Subtle changes

  • Instead of two meals/day he now has three – he has to take tablets three times a day and some have to be taken with food. He doesn’t complain about this but somehow he sometimes manages to filter out the nasty tablets and leave them slimy in the bowl or on the floor. I wonder how this is possible with the speed and gusto with which he hoovers up the contents of the bowl, ears swinging back and forth and identity tag chiming on the stone bowl as he licks clean every last millimetre
  • When he needs to pee, he really needs to pee. Right now. Quick, get the door open and run to the garden or someone had better be behind us with the mop
  • Restlessness. He sleeps for a bit then stands up, goes to lie on the rug. Sleeps a bit more. Stands up again. Comes over and stares at me for a bit. Finds another spot on the floor and flops down. Sleeps a bit more. And repeat
  • Panting, even when doing nothing
  • When I come home he used to be at the door wagging, looking for a head rub even before my key was out the lock. Now sometimes I’m in, bag put away, keys put in the bowl and he finally appears from his bed to come and say hello
  • Walks are shorter, much shorter, and slower.
  • Running is for now a solo activity

Is this why travel rugs were invented?

Today I spoke to the surgeon. Mum came with me. Mum has lived with Labradors for many years and always offers wise words. She remembers the day Zelda (Smelda) died while me, my brother and sister were at school. She came home from the shops to find her dead on the kitchen floor. What to do with a dead dog? She didn’t want to leave her there for us to find when we got home from school, but also didn’t want to take her away to the vet without letting us say goodbye. Practical problem: how to lift a 33kg dead weight of a dog when you are 5′ 2″ and have never been a weight lifter?

Solution: get the travel rug from the car, pop her on it and lift her into the car boot. Good idea, difficult to execute. However, my mum has never been one to shirk a challenge so she somehow managed to get her onto the rug, down the half-dozen steps and into the car boot before we came home.

A girl at work then told me that she knew a large, heavy cat who was also placed in a travel rug when it died.

My best friend then told me her parents also used a travel rug when their yellow Labrador, Sandy, died.

I think I now know why travel rugs were invented. It may also explain why older people keep a travel rug on their parcel shelf…

Excision, diffusion, lesions

The surgeon was accompanied by an intern and two students so the room was fairly busy. The students listened intently as the surgeon talked to us about margins and excision and diffusion and lesions and degranulation and primary closure. She explained the area across his shoulder, although looking less red than last week, still hadn’t shrunk to reveal a typical mast cell tumour. This means surgery would be what they call challenging. The wouldn’t know how big an area to cut out because they just don’t know where the tumour begins and ends. They wouldn’t know this until they had begun the surgery and shaved the area, and even then they wouldn’t really know until the lab results came back to show if they had managed to remove all of the tumour or not. The oncologist had also talked about possible amputation at the shoulder if they had to operate aggressively but they wouldn’t know until they started.

They were hoping the Prednisone he has taken for almost a week would have miraculously shrunk the area on his shoulder to leave a defined mass that they could neatly cut away. Nope. It has seemed to reduce the size of the tumour on his prepuce (foreskin) though, and it could probably be removed along with a 3cm margin. However, this would leave his penis partly exposed, which is a problem for a dog. It may require a second operation to pull his foreskin forward and attach it again further along the penis. This kind of operation is sometimes tricky to heal because of where it is – difficult to keep this area sterile as it keeps getting washed in urine, for example. Each operation would need a 2-week rest / recovery period. The only walks would be 5 mins to pee, on the lead. And then there would be the cone of shame..

The oncologist then came to talk me through the different treatment options again. He confirmed surgery wouldn’t have any guaranteed outcomes and could be difficult. It would also have to be followed up with chemotherapy and possibly radiotherapy. They may not be able to close the wound properly i.e. join skin to skin, which would introduce other difficulties. For a 12 year old dog, with no firm prognosis and certainly no cure, surgery seems a non-starter. I don’t want to artificially extend his life only for him to be poorly and restricted as this clearly wouldn’t be for his benefit.

