Saturday, June 30, 2012

I came home from walking #2 this morning and found Max wiggling his butt and trying very hard to get up!  Poor little guy, but he's working hard and he'll get it one of these days! If there are a few things that Max has always been, they are persistent, a perfectionist, and a very hard worker!  After all he is SUPER MAX!

Thursday, June 28, 2012

Max is trying to stand up!

So.... in my last post I mentioned it's the little things that we're grateful for and give us hope!  Well... today Max made a big old stride and gave us something big to be happy about!  For the last couple of days, when I put max in a sternal position on his chest, he's been using his hind legs to re-adjust himself. The first time I thought it was a fluke, the second time, I thought maybe there's something to it.. The 3rd time, I knew he was doing it on purpose!

Over the last few days, Max has been sleeping a ridiculous amount. At first I thought it was a sign that he was getting ready to say goodbye.. then it dawned on me, he's lost some weight but he's still on mega doses of prednisone and his very low dose of 100mg of keppra. That could be knocking him out. He's back on his chinese herbs - the ones that break through the blood brain barrier and carry other drugs right to the brain and kind of magnify them... so I decided to cut back his prednisone slightly from 2.5ml 2x /day to 2ml 2x day  and move his 100mg of keppra from morning to night time.

Sometimes it's hard to remember that the pharmaceuticals can be dulling the mind and make it harder to recover.. you just have to be very careful how to change it up to try and make them sharper.. and see if it works..

Max also has had 3 rounds of acupuncture so far. Tomorrow will be his 4th round.

I'm not sure if it was one thing in particular or a combination or just timing but today he made some big strides!

When Max had his head rubbed today he tried to lift his head!  His eyes were wide open and moving around and he was watching everyone.. Then he started to move his back leg, then both and then he tried to push his rear end up!  I managed to get a little of this on film, but not the big push when he got his whole rear end airborn for a few seconds!  He's been able to move his left arm for about a week now, and that arm is getting stronger and stronger. He still struggles to control the movement but he can focus and make it move.  He did manage to slide it out from under a towel this afternoon too!

Anyway - here's the video of Max moving his back legs and trying to stand up!



He's definitely a super dog!!! He's working hard!!! GO MAX!

Monday, June 25, 2012

It's the Little Things

It's definitely the little things that make a big difference.  Max's recovery has been extremely slow but each day there's a little more to be happy about.  I'm finally able to get a little of it on video.

Max is definitely more alert than he has been.  His eyes sometimes follow what's going on and his ears are definitely in tune to sound and he'll wake up out of a dead sleep if he hears something.  Last night when the dogs were running around the house, Buster #2 jumped over Max and Max's eyes got really big and he huffed and started breathing heavier and trying to push with his left arm...   He's working on it!!!

He can now move the tip of his tail about an inch in both directions.   He will wiggle his nose, and pull his head away - although he can't lift his head totally. He has held his head up for a few seconds when I've been moving him or putting him on top of a high pillow so he can be in a standing position.  He can straighten and pull his left arm back and bend at the elbow - all be- it a very slow process. He also can bend his left front paw. He has trouble when he has towels on it.. but he still will try and regain his strength. He's starting to push a little with his other legs too but not as strong and determined at this point as the left front paw.  He's working on it though. He has control over his ears and can actually flop them up and down now.

Anyway - here are a couple of videos.. again this is a slow process but it's improvement!

Below - Max trying to move his left arm (it's covered in towels so it's harder than if it was on it's own but you can see his muscles pushing

 

Messing With Max until he decides he's finished with me messing with him and he won't react any more!
  video

Wednesday, June 20, 2012

Nothing is impossible!

Naki'o is the world's first dog to be fitted with a complete set of bionic paws. They work naturally to allow him to run, jump and play like any other dog. Naki'o lost his paws to frostbite as a puppy after he was abandoned in the Nebraska winter by his owners. He was adopted by vet technician Christie Tomlinson. As he grew, Naki'o had difficulty getting around on his stubs, resorting to crawling on his stomach. So last year Tomlinson decided to get him prosthetics. Denver's Orthopets created two for the dog, and after seeing how well he did with them, made another two for free. It's really amazing to see how he jumps and moves around with his new feet!  visit http://www.dogheirs.com/elleng/posts/892-dog-gets-around-with-four-bionic-paws for more info

Max hanging out at Work


Max hanging out at work...

Monday, June 18, 2012

Max's Progress Report

It's Monday night and Max has been home since Thurs night (4 days).  Home care is not for the faint of heart, but we are managing on getting a better schedule together. Max is being very patient with me, and has put up with me squirting food all over him, me, the walls, the ceiling, through the screens on the windows.. (definitely not something I recommend!).  We've mastered expressing his bladder, which I wish I had known about with previous animals!  And he's making some progress!

