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Tuesday, March 30, 2010

Decisions, decisions...and updates!

Today is Tuesday March 30, 2010. Three days ago was my birthday. March 27th meant a lot more to me this year than merely the celebration of aging another year...it marked the one month milestone since Heidi was diagnosed with her MCT. I almost can't believe that it has been a full month; in some ways it feels like a year...in other ways it feels like it only happened yesterday.

My last update talked about our oncology visit at NEVOG. I left there with a lot of information: thoughts on what to expect for the future and ideas on what to do in terms of further diagnostics and treatments. I have had about 2 weeks to digest all of that information. I've done more research online, and tapped my greatest resource yet: the amazingly informative and patient doctors at my practice. I've come up with the following:

Ive decided not to pursue radiation therapy with Heidi. The costs of it far outweigh any benefits I see. Here are some of the pro's and con's:
Pro's: the radiation will hopefully kill any remaining cancer cells from the site of the tumor that may have been missed/remained outside of the narrow margins obtained with surgery. The treatment is short, and the side-effects are temporary. Heidi will receive treatment for 15 days (5 days a week for 3 weeks in a row) and should be healed (from the treatment) 2-4 weeks afterwards. That's it. Those are the only pro's. And those pro's have con's.
Con's: Heidi will have to be sedated and intubated 5 days a week for 3 weeks straight. That is getting knocked out and WOKEN UP 15 times in a row. (I had 4 surgeries in 12 days and THAT was rough for me!) Although the side effects are temporary, they will obviously add on another 2-4 weeks of recovery-which means everything Heidi enjoys doing, she wont be able to because of the burns she will receive from the treatment. She is just finally able to do some of her normal activities (more about that in a bit). She will get major burns in a very sensitive area-her foreleg and ARMPIT. It will be uncomfortable to just "be", never mind walk. If we chose radiation, that is about another 5-9 weeks of her not being able to do anything except sit in the house or in the yard. And we're hitting the Spring; one of the best seasons to get out and DO. I know this sounds trivial (I'm going to risk my dogs life to let her enjoy some hikes during the spring? 1-2 months is more important than years?) but there isn't enough evidence for me to think radiation is the best way to go; that it is our best choice.

Although the margins were narrow, they were also clear. Radiation is just a "just in case"-just in case they didn't get it all. At this stage of the game, it is almost being used as a prevention. I'm not willing to let her go through such pain and discomfort for "just in case"; not when the odds are already stacked in her favor. The oncologist said that only 80-85% of dogs are cured with radiation. So there is a chance it may not even work. And if we do it now, and it does come back, it might be more aggressive and resistant to the radiation itself. What then? I did (of course) consult with the surgeon, and she assured me that should it come back (on the leg, where the odds are better of it returning to rather than somewhere else) that we did have surgical options to take wide margins again. And again, at that point (should it ever get there) we had radiation as an option. I also talked with the Dr. who has been taking such good care of us, as she knows how I feel about both my girls, and she said she wouldn't do radiation either. That made me feel even more comfortable with my decision. The decision about the RT came pretty easy. What diagnostics to run, however, is proving to be much more difficult.

The options I was giving for a full staging work-up are as follows: spleen, lymph node and bone marrow aspirates; abdominal ultrasound; chest x-rays. I'm having a much harder time deciding on what to do here. My decisions change as the days do. At first I wanted to do it ALL. My love for my girls is strong enough, (and so is my paranoia) to be willing to do it all. But my gut and very limited medical knowledge are telling me all this isn't necessary. The chest rads and ultrasound are pain free and non-invasive. A splenic and lymph node aspirate are simple enough; not non-invasive like the others, but relatively pain free. But the bone marrow aspirate...yikes! Stupidly I watched a video that showed the procedure (the video looks a bit old, but I've been told the procedure is basically unchanged: http://video.google.com/videoplay?docid=4953415127475383802#). OUCH! That definitely is invasive and painful looking! NEVOG told me they did it without sedation; she said the pet is given a local and it is not usually painful until the bone marrow starts getting sucked out. The dog in the video is knocked out, and the surgeon said she would do it under sedation as well. Although I think it would be the best diagnostic tool (I mean, if cancer cells are being manufactured in the bone marrow, there's definitely a basis to have everything else done too) but can I do that to her? Especially where her kidneys were so bothered by pain meds only a few weeks ago? What would I use if she woke up in pain or if she had a reaction to the sedation/anesthetic?

I'm still really torn about what to do. My desire to do everything possible (within reason; again, I'm not doing RT) and know as much as possible is causing conflict in my mind and heart about wanting to do the least invasive and painful procedures I can. Heidi has been through a lot. Do I want to do more to calm my own mind and get to sleep easier at night? And what if I do it all and Heidi has residual effects from the aspirates? Nothing is ever 100% safe or without risks.

I have to say that a very useful tool I have had through this whole process is the book "Speaking for Spot". I have heard great things about it all over the place: magazines, other blogs, other books and websites. I finally ordered my copy a few days before Heidi's NEVOG appointment and read the whole thing through by that day. I wanted to be prepared. And the book helped me. Working in the veterinary field has taught me a lot, and a lot of the book I already was aware of, and although it didn't help me in exactly researching or collecting information, it did reemphasize what I should be doing to be prepared for the appointment. And what I should be doing after I get the information from the appointment. I went in totally organized (what a HUGE help!) and left with all of my questions answered...and clearly got (and retained) all of the information that I got from them. I definitely recommend picking up the book before you find yourself needing it: when your dog is having a medical crisis. Its an easy read and is well organized itself. I can only imagine how much more information I would have gotten out of it had I not worked in the field! If anyone out there in the great big world is reading this, I hope you get two things out of our experiences: trust your gut, and don't wait...and buy this book! (Or see if you can borrow it at our local library!)

I really REALLY appreciate all of your kind and encouraging comments. I don't usually comment back, but I read every single one of them. It's a great way to feel connected-even though the people leaving them live hundreds if not thousands of miles away. It makes me feel included in this great "dog loving family" that includes us all. As with any family, people have different opinions and approaches, but ultimately everyone has the same goal: to do what is best for our furry charges; our "furkids". I also just want to mention that although I don't always comment on YOUR posts, I do read them...ALL. Every morning I have the same routine: check email, check facebook, check blog-roll. Overtime there is a new post, I read it. And enjoy every word. Keep writing!

