Chemo, A Part of Life
I was committed to sharing our experiences day to day with JJ’s cancer and treatment. I knew very well that the chemotherapy’s purpose was to alleviate the symptoms stemming from her very high calcium level. Hopefully, it would slow down the progression of the disease. While many people would prefer to handle something like this privately, I was committed to being open about what we were going through. It would have been disingenuous of me to not to find a way to share these details. Dealing with a life limiting illness is not that different between people and our pets. Talking about the concepts of palliative care applied to both, and it has always been my goal to continue these difficult conversations, even when it was so close to home. I also knew from the very beginning that I would need to guide so many people through JJ’s disease progression and dying process when that time came.
I learned quickly after JJ’s video went viral that anything I put on her social media drew all sorts of opinions, usually posted through comments, but often through private messages as well. I have had family members of patients tell me how opinionated people could be through a keyboard, especially when it came to decisions around treatments. For the most part, people were supportive of how we chose to treat JJ, although of course, there were people who thought we were cruel to “subject” her to it. My husband and I had both been told how well dogs tolerated chemotherapy but had no experience. Our oncology team was very open to giving information and letting us choose the course of treatment with no pressure either way. My goal in being transparent with what we pursued was to share information and our experiences for anyone who chose this option.
Along the way, I got many, many comments and messages on what to do. “Tumeric.” “Ketogenic diet, otherwise you must be fine with killing her.” “CBD for pain.” “CBD to cure.” On, and on it went. I get that it was coming from a place of good intention with people trying to offer ideas and support, but it often didn’t feel this way as the recipient. It was a good lesson for me to remember to offer any information if asked, not when unsolicited. These days, I think it is safe to say that most people and pet owners have resorted to an internet search or two when faced with any challenging diagnosis. As a nurse, I also am fully aware that no one person or animal responds to treatment in the same way, so a blanket statement of “xyz” curing cancer is silly and not helpful. We felt very confident of our plan after coordinating care between conventional and holistic veterinarians. The critical thinking nurse in me also had done some research but chose not to pursue options that only had anecdotal evidence behind it. JJ was started immediately on a raw cancer diet and was on an assortment of supplements chosen to support her immune system and organs from the effects of the specific chemotherapy she would be getting.
Knowing the prognosis for T-cell lymphoma, even with treatment, was typically no more than six months, I took a page from JJ’s playbook and decided we would make sure to enjoy each day. Dogs are brilliant at living in the moment, and as a longtime hospice nurse, I see every day that we have no guarantees.
Except for needing to delay a few weeks of chemo due to low blood counts, the first six and a half months were uneventful. JJ continued to play and work as she usually did, even on work days. In July, however, we all noticed she was starting to have some changes with her breathing pattern. In hospice, we are all highly attuned to the changes in breathing. Our assessments tend to pick up subtle changes, and my co-workers and I had been watching her for a couple of days. On our regular follow up visit to OSU, I mentioned my concerns to the student, but I clearly was not insistent enough when I said I wanted a chest x-ray. I left JJ for her bloodwork and checkup. Because her physical exam showed nothing out of the ordinary, they chose not to x-ray. By the next day at work, even our clerical people were noticing a change. The next day was a Friday, the research day at OSU, so I took JJ in to our general veterinary clinic to have an x-ray done. I wasn’t sure what it would show but knew something was changing. She had developed bilateral pleural effusions, meaning she had fluid in the lining surrounding each lung. This also happens in people and is often related to a cancer. It makes it more difficult to get breath. I immediately called OSU and JJ’s oncology resident called back, wanting us to get to them as soon as possible. On ultrasound, they did find fluid and were able to remove 800 milliliters, which is quite a lot for a fifty-pound dog. True to her nature, JJ stood quietly while the fluid was removed with a needle. The pleural effusions were caused by the tumor in her chest, which had been present from her initial diagnosis and was not something that could be removed surgically. It was clear that the current chemo protocol no longer was working, so we immediately changed to a rescue protocol. Most of the time you get about half the remission time received from the first chemo protocol, but we were just hoping to slow her lymphoma down again, so she didn’t have a recurrence of her pleural effusions.
As I continued to share what JJ was going through, I learned that people had a very low tolerance for any perceived suffering she might be experiencing. When I would share stories from work, many would insist JJ needed rest, although she was the queen of sleeping half of the day away long before ever having cancer. Despite what I shared, I believe people equated her chemotherapy to the horrible side effects well known in people. During the time when she developed the pleural effusions, I started receiving many comments and messages along the lines of “How long are you going to make your dog live like this?” These were typically from people who didn’t know our story. It was upsetting at the time, but interesting to think back on. Over the time span of an entire year, JJ had about twelve "bad" days total. Having people tell me “you need to put that dog down” during one of these bad days made me wonder if they would choose euthanasia simply because they couldn’t stand thinking an animal had short term symptoms from a fixable problem. I was reminded of when JJ's sire Dash was hit by a car and fractured his femur. It took surgery and time to repair, but we had years together after his surgical repair. My viewpoint may differ because I am a hospice nurse and specialize in managing symptoms, while being present with the person experiencing those symptoms. Had we not fixed her simple medical complications at this time, we would have all missed out on several more months of enjoying her antics while she lived life. I have no doubt we made the right decisions for JJ.