Two More Milestones

Simone mastered two more tasks today....
hopping into the truck unassisted and going up and down the stairs.

We are so excited! It's been less than a week, and she's nearly back to her old self.

A Clean Bill of Health

We are delighted to report that after five long months, Simone has finally received a clean bill of health! She went in for blood work this past Saturday to see how things were looking, and finally everything looks good. Gary talked to our new vet, Dr. Rosenlicht yesterday afternoon, and she said all of Simone's values are finally looking normal. The enzyme that was elevated last time (CK, one that indicates muscle damage) was back down within normal limits again, and everything looks good. We can sure tell that Simone feels good, as she's got a great appetite (she now coerces us into an extra scoop of food at bedtime), enjoys running around in the mud and rain, and continually taunts us with her squeeky toys. We don't have to go back in for a recheck again until February or March. We hope everything will continue to go well and that we have all survived our journey through this challenging time.

We will be forever thankful for her recovery and for your support during this year.

Simone Update 11/24

It's been a good month. Simone has gained back the 20+ pounds she lost during her illness, and is now somewhere in the mid-80 pound range. The hard part has been cutting back her caloric intake from unlimited to something more reasonable for general weight maintenance. She's energetic, good-natured, and playful, and a lot more talkative now than she ever was. It's her new thing to walk into a room where we are and "talk" to us --not bark, per say, but make some very intent vocal sounds letting us know that something is on her mind! She used to only do it when we danced in front of her (she still objects wholeheartedly to that!), but now she does it when her water is low, if she wants to play, or if she is ready for some excitement.

We have switched vets, and were given a referral by the folks at OSU to Dr. Rosenlicht at Eastgate, on Peoria Road. Simone went in for a check-up last Saturday and had bloodwork done. Some of the results are back, and indicate that her red blood cell count is higher (up to 35 from 28). She is still slightly anemic, but this is an improvement. We're hoping the next time they check her red cell count that it's back in the normal range! Her liver values have basically dropped down to normal. Bye, bye fear of liver failure! We're excited that possibility is now no longer something we have to worry about. Her thyroid levels looked good, and she's on an appropriate level of medication for that. The only troublesome thing was her CK enzyme was really elevated. CK (creatinine kinase) is an enzyme that indicates muscle damage. It's an enzyme that can help identify if a heart attack has occurred, if muscle has been damaged, or if the kidneys are failing. Dr. Rosenlicht said this value was very high and she was concerned about it, but she was waiting to hear back from OSU to find out how Saturday's CK value compared to previous values. Since Simone's eating fine and acting happy and energetic, we're hoping that there isn't a problem and that maybe this value is lower than it used to be. We'll see. In the meantime, we're thankful to have our girl basically back to normal.

Life just wouldn't be the same without her.

Simone Update 10/27

It's been a good two weeks. Simone is doing really well. She went in for a recheck appointment yesterday afternoon. Two of her liver enzyme values have dropped substantially (ALT from 996 to 285 and ALP from 4295 to 1088). I think normal values for those two enzymes are supposed to be under 100, so we're getting closer. An approximately 75% decrease in two weeks is very promising! Her white blood cell count is finally back within normal range (it's been elevated nearly this entire time, indicating that her body has been fighting something), but her red cell count (packed cell volume) is still low at 28%. At least it's holding steady at 28% and hasn't dropped in the last three weeks. It's supposed to be around 40% or so, so it's something we have to watch. She has an appointment to go back in next Friday to recheck her red cell count and just make sure it doesn't fall. If it does, she might be looking at another blood transfusion. We're hoping though that as her liver inflammation subsides, and with her platelets and white cell count within normal limits again, that maybe her red blood cell count will rebound too.

She continues to eat voraciously though, and wants to play all the time. She's very good at distracting me from my homework! I can't resist her "play with me" look!

Simone Update 10/11

Things seem to be going pretty good this week. We had a nice weekend at the coast, and Simone enjoyed taking a quick dip in the ocean and sleeping on the bed with us at the Fireside. Overall, she seems to be improving. She is eating dog food again uncoerced, wags her tail a lot more, and frequently grabs a toy and wants to play. She went in on Wednesday for a recheck, and although her liver enzymes are still sky-high, they are a little lower than they were last time. She still has a ways to go before reaching the normal range again, but we are hopeful with her now eating and feeling more happy and energetic that it will happen. She takes her last prednosone pill tomorrow, and then will only be on liver support drugs until the enzyme values come down. The vet is pushing for us to authorize a liver biopsy, but we are against it. For one, the procedure would require surgery, and we don't want Simone to have to go through that. The other thing about the biopsy is that all it would do is give us a better idea of her overall prognosis, and it wouldn't change her treatment or fix anything. We're just hoping that all she needs is a little more time to get back to normal and will still have many happy, healthy years ahead.