And finally, the update on Heidi herself. She is doing WONDERFULLY!!! She is just about back to her old self. She had her last bandage change last weekend (after out NEVOG visit). The surgeon was changing them every day or two and decided that as the was starting to get irritated, only a few more would be needed. There is a fine line to using bandages: you have to make sure they are not doing more harm than good. Knowing Heidi's last bandage would come off last Sunday, (which meant her leg would then be exposed) I decided to take her to the farm for a walk. She couldn't even make it 1/4 of the way. And then I had to carry her for most of that 1/4 back. When we took off the bandage the next day, I found out why. The vetwrap (co-flex) that her bandage was being held on with started rubbing her fur and then her skin off. She had a crusty abrasion on her elbow and has redness and irritation on her side and forearm. I felt AWFUL! I had made her walk...and play ball the day before! She must have been really painful. But nothing will stop her from doing what she loves: playing and working. I relearned to trust her and listen to her-when she didn't want to walk, I knew something was up. It had become too ouchie for her.

But once the last bandage came off Heidi had a freedom that she hadn't had since her surgery. She could move! She was a little crunchy, as she had to use the rest of her body to over compensate for her bandaged leg, but soon got her spring and bounce back. She hasn't stopped since! The surgeon recommended this really neat cream to put on her site every day. Remember, that when the skin flap died and was then peeled off, her inner leg was pretty much exposed to the outside world. The bandage protected it and allowed it to heal quite a bit, but it was still an open wound. Well, this cream has fixed that! I bought her some shirts (they are made by "starter gear" and are very similar to the "under armour" that athletes wear-it hugs her body pretty tightly-including her legs, as it is a long sleeved shirt. I got them at Wal-mart for 3 bucks. 3 BUCKS! I bought 8!!!) and every night she gets her wounds cleaned with gauze and saline, a new application of the cream and a new shirt on. In even one week her wound has gone from its entire original length and the width of a "fat pen" to barely as long as my pinkie finger and barely as wide as a ribbon on a balloon. This is such a huge improvement! Her leg looks great and, as I said before, she is really doing well! The skin that was pulled from her side does need to stretch out a bit, but it doesn't seem like she's lost any ROM. I walked her twice last week at the park (paved surfaces) and took her to the farm again on Saturday. She did the WHOLE WALK including the "long way" via a detour on the way back. She's doing so well!!!

The girls annual PE's are coming up when I'll get their titers, HWT and 6 month blood work check and I hope to have decided on what staging tests I plan on doing. I am also seeing a holistic vet next Monday to get somemore natural ways to keep her healthy, and discuss options for pain management in the future...as we're no longer able to use NSAIDs. (We're seeing the same person Iris "The Rainbow Doggess" sees!) I will of course keep the blog updated on how things are going! Thank you all again so much for the time you take to read this journal of mine (well, the girls) and your thoughts and prayers. They all mean so much! And yes, Shelby is thrilled to have her sister (and in some ways, her Mom) back! Wrestling and tug-of-war have resumed! The best birthday presents I've ever received...

Friday, March 19, 2010

NEVOG

This past Wednesday was the big day. The day we went to NEVOG to get some more answers; to talk to an oncologist.

Typing that sentence makes me feel exactly how I felt when I was told Heidi had cancer. And it was exactly the way I felt making the trip to Waltham two days ago. I wasn't really thinking about anything on the way down. It was like my mind was wiped blank. I was focusing on the radio; probably a defense mechanism to make sure I didn't lose control while driving and sparing the lives of all the cars that joined me on a jam-packed rt. 128. I don't remember much about the drive itself; only that I wanted to make sure I didn't miss my exit and didn't fall asleep at the wheel.

I probably could focus more on "nothing" because I did feel like I was quite prepared. I read everything I could get a hold of on the internet; and luckily I have a pretty good sense of what is true out there and what is completely false. I wasn't necessarily looking for "answers"; no website or published paper could give me those. I was looking for information to compose questions to the human being (who happened to spend years in vet school) to be able to give me the answers. Because the answers meant closure. It is one thing to be able to type in an equation and get an "answer". But very often when discussing cancer (or any health problem) the equation can change so subtly that it is almost not really noticeable to anyone not trained to look for such small variances. But the difference in answers is huge. And even more important, is the way those answers are delivered. They need to be given in a soft, gentle and compassionate way. You cant get those feelings by reading something on the disease your dog has. So as I planned on seeing one of those people who would be able to give me the "answers" I was seeking, I owed it to them (for taking their time) and of course to my best girl Heidi, to show up with the right questions and a lot of them.

So feeling prepared and having a folder and note book full of stuff made me feel a little more at ease...you know, if that is even possible while trying to cope with the fact that your child (furry or otherwise) is sick.

I got to NEVOG with only a few minutes to spare. The traffic was not bad for most of the journey, but the last leg of 128 was bumper to bumper. And then when I got off at the exit they were doing construction. Great. Then when I did get on the right street, I passed the building. Then when I got to the right building, I went in the wrong entrance (I went in to the other vet, VESCONE by accident...I guess I missed the big blue NEVOG banner...duh!). I finally did walk in the right entrance and was glad to see other dogs waiting in the lobby. (I think I would have felt 100 times worse if I had to be there by myself...) It is small (well, I'm comparing this to our lobby or that of our sister hospitals) but was not cramped or crowded. I think it was nice for the type of hospital that NEVOG is-people are all there for the same reason; like everyone belongs to the same club. So the small-ness of it was conducive to people (and sometimes pets) getting to know each other. When I walked in, there were two Golden's and a small terrier mix that was being held, and their owners were chatting a bit. I walked up to the counter and started to check in.

I gave them Heidi's name, and they asked me to put her on the scale. It was a small one that was built right into the floor (I'm sure making it more comfortable for the dogs; I'm sure they need to be weighed every week and try not to make it a big struggle). I asked Heidi to "table" and she got right on and sat down. The people waiting were pretty shocked. They couldn't believe she just got right on and sat right down;no muss, no fuss. I explained she was an agility dog and knew her job well. They seemed slightly impressed...maybe it was a little bit of a surprise that an "agility dog" could get cancer too?

