Vigil

I cannot believe I am writing these words. Alec and I are nearing the end of our time together. Incredibly, unbelievably, tragically, I am saying good-bye to my partner, my best friend, the love of my life: Alec. How can I? Well, I don’t have a choice. My wishes have gone unfulfilled. Our miracle didn’t come.

At the end of my last post, I mentioned Alec’s cancer had come back. Two weeks ago, he had another bleed and the ultrasound showed the cancer had spread through his liver. We immediately tried a new chemo protocol and a little more than one week later, this past Monday, he started feeling badly again, lethargic and intermittently nauseous. I wasn’t sure if it was a reaction to the chemo, perhaps an infection due to lowered white blood count, or the cancer coming back. I fervently hoped for the former and that the antibiotic would help. It did not. Late Thursday night our wonderful vet came over to see him and although she did not see immediate evidence of bleeding (which was our first concern), while she was examining him he gave a little growl when she touched his tummy, which surprised us both. Upon further, very gentle, examination, she found a large mass in his abdomen. Not a bleed but a new tumor - she estimated it was the size of a round watermelon - which means the end of the road.

She said it is pressing against his tummy which is why he was nauseous and the tumor is secreting hormones that are making him feel weak and maybe like he has the flu. Also the fact that his abdomen is painful made him not want to move much. Although she said she didn’t think the pain was too bad because his heart rate was so regular, that made me feel terrible because I could not tell he was in pain. I know dogs are good at hiding this, but still…ugh. I had some tramadol (painkiller) on hand from his surgeries and we gave him those right away along with a stronger anti-nausea medication, which seemed to make him feel better and he drifted off while we talked about options, or rather lack thereof.

A third surgery is not an option (we can’t remove his liver like we did his spleen), nor is more chemotherapy. The cancer already resisted the first protocol, and now has come back despite using a second “rescue protocol” with a new drug. If you know anything about cancer – and I am happy for you if you don’t – the cancer cells come back stronger every time. He is not going to get better from this. It is hospice now, meaning I make him as comfortable as possible until the time comes, which can be anytime. It will be soon. Of course, I will help him with his transition if need be (although my fervent last wish is that he painlessly and peacefully drift off…don’t we all wish that; don’t worry, I know it rarely happens that way), but I want it to be done at home. He does not want to move and the thought of trying to get him to the emergency hospital where he has not had happy times, with doctors he doesn’t know, and all those horrible fluorescent lights…that is not where I want it to happen.

I tried to make a plan a few weeks ago, just so I was prepared, and both his vets agreed to be on call after hours should I need them. But as bad luck would have it, they are both out of town this weekend. His oncologist is also out of town. His vet gave me the numbers of two mobile vets who do home euthanasia, but one of them is out of the country on a family emergency and the other is especially busy this weekend and can’t promise anything. I am hoping he stays stable until Sunday (or longer) when his vet, whom I love, is back. But I need to be prepared for anything. If his condition worsens I will not let him linger. There is another wonderful vet filling in for my two regular vets this weekend and she gave me her number and said I could call if I need her. I hope I don’t have to call before tomorrow, but thank goodness I have an option. Although she did say her car is in the shop so it could be tricky for her to get here. What is up with this weekend?? Even my closest friend in Portland left town a couple days ago. Can you say ALONE? I don’t mind being alone with Alec. This is the purpose of these last few hours, minutes, days, however long we have left together. But the scary part is everyone on our veterinary support team being gone at once. Hopefully he will stay stable until at least tomorrow. After everything, I can’t believe this is good-bye.

Alec has a big kennel with a bed and pillows called his “little house,” which is his safe spot where he loves to rest. This is where he has been hanging out. He is eating some snacks here and there but is not much interested in food (believe me, I have tried everything), he is drinking lots of water, and sleeping and dreaming intermittently. He is not flat-out or anything. He sits up occasionally and when I leave his side he turns his head and follows me around the room with his eyes, which are bright and alert. I am camped out next to him as I type this. He is napping. I have been alternately journaling and crying into his fur (I gave up the trying to act positive stuff) and telling him how much I love him and how being with him has been a dream come true and how sorry I am I can’t fix this. I have thanked him for making my life so good these last seven years. I have let him know I have never loved anything or anyone the way that I love him. I have been saying a lot of things. I also smile and laugh. There has been some music and singing. It is not all dirge-like. He is still smiling at me, too.

But the end is near. And as my vet put it Friday morning, I am holding vigil at his death bed. There is nothing beautiful about this. I want so badly to wrench meaning out of it, but it is nothing but sadness. It hurts so much. There aren’t words to describe the awfulness of my heart breaking, of the air slowly being sucked out of the world. No, it’s not my heart breaking…it’s ME breaking. I can’t think too deeply about what is happening beyond the immediate or I will go crazy.

I know I did my best, but nothing helped. The oncologist told me she was seeing remissions of 2-3 months to a year with this chemo protocol, in dogs with Alec’s cancer who were sicker than he was when they started. How I hoped Alec would be at the long end of the average remission! How I hoped the fact that it took so long to find it (43 sections!) meant something optimistic. The news of the cancer, of the multiple false biopsies, was crushing, but still I kept relentlessly hoping for the best. It seemed too unfair after everything Alec had been through. And here he barely made it to the lowest point in the range: 2 months. I have tried to keep positive, but knowing I lost 1.5 months of treatment time because of the false “benign hematoma” results just hurts so badly, even though I know there was nothing I could have done. Two additional benign biopsies followed. The cancer was hiding. It seems this cancer was determined to take him.

This all feels so familiar. Caring for Alec and tending to him. He is even wearing his Walkabout Harness again to help me get him outside, just like when he was paralyzed and recovering from his spinal surgeries. He is a good and sweet patient. I know this from before when I monitored him so closely for depression when he was on crate/bed rest for 6 weeks. I was amazed how well he adapted. But this time he will not get better. My love for him is so deep. I would bargain away anything to keep him here with me, anything, if only someone would take it. I feel so fiercely protective of him, as I know he protects me. It sucks to be so helpless, to be unable to keep him safe. Someone said that the hardest part of loving someone is being unable to prevent their suffering. Not that Alec is suffering – I would not willingly let that happen. The person relaying this quote (a psychiatrist and author who was paralyzed in a car accident many years ago) was talking about how his quadriplegia was harder on his mother than it was on him. I can understand that completely. Indeed, pure love could not exist without the potential for the most unfathomable pain. I guess that’s what the rose and thorn metaphor is all about.

