This was a tough Spring and Summer in Maine. The bugs were out in full force and constantly biting. As miserable as it was, it was worse for my Standard Poodle, Spencer, who was left scratching and biting and licking all the discomforts his skin suffered from bug bites. (Yes, our dog is an “indoor dog” – – except when we are outdoors, which is a lot of the time. And yes, we use Heartguard and Frontline. But you can’t put DEET insect repellent on a dog.)
So when Spencer started licking a bit under his tail I thought it was kind of gross, but figured he’d stop when the discomfort of a bite faded away. He was still occasionally licking the area in September once the bugs were gone, but I couldn’t find any irritation on his tail that would indicate he’d been bitten. So when I dropped him off to be groomed, I asked my groomer, Chris, to check and make sure he didn’t have a clogged or overly full anal sac. Spencer had not been “scooting” on the ground which would have hinted at this problem, but I figured since Chris was going to be grooming him anyway, it was a good opportunity to check.
Her answer was alarming. “Something is wrong,” she said. “The sac is hard and dry, and it felt weird. You need to go see a vet – – immediately.”
We were leaving for Maine in two days so I decided to wait until we got back to Maine before having him seen. Within a day or two of being back, I took Spencer to the vet for an exam. Meanwhile, ever the clown, Spencer was his exuberant, happy self; he was eating well; and still enjoyed chasing a ball and going for long walks. I had no reason at this point to be overly concerned. But the vet sucker-punched me.
“Bad news. Spencer has a walnut-sized growth in his anal sac, and these types of things are almost always adenocarcinoma.”
She said he needed surgery sooner than later, but it would require a specialty surgeon, due to the delicacy of the area. “I don’t have enough experience with soft tissue surgery of this nature. And I’m likely to do more harm than good if I need to get aggressive.” She recommended a specialty veterinary surgery practice in Portland ME – – but when she got an estimate from them by phone, it was $4,000!!!!
That’s when I cried. I felt like it was only my inability (and let’s be honest, my unwillingness) to come up with such a hefty sum that was dooming my dog to a premature death. I felt so guilty! I called two vets back in my hometown for a second and third opinion, and they both said the same thing: Spencer would require a surgical specialist to do the surgery.
Maybe in big cities you can find specialists, but in rural Maine it’s another story. For one thing, out in the country many dogs are working dogs. Many of them live outside or in a barn. Many people in the country are of very limited financial means. If a dog gets really sick, and they don’t have the money for a vet, they will euthanize the animal (and many will simply shoot the animal behind the barn). That’s life in the country. They may feel sad, but not sentimental. Bad things happen, and that’s just part of life. So there is very little incentive for vet specialists to set up practice in rural Maine.
None of the vets I called within an hour’s drive of my house in Maine said they had the expertise for this surgery (at least they were honest). I called the renowned Cummings School of Veterinary Medicine at Tufts University and Foster Hospital for Small Animals in North Grafton, Massachusetts – – and they quoted me a price that was a fraction of the $4,000 quoted earlier by the specialty vet practice in Portland. Even though it was a 3 1/2 hour ride from our house in Maine, I made an appointment for a consult and the surgery, which would take place in a week’s time.
I couldn’t bear to euthanize him, because he was not ready to die, nor was I willing to let him go – – at least, not yet. Spencer certainly didn’t realize he was terminally ill! He was bouncing around jubilantly and not currently suffering in any way. Partly I was in denial – – how could a creature so full of life be dying?
On Friday, a week before the upcoming surgery, we were playing hard outside. It was a game of chase combined with hide and seek. First, I would hide. Then he’d try to find me. Then he’d run like the wind to get away from me, encouraging me to chase and “catch” him if I could. Of course I never could, and he loved that. Then it was my turn to hide again and the whole scene repeated itself. He always loves to play this game and he always sports a huge devil-dog “grin.”
But on Saturday morning, he most uncharacteristically did not get up from his bed to do his business outside. Instead, he lay on his dog bed, listless and apathetic. My first thought was that the cancer must be super-aggressive, and perhaps this was the beginning of the end. When I finally convinced him to get up and go outside, he hobbled painfully. But upon examination I couldn’t find anything wrong with his feet or legs. The entire day he was stiff and clearly in some kind of pain.
By evening things deteriorated dramatically. He was hot to the touch, as if he was running a fever. But – – and this had NEVER happened before – – he would not let me touch him at all. His right front leg was completely lame, but I could not visually see anything wrong with it. The pain was so intense that the muscles of his leg were involuntarily quivering. The closest 24 hour emergency vet facility is about an hour away, but since his cancer diagnosis I knew they would want to run tests with equipment their clinic didn’t have, and they would send me on to Portland. So I waited until the first morning’s light and set out for the Tufts Foster Animal Hospital emergency room. Luckily I had all his vet medical records on hand.
