Raven's Surgery, The Complete Story

Now that I've had some sleep (although still not enough), I thought I'd let you know how things went with Raven and her surgery. I've never used the "extended post" function of Typepad before, but this is a long story so I'll continue it after the jump.

Raven was diagnosed with osteosarcoma on Monday, May 31. We scheduled her for an amputation of the affected leg on Wednesday, June 8. The surgeon prescribed pain medication to use in the meantime, as osteosarcoma is known to be quite painful. We seemed to have the pain well under control, but about a week later she suddenly became much more lame and obviously in a great deal of pain. I assumed her leg had fractured at the site of the tumor and considered trying to move the surgery up to the 6th, but on that morning she seemed much better so I decided to stick with the schedule. This turned out to be a mistake.

On the night before her scheduled surgery, Raven began to cough. I was afraid she might have developed aspiration pneumonia, which is basically when you aspirate  food or water or even saliva into the lungs, and an infection results. Normally this doesn't happen, but I had been feeding her lying down, and with their long necks, deerhounds tend to be somewhat susceptible to aspiration pneumonia. Other than the cough and a low fever, Raven didn't seem that ill, though. I am three hours from the veterinary hospital, and we were having a freak summer storm that day, so I had to leave long before the main hospital was open (they have an  ER clinic that is always open). I took a chance and headed out, calling them from my cell phone part of the way there to let them know the situation had changed.

I sound very calm recounting this story. Trust me, there was nothing calm about how I felt at the time. Since the day of her presumed fracture, I had been counting the moments until we could remove her leg, wanting my girl to be free of the terrible pain she was in. Every night I would pet her and tell her that on Wednesday it would all be over, just hang on. I had not been sleeping well, and that Tuesday night, her cough kept me awake for hours, and  after she'd fallen asleep, my worry did. I had slept less than two hours total, there were five accidents on the freeways between me and the hospital, and traffic was crawling. I was crying so much as I drove that I probably should have pulled off until I stopped.

When I got to the hospital  after my  long, harrowing drive, my worst fears were confirmed by Raven's x-rays: She had aspiration pneumonia and a pathological fracture at the tumor site. Surgery would have to be delayed at least 24 hours.

The vets put a splint on her fractured leg to minimize pain, and  put her on antibiotics and fluids. One of the vets in the practice was on vacation, so they put me and Raven into her unneeded exam room on the two big dog beds I'd brought in from the car, and hooked her up to IV fluids and gave her  morphine for pain. We were surprisingly comfortable, as the room was quiet and she and I just kind of snoozed all day.

The splint made Raven much more comfortable when she was lying down, but it completely confused her when she tried to get up, walk, or go to the bathroom. She had been holding her leg up, and now it was too heavy for that. So she simply clumped it along, hitting the ground with every hop. She couldn't figure out how to go to the bathroom with this big thing on her leg. I took her out and walked her several times but she simply wouldn't go, and was upset and exhausted coping with the splinted leg.

After much discussion, we decided that I'd take her to a hotel that night with me instead of leaving her in the hospital.  She'd have had to have been moved to the back of the clinic, which is much more chaotic, and since she really wasn't that sick, we all felt she'd be less stressed out if she was with me. They gave Raven a little extra morphine "for the road." She was getting very, very small amounts of morphine, and even this "extra" was not much for a dog her size. My hotel was only 5 minutes away so if things went bad, I could come back. This turned out to be my second mistake.

We arrived at the hotel and I walked her, to see if she'd finally go to the bathroom. They had a small fenced area for guests' dogs, but she  just stood at the gate with me, then raced around the edges clumping her leg, then back to the gate. It was pouring rain and she was miserable. This might have been the first sign that she was suffering from a reaction to the morphine, or it might have simply been that we were in an unfamiliar place and she was confused and in pain. I took her out of the little run and walked her around and around the parking lot in the pouring rain, with her getting more and more exhausted every minute. Finally, after about half an hour, she peed in a patch of ivy. I immediately took her into the room, which I had already checked into while she waited in the car. It had her big dog bed, a dog quilt on the bed, and a bowl of water ready for her. Unfortunately, the room was quite far from where we had walked to get her to potty, and by the time we got in there she was panting, her breath very hoarse and rasping. She lay down on her dog bed while I started to prepare some dinner for her, turned on the TV, poured myself some water, and generally tried to settle into our room.

