Homecoming

On September 28, 2008, four days after checking in at the NWVS to undergo an operation to repair his liver shunt, Curly Joe came home. He wasn't all that excited to see us when we picked him up, but he was pretty gorked up on codeine, so I wasn't insulted. He slept a lot the next couple of days, but his appetite was good and he was obviously happy to be home. I had to tether him to heavy objects a lot of the time because the urge to chase cats proved far too great, even for a puppy with 18 staples in his belly.

His recovery went really well, considering what dire straights he'd been in just a few days before. When his pain meds ran out, he had one bad day and then he was back to normal.

When we picked Curly up from the vet, they gave me release papers for him:

Summary: Curly Joe had surgery with Dr. Donna Lee Taylor to repair a porto-systemic shunt. Unfortunately, the shunt was found to be intra-hepatic and could not be ligated. Dr. Taylor entered the abdomen and also the chest in attempts of finding an extra-hepatic shunt. Curly Joe had some bleeding and hypotension during anesthesia. Post-op Curly Joe was very critical and overnight after surgery, he had developed hemothorax and was administered multiple pRBC transfusions, a plasma transfusion and was ultimately given several auto-transfusions over 24 hours. About 48 hours post-op Curly Joe was much brighter and started eating on his own and maintaining his PCV count. He has severe hypoproteinemia with TS of 3.0 and Albumin of 1.3 (Albumin improved - post-op = 0.7). Curly Joe is being sent home today and will follow up with Dr. Taylor.

Medications:
1) Cephalexin 250mg capsules: Give 1 capsule by mouth every 12 hours with food. (antibiotic) Next dose is due at 8pm.
2) Codeine 30mg tablets: Give 1/2 tablet by mouth every 6 hours for pain. Next dose is due at 8pm.
3) Purchase Pepcid 10mg tablets over the counter. Give 1 tablet by mouth every 24 hours - next dose is due this evening.

DISCHARGE INSTRUCTIONS
1. Strict exercise restriction. No running, jumping or playing. Only take Curly Joe outside on a leash to urinate/defecate.
2. Monitor incision daily for any signs of redness, swelling or discharge. If any of these signs are noted, please have Curly Joe rechecked by a veterinarian.
3. Keep an e-collar on at all times to prevent Curly Joe from licking at the incision site.
4. Monitor Curly Joe closely; if he becomes lethargic, stops eating or drinking or starts vomiting, please have him rechecked by a veterinarian.
5. Schedule a recheck with Dr. Donna Lee Taylor in 10-14 days for a recheck. Please call her team on Tuesday to give us an update.
6. Please feed Curly Joe the L/D diet.

I followed those instructions faithfully (except for that minor bout of horseplay, but that was two weeks after his surgery), and recently took Curly Joe back to NWVS for his check up. As we sat in the lobby, at least two techs walked by and greeted Curly by name. He's a rock star to these people. They took him in back for the recheck and came out to tell me the doctor was thrilled with how well he is doing. I had taken him to my regular vet a few days before to have his staples removed, but was concerned about some swelling in that area. I was paranoid it was a hernia, but the tech told me it was his body's reaction to the internal sutures. She said it would go away as soon as the sutures were completely dissolved. Whew. Other than that, he was in great shape. He now weighs 26 pounds!

When we first got him, he was scrawny. His ribs were showing, his fur was patchy and he had a skin condition. I believe that the L/D food I've been feeding him, as well as the Hepato Support and 3V I've been mixing with his food has really done wonders for him. The doctor said he looked amazing and that I should keep doing what I've been doing.

The tech told me Dr. Taylor was going out of town for a week, but is still looking for other options for Curly Joe and would get back to me as soon as she found something.

Today, a little over a month later, Curly Joe continues to improve. He still has a messed up liver, but for now he is doing well. He still hasn't learned that cats hate to be chased and that he shouldn't turn his back on the geese when we're out in the yard, but he takes everything in stride and keeps me laughing with his antics. Sometimes we'll be out in the yard, and I'll look over and see Curly standing there with his front legs wrapped around Tank's neck. Or I'll go to call them in and see Tank running for the door on three legs because Curly Joe is running alongside him with one of his legs in his mouth. A leg or an ear, Curly's always got something that doesn't belong to him.

Halloween will soon be upon us, and I promised LaShea I would buy Curly a costume. I found the perfect one for him and took pictures yesterday. I will post them as soon as I get the film developed.

Until next time . . .

Riding the storm out.

September 26, 2008

Two hours after almost losing and then maybe not losing Curly Joe, my sister and I were on our way to the Northwest Veterinary Specialists to see him. I called ahead of time to let them know we were on our way, and the tech told me that they were halfway done with the transfusion and Curly Joe's blood pressure had gone down and he was able to breathe better, too. We got there at around 2:00 in the afternoon and waited in the lobby until the tech came out for us. As he led us in back, he warned us that Curly was hooked up to a lot of different things, so I prepared myself for the worst. Then he led us into the recovery room, and there was my Squirrely, lying in a big, see-through (oxygen) cage. As soon as he saw us, he lifted his head up and started whining. The tech opened the door and when I leaned in to give Curly a kiss, he (Curly) tried to get up. Sis and I settled him down, and he seemed content to just lie there on his side and sniff us. I gave him lots of kisses and told him he was a good boy and that we missed him and loved him so much. His nose was all crusty, so I could tell he'd been eating baby food.

