Grovers grand finale

Relief at last. Trazadone brought us all a night of sleep. I’m amazed how much clearer one can think, how less dramatic things seem and calmer the world feels with sleep.

The next two nights we left the lights and TV on and had two more successful nights of sleep and good days and then … back to our normal routine.

We were hoping for an official consult with the behaviorist this week but chemo finally kicked Grover’s white blood cell’s in the butt. If we didn’t check his blood work we would never know — which is a good thing! Day 7 post chemo his white blood cell (WBC) count was completely normal. Day 9 his WBC, neutrophil and platelet counts were very low. I didn’t know things could change so quickly.

We learned that the chemo (carboplatin) targets rapidly dividing or growing cells, such as neoplastic or cancer cells. But, there are other rapidly dividing cells that are important that also get targeted — such as the bone marrow which makes the white blood cells and platelets. We hope that if the chemo is kicking his white blood cells it’s also kicking the cancer cell butts too!

With low WBCs and neutrophils (which we learned are particularly important for defending our dogs from infection) we need to be careful about limiting Grover’s exposure to potential pathogens or infections. Basically it means we need to avoid strange dogs, avoid going to the hospital unless it’s a real emergency (sadly, including rehab … Grover’s going to be sad he’s missing out on jacuzzi time!) and avoid outside places where he might be tempted to eat or drink things (i.e. the park) until his neutrophils rebound. We are also taking his temperature twice a day to keep a close watch for fevers, which would indicate we need to start antibiotics.

The good news is that there’s plenty of fun that we can have at home now that he is comfortable, happy and (we are all) sleeping well.

A super picture that was sent to me by two amazing  vet students as “proof of wellness” from inside the ICU one night when Grover was particularly whining/panting/restless and I panicked he could have had a GDV. We feel very lucky to have them as part of our team — it’s so comforting to know he has such good friends even when I can’t be with him. (Posted with student permission)

Luckily, even though we are “home bound” we can still enjoy the beautiful evenings and last bit of summer. You can tell by the golden hill in the back that wheat harvest is coming soon!

We are, admittedly, behind in updates of #Groversgrandfinale. Week 2 after surgery was … challenging and emotionally draining.

Week 1 after Chemotherapy? That was nothing. Grover never blinked an eye — no nausea, no diarrhea, no worries.

But, (there’s always a but), we began to really struggle with pain management. 11 days after surgery (on a Friday night of course) Grover started crying out when he lowered his head to eat, went to get up and sometimes just laying there in bed. The kind of screams that rip your heart apart. All of the warnings about exacerbating cervical disease and concerns about his remaining forelimb holding up came flooding back. Maybe we made the wrong decision. How long could we “ride out” this kind of pain to see if it improved?

To get us through the weekend our veterinary team prescribed us a fentanyl patch. We got his patch on and settled outside to try and enjoy some vitamin S (sun). Grover was finally able to rest, so we let him soak up the rays. As the day progressed he became increasingly unsteady on his feet. Panic started to set in … was it worsening of cervical disease? But … mentally he was slow … almost like he acts when he comes out of anesthesia. <light bulb moment>. The fentanyl patch. We remembered the veterinarians telling us, before his amputation, that they were taking the patch off because they could melt under the warming blankets and release uncontrolled amounts of fentanyl. All day he laid out in the sun … and melted his fentanyl patch. Essentially he was high as a kite from melting and releasing 3-5 days of fentanyl over a period of 12 hours. Son of a biscuit. We worked to get the patch off, wash the area and tried to comfort the now higher than a kite three legged Great Dane. Imagine trying to sooth a drunk Octopus. On the positive side of things … he wasn’t painful?

By morning he was back to normal and we were lucky that the neurology and rehab team got us in for assessment. The good news was that they didn’t find a significant abnormality on any of his exams … the bad news was that we didn’t know what the problem was. After another sleepless night of whining, panting and crying we ended up getting an MRI of his cervical spine/neck.

Normal. The MRI was normal. Relief washed over me and I have to admit I had no idea how stressed I had been until I felt the release of hearing the words normal. No mets to his neck. No compression of his cervical spine. Our best guess? The pain was from a pulled muscle. We added amantadine to his pain management schedule.

The relief was short lived as we all struggled through two sleepless nights of panting and whining. He wouldn’t lay down but would pace … it just didn’t make sense. If he was painful, why wasn’t he laying down?

We talked to our veterinary team the next morning and were referred to a veterinary behaviorist who explained to us that dogs can get dementia, similar to elderly people, which can be acutely made worse by anesthesia. He’d now had (2) anesthesia events in the past 2 weeks… it made sense. We were prescribed a sedative help us all get some sleep, left the lights on at night to hopefully remove some “night time anxiety” and had a formal appointment for more evaluation with the behaviorist the next week.