After a few minutes it seemed to me she was in trouble. She wouldn't take any food at all, nor any water, and while that was not a huge surprise given she was on morphine and had been on fluids all day, her eyes were kind of fixed and glassy, her breathing was slow and ragged and irregular, and her tongue was hanging out of her mouth in a way that frightened me.

I called the hospital, and they said it might be the morphine and to bring her in. This was much easier said than done, as Raven weighs over a hundred pounds and at this point couldn't even lift her head, let alone stand up. They suggested I call a pet ambulance service, which I did.

While waiting for them to arrive, I lay down with Raven on the floor. Several times she stopped breathing, and I'd shake her and call her name and she'd draw a big, shuddering breath and start again, shakily. Several times her eyes became very fixed, and I was absolutely sure she had died.

I'm doing it again, sounding calm.

I was crying and begging her not to die. I was shivering so hard that I pulled the quilt down off the bed and put it over me, but my teeth were still chattering. I called my mom, who called the hospital to let them know we were coming in, and then called me back. She was scared at how I sounded, and worried that I was alone. I remembered at that moment that I had a friend in the next town, Mary Straus, one of my co-moderators on K9Nutrition, who I had met a few times before and who had offered to come to the hospital with me when she'd heard of Raven's upcoming surgery.

I didn't have Mary's number with me, but called my dear friend Nancy Campbell, a vet tech up in Washington state and a member of K9Nutrition. She got me somewhat calmed down, gave me some professional advice on Raven's condition, and emailed Mary to phone me on my cell phone.

While I waited for Mary to call and the ambulance to arrive, Raven began to get somewhat better. Talking to Nancy had calmed me down, too. Mary called and said she'd meet me at the hospital, but I started to wonder if I should cancel the ambulance. Suddenly, Raven jumped up and started racing around the room, her splinted leg flailing and whacking the walls and furniture and floor. When I tried to put a leash on her, she ran from me. She didn't seem to see or hear me. She looked crazy.

I finally got a leash on her and took her outside, and saw the ambulance, standing empty. The crew and I must have passed each other in the elevator. The manager of the hotel was there and he ran upstairs to direct them back down. Several of the staff gathered, offering help and sympathy. The ambulance crew, who were wonderful, gently put Raven on a stretcher and then placed her on a gurney, and slid it into the ambulance (a real human ambulance, by the way).

I followed them to the vet hospital, where the vet diagnosed a suspected  adverse reaction to  morphine, despite the smallness of the dose they gave her and the fact that she'd been on it all day with no apparent problems. Sighthounds can be unpredictable in how they react to drugs and I agreed with her diagnosis.

Although it wasn't clear to me at that point that it was necessary to hospitalize her, I was scared to take her back to the hotel. However, having had no sleep the night before, I wasn't sure I could make it through another night without, and didn't want Raven in the noisy back area of the clinic. They said if I stayed with her, we could remain in the exam room we'd been in all day, so I thought I might sit with her all night. Mary, and my mom on the phone, thought that was a terrible idea. At about midnight or 1 AM, Mary got me to leave, taking me to a diner where I ate something, at which point my adrenaline ran out and I barely made it back to the hotel.

I slept a few hours and went back to the hospital, and they moved me and Raven into the empty exam room with her big dog beds. Helen, her vet, examined her and did a repeat set of chest films, and said we needed to wait until the following day to do the surgery. She was not convinced that Raven's episode the night before was a morphine reaction.

I again spent most of the day snoozing with her on the floor. Mary came by a couple of times, bringing food and sitting with me, and staying with Raven while I used the bathroom and called my family and Raven's many friends and fans. My friend Gina had been blogging about Raven's troubles over on Dogma, so there were lots of folks pulling for her. Raven seemed fairly comfortable and even calm, and her pneumonia was much better. Although it seems crazy to say this, it was actually kind of nice, and it's a shame that hospitalization can't be more like this.

As evening came on, I was worried about the effect on Raven of being moved back into the other room and being left alone while I went back to the hotel, and suddenly got the idea of seeing if one of the hospital's off duty vet techs might be willing to stay with her. The vet called one of the techs, who agreed to come in and be what we jokingly called "Raven's private duty nurse." She arrived around 10 PM, and I went to the hotel to get some sleep.

When I got into my room, my message light was flashing. I called down to the desk and they said that they had something for me, which they would bring up. I was puzzled, as no one knew where I was, and I couldn't imagine who had sent me something.

The woman at my door had a big (and I mean BIG) basket full of dog treats, balls, stuffed animals, and other toys, and a handwritten "get well" card for Raven. I promptly burst into tears, and she hugged me and told me about her family's dog, and how everyone at the hotel was so worried about Raven and wished us all the best.

