Is enough REALLY enough?

"Old dogs, like old shoes, are comfortable.  They might be a bit out of shape and a little worn around the edges, but they fit well." ~ Bonnie Wilcox


Tomorrow is Asa's next oncology checkup. I hate those days. Mind you, I believe the UGA vet faculty, residents, students, and staff walk on water. Heck, Asa was expected to live 2-6 months after surgery (even with chemo), yet here we are sneaking up on month 22! (Yes, you celebrate post-cancer survival like a baby's age when the prognosis is so dire) So I feel so blessed and lucky beyond imagination, but it's still unnerving to return to the scene of the crime each month. 

For extra fun, Asa had some chemo side effects since the last update, and I haven't felt much like writing. What seemed to be a UTI or the beginnings of old age incontinence has turned out to be bladder inflammation brought on by the chemo. As we all know, chemo is poison, and as we also know, the body purges what it can't use. Chemo by-products (or whatever the technical term is) have to stop by the bladder on their way out, thus the frequent advice from our vets that he should get outside to pee-pee frequently. My post-game analysis is that I should have interrupted his champion sleeping habits more often to get him outside more. 

Thanks to the bladder fun, he had to stop chemo. Thankfully he's already on a cocktail of pain meds (NSAID to complement the chemo, tramadol (aka doggie Tylenol in my house) and a nerve blocker for his old man arthritis), so Superdawg hasn't felt the misery of bladder problems. 

Several months ago, when he had been on the metronomic chemo pills for a year, the amazing Dr. R.R. gave me the option to stop the chemo for a couple of reasons - 1) no long-term research on the benefits or side effects of his kind of chemo and 2) good chance the cancer might not come back since he made it this far. But we agreed it probably wouldn't hurt to keep him on it, and I'm ok that we did despite this episode. If it ain't broke, don't fix it, right?

Now we wait for the bladder condition to improve before we even think about more chemo. Could be a week, could be 6 months or more. In the meantime, he needs to go outside every 2-3 hours. Oi vey! Thank the dear Lord for my helpful Superparents who come by my house to take him outside when I'm at work. I simply couldn't play this as a one-person sport, and if you look up "there for you" in the dictionary, you'll see a picture of my Mama and Daddy!

My big worry about being off chemo is... being off chemo. Is "the cancer that ALWAYS comes back" waiting to pounce now? Or has the sum of the treatments been enough to make him the 1 in 100+ who defies hemangiosarcoma and gracefully rides into the sunset of old age?

In reality, it's not my choice to make this time. His body has had enough chemo. We'll continue to celebrate each monthly milestone (heck, every single day!) as extra innings. I just find myself still surprised he's almost 14 and not the psycho puppy he used to be. Except for that sleeping championship he seems to be competing for, he doesn't seem to know he's not a puppy either.

PTSD

"You're not the same as you were before. You were much more muchier.  You've lost your muchness." ~ the Mad Hatter to Alice in "Alice in Wonderland"


On Sunday I found a reddish, purplish* lump on Asa's chin (do dogs really have chins?  I guess it's under his mouth and above his neck), which I thought might be a metastasis. Sure, he's a lumpy, bumpy old man, but I've never seen a reddish, purplish one before.  It must be related to his blood-based cancer, right?  I mean, what other reason could there be for a reddish, purplish* lump?  (* Reddish, purplish is my scientific description)  And I'll admit, I've researched his cancer online many, many times over the past 20 months... and what do you know, the low-res pictures of a skin hemangiosarcoma look a lot like his lump.  Or a million other things... Armchair quarterbacking seldom pays off, kids.


Convinced he was going to collapse on me that very day thanks to a 0.5 cm bump, I called the vet school's emergency weekend number, AND I used his oncologist's personal email address to show her a picture.  Overreact much??  I've probably become that annoying OCD client they dread.  But hey, MY dog is the one who has outlived expectations, so I'm ok with being the crazy lady.


Sidebar - as of today, HAPPY 20 MONTHS CANCER-FREE, ASA!!

(Photo by Alecia Lauren Photography)

So I was freaking out and decided to take him to the vet school 1st thing Monday morning. I figured we had 3 potential situations here: 

1. It's nothing and I'm freaking out for no reason (PLEASE PLEASE PLEASE PLEASE PLEASE)
2. It's a small hemangiosarcoma of the skin and can be removed by simple surgery 
3. It's a hemangiosarcoma metastasis and has internal friends, which could be a dealbreaker

Fast forward.  Yes I overreacted.


