The "C" word?
Bear wants to fight this cancer & swim in the Spring!
Diagnosis & Decision to Fight
Follow my personal journal entries for 10 days as we discover and make decisions that will forever change our lives.
IMPORTANT:
Throughout my journal you will see areas that start with (NOTE:) and are in this cyan blue color. This is information that I have learned after the fact from research or piecing together information. Some of my NOTE areas are things that I now question from looking back on events. I think these areas are as important as the notes & entries made at the actual time. So please read them also.
JAN 14, 2009
WED - Jan 14, 2009 - I took Bear in to see the Vet today. Two days earlier, my husband was rubbing Bear's head and shoulder's and told me to come over to see if I felt anything odd on him. I rubbed him and his lymph nodes seemed enlarged, but not too terribly enlarged. So I wasn't really too worried. Bear always has skin infections, allergies, ear infections and I just figured, ok, so now he probably has a throat infection.
We have a Vet that is easy to talk to and Bear really likes him. So going to the Vet wasn't a big deal for Bear. Dr. Beach came out to the waiting room to see Bear and I told him that he had some swollen glands. Dr. Beach was all smiles and talking to Bear as he placed his hands near his throat feeling around and then down to his shoulders and it was about this time that something in the air seemed to change. It got quieter and the vet wasn't smiling anymore. He eventually worked his way all over Bear feeling for what I later learned was his lymph nodes.
Dr. Beach said, "here, do you feel this?" I put my hands over another set of lymph nodes and was surprised that they felt so big? These were ones that I had missed. "How did I miss those?"
It seemed like the entire waiting room got oddly quiet and I looked at the vet. He said, "Joni, it doesn't look good."
"What? What do you mean?" I asked that question, but really there was something in me that just knew. I knew he was going to say cancer. I just knew... I just knew.
He told me that Bear's symptoms looked like Multicentric Lymphoma (probably a Stage 3 which just affects the Lymph Nodes as Bear doesn't have any other symptoms) and he wanted to do a needle aspiration and send it off to the lab. Could I bring him back on Friday morning to have this done? Yes, of course I could. But immediately I spit out ... "couldn't we do surgery and fix it, what about medicine to fix it, what can you do to fix it?, you CAN fix it?"
The waiting room was so quiet and he just looked at me and shook his head and said I'm sorry.
Then he told me that he would give Bear Prednisone for his last few months. Yes, possibly 2 - 6 more months.
Last few months? 2-6 months? Did I hear that correctly? WHAT? ....... I felt dizzy.
I was not prepared for that. 2-6 months and Bear would DIE? No, no that wasn't right. I could feel my body starting to flush and my head felt like it had dis-attached itself from my body. This isn't happening, Bear's not sick! No, you must be wrong, Bear isn't sick.
I was vaguely aware of people coming into the waiting area with their pets and wanting to talk to the Vet, but he never turned away from me. I kept thinking that he was going to tell me that this was just the worst case scenario and that more than likely Bear's ear infection had drained into his throat area and that it needed antibiotics or something... but he never said that. He just looked sad. I looked over at the front desk where there was always a cheerful face ready to pet Bear and tell him how handsome he was. But when I looked at them they just looked down and they were sad.
Tears filled up my eyes and spilled down my face. I couldn't speak. Dr. Beach started to say something and I just raised up my hands and turned my head away, as if to say, time-out. I couldn't stop the tears. Like a zombie, I rubbed Bear's head, stood up and left. No other words were spoken.
Bear and I got into the car and I think I sat there for a long time trying to wrap my brain around this news... but I just couldn't quite comprehend it. Cancer was all jumbled around in my mind and I couldn't form a cohesive thought about it. I drove home (at least I must have as I did end up at home.)
(Note: After I went home, I did a lot of research on Canine Lymphoma (lymphosarcoma) and found that it is one of the most successfully treated canine cancers and that there is a lot that can be done for him. Chemotherapy protocols are extremely successful in extending their lives and providing a great quality of life for dogs.
So, I can't understand why on that day when I asked what we could do, Dr. Beach just said treat him with Prednisone to make him comfortable, but that his life expectancy would only be 2-6 months.