Simone Update 10/6

It's been another crazy 24 hours. We woke up yesterday to find Simone in serious discomfort from her enlarged abdomen. Her breathing had become labored, and she was stuck under the bed because of her increased girth. We debated about whether to take her to the emergency clinic (our old vet) or wait until the OSU hospital opened up. We decided to try and wait for the latter since the staff there is more familiar with what's been going on. I kept an eye on her until I left for class at 8:30, and then Gary was able to get her in at 10:30 am. Dr. Gordon said her abdomen did look distended, but she didn't know it was absolutely necessary to drain the fluid. Gary emphasized that it was affecting her breathing, and the doctor agreed to perform the procedure. Gary left Simone at the hospital and then went back to work to wait for a call.

He went back at 4pm and found a happy, energetic, bright-eyed Simone. They had inserted a tube into her abdomen and drained out 1.5 liters (nearly 6.5 cups!) of a clear fluid. No wonder she was so uncomfortable! They also did an echocardiogram to check for clots in her heart/lungs, but didn't see any. Less pressure on her abdomen helped her appetite to return, and she ate some of their dry dog food while we were there (something she hasn't done voluntarily in about 2 weeks). They sent her home with revised medication instructions, and will go back in on Wednesday for a recheck. There is a chance her abdomen will need to be drained again, but we're hoping that with the increased dose of blood thinner (stepped up again from the other day), all of her blood components will be able to stay within the vessels and not be forced out. We'll see. At least for now, things are looking up (yes, again), and we continue to be hopeful that they will stay that way!

So, we are headed to the coast today for an overnighter at a pet-friendly motel in Yachats called the Fireside. We have decided that we need a little family get away from all of the stress and chaos that is our life these days. We are looking forward to a nice walk on the beach and hopefully a good night's sleep.

Simone Update 10/4

We're starting to feel like a yo-yo, continually being yanked up and then thrown back down. We took Simone back in yesterday because she's still not eating and her abdomen has become enlarged over the weekend. The doctor did an ultrasound and discovered new blood clots in her spleen and liver and quite a bit of fluid in her abdomen. They took a sample of the fluid and found it to be clear. The doctor thinks that there is maybe a clot higher up, closer to her heart, that is causing hypertension, which is forcing the watery part of her blood to be pushed out of her arteries and into her abdominal cavity. That's one theory, and there are others too numerous to list. She has suggested we do an echocardiogram to see if there is indeed a clot higher up, but that won't change the treatment (she's already on heparin, a blood thinner). She also suggested doing a surgical liver, stomach, and small intestine biopsy, but we have decided not to put Simone through that. That test also wouldn't really change how she is being treated as she's already on antibiotics and a number of liver support drugs. They did give us another injectable medication to give her three times a day to hopefully stimulate her appetite; it worked last night, but this morning she seems to have a fever and won't touch anything resembling food. We're hoping that maybe once the antibiotic kicks in and she starts feeling better that she'll want to partake of the smorgasbord downstairs (2 different kinds of dog food, a bowl of tuna, and a bowl of eggs). Time will tell. We're afraid that despite having made it through a really scary time last month, we may be headed back to the "dark place" once again.

Simone Update 9/30

Simone is doing well. She had a check-up Friday at the OSU Veterinary Hospital and was well received by her previous medical caregivers :) She has gained about a pound in the last week despite not wanting to eat much other than chicken, hot dogs, and canned tuna. The doctor prescribed an anti-nausea drug to give her three times a day, and has taken her off the antibiotic and one of the liver support drugs to see if that makes a difference. Her bloodwork came back as improved. Despite being down to one prednosone a day (her original vet had prescribed 8 pills a day), her platelet levels are still normal, so her thrombocytopenia is under control. Hooray! Her bilirubin was down to 1.7 (still more than twice as high as it should be, but considering that it was 16 about a week and a half ago, this is amazing!) Most of her liver enzyme values are lower than they were a week ago, with the exception of her ALT, which is about the same. The decrease in the other liver enzyme values was significant, but they still are elevated and still not in the normal range. We have been told this is just going to take some time. We forget that she's only been home a week!

