BayWing

Today was Ritka’s first day at home from the hospital. She was allowed 1/2 cup mixture of cottage cheese and rice every few hours and a small amount of a prescription canned food with each meal. She ate well today. She is back to carrying items in her mouth, sleeping with her family and barking at activity in the school yard behind hour house. She is definitely much more herself than she was at the hospital. At no time did she try to carry her blankets at the hospital, but she has done that several times today.

Fortunately, she’s had no vomiting and while she had liquid feces, at least she is not leaking. Wesley took a few pictures of her at home. First eating in the kitchen where Wesley set up camp in case she did vomit, etc. Then in the front yard trying to show off her bone structure.

We got a phone call from Renae at UC Davis VMTH a few minutes ago. She said that they are checking a few blood values, and if those look OK, Ritka will be released to us today.

Update: It’s official, Ritka will be coming home this evening!

We set up part of the kitchen for Ritka. And for me to sit with Ritka. Up with wireless networking…

Renae called about 9:30 this am. The bad news was that Ritka had vomited about 3 am. But otherwise she looked good. They were happy with her willingness to eat. They planned to take her to ophthalmology today. They said they may take her feeding tube out today.

We had a 6:45PM appointment to see Ritka at the UC Davis VMTH. We spent a few minutes waiting for Renae to get the exam room set and get Ritka. When Renae appeared at the end of the hall with Ritka, Ritka recognized us and starting pulling at her lead to come our way. After a few minutes in the exam room, Ritka lay down to take a nap. She seems to use all her energy in greeting us. Renae told us that Ritka does not get as tired after a trip to the outside, another part of the clinic, or to ophthalmology, which is in another building.

The esophageal feeding tube had been taken out, and her IV line had been moved to one of her hind legs, so when we got to the exam room we were permitted to remove the Elizabethan collar (e-collar or cone) for the visit. The cone helps prevent Ritka from chewing or removing her IV lines.

Ritka ate cottage cheese and rice today. Ritka’s kidney values are still heading toward normal. They did not take a CBC today, so we do not have a new platelet count. However, we learned that the normal range for platelets begins at 150,000 and goes up to 400,000. So, the 123,000 from yesterday is better than we thought.

Ritka was also seen by the ophthalmologist today, who said that she may have prednisone sensitivity. She was treated locally with prednisone for her eye ailment. So they have stopped using the prednisone.

One of the reasons that we think of Ritka as a very special dog has to do with the story that goes with this photo:

The dog playing with Ritka here had not been properly socialized as a puppy. It had some tendency toward aggressive behavior, as is typical of insecure dogs when forced into contact with other dogs.

Ritka, though, is an uncommonly good reader of dog behavior cues. We had sessions where Ritka and the other dog would meet and eventually play, as in the above photo. Ritka would properly interpret the small cues of the other dog that, if ignored, could lead to an aggressive encounter. Instead, Ritka consistently gave back submissive and play signals. These training sessions helped the other dog figure out some of the social cues that it had not had a chance to learn as a puppy. This sort of training can easily make the difference between a dog that fits into a home and one that gets surrendered to an animal shelter. And a dog surrendered to an animal shelter with a record of aggressive behavior has two strikes against it already.

Renae called about 10 am to up date us on Ritka. She was not feeling well this morning. She had her third eyelids closed again. She did not want to even look at food and was generally lethargic. Renea called ophthalmology to look at her eyes. I worried all day today, but decided not to bother Renae and wait till this evening.

Wesley and I went in to see Ritka about 7:30 this evening. Now the front desk folks recognize us. I paid some more on our bill and waited for Renae to bring Ritka out and take us to our visiting room. Ritka was trotting ahead and wagging her tail to see us. Renae said Ritka started feeling better in the late afternoon. They did put in the nasoesophogeal tube to feed her. They gave her about 50 ml total today of something the nutritionist came up with. In the afternoon, Ritka did eat some rice and cottage cheese for Renae. Renae brought some rice and cottage cheese for Ritka to eat. She was willing to eat the amount Renea said Ritka said she was allowed, but did not want any more.

