Tuesday, December 17, 2019

#Nostalgia #Football #Injury A ruptured Spinal Disk and Giant Snowflakes – Part 9

Giant snowflake from Disney's Journey Through Inner Space attraction. Circa 1967. Read on, McDuff!

In Part 8, I described the first time I walked after my spinal fusion surgery. It's a good lead-in for this part if you haven't read it yet. Here's the link to that post.

When the nurse came in with my 1:00 PM shot of Demerol, I asked if I had to have it.

“Are you sure? Most people don’t want to skip any doses until the fourth day or so.”

“It really doesn’t hurt that much,” I insisted. I was glad it hurt so much less than before that the idea of even less pain didn't mean anything.

The nurse looked skeptical, but she left. Everything was fine until about 4:15 PM. Then, my back began to ache painfully. I pressed my “call nurse” button.

“How can I help you?” the nurse responding to my call asked.

Aside: This is a different nurse from the one who did not give me the 1:00 PM shot. There was a shift change at 3:30 PM.

“Let me check,” she said. She returned with a syringe in hand. “It’s a little early for your next shot, but you’re a big person, so it should be okay.” She administered the Demerol.

For those of you who don’t know, Demerol is a narcotic. It is highly addictive if abused. It is stolen from hospitals because of its hallucinogenic properties. It’s also very effective at relieving pain. And relaxing the body.

Within seconds, it felt like my body was merging with my mattress. All pain was either gone or forgotten. I lay there enjoying the feeling for a bit. Then I closed my eyes.

Aside: A new ride at Disneyland at that time was Journey Through Inner Space. The essence of the ride is being miniaturized until you travel inside a molecule of water frozen in a snowflake. There was a myriad of GIANT SNOWFLAKES displayed in the waiting area viewed during the beginning of the ride.

You know how when you close your eyes, sometimes there are flashes of color? Well, it was almost Christmas, and the colors red and green were prominent all around San Diego. I saw red and green when I closed my eyes…

GIANT RED AND GREEN SNOWFLAKES! 

And, they were falling through the ceiling! 

I opened my eyes. The snowflakes disappeared. I relaxed even more. I closed my eyes again.

Once again, 
GIANT RED AND GREEN SNOWFLAKES 
were falling through the ceiling!


My eyes snapped open. The snowflakes disappeared. Now I could see myself lying on my hospital bed.

My eyes said, “Look! There you are laying in your hospital bed.”
My brain countered with, “Don’t be stupid! You are lying in your hospital bed. You can’t see yourself!

The debate between eyes and brain raged. I tired of the argument and closed my eyes.
GIANT RED AND GREEN SNOWFLAKES 
were falling through the ceiling and getting closer to me!

Opening my eyes, this time, revealed me lying in my hospital bed. After repeating the mental dialog described above, I decided to ring for the nurse. 
I reached for the call button. My arm moved maybe an inch. It was obvious that the Demerol had relaxed me very well.

Over what seemed like the next hour (but was probably a couple of minutes), I repeated the closed eyes 
GIANT RED AND GREEN SNOWFLAKES 
falling through the ceiling and open eyes watching myself lying in my hospital bed cycle over and over. Until, finally, my hand reached the call button.

Now certain I was schizophrenic, panic struck! I pushed the button and held it down.

The nurse who gave me the shot of Demerol appeared at the door. I shouted a warning.

WATCH OUT FOR THE GIANT SNOWFLAKES!

The blood drained from her face. She turned and, based on the sound of her footsteps, she must have sprinted to the nurses’ station. Her return was quick.

Aside: I’ve not verified the facts in this Aside. These italicized paragraphs are based on what I remember. If the facts aren’t true, I don’t want to hear about it. What I remember makes for an explanation of the events that I understood then and still makes sense.

I remember being told that the body metabolizes Demerol quickly. As with many narcotics, it requires increasingly larger doses over time to ensure the desired effect. For that reason, each of my shots was customized to be slightly more potent than the previous dose. 

December 2019 UPDATE. I told this story to the last group of nurses in the "Technical Writing" class I teach for PLNU. They verified that this is how Demerol works.

