Wednesday, July 23, 2014

Day 1681

Dot started eating solid food again today. She ate a small jar of baby food yesterday, but this was the first time she has been able to hold down solid food since last Thursday. Janet and I fed her some canned chicken when we went to visit this evening and she enthusiastically devoured the entire can. If she doesn't vomit tonight and is able to pass the chicken she ate through her system, we'll finally be able to take the catheter out of her leg and unhook her from all the IV tubes.

Considering that she'd had major surgery less than 24-hours ago, Dot looked great today. Her medical team is very pleased with her progress. We continue to take things one day at a time, but if she continues to improve at this rate, there's a chance she'll be able to come home with us tomorrow evening.

Fifteen years ago, our first Dalmatian had to go through a very similar type of abdominal surgery. Spot survived, but he didn't have the advantage of the advanced medical care Dot is receiving now. I continue to be amazed at the resources veterinarians have at their disposal these days. Getting a CAT scan for Spot in 1999 wasn't even an option. The surgeon just opened him up and started looking around. Surgical techniques and medications are much better now. Actually dogs have more advanced care options than you or I do, since progress isn't hindered as much by government and FDA restrictions. Laser surgery, genetic testing, stem cell transplants, MRI imaging and much more are all commonplace in today's veterinary world.

It is terrible that Dot has to deal with the complications of major surgery and possibly cancer. She is lucky to live here in Dallas though. We have some of the best specialty care facilities in the country right here. I like to think that Dot is in the Mayo Clinic for dogs right now. Her doctors are taking very good care of her.

I'll have to admit that I'm getting some very good care myself. Tomorrow I go for my last regular  visit to the liver clinic. I will repeat all the tests I had at the beginning of my treatment, and if all looks good, I am officially cured of Hepatitis-C. Technically, I've been virus free for several months now, but these doctors are very cautious about over promising things.

We took Dash to dog training class by himself tonight. Janet thought it would be good for him to be around other dogs again. Dash seemed to enjoy himself until a cold front blew through and he sensed a change in the weather. Rain was on the way. I don't think Dot can hear the rain inside the hospital. I hope she can't anyway. She needs to get a good night's rest.

Jewel is today's Dalmatian of the Day
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Tuesday, July 22, 2014

Day 1680

Dot is resting in the ICU after a very long and arduous day. Sometimes waiting is the hardest thing of all. I could hardly breathe until I got a call from Dot's surgeon toward the end of the day. "The procedure went exactly as expected," he told me. This is as close to joy and elation as you'll ever get from a surgeon. Surgeons are extremely matter-of-fact. This is a good thing. You wouldn't want an overly emotional surgeon cutting you open. I've talked to surgeons before and I was delighted with his short message. I could tell from the tone of his voice that the surgeon was pleased. He should be. This was a difficult and somewhat risky surgery and he had succeeded in allowing Dot to move forward and continue her journey to recovery. Dot isn't out of the woods yet, but a thumbs up from her surgeon was the best news I've heard all week.

It was a very long day. I got up at dawn to walk Dash before we drove to the cancer center to have a consultation with Dot's surgeon before she was wheeled into the operating room. You have to bite your lip when talking to surgeons. He mentioned risks that I had never even considered. I trust him though. This was the same surgeon who had expertly removed Dash's cancerous thyroid without any of the complications that are often associated with thyroid tumors. Later in the day when he called to let us know how Dot was doing, he told me that he was very glad that Janet and I had been proactive and gone to the extra step of having a CAT scan. "Sometimes, this is the only way to find these tumors," he said, adding that the growth was even larger than he expected and that if it hadn't been removed, Dot would have definitely died.

As soon as we got Dot checked in for surgery, I drove Janet across town to another hospital and we got her checked in for her colonoscopy. We both have a colonoscopy every five years and today was her turn. I basically spent the day driving back and forth between one hospital and the other. Veterinary Specialists of North Texas is much smaller than the huge complex of buildings at Baylor, but it is every bit as advanced. If you have a very, very sick pet, I would highly recommend VSNT. If I was very sick myself, I would want to go to Baylor. My own liver doctors practice at Baylor and most of Janet's doctors are there as well.

The next few days are critical for Dot. Ileus is always a risk after abdominal surgery. This intestinal paralysis is usually temporary, but if the tiny muscles inside the intestines do not begin functioning again after surgery, food can't move through the intestines causing serious complications. There is always a danger that the sutures won't hold either. It usually takes four or five days before you're out of the woods with abdominal surgery. I'm going to remain positive though. Dot passed a very important milestone in her road to recovery this afternoon.

