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A Vizsla, an Osteosarcoma and an Emergency Vet all walk into a bar…

Apr 21

By the end of our first day at CSU,  several things had happened. Hank was examined by what seemed like 10 people (students, interns, residents, oncologists, surgeons, probably a custodian or two), his records reviewed, treatment recommendations discussed, prognosis relayed (this was the only time during the day that I cried) and then they asked the big question- “so do you want to do his first chemotherapy session today??”

Ummmmm…..

Before my brain could say no for all the reasons I had previously thought of (I just got all the info and hadn’t had time to digest it, the cost, the possibility of him not feeling well, yada yada), my heart screamed “YES- AND IF YOU DON’T KILL THOSE CANCER CELLS I WILL AND IT WONT BE PRETTY” in the voice you would assume would have come from a zombie doctor with really bad hair, wearing a bloody lab coat and carrying a 5 foot syringe filled with green, steaming liquid. Yep, I said it. Chemo it was. Mostly because if it meant I could give Hank at least a year of happiness and wiggles, and selfishly, I could give myself a year to figure out how I would live without him, I would do anything. More importantly, they did a pretty good job convincing me that any side effects would be minimal and treatable. And thankfully, over my years as a vet I had accumulated a huge drawer full of random veterinary drugs- antibiotics and probiotics for diarrhea, anti-emetics for vomiting, anti-inflammatories for pain, sedatives for the times Hank acted like he had that day…..so I figured I was prepared.

And then…..the student and intern took Hank “to the back” for his treatment.

For anyone who has ever taken their pet to the vet before and they ask to take your pet “to the back” for whatever reason, it really is ultra secret veterinary code to mean one of the following :

  1. You are clutching your dog/cat so tightly against your chest or lap that I can barely place my stethoscope on them let alone actually do a complete physical exam without my having to get handsy with you (Have I mentioned how many clients’ boobs or junk I have inadvertently touched trying to do this?? Awkward.)
  2. Your pet is an asshole and I don’t feel like getting my face bitten off today so he/she needs to be muzzled so I can do an exam (But I dont judge- I get that dogs/cats seem to think that all vets are blood-sucking alien-type creatures that do nothing but inflict pain. I would try to bite me too.)
  3. We need to do things like draw blood, take x-rays, squeeze pus from something, stick our fingers up their butt…ya know, stuff the general population really doesn’t want to see happen to their animal and without fail, stuff we will mess up if you are watching
  4. So we have an opportunity to make fun of you. Well, only if warranted. For example….when a client tells me that the reason they didn’t spay their dog (who is now pregnant and needs a C-section) is because they heard that if you don’t let female dogs have at least one litter of puppies in their lifetime they will suffer from severe depression…and I have to try to keep a straight face and politely tell you that’s not correct when I am dying inside with laughter…..that’s like holding in a fart. Its not good for you.  So…. I have to tell someone and it may as well be my staff “in the back” because only they will understand the hilarity of that comment. Sorry.
  5. So we have an opportunity to tell jokes about very morbid and awful things without offending anyone (especially in the ER…we have to do this…it keeps us sane given all the bad stuff we see)

 

Since I had all this inside information, I tried to get myself to believe that the “back” at CSU’s Animal Cancer Center was more like doggie heaven. Smart people walking around all in white, cushy pillows all over the floor, endless baskets of toys and treats, cages made of rawhide, horse poop-covered mats for dogs to roll on, ear scratching machines, no needles or pokey things…and chemotherapy would be administered by an elf-like creature with rosy cheeks and really white teeth through an edible meat straw, via osmosis. I was sure that’s what they were doing. At least that’s what I told myself because I was positive that when they were done with Hank, he would come back to me looking like he had lost 15 pounds, puking and pooping all over, and would never love me ever again for doing such an awful thing to him. However, 4 hours later when we went back to pick him up after my mom and I did what we do best- eat, talk and shop- he still made an ass out of himself in the waiting room upon discharge by just being his stupid/happy/wiggly self, he dragged me out of the building just as he had on the way in, he refused to let me help him up into the back of the car….and then….he slept the entire way home like he had had the best time of his life. WTF?

