The Journey to Now

About Us:

Hi, I’m Robin–mom to Forest, aka MoonMoon (as in the derpy wolf from the memes). I had debated whether to start this blog or not, and finally settled on it so that 1. I could have a lasting record of the things we have gone through together over the past several months, and hopefully many more years to come and 2. I could help someone else, because it seems not a lot of the dogs here get hemipelvectomy surgeries.

Forest is a 7 year old Chow Chow mix that I have had by my side since he was 7 weeks old. He was found alone, abandoned at a dump site, and covered with canine lice. I was a poor college student, halfway through getting my Forestry degree at University of Georgia (you can guess why I settled on his name!). I was living on student loans and my wallet was tight, but I always promised Forest that once I graduated and got a job, he would live like a king. That day came about 2.5 years later, and I held up my promise. He got to come to work with me, run around in the woods, chew all the sticks he could, and get belly deep in mud puddles. What more could a dog ask for!?

In a series of events over the next 5 years, he moved with to me from Georgia to Mississippi, the Willamette Valley of Oregon, and now we have recently settled on the Southern Oregon Coast. We spent tons of time together in the woods, both in work and in play. We both enjoyed exploring our new western world by hiking, camping, and spending time at the ocean.

Finding the cause:

In early December of 2019, I started to notice that Forest’s bowel movements were slightly flattened, but he didn’t seem to be particularly straining to pass poop. His appetite and attitude were totally normal. I did a bit of research and all I could find via Google was that it could possibly be an enlarged prostate. I kept monitoring the situation to look for improvement, and with him now struggling to pass stool, took him to his normal vet December 19. At that appointment, he got a rectal exam and the examining vet said she didn’t feel pressure from below, as you would with an enlarged prostate, but instead felt pressure she thought was from above. This made her think that his lymph nodes were enlarged, but no signs of his other lymph nodes having issues. We began to give him stool softeners to help and scheduled an abdominal ultrasound for the next day, as Forest and I were about to go to head to sunny Santa Barbara for Christmas for the next 2 weeks. He had the ultrasound, the vet didn’t see anything abnormal about his lymph nodes, but sent the imagery off to be assessed just in case she was missing something. While in California, we got a call from the vet confirming that the imagery service also saw nothing abnormal from his ultrasound. So we decided to start him on a round of antibiotics and steroids, along with the stool softeners to rule out an infection as the cause. His appetite and demeanor were still totally normal throughout our whole trip, however I saw no improvement in his potty situation as a result of the medications.

Upon returning to Oregon after the new year, we returned to our vet’s office because even with the lactulose, Forest’s struggles to pass poop were increasing. The vet who performed his ultrasound came in to do his rectal exam this time. She could feel a protrusion on his right side and only a very narrow passage area for feces because of that. They did x-rays on his right hind leg and found a mass. She immediately referred us to Oregon State University Small Animal Clinic because of the size and location of the mass. We got an appointment scheduled with their Oncology department for 2 days later–Jan 8th, 2020.

Diagnosis and Hemipelvectomy:

That was the day it all changed for us. They performed a CT scan and found a large mass that had originated in his intra-pelvic muscles and was now extending into his pelvic canal and pushing against his colon, prostate, and bladder. Because of this, his bladder had become incredibly distended and was also pushing all of his other organs forward. They performed a needle aspirate of the mass and submitted the fluid for testing, with the results being consistent with a sarcoma.

We had two treatment options. I could take Forest home and try to keep him as comfortable as possible-which would be frequent trips to the vet to have his bladder drained until it eventually ruptured. The second option was a hemipelvectomy and right back leg amputation. This procedure was the only way for them to be able to expose the tumor and be able to remove as much as they could.

I was not ready, and nor was Forest, to have him live his last days by taking option 1. So, we went with the surgery option. They put him on the schedule for the very next day, Jan 9. So I took home my drugged up dog and through many tears, told him how much I loved him and that I hoped I was doing the best thing for both of us. The next morning, I dropped him off bright and early with the hopes that in a day or two, he would be back home with me as he healed and we adjusted to our new normal.

