Ebb and Flow... The Journey here on earth ends

AP here:
I have spent a great deal of my life in the water, waiting on waves or wind and they have their own rhythm, their own beat that they march to and it is known as -ebb and flow.
Then ebb is not so fun, peaceful but not so fun, but when wind or water is flowing and you stand up and ride it is an incredible feeling. Happiness!

life on land also follows the same
The situation that Tonka and I are in seems to exaggerate these downs and ups, the ebb and flow. The bad moments, the labored breathing, the nosebleeds and the eye that is being pushed slowly sideways these are the things that suck the tide back and make for a not so enjoyable day.
When things are good though and he is surrounded by his peeps, or enjoying his breakfast, or just loving the cooler weather sleeping on the porch with me, this is the flow. Happiness!

It was my wish that Tonka would get to the bridge in a very peaceful manner, not in a crisis and not when he was stressed. I had made plans to have him pass at the house and my gut kept telling me it was time. The problem was everyone stopping by to see him commented on how great he looked and he was doing and I second guessed my gut. I started to think we had a little more time and his last day was such a great day that I actually called in and refilled his prescriptions.



Tonka's last day was a truly great day, he and I slept outside on the porch from about 4am on and then "watched" the sun come up. I was home for the day and so I got to spend time with him. He had a good breakfast, a buffalo bully stick and some cheese.

I'm up

Back to sleep on Porch with Mom

Back up for Breakfast

Can I have a scone?

No Scone then I'm going back to bed

I like Buffalo

Chomp, Chomp

Caitlin and Noodle came by and that is always a fun time. Tonka and I love Caitlin dearly, she has been such an enormous help during the past year and is a truly amazing person.

Hi!

I like to drag Caitlin around the yard

It's my buddy Noodle

Love the Noodle

 Noodle is a such a good dog and he and Tonka had fun sniffing and playing with the brick puzzle.

Noddle and I took a nap

I said goodbye to Caitlin

After Caitlin and Noodle left I ran down the road to meet his Aunt Gina. She had picked up a Chinese herbal medicine for me that was supposed to help his nosebleeds. On the way back I also picked up a new refill of his piroxicam. He was doing so well and was so happy it seemed like we were going to have a little more time.

When I got back it looked like a storm was rolling in. Tonka and I love storms so we headed for the porch. 

Mom and I hung on the porch waiting for the storm

Still waiting

No Storm- I'm going to nap

It turned out to be a dud and blew over so when CM got home we took a little walk/roll down the street and back. We ran into some neighbors who of course fussed over him and told him what a good boy and an awesome dog he is so he was very full of himself when we wheeled back into the house.

No storm so took a little walk with AP and CM

He had a good dinner and took all his meds and finished off his nightly frozen PB Kong.

Peanut Butter Kong Time

This is the last picture of my boy.

After his Kong he settled into sleep and in a little bit I stood up to move to the floor to give him some love and noticed the spot of blood under his nose. I lifted his head to reposition the towel and see how bad it was,  he sat up and it just started pouring. CM and I went into full nosebleed stop mode with extra towels, paper towels, tissues and epinephrine but he kept sneezing.. the more he sneezed the worse it got until it was running out both sides and his mouth. The epi was not working, nothing was working so I bundled his head in a towel and while CM got the truck in position I got him belly walked out of the house and around the front. I got the ramp in place and I got him up in the truck and off we headed to the ER. Poor Cathy had to stay behind to clean up what looked like something out of a horror movie. I called his Uncle Mike to let him know where we were heading and I made a quick phone call to the ER to tell them I was coming. Tracy answered and I and I told her I would need help as I didn't have his wheels. At the first red light I send out a request for prayers although somewhere in my head I knew what was coming. At the next few stops I sent some texts to his support peeps to give them a heads up.
When I pulled in the circle at the ER and blew the horn they all came running with the gurney - I got him up and down the ramp and he was still bleeding everywhere. I helped lift him to the gurney and they rushed him in the back. Dr. Fleury who is a great Dr. and wonderful person came out while I was still putting the truck back together. She said something to the fact that she had looked at all his records and that she knew that we were nearing the end of things. She wanted to know if we should just let him go or try to stop the bleeding. I told her to try because this was not how I wanted him to leave I really wanted him at home and not in a crisis.
I parked the truck and entered the lobby where they told me I could wait in a room or not it was up to me. I wanted to be where I could see the ER doors open so I chose the lobby. Tracy gave me a bunch of wipes to clean off the blood that was all over my legs, arms and hands and then I waited. I did not have to wait long Dr. Fleury came out and explained it was a massive bleed and they had given him a sedative to drop his blood pressure and had gotten it slowed with strips soaked in epinephrine stuffed in his nose. The only thing that would stop it was an embolization procedure but that it would only keep re-occurring. The option was to leave him for the night get him stable and bring him home to let him pass at home on the porch or just let him pass over now.
It was with a very heavy heart and some anger that I decided to let him go. THIS WAS NOT WHAT I WANTED FOR HIM.I wanted him home at peace not in a crisis, not suffering in any way.

