Tuesday, May 18, 2010

A Cruel Joke.

That's what the "benign hematoma" results were: a cruel joke. They gave me the standard disclaimer when the results came back: that you can never be 100% positive with biopsies and there is always a chance the cancer was missed. But it is supposedly a small chance. This is very difficult for me to write, but I need to start telling people and I cannot bear to send out multiple emails with this terrible news. Apparently the benign biopsy results were wrong and the cancer has now spread to Alec's liver, where they found not only another bleeding mass, but a bunch of tiny bleeding tumors throughout his liver. They discovered this during another surgery Friday night. When they found out how bad it was during surgery, one of the doctors called to ask me if I wanted to "let him go" on the table. She said my choices were to not wake him up, or they could try to stop as much bleeding as they could, sew him up, and bring him out of anesthesia. It was wrenching. As I tried to focus and ask questions the doctor finally said we need to decide now because they did not want to leave him under anesthesia for too long. I told them to remove as much of the big tumor they could and wake him up. I struggled with this. She told me he might have weeks, or days, or hours. She said bleeding out was an unpleasant way to go and I needed to think about this if I brought him home. But how could I make this decision? He was showing no symptoms when I brought him to the emergency hospital that evening. I was just being cautious (or so I thought) when I brought him to my regular vet earlier that afternoon. Before he went to surgery, we took a walk around the block in the beautiful warm spring twilight and he was his usual happy self. They did CT scans before surgery to see if there were tumors elsewhere and those came back clean. So how could I decide to let him go when he was fine right before surgery and the cancer showed no signs of spreading beyond his liver yet. On that basis I made my decision. I had to try to get him to chemotherapy. He would be in the hospital at least overnight and she told me, "he might make the decision for us if he does not stop bleeding in the next 24 hours." Oh my god I can't believe this is happening. But I have to be strong for him. I cannot collapse.

This began two Fridays ago, when Alec began to be lethargic mid-way through the day. He showed no other symptoms - his vitals were normal, he was eating and drinking, and he was alert. But he did not want to go for a walk. He just wanted to lie down. This is very unusual for Alec so after consulting with his regular vet (who was of the opinion that given his history I should not wait to have him seen), I took him to the emergency hospital again. There they did a chest x-ray and blood work. Those came back normal and the doctor told me I should take him home and monitor him to see if he gets worse, basically. He did not. By mid-day the next day he was his old self again. The doctor said his abdomen was slightly painful and I assumed he pulled a muscle (a tech suggested this possibility when I called the next morning concerned he was still lethargic and asking if I should bring him back in). I remembered that his lethargy came on while we were doing his physical therapy rocker board exercises; he balked and did not want to do them and instead went to lie down. Alec enjoys these exercises because he gets treats the whole time so this was unusual. But in retrospect that seemed to fit the theory that perhaps he pulled a muscle in his abdomen and when he was back to his old self the next day I breathed a huge sigh of relief.

He was fine all week and then this past Friday when we woke up it was the same thing all over again. He looked weird when we woke up, ears slightly back, eyes dull, and he did not want to go on his morning walk. He drank a ton of water, which was odd, but he ate breakfast. I called his regular vet again and she wanted to talk with me about a plan of action before I brought him back to the emergency hospital. By the time I spoke with her a few hours later his lethargy had lifted and I had taken him for two walks. The only sign he was showing was that he was acting weird and clingy, following me from room to room, lying down right next to my desk chair, which he never does, looking at me funny. His vet mentioned gas pains or cramping, asked if I had given him any new treats lately, etc. The answer was no. I had an appointment with them for 4pm that afternoon and I asked her if I should keep it given the fact that his lethargy had lifted and by now he was showing no clinical signs at all (except looking at me funny). She said I might as well cancel it because they probably would not find anything in a basic exam that I had not noted (I had already taken his temperature, palpated him, etc...all the obvious stuff) and to continue monitoring him over the weekend. But after I hung up I got a weird feeling and called back and asked to still come in. I just wanted to be sure I was not missing something obvious and I figured it would be good to have peace of mind as we were going into the weekend.

My regular vet's partner saw Alec and he was cheerful and perky during the exam. She decided to do a baby ultrasound (they have a mini-machine there) to rule out fluid in his abdomen. To our surprise she found fluid. She just started saying "I'm so sorry" and sent me over to the emergency hospital (Dove Lewis) to get a full ultrasound done.

