37 Weeks and the Power of Anxiety

Yeah - my size is no longer funny. It's profoundly sad.

At my 37 week appointment with Dr. G, I told him that I didn't expect to have dilated at all the previous week, as I'd been under a fair amount of stress and I had a feeling I'd given myself a bit of a set-back in terms of progress. Well known fact - stress can delay labor.

Dr. G said we'd see, and then went about the extremely fun process of checking my pelvis. He announced that I was now 90% effaced, and that Rhys was excitingly low in my pelvis. He said, with the sort of flair that one reserves for a waiter announcing a very special dessert or similar in a fancy restaurant, "the baby is ENGAGED in your pelvis! ZERO STATION!" all of which made me feel like some sort of science fiction event. He then added, "You're right though - I don't feel much dilation, but I'm okay with that - I think we're on track still for your due date!" And I rolled my eyes at him and said, "Yes Dr. G - you told me that last week and to be honest, it kind of made me want to punch you." He grinned at me, and then indicated the nurse intern who had been shadowing him through my last three visits. He said, "Punch her! It's what she's here for."

So - 90% effaced, zero station - still around 1/2 centimeter dilated, at 37 weeks.

If you're curious as to why I had issued a clamp-down on my cervix, when it would be, at this point, so very very awesome to get this whole pregnancy thing over with...then keep reading.

On Tuesday evening around 5 p.m. the dogs and I went for a swim in the pool, but my Pooka Bear refused to swim...he just stood on the steps and then he asked to go back to the house. This was strange behavior, but I thought maybe it was just too hot for him.

That evening, he was acting a bit uncomfortable. I thought his hips were bothering him, as he has hip dysplasia, so I gave him a Deramaxx and massaged his tush for a while. He had a hard time settling down that night, and he woke me up at 3 to go out, wandered around the yard, asked for a drink - in general wasn't entirely himself but again I chalked it up to heat and his hips being uncomfortable.

Later that morning, he wasn't super enthusiastic about his breakfast, but he ate it. I started worrying - and called and made an appointment for him with the vet for 11:30 a.m. Then, as I was looking at him, I said - "you know, let's take your temperature...just in case." I didn't think he had a fever, or at least not a high one, because he'd eaten all of his breakfast - but you never know with these stoic Newfs.

The thermometer read-out said 105 degrees. I said, "get in the car, Pook." I called the vet's office to let them know I was bringing him in as an emergency case instead of waiting the hour remaining until our appointment. Then I called Sandy to let him know I was taking Pooka to the vet immediately. He asked me if I needed him to come with me. I said, "No, you need to be at work today - I'm okay..." He said to keep him posted, and call him if I needed him. I rushed to the vet's ER. Pook was in seriously bad shape when we got there - the stress of riding in the car in the heat we had on Tuesday was bad news for him, and then the ER vet had to deal with a more urgent case and we waited in an exam room alone for 40 minutes* before she was able to come and take his vitals. At that point his temp was 106. I'd been dripping water onto his tongue from a wad of paper towel, and wiping down his ears and groin with cold water while he and I waited.

The doctor took the history of the past two days, and then hustled him into the back. Pooka tried to hide behind my legs when she took his leash. I cried again, but walked him into the back hallway and got him started for her so she could get him to the Critical Care Unit. I went out to wait in the waiting area of the hospital.

Meanwhile, in the back they hosed him down with cold water to reduce his temperature quickly, while catheterizing him for a cold-fluid IV and drawing blood for a full CBC and Snap4DX test. At this point, we had no idea what was causing the problem, but we had to address the fever asap. The vet came out to the waiting area and discussed possibilities with me. Lymes or other tick borne illness, aspiration pneumonia because Pook has Laryngeal Paralysis, virus or bacterial infection, the possibility of him ingesting some poisonous substance (highly unlikely as he is never outside without me present, and isn't the sort of dog to get into the under-sink cabinet and start drinking windex - I mean - I keep his bag of kibble right out in the kitchen and neither dog ever tries to get into it!), or cancer - although the vet said at his age she considered that last one to be highly unlikely. Pooka is just four years old. The vet hoped we'd know more once the bloodwork came back.

But the bloodwork came back absolutely fine, liver and kidney functions perfect, Lymes, Heartworm, Anaplasmosis and Ehrlichiosis-negative, apart from an elevated white blood cell count which could be caused by many things. His white blood count was high though - 20,000. So far, no smoking gun. The next step was taking chest radiographs to search for pneumonia in his lungs - the most likely culprit considering his medical history, and the fact that I could remember him inhaling a little pool water a week prior while playing with a ball in the pool.

