Grovers grand finale

Although Grover had exceeded our expectations in terms of getting home and walking/hopping, these first days weren’t without their hard moments. Getting up when Grover was laying in lateral with his amputation side down proved to be not only challenging but also very painful. Although the picture of him sleeping on the couch from the previous post looks peaceful … that only lasted until it was time to get up and he started screaming. This screaming was only made worse by me trying to help. The sound of him crying like that made me want to cry …. but he couldn’t lay there forever so we had to get it over with. I think that the pain came from his neck, but who knows for sure. The good news was that once he was up he could hop around fine … it just seemed to be getting up that was hard. Luckily, it only took two painful attempts to get up for him to realize that he should probably lay on the other side … smart boy!

I have to thank the tripods website for alerting us to the ruffwear harness … it works great! This is the harness that G is sporting in these photos. First, there is a size that actually fits a Great Dane (hard to find!) and second, it is comfortable enough for him to wear all day/night. With the brush guard it helps evenly distribute pressure and we never had to worry about it ‘cutting’ into his incision.

Our couch struggles lead to trying to create “alternative sleeping arrangements” …  although well intended I’m not sure he was amused. We also ended up taking our bed off the frame and putting the mattresses on the ground so that he didn’t  have as high to jump and could get into bed with us at night easier. I must have a saint for a husband because without asking he started sleeping in the guest room so that Grover could have more space on the bed with me while he was recovering. <3

showing off his new walking skills:

Photos:  our handsome boy showing off his new standing on 3 legs skills and a “modified sofa” 

I arrived back home after a long day of flying at 1am and used all of my self control not to visit until the next morning. The truth is that the ICU is a place to heal and where dogs need to get their rest … not necessarily be smothered by their overly worried owners in the middle of the night. Of course coming home to a photo in an email of Grover hanging out with his three favorite students helped ease my mind — he was in the best care possible.

The next morning we stopped at McDonalds to pick up a breakfast sandwich for him (last I heard he still was not eating), a few for his devoted students, technicians and residents and at Starbucks to pick up appreciation lattes for his team. You can imagine my surprise when Grover comes hoping out to meet me in the lobby! Tears of joy and hugs all around! Grover had a great night — he was able to get off of the fentanyl and with that his appetite returned. He had eaten a full breakfast, was able to get up on his own, go outside to go to the bathroom. It turns out our “morning visit” turned into morning pick up! 36 hours after surgery we were ready to go home!

A video of Grover sound asleep on his favorite couch after coming home  — he climbed up all on his own before I could stop him! 

With home being 3 hours behind in time it was a long wait for new news. But , I know that middle of the night phone calls are never a good sign … so no news is good news.

Imagine my surprise and tears of joy when I received a video from the resident of Grover taking his “first hops” outside. ALL OF THIS WAS JUST 12 HOURS AFTER SURGERY!

I should caution that despite this victory we were not out of the woods. It wasn’t as though he was pain free, smooth sailing and ready to go home. But this was a great start for a dog we weren’t sure would be able to walk/hop on his own at all … let alone 12 hours later.

The down side, was that as voiced as a concern by his team pre surgery, he did have more neck pain than a normal dog would after amputation. He would cry out when they rotated which side he laid on and cried out when they helped him to stand. This is not surprising when you think of the way a forelimb amputee Hops … all that up and down neck movement and using your neck to stabilize and balance yourself is not great when you already have cervical arthritis, narrowing and possible disc disease.

Physical therapy stopped in to do acupuncture, laser therapy and passive range of motion exercises and the amazing critical care team worked to keep him comfortable with a continuous rate infusion of fentanyl, gabapentin and NSAIDs (Galliprant). He was unwilling to eat (not uncommon for Grover when he is on opioids) even with anti-naseau medication but that also meant he needed fluids to stay hydrated.

We had 3 goals that needed to be met to go home:

(1) Able to get up on his own (at least we had the walking part down!)

(2) Able to get off continuous rate infusion pain medications and on an oral or transdermal plan that kept him comfortable

(3)Willing to eat and drink on his own

We still had a ways to go … but so far we were off to a good start!

As I left for a cell phone dead zone in Canada for work, we started to second guess our future decisions. Grover was back to Grover after radiation. Was 3-6 months of life like this better than potentially getting more time with 3 legs? Radiation impressed me … I didn’t expect to see such a positive response. Who was I doing the amputation for? Was it for me, or for him?

