Holding Pattern

I have stopped myself from writing this at least a dozen times. I’m trying to stop now. It’s not working, but at the same time, I can’t seem to start. A typhoon of images and sounds and thoughts floods my head, desperate to drown the memories of that sad, sad time, when what we did was what must have been done, but still, so relentlessly and ruthlessly heartbreaking.

I don’t think I can. I’ll have to try again tomorrow.

Part Three, postponed.

Lost and Found, Part Two

That conversation lasted a long time. The facts were not complicated:

  • we are doing everything we can, but we do not have any real options, since he would not survive the treatments;
  • he is not in pain … yet … but he is not happy;
  • draining the fluid gave him relief, but it is only temporary;
  • we will not send him away to the hospital again;
  • we cannot allow him to become that sick again;
  • he is a proud dog and it hurts him to fail us, but if he gets any sicker, he will begin to fail, and he is worth more than that;
  • he deserves to be free from pain and fear;
  • we do not want his last memories to be my carrying him to the car at 3am, driving frantically to the emergency vet, all of us petrified of what is happening; and
  • we understand we can never repay him for what he has given us, but we owe him at least his dignity, our respect, and some peace.

The conclusions resulting from that conversation were somewhat more complicated.

We knew that eventually, we would have to help him pass. We just didn’t want that to be now. We owed him a chance to fight, once again, to see if the relief he is experiencing would give him the strength to heal. If we felt it was time, if he let us know, we would have to act. He told us he wanted to come home from the hospital, so certainly he would be able to tell us sadder truths, too. In the meantime, we had to make every moment he was with us special, so that his last days or weeks or, if there could possibly be more miracles in this dog’s life, months, would be something that we could look back on and say that we had done good for him.

I bought a pizza for dinner; I hadn’t actually cooked for anyone but him for weeks, and we were sick of takeaway. Besides, he used to love eating the crusts and sausage, and I hoped he might be up to it now that he was feeling more like himself. I was right. M hand fed him sausage and pizza crusts, along with one of her fingers that he seemed to think was another piece of crust. She managed to keep smiling as he bit down and tugged at her finger. She told me that she couldn’t help but smile, it was so nice seeing him strong and able to bite down so hard again. He even drank his Gatorade — orange, this time.

Wagon Boy

Life in the fast lane ...

That night, I wanted him to take him to his old stomping grounds, places where he used to love to walk, places where he would stop and sit and stare, listening to the sounds, smelling the air or the ground, just taking it all in and experiencing as much as he could. He was still too weak to make it on his own, though, so I helped him into his wagon, and out the door we went.

The first stop was Daley Plaza, where he liked to sit on a bench, stare at the lights and the fountain, and smell the flowers. He met a few new friends that night, people amazed to see an old white pit resting in a red wagon rolling down the sidewalk, pulled by me, and accompanied by a woman fighting to stay strong and positive. Along, of course, was a very patient red nosed pit mix called Sophie. He had raised her from a puppy, steadily by her side for more than thirteen years. One man walking alone asked about him. Visibly moved by our explanation of the reason for the whole scene, he knelt down next to the wagon, rubbed Dexter’s head, hugged him, and scratched his back, before softly telling him that Saint Francis would be watching over him.

Dexter at Daley Plaza

So on we went to Daley Plaza, so that Dexter could stare at the lights dancing in the fountain, listen to the water, and smell the flowers.

Our next stop was a strip of dirt and grass along the sidewalk next to a vacant lot. He used to love to patrol it so much we called it Dexter’s Alley. When the wagon approached the spot he liked to mark, I glanced over my shoulder just in time to see him clamber out of the wagon, big grin on his face, front legs on the sidewalk, dragging the rest of him out of the wagon and towards the dirt. Before I could get over to help him, he made it out, walked over towards the fence, and relieved himself of all that Gatorade. He turned and walked back to the wagon, paused, and looked up at me to help him get back in, as if to say “We have one more stop to make, get me up there, let’s go!” So on we went, to the little public plaza where Sam’s Hot Dogs used to stand, where he had his favorite patch of grass. Every walk he took seemed to end up there, in one way or another, so he could plop down, take a rest, and smell the grass.

My Own Private Patch of GrassIt was in this spot where a couple of weeks ago, the night before we brought Dexter to the hospital, a hobo walked down the sidewalk and asked if he could say hello to the dog. Before you laugh, this guy really was a hobo … white hair, dungarees, his t-shirt stuffed into his back pocket, carrying a nearly empty bottle of water … all he was missing was a bindlestick and a 1950’s nickname like Lefty, or Lucky, or Knobby. I could have sworn I saw soot from a coal fired locomotive under his eyes. In most cases, I would say no, but this time I said “Sure, come on over.” He walked over and sat on the grass next to Dexter, who didn’t seem to mind.