They put us in a private room and I tried to clean some of the blood off of his big beautiful face. His Aunt Gina sent a text that she was on the way so I lay there and sang to him. He was sedated so I am not sure how much he heard or knew about what was going on. He did pick his head up when she arrived but was not very responsive. I called CM and told her what was happening and since he was so out of it we decided she would finish cleaning the disaster area as she had already talked to him when he was coherent at home waiting for me to get the truck ramp out and together.
Gina and I spent some time with him and then Dr. Fleury came in and we let him go. I laid my head on his heart so I could listen to it beating until it beat no more. My beautiful, beautiful boy with the sweet smile and the heart of gold was gone. On Friday the 13th of September 2013 at 11:30pm the Journey of Tonka ended here on earth and I am sure a new one started for him at the bridge and when we meet again he can tell me all about it.

At this juncture I feel as if the flow is completely gone  there is only the endless pull as if the life has been sucked out of me. I know in time this will lessen but for now I am empty and alone in this.
Thank you for all your kind words, your thoughts, your gifts and your prayers. He was an amazing soul and I thank you for your love and support of him through the years.
Much Love
AP

The Puppy Plunge 2013

AP here:
Tonka and I attended the Puppy Plunge this year in Annapolis at Camp Letts. We hung out with Tonka's friend Ollie Lollie Stanford and his humans at the Veterinary Housecall Service booth.

On the Way

I'm here

I hung out with my buddy Ollie

I stopped to see the ladies at the Petsmart booth

 There were lots of booths to roll around and visit and "see" people to get treats from. Since we got there early it wasn't very crowded at the little beach and Tonka got to get his feet wet with the help of his friend Hannah.

My friend Hannah and I got in the water

Ollie was chillin

I took a break with my fan

Ollie took a break with some ice water

There were lots of people and puppies

 Later in the day Caitlin came with Noodle and we hung out a bit.

My friend Noodle showed up with a turtle costume

I love Noodle he is a happy boy

This little guy had big ears

Telia and I had a chat

 As the day wound down Ollie and I were tired and ready to go home.

Ollie was ready to go

AP packed everything up

I was asleep before we left the parking lot

Home and time to unpack

It was a really fun day....

It is not a tumor...

AP here:
With the breathing problem getting worse and his inability to get comfortable I was becoming more worried that we were dealing with a tumor in his nose and that perhaps he had a broken rib. There are always options for diagnostic tools in our immediate vicinity as we are very fortunate to have not only specialists less than 20 miles away but also an MRI machine at VIoC. Tonka had 2 MRI's when he started having difficulty walking and both showed nothing abnormal at the time. An MRI requires full anesthesia and since he just had such a lengthy surgery I decided that perhaps we should just do some x-rays to get started. I had the x-ray of his nose from May which showed how congested his right side had become.

Several Dr.s had looked at the x-ray and since it did not show any bone loss at that time the thought was it was just a sinus infection. From April to mid-June he was on 2 rounds of Amoxicillian and Baytril as well as an antihistamine hydroxyzine  and Flonase as an inhaled steroid. None of the medication seemed to help so now I wanted a new x-ray to see if anything had changed.

We scheduled an appointment at GAVH for June 25th and Caitlin happened to be working that day so that worked out perfect. Tonka loves Caitlin and she would be able to help. They gave him a 1/2 a dose of a sedative and took x-rays of his nose, his chest and shoulders and abdomen.

Groggy

No broken bones or fractures  were apparent so that left either a muscular or neuro muscular problem.  The nose looked the same as it had in May so no overgrowth that would indicate infection and no destruction that would be indicative of tumor. The theory became that it could be a polyp and unfortunately with canine noses a CT, MRI or scope would be the only way to know for sure. Dr. Woodburn and I discussed the fact that since this seemed to all be muscular we should try some muscle relaxers and pain medicine and see if that would help.  He also made sure I understood that this could also be caused by a brain tumor. I could tell a difference already as he was more relaxed from the sedative and his muscles were no longer twitching under my hands. He was groggy all day and slept really well and that night we did not have the bizarre grimace breathing episode.