They're 100% sure it's not a hemangiosarcoma skin tumor.  Apparently it looks nothing like that, despite my extensive "knowledge" from low-res images on Wikipedia :)  They're 99% sure it's not cancer at all, but since it was irritated and inflamed (which can mask cancer cells), we have to go back next week for another test just to make sure.  I get the honor of putting warm compresses and Neosporin on his chin twice a day until then (not easy with a dog who doesn't like to do anything new).


I'm so relieved.  And I'm also ok with overreacting.  Better safe than sorry, though my blood pressure probably doesn't want another hit like that anytime soon!
Tell me about your experience:

1. Do you get unnecessarily or irrationally worried about little things related to your pet's health?  More so because they've had cancer?  
2. Do you try to armchair QB your pet's (or child's) health?
3. Have you ever successfully armchair QB'd your pet's (or child's) health?

The sidekick

www.alecialaurenphotography.com

Piglet sidled up to Pooh from behind. "Pooh," he whispered.

"Yes, Piglet?"

"Nothing," said Piglet, taking Pooh's paw, "I just wanted to be sure of you."

~ A.A. Milne

Three years ago today, Matilda joined the family (thank you, Atlanta Humane Society!).  She’s a pointer-boxer mix, now 3 ½ years old, 65 pounds of bones and muscles, fast as lightning… and completely skittish and submissive. 

She and Asa make a perfect pair.  He’s overly confident and opinionated, and she loves following his lead.  In return, she keeps him alert and energetic by chasing him, trying to wrestle (and always letting him win), and letting him know when those pesky squirrels have invaded the yard and need an immediate talking-to.  The antidote to old age in my house has been a young dog to shake things up.

There’s a little English girl who often comes on the Ellen Show to sing and rap – Sophia Grace.  And each time, she brings her “hype girl” – her younger cousin Rosie who gives her support and confidence.  My dogs have that kind of relationship – Matilda is Asa’s hype girl!  He is more comfortable at all these vet appointments when she comes along. (see Sophia Grace and Rosie in action on Ellen)


And just as Robin would be nothing without Batman, Matilda was absolutely lost when Asa disappeared for surgery and recovery.  She whined constantly, spun in circles, wandered the house and sniffed for him, laid down in his favorite spots, and whined more.  I had to take her on multiple runs to distract her and use up her energy each day he was gone.

Considering he has 10 years on her and she’s so attached to him, she might have an even harder time than me when he leaves us for doggie heaven.  But we’ll worry about that when the time comes.  In the meantime, Batman and Robin keep things exciting (and messy) around here.

Tell me about your experience:

1. Do you have more than one dog in the house?  How do they get along?
2. Have you had to help a pet adjust to the loss of another beloved pet?

Update (Happy 19 months cancer-free, Superdawg!)

Asa and I went back to UGA on Thursday for his next restaging appointment.  We go monthly for a checkup and bloodwork (you don’t mess around with aggressively metastasizing cancers like this).  Then every 3 months is a biggie when they restage him.  X-rays and ultrasounds and other scary stuff, oh my!  It takes all day, and I take the day off work when I can because I turn into a cranky Katieball of stress.

Ultimately, the goals are to keep his cancer at bay and to keep him in good working condition… as long as he’s happy and pain free (and has no signs of metastasis).  Superdawg has been feeling good and acting playful for the past several weeks (which is odd for a super senior large dog), so I was confident on Thursday.  BUT I’m always still worried.  Any day could be THE day.

I’ll spare you more play-by-play of my self-absorbed stress and emotions and jump to the conclusion.  Lots of old age symptoms are creeping in, but no issues from his medicines and still no cancer!!!  His oncologist, Dr. R.R., even said we can cut back to restaging every 6 months now.  It feels like such a victory!

Then yesterday, March 10th, brought him to 19 months since his emergency and diagnosis.  I celebrate each and every monthly milestone by treating both my dogs to Frosty Paws doggie snacks and peanut butter.  Yummy!