She's still pretty weak, but is getting better at going up and down stairs. She decided she wanted to come upstairs today and did so with no assistance (just mom and dad on either end for support, but she didn't need it). She also made it back down okay. We're excited by the prospect that she is starting to get her strength back. We're still sleeping downstairs on the air mattress with her until we feel comfortable with her going up and down the stairs unsupervised. We'll probably still be camping downstairs for awhile, but it's nice to know we're getting closer to normal every day!

She's perked up quite a bit in the last 24 hours (probably thanks to the anti-nausea drug), and has been wagging her tail a lot more and wanting to play. She's been taunting us with her new teddy bear and squeaky car toys and chewing on her bones. She's also started burying things outside again, as evidenced from her muddy nose and missing bones/treats. We're so happy to see her coming back from this!

Simone is Home!

Just a quick note to let you all know that Simone was released from the hospital late yesterday afternoon, and has been resting comfortably at home ever since. She was delighted to arrive at home, and has been surrounding herself with both her new and old toys. She is still pretty weak (and down to 66 lbs, an all-time low), needs assistance going outside (two steps down), and isn't eating as much as we'd like, but we trust all of these things will improve with time. We go back to the hospital either on Friday or Monday of the following week for a liver enzyme/bilirubin re-check. Hopefully those levels will fall a little bit quicker now that she's at home and back in a familiar environment.

Thanks again for all of your love and support these past few weeks. We wouldn't be where we are without it!

Love, Carley, Gary and Simone

Simone Update 9/21

In the high stakes game that Simone was a part of this past week and a half, we feel as though she has finally laid down a winning hand. After 10 long days in the ICU, Simone will finally be coming home tomorrow.

Her bilirubin was down to 10.1 today. Hooray! It appears to be on a steady decline. Some of her other liver enzymes were up though, which continues to be a concern. Dr. Brownlee said it will likely just take time for them to get back down to normal levels after the level of insult her liver has suffered.

I saw her today at 4pm, and she got out of her cubby to greet me. She seemed very energetic and happy that I was there. The staff said she had actually tried to make a break for it twice today, stretching her IV cord near to the breaking point before they caught her and persuaded her to go back to bed. That tells us that she's finally ready to come home!

They will keep her hooked up to her IV overnight and through tomorrow afternoon to help keep flushing the bilirubin out of her body, and then she will get to come home to recuperate. She's lost quite a bit of weight and is pretty weak, so we won't be doing any long walks anytime soon. But hopefully some time at home, resting in her favorite spots with her favorite toys, and her mom and dad attending to her every move, want, and need will all get her back to her old self.

We definitely feel like we've won the lottery.

Simone Update 9/20

Tonight will mark Simone's ninth night in the ICU. Hopefully she will only have one more. She seemed pretty good this afternoon; not as energetic as yesterday, but still happy to see us. We were able to pet and talk to her for about an hour. She seemed pretty sleepy, and dozed quite a bit while we sat with her.

Her bilirubin did drop from 15 to 12. That was a significant change. Now if it will only continue to fall, and the closer to 1.0 it gets, the better. The nurses noticed this morning that her eyes were a lot less yellow, and this was evident to us as well when we saw her at 4pm. Her skin is also starting to look more white/gray, without the orange tinge. So, that's good. But, one of her liver enzymes (alkaline phosphatase, ALP) was higher today, and that is concerning to the doctor. Hopefully when they check her again tomorrow, they will discover that it too is on the decrease.

She's eating okay. Deborah asked us what her normal feeding schedule was because they were noticing that she only seemed hungry at 4am and 4pm. We told her that's what she's been used to since she was a puppy. Gary is always the one that gets her breakfast when he gets up and dinner when he gets home. She's gotten set in her ways over the years!

Once her bilirubin drops a little more, and hopefully her liver enzymes as well, they will consider discharging her. Tomorrow may be a bit optimistic, so we'll likely see her released Saturday or maybe Sunday. Then she'll be able to come home and rest. It sounds like we'll have to give her subcutaneous injections of the heparin to help prevent any more clotting, and limit her activity, meaning lots of time on the futon! Dr. Brownlee said that provided we can successfully make it past this hurdle, Simone should be able to have a normal lifespan. That is so encouraging to us. A week ago we feared the worst, and now it's looking like she's going to make it through this and have many more happy years ahead.

