To whom it may concern.
This email letter is to certify that the dog Gregorio, from Mrs. Hess, that was brought in complete healthy state to Switzerland recently, is in a very serious condition associated with a lot of suffering and pain.
Please let me explain what happened to Gregorio in the last few days.
The problem started with a minimal lesion in the inguinal area next to the scrotum, and within a very short period of time involved the whole inguinal area, scrotum, and tissue down both hind legs.
The lesion is characterized by massive tissue destruction and tissue loss. There were gas inclusions subcutaneously deep down both hind limbs.
After initial ultrasonographic examination, later also a computed tomographic examination was carried out to rule-in or rule-out any treatable underlying cause, e.g. a foreign body. No underlying cause could be found. Therefore, it is our suspicion that a very aggressive bacteria has infected this dog, similar to a disease known and feared in human medicine, where similar aggressive bacteria penetrate the skin, sometimes even without important trauma, with very fast tissue destruction, and where amputation of limbs maybe the only way to stop the disease and to save the life. (Amputation is not an option in this dog, because the lesion starts in the middle of the body.)
Additional lesions in Gregorio include diffuse ecchymotic (patchy) subcutaneous bleedings in the rear half of the dog´s body. These lesions are due to severe thrombocytopenia (initially 17´000, decreased to 3´000; normal more than 200´000), probably due to septicemia and disseminated intravascular coagulation.
An additional problem in this dog is severe pancytopenia, i.e. besides very low platelets also very low white blood cells (600/ul; normal around 6000-12´000/ul) without any formation of new young white blood cells, and very low red blood cell count (Hematocrit 14% on Wednesday). This problem worries particularly, because apparently in spring of 2010 the dog already had had thrombocytopenia and anemia. The question arises, whether a very important bone marrow disease was latently present before, and the lack of white blood cells fascilitated the development of the infection. The important thing is, that many dogs with severe bone marrow disease die, even without such severe and diffuse infections.
An additional new problem is, that on radiographs of the lungs, lesions were detected suspective of a pneumonia. In a dog without any immune defense that is constantly recumbant, such a complication is feared.
The situation of the dog now is the following: all the dead tissue had to be removed, there is a large area in the inguinal-parascrotal area without any covering skin. This lesion is very painful, and therefore the dog is receiving a constant rate infusion of fentanyl, an opioid pain killer. The dog does not produce blood cells. The dog has evidence of a new pneumonia.
The chances of this dog to survive the combination of these problems is very small. More importantly, even if Gregorio did not succumb to septicemia or DIC or associated with lack of all blood cells, he has no life quality and will not have life quality for many weeks with absolute need of most intensive care.
The intensive work and money involved are in my perception not the primary problem, rather ethical considerations should supersede. It does not seem justified to continue the treatment in this dog considering his current suffering and at the same time a very poor prognosis for complete recovery or even survival.
I very highly estimate your concerns and your willingness to do everything for this dog and for other dogs, and it is always my and my coworkers intent to try the best for our patients. However, in this patient with his condition and poor prognosis, I would like to ask your permission to euthanize Gregorio as a last favor to him. It is unfortunate that you can not see his condition, however, I hope very much you trust my observations and thought processes.
Sincerely