Reacquainting Myself with Anguish

The discovery of Hudson's new tumor has reawakened my soul deep dread of what is to come.  I asked him last night to just give me five more months.  I keep telling him if he can just make it to the date of his diagnosis, it will be enough for me.  That’s a lie.  No amount of time will be enough.  Hudson is my baby.  He was the first Dane we ever adopted and he has been a mama’s boy since the moment he arrived.  I don’t know how to exist without him.

Hudson isn’t currently on any chemo.  It’s been over a month since his last IV chemo treatment, and his oral chemo meds haven’t arrived.  He’s been extremely tired lately and has to be tempted off the couch to go outside.  Occasionally, I see flashes of my goofy boy.  He will toss his toys around, or play with the ten pound Min Pin that we are fostering.  He’s not in pain and he’s not ready to go, but I’m beginning to get glimpses of what the end will be like.  I’m not ready.

On my way home from work, I broke down in the car because of the words of a song…

Lord, make me a rainbow
I’ll shine down on my mother
She’ll know I’m safe with you
When she stands under my colors
Oh, life ain’t always what you think it ought to be, no
Ain’t even grey but she buries her baby
The sharp knife of a short life
Well, I’ve had just enough time

Chest X-Rays and the Oral Chemo Choice

Hudson and I went to AHSC last night to get chest X-rays and a CBC.  It was very snowy, so it ended up taking us 1/2 an hour to get from our house to the office, which is normally a 10 minute drive.  Hudson was quite comfortable since he was wearing the coat his foster mom from RMGDRI made him over five years ago.

As usual, since I'm a worrier, I was stressed about the x-rays.  My stomach was in a knot all day.  I'm sure Hudson was feeling my concern, since he promptly peed on the floor at the Oncologist's upon our arrival.  He'd gone potty before we left home, so it's very likely it was a response to my stress. I try to maintain calm around him, but failed miserably this time.  (Then I start to worry that my worrying upsets him. It's a never ending cycle.)

If you will recall, at Hudson's initial time of diagnosis in June, he had zero visible tumors in his lungs on the first set of x-rays.  The 2nd set taken three months later in September, showed 7 tumors had grown in his lungs ranging in size from 0.5cm to 2.5cm.  The 3rd set, taken a month later, showed that 6 of his tumors had shrunk by 25-50% and that the biggest had disappeared all together from the x-ray.  Fast forward two months, to the chest x-rays taken yesterday.

The six remaining tumors have all decreased in mass.  Five are visibly gone (but likely not microscopically) and one was reduced by 75%.  Unfortunately, a new one has shown up.  It is approximately 4 cm (try looking at that on a ruler.  It almost stopped my heart.)  Fortunately, it's not in a bad location in the lungs and Hudson remains asymptomatic.  Our hope is that the new metronomic oral chemo protocol will either help to reduce the size, or at the least, prevent it from growing larger.

Our chemo meds are in the mail and will be taken daily.  (Previously, I had said that it would be every other day for the Metronomic Protocol, but recent findings show that daily meds are best.)  The most common side effect (30% likelihood) is bladder irritation, so we have to be certain to provide plenty of fresh, clean water.  We will also need to pay attention to how frequently he is urinating, as well as whether there is any blood in his urine.

Chemo the 8th - The End of IV Chemo

Hudson had his final IV chemo today.  His white cell counts were where they needed to be and everything checked out great.  His breathing and his heart sound good.  He goes back in three weeks for new chest xrays and to determine the oral chemo protocol we want to follow.

There are two oral chemo protocols out there.  Traditionally, vets follow a metronomic protocol.  This protocol combines medications (Doxycycline, Rimadyl, Cyclophoshamide and a few others) to work on slowing down the blood supply to cancer cells.  By starving the cells, you limit the growth they can achieve.  The tumors are not likely to get smaller while on the metronomic regimen, but the point is more to prolong quality of life by preventing or delaying further growth.

The second protocol is only beginning to gain a following.  It utilizes Tyrosine Kinase Inhibitors, and combines Palladia, Kinavet and Rimmadyl.  Tyrosine kinase inhibitors (TKIs) are a class of chemotheraphy medications that inhibit or block the enzyme tyrosine kinase.  Tyrosine Kinase basically acts as an on/off switch for cell replication and growth. this on/off process can become disrupted, often due to a mutated kinase, and actions become unregulated.  This can lead to uncontrolled growth and division in the cell, which could lead to cancer.  These mutated cells often lead to oncogenes, which are genes that help turn a healthy cell into a cancerous cell.  Tyrosine kinase inhibitors treat cancer by correcting this deregulation. How this is done varies depending on the medication.  Toceranib (Palladia)  inhibits EGFRs (I have no idea what that is), preventing that signal from being stuck “on” and creating uncontrolled proliferation.  The gist of tyrosine kinase inhibitors is that they allow for targeted treatment of specific cancers, which lessens the risk of damage to healthy cells and increases treatment success.

TKI's have not been fully proven yet in canines, they are (for giant breeds anyway) four times the cost of the metronomic protocol, and dogs on TKI's are 50% likely to experience severe GI side effects, like vomiting and diarrhea.  In contrast, the metronomic protocol has a 20% change of side effects.