Thank you all again for keeping her in your thoughts and prayers :)

Simone Update 9/19

Today was another good day. Simone's liver enzyme levels dropped a little, as did her bilirubin (from 16.5 to 15.0). While not a huge improvement, they are headed the right direction. She seemed to be breathing okay most of the time and alert. When we saw her at 4:30pm today, she actually stood up in her oxygen cage and walked out to greet us, her tail wagging ecstatically. This was the most animated we'd seen her in over a week. The nurses told us that she didn't eat breakfast, but did eat her dinner, dry and canned, and two of the gingersnaps I made her. I offered her five or six treats that I brought from home, and she ate those too, and made sure to not leave behind any crumbs!

She still can't come home yet, as she needs to be hooked up to an IV for fluids to help flush out the bilirubin (normal values are less than 1). Dr. Brownlee said that she wouldn't feel comfortable sending Simone home until the bilirubin drops below 10. She said she would check just the bilirubin tomorrow, and then the liver enzymes on Friday to see where things are at.

So, we're still missing our girl terribly at home, but her prognosis is looking up. Yesterday Dr. Brownlee said it was now "guardedly optimistic". It's looking more and more like she may very well be able to make a complete recovery. We've been told that Simone is also the best patient in the ICU! They alternate between having her closed in the oxygen cage, and having the doors open. Sometimes she steps out and lays on the floor. None of the other puppies in the ICU gets that privilege!

Thank you all for your continued love and support. We believe all of the healing thoughts and energies that you have been sending Simone this past week are truly going to give us our miracle.

Simone Update 9/18

We're back on an upswing. Today went pretty well. Simone had an ultrasound this morning to check and see what was going on with her gallbladder and liver. They saw one small gallstone, but it didn't appear to be blocking anything. No tears or leaks around the gallbladder were evident. That was positive. But, the ultrasound did show that one of the branches of her right hepatic artery is blocked by a blood clot. It is about 90% occluded, which is making it difficult for cells in that part of her liver to get adequate nutrients or oxygen. Fortunately, it's only one branch of the artery and not the entire artery that is blocked. Dr.Brownlee said there wasn't anything that they could do to get rid of the blood clot other than wait, since she's not a good candidate for surgery. So, Simone's on a blood thinner (heparin) and a couple other drugs to help support her liver. They didn't do any liver tests today, but will tomorrow to see how her bilirubin and liver enzymes are doing.

She seems to be breathing a little easier, and her blood gas went up to over 60% from 52% yesterday. Hooray! Hopefully we will continue to see a marked improvement in this area. Her PCV is also back up to 33 from 30. Hopefully her red blood cell count will continue to climb back up to the normal baseline of 42. Her appetite has also returned, and she is back to eating her dry duck and potato food without coaxing. Simone also took a cookie from me for the first time in what feels like forever. She even licked up the crumbs it left on her bed! So, she's breathing easier, has more red blood cells, and is eating better...now if we can just get her liver functioning better, she will be able to come home.

Dr. Brownlee still can't give us a tentative release date. We continue to hold in the wait-and-see arena. We're hoping she'll be able to come home by Friday. It's been a long, lonely seven nights at home without her. But if spending a week or 10 days in the ICU is all it takes to help her recover, and have many happy and healthy years ahead, then it's worth it. We did notice they're not discussing cancer any more as an underlying possibility; it is starting to look more and more like the treatment for the thrombocytopenia is what is to blame. Simone's reaction to the prednosone is pretty rare, and not one anyone could have really expected. We always knew that she was one in a million, but didn't think she'd be the one in the million in this way too!

Simone Update 9/17

We just got back from an hour-long visit with Simone. She seems to be doing okay today, but isn't as perky as she was yesterday. Rotations took place today, so we have a new vet in charge of her case, Dr. Brownlee, and a new fourth year student named Deborah. Simone had bloodwork done around noon, and the results showed that while her ALT value is lower than it was, her other liver enzyme and bilirubin levels have continued to climb. She's pretty yellow. They are becoming more concerned about the high liver enzyme values. Dr. Brownlee says a couple of things could be going on. One is that she may have a ruptured gallbladder or leak in a vessel connecting the gallbladder to the liver that is letting bile get out. She wants to do another ultrasound tomorrow to look at her gallbladder specifically and see if there is any evidence of a leak. Another possibility is that her liver is failing, which worries us and the doctor. If there is a gallbladder leak/tear, surgery will probably be required. If it's liver failure, then there are medications they can give her to try and help that.

