The Battle of Cancer, Leroy's Tale

There are the stories of the pets and the people that you meet that nestle their way deep into your heart and capture your spirit. They define who you are they shape who you want to become and they remind you that the beauty of life is sharing the love that surrounds us all. 

For me, and many of my clients, these stories are centered around our pets. Those creatures who stand beside us, lay by our feet, follow our wanderings, and gaze up at us with adoring eyes. For us our pets do not merely provide companionship, they are the truest form of devotion, respect, and love that we know.

To be a part of that relationship and to be able to assist in keeping those pets healthy, or comfortable, and sharing all aspects of that families joy, pain, and sorrow is a humbling, deeply meaningful duty.

There are few dogs and few people who will mark my heart with more memories and sense of devotion than Leroy.

Leroy was a Bassett Hound whose spirit was evident in every piece of his being. The long droopy apathetic ears, the sagging soft eyes, the sway-backed sorry Eeyored back, and the low slung cowboy tail, with just enough sway to notify you that “Yes, I am a very nice boy.”

Leroy’s tale spans many years at our clinic. There were many years of routine visits of varying importance where he was always a willing patient and a friendly face. Leroy could always be found at the feet of his parents, attached to them by a leash but seeking security at the safety of the tops of their shoes. He was ever faithful, ever calm, and ever present. Although he was a shy and timid boy when you knelt to see him and gave him a soft “Hello” he would always respond with a slow low wag. He, like so many other Bassett’s, always portrayed the peaceful charm of a man secure in his own down trodden excessive skin.

When his parents arrived to notify us that fateful day that his demeanor had dampened a bit, we quickly discovered that he had cancer. It was a painfully difficult realization for his parents but they persistently and faithfully brought him to every appointment with every specialist and followed every path with any promise of recovery and return to wellness. They were a steadfast two person army charging forward regardless of any roadblock set before them. Through every visit, every blood check, every i.v. fluid therapy, and every step and stumble along the way they remained determined to make Leroy better.

I have seen enough cancer to know a few things;

First, it is a crap shoot. There are statistics, and options and twists and turns in a mine field of uncertainty. The more people you invite into your disease discovery and treatment process the more opinions you get and the more confusing it is to know which way to go.

Second, your chance of success in beating the odds and surviving to see a remission is better if you go to a specialist. I know it is more expensive, and incredibly time consuming, but I have seen successes with their help in pets that far exceeded even my optimistic spirit.

Leroy was one such dog. His diagnosis of cancer led to weekly trips to the veterinary oncologist for months on end. The repeated i.v. infusions, chemotherapy drugs, anti-nausea medications, endless blood checks, and many days of rescheduled treatments were an ever constant fight to beat the disease that raged inside of him. Even when his body didn’t appear to be strong enough for another chemotherapy knock-down he would waddle into the front door, give a little wag, and settle on the floor by the door.

Through the ups and downs Leroy’s tale wagged, granted, it slowed and it lowered but his sweetness persisted.

There were many days that his blood count was too low to withstand another dose of chemo, or days when he wouldn't eat, or stubbornly protested the placement on yet another i.v. catheter. But there were periods of his smile and joy that let us all believe that the treatments were worth the efforts of everyone involved.

The treatments gave him months that he would have otherwise likely not had. And in the end his spirit was diminished by the anemia and exhaustion brought his parents to us for that final visit.

I have had my own long, sad, frustrating, and emotionally draining voyage down the road of cancer. I meet with clients facing the same road I had been down with a different perspective because of this. I remind them that every disease has its own path, its own enemies, and its own destiny. Be aggressive if you can, fight for every day you can give them, be hopeful, and in the end, for however long it may be from today, love them enough to let them go peacefully. 

Third, remember they are not afraid. I think they understand what our human higher consciousness has lost, that we are all a part of a life with many shapes, and forms, and our spirit is always with those we leave behind.

I see and talk to Leroy’s family often via the pages of Facebook. They are and always will be a part of our family. They don’t have any pets now, but I know in time Leroy will lead them to another hound to make a place in their heart and home. 