 

One of the many car trips to CSU

One of the many car trips to CSU

But…the next week was rough. Really rough. And I again started feeling as if I had made the wrong choice for Hank. He stopped eating and I became unhinged. So, I did what any pet owner whose dog goes a day without eating would do. I offered him whatever he wanted to eat (do you know how many thousands of clients I have told NOT to do this when their dog is having any GI upset?) because clearly he was going to die of starvation soon if I didn’t do something. So I gave him chicken, rice, 5 different kinds of canned food, some weird pureed “immune boosting food”, a chicken wing or two, some bread, mushroom supplements, hamburger meat, and lots and lots of fish oil. Which of course got him eating, but as you can imagine, after a few days this turned out badly for Hank……and then the diarrhea started. And not just any diarrhea…bloody diarrhea.

As a vet, “bloody diarrhea” is a presenting complaint I see on a daily basis. It usually involves a middle-aged, otherwise healthy dog that out of nowhere starts spewing the most foul-smelling bloody fluid out of their rear ends. This really freaks people out. I had a lady pass out in my exam room once when her dog pooped this awfulness all over her lap. But to me, no biggie. These patients usually just need some fluids, anti-emetics, antibiotics and a bland diet and after a day or two, they are back to pooping like normal. So of course when poor Hank developed this symptom, surprisingly, I wasn’t too worried. Until about 2 days after it started….

Post-chemo yard lounging

Post-chemo yard lounging

I can legitimately remember Hank waking me up in the middle of the night to go outside twice in his lifetime. So if this happens, it usually means its an emergency of epic proportions. Most of the time, if I’m in bed, he’s in bed no matter if its dinner time, breakfast time, morning/noon/night, or if its been 14 hours; he is truly the best dog possible to have for a person who works my ever-changing overnight work schedule and has flip-flopping sleep hours from week to week.  And generally, because I am usually sleep deprived, I sleep well on my nights off. Very well. However, there are two things that will blast me out of bed from a deep sleep faster than you can say “upchuck.” One of which is the sound of my cat starting to puke. Ya know, that dry-heaving, insanely fast burping sound that gives you at least a 10 second head start to jump out of bed, grab said kitty and remove them from whatever carpeted surface they are clinging to and throw them onto a non-absorptive, non-staining surface (tile, wood floors, the sink, the bathtub…yes, I have thrown my cat mid-vomit to most of these places in the middle of the night so I didn’t have to spend the next 20 minutes cleaning cat puke off my carpet at 2am).

The other is the alarm I will call “Hank.” Hank has found a very creative way to wake me that fully exemplifies his ability to wiggle. I was sad that after his amp he would lose this ability and although its not quite the same at it was, he still has a little wiggleability. What he will do is line his body up along the long side of my bed and lean against it. And then the wiggling and tail wagging starts. He starts to wiggle with such force that it legitimately makes my entire bed shake and convulse similar to the feeling of being asleep on water bed and having someone jump on it while you are sleeping. Its not the most pleasurable way to be woken up, but its also not the worst I could imagine (i.e projectile cat vomiting).

So you can imagine that when Hank woke me up in the middle of the night when he had been having diarrhea all day, I flew out of bed, ran him down the stairs in my underwear and let him outside. But the longer I stood at our sliding glass door waiting for him, I started to wonder what was happening (we have a light that shines onto our deck, but it shines no light into the yard which becomes a black abyss at night). Was he having diarrhea? Was it still bloody? How much was he having? Was he vomiting? Had he pooped out his intestines? I needed to know these things. So I did what anyone else would do…I grabbed my cell phone, turned on the flashlight and ran out into the yard in nothing but my panties to investigate. When I came across Hank, he was squatting in the corner of the yard, but since I couldn’t tell what was happening from a distance, I went right up to him and shined my flashlight right onto his butt. Yep, I did this. He turned and briefly looked at me as if to say “Really?” and then went about his straining. And then I waited. While squatting there in my yard, half naked and next to my dog intently watching his butt as if something a lot more intriguing was going to come out of it than poop, it occurred to me that I have neighbors. Lots of them. With windows that point directly at our back yard. What an interesting picture this must be being witnessed through someones window…..Oops. At that time, my common sense took over and I turned off my flashlight and backed away very, very slowly. He eventually came back inside and we went back to bed, but I couldn’t help but wonder what the hell happened to my common sense through all of this.

