Tuesday, July 24, 2012

So, What Now?

Just to recap, the following is a fictitional representation of the actual conversations I've had with veterinarians regarding Lexie since the beginning of June, 2012:

June 5, 2012 - Dr. Corbett:  "Lexie has an eye condition called anterior uveitis, but the good news is that she's not going blind!  Just give her these medications and follow-up in a couple of weeks.  That'll be $300."

June 18, 2012 [Lexie's eyes are worse] - Dr. Lilly:  "Lexie has glaucoma and she could go blind any minute!  Quick, you must rush her to MedVet!  Oh....wait....nevermind.  Dr. Corbett said to just give her these $100 eye drops, and then take her back to MedVet in two days."

June 20, 2012 - Dr. Corbett:  "Remember when I said that Lexie wasn't going blind?  Well, I forgot to mention that she could develop secondary glaucoma and potentially go blind within hours, which is what has happened.  So, we need to figure out what's causing her anterior uveitis because then we can possibly get rid of the glaucoma, too.  Cancer is one of the things that causes anterior uveitis, so let's rule that out.  That'll be another $700 for a chest X-ray, abdominal ultrasound, and blood work, please."  [An hour later.]  "Good news!  Lexie doesn't have cancer!  Therefore, this must be an autoimmune condition.  Give her these new meds and I'll see her again in two weeks."

June 21, 2012 - Lexie officially loses her sight. 

June 25, 2012 - Dr. Ellis:  "I've consulted with Dr. Corbett, and becuase Lexie's eyes haven't reponded to treatment and just keep getting worse, we both recommend enucleation."

June 29, 2012 - Dr. Ellis:  "There has been a surgical complication.  Lexie's blood won't clot.  She must have developed Von Willebrand's disease.  We're going to do a transfusion, but she's in critical condition."  [Two hours later.]  "The only way we could get the bleeding to stop was to pack Lexie's wounds with gauze, but she's now bleeding through those.  Therefore, you need to rush her back to MedVet tonight and pray she doesn't die on the way there.  You'll also need to pay a $1250 deposit when you get there."

July 2, 2012 - Dr. Corbett:  "Good news!  Lexie's surgery to remove the gauze was a success!  We're not really sure if she has Von Willebrand's disease, though, and we noticed an infection has started in her wounds, but we cultured the infection so we'll know exactly what kind of antibiotic to give her when she goes home."

July 3, 2012 - Dr. Corbett:  "Good news!  Lexie is stable and is cleared to go home!  That'll be $2300."

July 4, 2012 (14 hours later) - Lexie's stitches burst in her right eye, and she has to be rushed to the local Animal ER for an overnight stay.

July 5, 2012 - Dr. Lilly:  "Sorry I waited until fifteen minutes before we close to tell you this, but I don't want to stitch Lexie back up, so you're going to have to take her back to MedVet."

July 6, 2012 - Dr. Webb:  "We just got Lexie's cultures back and it turns out that she has TWO different bacterial infections, which are pretty extensive.  No wonder her incision pulled open!   I guess she wasn't "stable" when we sent her home the day after surgery, after all.  Anyway, we're going to need to keep her for another few days and then perform another surgery, but don't worry, we're going to do everything we can to keep the costs as low as possible for you."

July 7, 2012 - Dr. Kennedy:  "How long has Lexie had these swollen mammary glands?  There's a 50/50 chance that those are canerous.  Those are going to need to come off, too.  I don't have a cost estimate for you yet, but don't worry!  We're going to do everything we can to keep the costs as low as possible for you."  (I mentioned that Lexie JUST had an abdominal ultrasound and I was told that they did not show any cancer.)  "Well, it takes billions of cells for even the smallest tumor to show up on imaging, so even though it's GOOD that her ultrasound didn't show any tumors, that doesn't necessarily mean she's cancer-free."

July 8, 2012 - Dr. Sawyer:  "Lexie is responding really well to her new antibiotics, so we're going to push the surgery back until Wednesday.  I don't have a cost estimate for you yet, and I know we just tacked on another three-night stay to your bill, but don't worry!  We're going to do everything we can to keep the costs as low as possible for you."

July 10, 2012 (the day before surgery) - Dr. Sawyer:  "Dr. Kennedy told me to tell you that he was given permission to discount your services, and the cost of Lexie's surgery is going to be ONLY $1800!  That doesn't include the cost of her seven-night stay, though, which will be an additional $1400.  Don't worry, though!  We may still be able to get you more discounts!"

July 11, 2012 - Some random surgical tech:  "Ms. Bell, I'm just calling to let you know that we're getting ready to perform Lexie's incision repair and mastectomies now."  (I hadn't approved the mastectomies yet because I was told "there may be more discounts," which would be the deciding factor as to whether or not I could afford the mastectomies.  I raised a fuss, and they finally agreed to charge me "only" $1800 for all of Lexie's services over the last seven days, including the mastectomies.)

July 13, 2012 - Lexie comes home.