Dr. Jansen is going to go over these options with us in detail while Hudson is getting his chest xrays and will provide us an estimate of the cost at that time.  Based on what I know so far, I'm honestly leaning toward the metronomic protocol.  I freely admit that cost is an aspect for me at this point, but my primary concern is the side effects.  Hudson is already 7 ½ years old.  Danes typically live 7-10 years.  I would LOVE for him to get to 10, but I don’t want him to be miserable on the way there.  Traditional IV chemo is given every 2 ½ weeks.  Hudson feels a tired and maybe a little nauseous for 2-3 days following chemo, then he gets two weeks of happy healthy days.  On oral chemo, he would get pills M/W/F of each week.  He’d feel bad virtually all the time.  Dr. Janson explained that his dosages could be adjusted to keep him feeling the best possible, but I don’t want the time he has left to be the best possible.  On the metronomic protocol, he has the same side effects odds as normal chemo.  Normal chemo never really upset his stomach.  He never had diarrhea and we can proactively treat for nausea.  He was just a little tired. 

Dr. Janson said that she is leaning the same way as I am on this one.  We can try metronomic first.  If after a few months, we notice growth in his tumors, then we can try the TKI’s.  Obviously, I’ll be doing a great deal more research on this over the next few weeks.

Hudson's favorite oncology tech came running after us to make sure Hudson got his "graduation" present.  J

Chemo #7 - Hudson's Exciting Day at the Vet

I had to travel this week for work, so Tony took Hudson to his chemo appointment on Wednesday.  He had to take personal time and everything, only to discover that Hudson's white cell count was too low to give him chemo and could we please bring him back tomorrow?

Tony panicked.  He didn't know how he was going to get the time to take Hudson back to the vet and still attend supplier meetings he had scheduled the next day.  Dr. Janson suggested that Tony drop Hudson off in the morning before work, and he could pick him up the next evening.  Best of all, they wouldn't even charge us for a day of "hospitalization."

So Tony did, and Hudson did great.  From what we were told, he was the clinic's mascot all day and spent very little time in his cage. :)

Next up is his very last IV chemo.

Finally, Some GOOD News! (Plus Chemo # 6)

Hudson's tumors are shrinking!!  All have them have shrunk by at least 25-50% and the biggest one has disappeared altogether from the x ray.  This is fabulous news, of course.  Hudson is still completely asymptomatic.  He shows no signs of having cancer.

Since we are seeing improvement on the doxorubicin, we will finish out his course.  Doxorubicin is heart toxic, so there is a set lifetime amount of it that a dog can have.  Hudson can have two more treatments (aside from the one he received today) and then he must never have it again.  Once he's completed the doxorubicin, he will begin a metronomic protocol.  This protocol combines several medications: Piroxicam, deramaxx, Rimadyl (NSAID), doxycycline (an antibiotic) and cyclophoshamide, an oral chemotherapy drug. These medications work on slowing down the blood supply to cancer cells.  By starving the cancer cells, you are limiting the growth they can achieve.  They are unlikely to get smaller while on the metronomic regimen, but the point is to prolong quality of life by preventing or delaying further growth.  Doxorubicin shrinks the tumors as much as possible, then the metronomic protocol keeps them small. 

Conceivably, Hudson could go on to live for a year or more, provided the tumor growth remains minimal.  We are so happy to have finally received some good news.  I know that Izzy and Shira put in a good word to get Hudson some more time. :)

Yet Another Osteosarcoma Loss

Shira, Marie's ten year old Great Dane, passed away on Monday.  She had begun limping and crying on Sunday.  Upon xraying her rear leg, it was discovered that she had a large tumor.  It was very close to the point of pathologic fracture.  Unfortunately, due to Shira's age and existing conditions, amputation and chemo weren't options.  Her family chose to release her from her pain and she passed in her mom's arms.

We love you Shira!  I know that you and Izzy are up there together playing.

Hudson's Pictures

As a gift to ourselves, Tony and I had pictures taken of Hudson by Claire Roeth of Rouxby Photography. He's been added to Claire's blog, http://www.rouxby.com/hudson/

She did an AMAZING job!!

Hudson and Those Fabulous Fish! (Chemo #5)

We had a night appointment (our first) for chemo this time.  Our appointment wasn't until 7:15, but we arrived at 6:45 in case they could take him early.  Hudson went back at 7 and the white cell count was good enough to proceed!  The fifth chemo (2nd Doxorubicin) dose was given and Hudson did great.


While I was waiting, one of the surgery techs stopped to chat.  Apparently she assisted on his amputation, though I had never met her before.  She told me what a great dog he is and how everyone looks forward to his visits.  She also mentioned that he gets to go on a tour of the hospital each time he comes in so that all the different departments get a chance to see him.  I'd never been told that before and it cracked me up.


Dr. Janson came and sat with me for a bit while Hudson was in back getting his treatment.  Our next step is to take chest films at his next appointment (October 19.)  Once we assess the effect that chemo has had on his tumors, we will evaluate and determine next steps for treatment.  He's still asymptomatic and Dr. Janson does not hear any difference or difficulty in H's breathing.  We are keeping our fingers crossed that his tumors will have either remained the same size, or gotten smaller.  If there has been growth, we will likely stop chemo and  begin pain management regimens to keep him comfortable for the time he has left.


Once Hudson's chemo was done, he hung out with me in the lobby while we waited for our discharge instructions.  AHSC has a giant freshwater aquarium and Hudson is absolutely fascinated by the fish.