Simone was panting pretty hard when she was brought into the exam room for our visit, but it settled down once she laid down on the floor and we started petting her. They have had her in the oxygen cage off and on all day and have been monitoring her breathing. Her blood gas is still pretty low. Dr. Brownlee said they might do a scan tomorrow where they would inject her with a dye and then take an X-ray to see how the vessels in the lungs are looking. She thinks it's likely that there are blood clots in her lungs. She said if that is the case, then the goal is to prevent her from making any more, and then give her body time to form new vessels to allow for a better exchange of oxygen.

Simone's red blood cell count dropped a little, down to 30. The doctor said that she wasn't too concerned about it though, as it was likely that is was due to her body breaking down some of the blood cells from the transfusion. While not normal, she said many dogs can go on to live well with low red blood cell counts in this range.

Dr. Brownlee said she did have a patient many years ago who was treated for the immune-mediated thrombocytopenia and responded poorly to prednosone. She thinks that while it is rare, Simone may be having the same problem, and that the prednosone could possibly the root of all of her problems. She said they would continue to decrease her dose, and try and get it as low as possible so that she will have high enough platelet levels, and minimal side effects to her liver/blood cells. Time will tell.

As it stands right now, we're looking at another 2-3 days in the ICU, maybe longer. We will just continue to take one day at a time and hope that her bilirubin and liver enzyme levels begin to fall back down to normal levels. The one encouraging thing was that she did eat a cup of her dry food, and a little bit of her canned duck and tater. Deborah said she thought it was funny that Simone would only eat the canned food if it was spoon fed to her.

What can we say, that's our girl :)

Simone Update 9/16

Today was encouraging. We went in and saw her at 10:30 this morning. She was the most alert we've seen her in about a week, and was excited to see us. She was laying down in the oxygen cage with the door open and her tail wagged exuberantly when we walked into the ICU. Every time her tail wagged down, it dipped into her water dish, and on the upswing, flung water all over us and the floor. We could tell that she was feeling better...such a relief!

We talked with Dr. Gordon for about 30 minutes. She said that one of her liver enzymes has come down quite a bit (her ALT was over 1600 last week, and was below 900 today. Hooray!) She is still quite jaundiced though, and her eyes, gums, and skin are all really yellow. Dr. Gordon said she's not too worried about that though right now. She said that her PCV had risen to 33, so she is definitely making red blood cells on her own now. Another encouraging thing!

Even though things seem to be getting better, she's still not out of the woods. Simone is still having difficulty getting enough oxygen. She is near the point when they may consider putting her on a ventilator, which is a little scary. Dr. Gordon said they would give her a bronchiodialator drug this afternoon and may put a scope down her trachea tomorrow to see what's going on in her lungs. She said her lungs may be inflamed as a result of the high white blood cell count or liver inflammation, or there may be blood clots in her lungs, which is a little scary. Hopefully we'll know more tomorrow.

Simone also isn't really eating at this point, which is the other problem. We won't be able to bring her home until she is able to breathe well on her own without aid and get her appetite back. But hopefully if they can get her breathing better on her own, and if the liver enzyme levels continue to fall back to normal range, she'll start to feel like eating more again. We are currently cautiously optimistic that we may just well get our miracle and that our girl will get to come home and be with us in a few days.

Please send her thoughts of clear and easy breathing, continued liver and red blood cell count improvement, and increased appetite! We really do believe that everyone's loving and healing thoughts directed towards Simone are helping her (and us) get through this scary time.

Until tomorrow... ;)

Love, Carley and Gary

Simone Update 9/15

The sun peaked out of the clouds today for the first time since Wednesday. It seemed symbolic as we received a little bit of good news for what felt like the first time in ages.

We gave the vet permission to do the blood transfusion early yesterday afternoon, but they weren't able to start it until 6pm. We didn't hear anything until 10:15pm last night when Amanda called to say that everything had gone well. Simone didn't have a bad reaction, and laid quietly in the oxygen cage during the entire 4 hour transfusion. Amanda said Simone had eaten a can of chicken and rice earlier and seemed to be doing okay. She said they would repeat the PCV test at midnight and then again at 7am along with a check on the liver enzymes. They also started her on heparin, a drug to support her liver, and gave her some anti-nausea medication in case an upset tummy was causing her inappetite.

