Today the staff at OSU Veterinary Teaching Hospital found a large tumor in the right ventricle of Marissa's heart. Hemangiosarcoma. It's a cancer of the lining of the blood vessels. Very aggressive, rapid growing. Bijou died, indirectly, from this type of cancer when the unknown tumor on her spleen ruptured causing massive bleeding into her abdomen.
But Bijou was almost 13, a dog large breed dog who had been tackling increasingly difficult, but anticipated, issues of aging for 2-3 years. It wasn't a total shock.
Just Sunday, Marissa was bouncing around the back yard as she does; very excitedly and athletically running from one side of the yard to the other to boldly protect our claim from the assortment of old men and women and their dogs that have walked past our house every day for the last 7 years. Bouncing like a tigger, barking and whining like mad in excitement.
I'd taken her to the vet about a week and a half ago for a little cough; we'd only heard it once or twice but as we'd NEVER heard her cough, it seemed worth investigating. Her senior blood panel was good; her physical exam resulted in a bill of good health aside from a puppy cold, something that just needed a little antibiotic. Although it always surprised me when they referred to her as a "senior." She was nine but slim, athletic, full of life and energy, just as when she was a puppy.
Scot turned to at one point in the past few days and said, "This is all such a shock. I just assumed that Winston would be the next one to go, and we still had years to be with Marissa." For those who don't know, my beloved Winston is 13, fat, and with a few odd health issues of his own.
Marissa woke us up at 1am Monday morning coughing; a deep, long, violent cough that lasted for a few minutes. When she ceased, she was heavily panting and looked... awful. Scared, pained, confused. We tried to calm her, but with time her breathing didn't improve. It was fast, and shallow.
We rushed her to the emergency vet in the middle of the night. The wonderful vet there did a quick exam, then a chest x-ray. When he came back to call us in to see the results, he looked scared for us. Lungs on an x-ray usually look black, as the tissue and air in the lungs doesn't stop the x-rays. But her lungs were perfused with... something. The vet described it as looking like it was filled with puffy cotton balls; I thought it looked like someone spray painted the inside of her lungs. It was so bad you couldn't even visualize her heart well. He thought cancer, or possibly a fungal infection. He warned however, that regardless of the diagnoses, there was likely significant loss of viable lung tissue.
She spent the night at the emergency vet, on oxygen and fluids. That morning I took her to our normal vet where she went into ICU for further testing. The short drive there was hard on her; she was clearly not comfortable, her breathing labored. She remained on oxygen and fluids all day there. The options remained cancer, metastasized to the lungs, or a fungal infection of the lungs (highly unusual and not seen in this area). But it would be unusual to see the lung as the primary site of cancer given this presentation. They didn't find a tumor in the abdomen on ultrasound as expected.
It was then recommended we take her to OSU for further testing and treatment options. We took Winston with us, and she was happy to see Winston and they spent the ride to Corvallis cuddling together in the car, kisses and licks. And Winston got lots of attention from everyone there, too. They thought it was awesome we'd brought him for moral support.
Hey, it's what we do, we're a family.
We ran her down there last night where she stayed, again on oxygen. The plan was to do an echocardiogram, then a bronchoalveolar lavage to attempt to get cells to evaluate, and if those yielded nothing, then a biopsy. She was more comfortable there as they had a little oxygen cage she stayed in, so she could relax without a nasal cannula and e-collar to stop her from pulling it out. (She hated BOTH of those.)
The staff there are really awesome; kind, considerate, loving. They called me first thing in the morning to let me know how she'd done overnight, and that she was ready for her day. They'd call me between diagnostics because at each step we could find something that completed this picture.
And during the first test, they did. They found a large tumor in the right atrium of her heart. What we saw in her lungs was the metastasized cancer, essentially having set up shop in all the blood vessels in her lungs, hence the wide spread patterns we saw in her lungs.
