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Crash Course: Caring for the Canine Cancer Patient 101

Pictures can be more fun than words, so let’s start (and end) with them! Some scenes from Alec’s adventures during the last few weeks:

Happy hour outside the Victory Bar on SE Division St, 8 blocks from our house. There was a pug a few tables away and Alec only barked a few times! It helped that I brought lots of cookies with which to distract/bribe him…

Taqueria Los Gorditos, my favorite neighborhood taco truck. Since I am not up to cooking these days (at least not for myself) it has been burritos almost every day.

Sharing a tofu burrito…

…outside the Portland opera house on the east bank of the Willamette River.

Strolling along the east bank esplanade with the Hawthorne Bridge – one of downtown Portland’s eight bridges – in the background.



Playing in the Columbia River at Sauvie Island last weekend; our heads are conveniently blocking the naked people behind us on the beach! The “clothing optional” beach is the only one that is accessible for Ali; the regular beach has stairs.

Sociable Alec hanging with the neighbors outside our row of connected apartments, which are converted army barracks originally built in the 1940’s.

The upside of staying home all the time is I have gotten to know my awesome neighbors a lot better! And the sheriff likes to be part of a pack (more people to protect).

On the stoop with Uncle Mike.

Since Alec’s spinal injury two years ago, I have taken him swimming on a regular basis for fun and exercise. We had to take some time off after his recent surgeries, but two weeks ago he was back in the pool…


…and loving every minute of it!

This winter we began swimming once a week at Paws Aquatics Canine Swim Center, a wonderful indoor pool facility south of Portland. The proprietor, Diane, has been very supportive of me and Alec. We love her! If you live in Portland, you should take your dog here.

Alec is a very strong, smooth swimmer. He never seems to get tired of chasing the ball or swimming gentle laps with me. When we are done, I shampoo him in the bathroom off the pool.

Thank you to everyone who has phoned, emailed, or left comments asking for updates about Alec. I meant to post sooner, but these last few weeks I have been in full research mode, consulting every source I can get my hands to educate myself as much as possible about Alec’s cancer (hemangiosarcoma) and available potential treatments (to prolong his quality of life; the cancer is incurable). The first days after learning of his diagnosis, especially after three (!) benign biopsy results, I could not help being devastated. I could barely talk to anyone, and I found myself sinking into despair. As a tidal wave of unreality washed over me, my primary emotion was the shaky feeling that I might simply “lose it.” But then I realized I could not do that, not yet. Alec was still here with me, and he needed me to focus. So for his sake, I gathered all of my energy and resolve and began to deal with the situation as best I could.

This meant, first, maintaining a positive and happy attitude around Alec (no blubbering or hysterics! The last thing he needs is to worry about me, right?), which for the most part I have done successfully, with one notable exception this week (more on that later), and second, assembling a team of veterinary experts while also (and just as importantly, I think), educating myself so I would be in a position to make the best decisions for Alec moving forward. Sounds sensible, doesn’t it? Well, let me tell you, this latter has proved to be no simple feat! Unless you have been through this, you might be surprised at the amount of confusing and contradictory information that exists about cancer treatments – even the veterinarians don’t agree with each other. This has left me in a position where I have had to make a lot of big decisions by myself, a daunting proposition considering I was basically starting from scratch in terms of my knowledge base. Of course, I knew that I would be the “leader” of Alec’s veterinary team and that all decisions ultimately fall to me. But I didn’t realize there was such a lack of consensus (to put it mildly!) about optimal treatments for canine cancer not only between holistic and conventional realms, but also within these two distinct spheres. Trying to distill and make sense of all of this information – while also attempting to critically evaluate each source – has set my head spinning repeatedly during the last few weeks.

Let me give just a couple examples. The controversy over antioxidants and chemotherapy is probably the most well-known. It is the same in human medicine, by the way (unsurprisingly, as canine cancer treatments “trickle down” from methods used to treat people). Alec’s oncologist told me to not give him antioxidants while he was undergoing chemotherapy because they interfere with the cancer-killing properties of the chemo medication. However, many holistic vets say that antioxidants not only don’t interfere with chemotherapy, but may increase its effectiveness or at least help mitigate potential side effects. I consulted as many sources as I could find and there is absolutely no consensus on what would seem like a straightforward issue: antioxidants during chemo – good or bad? From what I can tell, the latest evidence seems to indicate that antioxidants are not harmful during chemo…but what do I know??

I was willing to keep him off antioxidants at the oncologist’s recommendation, but when I asked her which of the ten supplements the holistic vet had prescribed for Ali counted (many are blends of several different ingredients), she never gave me a straight answer. After inviting me to email her with questions she simply stopped answering the ones about supplements. I think it might be that she is just not that familiar with them. Most have not been through the holy grail of western medicine, controlled double blind studies, due to cost and lack of funding from big pharmaceutical companies (at least this is my understanding). And veterinarians (and doctors) trained in conventional medicine tend to be skeptical or downright dismissive of anything that has not been subjected to a controlled double blind study. Don’t get me wrong. Although I am open to it, I would not characterize myself as a devotee of naturopathic medicine. I had done some reading on the subject and recently developed an interest in “alternative” treatments, but the whole field is very new to me; in fact this is the first time I had ever consulted a holistic vet (except for acupuncture when Ali was paralyzed). As I mentioned, my intent was to eschew neither methodology, but rather to combine the best insights from both. Easier said than done! Anyway, regarding my antioxidant confusion, after consulting the holistic vet who had prescribed them and conveying my concerns – he said none of the antioxidant levels were high enough to interfere with chemo – I decided to keep Alec on most of them.

Another example is when I showed the oncologist the supplements the holistic vet had prescribed for Ali. She scoffed at an ingredient in one of them, saying, “This bypasses the stomach and does not even get absorbed!” I called the holistic vet and told him what she had said. His response? “That’s absurd! It’s just not true.” The oncologist made a few other disparaging remarks about some of the supplements. When I relayed these to the holistic vet, he did not agree (nor would I have expected him to, since he had prescribed them). So it falls to me to figure out who is correct. Yikes.

