My Fire Hydrant

Last night, I heard from Dr. Fulton who is the chemo specialist at Med-Vet. The conversation felt a little cold and clinical, but I guess you have to be when you’re a doctor who’s patients are all gonna die soon.

Here’s what she said:

With the surgery alone (Option #1), Bailey will probably live 5 to 6 months more. She feels that this is an aggressive cancer (which is not what I got from Dr. Prescott) because it was so small in the anal gland and yet spread to the lymph nodes.

Option #2 is radiation and chemo. Not gonna happen for my dog, so don’t even mention it. Option #3 is chemo.

Chemo is a drug therapy. It is given less frequently and in lower dosages than for people because the goals are slightly different. For people, they want to do everything they can to prolong life. For dogs, they want to do everything they can to maximize the quality of life for as long as possible. Because it’s in lower dosages, only 20% to 25% of dogs have mild flu symptoms which include nausea, vomiting, loose stools, and lack of appetite. These symptoms usually resolve themselves in 12 to 24 hours.

For Bichons, there is also hair loss–so Bailey would need a coat when it’s cold and a tee shirt to protect her from sun burn in the warm months. Because the chemo drug kills all rapidly dividing cells, there’s the possibility of anemia (it kills red blood cells) and immune problems (it kills white blood cells).

She told me about 3 chemo treatments:

1. An oral medicine called melphalan. She said the research on this med is anecdotal, so she is not really certain how good it is. The dog gets a pill once a day for 7 days, then is off for 3 weeks for the rest of the dog’s life. You pay $3 per pill plus the costs of blood tests to monitor the cancer. I could do this at home.

2. An intravenous cocktail made up of doxorubicin (or mitoxantrone) and carboplatin. Once every 3 weeks, for 6 to 8 dosages over between 18 to 24 weeks. This has been shown to be most successful in anal sack carcinomas. It costs between $250 and $300 a cocktail. This would probably have to be done at Med Vet.

3. Immunotherapy–where you try to turn the dog’s immune system on against the cancer. This is done with something called piroxicam which is an NSAID. Side effects are mild–although it might cause ulcers because it is a cox 2 inhibiter so the dog also takes an OTC ulcer drug like Pepsid. It could cause liver or kidney problems. This drug is not intended for cancer therapy, but has been shown to work (they don’t know why). She would stay on it for 6 to 10 months and it would cost approximately $60 a month for the pills. I could do this at home.

THE DOWN SIDE: All of these drugs have only a 50-50 chance of even WORKING! Half the dogs who do chemo have NO CHANCE OF IMPROVEMENT WHAT SO EVER! And the half that do have improvement live for 2 to 3 years.

I’m still not 100% sure what’s the right thing to do, but I think the door is closing on chemo.

Today we trekked back to Columbus to get Bailey’s stitches out and to meet with the radiologist. Dr. Prescott has amazing credentials–she’s like the top dog of radiology in the three closest states.

For maximum tumor control, we have “Full Course Radiation Therapy.” This is one radiation treatment a day, Monday through Friday for 4 weeks (19 total treatments). The side effects include a “weepy” wound on her butt, sorta like a hot spot but more painful, which shows up approximately 3 weeks into the therapy and lasts for approximately 4 weeks if it’s kept clean. If it gets dirty (remember this is on her butt right where the poop comes out) it could be a problem for a couple of months. Additionally, the part of her colon which would be in the way of the x-rays could be damaged which would mean it loses its elasticity and would kinda close up so she wouldn’t be able to poop normally. The cells lining the last part of her intestine would also be effected and she would probably have several weeks of bloody, possibly painful, diarrhea. Lastly, because Columbus is so far away, she would have to board at Med Vet while she’s having treatments and come home on the weekends. Dogs with cancer like Bailey’s have an average life of 2 years with this kind of treatment–but nothing is guaranteed. Can I put my dog through 2 to 3 months of hell with no guarantee?

Chemo is also an option–along with radiation or by itself. The chemo specialist is gonna call me for an over-the-phone consult early next week (she was gone to a funeral today) so we can discuss the side effects and the lack of guarantees.

