Tuesday, April 24, 2018

The Road of Radiation. Veterinary Radiation Therapy. My Jekyll's experience

It is Tuesday, the designated cancer day in our family.

Jekyll has retired from the chemo circuit. It has been a long run, and I have to say my little boy looks pretty darned good for the barrage of poisons we have forced into his athletic beagle body. If pets are a reflection of their owners, this boys determination and stamina have me set for almost anything life wants to toss at me. That boy wagged and winked through every round we gave him. Four doses of Gemzar, and before that three other drug trials to cover 9 rounds in total.

Today is round one of radiation therapy. Today is also the first day that I am tentative about the steps I am taking. I am not even sure why? It is my gut talking. The longer you live in vet medicine the more you listen to your gut. I don't know what's with this unsettling gnawing, but, this is more than new therapy jitters.

This is fear. Unadulterated, massively apprehensive fear.

This is our last shot. I suppose most of my guarding and clutching him today is about whether this will work. I have to leave him with strangers for this last step in the hope of beating the demons residing in his belly. The fear is also my not wanting to accept that there isn't a plan of attack after this.

Now I should clarify my current state;

The fear of medical care is universal. There isn't one person who hasn't been troubled with a medical decision about what to do, or, not do. If only we all had that crystal ball to tell us what was lying around the corner of every decision so we could pick a path to travel.

The access to radiation oncology therapy, now ubiquitous in the human healthcare circles, is still limited in the veterinary world. For us, stuck half way between Baltimore and Philadelphia there are three places to pick from. All are about 2 hours away, each with its Pandora's box of traffic snafus. You pick based on availability, ties to your oncologist, and (in my case) my total lack of scheduling flexibility.

I was here almost a decade ago with my last cancer dog: Ambrose. His radiation schedule was daily for three weeks. I was unable to bring him everyday so I hired a chauffeur to help make the schedule for him the reality he needed for his cancer. Ambrose's treatments cost us about $10,000 when all was as fate had it. He got about 6 months that I wouldn't have gotten without it. But even as he passed away from the cancer and the wear and tear that the surgeries, radiation and drugs delivered I was left with a feeling of unrest. I expected more time. I had been led to believe that was the price for the calendars prognosis. I went into radiation being told that his type of tumor had an 80% recovery rate with radiation. I mean who wouldn't take those odds? He was 10, I wanted two years. I placed him on his hospice care a few months later promising myself I wouldn't do radiation again.

And yet, a decade later,,,

Here we are. The desperate souls seeking to rewrite our own destiny. Jekyll is 8. He looks like a million bucks. He has an insidious cluster of cells that every human man would be told is 'treatable/manageable/curable' and yet I have to designate him as "terminal." (What a fucking awful blasphemous word.. Can't vet med give us some good decades left ahead too for the common place condition of every middle aged man)?

The two hour drive to the radiation center took us through highways, traffic jams, and interstate construction zones. Jekyll slept passenger seat shotgun. You put him in a car and he snoozes. He is so used to traveling that he prefers to save his energy for the destination and just recharges for the rides.

At our arrival to the little old (in need of serious remodeling as its 'quaintness' starts to overly patina), I was met by a disheveled anxious man. "Hello?" he said quietly and submissively. I was trying to clean Jek's butt after his scant confetti poop session in the parking lot. I looked up so hoping he wasn't talking to me, or about to chastise us for the shrapnel poo mess we were trying to clean. "Does your dog have cancer?"

"Yes," we are after all in the parking lot of the dog cancer radiation center.. and I do have a dog with me.

"Do you trust this place?" He was quiet, withdrawn, emotional, and empty handed.

"Yes." Oh god I didn't want to have this discussion this morning. And, here I was. Angel of unkempt hair in the otherwise empty parking lot, seconds before we could no longer make our clean get away. The fear mounts to struggling almost paralysis.

We clean up, replace his colon after it slipped it mark from aggressive straining to sit in the reception area,, and we wait. We wait, and wait. Second chance to run,, we are already an hour behind schedule.. fingers crossed, gut in floor. The saddest beagle eyes calling me to just stop being so stubbornly dogged. Jekyll is panting. He is anxious. He is afraid. I get it buddy, I do.

For everyone who loves their pet and can't live life without them the slope to terminal death is tragically looming in its inevitability. It is that part: the knowing, the watching, the scrutinizing and the fear of every bump, twist and turn in the road that eats you.