Thankfully, his diarrhea did resolve and his appetite came back, but I would say it was about 2 weeks before his digestive tract was back to “normal.” And then it was already time for his next treatment. Ugh.

So I made the trip back to CSU, feeling the whole way like I wasn’t sure I was prepared to go through it, let alone deal with the aftermath and have to watch Hank lose his appetite and poop his guts out again.  I hated that I was doing this to him and I contemplated stopping his treatments; I almost turned around. But yet again, despite my stress, worry, guilt, fear, etc. Hank dragged me through the door of the teaching hospital, embarrassed me again in the waiting room (and I think he was even worse this time), came bounding out of the cancer center 4 hours later like he had had the best time of his life for the second time, and we made the trip home.

In the car on the way home to Boulder, I remember glancing into my rear view mirror where I saw his smiling face as I had a million times before. He was happy and content just to be there with me and didn’t seem to know or care what had just happened. He wasn’t anticipating feeling ill, or depressed that he had cancer. And at that very moment, I felt a shift in my attitude and I remembered something. Hank doesn’t know he has cancer. He doesn’t even know the word. He just knows that he likes to play, sleep (a lot), cuddle, run, have his belly scratched, make weird noises, shove his face in crotches and be in the car with me.  And he loves chicken wings and hamburger meat (even if it causes him to have diarrhea). And despite the setbacks, wasn’t this was our ultimate goal? For him to be happy, enjoy all the things he used to and to feel well the majority of the time?

It was.  And as far as I was concerned,  despite the late-night wake-ups, the poop and the occasional missed meal, this goal had been reached. We were back to hiking, playing, running, wiggling and get this…even swimming (more to come). And for every extra second of time that I get, I will be grateful.

 

LP

 

Sunny day selfies

Sunny day selfies

 

 

 

 

Apr 06

I’d have to say that I knew from the get-go that Hank’s recovery from surgery was not going to be easy, but it was more of the logistical stuff I was worried about. Like the four flights of stairs in our house, plus the flight of stairs leading down into the backyard; getting him in and out of the car, keeping our other dog away from him, changing his bandages by myself, etc. I figured that since I had a new Ruffwear harness, a baby gate and pretty decent biceps, I had this in the bag. Ha.

By day#3 post-op, I had pulled a muscle in my back from schlepping him up and down the stairs, he wasn’t eating well, he hadn’t pooped in 3 days (I always made fun of clients for getting so hung up on their dogs’ pooping habits…I totally get it now) and I had gone through more Maxi pads to cover his weeping incision than I think I ever had as a woman. Not only was I a mess and feeling like I was way in over my head, but Hank was not having the best time either. He hated me carrying him, he sat in his bed ALL DAY everyday for the first week and a half looking like a child that was just told Christmas was cancelled this year, and he figured out Pill Pockets faster than I could turn around and find him eating the pill pocket but promptly spitting out whatever pill I was trying to give him. Epic fail.

2016-03-02 13.37.58

This was the pathetic face I had to look at every moment of every day following surgery.

 

At first, I expected Hank to be different as he recovered, but I was not prepared for the immense change in his personality. I had never really seem him so down. He was the dog that was always in someone’s face (or crotch), wiggling, knocking things over with his tail, obnoxiously shoving a toy into your hand/lap to try to get you to play with him, etc and as much as he drove me nuts sometimes, in the first 2 weeks after surgery, it was almost like he wasn’t even there. It was even more heartbreaking than the morning I brought him home from the hospital because there was a large part of me that worried that he would never be the same. I worried that I had taken away the one thing that made him “tick” and have a true love for life- his ability to run. I would cry from overwhelming guilt most nights as I sat next to him on the floor before bed while he looked up at me with a look on his face that said something like…”What the hell is your problem?”

 

Couch potato goodness

Couch potato goodness

 

The day that changed it all occurred about day #12 post-op when we made the trek up to Fort Collins for an Oncology consult at CSU. I was still unsure about doing chemotherapy, especially now that Hank had decided to turn into the canine form of Eeyore, but thought I would at least hear what they had to say so I could make an informed decision. The only appointment I could get was in the morning on a day after I had worked all night, so once I left the hospital, all I had time to do was get home, nap for about an hour, change, and collect Hank and all the crap that he now needs when we travel (ya know….just the essentials….sweaters & jackets in different weights and colors, T-shirts, toys, treats, all his medications, his harness, food, his own water bottle, and an encyclopedia-sized file of all of the medical records he has ever had, because I am sure the oncologists really needed to know about the time I accidentally cut him with a pair of bandage scissors when he was three and I had to suture him back together on my kitchen floor….however, what did I forget? The X-rays of his leg, and tumor, before I amputated it….just the single most important thing they actually needed to confirm his diagnosis. Epic fail #2).

