Kayas Blog

February 3rd, 2011: (here is my "Gazette Vet" column for February. A humble tribute to my girl...)

A few months ago, I saw a bumper sticker that had a paw print next to the words "Who rescued who?" It stuck with me as a profound thought as I had been dealing with what I knew were the last few months of my own rescued dog's life. Sadly, we lost Kaya just after Christmas. She was an incredible companion and gave us 11 memorable years of her life. It's odd sorting through mixed feelings at the moment. On one hand, my wife and I are incredibly sad at the loss of our beloved friend. Our home is simply not the same without her presence. On the other hand, we have an acute sense of how blessed we were to have her in our lives. It's funny how a dog can so profoundly impact our complicated lives.

Kaya came to me from the Roanoke SPCA at the start of my second year of veterinary school. She was supposed to be spayed by the third-year veterinary students but had already been spayed. My girlfriend at the time (now wife) was in that lab and knew I was thinking about a dog. Apparently this dog was very sweet and so a meeting was set up. After class, I went down to the lab cages and there, cowering in the back of her cage, was our Kaya. She had the sweetest, most terrified expression on her face, and as soon as I got her out of her cage, she just sat down and handed me her paw, as if to say, "I'll be really cute if you don't hurt me!" It was love at first sight.

In our first few weeks together, Kaya had all the markings of a previously abused dog. She would hide under my bed when I left the house and would not come out when my roommates tried to get her outside. Only when I came home did she cautiously emerge from her hiding place, still so unsure if she could trust her new situation. Slowly but surely, she and I bonded as we spent hours upon hours hiking the nearby national forest and with her sitting at my feet while I studied. Over the years, Kaya continued to come out of her shell as she began to trust her new world. Her MO was to sit in front of you and stare with her soulful eyes, demanding that you hold her paw or pet her.

There are timeless lessons dogs teach. Lessons about loyalty, love, and devotion. And don't forget joy, enthusiasm, and peace. But for me, the biggest lesson was learning how to simply give part of myself away freely to help someone/something else. The food, the walks, the gear, the vet bills, the house repair, these were never a trade-off for having a great companion, this was for the great companion. And I got something more special back: loyalty, love, devotion. Kaya was with me through my immature bachelorhood, an engagement and a new marriage, our move to our Crozet home, and for the first four years of our son's life. A steady presence in changing times.

In August of 2009, we diagnosed Kaya with stage 5 lymphoma (a cancer in the immune system) and were devastated. Our perfect dog who had been aging so graciously had suddenly had the wind taken out of her sails. Incredibly, with plenty of ups and downs, she lived 16 more months, well beyond the average survival for such a condition. Along the way, she taught us a few more lessons about caring for others, staying positive, and enjoying a limited time on earth. She raised a puppy and was the best big dog for a little boy to have grown up with.

By December, I knew her time was near. We had run out of tricks. She could no longer go on walks, was tired all the time, and the cancer was physically changing her body. As many of our clients have, we worried if we would know when it was "time." We wished she would pass away quietly in her sleep, but as veterinarians we know that is uncommon. We just loved her, cared for her, and trusted we would know.

The morning of Dec 27, she didn't come out from under our bed. This was the first time she had done this since her first days out of the pound. I finally got her up and tried to feed her some pancakes. She took a bite just to appease me and went back under the bed. My eyes filled with tears, as I knew this was the day. We had cared for her so long, but she could go on no longer. Later that day, she had declined further. As my wife put our son to bed, I lay next to Kaya, knowing these were our last moments. It was surreal and sorrowful. She was so brave, yet so exhausted. I wanted to delay every minute. My wife soon joined me and we both lay there for a while, smothering her with love, probably freaking her out a little with all the tears and crying. In one of her finest moments, my wife placed an IV catheter in Kaya's rear leg and while we both held one of her paws, we gave her the medicine that finally let her rest.

As sad as that moment was, we could immediately feel relief that her time of suffering was over and feel gratitude for all she gave us and meant to us. Life quickly moved on, as it inevitably does after any high or low. There has been time to ponder her life and how a dog can so profoundly impact ours. Wherever your beliefs may lie, know that we are truly blessed to have dogs (and cats) in our lives.

