Sick as a Dog


    
Only three weeks ago our 11 year old terrier, Sparky, had a full health exam, check- up and blood work.  Shockingly, our pooch—who, in the past, had unrelentingly devoured food and non-edibles like face cream and Kleenex—had not eaten  his dinner or breakfast. While he had an upset stomach and seemed lethargic, the vet said he looked okay.  One of Sparky’s lymph nodes was slightly swollen; he was a little anemic, but was normal otherwise.  The vet gave our beloved dog anti-nausea medication and suggested an MRI if he exhibited symptoms such as vomiting, diarrhea or lack of appetite. Over the next week, Sparky began eating again, but certainly not with his usual gusto.  He lost his desire to walk, and his breathing was labored.
      Max and I brought Sparky back to Manhattan Veterinary Group, where he’d been a “patient” since he was a puppy. Max and Sparky had grown up together, and the dog had always been his baby, his best friend and an integral part of his childhood.  After years of begging us for a dog, we’d finally relented when Max was 11, and old enough take on most of the responsibility for his pet’s care.

     This time Sparky was examined by a different vet, and the examination seemed to last an eternity.   

     “I’m sorry to tell you that I think your dog has lymphoma.” She spoke softly and sounded genuinely sad, after palpating his panting body and even removing a chunk of red fur. “All of his lymph nodes are swollen, and he has fluid in his lungs.”

     My son had tears in his eyes, and I felt like an anvil had fallen on my heart. Sparky was the same age Max had been when they first met.  Now –suddenly it seemed—Max was a young man and Sparky an ailing grandfather. “But you saw him 3 weeks ago,” I protested. “How could his condition change so much so quickly?”

     “It’s very common for animals to exhibit no symptoms until they are very sick,” the vet said in a kind but matter of fact tone. “Unfortunately, animals can’t tell us when they don’t feel well. They just do their best to carry on with their normal routines until they can’t anymore. That’s when pet owners notice something’s wrong, but by that time the disease is often very advanced.”

     I wanted to protest that lymphoma was not on our breeder’s list of diseases which are common to Norwich Terriers –an extremely hardy and stoic breed—but I was in too much shock.  

     Although lymphoma is the most common type of cancer in dogs and cats, 11 years ago the breeder had assured us there was no cancer in Sparky’s bloodline.  When we first brought home our adorable feisty pup, we were told that he would probably live to be 15 or 16, the normal lifespan for a Norwich terrier.  At 11 years old, Sparky was beyond middle-age, but certainly not elderly.  Those who follow my blog will remember that only three months ago, Sparky underwent surgery on his leg. At that time, we had believed he was in good health, and we wanted him to enjoy the next 4 or 5 years without limping or the pain of arthritis.  Sparky had bounced back from the surgery nicely, and now, just when we were cheering his recovery, he was— suddenly, inexplicably— dying.

     “Mom, HOW could this happen?” Max demanded, wiping his nose. “It’s not fair.”

     “No, it’s not fair.”  Briefly I thought of all the “unfair” situations in our family, including Sarah’s autism, Max being born with a hole in his heart and ADHD. None of it was remotely fair.  With a sigh I turned toward the vet. “How sure are you about this diagnosis?” I asked.

     “More than 50%, I’m afraid.  We’ll know more after the x rays.”

     The room was silent for a moment. “Can you at least make him more comfortable and help his breathing?” I asked at last.

     “Yes.” The vet seemed relieved to be able to offer us some small comfort. “We can drain fluid from his lungs after the chest x rays and other tests.”

     The “other tests” included full blood work, urinalysis, and fine needle aspiration of the lymph nodes.  The vet asked us to leave Sparky for two hours and return for the results.

     When we got back, the vet was grim-faced.  In the examining room, she gave Max and me a guided tour of Sparky’s chest x rays. “These black, oxygenated areas around his lungs should be twice the size.  The cloudy sections around his heart and ribcage are fluid that’s most likely caused by the inflammation from a mass.  His breathing capacity was only 50% when you brought him in.” She paused, looking me in the eye.  “I’m so sorry.”

