November 01, 2010

A Much-Needed Reminder

On my way home from a vet appointment with our cancer-stricken dog late this afternoon, I called my dad to check in on him. He went into the hospital on Friday for a more hard core kind of chemo than he's received in the past, and today's his third day of it. I asked him how he's doing, and his response made me laugh out loud:

"I'm feeling great, baby! Plus, this new chemo makes me glow in the dark, so it's easier for wifey to find me at night when the lights are off..."

It was a definite reality check. There are certainly things in our world right now that are painful and not how we'd hoped they would be, but my dad's attitude serves as a reminder that no matter what the circumstances, a sense of humor and positive attitude are still possible. If we choose them. So I'm trying hard to choose them.

On that note, updates about the three D's that are dominating our world right now...

The Dad - As I mentioned, the hard core chemo is underway. He has four more days of it. The oncologist decided to take this approach because the other chemo he had been on was only helping for a week or so; it wasn't keeping him in remission long enough to get the transplant under way. It sounds like he'll be in the hospital at least 30 days, and possibly longer if the transplant happens. He'll be keeping the nurses on their toes with his sense of humor, that's for sure.

The Dog - We got a follow-up report from the radiologist late Friday afternoon, and I met with our regular vet today to talk about all of this. It was a sad appointment, but a decision has been made. As painful as it is, I'm also at peace with it because it's the right decision for our "baby boy". The only criteria we used is what we think is best for him. And unfortunately, we decided that is palliative care rather than surgery.

R, my mom, and I had talked about it over the weekend and decided that if surgery seemed like a viable option, we would do it.

However, I noticed during the past couple of days that the dog's hind left leg (it's his front left one that is affected by the cancer) is starting to show signs of weakness. It's shaking a little bit sometimes, and he's sometimes starting to lean his right hip against things - walls, the kitchen island - to gain additional support, which he hadn't been doing before. So I think the cancer has probably spread a bit further than the MRI images can detect at this point.

Our regular vet did an additional exam of him today and is concerned about the same thing. Also, he explained some things I didn't fully understand last week. Because the first sign of trouble was that the dog was holding his left foot off the ground, I assumed it had started in his foot. I thought that if we had just caught this a few months ago, they would have been able to just remove his leg and we would have had a chance for a much better outcome.

But the vet explained today that the tumor started deep in his armpit area, between two major muscles. He said that's pretty much the worst possible place it could start. So even if we had caught it earlier, it still would have been difficult to remove; even then, it wouldn't have been a simple leg amputation - they still would have had to go in and take out a significant amount of under-arm tissue to get to it.

The other thing he explained - and maybe the vet last week also explained it and I just wasn't hearing her since I was in shock - is that this particular kind of cancer isn't encapsulated. Instead, it's as if it's growing along tree branches, branching out into increasingly thinner branches along the nervous system. So not only does the main mass have to be removed, but all of those additional strands of the cancer that follow those branches would also have to be removed. And removing all of the cancer cells with clean margins without damaging the nerves in the process is a very challenging thing to do.

As if all of that wasn't enough, the radiologist's final report indicated that we would have to remove not only the leg and a signficant amount of muscle tissue, but also at least one rib and possibly additional ones.

And odds are that in all of that, somewhere, some place, at least a couple cancer cells would be left behind. Which means that it would grow back, the dog would have a missing front leg, at least one missing rib, and would still lose the use of his hind leg on that same side. Given what we've seen with his hind leg in the last few days, it's possible that he could lose the use of it before he's even finished recovering from the surgery.

So instead, we're going to keep him as comfortable as possible until he's no longer himself, and then we'll make the tough call. In the meantime, we're having a pet photographer come over tomorrow to take pictures of the entire zoo, while he's still feeling well enough that we can get images of him as his usual self.

In the meantime, we continue to welcome all prayers and kind thoughts that you care to offer up, because sometimes sanity can be a very tenuous thing. :-)

The Doctor - Somehow, I managed to hold myself together very, very well during my annual physical over the weekend, which included filling out the medical report for the adoption recertification.

I decided to take the approach of being honest without oversharing.