Assume my first dose of Demerol was given around 5:00 PM on Friday, December 20th in the Recovery Room. Also, assume that I had a shot every four hours from that time until 1:00 PM on Sunday, when I’d declined the offering. That means the shot I skipped was shot #11. Since I’d missed a shot and nearly eight hours had passed since my previous shot, I could have received the same dose as shot #10, which would have been effective. Instead, the nurse gave me my shot #12. That was two dosage strengths more than I should have received. Hence the hallucinations.

She sat beside me and held my hand for almost two hours. She alternated between agreeing that I was lying in my hospital bed, saying “I’m so sorry,” and dodging imaginary 

GIANT RED AND GREEN SNOWFLAKES.

I finally went to sleep. 

The next day, she told me that she hadn’t checked my chart before she’d given me the shot.

“That you would have skipped a shot never entered my mind. Nobody’s ever declined a shot after an operation like yours before.”

I left the hospital one week from when I entered. They kept me an extra day because I was running a low-grade fever. They finally decided it wasn’t bad enough to extend my stay.

Leaving the hospital with the fever proved to be an unwise decision. But, that’s for another blog, which details the of the post-catheterization mentioned in Part 8.

Also, in another future blog, I'll chronicle my follow-up spinal surgery:  Laminectomy & partial discectomy. 
It was done in 2005 to relieve pressure on my sciatic nerve.

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Sunday, December 8, 2019

#Nostalgia #Football #Injury A ruptured Spinal Disk and Giant Snowflakes – Part 8


Giant snowflake from Disney's Journey Through Inner Space ride. Circa 1967. Read on, McDuff!
When last we left our intrepid hero…

DisclaimerThe events reported in this story occurred in December 1968. Some liberties may have been taken in their sequencing. It all did happen, but maybe not in this order.
Note: There are three links to more information or illustration of events. I encourage you to explore them, too.

Once in my room, nothing of consequence happened until the next morning. During “rounds,” my surgeon, Dr. Laughlin, came in. His first words were, “Well, I guess it’s time for you to be up and around.”

I’d heard stories about spinal surgery. Weeks in bed with a massive cast. Horror stories of bathroom incidents. I knew I didn’t have a cast on. 

“Um, I don’t think I should be getting up yet,” I said. “You just did surgery yesterday. When do I get my cast?”

The Doctor raised his eyebrows and flipped open my chart.

“You won’t be getting a cast. I wanted to replace your ruptured disk, but your vertebrae are misshapen. So, I elongated the incision, shaved some of your pelvic bone, and fused your 5th lumbar vertebrae to your sacrum.”

An Aside: Later in life I saw a film [a film is a video precursor] of a different doctor doing my surgery. He took a hammer and chisel and began to beat on the pelvis and lumbar vertebrae, something like the reverse of this video footage. After cracking both bones, he took the slices of pelvic bone placed them on the damaged bones and sewed the patient up.
One screw is in L5, the other in the Sacrum in this photo of how they do spinal fusion now. Imaging a picket fence made of bone fragments in place of the screws. That's what I have.  

I wasn’t in a lot of pain at that moment. But, that was mostly the result of the heavy-duty pain meds. I realized how strong they were only after seeing the film of the operation. Cracking bones with a chisel causes pain!

“What about a brace?” I asked.

“You have a brace from before, right?”

I nodded.

“Just use that once you’re out of here. I’ll be back to tomorrow and we’ll get you out of that bed.” With that, he was off.

Every four hours I received a shot of Demerol to control the pain. More on that later— the illusive snowflakes are involved. The biggest event of the evening revolved around urine. More accurately, it revolved around the lack of urine release on my part.

I don’t know about you, but I don’t tinkle very well while lying down. Actually, I don’t tinkle at all. I hadn’t tinkled once since before my surgery the day before. By mid-afternoon, my bladder was FULL. I was given a bedpan. It remained dry. After another hour, even Demerol wasn’t masking the discomfort.

Long story short: They inserted a catheter and drained my bladder. 

Longer version: I knew exactly when the catheter reached my bladder. The relief of urine exiting is difficult to describe. Suffice it to say that I still remember it. Unfortunately, as is common in hospitals, that procedure led to unexpected consequences. More on that in a future blog series.

The morning after the use of the catheter, Dr. Laughlin entered during his rounds. He had the same opening line as the previous day.

“Well, I guess it’s time for you to be up and around.”

Again, I replied, “I don’t think I should be getting up yet. You just did surgery two days ago.”

The Doctor raised his eyebrows and flipped open my chart.