Hermangiosarcoma is known as "the silent killer" as by the time you see clinical signs of illness, it's too late for any type of effective treatment. Many dogs will die without ever being diagnosed because the tumors will rupture and bleed out, causing death fairly quickly, all internally.
We had no idea, but she was a ticking time bomb inside.
We won't ever know the exact series of events. Did the coughing jag cause areas of the lung to rupture and bleed? Or did it just happen spontaneously and that made her cough? Either way...
The staff went the distance with us. We asked for options. They gave us options, but none were really viable. As long as she remained on oxygen therapy, we could try chemo. That wouldn't be curative, but it might slow the progression giving her a few more... days? Weeks? She wouldn't get any better, regardless. She'd spend that time with the same difficulty breathing (or worse), feeling very sick from the chemo and stuck inside the oxygen box. We could do some non-chemo therapies that would also slow the growth. But she'd have to remain within the box. And the therapies wouldn't ever make it so she wouldn't need the oxygen therapy. With her system so stressed by the pulmonary difficulties, even low grade activity moving her from one place to another could cause the tumor in her heart to rupture, bleed into the paracardium and... on and on, every option led to a dead end. At best, we could keep her alive in the box for a little bit longer. But not comfortable, and not improving even for the short term.
If you know Marissa, you know that's not how she is. We understand the difference between quality of life and... just more time.
This just flummoxed me, though. How could it be? She was "fine" just Sunday! I had to take her home. I just couldn't bear the thought of...
They'd challenged her off oxygen this afternoon, because I'd stated our wish to pick her up and bring her home. They turned off her extra oxygen, and for two hours she labored, breathing at 120 breaths per minute or more, all while being confined to a 2'x3' box and doing nothing physical.
Normal respiration rate for dogs is 10-34 breaths per minute. Just sitting and existing was THAT stressful for her. When they'd called to tell me this just before we left to head down there... I started to confront what was already clear.
When we arrived this afternoon we knew there were few options, but our staff were talking with specialists trying to come up with options. They took us back to her; she had been back on oxygen in her little room for a few hours, but before she even saw us, we noted she was huddled back in the corner, struggling to breath. At that moment is really sunk in just where we were in this situation.
We visited with her there, just outside her box. She was drooling uncontrollably, a sign of pain. She barely moved aside from the four steps it took to exit her box, but in minutes her labored breathing became worse, and the look on her face, despite her joy at seeing us, was that look you never want to see. She's always been a very direct, open, eye gazing dog, and that look says, "Mom, Dad! I'm in pain and I'm scared! Help me!"
I would have given anything to say, "Honey, don't worry. It's going to be bad for a bit, but then it'll be BETTER for a little bit. It'll be okay, let's do it!" But... we couldn't say that. Of course, Scot knew. The staff kept offering what they could, but you saw it in their eyes, and they knew we'd come to the same conclusion in our own time. We took her to a room to visit and spent an hour on the floor with her. She fell asleep in Scot's lap. Her breathing never got better than 120 respirations per minute. Any activity such as walking a few steps, caused it to go higher for a period. Her posture and the drooling and the look... noted pain.
Winston laid around with us, periodically getting up to come up and demand some attention for himself, or giving Marissa a lick or a nuzzle.
Surgery was not an option. The treatment options we had would not improve her from this state -- which was already pretty horrific -- and she would continue to get worse, just more slowly, and have to endure it inside a plastic box struggling to breath even at rest. Could we... no. What about... no. But what if... no.
Scot and I had exchanged The Look a few times already, and after about an hour he nodded to me. I went into the back hall and found our vet and struggled to voice a summary of what I'd already heard over and over throughout the day, just to make sure there was no miracle cure that had been discovered in the last hour. I couldn't bring myself to say it, but I said that we'd come to the conclusion that taking her home with us would in no way benefit her, and we didn't see that we had any other viable options at this point. She said the horrific words and I nodded, and she gave me a hug and said she felt it was the right choice to make in this situation.
