Monday, August 20, 2012

Ripp’s Story, part 8—The Two-week Recheck

Ripp’s hanging at the NCSU vet school. 
The beautiful new facility has this great statue out front.

Ripp went back to the vet school this week to get his stitches removed and evaluate how his healing from surgery is progressing.  For the most part things are looking very good, but he does have a couple small pockets of infection remaining.  This is not surprising, because he didn’t start on his super-dooper injected antibiotics until a week ago (see Blog 7 for that part of his story). But to make very sure to eliminate ALL the infection, it does mean that we’ll be extending the injected antibiotics for a third week (we both say phooey on that!) and adding an additional oral antibiotic to complement the injected one.  Having come so far, going this extra mile is definitely worth it to get Ripp completely healed.

Really?  You need to measure my hair?  Sheesh!

Meanwhile, Ripp’s starting to look a little more like his handsome self every day.   Two week’s worth of hair doesn’t look a whole lot different than one week’s worth, but if you measure it, why, it’s a quarter inch!  Ripp is not especially a fan of the measuring, though…
Ripp’s still got a few ouchy places in his ears but is otherwise feeling GREAT.  
Ripp’s certainly feeling well, that’s for sure!  We MAY be cheating just a wee bit on the staying quiet thing.  But he’s well enough healed that a little ball-playing won’t hurt anything.  And really, who could resist? ;-)

Friday, August 10, 2012

Ripp’s Story, part 7—Recovering From Surgery

Lookin’ good Ripp!
Ripp is nine days post-surgery, off his pain meds except for Rimadyl, and feeling really good!  He’ll chase a ball if I throw it for him, but he needs to stay quiet for a full two weeks after surgery so we can’t do too much of that.  The white ointment in his ears is gradually fading away and his hair is starting to grow back (OK, you DO have to look closely to see this, but it’s progress!), so he doesn’t look quite so funny anymore.  Or maybe I’ve just gotten used to it. ;-)

Lots of hair there!
This week we received results from the antibiotic sensitivity testing that the NCSU vet school microbiology lab was doing.  Right after Ripp’s surgery, the team sent tissue samples to this lab to test, so that we could be sure Ripp received an antibiotic that would be effective against whatever trace amount of infection might have remained in his body.  After all, we want this to get rid of his infection for good!  Knowing that it would take a few days to get those test results, the care team discharged him with a “placeholder” antibiotic for him to take in the meantime.  

Well, the test results go a LONG way toward explaining why his ear infection had been so hard to clear up all along.  They cultured separately for three of the most common types of bacteria found in ear infections, and it turned out that at least one of those bacteria was resistant to each of the common antibiotics they tested against!   So, although we could have knocked one or two of them out with whatever antibiotic that was tried, the other one would have kept growing.  Not to worry, though, veterinary science has other tricks up its sleeve.  Although the COMMON antibiotics wouldn’t work, a less common one would.  The shock for poor old Foster Mom, though, was that THIS antibiotic would need to be injected twice a day!  For two weeks!   Well OK, if that’s what’s needed, that is what we’ll do…