Dr. MacGregor came out and went over discharge instructions with us.  She also mentioned that there was going to be an amputation surgery the next day for a pit mix with a pathologic fracture.  (This is when the tumor in the bone weakens the existing bone structure so much that the leg breaks.  It can break over something as simple as chasing a ball in the backyard, or even just going for a walk.)  The dog's family was very torn about making the decision to amputate, so the doctors had used Hudson as an example of how quickly and beautifully a dog can adapt to three legs.  Dr. MacGregor told me that they were taking pictures and video of Hudson walking around in the back to show the family.  Additionally, she asked if I had any words of wisdom or encouragement to offer the family.  I basically said that amputation was the best decision we could have made for Hudson.  After he had recovered from surgery, he was a completely different dog.  So much of his personality had leached away because he was in pain.  It happened gradually, so we didn't even notice and just assumed he was getting old.  After the pain was gone, my boy was back! The dog that loved to play and wrestle and toss his toys in the air reappeared.  Even if we lose him in a few months, I will know that his last few months were happy and pain-free.  I don't regret amputation at all!

The Chemo That Wasn't (#5)

Hudson and I went for Chemo today, but as usual, his White Cell count was too low.  We're due back on Monday to try again.

Goodbye Sweet Izzy

Despair & Hope at the Same Time

Unfortunately, we didn't receive the hoped for news on Thursday. X rays revealed that the cancer has metastasized in Hudson's lungs. There are 7 tumors spread fairly evenly through out his lungs, ranging in size from 0.5 cm to 2.5 cm.  We have elected to try a different chemo drug (doxorubicin) in an attempt to slow down the growth of the tumors, but it's not a life saving measure. At present, he is showing no symptoms and is a happy goofy boy.

As for how much time he has left, we aren't sure.  Best case scenario, where the tumors maintain present size, or even shrink, would allow him 6-9 months of quality life.

If the tumors don't react to the chemo, or H's body isn't able to handle the chemo, we have 1-3 months of quality time.


He is scheduled to return to the AHSC on Wednesday for an EKG.  Doxorubicin is toxic to the heart, so it shouldn't be given until an EKG is done to ensure that the patient's heart is strong enough.  I chose to have Hudson receive his first dose prior to the EKG.  There is a risk to his heart associated, but I felt the risk of letting the cancer grow for another week was greater.  His Oncologist did check him for a murmur or any other audible heart issues. 


He also has to get a CBC on Thursday.  I'm anxious to get the results of this.  Hudson seems to be doing really well on Doxorubicin so far.  It's supposed to be a tougher chemo, that is harder on the GI tract and shows more side effects.  We haven't seen any side effects.  Hudson hasn't been very lethargic and there has been no loss of appetite.

Tony's IM's

I've been stressing about Hudson's chemo appt all day today.  I'm thinking I'm going to ask them to Xray his chest a month early, because I don't know if I can do this for another month.


I sent Tony an IM telling him that I'm so nervous my stomach is upset and he said:


TMendrallaArrow 1:53 pm
(1:53:24 PM):     Bouncer and I had a 20 minute conversation last night while you were gone. He is aware that he needs to be just fine, and he said he isn't worried and feels great. I am not making up a cute story...I'm serious!


TMendrallaArrow 1:54 pm
(1:54:37 PM):      He knows his role! To protect his mama and to look after his siblings!!

(We call Hudson "Bare-Butt Bouncer" since he hops along, and his rear was mostly bare for two months after surgery.  Bouncing is what Hudsons do best!)

Worry often gives a small thing a big shadow. ~Swedish Proverb

At previous chemo appointments, no mention was made of doing chest xrays for Hudson on the fourth chemo visit.  Izzy had them done on the fourth visit, and so did most of the Tripawd blogs I visited.  I've been decidedly upset all day about the looming shadow of Thursday, so I called Dr. Janson today to confirm that chest films would be done.

I missed her return call (stupid cell phone signals) but she left me a voicemail.  She waits until the 5th chemo appointment to do the xrays. 

I now have another 30 days to worry about Hudson.  I know the worry does no good, but I think about it at odd moments through out the day.  I don't want to do this for another month.

Hudson is still blissfully happy, unaware of the sword that dangles over our heads.  When I am around him, I force myself to remain happy and upbeat.  I don't want him to sense any sort of worry or concern.

Only man clogs his happiness with care, destroying what is with thoughts of what may be.  ~John Dryden

Izzy

The day after Hudson's third chemo treatment, I logged into Facebook and found this post on Marie's Facebook.

I was sitting at my desk at work when I read it.  It was as if the world had stopped and everything went silent. 

Izzy doesn't deserve this.  She had an extremely tough life and she's fought through every obstacle that has arisen with grace and strength.  The last thing that should have taken her down was cancer.

She's been three weeks ahead of Hudson through his entire cancer fight.  She was my inspiration during Hell Week.  Her diagnosis has hit me especially hard.  I don't think I ever allowed myself to think that tumors could form in Hudson's lungs while he is on chemo. 

Logically, my brain recognizes that Izzy's case has absolutely nothing to do with Hudson's.  My heart doesn't.  I'm so afraid that Hudson's next appointment will mirror Izzy's.  I'm trying very hard not to think about it.  I've tried multiple times to write this post since August 19, but haven't been able to marshal my emotions until now.  Just thinking about Izzy and what is happening to her, and could happen to Hudson, makes me sick.  My stomach churns and my eyes fill with tears.

D Day is still two weeks away, September 15th.  That will be Hudson's fourth chemo treatment, and they will do chest films to determine if tumors have formed in his lungs.  In the meantime, Hudson gets to lay on the bed with me every night until Tony comes to bed and he's getting a lot more cuddles.

Chemo the 3rd...for real, this time.

Hudson got his chemo today.  White cell count was where it needed to be. 

