Just Pouring Out Her Nose

I gave her the Yunnan Bayaio and so far it is not working. I pulled out the utility blanket for her to lie on. It has been awhile since I have had to do that. I turned on Through a Dog's Ears. The blood is a steady stream pouring out her nose. Nuki will be eight years old on Tuesday. On Wednesday it will be five months that she has been bleeding.The previous several days I took off from work to take care of my health needs. We had some good days. Tomorrow I intended to go back to work. How can I? How can I not? How will this all end? It pains me to think of it. I can't stop crying.

Someone To Love Nuki

Nuki is in the middle of another big bleed. I can't fix this. I need to find someone who can afford to continue the quest to get Nuki well. I cannot. I have done more than I could. I have no more savings, no more equity in my home and no more credit. I need to look for a possible new home for her. I cannot wait until she needs emergency treatment, additional diagnostics or surgery. It is not fair to her.

Several weeks ago I e-mailed the breeder to clarify re-homing according to our contract. I wanted approval to be responsible for finding the home. She never responded. I want to try and place Nuki close to home. I can't imagine never seeing her again. If you or someone you know lives in the Washington, D.C. area and can love, and provide ongoing medical care for Pinuki, please let me know. Perhaps there is a veterinarian who would be able to care for her? I will find someone to work with me on evaluating homes. Right now I know I will not be able to do this alone.

Weight

Nuki weighed 59 pounds until her recent vet visit when I was told she had gained a couple of pounds. I am not sure exactly how much, but am guessing she weighs no more than 62 pounds. Since the vet visit, I cut back on her food. I like to keep her trim for health reasons.

Important Notice from Nuki

Nuki wants me to make sure I tell you that Costco (at least in Arlington, Virginia) has12 inch bully sticks for $1.79. They are selling them in 12 packs. On the front and back of the package is a Bernese Mountain Dog.

More Diet Info

The bulk of Nuki's diet is made up of three commercial diets. I rotate the brands and protein sources. Two of the diets are complete raw diets that meet AAFCO guidelines - Aunt Jeni's http://www.auntjeni.com/ and Primal http://www.primalpetfoods.com/. The third diet is a dehydrated diet - Honest Kitchen Zeal http://www.thehonestkitchen.com/. I usually put a can of salmon or sardines (packed in water) in with the Zeal.

What Went Wrong

I am doing my best to document as much detail as possible in hopes of identifying some pattern - something that leads to resolving this for Pinuki. The day before doubling the dose of Doxy, I began giving Nuki 12mg Proferrin ES http://www.emedicinehealth.com/drug-heme_iron_polypeptide/article_em.htm. It is a heme iron polypeptide supplement used for iron deficiency anemia. I have been using it for some time. The day I doubled the Doxy, I restarted Pinuki on Tramadol, 75mg two times a day. The day after doubling the doxy, I increased the 50mg of Diphenhydramine HCL (a.k.a. Benedryl) from twice a day to three times a day. 

So, after I got through panicking the other day, I reviewed all the possible causes for the event. I was reminded that iron supplements can decrease the absorption of drugs such as tetracycline antibiotics (e.g., doxycycline ), so I am now giving the iron at least two hours apart from the doxy.

I am continuing the medication/supplement regimen detailed at the beginning of this post. Currently, Nuki appears to be doing better. She had two bad days - meaning she bled more and longer than, she had for some time. Yesterday and so far today, she has bled minimally. She still sounds congested. I know it is time for her next dose of Diphenhydramine HCL because nasal discharge and congestion sounds have increased "significantly." 

The doxy definitely seems to help. When I first started giving it to her, I assumed that meant she has an infection that is causing the epistaxis. When I asked Dr. Saylor about this he said doxy has anti-inflammatory effects and that could be an alternative reason why it works. Why would anti-inflammatory medication reduce epistaxis? I have been noticing the last few days, Nuki's gait seems "off." Too hard to explain. I might try to video tape it. "Structurally" she seems off. It seems like she is trying to compensate for the lipoma on the left side of her neck - something is "off" about her left side. I would love to consult again with Dr. Canapp http://www.vetsportsmedicine.com/about/staff_scanapp.html, the vet who did Pinuki's orthopedic evaluation, but I just cannot afford to. Drs. Saylor and Canapp know each other. Is it appropriate to ask Dr.Saylor to consult with Dr. Canapp in behalf of Pinuki? I don't always understand the etiquette involved with all this.

If you are reading this today, to your right is a picture of Pinuki that I took this morning. 

Hoping To Stop The Bleed

I gave Nuki Yunnan Baiyo - the red dot - hoping to stop the bleeding. Yesterday I was so hopeful the Doxy might resolve all this. I hate roller-coasters and I feel like somehow I wound up on one I cannot get off.