The ultrasound At Dove Lewis showed a bleeding mass on Alec's liver. The ICU doctor brought me back and said "I have some scary news." He presented me with a bunch of options I barely understood and I tried to focus and make sense of them (one of them was "hospice and humane euthanasia" and my fragile composure broke at that and I cried out, "what? no!") but eventually he said he had to get going because it was busy and basically I needed to make a decision. He asked if there was anyone I could call to talk it over with. Not really. The main two options were go right to surgery or do something called a CT scan first. He said if I was going to do surgery no matter what, then don't bother with the expensive scan. But if the results of the scan might change my mind about surgery (i.e. if he has tumors in other places, would I still want to put him through surgery?) then it made sense. So I said do the scan and if it's clear go ahead with surgery. He said surgery was the only way to stop the bleeding and see what we were dealing with. I could wait on surgery but it was clear no good would come of that. Alec was stable with no clinical signs when he came in and those are obviously the optimal conditions under which to do surgery.

So I went home and at 11:30pm a different doctor called to say the CT scan was clear and they were prepping Alec for surgery. She said the surgery would be done in about an hour, but that she would call sooner if they found anything else during surgery. My phone rang 35 minutes later. She said in addition to the bleeding mass there were tiny bleeding tumors throughout his liver. She asked if I wanted to just let him go on the table. I think I discussed this part in the first paragraph, sorry I am repeating. I weighed everything and made the best decision I could. They woke him up and she said if he survived the next 24 hours (meaning he did not continue to bleed) and was stable, I could bring him home the next day. He was stable the next day and I brought him home and I don't know what I have been doing since then. I made an appointment with a holistic vet and an oncologist and we will see them this week. I am trying so hard not to fall apart but I fear I might go crazy. Not now, I know I need to be strong for Alec. I tried to find any angle, any remote thing I could hope for, but they couldn't give me anything. I asked could this be another benign hematoma, maybe something else besides cancer, but they said that was extremely unlikely and that even without the biopsy results we can say with 99% certainty that it is hemangiosarcoma (the very bad type of cancer I was so relieved to find out it supposedly wasn't the first time). This is the pattern of hemangiosarcoma. It spreads from spleen to liver, etc., and that fact that it grew so fast in the last month and a half (his liver looked normal during the splenectomy)...not good. You can gain some time with chemotherapy supposedly, but chances are obviously better the earlier you catch it.

To think I have been drinking champagne and celebrating for a month while the cancer was spreading. It breaks my heart. I have been on top of the world since I got the benign biopsy result, thanking my lucky stars, skipping around in a constant good mood and state of gratitude, looking forward to every precious day I have with Alec and now this. It is hard not to feel like a cruel joke has been played by the universe. Like I have done something wrong and am being punished, but I know the world doesn't work like that, and I can't think that way. Mostly I can't think that way because it is too much to bear. I try so hard to always stay positive and to always look for the "silver lining" but this is too much. The "benign hematoma" result was against the odds I know, but I thought we were just lucky, that Alec caught a break. To think I could have started treatment a month and a half ago before it had spread to a vital organ...I am devastated.

I hate to give bad news and I am sorry, but I cannot deal with telling people individually. I am barely holding my mind together. I took Alec back Sunday night to have his blood levels checked and they were stable and even a little higher than after surgery, which is good. I am just hoping he does not bleed again (I am giving him a Chinese herb that is supposed to help stop bleeding - recommended by the oncologist) and that he stays stable long enough to start some kind of treatment so we can have some time together.

8 comments:

Deb said...

My heart breaks. *hugs*

Reagan said...

Oh, Nicole.

Perhaps those test results were to give you blissful, worry-free days together.

I know it's so hard, but your doggie-mama instincts are second to none: trust yourself.

Sweet kisses to Alec.

cara h said...

i love you both very much. i know it's no comfort, but i am weeping here for you both. love to you. if there is anything i can do, please let me know.

kelly g. said...

I'm so sorry, Nicole. So, so sorry.

Don't beat yourself up; you've been a wonderful guardian to Alec, as I'm sure you'll continue to be. You couldn't have known.

And - while it's a small comfort - at least the last month with Alec has been a happy one. Just keep loving on him like you have been; there will be plenty of time for regrets and "what ifs" later.

{{hugs}} to you both.

Maggie said...

I am struggling for words, I am shocked and sad. This is so unfair. It is ok if you fall apart, I would. Sweet Ali and you do not deserve any of this. I am so sorry.

Sharon Discorfano said...

Sending love and light across the miles to you and Alec.

Anonymous said...

Oh Nicole. I am so very sorry. Give that Alec-boy a big hug from me. We are all sending thoughts of comfort and peace to you both during this time of crisis. Don't hesitate to call if there is anything we can do to help.

-Stephan

April said...

Oh, Nicole. My heart hurts. I am so very sorry. Sending you and Ali all of my love and healing thoughts. Be kind to yourself, as you are an amazing guardian to Ali. The best. Your love for each other is inspiring and beautiful. I love you both so much.