08/31/2006 - 02/20/2009

He left our lives as quickly as he came into it.

Got to NEVOG at 7pm. Said our goodbyes for a couple of hours. Vet asked if we wanted to take him home one last weekend, as he really wasn't in distress though he was in a near-comatose state. Slim chance he may still snap out of it, though our hearts said he wouldn't.

We decided against taking him home. This is not how I had hoped for things to end; he wasn't really there anymore. He seemed like a dog on auto-pilot, an empty shell. They said we had 3-6 months, and it has only been 4 weeks since the diagnosis. Cancer does what it wants to do.

But, in his fleeting moments of consciousness, he did walk around a bit, lift his paw at his dad, lick peanut butter of my hands, and perk his ears up at the sound of his leash being shaken! Definitely moments of his old self poking through the brain swelling, I know it. I lost it when he reached for his dad with his right paw. It was such a Brian thing to do.

Then, we decided it was time. We laid him on the bed that I had lovingly sewn for him during his happier, sick-free days. My beautiful baby went peacefully at 9pm on February 20, 2009. He was finally released from his broken body. Barely two and half years old.

Wait for us babe, 'til we meet again!

Click here to view his memorial from Dee and the wonderful BCD group.

Last weekend

Pictures from Valentine's Day. His last weekend with us.




He had a busy day: hung out with dad while the fence was being fixed, went with mom to work for half an hour while dad was shopping at Home Depot, stuck his head out of the car for some sniffing, napped a little, watched the world go by through the glass front door (his fave pastime).

This is how I want to remember him. I will be forever grateful for these photos.

Hilarious video from 01/28/2009.


Good morning greeting, 02/07/2009. Now, who wouldn't want to wake up to this every single day? :)

Rainbow Bridge

Heard back from the ER and onco vets this morning. After 3 days under observation, he seems to be declining rather than responding to the Cytosar chemo and Prednisone.

Brian is crossing the bridge tonight. Vets, Mark and I, and Brian, are in complete agreement.

It's pointless to stay at work, of course. So here I am, just waiting for hubby to get home. The drive to NEVOG, where Brian is resting comfortably, will be long and difficult.

Please keep him in your thoughts and prayers as he starts a new life with no pain! Finally, he can run and jump and bounce around like crazy once again!!!

Why bother...

...because if it is lymphoma, then he may have a chance at a remission. Lymphoma is known to respond well to chemo, and if he does, then he can lead a normal life for a while. If not, then, oh well, we tried. Will know in a week or two.

Got the call from the attending vet at the doggy ICU today. No seizures - they seem to have halted the cycle. And, no tumor lysis complications (dog can drop dead from tumor cells dying way too rapidly from the chemo, if so)! And, he ate and stood up, inspite of being drugged up on phenobarbital! And, he's going home tonight! Woohoo! And I get to drive to Waltham again, lol...

Valentine Nightmare

Seizures. Big ones. I have never seen this kind of thing before. Horror of horrors!

Since this is a "medical journal", first and foremost, I am obligated to document the frequency:

02/15/09, Sunday - 3am, lasted around 1 minute
02/16/09, Monday - 1:21-1:24am

He did snap out of it both times. Came out of it confused and energetic. He was looking for us, looking for reassurance afterwards. Later on I find out that epilepsy is not that uncommon in canines, his possibly being a) totally unrelated to the cancer, b) unrelated but triggered by the cancer, or c) a result of brain metastasis. Well, I'm not going to lie. It's probably c). We won't know for sure, and we won't go through crazy, expensive MRIs or CAT Scans just to satisfy our curiosity. The idea now is to address the primary cause, whatever it is, and hope that it will consequently address the symptoms. May it be brain metastasis or unrelated epilepsy.

He had his lymph node biopsy and bone marrow aspirate scheduled for Monday. Seizures greatly complicate things. Is he still a candidate for surgery, still able to go through general anesthesia? We're caught between a rock and hard place here - damned if we do, damned if we don't. I mention the "E" word to everyone, making sure it was clear that we wanted what was best for him, if all the vets decided so. Mark even took the day off, something he never does, in preparation for the worst.

