Archives for February 2012
Every year for Valentine’s Day, Ben makes me a heart.
I have hearts of brass, stone, wood, lead, steel and leather. This year, he really out did himself.
I am so glad I’m not married to a normal man.
This is the second post in a series on our dog’s diagnosis of osteosarcoma. Read Part I here.
Ben didn’t grow up with dogs. When we finally bought our own house eight years ago and I wanted to get a dog, he had…reservations. But he knew it was important to me. So one March day, I drove to the coast to look at a litter of yellow lab pups. (Ben wanted a yellow lab because they seemed so friendly to him and he didn’t want to be afraid of his own dog. I know, we’re bad people; we didn’t get a rescue dog. Would it help to say Hoover was unplanned? His dad was a fence jumper.)
There were two males left in the litter. I chose the one with the smallest paws, popped him in a crate on the passenger seat and headed back to Portland. For the big homecoming, we took him to the backyard and I put a thin leather collar on him. I think it was a cat collar; it was thinner than my pinky.
I set Hoover down and he started limping around the backyard. Ben was horrified. He thought I was so desperate for a dog that I chose a lame one. I took the collar off and Hoover immediately began frolicking around the flower beds sans limp.
That was our first clue that Hoover was a free spirit.
The second clue was when I took him to puppy training classes and put a gentle leader on him. You know, the type of lead that fit around a dog’s nose to prevent him from pulling you? Hoover threw himself to the ground and refused to move until I took it off.
“Some individuals just won’t tolerate that type of lead,” the trainer said.
Other than this hatred of anything that impedes his bodily freedom, Hoover is happy-go-lucky. He loves everyone he meets and everyone loves him. His recipe for happiness is submit, submit and submit some more. It’s what gets cuddles.
When reading about how well dogs adapt to life on three legs, I assumed Hoover would fall in the “Huh? What leg?” category. The surgeon had warned me that a small minority of dogs seem to experience a kind of depression for a few days after amputation surgery, but they usually come around in less than a week. I shrugged off this warning. I was thinking of the happy-go-lucky side of him and momentarily forgot about his love for being the ruler of his own body.
So Hoover woke up after surgery on Friday, February 3rd and had a major “Where the fuck is my leg?” moment. They gave him some anti-anxiety medicine to help him chill out for awhile. When we went to visit him Friday evening, he was sedated and comfortable. He did manage a few flops of his tail when he saw us, but he was pretty much a vegetable.
We had a beautiful chat with Hoover’s night nurse, Ora, who at one point referred to labradors as the “pure souls of the animal world.” She encouraged us to enjoy every moment we have left, because we have no idea how many moments remain. But she managed to say it without making it sound depressing.
Saturday morning we pick him up. Sharon, another nurse comes out to tell us told us how he’s doing. He’s walking on his own and refuses to move if they try to use the sling on him. He is also on a hunger strike.
He meets us in the parking lot and gives us a brave tail wag. He’s wearing a large vest-like bandage around his chest. It’s the first time we’ve seen him standing on three legs. I lift him into the back seat and sit next to him, holding him steady for the ride home, as he can’t wear his seatbelt harness in his current state.
Once he is safely in the living room, I lay next to him while Ben runs to the pharmacy to fill his prescriptions. Hoover lets go a soft whimper and begins breathing with the same sharp intakes of breath I use when I’m sobbing. This lasts a few minutes before he drifts off to sleep.
When he wakes up, I get him to eat some deli turkey and some pain medication. I take him outside to pee. As he begins peeing he is standing but soon becomes wobbly and sits down mid stream. Also, a scab on his leg from an IV opens and begins to bleed. We bring him inside and wrap his leg. Soon he is crying again. At first he settles down if I am right next to him. Then he only settles down if I’m feeding him cooked ground beef. Then he can’t settle down at all. We conclude he’s in pain.
I call the animal hospital and they tell us to bring him back in. They can give him an injectable pain killer for immediate relief. He falls asleep while I’m on the phone, so I wait, hoping his meds will kick in, but he wakes up twenty minutes later and cries again.
We head back to the hospital with Hoover softly whimpering through the trip. He doesn’t seem alarmed to be back at the hospital. Perhaps he’s was thinking, “Oh good, the last time I saw my leg it was here, maybe they still have it and I can get it back.”