December 28th, 2010:

Kaya's long journey finally ended yesterday. She actually had a great Christmas. We had some family in and she relished in the extra attention and excitement. But this morning (a Monday), for the first time ever she did not get up in the morning. She has been sleeping under our bed a lot more lately and this morning she just wouldn't get out from there. After getting our other dog fed and out, I finally went and had to pretty much pull our out and help her get up. She reluctantly walked outside and went to the bathroom and I took her into the kitchen and tried to get her to eat. We made some pancakes (her past favorite) and she reluctantly took a bite, then hung her head low and went back under the bed.

I'll admit, tears started to well up at this point because I knew today would be the day. We still had to go off to work and get our son to school, so I gave her some meds to help with pain and nausea and headed out. When we came home this afternoon, she did come out to greet us, but was still clearly exhausted and weak and would not eat. Her heart was racing from just the walk outside to pee. As much as I wanted to delay things, I just knew that tonight needed to be the night. To be honest, it would've been much more "convenient" for us if it could wait until Friday, since we both had the entire weekend off, but this would have been a decision for our comfort, definitely not for her. My wife agreed, and after we put our son to bed, we came downstairs, laid with her for a while, loved and cried on her for a while, then gave her the medicine which peacefully let her go. It was a sorrowful moment but we immediately felt the relief of her being out of her suffering. In an instant, I had a new perspective of the past few months of how we were really caring for this dog who was on her last leg, and decisions on what day was "the day" are much less important than how you care for them during their time when they are with you.

December 15th, 2010:

Looks like Kaya is really trying to hang on for another Christmas! We repeated blood work a few weeks ago that showed her white blood cell count to be 150,000!!! (normal is ~10,000). So what does a dog with a 150,000 white blood cell count look like?

• She still beats up her little brother (who is now 9 months and about 5 pounds heavier than her).
• She gets into the cat food container and eats the entire 1/2 bag that's left (first time in her life for that trick).
• She still woofs and barks for treats and to go outside.
• She takes advantage of our leniency and is often found snoozing away on the couch or bed (previously forbidden...).

All in all, life is good. This is a difficult and almost awkward part of the journey, not knowing when the end will come, but knowing its probably soon. I really feel a new sense of appreciation for our clients who have gone through this before me.

So here's to a Merry Christmas and Happy New Year to you all!

November 20th, 2010:

So much has happened (and not happened) over the past 6 weeks. With her last dose of true chemotherapy given Sept 24th, it was just a matter of time before the cancer began to come back. Starting in early October I could tell her lymph nodes were becoming large again and she also gets some mild tearing in both her eyes (makes her look pretty pathetic and definitely gets her some more treats). I gave her another dose of L-asparaginase (Elspar) Oct 15th - that is actually an amino acid that acts by competing with another important amino acid that the cancer cells need to live - so giving this essentially starves off a large proportion of cancer cells. The beauty of Elspar is that there are no other toxic effects on the body - it is almost side effect free...almost.

Kaya's cancer has thus far been very sensitive to Elspar. Most current chemo protocols only recommend giving one dose. This was Kaya's 4th and she responded every time. Eventually they tend not to get a response from the drug, and every additional time you give it there is a chance for a severe allergic reaction to occur. Fortunately, there was no such reaction on the Oct 15th dose and sure enough on Oct 16th her lymph nodes had completely gone back to normal!

However...for one fine Saturday (Oct 16th) , neither my wife nor I had to work so we took the whole family on a hike at Mint Springs Park in Crozet along with our good friends and their two young dogs. The dogs had a blast and Kaya clearly enjoyed frolicking around off leash. She was generally being the mature dog, not doing too much until...the deer trail. You could just see it in the way she shoved her muzzle into the forest floor as she literally took off up the mountain side. At first, it brought me flashbacks of our extensive time spent in the National forest around Blacksburg, VA. She was always just borderline under control off leash - well, I guess not really under control, but at least she always came back, eventually.

Later that night though, I noticed she was limping a bit and when I checked her out, the leg I had given the Elspar injection in was twice as big as normal! The allergic reaction finally hit her - it could have been more severe, but I did have Benadryl and steroids on board and it was gone in 48 hours. But it definitely was a warning to never give that again.

October 8th, 2010:

Friday night, hanging out with the dogs. Kaya and Boone are wrestling, score: Kaya - 4, Boone - 0.

