BLOODWORK

As I mentioned in my takeaway blog, Annie's medical issues were by no means over. After much battling, we finished her course of antibiotics and a mere 2 and 1/2 days later there was blood in her urine.

Artie and I were very concerned that a recurrence of her urinary tract infection happened so quickly. Then again, I was concerned the recurrence was an indication of cancer elsewhere in her body. To think Annie went through all she did only to find she wasn't cancer-free was too much to bear.

We called emergency to tell them we were bringing Annie in for a recurrence and to find out  if we could also meet with the Oncologist a week early. If we could get to emergency by 4 PM, the Oncologist would see her for her 3-month visit and another doctor would see her for the blood in the urine recurrence.

Off the 3 of us went. A few hours later, we were home after meeting with 3 doctors, 2 examinations, 3 x-rays, a sonogram, drawing of urine and a 14-day round of a new antibiotic. Now we were very apprehensive - the x-rays turned up several calcifications on Annie's lungs, a sometimes marker of metastatic cancer. Now we had to wait not only for the results of a urine culture but for results from a Radiologist reading of the x-rays.

Easter was about a week away - another holiday spent wondering what was going to happen. In the meantime, life with Orphée was definitely developing in new, interesting directions. The trick was to get through to the diagnosis without undue stress for Annie (or ourselves) and continue to integrate Orphée into the routine of family life.

TAKEWAYS POST SURGERY

What did I learn from this experience with Annie?

• If the consequences of the medical issue can be profound, always get a second opinion even if you agree with the diagnosis. We should have done this from the very first time the subject of the lump was discussed. An earlier surgery would have translated into less anxiety and worry for us, less of an ordeal for Annie and probably lower medical expenses.
• Don't lose sight of the bigger picture. I convinced myself everything would be OK, losing sight of the worst case scenario. I'm not advocating doom and gloom here, I'm just saying that hoping for the best but preparing for the worst might be the best course of action.
• Ask questions, ask questions, ask questions. And did I say ask questions? Ask 'em until you're blue in the face; ask 'em until you have satisfactory answers you can live with and enough information to make intelligent decisions.
• Stay calm and carry on. The British motto from the days of the blitz holds true when dealing with medical emergencies. The stress of a major medical crisis is the same as being under siege. If you don't stay calm you won't think clearly, act rationally or make solid decisions.
• If you're uncomfortable with any aspect of diagnosis, treatment, etc. talk it over and talk it out until you are comfortable.
• Above all, love your animal and try not to communicate your negative feelings. Our pets really do sense what we feel. You want to stay positive, calm and loving so your pet won't be stressed any more than necessary by their medical emergency.
• Finally, don't spend time beating yourself up. You are only human after all, there is only so much you can do and as long as you are doing the best you can be easy on yourself.

Annie's saga is by no means over. Our little family will  have to relive the possibility of another cancer diagnosis with every 3-month Oncologist visit. Another medical emergency came back in force and it will be the subject of the next post.

ANNIE'S CANCER POST SURGERY

After all the sweating, worrying, waiting and praying we received a call January 13th from the surgeon letting us know they'd obtained clean margins. Annie's office appointment 3 days later brought more good news - no radiation needed. Her stitches were removed but from now on Annie needed to see the Oncologist every 3 months for a checkup starting from the date of her 2nd surgery.

The surgery site was healing nicely. I checked her incision every few days gratified to see and feel the hard ridge of the incision receding nicely. It seemed a bit odd but both ends of the incision were still hard and lumpy. I surmised the reason to be extra dissolving stitches at the ends but didn't know for sure since I'm not a doctor or surgeon.

Meanwhile, Annie seemed to continue to be a bit uncomfortable when lying down on the surgery site although it happened less and less as time passed. My January 30th examination of her incision turned up a stitch protruding from the end of the surgery. We made a special trip to emergency to have it removed and were told if any more came up we could cut them ourselves.

