Mom's POV: Heidi's Good and Bad News

Hello!  Heidi has told you all about her illness, finally.  She would not let me write about it until she broke the news.  Now, I can tell you what it was like from my point of view.  I try to be stoic, especially in front of Heidi, but the news really broke my heart a little.  Likely, this is what will ultimately make her very ill and send her off for greener pastures, something I am dreading completely.

Heidi has improved my life so much there is no way I can express that to her or to you.  She was my first puppy as an adult when I lived alone and was not working because of a hand injury.  We got to spend a lot of time together in her formative months.  She is also the only dog that I took to puppy school which is why she is the only one who obeys me at all!  Although, she is also the only one who talks back to me and orders me around.  She is too smart for me - she always has been.  So, clearly, she is the reason my life has been as good as it has been.  And, clearly, the thought of not having her in my life scares the patooties out of me.

On to what is wrong with her: her body is really good at making mast cell tumors as she's had 7 removed so far.  Now, the new, bad problem is that her kidneys are having trouble filtering properly.

NOTE:
I started writing this over a month ago and I just couldn't bring myself to finish.
Heidi is doing well on her prescription kidney diet.  Although she is still having accidents while I am away from the house, the uses the pads every time.  Well, every time I remember to put one down.

Good News, Bad News

Which comes first?

In this case it was the bad news.

I have sick kidneys.  I found out a month ago and it has taken me a while to ponder it enough to be able to write about it.  I constantly feel like I want to drink water but then I have to pee all of the time!  I have tried so hard to start with an empty bladder when mom leaves for the day.  I try not to have accidents in the house, but sometimes I just can not hold it!  It is embarrassing and the boys tease me about it.  I feel ashamed.

Mom tries every day to make sure I am happy.  I have to give her credit - she has tried really hard to make me feel better - better about not feeling good and better about peeing in the house.  At first I thought she would be angry when she came home to the puddles.  She was never angry!  I think she got annoyed that I peed on the big rug sometimes instead of the washable one by the door.  I agree it was a poor choice on my part, but sometimes I missed.  Anyway, she keeps telling me there is no shame in what I have been forced to do.  She understands I am not trying to be bad and that I am sick and cannot help it, but I still feel bad anyway.  Mom tells me, "Heidi, there is no shame.  Pee on the pad - that's what it's for."  The big rug got so dirty that she rolled it up and moved it.  Now, I don't have to worry about that anymore.  I just pee on whatever is by the door.  It is so much easier, lol.

Oh, the good news!

I forgot about that for a minute.  Mom drove me to see our veterinarian.  He looked at my insides with an ultrasound machine and mom drew blood to send out to a lab for a CBC and serum chemistry tests (see the post SMILE - Pre-Anesthesia for a Dental Cleaning for an explanation about the bloodwork).  My vet did not see anything bad on the ultrasound and the only thing wrong with my bloodwork was the kidney values, BUN and creatinine, which are elevated.  This is expected with kidney disease (aka renal failure).  So, for now, all I have to do is eat a special food and recheck my bloodwork every few months.  The food is a special prescription diet which actually tastes really good.  I heard "prescription" and thought it would be awful and mom would have to force feed me.  Thankfully, that was not the case!

Digging to China?

Oh boy!  Edgar is in trouble.  With mom.

Mom spent a lot of time and sweat putting in a new plant garden in the back yard, complete with a little rock lined "stream" to help with drainage.  Edgar has spent a ridiculous amount of time digging in it.  Every time he goes outside, he digs a little more.  He eats something.  I do not know what it is, and I do not care what it is.  Mom sure does though.  She yells at him all of the time now and has to clean off his face and his feet every time he comes back inside.

I laugh.  She tells him every time he wants to go outside, "DO NOT DIG in the yard!"  Every time.  Poor mom is so frustrated with him.  I keep trying to tell her that he is a boy and a dog and he will not obey.  He just is not bright enough to stop.

Here is the yard after all of Mom's hard work.  

Notice the board across the "stream."

The preliminary plants are in, the mulch is thick, and the rocks are looking good.  Can you see me hiding behind the bush?

There's the board from the previous picture.

Destruction!