Her weight was just about what it has been through out the past few weeks; she has actually gotten back to her slightly heavier weight of 22#, but she is also bandaged, has not been able to exercise and has been drinking a ton. Not that I'm making excuses, but I would like her to be a little slimmer (I would like the same thing for myself too!) I went back to the counter where they had me fill out a registration form. I could have been taking the SAT's. In Spanish. I was STRUGGLING filling out the most basic questions. I wrote my cell phone number wrong. I couldn't remember the fax number for work. I couldn't remember the date (St. Patricks day?!? You know, why everyone was wearing green?!?!?!) That's when I realized I was really out of sorts; like I was in some sort of dream state. I finally finished (after many crossings out of misinformation that I am able to give correctly every other day of my life...)

I sat down and Heidi sat with me. She relaxed right away; but she always does. She just lays down and is completely content to watch the world go by...always on the lookout for a dropped morsel though! I hadn't fed her breakfast in case she needed to fast for any tests. I also hadn't brought Shelby (which I normally do-they go just about every where together). I felt like I should just spend this time, this important time, with just Heidi. Just while we got the initial consult out of the way. One of the Goldens went in for his "treatment" (which I assumed was chemo, but I could be wrong) and then left. After a bit of a wait (we were in no rush, we could have been there all day!) The Dr. came out and took us in an exam room. We saw Dr. Rosen-a fellow in oncology (but not yet board certified...which was fine with us! I understand that even though someone doesn't yet have the certification, they still have YEARS of experience and have access to many great minds should they find themselves with a difficult case. Maybe its from being at Mass Gen so often, but working in a "teaching" environment doesn't scare me at all...)

Dr. Rosen took us into an exam room at the end of the hall, invited me to sit down, and started to ask me some questions about Heidi: how old she was, how long shes been with us and about the tumor. I explained to her about her bandaging (and the slight complications after surgery-with her wound and kidney issues) and she asked if she had any other issues. I told her about her shoulder problems and arthritis, and also about her "choking" episodes where she hard-swallows and seems to gag. I found myself faltering again. I found I couldn't remember Dr.s names that we had seen in the past. When our Q&A session had ended and she was going to start talking about the MCT, I asked if it was alright if I tape recorded the visit as my mom couldn't come with me (and I didn't know if I was in the right state of mind to remember it all). She was fine with it, but cautioned me that she might be hard to understand as she just had her wisdom teeth out! So I pulled out my mom's Sony tape recorder (that is probably as old as I am) and it the red record button. The tape was rolling, and so was the Dr.

She explained what MCT's were (a collection of mast cells that for some reason grew out of control-like any type of cancer-and usually ended up as a mass on or just under the skin) and that the first most important part of treatment was to get the tumor surgically removed. After the surgery was done, the important answers could be obtained: were there clean margins? What grade was it given and why? Heidi's was removed with CLEAN but NARROW margins: which meant that the tissue around the excised tumor was free of cancer cells, but the AMOUNT of cancer free tissue from the very edge of the sample (the outside of the circle so to speak) was less that 1cm before they found cancer. Heidi's margins were clean at .6-.8cm. Heidi's tumor was then given a grade of II-but a LOW grade II. The importance of the grade was the mitotic activity-which means how many cells were seen dividing. A number under 5 had a very good prognosis as it meant the tumor was not highly aggressive. Over 5 was more worrying. Heidi had NONE. ZERO MITOTIC CELLS SEEN! Her mast cells also were clearly defined; meaning they were still cells as you would think of them, and hadn't burst. Both were VERY good indicators of how this tumor was going to behave. The Dr. said probably the only reason it was given a grade II versus a I because it had invaded past the skin and into the tissue just below it. But all those factors from the biopsy coupled with the small size of the mass and the fact that I (think) caught it early, means Heidi's prognosis is VERY good!! Yay!!! FINALLY some good news! But there still were things to discuss...

The Dr. then talked about 3 treatment options. She was very glad to see how non-aggressive this tumor seemed, but was worried about how narrow the margins were. She said that as MCT's grow, they spread out through the surrounding tissue-not down, but out. So if there are less than 1cm margins, there is a chance (hell, there is a chance even with the 1cm margins) that there are some cancer cells that remained. Which means there is a chance the tumor could grow back-and it could grow back bigger and more aggressive. She wouldn't be as worried if it were located somewhere else on the body; we could just go in and take nice big margins to hopefully get it all again. But where Heidi's is on her leg, there is only so much skin and actual BODY that is there. She said she was worried that if it came back and we needed bigger margins, there wouldn't be enough "Heidi" to allow us to get it all. So we had the three options: 1.) watch and wait-recheck the site with our surgeon every 2-3 months for a year. If it was going to grow back, it would probably be within the year. Obviously if this was the option I chose, I would need to discuss the options of future surgery with the surgeon; to make sure if it did come back, we would have options. 2.) Scar revision-where I mentioned Heidi may need a 2nd surgery to help close the wound on her leg (which used to be the skin flap) and she suggested we take off more skin and send it to be checked; to make sure those margins were still clean and therefore also achieve larger margins. 3.) Radiation Therapy-she said that with radiation treatment to the site, it would kill (at an 80-85% success rate) any cancer cells that remained. This would involve Heidi having treatments every day, Monday-Friday, for 3 weeks (a total of 5 treatments). She would need to be sedated for each treatment (with reversible sedation) but which would involve intubation. By week one, we wouldn't really notice anything. By the end of week two, it would be a burn-like a bad sunburn. By the end of week 3, it would bee a full blown burn-raw, red, painful and weeping. She would be healed in a week or two from the burns, and her hair would grown back in a few months-and it would grow back gray.

She told me the options, but then said there was no true rush to decide on them right away. She wouldn't be able to do any RT on Heidi until her leg was completely healed-at least another month. Unless I was going to have the 2nd surgery, there wasn't any rush to a decision. HOWEVER, she did then talk to me about other diagnostic tests. The talked about doing aspirations on her spleen, lymph nodes and bone marrow. She also suggested chest x-rays and an abdominal u/s. It would be about 1000$ for the diagnostics through them (but probably a lot cheaper at our hospital) and then it would be 3500$-4000$ for radiation therapy, should I decide to pursue that. Clearly I have some big decisions to make...