It’s almost time to go, huh? It won’t be long.

Yeah, he’s getting up there, fifteen years now.

Fifteen, huh? That’s a long time. He’s a lucky guy. Not much time left. That’s OK, though. We start dying the moment we’re born.

Alright boy, well, come on, Dexter, let’s get you home. You have a good night, OK?

Dexter got up, walked over to the hobo, and started licking his face. The hobo scratched him behind the ears, and Dex just kept on licking and wagging his tail.

Come on Dex, let’s go. Hey, do you want another bottle of water?

We kept a couple bottles of water in the bag we carried on Dexter’s walks. I handed a bottle to the hobo.

Thanks, I’d love one. You take care.

You too. Stay safe.

We walked off, Dexter strutting along. Time to go home.

Lost and Found, Part One

I have aged five years and lost five pounds in as many days. Forgive how scattered this post may end up; my hands are trembling as I begin to write.

The twelfth of July was a very special day. Dexter had made it home from the hospital, ate a little, and was looking more bright-eyed than I had seen in a week. He slept between us on the bed, where I turned him over every couple hours and massaged his back legs, where edema had turned them into sausages. You could massage the fluid out, but it eventually made its way back. They felt like those gel-filled stress balls. The next morning he spent on the balcony, soaking up the sunlight. He was not interested in food, but I managed to get his medicine in him.

A little grumpy, but bright eyed.

A little grumpy, but bright eyed.

I wanted to take him to some of the places he loved to walk to, but there was no way with his anemia and the weight from his abdominal fluid that he could get there on his own. M had been half-jokingly asking for years for a Radio Flyer red wagon she could use to pull the dogs around town. I thought, “Why not?” Something made me get up and head to the store, where I found the last wagon in the city. As I carted it away, I walked by a clerk at the store talking on the phone: “No, they were out of the Radio Flyer wagons, someone just took the last one.” That was spooky timing.

As the day wore on, something inside told me that maybe I was missing something, maybe we needed a new set of eyes to look at Dexter — I was too close to him, too focused on trying to help him and care for him, and maybe I was missing some key symptom that would explain everything; something that could be treated.

The day before, I received a card from Dexter’s oncologist, noting where her new practice was located: a veterinary specialty center in town. I called and they said bring him on in. I loaded Dexter into his wagon and off we went. I had to carry him into the center: he had so much fluid in his belly (he weighed 62 pounds … 10 more than a week ago), and just couldn’t walk very far, even with help.

Dexter’s regular vets had kindly faxed over his latest records, and spent time on the phone with the oncologist explaining what had been happening. She came into the treatment room, where I explained that I was afraid I might be missing something, and wanted to make sure that I live up to my promise to give him every opportunity. She explained that there were treatments we could do, like plasma or blood transfusions, IV fluids, and the like, and we could hospitalize him and get started tonight, but that there was almost no way that Dexter would survive the treatments. I had already promised him that I wouldn’t leave him in a hospital again, so that, coupled with his likely not living through it, meant that transfusions and more needles and medicines and pokes and prods wasn’t an option. She added that even if he did survive the treatment, he would still have to fight another high grade sarcoma, which is hard enough when you’re healthy.

I don’t normally speak so bluntly, but you have to ask yourself how deep a hole are you going to put him in, and then expect him to climb his way out? This is not the Dexter I saw two months ago. I think this is the end stage Dexter. It’s time to start thinking about euthanasia.

The welling of tears in my eyes burst into streams as she gave me a box of tissues. I apologized.

It’s OK, this is oncology, everybody cries in oncology.

I wasn’t ready for euthanasia, M wasn’t with us anyway, and after all, I just got him the last red wagon in Chicago, and he had barely used it. His oncologist said that she would give him some comfort by draining fluid and I could take him home. He wasn’t in any pain, but the amount of fluid in his abdomen made moving and walking difficult, and he was damned miserable. The treatment was a risk: he could go into shock right then and there, or the fluid that was removed could merely be replaced, leaving him worse off than before, even dead. We went for it. He deserved some relief from the bloating and swelling.