My hope had been that Alec’s oncologist and holistic veterinarian would work together in complementary harmony. According to my reading, this can and does happen! But it was not happening with these two, so I pressed onward to Plan B. The oncologist had mentioned another holistic vet with whom she had worked and of whom she spoke highly, whereas my first holistic vet and she did not know each other. So I made an appointment with holistic vet #2 for a second opinion, hoping she would be the tie-breaker, so to speak, and forge a nice bridge with the oncologist. The oncologist said she looked forward to hearing holistic vet #2’s recommendations regarding supplements. I was excited as visions of an integrated team effort once again danced in my head, and I couldn’t wait for my appointment. I showed up with all of the supplements that holistic vet #1 had prescribed for Alec. I also brought a list of other supplements that are supposed to be effective at killing cancer cells or preventing metastasis, which I had compiled during my reading, to get her opinion on those.

Although I liked holistic vet #2 personally, I was disappointed to find she had not heard of many of the supplements holistic vet # 1 had prescribed – yet she thought Alec was taking too much and that I should remove some of them. Nor was she familiar with many of the supplements on the list I had brought. When I asked the antioxidant question – which, if any, of the supplements might pose a risk – she deferred to the oncologist! I said, “She told me to ask you!” Jeez. Frustration…to the tune of another $150 exam/consultation fee (not that this amounts to a drop in the bucket of what I have spent – also not that I am complaining). And I left that appointment with more questions than I had going in.

The fact that she was not familiar with many of the supplements Alec was taking did not inspire me to follow her recommendation to take him off some of them. If she had a good reason, I would have definitely considered it. But “I think he is taking too much” alone did not strike me as a valid reason. When dealing with an aggressive, malignant, incurable cancer, I think you want to throw everything at it you can – as long as the supplements are not doing harm or interfering with each other or the chemo, of course. And it goes without saying your dog has to be willing to take them, with food or whatever, and because quality of life is the most important factor always, there should be minimal to no stress associated with giving them…but that is a whole different subject (and another big challenge if your dog is like Ali and lacks the indiscriminate appetite of a hoover vacuum; getting supplements in those voracious dogs is easy!).

Along these lines, holistic vet #2 also suggested only adding one herb/supplement every two weeks so we could monitor each for potential side effects. When I asked how we would know if any side effects were due to the herb or the chemo, she said there was no way to know for sure. So why stagger? And every two weeks there is a recheck exam to the tune of $45- $65 (this is not a lot of money compared to what I am spending, but I was also not happy with the exam…however, I will resist the urge to go off on that particular tangent). I don’t think this was some money-making scheme; I am sure she believes in the slow, staggered method of introducing herbs and supplements, but all things considered (including Alec’s particular form of cancer and everything I gleaned from my reading), I preferred holistic vet #1’s more aggressive approach, plus he just seemed more knowledgeable.

My next step was to call holistic vet #1 and ask him about that list of other supplements I had compiled from my research. I didn’t want him to think I was questioning his methods; I was just curious for his feedback (and these supplements should always be given under the supervision of a veterinarian so I would need to work with him, or someone else). He was familiar with some on my list but thought they were not as effective as those he had prescribed, and others he was not as familiar with. He was open to adding these to Alec’s regimen, however, if I wanted to. I liked his non-rigid attitude and willingness to add things that I might have read about on my own, whereas holistic vet #2 just thought Alec was taking too much without giving me any basis in fact. By the way, in case you are wondering if the supplements are expensive…they are. The total cost of what Alec was prescribed by holistic vet #1 is about $1,300 for one month (cue jaw drop – I cannot think about that, just hoping my credit cards will not max out; the chemo costs even more than this per month). I know they are not gouging because they charge exactly what the manufacturer does for the supplements and do not mark them up. Nevertheless, definitely not small change.

Another area of confusion is diet and nutrition, but I am not even going to touch that one. Of the three vets I asked about diet, all three had different recommendations! You may know that most experts recommend a diet higher in protein and fat and lower in carbohydrates for dogs living with cancer (people too, I think). Well, there is tremendous variation within that – commercial or homemade, raw or cooked, different ingredients and mathematical equations – and there is no consensus on what is best (have you noticed a theme yet??). I have tried to make the best decisions I could after weighing all the conflicting opinions and contrasting them with everything I have read, but it is a lot of pressure and fraught with uncertainty. I know much of this disease is out of my control. However, I don’t want to make a mistake with those precious few things that are within my control (i.e. nutrition, immune support, medication, etc.). I also know whatever I do may not matter. But I have to try.

Disclaimer: It is definitely NOT my intent to impugn the character or professionalism of any of these veterinarians! I know they are advising me to the best of their ability. My aim is merely to show it can be a challenge to make sense of conflicting recommendations, that’s all.

So this last month I have been muddling through what feels like a crash course in caring for the canine cancer patient. The reason it’s a “crash course” is because with a highly metastatic cancer time is of the essence, and I wasn’t prepared. Is anyone ever prepared for this? If anyone would be it should have been me, but I had only been reading books on general canine health and wellness. I thought Alec was perfectly healthy and that I was doing my best to maintain and improve his condition and well being. I had him examined regularly. I fed him healthful foods. I continued to follow a physical therapy regimen. Because of everything he has been through, I was vigilant. I was observant. I was slightly obsessed. But I had not gotten to the point of reading books about different types of cancer in my spare time. I wish I had. I might have seen this coming. After all, hemangiosarcoma is common in German shepherds. Yet I had never heard of it. I always called Alec’s vet at the first sign of anything unusual, but this cancer, like many others, shows no symptoms until it is already fairly advanced. Alec looked and acted healthy, energetic, and vigorous. There were no signs…until that first bleed. Well, there was one sign in retrospect. He had lost about 3 pounds over the last couple months. But I had also switched him to a new diet during that time, to which I was adding fresh foods, and I thought I just had not gotten the proportions perfect yet. Although I tend to blame myself for everything, even I can understand why Alec losing a little weight did not raise alarm bells in the absence of any other clinical symptoms. And he just seemed so healthy, vibrant, and happy…shining eyes, radiant smile, and gleaming coat. Cancer sucks.

