Saturday, 26 April 2014

Odin comes home from hospital

Posted by Cath

The short story is that Odin has been very ill with sepsis caused by peritonitis. He required three abdominal operations in 12 days. For the last two weeks he has been at the Queen Mother Animal Hospital which is attached to the Royal Veterinary College at North Mimms. He came home on Saturday 26th April. 

The long story is below.... and it is a long story.

Friday 11th April

We were planning to set off for the historic boat rally at Foxton over the Easter weekend, so Alan and I went to the boat to load it ready to go set off the following day. We left home around 3:00, leaving Odin with our sons David and Michael. He was fit, healthy, running around the garden, wanting us to play football with him.

Arriving home at about 8:00 we were met by concerned sons and a clearly unwell dog. He had vomited 3 times in quick succession at about 6:00, then had been happy to go into the garden, where he had done a poo – after which he didn’t want to be moved.  Odin was standing stock still, head low, staring at us, and could not be persuaded to walk more than about 3 or 4 paces. His back legs were a long way back, like the stance of a show German Shepherd dog. 

In some panic I rang a friend, "Starcoaster", who is a Veterinary Nurse. Trying to diagnose over the phone she wasn’t certain what was wrong, but felt sure that Odin needed to be seen by a vet - she was particularly concerned about the GSD stance. We got him to the emergency vet at shortly before 11pm, where he was given injections for nausea, but eventually wagging his tail before we left and behaving like there was no problem. He was diagnosed with stomach cramps, and we were told that he would probably be fine in the morning. 

He wasn’t, he had to be carried downstairs. So, we took him to our usual vet, who kept him in for observation and a series of X-rays. However, they only work until 12:00 on Saturday, so we took him back to the emergency vet some 6 or so miles away from our home.

In the evening the vet rang to say that the most recent X-rays showed that there was a problem in the abdomen – the whole area was dark, showing either infection, or a build up of fluid. She wanted to operate to investigate, before his condition began to deteriorate.

Afterwards, she rang us to say that he was comfortable, that she had found no problems in the abdominal cavity, although there had been 1 and a half litres of fluid. She said he would rest overnight, and that he would probably eat in the morning.

He didn’t, and began to deteriorate throughout the day – Sunday 13th.
During the day we made increasingly concerned calls, until in the early evening she said that he would be comfortable overnight, be transferred back to our vet on Monday morning, and perhaps be referred elsewhere from there. This was the first time that anyone had said anything about the possibility of transferral elsewhere.

Eventually, we agreed that she would arrange instead for an immediate transfer to the Queen Mother Hospital for Animals, attached to the Royal Veterinary College at North Mimms, and we would drive him there. The whole family drove to the vets, not quite sure what to expect, but in no way aware of what we would find.

She had to carry him to the table, he was heavily drugged, his breathing was very laboured and his belly was badly swollen. We loaded him into the back of the car and headed for the RVC, a drive of about 30 minutes.  At reception they asked if we needed help to get him in, and brought a trolley, then disappeared with our beloved dog. A student vet took a detailed history from us, and the veterinary team looked at the X-rays from both vets, and the notes from the emergency vet service.

Eventually, an Italian vet came and told us that our dog was extremely sick – about the worst that they could consider treating. The most likely cause was an anti-inflammatory drug had been taking for a few days, but they could not be absolutely certain of this. This had probably caused a hole somewhere in his alimentary tract – anywhere between his stomach and…well, the final exit. The vet was completely honest. Odin had a poor prognosis for surviving abdominal surgery, his blood coagulation was very poor because of the sepsis in his abdomen, his blood pressure was very low, and his heart rate was very high. There was also the strong possibility that he had pneumonia, which halved the chances again. What did we want to do?

We talked it over….

After some time the vet came back. The most recent X-rays suggested that it was possible that he didn’t have pneumonia. We had already decided to carry on. They told us that they would work to stabilise him, but it was a knife edge, and at some stage they would have to operate.

We went home. We went to bed. We did not sleep.

At 1:15 am the phone rang. We thought it was the final call to say that he had died, but it was the surgeon. They were getting ready for surgery – Odin was “not a good candidate for anaesthesia”. They had tried hard for some hours to stabilise him, to get his blood clotting, to bring down his heart rate and raise his blood pressure, but they couldn’t leave it any longer – he had to go into surgery immediately.