Last week, at the chemo the 3rd (1st Attempt), Dr. Janson had mentioned that Hudson was an inspiration to other clients.  Apparently, a family with a Pomeranian had seen him in the lobby a few weeks ago when they were in getting their dog a dental.  Two weeks later, they found out their pom had cancer.  The family was somewhat reluctant to go through an amputation, but Dr. Janson discussed how quickly dogs bounce back from the loss of a leg.  The family told her that they had seen a Great Dane in the lobby only a few weeks earlier and had been surprised at how graceful he was.  They were even more surprised when his owner had told them he was only (at the time) 6 weeks out of surgery.  Dr. Janson said "Ah, you met Hudson, the poster dog for amputation."  :)  The family decided to proceed with surgery. 

I met them today.  They were in the lobby while their pom was undergoing surgery.  When Hudson and I walked in, they both began crying.  They gave him love and told me that he was the reason they decided to amputate.  It made me a little weepy too.

After his chemo was done, Hudson and I were waiting in the lobby for his anti-nausea prescription to be filled.  A little girl and her twin brothers were waiting in the play area.  The little girl was clearly upset and had tears on her cheeks.  Hudson went right up to her and started licking at her cheeks.  She hugged him around the neck and held on.  Hudson then turned to the twins, who were belted into a double stroller, and started licking them.  The children's parents came out of the back room and thanked the receptionist for watching the children.  Both had red eyes and had clearly been crying.  When they saw their daughter with Hudson, they started crying again.  The parents hugged him too and talked softly to their daughter.  After the usual "what a beautiful dog" comments, they gathered up their kids and left.  Their little girl called "Bye Hudson! I love you!"  The receptionist later told me that their dog had been hit by a car and died in the dad's arms as they arrived at the hospital. 

Chemo the 3rd....only not

Well, the 3rd chemo session didn't work out either. Hudson's white cell count was too low again.  Dr. Janson said that since Hudson is already receiving the lowest dose of the protocol possible, we'll have to increase the time between rounds to 4 weeks.  This pushes us into the holiday season, which we had hoped to avoid, but what are you going to do?

Dr. Janson did mention that Danes as a breed seem to be more sensitive to chemo, so Hudson's reaction isn't uncommon.

We'll try again next Thursday!

7 Everyday Hero

The CEO/President of the rescue that I volunteer with, Big Dogs Huge Paws, was nominated for the 7 Everyday Hero award and won!  All of the Officers wanted to help surprise her, along with Mitch Jelnicker, so we snuck over to her office.

Channel 7 asked that we bring some dogs, if possible, so Hudson got to go!

He enjoyed the car ride over

Colin, Lindsay's husband, is the one in the black polo holding their newfie, Sully.  Lindsay is in blue, Bree in black, with Mitch standing just beyond her.  Susan Rafferty, the lovely volunteer that nominated Lindsay for the award, is wearing pink in the distance.  That's Hudson's butt in the lower right corner. :)

Because he loves me, Hudson was sure to make a generalized nuisance of himself.  He climbed in a big fountain three times and made me come in after him too.

Here's the finished product!  (The first dog shown is our boy!!)

http://www.thedenverchannel.com/7everydayhero/28764493/detail.html

The Return of the White Spot

It has been brought to my attention that I have failed to post updated photos of Hudson's surgical site.  While he was goofing around in the grass today, I took a few pictures.  It's been about six weeks and most of his hair has come back in.  You can still see a slight line where the fur is shorter if you look at him when he's standing up.  The incision has healed completely, with no serious scarring.

If you look closely, the white spot (remember the sobbing from amputation day?) has returned!!!!!!  Only a small piece of it remains, but the flap of skin that was used to cover the site has just a little bit of my beloved white spot. 

And yes...I cried when I saw it for the first time.

Just Got Back From Hell

The day I took Hudson to get his stitches out at Animal Hospital Specialty Center, a song called "Just Got Back from Hell" came on.  Ever since that day, every time I have put Hudson in the car and taken him to AHSC, my ipod has always played "Just Got Back from Hell by Gary Allan.  Consider that my ipod has over 700 songs and is on shuffle.  The coincidence is staggering.  Particularly since this song puts into words how Hudson's struggle has made me feel. 

I actually cried in the car the day the stitches came out after listening to it.  It talks about my guilt, how my life went on hold while we dealt with the immediate aftermath of amputation, and how I feel like I'll never be the same person I was. 

This song was written after Gary Allan's wife committed suicide.  Admittedly, the dark place that I came from was nowhere near the pain and suffering he was trying to relate, but this song really speaks to, and for me.

Perking Up

About 2 this afternoon, Porter demanded to go outside.  Hudson reluctantly hauled himself up off his pillow and joined him.  I helped him down the stairs, still in worry mode about his lethargy.  I shouldn't have been...

The instant he hit the grass, he dropped down and started rolling while making an awful growly noise.  This seems to be his "oh yeah...." noise, similar to the one Tony makes when I scratch his back.

His mouth was gaping open as he rolled in the grass like a fool.  Guess he's feeling better.

Chemo the 2nd (For Real This Time)

We went for chemo again today, only this time, Hudson's white cells decided to comply.  The usual Hudson-love was nowhere to be seen this time.  The hospital seemed to be operating in a state of chaos as several emergencies had come in.  Hudson and I waited about 30 minutes past our appointment time before we were taken back. 

The techs did a quick blood analysis and everything checked out.  Hudson's counts were where they needed to be and chemo was adminstered. 

Last time he had chemo, we saw no ill effects.  He didn't even exhibit lethargy, the most common side effect.  This time, he did.  From the minute we got home, he laid on the couch and didn't move.  He would get up to go potty, if I demanded it, but that was it.  Fortunately, his appetite was unaffected. :)

Since I'm a HUGE softie, he got to sleep on the bed with me for a while until Tony came to bed.  Then he got booted onto his bed on the floor.  I'd probably feel sorry for him, if it weren't a six foot long, 8" thick cushion.