They bring out a gurney out and I lift him onto it and he immediately jumps off. We get him back on, I hold him down and the techs and I walked him inside. They bring Ben and I to an exam room instead of the lobby, as I am sobbing uncontrollably. I am having a “What the fuck have I done?” moment.
The tissue box in the exam room has only two tissues left in it which I quickly cover with snot and tears, so I begin spouting lines from Raising Arizona, “God dammit, H.I.! Ain’t we got enough to contend with?” and help myself by opening the storage cabinet and pulling down a new box of tissues.
The Vet comes in and tells us that Hoover’s vital signs look good. “I don’t think he’s in pain, I think he’s thinking, ‘Where’s my leg?’ and it’s upsetting him.” My tears must have been a topic of discussion in the back because she relays that she told the vet techs that if she was in our place, she’d be crying too. We lament that dogs cannot be told in plain english what is happening and why.
She proposes leaving him there for a few hours and giving him a sedative to help with his anxiety. If he was calms down, we can take him home that night. If not, he can stay overnight at the hospital. She also recommends a glass of wine for us.
I realize I’ve made a mistake by not at least trying to explain the situation to Hoover. Ben and I had felt such a sense of relief once the surgery was over, like the biggest hurdle was cleared. But for Hoover, the misery had just begun.
If it’s true that dogs live in the moment, when the moment is waking up groggy and stumbly and suddenly without a leg, it stands to reason that a good cry is in order.
We call ahead before returning to the hospital. Hoover is more relaxed and ready to come home. We drive to get him and he hops out to the car and before I can pick him up, he jumps into the back seat on his own.
Sunday morning before anyone else wakes up I attempt a doggy mind meld. I crawl onto the floor and take his face firmly in both my hands. “Look Buddy, you had an tumor on your leg and it was going to kill you. We had to have the vet take your leg off so you could feel better. I know it’s scary and I’m really sorry but it had to be done. We love you and we’ll take good care of you.” He blinks at me and licks my hands as I pull them away.
We keep him on the anti-anxiety meds through Sunday. He is so sedated that his bottom eyelids are drooping.
I become the sort of person who makes makes dog food from scratch. Because I’ll be damned if we’re going to drain our emergency fund to pay for surgery and chemotherapy only to feed him food from a bag with god-knows-what cancer causing agents in it. I make a big batch of ground beef, zucchini and carrots. I put in some brown rice but then change my mind. No grains or potatoes. No carbs to feed the cancer that may be lurking in his lungs.
Monday and Tuesday Ben stays home. Hoover mostly sleeps, but is getting good at handling the front steps when he goes outside to pee. He eats, but won’t drink water. And he hasn’t pooped. On the vet’s advice we give him some canned pumpkin to loosen his stool.
The laxative power of the pumpkin may be negated by the fact that we have discovered cream cheese to be the perfect pill delivery vehicle. We were force feeding pills until Ben figured that out; he’d been rejecting even pills tucked in ground beef.
Tuesday Ben tells me the exciting news that after peeing, Hoover hopped over to the mailbox and grabbed the newspaper and ran up the driveway with it. This is an old trick of his, he likes to bring it to the backyard and shred it. He only makes it halfway up the driveway before tiring and going back inside, but it’s solid progress.
I work from home on Wednesday and Thursday, stationed at the dining room table in such a way that I can watch Hoover sleep on the living room floor, which is pretty much all he does.
Wednesday night I notice that his bandage has inched its way forward and is rubbing on his only front leg. I consult the vet and take the bandage off. She recommends putting a tight t-shirt on him to keep that feeling of security the bandage has been providing. Amputees tend to like the feeling of a constant hug.
She couldn’t be more right, the minute I take the bandage off his anxiety spikes. He is panting and uncomfortable. I try a t-shirt, but it doesn’t seem tight enough. I end up swaddling him in two t-shirts and tying a scarf around his chest. Then I place him against a wall with a pillow propped against his amputated side and lay against the pillow. I also give him another anti-anxiety pill.
Thursday when I bring him outside, he takes profound sniffs of the air and tries to lead me across the street to visit the neighbors. Instead Sandi comes to visit us and brings an abdominal wrap leftover from her husband’s hernia surgery. We dress him in a clean t-shirt and the abdominal wrap. It’s the perfect set up.
Thursday afternoon I get a call from the animal hospital with the results of the pathology test on his tumor: osteosarcoma. It’s not a surprise, but I had been fantasizing that it would turn out to be a different, less aggressive cancer. So, I spend the rest of the afternoon crying.
