We were at an agility trial in Elk Grove. One of the games is called Full House. Each person creates their own course to try to collect as many points as possible within the set time. Tanith ran her heart out and turned in a great score of 32 points. She even beat Tsuki who had only 27 points. Then we lined up for Jumpers, Tanith's favorite game. And she didn't want to run. She was glum. I took her off course and I couldn't imagine what was wrong. I decided that maybe she pulled something. That was the last run of the day and soon we were on the road home. By the time we got home she was her old cheerful self. Not a sign of any impairment. The only reason I hold this as the foretelling of future events is that it was so unusual for her to be sensitive to an injury. Ordinarily if she were injured I'd have to stop her, she wouldn't stop herself. It bothered me but since it was so short, with no after effects I didn't even consider a trip to the vet. And this is the way it is for most people and their dogs. The early signs of this disease are subtle.
Thursday night when I got home Tanith did not appear to greet me. She tottered out of the kitchen looking terrible. I could see no injuries but her gums were very pale.
I feel fortunate that I knew to check her gums, and understood the significance of their appearance. I took her into the emergency clinic. When I got her to the clinic I told them I didn't know what happened but that her gums were very pale. Someone came out from behind the counter, took a look, immediately picked her up and took her to the back.
Eventually I got to talk to the vet. I really don't know how much time had passed. They said she was stable and they had some tests to run but it would take some time (as in at least several hours). So I went home to wait.
Eventually they called me and said a mass had been detected in the spleen, and there was a lot of free blood in her abdomen. Their best guess was cancer of some sort. If I would choose to do chemo then the best choice was to do a splenectomy and send the spleen in for biopsy.
It was a terrible moment for me. The concept of doing chemo was not the problem. I did that for my Lab, Cindy, for lymphoma and it bought her a decent six months. But I had a suspicion that this was much worse. I remembered a story Chris Zink told at a seminar about her experience with her dog and hemangiosarcoma. I knew of other dogs that had had it. I wasn't sure Tanith would make it through the surgery much less survive for a try at chemo. I took a big gulp and decided that without the biopsy I was jumping to conclusions. So I authorized the surgery.
I was told we could wait until the specialists came in but since that would be at least another 8 hours I didn't want Tanith to have to wait. They did the splenectomy at 4 am.
I was devastated. I didn't know whether I'd ever see Tanith alive again. I also didn't want her to suffer. She looked so bad when I took her in. I pleaded with her to choose, and not make me do it. Tanith was entered in an agility trial in February. Now I didn't even know if she would be alive then, surely she would not be competing. I wrote to the trial secretary and cancelled her entry.
.
She came through the surgery well. They told me that in addition to the spleen there were nodules on the liver. They set in a sample of the liver for biopsy as well. The diagnosis was tentative - there were other things that it could be, but it did look like hemangiosarcoma. I had very little hope. I did some cursory internet research that did nothing to reassure me. The emergency clinic vet was very frank, and not the least encouraging. With the liver nodule it appeared that the cancer was well advanced.
In the morning Tanith was transferred to the specialty clinic that shares the building with the emergency clinic. Theoretically I could have transported her to my own vet but since they have no evening staff she would have had to have been brought right back in the evening. She was not ready to go home. She was having some blood pressure problems, and some heart arrhythmia. It was almost noon before the specialty clinic vets finished "rounds" and examinations and could get back to me on her condition.
That Friday afternoon I got to go visit her. She had a pain patch on (Fentanyl). She hadn't wanted to eat. That just about killed me right there. Tanith? Not eat? They gave me a bowl of food, put a big comforter on the floor, and brought her in. She was clearly uncomfortable, but happy to see me. I did get her to eat the food, all of it. And I was allowed to take her for a quick walk. She peed a huge amount of blood black urine. I stayed with her about an hour and a half but eventually I got the sense she really just wanted to be left alone to sleep. At home she always likes to be in my presence, and she does lots of cuddling, but she never touches when sleeping. When they took her back she didn't even complain. Again, so unlike her.
Tanith got to come home on Saturday. She was looking so so so much better. She was eager to go home and wanted to jump in the car. I had anticipated that and held her down while opening the door, then picked her up and put her in. She had the Fentanyl patch on one flank, and various spots shaved on her legs, and what looked remarkably like a big zipper down her belly, staples instead of thread sutures.