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That's the jist about how the consult went. As you can see, great news! Essentially, if your dog is going to get a MCT, the kind Heidi has is sort of the one you hope for: small, low grade, and seemingly not that aggressive. I'm glad we have not only have AN option, but several. I am SO THANKFUL that the prognosis is good. I am so GRATEFUL that my girl has such excellent care. And I am so HOPEFUL that we have a long and golden road ahead of us...
(next update will let you know what I have ultimately decided to do...I think, anyways! My mind keeps changing slightly from day to day...) Thanks again for the support and well-wishes!!! Heidi and I appreciate all of the good thoughts and vibes!

Tuesday, March 16, 2010

Week 2: more issues, more questions...

Sorry I've taken so long to update; I didn't mean to leave anyone in suspense, but things have just gotten busier. Here's whats happened last week:



Day 9: Saturday 3/6/10

Woke up early, yet again. I planned on doing my usual routine of getting up, starting to thaw the dog food and going in the shower-all while the girls stayed in bed. But Heidi stood up when I got out of bed. "Do...you need to...go out?" I asked tentatively. She started dancing around like she had ants in the pants. I guess that's a yes. I picked her up to put her on the floor and she took off out my bedroom door. I started to put on my slippers and by the time I reached for my bathrobe, she was back. Apparently I wasn't moving fast enough. I hurried to follow her to the door where she sprinted outside. I watched her squat and pee...about 3 times. Then as soon as she came in, she hit the water bowl for a drink. Something was definitely off. I thought about how the surgeon said that we would check blood work if she didn't seem better by Tuesday, but this was different-she was getting worse. I decided to take her in and have the blood pulled, but first I fed her...and she ate! Yay! I brought her to work and the Dr. who's been taking such good care of us (and who diagnosed the tumor) pulled a health check and sent it to idexx. I worried all day what the results would be; she was drinking way more than she ever had. She said to stop the previcox (which I had don't the day before after she wouldn't eat breakfast-I know gastric upset can be a side effect of any NSAID and is not to be messed around with). I waited all day for those stupid results to come in, but they didn't get posted by the time I went to bed that night.

Day 10: Sunday 3/7/10

Finally, a day to sleep a little late. My schedule changed due to our shortness of help, so I was scheduled to work 11-7 (a "swing shift") instead of my usual 8-4. I woke up early anyway though because I wanted to see if the results had come in. When I got up, Heidi did the same pee-pee dance and ran outside. Then she drank. Dammit. While she was tanking on water, I turned on the computer and signed on to idexx. The results were in...but not at all what I wanted to see. Heidi's kidney enzymes were indeed elevated. Her BUN was 70 and her creatinine was 2.9. WHAT? Her levels were beautiful the week before-we had run them the day before surgery; her BUN was 15 and her creatinine was .7. WTF??

I started to get really upset; that numb horrible feeling was back. The feeling like something was closing in and the ice-ball in the pit of my stomach had returned. I decided to go into work an hour early to see if someone could go over the results with me. But even going in an hour early gave me some time to look things up on the internet...which scared me even more. I read on one of the sites that by the time the kidney enzymes were elevated there was already significant damage. OH MY GOD. What was I going to do when on top of just being diagnosed with CANCER, Heidi was in renal failure too?? Was it the anesthesia during the surgery? The previcox? The raw diet? Her Lyme's disease? My mind was reeling. I did all I could to not just call into work and demand to speak with someone; or even calling in and asking to be put on the emergency board as a patient and wait to be seen. But I knew it was probably busy, and I could just as easily speak with someone when they had the time. I had to try and remember what I had hear our Dr.s tell other clients-when they are in renal failure, they felt really crappy; like a terrible flu. Heidi was not behaving any differently other than drinking and peeing a lot. Good. Her spirits were OK. She seemed a little more, I dunno, depressed? But that was because she was wearing the cone just about all the time...I was pretty sure, anyways.

So I went in early to work, and I had been right.It was busy. One of the Dr.s did take the time to look over the results quickly with me, and gave me a plan for the day: they would run blood work in house (to make sure the results were right) and would check a sterile U/A as well. They did that later that morning, and then the surgeon came in to check on some other patients and looked at Heidi as well. She said we would still keep an eye on the black, dead skin flap and then she looked at the results of the in house labs. She said something was making her kidneys angry, and for now we would do sub-q fluids then (and the next day) and then recheck her labs on Tuesday. She was given the fluids and hung out in her crate. This went on all throughout the day. It was one of the busiest Sundays I have worked in months; we were 1 Dr. down (we usually have 3) so it was nuts. This was probably a good thing, because while I was focused on working and getting other peoples pets taken care of, I couldn't stress about Heidi. Well, I should say I couldn't stress about her as much as I would have had I been idle...

I went home that night praying this fluid therapy would work, and we wouldn't be looking at severe changes to her life as a result of kidney damage or failure. And of course I worried how this would effect my future medical decisions regarding her care and her treatment-how will we control pain? What if she needs treatment for her cancer? What about her arthritis when she is back to normal? What if she needs sedation because of another procedure? Because I didn't know what caused this, I didn't know how to prevent it happening again...if best case scenario, it was cured. Worst case is that it wouldn't be cured and I could make it worse...

Day 11: Monday 3/8/10

A day off. Because I was starting school the following Monday, they implemented the schedule change this week to make sure they stayed with the same pay period. I decided to just take it easy. Spend the day snuggling, watching movies, and prepare my questions and concerns for her kidneys. I was planning on going in for her fluids in the afternoon-when she had been given them the day before. I was just planning on going in and having the technicians give them (just like any other normal client). But when I checked Heidi's incision and skin flap (which I did several times a day) I saw something that made me even queasier than just the black skin: it had started to separate from the pink skin; the healthy skin that remained on the back side of the flap-the side of the flap that was attached to the rest of her leg, rather than the black part that was stapled. It was not only pulling apart, but there was yellowish goo that filled in the gaps in places. Ruh-roh. What if it was infected? I had paused in her course of antibiotics while she was not eating, so what if I had caused this too? I decided to call work and make a formal appointment; we could get her wound checked, I could get my questions and concerns addressed and she could have her fluids.

