Pawcurious Vet Blog: With Pet Blogger and Veterinarian Dr. V

Good news!

Emmett is in remission!

He’s in his third week of chemotherapy. He will continue the weekly regimen until about 8-12 weeks, when it starts to decrease in frequency. After 16 weeks it is done once a month, hopefully for a long, long time.

We also typed his lymphoma. There are 2 types, B cell and T cell. I remember learning in school that B=Bad and T=Terrible, as in, neither one is good, but T is the worse kind to have. The median survival times are markedly less for T cell lymphoma.

And Emmett has B cell. It sounds strange to say, “I’m so glad Emmett has B cell lymphoma,” but you know what I mean.

Why dogs are better than people, part 32

Before I had kids, life was much more exciting for Emmett. We went to dog park all the time, I bought little dog cookies from specialty dog bakeries, I used to nap on his belly.

Life was good.

Then I had my daughter, and things got a lot more boring. We hung out at the house. He had to eat grocery store treats. I napped with the baby. It wasn’t that Emmett was less loved, or less important, or even that I thought things like specialty dog cookies were unnecessary now that I had a real kid. I just didn’t have the time. I mean, you could argue the same thing for what happened to my daughter after my son was born; life spreads you a little thinner with each new event, and you do the best you can. That being said, I understood when the dog who had been stellar for two years suddenly started peeing on strollers, eating diapers, and generally acting out. He got over it.

Now that the kids are older, I have a little more time to re-dedicate to dog parks and special cookies and the like, and I honestly intended to get right on that. It’s been 4 1/2 years since Emmett had me to himself, which doesn’t seem like that long ago at all, but it is. Now he’s middle aged. And now he has a terminal disease. I have a predetermined amount of time to make the past few years up to him.

The nice thing about dogs is, making amends takes all of 10 seconds. There is no long “I’m sorry” letter, no awkward reunions, no tearful accusations of neglect. Want to make up for not giving a dog a special cookie for a few years? Give him a special cookie. All is forgiven. (Apologies in advance for the blurriness of the pictures; I’m still learning the camera.)

Or in this case, a special doggie donut. Made of dog-friendly granola. It smelled like honey and seemed like it would be quite delicious.

I’m Emmett, I’m so sad, you know I’m sick, right? Want to give me a treat?

Yes, well, that will do quite nicely, I think.

Seriously? You’re seriously going to make me hold this on my nose? You DO know I’m a cancer patient, right? (And to that I respond, there is nothing more noble than going forth with life as it is normally, so yes, I made him balance the donut on his nose.)

The next 5 or 6 pictures were me realizing far too late that the fisheye lens does not have the capability to capture a clear picture of a dog messily devouring a donut with speed and great gusto. I guess the macro lens would have been a better choice. Trust me, though, he enjoyed it.

Only at the end did he slow down enough for me to get a somewhat clear shot of the sad remnants.

Voila! Happy dog.

A new reality

I am very fortunate to be in the position that I am, as a veterinarian, with a sick pet. I know I have more access than most to specialized care. I am very grateful to my colleague and boss, one of my clinic’s owners, who also works at an internal medicine facility and is both a very confident diagnostician and very good to his friends and colleagues.

On Friday at 4:30 pm, the lab faxed over the pathology results: DIAGNOSIS: LYMPHOSARCOMA. There’s never a good time to get that result, but of all the times to get it, 4:30 on a Friday afternoon is just about the worst time, since it leaves you with a whole weekend to stew over it, unable to do anything, picturing the malignant cells replicating by the millions as you sit there watching the clock until Monday when the specialists are back from the weekend.

But I am lucky, because my boss was at work when I sent him the text message on Friday, and on Saturday morning, Emmett got his first dose of chemotherapy. On Tuesday, he was good old sturdy Emmett, laying next to me in bed as I fought through that nasty virus we got last week, helping me get better. By Saturday, he was Emmett, chemo patient, fragile creature that must be fed rotisserie chicken and Greenies on demand.

Chemotherapy in dogs is different than it is in people. When a human gets cancer, you treat it like a leprosy-ridden home invader; you attack it with everything you’ve got, a knock down drag out battle that costs the patient almost as much as it gains, but with the goal of complete eradication.

With pets, cancer is treated more like an unwanted houseguest that won’t go away; try to make things an unpleasant as possible for the interloper, try to sequester them away and minimize their effect on your day to day life, but you accept with some resignation that they are indeed here to stay. It’s about quality of life, not quantity; making a pet miserable with chemotherapy completely misses the point.

Lymphoma is one of the most chemotherapy-responsive cancers; unlike the other cancers I’ve been unfortunate enough to experience firsthand (Nuke had hemangiosarcoma, and Mulan, of course, had melanoma). It has a 90% remission rate with an average first remission of about 8 months, and a median life expectancy of 12 months after diagnosis. Half do better, half do worse. Without treatment, dogs have on average 30 days.

12 months is a lot of walks, a lot of trips to the dog park, a lot of time to make up for my inattention while my kids were babies. Knowing what is coming is both a blessing and a curse, but one of the great joys of being a dog is that he is of course oblivious to the whole situation. All he knows is that he gets to come to work with me a whole lot more and everyone makes a big fuss over him, so what’s not to like? For him, I mean.

An unplanned entry

When Mulan was sick last year, the simple act of petting her was a stressful event. There was always a new lump, some sore spot, something to make me nervous and want to do tests and see what was going on. It was always such a relief to pet Emmett, so sturdy and unproblematic, to scratch him under the chin and not feel enlarged nodes, to thump him the way you thump big dogs in greeting and not worry about hurting him. And after Mulan died, under the grief and sorrow there was also a weight lifted, to not have to worry about daily meds and trips to the oncologist and the constant clock hovering over her head, counting down to a time I couldn’t pinpoint but knew was coming.

Three weeks ago, Emmett was attacked by the neighbor dog. His ear has healed nicely. Sure he’s been a little mopey since Mulan left, but he’s getting older. 7, not really old, just a little old. He’s been picking at his food, but he’s always picked at his food. Antibiotics like the ones he’s been on are rough on the stomach. He needs to lose a couple pounds anyway, his bloodwork after the dog attack was fine, no biggie.

These are the things we tell ourselves, even vets who should know better. He’s fine because he has to be fine.

I had him in on Wednesday to get groomed, and a niggling little voice in my head told me to weigh him. My tech took him to the scale, and when they came back in he put his head in her lap like he always does for rubs. “What’s up with the lump?” she asked nonchalantly.

“What lump?” I said, and there, oh, no, no, no, his lymph nodes were enlarged.

They were enlarged on the right side, which is the side he got bitten on, so surely this is some residual infection from the dog bite. Except it’s not.

Emmett, my best buddy, the healthy one, the coolest dog in the world, has lymphoma. I have just gotten to the point where I can pat Mulan’s box of ashes without tearing up, can talk about her without a knot in my stomach but just the sad tug of loss, just pushed through to the surface of the grey sea of grief that we all find ourselves submerged in from time to time, and now I have to do it all over again. Herein lies the flip side of loving a pet. The clock is back, hovering over his head like a grey cloud; I can’t read the numbers but I can hear the ticking, quiet and insistent.

I wish what I do for a living made this easier. Logistically, it does. Emotionally, I feel just as blindsided and sad and small as anyone else dealing with this kind of diagnosis. No other way to say it: This sucks.