Subtle As Steam: The Quiet Changes Are the Scariest

Max is changing. And has changed.

Many of the changes are both surprising and expected. Concerning yet manageable. Significant enough to warrant notice but not discouragement. As with so many of life's momentous occasions, contradictions abound.

There are the physical set of changes: his vision, hearing, mobility, energy levels, and expanding paralysis and there are the neurological or behavioral changes, which are much more subtle. These are the ones that are most difficult to cope with.

One of my many anxieties about opting for brain surgery for Max was concern about personality changes as a side effect. None of the other dogs in the study experienced anything like that - at least nothing that their parents could notice and report. Since Max's surgery nearly three months ago, I would say his personality has remained in tact, though we do believe he's lost some inhibitions.

But there have been changes.

Some of them are hard to detect. Like the temperature differences between food that's warm and food that's warm enough to have some light steam rising from it. You may not notice unless the light hits it just right that the steam is even there.

One of the obvious behavioral makers that pointed to neurological changes was Max's propensity to turn in slow circles - only one direction - and with no discernible intention to lay down or that he was sniffing to locate something or even just check out that spot of floor. He'd just turn in slow circles for no apparent reason.

It turns out that this is a symptom of canine Alzheimer's and Max's MRI had shown he'd had several micro-hemorrhages and would likely continue to experience them. This is not related to his surgery and may have even happened if he'd never developed the meningioma.

Because some of these changes are so subtle and difficult to define in some cases, I find I can't get the kind of guidance or reassurance I'd like from the veterinary community. Small changes occur in elderly humans that aren't pathological just as they do in dogs. Alzheimer's takes time to develop, and its symptoms present intermittently. My guess is while many people develop incredibly close bonds with their dogs, the percentage of dogs who live long enough to be candidates for Alzheimer's and live with a person who has paid close enough attention to notice changes this subtle would be small.

I also wonder how mine and Brandon's views regarding animals as persons influences our observations of Max vs. the culturally dominant view of other animals as inherently different or inferior to humans impacts individual relationships between people and their dogs and the humans; ability to detect such subtle changes in their dogs. I worry about coming off as superior or insensitive to people who have formed an intense bond with their dog but who don't recognize that other animals are every bit as individual as the one with whom they have formed this strong bond. Because I don't understand the mental or emotional compartmentalization that is required by people who can enjoy such a close relationship with one animal yet eat or wear others, I do wonder about whether or not the fact that I see all animals as people (individuals with a body and individual characters and personalities who value their lives as we do ours) results in a fundamentally different relationship with Max than those who don't regard all animals in such a way.

I worry about Max's experience and whether or not he feels any more lonely or alienated when he's disoriented. It hurts when I know he's not fully present - not only because he can't see or hear me as well, but because his mind is in an altered state, too. The most important thing to me is that he knows he's loved, deeply and fiercely and completely, and the potential that the changes in his brain could cloud any of that knowledge for him is the thing that scares me the most. And is the true source of my grief over him slipping away at times. I have enough love for him no matter what happens - but the idea of him not being capable of receiving and feeling it on his end is what hurts my heart.

Zero to Sixty

Max hasn't really gone from zero to sixty, but it sure feels like it.

It will be one month this coming Tuesday from the day Max had brain surgery. And this is what life is like with him now. Keep in mind that this is not even a month after brain surgery AND Max is fourteen years old.

In short, he's got a lot of energy.

And keeps us busy.

He's acting like a dog half his age, at least.

We're thrilled that he's made such an incredible recovery. And at the same time, it would be nice if it's weren't negative five degrees outside (before windchill) so he could burn off some of it outside. We live on the main floor of a 100 year old bungalow and it's not very big. When Max is awake, it feels even smaller.

He's pretty much got two speeds right now. Hyper-drive or Deep Old Man Sleep.

Scar almost four weeks after surgery.