After a couple hours, the door opened and he stormed in, face swollen from the fluids they injected under his skin to hydrate him, but on his own four legs and walking under his own power. The swelling in his back legs was gone, so he could walk instead of waddle for a change. They had managed to drain 3 liters of fluid — between half and two thirds of the total volume. That’s the equivalent of two and a half GALLONS of fluid in a 150 pound human. I wouldn’t have walked around much with that sitting in my belly, either.

For the first time in what seemed like weeks, but was really days, he walked in front, on his own, demanding that I get him the hell out of that hospital and back into the car, immediately. He even tried to jump into the back seat on his own. When we got home, he walked over the threshold and through the front door on his own, headed straight for the couch, and curled up. He shivered, and M covered him with a blanket. Unmistakably pissed off at me, he dozed off and on as he built his strength back up, and I had to have the most difficult conversation I’ve ever had.



Guess Who’s Coming to Dinner?

D back on the couch ...

D back on the couch ...

Well, theoretically, anyway. After a few days off the IV and a stabilizing CBC, we were able to bring Dex home today. It may be his last time, but he’s here where he belongs, and that’s got to be a huge mental boost. For a dog that is too weak to walk more than 25 feet at a time, he almost sprinted from the parking garage to the elevator. I carried him from the elevator to the front door, where he made very clear that he wanted to be set down so he could walk over the threshold on his own. Stop one: water bowl. Stop two: lift me on the couch, please. It’s so priceless to have him here. I spent two hours on his bed with him at the vet’s this morning, regaling him with tales from Food and Wine magazine, which he did not find terribly interesting, since he managed to doze off more than once. His primary vet for this case suggested that we won’t be able to get him to eat while he’s at the hospital, but we may be able to at home, and the massive psychological boost he’ll get will be well worth it. We were cleared to break him out at 5pm today.

He’s not eaten since last week, but he’ll drink as much as you’ll let him, so he’s getting a honey-water solution to sneak in some calories. Tonight on the couch, he ate a couple pieces of chicken breast (~.5 teaspoons) and a small piece of skirt steak. That’s monumental. Of course, it was skirt steak from a cow that was pasture raised, dry aged, and grass fed, but that’s a small price to pay to see him chew and swallow something.

I wrote before how I suspected a necrotizing enteropathy. With the CBC data we’ve been gathering and the symptoms he’s been exhibiting, we’re unfortunately looking at (perhaps, nothing 100% of course) a necrotizing pancreatitis … his RBC is 20 or 21, not at a level where he needs a transfusion, but still pretty low, his WBC is high (~46,000 if you’re counting), which means an infection, and his pancreatic enzymes have been high … one of them is now normal, but the other remains high. Sorry, I can’t remember if it’s the amylise or lipase that’s high, there’s just been too much happening. Kidney and I think liver functions look normal … that’s a great thing to say for once! The downside here is that if a necrotizing pancreatitis doesn’t respond to treatment, it has a 100% mortality rate … the enzymes begin to digest pretty much everything they come in contact with, including internal organs. In humans they sometimes operate to remove the dying tissue and affect fluid drainage, sometimes leaving large bore catheters to deal with the fluids, but in canines it doesn’t look like this is common. The upside is that this type of thing usually comes with pretty bad pain, and from what we can tell, he isn’t in any pain right now. He’s bloated like a balloon and looks like he’s about to pop, but he’s not exhibiting anything that would lead us to believe he’s in pain. As long as he stays that way, I’ll carry him outside and push him down the street in a red wagon, smiling all the way.

For now, though, I’m happy with him being home, in his spot on the couch, dozing off.

He ain’t heavy …

I’ve never held my breath for 24 hours before … maybe I’ve been lucky. Loss, death, pain, desperation, tragedy, all the vile, dark, sickening facts of life … I’ve had those in spades. And all delivered like lightning, quick and fast and to the point. There’s a liberating clarity when you’re struck with that level of intensity all at once. Steel striking flint makes sparks that, intense as they are, fade away as quickly as they were born. You know what has happened and what is happening and what is to happen. You have direction, and your compass still points north.

Worse is the sinkhole, the quicksand, the mire … a smarter or more worldly man might suggest La Brea … of not knowing whether the next time the phone rings is the last time they will call. You stay still, not daring to breathe … not blinking, even … on eggshells when you dare to hazard the smallest step. Wanting and not wanting, something, anything, to happen, to occur, in some way, even undoubtedly cruel, to punctuate this particular sad slice of reality. Something to stop the compass spinning so endlessly and pointlessly, to let the needle fix, if not north, anywhere at all.