Visited and consulted with the regular vet Monday morning. He bounded in and pulled on his leash, of course, as if nothing happened the nights before. I'm such a regular now, that she doesn't even charge me for the consultation! Bless her heart. She discusses the new situation with the surgeon vet, and they say including valium in the anesthetic mix will make it safe.

02/16/09, Monday - 10:51-10:54am

We get back from the vet visit, and he has yet another one. By this time, I am on emotionless/efficiency mode, noticing the onset or "pre-ictus" signs, making sure he has a soft bed to convulse on, holds him steady on his side, talks to him while it is happening, looking into his lifeless eyes, comforts him as he regains consciousness. Having sensed from the vet visit that these seizures were non-life threatening, I hope for the best, lay several blankets and dog beds down for cushioning, and head for work. I am guilt-ridden for having missed so many work days already, and today was the busiest day of the week (group meeting day!) Vets say surgery can proceed tomorrow. Everything is okay, right? Off to work.

A decision I will regret later on.

When I get back at 7pm, only one dog greets me by the door. Big concern, first time this has happened in Brian's two years on earth. Then, I see him standing up in the middle of the living room, completely disoriented. He does not recognize me, is almost terrified of me, then urinates. These are clear signs that he just came out of one. From the saliva stains on the floor, it looks like he had at least 6, throughout the day. I felt so bad for abandoning him on possibly the worst day of his life. I wait for hubby to get home.

02/16/09 - 7:10pm, twitching of the lips
-8:00pm, lasts around 5 minutes
-8:55-9:01pm
-9:38pm, while I was on the phone with the on-call oncologist at NEVOG

On-call onco at NEVOG says once the dog has one seizure, it sets off more. And that the cycle has to be broken with anti-convulsive medication, now. So, off we were to the Animal ER at Rocky Hill. They keep him from 10pm to 7am, and he has 3 more seizures, all successfully halted by intravenous Valium. They usually like to keep seizuring dogs overnight, for observation. We picked up one sleepy dog at 7:30am, that's for sure.

While all of this was happening, I was truly convinced this was the sign we needed. That Bri was telling us it was time. But all the vets (ER+regular+onco+surgeon) tried to get it under control, did get it under control for now, and all wanted to give him a chance with addressing the primary cancer. Their philosophy is, by addressing the primary cause, any other side symptom (including brain tumors, or epilepsy, or whatever this is) should be kept at bay. I kept asking, isn't this a lost cause? I almost felt embarrassed that I, his own fur-mother, was the one secretly giving up on him, while all these medical professionals had a sliver of hope for giving him the quality of life in his remaining time.

If you had asked me 6 months ago if I would push this far, I would've responded with a resounding "No way". But you never really know how you're going to react, unless you're faced with the decision, right then and there. There is still one stone left unturned. I just don't want to have any regrets for not having tried our best to fight with him.

Needless to say, he remained seizure-free all day today, peaceful and compliant while drugged up on Valium. Racked up some serious miles on the car: Went to W.Hartford, CT for his scheduled biopsy, only to decide in the lobby that he was too beat up from the seizures to undergo surgery. Surgeon vet talks to the head honchos at NEVOG, and sent us there to proceed with anti-convulsive + chemo treatments. An unexpected 1.5 hour drive one way, but hey, we've got our momentum going. We basically bypass the biopsy and just start the chemo right away, under the assumption that it is lymphoma.

(Side note: Bri pees on his daddy while snuggling together in the backseat, having been duly hydrated by his IV drip all night but too drugged up to think of where/how to pee! Totally funny... to me, at least)

Onco vet there said he put up a fight when they tried to stick a needle in him, which is good! Alert is good! Bri gets to stay there for two nights, while they observe him post-chemo. We sign a "Do not resuscitate" form, in the event of tumor lysis complications.

Nighty night Bri, enjoy the round-the-clock lovin' from the nurses...

Biopsy, yet again. 3 vets in 4 hours...

Fortunately, all over the phone. Busy day for my cell!

• Onco vet says she doesn't believe the conclusions of the bone biopsy report. Wording was a bit iffy to her, and she'll have the slides forwarded to her trusted pathologist. Never hurts to get a second opinion. The case, apparently, is so interesting that she is discussing it with colleagues at work. She also said that the little masses in his chest were in the lymph nodes and not in the lungs. Wow, a little ray of sunshine there! She wants Brian to stop the Deramaxx and switch to Prednisone.
  