I regret that I didn’t take him swimming the week before last on the oncologist’s instructions. She said there was too much of a risk of infection given the chemo treatment he had just had (potential bacteria in the water). If I had known what the next week would bring, I would have taken him. The indoor pool where Alec always loved to swim just reopened after being closed for renovations the last couple weeks, and I regret Alec will not get to swim in the new and improved pool. But I was told with his immune system compromised he could easily get an infection and become septic, which would be bad. I tried to make the right decisions. I still had my faith in the new chemo protocol at this point, and we only had to wait a week. I didn’t know that week was all we would have.

I also regret that I had to keep Alec from playing his favorite games “stick” and fetch, after his back injury, and that I had to keep him from rough housing with other dogs. But I did this for his protection, on the recommendation of several veterinarians and rehab therapists (I got fourth and fifth opinions on that). I really tried to make up for it by taking him swimming all the time, which I thought was a good compromise because he could chase the ball in the water, and taking him to special places and new parks on a regular basis. After he was paralyzed, I vowed never to dwell on the things he couldn’t do. I said I would only focus on the positive - all the things he could still do - and that I would make the most of those. He wasn’t even supposed to be walking, and I tried never to lose sight of that or let anyone feel sorry for him. When people would see him limping along with his little shoe and say “awww, poor dog” I would always say “actually, he is doing great!”

But now that the end is here I can’t help but mourn the fact that this poor dog has been through so goddamn much, only to have this cancer cruelly snatch him away, just when I thought things were calming down for us. He had been walking for only a year, but he was doing so well and I looked forward to many uneventful years ahead where Alec could relax and turn into a wise, old, gray, OLD shepherd, by my side, enjoying his much deserved golden years in comfort and security, surrounded with love and quiet reflection (by me) on a beautiful life well-lived. This cancer wasn’t part of the plan. I don’t care about me. I would do anything, make any sacrifice or life change, for him, but it hurts so badly to see his life cut short after all the adversity he amazingly overcame just a short time ago. With tears in my eyes, I say: it is unfair!! He deserved more. My sweet shepherd deserved a break. But we didn’t get it. Why?? Again, how badly I want to wrest meaning from this. And I know our story is not unique; we are not the only ones to go through this, or worse. This is the human condition. But I don't care. This is our story and it sucks.

Besides those, I don’t have any regrets. Alec became the center of my world when my first dog Kobi died almost exactly four years ago and it was just the two of us. Our relationship further intensified after he became paralyzed and I nursed him back to health and, eventually, mobility. There is nothing like that experience to strengthen an existing bond. And because he was still disabled, I had to pay attention to things I never did before, which further brought him to the center of my day-to-day experiences, thoughts, emotions, and plans. When Alec was in the hospital in Feb 2008, I thought he might die. When he didn’t, a simple truth came rocketing home. Something I had known abstractly now took on immediacy and became very concrete: every day is precious. And I never forgot that.

The result being the last two plus years I have known exactly how lucky I was, not in the back of my mind, but in the forefront of my consciousness. So when Alec got cancer and people would tell me to cherish every moment, all I could say was, “I have already been doing that!” Honestly. I knew what I had and gave thanks for it every day. For all intents and purposes, I structured my life around Alec. And I am glad about that, after all. I recognized - and celebrated - the profound joy and contentment I felt when spending time with him doing the most mundane things. I don’t think I could have spent much more time with him, or put his happiness more front and center (seeing him happy brought me so much joy that it was a route to my own happiness as well). So there is that. But imagine the void that is going to leave. I can’t. I am having serious trouble seeing my life without him in it. That is one big presence. As one of his vets said, "Alec is larger than life," and I could not agree more when it comes to his place in my world. All I know is everything is going to change. Just everything. He has become such a big part of me. I scarcely know myself without him anymore.

Awhile ago, before I knew Alec was sick, I was dancing with my friend Mike at a club. The song “Just like Heaven” by the Cure came on and for some inexplicable reason I thought of Alec and started crying. Yes, I had been drinking but I don’t tend to burst into tears every time I drink or anything. I cried again as I told Mike on the cab ride home what happened. Even though he is the only person I know who is as obsessed with his dog as I am with Alec, he made fun of me…as well he should have. I was being crazy. He didn't understand why I was crying and I tried to explain it was just because I loved Alec so much and I didn’t know what I would do if anything happened to him. It was this overwhelming emotion. I laughed while I was crying, knowing I was being silly. That was only a few months ago.

Here is something I scrawled in my notebook, again before Alec was sick:

blissful days
quiet nights
never wrote much before
when I was happy
never felt moved
to capture the moments
to carry the feeling with me
always
you have changed all that
you
changed everything

everything
and always a little more
the narrative never stops
it keeps pushing forward like a train and
downward like the rain
sinking into my bones
radiating out through my skin
this “we” I am in

backward like an old refrain
I try to hold onto where we’ve been
before and ever now
upward into speechlessness
and the disorientation of being found
you are my sense of time, of place, of weight
my clock, my map, my scale
you are my reason.

I would not normally share the random scribblings from my notebook with anyone, but I wanted to convey what I felt, even then, when I thought things were fine. That Alec was my anchor… my purpose. I feel that when he leaves I could just fly off into the ether. Even for someone as verbose as me, it is hard to explain. It feels like losing home.

I will close this by again saying I am grateful I cherished every moment with Alec these last few years, and I’m glad I have the scribblings to prove it, like this from two years ago:

I miss you
even when you’re right next to me
in the next room (our room)
but I’m in the bathroom
thinking about random things
and then it hits me
how much I love you!
and I suddenly, achingly
miss you – rush to your side
even though you’re right here.

In cherishing Alec I also feared I would lose him, as this is the flip side of gratitude. Gratitude exists because we know we are lucky to have something – the awareness that it could be taken away. So we try not to take for granted, but we can’t be obsessed with loss either. I tried to straddle that line but truthfully after Kobi died (my first experience with grief), I was always afraid of losing Alec, even more so after he became disabled. And it has occurred to me that my fears brought this on somehow, but I know that for every thought I had that said “What would I do without you?” I had twenty more that said “We will be together for a long, long time!” If my thoughts were so powerful as to change reality, my world would look very different right now, and Alec and I would have many more years left together, many more experiences, many more chapters to write.

