Wednesday, July 25, 2012

Regression and a Big Decision Today

Despite having a really good Sunday evening, Monday, and Tuesday morning, when I got home from work yesterday evening, Lexie had regressed.  She didn't want to eat anything, not even hot dogs, and she was very weak.  A little later in the evening, she finally went into the kitchen to drink some water.  She drank a TON of water, actually, but then she staggered into the living room and threw up all the water she had just drank.  Justin tried to tell me that she probably threw it up simply because she drank so much so quickly, but there was no consoling me.  I knew that none of this was good.

We decided to sleep in the living room with Lexie last night because she had started moaning and groaning a bit.  Mind you, Dobermans are known to be big whiney babies, especially when they're wanting some attention, and this is definitely true with Lexie.  However, Justin and I didn't sleep all night because we each took turns laying in the floor, spooning Lou and trying to comfort her.  No matter how much we cuddled her, though, she continued to moan and groan all night long. 

Finally, around 5:00 a.m., I tried to give her two Tramadol pills for pain.  She wouldn't open her mouth for me, but I managed to pry her jaws open just enough to slip the tablets into her mouth.  A few minutes later, she spit them out.  We did this a couple more times before she finally swallowed them.  I thought that the pain medication would at least knock Lexie out so that maybe Justin and I could sleep for a half-hour before we had to get up for work, but she still continued to moan and groan.

At that point, I felt that it was probably time to end Lexie's suffering.  It just so happens that she already had an appointment with Dr. Ellis this morning because she's supposed to have her stitches removed today (such cruel irony).  So, I texted Zach, Kristy, and my mother to give them all the heads up that Lexie may not be coming home from the vet today.  Zach and Kristy both came over to say their potential good-byes.  I asked Justin if he would be willing to help me take Lexie to the vet because I wasn't even sure at that point if she was able to walk.  She had barely moved a muscle all night long.  However, when I asked Lexie if she had to go pee, she actually sat up.  She even managed to stand up, although she was very unsteady, probably due to a combination of the pain medication making her loopy and half of her body being asleep from not moving all night.  Regardless, she managed to find her way onto the porch, then down the front steps and into the yard to pee.  She even got into the car all by herself.

Normally, I'd be very happy about those things, especially with Lexie getting into the car independently, but all it did was make me even more confused about what I should do.  On one hand, I know I'm going to have to euthanize her eventually, no matter what, and I certainly don't want her to suffer if she's in pain.  On the other hand (and I realize I'm probably just trying to convince myself of this), I keep wondering if her backslide yesterday evening and all the moaning last night were reactions to stopping her pain medication cold turkey.  (We stopped giving her the Tramadol after her Monday morning dose.) 

The reason I'm having such a hard time just "letting go" right now is because I want SO BADLY to be able to give her at least a few happy days after being fully recovered from her surgeries before it's time to finally say good-bye.  When I told this to Kristy this morning, she said, "But you have given her a LOT of good days.  She's lived a very happy life."  I know this is true, and Kristy makes a good point, but I just hate with all my heart the thought of Lexie going through all this pain and misery, all those trips to Ohio, those long, overnight stays at MedVet, and THREE surgeries, only to finally come home and be euthanized before her stitches are even removed.  I mean, what was the point of any of this?!?

People also keep telling me not to beat myself up and that I made the best decisions with the information that I was given at the time.  I know this is also true; however, that doesn't make any of this easier for me to accept.  It doesn't stop me from being SO ANGRY over the fact that I was told Lexie's abdominal ultrasound showed no signs of cancer, which was the reason why I decided to let her have the enucleation surgery in the first place.