Ritka stood for a while wanting us to cuddle her. It is hard to hug well when your dog is wearing a cone. The cone is needed as she has already tried to remove her nasoesophogeal tube. They have it stitched in by her nose and then secured with tape stapled in along the side of her head and on her neck. She really doesn’t want to tear all of that, but try to explain that to a Vizsla.

Ritka stood for a bit resting her head on Wesley’s hand, and then sort of went limp into my lap. She slept using my hand as a pillow. Unfortunately, she leaks diarrhea when she sleeps. When Renae came to get her, Ritka did not want to get up. When we got her to her feet, she was reluctant to leave. We followed Renae to her room, Ritka kept turning around to make sure we were with her. She does not trust us not to sneak off. And who can blame her – we don’t follow through the last doorway.

They won’t remove her nasoesophogeal tube until they are sure she is eating well. I’m hoping she’ll come home by Friday. Only time will tell. They also want her kidney and liver values to come down and stabilize. Her platelets are up to 123,000. So while only a quarter of normal, they are well on their way and that is not a major concern anymore.

Thanks for folks well wishes and support.

Diane

Laura Whitehead, our vet student, called this AM and left a message. She said Ritka seemed to feel better and was no longer dripping diarrhea. Her eyes were open and she was much more alert. She still did not want to eat, but had not vomited again since I left.

I was a bit frustrated today as I worked at my desk. I tried to call Renae Zumstein (the weekday student), but her pager was not working correctly and I did not get through. Eventually I talked to Dr. Guillaumin. They have been very busy in emergency today. The lab work included some good news. Her platelets are up to 88,000 and her white blood count was back up closer to normal. She is still anemic. Her creatinine was down to 2.1 and her liver enzymes are getting better. They did an official ultrasound this morning that showed her intestinal blood flow and pancreas looks ok, but showed gastroenteritis and low motility. She looked more alert and wanted to go out.

We went to see Ritka this evening about 6:30 pm. She came down the hall with energy and tail wagging happy to see us. She had her eyes open and they looked more normal. She was fairly energetic walking down the hall to the room. But once inside, she lay down and curled up on Wesley’s foot. We offered her some food, but she did not want any. She did leak a bit of diarrhea, which I cleaned up and washed her bottom. Then I curled up and held her while she slept. She slept with twitching feet. I hope she was not coursing more jack rabbits in her dreams – I’ve told her repeatedly this week that she is NOT a whippet – she is not even a lurcher. They let us have about an hour with her tonight. She squatted in the hall and peed on they way back to her cage bed. They don’t take her out often enough so I guess it is better than in her bed. She moved much better tonight than last night.

The best news tonight was that before we got there, Renae was able to get Ritka to eat a few bites of of rice and cottage cheese. Do you suppose she ate when she heard about the plans for the nasogastric feeding tube? I wish we could spend more time with her, but I’m so glad she is feeling better. The nutritionist was not happy about all the types of food we offered – but the vet thought getting her to eat anything would be good.

The vet student, Laura Whitehead, called 06 Aug 20 Sunday morning to give us a status report. They felt she no longer needed to be in the ICU and moved her to the regular wards. I’m not sure what they based it on since they had no new lab work. She is vomiting less often, but still twice a day. We have an appointment to see her at 8:30 pm. They also took her urinary catheter out which Ritka seems to appreciate. She is able to go outside to pee and is feeling well enough not to pee in her bed.

Near dusk, we took Rusty (Harris Hawk) and Farli (13 year old Vizsla) out for a walk. We only found one jack rabbit which Rusty ignored and Farli did not see. We have had trouble finding good places to hunt in the bay area.