• Surgeon vet, while secretly exasperated and believing the first malignant report, concedes and tells me to "follow my heart". He wanted to make sure I had no unrealistic expectations; assured him I had none whatsoever. A true professional respecting his clients' crazy wishes, I must say! He'll do the lymph node biopsy and bone marrow aspirate (diagnostic tests for lymphoma), and will send the goodies to the onco vet's pathologist.

• Regular vet says good luck. We discussed having a necropsy done (morbid, I know) due to the very bizaare nature of this case that has got several experts scratching their heads. That'll nail it down for sure.
  

Scheduled the biopsy for Monday. All the vet techs and receptionists know my voice now, as they don't even wait for me to introduce myself over the phone! Sorry Bri, here we go again. Say goodbye to one of your lymph nodes.

In the midst of all this insanity, the most important question to ask is: How is Brian, nowadays, anyway? Mantra: Focus on the dog, not the cancer! He's okay, seems like we've hit a plateau for now. Lethargic, limpy, and will not eat boring ol' dry kibble unless it's completely wrapped in ricotta cheese. Though he was all-out begging for sausages last night. All in all, he's still alert and happy to be with his pack. Plenty of tail/butt wags and paw high-fives.

NEVOG update

Last Monday, we trekked to NEVOG in Waltham, MA for yet another vet visit. A medical team of five and counting! Not looking for a miracle cure here. My only intention, really, was to discuss palliative treatment options for Brian, with the experts in canine cancer. While most vets just prescribe pain meds, oncologists typically have a more open-minded and innovative view of how to treat cancer pain for terminally ill patients.

Left the house at 1045am, got there at 1230, walked the dogs a bit and waited for my 130 appointment. Lobby scene, from one parent to the next: "So, what type of cancer?" Valid question. It is an oncology center, after all. A yorkie and a spaniel both had nasal tumors, while the kitty next to us had breast cancer. I pretty much won the "worst prognosis/most painful illness" contest there.

Comet and Brian, having waited the longest at the reception area, decided that this was their turf and barked at every dog that walked in. "We'll give you your own room," offered the receptionist. Embarassed again by my noisy and highly exciteable dogs...

Met Dr.Rosen at 2pm. Like the entire staff, she was very warm and positive. I guess compassion is the #1 job requirement if you're employed in the cancer care business! That, or they're just all plain nice folks, you almost forget why you're there, they're so nice. I originally was scheduled for palliative radiation, per the advice of my regular vet and the oncologist in Norwalk, CT. but Dr.Rosen (a radiation oncologist) had doubts about that original diagnosis, and had doubts about the efficacy of radiation in this case, where the disease is so spread out. She didn't even use the "C" word. I liked how she was critical of previous reports, explained to me why exactly she was critical of them, and then tried to look at the case history with a fresh set of eyes. She won my trust and respect right then and there. She explained how the language in his bone biopsy pathology can be vague. In any case, she decided to do more non-invasive diagnostic tests by taking 5 lymph node aspirates. They also took an ultrasound of the liver and spleen, for which a belly-shaving was required. Histiocytic sarcoma (the Norwalk, CT onco's suspicion) typically affects the liver and spleen, and this ultrasound could serve as another diagnostic test, another piece of the puzzle. *sigh* A hairless tummy, yet another stark, visual reminder of his sickness. I rubbed his belly to say goodbye to the fur before they whisked him away for half an hour.

We were the last to leave the center at 5pm. Long day indeed.

Fast forward to Wednesday (today) and I was informed that pathology of ALL five sites were suspicious for lymphoma. Lymphoma!?! I don't even know what to think now! What about the disintegrating bone that was our focus from day one? Dr.Rosen gave me all the possible scenarios ranging from best to worst cases, also stressing that Brian's symptoms were truly far from classic.

