The Overdose

The following was written by me in the days after the overdose occured. When I could no longer keep up with updates via e-mail and phone, I thought it would be easier to just keep a blog online.

October 29, 2003

Between 1:00 and 3:00 am on Wednesday morning, October 29, 2003, Tiny got out of bed, into a closed cabinet, and helped himself to a pill bottle and a bag of cookies. I have a bad habit of keeping a big pill bottle around and as different prescription and OTC medication expire, I dump them into that one bottle. Then when its full, I take it to the hospital and have a paramedic friend of mine dispose of them. The pill bottle was one that originally contained a prescription for Fiorcet. Fiorcet contains Butalbital and acetaminophen (Tylenol), a combination is a pain reliever and relaxant. It is used to treat tension headaches. Butalbital belongs to the group of medicines called barbiturates and barbiturates unfortunately act in the central nervous system to produce their effects. There were at least 50 of those type of pills in the bottom of the bottle. On top were various other meds as I mentioned above. I'm pretty sure there were some Motrin and some Aspirin, but I'm not sure in what quantity, or what other medications might have been in the bottle.

At 3 am on Wednesday morning I got up to get a drink, and remember stepping onto something round and plastic. My daughter had been playing with her toys in that area the evening before and I *assumed* that's what I had stepped on. I never bothered to check, just fussed and moaned about her leaving her toys around, finished my business and returned to bed. Before getting back into bed, I asked Tiny if he needed to go out. He lifted his head and looked at me and laid back down. Taking that for a no, Igot back into bed and went back to sleep.

I woke up around 7 am or so to his labored breathing. My first thought was that he was bloating and then I realized that he was unconscious. When I jumped out of bed to call my friend Al to come over and help me get him to the vets, I saw the bottle on the floor. There were two pills laying next to it, and I immediately realized what had occurred overnight.

He was taken to our vets, intubated, 2 IV's were initiated, and he was placed on a heart monitor. He heart rate was initially over 200 and his respiratory rate was 72. His pupils were tightly constricted (pinpoint). Over the next 48 hours, his pulse rate leveled out to 120 (still a bit high, but certainly reasonable), and his respirations returned to normal. He spiked a temperature the first day of 107 degrees and needed to be iced down to bring it back to normal. Since then, its been fairly steady at 103, occasionally rising to 105, but dropping back down without intervention. His neurologic status remained the same. He was unconscious, with no response to painful stimulus and a diminishing blink reflex.

My biggest concern to this point has been that even if we are lucky enough to have him recover from this acute phase of the poisoning, there is a very real chance that the medications will have damaged other organs, specifically kidney and liver, beyond repair. I don't want to see him "wake up" only to waste away slowing over the coming weeks or months from multiple system failure.

Friday, October 31, 2003

Today has been a roller coaster ride of emotions for me. When I went in to see Tiny this morning, the vet asked me to call him excitedly, clapping my hands as I did so. He raised his head about 4 inches off the ground and lifted his tail. This is the most movement we've seen so far. We aren't sure that he is responding to me personally or whether his body is simply reacting to the increased stimulation. His eyes are open today, but he is not focusing or tracking with them. Even so, that put me on top of the world! I was convinced he was getting better!

The vet allowed me my moment of happiness, but needed to tell me about the results of his urinalysis. They found protein and blood in his urine as well as red and white blood cells casts. This tells us that the kidneys have definitely been damaged to some degree. My elated mood came crashing down. What I had feared was true, even if he wakes up, he may not be able to survive without severe renal disease (or so I thought).

But... Hold on... That might not be true. The vet explains that the body is a wonderful machine and as long as there is no damage to the basement membrane (found inside the kidney and involved in the filtering process), the kidneys may still be able to function. In fact, if damage to the nephrons (filtering tubes inside the kidney) happens gradually, the surviving nephrons have enough time to adjust, a kidney can continue to function with a few as 25 percent of its original nephrons! Wow, are you still with me on this roller coaster ride? We are headed back up! Great!

Now, I ask the vet, how do we go about finding out if these basement membranes were damaged or if the damage has occurred slowly enough to allow for normal function? The answer - we don't. :( We wait and see. There really isn't anything they can do at this time to tell me exactly what has been damage or how fast or how severe. They took some blood as well and ordered a BUN and creatnine, levels that will help to tell how the kidney is functioning. GOOD! - uh... No. The results won't be completely reliable as they have been really pumping fluids into him (via IV) to flush out the toxins, so because of that, they can't rely totally on the lab results.

And to finish out this ride with a splash down... They found blood in his stool today. That tells us that the medications have caused enough damage to the gastrointestinal tract that there is bleeding in there somewhere. Will that continue? It might. Is his blood clotting fast enough to keep him from continuing to bleed? We think so. The blood thinning action of the medication has affected his body's ability to clot his blood.

