And Now, the Rest of the Story…

October 12th of this year ended an odyssey that began in early December of 2009. It was during that first week of December that Girly Girl and I got the initial diagnosis of osteosarcoma. I remember so well sitting on the floor with Girly Girl. She was still zonked out from the anesthesia they administered to take the x-rays. I was sobbing uncontrollably, holding her in my lap. I stayed in that exam room just holding her and crying for so long that at least three staff members walked in on me, believing that I surely must have collected myself and departed by then. But it was some time before I was able to come out of the room. Girly Girl just wanted to get the hell out of the building and into my car.

We fought for eleven long, hard months. Girly Girl taught me about amazing courage, equanimity and living to the fullest in the face of great illness and often, great pain. I frequently wondered how I would be able to live with the terrible hourglass poised over our existence at all times. There were times it drove me to complete despair. But mostly it helped me truly appreciate what it means to live in the moment. To savor each special minute we shared. It taught me to slow down and just sit in the sun for a nice long belly rub.

During that time, spending precious minutes writing blog updates simply wasn’t an option I was willing to entertain. But now that my girl has gone, telling the rest of her story seems important –if not just for my own soul, maybe also to share her brave, fighting spirit and to leave a record for anyone else who may face the agonizing choices you are forced to make when cancer enters your lives. I know it helped us to be able to learn what others had tried, done, and faced in their journey. Though most everyone’s story ended like ours, knowing what to expect and just knowing others had walked (and were walking) in our shoes made many a long night just a little shorter. If our story can help someone else make an important decision or avoid a mistake we made, then this is Girly Girl’s last gift.

At that, I resume our story where I left off in this blog. We had reached the end of Girly Girl’s chemo. She had sailed through her first round of chemo like a pro. We were discharged with an appointment to follow up in three weeks for our first set of post-chemo lung x-rays. The plan was to x-ray her lungs every three months. She also underwent an echocardiogram at discharge and was given a clean bill of health on her heart which could potentially have been damaged by the chemo drug she was on, Adriamycin (Doxyrubicin). My girl was minus all her whiskers but one stubborn hold out on her cheek. She had no eyebrows either. The chemo had made them all fall out, but by god, her heart was sound.

We arrived back for our first x-ray at three weeks out. A staff member disappeared with Girly Girl and Dr. Romansik was soon back out, asking me to come with him. I knew that this wasn’t good. There on the light box were Girly Girl’s x-rays from April and the x-rays from that days visit. Typically, there would not have been a set of April x-rays, taken during her chemo, however, on that particular day I had a very strong feeling of dread while driving to the chemo appointment. There was no outward indication that anything was wrong but I had such a strong feeling that I must have convinced Dr. Romansik. He took the unscheduled x-rays which revealed a tiny little spot on her lung. Dr. Romansik was of the opinion that it was a small tumor from the metastasized osteosarcoma. We learned, that day, about “lung mets,” what they call the tumors that almost always show up in the lungs of osteosarcoma patients eventually. The goal had been to keep them at bay for as long as possible. In my mind, that was going to be years off. We were going to beat all odds. I was devastated by the x-ray but Dr. Romansik told me to “keep my chin up.” (I would come to HATE that phrase out of his mouth.) The radiologist had to read it for the official diagnosis. I cried for the days it took to get the radiologists report back. The radiologist told us it was not a lung met but an anatomical abnormality. I wanted so badly for this to be true, I chose to believe it and I didn’t follow up any further.

I had done such a good job convincing myself that it was anatomical, when in June, her first set of x-rays post-chemo, showed a now larger lung tumor in the place where the questionable spot had been in April, I felt as if Dr. Romansik had physically punched me in the gut. Near the now larger tumor were three other smaller lung mets. I was so in shock by the news, it took me a couple days to snap out of it and decide what to do next. Whenever I looked at my heart dog, I couldn’t imagine losing her and so the decision was made to fight on. I wasn’t sure if I should put her through more chemo but she continued on living each day seemingly healthy and full of life. We made an appointment for further chemo and I worked with Ohio State University Greyhound Health Program to get Carboplatin sent for Girly Girl. OSU provides free chemo drugs for retired racers. Not only for the first round it turns out, but all subsequent rounds as well.