This morning, he was still exhausted.  My job is pretty flexible about letting me work from home when necessary, so I decided to stay with him to keep an eye on the situation.  I have a little hobby room, referred to as the reading room, where I settled to work.  Hudson laid on a dog bed next to his brother at 8:30 am and didn't move until 12.  I didn't need to stay home, but it made me feel a LOT better.

Chemo the 2nd (or so we had hoped)

Hudson went in for his second chemo treatment today.  I was not traveling this time and got to take him. 

The oncologist techs took us back to one of the visiting rooms to discuss how Hudson is doing.  I mentioned the wobbling and they said they’d have a look at his other knee, but that wobbles are fairly regular for tripawds.  If I notice trembling or buckling of the leg, then we have something to be worried about.  Hudson was only with us for a few minutes before one of the surgical techs came to steal him.  Apparently, some new vet techs had started since Hudson was last here and she had to go show him off.  James and I went over a few more things (appetite, stool/urine, etc.) before he left to start the chemo.

I sat in the visiting room while I waited and loved that this poster is hanging in there.

I also loved the HOPE with paw prints.  This must be where there they generally have cancer patient's family wait.

I tried to use my time wisely to get caught up on my blogging (since I’ve gotten lots of complaints about it.)  :D  However, Hudson’s white blood cell count was too low, so they were unable to administer chemo today.  Dr. Janson came in and explained to me that chemo attacks fast replicating cells in the body.  Cancer cells replicate quickly, as do hair follicles and white blood cells.  If we had given him more chemo this time, it would have attacked his white cells and left him immuno-suppressed.  Instead, we will wait a week and come back next Thursday to see if he is ready for treatment.  Dr. Janson also mentioned that she will be changing up the amount of chemo he is given to try to prevent this from happening next time.

Dr. Janson also mentioned that Hudson is the practice’s current favorite patient. She told me that everyone, specialists included, drop everything to come see Hudson when he comes in.  I asked if it is just because he’s a Great Dane, and she said that while she’s sure that plays a role, it’s mainly because he’s cool and affectionate.  He's also very patient and well-behaved during procedures.  I love that everyone loves him.  Porter tends to be the crowd favorite when we go out in public, so I LOVE that Hudson is getting some attention.

Bloodwork

Hudson went in to the vet quickly today to check his white cell count.  They typically monitor the white cell count about a week after chemo to see how the dog reacted.  If the white cells have dropped too low, they know that they need to adjust the next round of chemo.  Hudson passed with flying colors.  Dr. Janson saw a very small dip, so feels that my boy is on the right protocol.

Chemo the 1st

Damn my job!  Due to scheduling issues at the oncologists, I was unable to take Hudson to his first chemo appointment.  They could only get him in on Thursday at 3:45 and I was flying out of Sacramento, CA at the same time.  Fortunately, my wonderful husband and doggy daddy Tony was able to take him.  While I felt like crap and guilty as hell the entire time, I knew he was in good hands.

The downside of having Tony take him to his appointment is that he is a man.  I ask for details about how the appointment went and get responses like “Lot of waiting.”  Here’s an excerpt of our conversation:

K:        How did chemo go?

T:         Fine

K:        Uh…did you have to wait long?

T:         Yeah, like an hour.  They had an emergency.

K:        So you waited an hour and then how long while he had chemo?

T:         45 minutes.

K:        So what did they do?

T:         I dunno.  I was in the waiting room.

K:        Oh.  What’s all this medication?

T:         Instructions are in the bag with the medication.

Hudson showed no ill effects from his chemo.  Typically, dogs are lethargic and tired.  They can have nausea and diarrhea.  The vet gave us medicine to prevent nausea that we were to start the night after chemo.  They also provided medication for the diarrhea, but that was only to be administered if he experience diarrhea.  He didn’t.  We didn’t even see lethargy.  He took it like a champ!

One of the things that Hudson loved about going to the oncologist (and frankly, so did Tony) is that everyone at the oncologists LOVES him.  The moment they walked in the door, the receptionists were calling him.  One of them picked up the phone and called the techs in the back, because everyone wanted to see Hudson.  His surgery tech always comes out to see him, and Dr. Stubbs has come up too.  He always inspects Hudson’s incision, but he told Tony that he comes just because he “loves this dog.”  Tony is always so proud of Hudson and loves showing off his handsome tough guy, and said Hudson is a chick magnet. :)

Two Weeks Ago Today

Today was the first day that the dogs stayed home alone since Hudson's surgery.  They handled it well, though they were ridiculously excited to go outside when I got home.  Hudson's favorite thing during his recovery was laying in the grass in the backyard.  That hasn't changed.

I can hardly believe that two weeks ago today was ampuation day.  Hudson's incision is already greatly improved, as the picture below shows.  He gets around wonderfully, though he tires quickly.  Fifteen minutes of activity requires several hours of rest.  He's gradually building up his endurance.  You can always tell when he's tired, he tries to stand on his no-longer-there-leg and tilts back a little.  That's our sign that it's time for a rest.

 Hudson being frustrated by my excessive picture taking.

 Lexi demonstrates why sticking your nose through wood lattice in search of bunnies is not a good idea.

The Stitches Come Out

Today, we went to get Hudson’s stiches out.  He wore his harness to the vets, as well as his boxers.  His stitches are driving him crazy, so he’s really been trying to lick/chew at them lately.  For some reason, the flimsy material of boxers is enough to make him leave them alone.  He doesn’t try to push the boxers off or stick his nose up the leg hole.  (I kept meaning to sew it shut, but never did it.)

