Idiopathic

On Friday night, we put Toivo to sleep. After months of mobility issues and inexplicable infections, her final decline was swift and sure. Early Friday morning, Toivo was panting heavily in her kennel, so J took her outside, and she became uncharacteristically aggressive. By the time we arrived at the Angell Animal Medical Center, Toivo was listless, unable to walk, and had to be rolled into the critical care unit on a stretcher.

While at Angell, Toivo did not improve. Instead, the ER vet said Toivo’s neurological responses were “inappropriate” and indicative of meningitis, encephalitis, or a brain tumor. By evening, it was clear Toivo’s condition was dire. When we arrived for one last visit before putting her down, Toivo was awake but unresponsive, staring with glassy eyes and not reacting when the vet moved a hand quickly toward her face.

Before she died, Toivo struggled to raise her head as I got settled on the mat beside her, as I had so many times during her week-long hospitalization in April. I’d like to think that in some corner of her brain, Toivo could still recognize the familiar touch of my hand on her head, my scent, and my voice telling her she was a good girl and everything would be okay.

We had Toivo for a shockingly short period of time–roughly a year and a half–but she had become deeply embedded in our lives, and closely bonded with me in particular. When we first brought her home in February, 2018, she acclimated almost immediately, as if she’d been born and raised with us rather than arriving as an adult dog. From day one, Toivo loved playing with our other dog, Djaro, leading me to suggest the best way to tire a Belgian Malinois is to bring home a second one.

Initially, I hadn’t wanted a second Malinois. The breed is energetic and intense, and whereas J prefers tough and intelligent dogs–so-called “mean breeds”–I’ve always preferred floofy doofuses. What sold me on Toivo was her spunk. Too small to be a protection dog, Toivo was also too much of a goofball. Whereas the word that best describes Djaro is “intense,” the word that best described Toivo was “happy.” When her whole body wasn’t arthritic and painful, Toivo was a joyful, hyper little dog: a dynamo in a seal-slick coat who spun like a top when excited.

Although we’d chosen Toivo to be my walking buddy, what cemented our bond wasn’t the walks we took when she was able-bodied as much as the four months she was a Medical Mystery. Toivo was a fearlessly hardy dog for the first year we had her, eager to walk in any weather, but this past March, she was suddenly creaky and reluctant to move. It was as if she had gone overnight from being a dog of four to a dog of fourteen.

After many diagnostic deadends and weeks of physical rehab, we finally learned that Toivo had immune mediated polyarthritis (IMPA), a disorder that caused her immune system to attack her joints. When we started her on steroids and an immunosuppressant, she responded almost immediately. Within days she went from being hunched over and limping to being her old self: active, energetic, and hyperalert, like a lion caged in a dog’s body.

One word we kept hearing throughout Toivo’s veterinary odyssey was “idiopathic,” which refers to a condition with no clear cause. We never learned why Toivo developed a huge abscess on her left hind leg in April, why she developed laryngeal paralysis after her release from the hospital, or why her face swelled up for no apparent reason in May. On Saturday morning, after we’d already put Toivo down Friday night, we learned a chest X-ray had shown three masses in her lungs: the closest we came to a smoking gun. If Toivo had a brain tumor that metastasized to her lungs, no amount of physical rehab or immunosuppressants could have saved her.

But even a smoking gun can’t answer the question of why. Why did fate or chance choose this one dog–my dog–to struggle with so many medical challenges? Why did fate or chance choose to cripple then kill her so young? I’ll admit to feeling as much anger as grief these past few months. J and I would have done anything to keep Toivo safe and healthy, so why are there abusive and neglectful people whose dogs are still alive while my dog was taken in her prime?

There are no answers to these questions; ultimately, mortality itself is idiopathic. If you allow yourself to love a dog, you know how the story will end: they will die first, unless you do. Looking through the photos and videos we took while Toivo was with us, I feel cheated to have lost her so soon, but even luckier to have had her at all. Even the longest-lived dog leaves too soon. I don’t know why we continue to open ourselves to the heartbreak of loving creatures who are destined to die, other than we have no other choice.

 

The luxury of an able body

Today something remarkable happened on Toivo’s morning dog-walk: my mind wandered. We’re still limited to short and slow walks in deference to Toivo’s injured leg, so by “walk” I mean a leisurely stroll past two neighboring houses, where the mouth of a woodsy trail gives Toivo a place to pee and poop on pine needles before turning around and walking back home. It’s the shortest outing you can take while still using the word “walk.”