FEEDINGS:
So.. when Max first came home he was getting fed every 4 hours. His diet is supposed to be Purina EN (gastro-inestinal) which is ok.. not my preferred brand my any stretch of the imagination... but given the situation, I was following doctors orders. HOWEVER.... EN contains rice... rice does not fit through a feeding tube syringe.. even after going through the blender AND the food processor and having water and pumpkin added to it!  This has made the whole feeding tube experience INCREDIBLY frustrating.  Since Max has never eaten Purina in his life (we have only done home cooked raw and organic, or The Honest Kitchen or other organic, grain free, whole food brands) I talked with our holistic vets today and switched him over to WURUVA, grain free Steak Frites. It also has a higher water content and it's been tough to keep him as hydrated as he needs.. so I popped it in the blender with some water and additional pumpkin today and voila!  It slid right through the feeding tube! No issues! No safety pin required to fish out rice particles!  I also can more easily add his chinese herbs.  He's back on his Stasis of the Mansion of the Mind, and the Wei Chi Booster.  He's still taking 1 yunnan baiyao capsule / day to help clear up the bleed in his brain and keep any other bleeds from happening.  I've also added milk thistle and astragalus back to his diet too and just mix the powders from the capsules into his food. In addition I also have added colostrum to help boost his immune system and maybe help rebuild some damaged stuff. ... and I've also added a little polyMVA to see if that helps, but not too much. Don't need his fur to fall out again!  The Vit B complex in it should help though!

THE PROGRESS:
Progress has been very slow. We've had some good days and some flat days but I was told to expect that. Each day he seems to do something new though.  He's still in a coma technically, but he is definitely aware of what's going on around him.  I mentioned that when he was in the hospital he'd do a lot of sighing when the techs when to coupage him or do range of motion exercises or give him meds.. he's still doing that, but he's also doing it when the other dogs get all excited and bark around him (nobody touching him or near him). We know he can hear. Here's what he's done so far:
  1. Still stretching all 4 legs and occassionally his neck
  2. Slid his head about an inch to the side to readjust (hasn't lifted head yet)
  3. Gets really agitated when he has to urinate (once he urinates he's ok and calms down)
  4. He has moved his left front paw twice when he's been agitated and needed to urinate - just the paw up and down
  5. He also moved his left front paw up and down twice in a row when Buttercup and I sat down with him
  6. He is showing resistance when he's doing range of motion exercises and will push back
  7. He has slid his left front leg twice to reposition it - just a couple of inches
  8. He just stretched and flexed his right front paw (which he is laying on)
  9. While his position was being adjusted the other day, he kicked out his left leg to try and push and stop being rotated, definitely purposeful
  10. He has flicked the tip of his tail a number of times
  11. He licks his nose if you put something on it and can put his tongue right back in his mouth where it belongs.. his tongue is getting much stronger and movements are much more purposeful
  12. He can open and close his lower jaw without any issues now. He yawns, stretches his jaw, opens and closes his mouth sometimes just to do it, will open his mouth to try and lift up his head when he's in a sternal position
  13. He's grunted a few times but not sure why (could be a reflex or just testing his body)
  14. Tonight he barked or growled at me - or some kind of combination
  15. Today he pooped for the first time and was pushing hard to poop

EXPRESSING BLADDERS:
Who ever came up with this is GENIUS!! Not only is it a good thing for a dog who won't urinate on their own - which Max WILL do if left to his own devices - I just love the fact that I can help him express his bladder and not worry about accidents!  I received a hand out on how to do it, but there's a video I found of a paralyzed dog having his bladder expressed which was REALLY HELPFUL!

If only Max was a little smaller, and I could hold him over the toilet!  I actually just slide him to the edge of his bed, put a pee pad under him so that his urine goes down hill on the pad and it's an easy clean up!


