May 6, 2012 Random musings



At the base of the bare skin, is the darker fur

Now that Arri will be losing his leg, I look at it all the time.  I try to picture him in the yard as a tripod.   I watch which way he leans when peeing – gotta have one foot an inch off the ground.  I note which hip he prefers to lay on.  I think I would have to say he is a ‘left footed’ dog.  That is a bummer because that one is going away.  Another interesting thing is that the hair is starting to grow back and I really would like to see how it turns out.  It won’t grow fast enough to know for certain.  What am I talking about?  When I researched radiation, I had read about how it is not uncommon for the fur to be a different color when it grows back.  All of the examples were dark animals with new white patches.  As light colored as Arri is, I did not expect to notice a difference.  The funny thing is, it is A LOT darker.  Arri is very light/cream colored.  His darkest hairs are still sandy.  The hair coming is in caramel colored.  What can I do but take more pictures.  Yesterday I took a bunch from the rear – just his two back legs in a side by side comparison.  Tomorrow  we have a photo shoot to get a nice photo of all 5 dogs before Teva leaves for advanced training and Arri has surgery.  I didn’t really want to delay surgery but once Teva is at school, one less dog will be a bit easier. 

Odd things run through my mind.  I am so glad that I struggled but kept trying to get the right food for Arri.  For 10 years we battled with his weight between 60 and 70 lbs.  I knew he looked best at 60 but keeping him there was next to impossible.  I tried 4 or 5 different foods.  They would take the weight off but I could never find a portion size that would maintain him.  He was a constant yo yo.    1.5 years ago, I tried Pro Plan Shredded Chicken Weight Control.  It was amazing.  The extra pounds dropped off him and it only took a month to get the right adjustment for maintenance.  All through this illness, he has been a steady 57 – 59 lbs.  Not having the extra weight will make it so much easier for him.

Naturally, with all that is going on you would think I wouldn't have time to work.  Sadly, that just is not true.  My customers would not be happy if I called and asked for a few more days.  I officially entered my 'busy' season two weeks ago.  I am up to my elbows in cake and icing.  This weekend alone, I had 4 wedding cakes.  It is very hard to say no to my customers but over the last few years I have gotten better.  They are going to be really upset when they learn I am not going to take any more cakes for the next month - prime graduation time.  It is not unusual for me to work 14 - 16 hours on Wed - Fri to get ready for the weekend.  I just won't be able to do that while Arri is in recovery. 

May 3, 2012 Contemplating surgery

 It has been two days of non-stop thinking.  Me, myself and I are not sure what to do next.  Somewhere in there I also ask Tim what he thinks.  Logically, I know surgery is the way to go.  Emotionally, I don’t want to mutilate my boy.  I don’t want to see him in pain and struggling to learn to walk on three legs.  I know there are lots of dogs that have been through it and adjusted wonderfully.  They run and play like there is nothing different.  None of the dogs I know of were 13.5 when they lost their leg.  Arri is young at heart and playful when he isn’t napping.  On the other hand, stopping all treatment reveals a huge amount of guilt, just thinking about it.  Knowing he has a disease that has one more treatment option and not choosing to do it.  Watching the cancer grow and spread.  Seeing him become lame and then sick and in pain once the cancer moves to the organs or bone or lymph system.  As hard as it will be to see him without the leg, I can’t torture him with the disease.

So now I have committed to the surgery.  The next hard decision is who will perform the surgery?  I have an estimate from the cancer center.  But they also said to talk to my own vet.  They don’t want to step on toes and if I am more comfortable with him doing it, he should.  I know my home vet will be less expensive and less time travel.  But it is also a small clinic where amputation is only done once a year or so.  They don’t have overnight staffing which may or may not matter.  I know someone would stay overnight if it was necessary, I just don’t think it is common.  We would just as soon keep it local but my emotional side is taking over.  I don’t want Dr Mike to have this responsibility.  I don’t want him to be the ‘bad guy’.  You know, the parent that disciplines is the mean one.  Since I currently have four other dogs and a cat, he needs to be the good guy in my eyes.  I know he is capable of the surgery and would do a great job.  In a situation where there were no other doctors involved, I would not hesitate.  I don’t question his abilities.  It is an emotional choice. He has been Arri’s doctor for 13 years.  I don’t think it would be an easy surgery for him or his staff to do, unless they are faking how much they like Arri, which I do not believe they are.