But the reality is we are out of options, and all of my high hopes have dwindled to this last one: the hope for a good death. Oh, and hope for an afterlife, which I have never held much truck with before but the impossibility of me being without Alec has driven me to seriously explore this. I refuse to believe our bond can be broken. And so I won’t believe it. I am going to turn into one of those woo-woo types when he leaves me, because I have to turn into something. Who am I without Alec? This dog has been the absolute center of my world and I mean that in a really, really good way. Although I used to scoff at them, I am starting to understand people who turn to spirituality and the supernatural in times like these. The mind rails against accepting the unthinkable separation. The afterlife is too appealing. Until someone disproves it, I think I am on board.

Soon I will hug Alec for the last time. Soon the color will drain out of my world. Soon I will change forever. And I will try to keep going without him. But I am not making any promises. I love Alec desperately with every fiber of my being. He is the best thing that ever happened to me. The times I have spent with him have been the happiest of my life, hands down. He is my joy, my light, my happiness. He is my amazing shepherd, but we couldn't beat this. Alec, I am so sorry I couldn’t make you better. How can I say good-bye? I don't know how to end this. There is no good way to end this. Oh please, I don't want to end this.


We had a picnic at Mt. Tabor Park last weekend. I shared my vegan "steak n cheese" sub with Alec. He also had some kibbles and lots of treats.


It was a happy day.

These lines on my face are new. I'm surprised my hair hasn't turned white yet.

My sweet shepherd boy.

Outside our apartment, just last week. The thousand watt smile that lights up my life.

The little house.

Keeping watch on the stoop.

Hydro Power!

I uploaded some videos of Alec swimming in the indoor pool last weekend. Because of his disability, water is the ideal medium for Alec to play and exercise. Despite his activity restrictions on land, he can still enjoy his favorite game – fetch! – in the warm water at Paws Aquatics Canine Swim Center. During our weekly sessions at Paws Aquatics, I go in the pool with Alec and throw the ball for about 45 minutes. Recently I noticed he also likes to tread water and swim gentle laps with me. If I start doggie paddling across the pool he will follow or swim next to me while holding his ball. Very cute! My favorite part in the first video is at 2:42 when I go underwater and he looks around for me. I didn't know he did that until I saw it on the video. :)






I also take Ali swimming in the rivers around Portland. They are great in the summer but get very cold in the winter, so during the cold months the indoor pool is an ideal substitute. Now that the weather has finally warmed up here, I have been taking him swimming in rivers again. Sometimes lately he has been sluggish and not very interested in walking around the neighborhood, but he always perks up when I bring him to water! These two photos are from a recent excursion to one of our regular swimming haunts at George Rogers Park, south of Portland:

"I love my ball. It's so great!"

"Throw it!"

Alec has a very interesting relationship with water. When I adopted him seven years ago, he did not like it. Not long after he came to live with me in Georgia, we were on a hike and passed a small waterfall and Alec began biting and barking at the swirling water in the pool at the bottom. This was the first time I noticed something strange. I had tried to encourage him to swim but he was not interested, until one day I placed his ball just a foot or two into a gentle creek. His desire for his ball overcame his apprehension about the water, and he waded in. Ever since then, Alec has liked to swim, but he still barks at moving water. He becomes very agitated in the presence of waves (river or ocean); he will growl and grumble at them and sometimes bark using his high pitched “woof!” as he paces back and forth biting at the water in his adorable and strange way.

I took Alec to the coast a couple weeks ago on Father's Day and he had a good time patrolling the beach and playing in the waves (he does not swim in the ocean, just splashes around):

Here are some more photos from our trip to Cannon Beach.

I learned the hard way that Alec’s obsession with water means I have to keep him close anytime we are near it – especially if there are waves. Alec is a natural “heeler,” and when we are away from traffic and other dogs I often take him off his leash because he never goes far and never, ever runs away from me. Of course there are always exceptions, which is why I am such an advocate of dogs being leashed most of the time! However, at the risk of sounding like the most incompetent dog guardian ever, I will relay this harrowing tale:

One morning when we were living in San Francisco, I walked with Ali out to the Sutro Baths (ruins of an old public bath house right on the beach), where there is a lovely little promontory that overlooks the ocean. It was very early in the morning, and when we rounded the corner and I saw no one else was out there, I unsnapped Ali's leash. To my surprise and horror, he ran straight for the 4 ft. wall encircling the overlook, and, without hesitating, scrambled up and over this wall while I was still shouting his name. Miraculously he landed on a ledge halfway between the top of the cliff and the rocks below, but he was stranded there because the rock face was too vertical for him to climb up or down without falling. And I could not get to him. To make a long story short, Alec was rescued by the wonderful San Francisco Fire Department that morning (with only a small scrape on his paw) and I never made that mistake again! Alec had never done anything like this before and I realized afterward what prompted him to leap the wall; he heard the ocean waves and mistakenly thought the beach was right on the other side of the wall, rather than a story or two down. A close call that still makes me shudder!

The cliff. Not only the fire department, but also cliff and coastal rescue and animal control showed up.

That is my grubby hand in the frame. I talked to Alec the whole time so he would stay calm and still. It was a long time before the fire department (about eight members!) showed up and even longer before they got their climbing equipment set up. Alec was such a good boy. When one of the firefighters asked me if Alec would bite his rescuer, I said honestly I didn't know what he would do in this situation, considering he was stressed and scared. But to my great relief, when the firefighter landed on the ledge and grabbed hold of Ali's collar, he immediately started licking her face.

Once she got the climbing harness attached to Alec, she rappelled to the bottom holding him against her body. My hero! The firefighters were so sweet and told me how much they loved their own dogs as I thanked them over and over. As Alec and I walked back home, I was shaking from the aftereffects of my panic-fueled adrenaline rush. Alec, on the other hand, was completely unfazed and the first thing he did was grab a stick to play with!

I will wrap up with a general plug for hydrotherapy (not defined as jumping off a cliff into the ocean!). Although I swim Alec now mainly for fun and exercise, I cannot overemphasize the importance of water to his recovery from paralysis (not just free swimming, but the underwater treadmill too). Swimming is not only great rehabilitation for dogs with neurological conditions like disc disease, but it is also helpful for many other common ailments like arthritis, hip dysplasia, degenerative myelopathy, or even recovery following injuries. For this reason, if your dog is not a natural born “water dog,” you might want to get her used to the water now before she has a problem that could benefit from hydrotherapy.