RECOMMENDED EQUIPMENT:
Our house is a single story which makes life a lot easier to move Max around the house. (I've lived in a 4 story house with a golden retriever who couldn't walk and we all ended up moving to the main floor so she wasn't alone!)
  1. Diaper Genie
  2. Box of pee Pads - the cheapest place to get them I've found is http://www.valuepetsupplies.com/puppy-pads.html
  3. A boogie board (to put under the dog bed to help keep his body in line, also helpful to carry him without having him slide off his bed, you can pick him up and put him on your bed, or put him on the floor, and can put the head end of the board on a pillow to raise his head while feeding (head needs to be higher than stomach with the feeding tube)
  4. Gauze - to help keep feeding tube ring from digging into his tummy after it's first put in
  5. Neosporin - for feeding tube port until it's totally healed
  6. Small kids 100% cotton T-shirts or tank tops (wash before you put them on) They should be tight - and are good to cover the body and the port to help keep it clean. You may need to cut the arm pits and neck to make sure it doesn't cut off circulation to your dog's arms or legs
  7. A waggon (gardener's wagon, or red wagon) You can lift the whole boogie board with the dog bed on it and put it in/on the wagon and wheel your dog easily from one side of the house to another
  8. towels - always have a few extra handy just in case. They are good for proping up the body when you put them sternal, or propping up the head
  9. Extra big feeding tube syringes.. It didn't take me long to completely KILL one of the ones I was given!
  10. Roll of papertowls
  11. Sanitary wipes (women's or baby's will work to clean up accidents - we haven't used these much at all!)

One thing that is HIGHLY .. did I say HIGHLY?!!!  HIGHLY recommended!
If you have a veterinary tech who you can pay as a dog sitter for a day.. take some time off.  It helps to re-energize you, put a new perspective on things, and let's you step back a bit.  Today I had to go to personal appointments I had made a couple of months ago and if I canceled the appointments it would take a couple more months to make them again. Our amazing friend Amanda who is a surgical vet tech came over to feed, rotate, coupage, give Max his meds and check on him did an amazing job! and gave me the piece of mind I needed to be able to run up to my appointments!  (YES I was a total mess.. but the good news is that my blood pressure was actually normal! I still find that hard to believe!)

I'm sure there's more that I can write but sleep deprivation is setting in... I'm about to give Max his 11pm feeding and then we're off to bed for the next 6-7 hours and then we'll wake up and feed again!!! 

Thursday, June 14, 2012

Max's Case Study from Bush Veterinary Neurology Services


Below please find Max's original Case Study from Bush Veterinary Neurology Services You can also click on
http://www.bvns.net/up/editor/BVNS_CS_Max.pdf to view as well.   (Working on getting before and after MRI shots of Max's brain to show the brain stem tumor that is completely undetectable now, and the shrinkage of the other brain tumor.)






Home Coming Day!

Just got a call to come pick up Max from the hospital this morning!!!


We have been very fortunate, well mostly through looking for the RIGHT veterinary team and being very careful about who we choose to work with, that we have an AMAZING team of veterinary specialists who never give up! Dr. Lord, Dr. Raichura, Dr. Maniet, Dr. Pema, Dr Bush, Dr. Dumont, Dr. Young, Dr Joseph, Dr Paull, Dr.  Meyer  Dr. Choat, and everyone else in the ER and all of the amazing techs and reception staff who just never give up! Robin, Jenny, Stephanie, Ori, Cheryl, Katie, Regina, Amber, Amanda, Helen, Danielle, Terry, Tina, Julie, Diane, Jenny, Jen, Dan, Eric, Erin, Diana, Shannon, Amy, and anyone else I've forgotten!

Always give the chance, you never know what life will bring you!

Monday, June 11, 2012

It's Monday. Some Improvement!

It's Monday. June 11, 2012.  Max had a weekend full of ups and downs. Fri he showed some improvement with his reflexes and was able to swallow for the first time since his big seizure and going into a coma (induced to stop the seizure).  Saturday was not such a good day.  Max was flat and dull, and didn't reflex respond to much at all. He wasn't swallowing either.  When we went back to visit at night I noticed he had a blood shot eye.

Sunday though was a good day! I spent about 5 hours with him massaging his ears just like a few people had told me to do, from the base of the ear to the tip. Apparently this is like reflexology or similar to hitting all the important points in acupuncture / acupressure to help stimulate the body.  I don't know, but by the time I left last night, his pupil (we could only see one because of the scarring on Max's other eye from when I accidentally dropped him the night before his cyber knife) had gone back to normal size and was responsive to light.  I thought I could see him following people in the Emergency Room but wasn't sure.  He kicked the tech before the tech touched him, he bit me and the tech when we were messing with his mouth. He yawned a few times and pulled his tongue back in and repositioned it where it was supposed to be. He sneezed, he coughed. He looked like he might be able to hold his head up a little when they were coupaging him but it did fall down.  His muscles can shake him head as a reflex but he doesn't quite have the control to hold it up on command like he used to.  He also was swallowing quite a bit.  While I was massaging his ears he also started to pant and opened his mouth and panted that way. When I stopped rubbing he closed his mouth and stopped panting. Still a reflex to regulate his body temp, but something new.   Maybe there is something to that ear rubbing???