This is a big chain corporate hotel, obviously much more used to dealing with business travelers than hundred pound dogs who need pet ambulances, but they simply couldn't have been kinder or more helpful to me and Raven. I hope if you ever find yourself needing a place to stay in  Silicon Valley, you stay at the Fremont Marriott.

That night, I had my first good rest in three days, closing my eyes at around 11 PM and opening them at 6 AM. My back was in agony from too much sitting and lying on the floor, so I used the hotel's hot tub, then showered, ate breakfast, and went back to Raven.

She'd had a pretty peaceful night and I thanked her nurse, Linda, and arranged to have her come back that night. It wasn't cheap, but having really benefited from those seven hours of good sleep, I decided it was worth it. The surgery was scheduled for 2 PM, and I sat with Raven until then, while she slept very peacefully. They let me stay with her while they induced anesthesia, intubated her, and shaved the surgery area, and then I let her be wheeled away into the operating room.

The surgery took just a bit over an hour, and went extremely well. I was with her the minute she came out, packed in a warming bed and wrapped in blankets. I sat with her while she came very peacefully and calmly out of anesthesia (no, it's not "normal" for dogs to scream and thrash around as they come out of surgery, even if it's common). She weakly licked my hand, and seemed comfortable. After a while the drugs started to wear off and she was obviously painful, so they put her on a constant rate infusion of morphine, lidocaine, and ketamine, or " MLK CRI." which makes for very smooth post-surgical pain control in the hands of vets who know their way around pain management. When it was clear that was doing the trick, they moved us back into our "private room."

Mary had come to sit with me while Raven was in surgery, and she and I stayed with Raven while I called everyone to let them know the surgery was over and had gone well. Linda came back at 8 PM, and I actually went and ate some dinner, then went to the hotel, soaked my tortured back in the hot tub, and went to bed.

I didn't sleep well this time, and my back pain was almost unbearable. Raven's MLK started sounding good to me, but I settled for some Advil. I was back at the hospital at around 7 AM, and Raven was doing really well. She went outside to potty, and seemed very comfortable on her three legs, moving much better than when she'd had the splint. We spent the day resting, and Helen said we should be able to leave at around 5 PM. This was Saturday. I had left my house at 6 AM on Wednesday, and was supposed to have been gone one night.

At around 3 PM, I noticed that Raven's breathing was a little raspy. I got the tech, who got the vet, who was concerned at what she heard. She called Helen, who came in although it was her day off, and we repeated the chest films.

Raven had clearly re-aspirated, as this new pneumonia was in a different section of her lung. But this one was much, much worse than the first. Her fever spiked to 105. She had her neck stretched out and her nose pointed at the ceiling, gasping for air. No more quiet empty exam room ... Raven needed to be on oxygen, as her blood levels were dangerously low, in the 70s. They moved her into the back area, hooked her up to oxygen, started a human antibiotic called imipenem, and we all settled in to see if she'd pull through.

My brother McKenzie and sister-in-law Meewon, who is 8-an-a-half months pregnant, drove over from San Francisco to be with me, but it was impossible to fit us all into the back room with Raven, so they left after a while. Meewon is a pharmacist so she was able to talk to me a lot about imipenem, which she said is the antibiotic of choice for aspiration pneumonia in human medicine.

I was very afraid that Raven would die, and refused to leave her. I couldn't stop crying, and it didn't help that we were in the exact same area of the clinic where I'd sat with my dog Bran when he was dying. Bran had died in the hospital, and I wasn't there, and it had haunted me ever since. I was too afraid to leave her. Finally, one of the techs called Helen and said that I seemed really on the edge of some kind of breakdown, and Helen got me on the phone and told me to get out of there and come to her house and get some sleep, that Raven and I had a long road ahead of us and I couldn't be any use to her if I didn't take care of myself. She pointed out that if Raven got worse, she'd be the first person the clinic would call, and we could be there in 15 minutes. I finally agreed to go.

Helen called the clinic at 6 AM and was told she was better, so after breakfast both of us went over there. She was still on oxygen but obviously a lot more comfortable. Unfortunately, every time they took her off oxygen, her blood levels dropped down into the low 80s. Reluctantly, Helen told me Raven would need at least one more day and night in the hospital. It was now Sunday.