So Annie continued on the path to a full recovery. For the first time Artie and I felt she had a good shot at a full recovery and we had an opportunity to have Annie in our lives for a few more years at least. Dare I hope I could consider my sweet Annie a cancer survivor? I toyed with the idea of doing a monthly count of her progress but decided to put that idea on hold until after Buddy's one-year anniversary. Little did we know Annie would face more medical issues.

And my list of takeaways from this experience? The lessons learned will be outlined in my next post.

THE CANCER SAGA CONTINUES

New Year's Eve and New Year's Day were as depressing as Christmas. I was nervous over the different possible outcomes of the surgery; I hoped for the best but I was expecting the worst. Artie, on the other hand, was extremely angry about how this played out; the possibility of losing Annie so soon after losing Buddy was very distressing. Both of us were upset that by trying to avoid any surgery Annie now had to go through not one but two operations.

Friday, January 4, 2013, the day of the follow-up surgery arrived. Annie's appointment was for 7:30 AM. Her surgery was scheduled for morning. I received a call during the afternoon from Dr. Cherrone, the surgeon who performed the operation. She sounded very upbeat as she reported Annie went through the surgery successfully and was recovering nicely, however, we would have to wait for the biopsy results to determine if the margins were clean and whether or not we had to go forward with radiation therapy.

Both Artie and I were emotionally totaled, counting the hours until Annie could come home. 6 PM Saturday we were at VERG waiting to collect Annie, get post-op instructions and leave for what we hoped would be an uneventful evening at home. When Annie entered the exam room, we were stunned to see her acting completely normal. The only evidence of surgery was the big bandage wrapping her entire midsection. She was alert, thrilled to see us and busily exploring the room, smelling the floor and furniture and, as always, begging for attention from the Veterinary Technician and us.

Annie was on medicine and we needed to keep the bandages on for awhile until we were sure any residual bleeding or oozing from the wound stopped. Never in my wildest dreams did I expect to pick up Frankenweenie but that is exactly what Annie looked like with her long scar closed by staples! The pictures below were taken about two weeks after the surgery. A significant amount of swelling at the surgical site had already gone down and her hair was starting to grow back.

My next post will continue with our post-surgery experiences.

Annie resting prior to our daily exam of her sutures.

The second surgery incision was twice the length of the first surgery.

Close-up of staples; you can see swelling especially at both ends of the incision.

Another close-up of Annie's surgery.

ANNIE'S CANCER SURGERY

Quite a while ago I promised to write about Annie's surgery once I could bring myself to do so. Now is the time.

As anyone following this blog will know, Annie had a lump at the bottom of her rib-cage for more than a year. Both myself and Artie as well as Annie's doctors were monitoring it. The lump felt like a fatty tumor. At the time of Buddy's death, Artie wanted to have it removed; I did not want to put her through surgery if it wasn't necessary because of her age as well as the dangers associated with surgery and anesthesia. We decided to continue to monitor the lump.

Around Thanksgiving we noticed the lump was bigger. Not by much but now we were concerned with 'quality-of-life' issues - would it be uncomfortable for her to lie on her side? If we didn't remove it now and it became bigger wouldn't surgery be riskier as she aged?

Annie went for an office visit December 13th. We discussed our concerns with the doctor and a sample was taken. When the cytology report came in December 15th, the findings were as follows:

"No significant inflammatory response was evident. The spindle cells displayed minimal atypia. Findings may reflect a benign fibrosing cystic structure, cystic spindle cell tumor (fibroma or low grade malignant potential sarcoma), or other underlying nonexfoliating fibrosing cystic structure."

At that point the both of us AND the doctor wanted it removed. Surgery was performed December 20th; Annie came home the same day. She was still somewhat under the effects of the anesthesia, on Rimadyl, not interested in food or water and did nothing but sleep. It took a few days for Annie to return to her usual self - a sure sign that my girl is older now.

Christmas was a somber affair as we worried about the biopsy results. The results of the biopsy came December 26th and the lump definitely was cancer. The report characterized it as a slow-moving soft tissue sarcoma. The surgery did not produce clear margins; Annie needed to have additional surgery. If the second surgery did not produce clean margins, she would need radiation therapy. We were referred to Dr. Cohen at VERG (Veterinary Emergency Referral Group) and an appointment was made for the next day.