It obviously helps if your dog likes the water and is motivated to chase a ball other toy. However, even if your dog does not like the water now, this could change with positive reinforcement and the right motivation. As I mentioned, when I adopted Alec he would not go near the water, but he was so toy-motivated that I was able to coax him in one day using his ball as bait, and from that day on he loved to swim. So you never know! I thanked my lucky stars many times during Alec's rehabilitation that he liked the water so much. Because swimming can be therapeutic for so many conditions – in addition to providing an important physical and psychological outlet for dogs with mobility restrictions – I think it would not be a bad idea for every guardian to help their dog get comfortable with water while they are healthy, just in case. Again, you never know.

If you are considering swimming with a mobility-challenged companion, please use caution. Before we had the indoor pool option, I started out swimming Alec in various rivers. Alec is a very smooth swimmer and I was always careful to keep him submerged in the water as much as possible so that he was mostly treading water, rather than coming in and out, which would have caused more stress on his joints (I was always hip deep in the water in the beginning, now I usually only wade in up to my knees). If your dog gets wild in the water or is not a smooth swimmer, this is probably not the best activity for him if he is recovering from a back injury. If you can get him to walk in the water along the river’s edge that would be okay, but free swimming would not be a good option for a dog who may thrash or be rambunctious. Just use your judgment and talk to your dog’s physical therapist if you have one. I can only say what it seemed to do for Ali. Also, never put your disabled dog in the water without a life vest.


Until very recently, I always had Ali wear his "float coat" (Ruff Wear makes a good one, modeled by Ali here) when in the river as a safety precaution, just in case. And if you are trying to get your dog in a pond, lake, or river for the first time, enter the water with him and hold onto the life vest until you are absolutely sure of his ability. It was a long time before I was comfortable standing on the shore tossing the ball for Alec.

Ready to swim!

I did not talk about the underwater treadmill in this post because I have discussed it elsewhere, but that is another excellent option and one that Alec grew to love so much it was hard getting him out of the tank at the end of his sessions!

Alec in mid-squeak with his favorite underwater treadmill toy - the loudest one of course!

Post Script: This is the post I wanted to share this week, so I did. However, I had some bad news yesterday. Alec's cancer has come back. I don't want to write about that right now, but I will post another update soon. I wanted to get this happy post up now before I become too sad to look through pictures, etc. And I wanted to post it before I pick him up from the clinic, where he is getting an emergency chemo treatment, a different combination of drugs, in a last ditch effort to hold the cancer off a little longer. He has been there all day, and I don't want to spend much time on the computer when he comes home. Our time has palpably dwindled, my high hopes for a long remission seemingly swirling down the drain. This blog represents some of the most challenging times in my life but also the most rewarding. It has been, and remains, a labor of love.

Me and Alec in Animal Wellness Magazine

I wrote an article for the June/July issue of Animal Wellness magazine about doggie wheelchairs, titled, "Freedom Regained: Canine Carts and Wheelchairs Get Disabled Dogs Moving Again" (pp. 74-5). Unfortunately, it's not available online so I can't post a link, but I picked up a couple copies of the magazine at Powell's Books here in Portland; Barnes and Noble also carries it. Check it out if you happen to see a copy in your local bookstore!

It is a short piece (they only gave me 800 words, and you know I could say a lot more on this topic!), but I hope someone will see it and feel hope for their mobility-compromised canine companion. Knowing as much as I do about canine carts now, it is easy to forget that when Alec first became paralyzed two years ago, I didn't even know if big dogs could use them. So I am glad Animal Wellness decided to cover this important issue.

Alec Update: Alec had his blood rechecked on Friday and the white blood cell count was significantly down, which is good. The oncologist believes the spike was due to a reaction between the chemo drugs and one of the herbs, so we are reintroducing them slowly. Live and learn! The weird thing is the holistic vet has never seen this reaction in any of his patients. Then again, Alec is special... this would not be the first time he did not respond as expected!

Crash Course: Caring for the Canine Cancer Patient 101

Pictures can be more fun than words, so let's start (and end) with them! Some scenes from Alec's adventures during the last few weeks:

Happy hour outside the Victory Bar on SE Division St, 8 blocks from our house. There was a pug a few tables away and Alec only barked a few times! It helped that I brought lots of cookies with which to distract/bribe him...

Taqueria Los Gorditos, my favorite neighborhood taco truck. Since I am not up to cooking these days (at least not for myself) it has been burritos almost every day.

Sharing a tofu burrito...

...outside the Portland opera house on the east bank of the Willamette River.

Strolling along the east bank esplanade with the Hawthorne Bridge - one of downtown Portland's eight bridges - in the background.



Playing in the Columbia River at Sauvie Island last weekend; our heads are conveniently blocking the naked people behind us on the beach! The "clothing optional" beach is the only one that is accessible for Ali; the regular beach has stairs.

Sociable Alec hanging with the neighbors outside our row of connected apartments, which are converted army barracks originally built in the 1940's.

The upside of staying home all the time is I have gotten to know my awesome neighbors a lot better! And the sheriff likes to be part of a pack (more people to protect).

On the stoop with Uncle Mike.

Since Alec's spinal injury two years ago, I have taken him swimming on a regular basis for fun and exercise. We had to take some time off after his recent surgeries, but two weeks ago he was back in the pool...


...and loving every minute of it!

This winter we began swimming once a week at Paws Aquatics Canine Swim Center, a wonderful indoor pool facility south of Portland. The proprietor, Diane, has been very supportive of me and Alec. We love her! If you live in Portland, you should take your dog here.

Alec is a very strong, smooth swimmer. He never seems to get tired of chasing the ball or swimming gentle laps with me. When we are done, I shampoo him in the bathroom off the pool.

Thank you to everyone who has phoned, emailed, or left comments asking for updates about Alec. I meant to post sooner, but these last few weeks I have been in full research mode, consulting every source I can get my hands to educate myself as much as possible about Alec’s cancer (hemangiosarcoma) and available potential treatments (to prolong his quality of life; the cancer is incurable). The first days after learning of his diagnosis, especially after three (!) benign biopsy results, I could not help being devastated. I could barely talk to anyone, and I found myself sinking into despair. As a tidal wave of unreality washed over me, my primary emotion was the shaky feeling that I might simply "lose it." But then I realized I could not do that, not yet. Alec was still here with me, and he needed me to focus. So for his sake, I gathered all of my energy and resolve and began to deal with the situation as best I could.