His scar is healing nicely and his fur is starting to come in a little in some places. He's got a weird bump over his left eye and I'll be asking his doctor about that when we see her on Tuesday. The air under his skin (that was entering through his sinuses and the hole in his skull from the gap of the blade) crackles like Rice Krispies cereal when we rub his head, cheeks, and neck. The scabs from the warts Dr. Pluhar removed from his nose and the top of his head are healing very nicely, too.

I know a lot of people have been following Max's story and rooting for him. He's a pretty swell guy. Of course, Brandon and I will ALWAYS do what needs to be done to give him the best care no matter what, and at the same time, we have spent over $12,000 in vet bills in the past 8 months. My incredibly generous and take-charge-get-er-done friend is organizing a vegan bake sale benefit for us to happen this coming Saturday. And if you'd like to contribute but cannot make the sale, Chelsea set up an online account somehow that makes it easy for people to donate that way, too. 

Thanks for all of your support!

EDIT: Since the video was so popular, I will post the longer one I took here. I thought people might get bored with two whole minutes of Max acting like a doof, but apparently you people love it.

Max Wants to Eat Donuts with You!

Thanks to one of Max's guardian angels, you will have the opportunity to celebrate his incredible recovery by eating donuts with him at his very own vegan bake sale benefit on February 28.

Chelsea is a co-worker of mine with a huge heart and she has not only been working on this bake sale, but she also put together an account with an online donation site so anyone can contribute to Max's vet bills if they so choose.

Obviously, Max got all of the care he needed, and he will continue to regardless of cost. His vet bills in the last eight months, however, have exceeded $12,000 and Max is no help when it comes to pulling his weight around here. In fact, if we're not careful, he'll snatch dollar bills and sample a one or a twenty.

Max has a different take on the value of money.

I know it's been a long time since I posted an update, and that has everything to do with me simply being exhausted. Care giving is both physical and emotional, and we were on high alert for about two months worrying about Max's state and trying to keep him safe and comfortable. Things are starting to level out, but we're working on a pretty significant deficit when it comes to sleep and energy. We're incredibly grateful to have our boy in such good shape, and at the same time, it's come at a high cost - emotionally, physically, mentally, and financially.

Max is feeling great, though. He's smiling more, he's asking to go out on walks (even when it's 4 degrees outside), he wants to play with his toys all the time. Yesterday he went over to his toy box and pulled out a plastic ball with two pieces of kibble in it and made the biggest ruckus while he entertained himself for about 45 minutes. Of course he would roll the ball under the sofa at least 15 times in the course of that 45 minutes and bark until someone came to fish it out for him.

In short, he's behaving like he's six years old instead of fourteen. It's pretty awesome.

Ups and Downs

"You owe me a lot of treats for
bringing me here again, Mom"

“I don’t feel very much like Pooh today," said Pooh.

"There there," said Piglet. "I’ll bring you tea and honey until you do.” 
― A.A. Milne, Winnie-the-Pooh



A lot of people have been asking how Max is doing and coming up with an answer is difficult. I can think he's doing incredibly well in the evening and then we wake up in the morning and something doesn't feel right and Worry swoops in for a feast.

Exhaustion is also getting the better of both Brandon and me. The weeks going on months of interrupted sleep are starting to show. And, for me anyway, the care taking is more difficult when I don't know where it's leading. I don't know if we're moving toward recovery or decline because Max's behavior and mood change frequently and with little warning.

I brought Max to his home vet on Wednesday because I noticed blood in his urine during a 3am trip to the front yard. He was also agitated and peeing smaller amounts, so I suspected a UTI. It turns out he has a bladder infection (poor baby!) so he's got Clavamox added to his prescription regimen now. The calendar in our kitchen has morphed into a complex set of instructions for us to be competent as the boys' medication dispensary.

This is what the combination of a dog with a history
of bizarre health issues who has an over-protective mom
looks like. Behold: Max's file at his home vet clinic. 

He seems to be having some issues coming off of his steroids, but we have to taper him off of those so his immune system can recover. The side effects of steroid withdrawal seem to be full body trembling, loss of coordination, difficulty balancing, and drunken gait. He's also very likely in some pain because the steroids had been helping to manage his arthritis symptoms, and he can't start his arthritis meds until he's been off the steroids for a while. We're giving him Tramadol when he is having a particularly rough time.

