The Long Walk
Part 2
As with any person choosing treatment
for a life-threatening disease, deciding treatment options for a pet is deeply
personal. Veterinary medicine now has access to many choices used in human
medicine. However, such options usually come with steep costs. The reality is,
without pet insurance, cancer treatments can go from the thousands to the tens
of thousands of dollars. At the end of the day, while many may not agree with
me, our pets are animals, and while a part of our family, humans come first. I
begrudge no one for making the decision not to treat because the money is
needed for food and living necessities. I will tell you that after this experience,
we now have pet insurance.
We were in the position to try
chemotherapy to help with JJ’s symptoms. I knew well the effects of different
chemo medications on the human body but had not yet experienced an animal being
treated with it. As a young nurse, I had been chemotherapy certified, as our
hospital had an orthopedic surgeon who performed radical surgeries to remove
bone cancers. He wanted to ensure people could recover to the best of their
abilities with staff who knew how to handle these complex surgeries post-op,
but they also needed to start chemo as soon as possible. During that time, we
gave a wide variety of chemo medications to these patients, and I developed a healthy
respect for what it did to the human body. With JJ, we started down this road knowing
we could change our minds at any time if it either wasn’t working to slow down
the lymphoma or if she had symptoms that were intolerable.
I was very familiar with the different
medications JJ would receive, as they are the same ones used on human patients.
As with people, the protocol varied week to week with which drug she received,
and it required monitoring of her blood work, which any chemo patient can tell
you all about. The response between people and dogs is very similar regarding
the effects on bone marrow. JJ was very sensitive to one of the chemo drugs,
which often caused her neutrophils, one of her white blood cells, to drop
drastically. Our neutrophils are one of the elements that help to ward off
infection. In people, we have a drug that helps to stimulate production of the
neutrophils for cancer patients who need it during treatment, but it is not
used in veterinary medicine.

At OSU, she quickly became a favorite
patient, passing out hugs and love to everyone she met. I knew that she spent a
lot of time in clinicians’ laps throughout her treatment days. This was no
surprise to anyone who knew her from work at the Hospice House. I would drop
her off in the morning, and usually pick her up later in the afternoon,
especially on the days she required IV chemo. In the never ending small
community we live in, one of the techs knew JJ from the Hospice House when we
took care of her mother. It was common to read on JJ’s discharge paperwork
things like “She is such a sweet girl” and “She’s the best.” She was very
tolerant of these visits, although she made it very clear she would have
preferred to go home with me each visit. The look on her face slayed me as she
dutifully walked next to the tech or veterinary student down the hall for her treatment, looking back
in hopes that I had changed my mind. It reminded me of all of the time I spent in hospitals as a young child, not necessarily understanding much other than I would rather be home than on a multi-bed ward drinking mineral oil chased by a sugar pack. Dogs, however, are typically more obedient than young children when it comes to procedures, and I have no doubt JJ was a much better sport than I ever was. In her usual dog-self, living in the
moment, all was well in her world when I picked her up and got her settled back
into her chariot. Those days typically ended up at a drive through, delivering
a small burger or fries her way, further reinforcing life was good.
I’m not sure people, including my co-workers, fully understood how
well JJ tolerated chemo until we had to have her scheduled at OSU on one of my work days. I took my lunch break and picked her up in the afternoon, bringing her
back to work with me. She didn’t miss a beat, as she passed out hugs and
mooched from anyone she could find. On the days we returned straight home from OSU, she
immediately ran and played hard, usually doing her best to dig up some creatures at "her" hay bales before taking a nap. While people usually lose
their hair on the protocol JJ is on, it is much less typical to have alopecia
with dogs. However, Goldens do shed their undercoat typically twice a year, and
since JJ did this three months into her protocol, her coat remained sparse throughout the year because
of the chemo. The most noticeable thing was her lack of whiskers. Most of the
year, it looked as though I had shaved her closely and I can always tell at a
glance if a photo of her was pre- or post-chemo.
Along the way, I continued to share the
day to day stories, normalizing what we were going through to the best of my
ability. There was a great deal of support along the way, although I also knew I was easing everyone into what eventually would be a very difficult outcome. I was straightforward in my discussions about JJ's cancer and treatments, and spent more time posting articles and discussions about end of life care in our pets. However, early on it was very clear that people were hoping for a very long remission, if not a cure. My fellow hospice and palliative care workers understood my words without needing further explanation, and they knew I was slowly preparing people, just as we do daily with our own patients and families. At the beginning, the reality was she could very well die before June, even with treatment. Despite this, it became very easy for me to follow JJ's lead in taking it one day at a time. Dogs are pretty awesome in this way and we would all be better off if we could mimic them more often. The majority of the time, it was fairly easy for me to focus on what we had, rather than get lost in the anticipatory grief of what was to come.
We knew at the beginning of her cancer diagnosis that she did not tolerate the prednisone well, which was one of the reasons she was on it for just a couple of weeks at the beginning. It wouldn't be until midway through the year, after weeks and weeks of marching down that long hallway on the way to treatments, that we would find out just how damaging it could be.
JJ touched my heart in such a profound way, despite being thousands of miles away and never being a recipient of one of her famous hugs. I shed tears of grief when I learned of her passing, much like I did when my own precious pets passed. What a beautiful girl she was and what an awesome legacy she leaves behind. Barke Diem indeed!
ReplyDeleteThank you. Indeed!
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