I went to Portland today to see the Body Worlds exhibit at OMSI with my friend Sonya and have lunch. It was tough deciding whether or not to go, but in the end we decided I needed to take a little break and get away from things for awhile. Gary stayed at home to be near the phone and available in case anything came up. Amanda called at 11am and talked with Gary and told him that her PCV at midnight was 27, and it was up to 30 by 7am. That was positive, as it may indicate that she is starting to make red blood cells again. Dr. Gordon, the vet who took over for Dr. Ruaux (who left on vacation) said she was surprised that her PCV value was that high. It gives us hope that she may be on the mend.

Unfortunately, Simone still has some pretty major hurdles ahead. Even though she has increased numbers of red blood cells, she is still hypoxic (lacking oxygen), which is of concern. So, they still have her in the oxygen cage to help her breathe. Her liver enzymes are still elevated, but Amanda said that is to be expected because of the blood transfusion, and it may take some time for those to begin getting back to more normal levels.

Gary was able to go and see her this afternoon, and took her some of her duck and potato dry and canned food, and some pumpkin muffins that I baked her yesterday. She managed to wag her tail a little when she saw him, but still didn't seem to feel too good, and refused to eat any of the treats that he brought. He took her outside to go potty, and give her love. He was able to snap this photo of her with his cell phone.

We received another call from Amanda around 5pm. She said that Simone slept most of the afternoon, and while she wasn't too interested in "real" food, ate about 10 of the pumpkin muffins that I made her. She said they would do a CBC and check the liver enzymes again in the morning and then get back to us. Depending on how things look, they may give her another blood transfusion. As of this evening, she will be there through at least Monday, and we will continue to play it by ear.

We hope to be able to go visit her again tomorrow and find her feeling better. We'll let you know again tomorrow how it goes.

It would be wonderful if you could send her healing thoughts, ones especially targeted to her liver and blood. Think lower liver enzyme levels and decreased liver inflammation, and higher red blood cell counts with increased oxygen carrying capacity!

Thank you to all of you for your love and support. It truly means a lot to us.

Love, Carley and Gary

Simone Update 9/14

Simone will be staying the weekend at the hospital. Her PCV dropped to 16, and we gave them permission to transfuse her with whole blood about 30 minutes ago. She's is having difficulty getting enough oxygen, so they have her in an oxygen cage. Her liver enzymes are also very high, which makes them think that maybe liver failure is beginning, but the thought is if they get her more blood cells, and an increased ability to carry oxygen, maybe things will improve. We've been told that while the odds are not overly in her favor, there is still a chance. We will continue with an aggressive approach and hope for the best, while knowing that things may not turn out well. When we saw her today, we saw that she still has a fight in her eyes, and we can't give up on her now.

Simone Update 9/13

After my hysterical crying and screaming rage around 1:45pm today, I thought it was ironic that the word of the day displaying on my Gmail was "plangent: beating with a loud or deep sound; also, expressing sadness."

We have been expressing a lot of sadness today. Sadness in realizing that our girl might not make it through this. Sadness in learning that she is ill beyond repair. Sadness in discovering there is nothing we can do about it, except to love her and make her as comfortable as possible.

I received a call from Amanda, the vet student we were working with yesterday, at 8:31am this morning. She said that during the night Simone's arterial packed cell volume (PCV) had dropped from 27 to 17. Not good. Any lower and they would have to give her a blood transfusion. She said it appeared that the internal bleeding had stopped, and they were gradually removing the pressure bandage around her abdomen (1 inch every 2 hours). She said they had checked her PCV again at 8am and it was the same. She said Simone wasn't interested in eating the dry or canned food they offered her and asked if I could bring by Simone's chicken and rice that I had been making her. I told her I'd be right there.

I arrived 10 minutes later and the student was paged. She quickly came up to the reception area to greet me, and then escorted me back to the ICU where Simone was staying. She was laying down in a bottom cage with her belly wrapped tightly with what looked like a giant ace bandage. She flopped her tail a little bit when she saw me and sat up a little when I kneeled down beside her. I talked softly to her and tried to feed her some of her chicken and rice, but she wouldn't take it. She wouldn't even take any of the cookie I offered her. She was panting hard and seemed uncomfortable. Amanda said they had given her some pain medication in case she was hurting. I asked if I could take her home today, but the student said they wanted to keep an eye on her and make sure her PCV didn't drop any more.