     Max began to weep, and I leaned over to stroke his head. I was sitting in the only available chair in the exam room and my son was on the linoleum floor next to me. “Are you absolutely sure it’s lymphoma?” I was still hoping I‘d somehow gotten trapped in a bad movie or someone else’s life.   Maybe if I just asked the right question, I’d get a better answer.  But no, try as I might to avoid the bad news, it was slowly sinking into my brain that whatever was going on in Sparky’s cute furry body was killing him. It didn’t matter what name we gave it.

     “I’m 90% sure it’s lymphoma.  I’ll send out the lab work just to confirm.  Your next step is taking Sparky to a veterinary oncologist. The oncologist will talk to you about staging and treatment options.”

     Lymphoma in dogs and cats is always fatal.  But further research revealed that 80 to 90% of dogs treated with chemo therapy go into remission for about a year, (plus or minus a couple of months.)  We were also advised that dogs tolerate chemo very well, and don’t suffer the side effects of hair loss and nausea seen in humans.

     After the test results confirmed 100% that our dog had lymphoma, Max and I took him to see a perky, upbeat oncologist at Blue Pearl Hospital on West 55th Street.  It had been only 2 days since the vet had examined Sparky and drained his lungs, but our poor dog was already struggling to breathe again. Max carried Sparky like a baby, nestled inside his down coat, as the dog was unable to walk.

     “Sparky has Stage 5 lymphoma,” The oncologist told us. ”Because it’s in his chest, and he’s feeling sick, it’s sub stage B.”

     Max leaned forward in his chair. “Can you help him?”

     “With chemotherapy, Sparky has a good chance of going into remission and having a good quality of life,” Dr. Britton replied. The oncologist somehow managed to sound upbeat, despite the worst possible stage and diagnosis.  There was no stage 5 for humans; stage 4 was the final frontier.  Why was Dr. Britton so cheerful and optimistic?   According to Dr. Britton, dogs responded completely or not at all, regardless of their cancer stage.  In Sparky’s favor, his blood had normal calcium levels, and this suggested that the disease had not yet reached his bones. 

     We discussed a variety of treatment options.  The “first line” drugs used for chemo would cost $12,000 and be administered once a week for six months.  For half that amount (and half the success rate) there were second line drugs.   Max started getting hopeful,  while  I was skeptical and horrified.  Not only was the treatment wildly expensive, but also the vet hadn’t convinced me that dogs don’t feel sick from chemo.  If a dog can’t tell you he’s sick until he’s dying, how could the vet know what sort of pain the dog feels when the IV goes in? 
     We have only a week to decide because Sparky’s condition will deteriorate rapidly if we do not take action.  Dr. Britton offered to give Sparky steroids and a one-time injection of chemo ($800) immediately to see how well Sparky responds.  Max and I accepted that offer, and Sparky received a dose of chemo that day. Currently, our family is painfully divided about treatment. Max wants to save Sparky at almost any cost and is willing to spend his graduation money to pay for treatment. 

     I think chemo for the dog is crazy, costly and possibly cruel. But, to be “fair,” I decided to research further and gather all the information I could. I called Sparky’s breeder; I solicited the opinion of dog owners in similar situations. I even posted an open question on Facebook about chemo for dogs, and, of course, I Googled canine lymphoma. I also spoke extensively with our regular vet, who disagreed with the oncologist about treatment, and thought Sparky’s prognosis was poor.  Meanwhile, Sparky got some of his “spark” back after the first treatment, and even knocked over Max’s garbage can to forage for food. For once I was thrilled at his messy antics, thinking they were a positive sign.  But then a friend whose wife died of cancer told me that patients often experience the greatest relief from the first shot of chemo, and then less as time goes on.  Another friend insisted that the initial steroid treatment was providing the real relief, and once the chemo was added, Sparky would be weaker.

     What to do and who to believe? It’s still an open question.  Henry has yet to cross examine both the regular vet and the oncologist, and offer his perspective on treatment options.  Although I’m opposed to spending thousands to buy the possibility of one more year, I empathize with my son’s desperation to give Sparky more time. The pooch was Max’s first baby, and as a parent I know I’d do anything to save my child.  Now Max is experiencing himself as a parent (instead of a child), who is sick with worry, wanting his baby to get well.

     Unfortunately, there’s no cure.  No matter what we do, we have started to say goodbye.           

               

Labels: , , , , , , , , , , , , ,