The receptionists and vet techs that passed me sitting on my bench in the waiting room were worrying about me. They kept asking me if they could get me anything - water or...? I demurred - one of the techs had given me a paper cup earlier, and shown me where the water fountain was - I was trying to drink. I must have looked horrifying - eyes all bloodshot and red from crying. The vet again came out to see me, and said they were prepping Pook for the chest xrays. She suggested I run home and eat some lunch. His fever was starting to come down on the cold fluids and there wasn't anything I could do for him there. I stared at her. "What are the odds that I might lose him in the next hour or so?" I asked. "Because I can't...I have to be here if he..." She shook her head. Without knowing the cause of his collapse, there was no way to offer me any promises. She said she didn't think that he was bloating and she didn't want to charge me the money it would cost to do an abdominal xray or ultrasound without some clinical sign of bloat...but I told her I didn't care a bit about the cost, I wanted to be CERTAIN that we'd checked for everything, so do the abdominal ultrasound, check for bloat and intestinal obstructions. She told me he would have to be shaved for the ultrasound, and I gave her my blessing to hack his coat off as much as necessary. Then I drove home very quickly. I didn't WANT to eat anything, but at 37 weeks pregnant I had to.

As I was eating quickly, the phone rang. It was the vet hospital. My heart plummeted. It was the ER vet - she wanted to let me know that the chest radiographs had been somewhat favorable for pneumonia, but not classically indicative. Her real concern though was that it appeared his heart was elevated off his sternum, and she was afraid that indicated free air in his chest cavity. She told me she thought it imperative that she put a needle in his chest and try to aspirate the air - that if there WAS free air there, it would be putting a lot of pressure on his heart and lungs and that releasing it would relieve him of discomfort very quickly. I told her if she thought there was air there, to do what she felt she had to do. Then I called Sandy and told him that NOW I needed him. It was about 2 in the afternoon at this point, and luckily the event he'd been monitoring at the club was over, and he was able to hand the reins over to one of his assistant managers and come home. We drove back to the ER together, at speed.

When we got there, the ER vet came to tell us that she had been unable to aspirate any air from his chest cavity, so she was having a cardiac surgeon take another look at the radiographs. I asked her if she'd looked at the radiographs Pooka had had taken last year, when he was diagnosed with LarPar and they took rads to test for Megaesophagus. She shook her head. She pulled the older radiographs up, and compared them with the new ones - his heart was elevated off his sternum in both. Reassured that a pneumothorax, (air in chest cavity), was now probably not present, Sandy and I returned to the waiting room while the ER vet ran back to consult with the cardiac surgeon. He corroborated what we'd seen - no pneumothorax. Of course, poor Pooka had already been jabbed about 6 times, (based on the red marks in the shaved patches on BOTH sides of his chest), to try and aspirate air that didn't exist - but I couldn't blame the ER vet for jumping on a possible cause and trying to make him feel better. Especially since I knew he wasn't the only critical case she was working on at the moment, and I had only mentioned that he'd been tested for Mega-E in passing during our first conversation.

Having ruled that out, we were pretty much back to square one. She prepped Pooka for the abdominal ultrasound to make sure that his stomach, guts and other internal organs were all normal-looking. With a giant breed, deep chested dog, a condition called bloat or GDV can be fatal. In fact, I knew several people who had lost their Newfs to bloat in the past two weeks, and I was feeling very, very neurotic about the whole thing.

The abdominal ultrasound came back clean. The vet came out to tell us. We all stared at one another. Now what? The vet said, "I'm sorry I can't tell you exactly what's wrong with him. But at this point, without any other information, we're going to start him on an IV of antibiotics. We're going to keep him here overnight to pump him full of antibiotics, and to keep him on the IV of fluids, with the fans etc, to keep bringing his temperature down. We'll be monitoring his condition constantly, so if any new symptoms show up we'll spot them.

I asked her again what his chances were, and again, not knowing the cause of his fever, she was unable to give me any odds. I swallowed a gigantic lump of fear, and said, "can...can we see him?" She said, "of course. I haven't hooked him back up to his fluids yet, (since finishing the ultrasound). He's stable enough for you to see him." She brought him into the room and left, saying, "take as long as you need."

Pook wasn't himself. He was shaved, with the capped IV taped to his right front leg, but more than that he was unfocused, still very feverish, thirsty as anything, and wouldn't make eye contact with either Sandy or I. He went and stood by the sink in the exam room, asking me wordlessly for more water from the paper towel.

I obliged him. I tried not to give him too much though because I knew the vet didn't want him to drink too much and possibly vomit.