Quick search for "canine lymphoma" yielded the following:

Stage I:	only one lymph node involved
Stage II:	several lymph nodes in the same general area involved
Stage III:	all peripheral lymph nodes involved
Stage IV:	all peripheral lymph nodes plus the spleen, liver, and/or anterior mediastinum in the chest involved
Stage V:	bone marrow involvement, regardless of any other areas involved

His "Stages" are in reverse order, if this was indeed lymphoma. But the spleen and liver came back clear. Go figure. The case is so interesting that even the pathologist offered to do a bone marrow aspirate for free. NEVOG comes highly recommended, and I heard through the grapevine that they are among the top 10 best canine cancer centers in the entire US. If they're perplexed about the weird symptoms -- a cross between osteosarcoma, histiocytic sarcoma and lymphoma -- then I'm not sure who else can figure this out. And is it worth figuring out at this point, when it may very well be too late? They suggested an excisional lymph node biopsy, where they take the whole dang diseased lymph node out for analysis. I can't bear the thought of putting him through another surgical procedure. On the bright side, it will be much less invasive that the 2nd bone biopsy, from which Bri easily recovered from within a day.

I don't know - so confused at this point. Do I want to subject him to more procedures, or just follow the path of least resistance? Lymphoma can be responsive to specific chemo agents, potentially offering several months of remission. Provided that the diagnosis is not too late. And it can kill a dog within 4-8 weeks if left untreated. Brian's symptoms started with a 5-second limp way back in September. He should've been kaput 3 months ago, then.

Again, back to square one. What the heck is wrong with my dog?

I go home and discuss with hubby. After deliberating, we decide to keep pushing for answers. How can we arm ourselves with the proper tools, after all, if we don't know what it is we're fighting. The palliative treatment options (pain meds/chemo/radiation) would depend on exactly which type of cancer. Again, it's all about the quality of life, even if the length of remaining time stays the same.

Side note: Dogs do not suffer from adverse effects of chemo and radiation that humans typically do. No pain and suffering there, if we were to go that route.

I left messages with our surgeon-vet and regular vet to see what they thought of this new development, and will go from there. I feel like I ran a marathon. So exhausted.

Acupuncture II

He looked very relaxed after the itty bitty needles were in place. I'm almost tempted to try it out myself!

Visitors

Friends Mike S. and Sara visited Brian at our house, a.k.a. the doggy hospice, this weekend. Lots of pats, tail/butt-wagging, and limpy-indoor-fetch-playing. Mom and Dad are boring, but guests are a treat! Mike and Sara think Brian is one crazy, adorable pup, and Bri loves them back. I am glad to have this positive energy and excitement around.








A bit upset that I accidentally deleted a week's worth of doggy pics on my camera. Backed up on two drives, deleted the files on the camera, only to realize after the fact that some were not backed up. There were a couple of really good ones with Brian excitedly giving Sara the paw. Waaah! It's okay, I have "photos" captured in my head.

More on yesterday's road trip to NEVOG, later...

It's ALL about quality of life

I may be giving the impression that I'm in denial, and mean, for keeping Brian alive. Yikes, couldn't be further from the truth. If the pain becomes unmanageable, I would press the plunger myself!

Asked the vet a couple of panic-stricken times if it was time, and she said "Oh God no, he's still got some fight in him."

Dr. Alice Villalobos' quality of life scale quantifies what I already intuitively know:

1) HURT: Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen neccesary?
2) HUNGER: Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
3) HYDRATION: Is the patient hydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
4) HYGIENE: The patient should be kept brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.
5) HAPPINESS: Does the pet express joy and interest? Is he responsive to things around him (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed
be close to the family activities and not be isolated?
6) MOBILITY: Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does he feel like going for a walk? Is he having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, but an animal
who has limited mobility but is still alert and responsive can have a good quality of life as long as his caregivers are committed to helping him.)
7) MORE GOOD DAYS THAN BAD: When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is OK.

Patients can be scored, with ten points being the highest score per number. 35 total points and lower, out of 70, is unacceptable.

Thankfully, Brian is still near-perfect! He'll let us know. For now, every minute counts. :)

Let's radiate

Okay, so I caved.

We're reaching a point where the other procedures and pain meds -- though they do help a whole lot -- cannot sufficiently keep up with the increasing bone pain. He's not as comfy as I would like him to be, at this stage of the unforgiving disease.

