July 2, 2017

Rest in peace, sweet Mr. Bartles...


I am utterly and completely heartbroken and have been deliriously going in and out of emotions such as anger, sadness, calm and despair.

Mr. Bartles crossed the rainbow bridge late last night. We had taken him in to the ER on Friday when he woke up without an appetite. He wouldn't eat anything and the only thing I was able to give him was his Baytril for his UTI and his Gabapentin to control any pain he might be having wrapped in cheese.

We had originally scheduled him to get his ACTH stim test done on that day with his regular vet at Town and Country. After being off of his Cushing's medicine since April, I thought his symptoms had come back and so I had started him back on Vetroyl at 10 mg twice a day. The protocol in starting Cushing's medication is that you test them at 10 days, then at 30 days and 3 months to check their cortisol level and adjust their dosage if necessary. This is done through the ACTH stim test, which is performed 4-6 hours after they eat their breakfast and take their first dosage.

Friday was day 11.5 since Bartles started back on Vetroyl. He had a great appetite leading up to the 11th day except dinner on day 10 when he wasn't as excited with his food and only finished half of his meal. I thought it was because I gave an extra 1/3 cup of Orijen senior dry food late afternoon and he was still a bit full.

Nonetheless, Bartles woke up Friday morning without an appetite. And because he wasn't able to take his Cushing's medicine, we couldn't move forward with the test. It was deeply frustrating because I had been waiting to find out how his cortisol levels were doing. The 10 days since starting his meds, and even a couple of weeks prior, he had been showing signs like loss of mobility, circling while lying down, crying, etc. which I thought were both UTI and Cushing's related. I figured if we began to get those two under control and he was still howling and crying, then we can at least rule out a few things and start to get to the bottom of it soon. 

Despite having to cancel his cortisol test, we decided there would be another way and instead scheduled the first available appointment with his primary vet which was in the late afternoon to check out his loss of appetite, which was our priority, because it was so sudden and off.

However, as the hours went on, I got scared that may his kidney levels got worse or if he had pancreatitis or maybe his cortisol level dropped too low. I decided to take him to the ER instead for the sole reason of getting lab results on the spot, wherein if we went to his regular vet we would have to wait couple of days for the results. We went to Town and Country's sister hospital so that the attending doctor would have access to his previous records.

Perhaps I was too dramatic when I walked in holding a sleepy Bartles. I started to cry and couldn't talk and everyone was alarmed. I had actually started to cry because I got reminded of Piri and to be honest, I was a little scared, that maybe Barltes too would leave unexpectedly.

But, to the attending doctor's surprise, Bartles' vitals and blood work all checked out ok. Everything actually improved from early June except for his kidney values which were only slightly elevated and his red and white blood cell count was off, which suggested infection, but we already knew that he was battling stubborn UTI since April. 

I let the doctor know that we wanted to take care of his UTI first because I thought this was the cause of his loss of appetite, mobility, etc. and because he was on Baytril for several rounds, if we could go back to Clavamox. He agreed but he let me know that he had bigger concerns than his UTI. He thought Bartles had gone in Addison's crisis even though his electrolytes came back perfectly normal. He let me know that with atypical Addison's the electrolytes would actually come back normal and so he was afraid Bartles may have that. He gave Bartles a steroid shot (bad for dogs with Cushing's who over produce cortisol - steroid), performed the ACTH stim test, which apparently is also used to test for Addison's and gave us steroids to take home to administer. I was skeptical that he had Addison's but let the doctor give him the steroids. 

He was also worried about Bartles' condition - how he couldn't walk and how he looked out of it. I got frustrated because there is a difference with how Bartles normally looks vs. how he looks when he is lethargic. Bartles was on Gabapentin and he looks out of it and tired because the side effect causes drowsiness. When I looked at him that day, he looked drowsy. Not lethargic. When I told the doctor that, I only sounded like I was in denial. How is it that in these types of situations, a owner who is with the dog every day knows less than a doctor? 

The doctor cautiously let us know that putting him down wasn't a bad option. That I had to think about his quality of life. And about ours too. Everything just felt frustrating. I told him no. And that I wanted him to get his test done, go home with Clavamox and steroids if he thinks Bartles needs it and fluid therapy and I wanted to take him home.