I'm glad that Dot has so many friends. Three different vets who have Dot as a patient contacted me today to check on her progress. Her medical team is larger and much nicer than mine. Sometimes I worry about what will happen to Janet and I as we grow older and start to fall apart. Dot and Dash will always have someone to look out for them. I think we're going to be on our own.

I'm not sure if we'll be able to see Dot tomorrow. She's still pretty fragile. I hope that she sleeps well tonight and that her intestines begin working normally again as soon as possible. If we're really lucky, the doctors say she might be ready to eat a little food tomorrow evening.

Pongo is today's Dalmatian of the Day
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Monday, July 21, 2014

Day 1679

Dot is going in for surgery tomorrow morning. When we visited her early this morning, there was a lot to be encouraged about. Her temperature had remained stable. Her white blood cell count was slowly returning to normal. She even wagged her tail when we arrived. The doctors were still worried though. Dot hasn't eaten since last Thursday and was still refusing to eat this morning. The specialist wanted to do a CAT scan, and told us that based on Dot's vital signs she could safely handle the anesthesia. I was worried about the anesthesia required for a CAT scan, but everyone assured me that Dot's vitals signs looked very good. We gave the OK for the CAT scan and Janet and I went back to work.

Later in the day, we got a call with the results. The doctors had found a golf ball sized growth in her small intestine and wanted to do surgery tomorrow morning. They were confident that this growth was the source of her problems. Janet and I are both reluctant to subject an older dog to surgery, but we listened to what the internal medicine specialist had to say. She told us that since the growth had not yet become large enough to perforate the intestinal wall and cause systematic infection, the chances for a successful outcome were excellent. She didn't call the growth a tumor because, as she explained, there were literally dozens of benign growths or lesions that could attach to the intestinal wall. She said that surgery on the small intestine was routine these days and that Dot would have the same surgeon that performed the thyroid surgery on Dash earlier this year.

If we did nothing and Dot still refused to eat, she would die. Even if she did start to eat, the growth in her intestine would continue to grow larger, until it eventually caused the intestinal walls to burst. Dot was still weak when we visited her this morning, but her eyes were bright, her tail was wagging, and there was no question that she wanted to go on living. As frightened as Janet and I are of major surgery, we decided to give her that chance.

I think we made the right decision. The surgeon who will be operating on her is superb and was largely responsible for saving Dash's life. The specialist took the time to explain exactly why it was so important to remove the growth now, before it grew even further and caused her intestines to rupture. When I talked to the specialist on the phone earlier in the day, I imagined that the growth she was talking about was the size of a grape. When we heard that it was already the size of a golf ball, Janet and I became convinced that we had no choice.

There are no promises when you are wheeled into a surgery suite. It doesn't matter if you are a dog or a person, there are literally hundreds of things that could go wrong. We have been through this before and it never gets easier. We made the right decision with Dash. We made the right decision with Spot. And we made the wrong decision with Greta. The key thing with any serious medical condition is that you've got to be able to make a decision. You've also got to be able to live with the consequences, even if something goes wrong. Hiding from problems and pretending that they doesn't exist is almost always the worst decision you can make.

When we came back at the end of the day to visit again, Dot greeted us warmly. I walked her outside in the grass in front of the hospital and she squatted and peed normally. We brought her favorite blanket and let her rest with us in an exam room while waiting to see the specialist again. Her doctors wanted to see if Janet and I could get her to eat something. It is apparently important to preserve normal Peristaltic movement in the intestinal tract prior to surgery. Without any food to process, there is a danger that Peristalsis could stop. Dot wasn't interested in dog food, but when we opened a small jar of baby food, she eagerly ate the entire thing. This was a very good sign. It was almost as if Dot was telling us that the surgery was OK and that she definitely wanted to live.

Tomorrow is going to be a rough day. Not only is Dot having surgery, Janet is having a Colonoscopy on the same day. Neither of these things could be postponed or avoided. I hope we made the right decision with Dot. I don't know what will happen tomorrow, but I do know what would happen if we did nothing. Dot deserves better than that.