The nurse reviewed my meds. They know I've been on anti-depressants, it's in my chart, but somehow this time when she ran down the list to ask me if I was still taking each of them, she didn't mention that one. Nor did the form ask specifically if I've taken them. And when the doctor listed my meds on the form, she didn't mention the metformin or low-dose aspirin, only the thyroid meds.

The form did specifically ask about diagnosis of mental illness (no), anxiety (yes), depression (yes), and a couple other things I don't remember. I pointed out to her that my previous doctor had diagnosed (and prescribed medications for) anxiety, but none of the meds worked and the "anxiety" went away when my thyroid problem was addressed. So she noted very clearly in two places that the anxiety diagnosis was actually a misdiagnosis and that the issue was actually my thyroid.

The depression isn't a misdiagnosis, but she also put down that it was situational and caused by multiple miscarriages and by all of the hormones I've taken, which is entirely true. Before we started ttc, birth control pills caused the first round of depression I ever had, and when I stopped taking those so we could start ttc, it went away. (Well, briefly, until we started getting all of the IF diagnoses...) And Clomid and progesterone also trigger it.

On the form we have to fill out, it also asks about professional counseling, so I wrote that we've participated in "grief counseling" after our 4th miscarriage, which was of a baby with a heartbeat that died, and that we've continued to participate "as needed" while we've gone through additional treatments and miscarriages.

My hope is that "grief counseling" (which is a very accurate description) sounds better than "treatment for ongoing depression because my body can't seem to hold onto a kid", and that the social worker won't feel compelled to make a big deal about that in the home study. If she doesn't, international adoption might still be an option for us. Time will tell.


lastchanceivf said...

Your Dad's sense of humor is definitely inspiring! I hope the more aggressive chemo does what it needs to do without ravaging too much else.

I'm so sorry about your dog, but it sounds like you made the best possible decision given all of the information. It is so unfair and I'm so sorry. I think the photos sound like a great idea.

And yay for medical people who GET IT. Like I said before, you know that any diagnoses or meds do NOT mean you are not fit to be a mother--sheesh. Anyone who would go through as much as you have in the pursuit of motherhood is clearly demonstrating a desire so deep nothing can take it away.

Auntie Em said...

I teared up while reading this post. I am so sorry for all the pain you are enduring right now. It's great that your dad's sense of humor is still very much intact, and it reminds me to try to find the silver lining in life. I also feel so very sad about your dog. My dogs have served as my "children" during my battle with IF, and I'm devastated at the thought of ever losing them. You sound like a wonderful, concerned dog owner, and I am proud of you for handling this situation with such strength. I hope your personality shines through to that social worker much brighter than anything written on a piece of paper.

Libby said...

Your dad is quite the trooper. I hope the chemo does the trick and he continues to keep his spirits high. I do believe attitude makes a difference in such things.

I feel very bad for you and your dog. What a horrible thing to happen to a sweet animal who has done nothing to deserve this diagnosis. I just hope he has a peaceful rest of his life. Nothing was off limits to our girl once we found out what she was up against.

That's great that your doctor was sensitive to what you needed on your recertification. I can't imagine there are a ton of perfect people wanting to adopt, but I have also worried that my husband's medical record would hurt us if we end up on the adoption road. He has never missed a day of work for his diabetes, etc., but on paper, he doesn't look so healthy.

Hope things - everything - starts looking up for you soon.

Nic said...

cancer sucks. I'm really sorry that you're dealing with it on two fronts. I hope that you do get some more time to spend with your puppy, and definitely that this chemo helps your dad beat his!

And, I'm really glad that your doctor wasn't a hardass with the forms. It sounds like you're in a good place for your meetings with the social worker. I'm holding thumbs that this process continues to go smoothly!

MrsSpock said...

So sorry about your dog. We've had to put down two cats in the past 7 years, and it was hard. Glad there is less of a speed bump in the way of your adoption recert.

barfingrainbowsandunicorns said...

I'm glad that your dad's spirits are up - what a great attitude. I'm hoping for the best for him.

I'm so sorry about your dog. It really sounds like you've made the best decision that you can. Still, I can't imagine how difficult it must be, especially with your dad. Your situation just breaks my heart.

I'm glad your doctor handled things well. I might take a page from your book someday. :)