This meant, first, maintaining a positive and happy attitude around Alec (no blubbering or hysterics! The last thing he needs is to worry about me, right?), which for the most part I have done successfully, with one notable exception this week (more on that later), and second, assembling a team of veterinary experts while also (and just as importantly, I think), educating myself so I would be in a position to make the best decisions for Alec moving forward. Sounds sensible, doesn't it? Well, let me tell you, this latter has proved to be no simple feat! Unless you have been through this, you might be surprised at the amount of confusing and contradictory information that exists about cancer treatments – even the veterinarians don’t agree with each other. This has left me in a position where I have had to make a lot of big decisions by myself, a daunting proposition considering I was basically starting from scratch in terms of my knowledge base. Of course, I knew that I would be the “leader” of Alec’s veterinary team and that all decisions ultimately fall to me. But I didn’t realize there was such a lack of consensus (to put it mildly!) about optimal treatments for canine cancer not only between holistic and conventional realms, but also within these two distinct spheres. Trying to distill and make sense of all of this information - while also attempting to critically evaluate each source - has set my head spinning repeatedly during the last few weeks.

Let me give just a couple examples. The controversy over antioxidants and chemotherapy is probably the most well-known. It is the same in human medicine, by the way (unsurprisingly, as canine cancer treatments “trickle down” from methods used to treat people). Alec’s oncologist told me to not give him antioxidants while he was undergoing chemotherapy because they interfere with the cancer-killing properties of the chemo medication. However, many holistic vets say that antioxidants not only don’t interfere with chemotherapy, but may increase its effectiveness or at least help mitigate potential side effects. I consulted as many sources as I could find and there is absolutely no consensus on what would seem like a straightforward issue: antioxidants during chemo – good or bad? From what I can tell, the latest evidence seems to indicate that antioxidants are not harmful during chemo…but what do I know??

I was willing to keep him off antioxidants at the oncologist's recommendation, but when I asked her which of the ten supplements the holistic vet had prescribed for Ali counted (many are blends of several different ingredients), she never gave me a straight answer. After inviting me to email her with questions she simply stopped answering the ones about supplements. I think it might be that she is just not that familiar with them. Most have not been through the holy grail of western medicine, controlled double blind studies, due to cost and lack of funding from big pharmaceutical companies (at least this is my understanding). And veterinarians (and doctors) trained in conventional medicine tend to be skeptical or downright dismissive of anything that has not been subjected to a controlled double blind study. Don't get me wrong. Although I am open to it, I would not characterize myself as a devotee of naturopathic medicine. I had done some reading on the subject and recently developed an interest in "alternative" treatments, but the whole field is very new to me; in fact this is the first time I had ever consulted a holistic vet (except for acupuncture when Ali was paralyzed). As I mentioned, my intent was to eschew neither methodology, but rather to combine the best insights from both. Easier said than done! Anyway, regarding my antioxidant confusion, after consulting the holistic vet who had prescribed them and conveying my concerns - he said none of the antioxidant levels were high enough to interfere with chemo - I decided to keep Alec on most of them.

Another example is when I showed the oncologist the supplements the holistic vet had prescribed for Ali. She scoffed at an ingredient in one of them, saying, “This bypasses the stomach and does not even get absorbed!” I called the holistic vet and told him what she had said. His response? “That’s absurd! It’s just not true.” The oncologist made a few other disparaging remarks about some of the supplements. When I relayed these to the holistic vet, he did not agree (nor would I have expected him to, since he had prescribed them). So it falls to me to figure out who is correct. Yikes.

My hope had been that Alec's oncologist and holistic veterinarian would work together in complementary harmony. According to my reading, this can and does happen! But it was not happening with these two, so I pressed onward to Plan B. The oncologist had mentioned another holistic vet with whom she had worked and of whom she spoke highly, whereas my first holistic vet and she did not know each other. So I made an appointment with holistic vet #2 for a second opinion, hoping she would be the tie-breaker, so to speak, and forge a nice bridge with the oncologist. The oncologist said she looked forward to hearing holistic vet #2’s recommendations regarding supplements. I was excited as visions of an integrated team effort once again danced in my head, and I couldn’t wait for my appointment. I showed up with all of the supplements that holistic vet #1 had prescribed for Alec. I also brought a list of other supplements that are supposed to be effective at killing cancer cells or preventing metastasis, which I had compiled during my reading, to get her opinion on those.

Although I liked holistic vet #2 personally, I was disappointed to find she had not heard of many of the supplements holistic vet # 1 had prescribed – yet she thought Alec was taking too much and that I should remove some of them. Nor was she familiar with many of the supplements on the list I had brought. When I asked the antioxidant question – which, if any, of the supplements might pose a risk – she deferred to the oncologist! I said, “She told me to ask you!” Jeez. Frustration…to the tune of another $150 exam/consultation fee (not that this amounts to a drop in the bucket of what I have spent – also not that I am complaining). And I left that appointment with more questions than I had going in.

The fact that she was not familiar with many of the supplements Alec was taking did not inspire me to follow her recommendation to take him off some of them. If she had a good reason, I would have definitely considered it. But “I think he is taking too much” alone did not strike me as a valid reason. When dealing with an aggressive, malignant, incurable cancer, I think you want to throw everything at it you can – as long as the supplements are not doing harm or interfering with each other or the chemo, of course. And it goes without saying your dog has to be willing to take them, with food or whatever, and because quality of life is the most important factor always, there should be minimal to no stress associated with giving them…but that is a whole different subject (and another big challenge if your dog is like Ali and lacks the indiscriminate appetite of a hoover vacuum; getting supplements in those voracious dogs is easy!).

Along these lines, holistic vet #2 also suggested only adding one herb/supplement every two weeks so we could monitor each for potential side effects. When I asked how we would know if any side effects were due to the herb or the chemo, she said there was no way to know for sure. So why stagger? And every two weeks there is a recheck exam to the tune of $45- $65 (this is not a lot of money compared to what I am spending, but I was also not happy with the exam...however, I will resist the urge to go off on that particular tangent). I don’t think this was some money-making scheme; I am sure she believes in the slow, staggered method of introducing herbs and supplements, but all things considered (including Alec’s particular form of cancer and everything I gleaned from my reading), I preferred holistic vet #1’s more aggressive approach, plus he just seemed more knowledgeable.