The thought of having two dogs with cancer at the same time is both emotionally and financially draining. It's hard to believe this is even happening. It goes without saying that this has been a very tough year. Many people think of me as a negative person, but I am totally positive when it comes to the dogs. I believe in them. Dot is incredibly strong willed and tenacious. She may be old, but she loves her life and wants to keep on living. Our efforts may not succeed, but we're going to give her the best chance she's got. When she ate the baby food out of my hand this evening, I think she gave me her blessing.

Katie is today's Dalmatian of the Day
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Sunday, July 20, 2014

Day 1678

I keep looking at the last happy picture I took of Dot. Although she was just being transferred from one vet to another, she thought she was going home. Her tail was tucked under because she was still in pain, but she was happy. Dot's eyes practically sparkled as she was eagerly awaiting me to close the tailgate and get out my car keys. I'm so sorry to have disappointed her. Happy dogs make me happy and I am still sad.

We don't know much more than we did yesterday. The good news is that Dot is still alive. The bad news is that her medical team still isn't sure what is causing all the problems. I was afraid that we wouldn't hear anything at all until Monday morning, but we were surprised and delighted to receive a call today from her internal medicine specialist with an update on Dot's condition. I had initially thought that the specialist would leave Dot under the care of her support team during the weekend, but she was in the hospital herself on a Sunday morning, examining Dot and working on a diagnosis.

She told us that based on everything she knew so far, she suspected that Dot's problems originated in her liver. She thought Dot was stable and would make it through the weekend, but she still wasn't eating. This is bad. We won't know anything more until they do an abdominal ultrasound scan on Monday morning to check for hidden tumors, but there are strong signs that Dot may have acute Hepatitis, or even worse, Liver Cancer. I know a lot about Hepatitis after spending the past 30 years living with Hepatitis-C. Hepatitis can be managed and in many cases, completely cured. There are far fewer options available if you have Liver Cancer. For dogs, surgery is just about the only option, since organ transplants for dogs are still just a far-fetched fantasy. We lost Greta to Liver Cancer. We found the best surgeon available and elected to do the surgery, but it didn't work. Greta died four days later. She never even made it out of the hospital. I don't think I could subject a dog to that ever again.

I am not an emotional person, but a sick dog can still make me cry. It was hard to spend the day waiting, knowing that there was absolutely nothing we could do. I will be up at the hospital as soon as it opens tomorrow morning to visit Dot. All I can do though is hold her and hope. The next steps are up to Dot and her team of doctors. I was encouraged to hear the specialist tell me that she thought  Dot wasn't as depressed today as she was yesterday. She is still alert and engaged. That's a good sign, because she hasn't given up yet. Her incontinence appears to have stopped as well. The nurses take her out every four hours so she can pee normally. The doctor was even going to go to the store after we talked this morning and buy some fresh chicken for Dot to see if she could entice her to eat again.

I'm a worrier, but I really wish I wasn't. Worrying only leads to further worrying. I went to the gym today and cleaned all the water off the roof yesterday afternoon, knowing that lots of physical activity makes me tired. Maybe if I'm really tired, I will sleep better tonight. All I did last night was worry about Dot. Thanks for your support. It means a lot.

Lady Jane is today's Dalmatian of the Day
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Saturday, July 19, 2014

Day 1677

We had to make some tough decisions today. When we returned to the animal emergency clinic early this morning to check on Dot, it was clear that she wanted to go home. It was equally clear that her condition was becoming worse. Her temperature was still normal, but she refused to eat anything during the night and was having trouble controlling her bladder. When we took her outside to see if we could get her to pee normally, she headed straight for the car. We wanted to take her home as much as she wanted to go, but we had an appointment with an internal medicine specialist first.

The doctors at the emergency clinic had arranged the appointment with the specialist for us during the night and luckily it was right next door, at the cancer center where we have been taking Dash. The doctor we saw was very good. She did new blood work and told us that with the exception of the severe infection that was making Dot so sick, her basic vital signs were good. She also agreed with us that it was important to get Dot home to eliminate the stress and depression that was probably making her condition even worse. She thought that if we could get Dot to eat anything at all without vomiting, we could take her home for the weekend. Dot could have hamburger, boiled chicken, rice, anything she wanted. She prescribed some new antibiotics, anti-nausea drugs, and pain medication that she thought would be more effective. She explained that Dot's incontinence was caused by being pumped up with fluids and she should begin urinating normally again after she was off the IV fluids for a while.

