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for Excellence by a Veterinarian in the Treatment of Canine Autoimmune/Immune-Mediated Hemolytic Anemia |
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for Excellence by a Veterinarian in the Treatment of Canine Autoimmune/Immune-Mediated Hemolytic Anemia |
The winner of the 2008 Meisha’s Hope Award is Dr. Richard Shackelford. Dr. Shackelford works out of the Treasure Valley Veterinary Hospital in Meridian, ID and was nominated for the Meisha’s Hope Award by Carolyn & Don Watts. The Watts’ nomination of Dr. Shackelford for the 2008 Meisha's Hope Award is reproduced below the photo of the Watts' and Dr. Shackelford.
Carolyn & Don Watts with Dr. Richard Shackelford
displaying the 2008 Meisha's Hope Award
I am writing this with my little dog, Maggie Mae, curled up happily on my lap. She wouldn't be here today if it weren't for her wonderful veterinarian, Dr. Richard (Rick) Shackelford and the extra effort, intelligence and resourcefulness he used in her diagnosis and treatment, and the comfort of his bedside manner.
Early in April, 2008 Maggie turned up her nose at her favorite treat, cheese. She just sighed and went to her bed, as if she were very tired. It was a Thursday evening, and first thing Friday morning, we were at the veterinarian. It proved to be an unlucky Friday, however since Dr. Rick was out of the office. I recited my worries to a vet I had never met before, who didn't know Maggie for the young, high energy Rat Terrier that she normally was. "She is very 'flat' I said and has no energy. She wouldn't eat her treat last night or her breakfast this morning and this morning I noticed her gums seem very pale." "Nothing to worry about", he said. "Probably a little stomach bug." I wasn't convinced. He said he could give her some Metronidazole, just to be on the safe side. I said I thought something was horribly wrong. He humored me by doing chest and abdomen x-rays which were normal. He pulled blood to send to the lab in Seattle. To him, Maggie seemed just a little under the weather. To me, she seemed as if she was at death's door. I had been a veterinary technician for many years before getting a "desk" job, and knew enough to be worried.
Three hours after we got home, Maggie ran to greet my mom with her usual enthusiasm, and collapsed onto the floor, gasping. She was white as a sheet. I grabbed her and my purse and ran for the car. I called Dr. Rick's office as I backed out of the driveway, and the substitute vet directed me to the emergency hospital. The ER hospital threw every piece of technology they had at Maggie and couldn't find a thing wrong. I called every hour all night long. "Resting comfortably," they said. OF COURSE she was "resting"! She couldn't get up! "Why is she so pale", I kept asking, over and over. "Oh, she looks a little pale, but her blood work all came back normal. The ultrasounds, ECG and x-rays all look good". Her PCV was 35, low normal. They sent her home the next morning, my pocketbook $1,500 lighter, and Maggie no better.
I felt horribly guilty. Had Maggie been like this for days and I hadn't noticed? My daughter had been very ill all spring, and I had spent many days and weeks at the hospital with her, or taking care of my grandkids. Had Maggie gotten into something and I hadn't noticed? Our previous Rat Terrier had died suddenly four years earlier from eating poisonous mushrooms we didn't know were growing in our yard. I routinely patrolled the yard and savagely killed any mushroom I found. I checked the yard again, nothing. I checked again, still nothing. On my third sobbing trip around the yard, my husband, Don, came out and stopped me. Frantic, I called Dr. Rick's office again. It was Saturday morning, and Dr. Rick was back. I begged to bring her in, but he said he was heading out, and would stop by my house on the way home (it dawned on me later that my house is 10 miles out of his way). He was at my door in half an hour. Maggie didn't bark, or even get out of bed when he walked in. "She is so pale". I had said those words two dozen times in the past day. He put a comforting hand on my shoulder. "Let's take a look at her", he said. He gently laid his stethoscope on her chest. He patted her head. "What's wrong with you, little girl? We'll see what we can do for you." His words calmed me. "Well, she IS pale, and seems lethargic, compared to her normal energy level. From the ER report, we know she isn't losing blood. No signs of poisoning. So either she is not making blood, or she is killing it off. If this is an auto-immune problem, she needs steroids, soon. If it is leukemia, the steroids will do her harm. We won't know for sure until the blood work comes back from the lab. We can wait two days to get the answer for sure, or start her on steroids now." He got the classic question from me, "If she were your dog, what would you do?" He said he would start the steroids. I nodded. He called our local pharmacy and I ran down and picked up the prescription.
Dr. Rick called again the next morning. He had lain awake that night, worrying about Maggie. Was she any better? "No", I replied, she was worse. He told me to bring her straight in. They weren't open, but he drove out and opened the clinic. He got an IV catheter in her and started her on fluids. Wondering if she had Addison's, he gave her an injection of Percorten. She perked up a little, although her PCV was still hovering in the low 30's. After a few hours, Maggie and I went home. "We just have to give the steroids time to do their job", he said. All they could do at the ER was watch her, which I was already doing. Because her red count was still technically "low-normal", it was probably the sudden drop in red cells, and not the count itself, that was making her weak.