We saw Julien Guillaumin when we were waiting for Laura Sunday evening. He said that part of the reason to move Ritka was to reduce our cost a bit. The good news is that her Platelet count is up to 58,000 and her creatinine is down to near normal. The liver enzymes look like they are still responding to the damage done last week. The bad news is that Ritka is continuously dripping diarrhea and won’t eat. Laura walked Ritka down the hall toward the waiting room area. I heard Laura’s voice and went to see – Ritka was visiting another client waiting in the hall way. Ritka immediately started wagging her tail and came over to see me. I sat on the floor and we snuggled a bit there in the hall.
Wesley and Dr. Guillaumin came over to see and Wesley brought the supply of tempting food we had brought back to the exam room Laura had prepped for our visit. Laura had layers of soft blankets covered with absorbent bed pads. Ritka lay on the pads and we tried to tempt her with several foods but she turned everything down. Ritka had her eyes closed most of the time. Even when she opened the outer lids the third eyelid was usually closed. The insides of Ritka’s ears and around her eyes were yellow from the liver damage. Her eyes also seem sunken. Since she has nothing in her gut, she looks starved behind her ribs.

After a bit, Ritka got up and walked into bare floor to vomit. She vomited up quite a bit for a dog that has not eaten since last Tuesday. She lay down for a bit and then got up and walked into the corner to vomit one more time. After that she stood. She was obviously very tired, but I think she was afraid she’d throw up again. She still wanted to be petted. Eventually she wanted to lay down in my lap. Laura came by and gave her another dose of her anti-nausea medicine and left us to cuddle. Wesley slept in the chair and Ritka and I rested on the floor for a bit. We turned out the lights to help everyone relax. When Laura came back it seemed time for Wesley and I to go home to bed and for Ritka to her hospital bed. Ritka did not want to go with Laura back to the ward.

I had a call from the weekend vet student, Laura Whitehead, about 10:30 on Saturday 19 August. Ritka vomited twice since last night about 3 am and about 6 am. She gets up and tries to leave her bed to vomit. She also pushed on the x-pen door when Laura approached with a leash. So she is more active than before. She will have to move beds if she gets too active as the x-pen does not really close. When they did the ultrasound on her kidneys they also looked at her gut on Thursday. The area near the duodenum and again at the iliocolonic junction was dilated with thickened walls and peristalsis was slow. Ultra sounds since then indicate perhaps slight improvement, but peristalsis is still slow. There is no evidence of new bleeding. The sores from IM and sub-Q injections may finally be scabbing over. She is still jaundiced so her liver is still compromised. They doubled the amount of fluids she was getting from a maintenance levels and the urine production doubled so the kidneys are working even if damaged. She is considered in Multiple Organ Disorder (MODs). In her case: liver, kidney, clotting and GI. We have an appointment at 7pm to go visit tonight and will learn about the blood tests results then.

Wesley and I had dinner with my brother Joe and his wife Angela at RedRum Burger in Davis before going to visit Ritka at 7pm. Ritka was very sleepy but more demanding to be petted than she was last night. Laura said that she had convinced some of the techs to sit with her and she liked laps. Laura felt that if she recovered without any chronic organ problems that Ritka could probably go back to participating in her normal dog activities such as hunting, agility, etc. I of course will have to watch her to keep her from overdoing. She seems to be lacking in certain aspects of self preservation when caught up in the hunt.
We talked to Laura Whitehead about Ritka’s status. The kidney enzymes are showing some improvement from the 17th to the 19th with values of 4.2, 4.2 and finally 3.2. Urea Nitrogen was pretty stable with 76, 78 and finally 75. So there is slight kidney improvement. The liver showed acute response on the 17th with an ALT=517 and AST 702. Both of these dropped to the 300s on the 18th and continued to decline today. The tests that measure the liver’s response Alkaline Phophatase, Bilirubin total and Gamma GT all increased over the three days with todays values at 294, 7.6 and 10 respectively. They were all about double or more from their values on the 17th. This is indicating that the liver is trying to cope with damage from on about the 17th. Body temperature has stayed near normal for the past three days which is good. Ritka’s platelet count was 12,000 on the 17th. The 22,000 reported for the 18th they decided was not valid based on the appearance of the cells. Todays count was verified at 32,000. I certainly hope that is a continuing trend. I know the vets want her at least above 50,000 and eating.
Laura said I could bring some food from home to try to temp her to eat. She has been offered canned dog food. I brought boiled chicken, garlic liver, liver brownies and natural balance. Ritka sniffed them, but then turned her head away. When I offered again she quickly turned her head way as if to say “I said no already.” I also wondered if the smell triggered nausea. She is still vomiting clear fluid about every 6 hours and has runny diarrhea. Laura kept the tid bits to try to tempt her to eat. She has not eaten since Tuesday morning. After 7 to 10 days they may try a stomach tube or feeding her through an IV line. They don’t want to put in a jugular feeding line because of the low platelets. The stomach tube won’t help if her stomach is not working. But perhaps a tad of food will help get it going?