My next step was to call holistic vet #1 and ask him about that list of other supplements I had compiled from my research. I didn’t want him to think I was questioning his methods; I was just curious for his feedback (and these supplements should always be given under the supervision of a veterinarian so I would need to work with him, or someone else). He was familiar with some on my list but thought they were not as effective as those he had prescribed, and others he was not as familiar with. He was open to adding these to Alec’s regimen, however, if I wanted to. I liked his non-rigid attitude and willingness to add things that I might have read about on my own, whereas holistic vet #2 just thought Alec was taking too much without giving me any basis in fact. By the way, in case you are wondering if the supplements are expensive…they are. The total cost of what Alec was prescribed by holistic vet #1 is about $1,300 for one month (cue jaw drop – I cannot think about that, just hoping my credit cards will not max out; the chemo costs even more than this per month). I know they are not gouging because they charge exactly what the manufacturer does for the supplements and do not mark them up. Nevertheless, definitely not small change.

Another area of confusion is diet and nutrition, but I am not even going to touch that one. Of the three vets I asked about diet, all three had different recommendations! You may know that most experts recommend a diet higher in protein and fat and lower in carbohydrates for dogs living with cancer (people too, I think). Well, there is tremendous variation within that – commercial or homemade, raw or cooked, different ingredients and mathematical equations – and there is no consensus on what is best (have you noticed a theme yet??). I have tried to make the best decisions I could after weighing all the conflicting opinions and contrasting them with everything I have read, but it is a lot of pressure and fraught with uncertainty. I know much of this disease is out of my control. However, I don't want to make a mistake with those precious few things that are within my control (i.e. nutrition, immune support, medication, etc.). I also know whatever I do may not matter. But I have to try.

Disclaimer: It is definitely NOT my intent to impugn the character or professionalism of any of these veterinarians! I know they are advising me to the best of their ability. My aim is merely to show it can be a challenge to make sense of conflicting recommendations, that's all.

So this last month I have been muddling through what feels like a crash course in caring for the canine cancer patient. The reason it’s a “crash course” is because with a highly metastatic cancer time is of the essence, and I wasn’t prepared. Is anyone ever prepared for this? If anyone would be it should have been me, but I had only been reading books on general canine health and wellness. I thought Alec was perfectly healthy and that I was doing my best to maintain and improve his condition and well being. I had him examined regularly. I fed him healthful foods. I continued to follow a physical therapy regimen. Because of everything he has been through, I was vigilant. I was observant. I was slightly obsessed. But I had not gotten to the point of reading books about different types of cancer in my spare time. I wish I had. I might have seen this coming. After all, hemangiosarcoma is common in German shepherds. Yet I had never heard of it. I always called Alec’s vet at the first sign of anything unusual, but this cancer, like many others, shows no symptoms until it is already fairly advanced. Alec looked and acted healthy, energetic, and vigorous. There were no signs…until that first bleed. Well, there was one sign in retrospect. He had lost about 3 pounds over the last couple months. But I had also switched him to a new diet during that time, to which I was adding fresh foods, and I thought I just had not gotten the proportions perfect yet. Although I tend to blame myself for everything, even I can understand why Alec losing a little weight did not raise alarm bells in the absence of any other clinical symptoms. And he just seemed so healthy, vibrant, and happy…shining eyes, radiant smile, and gleaming coat. Cancer sucks.

And there was that period of lost time, the month and a half following the (first of three!) false benign biopsy results. I don’t think I mentioned that the pathologist, when repeating the last biopsy at the oncologist’s behest, ended up testing 45 additional sections before he finally found cells consistent with hemangiosarcoma – and these were only found in two of the 45 sections. This made me feel slightly “better” about it being missed the first three times, but I had NO idea biopsies could be so unreliable. Take heed. You don’t want to end up like me, fiddling while Rome burns…or drinking champagne while cancer fucking metastasizes inside your beloved. Sorry for the bitter bomb. I try, but sometimes my positive veneer slips.

This has all been about me, but what about Alec? This is his fifth week of chemotherapy, and he seemed to be doing well...eating (even gaining weight), cheerful, active, and basically acting like his regular self. I started taking him swimming again after he had completely recovered from the last surgery, and he did not miss a beat! I was cautious during our first time back in the pool to make sure he did not tire too quickly, but he was raring to go (in fact, wanted to stay in the water longer!) and seemed just fine afterward. In the past couple weeks, we have been to the indoor pool twice, the underwater treadmill once, and this past weekend I took him for a swim in the Columbia River at Sauvie Island. Every day I try to bring him somewhere new in the car – a park or even just a new neighborhood to stroll around – to keep his spirits and sense of adventure up.

I have been spending more time with Alec than ever, if that is possible. He was not alone much before, but I would sometimes go out with friends, leaving him for a few hours. Or I would go the store and leave him at home. I stopped doing that. Now, I really only leave him for 35 minutes each day – the amount of time it takes me to jog my little neighborhood loop - and I have been taking him with me to run short errands because he likes to go for rides. Since it is basically still winter here in Oregon, it has not been too hot to leave him in the car, which is an upside to the unseasonably cool weather. Although I stopped going out socially unless I can bring Alec, we have been spending time with neighbors and friends on my stoop. When we sit outside, Alec is still the feisty “sheriff” (his very appropriate nickname) and continues to do his job with relish and aplomb, which means protecting me from all the neighborhood menaces, i.e. barking at passersby, especially those of the canine persuasion!

That is the update as of last weekend. But early last week he started acting “off.” I mentioned earlier the one notable exception to my attitude of deliberate cheerful positivity in Alec’s presence. It was a few nights ago. For the third evening in a row he began following me from room to room…acting funny. Last time he did this he was bleeding internally. He showed no other signs then, but I brought him to the hospital and they found the bleeding mass on his liver and performed the second emergency surgery. Mind you, there can be no more operations at this point; there is nothing more that can be accomplished through surgery. This “following” behavior, this acting strange, is the only thing I had noticed the last couple days, and each instance was for a relatively brief time, so briefly I thought (hoped) maybe I was imagining it. But then a few nights ago, he also didn’t want his dinner. I am worried. I am scared. He has been doing so well, but now I am terrified again. So I cried. I cried in front of him while he lay on the kitchen floor (where he never lays) looking up at me. We came into the bedroom and he fell asleep on the bed while I cried some more. Then I pulled this out, because I had been meaning to update. Because I am afraid I will lose my voice.

