Tuesday, October 8, 2013

THE ROLLERCOASTER REPRIEVE



We had a follow up veterinary appointment this morning for D'fer and we have had some very, very good news.  What one vet and a radiologist thought was osteosarcoma may in fact be very severe osteoarthritis.  We sought out a second opinion this week, and had a second set of radiographs (the medical term for X-Rays is Radiograph) done today, ten days after the originals were taken.  What this allowed us to do is compare what his hips looked like ten days ago and what they look like now.  By finding out what the difference is we can find out one of two things; either the rate of cancerous growth is really fast and dangerous OR that perhaps the diagnosis of osteosarcoma was wrong and the diagnosis might be something else.  There are no significant changes between one and the other which means that most likely...we are NOT dealing with osteosarcoma.  We also did chest radiographs and there are no scary shadows on the film showing us that there has not been any cancerous spread to the lungs.  Phew!  Never the less, the radiologist did think that there is cancer in the bone, so we cannot dismiss that entirely.  If this is cancer, it is growing slowly enough that D'fer won't likely drop dead at any moment, and if this is not cancer, then we may have some treatment options that we hadn't had before.  And this brings me to the roller coaster metaphore for today.



D'fer with his celebration stick.  That would be the toy you buy when you get a different diagnosis than osteosarcoma.  Still not a great diagnosis, but better than death at any moment.

The injury that led to the osteosarcoma diagnosis was that Deef had been lame for a couple of weeks, off and on.  He had a sore shoulder and then he was gimping along on his left hip and then his right front leg looked a bit off.  Then one night, just about dinner time, I took D'fer out to pee and he asked me to throw his frisbee.  Normal D'fer stuff.  I took it and gave it back to him because he had been too sore to really play frisbee.  Then he trotted around the yard and did his thing, and brought me the frisbee again.  I took it and dropped it in front of him.  He launched himself into the air (much more forcefully than he needed to mind you!) and on his way up screamed in a way I had never heard him scream before.   He landed in a heap on his left hip.  When he got himself up he wouldn't put any weight on his left hind leg.  Off to the emergency room we went and they took a radiograph.  His left hip looked like scrambled eggs.  Not good.  I asked some questions and the emergency vet thought that he had severe osteoarthritis; a degeneration of the bone in the hip and sent us home with pain meds to keep him comfortable.  That vet visit is when we got onto the rollercoaster.


The injury happened on a Saturday evening so on Monday morning I went into my regular vet who looked at the radiograph and gave me the sad news that this might be osteosarcoma; a form of fast growing bone cancer.  He sent the radiographs out to a radiologist who confirmed his diagnosis.  My world fell apart, and I wrote last week's blog about how I was going to approach treating this.  D'fer's pain has been well managed and when his pain is under control, he really is a happy dog.  He is still quite lame, but he is a happy dog.  Even so, I felt like I was falling, falling, falling.
 

With the encouragement of friends, I sought out a second opinion; the second vet disagreed with the first vet and the radiologist.  Regardless of agreeing or disagreeing, a second set of radiographs would tell us if the image on the film was growing or staying the same.  That leg of the journey has been like the rollercoaster coasting along nicely and politely.  Things don't feel quite so disrupted or discouraging.  I feel quite a bit like I got my life back when I saw the rads today; especially the chest rads that don't show any cancer in D'fer's lungs.

Radiograph number one take ten days ago.  Compare the left and right hip joints; you will notice that one is nice and even and the other looks like scrambled eggs.  Or more technically "the left hip (right on the radiograph) presents with a  moth eaten appearance.  If you know about radiographs, this is a scary looking hip.

Now compare!  Don't worry that the bones aren't in the same exact direction as they were on the first radiograph; you can see that the problem joint is basically the same.  Now if you are like me, you expand this picture and then you look at it with a magnifying lens for fun!  The important part is that the joint didn't change between the first image and the second, even though D'fer was positioned slightly differently the second time.
 

