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.

On Saturday, we went to Dr. B. for a blood test to see if Bailey’s calcium levels had been reduced. I just heard from Dr. B–Bailey’s calcium levels are back to normal!! This is good news because it means the cancer is not big enough right now to generate enough of the hormone that brings her calcium levels up. (OK, I realize that this is not a very scientific explanation, but I’m not a doctor. I’m only a very worried mom. Trust me–this is a good thing).

Had our family Christmas on Sunday. Feels weird to be essentially done with Christmas by December 18. Bailey was her usual snotty self–into everything and under everyone’s feet like she’s bouncing back to normal. I finally confined her to the bedroom because she was just too energized. She took a power-nap–slept soundly for about an hour which is very unusual when we have a house-full of people.

Today is the 2 week anniversary of her surgery–and the only outside indication is her funky hairstyle. I have to remember to lift her onto the sofa or my bed–and also to lift her off. She jumped off the bed this morning before I could stop her and let out a yelp. I know she hurt herself, and I know she hasn’t a clue WHY it hurts. She looked so scared and lost in her bed afterwards, it devastates me.

I’m waiting now to hear from the chemo doc. I think the worst part of this whole thing is having to wait in ignorance instead of being able to make plans and know what to expect.

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.

I take back everything I said in my previous post about Med Vet–they are some of the nicest, most empathetic people I’ve ever come across!

Bailey had her surgery on Tuesday–Dr. Schertel called me around 10:30 am to let me know the surgery was done and she was in recovery (I also found out later that he called my vet, Dr. B. to let her know what was going on). It was actually 2 surgeries–the first one was to “strip” the 2 sub-lumbar lymph nodes. They did that through an incision that runs from about 3 inches below her rib cage nearly to her little “private parts” down her abdomen. The 2nd surgery was to remove the left anal gland–an incision that runs a little over an inch out from her anus.

We picked her up on Wednesday afternoon. Poor little sweetheart–she looked like some demented Poodle groomer had gotten ahold of her. Her front legs had Poodle puffs around her “ankles” then she was clipped down to her skin around her “calves” with her “thighs” being furry. She has a bare skin patch on the lower part of her back, and her little heiny is totally bare all the way around her private parts and her underbelly up to her rib cage (gives new meaning to “bare-ass nekid!”)

The incisions look healthy, but scary. She has stitches and metal sutures in her belly incision. The little incision off her anus has stitches.

They told me to keep the e-collar on her at all times–but she doesn’t rest well with it on. She behaves as if she’s being punished. So I’ve spent the past 3 days in the bed room with her as much as possible to keep an eye out that she doesn’t mess with her stitches (thank the Good Lord that I can work from home!). She’s stayed mostly quiet. I’ve not had much sleep.

We’ve had 2 traumas.

Trauma 1: Around 6pm on Thursday, Bailey vomited. This was scary because I got the e-collar off her just in time for her to urp (I had only put it on her 15-minutes prior, this was the defining moment for me and the e-collar–I now hate it as much as Bailey does). I heard her whining–she hardly ever whines–I popped off the collar and she threw up a mass of yellow bile (will need to get the stain out of the carpet soon), with a little bit of kibble thrown in (I had managed to hand-feed her 8 kibbles that morning). I called Med Vet. This is where my mediocre opinion about them changed.

I spoke with Dr. Jenny Lang–she works with Dr. Schertel and had been part of my original consult with him. She was more concerned over the vomit than I was (WHAT??). She told me to discontinue the Carprofen–she thought that might be upsetting Bailey’s tummy. She was also a little worried that Bailey had not been eating (see Trauma 2). She said she could prescribe a new pain med from a local pharmacy, if I thought it was needed, and for me to call her back in the morning.

Around midnight Bailey was restless–up to now she had seemed mostly sleepy and content to lay in her bed. I called Med Vet. The Emergency Room vet tech was incredibly empathetic to me–she took the Walgreens phone number (God bless the person who decided that Walgreens would be open 24/7!), and she contacted Dr. Jenny to find out what pain med should be prescribed (probably woke her up at home!). By 1:30am I was giving Bailey her new pain med (Tramadol) and by 2am she was fast asleep. (All of this happening during a massive snow storm–when I drove to Walgreens the only other vehicles I saw were snow plows!)

