January 18, 2012:

Treatment 8:  We got a little snow last night and it is cold.  The sun is shining and the roads are dry.  Today, I stayed home to work. Tim was on his own.  Before he left, I reviewed his responsibilities and made sure he had everything for Arri.  They were late in taking Arri back today so the trip was a bit longer.  Once again, Arri came out with a bandage on his leg.  Same spot as before.  Tim did ask and she said that is where the injection was.  On Monday she told me they don’t give injections there.  Maybe it is a different person injecting and they learned a little different.

January 17, 2012:

Treatment 7:  Tim and I went together again.  Left the 3 dogs at home in the kennel. They will be well rested and hyper when we get home.  It is 40 degrees with very heavy fog.  Visibility is only ¼ mile.  By the time we reach Canton, it is 52 degrees and sprinkling.  We were early for the appointment.  Yesterday, Arri removed the squeaker from the hedgehog.  Today, there is a new squeaky lamb.  Arri squeaked and squeaked and squeaked while we waited for the appointment.  I don’t know if they were ready or just wanted him to stop squeaking, but they took him back early.  They think he is a riot.  Once again, the girls said he is the happiest radiation patient ever.

No issues with treatment.  He was a bit more stable when walking out today.  We have to lift him into the van because he has no judgment for jumping while on drugs.  He thinks he is doing it right but he will crash right into the side of the van.

The ride home was better.  Arri did rest some this time.  We drove through drizzle, rain, flurries and finally a pretty good snow.    Winter has returned.  It is supposed to be much colder and nasty the rest of the week. 

On the ride home I got a phone call.  Caller ID said CCI.  Hhmmmm, I don’t have dogs at the center so this just might be about a puppy.  Sure enough, it was Suzanne asking how I felt about overlapping pups.  They have two that need homes. Teva doesn’t leave until May.  Normally, I would have his successor by now.  I didn’t think it would be fair to Arri, and I do need a little sanity so I have put it off.  I am planning on a March puppy so now I am officially on ‘the list’. 

January 16, 2012:

Treatment #5:   Tim and I both went to treatment today.    Last Friday, winter had arrived.  Today, it is spring again.  While the snow has not all melted, it is in the 40’s.  The other 3 dogs – Glamis, Summer and Teva - went to day care today.  At the Drs.  I asked about the welt.  Kathy didn’t know what I was talking about.  I showed her and she said they don’t inject there. We will make sure we don’t use that leg today.  Ok.  So no real answer.  Odd, he has a mysterious needle mark and took twice as long in treatment.  I’ll let it go for now and Tim will learn to ask questions.  Today’s treatment was 30 minutes, no problem.  I also needed to find out what to do if I find more lumps, talk to the oncologist or our home vet.  Answer:  The oncologist will check them for us.  Arri does have two more lumps near his collar bone.  They are too small to do a needle biopsy so I will wait to point them out.  The previous lump in similar location was benign.

We have started giving Arri his food 3 times a day.  He gets the same amount but now gets a ‘lunch’ right after treatment.  He has yet to get medicine sick or car sick so this works out well.  He was pretty glassy eyed today but by the time we got home, he was his normal goofy self.

Jan 14 & 15:

January 14, 2012:  day off  from treatment.  We won’t spend it resting at home.  If the weather holds up, we will take a quick road trip to Cincinnati to say ‘Merry Christmas’.



In the van:  Arri, Teva and Summer



January 15, 2012:  day off from treatment.  Back in the car for the 5 hour trip home.



On bench:  Glamis & Teva
On floor:  Arri and Summer



January 13, 2012:

 5^th day of treatment.  Old man winter may have been late to the party, but he knows how to make an entrance.  4+ inches of snow and still coming down.  I had to work today and Tim was off so he took Arri to his treatment.  They had to leave early to allow time for the weather and accidents.  They got home a little later than normal and Arri has a bandage on his leg.  Tim lets Arri in the house and turns around to go shovel the driveway.  I open the door and shout out….’ummmm, so what is with the bandage?’  “I don’t know, I didn’t ask”.  Sigh .. he did say the appointment was about twice as long.  Apparently Arri didn’t come out of sedation as well today.  Maybe that is the result it being the 5^th day of treatment in a row.  Now he has two days off. 