After picking up the drug and needed supplies from the vet school pharmacy, I stopped by North Paw Animal Hospital for a quick tutorial on exactly how to do this.  The wonderful staff there was happy to oblige, and gave me some great tips on managing this on my own.  YES, I’ve seen dogs get shots lots of times, but I’ve never paid attention to the details especially closely, nor did I ever think I’d be doing it myself!  Well, fostering for GSRA is always an adventure… so here goes.
A bit more complicated than pills:  two different sizes of syringe, needles, sterile saline, the powdered antibiotic, and a sharps container for the used needles.
That’s a big shot!  Ripp takes it like 
the brave German shepherd he is.
The antibiotic comes as a powder, so the first step is to reconstitute it in sterile saline.  Then, I draw out the correct dose into the syringe.  Ripp needs 16 mL each time, which is about the size of a tablespoon.  That doesn’t sound like much, but it sure looks like a lot when it’s in the syringe!  Then it gets injected just under the skin between his shoulder blades.  Ripp is SO good for this.  It surely can’t feel good, but he holds still and barely flinches when the needle goes in.  This makes it a LOT easier to make sure all the drug gets where it’s needed.  Of course, he gets lots of loving afterwards, and we congratulate each other for being so brave. ;-)  
When can we play ball again?  I’ve got two sizes 
and will chase whichever one you’ll throw!
Although it’s early days yet, I’ve been watching for any change in his personality now that the chronic pain he’s been living with for so long has been eliminated.  I can’t say I’ve seen any big changes, but he does seem more inclined to initiate an interaction or seek out affection than he did before.  This doesn’t really surprise me.   Sweet as he was before, that pain has to have been a barrier coloring his entire experience with the world for a very long time.  Now that it’s gone, I think we’ll see more of his full personality every day, as his recovery continues.

Sunday, August 5, 2012

Ripp’s Story, part 6—Ripp Comes Home With a Really Bad Haircut

The team did a CT scan just 
before Ripp’s surgery.
I did warn you, right? About the haircut? Even so, even I was a bit taken aback. We’ll get to that in a moment. But, first things first. When I arrived at the vet school, the senior student and resident who have been involved in Ripp’s surgery and progress went through all the discharge instructions before bringing Ripp out. They also showed me a sample of his CT scan. This imaging technique (CT = computed tomography) takes a series of pictures in different planes, front to back, and then uses computer magic (yes, a highly technical term!) to reconstruct a 3D image of whatever it is the medical team needs to look at. In Ripp’s case, it was the inner structures of his ears. They did this scan just before he went into surgery, to give the team a good idea of what was going to be involved. In this sample image, which was taken from the perspective of looking straight at Ripp, all the bright white parts are bone or highly calcified cartilage. The bone at the top is his skull, and of course you’d expect to see that. All of the bright white in the middle should NOT be there, and removing it was the goal of his surgery. The arrow on the right points at his right ear canal (to him, this would be his left ear). Although the canal is somewhat open to begin with, it is lined with bony, calcified tissue. This same structure on the other side, his right ear canal, is pretty much closed up. The arrow toward the middle of the photo points to his left middle ear. This is a round structure, and you can see that it’s lined with more bright white tissue, which wouldn’t be there in a normal healthy ear. This extra tissue was also removed during surgery.

OK, yeah, channeling the Easter Bunny here. 
But he still has those big, beautiful ears. 
He looks happy, too. ;-)
There’s a close up of Ripp’s left ear. 
The arrow points to the stitches where they 
closed the ear up. All the diseased 
inside parts were removed.
Ripp’s aftercare will be surprisingly simple: give him lots of pain meds for the next few days, decreasing them based on his behavior; keep him on antibiotics for the next 3–4 weeks, to make sure every last bit of infection is gone; and remove the sutures in 14 days. OK, now let’s get the boy home! So, now the haircut. Believe me, I would NOT be showing these pictures if people didn’t already know how handsome Ripp is! He’s been shaved from just behind his eyes to the base of his neck, including his ears. At the moment, his is a face that only the extended GSRA family could love. ;-) Adding insult to injury, his ears are smeared with a white ointment that makes him look like a GSD dressed up as the Easter Bunny! Poor guy…. But honestly, given what his life has been recently, do you think he cares? I don’t! He is very sleepy from the pain meds but happy to be back in a familiar environment. And, the surgery pain is fading fast, leaving…… nothing! No more pain! When has he felt THAT? No time recently, that’s for sure. So, although Ripp looks a bit pitiful in the photos here, please do not feel sorry for him. Yes, he has some recovering to do, but the worst is truly behind him. And YOU made that happen, with your generous outpouring of support. You’ve truly changed this boy’s life, and we will never forget it.
I gotta say, patting a bald-headed dog is
 kind of weird. But I’m getting used to it. In addition to 
the Easter Bunny, he has a sort of Yoda look going on. ;-)

One of his pain meds makes him pretty sleepy, but he’s happy to be home. The two red bandages are where his IV catheters were attached; they were removed this morning. The tan bandage on his rear leg (far right in the photo) is his fentanyl patch. This helps with the post-surgery pain, but it can be removed tomorrow.  