When dealing with a loved one's terminal illness it is amazing how your perspective shifts and shrinks to praying just for more time…a few months…please, a year. Before this happened, I prayed too, or whatever you want to call wishing and hoping. I would pray for Alec to live until he was 19 years old. I asked for that almost every day. Where did I get 19? Well, it is the longest I had ever heard of a German shepherd living. A few months after I moved to Portland I was walking Alec in his wheelie cart and some passersby mentioned their German shepherd lived to that age. I fixated on it, thinking it was wonderful that Alec could also perhaps live that long, even though it was far past the average life span. Why not, I thought? He has been through so much and I will be vigilant. I will do my best. I won’t miss anything. I will take care of him. I will keep him safe.

This is long and all over the place, but I will write more. I have a lot to say, and the truth is…I am afraid I will lose my voice if he leaves me. Anything I want to say, I figure I better say it now, while I still can. I’m not sure what will happen to me, where I will go, if he is gone. That’s the truth. It is raw and it is ugly and after my pledge to remain positive, I can only type it quietly, late at night while he is sleeping…still by my side, still here with me.

Please keep Alec in your thoughts. I started writing this a few days ago and his appetite is still off. I haven’t been able to give him most of his supplements because he is not interested in the foods I was hiding them in (they are too many to give by mouth; I have to open the capsules and sprinkle the powder in food he likes). I hope this is a reaction to the chemo and not a new bleed. I am worried but I am going to keep hoping for the best. It is all I can do. Thank you to everyone who has been thinking positive thoughts for Alec. It truly does mean a lot.

P.S. Update: Alec went in for chemotherapy yesterday and when they checked his blood work his white blood cell count was really elevated (too high or too low is not good). This is the exact opposite of what would be an expected side effect from the chemo drugs, which can cause bone marrow suppression resulting in a lowered white blood cell count. So this does not appear to be a reaction to chemo. The oncologist said this could be an infection, although she did not see signs of infection. However, she put him on an antibiotic to cover that base. The second thing it could be is a reaction to one of the herbs he is taking (boosting his immune system too much?), so she told me to stop those for a week. We will check his blood levels again next Friday. She said if he gets worse or stops eating, I will have to bring him in. I am so worried and really hope he feels better soon. He seems the same today - eating, but not as much as before, and slightly lethargic. Maybe I was wrong, after all, to follow holistic vet #1's advice and put him on so many things at once. Ugh! How can I know what the right decisions are? I am not an expert! And the supplements were all prescribed by a vet - it's not like I went out to the store or hopped on the internet and created a treatment plan myself (all the books caution against this!). Although I hope I did not do something wrong, at the same time I hope it is one of the supplements, because she did not have other theories about what could be causing this strange abnormality.

The barracks, the sheriff, and me...and the Portland sun making a rare appearance.

Love, love, love.

Alec sleeping on my shoe.

How cute is he? One of my favorite things in the world is to watch Alec sleeping soundly with his little eyes scrunched shut like that. Have I mentioned lately how much I love this dog?

First Chemo Treatment.

Yesterday, I got the confirmation I did not want. The oncologist consulted with the pathologist, who cut several more sections from Alec's liver biopsy and indeed - finally - found the suspected hemangiosarcoma. Stage III, because it has been found in multiple locations. It boggles my mind to think we received three benign biopsy results. Just a couple days ago, another doctor told me it was "good news." If only I knew biopsies were so unreliable, I could have demanded they retest the sample, especially the first one. If only, if only.

She wanted to get him in right away for his first chemo treatment, so I dropped Alec off at 8am this morning. His blood levels were good so they proceeded with the treatment, a new drug protocol with which she has been working and seeing results. The protocol is one dose of Vinorelbin a week for 3-4 weeks to start. She has seen survival times of between 2-3 months to a year. Big window there. I can only hope it is successful in extending his good quality of life as long as possible. This is a nasty cancer and the average survival time after diagnosis without medical treatment is mere weeks. Early detection of hemangiosarcoma is important, but early detection is difficult because clinical signs do not typically appear until the cancer has advanced. Throw some false biopsies into the mix and well, there you go...stage III hemangiosarcoma in a dog I thought was in perfect health.

The reason I am writing this without hysterically crying is I am exhausted. With Ali out of the house this morning, I found I did nothing but cry. It has been so hard. I do not want to cry in front of him (sometimes I can't help it, but usually I can stop myself quickly). With him gone this morning there was nothing to stop me and it was bleak. My friend Steve called in the middle of this and I cried to him for about 45 minutes. I had not talked to anyone but doctors in a couple days and it was nice to hear from someone, to cry to someone, to utter all the terrible thoughts going through my mind (although not nice for him - I know it is hard to witness a friend in so much pain). Yes, it is difficult to write about this, but I feel so alone right now, and writing here makes me feel some kind of connection because I know at least a few people are reading. And I know people care about Alec, even who have never met him, because we have received so much kindness and support on here in the past.

Now it's time to get Alec's dinner together, complete with 8 different powders, potions, and oils, and then snuggle with him while I read the second of the two books I picked up yesterday, both by Shawn Messonnier, DVM (I read one of his books previously and liked it: "8 Weeks to a Healthy Pet"). Last night I read "The Natural Vet's Guide to Preventing and Treating Cancer in Dogs." Dr. Messonnier is a holistic vet who practices integrative medicine, which combines conventional and complementary therapies to manage cancer. It is a good resource. The other book is "Unexpected Miracles: Hope and Holistic Healing for Pets." I could do with reading some hopeful stories right now, so that is on tonight's agenda.

Finally, in case you are not familiar with chemotherapy for dogs, they do not get sick like people do. This is because the doses used are much lower. The goal in animals is palliative not curative - in other words, not to cure the cancer but to manage it for as long as possible. Quality of life is the ultimate focus. There are occasional side effects (most commonly nausea or diarrhea) though these are usually only seen in 10% of dogs. Of course, quality of life has always been my number one priority with Alec...since the day I adopted him. I have tried so hard. Oops, here come the tears. Time to shut that thought down.

I have the diagnosis I didn't want, but now it's time to move forward and (say it with me) hope for the best.

Sweet shepherd in the doorway. That purple disc was filled with peanut butter (hence the towel).

Getting a ride from Uncle Mike last Sunday evening to get his blood levels checked (they were stable [phew!]).