Sadly, Kaya's lymph nodes are returning to size, will have to check some blood on Monday, but pretty sure her lymphoma/leukemia is back and sadder yet, she's at the end of the line for chemo. Got a few tricks up my sleeve yet...but just enjoying the time together.

Sept 24th, 2010:

Last dose of chemo today...I think. Just a few days ago I noticed her lymph nodes increasing in size again - not a good sign, pretty much telling me that lymphoma is returning. She is still doing so well, keeps making it difficult when I say we're done giving her chemo, but then she tolerates it well and continues to live a good life. She's enjoying all the walks and romps we go on thanks to our puppy Boone. I've got another dose left in the Mitoxantrone bottle so I may revisit this in a few weeks.

September 15th, 2010:

I am constantly amazed at how resilient dogs are. Kaya had her 2nd dose of mitoxantrone 2 weeks ago and is acting like there's nothing wrong with her. We can partly thank Boone for that, her 5 1/2 month old Labrador brother who keeps her playing and active every waking moment. We love to see her pin him on the ground when she's had enough, but she wags her little nubby tail telling us she's actually having a good time with it.

We took her to Sugar Hollow on Labor Day, 4 days after her treatment and she did great. She even "taught" Boone how to swim and hike around off leash. What an older sister. Our 4 year old son continues to give Kaya lots of hugs and love, knowing she's old and "sick", but not really understanding why. I think he and Boone are going to have a hard time when she goes.

For now, we have decided to give her one last dose of chemotherapy next week. She has lived longer than the average survival, and it is tough for all of us to see her continue to be a little sick after the chemo treatments - she has really done well with mitoxantrone, but you can't help but feel bad for her when she is clearly not feeling well because of something you've done. We are all a bit worn down after a year of treatment. But so far, worth every penny.

Sadly, Dr. Rose's dog Godiva just died last week from mast cell cancer in her body. I have seen so many dogs who have been diagnosed with cancer in this past year and who are dying, which is a bleak reminder that her day will inevitably come. She has meant a lot to me and my family and will be missed greatly. But for now, it appears she is going to live forever!

August 12th, 2010:

Today, Kaya has made it one year since her initial diagnosis with Lymphoma! The average survival with chemo treatments is typically 10-12 months, so we are thrilled to have her with us today. Not that the quantity of time is the important thing, but she has really done well and lived a mostly normal life during this time. When I discuss with clients "a 10-12 month survival with full chemotherapy" - it is so far away and there are so many mental roadblocks which make it difficult to imagine getting there - getting the dog into remission, side effects of chemotherapy, high expense of chemo treatment, all the office visits, blood draws, IV catheters.

Although we've shelled out a pretty penny on the drugs, administration, and lab work, its been worth it and a good experience for all of us. We have started a new medication called Mitoxantrone, the current bottle will last us for 3 treatments, and then my wife and I decided we're going to stop there. Its been a long road for all of us and we'll have no regrets.

July 26, 2010:

Its amazing to realize that we're only a few weeks away from Kaya living a year since her diagnosis and treatment began. Its been a long time, it really puts in perspective for me when we tell people "average survival with chemo is 10-12 months", how long a time that is. Life becomes routine at times, its not all spoiling and cherishing every moment...there are plenty of times of scalding, depriving of treats, continued training...times I tell her "you're driving me crazy!...Outside!". There's been a lot of emotional times too when she has been feeling sick. Still have to figure out where to go from here, we'll probably start a new drug next week with an every 3 week schedule and see how that goes.

It has brought our family much joy to see her live long enough to help raise our new puppy Boone. He is now 4 months old and just loves Kaya. My wife and I are chopped liver. It still if funny to refer to my "dogs", plural. Went on a nice long walk with both of them last night, it was a good walk.

July 14th, 2010:

Giving Kaya her last dose of Doxorubicin today. "The red death" can be toxic to the heart, so you're supposed to limit it to 6 cumulative doses - today is number 6. She had a pretty rough week after the last dose, didn't eat for 2 days, loose stool, but again rallied. Heading out of town with her this weekend, so we'll bring her feel good drugs and hope she does ok.