Also, my research had led me to this information "It must be noted that oral prednisone treatment prior to chemotherapy is not recommended and may actually reduce the effectiveness of the chemotherapy." Bear was on Prednisone for 12 days before he received his first chemo treatment. So, giving him Prednisone without immediatley starting the Chemo protocols put Bear's chances with Chemotherapy at risk right in the very beginning.
Maybe Dr. Beach didn't think I would pursue any other options and would just take him at his word. I find it hard to believe that he didn't know that dogs could have Chemo. But, one thing is for sure, I made it clear that I wanted to know everything possible that could be done for Bear. And I wasn't given any options.
JAN 16, 2009
FRI - We were told to not let Bear have anything to eat or drink after midnight and to bring him in by 8:30 a.m. for the needle aspiration. I'm not sure what to expect. We were told they would call us as soon as he was able to be released to come home. We reluctantly gave Bear a hug and told him we'd be back soon and gave the Vet Tech Bear's blanket to make him feel more secure.
Before we left I asked if they were going to do an ultra sound or xrays or bloodwork and was told that they didn't have an ultrasound machine and that xrays wouldn't be able to give them much insight and that Yes they would do the bloodwork. (Note: I've never seen any of the blood work and x-rays would have been helpful)
We started calling at noon and around 1:30 they said we could pick him up. At the Vet's office they told us that Bear did fine and didn't have any problems. They also gave us antibiotics to give him and started Bear on 20 mg of Prednisone twice a day. We were told it would make him thirsty and pee a lot. But that it should make him feel better.
I was so happy to see Bear when he came out to the waiting room, but I soon noticed a horrible smell. I thought it was his breath, but soon discovered that he had poop on his back legs, rear end and his tail. A girl came out of the back with a white garbage bag and said that Bear had an accident on his blanket and that it was in the bag. I was shocked to see that they left him in a kennel in that condition, but honestly all I wanted to do was hurry up and get Bear home.
(NOTE: Bear was put to sleep for a needle aspiration. THERE IS NO REASON A DOG SHOULD BE SEDATED/PUT TO SLEEP FOR THIS. THIS IS JUST FURTHER WEAKENING AN ALREADY COMPROMISED IMMUNE SYSTEM. The only reason a dog should be sedated is if the dog is extremely aggressive - Bear is a laid back, easy going couch potato - or if dog is for some other reason unable to be handled.
Again, this is one of those things that I didn't understand until after the fact. Bear was so terribly drugged and out of it when we got him. The feces on him had been there a while as some of it was dried on to him. He was put in a kennel all day and I was told he would have surgery /needle aspiration that morning. At 2 pm when we got him, he could barely hold his head up and the rest of the night he was out of it. What in the world would possess a Veterinary to do such an unecessary and extremely stressful thing like this to Bear? Not to mention the blow to his already weakened immune system. This is just one of many instances that Bear's immune system was put in jeopardy. I can only assume that it was done out of convenience for the vet. He has had surgeries before and we have never seen him so out of it. What kind of vet would do this?)
As soon as we got home I took Bear into the bathroom and gently cleaned him all up and told him that it was ok. He was very groggy for the rest of the afternoon. I still feel upset about the condition he was in when I picked him up and it makes me wonder if this was just a freak thing and they got busy and didn't see it or if this is the kind of thing that happens a lot? I don't want to think that way because really I have a lot of respect for the way they are with Bear... But still......I wonder.
(NOTE: In my after the fact research I've found that there are many things that should be done in the DIAGNOSIS process. A thorough physical exam is important, as it will dictate which further tests will be required. The work up should always include:
A Complete blood count (CBC),
A Platelet count
A Biochemical Profile
A Urinalysis
A Fine Need Aspiration or excision or surgical biopsy of the lymph node
These tests allow for the confirmation of the diagnosis and determine if the dog is hpercalcemic, assess kidney function and determines if the dog has normal neutrophil and platelet counts so that chemo can safely be administered.
Some Lymphoma can also be diagnosed with x-rays and ultrasound.
Yes, Bear's lymph nodes were swollen, but we have no idea for sure what stage he was in. We don't know if there was any involvement of the liver and/or spleen, and/or anterior mediastinum in the chest involved. Or if there was any involvement of the bone marrow... why, because there was no x-ray done, no ultra sound done, as far as I know there wasn't even the full blood workup done.