It really is an understatement to say that she is annoyed!  At least you can see some of the plants have grown well.  She has more plants to go in this fall.  I can not wait for the crepe myrtles to get planted.  They are so pretty!

*UPDATE: October 15, 2014.  Edgar is still at it and the yard is even worse these days.  Mom is now threatening to take him to the pound!  I know she is kidding, but still, I do not think that is funny because Edgar does not understand.  He does not understand that she is kidding yet he still digs in the yard.  Boys!  Go figure!

Heidi's Birthday Baking

Heidi's mom here.

I know that Heidi has written about her birthday party and how much she liked her cakes.  I had a lot of fun baking them for her.  It makes me laugh when I watch her eat her cake with her front teeth.  She sort of nibbles her way down through the frosting first, before enjoying the cake at the bottom.  

I baked the cakes the morning of her party.  While we were at the beach I sneaked out of the house and headed to Salty Paws Biscuits, a barkery we love.  I purchased this peanut butter cake mix that included a mix for yogurt frosting.  I only had to add an egg, a little bit of oil, and some water.  Super easy!

Just a few ingredients needed.

Mixed and ready to be baked.

Cooling before icing application.

The cake actually smelled like peanut butter.  I was tempted to eat one myself.  After cooling I mixed the icing powder with a little bit of water and applied it to the tops of the cakes.  It just seemed like they were missing something though, so with the help of my friend's daughter, we made a peanut butter drizzle to decorate the tops.

Wylie helping finish the cakes.

I love celebrating Heidi's birthday every year.  This year we couldn't do it at the beach - the first time ever.  We made up for it with my friend and her daughter and their two dogs coming over to celebrate with us.  Wylie had a great time distributing the cakes to the dogs and they had a great time eating them.  All of this makes me very happy!

It's MY Party!

This year, celebrating my birthday was a little different.  Instead of having a party at the beach like we usually do, we had it at home after we got back.  Mom invited a few of our friends over - humans and dogs.  She baked me some miniature cakes.  So yummy!  It was peanut butter cake with yogurt frosting and a peanut butter drizzle.  Oh my, I did not know something could be so good!

First licks prove yummy level is high.

Have to take a moment to taste it...

...before diving in!

But I still take my time to savor it!

Edgar, on the other hand just dives right in sucking the whole cake down in one bite.  I am not sure he even knew what flavor it was it disappeared so quickly!

SNIFF...

...CHOMP!

LOL.  I do not know how he did not choke on that cake.  Everyone else at the party bit into their cakes and savored them as I did.  Edgar is just a big, goofy goofball.

Olaf and Elsa enjoying their pieces of cake also.

Mom always knows how to throw a good party.  And yes, I am 13 now.  I will never be one of those individuals who lies about their age.  I am proud to have lived this long, although the aging body does have its issues.  But do not worry - I am still awesome.  LOL.

Aging Body, Aging Mind

Having just celebrated my 13th birthday in August (party pictures to arrive soon!), I have noticed some things have changed over the last year.  I suddenly feel "old."  I never thought of myself as being that old, but I am starting to get those old dog problems.  Getting up and down from the couch and bed have become a little difficult.  I am not as springy as I used to be!  Mom went to a used furniture store and found a set of wooden steps to help me get up on the bed.  She painted them and covered the treads with fabric so they wouldn't be slippery for me.

She has also put an old couch cushion in front of the couch to help give me a boost up.  Since I shed a lot and my hair really likes to stick to fabric, mom wrapped a sheet around the cushion so she can unwrap it easily to wash it.  The tan thing on the couch is a rubber-backed non-slip bath mat.  The leather is slick for my paws and I was always slipping around on the couch.  The mat makes me feel a lot more secure!  I no longer slide around and fall into the crevices between the cushions.

The saddest part of getting old for me is that I can no longer catch the frisbee.  My most favorite thing to do in all the world is catch the frisbee.  My eyesight has changed and it has made it difficult for me to accurately see where it is in relation to my mouth.  Mom suspected it was my eyes so she took me to the vet to make sure.  My veterinarian performed a pretty thorough eye exam and was able to determine that, aside from the usual age-related change to my eyes of nuclear sclerosis*, I actually have small cataracts in the center of my eyes.  He does not think I will go blind - thankfully! - but it does leave me with my peripheral vision being better than central vision.

