A topsy-turvy litter of little black duck-hunters-to-be. Two daughters with bright smiles and waiting arms. A devoted husband and doting dad, now gone from cancer, waiting patiently to learn which pup his girls would pick to become his canine companion on the Mississippi waterways.

This is the poignant memory that buttressed Giselle Thibaudeau Munn as she struggled with whether the Labrador her family named Pepper more than six years ago should be driven 12 hours to the NC State College of Veterinary Medicine for the only treatment that could save her waning life.

The day before, Pepper had eaten muscadine grapes from the family’s yard, and despite the best efforts of a local veterinarian and hospital, the grapes had ravaged the dog’s kidneys so badly that fluid had built up in her body and dialysis became her only path forward. 

When her veterinarian called to ask whether to refer Pepper to NC State, Munn coincidentally was already in Raleigh caring for a hospitalized relative. NC State is the only veterinary hospital between Florida and Washington, D.C. that offers pets extracorporeal therapy. 

“I’m falling apart, and thinking about the logistics of what would happen, and it was all a nightmare,” says Munn, who told the veterinarian she needed to call her daughters first. “And my girls just took control. They said, ‘Mom, we’re gonna do this cause Daddy would have wanted you to do it. And this is how we’re gonna do it.’”

Giselle Thibaudeau met Ian Munn at Mississippi State University, where she currently is associate dean for research for the College of Arts and Sciences. Her husband, whom she describes as “a very special, lovely, kind, amazing, one-of-a-kind human being, man, husband, father, friend, and best-buddy (duck hunting and just every-day pal) to Pepper,” was associate dean in the College of Forest Resources when he passed in 2023, having earned his bachelor’s from the University of North Carolina at Chapel Hill and a Ph.D. in forestry economics from NC State University.

On the phone, her younger daughter Mary Katherine, who lives in Mississippi, insisted she would drive Pepper to Raleigh. Later, when it became clear Pepper might be hospitalized for weeks, she devised an elaborate schedule so that one of the three women would always be in Raleigh to comfort Pepper — and, turns out, to revere Dr. Zsofia Vigh.

“I’m telling you, my daughter fell in love, like, very quickly with this woman,” says Munn, who met Mary Katherine and Pepper at the NC State Veterinary Hospital when they arrived near midnight. “She didn’t say it’s gonna be fine. She was extremely straightforward but kind and went through what was going to happen.”

Vigh, who is serving a fellowship in advanced emergency critical care and extracorporeal therapies, had been in contact with the Munns and was waiting for Pepper at the hospital.

“Unfortunately, with raisins and grapes, we do not have a lot of case reports, but it doesn’t really have a good prognosis,” Vigh says. “They can have a kidney injury, which is not always reversible. We gave like a 50-50 chance, but we warned them that this can be even less if the kidney is not responding.”

Up and Down Days

Due to the toxins, Pepper’s kidneys were unable to function, and they needed a break to recover. When Pepper was admitted to NC State, her BUN (blood urea nitrogen) level was 165 mg/dL and her creatinine was 16.8 mg/dL. Normal BUN levels for dogs are between 10 and 30 mg/dL. Creatinine should be between 0.5 and 1.6.

Vigh told the Munns that Pepper might need two weeks of treatment with up to 10 rounds of dialysis until she could tell whether the kidneys would be able to regain some function. During each dialysis treatment, the patient’s values drop, but then rise again like a roller coaster. The question is how high.

The women told Vigh to try everything.

“Because the kidney is not doing its job, all of the waste products back up, and the patient gets really sick,” Vigh says. “Before the kidneys actually have time to recover, many patients die. What we are doing with dialysis is technically taking the job over from the kidney. We are removing excess water, we are maintaining the electrolytes, like sodium, potassium chloride, and then we also are removing the waste products.”

When it comes to nephrology and urology, NC State has been a national leader in advancing the specialty, which the AVMA American Board of Veterinary Specialties conditionally approved as its own college in 2022. Dr. Shelly Vaden, professor of internal medicine at the NC State College of Veterinary Medicine, is the inaugural president of the resulting American College of Veterinary Nephrology and Urology, and NC State hosted the group’s first Lower Urinary Tract Symposium this month.

At NC State, extracorporeal therapy, including hemodialysis, hemoadsorption and apheresis for the management of renal failure, immune mediated diseases or toxicity, has been available for dogs and cats since 2013. Though tied closely to nephrology and urology, the Extracorporeal Therapy Service operates independently.

Pepper, a Master Champion duck hunter, surprised everyone by needing only three dialysis sessions and 19 days of expert care from the hospital’s nephrology and urology team to put her on the road to recovery. 

“Nephrology and urology were the ones who actually managed Pepper’s whole case during the hospitalization,” says Vigh, who praised Dr. Kimberly Kurdziel, a post-doc internal medicine resident, for how she managed Pepper’s care. “They are the ones doing all the necessary workups and administering the medications and treatments.”

Also there for Pepper was Munn. 

A Deep Dedication

Every morning, someone from NC State would call and give her a Pepper update and tell her what procedures to expect that day. And every day Munn would travel to NC State and sit with her pup, often on a blanket under a tree, read to her and play music.

“Dr. Zsofia laughed every time I told her this, but Mary Katherine made me promise that at least twice during my visit, I’d play this sapien music, they call it energetically tuned kidney regenerative music,” Munn says. “I swear I have the healthiest kidneys now because I put the phone in my leggings pocket.”

The two became a fixture on the veterinary campus.

“She encouraged her to eat and just made sure that the dog knew, because two or three weeks can be a long time, what happened, why isn’t Mommy here,” Vigh says. “She came in every single day.”

Munn has equal appreciation for Vigh’s dedication to her dog. When it was happily time to release Pepper, Vigh actually popped into the hospital on a day off to say goodbye and to make sure Munn had what she needed to care for Pepper, who will always have an kidney disease managed mostly with diet.

There are theories but no definitive explanation for why grapes and raisins are so toxic to dogs, Vigh says, but owners should always consider ingestion an emergency.

Now Munn has new memories to bolster her: the hospital receptionists who were always so kind, the NC State workers who oohed over Pepper as she sat on the blanket outside, the doctors who weren’t even caring for Pepper who checked on her and cheered her on.

Once Pepper was safely home, Munn sent an email to “Dr. Zsofia, Dr. Kurdziel, Erica, Nicole, Mary and the entire Dialysis and Internal Med teams,” thanking them for the medical attention and compassionate care they lavished on Pepper from the moment she arrived at midnight on a Wednesday until she left nearly three weeks later.

 “I also know that Ian (my sweet husband and Pepper’s best buddy) would feel the same as I do,” Munn wrote. “And for that, I also thank you.”