And there was that period of lost time, the month and a half following the (first of three!) false benign biopsy results. I don’t think I mentioned that the pathologist, when repeating the last biopsy at the oncologist’s behest, ended up testing 45 additional sections before he finally found cells consistent with hemangiosarcoma – and these were only found in two of the 45 sections. This made me feel slightly “better” about it being missed the first three times, but I had NO idea biopsies could be so unreliable. Take heed. You don’t want to end up like me, fiddling while Rome burns…or drinking champagne while cancer fucking metastasizes inside your beloved. Sorry for the bitter bomb. I try, but sometimes my positive veneer slips.

This has all been about me, but what about Alec? This is his fifth week of chemotherapy, and he seemed to be doing well…eating (even gaining weight), cheerful, active, and basically acting like his regular self. I started taking him swimming again after he had completely recovered from the last surgery, and he did not miss a beat! I was cautious during our first time back in the pool to make sure he did not tire too quickly, but he was raring to go (in fact, wanted to stay in the water longer!) and seemed just fine afterward. In the past couple weeks, we have been to the indoor pool twice, the underwater treadmill once, and this past weekend I took him for a swim in the Columbia River at Sauvie Island. Every day I try to bring him somewhere new in the car – a park or even just a new neighborhood to stroll around – to keep his spirits and sense of adventure up.

I have been spending more time with Alec than ever, if that is possible. He was not alone much before, but I would sometimes go out with friends, leaving him for a few hours. Or I would go the store and leave him at home. I stopped doing that. Now, I really only leave him for 35 minutes each day – the amount of time it takes me to jog my little neighborhood loop – and I have been taking him with me to run short errands because he likes to go for rides. Since it is basically still winter here in Oregon, it has not been too hot to leave him in the car, which is an upside to the unseasonably cool weather. Although I stopped going out socially unless I can bring Alec, we have been spending time with neighbors and friends on my stoop. When we sit outside, Alec is still the feisty “sheriff” (his very appropriate nickname) and continues to do his job with relish and aplomb, which means protecting me from all the neighborhood menaces, i.e. barking at passersby, especially those of the canine persuasion!

That is the update as of last weekend. But early last week he started acting “off.” I mentioned earlier the one notable exception to my attitude of deliberate cheerful positivity in Alec’s presence. It was a few nights ago. For the third evening in a row he began following me from room to room…acting funny. Last time he did this he was bleeding internally. He showed no other signs then, but I brought him to the hospital and they found the bleeding mass on his liver and performed the second emergency surgery. Mind you, there can be no more operations at this point; there is nothing more that can be accomplished through surgery. This “following” behavior, this acting strange, is the only thing I had noticed the last couple days, and each instance was for a relatively brief time, so briefly I thought (hoped) maybe I was imagining it. But then a few nights ago, he also didn’t want his dinner. I am worried. I am scared. He has been doing so well, but now I am terrified again. So I cried. I cried in front of him while he lay on the kitchen floor (where he never lays) looking up at me. We came into the bedroom and he fell asleep on the bed while I cried some more. Then I pulled this out, because I had been meaning to update. Because I am afraid I will lose my voice.

When dealing with a loved one’s terminal illness it is amazing how your perspective shifts and shrinks to praying just for more time…a few months…please, a year. Before this happened, I prayed too, or whatever you want to call wishing and hoping. I would pray for Alec to live until he was 19 years old. I asked for that almost every day. Where did I get 19? Well, it is the longest I had ever heard of a German shepherd living. A few months after I moved to Portland I was walking Alec in his wheelie cart and some passersby mentioned their German shepherd lived to that age. I fixated on it, thinking it was wonderful that Alec could also perhaps live that long, even though it was far past the average life span. Why not, I thought? He has been through so much and I will be vigilant. I will do my best. I won’t miss anything. I will take care of him. I will keep him safe.

This is long and all over the place, but I will write more. I have a lot to say, and the truth is…I am afraid I will lose my voice if he leaves me. Anything I want to say, I figure I better say it now, while I still can. I’m not sure what will happen to me, where I will go, if he is gone. That’s the truth. It is raw and it is ugly and after my pledge to remain positive, I can only type it quietly, late at night while he is sleeping…still by my side, still here with me.

Please keep Alec in your thoughts. I started writing this a few days ago and his appetite is still off. I haven’t been able to give him most of his supplements because he is not interested in the foods I was hiding them in (they are too many to give by mouth; I have to open the capsules and sprinkle the powder in food he likes). I hope this is a reaction to the chemo and not a new bleed. I am worried but I am going to keep hoping for the best. It is all I can do. Thank you to everyone who has been thinking positive thoughts for Alec. It truly does mean a lot.

P.S. Update: Alec went in for chemotherapy yesterday and when they checked his blood work his white blood cell count was really elevated (too high or too low is not good). This is the exact opposite of what would be an expected side effect from the chemo drugs, which can cause bone marrow suppression resulting in a lowered white blood cell count. So this does not appear to be a reaction to chemo. The oncologist said this could be an infection, although she did not see signs of infection. However, she put him on an antibiotic to cover that base. The second thing it could be is a reaction to one of the herbs he is taking (boosting his immune system too much?), so she told me to stop those for a week. We will check his blood levels again next Friday. She said if he gets worse or stops eating, I will have to bring him in. I am so worried and really hope he feels better soon. He seems the same today – eating, but not as much as before, and slightly lethargic. Maybe I was wrong, after all, to follow holistic vet #1’s advice and put him on so many things at once. Ugh! How can I know what the right decisions are? I am not an expert! And the supplements were all prescribed by a vet – it’s not like I went out to the store or hopped on the internet and created a treatment plan myself (all the books caution against this!). Although I hope I did not do something wrong, at the same time I hope it is one of the supplements, because she did not have other theories about what could be causing this strange abnormality.

The barracks, the sheriff, and me…and the Portland sun making a rare appearance.

Love, love, love.

Alec sleeping on my shoe.

How cute is he? One of my favorite things in the world is to watch Alec sleeping soundly with his little eyes scrunched shut like that. Have I mentioned lately how much I love this dog?