Ah, well, I guess there is nothing I can do about aging except get used to it!  No point in fighting it.  In fact, I asked mom if she would dye the big spot on my face.  It has almost completely disappeared!  She refused to do it!  She said it's better to accept the changes as they come and not try to hide from them.  I understand what she is saying, but I still miss the spot.

Take care of your friends and neighbors!  Especially the elderly ones.  We need it!

Beds on the Cheap

Since I have to live with three dogs, mom has gotten really good at buying, making, and recycling beds on the cheap for us.  Surprisingly, dog beds are quite pricey - at least according to her complaining about it.  A couple of her creations are shown below.

Mojo's favorite bed.

Mom took an old cat bed, lined the bottom with a heating pad and covered it with a fleece blanket.  This is where Mojo spends 95% of his day.  Even in the summer, he loves that heating pad!

A bed inherited from another family.
(Excuse all of the hair on it!)

The down insert with a piece of
memory foam mattress topper.

The green bed is where the boys - Mojo and Bentley - sleep at night.  The down insert was getting a bit tired and losing its plumpness, so Mom cut up an old memory foam mattress topper and put a piece inside.  Several of the beds have been fortified with pieces from that one topper.  It's actually quite a comfy bed.

The newest cover and bed.

Mom recently bought us a new couch.  The old couch was old, unsupportive, and quite heavily stained so it was headed for the dumpster.  The frame was sent off, but we kept the four big cushions to use for dog beds.  The plaid bed was created from some leftover fabric that Mom stitched into a cover.  The stuffing is the two back cushions from the old couch.  It's a nice place to catch a nap on a warm day.

Not good at sewing?  Don't have the time?  A really easy solution is to take an old sheet and wrap up the cushion with it.  Easy to change and wash.

Old yellow sheet.

One of mom's old bed sheets folded around one of the old couch's seat cushions.  In the picture below you can see the original cushion cover (red) is still on it.  It helps boost me up so I can get on the couch more easily.  It's also one of Edgar's napping locations.

Old red couch cushion.

This last couple of beds are really only good for small dogs.  Mom had an old pillow she was going to get rid of, but she decided to put an old pillow case (the plaid one) on it and it's suddenly a chihuahua bed!

Little dog beds.

The brown one on the right in the picture above is actually a baby changing table mattress with a piece of that excellent memory foam mattress topper.  The cover was bought at Babies'R'Us when the mattress was.  It's easy to remove, as is the pillowcase, so they get washed fairly often.  This brown bed is my favorite when Mom is working in the kitchen.  I can keep an eye on her and make sure she is not burning the house down!

Baby changing table mattress and old mattress topper. 

Dog beds (or cat ones!) do not have to break the bank.  Be creative and reuse as much as you can.  Another good idea is to take a cover and stuff it with an old comforter or feather bed.  If you do not have a cover, use an old sheet to wrap a folded comforter into a bed shape.  Easy to clean, easy to sleep on!

SMILE - Post-Anesthesia Recovery

All is done!  The teeth have been cleaned, the veterinarian has performed their examination, and it is finally time to wake up!

The inhaled anesthesia is turned off so that pure oxygen is given for a few minutes.  The monitoring probes and clamps are removed while an assistant prepares the cage with a heating pad and dry bedding.  The oxygen is stopped, the endotracheal tube is disconnected, untied, and the balloon deflated.  Since dental cleanings are wet affairs, the head is dried with towels or a hair dryer.

Your pet is carefully carried over to the cage and placed on the heating pad covered with bedding - usually towels or synthetic lambswool.  

Heidi's recovery cage.  

The endotracheal tube is not removed until your pet is awake enough to swallow on their own.  The risk of removing the trach tube too soon is that the animal will aspirate (inhale) fluid into their lungs.  Fluid in lungs = bad news.  An assistant or LVT will watch constantly to monitor the pet's ability to swallow.  Once the animal is conscious enough to swallow on their own, the trach tube can be removed.  This is why Heidi's tongue in the picture above is pulled out the side of her mouth; when she swallows, her tongue with curl up.  After a few good swallows, the tube is pulled.  Then, time takes over.  A nap and some quiet observation of their surroundings lead to full consciousness and bodily control.