The Dr. (yes the same we had been seeing) really took her time and patiently answered my questions. She thought it was the previcox that caused the kidney issues; once they had flushed them out, they should return to normal. No more NSAIDS-EVER. We couldn't really discuss what would happen if they didn't flush properly-if the levels continued to be high-because she didn't know just yet (well, I think she did, but she didn't want to freak me out!) She looked at the wound and said it was normal it was separating: "remember, its just a big, ugly scab". The yellow stuff wasn't puss, but connective tissue. Yuck. But relief. Heidi got her fluids and we went home. More time spent worrying and thinking about the future...its scary when you don't have things to actually worry about. This was ridiculous!

Day 12: Tuesday 3/9/10

Finally, a day to get some answers! We hoped to hear from the surgeon about what to do in terms of the skin flap (aka "disgusting scab") and her kidney levels. I thought about it all day, but didn't really get any answers until the end of my shift. The Dr. had booked some time to see Heidi just about the time my shift was scheduled to end. But I had a problem with my cash report (as I was missing cash and credit card slips) and so took a while to really get finished so I could be with her. I was really angry; I tend to let little things completely send me over the edge when I get stressed out. Finally I went out back where a piece of paper was waived in my face by the Dr. who was now giving Heidi her fluids. The piece of paper were her results. Her BUN and creatinine were NORMAL. Holy CRAP!!! Two days of fluids and she had been fixed! I high fived the Dr. but immediately got down to business-I had found a small bump on Heidi's neck the night before and wanted it checked. I couldn't be truly happy until I knew this was nothing too. The bump was small, white and felt completely part of the skin. It had been there for a while, but I wanted it checked. It was nothing. Just a bump. Yay!!! Now it was time to be happy! I went home feeling better than I had in days! Well, a little less nervous anyways! The surgeons report was also pretty good; she said she would "debried" the wound (aka "pick off the scab") on Thursday and we would go from there. She might consider doing a second surgery to close the wound remaining (with staples and sutures) or she would do wet to dry bandages. But she wouldn't decide anything until her kidneys were better...truly better. That was good enough for me!

Day 13: Wednesday 3/10/10

Another day off! I decided to clean the house in the morning and a friend came over in the afternoon. It was again nice to not be as worried about everything. Well, I was almost less worried. Heidi had peed herself in my bed while sleeping. Hmmm...not something I was pleased about. Not because I minded waking up early (as Heidi had woken up to go pee at about 4 am-which made the accident even more puzzling) or because I had to wash my bedding, but because I had to put her in the tub. And I had to wash her very delicately to try and keep her wounds dry. She was not happy, but I couldn't leave her with pee on her skin and hair. That night my mom and I went to run some errands and I found myself at Petco looking at doggy depends. I didn't want Heidi to ear something all the time (the cone was bad enough!) but I wanted something to wick the pee away from her skin should she have another accident. I had her wear them that night, but they turned out to be unnecessary. OK. Well, I have a 15 pack of doggy diapers that I'll keep on hand. No big deal; better to be safe than sorry.

Day 14: Thursday 3/11/10

One more day to sleep in; well, sort of. I had taken some Tylenol pm to try and allow me to really sleep, but I was so worried about Heidi I kept waking up anyways. When she moved, I woke up. And put her out. Then I tried going back to sleep. I was groggy due to the meds but also the inability to truly get a good nights sleep for over a week. I had to go into work early again to see the surgeon. I had really only planned on bringing her in for a suture and staple removal, but the "scab picking" soon commenced. I thought I was going to PASS OUT. Seeing it peeling away on its own over the previous few days was gross, but seeing it peeled away from the skin and being able to see the inside of your dogs leg was really stomach turning. She decided to do a wet to dry bandage to peel away any ickies that were on the leg; and to soften the rest of the scab, because not all of it would come off. Well, at least if its bandaged I would have to look at it!

Heidi was still drinking a lot, so I planned on keeping an eye on that as well. But we figured we'd give it a few days to a week before rechecking her levels. She would need daily bandage changes for the next few days anyway, so shed be with me at work should I decide to check them at any time, or if I saw her behavior changing in any way. She went home with my mom that night (as I was working until 9, and knew shed be more comfortable at home) but I told her she couldn't really walk with her bandage; it went essentially from her arm pit to her wrist-covering her elbow, which impeded her walking. Apparently my mom thought I was lying though, because she said she was fine when I did get home! I think it was because the bandage slipped down and she could move freer...but she could have just been playing me!

Day 15: Friday 3/12/10

Two weeks. Two weeks since our lives were tossed about like a doll house in a twister. But things were calming down. Sure, there were still issues-including having to still have a consult at NEVOG, still keeping an eye on Heidi's pd/pu and daily bandage changes (which are now over the shoulder style, as the bandage kept slipping down which was not at all conducive to healing the whole wound!) I'm trying to keep focused on how different our future will be-I'm trying to focus on the positive aspects of that: pretty soon we'll be walking and hiking again, hitting the beach and our favorite spots in the mountains and kayaking. I'm trying to keep a level head and keep things in perspective. I know none of our lives will ever be the same again, but I have to try my hardest to make sure that I keep doing whats best for Heidi; for all of us.
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The last few days have been sort of uneventful; Heidi is still getting her bandage changes and is starting to get some spunk back. She hobbles pretty well when she wants to, and wants to play again. The surgeon said her leg looks good, and we may not have to go in and reclose; it may just heal on its own. We have the appt. with NEVOG tomorrow, and I feel good about it. Ive been doing a lot of research and feel good about the information Ive gathered, and the questions I'm prepared to ask. My next post will be up when I can type it, and I'll let everyone know how the consult went. This is the big one. This is where we'll get the answers...

Thanks again for your support through this difficult time...it really is appreciated!!!

Monday, March 8, 2010

The worst week EVER...