This morning after we’d walked two doors down to the mouth of the woodsy trail, as Toivo was nosing and sniffing through the drizzle-dampened undergrowth, my mind wandered. After months of spending every minute of every walk fretting over Toivio’s feet–is she putting weight on her injured leg, is she limping, is she panting or showing other signs of discomfort or distress?–I let my thoughts fall away while listening to the umbrella-patter of raindrops sifted through leaves. For the first time in months, my dog-walking consciousness was as free and unfettered as an unleashed hound wandering wherever she pleased.

This is how Toivo and I used to walk, before her impairment. Toivo would sniff and wander on her end of the leash, and I would dally and daydream on mine. This is how Toivo and I used to walk before early March, when she first showed signs of lameness: back when we blithely took for granted the luxury of an able body.

 

An ouchy day

Today Toivo is having an ouchy day. There probably is a more clinical term for days when Toivo is slow and stiff-moving–often, these are the days after we’ve taken a longer-than-usual walk, so perhaps I should call them recovery days–but the word I hear in my head is “ouchy.” There are days when Toivo is chipper and energetic and fairly mobile–popping up and eager to walk–and then there are ouchy days.

One of the benefits of the month-long physical rehabilitation package we signed up for is a weekly appointment with a vet who knows far more about the rehab process than we do. Today Toivo and I will meet with Dr. P, and I’ll pepper her with questions. I’ll ask about pain management: should we be giving Toivo pain meds regularly, only when she’s ouchy, or not at all? How much exercise is too much: am I overdoing it by trying to take daily walks? And should we be giving Toivio supplements for the achiness she seems to feel in her other joints, not just the injured leg we’re rehabbing?

Lots of questions arise on ouchy days, and plenty of doubts. Am I doing enough to encourage Toivo’s recovery: should I be doing her passive range of motion exercises more often or differently, or should I be supplementing, medicating, and/or meditating more, more often, or more diligently? Or, on the flipside, am I doing too much, moving and massaging Toivo’s leg when she should be resting it, or walking her too much, too fast, or too far? Would Toivo be better off, in other words, if I just left her alone to sleep and heal and be as active or inactive as she wants without all this fussing?

All of these questions, of course, are different permutations of a central set of coupled questions: am I to blame, and is there something (anything!) I can control? Nobody wants to be the one to blame, but everyone wants to feel they can control their own and their loved ones’ wellbeing. If Dr. P. were to tell me that standing on my head and singing the Alphabet Song backwards would help Toivo recover more quickly, I’d drop right then to the floor and start singing, regardless of how silly it might seem. Ever since Toivo first started having mobility issues in March, I’ve been struggling with an unspoken existential question: if I somehow do things differently, can I unlock a magical formula where she will get instantly and entirely better and, better yet, live forever?

This, after all, is what I want for Toivo, myself, and all my loves: for us all to be forever young, forever able-bodied, and forever happy. And this, I know, is a guarantee I can never deliver, no matter how many rehab session I schedule. This stark realization–the undeniable fact that we are mortal souls in fragile bodies–is more painful than any physical injury: an ouchy no known opioid can cure.

As I write this, Toivo nestles her head on my lapdesk. On ouchy days in particular, I quit my desk and work as much as possible on the bed where Toivo is resting, encouraging her to snuggle up against me. Throughout the rehab appointments, the painfully slow walks, and all the enthusiastic exhortations to “Use your leg,” I cling desperately to the belief–the hope–that love, companionship, and lots of petting can work miracles–or at least provide some comfort in the meantime.

 

Mama-medicine

I submitted the last of my Spring semester grades on Monday, and I’ve spent most of my time since then doting on the dog. On Tuesday, Toivo had her stitches removed from the surgery she had earlier this month to drain a massive abscess in one of her hind legs, and tomorrow we have a physical therapy appointment to figure out how to encourage her to use her injured leg again.

I’ve never been to a doggy rehab appointment before, so today I filled out the necessary paperwork, read the rehab center’s frequently asked questions, and started doing some passive range of motion exercises I found on YouTube. When Toivo first came home from her hospitalization, I was afraid to touch her leg, not wanting to disturb any of her stitches, but at Tuesday’s appointment, our vet said her incisions are fully healed, so massage and manual manipulation of the leg would be okay.

The entire process of Toivo’s injury, treatment, and recovery has been a learning experience. J and I have nursed other dogs back to health after surgery, but Toivo is the first pet we’ve had who was hospitalized for a full week. Whereas our other dogs spontaneously started using their injured legs after surgery, it’s been a full three weeks since Toivo put weight on her leg: one week in the hospital, and now two weeks recovering at home. It’s not surprising that her muscles have atrophied during that time, so now we have to build those muscles back up.