So now we coast for a bit.  Some things have changed and will stay changed; we still have the radiology report saying that the image on the film looks a lot like cancer.  It still might be.  But it hasn't changed!  The vet cautioned us that we have to remember that it might just be.  Now we have a crate in the kitchen so that if we need to we can easily care for D'fer if he is in pain from his leg.  That will stay.  We are not turning D'fer out with other dogs in the yard because it just wouldn't be a good idea for him to get to running and chasing and rough housing with his friends given the state that his hip is in.  That is a change for sure.  We use the hip helper harness (http://www.hartmanharness.com/) to help him up and down stairs and in and out of the car and over curbs when he is stiff or sore.  Likely we will be using this more and more often as he ages and we are very happy to have it.  Probably the biggest change though is that we know that there will be more diagnostics and possibly more treatments on the horizon.
 
Happy D'fer on pain meds, with his cancer beating Frisbee and his hip helper.  One of the changes we have made is to make a rule that he cannot come upstairs without the help of his hip helper harness.  So nice to see him smiling again.  Good boy! 

 
Right now, D'fer's rads are being sent to the surgeon to see if they can remove the head of the femur and alleviate his pain that way.  IF, and it is a very big if, the surgeon thinks that she can successfully remove the head of the femur, then we will consult an internal medicine specialist and see if his heart is healthy enough to undergo anesthesia.  IF it is safe to anesthetize him, then we will work out a plan involving our veterinarian, the surgeon, the internal medicine specialist or cardiologist, and likely and anesthetist to remove the head of the femur.  This is a big hill on the Reprieve Rollercoaster, because a whole bunch of factors have to fall into place in order to be able to surgically help D'fer.  Knowing it is coming is stressful, and not knowing what the hill will surprise us with is even more stressful, but we are going to go up the hill and down the other side in the company of professionals who are educated and who care deeply about D'fer.

 
There are some important lessons in this experience that are not training related but they certainly do impact training.  The first is that you really need to know a little bit about your dog in order to advocate for him.  I have known for a long time that Deef has been "off" but have not been sure what exactly might be going on with him.  Once we had an injury, I count myself lucky on a number of fronts.  I know a lot about the basic anatomy and organization of the body, and how medicine works, so when the veterinarian wants to do something like taking a radiograph of my dog, then I have a good idea what she is talking about.  Also, I knew the emergency vet really, really well.  Those three things; knowing my dog, knowing a bit about biology and health and medicine and knowing my vet have paid off HUGE dividends this past ten days.  I have been able to talk to the veterinarians, I have been able to identify exactly how D'fer is not "himself", I have been able to ask good questions and I have been able to integrate what is being said so that I can advocate on D'fer's behalf.  When faced with an illness or injury being able to advocate for your dog like this allows you to return to training quickly and effectively.  This is really important.

 
Another thing to think about is that I had really clear boundaries about what I would and would not do to my dog before I needed to pull them out of my pocket and examine them.  I know that although I might amputate a dog's leg if it was injured or if it would buy him years of time, I am not going to amputate his leg to get a tissue sample (one of the options discussed when we had the osteosarcoma diagnosis).  I know that I will not engage in radical, painful, long treatment if it is not going to get us a great deal of benefit.  That means that for my dogs, although I might allow surgery, radiation or chemotherapy to happen to alleviate pain, or to significantly prolong life, I also know that I won't put being alive ahead of having what I consider a minimum level of quality of life.  I made this decision long before I needed it and I have discussed that decision at length with my veterinarian.  In fact I have decided these things about each of the animals I have responsibility for so that I can be certain that in a crisis I am not held over a barrel to make a choice I may not be comfortable with later.  Make your choices ahead of time where possible and then discuss them with your vet.  Doing so will save you a lot of headaches later on when you are faced with the decision and you already have a plan.