We had a few scraps of ragged sleep. The phone rang again at 5:00 am. Odin had survived surgery. He had a small ulcer in the pylorus, the area between the stomach and the intestine. This caused fluid from the abdominal tract to leak into the abdominal cavity. The infection was about the worst they had seen. The tissues had been very hard to repair because they had been so inflamed. There was infection in all abdominal organs. Now it was down to the Critical Care team.

We were regularly updated. Odin didn’t wake up for a couple of days. He had a very low blood pressure, his heart rate continued to be high. He might have slept a lot, but we didn’t. For several days we had very disturbed nights. We found it impossible to think very hard, so ended up doing trivial tasks that needed focus to keep us from thinking about Odin, but didn't matter if we messed them up. I found a series of sewing tasks, making simple  things on my new machine, Alan fixed things around the house.

People who have dogs know how closely bonded you become. Odin gets up when I do, watches me closely, knowing that when I put my shoes on it's time to go up the road, he knows when the coffee is ready to be taken upstairs, when it's time for bed at night. He greets us enthusiastically if we return after leaving the house for a short while, but knows the difference if we've just been in the garden or another room. He's always happy to spend time with you, particularly going for a walk, when he pesters constantly for you to throw a ball. He is interested in everything that you do. We were facing the thought of going boating without him, every lock, every bridge being a reminder of him. Alan and I were wondering if we could face boating again if we didn't have him with us.

We went to see him for the first time on Wednesday, after he had been moved from one of the cots to a kennel of his own because he was beginning to wake up. His heart rate was more manageable, his blood pressure more normal, but he was barely aware of anything, swollen with oedema, much of his body shaved for the drips and transfusions into him, catheters out. Despite this we were staggered by the high tech equipment. He blinked his eyes open briefly and the bleep of the machine monitoring his heart rate rose when we knelt down beside him to pat him on his soft mattress and fleecy bedding. We kidded ourselves that he knew it was us.

Every day brought more concerns, more hurdles. Would he develop pneumonia? Yes, after a couple of days he began to have problems breathing, but they worked on it, monitoring constantly, administering drugs and treatments. He was given oxygen, administered via clear tubing, to help his breathing, and to aid his damaged lungs. He couldn’t eat, but needed protein for his body to start to repair itself, so he was put on IV feeding.

He had transfusions. Without the work of the pet transfusion service he could not have survived. His blood coagulation was so poor because of the sepsis, but the transfusions helped this, until his own blood started to clot.

Gut surgery carries the possibility of breakdown after 3-5 days, they extended this period, because his tissues had been so severely infected. The vets were particularly helpful, but honest. If we tried to put too positive a spin on anything they gently brought us back to Earth, and made us understand just what the situation was. A couple of times we asked about whether it was still a good idea to be proceeding, but the vets said that they still held out hope of a good recovery, and that if they felt that his quality of life would be poor, or if he was suffering, then they would be having a conversation with us.

And, every day he got a bit better. Every day there was more recognition, a bit of a tail wag, an attempt to stand.

There was concern of a right side neurological problem, possibly caused by the low blood pressure for such a long time – resulting in poor oxygen to his brain, but they took him on a trolley outside into the fresh air, where he could walk on the grass, instead of the shiny vinyl floor, and he was able to walk and sniff the trees. He still needed a harness, for support to his wobbly legs, but he was moving them all, and strongly powering himself on a surface that he felt confident on.

Easter Monday in his kennel
On Easter Monday (21st April) the nurse put a harness on him and told him he was walking outside, no trolley, and he trotted off happily, with a wag, down the slippery corridor to outside, where he trotted around the trees, sniffing, sitting or standing (a bit uncoordinated) when asked. He had been taken off painkillers that day, and he only needed to remain in the hospital while he was still having IV drugs – he would be able to come home sometime soon. He’s very skinny, and ravenously hungry, but needs feeding little and often – he’s had surgery for a hole in his gut. They were a little concerned about a slightly high temperature, but had made checks of everything they could to see if there was any infection.

He has got a problem with his right eye. No-one knows if he will regain his sight in it – it is quite possible that he will, but we are assured that he will adapt whatever happens. Every day he shows a bit more movement, more coordination, more recognition and understanding. He quickly showed that he understands when he is outside, and waits until he can ‘do his business’ outside of his kennel.