Tell me about your experience:

1. How do you and your vet(s) define success for your pet's situation?
2. How do you celebrate your pet's milestones?

Hazmat gloves & poop bags

A dog owns nothing, yet is seldom dissatisfied. ~ Irish Proverb

My biggest fear about subjecting my dog to chemo treatment was the unknown side effects.  I heard that chemo doesn’t affect dogs the same way it affects humans, and I also heard that they don’t push dogs as far with chemo as they push humans.  Both proved to be true for us, and Superdawg Asa tolerated it quite well… with a few quirks:

It’s dangerous

As I previously mentioned, Asa has been taking maintenance chemo at home everyday since he finished his IV treatment in the fall of 2010.  It’s called cyclophosphamide (a type of metronomic chemotherapy), and I should have noticed that the vet oncologist’s slang term for it is “cyclotoxin.”  Yes, I am administering a hazardous substance at home on a daily basis.  A compounding pharmacy in North Carolina ships a supply of pills to my house each month, and they come with a month’s supply of those blue hazmat gloves.  The bottle and the accompanying literature warn me not to touch the pill without the gloves on, and they instruct me to dispose of the gloves immediately in a sealed plastic bag.

It stinks

Holy overwhelming, smelly dog poop!  Let’s be honest – it doesn’t smell like roses to begin with.  All dogs have stinky waste and toots, and it’s just part of their “charm.”  Well, throw a bunch of hazardous chemicals into your dog’s body, and it takes on an entirely new level of dizzying grossness.  I can’t begin to describe the smell, and I’m sure you don’t need a detailed description.  It’s just gross.

Leave no man behind

Confession:  One reason I bought a house as a single girl (instead of a cute condo or townhouse in the cool part of the city) was to get a big backyard where my dogs could run and play and poop freely.  No more leash walks just for doing “bizness,” no more picking up after them every single time, not for this girl!!

Life’s little way of putting you in your place:  Since chemo makes Superdawg’s poop toxic, guess who’s back to scooping and bagging?  In her own backyard no less!  My neighbors now think I’m weird, but they never ask.

Even more fun:  Stinky, toxic poop must be double-bagged and safely disposed of.

Under a microscope

All of the above add up to laughs and inconvenience.  The bigger challenge for me has been the emotional toll of the monthly oncology checkups.  When your dog is poked and prodded and sampled and examined so often, they find things.  Lots of things.  Even more so because Superdawg is well past the average life expectancy for a dog his size.

For example, he was diagnosed with a heart arrhythmia, and the wear and tear on his kidneys has been exacerbated by the NSAID he takes to complement the chemo.  On a good note, though, the heart problem is controlled by a small pill twice a day, and his kidney issues (which could have been helped by the kidney diet dog food they prescribed but he wouldn’t eat) have been mitigated by fish oil pills.  Yep, the same ones you take for your brain and heart and whatever other reasons.

I get way more information than I bargained for at these monthly checkups.  I honestly can’t decide if it’s good to know every little thing that goes wrong.  I focus on the issues that cause him discomfort or pain or could be fixed by a non-invasive intervention.  I’m not willing to subject him to another surgery or uncomfortable experience.

Tell me about your experience:

1. How have you found humor or encouragement when dealing with your dog’s cancer?
2. What side effects has your dog experienced?  How did you handle them?
3. What are the monthly recheck appointments like for your dog?  For you?

Asa goes to chemo

(Photo by Alecia Lauren.
www.alecialaurenphotography.com)

Why does his hair look like that? ~ my nephew, age 5 at the time

Deciding to do chemo was an agonizing choice.  If I said no, Asa and I would only have 2-ish more months together before the cancer was supposed to metastasize very quickly.  If I said yes, we would potentially get a few more months together – likely no more than 6 months - and chemo wouldn’t be an actual cure.  “This kind of cancer always metastasizes,” I was told, and there aren’t any other “optional” organs like his spleen.  Its favorite next targets are the liver and the heart – both dealbreakers.

I thought and stressed and thought and cried, and it all came down to the fact that I wasn’t ready to accept defeat and do nothing.  To me, the chemo was a Hail Mary pass, not just something to delay the inevitable.  (At the risk of bragging, my dog turned out to be Tim Tebow.  Our Hail Mary pass found a talented receiver downfield, and we’re now just a few days shy of 19 months since his diagnosis)

So we went for it – 5 IV treatments of Doxorubicin at the vet school, spaced every 2 weeks.  Then we started daily metronomic chemo pills at home, starting 2 weeks after the 5^th IV treatment.

Before the 1^st IV treatment, our vet oncologist Dr. R.R. recommended a cardiac consult to make sure his heart was strong enough to withstand the chemo (it’s poison afterall).  Asa passed the cardiac tests, and I thought it was just more $$$ down the drain.  But…  a few months later, Dr. R.R. told me of another dog who was diagnosed with hemangiosarcoma and started the same chemo protocol at about the same time as Asa.  Her owner decided not to do the cardiac consult in order to save a little bit of money, but the dog’s heart wasn’t strong enough, and she died from heart failure brought on by the chemo…  So you’ve been warned.

