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.  :)

Will This Ever End?

I swear, if you look in the back seat of my car right now, it looks like I have murdered an animal.  My car is covered in fur and spots of blood, which you can see in this photo.  Bless her heart, Lexie licked that seat almost the entire way to Ohio last night.  Anytime she leaves a spot of blood on the carpet, a pillow, the car seat, or even my leg, she immediately tries to clean it up for me. 

Anyway, I just got a call from Dr. Webb at MedVet (Dr. Corbett is in Cincinnati this week, but Dr. Webb works with her).  Lexie's incision sites did not bleed much through the night, which is good becuase it's a sign she does not have Von Willebrand's disease, but they don't know for sure if she has it yet because her test results still aren't back from New York.  Anyway, Lexie's bacterial culture did come back showing that she's got two different kinds of bacterial infections right now:  staph and serratia, which are resistant to the antibiotics she is currently taking.  I should also add that Dr. Webb believes that these infections may be the reason why Lexie's incisions are pulling.  So, they've changed Lexie to a more heavy-duty antibiotic. 

Meanwhile, Dr. Webb has consulted with their soft tissue surgeon, Dr. Kennedy, who will be repairing Lexie's incision.  Luckily, Dr. Kennedy feels Lou still has enough surrounding soft tissue to make it possible to re-close the wounds without having to perform a skin flap surgery, which is kind of an extensive (and I'm presuming expensive) last resort procedure.

I did ask Dr. Webb about Lexie's immune system because I know it has been weakened by the Prednisone (steroid) she was taking in the 1-1/2 weeks leading up to her bilateral enucleation surgery.  She had been prescribed Prednisone because it was believed that her original disorder, anterior uveitis, was an autoimmune disorder, and Prednisone's function is to weaken her immune system in order to get it to stop attacking her own body.  However, the ER vet on duty last night, Dr. Foust, explained that Lexie's weakened immune system could be a reason why she's having these post-surgical complications and not healing as quickly as we would like.  Therefore, I asked Dr. Webb if there was anything they could give Lexie that would help build her immune system back up.  Dr. Webb said I posed an excellent question, and she would speak to their Integrative Medicine department, which specializes in alternative therapies to compliment conventional treatments and veterinary medicine.  She said they may have some suggestions for improving Lexie's immune system.

On an up note, when I asked Dr. Webb about a cost estimate, she said that she didn't have one yet, but added, "I promise, we are going to do all we can to keep the cost as minimal as possible for you."  She said that I would probably still end up with a balance, but she said she was going to talk to Dr. Corbett and even Dr. Ellis to see what they could work out.  (I forgot to mention that when I dropped Lou off last night, Dr. Foust told me they weren't going to require a deposit this time, which was such a relief.) 

As I was writing this, Dr. Kennedy called.  He said that the fact that Lexie has a staph infection, which is quite extensive, in addition to the serratia infection, is a little concerning.  He said it would be prudent for them to treat this as an open wound for a couple of days in order to allow her new antibiotics to start fighting the infections while they also treat and clean the soft tissues of her wound.  That way they'll be as healthy as possible when she goes into surgery on Monday, or possibly Sunday.  He sounded confident, though, that Lexie is going to be okay when this is all said and done (if it ever ends!!!!).  I asked Dr. Kennedy if HE had a cost estimate, because Dr. Webb had predicted that Lexie would come home tomorrow, but now it looks like Lexie may not come home until next Monday or Tuesday.  Dr. Kennedy said he did not know yet what this will cost, but he said that they are still "working on it," and he'll call me later with an estimate.

Please continue to keep Lexie in your thoughts in prayers, especially for her immune system to regain strength in order to fight the bacterial infections, along with her new antibiotics.  As much as I love the doctors at MedVet, I'm hoping never to see them again after this next surgery.  *knock on wood*

This Can't Be Happening

I am typing this from my iPhone as Justin drives us BACK to MedVet in Ohio, so please forgive typos and formatting. Yes, you heard me correctly. Dr. Ellis wasn't at Animal Care Clinic today, and Dr. Lilly waited until 4:45 p.m. (I dropped Lexie off at 8:00 a.m.) to tell me that Lexie's incision needs to be re-opened in order to be repaired, and she basically refuses to do that because of what happened the last time Lou had surgery there. Therefore, the only option I was given was to drive Lexie back to Ohio so they can perform another surgery tomorrow. Another surgery, plus I'm predicting another weekend stay at MedVet equals another huge bill for me. Why is this happening?!??? And no, I'm not asking for any more donations. I'm not sure what I'm going to do, but I will figure something out. I'm just venting because I'm so incredibly frustrated and upset, which may be the understatement of the year.

