Working through the new reality

The oncologist post sat (completed) in the drafts for a long time. I had finished it only a couple of days after the visit, but was still stunned by the outcome...more specifically the news that there wasn't anything that could be done. For whatever reason I couldn't bring myself to publish it. I don't know why. Maybe it was simply once it was published it becomes even more real.

For over a week Gabby was eating steak on a daily basis; some days with a little more vigor than others. She still wouldn't go for it if we put anything else in the bowl with it, but we were very glad she's been eating. She's even had the urge to chew on an antler, even if she has to steal it from Dexter's mouth (yep, she did that). Over the last few days she hasn't been as interested in the steak, so we are now struggling to find something else.

This blog has been hard to keep up on, largely because it isn't really what I had planned. See, what was supposed to happen was we were going to have a long battle ahead of us. Gabby would live up to to the terrier in her and be difficult with some things but, over the years, we were going to learn some tips & tricks about homemade diets, supplements and giving Sub-q fluids. We would have sage advice about dealing with the roller coaster ride that is kidney failure. I even, for a brief period of time, allowed myself to dream that she actually has Addison's Disease and that suddenly, miraculously, the blog would come to an end because everything was all under control. And I could offer the advice to make sure that your vet checks everything.

These days we are in a holding pattern of sorts. She's been doing well. She likes roast beef sandwiches and burgers right now. It's actually been a few days since her last incontinence accident. She's been chewing on the antlers regularly. Grumbling and barking as she tries to fluff her bed. She's also back to coming to work with me, there was a period of time where she had just slept in the bedroom all day. If the weather were nice, I wouldn't be surprised to see her outside excavating the yard. I need to prevent myself from falling into a false sense of security because, for all intents and purposes, she hasn't really seemed sick. But I am very glad that, at least for now (knock on wood) she's comfortable.

The Oncologist Visit

We saw the oncologist last week.

I wish I could say it was a good visit, but it really wasn't. The night before, Gabby had fallen over. She'd gotten right back up. I had my back turned initially, and turned around to catch the point at which she was falling over, legs a little stiff. I can't say if she slipped, simply lost her balance a little or what happened. I wish I could say this was the only time I'd seen her fall, but it wasn't. A couple of weeks back I saw her stagger a little bit, like someone who'd had a little too much to drink and then fall over. I guess I tried to write it off as a little clumsiness. Goodness knows I'm not always known for my grace, but this second time...I don't know. That's 2 times more than I've ever seen her fall before. I mentioned the fall to the vet, but stressed I didn't see exactly what happened.

So now on to the visit with the oncologist. She had looked at everything from both vets. Unfortunately, she said there's nothing they can do. In a perfect world, or at least a world in which Gabby doesn't have kidney failure the approach would be surgery and chemo. She said even in that world, though, it would not be curative. It would only give us more time...a year, maybe a year and a half. But that isn't this world. Because she has kidney failure the vet isn't comfortable putting her through surgery and chemo. Both the anesthesia and the chemo drugs are hard on the kidney. At her age, surgery itself is a risk. With surgery alone, she could have 9 months, but, again, she doesn't feel it's worth putting Gabby through it. The outcome doesn't outweigh the risks. So, without either, she probably has 4-6 months.

She agrees with the other vets. There's a mismatch between Gabby's lack of interest in food and her vomitting (possibly her falling over) aren't really matching up with her current BUN and Creatinine levels. She doesn't believe that the cancer is at a point where it is making her feel sick. She left the room for a few minutes to go and speak with the internal medicine specialist. They both think that there is something else going on. That the tumor we are aware of is likely not the primary tumor, nor is the 2nd tumor she found during a rectal exam. They suspect that there may be something going on in her brain. To find that out we would need to do an MRI. It's very expensive ($1800) and is only really going to be diagnostic. Same with endoscopy to see if there are additional tumors that weren't picked up by the ultrasound and x-rays. She said something along the lines of it would likely only change the prognosis. It doesn't change anything else. The kidney failure is still there, and now the cancer. She still can't have surgery or chemo, and her overall treatment would be the same drug regimen, fluids and "keep her eating" plan. Prednisone has been added to the list, but that's really the only change.

So that's where we are.