One highlight from our last trip to the vet was Max making a new friend! I didn't know corgis, like beagles, are known for their extreme fixation on food. Nettie has a degenerative disease called canine degenerative myelopothy that is slowly paralyzing her, like a form of doggy ALS. These two pulled out all the stops to work the front desk crew for treats. Clearly, the staff had no chance. Come on.

Max and Nettie immediately recognized the potential
advantage of forming a begging alliance. 

Only a person with a shriveled, hard heart could possibly resist these two.

Thanks for all the love!

Max wants Cole to know how much he loves the
cookies! Warren thinks they're delicious, too!

We have been the recipients of so much love and support through these past weeks and I want to make sure you folks know how much we appreciate it.

People have made custom belly bands for Max on short notice, sent care packages from Florida, offered to cover shifts for me at work so I can be available to care for Max, brought us dinner, served as a taxi service for us since our Smart Car doesn't have a back seat, sent us monetary donations to help offset his sky-high medical bills, the many phone calls, emails, texts, Facebook messages and posts letting us know our family is in your thoughts... It means a lot that Max means something to more people than just those of us who live with him. Max is especially excited about the big batch of peanut butter heart shaped dog cookies, but that's not a surprise.

I've gone back to work and that means a lot more to do when I'm at home - hence the lack of updates. Max is doing really well for the most part. He's doing some things we didn't even realize he hadn't been doing for some time. He scratched the underside of his jaw with his back foot and we both realized it's been forever since we've seen him do that. This morning I brought him out to pee and he kicked the snow behind him when he was done, which he hasn't done in several weeks. His tail gets up to about horizontal with the ground on walks sometimes. It's been hanging down for a long time.

Max looking dapper and alert before his morning walk!

Max is smiling more, which makes my heart swell like you wouldn't believe. It's so good to see him with some light in his eyes again.

His incision has minimal redness and very little swelling, which is fantastic. I am concerned with the trembling he's been having, mostly in his back legs, but also throughout his body occasionally. It may be because we tapered him off his steroids a bit too quickly, so we're going to give him a little more time on those and hope the tremors dissipate.

Warren is getting a bit crabby and I think it's because Max is getting SO MUCH attention. We're trying to spend a little time each day just loving up Warren like mad. I took him to get his nails done and we had an adventure, just the two of us. Tomorrow he gets to visit the University of Minnesota vet clinic to see a dermatologist. I'd planned to call to make the appointment for Warren the Monday after Max had his first big seizure - and by then Max was in the ICU and Warren's dermatology appointment was put on hold for a bit.

Max and I love to spoon, and we've been indulging a lot lately.
I love his little feet peeking out from under the blanket in this one.

On a completely different note, I'm looking for something I can do with the pile of books that Max has "reviewed" by snacking on their covers. Any ideas?

On the mend

Look at this face! Look at it!

It's been two days since Max's craniotomy and he's definitely on the mend. Our little guy is such a trooper! It's incredible to us that he could undergo such major surgery and be doing as well as he is only two days later.

Max has much more control over his mobility than he did yesterday. He's pretty steady on his feet and has a better sense of judging spatially. He's still not allowed to have big means, so he's getting lots of small hand fulls of kibble throughout the day. He's big on the frequency of snacks but it's obvious he resents the paltry portions.

Last night was a little rough as Max was really whimpery in the night. He was up and panting a lot, which meant lots of trips outside. He also really wanted to scratch his stitches, which seems like a REALLY bad idea, so I spent a good deal of time trying to keep his behind under a blanket. He hadn't pooped since coming home from the hospital and had pungent gas. Poor guy. This morning he woke up and wanted off the bed NOW. Well, we can only move so fast, but I threw a hoodie on and scooped him up and put him on the floor where he immediately walked into the bathroom and took a massive dump on the floor. Way to go, Beag! I didn't even care about the floor - I was just happy he'd finally pooped cuz now we're cookin' with gas. Or dung. Either way, it's good.