“Yep. It’s time to be up and moving. Let me show you how to sit up.”

With that, he looked at my roommate’s bed. My roommate was an elderly man suffering from leg thrombosis. They were afraid a blood clot would break loose and become an embolism. That could lead to brain damage or kill him, so they check his vital signs every two hours. That’s okay in the day, but nights were hard to sleep through. 

Dr. Laughlin unceremoniously shoved my roommate across his bed against the wall with a thud. Then he lay down on the mattress and demonstrated as he narrated.

“Turn on your side. Bend your knees. Use the arm under you to push yourself up while you pivot on your hip. Be careful to keep your back straight.”

He jumped off the bed and came to mine. He helped me through the process. Then he watched me do it. Then he left. 

I’m sitting on the edge of my hospital bed. Legs dangling. I don’t know what to do.

The diminutive nurse came in. Notice how I avoided the potentially in appropriate term short once again?

“So, it’s time to get you out of bed. I’ll bet you’d love to go to the loo by yourself.” 

The term loo was my first verification of her accent as English.

“Okay.”

She moved until she was standing directly in front of me. Without hesitation, she grabbed my hands and place on one each of her shoulders.

“Now slide up to the edge of the bed.”

I did.
“Good. Now use me as support and ease yourself off the edge until your feet are on the ground.”

I hesitated, but eventually complied.

“Now take a step.”

I carefully slid my right foot forward.

“Another.”

I carefully slid my left foot forward. And stopped. Something was different than before my surgery!

“Does it hurt?” she asked.

I had to think for moment before I realized—I wasn’t noticing pain. It was the LACK of pain that stopped me. My disk ruptured in early September of 1968. It was now December 21st and the first day I’d had no pain when moving my leg.

“No,” I said.

“Then why aren’t you walking instead of sliding your feet along the ground. Just walk. If you start to fall, that’s why I’m here.”

I looked at her. Under five feet tall. No more than 6.25 stone (100 pounds). I’m 6’ tall and 13+ stone (210 pounds).

“You realize that if I fall on you, you’ll suffocate before they’ll be able to drag you out from under me.”

She laughed.


I was lost. It showed. She continued.

“It’s an English proverb from the time when ships were built of wood. To make them water tight, the builders would coat the interior below deck with tar. 

Unscrupulous builders would use the least amount of tar possible to appear the hold was tightly sealed. But, before long, the ship began to take on water. Many sank and men died.”

“Oh,” was my snappy retort.

“It means to do what needs to be done when you need to do it. Just walk and all will be fine.”

I did. It was.

Weather forecast for the Part 9 blog post: Snowflakes coming!


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Life as I see itTopics rotate between those of general interest to lovers of life,  authors, teachers—probably you, too.  Posts on Tuesdays and some Mondays.  http://crdowning-author.blogspot.com/?alt=rss
My Christian Context.Posts M/W of discussion questions. Thursdays - Timeless Truths. Fridays - Expressions of Faith. https://mychristiancontext.blogspot.com/ 
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Tuesday, December 3, 2019

#Nostalgia #Football #Injury A ruptured Spinal Disk and Giant Snowflakes - Part 7


Gurney circa 1968. Read on to find out why I was glad it had a foot board!

Part 6 ended with...

When I got a nurse’s attention the next time I awoke, things happened rapidly. 
  1. There was some accusatory discussion of who was responsible for my armboards still being attached before they were removed.
  2. I got water to sip through a bendy straw.

  3. I was shipped out of the Recovery Room.

 Let the saga continue!

I have to comment on #3 above. Remember, my day started before 7:00 AM with the not quite strong enough pre-anesthesia shot. By the time I was leaving the Recovery Room, it was close to 3:30 PM. At that hospital, 3:30 PM was when the day shift left and the evening shift took over.

I was on a gurney. A nurse and a male orderly were ordered to take me up my room on the 5thFloor.

Gurneys are not easy to steer. It’s common for the person at the front of the moving gurney—the foot of the bed—to be nothing much more than the propulsion device. (S)He pulls the gurney through the hallways. Steering was relegated to the person at the back of the gurney—the head of the bed. In this case, the orderly should have been at the head of the bed with the nurse in the steering position.

However, since it was time to go home, the quicker I got delivered to my room, the faster the orderly would be able to leave. He took the head of the bed. Having limited if any experience at the foot of a moving gurney, the nurse protested. The orderly prevailed. He began to pushthe gurney.

