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Veterinary Medicine

Beating the odds with Miyuki

December 2, 2009
By Carol Borchert

When Laurelyn Ashley and Frank Deck brought home their new English bulldog, Miyuki, they could not possibly imagine the life-and-death drama that lay ahead. Miyuki, whose name means "Beautiful Snow," was their second bulldog and they looked forward to breeding her with their male dog, Tank. Her rare coloring and sweet disposition held promise for exceptional puppies. Little did they know that, in less than three weeks, 4-month old Miyuki would be fighting for her life.

Miyuki, an English bulldog whose name means 'Beautiful Snow,' was treated at VTH for primary bacterial pneumonia.

Severe form of pneumonia

What started as a simple case of bordatella (or kennel cough) had exploded into primary bacterial pneumonia, a severe form of pneumonia, and Miyuki was given little chance of survival.

“English bulldogs are cute and have great personalities, but they aren’t built to breathe,” said Dr. Ryan Bragg, a first-year Critical Care Resident in the  Department of Clinical Sciences and one of the veterinarians who took care of Miyuki.

Narrow nostrils and airway

“They have narrow nostrils, a narrow trachea, a long soft palate and a tendency toward everted laryngeal saccules, further clogging their already narrow airway. When they get a respiratory infection it can go from bad to terrible pretty quickly.”

In February, Ashley and Deck first sought care for Miyuki in Boulder but, due to the severity of her case and need for intense respiratory treatment, including oxygen, she was referred to the CSU Veterinary Teaching Hospital where the Critical Care Unit could provide her the best shot at life.

Severe respiratory distress upon arrival at VTH

“Miyuki came in vomiting and with severe respiratory issues,” said Dr. Vicki  Campbell, an assistant professor in the Department of Clinical Sciences and part of Miyuki’s veterinary team. “She had an extended neck and elevated temperature, and was in severe distress. We moved her to the isolation ward and over the next 12 hours she continued to worsen. She was just in such severe distress and really struggling to breathe. We had her in the oxygen cage and on strong antibiotics, but her body was about ready to give up. At that point, we knew we had to intervene to stop her suffering.”

Intervention meant euthanasia or putting Miyuki on life support. The team met with Miyuki’s distraught owners and prepared them for the worst. The team detailed the road that lay ahead should Miyuki go on life support, including the financial and emotional commitment required, and gave realistic expectations regarding the outcome.

Miyuki receives special attention inside the oxygen cage from one of her VTH caregivers, Lindsay.

10 percent chance of survival

“I told Frank there was at most a 10 percent chance Miyuki would make it, and really thought he and Laurelyn would decide for euthanasia – they had only had Miyuki for about three weeks – but their bond was already incredibly strong,” said Dr. Bragg. “Frank looked at me and said, ‘10 percent? I’d go to Vegas on those odds.’ ”

Only a small percentage of veterinary patients ever go on life support, and it is usually as part of end-of-life care for severe disease processes. Life support is often the last resort and only 20 percent to 30 percent of animals that go on the ventilator ever come off.

Ventilators are used most often to give owners a little bit more time with their critically ill pet, and to be able to say goodbye while the animal is still alive, but not suffering. Miyuki, being young and having no other health problems, had a fighting chance and her veterinary team wanted to be sure she got the best ammunition they had.

24-hour nursing care

Miyuki was heavily sedated and placed on a ventilator inserted through her trachea, which relieved her of the incredibly difficult work of breathing. In healthy dogs, noted Dr. Campbell, about 1 percent to 2 percent of basal energy is required to breathe. If an animal is in respiratory distress, that energy requirement goes up to 30 percent and is simply unsustainable in the long term.

Miyuki also needed a special trachea tube with an inner sleeve that could be changed to remove mucus and pus being expelled from the lungs to prevent choking. Once on the ventilator, Miyuki received one-on-one, 24-hour nursing care.

More than 25 people involved in Miyuki's care

During her stay at the VTH, more than 25 people were involved with her care. Her care providers:

  • monitored her IV nutrition
  • kept her sedated
  • administered antibiotics
  • kept her tubes untangled and in place
  • provided supportive care

Other veterinarians from the hospital were brought in to consult.

Roller coaster ride

The first seven days were a roller coaster ride for the nurses, doctors, and owners, said Dr. Bragg, not knowing from one moment to the next whether or not Miyuki would make it. If putting Miyuki on the ventilator was difficult, getting her to breathe again on her own was even more challenging.

After six days, the veterinary team began to wean her off life support, but Miyuki was not able to breathe on her own. She was placed back on the ventilator, and the team tried again the next day, this time with success, as they took the next 72 hours to let Miyuki’s lungs begin to work on their own, reducing oxygen levels in her oxygen cage. She was more lightly sedated and her oxygen levels were closely monitored.

Laurelyn Ashley and Frank Deck with their English bulldog Miyuki. Also pictured are Dr. Vicki Campbell and Dr. Ryan Bragg.

Acting like a puppy again

“Three days off the ventilator, she began to eat on her own and was getting stronger and stronger,” said Dr. Bragg. “You could see her personality come out and she was acting like a puppy again, trying to chew on all the medical equipment. We still had to anesthetize her three or four times a day to clear her airway of secretions, but she was also strong enough to cough which was a good sign.”

After 17 days in the hospital, including seven days on the ventilator, and $13,500 in veterinary medical expenses, Miyuki was finally ready to go home. Ashley and Deck, both used to dealing with the respiratory issues of bulldogs, continued her palliative care by administering medications, giving her steam “showers” several times a day, and doing percussion taps on her chest to loosen up mucus in her lungs.

Medication the rest of her life

It’s likely that Miyuki may need to be on medication the rest of her life, and will always be more susceptible to respiratory infections – she had a less severe bout and had to return to the hospital for several days in April – but Ashley and Deck are just happy to have her alive and at home.

“When we brought her home, I couldn’t wipe the smile off my face,” said Ashley,  who recently became engaged to Deck. “For us, this was an emotional investment and we simply had to give Miyuki her chance at life. ”

Originally published in the Fall 2009 College of Veterinary Medicine and Biomedical Sciences Insight newsletter.