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Cooking For Two

Last week I had to make a trip to Phoenix to see the cardiologist. Phoenix being the smouldering Valley of the Desert Smog that it is, I knew I’d have to be running the air conditioning non-stop, because this fancy sardine can that I live in concentrates heat like the dickens. I booked two nights in an RV park as close to downtown as I could get, figuring I’d leave Atina the Wonder Dog at “home” safely plugged into 30 amps (RVs can plug into electricity to run all their systems) while I caught a ride to the medical center. She’d stay nice and cool.

Quick recap: Atina, my 3 year old Belgian Malinois, was born without kidneys. OK, she had the physical organs, but only about 10% functioning tissue. And as she’s grown, her body has outgrown her functioning kidney tissue. Dogs, for some reason, do not do well with kidney transplants, and only movie stars can afford doggie dialysis, so Atina’s lifespan will be drastically shortened.

One of the things that is bad for kidneys is heat stress. It’s something that’s seen in humans, notably in agricultural workers, say, in California, where migrant workers are frequently affected by acute kidney failure from working in extreme heat without sufficient water. Turns out dogs are extremely susceptible to kidney heat stress. Every episode, even those that pass unnoticed by observers, kills a little more kidney tissue. And for Atina, who doesn’t have much to go on, a bad episode could mean the end.

With all of my good intentions, there was one thing I couldn’t control: potty breaks. We had to go outside. For pee breaks, not such a big deal, since Atina knows what “Go pee, quick!” means. But poop has its own timing….very few of us can conjure up a poop on command, especially on short notice (well, there are those of us who poop, like, every five minutes, but that doesn’t count.) So in spite of my best efforts to plan for minimal heat exposure, there were several ten minute treks around the impeccable white-paved park, its fields of white gravel radiating 100+ degrees in spite of the relatively chilly 95 degree day. It turns out that even these brief exposures took their toll.

By the end of the first day I started smelling old pee. I checked myself. Nope, hadn’t had any accidental leakage, so where the hell was the infernal stench coming from? Atina jumped up on the bed. Yeccch! I whiffed her fur. Oh goddess, please no. It was urea crystals forming on her skin because her kidneys have stopped excreting it in her urine. Now she is peeing pure water, and sweating pee. Soon the entire interior of my van reeked.

I quickly hooked her up to the IV bag that hangs from a hook in the van.

I put 350 ml under the skin, to slowly absorb into her bloodstream and help wash the toxins out.

The next crisis came at supper time. She flat out refused to have anything to do with her prescription kidney-diet dog food that she’s been gobbling for two and a half years. She refused breakfast too. This is no joke, as she’s already lost 15 pounds over the past year.

After two missed meals I pulled out the “sick food:” rice with chicken broth. She sucked it down and asked for more. I let her have as much as I dared to give her. Then I sat and thought about how to proceed.

The object here is twofold: keep Atina feeling as good as possible for as long as possible, and…keep Atina by my side because she keeps me alive.

That’s an old joke between me and my psychologist. When business owners ask me what trained task my Service Dog performs, I can tell them honestly: “She keeps me alive.” And it’s actually not a joke. How can I kill myself at this moment, when my Doggess has tucked my foot under her neck as if it were her sleeping puppy? She guards my life from moment to moment. In fact, hearing me sniffling a bit just now, she’s gathered up my entire lower body and is wrapped around my legs peering anxiously into my face.

So you see I must take the best care of her that I possibly can.

I thought first about getting the hell out of hot Phoenix. To tell you the truth, I thought I was going to be hauling a dead dog to my vet in Flagstaff, or maybe a dog who would need to be euthanized as soon as I got there. I thought of calling ahead, but there was no possibility of speaking without breaking out into sobs, so I put the pedal to the metal and blasted up the 80 miles and 7,000 feet of elevation to my second home town on the edge of the Coconino Plateau (my first home town is, of course, Jerusalem.)

There’s a place on I-17 coming into Flagstaff where you power up the steep grade of the Mogollon Rim, and just before it levels off, a breathtaking view of the four Kachina Peaks fills the sky. These peaks are where the Kachinas, the Holy People of the Hopi (and Navajo, under a different name), came out of the Earth to serve the People. They stand like 14,000 foot guardians over the land between the Mogollon Rim and the Grand Canyon. White people call them the San Francisco Peaks.

As soon as the Peaks came into view, Atina was all attention at my elbow, peering out the windshield. Not dead. Not a bit!

So I kept on driving, stopping to get groceries and top off the diesel tank before setting out into the Coconino National Forest to find a good spot to camp….and cook.

She loves potatoes, and yams, and rice, and cooked veggies. For protein, I add pretty much whatever I’m eating. I searched the veterinary Merck Manual and found critical information on nutrients in kidney failure, which I now use as a guide in my home hospice nutrition program. I did make an appointment with her vet to talk about nutrients and what to do when…..

We’re doing daily subcutaneous fluids now, and this has had the strange effect of taking away her sense of thirst. It frightens me that she doesn’t drink. The vet says the subcu fluids do her more good than what she actually drinks, and of course my medical brain knows that but it makes no sense to my human brain.

The temperature is a balmy 63 degrees in the daytime and in the 20’s at night. If you hadn’t seen my girl when she had a bit of kidney function, you’d never know she was sick. She’s hell on squirrels. If a squirrel comes into her perimeter, she’s off like a shot, hell-bent for the Ponderosa pine she knows that squirrel is making for.

Today she treed a bigger trophy: a lost hiker! Poor fellow, he had got himself turned around in the woods because he was trying to navigate with a dim photocopy of an outdated map and got on the wrong trail. Atina found him, though, and scared him witless by leaping up and staring into his face again and again. In the K-9 business this is known as a “silent hold-and-guard.” In the lost hiker business, it’s known as “out-of-body, where’s-the-toilet-paper!” I pointed the poor chap on his proper path and took Atina home for a few Milk Bones. I never gave her Milk Bones before (“doggie junk food”), but now that she is on hospice I don’t care. She can have whatever makes her happy, as long as it fits the ratios of protein, calcium, and phosphorus that rule her diet now.

She is the best Doggess.