Thankfully my mother joined me for the trip not only for emotional support, but to help drive in the event my sleep deprivation put our lives in danger with my being behind the wheel of a moving hunk of metal. Plus, my mom is pretty cool. And I like her. And she loves Hank (most of the time….she’s more of the crazy cat lady type).

As we pulled into the CSU parking lot, I of course couldn’t shake the feeling that I had forgotten something. When we got back in that car almost 6 hours later, I knew what it was. Two things actually: The huge dose of Acepromazine (a sedative given to dogs for anxiety) I should have given Hank before we came and a large Xanax for myself. Why? Because Hank was back in his typical form that day while at CSU. However, his normally high energy self was now combined with cabin fever from almost 2 weeks of being stuck in the house with doggie depression, so he acted like a 4 year old kid that had just consumed a 60 ounce Coke, a Monster energy drink, an entire bag of Sour Patch kids and then snorted the contents of one of those huge Pixie Sticks prior to our arrival. As a result, this is a brief summary of what I really remember from that day:

Hank dragged me through the door of the teaching hospital, yanked me around by his leash while I was trying to check in and sign paperwork (of course with the multiple bags I brought hanging from both arms and a Starbucks cup in the other hand…my mother saw this disaster occurring as she stood next to me and at least managed to pry the Starbucks cup from my pale, Xanax-deprived fingers so I could at least try to sign the stuff I needed to) and by the time we finally found a spot in the waiting room to sit and drop all of our crap….the Hank “bark-whine-gasm” ensued.

Outside CSU

Outside CSU

For people who dont know much about Vizsla’s, they can be a nervous bunch. And although Hank is great at sending out a very loud, mean, confident, I-am-going-bite-you-in-the-nuts bark when necessary (someone comes to the door, approaches the car while he is in the back, or god forbid the UPS or FedEX guy has to leave something on the patio), the rest of the time, the noise he creates when he is excited/nervous/wants something faster than I am getting it to him is more of a combination of the sound a “de-barked” dog makes when they try to bark and the sound of someone letting air out of a balloon really, really slowly. In other words, its the most annoying sound in the world (speaking of which, has anyone seen the movie “Dumb and Dumber?”….again, I digress….). So there we were, 15 minutes early, sitting in the waiting room of the CSU VTH with what seemed to be all of the best behaved dogs on the planet….and Hank. Screech-barking, whining, panting as loudly as possible, knocking things off the side tables with his ridiculous tail from his incessant wiggling/wagging, frequently shoving his face into my crotch and of course trying to evacuate all the hair off his body onto my black hoodie.

When the oncology student finally came to get us, I was half tempted to tell her that I accidentally amputated the wrong limb and therefore he needed one of his back legs taken off STAT (I am an emergency doctor so I get to say stuff like that and it sounds cool). Maybe with only two of four legs left he would not act so absolutely insane. And as the student walked us back towards the exam rooms, I let Hank hop in front of me and pull me along.  But amongst all my embarrassment for his making such a scene in the waiting room, and my exhaustion from trying to make him sit still and behave, I realized something…..Isn’t this the dog I was trying so desperately to get back? And save? The one that despite his goofiness and eardrum rupturing noises would come home that night and spoon me for hours? The dog that was always up for any adventure yet would gladly sleep with me for 14 hours at a time because of my wacky work schedule? The one that loved me no matter what kind of awful noises I made, meltdowns I had or how badly I behaved?

Yes…..yes it was. And as I jogged behind him while he ran/hopped down that hallway, I was so, so glad to have him back 🙂

LP

One of our first post-op walks

One of our first post-op walks

 

Mar 26

So there we were. By the day following Hanks diagnosis, there were only a few things I knew for sure…..