He does not poop for me.
Friday I’m back at work. I get a text from Ben threatening to give Hoover a bran muffin, a cup of coffee and a cigarette to get him to poop. “Do it,” I say.
A few hours later I have the following text exchange with Ben:
Ben: HE POOPED
Me: Yeeeehawwwww! So great! What did it look like?
Ben: It looked just like dog shit. Do you know what that looks like? If not, ask someone or do a google image search.
Me: How much?
Ben: I just got done weighing it with your diabetic food scale and it’s 9.25 oz. What do you mean how much? It’s a little pile of dog shit. Length? Mass? Weight? Displacement?
Me: He hadn’t pooped in 7 DAYS. I want to know if there is MORE TO COME.
Ben: More to come, fuck, I hope so.
Saturday the weather is beautiful and Hoover spends some time with us in the yard. He has a new green jacket to protect his incision until the staples come out. He even takes a trip across the street for a quick pat down from Jim and Sandi.
We expect even more improvement as he slowly and carefully comes off his pain medication. He is already developing a fair bit of speed on three legs.
And it looks like we will be taking our trip to the coast next weekend after all. A few walks on the beach will do us all a world of good. I can already see the three-legged foot prints in the sand.
Yesterday was Hoover’s birthday and we gave him treats.
I get up to take a shower and let her know she can come to the bathroom with me if she needs to know what letter comes next. I expect her to bring her paper and pen and camp out with me while I shower.
In four-year-old style, she runs to the bathroom to ask me what comes after ‘V,’ then runs back to the dining room to write the letter, then runs back to the bathroom to ask what comes after ‘E.” And so on.
The night before Hoover had turned 8 years old. It was also the night we saw the tumor on his leg. In fact, my neighbor showed me the tumor and then several hours later I actually remembered it was his birthday: January 30th.
He had been limping for about a week and after a few days I realized it probably wasn’t a sprain, since it wasn’t going away. I examined his paws and concluded that his toenails were too long.
Somehow I missed seeing the huge swelling on his left wrist.
I’m staying home with Nora who appears to have pink eye. I get out of the shower and begin researching online and catastrophizing. I type in search phrases such as “dog leg tumor,” “hard swelling leg dog” and “dog cancer limbs.”
I soon discover a type of cancer called Osteosarcoma. It is most common in large breeds and frequently occurs in the limbs. It metastasizes quickly and often spreads to the lungs first. Even dogs that don’t show any tumors on the lungs at diagnosis often have it on their lungs, it’s just too small to see.
The standard treatment these days is amputation of the limb and follow up chemotherapy. The best outcomes happen for dogs whose lung x-ray is clear. And the best outcome is to live another two years after diagnosis. Which feels like a nice long time if measured in tennis balls retrieved, liver treats consumed and naps by the wood-stove.
Osteosarcoma is very painful. Part of the reason amputation is indicated is to stop the pain associated with a bone that is slowly exploding.
Another bit of research tells me that dogs don’t give a shit if they only have three legs, as long as they’re not in pain. It’s people who get squirmy at the idea of amputation.
I watch inspirational videos of “tripod” dogs enthusiastically catching frisbees and swimming.
We see the Vet on Tuesday evening. She is “worried about how firm” the swelling is. I tell her I know what it could be. The x-ray confirms our fears.
A second x-ray tells us that his lungs are clear. The Vet says there happens to be a radiologist in that day who was able to review the pictures. Which means he probably has a bit of cancer there, but it is still too small to show up on an x-ray. Still, I take this as good news. Treatment has a chance of working.
We leave with pain medication and a promise that the office will call tomorrow to provide and estimate and a time slot for the amputation, the sooner the better, we agreed.
When Hoover and I get home, Ben and Nora meet us outside and we all cry. I have been sending text updates throughout the visit and called with the bad news after the first x-ray. We get in the house and after giving Hoover a dose of pain medication wrapped in turkey, I do my best to explain to Nora what is happening. Hoover’s limp is because there is bad thing growing in his body and we need to get it out of there so he can feel better and be healthy. He will have a surgery to cut out the bad part and then we must take care of him until he feels better, which won’t take long. She is not bawling, which either means she doesn’t understand or she’s too scared to cry.
Being the pain in the ass that I am, I call the Vet’s office as soon as it opens at 7:30 the next day. The front desk tells me that I’ll get a phone call as soon the doctor who will do the surgery (not the same as the doctor who made the diagnosis) has a chance to get in and review the case.