Later in the evening, I removed the bandage from his foot.  This was his front foot.  At first, I didn’t notice why it was wrapped.  There had been no gauze, just the stretchy, sticky bandage wrap.  A bit later, I notice a very large welt on his foot.  It was at the connection of the foot and ‘pinky’ toe.  There was a blood spot in the middle.  Had it been summer, I would have said it was a bee sting reaction.  It seemed to be an extremely odd location for a needle.  His ‘good’ back leg had been shaved for easy access to the vein.  I’m confused.  I’ll have to ask on Monday.

January 12, 2012:

4^th treatment:  I don’t need the alarm clock now.  Arri has the best internal clock of any dog we’ve had.  At 4:20 am, he was sitting on me, letting me know it was time for breakfast.  I couldn’t get back to sleep today.  Today I feel the effects of less/broken sleep.  I am tired and a bit crabby.  It doesn’t help that I am still trying to keep the bakery open – operating at minimal hours…HA.  I didn’t do that quite right this week.  When I get home tonight, I will have a lot of work to do for cakes and meetings tomorrow.  Thankfully, Tim will be taking Arri tomorrow so I can work.

Arri’s post treatment munchies attacks are nuts.  I am not sure if all dogs act like him but he is really goofy.  I had hid the food in a bag in front the of driver’s seat.  Gives me time to open my door and grab it before he does.  We loaded him into the car and  I turned to ask Kathy another question (she might be getting tired of that).  Arri did his thing when I wasn’t looking.  He is so uncoordinated; I don’t see how he even climbs into the front seat.  When I opened my door to grab the bag, he was in the front seat, kind of.  He was more in the foot well but still on the seat.  He was rooting through everything on the floor.  By the time I realized he was doing more than rooting, he had eaten two gas receipts and 3 kleenex.  He had reached the plastic trash bag that had sucker sticks and chocolate wrappers in it when I stopped him.  I shoved his rear end into the foot well with the rest of him and made him sit there and gain his bearings.  I poured some food into the bowl behind my seat and waited for him to climb back.  He didn’t move.  He realized the food was by my feet and tried to crawl over…breaking my sunglasses, shoving CD’s out of the way…sigh  I got him back in the front seat and showed him his food.  He climbed over, kind of, again leaving his back end on the front seat to eat his snack.  Tim is going to have an interesting trip tomorrow.  I think he thinks I am exaggerating the munchie thing.  

January 11, 2012:

 3^rd treatment:  Fantastic day to drive.  Sunny and 55 degrees.  Forecast says it won’t last.  Arri is getting the travel routine down.  As soon as we pulled into the lot where the clinic is, he started clucking.  He is happy to be there.  He loves to do an UP at the counter to say hello to everyone.  He didn’t want the hedgehog today.  Maybe tomorrow.    He went to the back room with no issues.  He came out very drunk today.  We had to help him walk to the car and lift him in.  As soon as he was in, he shoved his face in my travel bag.  He was going for the food.  So I asked Kathy, and yes, whatever drugs they give him, will give him the munchies.  He had a serious case today.  I moved the bag out of his reach to the front.  How he moved so quick to the front, I don’t know.  He was so uncoordinated.  But he reached his goal.  He grabbed the sandwich bag of dog food, tore it open and wolfed it down before I could get to it.  I also learned that he is not to be bathed during treatment.  No soap or scrubbing the area.  Now I have to ask if it can get wet in general.  If the snow is deep enough, it will get wet. Is that ok, just don’t rub it dry?

January 10, 2012:

 2^nd treatment:  Since the Dr was ok with a 6 hour fast yesterday, I decided a strict 8 hour was not critical.  Instead of starving the boy from dinner at 4:30 pm until after the treatment, I set my alarm and give him breakfast at 4:30 am.  We were able to leave the house on time today so the drive was much less stressful.  Arri also figured out the routine already and decided he did not need to sit and look out the window the whole trip. 

