Catching Up

Nine months and three days after the bleeding began, Pinuki had a rhinotomy. All nasal structures within both of Pinuki's nasal cavities were surgically removed in hopes of resolving the chronic epistaxis (nosebleeds). The decision to have the surgery was a difficult one. I based it on the following facts:

1. The Natural Hydrocortisone (NHC), even at a high dose, was no longer preventing the bleeds;
2. The NHC was causing gastrointestinal bleeding (at all doses);
3. The bleeds were getting worse.
4. Pinuki was anemic.
5. Pinuki needed a third blood transfusion.
6. The surgery "solves the epistaxis in most cases of intermittent epistaxis of unknown origin."  http://books.google.co.in/books?id=6fO5tHfCX10C&pg=PA79&lpg=PA79&dq=management+of+intermittent+epistaxis+of+unknown+origin&source=bl&ots=jAnLQQokxa&sig=O2JP36h49Ol4go-V6CpxKF3g-ho&hl=en&ei=HRnMTt2nN-Hb0QH84rQN&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCYQ6AEwAA#v=onepage&q=management%20of%20intermittent%20epistaxis%20of%20unknown%20origin&f=false
7. At some point, Pinuki will develop enough of an immune response to transfusions that there will be no useable blood available to her. She has had four blood transfusions already.
8. We cannot "bank" her blood because of the anemia and even if we could, it would have a self life of 42 days.
9. She is able to clot and produce new healthy red blood cells.
10. Even after nine months, but for the epistaxis and anemia (secondary to the epistaxis), Pinuki's overall health has remained good. Pinuki has no other signs of illness. To see videos of Pinuki, before the surgery: https://picasaweb.google.com/102756076755266210672/PinukiBeforeRhinotomy?authkey=Gv1sRgCL7NpdaG_JCj7gE
11. I could not euthanize her looking and acting as she is.
12. No other viable treatments were suggested.

When I dropped Pinuki off for the surgery, she was greeted by several strangers inquiring about the breed, cooing over how beautiful she is, and expressing shock that she is eight years old. Because of her small size and behavior, they thought she was a puppy. It was exactly the affirmation I needed that I had made the right decision. But when I first saw her after the surgery, my heart broke yet again for her. She looked awful and I was filled with regret

A lot can change in five days. Nuki is getting stronger each day and appears to be healing nicely. Her appetite is returning. Her stools are less dark. She has not had a nosebleed. Please keep her in your thoughts and prayers. This has been such a long journey so I struggle to remain even cautiously optimistic this will work.