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First Chemo Treatment.

Yesterday, I got the confirmation I did not want. The oncologist consulted with the pathologist, who cut several more sections from Alec’s liver biopsy and indeed – finally – found the suspected hemangiosarcoma. Stage III, because it has been found in multiple locations. It boggles my mind to think we received three benign biopsy results. Just a couple days ago, another doctor told me it was “good news.” If only I knew biopsies were so unreliable, I could have demanded they retest the sample, especially the first one. If only, if only.

She wanted to get him in right away for his first chemo treatment, so I dropped Alec off at 8am this morning. His blood levels were good so they proceeded with the treatment, a new drug protocol with which she has been working and seeing results. The protocol is one dose of Vinorelbin a week for 3-4 weeks to start. She has seen survival times of between 2-3 months to a year. Big window there. I can only hope it is successful in extending his good quality of life as long as possible. This is a nasty cancer and the average survival time after diagnosis without medical treatment is mere weeks. Early detection of hemangiosarcoma is important, but early detection is difficult because clinical signs do not typically appear until the cancer has advanced. Throw some false biopsies into the mix and well, there you go…stage III hemangiosarcoma in a dog I thought was in perfect health.

The reason I am writing this without hysterically crying is I am exhausted. With Ali out of the house this morning, I found I did nothing but cry. It has been so hard. I do not want to cry in front of him (sometimes I can’t help it, but usually I can stop myself quickly). With him gone this morning there was nothing to stop me and it was bleak. My friend Steve called in the middle of this and I cried to him for about 45 minutes. I had not talked to anyone but doctors in a couple days and it was nice to hear from someone, to cry to someone, to utter all the terrible thoughts going through my mind (although not nice for him – I know it is hard to witness a friend in so much pain). Yes, it is difficult to write about this, but I feel so alone right now, and writing here makes me feel some kind of connection because I know at least a few people are reading. And I know people care about Alec, even who have never met him, because we have received so much kindness and support on here in the past.

Now it’s time to get Alec’s dinner together, complete with 8 different powders, potions, and oils, and then snuggle with him while I read the second of the two books I picked up yesterday, both by Shawn Messonnier, DVM (I read one of his books previously and liked it: “8 Weeks to a Healthy Pet”). Last night I read “The Natural Vet’s Guide to Preventing and Treating Cancer in Dogs.” Dr. Messonnier is a holistic vet who practices integrative medicine, which combines conventional and complementary therapies to manage cancer. It is a good resource. The other book is “Unexpected Miracles: Hope and Holistic Healing for Pets.” I could do with reading some hopeful stories right now, so that is on tonight’s agenda.

Finally, in case you are not familiar with chemotherapy for dogs, they do not get sick like people do. This is because the doses used are much lower. The goal in animals is palliative not curative – in other words, not to cure the cancer but to manage it for as long as possible. Quality of life is the ultimate focus. There are occasional side effects (most commonly nausea or diarrhea) though these are usually only seen in 10% of dogs. Of course, quality of life has always been my number one priority with Alec…since the day I adopted him. I have tried so hard. Oops, here come the tears. Time to shut that thought down.

I have the diagnosis I didn’t want, but now it’s time to move forward and (say it with me) hope for the best.

Sweet shepherd in the doorway. That purple disc was filled with peanut butter (hence the towel).

Getting a ride from Uncle Mike last Sunday evening to get his blood levels checked (they were stable [phew!]).

My continued (and seemingly futile) attempts to get a decent picture of me and Ali by myself…I took this one yesterday using the self timer on my camera. I am hoping this weekend a photographer friend will come by and take some (good) pictures of us together.

In the lobby at the holistic vet earlier this week. Waiting patiently and quietly…until another dog came in!

The books I am reading.

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Unexpected results…again (when “benign” doesn’t mean benign).

A doctor from the ER hospital called yesterday afternoon with Alec’s liver biopsy results. They did two biopsies; one of the nodule that was removed from his liver and one on a blood clot that was attached to the omentum (best I can understand, this is connective tissue that stores fat and is attached to the liver). She told me both test results were…benign. Before you get excited (as I cautiously did), during what I was hoping would be a superfluous consultation with the oncologist today (who specializes in this type of cancer) she said and I quote, “I don’t believe the results.” I knew last night I should not get too happy, but I admit I couldn’t help feeling cautiously optimistic about this news. It seemed unlikely there would be three wrong benign reports and the ICU doctor I spoke with yesterday agreed that the “benign hematoma” result of last month was probably correct in light of the fact that these two news ones both came back as benign. Obviously it made me feel better to think the initial result a month and a half ago was not wrong.

So the ICU doctor told me this was good news but to keep my appt. today with the oncologist to discuss a monitoring plan for Alec’s liver (monthly ultrasounds, etc.). When she walked in, the first thing I asked the oncologist (aka Dr. Killjoy) was whether she had seen the biopsy results. She replied, “Yes -and I don’t believe them.” As my face fell (definitely what I did not want to hear), she apologized repeatedly for “bursting my bubble,” but said she has seen enough of these false benign results to not believe them. Damn. Has seen “enough of”… in other words, she has seen this multiple times. She also said it did not make sense for there to be another mass in his liver – benign hematomas do no act that way. They do not spread. She said it is very likely the biopsy missed the cancer. I had no idea that biopsies were so unreliable and none of the other doctors I spoke with made it sound like this was the case. However, the oncologist unfortunately has had a ton of experience with exactly this. She even spent a year of her residency training as a pathologist. She was confident and definitely had the experience and knowledge to back up her reasoning, whereas the doctor last night who conveyed the biopsy results simply said, “Alec is a little bit of a mystery.” I wanted to cling to that of course (yes, Alec IS a mystery!), but the oncologist, unfortunately, did not find it so mysterious.

