January 18, 2019

White Dog seemed satisfied after we talked with both Dr. Julia and Dr. Heuberger this afternoon. Nilla had spent the day at the clinic receiving hydration and further testing and the input from both women provided the information I felt we needed for clarity.

Dr. Heuberger is  wonderful researcher at Central Michigan University who specializes in geriatrics, mostly nutrition but also end of life decision making. She headed the recently completed Paws To People study on those issues for both humans and dogs. She follows our White Dog Army Although she is an Akita rescuer herself. Patiently she heard about Nilla and answered my questions about hospice and pain management and  sustenance needs. It is critical that we provide a peaceful end of life journey without interfering in a way that will prolong pain or dysfunction.

When Dr. Julia called later, she had heartening news. Nilla had responded well to the hydration. And x-rays showed the lungs were clear of fluid. It is her belief that the MRSA infection has not become systemic and is still confined to the skin. She has a certain expertise having fought the human version years ago while recovering from a broken pelvis; she says in dogs the infection is generally confined to the skin and ears and only very rarely migrates to the lungs as happens in people.

Bloodwork showed a high but not catastrophic level of creatinine in Nilla's kidneys. "I want you to do subq over the weekend and I will see her again on Monday for another day of hydration and retesting so that we can measure progress. It will tell us if the issue is just dehydration or if we are starting to see organ problems. It will make a difference on how we move forward. Also, I suspect that some of Nilla's decreased cognition may also be connected to needing more fluids. So let's hold off the idea of moving from palliative to hospice...call it moving to a yellow flag instead of red one."

We agreed with Dr. Heuberger's suggestion to use distraction rather than medication to redirect anxiety whenever we can. "That will help us measure her cognitive abilities to change thought processes," Dr. Julia explained.

Loss of appetite might be spurred on by nausea, our healer speculates. Kidney troubles sometimes disrupt digestion. Toward that end we are ARE going to try medication. "It could simply be that things taste bad or go down sourly and if we eliminate that she will perk up on food again."

Nilla certainly seemed aware that she was back home when she arrived and the White Dog Army greeted her with sniffs and kisses. Our girl was glad to settle into her bed mat and drink in the smells and sounds of home...yes, even the piano music. At dinner she DID eat her bowl full of bone broth slurry. Her day was exhausting and she rests under the lovely personalized blanket sent to her from our friend, Sue. I expect she will sleep soundly through the night.

This will be a weekend of assessment without staring. White Dog warned me..."momma, please do NOT vulture Nilla and make her feel spied upon. That will only give you a false reading as you will create stress and concern." "Asking a momma not to be a momma?   Is that even possible?" I respond.