Tanith's recovery from surgery was remarkable. By Monday the difficulty was keeping her from playing and jumping, and scratching at her staples. The biopsy results were not expected until Tuesday, at the earliest. Since I didn't know anything yet I could keep myself in denial and mostly that was what I did. I didn't do anymore research. I was just happy to see I was getting my dog back.
I had been planning on taking Oso in for a lump check. He had some lumps on him that had me slightly concerned. Tanith's experience made it more worrisome. So I took him in for a lump check and brought Tanith along even though there was really nothing for them to do. We recorded Oso's lumps so they could be watched, but none were anything of concern.
The vet looked at her staples and we talked. It was a cautious conversation since we didn't have any biopsy results. We talked about what it likely was, what it also could be, and about my vet's personal experience with her own dog. Although her experience had a poor outcome I appreciated the discussion. For one thing part of the discussion included more "well for my dog this is how it went, but ... " This was the first discussion that suggested that the diagnosis was not imminent death. Not a good prognosis, but a chance to squeeze some good time for us to enjoy together. While waiting for the biopsy results I could take things exactly as I found them. And that was Tanith quickly recovering to her happy self.
One of the problems I had was figuring out how to keep Tanith from scratching at her staples. The usual recommendation is a T-shirt pinned up. But that kept getting all tangled and uncomfortable looking. So I went and bought an infant extra large onesie. I couldn't put her legs through the arm holes but that was easily solved by a cord through the armholes and tied to her collar. It fit snugly, but not too snugly and was lightweight enough that she didn't get too warm. At work we have a covered garage so I took her with me and left her in the car. That way I didn't have to worry about play sessions with my other two dogs and torn out staples. It also meant I could monitor her more closely.
On Dec 20 I sent out a note to let my friends know what's up. I started by explaining that Tanith had the splenectomy in December, then continued:
I've gotten the biopsy results back. It is, as we suspected, hemangiosarcoma. That is a quite nasty cancer. The biopsy results aren't as grim as they might have been. although they are quite grim enough. For those that are interested here are the results: http://www.dog-play.com/biopsy1.html.
If I do nothing she will likely live only another one or two months, although a bit more than 15% of dogs in similar condition made it to a year. Chemo has some chance of improving long-term survival if she tolerates it well. I have an appointment at the end of the month to discuss all this with the oncologist.
I'm just taking this one day at a time. Right now I'm happy that she's happy.
It was at this point that I learned that my friend Ellen and her dog Remington had been going through something similar. Remington had hemangiosarcoma on the heart. I really liked the Taj MuttHall Dog Diary which chronicled things in general for Ellen's dogs, but naturally focused where her attention was, and quite often that was Remington's battle with hemangiosarcoma. I told her pretty quickly how useful I found the diary. It reflected so much of what I was experiencing, so I wasn't alone.
The onesie worked OK for keeping Tanith from scratching, but it really wasn't the perfect thing. I checked out the obvious, dog clothes, but they either didn't cover the belly or they were too warm. I went to a thrift shop and looked at sleeveless girls tops. Then I found the perfect thing. It was a sleeveless girl's body suit. The armholes were large enough I could put Tanith's legs through them. The big scoop neck and stretchy fabric made it fit reasonably well. It was close fitting and I could snap the crotch area around her tail. It was perfect.
By Dec 30th Tanith got the last of her staples out and we went to see the oncologist. We talked about the fact that she had only one bleeding tumor being a good thing, and the liver node was benign. So although chances are the disease had already spread it wasn't yet obvious anywhere. Without chemo typical survival was 1 to 3 months, with chemotherapy it was 3 to 6. Dog have different tolerances for chemo. Some get quite ill, some don't seem affected at all, most have some mild nausea. We could try it and see whether she tolerated it well enough to be worth it, quality of life wise. We also discussed the neoplasia diet that has been found effective for lymphoma patients. But there is no evidence it is effective for other forms of cancer, and there are risks. I don't think that there was much deciding on the spot. By the time I had the conversation I had done enough research to have heard most of it. I knew I intended to do chemo. I left Tanith there for her first treatment of Adriamycin.
