Just about two months ago, we took our three Miniature Schnauzers — Jax (the white one), Sheba (the black one) and Manny (the gray one) — to the vet in Castelo Branco for their annual inoculations and rabies boosters.

We live in Portugal now, since relocating from the USA about four years ago.

Anyway …

When the doctor examined Mister Manny, as we call our little boy, she became very concerned: his eyes and mouth were yellow, indicating hepatitis of the liver. She took blood tests and ultrasounds, which confirmed her diagnosis. To us, she said, “Manny is very, very sick. The liver is one organ that can’t regenerate itself or be repaired.” Handing us six different prescriptions — some pills, others to be given orally by syringe orally — she told us Manny did not have much time left and that we should prepare ourselves.

Over the next six weeks or so, Manny went from bad to worse: He didn’t eat. He drank lots of water. He was tired all the time. He couldn’t control himself. We went to our home in another area of Portugal, with our vet urging us to find a vet in the area quickly and to take Manny in. We did. This vet, too, told us that Manny was in very, very, poor condition and that the end was very near. By this point, the skin under his fur was beginning to turn yellow, too. After prescribing two more medications, she said, “You will know when it is time to take a different course of action.”

Needless to say, we were heartbroken. What we wanted and needed from the pragmatic vets was hope—something to hold onto. But they tell it as they see it here in Portugal.

All three of our dogs suffered from pancreatitis and had always been fed high-quality, low-fat foods. But this was different. Different and deadlier.

After the fourth visit following Manny’s initial diagnosis (and prognosis), his condition further deteriorated–despite the number of medications we fed to him. His sweet and outgoing spirit, along with all aspects of playfulness, were nowhere to be found.

We believed his time had come, after nine years.

Our little boy exhibited all the signs of end-stage liver failure. Hadn’t the veterinarian told us, “You will know when it’s time”?

Joana Rodrigues, his groomer and owner of 4Patas in Elvas, had come to love Manny and contacted us frequently to ask how he was doing. When we told Joana that we were planning to take Manny to the vet for euthanasia the next day … and then drive to Setúbal for cremation, she had another suggestion:

“The animal hospital in Portalegre should see Manny. How can one more opinion from another veterinarian hurt? If the vet agrees, the hospital can perform the euthanasia. They have an agreement with a crematorium in Lisbon to pick up the body for an individual incineration, returning the ashes to you in an urn.”

Portugal laws require a death certificate from the veterinarian and a “disposal” (of the body) form to be delivered to our local junta.

Despite our tears flowing like the Tagus River, we were quite impressed with the VetAl hospital facility and staff. Everyone — veterinarians, nurses, staff members — spoke English and were quite compassionate. After a few minutes, the veterinarian came out to the waiting room where she sat next to us, reviewing the treatment, medicines, and diagnoses Manny’s vets had provided.

“I will do as you wish,” she began. “But I must ask you if, first, we can keep Manny here in the hospital for three-four days. I understand everything his veterinarians have done … but they aren’t a hospital. We are. There are tests and procedures we can do here that they can’t. Will you allow us to try?”

Once again, our hearts skipped a beat. We drew upon the last bit of hope that we’d held in reserve and left Manny in the care of VetAl do Alto Alentejo.

Manny’s treatment consisted mainly of feeding him by IV and taking him off almost all the medications he’d been taking. And lots of prayer from many people attached to Manny.

“He’s doing much better,” the animal hospital reported to us by phone. “His swollen abdomen has gone down … he is eating, as well as drinking … he’s standing … and his excretory tract is functioning. You should come and see him.”

That we did.

Indeed, he was better. But still not the happy-go-lucky, active and spirited little schnauzer whom we’d adored for nine years now. The doctor told us that this was to be expected, as Manny was knocking at death’s door when we brought him there four days earlier. But he was obviously better … better than he was. Even if his little, misshapen body was bones and fur without flesh or fat.

Two days later, the veterinarians took new blood tests and compared the results with his earlier ones. Had the “bad” numbers gone down and the “good” ones up?

Manny continued to have elevated bilirubin and alkaline phosphatase values, but the doctor said that was quite normal at this stage of the disease. His Albumin and phosphorus levels, however, already were normalizing; his other vital levels were doing better, too. He no longer had a swollen belly, he seemed happy, and took strolls on the street led by hospital staff. And, unlike earlier, when we had to add fiber pellets to his food for solid stools, he was producing much better than he had in a while.

The hospital was very pleased with Manny’s progress.

We brought him home two weeks after we had taken him there to be given his last rites.

Honestly, we believed the vets at the animal hospital would tell us that Manny would never again be the same dog that he had been before his liver catastrophe. Nonetheless, he could survive and live a happy and peaceful life with us … although, for how long, we wouldn’t know.

The subject didn’t come up.

Instead, the vet went through the goodie bag prepared for our little boy containing his hospital records and laboratory tests, five different medicines (most different than the eight we’d been giving him earlier), and two cans of special low-fat, gastrointestinal food which we were to feed him – as much as he’d eat – twice daily.

Manny came home with two cans of food. He had developed an appetite–more during his afternoon feeding than the morning. Soon, we realized that we needed to get more … as quickly as possible. First, we went to Rockipets, our go-to source for specialty dog foods in Castelo Branco. They didn’t carry the brand, but could order it for us. Normally, the order would be delivered the next day. But this was Tuesday and Thursday was Corpus Christi, a national holiday. Everything would be closed and orders backed up. The delay could extend until the weekend–or later. We called our vet, who also was out of the food. “We only carry it by special order,” she said, promising to have it the following Monday when Manny was scheduled for his check-up and examination. Now, we were getting worried, as we heard the same story from every veterinarian we contacted in the Castelo Branco region. Out of desperation, we posted large pleas for information leading to the food on our two local Facebook groups. A good friend located four cans of it at her vet in Fundão, about 30 minutes away. We called to confirm and reserve the food, then jumped in the car and headed north on A23. Soon, we were back home with one large (400g) and three small (200g) cans, which lasted through the weekend.

Slowly but surely, little misshapen Mister Manny was returning to his former self. He followed us around, everywhere. He licked his big brother and sister, as they returned the love while they curled up together. He went out in the backyard to do his business, which was consistent and normal. He began talking to us again in that strange gargling voice, on its way to becoming louder and stronger. And with his historic “tap, tap, tap,” he’d use his paws plaintively, asking to be picked up and placed in our laps. Expressing some interest in his baskets of toys, he’d soon be shaking them ferociously and playing tug of war with the others.

People ask us, “How much did you spend on his health care?”

Truth be told, it must have amounted to about €1,500 (about US $1,850) … all things considered, since he had been diagnosed with a failing liver about four months ago. Much more expensive than human care, which is universal and subsidized by the government here. Still, if cost were the issue, we would have spent probably four times that amount in the USA. And, even if health care for pets isn’t covered in Portugal, it is tax-deductible. For us, however, providing the best possible health care – and hope – for our Miniature Schnauzer was worth whatever the price tag.

After all, Mister Manny went from being malignant to a miracle.

And, for that, we are indebted and grateful.

Whether the miracle lasts a month or years, the joy of having our lively little boy back with us again — after everything we’ve gone through — is well worth it.

Shared here are personal observations, experiences, and happenstance that actually occurred to us as we moved from the USA to begin a new life in Portugal and Spain. Collected and compiled in EXPAT: Leaving the USA for Good, the book is available in hardcover, paperback, and eBook editions from Amazon and most online booksellers.