As soon as we entered the oncology office, Arri went for the Hedgehog. They have a couple of toys in the waiting area.   Another couple was waiting and the wife was loving all over Arri and started a game of tug with him.  She was his new best friend.  Kathy, our Rad Tech, let Arri take the hedgehog with him for his nap.  When he woke up from sedation, the first thing he did was grab the hedgehog.  He already has the ladies wrapped around his paw.  They told me he should take the hog home.  I made him leave it so he could enjoy it every visit.  He was  ‘drunk’ when he came out but able to walk without assistance.  Kind of funny to watch but I do have to be careful that he doesn’t hurt himself.  He had a good solid nap on the trip home and felt much better.  I have to ask the Dr. if sedation gives dogs the munchies.  He comes out of treatments like a starving bear. 

It is January 10^th, the sun is out and it is 50 degrees.  Oh, that’s right, and I’m in Michigan.  What incredible weather. 

Monday, January 9, 2012

 Started my day as I would normally if I have things to do but nothing critical.  I played a little bit of hookie over the weekend so I did have a list of things to do.  9:30 am…I am talking to a customer on the phone with a voicemail beeps in.  I check vm and it is the Oncology office.  They have all the paperwork in and they are ready to go.  They will see Arri TODAY at 12:00.  This causes my head to explode.  I am in a sudden frenzy.  If I am to make the appointment on time, I have to leave NOW.  It takes 2.5 hrs if there are no delays.  I start rushing around getting what I need and getting ready to leave the house. I wake up Tim, who is on night shift, to let him know.  This is how frenzied I was.  I didn’t need to wake him.  A note would have worked.  Duh….
Then I realized Arri had not fasted.  I fed him at 6.  I call the Dr and ask, do we come in or wait until tomorrow?  She says 6 hours fast is fine, come on in.  Great, back into frenzy mode.   It takes me 15 minutes to get my act together to leave.  Guess what, no gas in the car.  Another delay to fill up the tank.  My day really did start out very nice.  I speed just a bit to get to the appointment.  I didn’t dare go too fast.  In just two trips over, I have noticed there are A LOT of police hanging out on I-94. 

We are 15 minutes late but we get there.  Since this is his first treatment, it will take about an hour so I go find a McDonalds to grab lunch and wait.  He comes out of the appointment somewhat drunk.  There were a bunch of dogs in the waiting area so I met Kathy and Arri at a side door.  Kathy was holding up his rear end with a sling.  I guided his front end while she held up the back.  We got him in the van and headed home.  It was 1:50 pm.  I had a meeting with a bride at 4:30….why do I think I am going to be late for that too?  Arri would not lay down in the back of the van.  He is a front seat dog.  He likes to look out the window and hold your hand.  It was an effort to do it but he crawled into the front seat for the trip home.  He was so tired.  He was sitting up and his eyes would droop closed, then his chin would slip down and suddenly his head to pop up, alert, for only a minute and he would do it again.  An hour from home, he gave up and crawled in the back for a nap.  Thank you. 

We pull in the driveway at 4:25.  There are two extra cars.  Yep, I’m late for my appointment.  Wonder how long they have been waiting?  Tim said about 7 minutes but he settled them in with some photo albums to review.  I wonder if I will hear back from them?  Sigh….bible study tonight and then I can crawl in bed and do it again tomorrow.  Maybe a little less excitement tomorrow.

January 6, 2012

waiting for the call…and waiting and waiting……the call never comes.  I am not sure what to think.  The clinic is closed on the weekend so I know they won’t call on Saturday.  So, do I go on Monday or not?  It’s an awful long way to drive for nothing.  Yes, I could call them first thing Monday but my assumption is that if they didn’t call, they don’t have the plan yet.  They will call Monday and we will start Tuesday.  Works for me, I have things to do anyway.