After the first day of the second round of chemo, Girly Girl was so anxious to get out of the office and go home, she wouldn’t even wait for me to open the backseat car door. Instead, when I first opened the front passenger side door to drop my purse and her paperwork, she leapt in past me, over the front passenger seat, coming to rest in the driver’s seat. She could not be convinced to come back out so I ended up carrying her from the driver’s side, around to the back passenger side. On that day, Mumma felt pretty bad about her decision to move forward with more chemo.

Girly Girl, being my incredible brave girl, settled back into the chemo routine and after several treatments of Carboplatin, Dr. Romansik took yet another set of x-rays. I had come to despise x-ray days and on that day at the end of July, Dr. Romansik was out too quickly, dragging me back to the light box. There, like a horrible series of family photos where everyone gets bigger every year, were April’s, June’s and July’s x-rays. In July’s x-ray you could plainly see four tumors. Formerly the size of peas in June, they were now the size of walnuts. Carboplatin was not working. There was still a Hail Mary option and we had fought so long and so hard, I knew immediately I wasn’t going to give up. We got two meds Doxycycline, an antibiotic and Cyclophasphamide, a chemo drug, specially compounded for Girly Girl at a compounding pharmacy and sent to us in the mail. When I researched the drugs later, I learned they were a modified version of what is known as the Metronomic Protocol. The actual Protocol would have included a cox-2 inhibitor in addition to the two other drugs.

Thus Girly Girl began her third round of chemo. During this time, finally, my steel core magnolia showed some signs of not feeling 100% up to par. She developed a cough that was at first, dry and unproductive but as the weeks went on, became wet and at some points was productive. Dr. Romansik told us that canines could lose up to 50% of their lung capacity and not be affected; however, I felt that in this case he was wrong and the tumors were causing her cough. As time wore on, it became quite clear that this was so.

While Girly Girl tolerated the Metronomic Protocol well, her cough continued to get worse. Soon it was affecting her activity level. She would cough when she got up from lying down. She would cough when she lay down after standing up. She would break down into coughing fits trying to “speak” to me to demand her half of the couch. She stopped running with Blue in the backyard. It reached a point every movement she made or sound she tried to make would send her into a paroxysm of coughing. As if that wasn’t bad enough, the cough also got progressively wetter. Her lungs were filling with some sort of fluid. She also constantly ran a temperature of 103 degrees.

Based on her symptoms, I feared that maybe a heart issue had been missed on her last echocardiogram. The symptoms mimicked heart issues so closely that I took Girly Girl to see our family vet, Dr. Edelbaum. She examined Girly Girl. She did blood tests and took x-rays. She listened to Girly Girl’s heart. She found her heart to be normal. The x-rays, on the other hand showed a giant mass in the center of her lungs. Either one tumor had grown to the size of a baseball or two tumors had grown together to appear as one in the x-ray. Dr. Edelbaum feared to treat Girly Girl for a heart problem given that the tests weren’t indicating she had one. I was pretty distraught about my sweet baby’s growing level of obvious discomfort. I was begging for some sort of action to give her relief. Dr. Edelbaum got us in for an appointment with Dr. Rossi, scheduled for the next afternoon. Dr. Rossi would complete an ultrasound of her heart. The only catch was we had to drive to Salem, Massachusetts from Bowdoin, Maine being that he was the closest option. But drive we did.

The ultrasound revealed a perfectly normal heart. In fact, there was a heart in there that was in great shape for all the abuse it had taken in its short life. Dr. Rossi also did an ultrasound of her abdomen but found nothing out of order there either. Finally, he suggested a lung tap to see what sort of fluid was in her lungs. It was the last thing I wanted to put her through given what she had already endured, but Dr. Rossi told me dogs tolerate it well. I knew we had to find out what the fluid was in her lungs if I had any hope of getting her some treatment so I had him go ahead with the tap. Dr. Rossi extracted fluid from her lungs and it appeared to be blood. Examination under the microscope confirmed that but we sent a sample out to a lab to be absolutely sure. The next day, the results were back from the lab, and the fluid that was filling Girly Girl’s lungs was blood.