I have decided not to put Gabby through any more tests. It's not worth the stress to her when all it's going to do is give us more information that we really can't doing anything with. She's doing ok right now. The vomiting has stopped, she seems to be digging the steak, she's pampered even more than before. She even gets steak from New Seasons Market, the stuff from Safeway or Freddy's just won't do. We are doing all that we can to make sure the time she has left is spent comfortably and happily.

X-rays clear

Her x-rays are clear. I guess it's both good and bad news. Great that she doesn't have any massive tumors showing up in her chest, but bad because we don't know what type of cancer we're dealing with. Dr Z has suggested we go to an oncologist, she's not sure what more she can do. We have an appointment on Tuesday.

We're still waiting on the results for Addison's. We might get them tomorrow, if not then we'll have them by Monday.

I feel numb.

The heartbreak continues...

The new vet (heretofor known as DrZ) was suspicious of Gabby's symptoms since they weren't really jiving with her numbers. She was also concerned about the steady increase of her numbers so she suggested doing an ultrasound to see if there's something else going on. This is not an inexpensive proposition. Our previous vet did mention it when she was first diagnosed, but didn't recommend it. The diagnosis of kidney failure and the treatment wouldn't change. My gut was telling me that we needed to pursue what was going on, so I agreed to the ultrasound. DrZ told me to have my phone handy in the event that they found anything. I was afraid to answer the phone when it rang.

There was a small mass in her abdomen and her liver looked abnormal. She wanted to do biopsies. They were suspicious of the mass. The liver could simply be "old dog" liver...or, if the mass was cancerous, it could be the sign of it spreading. This was also an expensive proposition, but I needed to know what we are working with so we did both.

We got the results. The liver was, in fact, old dog liver.

The mass, however, is cancer. A "poorly differentiated carcinoma." Based on analysis of the cells, they do not believe that this is the primary tumor and recommended doing chest x-rays to see if there are any other visible tumors. If there are, then additional biopsies would potentially let us know what kind of cancer we are talking about. I had the x-rays done tonight. Along with a test for Addison's Disease (to be explained in another post).

Some might ask what's the point? Why spend all of that money on a 15 year old dog. She has cancer, she has kidney failure, the prognosis isn't good. And I know that, I do.

I want to be clear, though: I won't ask her to give more than she can for my own selfishness. I won't ask her to suffer just so I can keep her around as long as possible. BUT, at the same time, I don't think she's done living yet. She has never held back "telling" me anything, I don't think she'll hold back telling me when she is ready to go. I can't say, "Ok, that's it" when I don't have all of the information and I can't give up hope if there may be things that can be done to get her back on track and feeling better for a while longer. I have no doubt that the 3Cs (Cori, Carol, Celeste) as well as other friends and DrZ will keep me in line if I do momentarily step out.

She's my best friend, I owe it to her to fight the good fight, as well as to know when to let her go.

A New Vet

There's a lot of ways that I learn about things. I like hands on experimentation, but when that's not possible or I want some supplemental information I'm the type of person who actual reads user manuals. So it may go without saying that when we first got Gabby's diagnosis I not only found those Yahoo groups and other websites, I read a lot of the information they provided. And reading that information led to additional questions.

First I need to say that I liked the vet we had. He was very personable and very, very good with Gabby. I also need to say that I'm sure that there are a number of people out there who become "desk chair" doctors, veterinarians, etc., looking up everything on the internet and thinking they know as much as their dr or vet, but that's not me. What is me is trying to understand as much as I can and learning as best I can as a lay person how everything fits together. There were a lot of things that weren't clear, especially around the supplements and homemade diet. There were also things that don't fit into what I've read, like the steady increase of her BUN and Creatinine levels. There was also the rather severe trembling that didn't fit the stage of kidney failure she is in. So I asked questions. But somewhere along the way I think I asked too many questions. Maybe it was just me and my elevated sensitivity, but I thought there was a bit of an annoyed vibe coming from him the last visit. This impacted my comfort level with asking questions and I need to be able to ask questions.

Then Gabby had additional blood tests run on January 27th. The results came back the next day (his day off). We got a call from one of the other vets at the office to give us the results. He said to increase her fluids to every other day and gave us a new scrip for the vomitting. He told us her numbers went up 75% from where they were and mentioned that this wasn't typical...so we thought we'd actually here from our regular vet to follow up, but we didn't hear anything. I made the decision on Monday to go to a new vet (although I should note that it is now a week later and we still haven't heard from our first vet).