 
Finally, the most important thing that I did to prepare for the Rollercoaster Reprieve, was to carefully develop and organize a support system for myself.  This network is made up of close friends and family members, of dear and cherished clients, of veterinarians and technicians, of people on the net who have never met me but who have read my blogs and my articles and been to my seminars and who have reached out through this difficult time to help me, John and D'fer.  We are not out of the woods.  We may still lose D'fer imminently; he is after all ten years old with a heart condition.  He may or may not be a candidate for surgery.  He may over do it at some point tomorrow or the next day and fracture the neck of the femur, and we may be right back to where we were last week, when I wrote "IT WILL BE ALRIGHT", but I am confident that it WILL be alright because we have the support we need, we have good diagnostics and we have all the right things happening to help us to survive the Reprieve Rollercoaster and whatever it throws at us.  Thanks everyone; I couldn't have made it through this past week without you!

 



Tuesday, October 1, 2013

IT WILL BE ALRIGHT



        
Yesterday was a very hard day.  D'fer, my service dog, my best friend, my best and most favourite dog ever, was diagnosed with osteosarcoma.  This means that he will soon die, and likely he will, between now and then, suffer some terrible pain.  This means that my heart will break again and again and again as I face the reality of life without the dog who has meant more to me than nearly any being that I have ever encountered.    The sarcoma is located in the head of his femur, it is fairly advanced, and it is quite possible that there is involvement in the pelvis.  This is a fast growing cancer, and it will likely progress to his lungs within months at the outside.  D'fer has an unassociated heart issue, which means that he is not a terrific candidate for surgery, and the only available treatment would be amputation and chemo, and honestly, the results are not favourable even if we were to do this. Never the less, it will be alright.


D'fer in his prime with the expression I love best.

I am not going to tell you that some spiritual being will save him for me, or that I will see him at the bridge.  I will not tell you what I do or don't believe about the afterlife.  I am going to talk instead about love and leaving and loss and why it will be alright in the end.


Over the years, I have held many special dogs close to my heart.  I didn't think there would be a dog after Buddy who would mean as much to me as he did.  Buddy, majestic and beautiful, smart and strong, taught me about love and caring and change and accepting and working hard and being real with myself.  He accompanied me on endless adventures and trips through learning and things I could not have ever expected.  Buddy sure was special and he carried me through things I did not think I could survive.  And then one day, he could not get up and he lost control of his bladder while I was out.  He was very elderly then.  He had to lie in his own urine and wait till I came to rescue him.  He was too big to lift into the bathtub and he was too sore to get in of his own accord.  The next day I helped him to die, in my living room.  That last day, I double dosed him on pain meds and played ball with him.  I read him poetry.  I napped with him.  And when he died, I thought my heart would break forever. 


I thought there would be nothing that could ever come close to touching my heart the way that Buddy did.  I grieved deeply and long and hard and publicly for Buddy.  I still have pictures of him around the house, and at first every time I looked at them, I would cry.  Now I can look and I smile when I remember the walks, the journeys, and the learning.  I just didn't think then that there would or even could be anything remotely close to the love I felt for Buddy.


Then along came D'fer.  Deef was supposed to be John's dog.  He had other ideas.  He was an annoying and frustrating puppy and adolescent.  He was an accidental service dog.  And over the years, over time, he and I developed a dance together that is unique, that is special.  The dance has etched itself onto my heart and into my head until I cannot think about what is next.  In some ways, D'fer taught me to remember Buddy not with grief but with joy.  Surely, there cannot be anything better than the love that D'fer and I share?  Maybe there isn't.  But maybe there is something else.  Maybe what Buddy did and what D'fer is still doing is not teaching me to be a better trainer, not teaching me to be a better person.  Maybe what they have done is teach me to love better.  While D'fer did not replace Buddy in my heart, he taught me something I have told others in a very profound way.  True love doesn't divide; it multiplies.  Buddy prepared me to love D'fer.  D'fer has prepared me to love other dogs, and maybe, if I am lucky, he will have prepared me to love another dog as deeply as I love him.  Once again, it was alright.


