(Continued from Part 5)

edema3We hit traffic on the way to University Veterinary Services (UVS) and I called them to let them know we would be a little late. So they were basically waiting for us with a gurney when we pulled up. They adjusted the height until it lined up with the back of the Jeep and just slid her out, bed and all, onto the gurney. No screaming. No apologizing. Suzie accompanied her back to an exam room while I got us checked in at the desk. We only waited a few minutes before Ashley came in to go over Lena’s details and I handed her the disc with the rads on it. Dr. Kupanoff was still finishing up with another patient and would be in shortly. When she did come in we discussed the procedure and how long it would take (4 hours or so). There was one other patient ahead of Lena so it could be “late” before her surgery would start, but we didn’t know exactly when yet. We opted to wait around until she was out of surgery, no matter how late it was. I also had taken the opportunity to set up a meeting or two with some of the doctors at UVS to explore possible partnerships with GHI, so I knew we would have enough to keep us distracted during the afternoon. I can tell you without bias that everyone from the front desk to the Chief Administrative Officer are absolutely wonderful people with a clear passion for what they do. The owner, Mr. Horbal, even stopped by to ask about Lena. I thought he was giving us the VIP treatment because of our relationship with Dr. Couto and GHI, until, that is, I heard him greet someone else coming in the door and tell them that he had just looked in on their pet (he said her name but I don’t remember it) and that she looked ready to go home. At the risk of sounding like a commercial for UVS, that’s just the kind of place it is.

At some point we ducked out to get lunch. Then we got a tour of the facility from Mike, the CAO, and discussed partnership ideas. That’s when we saw Lena. She still hadn’t gone into surgery because an emergency had come in while we were at lunch — it sounded like a pretty bad trauma patient that could take a while. The only consolation was that we knew she was on some good pain killers and at least partially sedated. So “late” became “later” and 4:00 turned into 5:00. Then 6:00. The staff kept stopping by to check on us. 6:00 turned into 7:00. By 7:30 when she still hadn’t gone into surgery we started to rethink the sanity of staying through the 4-hour procedure: we had a 2.5-hour drive home and two more dogs that would be on their own after 8 when our “sitter” would have to leave. I still hadn’t slept and Suzie would have to drive home. Finally, at 8:00 we reluctantly bailed.

At 8:15, barely out of town, we got the call: they were prepping her for surgery. We almost turned back. But we were too exhausted from the events of the past three days for that to be a rational choice. I called around 11:00 for an update. Still in surgery. I told them to call as soon as she was out regardless of what time it was. “Later” then became “midnight”. It was a little after 12 AM when Dr. Kupanoff called and said the surgery was “uneventful” and that Lena was in recovery and doing well. [You may be wondering why she started the surgery so late. especially knowing how long it would take. Why not just wait until morning? When I asked, all she said was, “that’s just the way surgeons do it”. But I think it had to do with the fact the Dr. Kupanoff was only there part-time as a “traveling surgeon” and was due to leave the next day, so it was now or never. I’m happy to report that she has recently decided to work there full time.]

edema1

         Three Days post-amputation.

The next call we got was at 10 AM on Saturday. Lena was doing very well. She ate her breakfast and even stood up to do so. They were keeping her pretty loopy to give her a chance to heal in peace. The report Saturday evening was equally positive. We even started to discuss when we could bring her home! Dr. Couto recommends three days of post-op care in these situations and none of us were going to second-guess him. Sunday morning the report was that, “She looks fantastic. With the exception of the missing leg, if you looked at her from her right side, you’d never know she’d just had major surgery.” We talked about bringing her home later that night. She was doing so well that was a distinct possibility. Dr. Couto, who was getting regular updates from both UVS and me, was even cautiously optimistic. As Sunday afternoon rolled around we had to rethink making the trip due to a stomach bug Suzie had picked up — the thought of 5 hours in a car was not very appealing and probably ill-advised. So when UVS called at about 5:00 to tell us we could come and get her if we wanted to, it broke our hearts but we had to decline. We rescheduled for 9 AM on Monday.

Little did we know that that decision likely saved Lena’s life.