I got a call from an old dear friend just the other day. He called to tell me that his 3 1/2 year old Corgi was diagnosed with stage 5 b lymphoma. He was undergoing chemotherapy but having a very difficult time getting him to eat. I gave a few recommendations based on having my own dying pup who was refusing food more and more as his days grew shorter and shorter. He texted me back to say his appetite was improving slightly and that his chemo treatments seemed to be slowing the progression of the disease a bit. He is in my thoughts and prayers.

Ruger's Ominous Mystery Illness

Ruger’s story began in April 2010 when he came into JVC (Jarrettsville Veterinary Center) because he had a decreased appetite and was vomiting. Ruger, a 7 year old Golden Retriever, is owned by two of the nicest people and they adore him. He is a 70 pound gentle, docile, affectionate boy. He is charming and irresistible.

On his first visit we treated him like we do many acute gastro-intestinal disease dogs. We took a full history, gave him a thorough physical examination, offered to run some basic diagnostics, (but didn’t force because he was “acute”) and treated conservatively with anti-nausea drugs, subq fluids, and gastro-protectants. Three days later his owners called back to say he had begun to vomit again and now his stool was loose. This time his owners elected to run the recommended basic diagnostics. 

We ran bloodwork, took x-rays, and went over the history again to make sure nothing had changed or been overlooked. This time we learned that his food had recently been changed, and he wasn’t on heartworm preventative. So we ran a heartworm test, it was negative, thank-goodness, and put him on a bland commercial diet. We also learned that Ruger had had seizures in the past. His bloodwork came back inconclusive (a nice way to say, thanks for paying for this but saddly it didn’t really help us get an answer). But a day later Ruger was feeling better.

10 days later and Ruger was back. OK detectives here where the years of sleuthing pay off! So let’s go back over his history so far. Because we now have all of the clues we need to help steer us in the right direction.

·         7 year old Golden Retriever; unfortunately for Goldens this is the time we start looking for cancer. These guys are cancer factories. They all die of cancer!

·         Waxing and waning disease. Big red flag. There is something going on. The dog knows it, so you better start digging, it is there lurking somewhere.

·         Vomiting and loose stool/diarrhea means you have something going on in the gut. These cases frequently wax and wane so take serial weights. The scale doesn’t lie. He was 70 pounds his first visit, 68 the second, and 64 the last.

He now needs to be watched very closely. Any small note of concern is reason for discussion with the Vet.

He returned 4 days later, now it was 2^nd of May, with the complaint “still not eating or drinking.” His stools were getting even looser. His owners were offering anything and everything to peak his interest in food, but very little of the offerings were being contemplated or taken. We recommended they repeat the blood work and radiographs but they declined. (I think that initially this was acceptable to decline but now it should have been repeated. Just because the blood doesn’t indicate something on the first try doesn’t mean that it won’t later. I say this a lot; “Your body knows there is something wrong before the lab does.” Trust the dogs word over the labs!) We also recommended an ultrasound.

Ultrasounds are a much more sensitive way of looking inside the abdomen. Radiographs (slang = x-ray) are great for bone, but an ultrasound allows you to see the internal soft tissue architecture that is the contents of your belly. That’s why we use ultrasound for fetuses, and x-ray for broken bones.

The May 2^nd examination also revealed a depressed and dehydrated Ruger. I think most people significantly underestimate how important good hydration is. A day of not eating or drinking normally or a few episodes of vomiting can cause significant dehydration. Once the dehydration snowball starts every hour makes it exponentially and significantly worse. This is why we Vets tell owners to bring your pet in when you call and tell us your pet has been vomiting and/or having diarrhea. The Vet who saw Ruger on this visit had only two rule outs for his possible diagnosis; gastrointestinal disease and cancer.

