THE FIRST 7 DAYS in ICU for EVE

FRIDAY, FEBRUARY 19, 1999 (3 days post surgical)
Eve had a seizure as she was being admitted

• She appeared lifeless as she only had involuntary actions i.e. heart and respiration
• She could not hear, see, swallow, or have control of any muscles. She was like a limp dishrag.
• Her eyes, although opened, appeared vacant and her right eye has ventrolateral strabismus. (Strabismus is when the eye looks in an abnormal position. Ventro - from ventral meaning down and lateral meaning to the outside. - Lyn) So she is looking down and to the outside with her right eye.
• She was given a 50/50 chance of survival if there were any signs of improvement over the next 72 hours.
• She was started on medications for seizures.
• A  Neurological Evaluation   was done and it was determined that Eve was suffering from edema (swelling of the brain) due to  hypoxia (lack of oxygen during her spay). Valium was given once upon admission. (For a more complete description of everything that Eve is experiencing, go to the Neurological Evaluation.)
• She was also given IV fluids, oxygen, and solu-medrol and mannitol for the edema.
• We were allowed to visit Eve for short periods of time during the day. Any time that she became agitated and was thrashing around, singing or humming "You Are My Sunshine" settled her and she was able to drift off into a deep restful sleep.
• I tried an experiment and sang "Dream Lover" to her, but it didn't have the same results as "You Are My Sunshine".  No veterinarian can tell me that somewhere in her brain she remembered from infancy my singing to her, but I will always know that she did.
• Lyn was unsuccessful in contacting the veterinarian who performed the surgical spay.

• I spent about an hour with Eve early in the day. She had no balance and so had begun to paddle a great deal trying to get up.
• She was only calm laying on her left side.
• She reacted to pinching her toes and pulling her hair slightly by wildly flopping around.
• Again, singing to her calmed her greatly.
• Eve did not have her gag reflex and so could not swallow.
• We were advised that nutritional supplementation would have to be discussed and decided upon  by the end of Sunday.
• She was making tiny steps forward in as much as she could  now move, although uncontrolled.
• Her right eye was beginning to improve.
• There was a setback when she had a seizure at 2:30p.m. and a second dose of  valium was administered.
• Approximately 30 minutes after that dose of valium, Eve had a second degree heart block. The heart rate dropped to about 40 (less that half of normal) and she started showing p-waves on her ECG (a lack of the big spike on the EKG) She never had two in a row, but it was enough for Lyn to be very concerned.
• This condition responded by increasing her heart rate by using a drug called glycopyrolate which is similar to atropine.
• She had no further problems surface on  Saturday.
• Blood saturation (level of oxygen in the blood) was staying at 96% or above. Below 90% is considered alarming.
• Eve began to regain her balance as later in the afternoon she began to struggle to right herself and rest on her sternum.
• She regained her gag reflex some time during the afternoon and early evening.
• Upon visiting her in ICU at 10:30 p.m. I discovered that she was sleeping on her right side. This was something that she could not do previously because of the hypoxia and balance issues.
• Lyn was still in ICU at 11:00 and so we tried an experiment. We heated a small amount of A/D (food) and offered it to her on fingertip. She licked it off and was ready for more. She managed to eat 2 teaspoonfuls. Lyn didn't want to offer her more for fear of her aspirating and then having problems  with her lungs as well.
• The Registered Vet Tech in charge of ICU for the night was given orders to feed her every three hours as much as 2 tablespoons at a time.
• Eve was still on oxygen and IV fluids so my stay in the ICU was short and I left around midnight.
• We were becoming hopeful.
• Lyn was unsuccessful in contacting the veterinarian who performed the surgical spay.

• We all visited again at 8:30 a.m.
• Eve had a good night, sleeping on both sides.
• She was still on oxygen and IV fluids.
• She seemed to be more alert, stable and intentional in her movements.
• She was beginning to lose that vacant look in her eyes.
• We were hoping for ear movement as I felt sure that this would be a good indicator that she was able to hear us. Nothing!
• Hester had also brought Laddie, their 9 year old Scottie along to visit Eve, but she gave no indication that she knew that he was there.
• During the morning evaluation when being held in a standing position, Eve would correct her foot placement each time that Lyn would turn it under. She was still unable to balance or stand.
• Eve exhibited no more signs of seizures.
• She was making small steps forward.
• Her 72  hour deadline for some signs of improvement had been met.
• SHE'D CROSSED THE FIRST HURDLE.
• Lyn was unsuccessful in contacting the veterinarian who performed the surgical spay.