By 12:30pm no call has come. I call again. I am able to schedule the surgery for next Tuesday (which is too far out in my opinion, given that dogs die in about a month without any treatment) but the Vet is still too busy to talk to me. I am not provided with an estimate. I am assured that the Vet will call me sometime today.
When I get home from work I schedule an appointment with a veterinary oncologist and then report to my friend Sandi’s house across the street. I tell Sandi and her husband Jim everything I know. Then Sandi pulls me into the other room to tell me that when she asked Nora about Hoover, Nora wouldn’t answer. Sandi asked her if she didn’t want to talk about it because it hurt too much and Nora nodded, a single tear trickling down her cheek. Sandi and I agree that Nora needs a good cry over this.
As we are crossing the street back to our house, Nora says, “Mommy, I’m not ready for Hoover to die.”
“I’m not ready either, Nora. We’re going to do everything we can to help him feel better. It’s very sad and I’m glad we can talk about it and help each other out.”
By seven o’clock no call has come from the Vet and I sit down to write an email. I praise the service I have received over the years but express concern that I have not heard anything yet.
Thursday morning as I walk from my car to my office I see I just missed a call from the Vet’s office. I call back immediately. The Vet asks if I listened to the message she left and I say no. She tells me that she reviewed Hoover’s chest x-ray and she believes he does in fact have visible tumors on his lungs. She says another doctor at the clinic agrees. She has sent the x-rays for a radiation referral and has not heard back yet which is why she didn’t call the day before. She advises me that if the cancer is visible on his lungs, she would not put Hoover through a major surgery.
I am devasted. I stand on the sidewalk sobbing and finally scurry into my building. Tear soaked, I ride the elevator to my floor and flee to a conference room to call Ben.
We both cry. We know we cannot put Hoover through all of this for nothing. If it’s too late, it’s too late. A thoughtful co-worker opens the door long enough to place a box of tissues on the table.
I explain to my boss my new situation and she tells me to go home. I call the oncologist we were to see at two o’clock and get our appointment moved up to 11 o’clock, explaining my primary vet’s assessment of the chest x-ray.
I head back home and Sandi, my dear friend and neighbor and I cry for awhile. Hoover is delighted I’m there and follows me around constantly. I stroke him and cry. Then we all head to the doggie oncologist together.
The first thing the oncologist tells me is that she reviewed the x-rays again after I called and she disagrees with the primary vet’s assessment. She doesn’t believe the eight 1mm spots on the x-ray are tumors. She believes they are blood vessels. “The x-ray takes a 3 dimensional picture of the chest and then smashes all of the images together.” The spots in the picture correlate to blood vessels that flow through the lungs and are basically cross-sectional pictures of blood vessels. She wants to see what the radiologist comes back with just to be sure, but feels very comfortable moving forward with the assumption that any cancer in the lungs is still too small to see and therefore treatable.
God Bless the specialist, I think. (And I am agnostic.)
She also says a diagnosis of osteosarcoma is a best guess. A biopsy may be able to tell us for sure, but may not and it risks fracturing the compromised leg. The other types of cancer it could be are less aggressive. But in any case, the leg should come off. We talk about the option of chemotherapy post surgery if osteoscaroma is confirmed once the amputated leg is tested. I also readily agree to donate a sample of Hoover’s tumor to a Oregon Health Sciences University study that is using DNA analysis of dog osteosarcoma to help develop treatments for human children with the same disease. This helps assuage some of the guilt I feel over being lucky enough to live in the first world with enough money to buy chemotherapy for a dog when there are children in the world who are sick, starving and unvaccinated.
I tell the oncologist that I do not want to wait until Tuesday to amputate and she arranges for a surgical consult with the animal hospital where her clinic is located. In a few minutes, I have Hoover’s surgery booked for Friday (tomorrow!) and I am speaking to a veterinary surgeon so confident and reassuring that I would have little reservation about her operating on me.
They give me an estimate for the surgery and the chemo and the Vet tech walks me through every line item.
Hoover gets a thorough exam and some blood work. If the blood work comes back with an indication of other health problems, we will have to re-evaluate the surgery, but at this point I feel better now that we have a plan in place. I give Ben the good news by phone.
We head back home to enjoy the unseasonably sunny weather and Hoover’s last day on four legs. I can’t wait to get that fucking tumor off of him.
To be continued….