So, after we talked for about an hour, she said she wanted to speak to the pathologist (person who did the biopsies) directly about what he is seeing in the sample, and she also wanted to talk to the two surgeons about what exactly they observed during his surgeries. She talked to me about chemo and she really does seem to be an expert with this type of cancer (hemangiosarcoma – if it is that). She is actively researching and working with some new drug protocols and is in the process of publishing her findings, which is encouraging. If this is what it must be, she seems like an excellent person to work with, a real expert in the field. But she does not want to start giving him chemo drugs (of course nor would I!) until we know what we are dealing with and at this time that is still unclear. She said it could be a”low grade” hemangiosarcoma, which is why it is not showing up on the biopsy results. She said it could even be a different type of cancer. She also said basically it does not matter even if it was something “benign,” because it is acting like a cancer, in other words spreading, and she does not like the nodules throughout his liver – especially if they weren’t there at the time of his splenectomy (which, according to the surgeon, they weren’t. She said his liver appeared healthy when they removed his spleen. But who knows? There was also a lot of blood from the ruptured mass.).

I definitely had a more positive outlook (briefly) last night after talking with the ICU doctor, who said they removed the entire liver nodule (I thought they only got part) and that it was pretty small (an inch). She said the little nodules throughout his liver were really small, the size of pencil erasers, and were not bleeding. She also said she did not expect them to bleed. This made me hopeful but again, this was not the oncologist’s opinion. The oncologist is afraid they will bleed, that another mass will develop, etc. And we can’t put him through another surgery. It is confusing talking to all these doctors. When the surgeon called during surgery Friday night, she made it sound a lot worse than the doctor who called yesterday (saying the little nodules were bleeding and they could not remove the entire mass, etc.). Of course, the surgeon was the one actually in there observing and the doctor who called yesterday was just reading the report. But didn’t the surgeon make that report? It is confusing having seen a different doctor almost every time we have been to the ER hospital, but in a way that’s good because I am getting different opinions and perspectives. Although it is confusing it gives me more pieces of information to try to fit together than if I were just hearing one person’s opinion. Not that this makes my job any easier (it is so hard to evaluate this sometimes contradictory information), but I think it is probably best in the long run to have multiple input just to avoid the potential of dealing with only one person who may be wrong or incompetent or misinformed. Trying to put a positive spin on it, I guess.

Right now I am waiting for the oncologist to call back after talking with the pathologist and the surgeons. Then we will discuss options. As much as it hurts to know they are (or could be) wrong, I am glad there is someone there now to question these repeated benign results. I don’t want to lose any more time. And knowing it could come back three times that way makes me feel slightly better about not pushing last month for them to repeat the test. Honestly, that did not even cross my mind at the time – I really believed the result – but you know how hindsight is.

Speaking of different perspectives, I took Alec to a holistic vet yesterday and he prescribed eight different herbs and supplements. I walked out of there with a small pharmacy; a month or so supply plus the office visit cost me a thousand dollars! But I was anxious to get anything that might help (as long as it will not harm) into Alec’s system right away and, again, did not want to lose any more time. However, today during my consult with the oncologist, out of the eight herbs/supplements, she recommended only three. She is not opposed to using eastern medicine; she actually works in conjunction with a different holistic vet and seemed very knowledgeable about Chinese herbs and supplements. She said in fact many chemo drugs originated as herbs, which I did not know. Anyway, she had convincing reasons why this or that one would not be effective (based on research rather than anecdotal evidence) and she seemed trustworthy to me, mostly because she is not closed-minded on the whole subject and seemed to be current with the latest studies in both conventional and alternative medicine. So, too bad I bought all this expensive stuff! But I wanted Ali seen as soon as possible and the holistic vet appt. came open before the oncologist, whose first available slot was today.

Thank you for all the support. These last several days have been very difficult, as you can imagine, but I guess I am cautiously encouraged by the biopsy results…even if they are false, I hope it means the cancer is less developed than one that would readily show up. I know I am reaching, but what more do I have now?? If you can spare a positive thought, I am hoping and praying that Alec stays stable and that his insides are healing and healthy. Thank you so much. I believe in you, Ali!

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A Cruel Joke.

That’s what the “benign hematoma” results were: a cruel joke. They gave me the standard disclaimer when the results came back: that you can never be 100% positive with biopsies and there is always a chance the cancer was missed. But it is supposedly a small chance. This is very difficult for me to write, but I need to start telling people and I cannot bear to send out multiple emails with this terrible news. Apparently the benign biopsy results were wrong and the cancer has now spread to Alec’s liver, where they found not only another bleeding mass, but a bunch of tiny bleeding tumors throughout his liver. They discovered this during another surgery Friday night. When they found out how bad it was during surgery, one of the doctors called to ask me if I wanted to “let him go” on the table. She said my choices were to not wake him up, or they could try to stop as much bleeding as they could, sew him up, and bring him out of anesthesia. It was wrenching. As I tried to focus and ask questions the doctor finally said we need to decide now because they did not want to leave him under anesthesia for too long. I told them to remove as much of the big tumor they could and wake him up. I struggled with this. She told me he might have weeks, or days, or hours. She said bleeding out was an unpleasant way to go and I needed to think about this if I brought him home. But how could I make this decision? He was showing no symptoms when I brought him to the emergency hospital that evening. I was just being cautious (or so I thought) when I brought him to my regular vet earlier that afternoon. Before he went to surgery, we took a walk around the block in the beautiful warm spring twilight and he was his usual happy self. They did CT scans before surgery to see if there were tumors elsewhere and those came back clean. So how could I decide to let him go when he was fine right before surgery and the cancer showed no signs of spreading beyond his liver yet. On that basis I made my decision. I had to try to get him to chemotherapy. He would be in the hospital at least overnight and she told me, “he might make the decision for us if he does not stop bleeding in the next 24 hours.” Oh my god I can’t believe this is happening. But I have to be strong for him. I cannot collapse.

