Bo's Final Hours

As many of you know, I had to "put down" my best friend Bo yesterday. I had been posting consistently on his progress, and news had been getting better, but quickly changed in his final hours. I am going to include some pictures in this post that you may not want to see. I will put them at the end so you can skip that part if you don't want to see him. To see the, click on the "Read More" link at the bottom of this post.

I have been re-evaluating and re-thinking this blog. I have decided to make this blog more of a memorial of my friend, but also a resource for others to turn to if their family members have to deal with Inter-Vertebral Disc Disease (IVDD). You should see those changes in the structure to my posts in the next few weeks.

***Back to Bo's story***

On Thursday evening, I spent much of the night washing Bo's stuff. Toys, bed, towels... everything needed to be cleaned and ready for boy's homecoming.  Although not confirmed, we had discussed a time table for him to come home and I wanted to get ready for some "home healing" to recover from his paralysis. If things went well, the schedule was:

• Friday - check for "stability" and no further complications. If we could stop other issues from setting us back, we can then start focusing on the "big picture", which was recovering from his herniated disc and hopefully his paralysis.
• Saturday - re-check pnemonia. If pneumonia symptoms have improved, then we know that the antibiotics were working and we should have another 24-48 hours of recovery.
• Sunday to Monday - Possible release of Bo to come home for "in home" love and care.

It was the first time that we had discussed Bo possible coming home, which made me very happy. The original estimates were 3-5 days in the hospital, and all this would have been pushing 7 days (also increasing medical costs, which I will get to in another post). I was elated with the possibility of having my little guy at home.

Friday morning brought about more good news. Bo "looked" better (doctors use the term "clinically" better, meaning that you can actually look at him and see improvements, although tests may indicate something different). The plan for the day was to continue with the medical treatments for his pneumonia, and if things went well, we would also be removing his tracheotomy tube. This was great news.

(On a side note, I refrained from posting all of this information. For that, I apologize. I didn't realize that Bo's story had developed such a following, and I truly thank you for all the support you have all given. I don't consider myself superstitious or deeply religious, but I found myself thinking things such as "I don't want to post anything, it might 'jinx' all this good news we are receiving". It is strange how life and death decisions change your views in ways you never imagined. Again, more on this and other topics as I re-structure this blog.)

Friday went about as planned, and we got our Friday afternoon update call as normal. Bo's progress seemed good. The chest x-rays showed that pneumonia hadn't really improved, but it had not got any worse and we needed time for the antibiotics to kick in. Also, Bo was not getting as agitated and they were able to remove his tracheotomy tube. All of this was great news after everything we had heard over the last 5 days. I had visions of Bo coming home, recovering in an environment that was more familiar for him and less stressful. I felt that we had turned a corner.

"But there is something else." My heart sank. What more could there possibly be?


Bo started experiencing stiffness in his front legs. Our neorology specialist, Dr. Sullivan, was out of town at a conference, but working with Dr. Steele and conference-calling in on his progress reports. Dr. Steele explained that it might be "Schiff-Sherrington posture".

I was thinking the same thing you are right now, "what the @#$% is that?". Schiff-Sherrington posture is a phenomenon where the limbs tighten up and become stiff due to trauma or lesions to spinal cord area. Not the same as paralysis, but actually losing the mobility through stiffness. I researched this more through an online posting for A Practical Guide to Canine and Feline Neurology. Don't get me started on how dumb of a title that is. "Practical Guide" and "Neurology" don't belong in the same sentence, unless you are complaining about a stupid title like "A Practical Guide to Canine and Feline Neurology". Seriously, click on the link. You won't see anything "practical".

The cause of Bo's Shiff-Sherrington posturing could be one of two reasons:

1. The swelling from his surgery was changing and effecting his spinal cord in a different way. This could be putting pressure in different areas, causing this phenomenon and would go away as the swelling decreases. This would be considered "good news".
2. The changing in Bo's neurology could mean that his spinal cord was so severe that he has developed myelomalacia. Again, "what is that?"

Let me start by saying occurances of myelomalacia are rare. If you are reading this, then you or someone you love has or could be going through issues with IVDD. Please do not think your dog might have this and go running into your vet saying "well what about this?" The chances of your dog having myelomalacia are low. From what I was able to gather maybe 5-10% of only the most severe spinal injury cases develop myelomalacia. Severe spinal injuries from IVDD are rare, meaning that most of them are treatable. So think of it as a rare occurance in a rare occurance.

What is myelomalacia? In short (and from my understanding, not being a veterinarian or in the medical field), it is when the spinal cord suffers such a severe trauma that not only can it not repair itself, but the damage starts spreading and killing the rest of the spinal cord. It actually starts to liquefy. Think of it as gangrene, but spreading throughout the spinal cord. It is hard for me to write this, as the thought of this happening to my little guy hurts me so much.