We're not exactly sure where to go from here. She's done so well, and we can continue with some different drugs in the same class, but I also can't help but second guess at what point is it too much. Just gonna see how she does this time and watch her white cell count - we're thrilled she's back in remission, but again are faced with the reality that this remission won't be as long as the previous, and I'm just not sure I'll try and rescue her out of another. Her rear leg veins are pretty shot, she's got permanent shaved spots on all four legs (hair isn't regrowing very well from her catheters)?

But we noticed she was biting at our puppy's heels today. My wife pointed out that she used to do that when she was a young dog whenever she'd play with dogs off leash, like a herding dog. I had totally forgotten about that. Simple detail, but a refreshing blast from the past.

June 16th, 2010:

Repeated Doxorubicin again today. Kaya is definitely better and her lymph nodes seem normal. Poor thing is just having to deal with the puppy - she is his one desire, he wants to play and bite her constantly, and she is just not into it. Appetite is steadily increasing, I'm sure that'll go back down after todays treatment, but it still seems worth it.

June 8th, 2010:

The Doxorubicin is working! Lymph count has gone down to 8322, still well above normal, but 1/3rd of what it was last week. That is really a relief, I was getting pretty down on the whole scenario. Spoke with my oncologist buddy who recommended pounding her with that for a while, every 2 weeks (normally given every 3 weeks by itself), so as long as she feels ok, game on. Seems to be tolerating it so far.

We've got a chemo survival pack at home now. Filled with bottles of anti-nausea meds, anti-diarrhea meds, antibiotics, steroids, and canned food - we take it with us when we travel and keep it in our pantry. Seems like I'm getting stuff out of it daily. She's been having some diarrhea and a poor appetite, but I can tell she's actually feeling a bit better.

June 1st, 2010:

Feeling pretty stressed. Despite 3 rounds of chemo, Kaya's WBC has risen, her lymphocyte count is now at 27,000 and she's clearly not feeling well. We're feeling a bit of despair at the moment and still no Elspar, which might help. Today I'll be giving doxorubicin, perhaps our last hope. She hasn't had this since her relapse, and it's a pretty potent chemo drug. Its nickname is "red death" because of its red color and it has to be give via an IV drip - just looks very menacing going into your dogs vein. Has to be given via a central line catheter - Kaya is still so good, just sits there as we place this huge catheter into her vein.

May 26th, 2010:

Slightly lethargic this week post-chemo, but no vomiting or diarrhea. Unfortunately, her lymphocyte count has gone up, its at 20,000. Worried, but am going to stay the course for now. Gave another dose of vincristine today.

Kaya now has another grave challenge. His name is Boone, an 8 week old male yellow Labrador retriever. This is a mixed blessing - we are truly excited to have a puppy. We really weren't planning on this, but actually had discussed it before Kaya relapsed - we really wanted her to "train" a young dog in her incredible ways. Also, our son has some allergy issues, and we really didn't want a time without a dog in the house. Our friend Kim Maddox who raises labs that the local Virginia Service Dogs people use, has 16 puppies, and we decided it would be a good time - just before Kaya relapsed.

But we are committed and so far so good. He is a sweet pup, pretty harmless so far.

May 20th, 2010:

Repeat lab work shows her lymphocytes still elevated, but better at 8,480. It has me worried because they went down dramatically after just one treatment back in August. But also, one of the chemo drugs Elspar, is on backorder and is unavailable - grunt. Gave second dose chemo today, so far so good.

May 12, 2010:

I knew it couldn't last forever. We had felt like her lymph nodes had been getting a little more prominent lately and she seemed a little down last week. So we ran a CBC (complete blood cell count), and her leukemia is back. Her lymphocyte count is 12,000, so not nearly the elevation as at her initial diagnosis, but it'll get there if we let it.

I think I'm more upset about this relapse than the initial diagnosis. With the initial diagnosis, it was a lot of shock, but also I knew a lot of dogs respond well to chemo, so kind of like procrastinating - we treated her and got to "put off the inevitable" until later. Now I'm faced with the reality that its not going to be too much longer before we lose her. The fact is that it's a lot harder to get them back into remission the second time, if you are able to at all.

We decided to give it a try though. She really did well with chemo except for that one treatment, and we just don't want to lose her. One of my good friends from my internship after school is now an oncologist and has been an invaluable resource, helping us tremendously with treatment protocols and decision making. He decided trying the same protocol we used the first time, since she really responded well to it - so I took her in today and started with Vincristine and prednisone. The only other thing we've agreed on is to be super proactive on anti-vomiting/diarrhea medication. She was pretty good today, not a lot of trembling at the office?