When we first got Toivo, I bought a pair of grooming gloves I use to brush her fur, a process J immediately dubbed “mama-ssage.” Today, I brushed Toivo in advance of tomorrow’s rehab appointment, and as I massaged, flexed, and extended her injured leg, I hoped the power of TLC and some “mama-medicine” will move Toivo further down the road to recovery.

 

Restricted minutes

A few days ago, Toivo started limping after our morning walk, and for the past few days she hasn’t been her usual energetic self. We have a vet appointment next week to determine whether she has a passing injury or a more pervasive problem, and in the meantime I’ve been taking her on short, slow walks, just as I did when Reggie was old and increasingly unsteady on his feet.

Normally, Toivo is an active and energetic dog, jumping and spinning when I grab her leash for a W-A-L-K, so it’s been heartbreaking to see her relative lack of enthusiasm for even a slow stroll. Most dogs relish any excuse to be a couch potato, but Toivo loves to be outside in any weather, and she normally doesn’t have a “slow” setting: she’s either asleep or ready to run, and if left to her own devices, she will play to the point of exhaustion. But like an athlete benched by injury, Toivo will remain on restricted minutes until she is back to her bouncy self. Whatever is bothering her, we don’t want her to exacerbate the problem through overexertion.

 

Dog days

Our house doesn’t have central air, so during heat waves J and I hunker down in the rooms that have window AC units. Our bedroom, which doubles as my office, has an air conditioner, so Toivo and I have been spending a lot of time this week inside: me with my books, notebooks, and laptop, and Toivo with her chew bone and dreams of rabbits.

 

The place of pines

Today after running errands and attending a meeting on campus, I came home and walked Toivo to the place of pines and back. You won’t find the place of pines on any map: it’s my name for a segment of the Cochituate Aqueduct that snakes behind suburban backyards, with a trail that follows a shady ravine carpeted with pine needles.

I started calling this particular segment of footpath “the place of pines” when I used to walk Reggie there on hot summer days. We’d walk to a place where the trail climbs up the ravine, then we’d return on a path that skirts its upper ledge.

It’s a short walk there and back; the whole time, you can see houses, garages, and treehouses in neighboring yards, and you can hear passing cars and planes overhead. The appeal of the place of pines isn’t that it’s wild and remote, but that it’s near and handy. During a spare half hour, you can walk to a place with tall trees, indulging in a brief break on a day without much time for breaking.

As Reggie grew older, our trips to the place of pines changed. First, he struggled to climb the ravine, so we’d walk the level part of the trail and then retrace our steps when the way got steep. Eventually, Reggie couldn’t walk even that far: our walks got shorter and slower, and eventually he couldn’t walk at all.

Walking Toivo to the place of pines today, there was a thought at the corner of my mind: someday, this spunky girl who tugs at her leash, eager to sniff and chase after squirrels, will be too old to make it this far. But today the way is smooth and easy, and it would be a shame to stay inside.

 

The transition

This past weekend, just over a month after we’d put our white German shepherd, Cassie, to sleep, J and I brought home a three-year-old black Belgian Malinois named Toivo.

When we put Cassie to sleep on New Year’s Day, I was ready to spend a good long time grieving, but J believes in quickly moving on. It’s impossible to replace one pet with another, but welcoming a new pet provides a welcome distraction from the empty feeling you experience when you still expect your old pet to be there, but they aren’t: a phenomenon J and I call “phantom dog.”

Toivo wasted no time settling into her new home, hopping right onto our bed and lounging at full length. When we open the door to her crate, she walks in without any prompting, and when I ask her to sit while I put on my coat before our morning walks, she duly complies while looking at me with an intent stare: “Hurry up.” Best of all, Toivo has quickly befriended Djaro, our other dog, racing around with him in our fenced dog pen, each of them intent on their favorite toy.

Toivo is not a replacement for Cassie: their personalities are completely different. Cassie was affectionate with people but anxious around other dogs, barking and lunging and making it nearly impossible to walk her in a neighborhood full of dog-walkers. Toivo, on the other hand, is hyper but stable. She is completely unfazed by Djaro, and she is eager to DO SOMETHING the moment either J or I show any indication of moving. But the moment I sit at my desk, she calms and quiets, as if turning a switch.

You don’t get a new dog to replace the old one. You get a new dog to fill the emptiness the old one left behind. Our phantom dog isn’t entirely gone: both J and I occasionally call Toivo “Cassie” by accident, and she doesn’t seem to mind. One testament to how much you loved your old dog is your willingness to open your heart to a new one, despite the empty hole you know they’ll eventually leave behind.