Each IV treatment made for a long day.  We had to be at the vet school between 8-9am, so we’d leave home at 7.  They would perform a full physical, bloodwork, x-rays, and an ultrasound (which required shaving his torso from his armpits to his man parts – not a good look!).  After all those steps (including standing in line for the ultrasound machines behind emergencies and surgeries), they would put in the order for the chemo cocktail, which took additional time but couldn’t be requested from the pharmacy until he was deemed ok to proceed.

The price of the IV chemo medicine fluctuated.  Apparently the batches come in various bulk sizes, and of course, Asa just so happens to weigh too much for one size and too little for the next largest size.  For the first couple of treatments, there was another dog on the same chemo, so I learned I was splitting the cost of the medicine with that dog’s owner.  For the final 3 doses, we were going it alone – so the cost of the drug itself doubled.  Only a couple hundred dollars difference each time, but still, it was another variable in an unknown world.  I found it stressful because there were so many changing variables, and I didn’t know what would come next – or if he’d even survive to the next treatment.

I should probably dedicate an entire post to the oddities of canine chemo.  It was such a rollercoaster to go through, but now in hindsight with a dog that survived because of it, I have some handy (even humorous) insights.  So more on this topic next time...


Tell me about your experience:

1. What are/were chemo days like for you and your pet?
2. What risks and side effects were you warned about?  Which ones came true?
3. What do you know now that you wish you had known then? (about whatever topic you choose :) )

I have cancer too

Got an unpleasant unwelcome unexpected call from my dermatologist this morning.  My run-of-the-mill appointment last week yielded an unfortunate result - I have skin cancer on my forehead.

"Pre-cancerous?" I asked.  "No, it's already cancer, but it's common and straightforward to treat," she said.

In the cancer olympics, this situation wouldn't even make the practice team.  It just needs to be addressed before too much time passes.  I'll have a little outpatient surgery in a couple of weeks, and hopefully the worst case scenario will be a small scar and a lifetime of annual dermatology checkups to dread look forward to.

From my perspective, this is fair.  This is karma.  I'm fair-skinned and freckled, yet I have spent many happy days springs, summers, and falls soaking up rays and enjoying my childhood and young adulthood at the beach, river, tennis court, and in the stands at baseball games.  I knew I didn't wear enough sunscreen, and I allowed the burns.  I deserve skin cancer.  Cause and effect.  The punishment fits the crime.  And as a bonus, an unpleasant day of minor surgery will hopefully be the extent of my penance.  It hardly seems appropriate to call it the c-word.

I can't help but contrast it with my Asa's situation.  His diagnosis was dramatic, preceded by a violently painful day, and has culminated in a series of monthly pokes, prods, and tests.  No easy out for him.  And not his fault - he's not even capable of making bad decisions.  Not fair.  I guess that's the cruelty of real cancer - no matter if the victims have 2 or 4 legs.  It takes no prisoners, and it often isn't thoughtful enough to identify itself early and accept defeat peacefully.  (Disclaimer - I know that skin cancer is often "real."  I just wouldn't classify mine as "real."  It seems trivial compared to what others are going through)

I have no happy wrap-up for this post.  I'm tired of cancer.  Cancer sucks, and if you're reading this, you can probably relate.  It isn't fair, many forms aren't preventable, and it often isn't diagnosed until it's too late.  Including hemangiosarcoma.

But realizing (today for the first time) that his cancer isn't fair or preventable and that it often isn't easy to diagnose was actually eye opening for me about Asa.  I just now realized I wasn't a bad mother for not seeing the signs earlier.  I didn't fail my dog by not recognizing he was sick until he collapsed in my kitchen.  And it wouldn't have made me an evil person if I couldn't afford (financially or emotionally) to go forward with the surgery, recovery, chemo, and ongoing treatment.  While medical philosophy regarding humans seems to be focused on keeping someone alive at all costs, veterinary medicine seems to consider comfort, quality of life, and other factors when deciding treatment or non-treatment for our beloved animals.  Does that mean we have the option to take the easy way out with our animals, or does it mean we can evaluate a holistic set of needs when deciding how to handle a bad diagnosis?

Tell me about your experience:

1. How would you describe the word "fair"?  Is that even an appropriate standard to judge life events?
2. Did you feel guilty about your dog's cancer?
3. What advice do you have for others just finding out that a loved one has cancer?