And we did. And Bartles' appetite came back that night. He had dinner and took his Clavamox. And while he did try to circle and cry, it wasn't anything out of the ordinary. 

Then Bartles woke up on Saturday without an appetite but also looking terribly lethargic. This is what Bartles looks like when he is lethargic. I was screaming inside... 

I thought to wait it out. He wasn't eating anything but I still fed him his Clavamox with some yogurt which he was lapping up a little. I stuffed the Clavamox in his mouth and he swallowed. In hindsight, I regret doing this... we bought baby food which we watered down even more and I crushed his steroid medicine and fed him. Then later his Benadryl for his stuffy nose. He would later vomit everything up.

And then I waited all day for those ACTH results to come back but I never got a call. I needed to know if he was lethargic, not eating, was having explosive diarrhea and vomiting because of Clavamox (which was highly doubtful because he had been perfectly fine with Clavamox on previous occasions) or if he had Addison's or if they unnecessarily gave him too much steroid because he was actually not Addisonian but still Cushing's. I was seething after I never got a call back despite calling and leaving a message with the attending doctor from Friday.

I called back at 7:00 pm when Bartles' condition got worse - labored breathing and whimpering. While the previous receptionist told me that the attending doctor from Friday was working until 7 pm and that I would most likely get a call back, the receptionist this time around told me he wasn't in the office today and that's why I never got a call back. I didn't care for the discrepancy at the moment and demanded that another doctor call me back with an analysis because Bartles isn't doing well. They said earliest would be by 9 pm. We had the option of coming and admitting him. By 7:30 pm we were in the car rushing him to the ER. He just looked tired and breathing heavy, but I also noticed that his eyes were rolling backyard towards his head. 

We arrived and before taking him out of the car, I checked if he was still breathing. He was and I took him out of the car and handed him to the vet tech who rushed over to me to take him back. I was completely shocked when she came out quickly to let me know that he didn't have a heartbeat and if I wanted them to perform CPR. I had just literally checked if he was breathing when I carried him from the car.. I rode in the backseat with him the entire time and he was breathing. It was literally less than a 30 second walk from the car to the front door when they took him from my arms. Did I hurt him? Did I cause him to stop breathing??  How did he stop breathing in such a short period of time? I said, "He's not breathing?? Yes! Perform the CPR! Please!" 

They came out only minutes later and told me they were able to revive him (honestly, all this time, I thought it was a joke - or a horrible mistake they had made but didn't want to admit) but when the doctor spoke to us in the waiting room she told me that we had done so much for him already and he has so much going on that it's ok to let him go. That she didn't think he would make it through the night. This was despite the fact that she let me know that after somewhat stabilizing him she was surprised that he had a strong heartbeat, his blood pressure was normal and his blood work from the day was pretty stable and nothing alarming was going on.

I just asked her to please get him completely stabilized because I was confident that he was going to make it to the morning. That this wasn't some life threatening thing happening but maybe a bad reaction to something.

And then I asked about the ACTH stim test...

Bartles wasn't having an Addison's crisis. His cortisol levels were high. He still had Cushing's.

I told her how he had a shot of steroid and I also gave him his steroid medicine in the morning. She said that was fine. I didn't think so. She said she may give him more steroids if his fever doesn't go down. I was appalled. She just let me know that his cortisol levels were high. You don't give a dog with high cortisol levels more steroids... his organs will start to fail. But what do I know?

She said we can put him down that night, which wouldn't be a cruel thing to do, or we can admit him although she thinks that would be a waste a time and money but we certainly couldn't bring him back home. I was appalled at this too. Who was she to tell me what I could and couldn't do with my dog. But I was crying and stressed that I didn't fight back... in hindsight.. I regret this as well.. I feel like I wasn't Bartles' best advocate and that I failed him when he needed me the most... just like when I unnecessarily gave him his steroid medicine earlier that day or when I didn't rush to the hospital earlier. 