By May 5^th  Ruger still wasn't eating or drinking. At this point everyone at the clinic was worried enough to start talking about referring Ruger to a specialist. This and repeating the bloodwork was declined. We also scheduled them for an ultrasound in 2 days, (the soonest we could get it) and we added medications for diarrhea. We offered to run the diagnostics as soon as the owners wanted. We received a few phone calls updating us on Ruger. He was doing better, eating better, and his owners believed he was back to normal: disaster averted, and ultrasound cancelled.

On May 20^th Reuger vomited bile. His parents scheduled an ultrasound for ASAP, which was 5/25. The ultrasound finally hit pay dirt! Thank goodness, after all of this it was time to start finding a villain to point the finger at. The ultrasound found “the mid to distal (away from) small intestine revealed a significant infiltrative pattern with loss of detail, (something is there that is mucking up the normal architecture).. strongly suggestive of lymphoma or carcinoma (bad and worse cancer). Intraoperative ultrasound would be warranted." Another word’s the Internal Medicine Specialist reading the ultrasound thinks that the abnormal tissue won’t be seen grossly during an exploratory surgery. He recommends the surgeon be ultrasounding their way through the abdomen so we don’t miss the abnormal spot. Problem with that is it is waay expensive! I discussed the ultrasound findings and suggestions with Ruger’s parents and they decided to have me just go in and do the old fashioned exploratory surgery. (Ok time for my personal admission, I LOVE EXPLORATORIES! I love the whole treasure hunting, never know what your-gonna-find mystery, so fun I can’t even stand it!)

One big deep breathe and all doubts of ability cast aside the ext day Ruger was in surgery. I made my midline ventral abdominal incision and entered Ruger’s belly. Lucky for all of us I found a big abnormal mass in the area of the stomach. It was easily removed and Ruger’s worrysome surgery ended quickly and without fanfare. His intestinal culprit was put in a bottle and sent off to be fixed in formaline, shaved into little slivers, and scrutinized under a microscope. 5 days later we had a diagnosis for Ruger. It was lymphoma. His biopsy report read “intestinal mass: malignant lymphoma..the long term prognosis is poor.” With these words Ruger was taken to an oncologist for a treatment plan and a miracle.

Getting the already not eating Ruger to eat after having been opened and explored was not happening. He protested for days, and refused every morsel offered. We were also struggling with keeping his total protein, (specifically albumin, the tiny very important vital to life protein so that your blood actually stays in your vessels) in the normal range. He became so weak and lifeless that we were forced to give him a plasma transfusion. As happy as I was to have a diagnosis I was concerned I might lose my patient before we got to the treatment part. Even with the transfusion he wouldn’t resume eating. So we turned to drugs, and within a day those drugs had him eating. Ruger took his second wind and ran. He did great for a month. During this time he started his chemotherapy and we all regained our hope for his recovery and conquest of cancer. Because he was doing so well and because there are detrimental adverse effects to long term drug use we started to taper his drugs. But unfortunately as we started to taper him off of these drugs he started to turn his nose up to his food. Within a few days we ended up right back at transfusions and those same steroids and appetite stimulant drugs.

Ruger spent his last three days at the emergency hospital. They were suggesting he continue with the transfusions. His parents called me in deep despair seeking advice for what they should do. I knew by their voices that they wanted Ruger to be cured, but understood he wasn’t going to be. They wanted someone to give them advice based on what was right for Ruger and not what was right for the cancer. I told them that Ruger had given up a long time ago, and that keeping him alive in a hospital wasn’t what he wanted. He was weak, and tired and ready. They were so grateful for the permission to let him go. They just couldn’t say it and they didn’t want to admit it.

There were many conversations exchanged between us after Ruger passed. There were words of sorrow, acceptance, and grief, and many, many tears. I was sad to say goodbye to Ruger, but I was more saddened by the thought of not seeing his parents, or worse yet, not seeing them and knowing that they didn’t want to love another dog, or love anything again, because it hurts too much to lose a pet.

A few weeks later Ruger’s dad came in with an eight week old Golden that they named Timber.
Oh, Timber, you are another story! Cutest puppy ever, but his story, that’s another tale of drama and…oh, its too good to leak..stay tuned!