When we asked about danger signs to look out for, she told us that the biggest near-term danger was if she became dehydrated or started vomiting. If she started vomiting, we were to get her back to the emergency clinic immediately. The doctor prepared a package of medication to get Dot through the weekend until we could bring her in for an ultrasound test on Monday morning. We really thought we were finally going home. The nurse gave Dot an anti-nausia pill in a little meatball for the car ride home. As we were walking through the lobby on our way to the car, Dot vomited. She wasn't even able to keep the small amount of food she had just taken down for a minute.

When Dot vomited in the lobby, the doctor's tone changed immediately. She said this was a potentially life threatening situation and that Dot needed to go back on fluids immediately. She recommended that Dot be kept under observation during the weekend or we might lose her. We had two choices. It was a Saturday and the cancer center closed to the public at noon. We could leave her under 24-hour supervision at the cancer center, but we wouldn't be able to visit her at all during the weekend. Alternately, we could take her back to the emergency clinic next door, where we could visit or even take her home if her condition improved. If we did this, we wouldn't have access to the veterinary specialists and comprehensive support that the cancer center provided until Monday. It was a really tough choice. If we left her at the cancer center, we couldn't even call in to check on her condition until early Monday morning. They said that if her condition deteriorated, they would call us. This was harsh, but I understood why they had this policy. The cancer center routinely deals with the sickest of the sick. All these pets owners are just as worried as we are. The doctor told us that if their overnight emergency team accepted inbound calls, and had to answer constant questions from worried owners, they wouldn't be able to provide the dedicated level of of care that their patients required. I appreciated their honesty. These were people who were more interested in keeping Dot alive than they were with customer relations.

We could do whatever we wanted, but if we left Dot at the cancer center with the specialists, we had to trust them. I brought in a blanket from the car and we sat with Dot for what seemed like the longest time on the lobby floor. I was very sad. I knew Dot wanted to go home. I also knew that these doctors saved Dash's life. They are amazing. We finally decided to leave her at the cancer center over the weekend, even though there is a small possibility that we will never see her again.

I have to remember that Dot's basic vital signs are good. These doctors are the very, very good. I have seen how quickly a dog can die if help is not nearby. If she was at home over the weekend and we had to get her back to an emergency vet in a hurry, there's a good chance we wouldn't make it.

It's going to be a very long and very lonely weekend. I know that Dot is not ready to die. If anyone can save her, she's in the right place. Please keep her in your thoughts this weekend.

Jade is today's Dalmatian of the Day
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Friday, July 18, 2014

Day 1676

Dot took a turn for the worse today. We were really optimistic this morning. When we picked her up at the emergency clinic at 7 AM, her fever had subsided and she was a lot more steady on her feet. Dot looked like she was getting better. We had to take her back to our regular vet for the day, because the emergency clinic is only open at night. Dot's regular nurse called around noon to say that she was eating solid food again. This was encouraging too. It was only at the end of the day when our vet did new blood work that we realized her condition had actually gotten worse.

Dot's white blood cell count has significantly increased during the day, while her liver enzyme levels have gotten worse. This is not good! What it means is that the inflammation within her body that is causing all the problems is not being effectively controlled by the antibiotics or anti-inflammatory medications she's currently taking. Janet and I really thought we'd be able to take her home with us this evening, but since her condition was deteriorating, we went straight back to the emergency clinic instead.

She is spending the night hooked up to IV tubes again. Tomorrow morning, Dot will see an internal medicine specialist at the same cancer center where Dash is being treated. We stayed with her tonight at the emergency clinic until she got sleepy and was comfortably settled in for the night. I wish I could have just pulled up a cot and spent the night with her, but that was not allowed. I hope she sleeps peacefully and shows just as much improvement tonight as she did last night. One of the vets we talked to today told us that the anti-inflammatory steroids she was given today can cause a temporary increase in white blood cell levels. I hope that is all that's going on. Dot's escalating white blood cell levels could mean something far more serious.

It has been a very long day. I got a lot of website work done, but I was really just sitting by the phone all day waiting for updates from the vet. It is frustrating that nobody has been able to pin down the source of the inflammation so far. I've talked to a lot of people too. If we knew what was causing the problem, it would be much easier to treat it. I'm really hoping that the internal medicine specialist we're seeing tomorrow can shed some light on this mystery before Dot's condition becomes even worse.

Dot's sudden illness is the last thing I expected. Sure, she's old, but she is the healthiest Dalmatian we have ever had. I guess in some small, unrealistic corner of my mind, I kept thinking she would live forever. I"m hoping for the best this weekend, but things don't look good now.

