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
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1 comment:

  1. I followed you on pawbly too. this is really informative blog for veterans