Friday, August 3, 2012

Ripp’s Story, part 5—Discharge Day Approaches!

Ripp continues to recover very nicely from his ear surgery and will be discharged at 9:00 Saturday morning! He was interested in food beginning Thursday evening and has been eating well since then. Based on his behavior, the care team has been gradually decreasing his pain meds and this morning switched him over from IV to oral meds, plus a fentanyl patch. No doubt the poor guy has many shaved places now where the patch can be stuck. ;-) Although he’s doing well, the team wants to keep him in the hospital one more night to make sure these changes in his meds are really doing the job for him. Sleep tight big guy, tomorrow’s a big day!  

Thursday, August 2, 2012

Ripp’s Story, part 4—First day of Post-op

Ripp is so far having an excellent recovery from his surgery! He shows NO signs of temporary nerve damage to his face, which was a possible complication that we were warned about. He has not been interested in eating today, but this is not at all surprising, given the high levels of pain medication he’s still receiving. He is alert, though, and will take himself outside to potty (good boy, Ripp!), and the team is pleased overall with his progress. Tomorrow morning they will try changing him over from the IV pain meds he needs for the first 24 hours after surgery to oral meds. If he remains comfortable after making this switch, he can be discharged that evening. If the oral meds don’t seem to be strong enough they will move him back to IV pain control for a little longer. Please Ripp, this is no time to be stoic!! Much as we want you home, let them know if you need more drugs!

A word of warning: in the post-surgery photos we’ll post as soon as we have them, Ripp is going to be sporting a REALLY bad haircut. Yes, think Mohawk bad…. But hair grows back, and we know you’ll still be glad to see him. ;-)  

Wednesday, August 1, 2012

Ripp’s Story, part 3—Surgery Day

Today was the big day! Thanks to the amazingly generous financial support of so many, Ripp did not have to wait any longer for his ear surgery. He is still in surgery as I write this (6 PM on Wednesday, August 1), but we wanted to share what information we have. His day started with being sedated for a CT scan, which gave the surgical team the best look yet at how extensive his ear damage was. This test showed that the canals of both ears were very bad (no surprise there, that was obvious from just looking), but only the middle ear (also called the bulla) on the right side was also obviously damaged. Things might look different once they could actually see first-hand, but it gave them what they needed for planning purposes, which was an indication of which side to start on. That way, if Ripp was to have a bad reaction part way through, they could stop after the first ear. Interestingly, learning that the right ear was the worst of the two agrees with what I had seen in some of his behavior. When he was feeling his worst, his balance was off, which led to staggering in circles to the right (see part 1 of his story). But both ears obviously need surgery.

Because of other surgeries scheduled for today, Ripp’s surgery didn’t begin until about 1 PM. We were originally told it would be a 3 hour procedure, but at 6 PM we heard that the team had just finished the first ear! Absolutely NOTHING is wrong, and they are now moving on to his second ear. The delay was caused by the extensive calcification, which made it more difficult than expected to remove the damaged tissue (think of trying to delicately slice through bone). The team discussed stopping for the day because Ripp had been under anesthesia so long, but all his vitals are extremely strong and steady, so they decided it was OK to proceed to the second ear. We think this is a GREAT idea, because it means he won’t have to go through all this again. It ALSO means that we don’t have as much news as we thought. I would love to be reporting that he’s out of surgery and fully alert, but we aren’t quite there yet. We know Ripp is in many people’s thoughts today, which thrills me to no end! Please keep the positive thoughts flowing his way; we’ll post more news as soon as we have it.