It's a dog's life
Last page first: Everything is okay, Payton is doing fine and recovering well.
60 Hours Earlier: Saturday, April 7, 2007, 9:00 am
Somewhere around 9 in the morning, Payton vomited his breakfast from 6 am. This is not entirely unheard of, especially since mid-March he ended up at a vet clinic in Rapid City, SD, for symptoms of pre-bloat. They kept him for the day for observation, but it seemed to pass, and he came home just fine. So Saturday, with the first vomit, not really in panic mode.
However, after I get out of the shower, S tells me that Payton looks like he's feeling a little dopey; not that much later, we get another round of vomiting, this time a very viscous, bile-filled substance. He's now showing some signs of pre-bloat, much like in March, with a swollen abdomen, inability to get comfortable, distress panting, etc. My first instinct is that since we've just recently gone through this without any trauma, we can probably just watch him throughout the day. My second instinct to call the U of M vet clinic is the one I followed. Thank Dog.
We brought him in and they took him right back for xrays. When the doctor came back out, she asked if the Rapid xrays had shown anything wrong with the spleen area. There was some unidentified object there then, but they weren't really sure what it was, and he was obviously bloated at that time, so we didn't really explore that area. When she showed me the xrays, his spleen was huge. What they couldn't tell was if it was a) a twisted spleen, b) some kind of non-spleen mass, or 3) an enlarged spleen for some other unknown reason. She called the on-call radiologist who was pretty sure that it was the spleen, but he wasn't sure if the problem was torsion or enlargement. An ultrasound confirmed the radiologist's opinion.
At that point, we opted for a potentially less invasive procedure by having them do a needle asparate to see if they could detect anything in the spleen itself that would cause enlargement. When we asked her recommendation, she said that he was really borderline. She didn't know if the surgeon's willingness to schedule him in was indicative of a true emergency or just a comment that he had the time if we chose to go that way.
After that is when things really got scary. I had left the hospital around 12 thinking he would go to surgery (this was pre-ultrasound). With the option of needle asparate, things didn't sound very desperate, and possibly we could avoid surgery. However, shortly after the asparate, she called back and said that he was crashing and getting shocky, meaning losing blood. Furthermore, they found quite a bit of blood in the abdomen when they did the asparate, but they weren't quite sure if the blood was due to the procedure, which would then clot, or if it was from the spleen itself. She presented the option of attempting transfusions and playing the "wait and see" game, or just going to surgery; I didn't even ask S and just told her to go with the surgery.
At 8:30 Saturday night, we got the call that he was out of surgery and in the ICU (remember this is a teaching hospital at the U of M vet school, so the care and access to resources are pretty phenomenal). The spleen was indeed twisted, and it had indeed ruptured. They had to make a larger than normal incision to verify that the spleen was the only thing producing the blood (which was the case). They also tacked his stomach, which is a common procedure with dogs who might be prone to bloat if you're doing abdominal surgery anyway.
While he came through surgery all right, he still wasn't out of danger. Because the spleen had not been receiving good blood, it had been building up the toxins that it is designed to filter. So there was still a possibility that he would go into toxic shock if those toxins entered the blood stream. They also weren't sure if the transfusion would be accepted, or if he would be able to continue generating his own red blood cells. And, as we found out the next morning, he had lost so much blood pre-surgery that the surgeon wasn't even sure he would pull through. Talk about hearing something to make a mother's heart stop beating.
On Sunday when they called, he was doing well, alert and responsive, but they were concerned because they couldn't get him to move for them and he wasn't eating. He wouldn't even take hand-fed hotdogs. Part of the importance of him eating was to continue to build up protein supplies to combat the anemia. When we got to see him, though, he stood up for us and started eating. He not only ate the cold food that he had rejected earlier, but also the new food the student provided. They were happy to see him moving, too. Of course, this is my finicky boy who doesn't like slippery tile floors anyway, so I'm not surprised he didn't want to move, and he's also not food motivated, so I'm not surprised he didn't want to eat.
On Monday morning, he was doing well enough to move out of ICU into the regular hospital wards. We went in over lunchtime to see him and the surgeon said he was doing so well we could even take him home. Yay! When we asked Payton if he wanted to go home, he perked right up. During our visit he was somewhat whiny and squeaky, which we attributed to pain since our visit was delaying his next pain-killer injection. The student gave him the injection before we left, but he was definitely ready to go home. I think a large part of the whining was more to go home than for pain.
When we got home, he spent a little time in the backyard (he hates to potty on leash), then managed to get up the stairs. At that point, he was so exhausted from the hospital (the ICU really isn't the best place to get good rest) and from his emotional distress that he sacked out. I brought Remy to work with me for the rest of the day, and S was able to stay home with the boy. When Remy and I got home after obedience class at 7, he was alert and waggy and wanting to see us. He's moving quite well, and will probably be difficult to keep calm and quiet within a few days.
The entire episode cost under $5000, and I'll leave it at that. He's only 3 1/2, which, while middle-aged for a Dane (on the conservative side), is still young. But he has officially become the most expensive dog we've ever owned. And this is the second boy we've had now who had something go wrong with his spleen. I'm not generally one to bring my kids to the vet for every little thing. I have had enough experience that I can generally gauge if it is vet-worthy or not. I'm just a little scared that I almost didn't take him in. And the other scary part is the realization that if we hadn't been home, if this hadn't been a weekend when emergency visits become more expensive, we would have lost him. He would have bled so much internally while we were at work that even if he had still been alive when we got home, he would have been in pretty severe shock. I'm also pretty certain that if I hadn't taken him to the U, we might not have him with us now. Not that our vet is incompetent or anything, but we would have first had to push our way into a very busy schedule and they might not have had the transfusion/radiology/ICU resources tha tthe U has. Oy. I almost never say I'm glad the weekend is over, but this is definitely one time I am.
Right now I only have one picture of the incision site, and it's not a very good one. I'll try to get a few more and post them under the break to document his healing process.