She was barely two years old at the time of her death. The extensive diagnostic work-up (x-rays, sonograms, endoscopy, blood work) and subsequent necropsy and histopathology report all seemed to raise more questions than answers. Despite having access to the latest medical technology and drugs, veterinarians were relatively helpless in their efforts to arrest or reverse her deteriorating condition. Since no precedent had been set from any previous cases, the medical staff who worked with Duchess was truly entering new territory. The need for The Duchess Fund was obvious.

Duchess is not alone. Many other potbellied pigs die before their time. She is but one example of many. Veterinary medicine providers have little literature to guide them in the advanced care of companion pigs. Even though potbellied pigs have been popular as pets for years, most veterinary schools still offer little, if any, training in the care of miniature pet pigs.

When confronted with an illness in a pet pig, a veterinarian will have to use his/her best judgment in combining small animal and swine diagnostic and therapeutic techniques and then modifying them to reflect observable differences such as weight and size. Many practitioners who have cared for a number of these animals suspect that there are other as yet unrecognized factors that may mandate a course of care different from what is currently known. Even if current therapies are fully adequate, the limited data results in the practitioner taking a conservative approach, and watching carefully for unanticipated side effects specific to the breed or individual. Such an approach may not always yield the best long term outcome. More aggressive therapies are not prudent unless there is much better data available as to the probable impacts (both positive and negative) of various approaches.

Our trip to Pigstock began on Friday, September 8th when four of us flew to Pennsylvania (my husband, Bob, and Janie and Bob Finck). We arrived at Ross Mill Farm in the afternoon and spent the rest of the day and evening with "pig" friends.

The Memorial Service for Duchess began Saturday morning about 9:45 AM and was attended by a couple of dozen people. Lulabelle (mother of Duchess) was wearing her harness laced with fresh flowers for the occasion. Everyone attending was given fresh flowers to hold and carry.

Susan Armstrong led the way with Lulabelle by her side. We proceeded to the edge of the woods where Duke and Duchess used to romp, play and nap as young piglets. "Trumpets Voluntary" played from the Gazebo as we walked to Duchess' favorite "playground".

Once there, I was surprised by a tripod with something on it covered up by a sheet. I wondered what was under the sheet. Susan spoke first about Duchess as she scattered some of her ashes, followed by Richard Magidson, Janie Finck, Bob Baker, me and Colleen Nicholson. Colleen read the story of Duchess' short life as communicated to Colleen from Duchess. There wasn't a dry eye to be found.

Next came the unveiling of the contents under the sheet. Much to my surprise, Becky DiNolfi had painted a large portrait of Duchess as a piglet! It is gorgeous! I wasn't even aware that Becky could paint! Then the real flood came.

The ashes scattered, words spoken, tears shed, we progressed back to the main house and I took the portrait into the General Store to be displayed there for others that would be arriving later. Here I spent some time alone with the portrait.

I printed up cards for the occasion with a large golden "D" on the front
surrounded by colorful flowers. Inside it read:

IN LOVING MEMORY OF DUCHESS OF PORK
MAY 5, 1997 - MAY 28, 1999

MEMORIAL SERVICE, ROSS MILL FARM
SEPTEMBER 9, 2000 FOR THE SCATTERING OF SOME ASHES

THE DUCHESS EXPERIENCE - A SEGMENT - HER WORK IS NOT DONE
NEITHER "HERE" NOR "THERE". HER WORK WILL BE CONTINUED
"HERE" BY THOSE WHO PERCEIVE TO HAVE BEEN ENTRUSTED
WITH IT. ONLY DUCHESS KNOWS WHO WILL BE HELPING HER TO
CONTINUE HER WORK "THERE".

Duchess Of Pork initially presented to me for evaluation of seizure activity. As a small animal internist, I approached the case with an open mind and with the basis of a basic understanding of disease mechanisms. I quickly appreciated a lack of precedent and data in the intensive medical management of the ill pig for the reason of emotional attachment rather than commercial production. I have no special expertise or experience in porcine medicine.