I went back to Helen's and did some laundry, cooked some homemade food for her new greyhound puppy, Lyric, who was having some tummy troubles, and sat with Lyric while Helen took her adult greyhounds, Spirit and Apollo, out for some quality time without the new puppy. Then I headed back to the hospital, where despite my day trying to de-stress, I was almost instantly back in the same emotional state as the night before. It didn't help that Raven was getting very restless, and it was extremely hard for me to see her like this and not be able to help her. I started to cry again, and then tried to hide it so the techs wouldn't call Helen to get me out of there.

The clinic was extremely busy, however, and since sitting with Raven in the back was very uncomfortable, and the Advil cure was no longer working, leaving was not the worst idea in the world. I decided to get some dinner at the hotel, and while there thought I should just check back in, use the hot tub, and try once more to get some sleep. After a restless night, I woke early, used the hot tub again, ate, took more Advil, showered, and for what turned out to be the last time, checked out of the hotel.

When I got back to the hospital, Helen was there, and gave me the bad news: Raven was still not able to get off oxygen. I went through a lot of emotions at that moment, especially because she really seemed very well to me at that point. I took her for a walk, and when we got back, we did a new set of chest films and checked her blood oxygen levels again. Both were bad, so that was that. She was staying another 24 hours.

I had never thought I'd be gone this long, and since anything I did in Fremont would be just killing time in between brief visits to Raven in the oxygen area, and further back agony for me, and my mother, who was staying with my other dogs and my cats, really needed to go to San Francisco for a medical appointment of her own, I decided to go home and return the next morning for Raven.

Getting home was very sad without Raven, but seeing the other dogs and sleeping in my own bed made a lot of difference in my outlook. Then Helen called me at about 8 AM with the good news: Raven was off oxygen, her blood levels were in the 90s, come and get her.

So I did.

Raven actually jumped into the car, and slept like a baby all the way home, and has been getting around on three legs with no problems. She is tired and sleeps most of the time, and is still on antibiotics and some mild pain meds, and may have a bit of an upset stomach as she's not eating too well. But we're home and facing the next stage in our battle with this cancer that invaded her leg and our lives.

I have a lot of people to thank, from the folks at the Fremont Marriott to the staff at Veterinary Internal Medicine Service/Ohlone Veterinary Emergency Clinic, to my friends and family, to the deerhound and greyhound people who have shared so much information and support about osteosarcoma in dogs. You can read more about Raven, this disease, and the resources that have helped me so much, here.

Comments

[Emily]

I'm a Dogma reader and am relieved to hear Raven bounced back so nicely. I must say, people who work at emergency veterinary clinics are special. When our black lab was sick with lymphoma over Thanksgiving 2003, the vet and techs at our emergency clinic in central Ohio were similarly kind, letting us lie on the floor with Cookie in an empty room for hours at a time. She was too sick to survive the chemo, and you're right, it's not cheap, but we felt lucky to have her surrounded by such caring people at such a difficult time. So happy to hear Raven is on the mend, and that you are, too!

[Travis]

I'm glad you're both home, and healing. :) Thanks for sharing the story with us.

Travis

[kahy]

I'm glad to hear she's made it through all of this and you too. You must be exhausted. Thank you for taking the time to share. It's good to know that there are people, hosptials, and even hotels that are so caring. Welcome home and good luck through the next stages.

[Gimpy Mumpy]

Glad to hear Raven did so well. Although you had a terrible ordeal, you were very fortunate to find such caring and accomodating hospital and hotel staff.
Best of luck with Raven's continued recovery.

[ol cranky]

I'm so glad to hear Raven seems to be doing well (and that all the folks with whom you interacted - especially the hotel - were understanding & supportive). Best wishes for Raven's continued recovery.

[Jean Shirkoff]

I'm so glad to hear about Raven and am sorry you had such a horrible ordeal! I am Sengha's mom and talked to you before this surgery. I am very pleased to hear she is getting around okay. MaryAnn Rose was here in Oregon for the specialty and she took a picture of Sengha to show you. I understand how awful that all must have been because my Ibizan hound went in for suregery (minor) and he got pneumonia and sepsis and we lost him May 26th. It was awful and terrbily sad but a similar story to yours in terms of the experience at the Veterinary clinic. I wish you all the best. Hang in there. It all gets better from here.

[KathyF]

Glad to hear she's better. Now take care of yourself!

[Kim]

So wonderful to hear that Raven is on the mend! And great to hear that *you* made it through ok, too. Our prescription is lots of rest, a few celebratory daquiris, and a few days of just enjoying the sun, the air, and the dogs. Positive energy coming your way.