I got to spend about 10 minutes with her before I had to leave, and then told her I had to go. She perked back up and then started talking with her eyes. She looked at me, and then the student with a worried look, and then me and then the student. Yes, I told her, I'm leaving you with Amanda, but I'll be back soon. She looked at me, and then Amanda again, like, really, you're going to leave me here? It was hard telling her I had to go, but she was in good hands, and they would help to make her better. She then put her head down in the cage and looked sad. Say what you will, but my Simone has an amazing command of the English language. It was so hard to leave her.

I waited by the phone for the rest of the day. Every time it rang, I jumped. Amanda finally called around 1:30 pm. She said Simone's noontime PCV was holding at 17. No better, but no worse. She said they would recheck it at 4pm. I asked if I could come see her; she said she would have to find out when we could come in again and get back to us. I asked her about Simone's prognosis and likelihood that she could come home tonight; she said she couldn't comment on either, but Dr. Ruaux would talk with us later this afternoon.

So, back to waiting. And then a meltdown. And then that wild, jittery feeling like you have when you're hopped up on too much Halloween candy and are moments from seeing it come back up again. There was little peace this afternoon, and no work done. I couldn't tell you what I did exactly after that 1:30pm call, only that it took forever and I was able to fritter it away until Amanda called again at 4:00pm.

She said we could see Simone at 4:30pm, and also meet with Dr. Ruaux again then. She said the PCV was still holding at 17. She said the doctor was going over all of her test results and would be deciding if Simone would get to come home tonight or not. We gathered our things, and then headed out the door and over to the vet hospital.

The doctor met with us in an exam room at 4:45pm. He again did a fantastic job of explaining everything down to a cellular level and helped us to understand everything that they had done and what they knew about what's going on with Simone. He said they had taken a few more X-rays today to get a better look at her lungs, but didn't see anything. He said they had looked at a stool sample, but didn't see any blood or evidence of parasites. He said her abdomen wasn't as distended as it was last night, and some of the blood in her abdominal cavity had begun to be reabsorbed, but not all of it. He said he did not have a good answer for why her red blood cell count is so low. He said the only thing we haven't checked is her bone marrow, and there are basically two types of bone marrow cancers that might be causing her anemia. One is treated with prednosone (which she is currently on and her RBCs are not responding to), and the other is untreatable. Even if we were to decide to put her through the painful procedure, there wouldn't be much to be gained from it, except to know for sure if she had an untreatable bone marrow cancer. Or maybe it would show no abnormalities, and then we'd still be where we are, with no better understanding for why this is happening. Either way, we decided not to do a bone marrow biopsy, to keep her on the lower dose of prednosone, and hopefully get her home.

At this point, we don't know how much time we have left with our girl. It could be a few days or a few weeks. There's still that hope that maybe she'll snap out of it and respond to the lower dose of steroids, but without an adequate supply of red blood cells, she won't be getting enough oxygen. If she continues to have low/no appetite, then that will make things even more difficult and may accelerate her decline. We're not ready to make the decision about having to put her down; although the thought of finding her passed away at home is not an easy one either. We're hoping that we can make her comfortable, that we can let her know for a little longer how much she is loved, and then have her pass from this life without pain or misery in a familiar place with us at her side.

Realizing we have to begin letting go is one of the most difficult thing we have ever done. Simone was the child we chose to have, the child who chose us. Those of you who know her well know how much of a person she is. Her soul has touched ours in ways we never would have imagined. We're having a difficult time imagining life without her.

Please keep her in your hearts.

Love, Carley and Gary

Simone Update 9/12

Okay. It's been another tough day.

I took Simone in this morning to the OSU veterinary hospital. I gave her case history to a fourth year medical student, and then proceeded to wait an hour and a half in the exam room for the doctor to come in. Simone was pretty mellow, and took a nap on the floor while we waited.

The doctor finally came in around noon and examined Simone. He made a good first impression (he has a sexy Australian accent) and discussed the tests that he wanted to perform. He said he wanted to start out with a CBC and chemistry panel to check her liver enzymes (since her eyes looked a little yellow), and then do a liver aspirate (since her liver is so enlarged) and an abdominal ultrasound. Depending on the results of the abdominal ultrasound, he said they may want to do a bone marrow biopsy to check for bone marrow cancer. I left Simone with them and then went home to wait by the phone.

