A week after the initial phone call from the vet to tell me they had found a mast cell tumour I took Ash to the Dick Vet hospital at 0900 to see the oncologist. The very word oncologist sounds very odd in relation to a dog. I had only ever heard of oncologists treating humans and hadn’t appreciated Veterinary Medicine had developed along the same lines with chemotherapy, radiotherapy and the like.
My childhood Labrador, Zelda (Grizelda, or Smelda as my best friend called her…once within earshot of my mother to Fiona’s great and unforgettable embarrassment), reached the fine old age of 17 before finally giving up. Although she had some arthritis and was a little blind, deaf and leaky at the end and had to be helped into the boot of the car, there didn’t seem to be any industry offering complicated, prolonging, optimistic, shiny treatments when dogs got sick. Not in rural Perthshire at least.
I knew of a number of people whose dogs and cats got ill and were put down. It was a fact of life. Sad, but something people accepted as the way of the world. A large part of me still thinks that’s maybe a good thing. Death is part of life. We all have to deal with it. Yes, it can be heart-breaking when a loved one dies but die we all will. I have friends whose relatives were kept alive through breakthrough medicines for long periods of time, memories of hospital visits to people who became husks of themselves, surrounded by monitors, tubes and oversized hospital gowns, not able to go home but alive and there for people to bring flowers and cards and talk about happier times and pause while the nurses take their temperature every two hours, write on the chart and fill up the plastic water jug when it gets empty. I don’t want the dog equivalent of that; no forest walks, special meals, tablets disguised in ham, always walking behind to clear up accidents.
Yesterday we went running at Loch Leven. Ash and I have run together since I started running circa 2008 while recovering from a broken foot and beginning training for my black belt in Wu Shu Kwan. We have never run far, usually 4km or so, occasionally 7km.
Forest running is our favourite and we ran with the Edinburgh cani-cross group for a couple of years. Running and night and running in the rain also fun. Yesterday was warm but not hot, a little cloudy. We had been to visit my sister and had an hour to kill before picking up my partner from an event at Knockhill. The path was busy with cyclists and walkers to I had to keep Ash on the lead and gave up moving out the way or stopping for cyclists to pass, only for them to not even acknowledge I had actually stopped for them and was keeping my dog sitting beside me. So we ran for 15-20 mins and Ash had a dip in the burn to cool down (finally off the lead). After that he wouldn’t run again, sticking with a fast walk that he tried to make look like a run, silly grin and willing eyes plastered on his face. Cajoling, encouraging and treats couldn’t persuade him to run again and the lead got tight as I slowed again and again, practically running on the spot. We walked the rest of the way back to the car.
So we arrive at hospital, the same waiting room as my vet, sit in the usual place with Ash under my legs, his tail beating against the floor when someone walks past and looks at him. Commando dog, belly-crawling towards the other dogs to say hello. Except this morning’s dogs aren’t the usual 6pm general practice dogs, healthy and ready for their worming tablets and kennel cough spray. These dogs are just a little subdued, their owners just a little guarded. When they lay down I can see the long lines of stiches on shaved bellies, the slight hesitation when someone leans down to rub their tummy or when Ash reaches them to place a large, friendly paw. And a couple with no dog, waiting, watching Ash with fond smiles and a slight, almost imperceptible sadness.
It’s a teaching hospital. One of the reasons I chose this vet is reassurance that they will have access to the latest research, the latest developments in knowledge and treatment of disease. And the double checks – usually the first check-over is by a student who then recaps to the senior vet who checks it all again. That way, things won’t get missed, right?
Good theory. Great theory. Not so good in practice. More later on that.
The student and the oncologist appear, smiling and delighted to see Ash, and he’s delighted right back. Into the consultation room, usually a right turn into the General Practice, this time a left turn into a matching room. No different to the GP rooms, but different all the same. The student asks if she can examine Ash and the oncologist leaves the room while she checks his pulse, his skin, his teeth, ears, weight, all the usual things. Ash begins to remember his visits here for operations on sore ears and eyes and becomes a bit silly, trying to stop the student taking his temperature by playing, rolling over and batting her hands away, such a fun game. She doesn’t have the other vet’s tube of Primula cheese to hand; her genius idea to spread a small smear on the floor to lick while she does whatever she wants in the background.
The student tries to check his irritated side but he knows that’s what she’s interested in and he lies on his back, legs in the air for a belly rub instead. I mention last night the ‘cyst’ on his penis was bleeding. the ‘cyst’ I went to the vet about almost 7 months ago to the day. The ‘cyst’ I was told I should just keep an eye on and if it changed significantly to let them know. Well, it hadn’t changed until last night when I noticed blood on the white floorboards, Ash licking it but not managing to stem the flow.