But I was told that Bear's lymphoma is multicentric which is just the peripheral lymph nodes being affected. This is considered a Stage III.
I wish I had known more of what to ask for and made it clear that I wanted it all done while they were doing the needle aspiration. But I'm not a vet, I expected Bear to have a full diagnostic workup with something as serious as cancer.
Bear Loves To Swim
JAN 17 - 21
SAT - WED
This has been one of the longest weeks of my life. Bear had the needle aspiration on Friday and Monday was a holiday.
All I could think about was there is some monster inside of my Bear-Bear slowing (actually aggressively) killing him. I spent most of my time on the internet searching for an answer, searching for something that we could do to save Bear's life. I struggled with the ethical part of this scenario...what is the right thing to do? The line is divided between do everything possible and/or let nature take it's course. The only thing I knew for sure is that I didn't want Bear to suffer.
So I cried and cried and I cried some more. My heart is broken and all that was right in this world seemed to be wrong. How could this be happening? Did I do something wrong? Could I have prevented it? I needed answers. My mind kept kept referring to my vision of the vet shaking his head when I asked him if he could fix it. That picture in my mind plays over and over in super slow motion. But, I just can't accept it.
I read more than I ever hoped to know about cancer. It's scary. I never dreamed that so many animals died of cancer. In my mind I always thought that was just a human disease. But the numbers are astounding.
I immediately implement some of the knowledge I've gained concerning Bear's diet. I've changed his premium dog food to a high protein one with no grains (Solid Gold, Barking At the Moon Holistic 41% protein, Innova EVO dog food 42% protein & Taste of the Wild, High Prairie 32% protein ) and have added some supplements of Omega 3 Fish oil and Flax Seed Oil.
I have located some wonderful support groups for pets with cancer and in my research I discovered that Canine Lymphoma is one of the most treatable cancers in dogs and I also discovered that there are not any Canine Oncologist in our state. And it's apparent that my vet didn't have experience treating cancer. But now I have hope.
Ok, my mind is made. I will help Bear fight this as long as he can. I hope I'm smart enough to know when to let it go.
I finally locate an Internal Medicine Vet in Little Rock. His name is Anthony Gary. He specialized in small animal internal medicine in school, graduated summa cum laude from the University of Missouri-Columbia College of Vet Medicine, did an internship at North Carolina State University and his residency at Colorado State University. Ok, so this guy sounds great... but why was it so hard to find him?
His website says that our local vet must refer us. So I get on the phone and tell them to please call him and set up an appointment. They call Dr. Gary and he agrees to see Bear but wants the results of the aspiration that was done. Because as of right now, all we have is an unofficial diagnosis of Lymphoma.
Each day that passes is a day off of his short life! Ok, .... this is urgent. Time is of the essence.
My husband starts calling the Vet's office on Wednesday... do you have the lab results yet... they call the lab and check on it. Still waiting. But Marty calls them every day.
SATURDAY - TUESDAY Jan 17 - 20, 2009
The Prednisone that Dr. Beach put Bear on makes him pant like crazy and he has a very aggressive appetite. (NOTE: In one week he will gain 4 lbs because of it.) But Bear acts happy.
WEDNESDAY - Jan 21, 2009
The heavy panting is scary. And Bear's stomach seems to be distended, full & bloated looking. I'm worried about it and send pictures to Dr. Beach's office to look at. Is this normal? Is there a problem?
Below are the emails & pictures I sent to the vet and his reply. He thinks it's just swollen lymph nodes. But I'm worried and anxious to get the needle aspiration results back because we can't get an appointment with Dr. Gary until he has the results from the lab. (NOTE: As it turned out we didn't get the results for a full 7 days - the next Friday, Jan 23rd & the appointment with Dr. Gary will be on Monday, Jan 26th. Bear will have been on 12 days of Prednisone Treatment before he will start his first chemo treatment. Research shows that Prednisone treatments before starting Chemo can decrease the Chemo's effectiveness.)
As you see in my last email to Dr. Beach, I said "the sooner the ultra-sound is done the better." (NOTE: As it turns out, there has never been an ultra-sound done on Bear. On the day of Bear's needle aspiration I had asked if they would do a blood work up, x-rays & an ultra sound.
I haven't seen the blood workup, they didn't do any x-rays and from what I understand now, there are only a couple of ultra sounds around here and they didn't have an ultra sound done.)
