My Fire Hydrant

First, let me say thank you for those of you who have left comments of support and those of you I’ve talked with. We all love our furbabies, and your kind words are treasured.

I hospitalized Bailey this morning.

Yesterday morning she had to be coaxed to eat her biscuits. She flat-out refused the MiniChunks. In the afternoon I noticed a slight change in her behavior. She was a little more confused than normal (she’s almost 14 and I’ve noticed signs of canine dementia for quite a while).  And she totally lost interest in her biscuits. We made her some lean hamburger for supper–she reluctantly ate it. By bedtime she only took a couple of laps of water. She didn’t wake me during the night to get her off the bed for a drink and potty–I woke her at 4 AM–she very reluctantly went out to potty and had absolutely no interest in water. I knew then that it was time.

So at 7 I got up and got dressed–normally Bailey would have moved from her pillow at the head of the bed to the foot of the bed in prep to getting down, but not today. She refused water, food, and she wouldn’t go out to potty. I called the clinic–both Dr. B (our usual dogtor) and Dr. C (our stand-in from Friday) are off today, but good fortune smiled because Dr. T was in. I used to work with Dr. T, so I knew we would be in very caring hands.

The folks who work at the BR clinic are so wonderful! The 2 receptionists were so caring and empathetic as we waited to see the vet tech. They made a point of coming out from behind the counter and giving Bailey a scratch and me a pat. They are such lovely people.

We met first with the vet tech who got Bailey’s vitals. Dr. T was actually scheduled for surgery–but he was able to put it off so he could meet with us first. He did a very thorough exam, asked me lots of questions, looked over Bailey’s records, and took lots of notes. He also did x rays of her lungs and her liver.

The lung xray was to make sure that there was no cancer in her lungs. They’re clear.

The liver x ray was to see if we could get any hint of what might be happening. Her liver is enlarged, but Dr. T also had an x ray of her liver from a year ago and her liver was enlarged then, too. So no significant change in the size of her liver over the past year. He also looked at her blood-work–again, we had the same panels from last year and there’s no significant change.

He called Bailey “our little enigma.” He said that between the blood-work and the x rays he cannot find a reason for her symptoms and maybe we’re looking at a combination of things. Some of the older dogs he treats have lately had more problems with arthritis because our weather has been so cold. Also, he confirmed something that my friend from work Dr. Amy said to me yesterday: Sometimes older dogs who have symptoms like this simply need some fluid support to snap out of it. I’ll call him later this afternoon to see how she’s doing.

One thing I know for certain: we will not do any “heroic” measures to prolong Bailey’s life. I will not put her through invasive surgery or chemo. Her comfort is my paramount concern–and I will not consent to causing her pain just so I can have her companionship for a few extra months. This is a decision I made 4 years ago when we discussed putting her through chemo and radiation. And please understand, what’s right for me and Bailey is not what I consider right for every pet owner. We each make our own decisions based on our own experiences and knowledge of our pets.

I will probably have the dogtors take care of the bad tooth that Dr. C found on Friday–but I need more information about it before I make a decision.

So Bailey is now in hospital, and I miss her like crazy. The house seems empty without her here. But I still feel confident that I’ve made the right decisions. Keeping her home over the weekend allowed her to rest comfortably, and made me feel better too. But today her condition is beyond my skill and she needs the help of professionals. I’m going to do my best to keep thinking positive and hang on the idea that many dogs snap out of these symptoms after fluid support at the vet’s.

But, oh Dog! the house is so quiet.

Well, we’re pretty certain it’s not cancer.

I have that kind of headache that you get with crying.

Dr. C called a little while ago. Her calcium levels are normal (that’s what makes us think it’s not the cancer), her white/red blood cells all normal and blood count good, thyroid normal, her pancreas is good. Even though her bilirubin and albumin are normal, other liver values indicate that there’s something going wrong with her liver. In his words, “Her liver is not pulling its weight.”

His counsel:

• Hospitalize her today
• See a specialist early next week for an ultrasound and a liver biopsy

I pushed back on the hospitalization, and I’m still trying to figure out if I’m being selfish or doing what’s best for my dog.

Bailey and I are very bonded. This has really become apparent during the times I have had to travel in the past year and leave her at home. In nearly 14 years I think I can count on one hand the nights we’ve spent apart. I cannot tolarate the thought of her all alone, in a cage at the vet’s. I KNOW the folks at my vet clinic would take real good care of her–I’ve seen them in action. But they’re not there 24/7. And they close for the weekend today at 1–so it’s not like there would be regular office hours tomorrow. The other option is the emergency vet down the road from my vet. They’re there 24/7 but I have no experience of their work and I am reluctant to leave Bailey in their hands for the next 2 days.

Dr. C says the reasons to hospitalize is so that she can have some support in hydration and electrolytes. But he didn’t work too hard to try and talk me out of keeping her home this weekend. So, as long as she’s willing to eat (anything!), as long as she’s drinking water (and I’m pushing her on that), as long as she’s acting “normal” and not vomiting we’re fine. If she totally refuses to eat anything and/or starts vomiting I will take her to the emergency clinic for hospitalization.

So now we’re again in waiting mode. Dr. C will contact the local canine liver specialist on Monday and arrange for Bailey to have an ultrasound and probably a liver biopsy. She’s an old girl–nearly 14. I have got to do my best to make my upcoming decisions based on her quality of life and not my own selfish needs.

I wish I could stop crying.

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.

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.