Anxious

Actually anxious doesn't even begin to describe how I have been feeling lately. It mostly has to do with Noah. Actually it is all Noah. 

First, there is his big surgery scheduled for September 4th. We went in for a consultation at a dental specialist last week and we decided that he really does need cleaning, extractions and have his oral fistula closed to prevent his lungs from possibly getting infected should food particles get stuck there (if not already). There are pros and cons for him to have surgery vs. not and ultimately it is up to Yangkyu and I to decide. And these types of decisions are always so hard to make. He is old and has medical issues. Will the surgery make him worse off? Better off? Will not having the surgery make him worse off? Better off? Is there a manual that has the exact answers we're looking for? Because right now that would help greatly.

The doctor said she isn't worried at all with his age. To be honest, I'm not either. With Piri, I always had this fear of putting him under due to his age, which made us prolong a dental that he could have had at 13 instead of at 17. I think older dogs are more resilient than we think and with proper pre-op steps and preparations, seniors can get the dental cleanings and surgeries (depending on how invasive it is) they need.

Instead of his age, the doctor was worried more with his kidney disease There is always a risk that surgery will make it worse. The kidneys work to filter out anesthesia from the body. Dogs like Noah who have kidney disease can't properly do that and so there is always a higher risk that they may get damaged even more.

I don't worry too much with surgery... or maybe I should say, I have something that worries me more than surgery, which is the pre and post-op. 

For one, starting tomorrow Noah needs to come off several supplements that help not only with his kidney disease but also his memory and cognitive function.

Back in mid-July I noticed Noah behaving rather odd but chalked it off with it being his kidney disease. Noah was sleeping all day but getting up every two hours at night wanting to go out - sometimes doing his business but most of the times doing nothing and coming back in. After a few of nights of this routine I began to get worried and then it all of the sudden hit me. Dementia. I thought Noah was showing signs of dementia. He was sleeping up to 6-7 hours during the day without having to go pee but at night he was constantly getting up. I read something called Sundown Syndrome and it seemed to be what Noah was having. He also had difficulty finding the door to come back inside, standing on the wrong side of the sliding door. Constantly standing there even though I was sliding the door open and shut to let him know where to come in. Out of the many signs of dog dementia, Noah was only showing these two - he wasn't circling or pacing (Noah had a clear objective to go outside and not pace around indoors, but once outside he did pace aimlessly), barking out of nowhere, having accidents, showing aggression to other dogs or not eating. In fact, he had a great appetite, was chill with Momo and all our guest dogs, always made sure to do his business outside and never barked. The only aggression he was showing was when he was getting his sub-q fluids, which he had never done before. 

After reaching a bit online, I came across a video of a man whose dog had dementia and he had started her on herbal supplements. I bought all three but began to give Noah just one of them called Heart Hearth by Animal Essentials (the other two were human grade and had alcohol in them - It is my understanding that you can mix human grade supplements with hot water so the alcohol can evaporate but I decided to try the one designed for dogs first to see how Noah would do). This particular one has gingko biloba which is known to help dogs with dementia. Not to sound like an exaggerated review but after three days, Noah's day and night routine went back to normal and he did not have trouble finding the door to come back inside again. Needless to say, I was in complete shock. 

Unfortunately this is the very supplement that Noah has to come off tomorrow for an entire week (ginkgo can cause issues with clotting and so it is recommended that patients come off of it pre-surgery) and quiet possibly up to three weeks post surgery. Noah will also likely have to come off his Rehmannia, Milk Thistle, Goat Milk and Fish Stock, all that help with his kidney disease and all that I syringe feed directly into his mouth. Because he is having surgery not only to clean and extract his teeth but to close up the oral fistula (hole in his gum), I am not to touch his mouth flap and open it until he is healed completely, which can take up to 3-4 weeks. So unless he miraculously ends up taking his supplements with his food (highly doubtful - he is absolutely picky with the smell) and laps up the goat milk and fish stock on his own, we are going without all the good things that I think has been helping him these past few months.

To add on to this perpetual worry I have, I woke up this morning at 5 am to find that Noah had vomited all over his bed. It was undigested food, a late night half meal he had, but it also included white foam as well. He vomited yellow bile four more times since. I have given him something to soothe his stomach and while I think I may know what caused this sudden vomiting episode, I still worry nonetheless (for me, I tend to imagine things like his BUN and creatinine and maybe even liver values skyrocketing). 

And this is all happening a day before he goes in to his vet for his pre-op blood work. Of course it would happen on this day rather than any other day, right?

I think what scares me the most is the unknown. How will Noah fair with his ginkgo biloba? Will he start to get up every two hours for an entire week or up to four weeks? How are we going to even manage this if this is the case?

How will he fair without his kidney support supplements? He is already resistant to receiving sub-q fluids. What if he continues to go downhill after his surgery?

I just am not sure what to expect. I am sure we will figure things out as they happen as we have always done, but getting there is just.. always really hard.

I know. One day at a time. One thing at a time.

It's just... sometimes that's easier said than done.