Bulges in Bears stomach & emails to the Vet
JAN 23 - FRIDAY OFFICIAL DIAGNOSIS
FRIDAY
Finally on Friday, late in the afternoon, we get the call. Official diagnosis is Malignant Lymphoma! Even though we knew.. it was hard hearing it officially. Oh my god, it's true. Tears and more tears.
We are told we have an appointment set up to meet with Dr. Gary on Monday, Jan 26, 2009, at 10:30 am.
Dr. GARY - Internal Medicine Vet
MON, JAN 26, 2009
Bear and I meet with Dr. Gary today. Marty is in Denver, so I'm scared and feeling very small. I'm so nervous about getting there on time due to the traffic and the sleet that is falling that I leave 1-1/2 hours early. The drive takes me about 45 minutes and we go in and ask for Dr. Gary.
oops - he no longer works here. He is out on his own doing consulting work. I call my vet's office and am told that Dr. Gary will be meeting us at their office! Somewhere in my mind, I'm thinking that I knew that! (Dr. Gary's website still says that he works for this clinic in Maumelle, AR.)
Ok, so where is my brain? I haven't been thinking clearly and I need to get my head out of my @!*% and get it together so I can help Bear.
Ok, so it only took us about 30 minutes to turn around and go back to where we started.
I walked into the exam room with Bear and my 8 pages of notes and questions for the new vet we were meeting. Dr. Gary was nice. He listened patiently and answered my many questions. After spending 1-1/2 hours with him, I've decided that he is exactly the type of doc that in a perfect world I would have created for Bear. Let's hope I'm right. (NOTE: In retrospect, I still think the same about him. I believe that since he does not work out of an office and travels that he is at a slight disadvantage in some areas as he has to depend on the dog's regular Vet to provide him with all the necessary info that he will need. In other words, I think it is reasonable for him to assume that Bear is a priority for both of them as professionals working together to save this pet's life.
In reality, I think Dr. Beach only did the IV port insertion and then he took off. Dr. Gary freely said that he normally had specialists that did the IV's and frankly, that part of Chemo was his weak area. I appreciated his honesty and he asked Dr. Beach to insert the ports.)
JAN 26 MONDAY
Dr. Gary will draw some blood because he will need this before starting the Chemo and he'll do a needle aspiration so we can send it in to see what type cells they are ("b" or "T"). (NOTE: Dr. Gary quickly and easily did the Fine Needle Aspiration without so much as a whimper or a jerk from Bear. There was no need for him to be sedated the last time and no need for him to be as over sedated as he was.)
The "b" cell type is suppose to respond better to the chemo. I think he said that the "T" cells did not respond as well to the treatments. Regardless of the cell type, this won't change the treatment protocol for Bear. It is primarily for me to know what I can expect in terms of treatment and how Bear progresses or doesn't. It might help me also in preparing .......myself. (NOTE: We later find out that Bear has the "b" cell type. This is good news in how well Bear will do with the Chemo.)
But he said to plan on having the first treatment on Wednesday. I mentioned several times that I didn't want Bear to suffer and questioned him about pretreating Bear for Nausea. He said that dogs usually tolerated Vincristine well with little or no problems. (Note: If your dog is one of the ones that does not tolerate this well, then it doesn't matter what all the data says about how well dogs tolerate this. Have your dog pretreated with an anti-nausea medication to be on the safe side. Seeing them so helpless and so sick is very stressful on the animal and on you.)
We talked about the cost of the treatments and roughly it will be between $250 - $290 per week and it looks like there are about 16 treatment weeks. And that's only if there are no extras or emergencies. That's a lot of money when you don't really have lots of extra to spare. But, we'll find a way.
Tick, Tick, Tick, Tick............... (3 weeks after Bear died, we received a bill from Dr. Beach's office for $75.80. We had already paid him $800 for the 2 treatments that Bear had. I guess that would make the weekly cost of treatment a little different than I stated above. It figured out to $437.90 per week)
Follow us in our 2 week Chemo Journey
This is where OUR FIGHT BEGINS and follows our two week journal of Chemotherapy Treatments and our battle to save Bear's life.
This is a short battle as Bear will only receive 2 Chemo treatments and will only survive for 14 days
11/23/2009 9:45:19 PM