What are myelomalacia's symptoms?

• Paralysis (Bo had this, that's for sure)
• Numbness to pain in areas LOWER than the injury (Bo's symtpoms? Check. In fact, Bo had lost "Deep Pain" or "DP" sensation. Something I didn't understand until I researched it. Again, I will post about this as well.)
• Loss of tone and reflexes in hind limbs due to softening of the spinal cord (Check.)
• Hyerthermia (Check.) Not to be confused with Hypothermia (when your core temperature drops below the required temperature for normal metabolism. See Leonardo DiCaprio in "Titanic"). Hyperthermia is the overheating of the body, such as in heat-stroke. Bo was overheating and that's why the vet tech's and doctors were using wet towels to cool him down.
• Dilated anus - I didn't check this one out. Didn't even think to look. Actually, probably better if you don't if your dog is incontinent like mine was.

How do you diagnose myelomalacia? Forget what you read online, because it will just confuse you. The testing is very simple (again, from my understanding, and I am not a veterinarian by any means). For Bo, they ran several tests to confirm it, but the easiest for you and I to understand is if his "paralysis" and "pain sensation" is getting worse. If you test his skin reflex (pinch his skin to see if it twitches) and find that the area that is effected is growing along his spine, then he probably has myelomalacia. Barring a total separate injury occuring (highly doubtful), this would be an indication that his spinal cord is dieing and impacting other areas.

What are the treatments for myelomalacia? There aren't any. It is terminal. As the spinal cord begins to die, it starts shutting down different parts of the body and organs. With each section of the spinal cord that dies, the nerves attached to it  that are connected to organs also die. This shuts down the organs permanently and completely. The fatal part is when the spinal cord area that is attached to the lungs dies, so does the lung function, and the patient dies of suffocation.

Again, don't go running to your veterinarian like "chicken little" screaming that your dog has myelomalacia! As I mentioned before, it is very rare. Your pet will be dealing with so many other issues before it even get's to this state. If you are talking to ANYONE that is discussing IVDD and surgery, they are probably a specialist in that area and know what they are doing.

Back to Bo's story. So we had 2 scenarios. One that would resolve itself if we gave it time. The other was terminal. The only way to find out one way or another is to wait for one more day and see where his pain/twitch reflexes were. If they were spreading, then he has myelomalacia.

On Saturday morning, I got a call from Dr. Steele. It was our normal progress report time, but it started with "I am calling you, and it is not good news..."


My heart sank, I got a lump in my throat, and we discussed the details of what needed to happen.

It may seem strange, but I am happy that things went the way that it did. Do not get me wrong, I love my dog very much. But I couldn't bear the thought of putting my boy down if he was paralyzed and incontinent. Yes, I understand that it would have led to a lifetime of suffering and pain for him if he did not come back from his injury. But to know he would have otherwise been healthy and it was truly a decision about "quality of life" would have been more difficult. This decision was taken out of our hands, and it was more about ending it quickly and painless, or slow and with suffering.

That... is an easy decision to make.

Saying Goodbye...

This morning, at about 9:45 a.m., I had to say goodbye to my best friend, Bo. A lot has happened in the last 24 hours, and I will blog about it more later. It was in Bo's best interest, as his condition got to a state that was irreversible, degenerative, and terminal. To wait any longer would have just prolonged his suffering.

For now, I am happy that he no longer has to be afraid, confused, or in pain. I will miss him so much.

Goodbye, my friend...

Bo Rito Ochoa 7/18/08 - 12/10/11

Bo's Update 12/9/11 8:15 a.m.

No news is good news.

I spoke with Dr. Sullivan yesterday afternoon, and Bo seems to be doing much better. When I say "better", I mean "better" as in not going backwards. He still has pneumonia, his throat is still swollen and agitated, he is still breathing through a tracheotomy tube, and he still has no neurological response in his back legs. However, we will take victories wherever we can find them at this point, and not losing ground is a "win" in my book.

He had an "episode" around 11:00 a.m. yesterday while they were cleaning out some of the fluids from his lungs. Bo's surgeon had to come in to re-position his tracheotomy tube. Dr. Sullivan said she was about to give us a call, but the situation worked itself out. I am glad she didn't, because the call would have been a point where we would have to make a decision to stop all of his suffering.

In the meantime, the doctors and staff have been working hard to figure out what is causing so much distress for my little Bo. They think they have narrowed it down to his body temperature. Because of the pneumonia, and surgeries, and ... well ... everything the poor little guy has gone through, he is running a slight fever. His "overheating" is causing him to want to pant. When he can't pant (say that 3 times fast, "wan't pant can't pant") he gets agitated and gets worked up to a critical state. For the time being the staff is using water and wet towels to try and keep him cool in the hopes that this keeps him calm.