Heidi has been extubated (endotracheal tube removed).
Perfect time for a good, cozy nap.

After your pet has recovered from anesthesia and is comfortably accommodated at home, you may notice a lack of energy and propensity to sleep for the rest of the day and probably the next day too!  This is normal.  When Heidi came home, she could hardly keep her eyes open.  She and the other dogs slept the rest of the day and almost all of the next day.  Usually, your veterinarian will send you home with some home-care instructions.  There may be medications to be given at home, recommendation to feed soft or canned food for a specified period of time, and/or leash walks for a specified period of time.

Heidi can hardly keep her eyes open.

Cuddled under the quilt, she can hardly keep her head up.

Since Heidi had tumors removed from her back legs, she had to visit the vet's office to have her sutures removed after 10-14 days.  Because her teeth were cleaned, Heidi had a few days of canned food since her gums can be sensitive afterwards.

The saga is over - for now!

While dental cleanings can cost a great deal, they are a sure-fire way to maintain and improve the health of your pet.  You may even notice afterwards that they act like a much younger self.

Animals are very good at hiding pain so you may not even know that anything was bothering them until they get their teeth cleaned!

SMILE - Surprise Tumor Removal!

(slightly) GRAPHIC PHOTOS IN THIS POST!!  Do not read further if you do not want to see them.

While in the hospital to have Heidi's teeth cleaned, we found two little bumps on her back legs that turned out to be mast cell tumors.  This account is about how we found them, what they are, and how they were removed.



In a previous post, SMILE - Pre-anesthetic Physical and Pre-Medication, I mentioned how the licensed veterinary technician had a difficult time placing Heidi's IV catheter.  Sometimes this can be because the animal is not cooperating - they tend to not understand why we are poking them with sharp objects!  In this case, Heidi's cephalic vein (the one in her front leg) was the one not cooperating.  So, we decided to try to place one in her back leg in the lateral saphenous vein.  When placing an IV catheter, the area is shaved and cleaned to reduce the chance of infection occurring where the catheter enters the skin.  Well, to our surprise, the shaved area revealed a small bump.  It had no hair growing on it and was slightly raised.

The easiest, quickest, and least expensive way to assess a lump is to perform a fine needle aspirate (or biopsy) and cytology.  A thin needle attached to a syringe is inserted into the lump and cells are pulled into the syringe.  The cells are then pushed out of the syringe and onto a glass slide.  The slide, or rather the cells on the slide, are stained and examined under a microscope (cytology).  This LINK has some easy to read information on mast cell tumors, including a picture of what they look like.  Their appearance is distinctive and easy to identify.

Wikipedia's Mastocytoma Picture.
Mastocytoma = mast cell tumor.

Mast cells have a dark blue staining nucleus (center) with dark purple staining granules in the cytoplasm (dots in the area around the nucleus).  

The little lump we found, which was around 3 mm in diameter, showed mast cells in the cytology.  Mast cell tumors in the skin are easily removed when they are small, so we decided to try to place the IV catheter in Heidi's other back leg.  Well, when we shaved the other leg, we found another little mass(!!) in the same place as the first one.  When the vet performed the aspirate and cytology on the second lump, he found more mast cells!  The surgery to remove the tumors was performed before the dental cleaning.  

When an animal undergoes the physiological stress of anesthesia, the time they are anesthetized is minimized as much as possible.  The vet wanted to make sure there was enough time to remove the tumors since that was more important, at that time, than having her teeth cleaned, so the surgery was performed first.  (Luckily, we had enough time to do both!)

Once the IV catheter had successfully been placed, the LVT anesthetized and intubated Heidi in order to start the surgical preparation for the tumor removals.  This is described in the previous post SMILE - General Anesthesia and Monitoring.