Background - Part Two: Blindsided By Glaucoma

After making the six-hour drive (round-trip) to see veterinary ophthalmologist, Dr. Corbett, at MedVet in Worthington, Ohio, Justin and I immediately began administering Lexie’s medications just as Dr. Corbett had prescribed:  three and a half antibiotic pills each morning, steroid drops in each eye every six hours, and her ibuprofen-type medication (I forget the name) twice a day.  We did this religiously for about four days without seeing any improvement in Lexie’s eyes, but I wasn’t really worried because Dr. Corbett had said we probably wouldn’t see improvement until after a week.

Then, on about the fifth day following Lexie’s trip to Ohio, Justin and I decided to take Lexie and her sisters, Jocie and Sam (see the Introduction section of my blog below), to visit his parents.  The girls had a blast running all over the fenced-in yard and exploring Justin’s parents’ home.  It was during that visit, however, that I noticed Lexie’s left eye was looking cloudier than usual.  Upon further inspection, I discovered the whites of her eyes were also extremely red.  I wondered if this was due to her blood pressure being elevated from all the excitement, and I hoped that the redness in her eyes would decrease after she went home, settled down, and had a good night’s sleep. 

Well, the next morning (Monday), not only were her eyes still very red, but her left eye had gotten even cloudier than the day before.  At that point, I felt it was time to call Dr. Corbett to schedule Lexie’s follow-up appointment.  After scheduling her appointment for that coming Wednesday, I spoke with one of the ophthalmology vet techs, and she recommended I take Lexie back to see Dr. Ellis, our local vet, to have her eye pressures read that day.  She said that what I was describing sounded like Lexie’s eye pressures might be building up, which is a sign of glaucoma.  Not only that, but those pressures can increase very quickly and cause Lexie to lose her sight within a matter of hours! 

I immediately called my brother, Zach, and asked if he could take Lexie to the vet for me after he got off work. He agreed, and about an hour or so later I received a call from Dr. Lilly at Animal Care Clinic, who was filling in for Dr. Ellis that week while she was on vacation.  Dr. Lilly said that Lexie’s eye pressures were dangerously high, and she told me I needed to take Lexie IMMEDIATELY back to MedVet in Ohio for emergency treatment.  She said she would call MedVet to let them know I was coming.  As soon as we hung up, I found my boss and tearfully explained to her that I probably wouldn’t be able to come into work the next day because I was about to rush my Doberman back to Ohio.  She said that was fine, but as soon as I got back to my desk I received another phone call.  Apparently, when Dr. Lilly called MedVet to tell them I was coming, she spoke with Dr. Corbett, who told her an immediate emergency visit was not necessary.  Instead, Dr. Corbett prescribed two new eye drops for me to give Lexie every eight hours, and I was to bring Lexie back to Animal Care Clinic the next day to have her eye pressures checked again.   If the eye pressures were decreased at that point, then it would be okay for us to just keep our Wednesday appointment.   Thankfully, the new eye drops were successful in bringing down her pressures, so that Wednesday Lou and I headed back to Ohio to see Dr. Corbett.

At this point, I was starting to feel like the butt of some sort of cruel joke.  Wasn’t it just a week ago that I had been SO happy and relieved to hear an that Lexie WASN’T going blind?  What was all this talk about glaucoma and having to lower her eye pressures so that she wouldn’t go blind within a matter of hours??!?!   Dr. Corbett never mentioned the possibility of glaucoma developing, nor did she tell me anything about this serious, sight-threatening condition!  Were there signs I could have been watching for?  Was Lexie at a greater risk of going blind now because I didn’t realize she was developing glaucoma? 

