I can’t believe Koa’s been gone over a month. Sometimes I still look for her around the corner or find some black fur stuck to a sock buried in the laundry pile. We are still adjusting.
I did a quick Google Hangout video talking about some of the lessons I’ve taken from my own dogs as well as my experience in the clinic. I hope it has some information people find useful, especially to those who have never been through the process before.
I do not profess to know what happens to us after we die. Even those who have strong faith in what will happen to us after we go are sometimes unsure of what happens to our beloved pets. And to them, I quote the great Will Rogers: “If there are no dogs in Heaven, then when I die I want to go where they went.”
When someone close to me passes on, be it person or pet, I have a dream about them a week or so later. I don’t know why, if it is a quirk of my subconscious or an actual visit or who the heck knows; the theologians can debate it all they want, but these particular dreams always stick with me long after I wake and give me a good deal of comfort. And yes, I had a dream about Kekoa a week or so ago, right before the funeral service in our backyard arranged by our daughter and very kindly attended by all four grandparents.
But last night I had a different dream, and regardless of what it means it really struck me because it’s the only time I’ve had one like it. Those of you who have been around for a while may remember me speaking about my grandmother Mary, who passed away several years ago and is the person, I believe, who most set me on the path I am on today as a veterinarian. You may also recall my grandfather John, who passed away just under a year ago. It was from him, I later learned, that I got my obsession with adventure and the dream of climbing Mt. Meru, which I accomplished last year.
So in this dream, I am driving around on a grassy hillside and I pull into a driveway, quiet and remote. Another car pulls up, and it’s my grandmother.
“Open the window so I can see your face,” she says. “It’s been so long.”
But I get out instead, and look in her backseat. And there is my dog Mulan, who died of melanoma in 2009, right before I started the blog.
Not Brody! This is Mulan and Emmett, in 2008.
“Is she doing better?” I ask, reaching in as she licks me.
“Of course!” Mary says proudly. “I know how to take care of animals. She is doing very well.”
I peer into the drivers seat. “Is my grandfather up there?”
“Yes,” she laughs. “But he doesn’t want to come out.” Which is typical.
I pat Mulan, and I start to cry.
“What’s wrong?” she asks.
“I just lost another dog,” I said. “She had bone cancer.”
My grandmother takes my hand, and says, “I’m sorry.” She kisses me and I wake up with a wet pillow.
You know how some dreams are. Some are bizarre flights of fancy, some dreadful chasms of dark worries come to fruition. And others, in those rare and brief moments, sweep you up in their elusive beauty and show you something that stays with you long after you wake. They feel real. And of all the people for Mulan to find on the other side, my sweet dog who was abandoned by an owner who didn’t feel like treating her flea allergies and wanted me to euthanize her instead, I’m so glad that at least in my mind, she found Mary.
I don’t know what it means, or if it means anything. But I am so glad it was a dream I got to have.
Scientists have long been fascinated with the concept of “muscle memory”, that subconscious part of our brain that controls movement without us having to think about it. It’s what allows us to do complicated tasks such as riding a bike or typing “the quick brown fox jumps over the lazy dog” without having to stop and say, OK, I need to contract my left hamstring while extending my right quadricep and all those tricky things that go into motion. It’s what allows me to tie a knot during surgery without the laborious thought process that takes place during learning “around the forceps from the front? or the back?” After a while, it just happens.
It’s funny how it pops up in the most unexpected places. For the past 3 years, Kekoa has been my footrest. I literally could not sit in the house without her wedging herself beneath my feet. Now, my feet head toward the floor, expecting a mass to bring them to a halt about 12 inches off the ground. I don’t think about it or calibrate their momentum, they just go with the intent that they will hit fur. Without her there, they crash repeatedly into the floor, each time a jarring reminder of what is no longer there.
It’s odd to me how strong those tangible physical reminders can be. For some reason, I can’t remember the exact timbre of my individual dogs’ barks- and I know they were all quite distinctive- but to a one I can tell you how their heads felt in my hands. Taffy, light as a feather, ready to nip at the slightest provocation. Nuke, needle-nosed and gently, resting into your palm. Emmett, like a solid football, sturdy and reassuring. Mulan, like a brick, wide and solid.