I know this is long, but I'm almost writing this more for myself than for anyone else. I want to be able to look back and remember what it was like going through this situation as it was happening. I hope that when I look back, everything will be OK, and I will be able to see and realize how far we have traveled from now until then. I started writing this the other day, but only finished it to post now. I'll get the 2nd update up when I can...the saga is still on going...
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Today is Friday March 5. It is the end of the longest 7 days of my life...and although I'm posting this now, the ordeal is not quite over. I planned on posting last week about how my life was turning in a new direction; and with this hope, I was starting to feel better mentally, more optimistic. I was also going to talk about my little ones birthday-Shelby turned 7 last Saturday, February 27th. But instead of all of that good stuff, I'm here to talk about something that happened that completely eclipsed that; cast it all into shadow. I have had bad days in my life before-truly bad days. Days when I thought my very soul was being ripped apart and pried from my body in tiny pieces-shattered and broken from the immense grief and pain only losing a loved one could bring. I have felt that immeasurable sadness before, but this feeling was something totally different. It wasn't the crushing blow that you feel when you find out someone you loved has passed away suddenly, but the mind-numbing, full blown panic that hits every nerve of your body; freezing it with blinding fear that renders you unable to do anything: move, think or react. I can imagine being in the middle of the street seeing an oncoming car heading straight for you. That kind of feeling. What caused it? Here is the story of my worst week ever:

Day 1-Friday, 2/26/10

I worked my usual day shift of 7-4. I had a pretty rough time all day because I was still feeling sick. I had received a tetanus booster on Wednesday and it was hitting me hard: I had body aches and chills and was unable to move my arm. The weather was pretty bad (with a windy, freezing rain/snow mix) that just seemed to make me feel worse. I knew I had to go to the grocery store, so decided to take the girls with me to the doggie bakery for their goodies that same night. I figured that where I'd have to work tomorrow and still might not be feeling well, I should get everything out of the way now. Tomorrow we'd be able to relax and not have any running around to do. We could just celebrate Shelby's birthday, and I could watch them enjoy their snacks. So we ran the errands and went back home. I spent some time in the hot tub (to try and feel better) and had finally snuggled up on the couch with the girls. My mom was sitting next to me with Shelby on her lap, and Heidi was sitting facing me. I was rubbing her chest and the inside of her legs when I felt something odd: a lump.


I asked my mom to turn on the light as I flipped Heidi on her back. I searched her leg but couldn't immediately find what I had felt. Then I saw it: a small, pink, lump on the skin of her left front leg. It looked and felt fluid filled; it was squishy. It was bigger than a pea, but smaller than a dime. I didn't squeeze or pick at it. I knew I wanted one of our docs to take a look in the morning. I went to bed a little worried, but after looking up every version and picture associated with the googled phrase "dog lump", I felt it must be a cyst.

Day 2-Saturday, 2/27/10

I woke up felling a bit nervous, but pretty sure it was a cyst or big pimple. I packed up the girls and brought them with me to work. I was telling a friend of mine what I had found when one of the Dr.s walked up-I asked her if she could take a look. She said she could, and I found myself putting Heidi on the table a few minutes later. She looked at it and said something like "oh yeah, it looks like a skin-tag, but we always aspirate it to be sure." She stuck a needle in it, but not enough cells came with it. So she got a bigger one, and sucked some stuff out. Now the smooth pink nodule turned purple and very angry looking. One of the other Dr.s stepped over and agreed with the first that, as it now started to ooze a bit, it must be a cyst. I put Heidi back in her crate with Shelby, and tried to finish the work I had been doing. A few minutes later I was talking to a coworker when the Dr. came and asked if she could talk to me; she pulled me aside in to the Dr.s offices and told me the news that would change our lives: it was a mast-cell tumor. It was cancer.

I admit, I pretty much lost it. I remember crying and hugging her, thanking her for telling me. I remember her saying she wanted the surgeon to look at it right away, and she would go get her then. I went upfront (still crying) and sobbed to my friend what the news was. I asked someone to cover for me, and I punched out. I just wanted to be with my girl. When I went out back, the surgeon was already looking at Heidi. I cried as I kissed and petted her head. I remember someone telling me that she didn't know why I was upset; she didn't know she was sick. The surgeon was saying that it was small and in a good spot; she could get some extra skin from her side and armpit to close the wound-they wanted to obviously get as much tissue as they could to make sure they got it all. I was trying to focus on what she was telling me, but my mind was reeling. Cancer? CANCER? My 7 1/2 year old baby, who is raw fed and hasn't had vaccines in years? I didn't understand. I asked the surgeon when she could do it. "I can hold her if you want to do it right now!" I said. Everyone laughed. "Yeah, we use anesthesia here, you know" said one of the Dr.s. But the surgeon said she could come in tomorrow. She would come in on a SUNDAY to take care of my girl. I was blown away. I really do work with amazing and generous people.

I called my mom who couldn't really believe it; then she asked how much it cost. I know she was only asking because she was thinking of my future. I had just signed up to go back to school for canine massage. But at the time when I was so emotional, I took it the wrong way. I told her she wouldn't have to worry about it. The hospital is great with working with employees and payment plans. All I could think about is how badly I wanted this to be it. One lump. One surgery. No more cancer. I went home that night and snuggled with my special girls. I explained to Heidi what was going to happen the next day, and to Shelby about how we were both going to need her. I gave them some birthday cupcake (and I cut it up this time, so we didn't have another choking episode like last year) and we went to bed. I knew it was going to be a rough few days. What an understatement.

Day 3-Sunday, 2/28/10:

Surgery day. I got up early to get there for the surgeon to be able to start right away. My friend Ginny, who I had sobbed to the day before, came in on her day off to be with me, and jump in as receptionist back up so I could be out back with Heidi when she needed me. We got there for 7, and I didn't have to start working until 8-which meant I could be with Heidi while she got knocked out. The Dr. did a quick physical and looked at her blood work we had run the day before. They decided both were OK and we could proceed with surgery. The Dr. gave her a shot of hydromorphone in her "butt cheek" and she went down-hard and fast. She was really conked out. And a good thing, because she is such a hard stick, the technician couldn't get a good vein on her. (I knew she was tough from the blood work we had tried to collect the day before) She decided the best way to go was to put her cath in her back leg once she was out.

Her surgery went very well. They had to use little anesthetic until the end because the hydro had worked so well. Only when they were stapling her closed did they need to turn it up. They came to get me so I could see her. The Dr. lifted the blanket, and I was pretty shocked at what I saw: she has an incision wrapping from the inside of her front left leg up through her armpit and onto her side. I haven't counted the staples, but there are a lot. She also had 2 surgical drains. I hadn't realized it would be so large and extensive. It was a lot to take in. The tumor would be sent out to be biopsied the next day. I was planning on taking her home that night (they had me get a fentanyl patch to keep her medicated at home) but it was clear it was better for her to stay the night. She was a mess. They came out midway through the morning and said they were putting the "BAIR-Hugger" on her because she was cold. That was a scary sight. Not because of what it is (its just a big blanket of hot air) but because of the connotations associated with it; I really only ever see it used on extreme cases-like when a bulldog almost drowned in its owners swimming pool. But I knew it would help her, so I swallowed my fear and told myself it was just temporary.