The decision

By the end of the consult, Tim and I were on the same page.  We agreed that radiation was the way to go. In addition to all the information the Dr. gave us, they also had a lot of success stories posted around the office.  One of them hit close to Tim’s heart and he was convinced we should try it.  I am very glad I didn’t have to do this without his support.  Dr. Ottnod was glad we were going with radiation.  The next step was to send the test results and information to Colorado and get the plan for treatment.  She expected that information to be returned the next day (Friday).  They would call me to confirm and we would start treatment on Monday.  I don’t know if that always move that fast or if the fast growing cancer prompted it.  We discussed time of day for the appointment.  I am normally a ‘get it done and out the way person’ but I was overruled with arguments of commuter traffic.  Our route takes us through Kalamazoo, Battle Creek, Jackson and Ann Arbor.  Lots of opportunities for traffic issues.  Kathy, our radiation tech, suggested 12:00.  Ok, my day is shot but I gotta do what I gotta do and I’ll get it done.

Naturally before we left, we had to pay for today’s visit and the treatment plan – the Colorado portion.  Ouch.  Radiation hurts already and we haven’t even started.

It's winter in Michigan

The one additional comment I had in the consult was about the lump.  I didn’t know if it was scar tissue or cancer.  I had not looked at it closely.  I didn’t want to.    When he went in for his 3^rd surgery in November, I asked them to do x-rays.  Arri  was growing lumps weekly and I wanted to make sure he wasn’t hiding any.  At the time, he was clean.   Because the cancer was coming back so quickly, the 6 week old x-rays were too old.  They took Arri back for new x-rays.  He was clean – hooray!!!

Yet another topic to cover was boarding.  One of the potential issues is weather.  You wouldn’t know it to look outside but it is January and we are in Michigan.  Easy to forget with the winter we are having.  They do offer boarding at $40 a night but they prefer not to do it.  The dogs heal better if they are with their family and in the comfort of their own home.  We left that open ended knowing that if a big storm was predicted, we could board him instead of missing an appointment or stupidly driving in bad weather.

Does age matter?



Teva is very supportive of Arri

 Another factor I asked about was age.  Arri is almost 13.  Does it matter?    In some dogs, it might.  In MY mind it did not.  Age means nothing to Arri.  Most people are stunned when we tell them his age.  In fact, at the appointment, we had Teva along as moral support.  He was all decked out in his CCI cape and being a mellow fellow.  The technician started to address Teva because he was so mellow and Arri was a total dork.  Arri has the shell of a 13yr old, the energy level of an 8 yr old and the attitude of a 2 yr old.  I had every confidence he could deal with whatever we threw at him.

I should say at this point, I have had very few scary moments in dealing with this.  In the beginning, there was a bit of dread but overall, I have been pretty confident about the end results.  Part of me keeps thinking of how much worse it could be.  I remember sweet Maleah.  She was my 3^rd CCI dog.  My brother adopted her when she was released.  Last August, they were in town and she was sick.   It was her 10^th birthday and we learned she had cancer.  It was already in the lungs.  All my brother could do was to keep her comfortable.  She only lived 2 more weeks.  I have to believe because we caught it early and acted quickly, Arri’s chances look pretty good.

Options

We also discuss a new type of Chemo.  It is a pill that is given at home.  You have to check in with the clinic monthly and have monthly blood tests.  This would run approximately $450 a month.  The duration was anywhere from 12 months to the life of the dog.  It also involved very careful handling/disposal  instructions.

Doing nothing?  The tumor would grow and grow and grow.  Eventually it could inhibit use of the leg.  We could have it surgically removed every month.  Been there, done that already.  We did learn that repeated removal of the same growths could make it worse.  Every time it is removed we have the potential to change the dynamic of the cancer.  It can become more aggressive as well as return and grow much faster.  After the second surgery to remove Arri’s cancer, we did not have the growth sent in for testing.  We knew it was the same thing.  The lesson to be learned here is to always send it in.  It could have changed.  Your vet may not need that kind of information but if you are considering radiation/chemo, the Oncologist does.