And it seems to have worked. For the first time since this started I did not receive a single phone call all night. It's so funny how uplifting it is to NOT receive a phone call. On the other hand, it's not funny that I have a heart attack (figuratively, since we are talking about medical stuff here and I don't want to scare anyone) whenever my phone rings now, even if it's just a friend calling to check in on me and Bo.

That's it for now. I slept for the first time last night, and I hope my little Bo got some sleep as well.

Bo's Update 12:00 12/8/11

It's a Christmas Bo!

My little guy has had a rough run. My conversation this morning with Dr. Sullivan put it all in perspective. Bo has 3 major issues going on:

1. He had a herniated disc which caused paralysis/incontinence by damaging or compressing his spinal cord. Surgery was performed to repair the herniated disc, but to date he has been unresponsive to all neurological tests. We dot know if he will recover from this.
2. He is having breathing complications. In his extremely agitated and distressed state, he had worked himself up to the point of damaging his throat. The damage to his throat has caused his air passages to swell to the point of being in danger of closing off. He has had a tracheotomy to allow him to breath.
3. In the process of attempting to breath, Bo got water/saliva/mucus in his lungs. This has led to him getting pneumonia.

Anyone of the items alone is enough to put a dog into a "critical" state. The combination is "life threatening". Bo also can not understand what is happening and what is going on, but he knows something is wrong. When he is awake and alert, he has at times begun to "freak out" and work himself up again to an agitated state which becomes life threatening. This happened several times over the night. With each "agitated state", his chances for survival are diminished, not to mention being painful and full of suffering.

On the other hand, the cause of much of breathing issues has just been discovered, his pneumonia. He has only received 2 antibiotic treatments for his pneumonia. At the time of our conversation (about 2 hours ago), Bo was relaxed, sedated, and sleeping. If he stays in a "relaxed" condition, he has a chance to fight off the pneumonia and his swelling in his throat has a chance to subside. The paralysis is a whole other issue. So we are making this decision without even knowing that he will be OK in the long run.

For now we have decided to wait and see. If we give him 24 hours and he does not get agitated and his condition doesn't get worse, he has a chance to fight off the pneumonia. In the next 24 hours after that (through till Saturday) we should hopefully see signs of improvement, which means he has a shot.

However, if continues to work himself into an agitated state then we are just prolonging his suffering. We just have to hope and pray that he can stay calm so that his medications and Dr.'s can continue improving his chances.

I Am Ready to Deal With Today

Nap time with Bo

I don't know why I am writing this blog. I don't know if I am doing it to share information with my circles as easily as possible. I don't know if I am doing it to share Bo's story with the world. I don't know if I am doing it to ask for help, emotionally and financially. I don't know I am doing it as a cathartic release. I don't know if I am doing at as a form of a eulogy. Sometimes when I write I am crying, trying to figure out what it is that I am trying to say. Others times I am as focused as a college student, doing research, writing a paper, trying to process the information I received from Dr. Sullivan.

The news of Bo's state last night brought about so many emotions. I have lost loved ones in the past, but none that counted on me, who looked to me as their provider and care-giver. The emotions seem deeper, you feel more responsible. I do not have any children, but I do know that many people consider their pets their children. The reality is that they are not their "children", but the roles of "provider" and "receiver" transcend the bounds of human interaction.

Look! A squirrel!

When I think about Bo I think his habits and characteristics. He is stubborn. God is he stubborn. I feel I did a good job training him. He understands commands and is generally well behaved. But sometimes, he is either ignoring me, or not paying attention, or can't process what I am telling him. He sits there, with a blank look on his face, and after 2 to 3 (probably more like 4) times of giving my command his expression changes to "Oh! You are talking to me!" His ears go back and quickly processes your command with a speed that even the most responsive of Australian Shepards would be respect.

Co-pilot

He enjoys companionship. I have never had a dog that has followed me around everywhere. I am not sure if it is a frenchie trait, or just Bo, but no matter where I go in my house, he wants to be with me. If I am taking a shower, he will follow me to the bathroom and sit on my bathmat waiting for me to get out. If I am washing dishes or cooking dinner, he will patiently wait by my feet for me to give him attention. He loves car rides and road-trips, and is a great co-pilot (actually, he just stares at me or sleeps, but he's there).

