May 21, 2012: Surgery day!

May 21, 2012

Everyone sing with me….doo do do doo do, dooo do dooo do do.....Oh what a night…late December back in ’63……

Yes, it was quite a night. Knowing I had to get up at 5 am, I tried to go to bed early, just as a thunderstorm was starting.  Normally I can sleep through thunder but this storm was distracting.  I finally fell asleep forgetting to put Oregon in his kennel.  (Tim was still up).  I wake up a little before 11 and find he is next to me on the bed.  With the help of a cookie, Oregon goes to his kennel.  10 minutes later I hear him scratching at the floor.   I turn on the light to make sure all is well and he is sitting up with his paw raised as if in question.  I get up to check and don’t see anything but then I smell it.  Lake Oregon had been absorbed by the carpet mat in his kennel.  I tell him that raising his paw in the dark will not get the necessary attention to get the kennel door open.   The storm was still in full fury so Oregon got to hurry in the rain.

Fast forward to 1:30 am; It is still storming.  Golden girl Summer does not like storms.  She quivers and shakes and tonight or should I say, this morning, she chose to be sick.  She had been quivering at Tim’s head and managed perfect placement between the mattress and headboard.  She nailed the sheet, headboard, both mattresses, the wall and floor.  It was also one of the most foul smelling things.  The cleaning begins and there is not nearly enough Lysol and the Febreeze is MIA.  Summer ends up in a kennel for the rest of the night.

Fast forward to 4:30 am.  Still raining but the storm has passed. I think I slept a bit.   Summer is once again sick in the kennel.  This one was much easier to clean up – Thanks Tim!!!!  I had 30 minutes left to sleep.

5:00 am  When I exit the bathroom after showering, I see lights are on, all dogs are up and Tim is dressed.  What’s up??  While I was in the bathroom, Summer was barking at the front door to go out.  Boy that girl has issues today.  I really hope Tim can get some sleep today as he has to work tonight.  That is one good thing.  He does still have time to get some zzzz’s.  I, on the other hand have to load up the car for Operation Arri.  I should mention him since this is supposed to be about him. 

The final photo before surgery 5.20.12

We arrived at the clinic in good time without driving though rain.  Arri was happy to be there, as always.  He weighed in at 57.6 lbs.  After talking with the surgical tech, reviewing medication and getting a little insight about pick up and follow-up, Arri headed to the back room.  He walked so nicely to ‘THE DOOR’ and once it was opened, he started pulling to the back treatment area.  What a goof.  It is a rare dog that gets excited about getting stuck with a needle, poked, prodded and drugged.  Maybe it’s all about the drugs.

Let the waiting begin…………..

5:04 p.m.   Dr. Walshaw finally calls.  Ok, so this was the time I pretty much expected him to call but I can always hope Arri wasn’t the last surgery of the day.  Arri is doing well, resting comfortably.  The surgery went well.  They won’t send the tumors in for biopsy because they know what that is but they are sending in a lymph node from behind the knee to check.  I am not sure if it was suspicious or if this is precautionary to verify the cancer had not spread.  I will get clarification tomorrow.

I seriously hope the song ‘oh what a night’ leaves my head soon.

May 15, 2012: Beach day!!!

I had to take Arri to the beach today.  It was such a nice day and it will be awhile before he goes again.  I don’t want sand in the wound and learning to walk will be tough enough.  Once he has his balance down, we will try sand.    I could tell my boy has aged.  He used to drag me across the sand to get to the water.  Today, he pulled a little.  Once he saw the water, he pulled a little more.  He also did not jump right in.  Ok, so the water was pretty cold – only 60 degrees but that never stopped him in the past.  He would swim with ice on the water if I let him.  He went in and out, spending more time on the sand rolling.  Another change.  There was a time when he would enter the water and would not get out until I bribed him with treats or went in the water and dragged him to shore.  Some days I thought he would swim to Chicago.  He just kept going deeper and deeper.  

May 9, 2012 Chemo begins again

We got the call to go ahead with chemo.  Arri will take Cytoxan once daily.  There are special rules for handling and storage of the medicine.  You must wear gloves and store them in a hazardous waste bag when not in use.  We can reuse them.  If the pills touch a food surface (counter) you have to wipe down with alcohol, then soap and water, then rinse and dry.  All stool must be picked up immediately since we do have other dogs, some of which try to help clean up the yard.  If we were to continue with this treatment long term, blood tests would have to be done monthly.  Side effects may include: nausea, diarrhea, vomiting, loss of appetite, low white counts and bladder irritation.  We are to encourage water intake and exercise.  We are also to watch for blood in the urine or straining to urinate.  I will have to remind Tim to let me know if he notices any of that.  These are things he may notice when he takes them to the park but never mention to me – until I bring up the concern.    Arri is not big on drinking water so we have always added it to his food to ensure he is getting some.   We will have to add a bit more.

May 7, 2012 Photo day

Another visit to the vampire.  We cannot start the metronomic chemo until the blood count is good.  Dr Mike asked why they didn’t do chemo last week.  He didn’t see any number that was out of the ordinary.  His white count was low, but it was actually higher than the first chemo treatment.  I could not remember what code they said was low.    Arri and I waited for the test results and his white count was up.  The data will be faxed to the oncologist and when she gives the word, we will start the daily chemo pills.

Photo day!!!  Let the chaos begin.  We are taking all 5 dogs to a photographer to get GOOD photos done. This session is to get a group shot, singles of Teva before he leaves for school, Oregon’s puppy pictures and the last photos of Arri on all 4.   You would think these dogs have never gone out in their life.  Never mind all the socialization and experiences they have had during their CCI training time.  They just get SOOO hyper when in a group.  One or two at a time, you would think they were different dogs but get all 5 in a room that is new to them and chaos reigns.  It really is no wonder I try not to torture the same photographer twice.

I am fairly certain there were only 5 working brain cells during the dogs photo session -   All of them being contained in Teva’s head.  He held his positions and stayed in place.  He didn’t move at the goofy noises.  He did great with one exception.  When it was time for Arri’s solo shoot, Teva wanted to be with him.  He kept running into the shot.  I finally lured him away and told him to sit.  He did.  Right on the photographer.  Kevin was laying on the floor to get the photo and Teva sat on his back.  Laughter and chaos go hand in paw.

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.