As I write this he’s stretched out on his bed in the corner, belly lumps (limpomas) exposed where the hair is growing back, grey hair on the bottom of his paws and around his muzzle, his large thick tail curled in tight. As soon as I stand up, usually he would be beside me wagging, waiting for me to say “do you want out?” so he can tilt his head quizzically and wag even more enthusiastically.  Tonight, however, I expect he will get up when he feels like it, perhaps after I’ve put the laptop in its bag or when I go over to speak to him. He’s taking his time a bit more, not so eager to do things.

Foot went to sleep
Foot went to sleep

Chemotherapy was also discussed. Although this isn’t as invasive as it is with humans it does sometimes have side effects. More importantly, it doesn’t cure the cancer. It may stop or slow it spreading – but in Ash’s case, they don’t even know if this is likely. The practicalities of chemotherapy are important too. Once a week for four weeks, and then every 2 weeks for another 8 weeks (3 months in total) we would travel to hospital in the morning, a 30-40 min drive at that time of day. He would stay in hospital until lunch time. While there he would have his bloods checked to make sure he was able to cope with the chemotherapy. I know Ash will probably need sedation each time. He volunteered as a blood donor a couple of years ago and they politely told me he wasn’t suitable as he became too excitable when they were trying to do the necessary. He then took part in a research project where, again, he had to give blood and they had to sedate him. So, after the blood tests he would have an I-V infusion of chemotherapy. He would then rest for a bit until I came to collect him. Apart from changing work patterns to accommodate this – which wouldn’t be a big problem but would need some negotiation – it’s a real change to Ash’s pattern. He doesn’t spend mornings in hospital having treatment.

With no guarantee of extra weeks or months or years, this just seems a bit much. Instinct tells me I would be doing it for me, not Ash.

The third option is to continue with the prednisolone and anti-histamines he has already been using. They have had an effect on both tumours – one has shrunk back to looking like a small cyst and the other no longer looks as red, thick and scaly and he’s not scratching it as much.

What prognosis?

They just can’t tell me. They say dogs who have typical mast cell tumours successfully removed with straightforward surgery have a median lifespan of 8-12 months. That doesn’t seem like a desperately long time when you consider Ash’s unusual tumour wouldn’t be straightforward surgery and they don’t know if they can treat it at all. They can’t tell me how much longer he would live after chemotherapy. They can’t tell me how much longer he will live without. Given this uncertainty, my gut tells me that the steroid and anti-histamine seem to be the best option. He won’t have to compromise his lifestyle (makes him sound like a movie star…) at all, at least while he is as healthy as he is now, and it doesn’t involve weekly trips to hospital for more ‘procedures’.

They sent a detailed report of their findings and it reiterates everything the oncologist told me.

“There are multiple negative prognostic indicators which help us predict which MCTs are more likely to behave in a more aggressive manner, of which Ash has multiple”

Apricots, bananas, raspberries, tomatoes, apples

Instead of putting the leftover bits of steak fat in the food recycling I find myself slipping them into his bowl. He shares a couple of apricots with me in the evening. He has always loved fruit. When he was a puppy, he was left alone in the dining room while I was next door in the kitchen preparing a meal. I thought he was sleeping as the dining room was a lovely sunny room with long windows and low, broad window sills where the fruit bowl used to sit.

I’ll say that again….low, broad window sills where the fruit bowl used to sit…. yes, the fruit bowl that had a bunch of bananas in it. The fruit bowl that I found on the floor along with 7 banana skins, empty of the delicious fruit inside. How he managed that without thumbs I will never know but from then on he loved fruit. He would pick only ripe raspberries from the bushes in the summer, his big gentle muzzle and huge lips nuzzling into the ripe fruit to nimbly pick only the juicy deep pink ones, leaving any with a hint of green or white to ripen another day.

The one year I successfully grew several varieties of cherry tomato, Ash discovered the ripe fruit before I could harvest them. Every time he was in the garden he had to be supervised to make sure he wouldn’t steal them. The apple tree sacrifices its low-hanging ripe apples to Ash every Autumn. The only food he loves more than fruit is cheese.