March, 2010:

Spring is here and Kaya continues to do exceedingly well. She really is back to her normal self, eating dry dog food alone (of course getting a lot more scraps and treats these days though!). We keep checking her lab work periodically and its great so far. We both agree the chemo was well worth it and its been 3 months without it!

January, 2010:

So far so good! Kaya remains in remission and is feeling great. Still not back to her old appetite, but she's been happy and getting to enjoy all this crazy snow!! It was nice to have her for another Christmas and snowstorm.

December 23rd, 2009:

Well, I think we've reached the end of chemotherapy. Kaya got incredibly sick last week's chemo. She received 2 drugs, cytoxan and vincristine, both of which she has had before. But this time it made her very ill. She didn't eat for 4 days and had terrible vomiting and diarrhea a few days ago all over the house. My poor wife who had to come home to that with our 4 year old son! She even peed in the house that day which she never does. She kept enough energy in her though to greet me when I came home, poor thing.

As is the life of a dog owned by two veterinarians, we put an IV into her that night at home, hung a bag of fluids by the nightstand, and "doctor'd her up". Along with the fluids, we gave her some meds for the vomiting and diarrhea and she was much perkier the next morning. As of today, she still hasn't recovered her appetite and her poop is still pretty loose.

We've decided that we're just going to stop chemo now. We had another 6 weeks to go to finish the course of drugs that is associated with the 10-12 month survival, but that will just have to do. It was getting pretty hard on me anyway taking her into the office every week. She eventually started to tremble when I pulled up to the clinic, which she never used to do. She also would tremble the whole time she got her treatments, and wouldn't even take treats from us (she used to eat them by the handfuls during treatment!). I think it would be easier if I wasn't the one administering it - again its this balance of knowing its going to make her a little (or a lot) ill, but also knowing that it is to make her life longer. She doesn't know that though, all she knows is that she feels sick. Anyway, she had done really well, it was only this last bout that was bad, but that's enough. I hope she can stay in remission for a while.

November 2009:

Kaya continues to do great! Her cell counts are normal, just a little anemia from the chemo. She still is feeling pretty normal, maybe sleeping a little more. She has had a few bouts of diarrhea post-chemo, but really nothing bad. We do have to entice her to eat a bit more as well, but I think we've also spoiled her so that regular dry dog food is no longer acceptable! Oh well, we are happy with the progress so far?

October 2009:

Kaya is a tough old girl! To update, she is in complete remission and is actually tolerating the chemo without incident! She has had a few days of a less than usual appetite, but no other signs and is really back to her old self in terms of activity and energy.

She comes into the office with me every Wednesday for treatment. Thank God she is such a good dog, she sits perfectly still while we give her the IV injections she needs. She gets lots of treats from the staff, and the way I see it - she can get a little spoiled and chubby in her last year.

Sept, 2009 (this initial entry is taken from my September 2009 Crozet Gazette Vet article):

There comes a time when we all will realize that our pets have gotten old. Sometimes, it's a sudden and surprising catastrophe after seemingly endless years of perfect health. Other times, it's just a matter of realizing that the gray around your dog's muzzle is growing with each passing season.

This realization just hit me a few weeks ago when I diagnosed my own 10-year-old dog with leukemia. She has been in such good health her whole life that I figured she'd at least make it to 15 or 16?after all, she's owned by not one, but two veterinarians! I always thought we'd somehow have more control over her health, and be able to diagnose and cure any condition quickly before it became too serious. But as a dog owner, I'm really not much different from the next.

It's hard for anyone to separate what is normal "10-year-old dog" behavior from what is "maybe my dog is sick" behavior. For instance, over the past few months, she had gradually been sleeping more and more under the bed on my wife's side. Ten-year-old dog, or sick? She had also been eating a bit slower, but usually still finishing all her food by the end of the day. Normal for an old girl ? or is she ADR (ain't doin' right)? Also, I had clipped her coat pretty short about a month ago, and it was then that some of the glands under her jaw felt more prominent - not huge, just more prominent. Were they always like that?