Post Op Complications

The surgery was a success, they removed the tumor (which was 11cm x 9cm x 4cm) and stapled the incision closed. He was recovering well from the anesthesia and I would be able to visit the following evening and would be getting morning and evening updates each day. This is where things started to go sideways for us again. Forest was unable to pee on his own following the surgery. They kept giving him opportunities, he was able to poop, but no pee. They were draining his urine a few times a day via catheter (at one point getting 1200ml out). The thought was that because his bladder had been extremely distended prior to surgery, the muscle fibers to make the bladder contract were no longer touching enough to work on their own. After 1.5 days of draining his urine periodically and starting him on prazosin and bethanecol (medications used to loosen the bladder sphincter and to help the bladder contract/push urine), there was still no sign of him being able to urinate on his own. At this point, they placed an indwelling catheter to try to keep his bladder empty so it could work on repairing it’s muscle fibers and hopefully bounce back into action. The catheter was to be left in place for 2 days, at which point it would be removed and if he was able to pee on his own, he could be released to me. I should probably mention at this point-Forest is a complete mama’s boy and gets fairly nervous being handled by others and has pretty severe crate anxiety. Even with all the post amputation painkillers, which at one point included fentanyl, ketamine, and gabapentin, he began to have stress related diarrhea. They had a new anesthesiologist that used Forest as a teaching patient for acupuncture, specifically targeting his urinary problems and his diarrhea. He was apparently a perfect patient and would be out cold as soon as the first needle went in!

Release

The day they removed the indwelling catheter, Forest was able to pee on his own. They told me that the whole ICU staff was cheering for him when it finally happened. After 5 long days post-op, he was released to me Jan 15th. I was so relieved to have him home, but within a few hours I felt completely overwhelmed trying to be his caretaker. He was still having nearly uncontrollable diarrhea, which I was having to constantly wipe his butt and try to keep away from the incision that was probably within 2 inches or less. His butt was incredibly raw and sore from 5-ish days of diarrhea and he would cry horribly when I touched it with a wipe. The meds he was on to help him urinate also meant that he was peeing uncontrollably as well, so I was constantly changing pee pads, towels, and even the yoga mats underneath the towels and pee pads. I was using a sling to help him get around for potty breaks and he was so sure he had the 3 legged hop mastered that there were quite a few spills trying to get to the door, and of course the cone made it even harder by catching on doorways and throwing him totally off balance. He was getting medications 5 times a day, first dose at 7am and last dose at 11pm, so my sleep schedule was totally out of whack. I was also trying to work from home to stay with him (I do user support for a computer application), so I was trying to balance user needs, dog needs, and personal needs all at once. Because of his crate anxiety, I had set him up with a dog pen in my living room, which also meant I couldn’t leave him unattended because he could push the pen around and make it fall in or something terrible.

Infection Strikes and Surgery #2

On Jan 16th, I decided to switch him from the clear plastic cone he had been wearing to the comfy cone that OSU supplied at our discharge. All day he was totally fine and never even thought to mess with it. I decided that between his 8pm meds and his 11pm meds, I would go lay down for a short nap because I was completely exhausted from the last 30ish hours. When I woke up to my alarm and went out to the living room to give meds, I found myself sincerely hoping I was still asleep and in the middle of a nightmare. There was my pup, looking right at me, CONE-LESS. I was frantically turning on lights and hoping that I had maybe been lucky enough to catch him just as he had gotten it off….no such luck. In the middle of his incision, there was a space where at least 5 staples had been pulled out. Mind you, I was living in a tiny one bedroom apartment…I was directly on the other side of a wall and never heard a thing! I immediately called the emergency number for OSU-they had me email them pictures of the incision site. They told me it looked okay for now, but to closely watch for infection and to make sure he didn’t get the cone off again. Needless to say, I switched him back to the plastic cone immediately.

I started to get concerned about the incision site starting the next morning. I took photos and emailed again. The incision site had no signs of swelling, redness, or heat…but there was  some definite pus-like discharge. By mid-day on the 18th, they suggested I bring him in based on the photos I had sent. We loaded up and headed north for 45 min to get him treated. I was imagining that this would be a quick incision clean-up and an antibiotic regime to start immediately. Turns out, because of the hemipelvectomy, Forest had no body wall under his incision. This meant that the infection could have either originated in his abdomen, or could quite easily travel from the incision site into the abdomen. The surgeon presented me with 2 options: 1. re-opening the incision completely, removing any necrotic tissue, and flushing out his abdomen “until they got bored”, stay 1 night and be released to me on the 19th or 2. do all of the former, but instead of immediately closing, I could opt for him to stay 2 nights and be attached to a vacuum that would pull fluid from his abdomen for a day and help promote healing. He would go under anesthesia again to remove the vacuum and close the incision site. I chose option 1. I was finally seeing improvement on the diarrhea front after having him home for 4 days and I didn’t want him to be in ICU any longer than he had to be because I was afraid he would regress. I know having the cone off was the major catalyst for the infection, but I really felt that the diarrhea was a major contributor.