When I picked Tanith up she was eager to leave. No obvious adverse effects yet. I listened to a briefing on what to do if she got bloody diarrhea, and to take her temperature, watch out for any signs of illness. I went home with medications. I didn't end up using them. Tanith had no impairment of appetite, no lethargy, no nausea, no signs whatsoever that she had had a very harsh medication dripped into her veins.
I'm ignoring the future and taking pleasure that today she is to all appearances feeling as spunky as ever. If there is any luck to be had in such a situation at least I have that. She tolerated her first chemo treatment very well and that also is a blessing. The prognosis is grim, but all that really matters is today.
Tanith had been on restricted activity for the three weeks following her surgery. Strict instructions were for leash walks only. Certainly neither running nor jumping was to be allowed. Tanith, however, never read the instructions and it took a lot of management on my part to make sure she followed them .... well mostly followed them.
By Jan 21 I wrote
Geez if Tanith feels any better I'm going to be in deep trouble. She wants a lot more action than I've been giving her. Last week was only the forth week since her surgery but I took her to agility class. I wouldn't let her on the a-frame and I only jumped her at 12 but she was raring to go the whole class. This week she is even bouncier. It's like we've gone back in time a couple years. My intellectual side knows it *can't* keep going like this, but of course the emotional side can't help but glow in hope. Wednesday is her second treatment with adriamycin. We haven't discussed Cytoxan beyond a brief mention.
Of course the downside of giving in to the desire for more exercise is the angst of wondering whether we made a big mistake - is that dog bleeding out, or are the muscles just sore from disuse. I checked Tanith's temperature last night just to check and it was fine. Except that this evening I was going through her instructions and saw the warning that I was to contact them "immediately" if the temperature was 102.5. Suddenly I panicked. I thought that I had read 102 and carelessly thought it was OK. I thought that since 102 is not out of line normally that maybe I didn't notice the what (i.e. was it 102.0 102.2. 102.7 or what?) SO I positively flew home alternately telling myself it was stupid, slow down, nothing was going to change in the time it took to get there etc etc etc. I was much relieved to see a normal happy bouncy dog greeting me at the door. I checked the thermometer 100.2 - exactly normal for her. Duh sometimes its hard to trust yourself.
I decided early on that I wouldn't exactly do the neoplasia diet, but I would tip Tanith's diet in that direction. I don't know if it helps, but it sure makes her a happy dog. She needed an increase in calories anyway. That necessary increase is the most blatant sign I have that all is not truly well with her. All her life she has gained weight easily. Now I was supplementing her to maintain weight. I added CoEnzyme Q10 and flax oil and or flax seed powder to her diet almost immediately. Then I did the homemade version of the neoplasia diet and supplemented her food with that. Sometimes I'd add mackerel, but that was so rich. I added Benefiber (guar gum) to any particular rich diet and that seemed to help. When I didn't feel like cooking I'd simply open a can of sardines and add that. I did a lot of research on diets. A popular one is known as the Ginger diet.
I decided that there was good evidence on diet relative to lymphoma, but not hemangiosarcoma. I also noticed with various cancers that sometimes the recommendations were contradictory. That meant that I couldn't necessarily count on the lymphoma diet as being beneficial for hemangiosarcoma. I decided to just work with the general principle but to stay moderate not obsess over it. Every meal consisted of her regular kibble (Wellness) with one of the protein sources e.g. ground beef, boiled beef, chicken, various kinds of fresh and canned fish, eggs, yogurt and cottage cheese. I sometimes added parsley or garlic. Eventually I usually, but not always, added L-Arginine, L-Glutamine, CoEnzyme Q10, bone meal, flax seed powder, flax seed oil, and fish oil capsules to each meal. Since so far she has not actually been immune compromised some of the protein sources are raw, but most were cooked. The biggest "gotcha" I know of in creating your own diet is failure to pay attention to the calcium/phosphorous ratios. On the long term there are others, primarily with micro nutrients, but many of these can be taken care of simply by providing variety. But calcium and phosphorous need to be in balance as metabolzing one influences the other. Meat is high in phosphor, low in calcium. But calcium sources aren't as obvious as you'd think. Cottage cheese, for example, does have plenty of calcium but it also has enough phosphorous that it really doesn't have any extra to balance out anything else. So care must be taken to pay attention to what the source of protein is, and what calcium resources need to be added to keep things in balance. I chose bone meal and Tums as my mainstay calcium additives.