My continued (and seemingly futile) attempts to get a decent picture of me and Ali by myself...I took this one yesterday using the self timer on my camera. I am hoping this weekend a photographer friend will come by and take some (good) pictures of us together.

In the lobby at the holistic vet earlier this week. Waiting patiently and quietly...until another dog came in!

The books I am reading.

Unexpected results...again (when "benign" doesn't mean benign).

A doctor from the ER hospital called yesterday afternoon with Alec's liver biopsy results. They did two biopsies; one of the nodule that was removed from his liver and one on a blood clot that was attached to the omentum (best I can understand, this is connective tissue that stores fat and is attached to the liver). She told me both test results were...benign. Before you get excited (as I cautiously did), during what I was hoping would be a superfluous consultation with the oncologist today (who specializes in this type of cancer) she said and I quote, "I don't believe the results." I knew last night I should not get too happy, but I admit I couldn't help feeling cautiously optimistic about this news. It seemed unlikely there would be three wrong benign reports and the ICU doctor I spoke with yesterday agreed that the "benign hematoma" result of last month was probably correct in light of the fact that these two news ones both came back as benign. Obviously it made me feel better to think the initial result a month and a half ago was not wrong.

So the ICU doctor told me this was good news but to keep my appt. today with the oncologist to discuss a monitoring plan for Alec's liver (monthly ultrasounds, etc.). When she walked in, the first thing I asked the oncologist (aka Dr. Killjoy) was whether she had seen the biopsy results. She replied, "Yes -and I don't believe them." As my face fell (definitely what I did not want to hear), she apologized repeatedly for "bursting my bubble," but said she has seen enough of these false benign results to not believe them. Damn. Has seen "enough of"... in other words, she has seen this multiple times. She also said it did not make sense for there to be another mass in his liver - benign hematomas do no act that way. They do not spread. She said it is very likely the biopsy missed the cancer. I had no idea that biopsies were so unreliable and none of the other doctors I spoke with made it sound like this was the case. However, the oncologist unfortunately has had a ton of experience with exactly this. She even spent a year of her residency training as a pathologist. She was confident and definitely had the experience and knowledge to back up her reasoning, whereas the doctor last night who conveyed the biopsy results simply said, "Alec is a little bit of a mystery." I wanted to cling to that of course (yes, Alec IS a mystery!), but the oncologist, unfortunately, did not find it so mysterious.

So, after we talked for about an hour, she said she wanted to speak to the pathologist (person who did the biopsies) directly about what he is seeing in the sample, and she also wanted to talk to the two surgeons about what exactly they observed during his surgeries. She talked to me about chemo and she really does seem to be an expert with this type of cancer (hemangiosarcoma - if it is that). She is actively researching and working with some new drug protocols and is in the process of publishing her findings, which is encouraging. If this is what it must be, she seems like an excellent person to work with, a real expert in the field. But she does not want to start giving him chemo drugs (of course nor would I!) until we know what we are dealing with and at this time that is still unclear. She said it could be a"low grade" hemangiosarcoma, which is why it is not showing up on the biopsy results. She said it could even be a different type of cancer. She also said basically it does not matter even if it was something "benign," because it is acting like a cancer, in other words spreading, and she does not like the nodules throughout his liver - especially if they weren't there at the time of his splenectomy (which, according to the surgeon, they weren't. She said his liver appeared healthy when they removed his spleen. But who knows? There was also a lot of blood from the ruptured mass.).

I definitely had a more positive outlook (briefly) last night after talking with the ICU doctor, who said they removed the entire liver nodule (I thought they only got part) and that it was pretty small (an inch). She said the little nodules throughout his liver were really small, the size of pencil erasers, and were not bleeding. She also said she did not expect them to bleed. This made me hopeful but again, this was not the oncologist's opinion. The oncologist is afraid they will bleed, that another mass will develop, etc. And we can't put him through another surgery. It is confusing talking to all these doctors. When the surgeon called during surgery Friday night, she made it sound a lot worse than the doctor who called yesterday (saying the little nodules were bleeding and they could not remove the entire mass, etc.). Of course, the surgeon was the one actually in there observing and the doctor who called yesterday was just reading the report. But didn't the surgeon make that report? It is confusing having seen a different doctor almost every time we have been to the ER hospital, but in a way that's good because I am getting different opinions and perspectives. Although it is confusing it gives me more pieces of information to try to fit together than if I were just hearing one person's opinion. Not that this makes my job any easier (it is so hard to evaluate this sometimes contradictory information), but I think it is probably best in the long run to have multiple input just to avoid the potential of dealing with only one person who may be wrong or incompetent or misinformed. Trying to put a positive spin on it, I guess.

Right now I am waiting for the oncologist to call back after talking with the pathologist and the surgeons. Then we will discuss options. As much as it hurts to know they are (or could be) wrong, I am glad there is someone there now to question these repeated benign results. I don't want to lose any more time. And knowing it could come back three times that way makes me feel slightly better about not pushing last month for them to repeat the test. Honestly, that did not even cross my mind at the time - I really believed the result - but you know how hindsight is.

Speaking of different perspectives, I took Alec to a holistic vet yesterday and he prescribed eight different herbs and supplements. I walked out of there with a small pharmacy; a month or so supply plus the office visit cost me a thousand dollars! But I was anxious to get anything that might help (as long as it will not harm) into Alec's system right away and, again, did not want to lose any more time. However, today during my consult with the oncologist, out of the eight herbs/supplements, she recommended only three. She is not opposed to using eastern medicine; she actually works in conjunction with a different holistic vet and seemed very knowledgeable about Chinese herbs and supplements. She said in fact many chemo drugs originated as herbs, which I did not know. Anyway, she had convincing reasons why this or that one would not be effective (based on research rather than anecdotal evidence) and she seemed trustworthy to me, mostly because she is not closed-minded on the whole subject and seemed to be current with the latest studies in both conventional and alternative medicine. So, too bad I bought all this expensive stuff! But I wanted Ali seen as soon as possible and the holistic vet appt. came open before the oncologist, whose first available slot was today.

Thank you for all the support. These last several days have been very difficult, as you can imagine, but I guess I am cautiously encouraged by the biopsy results...even if they are false, I hope it means the cancer is less developed than one that would readily show up. I know I am reaching, but what more do I have now?? If you can spare a positive thought, I am hoping and praying that Alec stays stable and that his insides are healing and healthy. Thank you so much. I believe in you, Ali!

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.