And it's hard to feel like there's something wrong when your dog is so excited to see you whenever you come back home (even if you just checked the mailbox). Or when they would never turn down a treat or a walk, or still do those annoying but endearing "character traits" - like nudging your elbow when your cup of coffee is full.

Ultimately, nobody knows your pets like you do. With more prodding from my wife than from me, I took our former Roanoke SPCA mutt (priceless now, of course) in to work with me, only to find out that her white blood count was twenty times the normal range - consistent with leukemia. In one day I was saddened and surprised that my girl had somehow gotten old on me.

My point is to say that if you feel like your older dog or cat is just not right, get them checked out. Hopefully, they're just getting older. But dogs and cats are very talented at hiding signs of serious diseases. It's just not in their nature to advertise that they're sick. Survival of the fittest is a tough world.

I want to talk about chemotherapy for cancer treatment in dogs and cats. Many people may feel that only crazy people would do such a thing, or that it's unfair to the pets, or that you're simply beating a dead horse. But let me just say that our old girl is feeling pretty good and has a totally normal white blood cell count after just two weeks of pretty reasonable chemotherapy.

Still, whether to do chemotherapy in a pet with cancer is a complicated decision with lots of uncertainties. First, many cancers are simply not responsive to chemotherapy at all. Many that are, are only responsive for a short period of time. In fact, in the majority of cases where we are use chemotherapy in pets, we are not curing their disease, but rather trying to prolong their quality of life. So it's not always an easy call.

Second, there is the possibility for significant side effects. Chemo-therapy, simply, attacks rapidly dividing cells-?i.e., the cancer cells. But the cells in the intestinal tract and the bone marrow are also rapidly dividing, hence the chance for side effects such as vomiting, diarrhea, anemia, and a weakened immune system. However, chemotherapy protocols in dogs at least, are generally well-tolerated. They are designed to get as much control of the disease as possible, without making your pet miserably sick for extended periods of time. But tell that to the person whose dog spent the weekend in the emergency hospital because of fever and severe diarrhea a few days after their last chemo treatment.

Lastly, chemotherapy is expensive and becomes more expensive the longer they live. Not only are the drugs expensive, but they often have to be given in the hospital through IV catheters, and weekly blood tests are required to make sure the chemo is not wiping out the bone marrow.

Cost is a deal breaker for a lot of people, but nothing to be ashamed about. Who can argue with someone choosing to spend limited income on getting their child braces instead of trying to keep their 14-year-old dog going for another 6 months? These are tough decisions and take a lot of thought and understanding.

In the end, chemotherapy is not done commonly. But it's worth a discussion if you find that your old companion has been diagnosed with cancer. For some folks, four to six months of happy mornings and nudged elbows are worth it.

Cost is a deal breaker for a lot of people, but nothing to be ashamed about. Who can argue with someone choosing to spend limited income on getting their child braces instead of trying to keep their 14-year-old dog going for another 6 months? These are tough decisions and take a lot of thought and understanding.

In the end, chemotherapy is not done commonly. But it's worth a discussion if you find that your old companion has been diagnosed with cancer. For some folks, four to six months of happy mornings and nudged elbows are worth it.

August 12, 2009:

I can still remember coming into work that morning and seeing Kaya's lab work on my desk. I pulled blood on her the day before because she just hadn't been herself lately. Overall, it looked good, except for a white blood cell count of 210,000 (normal 6.0-17.0). I called the lab to see if they had re-run it yet, because I was pretty sure it was just some odd lab mistake - no way was my dog walking around with a 210,000 white cell count. When I called the lab, they transferred me to the pathologist on duty who sadly informed me that she had already run it again and looked at the slides herself, and that my dog had advanced leukemia.

I had to run a few more tests, and eventually found that she actually had lymphoma - a cancer of the white blood cells in circulation, which had spread to the bone marrow causing leukemia as well. It was really all the same though, as the treatment and prognosis are identical - No treatment, 1 month survival. Oral steroids, 3 months survival. Full chemotherapy, 10-12 months survival. No cure. Rarely survivors at 2 years.

We decided to at least start chemotherapy and see if we could get her into remission and see how she would tolerate chemo. Both my wife and I have spent a lot of extra time training in oncology and are fully aware of the side effects of chemo. We did not intend to put her through a lot of illness just to extend her life, but knew that a lot of dogs can do quite well with chemo - we decided to give it a shot.