February 8 and 9 I had an agility trial to go to. Tsuki was entered, but I had pulled Tanith fully expecting she would not be able to run. Well they hadn't sent me a refund or had any further communication since I notified them so I wasn't entirely sure that she was pulled. Of course the sensible thing to do would have been to write to the secretary and find out. Instead I waited until I arrived. Once I confirmed that she was not on the run list I contacted the trial secretary and asked if she could possibly be put back in the trial.
For Saturday it was too late, but he said she could run "FEO&" (For Exhibit Only). I ran Tanith in one short game. She had a fabulous time and she even would have qualified. The next day she was entered in everything. I didn't run her in standard but I ran her in Jumpers and Full House and she qualified in each. That also completed her level 3 title for Fun Games in CPE.
After that I started entering and running Tanith just as we had before her surgery. Her condition was not at all evident in her runs. Keeping in mind that she is also an older dog, getting close to 12, her performance was just full of joy. One person watching her commented on how she tended to bounce, rather than run. I grinned. I sometimes get the feeling of bouncing her around the ring like a basketball - boing - boing - boing.
Things are going so well that I'm afraid. That makes no sense at all. I should just be grateful. It's backwards of the issue where your brain knows that all dogs must die while your heart fights the merest notion. In this case intellectually I know this deadly disease has not gone away, and we are not remotely close to miracle survival time, and in fact we are just approaching the 3 months of the 3 to 6 months of survival that chemo hopefully buys. Emotionally, however, she appears so normal in everyway that it is tempting to just put it out of my mind. I don't want to obsess unnecessarily but nor do I want to be surprised or inattentive regarding developing problems.
The inspiration for this page is Ellen's Taj MuttHall Dog Diary. It took me a long time to get around to doing this variation of that diary. I didn't have much in the way of individual inquiries into Tanith's health, but one person told me they were afraid to ask so finally I wrote this page.
Today (March 5, 2003) when I picked up Tanith from her 4th chemo the report was glowing. Most dogs experience a drop in the white blood cell count after chemo. Tanith hasn't, it has always remained in the normal range. She does have a slight anemia, her red cell count drops a bit, down to 32, then back up. But I had my vets check her chart for a year ago and she was on the very end of normal, with a red cell count of 36. So a drop to 32 is not a very big drop.
Although they didn't attach a lot of significance to it I was disappointed to see that Tanith had lost 2 pounds. After the first time she lost weight I was able to put it back on again. Now despite the continued supplemental feeding she had dropped weight. Given her excellent appetite I'm sure I can put it back on her. But that isn't the real issue. The significance is that it tells me there is a cancer in there competing for her nutrition. It is the only continued evidence, which is a good thing from a quality of life point of view. But it is my caution to not take too much for granted. We have a reprieve, but not a cure, and that reprieve could end at any time. From her doggie perspective I suppose that she might not think it is so awful that I'm going to be giving her yet even more foooooooood.
Three weeks from now we will take x-rays then discuss whether to do another treatment or two. I hope that three weeks from now I will be feeling as hopeful and upbeat as I am today. Things can turn from good to bad in a remarkably short time.
Hmpf! I came home today and found I had not shut the bedroom door properly. The consequence of this oversight is that some dogs went into the bedroom, dragged out the big jug of cat kibble, gnawed it open and had themselves a feast. I seriously wonder if Tanith is entirely lacking in the mechanism that triggers "I'm full, quit eating now." Her tummy was packed with food, very tight. The other two dogs appeared happy, but not stuffed.
Tanith has done this before. I watch her for signs of distress and keep an eye on things. Only once did I take her to emergency and that was for bread and tortillas that began to ferment in her stomach so much that she puffed up like a balloon and her intestines actually crackled when I pushed the air bubbles around. That one got her an x-ray and a bemused vet who was astounded at the amount of gas. Treatment consisted of Pepto-Bismol, simethecone, and I think one dose of Reglan. Whatever, it turned out to be pretty much of a non-event.