July 23, 2012 - Dr. Kennedy:  "I just got Lexie's biopsy results.  She has Stage III mammary cancer.  The size of the tumors worries me, though, because they were both pretty large.  There is a 50/50 chance that in 12-15 months another tumor will appear.  You can speak to Oncology about chemo options if you'd like, but they will charge you for the consultation."

In summary, I guess that cancer was the cause of Lexie's anterior uveitis after all, but here's my main question:  If Lexie's TWO mammary tumors were "so large" that Dr. Kennedy is concerned about metastases, then why didn't those two large tumors show up on her abominal ultrasound?  If I had been told on June 20 that her ultrasound revealed Stage III mammary carcinoma and that there was a 50/50 chance that I would have to euthanize her in 12-15 months, I'm not so sure that I would have chosen to have her eyes surgically removed, which would have saved her from having to go through THREE different surgeries and a very difficult recovery (not to mention the thousands of dollars for which I am now in debt).  It also would have saved her the stress and depression that has resulted from her sudden blindness. 

However, I also cannot say for certain that I would have chosen to put Lexie down instead of going through with the enucleation if I had known she had cancer.  It definitely would have been a very difficult decision, but you also have to keep in mind that, at that point, I wouldn't have known that so many other complications were going to result from the initial enucleation surgery (blood clotting issues, infections, two more surgeries, etc.). 

With all of that said, I strongly doubt that I would have chosen to spend so much money just so Lexie could spend her final days adjusting to sudden blindness.  If I had chosen to euthanize her a month ago, I would have at least been at peace knowing that Lexie lived a very full, VERY happy life up until that point.  As it stands right now, I simply don't know how well Lexie is going to adjust to being blind, or how much time she has left.  So far, she's had a difficult time with both recovery and adjusting to blindness.  Her appetite is poor, she's weak, she rarely looks happy, and she has no energy.  If these things don't improve before the time comes when I have to make the decision to put her down (whenever that may be), I will always regret with all my heart that Lexie spent her final days being scared, sad, depressed, weak, in pain, and blind. 

So, what do I do?  I have had several people ask how much her chemotherapy treatments would cost and suggest that I try to do another fundraiser to pay for it, but my heart and my gut are both telling me not to do that.  For one, it took everything I had in me to swallow my pride and ask for donations the last time, and now I just feel horrible that so many people gave so generously to help save Lexie's life, only to find out later that she has cancer.  Besides, Lexie has already been through SO much, and I'm not sure how much fight she's got left in her to go through chemotherapy treatments.  For that reason, I feel like I'd rather just try to make her as happy as possible for as long as I possibly can, rather than keep driving her six hours back and forth to MedVet for however often she needs chemo treatments.

The travel that would be involved is actually another reason why I don't feel like chemotherapy is the best option.  I have already put a TON of miles on my little Prius, and I even had to buy new front tires before our last trip to Ohio because the ones I had been driving on were so bald.  Not only that, but traveling that far that often is just grueling for both us and Lou. I'm not saying that it wouldn't be worth it if it meant saving Lexie's life, but the fact of the matter is that there is no guarantee that her treatments would be a success.  I'm also not even sure that Lexie would be able to receive her treatments on the weekends, as most of the specialists at MedVet only work Monday through Friday.  If that's the case, I definitely couldn't take off work that often. 

Pretty much the only way I would be able to even consider putting Lexie through chemotherapy would be if I won the lottery, or if some other lottery winner came to our rescue, because it would require Justin and I quitting our jobs so that we could move closer to MedVet, finding a place to live that would allow us to have three big dogs, and also being able to afford Lexie's cancer treatments, which I'm sure are very expensive.  Unfortunately, I don't foresee any of that happening, so I feel like the best option is to try to make Lexie as comfortable and happy as possible for the rest of her days here with us. 

So, on that note, I do have some good news in regard to Lexie's recovery.  Since she enjoyed her solo adventure to Justin's parents' house and the car ride home so much on Sunday, we decided to take her on another little adventure yesterday evening.  She got in the car all by herself, which made me happy, although she wasn't as interested in looking out the window this time.  She just laid in the back seat as Justin drove us down to Camden Park, which is on the other side of town, so that I could scout shooting locations for a photo session I've got coming up.  Then, we drove to Kroger's so that Justin could buy Lexie some hot dogs and baby carrots (she gobbled up a hot dog that morning, and baby carrots have always been one of her favorite treats).  While Justin was in the store, Lexie and I took a walk along the grassy edge of the parking lot.  It was a hot evening and she was panting, but I really felt like Lexie was enjoying her "adventure walk."  When we returned home, Lexie ate not one, but TWO hot dogs!  Justin had bought some vitamins for senior dogs while he was at the store, and he managed to get her to eat a couple of those,  and since we were on a roll, I decided to also give Lexie her "hippy medicine," AgariGold and mangosteen juice, which Dr. Wagner from the Integrative Medicine department at MedVet had given Lexie to help boost her immune system and energy levels.  (I'm going to seriously start looking into holistic cancer treatments for dogs, by the way.)

