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From: Gail Graham <g.graham002@gmail.com>
Date: July 4, 2014 at 3:04:24 PM GMT+2
To: "g.graham002@gmail.com" <g.graham002@gmail.com>

Sent from my iPhone

Bao is gone.
He did well in the surgery, and when I left him, was recovering nicely. They called me at ten thirty last night, to let me know that he was having some difficulty. But it was nothing they couldn't handle. Things settled down. But shortly past midnight, his heart stopped. It was very sudden. They tried to revive him, but couldn't. By the time I got there, he was gone.
I can still feel him, somehow near to me. I cannot believe he's gone. I held him, afterwards. His dear little body was still warm. He might have been asleep.
What can I say? He was my dear companion. I loved him. I love him. And now he's gone. It doesn't seem possible. How can I go on without him?
Bao is gone.
It's over.

Waiting for test results

Looks like it's cancer. But where? In his pericardium? In his lungs?
They've done blood tests, urine tests and chest x-rays. Now we're
waiting for the consultation with oncology.
Bao is rather enjoying the to and fro of dogs and people in waiting
area, which is spacious and comfortable. As far as he's concerned,
it's just another outing.

We're in Fort Collins

On Thursday, Bao began to develop another pericardial effusion. (Why
do these things always happen during holiday weekends?)
"If he was my dog," said the cardiologist, "I'd take him to Colorado."
So that's what I did.
It was a 14 hour drive, which we did over two days. But Bao loves car
trips, so that was okay.
Our appointment is this afternoon, but we came a day early, which was
just as well because it turned out that Bao also had fluid in one of
his lungs!
The Colorado State University Veterinary Teaching Hospital is open
24/7 so help was at hand, thank goodness.
I'm pretty sure Bao is going to need the pericardectomy, and I'm
apprehensive, but we've got to fix this.
And we've got to find out what's causing it -- after all this time and
$10,000 in veterinary fees, we still don't have a diagnosis.

Bao and I managed to get to Mexico for a few days, but last week, another pericardial effusion. This is the fourth time he's had to go through this. Nobody knows what's wrong. The antibiotics don't seem to be making much difference. Today we saw an internist, and they ultra-sounded Bao's whole body and found "nothing remarkable". Now they're saying it's probably cancer, mesothelioma, which doesn't show up on scans and sometimes, doesn't show up in a biopsy. So how do they know whether or not he's got it? Well, they don't. Apparently, when they can't find anything else they simply assume it's cancer.

Cancer or no cancer, the only way to stop pericardial effusions is to cut a "window" in the pericardium. Unfortunately, there is a fairly high element of risk attached to this procedure. In fact, I'm not nearly as scared of the cancer (if it's there) as I am of heart surgery, which is what this is. (Amazingly, there is a video of this surgery on YouTube. I haven't watched it. There is such a thing as too much information)

Our cardiologist has suggested that we go back to the University of Colorado Veterinary Medicine Hospital to have the surgery done. He says all the best people in the field are there, under one roof. Although he could do the surgery himself, he told me that if Bao was his dog, he'd take him to Colorado. So I guess that's what we're going to have to do.

The internist did some blood tests, and we'll have the results of those tomorrow. But I could tell that even without the results of the tests, she thinks the pericardectomy is our best -- and only -- option.

In a way, she's right. Even if we never find out what's causing this, the surgery will eliminate the pericardial effusions, which could kill him instantly. After the pericardectomy, if fluid does continue to accumulate, it will accumulate in Bao's pleural cavity, where it's more easily dealt with. And if he does have cancer, I suppose it's better to know sooner rather than later.

Bao is snoring happily on the couch. He doesn't have a clue what's going on. He's not in pain. He's not frightened. He's fast asleep, with his dear little head pillowed on one of his stuffed toys.

He's fine. I'm terrified.

Aftera fabulous week, another pericardial effusion. And they still don't know what's wrong. This is so scary, and so frustrating. And so expensive!

Once again, Bao's pericardial sac had to be "tapped". But this is not a disease. It's a symptom. The question is, A symptom of what?

I have a theory. After the hernia surgery, Bao was on a 7-day course of antibiotics. After two days, he was a different dog. Lively, prancing, playing, happy. A few days after we stopped the antibiotics, he slowed down a little. A few more days, and he had another pericardial effusion.

So here's my theory. He has a sub-clinical infection somewhere; a handful of bacteria on a mission, but not enough to show up on standard blood tests. Although the post-surgery antibiotics were prophylactic (to help stop infection) they nonetheless zapped these under-the-radar bacteria -- but didn't kill them all off. And when we stopped the antibiotics, the bacteria regrouped.

Tomorrow, we'll go see Dr Mike and I'm going to suggest that Bao goes back on antibiotics for a week or two, just to see what happens. They can't hurt him. And if he suddenly peps up again, at least it's a data point.

This is a complete puzzle, the the veterinarians and to me. Any ideas?

The only good thing about the situation is that Bao is comfortable, happy, and not in any kind of pain. And that's a lot to be thankful for.

Poolside with Bao -- and as you can see, the area they shaved for the surgery was pretty extensive. They even had to shave part of his tail, but luckily, they left the little plume at the end of it.

His stitches come out on Wednesday.

We finished the antibiotics a couple of days ago, and Bao's "elevator anxiety" now seems to have dissipated. Maybe it had something to do with all the drugs he was taking. At one point he was taking seven different medications, twice a day!

What he had is called a perineal hernia, and anyone who has an intact, male dog should be aware of the dangers. Apparently, intact males (or males who are neutered late in life, as Bao was) are prone to these hernias and -- as we found out -- they just quietly get bigger and bigger until they become life-threatening.

I thought we were "managing" it with stool softeners, and that Bao's "slowing down" was due to his heart condition and advancing age. Now I know better. All that poop sitting in the "loop" of the hernia was not only constipating him, it was sapping his energy.

To see him trotting and prancing now, you wouldn't believe it was the same little dog. He's like a puppy -- full of eagerness, energy and vitality. I feel guilty. I wish we'd done this surgery years ago. I am amazed at the instantaneous difference it has made in his quality of life. If only I'd known!

Some medical diagnoses strike terror into your heart. However, "hernia" definitely isn't one of them. But now I'm thinking, maybe it ought to be.