The differential diagnoses for seizures can be broken down into categories, specifically congenital, inflammatory, metabolic, toxic, nutritional, traumatic (vascular) and neoplastic disorders. The cause of seizures can be difficult to diagnose. One is often left to make a diagnosis by rule out, in which the most likely diagnosis is selected by disproving other causes. A solid client history rules out nutritional, toxic and some traumatic causes. A basic medical database (CBC, serum chemistry panel, urinalysis, and radiographs) would rule out metabolic causes. If the cause of seizures is not nutritional, traumatic, toxic or metabolic, then it is likely to be located in the brain. Advanced testing to rule out the remaining differentials include analysis of the cerebrospinal fluid (CSF) and a scan of the brain (MRI or CT scan).

Duchess' initial bloodwork revealed evidence of significant liver insufficiency. The end products of hepatic metabolism (albumen, glucose and urea nitrogen or BUN) were low. Bilirubin, a product of body metabolism that is consumed by the liver, was elevated. These findings indicate and inability of the liver to meet the body's needs. The presence of elevated liver enzymes indicated active liver inflammation (or hepatitis).

If the liver does not work efficiently then it is unable to metabolize protein. Ingested protein is normally converted in the liver from ammonia to urea. In cases of liver failure the ammonia remains in the bloodstream and may act on the brain as a false neurotransmitter. The result could include dementia and seizures (hepatic encephalopathy). Hypoglycemia (low glucose levels) may also cause seizures.

Although there was clear evidence of liver failure, the presence of active inflammation was actually encouraging. If the active inflammation could be treated then the liver would have the opportunity to regenerate. The potential causes for hepatitis in this case included bacterial, viral, parasitic and immune-mediated etiologies.

Duchess was placed on several medications. Enrofloxacin (Baytril) and amoxicillin are antibiotics designed to cover a broad spectrum of bacterial infections. Ursodeoxycholic acid (Ursodiol) was used to promote bile flow through the liver. Lactulose was prescribed to decrease the absorption of protein (in the form of ammonia) from the intestines. Metoclopramide (Reglan) was used to counteract nausea. Famotidine (Pepcid-AC) was prescribed to decrease gastric acid secretion. Ivermectin was administered to rule out parasites and sweet treats such as gummy bears were added to help maintain blood glucose levels. Later, chlorpromazine was added on an as needed basis as a stronger treatment for nausea.
Abdominal radiographs and ultrasound appeared to reveal evidence of a small liver for the body size, in comparison to other species. Ultrasound also revealed evidence of inflammation within the wall of the gallbladder. Unfortunately, normal radiographic and ultrasound findings for the PBP have not been identified. The assessment of a small liver was not universal.

On medical therapy, the liver enzymes initially decreased but then elevated to original levels. The secondary evidence of liver disease (low glucose, low albumen, low urea) persisted. A definitive diagnosis would rely on a liver biopsy. Unfortunately, we were unable to obtain this sample, largely due to the small size of the liver. During a second anesthetic episode, we were also unable to intubate Duchess to obtain a safe level of anesthesia in order to perform endoscopic evaluation of the stomach.

Duchess died as a result of a seizure resulting in first respiratory, then cardiac arrest. The potential causes of the seizure include a low blood glucose, hepatic encephalopathy, and complications of anesthesia from the previous day. The most likely scenario is a combination of the above three. Necropsy revealed strong evidence of chronic liver disease. Samples of multiple tissues have been submitted for pathology. The final and hopefully definitive diagnosis will depend on the pathology results.

I would like to commend Barbara Baker and others for maintaining a remarkable degree of objectivity when confronting the illness and ultimate death of a family member, such as Duchess. The approach to disease mechanisms in this species is fascinating to me. However, I am frustrated by both personal inexperience in the management of and general paucity of sound data regarding the pathophysiology of pet pigs. The network of pig owners as well as a database of the medical history, laboratory and pathology results would be a needed and invaluable resource. I hope to submit a second article to this publication discussing the final diagnosis on Duchess and potential implications for the management of personal pigs.