While I was wuzzling him, I heard Sis tell the tech that he looked good. The tech said, "He looks a whole lot better than he did this morning." That made me feel a little better.

And honestly, he didn't look nearly as bad as I'd feared. He was covered in blankets, but there was no way I was peeking under them. I didn't want to see his incision. Not yet. He was alert, but you could tell he was uncomfortable. They had him on good pain meds, but still. Something like that, he had to have been hurting a little bit.

Curly whined almost the entire time we were there. Sis and I took turns petting and kissing him, though we were nervous about all the wires and tubes running into him. He had a pulse oximeter attached to his paws and one of the nubs came loose. As I was petting him, Curly Joe saw the stray nub and immediately tried to eat it. Luckily, the tech came by and put it back in place and Curly forgot about it. Surely he couldn't be that bad if he still wanted to eat plastic, right?

We wanted him to get a lot of rest, so we didn't stay long. Three hours later, I called the doctor. She said she was standing there looking at Curly across the room from her and he was napping. She said he'd had a good afternoon and had taken a lot of naps. He hadn't gotten all of his blood yet (it's good for 24 hours) because they wanted to check his PCV and then give him some food first. So he was resting comfortably. His respiratory rate was still high, but not as high as it was. She said that just by looking at his respiratory rate, she didn't think his chest was filling with blood again, but they would take some radiographs later just to make sure. She put me on hold to check his chart and then told me that his PCV was 22%. She wanted him in the high 20s, low 30s. He wasn't on any blood pressure support, which was good news. "He was not happy with us after the chest tap," she said. "Before that, he would wag his tail at us. Afterwards, he stopped, but he's starting to warm up to us again." I've done chest taps before. Animals DO NOT LIKE IT. It's hard work on everyone involved.

She said he definitely wasn't out of the woods yet. At least there was no horribly bad news that time. She said in 10-15 minutes, when he woke up from his nap, they were going to feed him and then finish the transfusion. Isn't that cute? Wakes up from his nap. It's like he was at daycare instead of fighting for his life in an oxygen cage.

At midnight, I called the hospital again and spoke to the tech taking care of Curly Joe. She said he was bright and alert and had been walking around outside and going potty. His blood pressure was even better that evening and he'd been eating well. She said he wasn't out of the woods yet but was showing some improvement. HIs PCV was only 25%, which was the low end of what they wanted for not needing a transfusion. They wanted him in the upper 30s, lower 40s. They had one syringe of blodo left on reserve for the autotransfusion, if he needed it. He wasn't having any trouble breathing, so I took that as a good sign that the hemothorax wasn't returning.

When I had spoken to the doctor earlier, she told me that, if we could get Curly Joe past this, then we could manage his health with diet and medicine until she could find someone who could address his problem. She knows there are doctors who specialize in super sucky intrahepatic shunt problems; it's just a matter of doing some research.

I thought that was really promising. Surely she wouldn't be saying that if she thought Curly had a short life expectancy outside of surgery.

I called the hospital again when I woke up the next morning. The on-call doctor told me that Curly Joe was doing very well that morning. He'd been eating a lot and was in good spirits. They didn't have to give him the second transfusion, and as of 6:00 that morning, his PCV was at 30%. The best news was, they said he would probably be able to go home the next day.

We went to visit Curly Joe again but couldn't make it out until that evening. We got there at around 8:00, and when I told the receptionist who we were there to see, her face lit up and she told us what a sweet little dog he was and how he climbed into her lap when the techs were cleaning out his cage. After a few minutes, a tech came out and said they were getting him ready for us and then led us into one of the exam rooms.

We waited another five minutes or so before a tech came in and put down a mat and a nice, thick blanket for Curly to lie down on. Five more minutes passed. The tech came back with a bowl of turkey for Curly, but cautioned us to feed him a little bit at a time so he wouldn't vomit. Finally, she carried Curly Joe in and put him down on the blanket saying, "Is this your baby?" He was happy to see us, but not quite as happy as the day before. I attribute this to the bowl of turkey. He fixated on it the entire time. Sis fed him a little while I took pictures, and when she put the bowl back up on the table, he would just sit and stare at it. Then he would walk around the room and look at it from different angles.

We scratched his head and doled out all the kisses from his adoring fans. He kept coming over to sit by me, so I took that to mean he was happy to see me. After a little more turkey, he let out a very dainty yet very human belch. I hugged him (gently) and was shocked to find that I was touching his incision. It extends from the (top) base of his penis all the way up to his chest. Staples all the way. After a little while, we could see in his eyes how tired he was, but he was too uncomfortable to lie down. Sis went to tell the receptionist we were done visiting, and she paged someone to come and get him. By the time she arrived, Curly Joe had managed to lie down. When he saw her, he immediately rolled over onto his back and exposed his belly for her, darting his front legs out and then folding them back up against his chest like "Pet me. Go on. You know you wanna." That's what he does when he sees somebody. He doesn't just walk up and sit politely, he falls over and exposes his belly. It was wonderful to see him do that, even if it did expose his hideous incision.

Every time the tech bent down, he would flop over, so she ended up having to carry him out of the room. He immediately looked miserable, but we gave him one last kiss and told him we would see him tomorrow. And that is how our visit went.

FYI: This website has an animation that shows what is wrong with Curly Joe's liver.

Up next, Curly Joe's homecoming.