This time was a non-event as well. But what had me shaking my head was that while her belly was still stuffed with food she was actually interested in my dinner!
That this was all normal dog worry stuff reminded me of a conversation I had this past week-end. We were at another agility trial. I was talking with the owner of the facility about how Tanith was doing and I was expressing my gratitude at how well things have gone so far. I said, "It's as good as a bad thing can be." That pretty well sums things up for the moment.
We went to Madera for the week-end. This was a USDAA trial and Tanith was entered in all the games - Snooker, Jumpers and Gamblers. I ended up scratching her from Jumpers because it was threatening to storm and I was tired, and I didn't want another almost. Anyway this report will likely make sense only to others in agility but maybe the sense of it will come through.
In gamblers Tanith got 20 in the opening, needed 21. Did the gamble - over time by 1 second. For Tanith the gamble was amazing. Normally when I send her away to a tunnel she has to look back and confirm that I really really really want her to do it. This time she didn't hesitate. Went from the teeter away from me out over a jump and kept going to the tunnel, I moved to where I needed to be to get her over a jump on the way back and - unlike many who failed - easily turned her to the table.
In Snooker I didn't get her out far enough so she side mounted the teeter (the #6 obstacle). Otherwise we would have collected what we needed for a Q (Qualifing score) - weren't even whistled off. Just a touch faster and even that wouldn't have killed us. The side mounting just doesn't get points, it isn't a whistle off fault in the opening.
She IS having fun but she also is getting way slow. I can't tell whether that is due to old age or her disease. She will be 12 next month.
I'm a little worried. Something is wrong and I can't put my finger on it. Her gums look nice and pink. She is eating, but not with her usual gusto. She seems a little sore, but I can't tell where. Now I'm glad I decided to leave this week-end's agility trial early, before her only run of the day. I guess I'll see what's up in the morning.
Still don't know exactly what happened but when I let her outside she kind of two foot hopped down the stairs. Eventually I noticed that she was favoring her left front leg. I couldn't localize any painful spots, but that has always been a problem with Tanith and injuries. Then I noticed that the muscle over her left shoulder was constantly twitching. I thought about taking her into the emergency clinic but considering how difficult she is to diagnose on things decided it would be better to wait until the oncologist was available for consultation. Her temperature was normal, color was good, respiration a little fast but no panting, heart rate OK, and while she was alert and oriented she also was actually able to relax and sleep.
I woke up around midnight and checked her out. She seemed perfectly fine. The muscle twitch was gone and she was back to being happy. I let the dogs out and she went down the stairs normally. I'm clueless. She goes into the oncologist for x-rays before deciding whether to do a fifth or possibly sixth Adriamycin treatment. Assuming nothing happens in the next two days I'll report it then and see what she says.
Twenty-four hours later and its like it never happened. Which does not, of course, mean that it was harmless or meaningless. Before I take things going well too much for granted I have to remind myself that we are just barely started on this journey. Yes, I'm very very very grateful that this time has been so good. But this week marks just 3 months - which is the outside survival time without chemo but just the beginning of the extended time I hoped chemo would buy us. Since the time has been so good I don't constantly live under the cloud of foreboding. That makes the events of December seem like the distant past. But I want to keep a sense of reality so that I can maintain whatever mental preparation is possible.
I know from experience that intellectual understanding is of very limited help when it comes to emotional crisis. But it is the only thing I have. It will have to do until such time as it doesn't. And at that point nothing is going to help anyway, I'll just have to ride it out like so much flotsam on the stormy seas. For the moment the seas are calm and the storm clouds are but a grey line on the distant horizon.
So today Tanith went in just for xrays. Any decision about further chemo treatments would be based on the results. First the good news (there isn't any truly bad news). The good news is that her lungs showed no signs of metastisis. There is no evidence of bleeding or spread of the problem. There was also no evidence of what might have caused Tanith's shoulder spasms. Tanith gained weight. Boy! did she gain weight! About five pounds in just 3 weeks. Since it was intentional that she gain some weight this is not a bad thing but I overshot the mark a bit. Three pounds would have been just about right. I'm not exactly going to put her on a diet, but I won't be looking at any excuse to stuff her face either.