Neil Shaw, DVM, Diplomat American College of Veterinary Internal Medicine
Medical Director, Florida Veterinary Specialists

Up until recently, I had never experienced a human or an animal having a seizure. Duchess began having seizures a year ago (April, 1998) at about age 1. Her legs would tremble and she would go down, unable to walk. These were mild seizures and very infrequent. As months passed, the seizures got stronger and her body would quiver and her snout would pull away from her body as she lay on her side. In the beginning, she was up and off again after a few minutes back to her normal self. I described what was happening to our vet and he said I was describing seizures. He said we could do some blood work to attempt to detect the cause of them or put her on anti seizure medication if they become frequent and long lasting enough to warrant the medication. Often times, the cause is never found. The frequency seemed to get less in the Fall of 1998 but they started up again before Christmas and started getting longer and more severe. In February, she had an extended seizure lasting over 2 hours and I had to take her into the vets office for a shot of valium to bring her out of the seizure. Blood was also drawn so we could attempt to get to the cause. The results showed abnormalities in the liver function.

Following this she was referred to Florida Veterinary Specialists where she began treatment by Dr. Neil Shaw (board certified in internal medicine). The entire staff of veterinarians at this clinic is board certified, each in their own particular specialty. They recently opened up their new clinic at 3000 Busch Lake Blvd. in Tampa. They have the equipment and facility to do the most sophisticated of tests required! Initially, I had a consultation with Dr. Shaw (March 22nd) about Duchess and after he reviewed the blood work that had already been done, he recommended we repeat the blood work, get some bile acid tests, do some x-rays, ultrasound and urinalysis (to be done on April 12th with a 24 hour fast prior). April 11th rolled around and I must say, fasting a pig for 24 hours while other pigs are eating is the
PITS! I packed her up early the morning of April 12th along with blankets and a host of other items. I got her unloaded with the help of the staff at FVS and get her in the exam room and waited on Dr. Shaw. When he walked in, he commented that I appeared to be in worse condition than the pig. Yes, I was a basket case but I didn't have any idea it showed that much!! I picked her up and held her while he gave her an injection of Valium. She barely moved. I then carried her to the procedure room where we held her and Dr. Shaw drew blood. Next I carried her to the X-ray room where Isoflurane was administered so the x-rays could be done as well as the ultrasound. The ultrasound illustrated an infection in the gall bladder. The blood test results came back, again, showing liver abnormalities with elevated bile acid. He said she was in liver failure. The x-rays were sent to a radiologist for further interpretation and came back apparently normal. The x-rays were then sent to Texas A&M (Dr Bruce Lawhorn) for a second opinion and came back normal. X-rays have limited value in evaluating the condition of a liver. They are best for judging the size and location. The liver enzymes were still elevated and she was put on two antibiotics for 10 days and lacktulose syrup, two ml three times a day. Blood work was repeated again on April 26th after the antibiotics were completed. This time, there was only a 12 hour fast (much easier but still the PITS!) I, once again, got her unloaded with the help of staff and got her in the exam room. No valium was administered so the liver wouldn't be taxed. I carried her to the procedure room and held her on the table with my arms around her girth and an assistant had their hands on her rump so she couldn't back up. Duchess was such a good patient. She "sat" there and never made a sound while the blood was being drawn from her front leg by Dr. Shaw. I then carried her back to the exam room and fed her the breakfast she missed out on earlier in the day. When the results were back that afternoon, the liver enzymes were elevated even more. I was devastated. On April 30th, I loaded her up again (another 12 hour fast) and a repeat ultrasound was done which indicated the gall bladder infection had cleared up with the antibiotic treatment. An injection of Ivermectin was given to rule out internal parasites (and repeated orally 10 days later and 7 days later by me).

Beginning on May 3rd, her medications were as follows:

Lactulose 10 gm 2 ml orally three times a day
Amoxicillan 200 mg. 1 tablet every 12 hours
Enrofloxacin 22.7 mg. 1 tablet every 12 hours
URSODIOL 250 mg. 1/4 tablet twice daily (May cause nausea)
Metoclopramide 5mg 1 tsp. three times daily (this was added on May 6th
due to nausea)

She could also have Pepcid AC every 12 hours.