Hudson was taken back to have his sutures removed and I stayed in the waiting room.  The lady next to me struck up a conversation.  She was there with her two labs, both of whom have cancer.  One has fibrosarcoma and has so far undergone SIX surgeries to remove tumors.  His mom had wanted to try to save his leg, so they only took pieces of the leg as they found tumors.  She said at one point, he only had two toes and half of his lower leg.  He was in for a check up to see if his cancer had come back.  Her second dog had osteosarcoma and was in for IV chemo. When I told her that Hudson had only been a tripod for two weeks, she was astonished.  She said neither of her two dogs had recovered as well or as quickly as Hudson appeared to.

Dr. Stubbs brought Hudson back out and told me that the incision looked fabulous.  He was extremely pleased with the way that it was healing, and with Hudson’s progress in general.

Next up is the first chemo treatment on Thursday.

Of Boxers and Skittles

A genius idea occurred to me today in the quest to get Hudson to leave his sutures alone.

I kept trying to think of something that we could put on him to cover his sutures.  A t-shirt would have worked for a front limb amputation, but I was drawing a blank for the rear leg...and then...it hit me.

 BOXER SHORTS!

The elastic helps to keep them around his waist, and his tail goes out the crotch flap.  (I tried to think of a less crass thing to call it, but that's what I've got.  Crotch flap.)  He's been meandering around the house all day in his Harley boxers.  He hasn't tried to take them off, and he has left his sutures alone, so far.  Fingers crossed!

I had to do some work from home stuff tonight, so I settled myself on my air mattress with my laptop and a handful of Skittles.  As if from nowhere, Hudson appeared and intently watched my progress with my Skittles.  Since I'm on the floor already, we're pretty much eye to eye.  I'm pretty strict about what my babies eat, so he didn't really have a prayer in hell...

 But then he kept making this face, and he had his adorable little boxers on...

So he got ONE red Skittle, and was the happiest boy ever.

Mom...mom...mommy....momma...

Hudson is doing pretty good.  His favorite thing to do lately is lay in the grass in the newly landscaped backyard.  I almost dread taking him to potty because it's a guaranteed battle to get him to come back in.

Yesterday, while he was lounging, Porter decided to help me water the brown spots in the sod. 

He's used to drinking off the hose, so this rainwater effect is a little confusing to him. :D

Hudson has still been having really rough nights.  The phantom limb pain always seems to strike about eight, and last all night.  He isn't crying anymore, but he trys to lick his sutures and occassionally bites at them.  I've tried putting the bite not on him, but he just whimpers until I remove it.  The ecollar isn't much better.  His favorite way to get that removed is to get off his bed and just start stumbling around the room.  He manages to hit me in the face with it, (I'm still sleeping on an air mattress in the living room with him,) knock things off the end tables, and bump Lexi and Porter.  He ends up waking the entire household up and annoying us all until I take it off.  After the ecollar has been removed, I swear to God, he's smirking at me. 

The only way to get him to leave his sutures alone is to tuck a sheet around his bottom half.  For the most part, he won't try to pull the sheet off.  The downside of this plan is that Hudson is really restless at night because he is so uncomfortable from the phantom pain.  He gets up and switches beds and positions all night long, dislodging the sheet everytime. Each time, he does, it wakes me up, so I am averaging 5 hours of sleep a night.  He gets to sleep all day, so the impact on him seems pretty minimal. 

Every morning at six, he wakes me up all happy and excited because he wants to go outside.  I'm pretty un-reactive initially but he's a nuisance until I get up.  Kind of reminds me of this Family Guy moment:

Stubborn Boys & Phantom Limb

Be careful what you wish for.  When we were going through the worst part of hell week, I couldn’t wait for the day that Hudson was feeling a little better.  I was anxious for the crying and whimpering to stop, and for my boy’s personality to return.

Over the last few days, Hudson has improved and his personality is back.  I kind of forgot about the whole stubborn part of his personality though.  He wants to do everything by himself, which he isn’t ready for.  I’ve had to block off the stairs, since he seems to think he needs to climb them.  His remaining back leg isn’t strong enough for anything more than the three steps down to our backyard.

Tony and I put his sling on him last night and assisted him up the stairs, thinking that might take care of his desire to climb them.  He struggled all the way up, then took a twenty minute nap at the top of the stairs to recuperate.  Coming down was not fun.  Hudson hasn’t yet learned to redistribute/rebalance his weight for coming down.  It was a nerve wracking experience for all of us, and we had hoped that would curb his interest in stairs.  Not so much.  I stopped him so many times today from going up that I lost count.

It was really nice in Littleton today, weather wise, so we all went and sat on the new deck while I worked on my laptop.  Initially, Hudson laid in the grass and just enjoyed being outside. 

All too soon, though, that wasn’t enough.   I had to get up constantly to stop Hudson from trying to wrestle with Porter in the grass.  I had to stop him from trying to walk on the rocks bordering the lawn.  He can’t yet balance on the uneven terrain, but sure thinks he should try.  Eventually, I made all the dogs come up on the deck and shut the gate to prevent them from returning to the yard.  Then Hudson wanted to lie on the wood.  I brought out his bed, a pet cot, and even just a plain sheet for him to lie on.  He wasn’t having it.  Eventually, we went back inside to save my sanity.

We removed Hudson’s Fentanyl patch last night, per the vet’s instructions.  His personality came back in spades, but unfortunately, he seems to have gained phantom limb pains as well.  I don’t know if the Fentanyl was blocking these sensations before, or if it was just coincidence that they began the day after the patch came off. 