For better or for worse, Grover made the decision for us, and while I was out of the country (Canada … so close, but so far away) Grover suddenly became very lame again. Repeat radiographs revealed that he probably felt a little TOO good with radiation and unfortunately his ulna had fractured. Unable to take calls and only get texts while hooked up to internet connections we made the decision to stick to the original plan and send him to surgery, except NOW instead of after I got home. It wasn’t fair to him to wait in pain just so that I could be there.

All the people on our team told him how much I loved him and off he went into very capable hands. Only time would tell now … would he be able to walk after surgery? Could the rest of him hold up? Or, were we asking too much of his already old and worn down body.

It was wonderful news to hear that he made it out of surgery with no major complications but we all knew the biggest battle was yet to come. Could he walk? Could he do so comfortably? Would the rest of him hold up? Only time would tell…

At the advice of a hospice veterinarian we made a “quality of life check list”. A list of things that we felt “made Grover, Grover” and indicated to us that he was happy. We also looked up quality of life assessments from Ohio State University and the hmmmmm assessment. These decisions are never easy but we wanted to be prepared with realistic goals and assessments so that if things didn’t go well we didn’t “drag” them out by saying “just one more day” only to find “one more day” had turned into weeks and he was none better.

A picture of Grover right after surgery recovering — snug as a bug in a rug (remember those great veterinary students … they kindly sent this worried out of the country pet parent a photo of “proof of recovery” so that I could see for myself that he was awake and safe)

After a weekend of soul searching (and a lot of crying in the shower) we came back Monday and had the opportunity to talk to all of “the teams”. It takes a village to keep an old Great Dane going and we are lucky enough to have a teaching hospital close by that we also use as our “regular” veterinarian.

I think that this is a great time to pause and talk a little about the term “teaching hospital.” Many times this brings up the wrong impression — that this is a hospital where people experiment or let unqualified people practice on your pet. It’s really not true and just the opposite. You have a team of people on each service (usually a board certified senior clinician, a resident and a 4th year veterinary student) that works with your pet. The resident has already graduated veterinary school and undergone at least one year of VERY intense specialty training and was now selected to pursue an additional 3 years of specialty training. No on experiments on your animal — however, if you are lucky you may have the OPTION to enroll your pet in ground breaking clinical trial research but it is YOUR option and you are ALWAYS fully informed and ALWAYS have the option to say no. And really, no one (student or resident) is allowed to do anything that they are not fully prepared to do and without intense supervision. The AMAZING side of teaching hospitals is that while the senior clinician may have many patients, and the resident has less but still many patients the students usually just have a few … this means that your pet gets so much extra attention.

The other benefit of a teaching hospital is that you get many specialists under one roof. So, Monday we met with the team. We met with oncology, soft tissue surgery, rehab, neurology, anesthesia, cardiology and orthopedics. Everyone got a chance to evaluate Grover, express any concerns that they had about going forward with an amputation. No one felt that he should NOT have an amputation, but everyone had concerns that there was a possibility it could go poorly based on his pre-existing issues.

Our amazing oncologist sat down with us and presented our options and spent so much time answering our 1 million questions while we continued to process the news.

(1) we could do nothing and stop. euthanasia is never a “wrong” answer and always an option to end pain and suffering.

(2) we could try palliative radiation. It could provide him with better pain control and on average gives animals 3-6 months. With this we wouldn’t have to worry about him not managing on 3 legs.

(3) we could amputate and go for chemo. Together, on average, this gives dogs 9-12 months. However, first the oncologist recommended a CT to take a closer look for thoracic metastases of the cancer. In a large dog like Grover, radiographs can be harder to interpret and she suggested that if the CT showed mets we may not have enough time left to make recovering from surgery worth it for him (given that we are expecting a harder and more challenging recovery).

To make things harder, I had to leave in just a couple days to go out of town for work. It couldn’t be re-scheduled … should we try to fit surgery in before the trip knowing I couldn’t be there right after surgery? Should we make him wait?

At the end of the day his CT still didn’t show any mets and we decided to do (2) doses of palliative radiation 12 hours apart to see if it made him more comfortable so that I could come back for his surgery. The great news … within 12 hours of the last dose of radiation Grover was back to being grover! He was off opioid pain medication, playing and comfortable on his leg!

A video of Grover back to playing with his favorite lamb chop (ok, lamb chop the 12th) IMG_0407