The Oncologist

Cancer area at first oncologist visit

The Animal Cancer and Imaging Clinic is a nice, efficient place. They examined Arri, loved on him, took pictures of the area, reviewed the info from my home vet and they gave us our options. 

Radiation would involve 18 -22 treatments.  Monday – Friday.  Each treatment is approximately 30 minutes.  The first is a bit longer since they have to do the initial set up.  Arri would be sedated every time so he is supposed to fast 8 hours before the appointment.   The side effects are minimal.  He may get tired but he won’t be nauseous or sick.  The treatment area will be red/raw over time.  The worst time being after treatment ends.  From what I understand, fleshy areas are more effected by the burns than boney areas.  They also provide an estimation of the cost.  This was comparable to the  research I had already done, radiation can run between $4,000 - $7,000.

The wait....

The week before Christmas was a time of waiting.  Appropriate for the season.  I wasn’t waiting in anticipation though.  I was waiting for Arri’s incision to heal.  I was waiting for Dr Mike to call in the referral so I could make an appointment with the oncologist.  I needed to have a chat so I understood all the options.   The first available appointment where Tim was also able to go was January 5.  Ok.  We wait a little more. 

Post surgery issues

Because the ankle incision was bothering him he was licking it a lot.  I couldn’t put an e-collar on him because of the upper shoulder incision.  The e-collar would rest on that incision and cause irritation and bleeding.  I tried an inflatable e-collar but he could still reach the ankle.  So a call to the vet with a ‘can we come in today’ request for antibiotics and we had to keep it covered to minimize his licking.  This would lengthen healing.  3 hours after that visit, I was wrapping his leg and I noticed 3 stapes were missing.  Another call to the vet.  Another trip to the vet.  I like my vet.  I like the girls in the office.  But this was getting ridiculous.

Two days after the new staples were put in, they had come out again.  I was puzzled.  The leg was constantly wrapped.  He could not have licked them out.  I was not calling the vet again.  I was going to make sure the incision site was closed and healing.  Only if that failed, would I call again.  In talking to the vet tech, we determined that the location, right on the ankle was the issue.  He would flex his leg and the staples would work their way out.

Thoughts on what happens next

At some point between initial diagnosis and the 4^th surgery, I reached out to my CCI family.  The responses I received were so helpful in understanding the real side of cancer.  I think the time aspect was very eye opening.  If we decided to meet with on oncologist, I was hoping to not be blindsided with information.  I also found all the clinics that were within driving range.  There are four:  Illinois, Indiana and two in Michigan. 

While I am the primary caretaker of the canines in the house, I am not the only two- legger.  It was time to have ‘the talk’ about what the next step might be.  We knew surgery number 4 was going to happen but what then.  The cancer came back in 5 weeks.  Do we put Arri through surgery after surgery?  So we pursue radiation?  I knew the route I was leaning towards but I had no idea what Tim thought.  So I asked.

Now, I am not saying this to air dirty laundry.  Family members may not agree on treatments.  It is a reality to be acknowledged and worked through.   Tim did not think we should put Arri through radiation.  My blood pressure immediately went up.  I did manage to calmly ask him what his reasoning was.  He had two reasons.  1.  The clinics were all 2.5 hours away.  It would take too much time.  2.  Labs only live to be 14 and Arri is nearly 13.  At that point I walked away from the conversation.  I was speechless.  He was not considering OUR dog but basing his decision on a statistic.  So the fact that he said NO was not what bothered me.  It was his logic.  It was then that I realized I had done the research, not him.  He was completely uneducated on what might go on.   Needless to say, I was going to do what was best for Arri and Tim would have to deal with it. 