Our kitchen calendar has notations for who gets what meds when so we can keep Max and his brother, Taz's, scheduled straight. Taz is our 17 year old cat undergoing a steroid load and taper right now, too. The boys' shelf in their kitchen cupboard looks like a mini pharmacy. Good times.

Yes, Taz is usually as crabby as he looks.
Brandon considers this his best quality.

Warren offers moral support by sacking out on the couch. 

After preparing and dispensing the four customized feeding and medication distribution as appropriate, we got Max ready for a morning walk with his dad. He's so cute in his coat - I wanted to snap a picture, but Brandon's not so indulgent in the mornings. You can take it up with him.

After picking up a bit in the house, I went to the front door to check on my guys. Brandon had max in the park across the street from our house and I could see him trotting along in the cold morning, looking for all the world like a normal dog. These are the quiet moments we're grateful for.

Max's head gets puffy from air that leaks into the space between his skin and his skull that was
destroyed by the saw blade because they had to go in through his sinuses to access his brain.
The amount of air varies depending on his breathing patterns. It's a bit creepy.

Back Home

On the journey home!

We picked Max up from the hospital this morning, which is both a huge relief and really daunting at the same time.

We were told he did wonderfully overnight. Eating, drinking, walking, peeing. All the things he's supposed to be doing. We were also told he'd been resting a lot, which is also good. We sat in a visiting room while Dr. Pluhar went over his discharge instructions with us. Max fell asleep on my lap during that brief meeting. 

He has a complicated regimen of medications that will be changing frequently over the next several days as we need to wean him off of his steroids and administer antibiotics for a while. He will be on Phenobarbital, his anti-seizure medication, for the rest of his life. He also got to come home with some Tramadol, and opiate-based pain medication. I'm a little jealous.

I'm trying not to let my worry run away with me, but Max is obviously not fully himself. I have never undergone surgery where I needed to be anesthetized, so I don't know what it feels like. And I don't know anyone that has undergone brain surgery. Max is a bit disoriented, unsteady on his feet, weavy when he walks, has difficulty judging spatial relations, and he also seems to fixate on odd objects. He stared intently at my water bottle for several seconds after it caught his eye. Same thing with the hanging fruit basket in the kitchen. Either this is a side-effect of the drugs he's on ("whoa, dude...") or something in his brain is severely damaged and he'll never be the same Max I loved again. Obviously, there is a likely explanation and an unlikely explanation here, but just because my worry isn't dragging me down the street doesn't mean it's not clinging to my ankles.

I won't be able to kiss his head or right between his eyes for a while.
He has some swelling. We're told an ice pack every few hours
will help. But, unfortunately, Max won't.

He's been whimpering a bit, too. Isn't it odd when a little tiny thing can cause such a huge concern?When Brandon attempted to put an ice pack on Max's head, he yelped and barked. A clear objection and request for him to back off. The whimpers, on the other hand, could be him expressing pain, discomfort, frustration, confusion, or even relief. I would much rather deal with a loud but clear message then a subtle and ambiguous one any day. From anyone.

My brave, amazing boy.

We're supposed to keep Max quiet and resting as much as possible. He cannot be left unattended unless he's in a crate, go up or down stairs, jump on or off furniture or into/out of cars. We need to monitor his stool for blood. We've been told not to worry if he bleeds from his nose, but do worry if the blood is pure and doesn't have snot mixed in. He's susceptible to pneumonia right now so we need to be careful about that and bring him to the vet at the first sign of difficulty breathing. Basically, I have a great excuse to be as neurotic as I want for the next couple of weeks.  Lucky Brandon.

We just have to see how everything unfolds. I'm guessing we'll know more in a few days about how ha's come out of surgery personality-wise. It's hard to imagine that part of his frontal lobe can be taken out and his personality won't change; though that's exactly what we've been told will (not) happen. I'll feel much better when I see for myself. I can't wait until he looks at me and I know without any doubt that he knows who I am and he's happy and excited and comforted to see me. I think that's all any parent really wants to see on their kid's face, right?