At 9 o'clock that night (Sunday), Dr. Rick came back over to check on Maggie. She seemed a bit better, but by Monday morning she was totally flat. Back to the hospital we went. I checked her in and ran back to the human hospital to sit with my daughter. Dr. Rick called that afternoon to tell me the lab had called. Maggie had auto-immune hemolytic anemia. She was started on Imuran, in addition to the prednisone . Her red cells had dropped to 24. I brought Maggie home that night, and took her back in Tuesday morning on my way to the "other" hospital. The grandkids were asking about Maggie. Why couldn't they take her to the park? Why was she in the hospital? Was she a "mystery" too, like mommy? Dr. Rick called me within an hour. Maggie's red cell count had dropped to 12. She needed a blood transfusion. With no local lab to do veterinary blood typing, he drew blood from all his own dogs, plus Maggie, and sent his technician to the nearest "human" lab to have them cross matched. One of his dogs, Jack, was a suitable donor, and within an hour, he was happily donating blood while being distracted by his favorite variety of canned food. Soon the blood was flowing into Maggie, and before my eyes, she sat up and started eating. Dr Rick put his hand on my shoulder. "She's fighting hard, and we know what is happening. She just needs time for the steroids to work." She had lost almost 2 pounds in the past 5 days, and she had only weighed 14 pounds to begin with.
Maggie went back at the clinic the next day. Her PCV was now 14. I took her back home, but couldn't get her to eat. She was on huge amounts of prednisone, and we just sat and stared at her, waiting for her to turn that important corner. The next two days showed a little progress, but on Saturday, Maggie's PCV was down to 10. She got another after-hours transfusion. Jack was no worse the wear, but my husband, Don, estimated that Dr. Rick was putting in about 2 hours of over-time per pound of dog. Finally things started turning around and Maggie started eating again. Her PCV crept slowly up 22, 28, 39. The grandkids could walk their little fur-sister in the park again. My daughter came home from the hospital.
A month later we tapered Maggie’s prednisone for the first time. We all held our breath. Her PCV held steady at 40, then climbed to and stayed at 47. One more month and we reduced the prednisone again. So far, so good, dog-wise. But our daughter, Joy, was back in the hospital. It came time to taper Maggie's medicine again. I balked. I couldn't do it. Life was dishing out more than I could handle, and I needed that little love sponge more than ever. Dr. Rick put his hand on my shoulder. "We can wait. There's no reason to hurry." A month later, our worst nightmare came true. We lost our beautiful oldest child, and our 3 "too-young-to-have-to-go-through-this" grandchildren lost their mommy.
7 months after Maggie’s AIHA diagnosis, she was weaned off the last of the prednisone and Imuran. She is back to her happy-go-lucky self. The grandkids take her to the park, sneak food to her under the table, and say "I'm glad she didn't have to go to heaven with our mom". We still hold our breath and watch her out of the corner of our eye, as the kids tear around the yard with her. Maggie gets periodic blood work and we check her gums so often, she thinks there is something wrong with them.
Dr. Rick doesn't think he went "above and beyond" in caring for Maggie. He treats all his furry, feathered and scaly patients with the same devotion and generosity of spirit. That is what makes him a special kind of doctor. He is an old-fashioned country vet in the best sense of the term. He runs a tiny clinic in an older building on the outskirts of town. He "opens the shop" on a Sunday, drives 10 miles out of his way "on the way home", and comes over at 9 o'clock at night to check on his patient. He lays awake at night trying to solve a puzzle. He runs a dozen samples of dog blood to a human lab. He uses all the tools at his disposal, but he knows they are only tools. He doesn't rely on "the lab work is normal", or offer pat phrases like "she's resting comfortably" or "don't worry". He uses that vast computer, the human brain, and his wealth of knowledge and critical thinking skills gained over 30-some years of practicing animal medicine. He offers comfort and calm by worrying along with you, and he practices medicine with his head and his heart.
Editor’s Note:
A week after Dr. Shackelford was named the winner of the 2008 Meisha’s Hope Award, I received the following email from Carolyn Watts.
"It is with the most profound grief that I tell you that our little Maggie died suddenly on Friday, January 9, 2009 . She developed a rapid onset of a neurological condition resulting in unstoppable seizures. Dr. Rick was out of town for the weekend, at a family member's funeral, so we went straight to the emergency hospital. After 4 hours of the ER staff's efforts to stop the seizures, we did the kind thing and put her to sleep. They ruled out any poisons or toxins, just because our house and yard are so safe, but suspected that the cause may have been meningitis, encephalitis, or some other unknown cause. We elected to not have a necropsy. We will always be grateful to Dr. Rick for helping us through these most trying times."
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