Unbelievable!

Yesterday and today, I gave Pinuki double the dosage of Doxycycline (300mg 2 times each day). Currently, she is having the worst nosebleed she has had since starting the Doxy in June. It is a unilateral - left-sided bleed. She has been bleeding for over an hour and a half. She has sneezed blood spatter and is bleeding onto the floor. Prior to the bleed, she was lying on her back playing with Kalu. When she turned upright, she sneezed and the bleeding began. There are gurgling sounds coming from her nose. I feel so helpless! What do I do now?

I Am Not Alone

I have learned and continue to learn a lot. When I began asking for help with Pinuki I was so wrapped up in the challenges of our story I paid limited attention to the bigger picture. As a social worker, perhaps I know better than most, the challenges people are currently facing. None-the-less, I have been reminded - often - since seeking help for Pinuki, we are all facing the challenges of difficult times. The details of our stories are different, but the struggles are a shared experience. This reality is not lost on me and I try to give and do what I can (a bottle of water to a stranger waiting in the heat for a ride, a McDonald's breakfast to a hungry stranger). Less than I would like to give, but my way of remembering I am not the only one seeking or needing help. That is what makes all your kindnesses so extraordinary. Humbling. You are not alone. We are not alone.

Take Nothing For Granted

...and say "thank you" at least once a day. Not a sermon, just a thought (as a local preacher often says). How in God's name did people survive before air conditioning, heat pumps or fans?  I cannot even take a cold shower. Even with the faucet turned completely to cold water - the water remains at best warm. What is that all about? The adventure continues! Oh yeah, and thank you ;-)

Early Birthday Gifts

Dear Sponsors, a special thank you for all the early birthday gifts! Check out Nuki's birthday page to see what you gave her. Thanks to you, we now know definitively she does not have any masses in her abdomen causing the bleeding. We know that her hematocrit is now normal. She has enough food to stay in her home for a couple of months. And these are all early birthday gifts! Thanks so much! Nuki is a happy girl - or more accurately, a happier girl! Your kindnesses have made quite a difference in her life. May you receive all that you have given. I am forever grateful.

Doubling the Dose

Today is day one of doubling the Doxycycline. The bleeds are continuing to get worse. The congestion in her left nostril continues all day and night. The top of her nose is dry and cracked and aloe gel is not healing it. When she bleeds she licks her nose and that probably does not help. She is limping a bit. I suspect the positioning during the ultrasound aggravated whatever is going on with the old left stifle injury. I am giving her Tramadol for the pain. Keep her in your thoughts and prayers.

Rhinoscopy

When Dr. Saylor did the rhinoscopy, he evaluated both the left and the right nostrils. He says, he is "not convinced" Pinuki has primary nasal disease.

Good News, Frustrating News

Nuki's bleeds are getting worse - not significantly - but getting worse none-the-less. As mentioned in an earlier post, the status change maybe allergy related (according to me). Discouraged and trying to stay on top of things, I decided to go ahead with an abdominal ultrasound (thanks to Nuki's sponsors who made it possible). I resisted for months. It was recommended by Dr. Saylor, Dr. Maniet, Dr. Smith (MRI vet), Dr. Franz (internist) and Dr. Kay (Speaking for Spot). My gut told me it would be normal, but the anxiety of not knowing definitively, the multiple recommendations and the continued bleeding prompted me to concede. [I am extremely grateful to Mary Straus of Dogaware http://www.dogaware.com/about.html for all her support, even though ultimately my anxiety won out over my instincts, I agreed with her "ideas." She and her website are an invaluable resource].

Pinuki's gallbladder. liver, spleen, kidneys, adrenal glands, urinary bladder, stomach, small intestine and colon are all normal.  In other words, Nuki has a normal abdomen. I am grateful. Jean has posted the results on Nuki's Longlease page http://bernese.biz/fundraiserPinuki.htm

A Complete Blood Count was done. Her hematocrit is now normal. She gained a couple of pounds. The MCV and MCH counts are low and the platelet count is high (although lower than it was 7 weeks ago). I think this means she has iron deficiency anemia, most likely secondary to chronic hemorrhaging. I will follow-up with the vets.

To sum up, Pinuki's nosebleeds continue daily, throughout the day; cause unknown; still the only symptom.

In the meantime, my abdomen increased two pants sizes and I recently found out the integrity of my clotting system has been compromised by a vitamin K deficiency. So welcome to my household - one dog with epistaxis, one dog at risk of epistaxis and me with clotting problems. Life is such an adventure!

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