Once we knew what the fluid was, Dr. Edelbaum gave us a Traditional Chinese Medicine to use called Yunnan Baiyao. The next day, a Friday in mid-September, we saw Dr. Romansik for our first follow up on the metronomic chemo. I explained what had happened during the week and he began calling around to get all her records. Eventually these were all faxed to him while we sat in the waiting room. He took Girly Girl and gave her a quick exam. He was soon back with her. He told me to take Girly Girl home. He said there was nothing more we could do. We had lost the fight. The blood in her lungs was due to the tumors growing and bursting blood vessels in her lungs. Her fever was also common in end stage cancer patients. It was a completely unreal moment and I had a hard time believing we would not be coming back. I did have the presence of mind to beg him for something to make her feel more comfortable. Though he said there was not much he could do, he did send us home with 20 mg of Prednisone to give her daily. He said it would give her a sense of well-being. If she was in pain, he would call in Gabapentin or Tramadol.

I cried the entire two hour drive home. I am not proud to say I drove in that condition but I just wanted to get home with my girl. We stopped at Grammy’s on the way and broke the awful news, then we went home to begin the last leg of our journey together. I started giving her the Prednisone and Yunnan Baiyao. Though Dr. Romansik said there was no point, I couldn’t give up the fight and continued to give her the Metronomic Protocol drugs. The Prednisone and Yunnan Baiyao worked a minor miracle. Girly Girl’s lungs cleared of blood. She still coughed from time to time, but it was dry. She began playing with toys again. She was running in the backyard with Blue. She was the girl we had before the tumors began to affect her lungs.

Dr. Romansik had given us a couple of days to a week at most. Girly Girl, being stubborn, and not speaking human, made it a month further. More amazingly, the Prednisone and Yunnan Baiyao gave her a very good quality of life. We were cruising along in a strange sort of limbo until the evening of Sunday October 10th. At 6:30 pm that night, one or more of her tumors pressed on, or ruptured something crucial. At that time she had been laying on the living room rug. She looked up at me strangely and struggled to her feet. She took a halting step towards me. She stood where she was a while longer staring far away. Panic set in and I called her to me. She lurched towards me slowly. From that moment on, she slid downhill quickly.

Blood filled her lungs again. She had difficulty walking any distance. It was bad enough that I was carrying her in and out for her potty breaks, fearing she would collapse on the stairs and seriously injure herself. She had trouble keeping her balance long enough to pee. At one point when I carried her back in from a potty break and set her down I noticed drops of blood on the kitchen floor. She was bleeding from her nose. There was nothing I could do for my first baby, my heart, my soul dog.

In the afternoon of Tuesday, October 12th, Dr. Edelbaum made the trip to our house. Girly Girl, Blue and I had spent the day being together and, as if to make me question everything, Girly Girl rallied a bit. My girl got belly rubs in the sun in the backyard. She got stuffed with all her favorite treats. She and I spent a lot of time just cuddling on her bed. Then, as the sun was setting, out in the backyard in Girly Girl’s favorite belly rub spot, with her beloved Grammy, Charlie and Blue by her side, she departed for the bridge from the shelter of her Mumma’s lap.

We kept Girly Girl with us overnight. I wanted Blue to have a chance to understand what had happened to her and to say goodbye in whatever way he chose to. The next morning, I took my sweet girl on her last ride to the cremation facility. We are truly blessed here in Maine to have Fluke’s Aftercare. This small business located in tiny Litchfield, Maine came to be after the proprietors had to experience the traditional method of death and dying with their cherished dog, Fluke. Not wanting to ever have anyone go through that again, they decided to give people in Maine a different option. To put respect, dignity and trust into a process that is extremely hard to deal with while you are trying to come to grips with the loss of a companion that meant so much. They are amazing people and I at least had the peace of mind that my heart dog was cared for and treated with respect. I also knew that the ashes I received back were hers. The next day, she came home in a beautifully hand carved box. Meanwhile, Blue and I have been trying to move forward with our lives that don’t include Girly Girl. He experienced grief and depression. Normally a social butterfly, Blue became withdrawn. He would wander the house whining every day for a month. He spent a lot of time lying in my lap. Don’t let anyone tell you that dogs don’t mourn.

That, as Paul Harvey used to say, is the rest of the story. I know that I will bring another greyhound into our lives at some point when I am ready. At this writing, I can’t conceive of that time yet. Blue is desperately sad and lonely and I know he needs another four legged family member to share his experiences with. The chance that Blue or this future unknown hound may take me on another cancer journey looms large in my thoughts and frankly petrifies me. Still Girly Girl changed my life so profoundly, telling her story, and our life together would not be honored if we remain a one dog household. Maybe, after all, the one person that this story will end up helping is me.