Ash’s best distraction technique was when he was around a year old, a fully grown (and at that point still a “full male” before I selfishly had his bollocks removed), vital, shiny boy, 30kg of muscle and sharp but playful teeth. We were at the same vet, either planning a bollock-removal date or ready to give him that unpleasant, neon green kennel cough spray up both nostrils. Whatever procedure it was, he had to have his temperature taken. If you have a dog you will know how this works. If you don’t, it involves a thermometer up the rectum which is a bit of a surprise for any dog, as you might expect. The consultation room had 3 wooden chairs in a row and I was sitting on the middle chair. Ash was beginning to get fidgety as they poked and prodded him, trying to get him to stop panting while standing so they could check his heartbeat with the stethoscope. He will stand on command but I haven’t taught him the ‘no panting’ command. ‘Shut your mouth’ normally works for a few seconds but not at the vet.
First the front paws appeared on my lap, so I swapped a reassuring pat for smelly breath right in my face, allowing the vet to check his heart for 15 seconds. Then the thermometer appeared and an attempt was made to insert it as he was kind of standing with his paws on my lap. Now, what happened next was an entirely reasonable reaction to having a cold thermometer thrust into his rectum. The front paws appeared on my lap again, Ash still kind of standing so his face (and particularly smelly breath) was level with mine, soon followed by his back paws, stepping up onto my lap as if he did this every day, trying not to fall off the sides as I’m not really made for a fully-grown Labrador to sit on my lap while myself sitting on a small wooden seat. So there I am, with Ash on my lap like Scooby Doo, all 30kg of him. Great technique – they really couldn’t take his temperature.
Back to the oncology consultation. She politely excused herself to report back to the oncologist. Ten minutes later they both come back in the room, the oncologist politely summarising everything the student found. He tells me about mast cell tumours. That this is a particularly unusual presentation as mast cell tumours are normally well defined swellings, very much like the one on his penis. He asks when I reported it. I tell him I think it was December. I ask why they didn’t take a sample then, why they didn’t consider it was a tumour. He doesn’t have an answer. He tells me the tumour is difficult to diagnose as it doesn’t have a definite edge. The normal treatment is surgical excision, with a 3-5 cm margin for safety – deep as well as wide. These bastard tumours are 3-dimensional. Looking at the large area on his shoulder, even if they can figure out where the tumour begins and ends, it may involve an extensive excavation, possibly involving an amputation of his front leg from the shoulder. What the hell… he’s 12. Losing a front leg at 12 really doesn’t seem right. Expecting him to learn to walk without a front leg, possibly prolonging his life by a few months. Who would this benefit? Not Ash to my mind. But we carry on the conversation.
He asks when Ash last ate and I tell him he had his usual breakfast at 7am. He tells me he shouldn’t really have eaten this morning if he is going to have the ‘procedures’. The what? I was only aware I was coming to speak to the oncologist. He tells me they want to keep him in for further tests. They need to examine his abdomen for swellings; ultrasound to check his liver and spleen and fine needle aspiration of lymph nodes, the ‘cyst’ on his penis, his liver and spleen and more blood tests. They need to grade the cancer. They need to know if the ‘cyst’ is another mast cell tumour. They need to know if the cancer has spread – metastasised – and whether it has affected the lymph nodes or internal organs. This will help determine the grade as well as the stage of the cancer.
They can keep him in and perform the procedures later in the afternoon to give his food time to settle. I read and sign the consent form and they hope to do it under sedation rather than general anaesthetic, but it depends how he copes. They replace his collar and lead with a thin, red lead and he goes happily away with the student into the inpatient area of the hospital and I go to work. They will phone me later to let me know when I can collect him.
Small metal box
As I leave, I hand my insurance form in at the payment desk and the couple with no dog are waiting behind me, carefully holding a small metal box.
I get a call at around 4.30 to say he has only just gone into theatre as there was an emergency that had to be prioritised, and I should collect him at 6pm when they shut. On the way home I get stuck in horrendous traffic and arrive just after 6 to see the doors closed and the lights off. I’m not sure what to do but see a sign on the window that says if you are expected after hours to ring the buzzer and someone will answer. Of course, it’s a hospital. Staff work at night too. I ring the buzzer and a nurse in scrubs takes me into the consultation room to wait. She disappears for 15 minutes or so and finally the oncologist appears with a very wobbly Ash who has only recently come out of surgery. They did only give him sedation but he’s clearly still very sore and a bit unsettled with a large shaved patch right across his abdomen on both sides.
The oncologist tells me I will have to wait a few days for the results and they may come back in fits and starts. He does say that he’s pretty sure the swelling on his penis is a mast cell tumour, particularly as when they took a sample it swelled considerably, which is a typical indicator of a mast cell tumour – degranulation, a sudden release of histamine and heparin. However, he would know more after getting the lab results.
Ash can’t jump into the car boot so I help him into the passenger foot well and he curls up and puts his head on my hand when I reach for the gear stick. 25 minutes later we are home and he goes straight to bed, not quite sure what to do with himself. We have some things to unload from the car and usually have to send him to bed or barricade him in to the hall so he doesn’t escape outside or get under our feet. This time all I hear from the living room is a deep howl, getting louder and not stopping till one of us goes in to comfort him. Back outside to unload more and the howling starts again. We can hear it outside and Ash doesn’t leave his bed. I have to block out the sound to finish what I’m doing.
Then I go to him and stroke his head and the howling stops. We stay with him the rest of the evening and he doesn’t howl again. I think about the couple with the small metal box.