One of the things that held me back was knowing that the likelihood is there that we will have to make the decision to end her suffering. I had Cori ask our now previous vet if he would come to the house. Gabby has always been a nervous dog when it comes to strange places and I cannot allow her last moments to be in fear at the vet. He said for us he would. So it was critical that any new vet we go to be willing to do this. All I could stammer out when talking to the new vet, was "If we have to, uh...can you..."
She cut me off..."Make housecalls? Yes."

If you are ever in this position, I would encourage you to find someone you are comfortable with. It's ok to ask questions. For some I know this isn't an easy thing to do, it wasn't easy for me at all, but I feel better now that I have. This is difficult enough, don't make it moreso.

The Food Battle

When we first decided to do the homemade diet, I was so scared. Everything I read stressed the importance of balance. I also had to worry about the amount of protein...and that it was high quality protein. Then there is concern about the amount of Phosphorus, and that you should make sure that the Calcium/Phosphorus intake is balanced. Many have it on a 1:3 ratio. We are on a 1:1 ratio, particularly since her phosphorus levels are still within normal range.

We take all of this into consideration, that is, when we actually have the opportunity to worry about it. Generally speaking, though, the concern is more that she eat something...anything(although preferably something that still fits into the right parameters.

To make matters more difficult, Gabby has always been a picky AND an unforgiving dog when it comes to food. Picky speaks for itself, but unforgiving probably deserves some explanation. Seven years ago, Gabby was sick. Our vet at the time wanted us to put her on a bland diet of either cottage cheese or plain rice. We tried the cottage cheese first, which she gobbled down happily...and then threw up a couple of hours later. She refused cottage cheese after that. Ok, rice. Same experience. "Yummy. Gobble. Puke. Get that rice away from me." Now, seven years later, she still refuses cottage cheese and plain white rice (rice with something done to it she has been willing to take).

Unfortunately with this disease, eating often leads to not feeling well. I think this may be why she only likes foods once or twice, but refuses them after that.

The thing I find most funny about this is that I now cook more for Gabby than I do for myself! Some of the foods we have been successful with, even if it was just once:

• Tapioca and ground beef


• Ground beef only


• Egg white omelet with touch of bacon


• Egg white french toast


• Just plain ol' toast


• Poptart crusts


• Malt-o-Meal and chicken


• Sliced ham


• "Meatloaf" of ground beef, egg, pumpkin, and glutinous rice
  
• Spaghetti noodles and ground turkey, with a hint of parmesan cheese


• Shredded wheat cereal

And here's what I've learned so far:

• She seems to prefer her eggs over easy, then egg whites cut up with the egg yolk stirred up giving everything a nice coating.


• Things that I think she might not I should go ahead and try. This was how we discovered that she actually likes shredded wheat cereal.


• She doesn't seem to like things that are gelatinous in texture. Tapioca and glutinous rice are 2 things that many of the homemade diets you find online call for. The rice she ate in something, but never by itself. I couldn't add enough water, chicken broth, etc to get it less sticky enough. Same with Bob's Red Mill Tapioca. No matter how much water I would add, it never was quite right for her. Minute Tapioca, on the other hand, she has eaten willingly.

Helpful Groups and Websites

Fortunately early on I discovered 2 Yahoo groups that have been very helpful.

K9Kidneys There's a lot of information in their files about the disease, medications, treatments, blood tests, supplements, diet, SubQ fluids, where to buy supplies and so on.

K9KidneyDiet As the title implies, there's a lot of information here regarding homemade diets and supplements.

More importantly, both of these groups provide helpful answers to questions you may post...and I've posted a few. There are members in the groups who have been dealing with kidney failure with multiple dogs and/or for long periods of time. Some have medical training. The environment is incredibly supportive. No question too simple.

I've learned, sadly, that it's more uncommon than not with this disease that we have to make the decision about quality of life. That's one of the downsides of this group. The reality of the disease is always at the surface. It seems on a regular basis someone writes struggling with making the decision, or writes to say that their battle has ended. As is the nature of the group, there are no judgments when someone gives up the battle only an outpouring of caring and support.

Other informative and helpful sites:

• http://www.dogaware.com/ There's a section on kidney disease which provides some good information on diet and the disease itself. They have information on other conditions as well.


• http://www.thrivingpets.com/ Good source for supplies, particularly needles and IV kits.