• Eve's nasal tube was removed so the veterinarian team felt she was not in need of oxygen.
• She seemed to be tracking movement with both eyes.
• She now has control of head movement and doesn't flop around like a fish on land. (not a very medical description, but accurate.)
• She still has not given an indication that she is hearing us.
• Eve is aware of her body functions. She was always a very clean puppy in her "potty" habits and gets extremely agitated each time that she has to urinate.
• We stand her up now on all four feet and she can balance for a short time.
• The student assigned to her case saw Eve make an attempt to eat on her own. PROGRESS!
• Lyn was successful in contacting the veterinarian who performed the surgical spay.
• For a more detailed (as much as Lyn was able to get from this vet) summary of surgical protocol used by this vet, go to: Surgical Protocol

• Eve has started licking constantly and then grinding her teeth. Possible seizures in the frontal lobe.
• Lyn and Neurology have decided to put Eve on potassium-bromide for seizures. The loading dose will be stretched out over the period of a week.
• She has begun to eat from a bowl and is calm enough to have a water bowl left in her room.
• Tuesday they started to wean her from her IV fluids to encourage drinking.
• Eve has begun to be able to stand on her own, so we know her balance is coming back.
• Lyn thinks there's a possibility Eve might go home (at least to Donna's house) soon if she continues to progress.
• Lyn's given her an 80% chance of recovery and maybe a 70% chance of coming back to us as the same dog in personality.
• Eve was taken outside by her vet student and walked in the sunshine.!

All seems to be right with the world! SHE'S IMPROVING!

WEDNESDAY, FEBRUARY 24, 1999 (8 days post surgical)
 

• We're going from famine to feast!
• Eve is extremely agitated and unable to settle.
• When awake, she's constantly in motion and barking.
• I had her outside this morning and she couldn't be still. She was constantly walking, even into trees. I had thought a few days ago that she could see, but we know that she can't now.
• Lyn and Neurology feels that now that the brainstem swelling is going down we're seeing where the rest of the damage is.
• Neurons are firing and have no where to go. They're trying to establish different pathways. Only time will tell if she'll be able to accomplish that.
• If Eve's extreme agitation doesn't pass quickly when she is held or restrained, our visits will be suspended indefinitely until she can handle the stimulation.
• Dr. Curtis Dewey, Neurology, was impressed with Eve's progress. He had not seen her for 5 days. Tremendous improvement was a term that he used.
• The Neurological Evaluation was done and this is the results:
• Eve may be able to hear in time, this is a processing problem.
• Eve has cortical blindness - the retinas and optic nerves work, but the brain is not processing.
• Lyn has started loading her with  tiny doses of valium three times a day for this severe agitation. Maximum dose: ?
• All of these symptoms were masked by the inability of the signals to get past the brainstem until the swelling started to go down. Now we're seeing the rest of the damage.
• Eve is beginning to drop weight again. She's too agitated to eat. If the valium doesn't take affect very soon, they will have no options but to sedate her ( with a general) and put a feeding tube in place. She's down to approx. 10 pounds. (1/3 of her body weight)
• The hope of a release soon is not a reality!

• Eve will go under anesthetic later today, probably between 2 or 3 to insert the feeding tube. There are no options, she cannot be allowed to drop any more weight.
• We have been asked to suspend our visits because she just can't control herself and becomes too agitated when handled.
• The surgery has been pushed back to 6 or 7 this evening.
• Eve's vet student called around 5 p.m. to tell me that they had been able to move Eve back up and that she was coming out from under the anesthetic.
• ALL WENT WELL!
• Eve was put under general anesthetic with a new drug called propofol. She had no complications and was awake and doing well. Lyn was relieved that this was behind us.
• LET'S EAT!
• Eve has been on the valium and potassium-bromide for a few days now. She has stopped grinding her teeth.
• Now we watch and wait.