She was taken off the URSODIOL after a few days due to nausea. However, the nausea and sleeplessness continued and stomach ulcers were strongly suspected. She was given Chlorpromazine at bedtime to treat the nausea and help her sleep (short term medication only).

Some of these medications have side effects and one is nausea. At least one of them is very bitter so I placed the pill inside peanut butter and then froze them and then placed them inside of yogurt on top of her pellets. One morning, half way through her breakfast, she stopped eating and put her bristles up and started making little "woof woof woof" noises at her bowl. She quit after a minute or so and continued to eat. She certainly was telling that food something (maybe to quit making her sick!!!).

I cannot stress how fortunate pet owners are to have the Florida Veterinary Specialists here in our area. People bring their animals from all over the country to this clinic. It has given me a tremendous sense of relief having her tests and treatments done by Dr. Shaw and his staff. I have been with her throughout every procedure which lessened the stress on Duchess. She is deaf and very dependent upon me. Treating potbellied pigs continues to be a challenge due to the lack of medical case histories and a medical data base for them. I have launched a national seizure questionnaire so that we can collect medical history to better equip us to treat potbellied pigs of the future that are experiencing seizures. The questionnaire appeared on the front page of NAPPA NEWS and is appearing in some national potbellied pig magazines as well as pig club newsletters across the country. Thanks to everyone that is cooperating with this effort!!!!

I spoke personally with Dr. Bruce Lawhorn of Texas A&M (who heads up a swine research farm there) and Dr. Oliver Duran of Michigan State, another swine expert. They both confirmed that we are entering new territory here. Dr. Duran said most of his work relates to swine production (where the $ is) and no individual sow or boar is valuable enough to warrant these sophisticated tests be done....after all, slaughter is on their agenda.

Interestingly enough, the last seizure Duchess had was March 31st and it was about a minute in length and very mild.

Update: 5/29/99. Blood work was repeated on 5/27/99. I was encouraged because two liver enzymes had dropped approximately 50% but after talking to Dr. Shaw my encouragement soon waned. The remainder of the results remained the same indicating liver failure. In the event the immune system was attacking the liver, steroids would be given next but this treatment comes with a host of side effects. The day after her blood work was done (Friday, May 28th), she started tilting her head and going down on her side and "wiggling" then getting back up again. She was very restless and disoriented. I phoned Dr. Shaw and said to bring her in immediately. Upon arrival, he felt that she needed to be put on IV to flush her body out for 24 hours. This probably was from toxin buildup because of the insufficient liver function. He phoned Dr. Bruce Lawhorn at Texas A&M and Dr. Lawhorn also agreed that the "IV flush" was needed. They also discussed her entire medical history, prognosis and future treatment plans. She was admitted to ICU and was given an injection of valium to calm her for later insertion of the IV in her ear. I left the clinic to drive my husband back to his office and while driving, Dr. Shaw phoned me on my car phone to inform me that she went into a massive seizure followed by respiratory failure and they were unable to resuscitate her. I requested a necropsy be done and he phoned me later that afternoon to report that the liver was small, shriveled and hard and appeared to be degenerating. The gall bladder was enlarged with debris in it. There were small ulcerations inside the stomach wall. There was fluid in the abdomen which was secondary to low proteins. It was all consistent with massive liver failure. Pathology reports and a written necropsy report will follow. Florida Veterinary Services made the arrangements for cremation and having the ashes deposited into an urn for us.

I'd like to thank everyone from coast to coast for their support, friendship and compassion throughout this ordeal. Duchess was loved by everyone that ever met her and many that never met her.

In her honor, I would like to establish a Duchess Memorial Fund for pigs in the future. It is my desire to set up an interest bearing savings account with no service charge where these funds can be deposited. Ideally, an advisory board will be appointed to evaluate the cases whereby funds would be released for future necropsies and other diagnostic lab work. The mechanics of this will be worked out in the days to come. Medical histories and a medical data base for potbellied pigs needs to be established in conjunction with this effort.