Early the next day, Artie and I took Annie for her consult with the oncologist. Dr. Cohen was wonderful and Annie fell in love with her. After the exam, Annie was taken for a series of x-rays while we waited in the examining room.

Dr. Cohen returned with the x-rays and reviewed them with us. Annie had several points in her favor.

1. Her behavior was normal which Dr. Cohen assured us was a good sign.
2. There were no visible tumors on any of the x-rays - a good indicator that the tumor most likely wasn't metastatic.
3. Radiation would only be needed if the second surgery did not produce clean margins.
4. Annie had a good chance of a 100% recovery if the second surgery produced clean margins.

We discussed radiation therapy which would be done over a period of eighteen days if needed. My mind was reeling from the logistics.  There were 3 places Annie could go to, the Animal Medical Center in NYC, a facility upstate or a facility in New Jersey. She would go on an outpatient basis which meant going in and coming home daily or she could stay for 5 days coming home for the weekends. Dr. Cohen suggested not thinking about next steps until we had the post-surgery results. The follow-up surgery was scheduled for January 5th and we all went home to wonder what 2013 had in store for Annie health-wise.

I will pick up this narrative in a second post along with post-surgery photos.

DOGGIE PRESCRIPTION

One of my friends told me about a pharmacy for pets in Manhattan. New Yorkers are really wrapped up in their pets and apparently one pharmacy on the Upper East Side took it as a call to action.

Best Pet Rx carries all kinds of personal needs and has the standard prescription drug counter but this traditional drug store took it one paw further by catering to pets. The personal needs items are most likely for dogs, cats or birds. The pharmacists fill prescriptions from veterinarians.

During Buddy's illness, I injured my ankle and couldn't go to Hope Veterinary Clinic to pick up refills of his IV supplies. Doctor Young gave me prescriptions and my local neighborhood pharmacy filled them.

It looks like Pet Pharmacies will be the wave of the future.

RAW FOOD - THE REAL THING

During last week's doctor visit, we discussed starting Annie on raw foods. I'm uncomfortable with this idea but I'm willing to give it a try.

Thursday's list of errands included a stop at Hope Veterinary Clinic to find out if our Primal raw bones order came in yet - it didn't. Since we were there, Artie and I decided to purchase a 4lb. bag of Primal Raw Formula food to take home and refrigerate for future use. We also purchased a large bag of Stella and Chewy's Raw Freeze-dried Chicken Patties. Annie's had them before (they are the treat-of-choice-reward given by the doctors during exams) and I decided to add them as a supplement or substitute for regular meat to her daily meals.

As soon as we opened the front door, Annie's nose was in the shopping bag containing the Stella and Chewy's patties. After a day of running errands, I was too tired to cook for any of us so all dinners, human and canine, consisted of left-overs. Believe me, nobody complained. In fact, Annie was more than thrilled because the Stella and Chewy patties were substituted for her regular cooked meat. Mixed in with her Healthy Powder, olive oil, apple cider vinegar, vegetables and Quinoa she happily gobbled up supper then settled down on the couch with a contented sigh.

Maybe raw food alternating with cooked food or supplementing the cooked food will be a good way to go? Only further conversations with Doctor Young, time and Annie's reaction to the new diet will tell.

ANNIE'S LICK GRANULOMA

We kept Annie's doctor appointment last Friday and the news was all good. No need for dental surgery. The Perio-Support has been added to all her meals since Friday night and I need to clean her teeth with a bit of  wet gauze and some of the Perio-Support as well.

It might be best to redo her daily chart adding the Perio-Support and hand-cleaning to the list. I'll have to think about that a bit before I make my decision. Lately, I've been thinking about adding her bath to the list just to keep track of the frequency.

And Dr. Young was right about the allergies. We dropped the cheese from Annie's meals and she is no longer licking her back paw. She is still rubbing her muzzle a bit but not nearly as much as before. What a relief! 

Thanks, I'm feeling better!