The area where the surgery will occur needs to be shaved and cleaned.  Both legs were shaved so that there was a few inches clear around each tumor.  These areas were scrubbed three times alternating with chlorhexidine or iodine scrub (a soapy disinfectant) and alcohol (to clean off the soap and dirt).  Heidi was moved to the surgical suite onto a heated surgery table so she would not get cold.  Anesthesia causes heat loss, as does lying on a cold metal table.  For this reason, heating pads are used to help keep an animal warm during surgery.  Even on the table where dental cleanings take place and in the cage during recovery, there are heating pads.

Heidi's leg has been "prepped" for surgery.
The area has been shaved and cleaned.

The LVT opened the surgical gown and glove outer wrappings as well as the surgical pack and anything else that might be used during the surgery such as a scalpel blade and suture material (the thread used to close the incision).  The vet put on a surgical mask and cap, scrubbed his hands, donned a sterile surgical gown, and carefully put on a pair of sterile surgical gloves. 

Here you can see the surgical instruments, sterile gauze, and suture material.

The area around the surgical site was covered with a sterile drape.
The incision was made using a scalpel blade (very very sharp!).

All sewed up!
There is a little bit of blood and serous fluid
(liquid of blood that does not contain cells) oozing out.
This is totally normal.

Heidi had the tumors on both back legs removed and her teeth cleaned without any major issues discovered.  Everything complete, she was moved to her cage for recovery which will be described in the next post!

Mast cell tumors can be very bad or ok.  Heidi's have all been in her skin and removed completely.  As of today, she has had 6 removed.  She is a mast cell making machine!  I keep trying to convince her to stop!  

SMILE - Cleaning Teeth

Finally, we are ready to actually clean the teeth!

The licensed veterinary technician performs the cleaning much as a dental hygienist does with people.  The LVT will start by assessing the overall health of the mouth by looking at the teeth to see if any are broken or missing, noting any discoloration, excessive tartar buildup, and/or excessive wear; by looking at the gums to note any redness, swelling, or presence of pus; by looking for the presence of a gingival pocket which is a space where the gums have become detached from the tooth; and/or looking for tumors or gingival hyperplasia (excessive growth of gum tissue); and by looking at the tongue, cheeks, and other structures of the mouth and throat that are visible.

Here you can see Heidi's dirty teeth.  There is a little bit of blood on her upper back teeth.
This happens when your gums are not very healthy.

Dental scaling is the term for cleaning the teeth.  A pointy metal instrument scrapes the tartar from the visible portion of the tooth as well as a short distance under the gumline.  Dental cleanings mainly involved the use of these hand scalers.  However, these days the majority of veterinarians use a dental cavitron scaler which is a small handheld device with a metal tip which sprays water or a solution of chlorhexidine (a disinfectant) and water combined with ultrasonic pulsations.  It's the use of ultrasonic waves that makes cleaning teeth less painful and time consuming and much easier than hand scaling.

The ultrasonic scaler can be seen above.

Scaling the teeth, whether by hand or machine, creates a roughened surface that is a magnet to new tartar growth.  If this roughened surface is not smoothed, it would be worse than not having your teeth cleaned at all!  This is why teeth are polished after they are cleaned.  Keeping tartar away is the key to good dental health.  Tartar builds up on teeth after 24 hours of being dirty.  This is why we, as humans, generally clean our teeth at least twice a day.  This keeps tartar from firmly attaching to our teeth.  This is also why brushing our pet's teeth is a kind way to keep their teeth healthy.  Brushing keeps their mouths healthy which keeps them healthy!

Once the cleaning and polishing is complete, the LVT will get the veterinarian to examine the mouth and share any observations noted during their initial examination.  The veterinarian performs their own examination with a periodontal probe.  The probes have markings on them to show varying lengths in millimeters.  This allows them to measure how deep a gingival pocket is.  The deeper the pocket the more chance there is for bacteria to enter the bloodstream.  This bacteria travelling to the heart is what can cause infections that damage the heart valves and cause other life-threatening complications.

The periodontal probe shown has very faint markings.
The bottom two are 3mm each and the upper two are 2mm each.

Look how far back Heidi's teeth go!

During the examination, the veterinarian uses a chart to keep track of the observations.  Missing or broken teeth, which teeth are extracted, presence of gingival pockets and how deep they are, presence of tumors or hyperplasia, etc. are all noted on the this card which is attached to the chart as part of the permanent medical record.