Well, so far overall slight improvement, but not out of the woods yet.
Sick dogs are expensive – to the tune of about $2k/day.
I sure hope the platelets continue to go up and she starts eating soon!

I talked to the resident assigned to Ritka, Julien Guillaumin at 10:30 on Friday 18 August. Her platelets were 22,000. However I’ve been told that the margin for error is such that this might not indicate that platelets
are really going up. There is that much error in the tests. The blood in her eyes is beginning to clear up. She vomited another 2 or 3 times since 5 pm yesterday. She has a urinary catheter now – good so she does not pee on herself and they can monitor urine output. Overall, he thought she was a tad better than yesterday.

Thanks for everyone’s thoughts and prayers. I appreciate the nice notes.

I was able to have two short visits with Ritka on Friday 18 August mid afternoon and early evening. The blood in her iris is draining so her eyes are no longer bright red. They took her to opthamology to have her eyes checked. She shows inflammation, but her pressure is normal – so the high blood pressure did not start any glaucoma type problems. She was willing to walk to opthamology pulling in front down the hall. Late afternoon on the 17th she could barely walk so that was good.

When I visited she wanted to rest her head against me and be petted. When I left at the end of the first visit, she gave me the “look” that said – don’t leave me. The second visit I did a better job of easing away and got away while she was sleeping. For the weekend she has Laura Whitehead as her student. Julian Guillaumin (her resident from France) has been consulting with Dr. Smart (from Austrailia) so Ritka has a nice international team working for her.

Wesley went by the emergency hospital first on Aug 17 Thurs am. I did a bit more to get ready to spend the day with Ritka. But when I got there the Vets were discussing sending her to UC Davis. Her blood pressure went down to 128 last night, but back up to 15? later. They wanted a Doppler Colorized flow ultra sound of her kidneys and a few other things that Davis had diagnostic wise that the hospital in Concord does not have. So they completed a pouch of plasma and we packed her up in the Van to go to Davis.

The hospital in Concord encouraged me to come and sit with Ritka – they thought the dogs were calmer and that the owners presence helped the dogs get well sooner. My biggest disappointment with Davis so far is
they will only let me have one or two 15 minute visits per day. I have visit schedule for 5:30pm. The will try to schedule her for the ultrasound and check her liver function.

I’m a wreck. The prognosis for Ritka was about 50% chance survival earlier today.

I saw Ritka at 5:30 on Thursday 17 June but she was out of it from pain killers. I’m not sure she knew I visited. She had been in a fair amount of abdominal pain. The good news was that they did the Colorized Doppler Ultrasound on her kidneys and the flow patterns looked good. Also her blood pressure was about 115 which is good. Her platelet count was 12,000 where normal is 400,000. It takes a week or more for the bone marrow to produce replacement platelets. The liver and kidney enzymes are slightly above normal, but they are not too worried. The PT was 8.5 and the PTT was 48.9

Prognosis is still guarded. She is probably through most of the DIC. But she could still be in trouble if she starts bleeding in her brain or lungs. The vets at the Animal Emergency Hospital are great – they have
still been answering my questions and calling the UC Davis Vets to check on her progress. Dr. Groff assures me that UC Davis is the place for her to be even if I can’t visit her as much as I’d like and they don’t communicate as well.