Then I kissed him many times on his nose, and told him that I needed him to get better because he was going to be a big brother soon, and Rhys will be HIS baby as much as he is Sandy's and mine. Pooka loves children, especially babies. I told him I needed him - and then I pretty much started bawling, and told Sandy I needed to leave the room. Sandy stayed with Pooka, and massaged him and told him he was going to be okay, until the vet came back for him. I sat out on my bench in the waiting room and cried until Sandy came out to join me.

She got Pooka settled down again with his IV and his fans, and then came out one more time to give us the estimate for Pooka's care, and make sure we knew everything that they'd be doing. She told us she wasn't working the following day, but that Pook would be passed on to the night ER doctor's care, and then in the morning to one of the hospital's regular internists. She reminded us of the hospital's Comfort Call feature, (you can call and speak to the vet tech in the CCU and ask how your dog is doing before 10 p.m.), and told us the internist would be calling us with an update in the morning after rounds.

Feeling utterly helpless and terrified, Sandy and I went home to a much emptier house around 4 p.m. It seemed impossible that 30 hours earlier, Pooka had been bouncing off the walls begging to go for his daily walk. He'd deteriorated so quickly we both felt blind-sided. Nanook was particularly heartbreaking, when we got home. He sniffed us both thoroughly and then ran outside to check the car for his brother. He insisted I open all the doors so he could look for him. It was awful. Especially since I couldn't tell him that Pooka was going to be okay, because we just didn't know.

Sandy fed me something for dinner - I have no idea what. He suggested we go upstairs and watch a movie or something to distract us - I don't remember what we watched, either. Nanook began to display symptoms of anxiety, and started carrying his stuffed fuzzy ball toy with him everywhere. He sat between Sandy and I on the couch, holding it in his mouth, looking worried. This made me cry also. Around 9:30 I asked Sandy to call the hospital and check in on Pooka. The tech was able to tell us that his fever had dropped significantly, but that when they tried pulling the cooling fans off of him to see if it would stay down, it spiked back up to 103.5. So they'd given him his fans back, and it was on its way back down again. She said he was drinking water, and had gone outside to potty. And that was that. I suddenly felt like I couldn't bear to be sitting there, staring blankly at the tv anymore. I just wanted for the day to be over, and for the next morning to be there with good news. I told Sandy I was going to bed.

I don't think either of us slept much.

The next morning, at 6 a.m., Sandy once again called the hospital. The receptionist gave him a bit of a brush off, explaining that the night staff was busy but that once the day staff had been read in on all the cases passing into their care, and had finished rounds, Pooka's new vet would be calling us - probably between 9 and 10. Sandy accepted this fairly calmly, and hung up the phone. I, on the other hand, did not. An hour later I decided I wasn't going to be able to wait three hours to find out whether or not my dog had made it through the night. Especially since I had an appointment with Dr. G that morning, and was afraid I might miss the call.

I called the hospital back, apologized for bothering the receptionist, and said, "I was just wondering if you could tell me if my dog survived the night. I'm awfully sorry, but I'm pregnant, hormonal, and if I have to wait another two hours to find that out I will lose my nut." She groaned, "oh no - no we would have called you immediately if something like that had happened! But you know what, hang on..." I could hear her typing in the background. She came back to the phone. "Okay - the vet on duty this morning had entered in her notes on his status so I can tell you his temperature is around 102, and he spent the night comfortably - no vomiting or diarrhea. He hasn't eaten anything yet, no interest in food, and some few episodes of coughing." With that, I had to be content. I thanked her effusively for her help, apologized again for bothering her, and went to shower and get ready for my OB appointment at 8:45.

As I told Dr. G - I'd been feeling cervical changes take place all week, since my last appointment - but I hadn't felt ANYTHING of that nature in the past twenty-four hours, and I suspected I'd perhaps even managed to reverse any progress that I'd made through sheer nerves. I would have been very surprised if I'd dilated at all, considering. And this time, I was right.

The OB visit over, Sandy dropped me off at home and went to work. I told him I'd call him with news after the vet called. And then I waited. And waited. 10 came and went. I worried, and paced, and stared at the phone, and willed it to ring, and waited. I made deals with myself, like, "if the vet hasn't called by 11, I'm going to the hospital again..." 11 came and went. Just as I was about to pack my purse full of snacks and water bottles and drive over there in all my enormously-pregnant glory, the phone finally rang. And for two rings I stared at it with my heart in my throat. Then I answered.