Kekoa’s head was disproportionately small compared to the rest of her body. She looked somewhat like an engorged tick, but in a nice way. She would lumber over and plop on your feet, her manticore tail smacking into the wall with such force you’d think someone was cracking a whip on the drywall. She never seemed to notice. Such was her excitement that she would hover over you, massive, looming, and then with the gentlest motion ease her tiny head into your hands and cover them with kisses. You’d try to push her head away when you had enough but then she’d kiss that hand too, so eventually you’d just give up. Her tail wouldn’t stop wagging the whole time.
She had a terrible wail. A piercing bark so heartbreaking and eardrum-wrenching that she lost two homes because of it. We used our baby monitor to listen in while we were away, and eventually I had to stop because it was too much to listen to.
That sound I can’t bring up. Already, I’ve forgotten it. But the sound of her tail hitting the cabinet, and the feel of her head in my hand- those will be with me forever.
Are there any strangely strong memories you carry with your pets who have moved on?
Tramaducken: A turkey, stuffed with a duck, stuffed with a chicken, stuffed with assorted pain medications. Merrick makes a Turducken canned food that allowed me to get all three in there in one shot.
Did not have any problems getting the dogs to eat this, lick the plate, lick each other’s plate, then beg me incessantly for more.
Every bucket list should include a good bit of pizza, I think. So I sliced off a little dog-sized piece of a cheese pizza for Koa, just enough for her to get what all the fuss has been about these last few years.
Brody’s getting to play along just because I feel sorry for him being left out. That being said, if he wants in on this, he’s gonna have to work for it. He has no bucket list excuse.
It’s weird how the universe works in parallel sometimes.
About 10 days or so ago, I broke my toe. And just so you know I’m not making this up:
I really did. Not doing anything heroic, unfortunately. I broke it by running too enthusiastically into an unpacked box that was filled with some as-of-yet unknown substance, probably cement, or maybe iron bars or something. Nonetheless, what I thought was a stubbed toe turned into that mess within a day or so.
It’s not bad. It’s taped up and I can get around just fine, but that doesn’t mean it doesn’t hurt.
Bone cancers are known to be one of the more painful types of cancers. This is what I struggle with, with Kekoa. She was not acting particularly painful when she was diagnosed, though we know how a pet acts on the outside doesn’t mean they aren’t actually experiencing any pain. So the second I realized what was going on with her, I started her on pain medications. She has a little more pep in her step now, an indicator she was feeling better than she was.
I almost cried when I found this today:
Heaving herself up onto the couch is not something she usually attempts. It’s good to see her feeling well. I know it won’t last, so I am happy with what I can get.
So back to me and my inflated cocktail weenie of a pinkie toe. This weekend, there was a local meetup group that was hiking a trail called Mt. Woodson. I’ve always wanted to go, and this was the first time it’s worked with my schedule. I’ve missed being outside, my hiking routine cut short during the hassle of the move and the holidays. I really wanted to go.
Part of me knew that after two months off, I should start on a flat 3 miler, not a hilly 8 miler.
Another part of me knew that my toe was probably not ready for any hiking, regardless.
But I’m nothing if not impetuous and prone to occasional bursts of Type-A ness when it comes to competitive challenges, particularly when I’m competing against myself. So I stuffed my foot in the boot and went.
The good news is, the trail was choked to the gills with New Years Resolution types moving uphill like spawning salmon, so had I fallen, I was a mere 2 seconds away from salvation in the form of a high schooler with a cell phone.
The bad news is, I did indeed jam or inflame or otherwise brutalize my toe. The fact that no one in the group stopped to ask me if I had accidentally stepped on a rattler is an indication that mind over matter indeed works and my outside demeanor in no way reflected what was going on with my neural pain pathways. I made it, but man it hurt.
Pets are notorious for doing the same thing. Dragging themselves way beyond the normal limit, not wanting to disappoint us. I was distraught to read the Yelp reviews of the exact trail I was on and read people say that dogs were getting carried off the trail routinely, having pushed themselves to exhaustion trying to keep up.
I suffered the throbbing pain gladly, knowing there was an end in sight- though I did have to grit my teeth when I felt the bones grind against each other. Guess it was a break and not a sprain after all. I could take a rest when I needed, catch my breath, and go on. And shortly enough, I’d reach the end of the hike, and with some rest, the toe will heal. As long as I stop doing stupid stuff like this.
