The first time I saw Mugsy, he was under anesthesia, prepped for surgery; huge patches of skin over his legs, chest and flanks were beginning to slough and surgical intervention was required. “Is that what I think it is?” I asked Dr. Khorzad, the ER attending in charge of the case.
“Yep. Necrotizing fasciitis,” she replied, avoiding the more sensational and fear-mongering synonym: “flesh-eating disease.”
Mugsy was a gregarious, four-month-old male Shar Pei who had suddenly developed a dime-sized swelling on his chest.
“I thought it was just a bug bite,” said Mugsy’s owner, Chuck. But within 24 hours, his boisterous puppy had collapsed and become septic, and he was in excruciating pain.
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Though the media plays up the concept of invisible bugs munching their way through tissue, the disease typically starts out with a minor injury, or even no identifiable trauma. Bacteria inoculated under the skin produce toxins and protein-destroying enzymes capable of cleaving skin from underlying fat and fascia.
“Now he’s doing better,” said Khorzad, as one of our residents began removing dead and dying flesh. “Good job I didn’t reach the owner when I wanted to put him to sleep.”
Her comment sent me backtracking through Mugsy’s history to discover how a failure to communicate had saved the dog’s life.
Shortly after his admission, Mugsy had taken a turn for the worse; his blood pressure plummeted and his pain became intractable. Given his blood work, clinical parameters and response to therapy, Khorzad was convinced that Mugsy could not survive. Ready to recommend humane euthanasia over suffering, she called Chuck, urging him to get to the hospital as soon as possible. But Chuck didn’t pick up. Every call went to voice mail.
It turned out that Chuck was in the middle of a “Tough Mudder” event, running up and down an intense army-style obstacle course in rural New Hampshire. When he finally listened to his messages some five hours later, he jumped into his car and headed straight for the hospital, still covered in mud. Amazingly, by the time he arrived, Mugsy had done the unthinkable. His puppy was more comfortable and his fever was beginning to subside. Mugsy actually wanted to eat.
Chuck told me, “When we first came through the ER, I lay down with him and said, ‘If you’re going to fight, I’ll fight with you.’ As weak as he was, he placed his paw on my hand. I knew he didn’t want to give up. During the race, I wore an armband with his name on it. I didn’t know whether I would be strong enough to complete the course, but I reckoned that if Mugsy could fight, then so would I.”
Roughly one in four people die from necrotizing fasciitis; many are subjected to multiple surgeries, including limb amputation. Fortunately, in dogs, nearly 90 percent survive. Mugsy required only one major procedure, managed to keep all four legs and came back to make a full recovery. Today, he is a healthy one-year-old, with a few lengthy scars to show for his brush with death.
I asked Chuck and Dr. Khorzad what they learned from the five hours that made all the difference.
“I know what would have happened,” said Chuck, “but Dr. Khorzad was always totally up-front with me. A while back, I got in a car accident and damaged the tendons in my hand. Doctors said I’d never catch a baseball in a glove again. Guess what?”
Chuck didn’t dwell on the kismet of being incommunicado. It was enough to be an optimist, a fighter—and, as he said, “it’s not over ’til it’s over.”
I know how it feels to see a dog you had given up on, a lost cause, come back from the brink of death. It’s a humbling and haunting experience. Dr. Khorzad did not make a mistake. Hindsight is not a prognostic tool. She made a call in real time, and as I see it, her fallibility defined her honesty, prioritized her desire to stop suffering. She saw the lesson as a new perspective on future cases.
“As the years pass, I am more and more willing to give a chance to the cases that have a low chance of recovery.” It’s the mindset of a clinician who never ceases to be amazed by the power of canine determination. It’s the silent whisper in an ear, the invisible tap on the shoulder, the reminder that—as was the case with Mugsy—it’s not over ’til it’s over.