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?

To chemo or not to chemo?

Scratch a dog, and you'll find a permanent job. ~ Franklin P. Jones

"Without chemo, he will probably live another 2 months. With chemo, he might live up to 6 months." Well, why would I subject him to the misery of chemo when it's only going to extend his life a few months???? I might have actually yelled something like that (with a choice word or 2 to emphasize my point) at Surgeon as he suggested that I have a sit-down with UGA vet school’s oncology department.

I did a lot of crying and somewhat pulled myself together, and a week later, Dr. R.R. the oncologist and I had that sit-down. It never hurts to have a convo and get the scoop, right? I mean, what if she might offer a miracle cure?? (nope! no such luck)

Her suggested course of action:

• Cardiac consult  to make sure his heart was healthy enough to take the chemo (chemo is poison, afterall)
• IV chemo Doxorubicin once every 2 weeks for 5 treatments (2 weeks x 5 treatments = 10 weeks)
• Daily NSAID pill at home to help the chemo’s efficacy
• After that 10 weeks, metronomic chemo - cyclophosphamide pill at home each day – and continue the NSAID… until the cancer metastasizes (the elephant in the room) 

Surgeon and Dr. R.R. – now one of my favorite people in the whole wide world – both gave lots of helpful info, but they were practical and sterile and honest about the pros and cons. That’s the right thing for a medical professional to do afterall. But I wanted some perspective on what it’s really like. I was still stunned that dogs could even get cancer!! And I sure didn’t comprehend yet that there was a whole vet specialization full of big words and drugs and poisons I couldn’t pronounce.

Then out of nowhere, 2 beautiful people - a knowledgeable vet friend of a friend and my colleague whose husband is a dog trainer - shed some light... chemo doesn't usually affect dogs the same way it affects humans. They usually don’t experience all the hair loss, nausea and diarrhea, lethargy, and the all-around rotten feeling. (Disclaimer: I don't know whether that's a medical fact or not, but it proved true for Asa) And the vet friend of my friend threw in some additional considerations for me to ponder:

• Can I afford it?
• How will it impact his quality of life?
• How will it impact my quality of life - financial trade-offs, all the visits to the vet school, setting a schedule around his at-home medicines, being available to let him outside more often (chemo can cause kidney issues if they don't go potty every few hours), delaying the inevitable loss of him?
• What maintenance regimen will they prescribe after the initial IV treatments?

So basically, a (not at all) straightforward, simple, everyday decision...............................

Tell me about your experience:

1. What factors informed your decision to pursue or not pursue cancer treatment for your pal?
2. Who was helpful in making your decision?
3. What is your dog's treatment protocol?

Hemangi... huh??

One reason a dog can be such a comfort when you're feeling blue is that he doesn't try to find out why. ~ Unknown

Hemangiosarcoma is a huge, ugly-sounding, complicated word. So is its parent - cancer. It’s mean, and it’s selfish, and it takes no prisoners. I didn’t know my dog was sick and hurting… until I found him collapsed on my kitchen floor in a pool of his own urine. Called my father, and he rushed over to help me take him to the vet to put him to sleep (so we thought). Asa weighed 80 pounds, so I needed help just to get him into my car.

My loyal buddy groaned this excrutiating noise and lost control of his functions all over my shins and feet as we lifted him and carried him to the car. Found out later his spleen had ruptured, and he was bleeding internally and in a ton of pain. Even though I thought I would have to put him to sleep that day, I couldn't drive to the vet fast enough. I just wanted to ease his pain, make him feel better as fast as possible.

Fast forward a couple of hours, and we were leaving the vet (with my dog still in the game) and heading to the University of Georgia's vet school, about 45 minutes away in Athens, GA. His vet (Dr. N.C.) diagnosed his ruptured splenic tumor via ultrasound and determined that he had a significant amount of internal bleeding. She told us he might make it if we got him to surgery fast enough.

Upon arriving at the vet school, everything happened in a blur: he was taken into the back, but my dad and I had to wait in the lobby... saw several vet residents and vet students... Emergency specialist, Dr. S.O., said he was bleeding out quickly... connected him to IV fluids... my mother arrived too... got to see him... my gorgeous, fiesty lab mix was a meek, exhausted blob of fur lying on a rolling cart with tubes and IVs everywhere... I sat down on the floor next to him, and he flopped his head on my hands when I offered them... Vet Surgeon came in... 2 options - surgery which he had a 50/50 chance of surviving because of the blood loss... or put him to sleep. Since he would be under anesthesia and not in pain, I was willing to give surgery a shot... blah... Go home, and I'll call you by 2am... blah... but first, do you want to sign a DNR?... oh and we need a credit card for a HUGE deposit... blah... blood transfusions... blah... potential things that could go wrong......................................................................

