Sunday, August 14, 2011

Things Are Never So Bad That They Can’t Get Worse: Part I

My family has always had a dark sense of humor. My grandfather always had a saying, “Things are never so bad, that they can’t get worse.”

In the span of about 2 weeks, I had left everything and everyone I knew and loved. I had gone through a breakup. I had said goodbye to my best friends having no clue when I’d see them next. I had the roadtrip from hell that included getting pulled over and staying in sketchy parts of town. My well meaning landlord did not have my apartment ready for me, even though I had been paying rent to hold the empty place for 2 months. I was so homesick, I was barely capable of eating.

But things are never so bad, that they can’t get worse.

The best way I can fully describe what has happened is to go as chronologically as I can. I can only give you how I saw things, how I felt things.

Wednesday I drove my mom and Espresso to Paramus New Jersey for an epic IKEA expedition. While my apartment came “furnished” I found I had too many clothes for 1 dresser, and too little patience to deal with seeing what my landlord had in storage (and reminding him again...and again..what I needed). I was very excited about a Mom-Daughter-Dog overnight trip to shop, get what I needed to settle into my awesome apartment.

Everything was pretty damn normal that day, except Espresso was...well, quiet. The last two days since my Mom had arrived had been filled with squirrel chasing, furniture climbing, many walks, and we assumed she had finally just tuckered out. We also noticed her, what my mom called, “vibrating.” It was’t her normal small dog quiver of excitement, fear, anxiousness, etc. It was more subtle and in sync with her breath. I just figured she was maybe cold or excited still. But it had us both observing her more carefully...starting to wonder what was up.

My mom and I only even noticed these mild signs since we know her so well and because we were in the car for 4+ hours with her and merely resting in a hotel with her that evening. Few distractions, lots of intimate time with her.

I knew something was wrong when Thursday morning, she wasn’t all that hungry. She ate a little but walked away from a half full bowl of kibble. I started freaking out a little bit. But she finished some more when I hand fed her and just took it that she wanted a smaller breakfast. I was deeply concerned, but was more thinking she was stressed from travel (although she handled 10+ hours of a cross country trip fine) or that she had some residual car sickness (not that she had ever before...).

She slept in her crate quietly in the truck in IKEA’s shaded parking garage. She barely moved on the drive home. My mom and I got home, and decided to postpone unloading our haul and go straight to dinner. Espresso plunked into her crate like any other day and we went off to enjoy a very nice meal at a lakeside grill.

The nightmare began when I came home.

I will never get over the guilt of these next few moments. I walked into my place like any other day, opened her crate, and walked straight to the kitchen and put kibble in her bowl.

It was my mom who noticed the vomit on her blanket and pulled it out. We then saw the tons of vomit on her cratebed. I don’t know how long it might have taken me to notice of my worst mommy moments.

I panicked when she sniffed her kibble bowl and walked away completely not taking a single bite. She did drink water, but refused to eat even at my goading.

I held my baby. She was hot to hold, hotter than my little hot water bottle normally is. And the “vibrating” was like what I do when I have a fever with chills I realized.

I almost didn’t bring my UC DAVIS Dog medical reference book to New York - I was parring so much down and while it was a thoughtful gift from my folks the first Christmas after I had gotten Espresso, I had never actually used it. But the tome fit into a box I had already filled with books, so what I figured what the hell and brought it.

I ran to my bookcase and looked up vomiting - I immediately started googling vet hospitals after I read “...vomiting is a sign of severe disease when it is seen in combination with other signs such as lethargy, inappetence, pain or fever.” She had a trifectra of serious symptoms.

We took her to honestly the first place I found that was still open at 8:30pm on a weekday -Colonial Animal Hospital.

Why not Cornell? To be honest, I HATE the way most university veterinary hospitals are run. What do I mean? I mean you don’t get a single doctor, you get a team of students or even student, singular, who refer to their higher ups as needed. Staff changes completely with different shifts and there is no ability to contact for updates, easily make visits, and I always feel like when they take your dog away you don’t really know whose hands they are in, where they are, and honestly if you’ll ever see them again. I thought Espresso had some mild stomach inflammation - like a stomach flu right? - and I wanted direct, simple care with people who k

now her case and my name. I chose a local emergency animal hospital that would offer me personal care and not overwhelm me, an already terrified Mommy.

Well, or so I thought. It will always be my biggest regret, letting my fears of not knowing what to do impede me from taking her to Cornell.

The animal hospital we did go to itself was great - cleanest facility, great front desk staff, kind vet techs.

But god did I get the worst vet - lets call him Dr. Pathetic for our purposes. When I found his bio online later that explained how HE JUST GRADUATED VET SCHOOL THIS MAY, it explained so much.