It was immediately obvious to me, as passengeron this rolling bed, that the nurse lacked precision control of the gurney from her position in the leading end of the gurney. Everyone in the Recovery Room became aware of that within seconds.

As we neared the double doors to the Recovery Room, the nurse darted away from the gurney to push the automatic door-opening button. That left… no one steering

The gurney hit the door frame at full speed. I slid down the bed with my feet clanging against the rail at the foot of the device. Remember, I’ve just had hours of back surgery.

The silence was immediate but short-lived. The Head Nurse of the Recovery Room spotted the departure from standard protocol. She informed the orderly that he and she would be having some one-on-one time before he left for the day. I sanitized that directive a bit. Okay, more than a bit.

After rearranging the driver and propeller, we made it to the elevator, up to the 5thFloor, and to my room without further mishap.

I was larger and heavier than most of the 5thFloor patients. After one feeble attempt to slide me off the gurney, there was a “y’all come” call for help in moving me from the gurney to my bed. Within minutes, five nurses and the orderly had arranged themselves three on a side.

Moving a patient from a gurney to a bed requires the two beds be placed side-by-side against one another. Half the movers reach across the patient’s in-room-bed and grab the sheet on the closest side of the gurney. The other half of the moving crew stands next to the gurney and grab the other side of the sheet.

After the obligatory, “One. Two. Three!” the movers on the in-room-bed side lift the sheet and pull the patient toward them. Meanwhile, the movers on the gurney-side lift and reach across the gurney as the patient rides the sheet onto the in-room-bed. That’s the theory.

5/6 of the movers were tall enough to perform the requisite actions. Mover #6 was a nurse who might have been 5’ tall if she measured her height in the morning in her nursing shoes. She was stationed on the gurney-side of the tableau and was responsible for the corner of the sheet closest to my right ankle.

Understand that the nurse in question was not on the in-room-bed side because the couldn’t reach across the bed, grab the sheet, lift and pull. She lacked the vertical dimension required for that. If you think about it, after the patient is moved, the people on the gurney-side end up in the starting position of the people on the in-room-bed side. 

I’ll wait while you visualize…

Okay, if you don’t have that visualization by now, you might never get one.

As I was pulled off the gurney, about halfway on to my in-room-bed, the vertically-challenged nurse lost her corner of the sheet. I kind of bounced into my final resting position.

Part 8 had another episode with the short nurse very near the beginning.

Oh, yeah. 
I GUARANTEE snowflakes in Part 8!
or 9

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Life as I see itTopics rotate between those of general interest to lovers of life,  authors, teachers—probably you, too.  Posts on Tuesdays and some Mondays.  http://crdowning-author.blogspot.com/?alt=rss
My Christian Context.Posts M/W of discussion questions. Thursdays - Timeless Truths. Fridays - Expressions of Faith. https://mychristiancontext.blogspot.com/ 
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Tuesday, November 26, 2019

#Nostalgia #Football #Injury A ruptured Spinal Disk and Giant Snowflakes – Part 6




Disclaimer.
I’ve never written out this story before. I have no defensible estimate of how many words it will end up. Therefore, there will be no snowflakes again this week. However, I’m almost positive that there’s a possibility that I might get to the snowflakes two weeks from now. 

What’s here today is funny. I’d read on anyway because you'll see the relevance of the photo above. 

But, I’m not you.

I remember regaining consciousness after the surgery. Originally scheduled for something like four hours, the operation ended up taking over five hours. When I did re-enter the world of the awake, I wasn’t really “with it.”

Because my surgery ran long, there were folk in the Recovery Room that would not have been there an hour and a half earlier. Ultimately, there was a plethora of patients and a paltry amount of providers of care. (That is weakly alliterative. Try reading it aloud. Emphasize plethora, patients, paltry, and providers as you read. That makes it sound much more alliterative.)

The first time I woke up, my focus was on my very dry mouth. Sodium Pentothal does that. I guess 5+ hours of Sodium Pentothal creates Sahara Desert conditions in the oral cavity. I croaked some unintelligible sounds, the best I could do to indicate my parched condition. For that, I received a pat on my crew-cut and an “It’ll be alright” from one of the Recovery Room nurses.

I dropped back out of consciousness.

When I awoke the next time, I was determined to get some water… Until I realized something terrible had happened during surgery!