December 6, 2011:

Surgery #4.  The cancer was indeed back and removed.  Unfortunately, this type of cancer often grows in ‘fingerlings’. Gardeners might think of it like a tuber.  There is the main growth but cells travel out from that and sprout new growths.  Dr. Mike removed the growth and did what he could.  He used a ‘football’ incision which removed some of the skin above but he knew he did not get clean margins and the cancer would resurface.  Unfortunately, the incision made healing more difficult.  There isn’t a whole lot of extra skin around the ankle and so it was pulled tight to close.  In addition, the nerve was poked and prodded so that left some discomfort.  And then there were the two other growths I found before surgery and asked them to look at.

As a result, Frankenstein was what I picked up post surgery.  The growth on the upper shoulder was removed and the fatty tumor, on his foreleg, was in the way of the IV so they took it out.  My poor boy had 3 incision sites and 21 staples.

This was by far the most painful surgery for him.  Normally he bounds out of the office like nothing happened.  But that day he was crying in pain. 

After 2nd surgery to remove cancer

November 28, 2011:

  Good News! The collar bone, shoulder and mouth growths are all benign. We are waiting in the lobby for the mouth surgery follow up appointment.   As Arri is standing, staring at the girls behind the desk, mentally willing them to give him a cookie.  I notice a bump.  It is very small.  Smaller than a pea.    I just can't ignore it.  I have to look.  I have to touch.  It is on his ankle bone, under the scar from the sarcoma surgery.  I already know in my heart.  This is not post surgical reaction.  Only 6 weeks after the initial removal, the Nerve Sheath Sarcoma has come back.  We delay surgery until December 6th.  This will be Arri's 4th surgery in 8 weeks.  The boy needs a break.    My husband starts joking that I need to stop touching the dogs.

November 5, 2011:

  Day after surgery.  I am laying on the floor, Arri is laying on top of me.  I look up an notice a fat lip - on the inside.  Never, ever would have seen it otherwise - not even when brushing teeth.  The bugger has a growth the size of my thumb nail inside his lip.  Oh Doc, Arri has something you need to see.  Now the surgery on Oct 4 also included a teeth cleaning and removal of a cracked tooth.  No growth at that time.  Next surgery is set up for Nov. 18.

October 24, 2011:

 Arri has his post surgery check up.  Being the wonderful, attentive mom that I am, Arri gets pet/rubbed down alot.  He is my lumpy boy.  He has many, many benign fatty tumors that I monitor for changes.  The day before staple removal, I notice a firm lump by his collar bone and what appears to be a cyst on his shoulder.  Thanks Doc for removing the staples, now please check this lump.  Needle biopsy is inconclusive/questionable so the decision is made to remove it.  Surgery is November 4.

October 11, 2011:

  Arri visits the vet to have his lump looked at.  Doesn't take a genius to know it has to go so surgery is scheduled for Oct 14, 2011.  Surgery goes well and the mass is sent away for testing.  It comes back as a Nerve Sheath Sarcoma.  This is classified as a soft tissue cancer.  I dive into research and learn it does not typically metastasize to other areas of the body.  That is good.  However, it has a 72% chance of reoccurance.  Preferred treatment is surgical removal.  Radiation is also an option.  I decide to wait it out.  If it grows back, I will look into radiation closer.  After all, Arri is almost 13.  Maybe it won't come back and radiation might do more harm than good.

Cancer journey from the beginning

  October 4, 2011  I walk in the house and Arri is doing the happy dance on the other side of the room.  I spot a very large lump on the inside of his rear leg, just above the ankle.  It looks like 1/2 a golf ball attached to his leg.  Initially I thought he hurt himself and it was swelling.  Upon closer inspection, it was a very firm but movable lump.  I know this is not good.  Arri has made me the expert in fatty tumors and this is not one of them.  He gets his nails trimmed regularly so I also know it grew very, very fast.

About Arri

I am going to attempt to do a journal about Arri's cancer journey.  Journaling isn't my strong point but I thought some of you might want to share the ride.

 A little about Arri.   He was my first CCI pup to raise.  He was born January 31, 1999 to Campbell II and Patrice.  Being my first CCI dog, I thought he was wonderful.  I now know the difference between a good dog and a working dog.  He was released after 2 months in AT and became our furever dog.

Arri - March 2007