I sit with a lot of my clients who all grapple with the grief and  trauma of the inevitability that the end of life decisions bring. The more I participate in their journey's the more I question and renegotiate my own. I feel their pain. Their not understanding the options. The costs of those options and the incredible resiliency of the pets who elect to try the best medicine has to offer. I hope to write blogs about how well Jekyll has done so far. How he has not lost himself in the process of killing the parts of him that aren't welcomed nor wanted. Those little parts that are killing him.

I have a wonderfully gentle client who is a practitioner of alternative human health care. She is dealing with her own aggressive cancer and she also has two older, failing dogs. She isn't seeking traditional chemotherapy for herself, she also isn't electing it for her dogs.

She asked me recently, "Do you think he is sick because I am sick?" Inferring the transference of her illness to him because they are so connected to each other. I couldn't even answer her with anything reassuring or merciful. I was caught so off guard. I didn't want to discourage either of them from not enjoying every second they have left, but the medical hardness of the reality was that he was dying. I knew that. The suffering, the burden, the weight of the responsibility for her, who already needs optimism and focus, was daunting. In times like this all I can offer is to reduce the current place to the joy they have at this moment to still be alive.

I ask myself every single day how much I am willing to pay for this one single day?

I walked out of the radiation office without my Jekyll. He is going to die.. someday.. I am trying to come to terms with that. I am buying my reluctance to accepting this ending today with leaving him in someone else's hands. Trying to go down swinging. Giving his cancer the hell I want to banish it to. It is the price I am willing to pay to walk away without him one day.

I can walk away feeling like I am afraid for him, afraid for life without him, and even feeling a little bit of solace in the statement I tell too many clients. "I would rather have him die trying to save his life, then dying because I was paralyzed and let it be taken away by his cancer." Truth be told if I got that call, that one that says "Jekyll didn't make it through anesthesia, or radiation, or the procedure, etc." I would be ok with any of these. I might even be better with that ending. As the more likely scenario is that he will be put to his end at my hand. For every client who wishes that their pet "die peacefully in their sleep" so they didn't have to come to my office and make this last impossible decision, I only wish that it didn't have to be me. I don't know how I am going to do this. And I don't know how I can let anyone else do it? For me, the single greatest cross to bear is this act. This impossible goodbye all on me..

Monday April 23, 2018
Maybe the fear grows a coward? And the coward who wants the easy way out of goodbye. The goodbye while he is still happy, functional, and himself. Where is the mercy? How much do I let fear guide us?

Three more radiations to go. If this one goes ok. But all I can do is hope for today,, again.

Tuesday evening, day of radiation treatment number 1

More  on Jekyll here;

Jekyll Arrives

Jekyll Loses His Tail Mo-Jo. Tail Droop.

The Things Only A Mom Knows. Planning for our pets lives beyond our own.

A Tribute To A Beagle, Jekyll.

Slowing Down Without Giving Up.

How Do You Say Goodbye When You Can't Let Go?

P.S. It is Wednesday morning.. The day after his first round of radiation. He is doing very well. Better than I expected. He slept the night comfortably at my feet on the bed. Pee pad in place as he is now almost urinary incontinent, and ate breakfast with bravado. He is a trooper. He  is a beagle. He  isn't checking out yet, it isn't rabbit census season, yet.

Weds 25 April 2018
If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow me on Pawbly.com, our my vet clinic website Jarrettsville Vet, or our Jarrettsville Vet Facebook page. 

I am also on Twitter @FreePetAdvice, and YouTube

Thursday, April 12, 2018

Breaking Through. The Good Days That Chemotherapy Delivers and the Life We Enjoy Around Them

For 48 hours every week I have him back.

The youth, the joyful expression and the wanderlust spirit of the boy I yearn to preserve.

For those few blissful days everything is as it should be once again.

We are free, we are happy and we are explorers in a world with adventures yet to be discovered.

He is back with me again and I live in the moment alone - abandoning the painful yesterday of excruciating moments of death hovering around us.

For these few days there are walks, and wags and jubilant reunions.

We are as we were. Time has lost its grip on us and fate looms for another.

There are mornings of wiggle dancing on the bed.

Kingdoms to perch over and protect and beasts yet to face and foil.

There are barking bellows to beg a meal. couches to claim and companionship to solidify and cement. We are each others best friend and no fate awaits us.


Jekyll has prostate canner and urethral transitional carcinoma. This is a show stopper. A final act. You aren't cured of this. You, me, I am buying him as many "good days" as I can.

