jeudi 15 juillet 2010

Any port

Wisp, in Rapide's neck

This is where she normally seeks comfort, only in Baccarat's neck. Any port, as they say, in a storm. Her dog has disappeared, and Rapide is wondering when it will be her turn to suddenly leave and not come home again. She is as nervous and jumpy as a cat on a hot tin roof. All I have to do is touch her when she can't see my hand coming, and she tenses and leaps into the air. I have to remember to announce my intention to reach out, from where she can see my hand, and then touch her.

What a lot of anxiety and loneliness one dog's illness and being hospitalized can create.

This morning, my husband tried to draw the vial of Rapide's blood necessary to serve as a control for Baccarat's D-dimer results. We are in the "jamais vu" in veterinary medicine. A D-dimer blood test is used to rule out a pulmonary embolism, deep venous thrombosis or disseminated intravascular coagulation (DIC), or, in other words, the presence of other blood clots (thrombi) in the vascular system. Basically, they are looking to see how much D-dimer is in the bloodstream.

This is not a veterinary blood test, as the incidence is non-existent in dogs, being more common in cats, but possibly still statistically small, and so the test has had to be done in a lab for human blood testing. Happily, the lab with which my husband works the most does test animal blood for our local veterinary clinic, and they agreed to perform the D-dimer, charging us for one test, instead of the two needed. However, the results indicate normal and elevated levels for human beings, and we cannot be certain of normal in canines.

This rather amazed my husband, but you also have to consider that the D-dimer test was first described, according to Wikipedia, in the 1970s and its clinical application discovered only in the 1990s. That it hasn't been established for non-existent cases in veterinary medicine is not, then, wondrous. Rapide and Baccarat would offer some information to veterinary cardiovascular science should Baccarat's levels differ significantly from Rapide's, and their comparison to human D-dimer levels would be interesting.

D-dimer is a fibrin degradation product, or a small protein, that is present in the blood after a blood clot is degraded by fibrinolysis. If there is a lot of D-dimer, chances are good that the body has been busy degrading blood clots, meaning that there is the possibility of a thrombosis, or an illness tending to produce blood clots. If Baccarat's blood sample indicates a higher than supposed normal level of D-dimer, we can suppose that there is another clot, or more, elsewhere in her body, that she has suffered a pulmonary embolism, or that she is suffering from DIC. It is nearly certain that if she is, it is not a severe case yet because there is not the bleeding that accompanies severe DIC. If it is mild DIC, the possible causes are several, with only some being likely or possible in Baccarat's case:

A cancer has been ruled out, at present, and Baccarat has been spayed, so obstetric causes are not in consideration; nor has there been any trauma. There are no indications of infection, either, and the hepatic results show a normal liver. There are no lesions to indicate vasculitis, which is common in dogs and horses, and Serotonin syndrome can be ruled out, as well, because it is an adverse drug reaction, and Baccarat has not been on any medications. An aortic aneurysm has not been mentioned, since there does not appear to be anything abnormal with the thoracic aorta, and I believe they have looked at the abdominal aorta in the abdominal sonograms performed. As far as snake bite is concerned, we cannot be certain that there was no poisonous snake bite, but she has demonstrated no pain, we have seen no swelling or oozing blood-like liquid from a snake bite site, and there have been no neurological indications.

This tends toward what the veterinary cardiologist has been suspecting, should the D-dimer level indicate DIC, which is that Baccarat possibly suffered heat stroke.

We are obviously hoping that the D-dimer level matches Rapide's and tends to correspond to normal levels in humans.

Last evening, after the finish of the 10th stage of the Tour de France, which we watched collapsed on our respective sofas, the healthy animals draped over furniture, cushions and each other in similar repose, we took Rapide for our old walk, down on the path along the edge of the fields where they end at the bank of the Seine. We went as far as the little stone-covered beach under the willows and other trees I cannot identify, or haven't bothered to, and Rapide waded in the cool water, while my husband sat up on a bench and rested his back. It has been hurting again. I watched Rapide, and I remembered all the walks we took there, moments spent watching them play in the shimmering river, back before Baccarat tried to bring back one too many stinky, foul dead things she'd scarcely fail to find, or, worse, to roll in, like her mother.

I thought about how precious moments are, and how even if we know it at the time just how precious they are, one day they will be unrecoverable, memories only, and they will sear the throat and heart, and the greater the joy and beauty, the greater the pain.

I thought about taking Baccarat and Rapide to walk along the Seine from the vet's, past Sam's lycée, and on a little farther toward the bridge to Limay Monday morning, and how I could see the Ile aux Dames, where the tennis club where Sam used to play is, and how I used to bring the dogs to walk in the park and wait for Sam's lesson to be finished. I had wanted to get there, to sit with them in that park again, but Baccarat could go no farther than halfway up the stair to the bridge, and then she found a damp spot in the shade and let her front legs slide until her belly touched the stone and she did not get up until I had to try to get her back to the vet for care.

We sat there and I looked at where the club would be, on the other side of the bridge, and I thought about how those moments are unretrievable, part of another part of my life as a mother, and how Sam has joined me as an adult, ready to care for our dog with all the love he has learned he has for her. I wanted to run to that parking lot and sit there again in my car, see him walk up the gravel path between the courts, his racket over his shoulder, his curling hair long over his brow and down his neck, a can of coke in his hand, won because he beat everyone, ready to tell me again how they are lousy, anyway, but he started too late to be one of the chosen players. I looked at Baccarat, and I thought about how that Sam is gone, just like she might soon be gone, a memory, photos, the stories we can tell, and I felt almost desperate against the nostalgia you have to fight.

Go on, only on. Love and let the future take care of the past and the pain.

Rapide came to my side and looked at me. It was time to join my husband up on the bench. I told him, my voice so tight the words could barely come out. I looked at the opposite bank, the water flowing by. He touched a tear that hung from my lower lashes and threatened to betray me by being followed by another, running down my cheek.

"Je pense," I told him, "que ce n'est pas pareil pour toi qui passes ta vie à l'hôpital, où les jours sont les mêmes sur toutes ces années qui filent, mais nous, les mères qui peuvent, qui sont avec leurs enfants, même si on travaille, qui les amènent à leurs activités, qui s'en occupent tous les jours, on vie ces périodes, ces phases, on doit les laisser passer pour vivre la prochaine et un jour la voir passer aussi. On a tant de petits deuils à faire, et on doit se battre contre la nostaglie tout le temps ou couler."

He considered a moment. I glanced at him and saw him looking out over the Seine, as well. Once, my husband told me that he couldn't imagine not living by water. Twice this week, I had sat and watched the river flow by along with my memories and thoughts.

"Tu as peut-être raison," he finally said, "mais je vie des moments de nostalgie aussi, seulement, je les repousse."

"Moi non plus, je ne me laisse pas rester dans la nostalgie. Je serais trop malheureuse pour rien faire. Ce n'est juste que la coincidence entre ce moment quand on risque de perdre Baccarat et je vois Sam devient un adult, son enfance dans le passé, c'est trop fort, mais je n'y reste pas." He put his arm around my waist, and we headed back to the path along the Seine and home, to our bottom gate.

The coincidence, the terrible synchronicity in perhaps losing Baccarat at the very moment that Sam's childhood ends, is too much, but I won't let myself get lost in that. Baccarat needs me to do what I can for her, and Sam will need me in different ways, with new things to live. Ends are never so neat as that, thank heavens. They just seem that way when we are fragile.

It's time to leave for Maisons-Alfort. I'll take my motorcycle today, since Baccarat won't be coming home yet.

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