Saturday, November 1, 2003

Good morning everyone! Great news today! Tiny is AWAKE! When I went in this morning, he was up on his elbows, DRINKING! Yaaaaaah! We aren't out of the woods yet though. We still aren't sure of his neurological status. Right now he is sorta, "Lights are on but nobody's home". He did recognize me once briefly while I was there and wagged his tail, so that's a good sign. As far as his clinical status - he does have liver damage, but not as bad as we expected it to be. The doc has seen dogs alive and well with 5 times the blood levels Tiny is showing. His kidneys are damaged, but here again, not as bad as initially expected. We are hopeful that both organs will be able to regenerate and function properly. The bad news comes with his other body system - the GI tract (stomach, large and small intestine). He is showing signs of substantial damage. They are estimating that he has developed large ulcers throughout his system. There is blood in his stool, and his lab work is showing signs of anemia. Both are indicators of blood loss in the GI tract. The other very serious result of the ulcers are the potential for sepsis (blood poisoning or blood infection). He is currently on antibiotics and two different types of medication to protect his stomach and help it heal. The worst part of it all is that right now he is in a good deal of pain. I told the doctor that I really hate to even mention the words "pain medication" but I'm concerned with the level of pain he is in. Any time he repositions himself (either on his own or with the help of the staff) he cries out.

Please continue to pray for both Tiny and me. The decisions facing us right now are often overwhelming. Its so exciting to see him doing so well, but so heartbreaking to see him in pain. I just hope I'm making the right decision by waiting this out. I won't be able to see him any more today, the vets office closes at noon, but I'll be able to go over tomorrow morning. They aren't seeing patients, but will be there to care for the animals and I'm welcome to visit him then. Again, thank you so much for your warm thoughts and prayers!

Sunday Morning, November 2, 2003

Its 11 am Sunday morning, and I've just returned from seeing Tiny. Things are, as usual, both good and bad. My friend Al and I rode over together this morning to visit with Tiny. When we arrived, I asked the vet how he was doing, and she said that she was waiting for us to evaluate him. Apparently, when she went into his cage this morning, he bit her. Ty allowed me to put a basket muzzle on him with no problem. The vet stated that they haven't been able to do that without a major fight. He is still apparently in a great deal of pain. They are still giving him medications for his stomach to help heal the ulcers, reduce the acid his stomach produces, help soothe the lining of the stomach and reduce the pain. Another major concern right now is that he is refusing to eat anything. I'll be making some boiled chicken this afternoon to take back over to him. Maybe that will entice him. He hasn't eaten anything since dinner on Tuesday night.

Physically, he looked good this morning. With a blanket underneath him and Al and the vet helping, he was able to stand up and take a few steps! Yeaaaaah! :) So that was very encouraging.

They are talking about allowing me to bring him home on Monday. I am both thrilled at the prospect of having my baby home, and terrified at the thought of what that will involve. He will be coming home still unable to stand or walk. He will have to be muzzled any time we are near him to prevent him from biting. It will be my responsibility to reposition him and keep him clean. It will be hard doing that, knowing that I am causing him pain in the process. I'm familiar with belly bands, but if any one has any other suggestions on how to keep him clean and comfortable, please contact me, my e-mail address is below. Also, if anyone is familiar with physically maneuvering a disabled large breed dog, I'd love some tips! I have a pretty nasty back injury so I'm trying to prevent further injury to myself or to him!

Again, thank you all so much for your prayers and well wishes!

Sunday Evening, November 2, 2003

Wow, what a difference a day makes. I have to tell you, the doctor and I talked for almost an hour today at lunch time. We did a "review of systems" and a head to toe assessment on Tiny. The way it stood this afternoon was - kidneys and liver look damaged, but functioning. With time and some herbal support they should be fine. There were two major concerns. One was his GI system. We don't know how big the ulcerations are or how much pain he is in because of them. The other was his neurological status. The doctors were beginning to worry that perhaps the reason he hasn't stood up is because he CAN'T stand up, not because its too painful for him to try. We agreed to allow all three vets in the practice to get together in the morning and do a thorough neurological exam on him. If they found signs or symptoms of damage that would prevent him from standing and walking, we agreed to say goodbye tomorrow afternoon. I spent almost an hour with him after that, crying and just being with him and loving him.

