking a bra off at the end of the day, I suspect.

Everyone always says "you'll know when it's time."

We knew it was time when Kermit's mashed potato brains led him to injure himself. He began to chew on his left front leg. At first, it was a little nibble, as if he had an itch that wouldn't go away. When he drew blood, we bandaged him. We took him to the vet, and there was nothing wrong with his leg. He would chew the bandage off, so we put him in a t-shirt. It seemed to help, but he could still get at the leg. He chewed and chewed, and chewed. And he wouldn't snap out of his daze. Our Kermit was gone.

It was time. We all cried, and we all hugged Kermit. My husband honored the agreement we made when we married. I told him "there will be lots of animals in our lives, and I won't be able to 'do the deed' when it comes time. If you marry me, you have to agree to take care of it." Brennen scooped Kermit up and put him in the car. The littles and I watched out the window as they drove away.

For weeks after, I didn't know what to do with myself in the mornings. There was no medicine to administer and no diapers to change. There was just nothing.

Kermit was a special dog with a rare disease that had a huge impact on our lives. Was it all worth it? Without a doubt. I hope he'd think so, too.  

Further reading:

living with canine addison's disease: kermit's story, part one (the adoption)

living with canine addison's disease: kermit's story, part two (our lives before the disease)

living with canine addison's disease: kermit's story, part three (the diagnosis)