Since phantom limb pain is a psychological problem, pain meds can’t help.  I did a little research on the issue to not only better understand what he was experiencing, but also to find ways to perhaps help him deal with it.  What I discovered is that about 80% of human amputees report having pain and sensations in their missing limb.  Sensations are often described as burning, aching, tingling, or feeling the missing limb is “crushed” or somehow sitting at an uncomfortable position. There are many theories as to why this occurs, but the bottom line is the pain is real. The most current theory is that the brain has an idea of what the body looks like, a “map” that it refers to. After amputation, the map in the brain is still a whole body, as it takes time for the brain to re-map to the new body configuration. Because the brain is expecting input from the missing limb and not getting any, it sends sort of a panic signal that is interpreted as pain.

I found several things we can try, but most of them require waiting until the incision is healed.

• Gentle massage
• Wrap the stump in a soft, warm fabric (like a towel)
• Warm soaks or heating pads
• Mild exercise – just to increase circulation
• Wrap in a snug, but not confining bandage

Even though Hudson’s incision has another week before the sutures are removed, I’ve been gently massaging the muscle above the surgical site in an attempt to help.  Hudson doesn’t seem to mind me doing it, and it really decreases his anxiety.  I’ve also noticed that some of the twitching of the muscle stops almost right away, and completely stops after a few moments.

Dr. Stubbs called this afternoon with the results of the pathology.  Hudson’s tumor was indeed Osteosarcoma.  (There was a perhaps 1% chance that it wouldn’t be, so I was prepared for that answer.)  It isn’t an aggressive strain, but it isn’t one of the easier ones either.  Hudson will be going in for suture removal on Monday, June 20^th and will have his first chemotherapy session then as well.

Emotions

Initially, my intention for writing a blog about Hudson’s progress was simply to keep friends and family informed on what was happening without sending a million emails and texts.  As we’ve been going through this though, I’ve also come to want to write a blog that could help someone else going through this with their dog.  I found a lot of help and support on Tripawds.com and I really appreciate it.  I’ve read through many of the blogs there, and it provided hope and inspiration in a really dark time for both Tony and I.  I was reading some of these blogs today, and it struck me that I never have really written about how I felt when Hudson was diagnosed or how I reacted.  I kept my first post, The Beginning, very clinical and tried to take the emotion out.  I now feel that I may have done a disservice to anyone going through this same ordeal who might read this blog.

I was devastated at the vet, when they told me Hudson had cancer.  I kept it together while Dr. Stubbs was in the room.  My eyes were dry and I was very calm.  I asked questions about Hudson’s chances, his suitability as a surgical candidate for amputation, and chemo treatment options.  Unlike a lot of pet parents that have been hit with the osteosarcoma diagnosis, I never questioned amputation.  As the CFO for Big Dogs Huge Paws, Inc., I’ve seen tripawds come through who live a happy, fulfilled life.  It didn’t even occur to me how much of a struggle it was for a lot of pet parents to make that decision, because they didn’t have the same frame of reference that I did.  Dr. Stubbs hadn’t even told me what our options were for osteosarcoma treatment before I was asking how quickly we could amputate.  It was an easy decision for me.  When they took Hudson away to do chest x-rays, I texted Tony, my friend Marie, and my brother about Hudson’s diagnosis.  Each time I typed the words cancer and amputation, my eyes filled with tears.  I got myself back under control by the time Dr. Stubbs and Hudson returned and made arrangements for surgery.

I took Hudson home and returned to work.  My boss, Brian, suggested I go home early, but I didn’t want to.  I knew I’d just sit there and worry, driving myself crazy.  I couldn’t talk to Tony about the whole thing without tearing up and losing the ability to speak.  We decided to wait until we got home that night to talk about it.

Once we started talking, I realized that Tony and I were not on the same page.  He had a lot of reservations about amputating Hudson’s leg and putting him through chemo.  I had been worried all day that the cost would be a large sticking point.  To my everlasting gratitude, that wasn’t it at all.  Tony’s concerns centered entirely around making sure that Hudson had quality of life.  He wanted to make sure I wasn’t trying to hang on to him, inadvertently causing his suffering to ease my fear of letting him go.  I remember him saying “It isn’t the money.  I don’t care about the money.  I’d fight this with every penny we have for any of our dogs, including Lexi.  But we need to be sure it’s the right choice for them.  We need to make sure we’re not letting them suffer so we can hold on.”

Once we discussed how quickly dogs bounce back from amputation, and the fact that Hudson would be in less pain the day after he went through amputation then he was the day before, the decision was made.  Bone Cancer is THE most painful condition that a dog can experience.  Dr. Stubbs compared it to having your bones slowly explode from the inside and having to walk on them.  If we hadn’t amputated and chosen instead to just manage the pain for whatever time Hudson had left, he would have had 6-8 more months, and he would have been in pain the entire time.

Our next sticking place was the chemo.  Tony felt it wasn’t fair to put Hudson through amputation, and then just as he was recovering from that, start chemo.  Everyone is aware that chemo is excruciating for people that go through it.  They lose their hair and get extremely sick, experiencing nausea, vomiting and diarrhea.  Tony didn’t want  to buy six good months with six bad months.  While I knew that chemo isn’t as aggressive with dogs and that the side effects were much more mild, I didn’t have all the details of what it would be like.  Oddly, searching the internet didn’t help.  I continued to find the same refrain.  “Dogs react much better to chemo than people.  Few of the unpleasant side effects are noticeable.”  What the hell does that mean? What are the side effects?  Just because it’s not noticeable, doesn’t mean my dog isn’t suffering!  I needed details.  That’s when we set up a phone consult with Dr. Janson and got our answers.