Tiny and I had another little heart-to-heart talk. We've been having them daily in fact. I told him on Thursday I needed for him to tell me when it was time to let go. If he wasn't going to wake up from the attack on his system, I was ready to say goodbye on Friday. As you remember, Friday is when he "woke up" and lifted his head for me. Friday night we talked again. I told him that if he wasn't going to ever be able to recover and sit up and drink on his own, I would let him go. Saturday I walked in to see him lying in a sphynx position, drinking water. Today I told him that if he was never going to be able to walk on his own, I would say goodbye and let him go. Tonight at 10 pm I went back and found this:

   

Can you believe it?!?!? He was STANDING - ON HIS OWN! My friend Al took his collar and he just started walking out of his "cell". He headed on out into the main area of the office! I was laughing and crying and yelling and the vet was standing next to me doing the same!!! We quick took him back before he could get too winded.

Now as you can see there are three "cells" in the room that Tiny is in. We transfer him from one to the other, so the staff can clean and sanitize the cell he was in previously. I've been trying to help out and I went into the cell he was in all day to get his blankets and take them out to the washer. They were DRY. My first thought was OH NO - his kidneys have failed! Al saw it another way. He said, "You know, when we walked him out there, he was heading for the door... I wonder...."

We got a leash and hooked it to his collar. He stood on his own, walked to the door, went outside and PEED! WHOOOO-HOOOO! I have never been so excited to see a dog go potty in my whole entire life! The vet and are are now standing outside cheering and laughing and crying all over again!

We are doing it! Slowly, step-by-step, day-by-day, we are doing it! Please continue keep us in your prayers! The vet has named him "The Miracle Dog". I agree! What do YOU think? :)

Monday, November 3, 2003

What an awesome day. :) We picked Tiny up from the vets at around 3 pm and brought him HOME. He seemed to be feeling even better then yesterday. He wanted to check out all the other dogs and cats in the cages on his way out the door. He climbed into the van like a champ! Once home, he sniffed around a bit and re-marked some of his territory. He stole a rawhide chew from my parents golden retriever and did NOT want to give it back! :) We don't allow him to have rawhide on a good day, so that had to go, but it felt good to seem him frisky enough to try and steal it! We set up an X-pen in the kitchen instead of letting back into my bedroom downstairs. He is still really weak and unsteady on his feet and there is just no way that I'm letting him attempt steps yet. Thats ok, it doesn't matter, I'll be sleeping on the floor in the kitchen with him. :)

They did draw more blood before we left. We'll have the lab results tomorrow. This will give us an idea of where we are going. Right now he is home on antibiotics for the next two weeks, Carafate, which basically "spackles" the ulcers, and OTC Pepcid to reduce the acid in his stomach. The last two he will be on for at least a few months until we are sure his ulcers have healed.

My poor boy is thinner then I have ever seen him. We keep him lean anyway because he has OCD in both shoulders. So not eating for almost a week really took a toll on his body. He coat looks horrible. He walks with a stiff gait and his tail tucked between his legs. But he is HOME. The only place to go from here is up! I need to coax him to eat, but I'm sure as he feels better his appetite will improve. :)

I can never find the words to thank all of you for everything you've done. Instead of blaming me for the accident, you surrounded me and Tiny with love, support, prayers and good wishes. Thank you just doesn't seem like enough, but please know that I am forever grateful.

I'll be sure to keep the page updated as we get results back from various tests and as he regains his strength and his weight. I apologize for not getting pictures up tonight. I honestly haven't wanted to leave his side. :) I promise to work on that for you all tomorrow.

November 6, 2003

Its been a few days since I've updated you on our progress. How are we doing? Lets just say that we are settling in. :)

We are still quite concerned about his liver and kidney status. He is putting out an extremely large amount of urine. The concern right now is that he is not concentrating his urine. We are also worried about potassium loss because of the large fluid output. We will be continuing lab results on a weekly basis to keep and eye on his organ functions. While speaking to the vet, she also mentioned that he has pancreatitis and that his bile is "sludgy". He was placed on a medication called Actigall for 2 weeks (and let me tell ya, I'm glad its only for two weeks - that stuff costs $130 for a two week course! - Ouch!).

We are trying to make him comfortable. He is still pretty sore so he doesn't like to move around too much. Keeping him clean and dry is also a challenge. He goes out and potties every hour. I've found that the belly bands keep him from leaking while he is laying around, and we've been putting down newspapers and pee-pee pads. He hates to go on the floor, but at night, I've been getting up every two hours instead of every hour and he just isn't able to hold it. Poor baby, he is just so stressed :(

He still isn't eating as much as he should. He's only eating canned food right now, and only about 1 can a day. For a fella his size, it should be quite a bit more then that.

There are many wonderful things about having him home too. Its wonderful to snuggle up with him again at night. Its wonderful to be able to check on him any time I wish. It's just wonderful to see him alive. :)