  1. My dog had a bone tumor
  2. I had a massive headache
  3. That awful, terrible leg and it’s stupid tumor was gonna come off ASAP
  4. There was no way in hell I was going to be the one to do it, because despite how comfortable I was with surgically amputating any limb on a dog or cat, if I did this to my own dog, I would for sure screw it up royally and kill him

So I did what any other  surgically competent and confident veterinarian would do….I bribed my colleague with a bag of Skittles and a bottle of wine to add Hank to her already booked surgery schedule for…..why not, Monday. Yes, that technically would be the next day (the day after I diagnosed him).  And, even better, I was working that next night so I could care for him post-op and take him home with me the following morning. No biggie.

2016-02-29 11.51.28

Pre-op…..not terrified at all

So, so, so many bad ideas that seemed awesome at the time.

By the morning following Hanks surgery, there were yet again only a few things I knew for sure….

  1. I had no idea what I was doing
  2. I was in no way prepared for what was in store for us in the weeks to come
  3. I would never attempt to be my dog’s doctor overnight again…EVER. [for example…any other post-op amputation patient I would have had in the hospital would have been placed on a Fentanyl CRI, a Lidocaine CRI and given Rimadyl/Carprofen injections for pain management which has always worked perfectly fine. When I had Hank overnight, I had convinced myself that he was in horrific pain, so he got Fentanyl and just about every other opiate pain medication I could grab from my cabinet, along with some Ketamine (why not?) and a bunch of sedatives, which, as you could imagine, got him so stoned out of his mind that he spent most of the night flopping around his cage and crying from dysphoria…which every time I heard, would turn me into a blubbering idiot incapable of making any more decisions about his care. By the end of the night, I was exhausted, Hank looked like he had just stumbled out of a Led Zepplin concert from 1971, and my nurses were trying to usher me out of the door as fast as they could. Yea…fab idea Dr. P….you’re a moron. On my drive home with him in the back of my Subaru, I could imagine it’s how new parents feel bringing their new baby home from the hospital…what went through my mind was something like “Wait…you’re letting me take him home? Are you sure you want to do that?”

 

Hank immediately post-op

Hank immediately post-op

 

When I got home from that torturous 13 hours at work, I had Adam help me carry him out of the car, up a flight of stairs and into our living room where Hank’s bed was settled on our floor next to the couch. After we set him down and knelt together next to his bed,  I finally got a chance to look at Hank’s face, his worried and confused eyes, his huge incision with lots of bloody fluid already dripping from it and just how completely different he seemed compared to the dog I brought with me to work the day prior. And I began to sob. I remember looking at Adam (who was also teary-eyed and very shocked at Hank’s appearance) and thinking there was NOTHING I knew for sure at that very moment, hence the one sentence I was able to squeak out….

“Did I do the right thing?”

I would spend the next 2 weeks asking myself that question every moment of every day and also questioning the countless times I had nonchalantly recommended amputation to an owner for whatever reason their animal needed it because “they were given four legs for a reason, right?” and “they would recover much faster compared to _____________ (a major fracture repair, an FHO or hip repair, daily bandage changes for severe wounds, etc).” Turns out I may have been full of shit and the big thing I learned from this situation… unless I have been through such a thing, I have no right recommending it owners as if its as easy as having a wart removed from your foot/hand/arm. Mostly because what I completely underestimated about having a dog as a post-op amputee was not just the intense recovery for the body (which my medical knowledge told me made sense), but the HUGE affect it has on their mind, which, in my opinion, was possibly the hardest part of the whole process.

Lesson learned. Big time.

Thank you, Hank-  not only being the best companion/face-licker/wiggler/crotch punching dog a girl could ask for, but for also making me a better veterinarian.

LP

hank post-op home

Mar 22

Welcome to Hank’s Blog!!

As I tried to decide where to start with our story, I went back and forth between inserting everyone into where we are now (one leg less, in the middle of chemotherapy, daily meltdowns…), and telling our story from the beginning. I elected to go with the latter, mostly because I think reflecting back on my life with Hank will be therapeutic, but also to give everyone a better idea of who we are and how our past together led us to our current stage in life. I am open to most kinds of therapy and even though mine typically involves a large glass of ________ (insert my alcoholic beverage choice for that particular day/crisis),  I love to write and there is no reason why I can’t pair my alcoholic beverage with writing. Plus, I was told recently by my mother that I am funnier through the written word than I am in person. Still not sure if that’s a compliment or a burn…..