Fingers crossed this would help us overcome this new obstacle.

 

Grover getting some “jacuzzi” time in the under water treadmill during his rehab appointment

 

We are pleasantly surprised that the day after chemo G is digging into breakfast and seems far less worried than we are. Lesson 1: I need to learn to “be more dog”.

The oncologist said she chose a slightly lower dose for him until we see how he responds because she has had a few patients end up septic in the ICU. We go back in 1 week to check is white blood cell counts but in the mean time … physical therapy!

The Tripawds group is a huge supporter of physical therapy in post amputation dogs which we think is amazing!! So much so that they will even pay for your first Physical therapy consultation! tripawds rehab program   What a generous program to help dogs get back on their feet!

We were lucky enough to already be enrolled in a physical therapy program pre-amputation to help keep Grover active and hiking in his golden years … the focus of his PT is shifting but we are lucky to have them as part of #teamgrover. Owner brag moment: Grover has even been featured on the American Association of Rehab Veterinarians Facebook page before! If you haven’t been there, check them out and scroll down to a June 21 post that has a most handsome Great Dane loving his spa day (not that I’m biased or anything).

Here is a photo of Grover getting some bonus massage therapy by some visiting veterinary students have his acupuncture treatment. We have to wait for suture removal before he can get back in the underwater treadmill … we are counting down the days!

 

 

As we progress through recovery our “old man” (said with all the affection and love) continues to amaze everyone. Several individuals at the vet clinic have come over to say they didn’t think he would do so well after surgery and that they are so glad we forged ahead. I will forever be in awe of the resiliency of dogs. If only us humans could be more like them.

Chemotherapy is such a hard decision. There are so many factors that go into it — of course there is the money part (a sad but true reality for veterinary medicine) and also the (even harder) “what is fair for my pet” part. I learned some interesting things about veterinary chemotherapy from our oncologist that I wanted to share.

When most of us (myself included) think of chemotherapy we think of very sick people — loosing their hair, getting mouth sores, unable to get out of bed, extreme nausea and other gastrointestinal upset among other terrible side effects. I was surprised to learn that this is rarely the case for dogs and definitely not the goal. The main reason is because veterinarians don’t use the same high doses and frequencies  for the chemotherapy drugs for dogs that are used for humans. There are two reasons for this – (1) those side effects just wouldn’t be fair for dogs. (2) with point (1) in mind, the goal is usually not to fully cure dogs of their cancer, but rather to prolong the time until the cancer recurs or spreads. Sometimes we get lucky … but because the goal is to prolong the “disease free time” we can use lower doses and thus hopefully avoid so many side effects. Our oncologist told us that she doesn’t even usually need anti-nausea medications for her patients, but of course we have them if needed!

Day 1 of chemotherapy (carboplatin) is behind us and we will be carefully watching him and getting recheck blood counts performed every week to make sure his immune system doesn’t take too much of a hit and to see when his personal “right” time is for round 2.

Resting in his “kennel”. His crate was always his safe place, but we had to modify it post amputation as we were afraid that he would get stuck in it … luckily in his old age his bed and moveable ex-pens give him the same “safe zone” feeling

The resiliency of dogs continues to amaze me. As you can see below, G is not only getting into a good “hopping groove” but he’s getting to enjoy the “little things” in life. We may not be hiking any mountains anytime soon … but that doesn’t mean we can’t lay in the sun, hang out in the grass and appreciate simply being together. These may be our “new normals” but that doesn’t make them bad.

We are finally starting to breath a sigh of relief. His appetite has been great, he’s getting around well and has almost broken into a run a few times. Grover is known for being absolutely maniacal about incisions in the past. He will even use the EDGE of an E-collar to scrape them open! What skill.  This incision is an important one though and we are watching him like a hawk to try and prevent him from doing damage.

We are watching his diet closely.  Our veterinarians said the fact that he was already so lean likely played a roll in how well he recovered and that veterinarians are now realizing that obesity has a more negative impact on recovery from amputation than actual size of the breed. Our activity level has dropped dramatically so it’s up to us humans to make sure G’s calorie intake drops too … it’s so hard when we want to smother him with treats! Unfortunately, obesity in pets is a real problem. Over half of the dogs in the US are obese and this can have serious effects on their health, mobility and ability to recover from major surgery. Did you know that if you are working to get weight off your pets, many vet clinics will let you stop in to jump on the scale for free? It’s can be a great tool to help us keep our dogs on track. Dog food is a hot topic these days and one we don’t really want to dive into … but we will advocate for keeping your pet lean regardless of what you feed them! Here is a website that offers information about pet obesity, tips and hints if you are like us and need to watch the pounds: petobesityprevention.org 

Grover getting his groove on:

Getting some sun time in the grass