Since the xrays looked good now I have to decide whether to continue treatment. Basically it comes down to this (1) will I feel guilty if I continue and she is one of the more unusual cases that suffers heart damage earlier than six treatments or (2) will I feel guilty if I stop and then we have significant a re-occurrence episode relatively soon? My vet phrases it slightly differently. "Pick the one that makes you the least uncomfortable"
There aren't apparently any good studies on whether continuing improves outcome. Who wants to give useless toxic chemicals to their dog? I don't. But then again if they AREN'T useless then I want to use them. Arrrgh. Bottom line, there is no right choice or wrong one. You make your choices and you take your chances. Me? I'm bound to second guess no matter what.
I also asked where Tanith was on the spectrum of patients she had treated. Tanith is at the 50% mark. 50% of her similar patients survive to this point, 50% don't.
One of the sucky things about this disease is how quickly things can go from great to bad. Yesterday we did agility. I pulled her off of jumpers as she tuckered out in the middle. Late in the day she seemed raring to go and we did tunnelers. That seemed OK. Everything was fine when I went to bed. This morning she looked miserable. A little pale in the gums, cool, lethargic, worst of all no interest in food.
Her oncologist wasn't going to be in today, and they had no time available with the internists until 1 pm, unless it was an emergency. So I called my regular vets (who are perfectly competent to deal with the issue anyway) and got her in about ten. She's definetly bleeding. CBC red cell count down to 26. The good news, more or less, is that the ultrasound doesn't show anything significant in the way of free fluid. The reason for the "more or less" is that there is nothing to drain off and make her feel better. There are small pockets of fluid which will get reabsorbed
The course of this disease is that it metastasizes to other sites which eventually bleed. Sometimes it stops and good quality of life resumes and sometimes it doesn't. Which is where we are at. Waiting to see which her body is going to do. At the moment there is really nothing useful to do but monitor her and wait. She is being monitored at the vet's office for the day. They will take a couple more blood counts over the course of the day to see what's going on.
She was feeling much better when I came back at 4:30. Her count is about 24. She was eating. And she wants to be more active than she can be allowed. Before they brought her in we sat down and had one of those discussions. The ones that are only too familiar for those of us with pets with cancer. I guess we are lucky. People don't really get much in the way of choice. But choice is a two edged sword. Having choice means having taking responsibility for the choice.
Just by chance it turned out that the vet checking her out with me, and having this discussion, is also in our agility classes. This made it rather more personal for her as she's seen Tanith in her natural element. There were tears from both of us. Ultimately I decided to not make any decision until after consultation with the oncologist, Dr. Cecile Siedlecki.
One of the problems is that while there certainly can be the kind of decline where you just know that the time has come, that isn't the way it necessarily happens. The obvious goal is to avoid any unnecessary suffering. If that were the only consideration it would be easy to solve. Euthanize as soon as the condition is discovered. But the problem is more difficult when part of the equation includes preserving life while it is of good quality. Especially if you believe it is this life or nothing. Then the question gets inordinately more complex.
Looking at her this minute I can say with confidence that she has no wish to die right now. True she's not at her peak. But she just ate a good dinner, had a good poop, wanted no help down the stair thank-you and is simply tired. I'm not sure I have the strength to say "now" when she is feeling good, but I am very afraid of what my reluctance might impose on her. I don't mean just a couple hours of feeling crummy, but what if she has a serious crisis while I'm at work? Or if I'm asleep and she doesn't wake me? It isn't so simple as looking at whether the bad days outweigh the good. Oh, and you thought that was hard? Well it is, hard. But I went through that with my lab and I did get that look that said "I'm tired of fighting this." What I fear is missing that stage and skipping straight to something that causes true fear, panic, serious pain or misery. Sure it will make the decision obvious, but at a great cost.