They also had reduced his keppra to 100mg 1x day, and reduced a number of his other drugs on Saturday so maybe his body was just adjusting.

This morning's call with his neurologist was encouraging and he said his reflexes were crisp and more consistent. Mentioned his eyes and that when he touched Max he seemed to respond appropriately. He said he thought we had a little improvement! Improvement is good! Of course we still don't know where we will be with regards to brain function until he totally recovers..  He also mentioned we're going to have up and down days, recovery ebbs and flows, so we have to look at it as a big picture vs day by day.  He also mentioned that there isn't a lot of information out there about how dogs recover from coma's, so hopefully what we're doing will help others in similar situations, just like all of my blogging about what Max went through with the brain tumors and the cyber knife.

Today Max is getting a feeding tube put in.  The goal behind doing this is two fold. 1) To give Max more time to recover and 2) Let Max go home to recover at home.  They should be putting it in early afternoon. Then they're not going to use it for 24 hours and then tomorrow they will start with water and see how he absorbs that, and then start on some gruel and see how that goes.

The positive:  He will no longer need his urine bag (which could be a negative from a clean up perspective!) His tummy will hopefully start working, he'll get more nutrients and hopefully be able to get stronger

The negative:  He's going to be pooping now and he can't get up to go out yet!  Good thing we have a big box of pee pee pads from Daisy still!

I was told that I'm going to need to build Max a ramp to sleep on about 6 inches high on one end. Put a yoga mat over it for traction and then his bedding... However, while walking the dogs this morning we saw a bean bag toss toy out in someone's front yard that looks exactly like what we need to build.  Luckly the Local ACE hardware store carries them... might be a very easy solution!  Max also will need small t-shirts to cover his feeding tube and keep it clean, so I've got to go get him a little wardrobe!  (100% cotton - he broke out when he was modeling for Christian Dior at Sax 5th avenue that one time!  Yes Max has been a runway model in his earlier years.. not much he hasn't done!)

Please keep those good positive thoughts coming Max's way for a good strong recovery!  He's making baby steps but he's definitely improving!  I'd love to see him running again!  I keep remembers that he was in a similar position last Sept and he came out of it running and jumping and chasing puppies!  He is a super dog!!!  He deserves a shot at showing the world what he can do!

Saturday, June 9, 2012

Max Update 7-8-2012 - He is swallowing!

videoWhen I finally got to the hospital today the gang from the neurology dept had left for the day but the ER tech who came to greet me was excited and told me that when she flipped Max a few minutes before she started to see more of a spark in there. She took me back to see him and his eyes were open, he was blinking. His right pupil was responding to light, but the left one isn't yet.  He could move his legs a little, and was able to swallow which I thought was great!  If he can keep it up and keep improving HOPEFULLY we can avoid a feeding tube. 

I put my finger in his ear and he shook his head, however, when I tried to film it, it didn't work that way - he coughed instead.  Not sure he can see yet, but sometimes when I had my hand over his eye (not touching but a few inches away he'd close his eyes.  Still a reflex.. but a lot more than he was doing the day before.  Also when the tech went to inject his keppra into his leg catheter he kicked his leg.  Again, technically a reflex, but more than he was doing the day before and that was a reflex to something that was irritating him so he can feel it.

Please keep the good positive energy coming!  He's doing great!  The ER vet let me know that sometimes it can take 5-10 or more days to come out of a coma, we're on day 5... 

I wanted to post this video for anyone who is dealing with this sort of a thing... don't give up hope too quickly. It may look dire, but sometimes you just need time.

Wednesday, June 6, 2012

Wednesday

I wish I had better news to report.  Max is still in a comma. He's no longer on Pheno and they reduced his keppra dose down to 250mg today. He's still on something to reduce the swelling in his brain. His blood pressure started to drop around lunch time today and his respiratory rate dropped and his temp dropped down to 98, but by the time we got to the hospital it had started to get better. His respiratory rate went back to relatively normal, and his body started to regulate his temperature again.  His blood pressure was still fluctuating when I left earlier this evening, but they're monitoring and adjusting his fluids accordingly.

When they get his BP back to normal he has normal reflex reactions in his eyes. At one point I did see his eyes and ear move on their own, but it was short lived. What we're hoping is that the drugs will get out of his system enough that he'll start to wake up. They're working on flushing him. 

So far his kidney and liver seem to be functioning well.