For everyone who thinks that chemotherapy is beyond what dogs deserve, you won't understand my grief. For those of you who think that dogs lose their hair, will to live, or are "miserable" while undergoing chemo I will testify that after 9 rounds (weekly) he is alive and functional, because of the chemotherapy. He has good and bad days. We have great days, and days where pain meds are his elixir of bearability. The idea that we give up when "terminal" is assigned is like trying to get through life with just the good days being acceptable. You don't/shouldn't get to chose one without expecting (and maybe even trying to embrace) the flip side. Life isn't a lesson on navigating the shore. It is about the greatness that lies in the depths of magic of beauty. There isn't more in the sunshine, there is equal luminescence in the darkness.

I am here to stand beside him through the joy of his sweet puppyhood as much as his dying oldness. It is a path together. For as long as we have. I will always let him decide, as I try to see the grace in every shade of the spectrum and make his journey full of love and life for as long as we have left.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow me on Pawbly.com, our my vet clinic website Jarrettsville Vet, or our Jarrettsville Vet Facebook page. 

I am also on Twitter @FreePetAdvice, and YouTube

Sunday, April 8, 2018

The Threats To Impending Death and A Vet Moms Promise

For the first time in my long pet mom life I am consciously taking a radical new approach to the impending death of my beloved pet.

Jekyll is dying. In little excruciating tiny steps and failing pieces. He is doing it with his beautiful velvety ears, bright shiny coat, and soft youthful muzzle all suspended and preserved with his outward beauty and youth still intact. His dying is so subtle that no passerbyer would recognize it. But he is slipping and being ratcheted into deaths grip with his soulful yearning eyes eclipsing into subtle tiredness. It is killing me. I cannot lie, nor belittle its impact upon me.

It is the hard jagged robbery of a life lived with effervescent jubilant joy meeting its final curtain call.

I feel cheated. He is being robbed.

AND, I won't stand still, nor quiet, for it! So, I do what I am trained to do. The whole reason I stepped into vet school. I fight with targeted tools and obvious intentions. The passionate, determined, unyielding sleuth who is ready to fight longer, harder, and dirtier than the microscopic thief holed up and harbored inside my pup. It is the lifeblood of being a fierce hot headed Italian determined to shape the world until it conforms to your pleading tantrums. The truth of diseases elusive lure belongs to everyone else. I, I spent decades learning in tutelage so that my pups fate could be altered, detoured, and selected. Or, so I convinced myself to believe. Surrender is for the other side to chose.

When medicine fails, faith is offered refuse.

Jekyll was always the affable, charming spirit who loves everyone he meets. Always the warm glowing light of the gathering. The star of the party, the beagle with a celebrity charisma to draw the entire crowd to him. He is a people pleaser. Everyone who meets him loves him. He has always been this way from the first moment he came to me those many years ago broken and unwanted.

Jekyll's life has been a long list of challenges. As I reviewed his medical record for his last specialist appointment I was reminded how bumpy our road together has been.

Brought to me to be euthanized at 8 weeks old as it was the cheapest option available, I refused. At the time I was a new practice owner in a rural farming community and I said "no" to a client request. It was a taboo, defiant gesture for the new girl to even consider uttering. Had I been working for someone I would have been reprimanded harshly. Clients decide, because clients are our paycheck. He was one of my first defining vet moments. The real life scenario to decide who I would become. I lost a client that day and gained my dearest friend. He was irresistable from the beginning. He was also in very dire need of multiple surgeries; a prolapsed rectum from too much cow dewormer left him straining to poo so hard he pushed his colon out of his body. He was adorable from the front and heartbreaking to look at from the back. Three surgeries over two weeks and a he graduated from pediatric patient to permanent resident at both the clinic and my side of the bed.

The next few years yielded even more bumps in our road. Bilateral cruciates left him hobbling and crippled after a long rabbit foray to the edges of his farmland horizon. He would obsessively drive his body into the grave to let a rabbit know his masterative prowess. At five he had a mast cell scare. This took one hellaciously aggressive surgery to remove them. The last surgery was a year ago to eradicate some funky foot tumor that was a total pain to both manage and remove. This adorable boy of mine has been a short medical text book of his own making. Thank goodness he landed in a vets hands if he couldn't find Daddy Warbucks front door.

This one, this last diagnosis to his current dilemma is to a disease we hardly see. This one might be the undoing of me.

When I said goodbye to Savannah it was after a long many year long decline due to old age and dementia. She was ready to go. Her body was spent. She had cashed in every last chance, and I was able to accept her passing as a life well-lived and a journey at its end. Saying goodbye is never easy, but acceptance is a gift. I could grieve and forgive and move on in time. Savannah had made it to 17. There is an easier gracious acceptance when the expected lifespan has been exceeded by many months. I could grieve her loss and be grateful for our time together. Jek's saga just has me angry and determined to cheat death's unrelenting shadowed hands. He is only 8! He is at his half way point. Who said its ok to steal half his life? I have, (are you listening?), beaten you at this game before.