She asked if we wanted to be present--that question always offends me greatly, but I'm sure some people "can't handle" that. To come all this way together in life and then abandon her at that moment... that seems utterly inconceivable to me. For all the pricelsss love and joy these furry little devils give us, if it comes to this they deserve for their last breath to be taken in the loving arms of those they lived for, hearing our words of praise and love.
For another half hour the four of us cuddled together on the floor, Marissa between us and resting as comfortably as she could, napping with her head on Scot's lap while her body shook with short sharp breaths. The vets came in, and we talked about our wishes for the issues after.
By now we're on our thousandth kiss, stroke, "You are such a beautiful girl," "You are such a wonderful dog," "You are so strong, baby." No amount of time would ever be enough. The next few moments are the worst hell I've ever experienced, and it never gets any easier. I'd never wish them on my worst enemy.
We've been through this horror before, twice. I pointed out we might want a towel to wrap around her rear end after they explained that sometimes after they are gone all those things release, and on a tile floor... They said of course and went to fetch things.
She already had a line in her arm for the meds and fluids they were giving her. At our okay, first they fed in a sedative, and she calmed a bit, her eyes got a little loopy, and then we nodded again and the cursed blessing of that vile pink liquid was pushed in. She was gone before the dose was all in, it was so stark when the labored breathing stopped.
That moment is something you can't explain to someone who hasn't experienced it. You suddenly go from the depth of the most horrific thing you can ever imagine, to a peaceful release. In each of our cases, anyway, the pain and suffering lifts and there is your sweet little baby just as you felt her the last time you cuddled on the bed in the afternoon sun, all relaxed and happy. You realize just how heavy that shroud of pain, fear and suffering was. It's that moment that makes you realize you made the right choice. It didn't seem like much of a choice, but it was the right one, regardless of how much you may fight against it.
We sat with her for a few more minutes, and then Scot gently moved her head from his lap to the ground, so it was then in line with her body. Just as the torturous thought of, "My God, did we do the right thing?" started to form in my mind, blood starts to pour out of her nose and mouth onto the floor. "What the..." I said in shock. "Is that what was in her lungs!?" They are rushing around trying to get wads of paper towels big enough to stem the flow. Candace said, gently, "Yes, it is." They were probably thinking we were going to freak out, but it was that discovery, horrific as it was, that answered that question before it even fully formed in my mind. Our baby girl was drowning in her own blood, as the vessels in her lungs ruptured and bled out into their airways. I've seen pictures of organs that are covered with tumors from hemangiosarcoma. You can't fix that.
We left in a haze of shock, horror and relief. We stood outside for a moment in the cold air, then took Winston for a short walk in the falling snow. He ate some snow, defiled the sidewalk with #1 and #2 (of course we had baggies) and then looked at us like, "What now?"
That peace for you quickly evaporates as every thing you think or see reminds you of what's missing. Us walking out with just the two of us and Winston. Just three. We used to be a family of six, and now, it's like a war rages on and we are losing, badly. Scot pointed out it's been 16 years since it was just he, I and one dog. The car ride home is too boring as Winston snores in the back, without Rissa always poking her head up between us for love and cuddles. The house seems cold, still, stale and empty. A thousand little things she used to do torture me with their gone-forever-cuteness, simple pleasures I'll never again experience. And its worse for Scot; I loved her but she was his special little girl and she clearly loved him best.
How she always had to give Scot's pants the sniff inspection ever single morning. The way she'd poke her head between the curtains when we left. The way she's roll and snort in our bed covers. Every morning she was happy to get up, and would stand and dance in front of you, blocking your way to the bathroom, the kitchen, walking backwards in front of you so she could smile at you.
And now she's gone.
We weren't ready for this. We've spent some time preparing ourselves to lose Winston, due to his age and troubles. But we didn't see this coming. We hadn't even contemplated it.
We don't know what to do.
Damn you, cancer. Damn you.