White Dog jumped every time the phone rang this morning and the entire White Dog Army huddled around listening to my conversations. The group was disappointed most times that the calls did not regard Puff, but when they heard me say, "Hi, Dr. Julia, thought you were out for a few days..." they high pawed each other in excitement.
The emergency hospital had emailed our beloved vet last night with an update report expecting that it would be seen first thing at her office today. Dr. Julia checks her emails and answering machine right before bed...and discovered that our Puff was in ICU. She could access the office digital xrays and such but could not get to Puff's chart and files. So our wonderful vet drove in first thing this morning specifically to deal with our girl. In her call, Dr. Julia pressed me for all of the details from the weekend that led up to our decision to take Puff in; she questioned what we understood the ER vet and the internal medicine specialist had diagnosed. She listened to my concerns about the sedation needed for the bronchioscopy (and wondered also about the safety of anesthetizing a pup who was still being kept under oxygen). She agreed to call Dr. Reese (whom she knows and respects) before the procedure and discuss his ideas and game plan.
Ultimately we all decided to do the scoping and Puff the Magical proved herself once again by coming through it without issue. The procedure however, provided no answers. Yes, our girl has a very narrow trachea but it is not collapsed nor is there any other site of collapse down the bronchial tube (which is what Dr. Reese was looking for). The team took samples to send for culturing and to send for pathology (looking for unusual diseases). But we are now on a Sherlock Holmes hunt to find the cause of Puff's breathing difficulties since the usual tests have revealed nothing.
We have ruled out parasitic pneumonia, parasites in the bronchial passage or lungs, Hanta virus, and a host of other possibilities. The blood panel has turned up nothing out of the ordinary either. There is mild pulmonary hypertension but both vets agree that this is probably attributable to the stress SAWD is under right now rather than the cause. Meanwhile, Puff is still in the oxygen chamber and doing well in there.
Dr. Julia believes that we will find Puff has chronic bronchitis which when combined with the super pneumonia has just been more than our fragile girl could handle. The question is whether the bronchitis is bacterial (in which case an antibiotic will be chosen) or allergic (a steroid). This will not be known until the culture comes back in a couple of days. We have asked that she head up the decision making process on Still Another White Dog since she has a long view of Puff's history (with no slight intended to Dr. Reese).
The plan in place is that Puff will stay one more night in ICU in oxygen. At 1am she will be given a steroid to reduce inflammation and her usual heart meds. In the morning Puff will be moved out of the oxygen chamber into a regular kennel where she will be monitored and in the afternoon given a second dose of steroids. We should be able to bring her home late afternoon. Dr. Julia will see her on Friday and will remain in regular phone contact as she settles back in at home.
It is Dr. Julia's "gut" that the bronchitis will turn out to be allergy driven and since Puff's cough seems to be worst first thing in the morning she is focusing on something in her sleeping environment. In preparation for SAWD's return we have washed all of her blankets and sleeping pad in hypoallergenic laundry soap and scrubbed the floor with vinegar. We have thoroughly dusted and made the areas as dust free as possible. For now we are to leave the windows open near her area as we normally do since she has no coughing problem on her nightly walks or when she is in the yard.
Both Dr. Reese and Dr. Julia have instructed us on how to make an oxygen chamber out of a travel crate, plastic, and the oxygen concentrator I use for my sleep apnea. That way we have a safety plan should Puff face breathing issues or need a boost during her recuperation. That is all we can do for now until we get some results from the cultures.
We are, at White Dog Ranch, feeling incomplete without Puff. The WDA is depressed and lackluster and still check the door and frenzy every time they hear a car door slam or a pup bark in the neighborhood. She simply cannot get home too soon for us. We wish there was a clear explanation and an obvious "fix" but at this point we will take a smoother breathing Eskie girl who is not in pain and who is glad to be home. The White Dog Army is planning a victory party for when Puff gets back to health...with a VERY special place for Dr. Julia.
And just because all of this has not been challenge enough, this morning began Steve's grad seminar at the University and it is his late night of teaching.
Although we are out of catastrophic crisis mode, Puff still has much healing to do. Please, we ask, keep our littlest one in your thoughts...you are working miracles for her.
With love and thanks.