This began two Fridays ago, when Alec began to be lethargic mid-way through the day. He showed no other symptoms – his vitals were normal, he was eating and drinking, and he was alert. But he did not want to go for a walk. He just wanted to lie down. This is very unusual for Alec so after consulting with his regular vet (who was of the opinion that given his history I should not wait to have him seen), I took him to the emergency hospital again. There they did a chest x-ray and blood work. Those came back normal and the doctor told me I should take him home and monitor him to see if he gets worse, basically. He did not. By mid-day the next day he was his old self again. The doctor said his abdomen was slightly painful and I assumed he pulled a muscle (a tech suggested this possibility when I called the next morning concerned he was still lethargic and asking if I should bring him back in). I remembered that his lethargy came on while we were doing his physical therapy rocker board exercises; he balked and did not want to do them and instead went to lie down. Alec enjoys these exercises because he gets treats the whole time so this was unusual. But in retrospect that seemed to fit the theory that perhaps he pulled a muscle in his abdomen and when he was back to his old self the next day I breathed a huge sigh of relief.

He was fine all week and then this past Friday when we woke up it was the same thing all over again. He looked weird when we woke up, ears slightly back, eyes dull, and he did not want to go on his morning walk. He drank a ton of water, which was odd, but he ate breakfast. I called his regular vet again and she wanted to talk with me about a plan of action before I brought him back to the emergency hospital. By the time I spoke with her a few hours later his lethargy had lifted and I had taken him for two walks. The only sign he was showing was that he was acting weird and clingy, following me from room to room, lying down right next to my desk chair, which he never does, looking at me funny. His vet mentioned gas pains or cramping, asked if I had given him any new treats lately, etc. The answer was no. I had an appointment with them for 4pm that afternoon and I asked her if I should keep it given the fact that his lethargy had lifted and by now he was showing no clinical signs at all (except looking at me funny). She said I might as well cancel it because they probably would not find anything in a basic exam that I had not noted (I had already taken his temperature, palpated him, etc…all the obvious stuff) and to continue monitoring him over the weekend. But after I hung up I got a weird feeling and called back and asked to still come in. I just wanted to be sure I was not missing something obvious and I figured it would be good to have peace of mind as we were going into the weekend.

My regular vet’s partner saw Alec and he was cheerful and perky during the exam. She decided to do a baby ultrasound (they have a mini-machine there) to rule out fluid in his abdomen. To our surprise she found fluid. She just started saying “I’m so sorry” and sent me over to the emergency hospital (Dove Lewis) to get a full ultrasound done.

The ultrasound At Dove Lewis showed a bleeding mass on Alec’s liver. The ICU doctor brought me back and said “I have some scary news.” He presented me with a bunch of options I barely understood and I tried to focus and make sense of them (one of them was “hospice and humane euthanasia” and my fragile composure broke at that and I cried out, “what? no!”) but eventually he said he had to get going because it was busy and basically I needed to make a decision. He asked if there was anyone I could call to talk it over with. Not really. The main two options were go right to surgery or do something called a CT scan first. He said if I was going to do surgery no matter what, then don’t bother with the expensive scan. But if the results of the scan might change my mind about surgery (i.e. if he has tumors in other places, would I still want to put him through surgery?) then it made sense. So I said do the scan and if it’s clear go ahead with surgery. He said surgery was the only way to stop the bleeding and see what we were dealing with. I could wait on surgery but it was clear no good would come of that. Alec was stable with no clinical signs when he came in and those are obviously the optimal conditions under which to do surgery.

So I went home and at 11:30pm a different doctor called to say the CT scan was clear and they were prepping Alec for surgery. She said the surgery would be done in about an hour, but that she would call sooner if they found anything else during surgery. My phone rang 35 minutes later. She said in addition to the bleeding mass there were tiny bleeding tumors throughout his liver. She asked if I wanted to just let him go on the table. I think I discussed this part in the first paragraph, sorry I am repeating. I weighed everything and made the best decision I could. They woke him up and she said if he survived the next 24 hours (meaning he did not continue to bleed) and was stable, I could bring him home the next day. He was stable the next day and I brought him home and I don’t know what I have been doing since then. I made an appointment with a holistic vet and an oncologist and we will see them this week. I am trying so hard not to fall apart but I fear I might go crazy. Not now, I know I need to be strong for Alec. I tried to find any angle, any remote thing I could hope for, but they couldn’t give me anything. I asked could this be another benign hematoma, maybe something else besides cancer, but they said that was extremely unlikely and that even without the biopsy results we can say with 99% certainty that it is hemangiosarcoma (the very bad type of cancer I was so relieved to find out it supposedly wasn’t the first time). This is the pattern of hemangiosarcoma. It spreads from spleen to liver, etc., and that fact that it grew so fast in the last month and a half (his liver looked normal during the splenectomy)…not good. You can gain some time with chemotherapy supposedly, but chances are obviously better the earlier you catch it.

To think I have been drinking champagne and celebrating for a month while the cancer was spreading. It breaks my heart. I have been on top of the world since I got the benign biopsy result, thanking my lucky stars, skipping around in a constant good mood and state of gratitude, looking forward to every precious day I have with Alec and now this. It is hard not to feel like a cruel joke has been played by the universe. Like I have done something wrong and am being punished, but I know the world doesn’t work like that, and I can’t think that way. Mostly I can’t think that way because it is too much to bear. I try so hard to always stay positive and to always look for the “silver lining” but this is too much. The “benign hematoma” result was against the odds I know, but I thought we were just lucky, that Alec caught a break. To think I could have started treatment a month and a half ago before it had spread to a vital organ…I am devastated.

I hate to give bad news and I am sorry, but I cannot deal with telling people individually. I am barely holding my mind together. I took Alec back Sunday night to have his blood levels checked and they were stable and even a little higher than after surgery, which is good. I am just hoping he does not bleed again (I am giving him a Chinese herb that is supposed to help stop bleeding – recommended by the oncologist) and that he stays stable long enough to start some kind of treatment so we can have some time together.

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BENIGN HEMATOMA!!!!


