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.

It's a boy!

On August 12, 2008, we arrived home with Curly Joe. We introduced him to Tank in the street (neutral territory), but Tank was so excited to see me, he barely even looked at Curly Joe. As for the puppy, he loved Tank instantly. A split second was all it took for Curly Joe to consider Tank one of his best friends.

I wasn't really all that surprised. I had only known Curly Joe for a couple of hours before I realized how special he was. It's hard to pinpoint, but there's something about him that just sucks people in. His eyes? His ears? The way he immediately flops over on his back for belly rubs whenever someone approaches him? His penchant for sleeping in suitcases? Whatever it was, I saw it when we walked around Boulder with LaShea and Chad, and I saw it the entire drive back home to Oregon. He is impossibly cute. Sometimes you can't even stand to look at him, he's so cute.

But I digress. It took a couple of weeks, but Tank finally climbed up out of his depression and warmed up to Curly Joe. The cats are a different story. I think Curly thinks they're puppies because every time he sees one, he jumps on it.

One of the things I noticed early on was how much water Curly Joe drank and, inevitably, how much he urinated. I'd been planning on taking him to my regular vet anyway, to find out if he had any lingering issues from being poisoned. Now I was concerned there was something wrong with his kidneys. So on August 19th, I took him to my vet for blood work. On August 20th, the vet called told me that Curly Joe's kidney values were perfect, but his liver values were off. She said it could be one of three things:

1. Hepatitis.
   
2. A shunt problem.
   
3. Leftover toxins from when he was poisoned.
   

She recommended taking him to the Northwest Veterinary Specialists for an ultrasound/biopsy, but not before we did a clotting profile to make sure he'd be alright for sticking needles into his organs. The labs came back normal and he got the green light for an ultrasound. On August 30th, I took Curly Joe to a picnic and (thanks to some incredibly generous people) on September 12th, I took him to VDIC for an ultrasound and biopsy. The good news was, they didn't need to take any biopsies. The bad news was, the reason why is that he very clearly has a serious shunt problem. In fact, he probably wasn't ever poisoned; all of the symptoms that made the Louisiana vets think he was poisoned are classic signs of Portosystemic shunt problems: vomiting, seizures, head pressing, anorexia, stunted growth, etc.

On September 24th, I took Curly Joe to NWVS for his surgery. On September 25th, they operated on him. (They like you to bring your animal in the night before so they can get a catheter all set up.) About four or five hours after they started surgery, the doctor called to tell me that she had been unable to fix Curly Joe's shunt. It turned out to be intrahepatic (inside the liver), and she couldn't get to it without compromising him. There were no exit vessels to clamp off, and she cut up into his chest cavity a little to see if she could find a way through there. She was basically telling me there was nothing she could do. One of the two options I was given when Curly was diagnosed was surgery or managing the condition with diet and medicine. (l/d and lactulose.) Knowing Curly Joe would die without it, I chose surgery. I was devastated when the doctor told me there was nothing she could do. She then told me that she would look into other surgery options for Curly; there were other vets out there who had experience working with intrahepatic shunts, and she said she would keep researching. She also said that Curly Joe might need a blood transfusion.

An hour later, she called me again, this time to tell me that Curly Joe was still intubated and not waking up as fast as he should. I tried to keep myself from freaking out, but all I could think about was something my regular vet had told me a few days before Curly's surgery: a third of the dogs she'd seen go through this procedure never woke up.

They put him in an oxygen cage and covered him up with warming blankets because his temperature was low. He had lots of fluids going into him, too. They checked his pcv (packed cell volume) and it was low, so they consulted their critical care specialist who recommended giving him half a unit of blood, recheck in an hour and then give him the other half if needed. This was basically for supportive care. The doctor said she hadn't seen any evidence of seizures or clotting problems, but was a possibility.

At around 2:00 a.m. I got another call from the hospital. Curly Joe still wasn't doing well. His blood pressure was really high and his protein was low (which means he wouldn't be able to heal). The doctor asked for my permission to give him another blood transfusion (which I did) except this time it would be plasma. She said there was no guarantee that he would be better in the morning. He was responding to them, but not getting up on his own. They considered him a very guarded patient.

Six hours later, the doctor called again. She told me Curly Joe had developed hemothorax and was not improving. After some discussion, she said she didn't think that Curly Joe would recover from this. I asked her if she thought he was suffering and she told me that he was on two different pain meds and wasn't in pain. I told her I would call her back. My sister (who works from home as a transcriptionist) was working in her office. I went in to tell her what the doctor had told me and made the decision to euthanize him.

I called NWVS back and told them we would be coming in and then went to get ready. 20 minutes later, I called them back to check on Curly and make sure he was comfortable and able to hold on until we got there. I talked to the tech who assisted Curly's surgery and he told me that the doctor wanted to talk to me. My heart sank. My first thought was that Curly Joe had died before we could get there. Then the doctor got on the line and told me that she had consulted with another doctor at the hospital (one of the many great things about NWVS is that it's full of specialists). He examined Curly Joe and said that he didn't see a dog who was ready to die. He took radiographs (at no charge to me) to see just what was going on inside Curly's chest. They revealed that he did have blood in his chest, mostly on the left side where the doctor had made the incision to look for another way to get at the shunt. She said she would like my permission to do a chest tap and use the blood for an auto-transfusion. He would still have his shunt issue to deal with afterward, but she wanted to get him through this first. They wanted to give him a chance. She said he was interested in food and wagging his tail when people stopped to say hi to him. They didn't think it was time to give up yet.

At that bit of news, I told the doctor that they should do all they can for him, hung up, walked into the office and started sobbing. My sister immediately walked over, gave me a big hug and said, "See? This is good news!" I was so afraid to hope, but I stayed positive for Curly's sake.

There were a lot of people pulling for Curly Joe, most of whom had never even met him.

Next up: The power of positive thinking and a little dog who doesn't know the meaning of the word "quit."