I remember at one of the agility trials when I was debating whether to scratch her from a run, or run her. And someone commented that she wouldn't know I had scratched her, so she wouldn't miss it. And from that perspective they were quite correct. But even though she wouldn't miss it she also wouldn't experience the joy of running it. So we did it. She wouldn't have been sad for not doing it, but doing it made her very very happy. So I was glad I stayed. It's the same kind of thing. Surely if I decide "now" she wouldn't know any different. At the same time there are some very good days she might not have a chance to experience. Yet ultimately I will have to decide that those good days come at too high a cost. And the more I try to squeeze out those few good days the bigger the risk that I'll end up putting her through something that will haunt me. It's not the bad days vs good days that trouble me, its the good days at the risk of a truly horrid one that has me wincing.
Guilt. Will I feel guilty? Yes and no. Intellectually I know that if I decided "now" this very second that it would not be the wrong thing to do. And waiting to talk to the oncologist is not wrong - not even if she has a crisis during the night. Oh I'd regret the decision then, but intellectually I'd know it was not a wrong choice. There aren't any wrong choices, just ones that didn't turn out as hoped.
I recently made the comment to a friend whose father was in crisis that if I were in control I wouldn't allow for miracles. The existence of miracles give that tenous hope that increases the burden of the decision. Someone else found the idea of no miracles shocking and horrible. Because hope is what keeps us going in bad times. Well, yes. But this decision would be a lot easier with out hope whispering in my ear.
I know that I will make the best decision I can and I will second guess myself regardless. In the past even when the decision was clearly right I had my wavering moments. My cat had kidney failure. I kept her going for months with reasonable quality of life. One evening she went into convulsions. I made the obvious choice. But even though it was undoutbtedly the right decision I still clearly remember the impulse to the vet back and scream that I didn't really mean it and I wanted her back. And of course I did want her back, but not that way. I wanted her back all healthy. It was the miracle effect at work. The mere fact that they do happen had me wanting to recant. My brain knows better, my guts want to go back in time and keep making different choices until the miracle cure shows up. It is all perfectly normal and predictable, which likewise does nothing to alleviate the pain of going through it.
So it was the right decision and I seconded guessed it. And my decision to wait so long that she had that experience? You know I felt horrible about that but there really wasn't an earlier point where I would have felt OK to have stopped. And to be brutally honest it did make the decision easy. If I could have predicted the occurence I most certainly would have bent heaven and earth to have avoided putting her through that. But absent that ability to predict .... well I guess I'm going to have to do more thinking. I don't want Tanith to have to go through that. Just the risk that she might tears me up. For most dogs the final event it isn't that dramatic. I can look at the sparkle in her eye tonight and decide it isn't time. But oh the pain I will feel if her last moments are not the typical lethargy and undefined maliase but fear and panic. I just have to keep reminding myself that I can only make the best decisions I can. I can't predict, I'm only human.
On April 1, 2003 I wrote an update to my friends to tell them what was up with Tanith.
In her vet records Tanith's birthday is June 1, 1991 but at some point I got Oso's and Tanith's mixed up, switched them and indelibly imprinted those wrong dates on my brain. Since both have unknown backgrounds their real birthdays are unknown and I invented them in the first place. So for all practical purposes Tanith's 12th birthday is today. She managed to survive to see this morning but the margin was unexectedly small. After three wonderful crisis free months she had a major bleed Sunday night. Apparently it stopped on its own - or at least enough that she could recover some spark and appetite. The huge uncertainty factor truly sucks. Her time isn't up now - this minute - all of us (my vets and I, and Tanith) agree on that - but I'm terrified about leaving her to go to work since feeling fine can turn into crap in an instant. These bleeds can hold off for weeks - or not. She could have a rapid bleedout - which apparently isn't too bad as deaths go, or a slow one, or bleed into someplace that interfers with vital functions and experience something more distressing - seizures or suffocation. There is absolutely no way of predicting.
I just got off the phone with the oncologist. Nothing new to add.
I pretty much figured when I wrote the first reprieve section that there was a good chance I'd be writing another one ... or two. At work we have a covered garage. So even though I couldn't bring her inside I could have her close enough to check on her. In the morning she was normal although not as energetic as usual. For our noon walk she was interested in sniffing and sniffing and sniffing and following whatever trails were out there. This despite the slow drizzle.
By the time we got around to fixing the evening meal Tanith showed her old impatient self. She bounced up and down wanting dinner now!. Ah Tanith, a lesson for us all - Embrace life while you can.