We let them know that we wanted him to get as much support and treatment to help him make it to the morning and if he still doesn't have an appetite and his eyes are still rolling to the back of his head then we will discuss again. I was so confident though that he would make it. I thought all this time we were trying to solve his recurrent UTI. If we just got that under control he would make it through. The doctor thought he had a seizure and that he had a brain tumor. She would make all different types of guesses which would all be wrong. 

I asked if we could see him before we left... and there he was on his side, on top of the examining table. His eyes still rolling toward the back of his head. I felt terrible but asked him to hold on... I kissed him and petted him. And I carried with me all this hope and faith that he was going to make it. All this vitals and lab work were on our side. 

Then I got a call at 11:30 pm saying that Bartles was crashing. The doctor let me know that x-rays revealed something bad was happening in his chest. I asked what and she replied, "I'm waiting for the interpretation, but I think it's cancer." We rushed over but he was already gone... we would later find out that he didn't have cancer. It was yet again another disappointing exchange with the doctors within the past 24 hours.

The ride over I kept thinking how I think Bartles already passed. Then deliriously I wiped away tears and thought, no.. he's waiting. I know he is... he's waiting for us. Even if he's ready to go, he's going to wait for us...

We ran inside, and I asked about Bartles. The vet tech didn't say much. I asked how he was. She didn't say anything and instead led us to a room and said, "I'll get the doctor for you." I looked over and saw that Bartles was wrapped in a blanket on the examining table. His eyes were open. I felt that same cold rush when I found Piri that early morning... his eyes open and me not being able to determine whether he was alive or dead.

With Bartles, I also thought he was still alive. I thought he had overcome another crash and was stabilized and they had prepared him already so that we can interact with him before he goes back inside his cage. But then I looked over at the vet tech and asked, "Is ... he ok? Is he gone??" And she nodded and said, "I'm sorry. I'll get the doctor for you."

My exchange with the doctor continued to be frustrating... she got defensive when I asked her what happened. She said, "I tried. I really did. I mean I didn't give up on him. I tried to revive him for 15 minutes." I said ok.. but what happened that made him crash. I don't know what that meant... did he have a seizure? She said his eyes had come back to normal an hour before, then he started to have trouble breathing and so they put a tube down his throat and tried to revive him for 15 minutes with CPR but he didn't respond. 

I still didn't know why he was having trouble breathing. Why wasn't anyone explaining to me the cause of this. Was it the medicine? His Cushing's? Because you pumped him with steroids when he shouldn't have gotten it? Was he in shock? What was it?? 

I didn't get an answer. 

I asked for x-ray interpretations, which she replied, "Something was going on with his abdomen and his chest, well, his chest has bruises... the bruises they said was consistent with what a dog would get after receiving CPR." 

I just nodded and said ok. I see. She left the room. And I was pissed. And all I could think was.. you hurt him. He couldn't breath this last time because you hurt him while giving him CPR earlier. CPR that he probably didn't need because he was actually breathing. You hurt him... I let you hurt him. I didn't know how many more times I could've failed him this day. 

I was so angry... I know, I was irrational. I wanted to blame someone and most often it's the doctors and vet techs who are there to do everything they can for your pets. But I just still couldn't accept her answer that despite the bruising she thought it was something neurological that took him. It was just too sudden... it didn't make sense.. and the sloppiness and unnecessary guesses and treatments by the doctors all make me think this way, still. 

When we admitted him after he was revived, I asked if maybe they could hold off on injecting him with anti-nausea medicine and anti-diarrhea medicine and only give him what is necessary. Perhaps Clavamox via injection, fluids for his dehydration and anything else that can help stabilize him. I asked if he has another bout of vomiting and diarrhea, if they could administer those medicine then. I said he didn't eat much.. and what he did he threw up so his stomach is pretty empty. I wasn't sure if more medicine would be harmful to him. She said, dogs can do without eating and that hydration is more important. And she said the medicine is fine. It's being injected into his veins. He's not eating anything. So he got those medications despite me asking her to hold off.

I know I sound like I'm in denial. That I can't accept that it was his time. But when I think back to the last 24 hours, and the way everything was handled to poor explanation, I can't help but wonder if a treatment had gone bad. I know it's a far fetched and possibly dangerous accusation.. but he was just... so ok... it just seems unreal. 