He lost approximately half of his blood from the internal bleeding and the surgery, but he survived (thank you, doggie blood donors!). Huge ruptured tumor on his spleen but no other tumors, nodules, or spots in or around his stomach, liver, lungs, and all those other necessary organs. I thought we'd already been through a lot, but that was only the 1st hurdle... He stayed in doggie ICU for 2 days, and I came to visit him each day.

To the vet tech he bit the day after surgery, SORRY!!! Surgeon actually apologized to me instead - said Asa gave them a warning growl when they checked his EKG pad things, and they knew better than to corner a wounded dog, but they kept messing with him... His chart now has the scarlet letter stamp of shame - WILL BITE.

Fast forward a few days, and Surgeon called me with the biopsy results. The worst possible results. It was hemangiosarcoma. A word I couldn't say correctly until I practiced it. Chance of survival past 6 months is less than 5%, and that 5% is almost exclusively comprised of dogs they catch before their spleens rupture. He was probably going to be on the lower end of the 2-6 month scale because all that contaminated blood had been pooling in his abdomen, microscopically metastasizing its hatred. This cancer is aggressive, and it obediently follows the average prognosis, almost to the day.

I took the rest of the day off and spent the afternoon lying on the floor next to him and crying. He licked my tears off my cheeks. He's thoughtful like that.

Tell me about your experience:

1.    How did you realize your dog was sick?

2.    What decisions did you have to make?

3.    What helpful resources did you find and use (people, websites,
etc)?

Superdawg!

There is only one smartest dog in the world, and every boy has it. ~ Unknown

My dog is a superdawg.  It’s a complete miracle that he’s still alive. His name is Asa [A (as in “play”) – suh], but explaining his name and why I chose it will require its own separate post.  He has been the linebacker type since the day I met him at the Athens, GA pound.  Clay Matthews would be proud of his blonde hair, sneak attack from the outside, charming way with the ladies, and all.  He's now 13 ½ and still a force to be reckoned with.  Never had Cesar Milan-approved manners (I tried and failed), but a boisterous, social guy who used to welcome everyone at the door with 2 paws off the floor (don’t tell Cesar…). 

18 months ago, my Asa collapsed, and I thought we’d have to say goodbye.  After emergency surgery and 3 of the worst days of my life so far, he was diagnosed with hemangiosarcoma.  All kinds of cancer are bad.  Hemangiosarcoma is an imminent death sentence for a pooch.  For some miracle reason, Asa is the superdog superdawg (spelling = nod to his UGA vet pals) who has busted the curve.  February 10^th was his 18-month Asa-versary since his surgery, and YES, we had a party!

Superfriends made him a Superdawg cape
(more on Superfriends later)

I know slightly more than Jack crap from a medical perspective about his kind of cancer, why treatments aren't effective, and how they try to delay the inevitable… but I know LOTS about what it feels like as his mama to get such an abrupt diagnosis, how difficult the decisions are, how expensive the treatment options are, and how stressful it still is every month when we go back to UGA vet school for his oncology recheck.

I've made accidental new friends around the country whose dogs have also been diagnosed with hemangiosarcoma. Their comments and questions range from "what's your miracle cure?" to "don't you know that dogs can't survive without a spleen???" and everything in between. To the 1st extreme, I'm sad to say I don't know the miracle cure.  I’d hand it out like candy if I knew it!  We've been extremely blessed, and his vet oncologist and general practice vet both say he's the most successful case they've seen.  So I don't have magic answers, but I'm happy to share our experience and let you know what the ride has been like.  To the other extreme who think the vets have ripped me off because "dogs can't survive without spleens," all I know is that my boy has been doing just fine without his for 18 months.  I wouldn't be surprised if it's a life-ending surgery for some sweet pups, and my sympathies to those owners.  In Asa's case, it was do the emergency splenectomy to save his life… or put him to sleep right then and there, so I didn’t worry until later about the pros and cons of having a spleen.  More about that drama later though...

I'm writing this blog to share my experience.  Having a dog with cancer might sound like a silly problem until it’s YOUR dog.  I have been blessed with supportive families and friends and some amazing, caring vets, but it has been tough to find dog people who have been there and could openly talk about the experience and let me know what to expect.  Hopefully Asa and I can pay it forward by telling our experience.