Hudson was diagnosed on Thursday and went through amputation the following Tuesday.  During this time, I told virtually no one.  I didn’t want to talk about it, I didn’t want people to feel sorry for me or him, and I didn’t want anyone’s opinion on what we should do.  That was something we had to work out for ourselves.    Why didn’t I question the vet more when he diagnosed a sprain?  Why didn’t I insist on x-rays when he said Hudson’s spondylosis was advancing?  Why didn’t I ask for x-rays of the long bones when they did his knee?  I was aware that all this regret was useless, but I couldn’t (and still can’t, to some degree) stop feeling it.

The morning after Hudson’s cancer diagnosis, as I drove to work, I started crying and I couldn’t stop.  I got to work and wore my sunglasses for a half hour after I got there because I couldn’t get myself under control.  As I drove home that night, I started crying again.  I remember literally screaming as loud as I could as I drove down the street to try to find a release for all the emotion.  Marie told me that I should go home that weekend and have my arguments with my god.  That made me laugh at the time, but I fully understood what she meant.

I don’t blame any higher power for Hudson getting sick.  What is meant to be will be.  What I struggled with, was how to handle my emotions toward it.  Tony has always been a fairly stoic guy, with the exception of his temper.  He doesn’t show his pain often, and as a result, I tend to hide mine from him.  It’s not his fault, he’s never shown any kind of disgust when I cry.  The opposite in fact.  I just feel weak when I cry in front of anyone.  As a result, I mostly kept my tears to myself.  I cried myself to sleep every single night between Thursday and Tuesday.  I did so silently, because I didn’t want to upset Hudson, Tony or any of the dogs.  I never saw Tony grieve at all, and that worries me.  I know he needs to.

Tony has been really awesome and supportive throughout this whole ordeal.  He has never once balked at the cost of treatment, or questioned the necessity.  He’s been an advocate for Hudson’s quality of life and I couldn’t ask for a better partner to go through this with.  He’s absolutely dedicated to helping Hudson recover.  He’s gone shopping with me for flooring options to cover the slippery wood floors, and helped me pick out harnesses that will allow us to assist Hudson with obstacles he may encounter.  I read this post to him after I had written it, and we both had tears in our eyes.

My Boy is Back!

Hudson just, for the first time since his surgery, sought me out for attention.  He buried his head in my lap (a typical Dane move.)  Tony came to watch, since it's the first sign we've had that our Hudson was returning.  H left me and went to Tony and leaned on him.  Our first lean since surgery!  My affectionate little mama's boy is back!

It was really hard for me after Hudson's surgery, when he would turn away from us when we offered affection.  We both realize that he was on drugs and we can only guess what he may have been thinking, feeling and seeing.  We know his reaction wasn't really him, so much as the drugs, but it was still really hard.

I have joyful tears on my cheeks right now, since he's sitting next to me on the couch nuzzling his head between my back and the couch.  Normally I hate that. :D

The Best Bridge Between Despair and Hope is a Good Night's Sleep. ~E. Joseph Cossman

Hudson slept through the night with no issues and I got eight hours of blessed sleep.  The dogs woke me at 8:30 to go outside.  Hudson got off the couch on his own, walked outside, down the deck steps and into the grass with no assistance.  He went potty and then did some short sprints in the grass.  He did attempt to walk in the rocks at the back of the yard, but quickly decided he wasn’t yet ready for uneven terrain and returned to the house.  I fed the hounds and we all went back to sleep. 

We next got up at 12.  I ate leftover pizza (Yay! Pizza for breakfast!) and took Dakota home to my parents.  They kept me chatting, as usual, so I didn’t get back home until 2.  I lay down on the air mattress next to Hudson for just a moment, and woke up four hours later.  Tony had joined us sometime during that four hours and we all had slept.  Clearly, the Mendralla household was in need of sleep after Hell Week.

We all went outside for a bit and hung out on the deck in the sun.  Hudson meandered around the yard, which really seemed to tire him out, since he’s been asleep on the couch ever since we came back in. 

Having Dakota gone has really decreased my anxiety level.  It’s kind of silly, since she was the easiest dog to deal with.  For the most part, she stayed hidden in a corner behind the couch trying to avoid my dogs.  She wasn’t a pain, like Lexi, or needy, like Porter.  Maybe it’s just that the pressure to make sure all four dogs have eaten, pottied, had water, and all have a nice soft place to sleep is over.

My dogs are snots, and tend to fight over beds.  We had three beds for a long time, and they would still fight over one particular bed.  We ended up buying another of the favorite bed and now have four dog beds.  As any long time pet owner can tell you, always have one more of a hot commodity than you have dogs.  If the dogs get Zuke’s bones, I always buy four instead of three.  Someone (typically Lexi) will steal someone else’s (typically Porter's) bone.  She’ll leave hers on the floor unattended, but if anyone approaches it, she gets attitude.  It’s easier just to give Porter another bone and take away her old one.  Stupid, but easier.  Same with the beds.  When Dakota was here, the dogs equaled the beds.  Someone was always hacked about who had what bed and many times, Lexi would stretch herself uncomfortably across two beds, just to block someone else from sleeping there.  I got tired of refereeing that, which reminds me....

Hudson is definitely starting to feel better.  He will only eat about a cup and a half of food at a time and it takes *forever* but he's eating.  Lexi decided he was done and that she should finish for him today.  She pushed her way past him and started to eat his food.  Rather than passively allowing her to, as I half expected, Hudson started a brawl.  He had her on her back and cowering in short order.  I was so proud.