Well she's sleeping more, but other than that she's a happy girl. I got the two foot bounce when I told her we were getting ready to leave. One of the best things about this dog is that she's always smiling. It hard to stay miserable around her. With her life is always joyful. For our noon walk we went out to the vacant lot and she had a great time sniffing and rolling, scratching her back with all legs waving in the air.
Some situations give us odd obsessions. Parents and puppy owners are prone to discussions on the frequency and consistency of poop. Caretakers of cancer patients are the same way with the obsession varying by the cancer. Lymphoma caretakers are constantly checked lymph nodes and obsessing over whether an identified lump has grown or shrunk. For hemangiosarcoma the obsession becomes pinkness - as in are the gums pink or pale or white or grey. So this evening as I returned to my car from work I looked at Tanith's gums and thought they looked a bit pale. My heart took a jump as I wondered if another bleed was occurring. But since there is nothing to do and no decision to be made I just took a deep breath and went on. I shopped for dinner, returned home, fed everyone, then messed around on the computer. Just now I leaned over and checked her gums. And so I'm singing "They're pink, they're pink". Ok they are pink now who knows what they'll be like a couple hours from now. I don't want to think about it, for now they're pink.
She appears to be comfortable. She is just lacking in energy. At least she doesn't appear depressed and she is eating well.
It has been a week since Tanith's last crisis. As good as a bad thing can be pretty much describes this past week. After Tanith recovered from her bleed the rest of the week was pretty much unremarkable. What more can I ask for? Well I want a miracle. But if I can't have that I ought to be well satisfied that her quality of life has been good.
I left her home when I took Oso out for therapy dog visits. In each case I was so relieved when she greeted me at the door. One of these days that isn't going to happen, but I'll try to leave dealing with it for then.
Meanwhile I got some OK video and pictures of her walking around the mowed weed lot at WalMart. It is about half acre of what looks from a distance to be a nice lawn. When you get up to it you find it is nicely mowed weeds. It's green because it's been raining. It's really perfect for dog walking because the vegetation is short enough to make pick up easy. And I don't feel guilty because it is not the kind of comfortable vegetation where someone might set a child down to play, or set out a picnic or anything of that kind.
Tanith just came up for some attention. It was so nice to feel her silky soft coat and well padded ribs. For years I worked at keeping her weight down. Now I worry about keeping it on. So far so good. She is no longer skinny. This is a good thing.
Dinner tonight was cottage cheese, yogurt, 1/2 patty of Prairie freeze dried lamb dog food, 1 cup of Wellness kibble, and the usual pharmacy of additives. For her time in the car I stuff a small Kong with some cubes of Steve's freeze dried real food. The frozen version is thawing in the refrigerator for tomorrow's dinner.
The definition of suspense is returning to a seriously ill loved one whom you have left alone for sometime. My vet warned me that it is completely typical to have a sudden and unrecoverable bleedout. More typical, I think, is where the bleed just becomes continuous and they can't make blood as quickly as they lose it. All of it is a rather distressing proposition but not as bad as some scenarios in other cancers. I suppose I should be grateful for that. Anyway each time I return to the van or open the front door I kind of hold my breath. I've lucky with this additional week, and I hope I get another.
Well we didn't get that additional week, or even another day. This morning Tanith's gums were white. She could barely get up the energy to walk down the stairs. Could she pull out of it? Maybe, but she would go through it again. And then she might die alone. At 8:45 A.M. April 8, 2003 Tanith went peacefully to sleep with the help of her caring vet Dr. Dunn. And I went on to work because I will have more than enough time to notice her absence in days to come. And I won't be worried about her anymore. Sleep my little shadow, sleep. I will miss my little pickle dog.
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For us there is no Rainbow bridge, it does not comfort me.
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Tanith's page
You may find these resources to be useful
Help Your Dog Fight Cancer - Empowerment for Dog Owners, Turn Despair Into Confidence, Become Your Best Friend's Best Advocate 3rd Edition by Laurie Kaplan
Home Prepared Dog and Cat Diets by Patricia Schenck
Ultimate Diet: Natural Nutrition For Dogs And Cats by Kymythy Schultze
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Copyright © 2003, Diane Blackman Created: April 2003 Updated November 12, 2007
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