The reason for this occurrence isn’t important. It is sufficient that you know that both my arms were strapped to boards during my surgery and IV needles were inserted in both arms as well. The normal procedure is to remove the boards early in the Recovery Room stay. My boards were not removed. As a result, the second time I woke up, both my arms were asleep.

After realizing I was awake and while preparing to call for the water truck, it struck me. 
The doctor amputated both my arms during surgery!

Before you dismiss that thought as ravings caused by drug-induced lunacy, 
  • realize that my sensory systems were operating far below normal because of the painkiller I was on after the back surgery. 
  • In addition, I had no idea where I was. 
  • Add to that that I had no sensation of any kind in either arm, and you should have a better picture of my situation. 

My priority changed from wanting water to making sure that someone retrieved my severed arms before they were sent down the trash chute.

“Aaa ut rms fff,” I croaked… Repeatedly.

“It’ll be okay,” was the nurse’s response, along with another pat on my pate. Once again I descended into the realm of the unconscious.

The third time I woke up, I was determined to get someone to understand my plight. After all, I’d had both arms surgically removed when I was supposed to have had a ruptured spinal disk repaired. I worked up a mouthful of spit, which was about 1/8 teaspoon of saliva, and swallowed.

“Wa… er,” I managed to semi-articulate.

There must be some protocol in Recovery Rooms about when someone gets water. I think it’s when you can finally make a noise that sounds something like the word water. I say that because I don’t remember having to ask a second time before…

“Here you are,” a nurse said. She placed one hand behind my neck, lifted my head, and placed a single ice chip on my dehydrated tongue. It melted faster than homemade ice-cream in a bowl in the sun at the 4thof July picnic.

I passed out again.

When I got a nurse’s attention the next time I awoke, things happened rapidly. 
  1. There was some accusatory discussion of who was responsible for my armboards still being attached before they were removed.
  2. I got water to sip through a bendy straw.
  3. I was shipped out of the Recovery Room.

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Life as I see itTopics rotate between those of general interest to lovers of life,  authors, teachers—probably you, too.  Posts on Tuesdays and some Mondays.  http://crdowning-author.blogspot.com/?alt=rss
My Christian Context.Posts M/W of discussion questions. Thursdays - Timeless Truths. Fridays - Expressions of Faith. https://mychristiancontext.blogspot.com/ 
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Saturday, November 23, 2019

#Dogs #Pets Chuck's Dog Part 2

Chuck's Dog

I'm reposting this because I miss this wonderful dog.

What follows is a true story. It's about a dog named Duke. Other key players in this drama are Chuck-that's me, Leanne-my wife, Barb-my sister, and Ed-my brother-in-law.
Duke was a faithful companion for a decade. Early in our relationship, we got up at 3:00 a.m. M-F during the school year and walked about an hour each day. I'd drive 60 miles to work, teach, and drive 60 miles home. Duke was waiting for me at the door from the garage at least 90% of the time. 

He was my dog.

Part 1 describes life before Duke, his adoption, and his early time in the family. This post continues to the end of  Duke's courageous life story. 
Warning! If you cry at movies or when you read books, get your tissues out for this blog post.

Chuck’s Dog - Part 1


Family, Continued.

The biggest difference between Duke and Hogan was their response to the WAIT command. Hogan sits and trembles with anticipation. Duke stood or sat like the Sphinx a steely stare boring into the command-giver.

The Stare. This one is demanding a carrot.
When we got Duke home from the rescue people, we discovered that he hated females. This really upset my sister. If a female reached for him, he’d growl. I mentioned his teeth above. We were worried about this trait.

I must say that Duke ignored most people, tolerated some people, liked a few people, and loved me. Over the years his love list grew to include Leanne and Barb, but not many others. 

As a result of this serious difference in attitude and actions towards me, Ed began telling people, "That's Chuck's dog" when asked about Duke. Not "Leanne and Chuck's dog." Chuck's dog. Period. That never changed from either side of the relationship

My wife began feeding Duke. Put the food in the dish. Say WAIT. Put the food down and say OKAY while giving a hand signal. It didn’t take long for Duke to allow Leanne to pick him up. Well, to be honest, he never liked anyone to pick him up. Ever.