Speaking of that, I sent Dr. Kennedy an email full of questions yesterday, to which he replied yesterday evening....from his iPhone.  I am now going to copy and paste the questions I emailed to him and his answers for you to read (I have not altered this text in any way, other than highlighting his responses):

  1. Could you please tell me again exactly what Lexie’s cancer diagnosis is?  I tried to take notes while we were on the phone, but all I wrote down was “vascular and lymphatics,” “inflammatory mammary carcinoma, “Stage III,” and “50/50 it will return in 12-15 months.”  Obviously, I should have taken better notes, but I was in a combined state of shock and devastation at the time.
Mammary carcinoma

  1. You mentioned on the phone that the size of the two mammary tumors removed during Lexie’s surgery were quite large, and you said this was “concerning.”  I actually have a few questions regarding this:
    1. How big were the tumors? Over five cm
    2. Why is the size of the tumors still concerning if they were removed? Because we could not take the amount of normal tissue desired to be sure all cancer was removed
    3. When you first mentioned the possibility of removing Lexie’s swollen mammary glands on July 7, 2012, because you said the tumors could be cancerous, I informed you that Lexie had just recently had an abdominal ultrasound, which I was told showed no cancerous tumors.  At that time, you explained that it takes billions of cells to form even a small tumor that is visible enough to be seen on an ultrasound.  If that is the case, and the two tumors removed during Lexie’s surgery were so large that you find them to be concerning, why weren’t they visible on her abdominal ultrasound performed June 20, 2012? The statement about the cells refers to x-rays. I do not know what to say about the presence of the masses at the time of the ultrasound. There is always some mixed inflammation. In these rumors and that might be why they were so obvious to me.

  1. When you said that there is a 50% chance that another tumor will appear within 12-15 months, does that mean that the two tumors that were removed during Lexie’s mastectomy were the only cancerous tumors she had?
The only ones we could detect. It is likely that more will form in others glands or within our surgery site

  1. You mentioned something about further tests being done on the tumors to see if any lymph nodes were also removed during surgery.  Could you please re-explain the reason for this?  Also, when do you expect to have the results of these additional tests? We submitted a mass of tissue. The lymph node should be in that mind of tissue. If the pathologist finds it he can assess any sites for metastasis (spread) as this will worsen her prognosis if found.
I do not know when to expect it back but hopefully by the end of this week

  1. Does Lexie have a life expectancy given her recent diagnosis?
 Potentially as little as 5-7 months

  1. Do you know of any current clinical trials for canine cancer treatments for which Lexie might be eligible?
 not that I'm aware of

I'm a little infuriated by his response to question #2c.  Why would he have answered my question about Lexie's abdominal ultrasound with information that pertained to X-rays?  I am 100% certain that I did not ask him about Lexie's X-rays because 1) her X-rays were not performed at MedVet; they were done at Animal Care Clinic in Huntington, and 2) When Dr. Kennedy called on July 7 to discuss Lexie's swollen mammary glands, I mentioned her abdominal ultrasound to him because it had just been performed at MedVet two weeks prior, and I was told that the ultrasound did not show any cancer.  I didn't mention Lexie's X-rays to him because they were X-rays of her chest, not her abdomen.

Anyway, I know that what's done is done and that going over all the shoulda, woulda, coulda's isn't going to change anything, but I just feel so...wronged.  While I can accept that Lexie has cancer and will eventually need to be euthanized, possibly even today, I simply cannot accept the fact that the veterinarians at MedVet missed two Stage III mammary carcinoma tumors that were both over 5 cm in size, nor do I find Dr. Kennedy's reply of "I do not know what to say about the presence of the masses at the time of the ultrasound..." to be acceptable in the least.  I plan to call MedVet today to request a copy of Lexie's medical records, including her ultrasound images.  If another veterinarian looks at Lou's ultrasound and tells me that they do not see cancer, then maybe I will stop feeling so angry. 

In the meantime, Lexie is currently at Animal Care Clinic, and I am waiting for a phone call from Dr. Ellis so we can discuss Lexie's current condition and whether or not she should be euthanized today.  If Dr. Ellis tells me that Lexie's behavior yesterday evening and last night were a result of the sudden medication withdrawal or possibly some other explanation, and if she thinks that Lexie's still got a few good, pain-free months left in her, I will probably choose to bring her home.  If Dr. Ellis tells me that Lexie is in pain due to the cancer, I will not make my Lou suffer any longer.

1 comment:

  1. I have been checking your blog all day to see how today heart hurts for you!!! Do know that whatever decision has to be made will be the BEST decision for Lexie! I am praying for you and your baby girl!