They realized that you can't give chinese herbs rectally because they are absorbed in the stomach through digestion, not the colon / rectum so unfortunately we can't give him the Stasis of the mansion of the mind.  Today we did give him the yunnan baiyao with the medicine that shrinks swelling in the brain. Hopefully that will help carry the Yunnan Baiyao to the brain and stop the bleeding, break up the clot and help reduce the pressure.  It's pretty much a wait and see kind of a thing right now.

Kind of a scary day.. I think he's still in there though. I sat and pet him for about 3 hours today.  Please keep my sweet little guy in your prayers and thoughts and send him some good energy! 


Tuesday, June 5, 2012

Visit with Max

Just got back from a visit to the hospital. Max is still unconscious - or at least looks that way - but sure looks comfy... His blood work is good, his vitals are good, he's still in a drug induced comma, but they've been lowering his meds a bit. He's been seizure free since actually midnight last night and that seizure at midnight was a tremmor with a little paddling.

He has Jennifer taking good care of him... He has had some eye movement under his lids and when you whistle or call him his ears move. They're still not sure if it's automatic or if he's processing but they seem to think he's actually reacting a little to it..

He aspirated a little during his seizure and has started to develop a pneumonia so he's on full spectrum antibiotics right now through IV... and seems to be making some baby steps forward. They're going to keep him at maintenance doses of everything over night and then work on lowering the meds again tomorrow to see how he does and if there are additional improvement signs..

I brought up more yunnan baiyao and he's taking the emergency pill, which hopefully will help. They are probably going to start his chinese herbs up again (stasis of the mansion of the mind, wei chi booster, and the anti-seizure one) but give them to him rectally, The herbs help flush edema, bloodo, and tumors out of the brain and cross the blood brain barrier. Max is super sensitive to the drugs so they herbs may throw him for more of a loop and make him more drunk.... but hopefully will help.. Dr. Young mentioned the absorption rate given rectally is something like 60% that of an oral dose, but since he's comatose they can't do the oral dose obviously..

His vitals are all normal, his blood work is all normal, his blood pressure is all normal.. he's doing great! We'll give it a few days to get him back down off the drugs and then see where we are. But it is good he's responding.

For his pneumonia they are coupaging him every few hours, and rotating him from side to side every few hours as well. Once he regains consciousness he'll be able to move more. He also is coughing bit it's probably a reflex...

Anyway - keep the good thoughts and prayers coming!

I got a great message from someone who's mom was one of the first Cyber knife patients and it's been 8 years and she's cancer free so lots of good stories coming to us from other cyber knifers!!! Thank you everyone!!!!

Max Update - BIG Seizure..

Max had a massive seizure yesterday... it wouldn't stop. I managed to get him to the local vet to get some injectible vallium and then got him up to the hospital an hour away to his neurologist.

They got him stabilized, and did an MRI and blood work..

Good news... is that the Cyber knife completely - I MEAN COMPLETELY!!!!!  got rid of the tumor on his brain stem!  How amazing is this!!!!!!!  His blood work was relatively good too.

The tumor on the left side of his brain was still there and may not be a meningioma since it didn't respond.  But it could be b/c it didn't increase in size... and may have just gone dormant... so from all of that.. all - things considered, he's doing great..

BUT then there's the long cluster seizure... The MRI also showed blood in Max's brain... He had a bleed- it's contained (vs all over his brain - which is a positive)... so we're trying to stop the bleed and then flush out the edema and the blood... They put him in a drug induced comma to stop the seizing.. and we started him on emergency yunnnan baiyao last night.. today they are going to work on slowly trying to wean him down from the drugs and bring him back to awareness if we can keep him from seizing...


The bleeding is what's causing the seizures.. Dr. Joseph mentioned he'd seen latent damage to blood vessels in some CK patients and that's what it looks like has happened with Max. We have him on Yunnan baiyao to try to stop bleeding, then try and figure out how to flush the swelling and blood out of the brain.. We also want to see if we can reduce the drugs he's on and make him more aware and if we can get him to come out of the comma and give him time to get back to normal... gonna be a slow process.. Going back up to the Hospital in a few with more emergency yunnan Baiyao...

One other good thing... during his seizures his color stayed pink so he was still getting oxygen to his brain which hopefully means no brain damage... time will tell but we definitely have some good things going on here... Just need to get rid of the edema and the blood.    Last I heard his last seizure was around 2AM.. it's just about 2pm...   so hopefully that's a good sign ... I'll find out more when I get up to the hospital

One other thing to note -  Max did not get his anti-seizure meds when both of his last seizures took place. 

Keep those prayers, white light, good energy, good vibes, and good thoughts, etc coming!!! .. He's a fighter!!!