For my sister, she began putting her hands on Duke’s sides and saying, “Hug.” We began saying, “Hug,” whenever we picked him up. After about six months, my sister could pick him up. We left him with my sister while we traveled. After that week, Duke and my sister were best buddies. I’m not sure my brother-in-law ever made it all the way to the buddy category.
Saving the world from turtles in Barb's backyard.
The first day we had Duke home, he squeezed under the gate to our backyard. He went around the house. The college student who was renting a room found him on the front porch when she got home. I fixed the fence. Duke never left the house or yard after that to escape—except to chase a pickup truck or two.

Scary Times
The first scary time was a Sunday morning. Duke and I just finished our 2-mile+ walk. As we turned on to the path down the side of the house, I saw two large dogs skulking along the neighbor’s house.

Within seconds, Duke and I were in a pincer move by two Pit Bulls.

I grabbed Duke with my left arm and held him close to me while I pushed on one dog with my right hand, holding it away from Duke. The other dog grabbed Duke by the back of the neck.

I forgot the first dog and poked the attacking dog in the eye with my right hand, screaming all the while.

I heard a sound behind me, as did the Pit Bulls. My neighbor heard the screams and was waving a rake. The attackers loped away.

I shoved Duke through our gate to the backyard and started after the Pit Bulls. They were meandering down the sidewalk. I stopped to watch where they were headed. They caught my scent, turned around, and started toward me.

I took a step toward them, and they stopped.

I turned to head back to my house, and they resumed stalking me.

My neighbor moved between the dogs and me waving her rake from side to side.

The dogs turned and jogged away.

A door to one of the houses across the street opened and a woman stepped out. The Pit Bulls ran up their walk and past the woman into the house. She closed the door behind her.

I went to the end of her driveway.

“Your dogs just attacked me and my dog!”

“My dogs never leave the yard,” was her answer. She went inside her house.

I called animal control. They came out, examined the fence of the Pit Bull house, and required the owners to fix a gate latch and some loose fence boards.

I didn’t take Duke to the vet because, besides hiding in my closet after the ordeal, seemed to have no ill effects. A couple of weeks later, I was scratching Duke’s back and scab material flew out. The Pit Bull had drawn blood.

The second scary time was also on a walk, but this time we’d just turned up the hill at the end of our street. Duke stuck his nose into some appealing smell, yelped, leaped back, and collapsed. His back legs were limp.

I carried him home, loaded him in the car, and drove straight to the vet. The doctor held him under his front legs and pulled his legs toward the examination table. Both feet clunked into the table’s edge.

“That shouldn’t happen,” the vet said. “Dogs will pull their legs up at first contact. I’m afraid this is related to his dachshund physique. Keep him in his crate for a week. You’ll have to carry him out to relieve himself. If he doesn’t improve bring him back.”

We did as directed. Within two days he was able to navigate the dog door. By the end of the week, he was his old self. We still don’t know what happened, but it never happened again.

The next crisis was another oddity. During one of his comprehensive examinations, the blood work came back with a very high titer for a specific antibody. The vet ran the blood two more times, each with the same result. She sent a sample away for more analysis.

The diagnosis that came from the advanced analysis was vague. The vet researched the phenomenon. She couldn’t believe what she found as the most probable diagnosis.

After Hurricane Katrina, thousands of dogs and cats were shipped far from New Orleans because the owners had no way to take care of them. Their fleas and ticks traveled along.
There is a disease known as Ehrlichiosis that is carried by ticks. It was common in the southern U.S. Until Katrina, it was of little concern in California. Duke was diagnosed with the disease.

The vet called a colleague in New Orleans early in the process to ask about the course of the disease and treatments. Her friend reported that the symptoms and complications were so diverse that it was hard to say for certain. A round of antibiotics knocked down the infection, but his titers remained high the rest of his life.

 The Beginning of The End.
One day, I noticed a scaly crust on Duke’s abdomen. Ultimately, he was diagnosed with Cushing’s Disease. It’s a malfunction of the adrenal gland. Too much adrenalin is produced. Symptoms include a calcium crust, muscle loss, and extreme thirst among others. I rubbed DMSO on his abdomen daily for the last 19-months of his life. The DMSO carried the calcium back into his body. He smelled a lot like garlic for about an hour after each treatment, but he didn’t have scaly crust anymore.

Two comprehensive exams before he died, the vet heard a heart murmur. It got worse. His skeletal muscle degraded from the Cushing’s.