By the end of the day, Lexie was pretty tired, but she had a full belly and seemed happy, which is all I can ask for.  This morning, I was also very pleased because she seemed a little bit stronger than she had the day before.  She was more steady on her feet, seemed more alert, and even had a decent poop!  (It's hilarious how excited we get over Lexie's bowel movements these days.)  We've decided to try weening her off her pain medication again, too.  She didn't have any last night and seems okay so far, so I didn't give her any this morning, either.  Justin will check on her during his lunch break today, and if he thinks she could use some pain medication he's going to give her one pill instead of two.

So, basically, I'm going to try to stay focused on the positive things that happen day-to-day, rather than stay focussed on the fact that, oh my God, Lexie has cancer!  I'm still angry and heartbroken about it, and I probably always will be, but wallowing in sorrow isn't going to help either of us.  So, for Lou's sake, and for the sake of all the kind people who have been so supportive and encouraging, Justin and I are now going to do everything we possibly can to help Lexie fully recover from her surgeries so that she can continue to live the happiest life possible from here on out, even if it means feeding her hot dogs for every meal and driving her around the neighborhood for a couple of hours every evening.  :)


  1. Ahh, I have so much to say!
    1) I'm so pissed at all the doctors. I just can't even right now.
    2) I noticed the poop outside this morning before you cleaned it up. I was also happy :)
    3) Sorry I didn't stop by yesterday. In case you haven't noticed, I can't bear to see you upset so I'm just a bad friend and I avoid you. I asked Zach how you were doing though, I promise.
    4) I think you should feel at peace about your decision. As long as Lexie seems comfortable, there is no need to worry. I don't at all blame you for not putting her through Chemo. IF the money was available, I wouldn't blame you for not putting her through that. She's already been through so much.
    Love you!

  2. I hate when one has to make difficult important decisions without all the facts. I like to believe there had to be some good reason but you make a good case.

    Chemo would be a tough decision even if it were free. It isnt an easy treatment to experience and doubly without a guarantee. I know hot dogs and walks for the rest of my life sound better to me.

    1. I'm glad you agree. Thank you for your support. :)

  3. You're never a bad friend, first of all, and I certainly didn't feel like you were avoiding me. I know this has all been difficult for you, too, so I just assumed you were dealing with the news at home in your own way. I appreciate you being so supportive of my decision, though. I'm sure some people may wonder why I could fight so hard for Lexie and then suddenly just "give up," but I'm totally not giving up. We're still going to fight, it's just going to be a different kind of battle from now on.

    1. The comment above was intended to be a reply to Kristy, by the way. I must not have hit Reply.

  4. These things are so difficult. I don't pretend to understand what you're going through or know the right answer. When my babies were sick, we just had to put them to sleep. I cried for days. I still cry sometimes. There was no money for rent, let alone vet bills, and we just didn't know what else to do. We couldn't justify putting them through the pain and agony of "treatment" only for them to potentially die anyway... not that we had the money even if we wanted to... it's funny how important that stupid green paper is in our society, huh?

    No matter what you choose or what you feel, it's okay and we will support you and send wishes of support and comfort. There are a number of spots to point out and wish the doctors had said or done something different, but the bottom line is evaluating two things: 1. how much is your baby suffering and is it worth it because in the end she'll be happy and healthy again? and 2. can you afford (both financially and emotionally) to deal with this cancer?

    I don't envy your decision and I hope with all of my heart that whatever happens, you can find some peace in knowing that you did everything possible for your Lexie. Please continue to keep us posted and let us know if there is anything we can do.

  5. we struggled through the decisions involved in a cancer diagnosis less than 2 months ago with our rottie. though we were referred to consult an internist or oncologist to pursue the next steps after the "most likely cancer" diagnosis, i asked our regular vet for some rough idea of what our options might be. she briefly described a spectrum - from keeping him eating as long as possible, or add prednisone that will help him feel better and maybe slow the progression slightly, up to surgery, chemo and radiation. but what struck me was that she said that for dogs, because they are not able to decide to feel extra sick now for the sake of the long run, chemo is done somewhat differently than with people. our vet was going through cancer treatments with her own dog taking her there one day every 3 weeks for treatment purely with the goal of slowing the progression of the disease just enough to maintain her quality of life for as long as possible
    we have had several people in our lives deal with cancer in a variety of ways in the last few years, including my partner's brother, and then their mother who having watched her son go through every type of treatment i've ever heard of, she decided to forgo chemo, and settle with symptom preventing radiation and living the weeks she had at home surrounded by family. So our immediate reaction to the diagnosis of our rottie was "no surgery, no chemo" but as we thought about it, we drifted towards "whatever is going to make the time he has the best it can be." our medical options ended up being very limited by his type of cancer, and our time very brief, but we made the most of it with daily trips to the store, bones, treats, multiple small meals a day, plus steroids and tramadol. (wish i had thought of hot dogs! :)
    this is my excessively wordy attempt at saying that treatment options for canine cancer surprised me and were for me worth the consult, and also it would be very meaningful to me and to other people who know your lexie or have been reading about her to have the opportunity to contribute to making every day lexie has with you and her sisters be the best days they can be.