Kekoa, on the other hand, is on a perpetual hike with a broken limb, an ankle that, I know, pains her, though she, like me, is content for the moment to soldier on because the view is still worth it.
So when she stops to rest, I will know what it means. But as strange as it sounds, I’m grateful to have had this personal reminder of the power of pain, and be reminded of my responsibility to her to manage it as intensively as I can.
And of course, feed her lots of snacks along the way.
Well, just because my dog is sick doesn’t mean we can’t have fun. Indeed, I would argue it is more an impetus than ever to have fun.
With Emmett, that meant taking long walks every day until he didn’t want to anymore. He was an explorer, a retriever’s retriever, and all he wanted to do was splash in the water and chase birds.
Koa hates adventure. She’s a homebody. I was thinking to myself, what would be on her bucket list? And all I could come up with was, A Menu.
So there you have it. From now until the day she leaves us, I will let Koa indulge her gourmand appetites and try a new food every day (or almost every day.) Because Koa is, and I know this, a foodie above all else.
I’ll start with what I have around, but if anyone has suggestions for treats that ALL DOGS MUST TRY before they leave this planet, let me know. I’d like to make a list.
Day 1: Jicama
Ate it.
And you know this would not be Brody’s bucket list adventure choice at ALL, because he spit his on the ground. Then Koa ate that too.
It was the day after Christmas, which is how these things always seem to go. I looked at the x-ray on the monitor and smushed my lips together at what I saw. “That looks terrible,” I say to my friend Kristen, also a veterinarian. She nods glumly. A lytic, destructive bone lesion. Pretty cut and dried for cancer.
Survival statistics for cancer depend on a lot of things, but one of the main prognostic indicators is type of cancer. Bone cancers are notoriously nasty and challenging to treat. Typically, one would deal with a lesion like this- sitting right on the ankle bone- by amputation, a treatment that removes discomfort on the part of the pet but doesn’t increase survival time. So, it’s a palliative treatment. There aren’t a whole lot of options.
Kristen scratched the patient behind the ears. “I’m sorry, old girl,” she said.
And Koa licked her hand, like she always does.
So yes, that’s been our holiday, which is fast turning into my least favorite time of year. As you all know, Koa has been at my mother-in-law’s for a period of time, during which she has done very well. But it also means I didn’t see her ankle joint starting to swell. I noticed it right after she came home on Christmas, as she was walking in the backyard.
There are a lot of different reasons I assumed it was what it turned out to be, that “clinical intuition” in actuality a combination of physical exam, statistics, and experience. Sometimes things surprise you, but usually they don’t. The radiograph the next day confirmed it. Koa has a cancer lesion on her ankle, and it sucks.
With the exception of Taffy, my childhood Lhasa who expired of heart disease, all my dogs have died of cancer. Hemangiosarcoma, melanoma, lymphoma, and now what is most likely a synovial cell sarcoma. I’ve spent more time than I care to talk about at the local specialty hospital and I’ve done some pretty aggressive treatments, both radiation and chemotherapy. And this is what I’ve learned:
It’s OK to be angry, even if you kind of knew it was coming.
It never gets easier, no matter how many times you’ve gone through it.
You know your pet has a finite lifespan, but there is something about getting the diagnosis of a terminal condition that is just so final. The sense of dread when the stopwatch starts ticking is always there.
It’s OK to not do the most aggressive thing.
Suffice it to say, there are a lot of factors that go into deciding on an appropriate course of treatment for your pet. Their state of health, economics, effect on outcome, quality of life- all of that matters. And it’s your veterinarian’s job to help you make the best decision for yourself and your pet. That is what I want to stress to everyone, because I know so many of you have agonized over the same questions- you don’t have to do everything if it’s not the right thing for your family.
For a variety of reasons I spent a good deal of time thinking about, I have decided not to do a limb amputation on Kekoa. I’ll be as aggressive as I can with pain management and keep her quality of life good for a long as it makes sense. To be honest, were it not for the swelling I probably wouldn’t have noticed anything amiss- she’s as happy and active and prone to stealing rolls as always, and the only difference now is that I don’t get mad when she does it.
Today, she sneaked into the garage through a door normally just cracked open for Apollo.
This was an unopened can of cat food. How she managed that, I’ll never know.
Then to top it off, she had cat litter for dessert.