Trauma 2: Bailey has not eaten anything since Monday night–the night before her surgery. On Thursday morning I managed to hand-feed her some kibbles, but she urped them. When I spoke to Dr. Jenny on Friday morning she said to try anything to get her to eat–chicken and rice or canned food. I called my vet (wonderful Dr. B.) and got a prescription for EVD Low Residue canned food.

OMIGOSH! I gave her a couple of healthy tablespoons with a little chicken broth and you would think she was starving the way she attacked her food! (I guess she was, poor baby, with nothing in her tummy since Monday night!). We did small servings all day on Friday. She seemed to be a little perkier.

At 7pm Mom and I sat down for supper in the great room (first time that we’ve had supper together since Monday night). Guess who joins us! Little Miss Puppy Butt comes out of the bed room (she had not voluntarily left her bed since she came home), not at her usual frisky trot, but at a kinda nervous gait plopping herself down at my Mom’s feet (the best spot for fallen tid bits). She stayed there the entire time we ate supper, then minced nervously back to her bed.

Later on, she “asked” to come up onto the bed with me. She has not done that all week. Around 4:15 this morning she jumped off the bed before I could lift her down and headed for her pee pad. She did a massive pee (first time she’s used the pee pad since the surgery–I’ve been putting a coat on her and “forcing” her to go outside to pee–she hasn’t wanted to leave her bed). Then, wonder of wonders (!), she started to do the poopy dance.

[OK, if you're reading this you probably think I'm nuts, but my dog exhibits definite, definable movements when she's getting ready to have a bowel movement. She does a poopy dance. I don't know how to catalogue it, but I can recognize it when she does it. Just like I can recognize the way she moves when she is uncomfortable (like when she joined us for supper last night). Her moves are fast and jerky, her tail is at half-mast, and she moves to her destination without stopping for anything--not even an interesting smell.]

The whole BM thing has had me worried because–remember–she has this incision held together with stitches at 8 o’clock coming off of her anus. But out popped 2 little poops with no apparent problem! They came out easily, and she did not seem to experience any pain when they did. I felt like doing my own dance. Bailey re-settled herself on her bed with the opinion that I was silly to be dancing around the bedroom in the middle of the night.

Her stitches/sutures come out next Friday. We will also see the radiologist then. I am not convinced that I should put Bailey through radiation or chemo, I hate the idea of making her suffer anymore than she already has! But I’m going to hear what the radiologist has to say.

These past couple of days I find I am able to talk about Bailey’s cancer without crying, maybe I’ve begun to accept it (even as I type this I feel my eyes stinging and tearing up). And I am amazed and humbled at the number of friends and acquaintances who have come forward, asking about Bailey and offering support. I’m still not in much of a holiday mood, but I’ve begun to think I might make it to January.

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.

Tomorrow, we take Bailey to an internal medicine specialist. I’ve spent most of the past weekend as a watering pot with tears coming to my eyes unbidden and unwelcome. Happy Thanksgiving.

She had another blood test last week. Dr. B. called me on Friday to let me know that not only is her calcium level still high, it actually got higher from the last blood test. So she has referred us to a specialist at a clinic in Columbus (MedVet which upon investigation seems like an excellent place to go when you gotta go to a place like this).

On the patient referral sheet, Dr. B. lists as her possible diagnosis Hyperparathyroid or Neoplasia. Neoplasia is a nice way of saying lymphatic cancer. I am a basket case.

There are treatments for lymphoma, and in my head I know that things may not be as bad as they seem.

Ah! But in my heart! In my heart there is a crazy woman having hysterics because her beautiful fur child is about to experience pain and fear. I am totally irrational. There is no logic in my heart.

I can no longer distinguish between normal doggie behavior and behavior that might indicate a very sick puppy. I don’t know if she’s sleeping because she missed out on her normal naps this past weekend or because she’s exhausted from fighting off whatever is causing her excessive thirst.

She drank an entire bowl of water by mid afternoon yesterday. On a normal day, the water level might go down a quarter of an inch. Every lap her little tongue makes in that water dish is a dagger in my heart.

Silly to tie myself up in knots over a little white fluff ball. My eyes burn, my stomach is churning, I can’t concentrate. The next 24 hours are really gonna suck. Christmas? Bah! Humbug. My baby is sick and I can’t stop crying.