So we begin…..

Clearly, I’m a vet, so my ability to accumulate degenerate animals is pretty amazing. However, since I have been a renter for the majority of my adult life, there has always been an annoying “cap” on this number, so I have had to make due with one or two cats and one or two dogs to avoid being obvious about lying to my landlord about how many animals I actually have (“No, thats not a new cat….its my mom’s cat who I am watching for a few weeks…. or years. Dont worry, she will be wont be here for long”….suckers).  I had gone through college with one cat (“Lulu”- most often referred to as “Little Shit”) and my childhood dog, Roscoe, who passed away when I was an undergrad.  So it was just Lulu and I (and an ex-husband, but I digress) when I moved from the Western slope to Loveland, Colorado to start veterinary school at CSU in 2008.

I was a competitive runner at the time and one Sunday afternoon in broad daylight while on a jog, some homeless douche bag made the mistake to try to attack me from behind. I was able to get away thankfully and run to safety, but that’s when I decided that I needed a big, scary dog (I was envisioning “The Beast” from the movie the Sandlot) to accompany me on my runs. After lots of looking, one of my besties from vet school got me turned onto Vizslas as a breed because she had recently adopted one from a local Vizsla rescue and was in love. These dogs were considered sleek, athletic, intelligent, fast, “velcro dog” snugglers that could not only run, but cuddle…the perfect mixture. And then came Hank…..a goofy 1-year old Vizsla who when I met him for the first time, shoved his face in my crotch (and Im not talking a gentle nudge….he was all up in there as if he was trying to judge my underwear choice for that day), dragged me around the block on our first walk and tried to bite my ex-husband….ahhhh- it was love at first sight.

image

One of the first Hank pics. It captures his personality impeccably

 

image

Pre-10k we ran together in 2010.

 

Fast forward 7 years an Hank was by my side through it all- finally completing vet school, going through a rigorous internship program, a divorce, multiple moves, etc. He was always there to “crotch punch” me with his nose (this became his signature move and when that stopped working to get my attention, the “ass punching” began) when I walked in the door, to sit with me when I had a meltdown after working multiple 16-hour shifts in a row and realizing I had no wine in my fridge, to accompany me on whatever hike/run/bike/snowshoe/cross country ski trip we were doing that day and to always be counted on to growl or bark at whatever male made the mistake of entering my “bubble”/apartment/car with him around. Well, except for one…..Adam. My current live-in partner who I am in love with and am thankful for for many reasons….one of the most importantly is, however, that he may love Hank almost as much as I do.

It was a Saturday night and I was at work when I decided to take x-rays of Hank’s left forelimb because he had an ever-so slight limp I had noticed on Thursday. Whats interesting to me is if a client had come to me with an active, 8-year old larger breed dog with as mild of a limp as Hank had, I would have sent them home with anti-inflammatories and pain medications and told the client to not waste their money on x-rays this early. I would usually recommend rest for 1 week and then if they were still limping, to return for x-rays. In Hank’s case, that may have been the difference between life and death….  It was about 2am and it had been a horrible night in the ER when I asked one of my nurses to help me gets some rads (x-rays) of Hank’s leg. I remember when I looked at that screen and the x-ray popped up, I had in some way already known what I was going to see……

Osteosarcoma: a malignant tumor of bone in which there is a proliferation of osteoblasts (the type of cell that makes up bone).

image

Osteosarcoma is pretty much the only cancer in dogs you can diagnose with an x-ray alone. Damn it for that. Instant diagnosis = instant realization of badness.

After staring at the screen for what seemed like 2 hours hoping that the image would correct itself and I really wasn’t seeing that my own dog had a bone tumor, I am pretty sure I blurted out some inappropriate expletive, helped get Hank off the x-ray table and walked him back to his kennel were I sank to my knees and cried with his muzzle in my hands for what seemed like days.

That’s where we begin…..with my dog, newly diagnosed with Osteosarcoma, and myself, newly diagnosed as a veterinarian with no more medical knowledge whatsoever about OSA/cancer/surgery/pain management now that it comes to my own pet- the result of a little thing called unconditional love.

Now begins our journey.

LP

image

 

Mar 09

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