Beemer is today's Dalmatian of the Day
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Thursday, July 17, 2014

Day 1675

What a difference a day makes. This morning Dot seemed fine. Now she's hooked up to IV tubes at the emergency vet. We still don't know what's wrong. The day certainly started out normally. Dot ate a good breakfast. We took a nice walk. It was just an ordinary Thursday. After lunch, I let the dogs out in the back yard to pee, and then Dot took a nap by my desk, just like she usually does every day.

I became alarmed when she didn't get up again. Instead of following me back and forth around the house like she usually does, she stayed under the desk, panting heavily and appearing visibly uncomfortable. When she still refused to move and wouldn't eat her favorite treats after I let her rest for a while, I called her vet. Actually, I called all her vets, because she has several. When an old dog refuses to get up and isn't enticed by food or water, you really start to worry.

After a quickly scheduled exam, which included x-rays and new blood work, we discovered that she had an unusually high while blood cell count and was running a high fever. This usually indicates severe inflammation or infection. There were no immediate explanations as to how her condition could have changed so rapidly, but everyone agreed that the most important thing was to get her fever down and get her on some antibiotics and anti-inflammatory medications. The vet thought that she might have a bacterial infection, a virus, or even pancreatitis.

Dot needed to be on intravenous fluids so she wouldn't get dehydrated, antibiotics to fight the infections, and pain medication to relieve her obvious discomfort. To get this kind of care, we needed to take her to a 24-hour emergency vet. She is resting at the emergency vet now. Her fever has subsided a bit and after further testing, we now know that she does not have pancreatitis. Hopefully we will know more when we pick her up in the morning to take her back to our regular vet. The emergency clinic is only open at night when regular veterinary hospitals are closed. I hate to haul her back and forth like this when she's sick, but there is really no choice.

Hopefully we will know more in the morning. It's possible that she might have a type of cancer that is undetectable in the early stages. I'm going to be optimistic though. I'm hoping that she has an easily curable bacterial infection that she got from eating something bad. All I know now is that Dot is very sick.

Riley is today's Dalmatian of the Day
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Wednesday, July 16, 2014

Day 1674

Someone has been sprinkling ground up bits of broken glass along several of the paths in the park. I don't know if this is to cause passing bicycles to have flats, or an effort to hurt animal paws, but it is definitely malicious. One more thing to look out for every morning. This city is wearing me down. Daydreaming is one of my favorite things, but it's just not as easy to absentmindedly daydream during our walks anymore. There's always something to look out for.

Dot worried me today. She was very slow and a bit stiff on our walk this morning. You could tell she wanted to walk, but just didn't have the energy. She went to sleep as soon as we returned home, but even her sleep wasn't restful. She kept changing position and groaning occasionally as if something was bothering her. There were no visible injuries. She was breathing completely normally. And she didn't appear under any stress. She just seemed tired. I'll ask the vet to check for any hidden warning signs, but I think she's just getting old. I know how she feels. It doesn't take much to wear me out either.

We don't get much mail anymore. I used to always look forward to getting the mail everyday, but the steady stream of magazines, circulars, and catalogs has almost come to a standstill. I think the battle for shoppers hearts and minds is over and that Amazon has won. Practically the only thing I get in the mail these days are bills to pay. Even the bills come with admonitions and enticements to get me to switch to online payments. Switch to online payments and we'll give you a $25 Starbucks card they say. No thanks for now. I still like printed statements. I prefer reading a book to looking at the same thing on a Kindle. I'd still rather read a magazine than visit a website. My days are numbered though. I've become a dinosaur.

A few more observations about my day at the courthouse yesterday. I think you can divide people into two categories. There are the ones who check their e-mail and texts obsessively. And there are the others who play Candy Crush Saga obsessively. I hate waiting and paced up and down the courthouse halls all day while the lawyers were deciding what to do with us. I was virtually the only person walking around though. Most people were just sitting on a bench and staring at their phones. They couldn't leave them alone for five minutes. It's kind of sad. I suspect the smart phone has already had an even larger impact on society than the automobile. For the Millennials, the phone has actually replaced the automobile as the iconic object of their generation.

Even though Dot was tired today, we still took both dogs to training class tonight. Dot spent most of the evening sitting in the grass with Janet, while Dash and I went through the exercises. Dot was happy. She doesn't like to be left out and there is no reason to leave her out of anything. We'll all just slow down a bit and let her enjoy her remaining days

Laura is today's Dalmatian of the Day
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