On Tuesday 22nd April he had the final IV line removed. He nearly bowled the nurse over when he saw us walk into the ICU, he rushed over to us wagging and greeting us. He had a good appetite and was happily snuffling our palms for treats. The vets said that he could probably go home on the Wednesday, but would need to be checked soon afterwards, because he still had the slightly elevated temperature - they still couldn't find a cause and had begun to think that it was just one of those things. One of the vets knew that Odin had known a lot of commands before his illness, and asked if Odin still seemed to remember them. He was reluctant to do some of the commands, as he still has coordination problems, and things like "sit" and "where's your tail" were difficult, but everyone was delighted when he managed a really good "speak". It's clear that his memory of things before his illness is good.

On Wednesday 23rd April we were really looking forward to having him home. I was planning to go shopping for all sorts of tasty treats that he would find easy to digest, however, the phone rang in the morning. It was the hospital. His temperature had gone up again over night, and he had vomited. He couldn't come home, and they had begun a further range of tests.

Mid afternoon we got another call. Ultrasound had shown that his spleen was very enlarged, and probably had poor 'vascularisation', it might well be twisted. They wanted to open him up again. Soon after the vet in ICU rang we were rung by the surgeon. He listed all the risk factors involved in the surgery, but it was clear that without the surgery Odin had no chance. He was really sorry, he had seen Odin the previous day, and had been sure that he was recovered and would be able to go home.

We were once again sent into a panic, I sent a message to 'Starcoaster', our friend who is a veterinary nurse. She responded by explaining that removal of the spleen is not uncommon in dogs, and that they generally cope quite well. We were somewhat reassured, but still panicky.

In the evening both the surgeon and the vet in ICU rang. Odin was doing well, his spleen had been enlarged, partially twisted, and in a very poor state, so had been removed. He had come through the operation well, and was already awake, but still dozy.

The next morning the vet in ICU rang again. Odin was making good progress, the niggling high temperature had gone, and was now in the normal range. He was eating, responsive, and alert. 

We visited him that evening. He was alert and responsive, he seemed more aware of everything going on around than he had been only two days before, before the splenectomy. He really didn't want to get up, and wanted to lie down, but was better coordinated when he was moving around. Not surprisingly he was painfully thin.

On the Friday evening we were shown into a room with Odin. He was interested in us, but also interested in the room, sniffing into all the corners. He was eating well, but had a slight temperature - lower than the previous raised temperature. His painkillers had been reduced, and he was coping well. He really looked like our dog again. Much better coordination, better focus, alert and very responsive. He lay down on the vet bed provided, and leaned against our legs when we sat down with him. He was happy to just be stroked and fed treats. 

Saturday morning we got the call, his temperature was normal, all IV lines had been removed, he was on oral drugs, eating well. All he needed from then on was nursing care. He could come home. Actually, that's quite scary, given that he's been so very ill. 

Coming home
We picked him up in the afternoon, with a detailed explanation of what he can and cannot do until after the staples come out in 10 days time. He needs to be stopped from running about, supported while walking upstairs, and may need to be carried downstairs. No exercise except short walks on lead, and he will probably need to sleep a very great deal. He needs to eat about 50% more than normal to get his weight up again. His coordination is better, but he still has a problem in his right eye. They say that he responds to a light shone in it, so it is working, but something is happening between the eye and the brain, and he isn't seeing things well as he is walking around. The vet wouldn't commit to it, but his gut feeling was that Odin would recover his sight, as he continued to improve his coordination on the right side.

Not surprisingly, we were told that Odin should not be given the class of non-steriodal anti-inflammatory drugs again.
Odin will need quite a lot of rehabilitation, but he gets much stronger every day. We are looking forward to being able to go boating with our dog again.

Odin could not have survived without the Surgical and Critical Care teams at the Queen Mother Hospital for Animals at the Royal Veterinary College at North Mimms. They showed enormous care, dedication and skill. Nor could Odin have survived without several transfusions, supplied by the Pet Blood Bank, and the selfless dogs and owners who have supplied that blood and plasma. Expect to see us raising funds for this service in future. 

Odin cannot now donate to the blood bank, because he has had transfusions, but do you have a healthy dog that meets the criteria and  can help to save lives too?

I would also like to thank our friend ‘Starcoaster’, who has been behind us all the way, answering questions, giving advice, and very much needed support.

If there is one moral I could draw from this – get the very, very best insurance that you can afford, there is no NHS for animals. Once you have committed to the process, you will not feel that you can pull the plug on your animal if they are showing progress.

No comments:

Post a Comment