All I want from a vet is an assessment of my dog’s current state, a judgement of what is the matter or range of possibilities to the best of his ability, and what are my options for treatment and follow up care.

I mean, really, that is kinda the minimal standard for veterinary practices right?

Apparently not anymore. He was a Cornell graduate and obviously scientific minded. But so quiet, unconfident, skeptical and honestly kinda self righteous I wanted to punch him in the face with anger and fear for my dog.

He explained she had some slight stomach tension. My mom saw he wrote on his report “alert and awake” essentially ignoring my descriptors of her lethargy. I had to point out the vet tech find her to have a fever (102.5) and he replied “well, only a very slight one.”

He never considered a toxin. He threw out the idea it was a blockage since “she is not continuously vomiting.” He never stated what he did think it was nor did I even fully understand what he thought we should do.

Thank god it was me, a take-no-shit, strong personality on defensive Momma mode. I only regret I was as upset and worried for my dog as I was because honestly, I should have taken him to town for his lack of bedside manner and patient-relations skill. I only had the energy to pry so many answers out of him.

I insisted finding out what were my diagnostic options. He, rather reluctantly, I could do a blood test to see where her metabolic state was at ($150) or do an xray to be sure there were no blockages ($230). He almost outright stated that they were both probably unneccesary.

She didn’t seem to have an obstruction, from what I know and have seen of them. I was worried it was something much more serious going on inside my pup metabolically- my dog book had warned me after all. And while I could tell Dr. Pathetic was probably largely waving me off as an overprotective blonde Californian small dog owner, I know fever denotes infection/inflammation and god damn if I was going to be sent home with some doggie antacids and his nonchalant attitude.

An hour later we got the blood results back. Now, it all makes so much sense. Hindsight is always 20/20.

Everything is fine, except a couple of her liver enzymes were abnormally high.

Now, in recent days, I have learned a little something about liver enzyme levels. Guess what elevated enzymes typically mean? LIVER DISTRESS. I don’t think that took an Einstein brain leap. I feel like that should be covered in vet school.

Guess what Dr. Pathetic said? “Well her liver could be somewhat stressed from stomach inflammation, but it could be a sign of Cushings disease...but that normally only happens in much older dogs.”

Essentially, Dr. Pathetic has the diagnostic skill of the woman Dr. House brought back from the FBI and had to promptly fire for her inadequacy. Or you know, less diagnostic skill than my NOT veterinarian educated 22 year old self. Or you know, a hamster.

What else was I going to do? He didn’t even offer to hold her overnight for fluids, he didn’t suggest more than the xray. He did however, give her an injection of antivommiting medication and (I think...some details are hazy through all this) an antibiotic. They didn’t carry antacids small enough for Espresso so I was even going to have to go the grocery store for those.

We took my sick puppy home, hoping she would just improve on her own.

I slept with her that night and knew things weren’t okay. We tried getting up at 9 or so, but both of us just fell back asleep until noon.

She was so hot, she pushed her way out from under the comforters, and actually crawled down to the end of the bed to be near the fan. Except it was on too high a setting so her ears would flap wildly when the fan rotated directly in front of her, so she crawled back up to me. I knew something was seriously, gravely wrong. This was the photo I took of that morning, me worried sick about Espresso, and Espresso sick, but still absolutely adorable. I never realized this may have been the last photo I'd ever take of my beloved baby puppy.

She didn’t willingly move the whole day. She refused breakfast, but I had a glimmer of hope when she licked a smudge of avocado off my finger. But that was the last thing I could get her to eat.

It was nearing the evening and she was showing no improvement, and had not drunk since a few laps from her bowl in the early am. I knew things were getting worse.

We took her back to Colonial.

Dr. Pathetic was not on call, so instead we met with another vet of the practice - a very nice and serious woman I’ll call Dr. Competent. We saw the fever was finally gone, but she even noticed the lethargy in my pup who was mostly just laying quietly in my arms. She felt the stomach - once again, only slight tension. But without Espresso drinking, we all knew she would be admitted for the night - an IV would provide the critical hydration she needed while we tried to see what was the source of the problem. The doctor was clear that she didn’t know what was up, but that generally dogs either improved or started deteriorating in 24-48 hours. If she improved, great. If she deteriorated, we’d at least begin to know what was going wrong. She didn’t think it was an obstruction, and knowing the elevated liver values, suggested it may be a toxin or infection, and supportive care was all we could do for that anyway.

I asked what we would do if things were the same - She told me that at that point, we would probably do an ultrasound of the abdomen and surrounding areas to ensure there wasn't an obstruction or anything else obviously wrong.

So I left my baby girl at the hospital. She had never been away from me or a close friend she intimately knew for a night before. She wasn't eating, drinking, and didn't have the energy to move. I was nervous, anxious, and so worried.

But things are never so bad, that they can’t get worse.

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