If we let things go as they are–surgery alone–the pup will probably live somewhere between 3 months to a year. This is a slow growing cancer, and the high calcium levels that it creates will probably compromise her kidneys or her liver before the cancer has a chance to kill her. It’s recommended that we do blood tests every month as a way to monitor the cancer. We have an appointment tomorrow at Dr. B’s for a “threshold” blood test–to see if the calcium levels were lowered by the surgery (I think they must have been–her water-drinking is back to normal).

I’m totally freaked out about the radiation treatments. Bailey has such sensitive skin, she’s used to peace and quiet, she’s used to being at home with us. My heart cries out against punishing her for 8 to 12 weeks in order to buy her an extra year, if that.

Am I being selfish? When Bailey is suffering and uncomfortable, I’m a basket case. My concentration sucks, I’m depressed, it’s hard to get any work done. I’m not sure I have the strength to put myself through the suffering she would have with radiation treatments. I keep remembering my Uncle Ollie–he died of lung cancer. By the time they diagnosed it, he was so sick and tired that he decided it wasn’t worth going through radiation in order to live a couple extra years. He went into hospice and though I won’t say he died happy at least he died clean and comfortable–which is what he said he wanted. I want Bailey to be clean and comfortable.

I’m really starting to feel that a hospice approach might be the best thing to do, but I’m conflicted. Some days I feel like I’ve accepted the fact that somewhere a stop watch is running down my time with her. Some days I wonder if I’m in denial. Am I doing what’s best for her, or for myself?

And since Monday she’s been sneezing off and on like crazy. Dr. Prescott the eminent oncologist said not to worry, it’s probably nothing. Of course, it might be a small tumor in her nasal passage unrelated to the one that was in her butt. And it would be inoperable because of it’s location. More good news.

Today, my sweet little girl had surgery to remove her left anal gland and 2 sub lumbar lymph nodes. Dr. Schertel just called to say the surgery is complete and she’s doing well. I’m to call tomorrow to see what time I can pick her up.

I was not totally thrilled with my first visit to Med Vet–but maybe I’m also looking at it through the lens of my grief and anger. This second visit has been a little less frustrating. Dr. Schertel–Bailey’s surgeon–is very nice, very informative.

We took Bailey to Columbus yesterday for a consult with the surgeon–though we were pretty certain that we would be leaving her for surgery today. After a 45 minute wait (I’m beginning to think this is normal for Med Vet–you schedule an appointment but end up waiting 45 minutes anyway) they took us into the exam room where we waited another 30 minutes.

Once we got into the exam room Bailey started trembling. I wrapped her in her blanket and I think the warmth calmed her down. We waited. A vet tech came in, talked to us, then left. We waited. Then another vet tech came in and asked if we wanted x-rays to check that her chest had not been compromised. So she took Bailey for x-rays and we waited some more. Then the Dr. Schertel came in–and left almost immediately afterward to do an anal exam of Bailey. We waited. When he came back we talked through how he would do the surgery. He was very patient with me–answered all my questions (I got a much better feeling from him then I did from the internal medicine guy who seemed like he was always watching the clock–maybe he charges by the hour).

I got through almost the entire thing without crying–but then I broke down at the end. And I really felt crappy because when the vet tech took Bailey to be x-rayed I didn’t realize that Bailey would be staying on the other side of The Door (there are 2 doors into the exam room–the one that the client uses from the waiting room, and The One that the staff uses. This 2nd, mysterious and terrible Door, goes into what looks like a back hallway–maybe a parallel universe. It’s The Door through which issues all hope and all despair. It’s The Door to wellness or the rainbow bridge. I don’t like this door).

So there I was, in tears, and unwilling to upset my little dog by bringing her back into the exam room, so we left Columbus without saying bye-bye to the puppy.

Last night and this morning have been a little surreal. I keep hearing Bailey getting into mischief–but she’s not there, she’s in Columbus. Dr. Schertel said I can call later today and ask how Bailey is doing. And then call tomorrow to get her release time.

She’s gonna be wearing an e-collar for the next 2 weeks which isn’t gonna make her very happy.