I was bursting with questions when we arrived for our follow-up appointment at MedVet on Wednesday, June 20, 2012.  Dr. Corbett was just as nice as ever and seemed genuinely disappointed that Lexie’s condition had taken a turn for the worse.  After examining her, Dr. Corbett explained to me that Lou had apparently developed glaucoma secondary to her anterior uveitis.  Here is what happened (at least, how I understood it):

Dogs have a sort of “drain” in their eyes, which allow fluids to, well, drain from their eyeballs.    If that drain becomes clogged for some reason, the fluid cannot escape and then pressure begins to build up in the eyes.   If that pressure builds up too high, it causes permanent vision loss.  That, in a layman’s nutshell, is glaucoma. 

Now, there are two different kinds of glaucoma:  primary and secondary.  Secondary glaucoma is when it develops due to another underlying condition, such as anterior uveitis.  In Lexie’s case, her anterior uveitis had caused her eyeballs to become inflamed, and the swelling is what caused the drains in her eyes to clog.  Dr. Corbett explained that if we could successfully determine the cause of her anterior uveitis, we could hopefully treat it, which would then get rid of the inflammation and allow those drains in her eyes to re-open; thus, also getting rid of the glaucoma. 

First thing was first, and that was determining the cause of Lexie’s anterior uveitis.  We had already ruled out an eye injury, and we had been treating her with medication as though the cause was either a tick bite or an autoimmune disorder, but we still hadn’t ruled out cancer, fungal infection, or disease of her internal organs. Therefore, Lexie underwent a chest X-ray and abdominal ultrasound, both of which thankfully came back completely normal.  As relieved as I was to find out she did not have cancer or anything else wrong internally, that only brought us right back to square one:  assuming her anterior uveitis was caused by a tick bite or autoimmune disorder.

Dr. Corbett decided to treat Lou much more aggressively for the next two weeks by adding an oral steroid, Prednisone, on a tapering dose, maintaining the antibiotics and steroidal eye drops, and also adding three different eye drops to treat her glaucoma, which were intended to help stabilize and maintain the pressures in Lexie’s eyes at a safe level.  Dr. Corbett told me that after two weeks of this aggressive treatment, we would have a much better idea of Lexie’s long-term prognosis, which we would discuss at her next follow-up visit. 

I was very careful with the wording of my questions, but basically I told Dr. Corbett that when I left there the last time, I left under the impression that there was not any danger of Lexie going blind, so I just wanted to make sure that I had a full understanding about what was going on with Lexie’s condition so that I hopefully wouldn’t experience any further heartbreaks or disappointments.   Dr. Corbett never acknowledged or apologized for the fact that she did not at least give me a heads up about the possibility of Lou developing secondary glaucoma, but I did appreciate how nice Dr. Corbett was and how she made me feel as though she had all the time in the world to answer my questions.   I also felt confident that Lexie was receiving the best possible care at MedVet.

This time, as I made the three-hour drive back to Huntington from Worthington, I was relieved that at least Lexie’s condition wasn’t life-threatening and still slightly hopeful that her new aggressive treatment would cure her anterior uveitis and glaucoma, but overall I was just extremely saddened and disappointed by the fact that there was now actually a strong possibility that Lexie could go blind. 

Justin and I literally had to set alarms on our phones to remind us which medication Lexie needed at what time, but we continued to administer all of Lexie’s medications, just as Dr. Corbett prescribed, 24/7.  The cloudiness in Lexie’s eyes did actually clear up for a couple of days, which made me hopeful, but on Sunday night I noticed her right eye was starting to turn really red once again.  The next morning, her right eye was very cloudy, both eyes were extremely red, and her right eye even looked like it was bulging a little bit.  Even worse, it was obvious that she wasn’t seeing much more than shadows and light.  I called MedVet as soon as I got to work, and they advised me to take Lexie back to Animal Care Clinic to have her pressures read.  So, I left work, picked Lou up, and dropped her back off at Animal Care Clinic. 

Finally, just as I was leaving to go pick her up, Dr. Ellis called me.  I expected to hear a progress report on Lexie.  Hell, I was even expecting the report to be bad.   What I wasn't expecting was that Dr. Ellis was about to present me with the hardest decision I've ever had to make...