After my shift was done, I decided to take Shelby to our friends dog playgroup. I went more for myself then for Shelby (you know, because shes a snob and hates it). I could use the support of dog-friends, and knew someone who's dog had a MCT removed off of the top of his foot; if anyone would know how I was feeling, it would be her. I did have a nice time talking with everyone and left feeling a bit more placated. I drove back to the hospital to visit with Heidi and to tempt her with some food. (Just like when they had dentals, I decided to have her on "the honest kitchen" instead of her raw; I didn't want any extra bacteria around her with her drains in, and knew it was gentle on her tummy). She was still in the BAIR-hugger, but it was placed under her blankets rather than on top, heating her from beneath. She was more awake, but clearly not herself. She was still very sleepy and seemed to be uncomfortable. I offered her some food and she ate like a champ. I petted and snuggled with her for about an hour and then got Shelby so she could visit as well; she hadn't seen Heidi since that morning, and I thought it would be important for Shelby to see her so she could settle when we got home. Shelby was so good: she sniffed and smelled her, but was extremely gentle. She laid down next to her and laid her head so softly on the very edges of Heidi's feet. She stayed like that and fell asleep while I snuggled and petted them both. The techs I work with are great. They kept an eye on when she was due for her pain meds (and if she might need them earlier) and when she needed to be iced. One of them tried getting her up every so often because she was essentially stuck laying on one side. But when lifted, she screamed; and she couldn't stand on her own. It was hard to watch. They would have let me stay the whole night, but I knew I had to get home and get some sleep. And I had to feed Shelby. I left around 9:00 when they were starting to get busy again, and went home. I fed Shelby, did some random things around the house, and ate a small frozen dinner myself. I wouldn't have eaten at all, but I knew I would feel worse if I didn't. I took some Tylenol pm to help me sleep and went to bed.



Day 4-Monday, 3/1/10


Looking back now, I don't really remember much of Monday. I got up early to be at the hospital for 7 to feed Heidi breakfast. I didn't have to actually work until 12:30. I got there and was pleasantly surprised at how good she looked. She was laying more upright (versus on her side) and had an elizabethan collar on. She could now stand (when helped up) but couldn't really walk. Her front leg hurt, and her opposite back leg was bandaged right to the toes for her IV. When I picked her up, she didn't scream, but she was covered in pee. Not like she had been laying in it for a while, but she was still laying on pee soaked blankies. I decided to take her out any way to see if she needed to do anything else and carried her carefully outside. When I put her on the grass, she stood there but really couldn't move. When I moved to try to get her to follow, she just ended up spinning in scared circles-she was worried about the traffic (because she was doped up on the pain meds), and her bandaged leg was the opposite from her "boo boo leg" so she spun. It was heartbreaking. I picked her back up and took her inside. I cleaned out her cage and put her back in. She seemed gratetful to be able to lie back down in warm comfort. I spent a little more time snuggling and then went back home. I fed Shelby, let her out and then we both got back into bed. I was exhausted. I slept for an hour or two and then had to start getting ready for work. I went back an hour before my shift started to spend some more time with Heidi and offer her the 2nd half of breakfast (which she again ate hungrily). I noticed that she was laying in pee again. I changed her cage, and took her out (she still hadn't pooped) to no change from that morning. I spent some more time with her and she had peed herself again when I had left for a few minutes. I let the Dr. know. This was unusual for her. She said we'd turn down the fluids. I worked my shift, checking on her sporadically, and the technician came in a little before I was leaving and let me know they took her completely off the fluids and pulled out her IV as she was now on her oral pain meds (tramadol and previcox which I had brought from home-it seems to be the only thing she responds to for her arthritis). I could take her home if I wanted to, but where I was just going to be back first thing in the morning, I decided it would be better for her if I kept her there rather than dragging her home just to truck her back in the morning. I fed her dinner, and left for the night. I missed having her warm body sleeping next to my head on my pillow...

Day 5- Tuesday, 3/2/10

Up early again. I was supposed to start at 7, but went in at 6 to get an update, some snuggle time in and feed her breakfast. She looked SO much better. She was more alert and able to walk. I took her out and she pooped! Yay! I felt much better now that she was empty. I never thought Id get so excited to have to scoop poop! I put her back in her house, fed her breakfast and went to work. The day (just like all the others) passed by as a blur-full of nervousness and worry about her: how would she do at home? How was her incision? WHAT was the biopsy going to say? I had put a large note on her account so when the report came in, whoever got it off the fax machine would call me with the results. The Dr. who had diagnosed the tumor noticed how anxious I was and gave me the ability to check the results from home. You bet I was going to! I left at the end of the day leaving Heidi at work. She couldn't ride in my car because she couldn't fit in the crate with her cone on. My mom and I would be back to pick her up when she got out of work. I told her we would be back soon, and left her for the last time. I went home to get Shelby to the doggy store to buy some salmon oil, but found myself on the computer looking to see if the results were in. THEY WERE. I clicked the results with my hands shaking. I scanned the page quickly: GRADE II-clean margins noted at .6 to .8. I felt happy and let down at the same time; that numb feeling had returned. Grade II. We were hoping for a Grade I. I couldn't believe it...what did this mean?

I did end up taking Shelby to the store, and then met my mom at home. She kept pestering me about Heidi's bill. I didn't want to tell her because I didn't want her to pay; she has done SO much for me, especially over the past year, I didn't want her to have to do something else. It was not that high (as the surgeon gave me a break) so I could pay it in full myself. I tried leaving it at that...

She had made a HUGE box of cookie cake (for lack of a better word) for everyone at work. She put two rows of about 8 flavors of cookies in a large box and labeled them. I was touched. Truly touched. I had barely eaten for the past few days myself and couldn't fathom baking something...but my mom, she is truly wonderful. I knew she was just as thankful for the wonderful people who cared for our girl as I was. We took the box of delicious with us as we headed to the hospital. I let my mom visit with her as I grabbed her chart and waited to talk to someone. They had just started to get really busy; it was almost 6 pm. Finally the Dr. who was on that day could talk to us. I mentioned Heidi's incision and how it looked black-something the surgeon told me to watch out for. She assured me it was probably just dried blood. She said when I left earlier she would try to clean it, but it had gotten busy so she wasn't able to. Looking back, I should have pushed her to look a it while I was there...