From the time I put Spencer into the car until 3 1/2 hours later when we arrived, Spencer’s leg had meanwhile swollen to gross proportions. He also had a tennis-ball-sized lump in his joint that was soft and mushy. His pain was extreme.
“I think it’s bone cancer,” the intern (1st year medical resident) said. She recommended an x-ray, but said that if the x-ray showed cancer, I’d have to have his leg amputated and even then, his prognosis would be extremely poor so it would be in his best interest to be euthanized. Her severe hypothesis came as such a shock to me that I burst into tears. Meanwhile the lump on his leg burst and (spoiler alert: this gets gross) it started seeping pus and blood.
“Well,” she said after the x-ray, “the radiologist (yes, there are vet radiologists! And just about every other specialty too, from ophthalmologists to oncologists to orthopedists to nephrologists to neurologists to surgeons, etc.) said that there is no evidence of bone cancer. So that’s good news. But we need to figure out what IS happening and why. Meanwhile I’m starting him on an antibiotic IV to see if we can control the infection.” Cummins vet school at Tufts is a teaching hospital, but overall the vet residents are really smart people. Statistically it’s actually harder to get into Tufts vet school than it is to Harvard medical school. But it was interesting to see how Spencer’s cancer diagnosis prejudiced the resident giving the intake exam, and that bias made her overreach her initial assessment regarding his leg.
Spencer was then seen by an Attending (yes, veterinary medicine in the US is engineered similarly to our medical school system: after veterinary medical school vets do an internship and residency, and there is a chief resident and an attending physician on duty at the hospital for in-patient creatures big and small), who then referred him to the surgeon on duty. Here is where we really lucked out, because Dr. Kudej (pronounced KOO-jee) is arguably the best surgeon at Tufts and a professor of veterinary medicine at the school. Besides being a true mensch and explaining things carefully and giving me all the options for Spencer’s care, he consistently kept in touch with me in person and via cell phone throughout the entire ordeal.
As it turned out, Spencer’s infected leg was the result of a totally freak accident and had nothing whatsoever to do with his cancer. While we were playing on Friday, he suffered a puncture from a small piece of bark or wood that was lying about. He must have slammed into it very hard, because although it was small it traveled up into his leg five inches (!) taking with it a bunch of his hair (poodles have hair, not fur), and the two foreign bodies (hair, wood) caused massive infection. Spencer would not only need surgery to remove the cancerous growth; he would require surgery to open up the entire length of his leg and debride it.
As far as the surgery to remove the growth, the real question is how far the cancer had metastasized. An ultrasound revealed that his lymph nodes near the abdomen were enlarged – – a really bad sign – – and there was a tiny lesion on his spleen. Dr. Kudej indicated that for the best outcome, he would have to remove the lymph nodes and spleen, which was a rather involved abdominal incision and surgery that would require a longer post-op recovery. And expense: it would be an additional $2,000. But Dr. Kudej was not finished. He suggested that Spencer ideally should undergo both chemotherapy and radiation treatments. The chemo would be administered weekly by IV; and the radiation was not only a huge commitment of time, it would be an additional $5,000 – $6,000!!!!
Once again I cried. I knew there was no way I was going to commit this kind of money to my dog’s recovery, nor was I going to put the dog through the pain and suffering of treatment which would buy him an extra year at most beyond treating the primary cancer. The vet said that the goal was not to “cure” Spencer: since his cancer was terminal, the chemo/radiation was merely to extend his life. I was heartbroken, but knew that we would not be treating him beyond removing the primary tumor.
It is hard, but I have to put it into perspective. I am very sad about the cancer diagnosis, but I am also glad it is not my husband, children or grandchildren. Spencer is such a wonderful dog. He’s a companion for my many walks and hikes in the White Mountains. He’s a loving dog with great tolerance and love for baby grandchildren who unintentionally clobber him or pet him a little too hard. He loves to run around with the older grandkids and appreciates their attention and excitement, and has taught them a bit about pet ownership and responsibility that they would not have had the opportunity to experience otherwise. There is not a person or other dog that he doesn’t greet with excitement and friendliness and love. He can be wild and crazy and fun, but is always gentle and kind. I cannot justify spending tens of thousands of dollars on my dog, although I met many caring people while waiting in the emergency room at Tufts who were doing just that, and no, they were (mostly) not neurotic (stay tuned for more about our Tufts adventure in a future blog post). I will not judge them for their decisions to treat their animals sparing no expense, though those decisions are different from mine; and I only ask that they not judge me. My goal is simply to appreciate Spencer for whatever time we have left (6 months? 1 year?), and when the joy goes out of his demeanor, and he is in pain that cannot be resolved, I will know it is time for us to say a final goodbye.
Right now Spencer is full of life, and enjoying every minute of it.
If you click on this link you will see Spencer a week after his surgery, once again playing “catch me if you can.” He is wearing an e-collar temporarily until his stitches dissolve.