I got Alec’s biopsy results (BENIGN HEMATOMA!!!!) yesterday, and it was hands-down the best day of my life. Yesterday simply was not long enough, though, so today is also the best day. And probably tomorrow too. And the day after that. It’s a miracle. There are just no words. But there IS champagne. And that is what I am doing now. But first I wanted to share the incredibly happy news and also say THANK YOU to everyone who spared kind words, good thoughts, positive energy, well wishes and/or prayers for Alec over the last several days. I just know IT WORKED and I straight up love you even if I have never met you. On behalf of me and Alec, thank you so much. We are so lucky. I can’t stop saying thank you out loud. I still think I am in shock. I have never been in shock from happiness and relief before. It is interesting and wonderful. I can’t describe it. I wish I could share a glass of champagne with you – although I only have one champagne flute, so yours will have to be served in a jar 😉 – but I lift my glass in spirit. I have never had a better reason to celebrate. I propose a toast to hope and love and faith in things not seen. Thank you, thank you, thank you. I hope your evening is as beautiful as mine.

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Hoping for the best.

Alec in the van after getting sprung from the emergency hospital…let’s go home!

Nap time! When we arrived home, Alec whined fussily for about 15 minutes and then passed right out. Adorably, he is using his cube toy as a pillow.

After two days in the emergency hospital, Alec is finally home! He is doing well post-operatively. The last couple days he was being monitored for heart ayrrhthmias (very common after splenectomies, apparently – if the irregularities had persisted he would have been put on heart medication, but he did not need it). They were also monitoring his red blood cell count and warned me he might need a transfusion after surgery because of how much blood he lost. However, we were lucky and he did not need that either. Finally, they wanted to make sure he was eating well (and not vomiting) and doing okay on his oral pain meds before releasing him. Although he was picky when the staff fed him, he ate heartily for me when I visited him yesterday and he kept it all down so I got the green light to bring him home this morning. I am so happy he is home with me!

When he saw me, Alec began to whine excitedly (he is a very whiny little boy). Because they brought him out the side door directly into the parking lot, and not into the exam room where we had had our visits, I think he knew he was going home. I was nervous about lifting him into the van but that went okay. He has staples in his abdomen and I had to alter the way I normally lift him in and out of the van. I am hoping to not have to transport him while he is healing. The staples have to stay in for two weeks, and he is on pain medication, but nothing else for now. He has activity restrictions due to the staples and his incision, but basically these are the same restrictions he already has because of his back (plus very short walks for now). I was so worried they might hurt his back inadvertently in the hospital. Each time I talked to a new tech or doctor: “And you know about his disability, right?…Okay, just checking!” They were all great and assured me they were being very careful and that there was a big sign on his kennel alerting staff to his back issue.

I look for good news where I can find it, and upon discharge I was happy to learn the final bill was less than the estimate they had given me (because he did not need the blood transfusion or have other complications). The total was $3,887 and I have one credit card that is still within a 6-month introductory period with 0% APR (I actually got it in Feb. to pay for Alec’s new rehab treatments in Corvallis – the ones that unfortunately did not work!). This credit card has a $5,000 limit, and with the $1,000 for the rehab treatments from last month, I still had just enough room to put this bill on it, which is good because my other two credit cards are not in introductory periods and have high APR’s (I originally got both of those for Kobi’s chemotherapy treatments a few years ago and now retain them for emergencies, aka vet bills). Not that I will be able to pay this off in 4 months, but I am glad the interest will not kick in right away!

Of course, we are not out of the woods. Today’s bill is truly the least of my worries. Alec’s spleen and the grapefruit sized mass that had ruptured, along with a biopsy of his liver, were sent to the lab and I will not learn the results until next week – they said probably Wed. or Thurs. They told me the regular statistics are 60-70% chance it is malignant, but given his age (9) and breed, the chances is higher. Not the greatest odds, but I am hoping for the best: a benign hematoma. If it is malignant, we will have to begin chemotherapy right away, as this is an aggressive type of cancer. So there is a lot more potentially coming down the pike at us, financially and health-wise, the latter of course and without saying always being the most important, but I am scared about hitting the limit on all my cards eventually (it happens fast; I was credit card debt free only a month ago!). But I will cross that bridge when I come to it. Step…by…step. I am trying to keep my thoughts positive.

For now, he is home! He was so cute when I brought him inside. He lay down on his bed and whined softly for about 15 minutes (I think he was just “telling me all about it,” if you know what I mean). I assured him I was very sorry for leaving him at the hospital for two days but that it was for the best, etc. He even let me cuddle him a bit! Usually my attempts to cuddle him elicit escape attempts, but I think he did not mind being babied a little as I listened and sympathized. It was the cutest whine; I am no dog translator, but I think the meaning was transparent: “I am happy to be home but I did not like being in that hospital at all!” Then suddenly he just fell asleep – passed right out on his bed (yes, he is breathing! Of course I checked!), and now his little paws are twitching as he is probably dreaming about his stay in the ICU. Poor little guy is tuckered out. He went from whine, whine, whine to fast asleep in 30 seconds. I hope he continues to sleep and rest. I know he did a lot of sleeping in the hospital, but I think being home in one’s own bed is different.

We have been fortunate so far. His surgery was a success and his surrounding organs looked good. There were no masses on his lungs (they x-rayed those before surgery). He has recovered amazingly well from surgery so far (knocking on wood!). And dogs can live just fine without their spleens, in case you were wondering. Finally, when it happened, I was here with him and brought him in very soon after noticing he was acting strangely (thanks again to Daniela, the wonderful receptionist at my regular vet, who when I called strongly advised me not to wait). This could easily have happened next weekend when I was at a work conference on the east coast. I had planned for a couple friends to take turns watching him, but I doubt they would have been as alarmed as I was by his sudden lethargy; they probably would have thought he was just depressed that I was gone. They obviously don’t know him as well as I do, and likely would not have realized how strange his behavior was or that it was an emergency situation. I almost didn’t (and if you have been reading this blog you know I am borderline obsessive about observing Alec, just because of all he has been through). He could have easily bled to death if much more time had gone by. So if this was going to happen, we have been lucky so far.

I just need our luck to hold out a little longer. I appreciate all the well wishes and support. It really means a lot. If you could do me a little favor and make a wish for a benign hematoma for Alec, I would be so grateful. I know so many people are pulling for him and thinking good thoughts and it helps so much.

And now…I wait. Love is not easy. It holds the potential for the greatest joy but also the deepest pain. The hardest part about truly loving someone, at least for me, is the intense desire to protect them from harm. You try to do everything in your power to keep them safe, but still there are things you cannot control. That’s where the hope comes in.