Scheduled him for radiation at the nearest center, at New England Veterinary Oncology Group (NEVOG) in Waltham, MA. Very highly recommended facility in the canine cancer community, two hour drive from where I live. Two weeks ago, I said that I wouldn't, for fear of radiation dermatitis, anxiety over more vet visits, more cons than pros, etc. Fast forward two weeks later, and I see that the limp is here to stay. No more limp-free days, no more denying. He starts to run after his brother in glee, then realizes it hurts and trots back to cower behind me. As if the cancer pain is some visible, physical entity in front of us that I can protect him from. Next to the horror of seeing pain in his eyes, that feeling of helplessness, as my pup leans against me for emotional comfort, is a close second.

The fact that he tries to run attests to his spirit. But, while the cancer whittles away at his bone, the pain whittles away at his spirit. I can accept the physical deterioration that will come with time, but I have to keep fighting with him, as he still wants to fight now. His tail and butt are still wagging and he still rolls around in the snow! And, he greeted me excitedly this morning as I awoke! Ah, the simple pleasures in life. :)

Amputation for improving the quality of life, even if it won't cure the cancer, is the gold standard. Fur-parents of 3-legged-beauties all tell me they have never regretted their decision, as it gave them their pups back, who, unlike humans, aren't socially or emotionally scarred by the procedure. They readjust their stance, and then move on quickly -- literally and figuratively -- never looking back. Boy, can we ever learn from them! One nice lady whose dog lived for only two weeks post-amp said that she would do it all over again, as those last two weeks were blissfully pain-free. Certainly, a wonderful memory to have. Also viewed their happy videos of amputee doggies playing fetch and running fast as cold, hard evidence. Would amputate in a heartbeat, if Brian was a candidate. Alas, he is not, due to the metastasis to other bones. And short of chopping the miserable right front leg off, radiation is the next best thing.

I love the BCD board. Another member sent me an email and threw me a lifeline:

"I just wanted to throw my two cents here - for what it's worth. I know how you feel. When __ was diagnosed, we were not able to amputate because she had lung mets. I started off with just pain medication, but as soon as we went to the oncologist I changed my whole plan. The radiation was a miracle for us. Of course it did not cure her cancer, but it did give me months more of time with her -- pain free months that I will always be grateful for. The first radiation therapy session honestly didn't show much improvement. So we tried one more and after the second one she was walking without a limp! I couldn't believe it. In all, she had 4 treatments. If you want to know more about it, please email me and we can talk further."

Definitely feeling more confident about our next step!

Fortunately, radiation, unlike most of our unexpected expenditures thus far, is covered by his slimeball of a pet insurance. But wouldn't hesitate one bit if it wasn't. (I can almost hear Suze Orman saying "Shame on you!")

Acupuncture

First and foremost, Dr. Emily Elliot (another vet-specialist, chiropractor/acupuncturist) of Chippens Hill Vet Hosp was out-of-this-world awesome. Compassionate and comforting - a rarity nowadays. I was right at ease talking about my pet's impending doom with her. They got his records before we arrived, so they knew what they were dealing with. They took one look at Brian, and I could almost hear their hearts breaking as well. "Poor guy..." He is so freakin' gorgeous and sweet, after all, just very unlucky!

Dr. Elliot uttered the most meaningful words I've heard since this whole thing started: "He's here to teach you a lesson about life." The only other person who said that to me was Ros, our wonderful Chem dept mother-figure (kinda creepy actually, since she walked in to check in on me just as I was typing her name. Probably shouldn't be updating blogs at work. lol).

It was good to see Brian up and about. He was very interested in his surroundings and was pulling on his leash. Checked out the birds and reptiles in the cage, said hi to a toddler, and sniffed up and down, left and right. I just had to laugh at the sight of him with a needle sticking out of his forehead, among other body parts. Seems to work, he definitely looked relaxed! Even the ever-so-skeptical hubby remarked the same later that night.

Will post pics later, of him as a pin cushion...

Yesterday (Sunday) wasn't so great. He prefers to lay down most of the time now. I wonder if it's the masses in his lungs depriving him of oxygen, resulting in exhaustion?

We took a 30 minute walk, which he enjoyed. Sniffed here and there, trotted alongside his brother. He ate chunks of chicken breast, but cares very little for his kibble and stinky sardines. As usual, Comet wolfs down what his brother won't eat.