The vet student called around 4pm and told us that Simone would be ready to pick up at 5pm. She said they wanted to take her off the new immunosuppressent drug, and lower her steroid drug to two pills twice a day. We got there at 5pm, waited until 5:45pm, and then the doctor came in. He was very good at explaining what he thinks is going on. He said that the initial diagnosis of immune-mediated thrombocytopenia seemed to be accurate, and that her platelet rebound once she was put on steroids was good evidence of that. He said that her anemia doesn't appear to be immune-mediated though, since one of the tests they did (Coombs test) came back negative. Aside from a 1 cm mass, her spleen appeared normal. He thinks her enlarged liver is due to the new immunosuppressent drug, as it can apparently rather toxic to the liver. He wants to take her off that immediately, and give her liver a chance to recover. He said he also thinks that she has been on such a high dose of steroids for such a long period of time that may be what is causing her to have problems with her red blood cells. He thinks that lowering the steroids, and getting down to the lowest dose possible, will help her red blood cells to rebound. So, he thinks her overall prognosis has the potential to be positive, so long as there isn't another underlying cause (which, on this horrible roller coaster ride, there still could be). Only time will tell. We're going to take a baby step and discontinue the one drug and lower the dose of the other and hope for the best.

Simone's X-ray from 9/5/07

So, around 6:00pm, Simone was finally brought back in to see us. She didn't seem herself. She was drooling, and only did an obligatory tail wag. She swaggered down the hallway and out into the parking lot with us. When we got outside, she urinated, but couldn't use her back legs very well and seemed to be having trouble. I got to the car and took her dinner out, but she wasn't interested in it at all. When she made it to the car, she collapsed. Her gums were paper white and her heart was racing. She seemed distant and not aware of her surroundings. Gary ran back to the building (which was now closed and locked), and pushed the intercom. After being asked where he got the inside phone number (apparently someone was new and didn't realize they had an intercom phone in the parking lot!), a crew of six vets rushed out with a stretcher and loaded Simone up. They took her inside and told us they would call us later.

In shock, Gary and I headed home to again wait by the phone. At 7:30pm, the vet called and talked to Gary. He said it appeared that she was bleeding internally. He said it seemed likely that a clot had been dislodged when they did the liver aspirate, and she began bleeding. He said they had started a plasma transfusion and that she seemed to be responding. He said he would call back in a couple of hours and give us an update.

At 8:45pm, he called again, and said that Simone seems to be perking back up. He said they had taken her outside to pee and that she was wagging her tail and her eyes had reanimated. He said that her blood pressure was back up to a normal range and that the blood in her abdominal cavity had a lower packed cell volume (16) than her arterial blood (27). While neither value is good (normal is 42), the lower value in the abdominal cavity indicated that there wasn't a direct arterial bleed. So, they have a pressure bandage on her abdomen, should be finishing up her plasma transfusion, and will be keeping an eye on her tonight. We were told to expect a call from the vet student in the morning to let us know what's going on and when we might expect to be able to pick Simone up.

We're exhausted, but encouraged. At the top of the roller coaster again, but it's so much better to be up here than at the bottom. It seems like we've been spending too much time there.

Thanks for all of your kind words and thoughts. We'll keep you posted.

Love, Carley and Gary

Simone Update 9/11

Things are sliding a bit. We started her on the immunosuppressent last Wednesday with hopes that it would stop the destruction of red blood cells and allow her body to make more. We went in on Friday for a hematocrit, and it was 34. We went in again on Monday, and it was 32. She is not responding to the medication. Our vet is at a loss for what might be going on; she thinks the lack of response to the immunosuppressent indicates that the disease is not autoimmune. So, we're back to the beginning almost, and don't know what is causing it. We know it's not a rodenticide, a tick-borne illness, or immune mediated. She's losing weight (down 4 pounds since Friday), and her appetite is decreasing, so cancer is still a possibility even though the X-rays didn't show a mass. We have been referred to the OSU vet school's medical clinic for additional tests and an abdominal ultrasound. We go in tomorrow at 10:00 for our appointment. Hopefully they will be able to piece it together and give us some answers. I don't know how much more of this we can take.

Please keep her in your hearts.