Got the blood test results…Her calcium amount has gone down so the “fatty” blood must have been skewing the results. Dr. B. thinks it might be a problem with her liver.

I’m sorta relieved about this, but I’m not ready to start dancing yet. Dr. B. put Bailey on an antibiotic (Amoxi-Tab, 200 mg) 2x a day and something called Denosyl (90 mg) 1x a day. Bailey is in 7th heaven because it means 3 pieces of cheese (I may not be dancing, but Bailey is!).

Found a great way to give her the pills. I always used to wrap them in Velveta, but am trying something from Laughing Cow called Cheesebites. They’re a soft cheese wrapped individually—about 1 teaspoon each. I cut each cube in half for each pill. Because it’s soft cheese I can push the pill into the center of the cheese. Bailey snarfs it down–no time to even taste the pill. I’m able to give her a much smaller bit of cheese then I would using the Velveta–so fewer calories/less sodium.

Two weeks of antiobiotics twice a day, 30 days of Denosyl. I wonder if there’s a support group for dogs with cheese habits.

Once she got over being ticked off, Bailey was surprisingly quiet last night for not having been fed. At bedtime, I got in my jammies and we had an extended groom-the-puppy session–good for both of us on so many levels. When we were done I thought she was so relaxed that she would hit snooze-city. But no! She of the sleepy eyes sits right up and says “so where’s my bedtime snack? And by the way, what happened to my midnight supper?” I pretended not to notice, so she hopped off the bed (in a huff) and sniffed the entire bedroom for the next half hour in case I had hidden her food. Then she flopped down into her own bed (at the foot of mine) and slept there for most of the night. She woke me around 4am getting a long drink of water. After she peed (I think I’ve mentioned my love of pee pads) she asked quite politely if she could come up into my bed where she slept until the alarm went off at 7.

We were at the vet’s by 7:50. The tech came out to the waiting room and took Bailey back–by now she was trembling (another dagger to my heart!). God bless Dr. B.–she came out to explain to me exactly what the goal of today’s blood draw is. First, it needs to be non-fatty blood (hence the fasting); if it is, she’ll send it to the local lab to make sure the calcium numbers are correct and not skewed by the fat that was in yesterday’s draw. If the calcium numbers are still high then the sample goes for more complex testing which will take a week. Either way, no real resolution to what’s going on with my baby girl.

I’m totally useless right now–can’t concentrate–so I’m taking some vacation time. But I had to go into the office today for my flu shot. I work with such a great group of people. As I go bumbling around in this haze of not knowing, my buds are there to share their strength. Dr. D. is like a rock–confirming that Dr. B. is totally on the right path (as if there could ever be any doubt!) I am so effing neurotic about Bailey and Dr. D. is so wonderful about talking me down off the ledge (Dr. B. is pretty good about it to—I’m so thankful for both of them!) S. was also pretty wonderful–she wanted to hug me, but I wouldn’t let her–I knew it would send me right over the edge. And poor K! I was trying to sneak out as quick as I could and he saw me with red eyes and actually chased me nearly into the bathroom because he was concerned about whether it was because of my mom or Bailey. God I love them all!

This whole blogging thing is kinda cathartic, but ICK! I really am getting kinda drippy and maudlin! Time for bed.

OK, here’s something scary that I don’t like at all. Bailey’s been drinking a lot of water. Took her to see Dr. B. (the best veterinarian in the world!) yesterday and they took blood. Dr. B. called me today…her liver and kidney numbers look good, but Bailey’s blood was “fatty” and had a high level of calcium. So I have to fast Bailey tonight and return to the clinic tomorrow so that they can do a fasting blood check.

This sucks on two levels. First, high calcium in the blood can be caused by any number of things including problems with the thyroid or CANCER (my new mantra: I will not research this on the web until I know more). Second, Bailey is used to playing chase the kibble around 9PM, then a late meal at 11:30PM, and a handful of kibble under the pillow for her to root out while we settle down to go to bed. I’m not supposed to give her any food after her 6PM feeding. When bedtime comes, she’s not gonna wanna settle down because she’ll be hungry.

Who am I kidding. I’m not gonna sleep tonight anyway because I’m gonna worry about the possibility that she’s got the big C.