Pooka's temp was low enough and stable enough without the fans that the ER vet felt he could come home. Especially since he'd eaten some wet food for them that morning, which meant he could be fed oral antibiotics from this point on. His lungs sounded clear enough to her. She felt pneumonia to be the most likely culprit. She said, "when can you come and get him?" I said, "Whenever you're ready to send him home, we'll be there." She said, "after lunch is best for us." I said "See you then." I hung up the phone, I sat down on the ground, I burst into tears, and I gave Nanook a huge hug and said, "Pooka can come home, Nooks."

I called Sandy. He suggested he pick me up at lunch time, we'd grab something to eat and then pick up Pooka. (He knew I'd forget to feed myself if he didn't make sure I ate). So that's what we did. When we got to the hospital I stayed in the car to keep the AC running on full blast because it was 97 degrees outside and I didn't want Pooka to get into a hot car. Sandy went in to pay the rest of the bill, talk to the vet about discharge instructions, and lay hands on our much-loved bear dog. It took forever - but when I finally saw them walking across the parking lot I knew things weren't certain to be okay yet. Pooka was walking very slowly, still almost aimlessly. When he reached the car, he acted like he wasn't certain he could make it up the steps into the back, and it took 5 minutes to coax him up them. He was walking a little funny on his right hip, also - a bit duck-footed on that leg. I think he probably lay on that side all night, and was stiff and sore from inactivity.

We got him home, and I hustled him into the AC but he insisted on going right back outside again. He had to use the bathroom. Then he went and got a long drink from the spigot out in the garden. I worried the whole time about him being out in that heat, under the sun at midday. Finally I got him into the house, and I fed him a can of wet food. Despite clearly not being himself, he was VERY interested in food, which made me feel a little better. There was a raspy, growling quality to his breathing, and his side and stomach heaved queerly when he breathed in and out. I got him to settle down in front of his fan. Sandy left again to return to work, and I lay down on the couch next to Pooka. We both napped, (although I woke up every 15 minutes to check and make sure he was still breathing.)

Long story short, we had an iffy 24 hours after he first came home where all he did was sleep, eat, drink or go to the bathroom. He wasn't himself. I would rub his chest in a circular massaging motion for half-hour intervals, which seemed to calm him and make his breathing a little easier. Sandy slept down in the kitchen with him because it was much cooler than our bedroom, and Pooka was still sporting a fever that would go up and come down, go up and come down.

The fever continued to ebb and peak. Pooka came home Wednesday afternoon - and yesterday (Friday) was the first day that his temperature stayed below 102.5 (high end of normal) for the entire day. We've kept him in the AC and by a fan, and gradually his personality returned to him. He's slowly gaining energy as well - each sign of normal behavior is so welcome - the first time he went outside and sniffed around instead of just staggering aimlessly - the first time he lifted his leg to pee, the first time he was able to get up and go to the window to see who was pulling down the driveway, the first time he got up and brought a toy to Sandy when Sandy got home from work...all minor triumphs.

The little bursts of energy he gets don't last long, he's soon lying down again and sleeping again, but they are becoming more and more frequent and lasting a little longer each day. Tomorrow if it is cool enough in the early morning Sandy might take him for a very short walk; gentle exercise is supposed to help him express whatever nastiness is *probably* sitting in his lungs. Because we STILL don't know what caused the fever.

Today, the vet came out to the house and drew blood to retest his white blood cell count. She gave him a thorough going-over and is very happy with how he's doing, and feels he's responding very well to the antibiotics - although she does feel like it might be beneficial to extend his antibiotics for an extra four weeks, or possibly double-up the antibiotics - she wants to make absolutely sure we kill whatever it was that did this. So do I! We should have the results of the CBC tonight - if his white blood cell count is coming down, it means the antibiotics are fighting whatever made him sick, and I can probably relax a little bit. Which will, of course, help get me to the point where I can start thinking about relaxing my girly bits and maybe having a baby again. Because I'm not ready to leave Pooka for my hospital stay until I know he's out of the woods! I can't even imagine. Like labor isn't going to be bad enough!!!

Anyway - that's what's been going on here.

Many hugs to y'all...

Nessa

*After waiting 40 minutes and watching my dog get worse and worse I snapped like a twig, (ordinarily I try very hard not to be one of those people that pushes themselves forward ahead of other folks because I'm sure there's a reason why we're being put on hold and maybe someone needs the doctor more than I do), went out into the waiting area, grabbed a tech, and - sobbing hysterically, begged her to get me a doctor for my dog because he was getting worse and worse every minute and we'd been waiting forever. The combination of my hysterical tears and my gigantic pregnant belly made quite an impression - the doc was in the room within 5 minutes of my releasing the tech.