Duke was a smart dog. He never tried to get up on any furniture during his last couple of years. Early on, he’d sprint around the living room, banking off the sofa and love seat. He’d launch himself and land on our bed like a box of rocks. To this day, Hogan jumps onto the bed with grace and lands like a feather touching the covers.

Deafness
Duke always came with a single whistle or the "snick" sound I made with my tongue. And, he recognized car sounds as mine or Leanne's vehicle. He lost his hearing very quickly about two months before the end. 

There was a window of maybe a month where more "snick"s or whistles were needed. But, he was deaf soon after I noticed any decline. 

The clincher was one day I came home from working with student writers in Ramona. Duke was at his post on the rug in the foyer, but he was sitting at attention while looking out the tall, skinny window next to the front door. That spot by the window was his letter carrier attack center.

I opened the door from the garage to the foyer. Hogan trotted over from the living room. Duke sat, ramrod straight, ears cocked, eyes out the window.

I "snick"ed.
Duke did nothing.
I whistled.
Duke did nothing.
I walked over to him.
He did nothing.
I squeezed his ear between my fingers, one of the things he loved best.
He gave a start, looked at me, turned, and leaned in for more squeezing and rubbing.

I made sure I did more ear scratching, squeezing, and rubbing after that.

Into the Sunset
He woke up his last day and couldn’t eat his food—too much of the masseter muscle had degraded. He and Hogan were at my sister’s because Leanne and I were visiting our granddaughters in Wisconsin. I came to pick the dogs up around 10:00.

Hogan was outside. That was his normal location at Barb’s house.

Duke was in his bed. Barb had covered him with a light blanket. When I came in, he barked twice. Struggled out of bed and managed to head in my direction.

Barb told me about breakfast.

By then, Duke’s breathing was shallow and labored. I called Leanne and took him straight to the vet. I did not put his car harness on. He didn't give me "the look" like he always did when we didn't strap in to ride in the car. I knew he was worse than I'd thought. I put him in the passenger seat, stroked his head, and scratched his ears while I drove.

When we got to the vet, I sat Duke on the asphalt and started walking. I looked behind me. For about five seconds, Duke pranced just like the day we adopted him.

He staggered. I picked him up and carried him inside. His breathing was labored. I was crying. Somehow I managed to convey to the reception desk that Duke was most likely dying. 

Leanne arrived. They put Duke, Hogan, Leanne, and me in an exam room and blocked off the window in the door. We cried and hugged Duke for what seemed like a long time. One of the vet assistants took him in the back. The vet carried him back to us.

“He’s really in distress,” she said.

All I could do was nod.

Chuck’s dog died in my arms at 11:30 on November 15, 2017, while we told him how much we loved him through our tears. He was probably 11-years old. 

I mentioned the vets above. This day, our vet and I hugged as we cried unabashedly. I cannot thank her enough for her kindness toward Duke, Leanne, Hogan, and me that day. 

We got a sympathy card from Banfield a week after Duke died. I suspect that's SOP. Nevertheless, it was nice to see the vet's name and the others we'd come to know by name.

Epilog
I hope all dogs go to heaven. I'm not convinced of the theological soundness of that position, I posted a Timeless Truths blog titled: Spiritual Lessons I Learned from My Dog on my "Christian Context" blog. The URL is below.

It took me a long time to write the last 12 paragraphs. I had to stop five times because I was crying too hard to see the computer screen. Once, I picked up Hogan and hugged him through my tears and sobs. He licked my face, something Duke might have done to me 10-times in his life.
Clockwise from top left. First hat. On the old backyard steps at our house. With a chew toy--Duke's Godzilla teeth destroyed heady-duty Kongs in 3 months! At Crown Point. Rolling on the new artificial turf while it's warming in the driveway before installation. Sunning on the new steps in our backyard. Center: Chuck and Chuck's Dog taking a nap, which we both liked immensely! I still nap . . .  but it's lonely without my dog.

I think Hogan misses Duke off and on.

I know that I miss Duke all the time. Because
I'm Chuck, and Duke was Chuck’s dog.

Update/March 2022
Below is a photo of our newest dag. Her name is Zoey. She's delightful. I think she and Duke would have enjoyed each another. 
We have photos of Duke and Hogan in this exact spot.
Do you think Zoey was channeling?

She looks like a doxie mix from the side.