I call the cancer center to schedule the surgery.  It brings tears to my eyes to commit to the appointment – May 21, over two weeks away.  The receptionist is very encouraging and that is reassuring.  Since we didn’t really talk details of surgery during the appointment, I ask if the surgeon can call me so I can ask questions.  She suggests I consult with him the day of surgery.  Thank you, NO.  I can’t mull over questions and doubts for the next two weeks.  As soon as I mentally committed to the surgery, I immediately started planning.  Do we need a ramp for the van? What about the step going out of the door, too steep?  How long is recovery?  What kind of pain treatment?  Post surgery care?  Wound care?  Do we need to get a sling?  And on and on.  My brain and stomach hurt, not to mention my heart.  While I didn’t ask her any of the questions, she might have been able to hear my brain swell over the phone.  She says she will ask Dr Walshaw to call that afternoon.   

Dr. Walshaw did call fairly promptly.  That was nice because I don’t need more time to come up with questions  and fret about them.  He initially started into the ‘day of surgery’ routine….drop off, surgery, phone call, overnight, phone call, pickup.  Been there, done that, not what my questions are about.

Question:  What does the surgery entail?  Is the leg removed at the hip?  Answer:  no, that is not necessary in this case.  The femur will be cut in a ‘1/3 something something’ (medical term) procedure.  In other words, a portion of the femur will be left.

Question:  Will there be bandaging?  Answer:  No, for (obvious) reasons.  Bandages will prevent proper toileting.  There will be a need for compresses and cleaning.  I didn’t ask details but that will be covered when we go home.

Question:  Will he have staples or sutures?  Answer:  Neither.  Dissolvable sutures will be used internally.  The outside will be glued – like the ankle surgery.  (me: This I have got to see.  That is going to be a big wound  or maybe not)

Question:  What about post surgery pain care?  Answer:  They intend to insert a catheter into the spinal area for direct pain control during the surgery.  It will stay in for 3 days.   (me:  I did not ask if a return visit is necessary to remove it)

Question:  do I need a special sling?  Answer:  They will provide one.

Arri is to avoid stairs, be kept on a single level of the house.  He will need help going in and out – one step.  Recovery should happen in 2 – 3 weeks.

I felt a lot better after the call.  I am still not thrilled but I know my choices are bad option and worse option.

May 1, 2012 Second Chemo?

By breakfast, I had made up my mind to keep the appointment regardless.  I know the Dr. will not talk over the phone about treatment knowing the tumor has changed but not being able to examine it.  Much to her credit, the tech did call before 9:30.  The surgeon said we should come in even if chemo is not done. The change in tumor needs to be looked at.  They had not seen it in 3 weeks so it was much larger than the last time.  I see it every day so I just know it is larger.  Only looking at the photos I have taken can I see just how large it has gotten in such a short period of time.  (Note to anyone with a pet that has a visible medical issue – take photos regularly.  It makes a world of difference to see any changes in color or size)

We arrived to the appointment on time.  Arri was happy to be in the car and just as happy to arrive at the oncology office.  His lamb toy from months ago had been washed and was waiting for him in the reception area.  The first step was for the tech to take him in back and give him a once over.  I got the impression she was going to do blood work.  This was a different tech than the one that called so I don’t think she had yet realized chemo wasn’t going to happen.  I pointed out the lump in his tush so they could check it.  To the back he went for vitals check etc. 

He returned to a patient room with Dr. Obradovich.  She confirmed the mass she found was the same one I found.  We discussed the growth of the tumor and lack of effectiveness for the chemo.  There are other chemo drugs but the Carboplatin is supposed to be the most effective.  Since it was not effective on Arri, it is very unlikely that another drug would work.  Back to the treatment area he goes to have the two lumps aspirated.  When Arri returns, I learn that both lumps are lipomas – fatty tumors.  Nothing to be concerned about. 

On to the serious discussion.  What is next?  I have 3 options. 

One;  stop treatments and let the cancer grow unchecked.  At some point the cancer will affect a major body system and he will die. 

Two: try metronomic chemotherapy.  This one has come up before.  It is a daily at home pill, low dose chemo.  I think this might be the first time I learned or it sank in, how it is different from regular chemo.  Regular chemo attacked the cancer itself.  If I understand correctly, metronomic attacks the blood supply to the tumors.  How it does not attack the blood supply in the whole body is a mystery to me.  The same way aspirin knows to take care of the pain in your back and midol is for cramps.  Just how does the medicine know to go where it is supposed to?

 Three:  amputation.  This is the best and final treatment option at this point.  Even though it has been floating around in the back of my head for 4 months, it now has to be seriously considered.  All other methods have been ineffective.  All Drs and techs involved think Arri would adjust just fine.  It will be much harder on me than on him.  Dr Obradovich would do hip x-rays before continuing forward to ensure Arri could tolerate being a tripod.  I authorize the x-rays to be done right then.  Might as well get it over with.   While I am pretty sure his hips are fine, no point in struggling over a decision that becomes a non-option if his hips are bad.