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Not this.

This morning when I woke up, I noticed Alec had vomited a little in the night, or maybe that morning. I had given him a CET chew (dental rawhide chewy thingy) the night before, which I have given him many times. There was a chunk of this along with some food in the vomit. I thought maybe he had an upset tummy because he ate the whole thing before bed (sometimes he chews them over the course of a few days, but not always). When we got up he went right to his water bowl and started drinking…and drinking…and drinking. Finally I called him away before he could drain the whole (big) bowl and took him outside where he urinated and defecated like normal, but he did not want to walk – not normal – and just stood there obviously wanting to come back inside. He seemed weak and was acting strange. I brought him inside, thinking again maybe just a little upset tummy. He went straight into his “little house” (his kennel) and showed no interest in breakfast – very unusual. It crossed my mind he might have some of the chewy hung up inside but I (mistakenly, it turns out) thought he could not be blocked if he had peed and pooped. I called his regular vet and they were booked of course, but Daniella at the front desk (who is wonderful) told me if it was a blockage I would not want to wait; she recommended I take him to the emergency clinic. Even though it turned out not to be a blockage, this was very good advice.

As luck would have it, my annual performance review at work was scheduled for that morning. I was going to take Alec in as soon as it was over. When my boss called at 9:30 am, however, she could tell immediately something was wrong (I have neither poker face, nor poker voice, nor poker anything) and she suggested we reschedule and thank god she did. I took him in right after that and he was so weak by the time we got to the emergency clinic. There were dogs in the lobby and he did not even respond (again, highly unusual) and he laid down while I was at the front desk checking in…also unusual for this normally anxious boy. He was weak and lethargic and clearly did not want to walk. What was wrong with him?

After the front desk called for triage, a tech came out to the lobby. He asked me some questions about things Alec might have gotten into. I assured him Alec was rarely out of my sight, and he was not the scavenger type dog anyway – never has been (that was my dear Kobi – totally different story). I asked, but was not allowed to come back with him. I waited. Someone came and told me they were doing an ultrasound to see if he was blocked. An hour or so later the doctor came out to the lobby to call me back. She did not have a poker face either. My heart sank as the panic rose.

She said Alec was bleeding internally – a lot. There was a mass on his spleen, and it had ruptured. There was no blockage; it wasn’t the rawhide chewy I gave him. She said I could not have known ahead of time (as I pleaded, “what signs did I miss?? I watch him so closely!”). She told me there are usually no clinical signs for splenic masses until they rupture. She said cancer of the spleen is common in German shepherds but there is a chance it could be a benign hematoma. As remote as this chance may be, it is what I am hoping for.

The only option was surgery to remove the spleen. They recommended x-rays first to be sure there were no tumors on his lungs, in which case surgery might be futile. They brought him to me in the exam room and I said good-bye to him before the x-rays (he was alert but weak…although he walked in on his own, we had to drag him back across the slippery floor on the blanket because he did not want to walk) and waited another hour. The doctor came out to tell me his chest x-rays were clear. Hurdle one. Then he went into surgery. I came back home as there was nothing I could do and waited by the phone. Three hours later the surgeon called to tell me he had come out of surgery okay and was stable. Hurdle two. She had removed his spleen, which had a grapefruit sized mass on it. They sent his whole spleen out to the lab, and I won’t know until next Wednesday or Thursday if it is definitely cancer. Again, if you are reading this, BENIGN HEMATOMA is what we are hoping for!!! Alec has beaten the odds before. He has been through so much. I know life isn’t fair, but he deserves a break. The estimate for today was $6,300. If it is cancer, chemotherapy will be an option. And of course, one I will take. The prognosis is only 2-6 months without chemo.

Of course I asked, if it IS cancer (please no!!!!), is there a possibility it was all removed when his spleen was taken out? The surgeon told me no; because of the vascular nature of the spleen, with so much blood passing through (unlike some random leg muscle for example) there is the potential that the rest of his cells have been “showered.” He would require chemo.

He came out of surgery three hours ago. The surgeon said I could visit in five. I will be heading to the hospital soon. I am writing this to take my mind off things, to keep from drinking too much whiskey. I just poured myself a finger when I learned he made it through surgery okay. I don’t know what to do with myself. I am trying so hard to think good thoughts, but my brain is crazy with worry and anxiety. I don’t want to let the bad thoughts in. Whiskey helps. But I can’t drink too much because I need to drive to the hospital later.

He will be monitored overnight, his heart, his blood levels, etc. If everything looks good tomorrow I can bring him home. Or it may not be until Sunday. As luck would have it, I am traveling to the east coast for work next weekend. I don’t think I will be able to stick to the original plan of having friends watch him now. The emergency clinic does medical boarding. I got a quote: $630 for 72 hours. This might be my only option. I was nervous enough leaving him before this…I can’t imagine leaving now without him being monitored 24/7.

In keeping with my previous post about bedside manner, the ER doctor who first spoke to us, Maree Doolan, was wonderful. She was so compassionate and really caring and spent time talking with me until I was out of questions. I did not feel rushed. This is a special skill; its easy for busy vets to inadvertently make you feel hurried. This is also what I love about Kristin Sulis, our regular vet at Mt Tabor Veterinary Care (and her wonderful staff). Our neurologist back in California, Lisa Tieber, shared this quality. I have had lots of experiences with vets and if they could all be like this, it would be great. Dr. Doolan even called to check in after the surgeon had already called with an update. Those of you who have been in similar situations know how much that means…not a perfunctory call, but genuine. One can tell the difference, and it made a difference to me.

Quick note about my previous posts: the laser and VOM therapies I wrote about last time had no effect; Alec did not show any improvements. I was holding off writing that update, for obvious reasons I guess. But I am glad I tried. If only it hadn’t been so expensive for nothing to come of it. The doctor was so hopeful at the outset; she was really disappointed he had not improved. Oh well. All of that matters little now. I just need him to get better. Benign hematoma, benign hematoma…and no complications. Please say it with me. Please let him be okay.

I just took this photo a few days ago during a stroll along the river front.

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