She read the results and said they were good. She told me Id be hard pressed to find a pathologist that would grade anything a I. Most (like 70-80%) were graded II. And of course the serious ones were graded III. That lessened the numb feeling slightly. I started to be grateful for the truly good news: THEY GOT CLEAN MARGINS. That meant they got it ALL. I felt better thinking that this could be it. I talked to 2 other Dr.s on my way out; they were equally as thrilled. Clean margins, they reminded me. I felt better. One said that she would still recommend a consult with NEVOG (New England Veterinary Oncology Group) to give us more answers, but she felt confident that with clean margins they wouldn't want to pursue any other course of treatment. I felt even better! And now I got to enjoy the experience of taking my girl home. My mom threw a bit of a tantrum when she found out no one would tell her what Heidi's final bill was (as I had put a note on her account about that too) and wouldn't really speak to me the rest of the night. That definitely deflated that happy feeling I had felt so fleetingly only a few minutes before. I spent most of the rest of the night in my room with the girls; wishing I had my mom to celebrate with, but enjoying Heidi's company none the less...

Day 6-Wednesday 3/3/10

My day off. The first in a week. I felt exhausted, but also was so full of nervous energy that I really couldn't rest. I waited and waffled before finally making the call to NEVOG. Making that appt. made it seem so final; so real. More real then anything else that happened so far-even watching Heidi have surgery. Calling NEVOG meant it wasn't just a bump we had removed. It was CANCER. I finally called and they told me they couldn't make an appt. without a Dr.s referral. They took my info, but I hung up feeling upset. Like I was having to go through unnecessary obstacles to have my baby taken care of. I didn't take it personally because I knew it was their policy, but its different I guess because I work in the same field. I knew how easy it was to make an appt. with one of our Dr.s, so had a hard time swallowing how difficult it seemed to have an appt. with one of theirs. I got off the phone and called work. I asked for the Dr. to send the referral down as soon as she could, and asked to book an appt. with the surgeon for the next day to have her drains taken out. I also was concerned about the black skin on her leg; it was the skin flap that they had used to cover where the tumor was taken from. It just didn't look good to me...not at all.

We spent the rest of the day snuggling, and having icing and massage sessions. She was doing so well at home. And Shelby and I were sure glad to have her back! I called my mom to tell her about the procedure at NEVOG and she seemed better too; not so mad anymore. Heidi was still eating really well and taking her meds. I felt slightly more relaxed. I ate my first meal for dinner in days...

Day 7-Thursday, 3/4/10

I got up early due to the ever present nervous energy. My mom was having surgery on some vericos veins in her leg; she has many of them and they are causing a lot of pain and problems. I was going to bring Heidi in to work an hour before my shift started to have the surgeon look at her leg and remove the drains. Shelby would stay at home to help my mom heal after her surgery. (A friend was picking her up and driving her home-she wasn't being knocked out, but was given relaxors. I was a minor surgery, so I felt OK keeping my shift at work). I got to work and waited for the surgeon to take us back. I had gone off food again, and couldnt eat breakfast. I was really worried about her leg. I waited in the lobby like a regular patient. I was nervous as hell.

The surgeon called us out back and put Heidi on the table. She was shaking. I felt sick. It was awful. She looked at the leg and said she wanted to give it another few days. There was a chance the flap was not dead, but was "congested" from the trauma of the surgery. It was gross looking, so I felt a little uneasy about that, but trusted her. She said it was fine to take out the drains though, and pulled them. Yeah...that was unpleasant. It was icky enough seeing them taken out of one of our emergency department dogs, but to see it done to your own was...just wrong. I felt pretty lightheaded and nauseas for most of the rest of the day. Heidi stayed with me at work until it was time to go home. I took her home and fed both girls. I told my mom about the leg and she said she didnt want to see it (shes pretty squeamous). Her own surgery went well, but she was in pain-she wished they had used some kind of sedation because she had been able to feel quite a lot during the procedure. I felt bad, but glad she was OK too. I went to bed that night still worried about Heidi's leg. I thought it was dead, and worried what would have to be done to fix it. She said we would recheck on Tuesday...almost a week later. I didnt know if I could hold out that long.

Day 8-Friday, 3/5/10

One week. One full week had passed. The worst and most difficult week I had been through. The worry was driving me mad- and not being able to eat or sleep was taking its toll. But, I felt that in a few days, we would have answers for Heidi's leg, her staples could come out, we would have our consult with NEVOG and life could go back to normal. I should have known.

I made some oatmeal for myself and then fed the dogs. Heidi wouldnt eat. She got in her crate, stuck her nose in the bowl, and then walked out. I just stared. I've had Heidi since she was 16 weeks old and she had NEVER turned down a meal. Maybe it was because I hid her meds in the bowl. I took out the food, and took out the meds. She still wouldnt eat. She did however, walk over to the water bowl and took a big drink. Uh oh. It hit me. She drank 3-4 times the day before, and this was her 2nd visit to the bowl this morning. I know she was off her raw, but her food is dehydrated-she was still getting quite a bit of water in that. Why was she drinking so much? I tried having my mom feed her while I finished getting ready for work. She ate a little, but then stopped. Needles to say my own breakfast went in the trash. I got to work late after trying to get her to eat more myself. What was going on? I didn't give her her meds because she now had an empty stomach. I left her at home because my mom had taken the day off to recover from her surgery and Heidi was barking and chasing me as I left. She seemed to be feeling fine, even if she wouldn't eat.

I forgot the surgeon was there, but was glad to run it by her when I saw her at work. I told her she was drinking alot and wouldn't eat. She said to let her know about the drinking on Tuesday, and try something else for dinner. I figured d put her back on raw. If she wouldn't eat that, I would know something was really wrong. I spent all day at work worring (and again it passed as a blur) and called my mom every few hours to check on Heidi. She was doing well, and would eat cookies but not her food. I got home and thawed her some raw. She ate! Yay! I still didnt feel comfortable giving her her meds, so I didnt. I prayed she would eat for me the next day...
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I'll post the next update when I can...when we have some more answers...