Five or six years ago, I lost my Dad.  He was unexpectedly hospitalized due to a collapsed lung and suddenly without warning we were faced with a diagnosis of bullous emphysema.  Essentially, his lungs had large holes in them, making it impossible for his body to take in enough oxygen to live unassisted.  Over the weeks he was in hospital, I wanted the minutes.  I hoped for the time minutes.  I wanted just a few minutes to talk to my father.  Those minutes were not possible.  Over the weeks he was in the intensive care unit, D'fer took me to visit him.  In one of my dad's few lucid periods he asked who I was.  I told him I was his daughter, Sue, and he looked right at me and said "no you aren't...where is your dog?"  When I showed him D'fer, he relaxed.  He knew me, because he recognized Deef.  D'fer facilitated that last minute with my father, a gift so precious.   That last minute was a gift that D'fer made possible for me.  In his patient way, he showed me that the minutes that counted were the minutes in the moment.  Love is the minute we get.


I don't believe that D'fer is afraid of death.  I know he doesn't like the pain, but we have good chemical control over the pain.  I know that when we take the pain away, the joy and curiosity and intelligence and wonder that make D'fer special are still there.  Last night, after we gave him his first dose of gabapentin, he started to dance around the kitchen where my desk is.  He wanted me to play.  In my grief, I didn't want to play, I wanted him to lie down and rest and not tax his body.  I was thinking about the one more minute attitude; I just want every precious minute with my special boy, and I was crying because I know that there aren't a lot of minutes left.  D'fer is wiser than I am.  He always has been.  He doesn't want one more minute.  He wants to play frisbee.  He wants to go search for things.  He wants to run around.  And really, his minutes are love.  He loves me, he loves life, he loves his frisbee and his friends.  When he is pain free he just wants to be himself, much more than he wants one more minute of time.  His minutes are written in love.



I would give a lot to have one more year, or one more lifetime, but in the coming days, weeks and months, I will work to let go of wanting one more minute of time.  I will work learn and relearn that minutes with D'fer are measured in love.  Living carefully, feeding him only cancer reducing foods, and maybe putting him through very painful treatment  will buy us time minutes, but will not give us even one more minute of love.  Instead, I have to give up looking for minutes and instead, look for love.  This is why I won't be even considering radical treatments, or herbs or a magic wands or crystal balls to address this.  I am going to treat cancer with Frisbees and banana bread corners and his own pieces of pizza and little house searches and visits from friends.



Knowing that I won't have the years, months or days doesn't make this easier or fun.  This is hard, and depressing and sad and terrible and something I don't feel ready to face, but I know it will be alright in the long run.  I know this because I have been through this, as a part of an unbroken chain of the experience of thoughtful beings.  I have faced loss, and in my turn, there are those who will face my loss.  I grieved deeply for my father who grieved for his own father, and presumably, his father grieved for those who were important him when they passed in their turn.  Grief is hard, and knowing that the end is near highlights coming loss, but then I come back to being a part of an endless cycle of gain and loss, of birth and death, and of love for those being who walk beside and before and after me.  I know that right now, this time is an important time not to borrow grief ahead of time, but to cherish what we have together now; not to cherish what we have left, but what we have.


Now that I am facing the minutes, the hours, the days and hopefully the weeks or months that make up the end of D'fer's life, he is teaching me again that when pain is under control, the minutes we have are love.  I will cry often and smile and throw the Frisbee and hide toys, and make sure that my special friend gets time with the people he loves.  The support from my community, my friends and my students are the minutes of love that we get.  And a Frisbee tucked in the bookshelf to find is one of those special minutes, when you cannot make the illness go away.  In the end, when I lose him, I will grieve, and I will cry and then I will probably find his Frisbee and a minute of his love.  It will be alright.

D'fer has told me over and over again throughout his service career that I will be alright.  He is right.  In the long run, it will be alright.


For those who follow my blog, please be patient.  I may not be posting very regularly while I work through these last minutes with my very talented and special chesapeake, D'fer.  I will be back when I can.