He seemed to be more relaxed on the meds but still not breathing well especially when laying on his left side. Then one day out of the blue his right hind leg no longer wanted to support his weight if I put him in a stand. This gave me something new to worry about and I thought that perhaps he had tried to get up and fallen and torn something. I called and made an appointment with the surgeon that removed his tumors Dr. Roa at CVSS to rule out anything orthopedic. The first appointment I could get was 2 weeks out so in the meantime I started icing the leg just in case.

While working on a blog post I happened to look up the proper spelling of metoclopramide which is the official name for reglan. This is a drug that is given along with chemo to help with motility and nausea. It occurred to me as I looked it up that I had researched the Palladia up one side and down the other. I had even joined some canine cancer groups to specifically ask about it but I had not really looked into the Reglan. This was the first site I landed on http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684035.html
The first thing I saw was the huge warning box and in reading through the symptoms my stomach turned and my heart sank.......  These symptoms were some of the things he had been exhibiting and upon reading further it was contraindicated if there was a history of seizures. That hit me hard and I looked back through his history that  I had given when we started down the chemo road to make sure I had not forgotten to include that. His seizures had always been so infrequent it was not always the first of his medical problems to think of. It was listed in his history so I had not forgotten which made me feel a tad bit less sick but no less angry with myself for not having researched it before letting him take it. Tardive Dyskinesia is the name of the disorder and when I started looking for that in animals I did not find much but I did find people on the canine cancer group whose dogs had developed the same symptoms.Everything I read said the symptoms could disappear once off they medicine or they could be permanent. Thankfully he had only been on it a week but the problem with Tonka is he is so sensitive to medication that a week on something that does not agree with him is a week too long. Hopefully I can wean him off the muscle relaxers and the symptoms will be gone.

The Crash

AP here:
The ER at CVRC is a busy place but it is the best place for Tonka when he is in distress. Most all of his specialists are there and everyone knows him. So when he had the multiple instances of diarrhea and was weak and dehydrated it was the place for him to get the best care.

We arrived around 5:00pm on Monday June 3rd and he would not be leaving till Tuesday June 4th at 7:00pm. They had taken him back and started him on IV's and his Aunt Gina came to sit with me and make sure he was OK. She also came to make me go get dinner with her since she knew that I would be spending the night there and would not eat otherwise. They put my boy in one of the nice large condos with lots of comfy bedding.

In the Condo

This is where I would also be spending part of my night and most of the next day. It was a little surreal being there again overnight as it was just a month earlier I had been there for 2 nights when he had his surgery.

Sleeping with Me

The next morning his care was transferred from the ER staff to the Internal Med./Oncology staff.
Diana who had helped me carry him in the night before was kind enough to bring me coffee and a muffin for breakfast when she came in to work. Since it was Tuesday morning it was also his usual therapy day so all his therapists were there and came by several times to pet him throughout the day as well as his Aunt Gina and his surgeon Dr. Roa.

I went back to sit with him whenever they would let me and I stayed cuddled in the condo with him for a good part of the 20 some hours we were there. At lunch his therapist Chris went out and got me a sandwich and sat with him while I went out front to eat it. Everyone was super about taking care of him and me and giving him lots of love. It is both a blessing and a curse that he is so well known there by everyone. We are fortunate that we have the resources locally for the kind of support and medical attention he needs.


In the afternoon his oncologist Dr. Peterson talked to me about his blood work which was pretty normal and wanted to do an ultrasound to see if they could come up with anything else that could have caused this. Since the last chemo dose had been Friday and he tanked early Monday the theory was it was not the meds that had upset him. The chemo meds are supposed to clear the body within 48 hours.  I agreed to the ultrasound and when it was done it also looked normal the only thing was a little thickening of the intestinal wall in a spot but after consulting with Dr. Roa it was agreed that was from he surgery. Tonka may be a big boy but he is a very sensitive guy when it comes to meds and this had not gone well. Part of the medicine protocol was Metoclopramide which helps move food through the system. I had given Tonka his heartworm meds Sunday morning which consists of two squares that look like treats (heart guard) and the smaller one had passed through completely intact. I think perhaps the medicine worked a little too well.....

It was now past 24 hours of being on fluids non stop and both of us were ready to go. They wanted to keep him overnight again but I said no and promised to keep him hydrated. Now that he was no longer in distress the best place for him was home.