When the tech brings Arri back from x-rays, she tells me they weren’t quite sure how that (getting x-rays)  was going to go.  They are well aware that Arri is a dork.  They needed to put him up on the table and have him lay still on his back.  They didn’t sedate him at all.  If I had known that ahead of time, I would have wished them luck.  Arri doesn’t mind being on his back and getting a belly rub but up on a table is different from a soft, comfy sofa, the floor or a bed.  They were very pleased when they got him in position, he just relaxed and stayed in place.  Both Dr Obradovich and Dr Walshaw (surgeon) reviewed the x-rays and declared him good to go.  Now, I just have to decide what to do. 

We leave the appointment with an estimate for surgery costs and two weeks worth of metronomic chemotherapy drugs and anti-inflammatory.  Arri still has to have a good blood test before he can start the chemo but I will have them when I need them.  If we don’t use them, I can return them and be refunded for the cost.  Tim was not at the appointment so deciding about surgery has to wait.  On the drive home, I call Dr Mike to make an appointment for a blood test next week.

April 30, 2012

Time to visit the vampire.  Arri, Teva and Oregon are headed to the vet.  Oregon for his 3^rd set of puppy shots, Teva to get weighed in one last time before leaving for college and Arri to get bit by the vampire.  He needs to get a chem panel and CBC test to see how his blood is before his chemo appointment tomorrow.

After our local vet visit, I got a call from the oncologist office confirming Arri’s appointment for tomorrow.  I let her know they should be getting a fax with the blood test results.  She said they already received them but she did not think they had been reviewed yet.  I asked that they review them and call me yet today with the results, explaining that in the morning will be too late based on what time I need to leave to arrive at our appointment.

I didn’t think they were going to call but at 5:30, the phone rang.  The tech said one of Arri’s numbers was low and she did not think the Dr would want to do chemo tomorrow.  The Dr was gone for the day so I could ask no questions. Or I should say, I wasn’t going to get many answers.   I told the tech the tumors are growing and I felt a lump higher up on the leg.  Do I keep the appointment or reschedule?    This brought up an interesting schedule issue.  The tech wasn’t sure what was going to happen but she would talk to the Dr in the morning.  I pointed out that if they wanted Arri to come in, I had to know by 9:30 in order to make our 12:00 appointment.  I can only say my blood pressure went up in frustration when she said the oncologist won’t be in until 10:00.  She did make a note to talk to the surgeon right away in the morning and call me before 9:30.

April 26, 2012

I found a lump higher up on Arri’s thigh.  It might be a lymph node swelling from the chemo or it might be a lump.  Arri’s next appointment is on Tuesday.  He is in high spirits.  Playful and energetic.

April 18, 2012

I have noticed that the hair on Arri’s leg is growing back.  Yeah!  Although if I had my choice, I would rather the leg be permanently bald and the cancer gone.  I know chemo doesn’t work instantly but I was kind of hoping to notice a change.  The waiting is really annoying.  Arri has not shown any side effects.  I guess his blood work came back fine.  I called the oncologist to see if he needed a refill on the Amoxacillian.  I was told to finish giving him what he had and he should not need any more unless he starts to appear ill.  At that point, he will need a blood test first but then he may need more.

At the first meeting with the oncologist, I was told that the more treatment you do on the cancer, the greater change you have of the cancer changing.  It may spread more or become more aggressive.  I have noticed that the current cancer is growing differently.  Before, it was firm but stayed fairly round.  The current growths start round but now seem to be growing like a cookie in the oven – spreading out more horizontal than vertical.  The area of growth is roughly 2.25 inches by 1.25 inches.  There are many ‘pebbles’ that have merged together.  I was not thrilled after the last surgery – that the doctor did not remove the additional 3 growths I had found.  Now I know it does not matter.  Within a week of removing the cast, I had found two more growths.  Even if he had removed all that I had found, the cancer would have been showing it’s ugly face in a matter of days.

April 14, 2012

The tumors are growing.  I can see them clearly now.  Maybe others wouldn’t notice but I do.  Arri went in for his blood test yesterday.  Tim took him in.  Dr Mike agreed they are bigger than the last time he checked.  I don’t know the results of the blood test.  Not sure if anyone will call to let me know or not.

Personality wise, Arri is still a dork. He is playful and goofy as always. He is shedding like a fool right now.  Just the weather I think.