We are going to exhaust each option to keep him happy and functional. After all, this disease of his, a tumor on his urethra and an overzealous prostate, makes it difficult for him to urinate and defecate. Life, for pets at least, is four basic functions; eat, drink, pee and poo. Ambulating and being happy are second tier preferences. Jek has half of his most basic functions up for grabs.

We are also keeping an internal daily bucket list. It is his list. Not some ridiculous crusade to make expensive trips to the ocean or 4 star hotels. He is all beagle. He seeks acrid excrement, purview over his kingdom, and trips in the gator and truck to fuel his King of the Jungle self designation. We are giving him his favorite things everyday; runs in the parks, chicken and delifresh dinners, belly rubs, long walks to see the wildlife, and lots of re-affirming accolades. He loves a few things and he will get them every single day.

Jekyll is an adventuring spirit. He loves to survey his domain from his front porch. We designed it, the whole front of our home, for him to have this vantage point. Dog bed, custom cushion and best view around. His preference is to stand guard on his front porch, post in command and barking should any critter muster his purview. He could spend the whole day there. He wouldn't let a soul pass without warning. It is his calling. His purpose. The genetic code of a long legacy of invaluable guardians he serves. He is unsurpassed in this single skill. He has earned his keep ten-thousand times over. His contribution to a deep commitment we both have for each other.

He is the pup who digs succulent gummy grubs in late Spring. The mole hunter gatherer meets praying mantis appetite. He was also the only dog I ever knew who would seek his own snacks from the labors of others work. He can be seen propelling himself off of his perch to march directly to the corn field across the drive, sniff the largest juiciest kernels where he sniffs, selects, and snaps! The corn ear is twisted twice and ripped from its stalk. The confident thief then saunters back to his perch to enjoy the spoils of his plantation. When the first ear filled him he would select a few to bury in the yard for a darker day with leaner choices. He is the self-reliant MVP should the zombie apocalypse hit. Grab him and run, he will keep you fed amongst any seemingly barren wasteland.

Each Summer a few randomly placed stalks erupt in various places of the yard. An ear here and there he forgot about, or never got around to needing. I know those volunteer kernels will live on for many years to come after he has gone from me. The remnants of the time capsule to remind me he is always here with me.

This time he is dying in front of me, mind still sharp, will still focused on adventures in the woods, and failing to respond to anything I try to cease the aberrant alien cells within him.

I won't get a neat package of decay this time. I will get failure of viable options, inability to provide human standards of intervention and fury to become, and will myself into providing mercy. I am not sure I can do this for him this time. I am not sure I can push him into another place without me.

Veterinarians are trained to say goodbye. To accept that life will not play by a fair hand. That you cannot pick the fate it delivers on your terms. That acceptance is how you define it and how you resolve the unimaginable.

This time I am going to try to get through this without the anger of disappointment and the heartbreak of feeling cheated. This time I am going to just see the good, dismiss the unchangeable the battle already won on a scale only he can feel and I can see. We will live each day on our own terms, without judgement, without guilt and without fear.

Beagles are built this way. To only see the good, to only look back if it helps get through today. Beagles are not built to be brave, just beautiful.

More  on Jekyll here;

Jekyll Arrives

Jekyll Loses His Tail Mo-Jo. Tail Droop.

The Things Only A Mom Knows. Planning for our pets lives beyond our own.

A Tribute To A Beagle, Jekyll.

Slowing Down Without Giving Up.

There are pieces that I write that serve a singular selfish purpose. A cathartic way of putting the shit out to dry and letting the world take care of it in for some hopeful wish I can get a bit of an emotional respite. I also feel that my adoration for my pets is felt similarly by so many others. Others who sit quietly at home struggling with how to say goodbye, and how to process a grief they fear others might mock at. To all of you who feel that the loss of your companion is one of the most painful things in life I understand. I also empathize. It is impossible. I know it. I feel it too.

Be who you are. The most precious and beautiful parts of everything are fleeting. Savor and celebrate them even if they hurt later. The hurt will fade and the joyful memories live forever. Protect your compassion with everything that you are for it is your most valuable asset.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow me on Pawbly.com, our my vet clinic website Jarrettsville Vet, or our Jarrettsville Vet Facebook page. 

I am also on Twitter @FreePetAdvice, and YouTube