Duke doesn't know life without Duchess (littermate brother) and he worshipped the ground she walked on. He would lay with her as if to protect her should the larger two pigs "pick on her". Duke has some difficult days ahead of him to adjust life without her as we all do.

THE DUCHESS EXPERIENCE - A SEGMENT. 

HER WORK IS NOT DONE NEITHER "HERE NOR THERE". 

HER WORK WILL BE CONTINUED "HERE" BY THOSE WHO PERCEIVE TO HAVE BEEN ENTRUSTED WITH IT. 

ONLY DUCHESS KNOWS WHO WILL BE HELPING HER TO CONTINUE HER WORK "THERE".

AGAIN, THANKS TO:

FLORIDA VETERINARY SPECIALISTS - DR. NEIL SHAW
3000 BUSCH LAKE BLVD.
TAMPA, FL 33614
813-933-8944


ABOUT FLORIDA VETERINARY SPECIALISTS:

They are a state-of-the-art regional veterinary referral center and provide specialized referral services as well as emergency and critical care, 24 hours a day. Their practice operates strictly by referral from the family veterinarian. They offer a full range of diagnostics and treatments in Internal Medicine, Cardiology and Neurology as well as Dermatology, Oncology, and Surgery. They have the only veterinary designated linear accelerator in Florida for radiation therapy. They provide orthopedic surgical procedures as well as soft tissue and neurologic surgical procedures including CSF taps, myelograms and intervertebral disk protrusions. They provide consultation on complex medical cases including a full range of diagnostics and treatments including ECG, Radio-iodine (I131), Oxygen therapy and blood gas determination, ultrasound, endoscopy, contrast radiography, CT scans and MRI access. Hotel accommodation information is available for out-of-town clients.


Visit their website at: http://www.F-V-S.com or email them at [email protected]

Do not stand at my grave and weep,
I am not there, I do not sleep

I am a thousand winds that blow,
I am the softly falling snow.
I am the gentle showers of rain,
I am the fields of ripening grain.

I am in the morning hush,
I am in the graceful rush
Of beautiful birds in circling flight.
I am the star-shine of the night.

I am in the flowers that bloom,
I am in a quiet room.
I am in the birds that sing,
I am in each lovely thing.

Do not stand at my grave and cry,
I am not there _
I did not die.

For anyone that has lost a beloved pet, you may find comfort in visiting the following website: http://www.petloss.com

You can also contact your veterinarian for a local pet loss support group in your area.

Background:
1992-present Pillar Pigs of the Community, a Tampa Bay area potbellied pig club that has quarterly meetings and publishes a quarterly newsletter, assists pet pig owners with care, feeding and medical issues as well as rescue/adoptions.

1994-2000 Secretary of the North American Potbellied Pig Association.

President:
Lobbies with state and local government on pet pig issues.
Meets quarterly and publishes quarterly newsletter.
Assists pet pig owners with care, feeding and medical issues as well as rescue/adoptions.

Accomplishments:

Recipient- PET PIG HERO OF THE YEAR award, January 2000, by PIGS AS PETS ASSOCIATION at the annual conference held in Ft. Myers, Florida.

Established the first law in the country to regulate potbellied pig breeders- Hillsborough County, Florida.

Helped State Health Veterinarian establish pet pig rabies protection guidelines for Florida (first in nation).

National conference speaker, last two years.

Author of numerous articles on pet pig care and issues.

Appears frequently in TV news stories.

Upcoming feature for Animal Channel: PETS PART OF THE FAMILY.

Nominated for Hillsborough County's 9th Annual Moral Courage Award for committed service to the community pertaining to pet pigs.

Recipient HAPPY HOG AWARD 1999 by Florida Voices for Animals for untiring work in Hillsborough County for the benefit of pet pigs.

Upcoming feature for Animal Planet (Pet Project) on potbellied pigs as pets and medical requirements.

Pillar Pigs recipient from the SPCA of Pinellas County, Florida for devotion to the pigs of the community.