Re-Release and Recovery

The surgery was a success. Thankfully the infection seemed to only be at the incision site and wasn’t present throughout the abdomen. They also found that his bladder had been “free-floating” after the hemipelvectomy. Normally a bladder is held in place by a ligament on each side, but the ligament on his right side no longer had anything to attach to. They tacked the right ligament to his body wall to keep it in place. He was re-released to me on Jan 19 with a few changes made to our recovery plan. 1. He had stitches instead of staples (this made his incision site look phenomenally better). 2. I was to try to keep him from laying incision side down to reduce the shear forces that would keep the incision from healing as quickly. 3. Antibiotics and a probiotic to help help keep his gut healthy during the course of Clavamox. Getting him home and settled this time was so much easier than after the initial release. He thankfully didn’t develop diarrhea again, so his poop continued to firm up. He was still on the prazosin and bethanecol to help him urinate, but we were able to reduce the dosage so that he wasn’t having so many accidents. It seemed we were on a smooth path to healing.

I continued to update his surgeon with nearly daily pictures of his incision site so we could monitor for any infection. Two weeks seemed to fly by, and we went back to OSU for our oncology follow up and to have stitches removed.

To treat, or not to treat

The biopsy results showed that his mass was a soft tissue sarcoma and was a Grade I tumor with his lymph nodes testing negative. Even though the surgeons removed his entire tumor, they considered the mass incompletely excised because they could not take a margin of healthy tissue surrounding it due to the fact that it was pressed against several internal organs. The oncology options were a low dose of chemo therapy that I would have to give by mouth every day, probably for the rest of his life. Side effects were mostly bladder irritation. I would also have to return every month to have a urinalysis done, his prescription refilled, scans, and other blood work done. The other option was to allow him to live normally and return for scans every 3-4 months to see if the cancer recurs or metastasizes. At this point, Forest and I were in the middle of a move to the southern Oregon coast, putting us 3+ hours each way from the vet school. His bladder had already been through the wringer pre- and post-surgery. Not to mention, his anxiety about being handled by others. It seemed like the best quality of life for him was to live his best life on three legs and hope the odds were in our favor. I have elected not to do chemotherapy with him. With that we left the vet school with only an appointment for scans later that spring.

Bladder Battles

Forest finally got to leave his cone behind on February 10, 2020, after a solid month of wearing it. He was hopping around as if he had been on three legs forever. We were moved down to the ranch and he was having the time of his life. Living like a king with a real kingdom now.

On Feb 13th, I noticed that he seemed to be struggling to poop and not passing anything, and possibly not urinating. I called the vet school that afternoon and gave them a heads up about my concerns. I re-started him on the stool softener to see if he could pass something and saw no results throughout the day and also no urine. The following morning, Feb 14, I took him back to the vet school because I could see that his side was pretty distended and he quivered when pressure was put on it. We got in to see them about 10am, at which point they diagnosed him with bladder retroflexion–his bladder had relocated to where his right hip had previously been. This essentially caused a kink in his urinary system, which was causing him not to pass urine. They drained 1060ml of urine from the bladder, but during ultrasound also noticed a small amount of free fluid around the bladder after decompression. This made them suspect that he had experienced a small rupture to his bladder wall.

Surgery 3

He needed surgery to tack his bladder to his body wall. In his second surgery, they had just attempted to tack the ligament because he had an infection at the time of surgery and they didn’t want to introduce it into the bladder. Generally tacking the ligament should work, but the suspicion was that the suture failed or the ligament stretched out and that allowed this retroflexion to occur. He had a successful surgery on the evening of the 14th. They ended up finding a discolored section of bladder and had to remove that and send it to be biopsied in case the cancer was already rearing its head. Because of that, his bladder is now smaller until if eventually stretches back out in a month to a month and a half. He was able to come home the morning of the 15th after successfully peeing on his own!

Final Recovery (*fingers crossed*)

The recovery of the third surgery has been a success. We just got stitches taken out yesterday, where I was informed that Forest is quite famous around the vet school these days. (Not surprising since we have been in and out of there the past 2 months!) I was also told that he is a poster child for mobility following a hemipelvectomy procedure. He does get around super well. He has no issues on hard floors, though we have added Dr. Buzby’s Toe Grips for added support. Prior to using those, there  was really no difference walking on hard vs soft surfaces unless he was too excited and try to rush, in which case he would do some slipping and sliding. They would like a video of him running through a field, but I think I’ll wait until the cone comes off in about 5 days!

And that is the long and drawn out journey over the past 3 months of becoming symptomatic and now finally seeing light at the end of the tunnel! Big thanks to all the other blog writers because I would have never known how to prepare for his initial homecoming without this community!