I miss Mr. Bartles like crazy. It's hard to believe how much attachment and love I felt for him in the short 6.5 months he was with us.. and to have to say good bye so suddenly and unexpectedly has been painful to accept. We had so many more things on our bucket list to cross off... I had wanted to show him the beach. We had planned on going to Virginia Beach after Labor Day but then thought that maybe Dewey Beach would be better. Although Virginia Beach was meaningful to him (his first foster home was there) and for us (it was a place we always went with Piri), I wanted to give him his own beach. And Dewey sounded like something Bartles would love. And now we will never get that chance.

When we were given time to grieve and say our last good byes, I touched him, kissed him and put my head on the examining table so I was looking at him, like I do every morning while he was still sleeping... and he looked like he was doing just that... sleeping... and it felt like he would wake up if I tickled his face or booped his nose. After 30 minutes of being with him, crying and feeling completely broken, I got up to leave.. but I couldn't and kept sitting back down to shake him lightly because I felt like he was going to wake up... I whispered, "Bartles.. wake up.... wake up...", but he was cold and his face stiff. He was gone. 

We had yoga mats and children's play mats all over our living room floors because Mr. Bartles had trouble walking on our laminate. I used to always fancy having a nice looking home and at first those mats were an eye sore, but if it helped Bartles, I was ok. 

I cleared those mats this morning... and while I thought our house was going back to "normal" it wasn't normal at all. Our normal had been Bartles on his bed and mats that covered our floors. And now I don't know what anything is anymore. And it leaves me confused and uncertain.

Rest in peace, sweet Bartles. Thank you for waking up every day with your Bartles smile and touching us with your perseverance, resilience and love for life. 

I"m so sorry that it was so rough for you the last several hours.. I wish you didn't have to go alone.. I wish I was there with you. I hope you know that you weren't abandoned, that I was going to come back for you. And take you home. 

8 comments

  1. Oh this is heartbreaking. My thoughts are with you Jane. Stay strong <3
    Rest in peace Mr. Bartles. You're loved. <3

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  2. So hard to read Jane, so shocking and sad on so many levels - such love to Mr Bartles and you guys, I'm keeping you all in my heart xoxox

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  3. Jane, I really don't know what to say except I am truly sorry. My heart aches for you. And I want to let you know I totally understand. Reading your ordeal and what the doctor said/did...I understand where the doubt and anger come from. But please don't doubt yourself whether you could've done enough. You did. Reading your posts, the 6 and a half months that Bartles spent with you....Bartles was lucky to have you guys.
    XOXO

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  4. I'm so sorry for your heartbreaking loss Jane. Even though you may question how everything was handled in the end, never question that Bartles was fortunate to have you guys as his humans for these months and that he loved you as much you loved him. He is not alone because he's now with Piri on the other side of that rainbow bridge. Sending you love and hugs.

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  5. Bartles was very lucky to have you and Yangkyu. You took great care of him.

    So sorry for your loss.

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  6. Rest in peace Mr. Bartles and give Piri a hug from all of us

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  7. Rest in peace sweet Mr. B.
    Run free with Piri and enjoy all those treats! We will miss you!

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  8. I came across your blog through the cocker spaniel rescue post. I am deeply sorry for your loss. I lost my sweet Cockapoo Jack August of last year. I also experienced the unknown of what happened to my dog after he came home from a tumor removal surgery and he stopped eating. He did have liver cancer but he was 100%normal before surgery, after it, he was never the same and doctors could not explain why he never got his appetite back from surgery. I tried nausea mess, appetite stimulant shots, and he never was the same. I didn't want him suffering, so 2 weeks exactly from the surgery I made the tough decision to let him go. He was not the same, he was so weak, couldn't walk much at all and I knew I didn't want to put him through anymore suffering. I pray I see him again in the afterlife. It is so tough, never felt this much heartbreak ever in my life. I am still torn inside with so many unanswered questions. My only comfort is that he is no longer suffering and is happy again at the rainbow bridge. Thanks for sharing your story. Best wishes.

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