And so it was last night and today: the long wait, and I am not a patient man by anyone’s standards, which makes it seem much, much longer. BUT … I heard the most joyous words I’ve ever heard in my life earlier tonight: “He looks a *lot* better than last night, he even chewed out his catheter, completely destroyed the thing, and in my book, that’s a good thing. I’m going to leave him off the fluids tonight and keep some food with him to see if he’s ready to eat.”

Those were the words of Harold Reece, DVM, who graduated from Auburn University with his veterinary degree in 1968. Yes, 1968. The tech who answered the phone, on a Sunday, when the hospital is closed, told me that Dr. Reece carried Dexter up onto the roof a couple times today, so that “Dexter could get some fresh air and sun.”  That man is a hero. In fact, all of the doctors and staff at Gold Coast Animal Hospital have been so wonderful; they’re a part of Dexter’s family. I sometimes call them Dexter’s Heroes because of everything they do for him.

The road is long
With many a winding turn
That leads us to who knows where
Who knows where
But I’m strong
Strong enough to carry him
He ain’t heavy, he’s my brother …

You should listen to The Hollies now.

Highs and Lows

Well, the good news is that the kidney levels are dropping and starting to come back to normal. The bad news is that the liver enzymes are still high and the pancreas is playing games, so he’s not coming home today. The horrible news is that in his doctor’s opinion, if he were to come home today and be taken off the IV, he probably wouldn’t make it to Monday.

That’s a hard blow to take when only a week ago we were shooting for six months and praying for twelve. We brought Sophie in to see him today and she immediately tried to join him in his bed, and we’re going back in this afternoon with a lamb chop and a hot dog to see if he may be interested in eating, and some grass from his favorite spot at the park.

Still, it’s encouraging at least to see some kind of return to normalcy. We’re keeping him on the IV for another couple days to see if they come down more, and to give him a fighting chance.

Small victories …

D with his favorite pillow

Dexter with his favorite pillow ... AKA me.

Dexter has been admitted to the hospital for tonight and probably tomorrow night as well. The free fluid in his abdomen, though NOT CANCEROUS (A-friggin-MEN!), had increased to a point where the bloating was causing him enough distress that we needed to get it drained. He weighed 50 pounds last Saturday … and 55 pounds today … all without eating much of anything. Basically, the fluids he ingests are ending up in his abdominal cavity, leaving him dehydrated, and since his motility issues won’t let him eat much, malnourished as well. Think about having an extra 10% of your body weight sloshing around in your belly and you’ll get an idea how uncomfortable it would be.

Tonight, he’s on a drip to deliver drugs, fluids, and nourishment, in order to get the stomach and intestinal tract healed, kick start his kidneys, and tell his pancreas to calm down and start acting normally. I’m going to ask them to add metronidazole tomorrow morning, I have a hunch that he’s experiencing a rare (for North America, anyway) disease called CNE (clostridial necrotizing enteritis), or a related illness that can be a precursor to CNE. I had his fecal cultured and know that he had (has?) a strain of clostridia in there, and we had him on metronidazole for that, but it may be that he wasn’t absorbing the oral dose and this stuff has been multiplying relatively unchecked.

But small victories, anyway, he’s getting fluid, meds, and nutrition, and they have him in a small pen in an area adjacent to the main surgery suite, so he’ll have plenty of activity to keep him entertained. Just to make sure I’m living up to my end of the promise (Remember? He keeps fighting, and I make sure it’s worth it.), I dropped off his goose squeaky toy (sans head, since he tore that off minutes after first receiving it), a blanket belonging to his faithful and courageous companion Sophie, and my “Arnold’s” hoodie, which we alternate sleeping in (me) or on (him) every couple nights.

Medical Update

As it turns out, Dexter’s health problems don’t stop with the cancer. While otherwise he’s a good candidate for lomustine chemotherapy, his liver enzymes have to be at normal levels before he can start. He has a “hot” liver under ultrasound (OK, hyperechoic), but no masses or nodules can be seen. Unfortunately, though, his enzymes are high, and growing higher, and his red blood cell count is low and dropping. He just got over separate UTI and GI tract infections, and he has developed some gastric motility issues … basically, he wasn’t able to digest food, it just sat in his stomach without moving through the intestines and into the colon. There’s also fluid buildup in the abdomen; it isn’t contiguous, so you can’t do a simple stick-and-drain, which is what we tried yesterday. We can’t do the chemo when he has all this other stuff going on. The main issues are getting him nutrition so he can heal up from the infections and get his red cell count back up, and then get the enzymes down so he can get start the chemo.