He is noisy. Those unfamiliar with french bulldogs won't laugh when they read that statement, but those that do know what I mean. There is no other way describe the amount of sound that Bo produces. Nothing that Bo does is quiet. Breathing is loud. He snores when he sleeps. When he is walking it sounds like he is wearing heals as his claws "tap" away on my hardwood floors. When he chews his bone the grinding and slurping is audible. He is "gassy". Those of you who are close to me probably caught the joke on his blog. We have affectionately referred to Bo's "gassiness" as "spreading some 'Bo Love'". Not having him here the last few days,I miss the "noise" the most.

Bo & Punky on their last play-date

He loves chewing so much,
he decided to nap on
his bone!

I have had times without him with me. He might be off on a play-date with his "girlfriend", Punky, who until just last week lived in the same building with us. Every once in a while my ex-wife would ask to spend some time with him and take him for the weekend. I would leave him with a friend or a family member, or even board him, while on vacation. I would always look at those breaks as a "relief". No getting out of bed for a walk. No need to think about feeding him, bathing him, playing with him. And I always joked about how different my house "sounded" without him. There was no "noise" and I could hear other things I never noticed before. Something as simple as the humming on this computer.

I found him like this when I got
out of the shower one morning. He must
have been cold.

I feel I am ready for whatever today brings. If there is a chance for Bo, I am willing to take it no matter what personal or financial sacrifices I have to make. I am sure that Dr. Sullivan wants to have a "quality of life" conversation with me. I have had tonight to process that thought in my head.

I love my dog very much. I miss him terribly and want the best for him. I don't want him to be in pain. I don't want him to suffer. But I also want him to run, play, chew on his bone, snore, and fart! When this whole thing started, my brother told me "You try everything you can, but at some point you have to ask yourself if you are doing all this for yourself or are you doing it for him? Are you doing it to make yourself feel better or are you doing it so that he can feel better?"

God, my house is so quiet . . .

Bo's bed, bone, and favorite toys . . .

Another sleepless night...

I just received a call from the evening Dr. and Bo has taken a step back. He had several episodes thoughout the day where he became agitated. The investigated the cause and he is aspirated with fluids and/or mucus. He has now contracted pneumonia.

The Dr. said is he is fine for now and that they have sedated him again. She wanted to let me know to prepare me for a conversation with Dr. Sullivan in the morning.

I am so sad . . .

Bo's Surgery Update 10:00 12/711

A long, anxious night.

At 7:50 last night we got a call from the overnight doctor about Bo. He was waking up from his anesthesia and was having complications. Before his surgery, Bo was in so much pain that he was hyper-ventilating with a deep frenchie guttural growl. The prolonged agitation caused a lot of inflammation and damage to his throat. The fear was that upon waking up from his surgery and finding himself in a strange environment, unable to move his legs, and having difficulty breathing he would immediately become agitated again.

Agitation = labored breathing = more swelling = difficulty breathing = more agitation. It's a cycle.

Human tracheotomy

 It was decided that Bo needed a tracheotomy (medical procedure to open his trachea, or throat, bypass the swollen areas, and allow air to pass through a tube). He was critical at that point, and the decision needed to made immediately. With audible instructions from the on call Dr., they began to intubate Bo and prepare him for his emergency tracheotomy.

Tracheotomy tubes

The Dr. then said that Bo is in not in the clear for the night. That they will work on him and try to stabilize him. She verified that I had signed a Do Not Resuscitate form (DNR - they have 3 levels at the hospital at different costs. 1. Do nothing, 2. Outside Compression Only 3. Open chest cavity if needed). She then asked if I wanted to be contacted, no matter what time of night, if I need to come down to "see him". "Of course. Please call me". We hung up, and the conversation sunk in.

How can you sleep after a conversation like that?  The answer is that you don't. I tried. Two glasses of wine didn't even help. I woke up every 1/2 hour or hour checking my phone, thinking maybe I missed a call. No call came. No news is good news.

This morning I talked with Dr. Sullivan about Bo's status. The news was good and bad. Bo is stable, heavily sedated, and breathing through his tracheotomy tube. He is still very agitated, so we agreed that I should not visit him today to reduce the chances of him becoming more agitated. The bad news is that he is still not responsive in his hind quarters. I know knew this was a possibility, but I was hoping for the best possible news.

This does not mean that he won't recover. The pressure from the disc herniation has been relieved, but there is still plenty of swelling. His paralysis and incontinence is due to one of two reasons. It is either due to a compression on his spinal cord caused by the herniated disc (now the swelling is effecting it, and as the swelling goes down he will regain control) or he has some permanent damage and the question is "how much". Dr. Sullivan says that going through this is a two week commitment for him to try and recover.

I think he looks like this, sleeping.
But I know he looks
completely different.

The only thought that runs through my head is "how much can his little body take?" He is so small. I can't imagine his little body with all those tubes. But I know he is strong. I will get another update this afternoon.