Overnight Lena swelled up like a water balloon. Edema (fluid build-up and retention in the body cavity), apparently, was not uncommon after traumatic events like this, even with the “controlled” trauma of surgically removing a limb. Though it normally doesn’t wait 48 hours to present itself. When we left our house at 6:00 on Monday we had no idea anything was wrong. When we arrived at UVS, we were fully expecting to leave in the next hour or so with Lena. Our first indication that anything was wrong was when we met Mr. Horbal on his way out the front door to a meeting. He said Lena and had had some complications overnight and we might not be able to take her home today. It didn’t sound too bad… “might” not take her home. 15 minutes later Dr. Brown was telling us about the edema and how it had happened in a matter of few short hours overnight. Five minutes later they walked Lena into the exam room. At least she was walking. I don’t know how to describe how she looked without it sounding like an exaggeration, so you can look at the pictures below. edema2She immediately laid down on the bed we brought for her. She was so full of fluid that her skin was stretched tight like it an over-full water balloon. There was actually fluid leaking out of a hole in her skin left by the IV from the surgery. I half-jokingly asked if we couldn’t just stand her up and let the fluid drain out that hole (or, more realistically,  put a port in to drain the fluid intentionally). Apparently that wasn’t a good idea. At this point we knew we couldn’t take her home. Her protein levels were incredibly low and that was likely causing the fluid leaking into her otherwise tiny frame. She had watery diarrhea and couldn’t control her bowels, which was likely contributing to her protein loss. She was alert, but clearly miserable. At one point while we were alone with her, Suzie asked me, “What have we done? I don’t want to see her suffering like this. Hasn’t she been through enough?” I know she wasn’t really saying we should let her go at that point, but I think her heart was breaking and couldn’t see past the distress in Lena’s eyes. All I could say was, “We’re giving her a second chance. This is just a temporary setback. She’s already shown us she’s a fighter, so let’s give her every opportunity to fight.” I don’t know if that made any difference to Suzie, but it helped calm my own doubts. A little. We stayed with her for about an hour and a half before she started getting fidgety and we thought she’d be more comfortable if they took her into the back and gave her something to calm her down. When I asked if they had anything for my nerves, too, one of the vet techs said something about a bar up the street. Even with her swollen feet and legs, even looking 3x her normal size, even though she was still adjusting to being a tripod, Lena walked away with the tech. That’s my girl.

We knew it was being overly optimistic thinking we might actually take her home tomorrow, but that’s what we chose to believe.

edema4Later that night I got another call from Dr. Brown. The fluid was still building up, her protein levels hadn’t improved and neither had the diarrhea. Her breathing had also become labored due to the pressure on her lungs (and heart?) from the fluid, so they put her on nasal oxygen. At this point there were two treatment options: a blood transfusion to introduce protein into her system or a drug that I can’t remember the name of. What I do remember was that the drug could cause a severe reaction if her body rejected it — I think there was some human component to it that could trigger an immune response that could ultimately kill her. Dr. Couto recommended the blood transfusion. There were no guarantees that it would work, but the side effects did not include possible death, so we chose that option. Over the next 24 hours they put a lot of blood into her. Tuesday morning they said her protein levels had started to come up, which I thought was a given since they’d been pumping her full of the stuff. But Dr. Brown seemed pleased so I took it as a good sign. But we were not going to get to take her home today. Maybe tomorrow [looking back it seems clear that by this point optimism was a defense mechanism masking the reality that she might never come home]. That evening they decided to give her another transfusion. All told, I have no idea how much blood they put into this 50-pound girl, but by Wednesday afternoon her numbers were up, the swelling was starting to go down and the diarrhea was “better” (let’s just leave it at that. If you want a detailed description of her poop, you can PM me).

Thursday morning at 10 AM her breathing was still labored and they hadn’t started to ween her off of the O2 yet. As a rule, they wouldn’t want to send her home until she’d been successfully off of the oxygen for 12 hours, so we knew we’d be waiting at least one more day before bringing her home. Hang in there little girl, maybe tomorrow. Her protein levels were up and her stool was, uhm, “soft but formed” (can any greyhound story be taken seriously without at least one description of their poop?).  By Thursday evening they had started to dial back the O2. Dr. Brown would be out for the next couple of days and would be handing Lena over to Dr. Lubold. Friday morning we didn’t get a call from UVS. I knew how busy they’d been and I also knew how much time I’d spent on the phone with them over the past week. They said they’d call when they had news. I distracted myself with work to keep from calling them. At noon Dr. Lubold called with the best news we’d had all week: We could take her home that evening!

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 7 | Part 8 | Part 9 (final)