Going Home

I had wrapped up his tail with an ace bandage after his third bout of diarrhea as I was out of vet wrap and Caitlin had bought some with her and re wrapped it for me. Once home I kept his tail wrapped for a few more days just in case.

Home

He could not seem to get comfortable and would puff his cheeks out and sigh as well as twitching and jerking a bit. He was still hating to lie down on his left side and his breathing was not getting any better. I was hesitant to put him back on his meds for his allergy/sinus problem so I waited a few days to make sure he was OK and eating well. I kept him on Flagyl for the diarrhea for next seven days. On that seventh day we went to see Dr. Philips for acupuncture, we had tried it before for his lameness but now I wanted to see if it would stimulate his appetite and perhaps make him relax. I showed Dr. Phillips how he had an issue laying on his one side and how he was jumpy around his ribcage. She agreed that something was definitely off and that he was not his normal happy self. We discussed maybe having a full MRI done to figure out
1. does he have a tumor in his nose and it is not allergies or sinus 
2. is something broken and making him uncomfortable
That night he had a full blown seizure. It had been two years since he had one and it caught me off guard. It was 11:30 at night and I called the ER and spoke to one of the Dr.s that had seen him the week before. We agreed that since it was only one and under 5 minutes long we would wait to see if he had another one before rushing him in. Running down his list of meds the only one that could have possibly been a cause was the Flagyl. He was postictal for about 20 minutes and during that phase he knows nothing not even his name. He kept trying to stand and walk which completely broke my heart. I had to keep repositioning him to stay down and he was flailing frantically.  When he did come back to being fully himself he was very hungry and thirsty. I had been sleeping on the floor with him for only 1/2 of the night but after the seizure I went back to sleeping with him all night.

He was very jumpy and snoring a lot and then one night I could not wake him up. His face was contorted in a horrible grimace and his breathing was very labored. He stayed like that for almost an hour and then sat up like nothing had happened. I got him some water and he then laid down and slept normally the rest of the night.

This became a nightly occurrence so I took a video and sent it to someone who could maybe tell me what this was. The answer came back perhaps a different form of seizure. Every vet I talked to about this felt that perhaps his breathing and strange activity was being caused by a tumor in his nose that was now pressing up into the brain. It was time to decide a course of action

Happy Easter From the Tonka Bunny

Happy Easter!

My Caitlin (who I love very much) came by the other day and she and I had a lot of fun with my new rabbit ears that she got for me.

Hello I am the Tonka Bunny

Getting Ready to Deliver Baskets

Happy Easter

Back to Sleep Till Next Year - Tonka Bunny Out!

Have a Very Happy Easter Everyone

Caitlin and Tonka

AP here:
It is 30 miles for me to get to work. To make that trip 4 times in one day is 120 miles which is wear and tear on the truck, way too much in gas and makes me tired. I have an incontinent 125lb dog that needs his bladder expressed every 5 hours and needs to be flipped to his opposite hip to allow blood flow and prevent sores. This means that I have to drive home from work mid day to take care of him. Now if you follow the blog you know there is nothing I would not do to keep my boy healthy and happy including making that drive. The only problem with that other than the reasons stated early was that sometime I get stuck at work or in traffic and cannot get back in time. Between 5 and 6 hours Tonka starts to get restless, he knows he has to go and he will try to get up and get to the door. I love the fact that he still knows he has to go and that he still tries to make it out. The issue is that once he tries to get up into a stand his bladder leaks and he ends up wetting the bedding or the floor. Since he cannot maintain a stand for more than a minute he usually ends up falling back onto the pee spot.
This is not fair to him and its not healthy for his bladder to stay too full so I started looking for someone to help out.

Enter Caitlin who runs a local pet sitting business and is a certified veterinary technician for one of Tonka's doctors.
Caitlin has been pet sitting for the past 9 years and grew up on a farm showing dogs, cattle and sheep. She is also very familiar with exotic animals and wildlife having worked both in a pet store for 5 years and at a wildlife rehab in Colorado for 3 years. Her knowledge and experience combined with her love of animals makes her invaluable as part of Tonka's team of caretakers.

Tonka loves Caitlin to pieces and is always happy when she arrives. She does not just come in do the job and leave, she spends real quality time with him engaging him in play and giving him love and attention. I get feedback with every visit and she is quick to catch if something is not quite right with him. She is an amazing individual and we are so grateful to have her in our corner.