Mojo's chart is shown (see his feet?)  Circled teeth are missing.
X's are teeth that have just been extracted.

Luckily, Heidi did not need any teeth pulled this time!

Shiny, white(ish), and clean!

Next will be a post about the tumors we found (when the techs tried to place Heidi's IV catheter) and how they were removed.  For not very weak stomachs (only due to mildly graphic pictures)!

Apologies, Dear Readers

This is Heidi's mom.  I am sorry for such a long break that I took, and forced Heidi to take, from writing.  Heidi has been urging me to continue for a long time.  In fact, she got quite insistent about it and I had to explain to her that I just did not have the energy.  As she mentioned, I was diagnosed with a sleep disorder called narcolepsy.  The part of the brain that regulates when you are awake and when you are asleep starts to get mixed up and quits working properly.  It tells your body to be awake and asleep at the wrong times.  Narcolepsy also makes you sleep in REM too much causing a major lack of the restful and restorative deep sleep that keeps us healthy.  Other symptoms include things that occur with severe sleep deprivation, the worst for me being memory problems and not knowing whether something occurred in real life or if I dreamed it.  Cataplexy is a condition that accompanies many people with narcolepsy.  It causes a sudden loss of muscle tone resulting in anything from a slack jaw to completely falling down like a rag doll while still conscious.  There are many more signs and symptoms I can not list here.  Narcolepsy is a fascinating and complicated disease.  I never dreamed (no pun!) that my excessive sleepiness was caused by narcolepsy because I thought TV portrayals were accurate.  I was quite stunned when the doctor diagnosed me!

I am now taking medication to improve my sleep at night and another to help keep me awake during the day.  It has been a struggle, but I am finally getting some good sleep and feeling more human again.

So, now I am back as Heidi's typing minion.  I hope you all enjoy reading what she and I write!

I Am Still Here!

I have missed you all and I am finally back!

Mom has had a rough time for the past year and it has taken us a long time to get geared back up for writing.  Quite a year it has been too!  I have had more mast cell tumors removed.  All have been cutaneous which means that they are located only in the skin.  Having them surgically removed basically means they are gone.  The dogs and I all had our teeth cleaned in May, Edgar had pancreatitis, I had my tumors removed, and now Bentley is having anxiety issues keeping us up all night crying.  Mom had surgery on her hand last year and spent a lot of time in physical therapy only to find out that she couldn't do her job anymore.  She was also diagnosed with a sleep disorder called narcolepsy and had her eardrum rupture over Christmas.  Not fun times!  She has not worked since just before Thanksgiving; we are all getting a little bit sick of her being home all of the time.  (Ok, maybe a lot, but do not tell her I said that!)  She is starting school again in less than a month to become a radiation therapist.  I am hoping that some time away from the house will be good for her (and us!).

We are once again at the beach for my birthday!  I will be 13 this year.  I remember coming here as a puppy and I love it just as much now as I did then.  The smells are amazing!

Since Bentley's anxiety has suddenly gotten so bad, mom is trying to tire him out so that he might be more inclined to sleep at night instead of crying and hyperventilating.  She made an agility course in the backyard with a bunch of beach toys she found in the garage.

Beach agility for Bentley

It starts at the A-frame of the boogie board, then the weave balls and weird plastic things, over two jumps, through the floaty ring, under the pink chair and over the plastic bats and pool noodle.  Everything is chihuahua sized for Bentley so that he does not hurt himself.  He dislikes the floaty ring the most!  He does seem to like the A-frame and weave balls and weird plastic things the most.  Mom's mom (we call her Mimi) took Bentley for a walk after dinner and I think that helped him sleep a lot more than he has in a while.  It is sad that he has this anxiety, but honestly, I need my beauty sleep - especially at my age!  I really hope mom figures out how to make him feel better.  We are all a bit grumpy from it.  Even Mojo got a little ornery with him last night when we all got in bed.

Well, I am very happy that mom has decided we can continue to write for you.  I have missed you all so much!
Take care of yourselves and brush your teeth!