Downhill Day

One of my favorite bloggers, Sarah Hart-Unger, wrote about going into “low-gear” (i.e., giving herself a break) as she and her husband both were “on-call” this weekend. Since they’re both full-time medical specialists (he’s a surgeon, she’s a pediatric endocrinologist) and have three young children, their lives couldn’t be much more hectic than it already is, but Sarah is also a prolific blogger and co-host of one of my favorite podcasts, The Best of Both Worlds. Although she may not describe herself as a master of time management, that’s exactly what she is, so if you haven’t had a chance to read her blog and/or listen to her podcasts, I couldn’t recommend enough that you load up your favorite podcast app now with all their episodes and grab yourself a coffee while you peruse her delightful blog.

Anyway, the whole point of this particular post is to echo the theme of Sarah’s recent “low-gear” essay. This weekend P. and I took one of our dogs to a major veterinary clinic and research hospital, where G-Dog, a 7-1/2-year-old beautiful black Lab mix, is participating in a clinical trial to test the efficacy of a type of immunotherapy treatment on canine cancer. G-Dog was diagnosed with chondrosarcoma in June of 2017 and had undergone a series of about 20 daily (except for weekends) radiation therapy on the affected area (his back left knee) from July-August. He tolerated it incredibly well, which was to be expected, as dogs apparently handle radiation therapy much, much better than humans do. In fact, usually G-Dog would be playing with his siblings the morning after each treatment. It was only a week or so after his last treatment when he did have severe discomfort, and that was expected as well, although not quite as severely. As most humans who have undergone radiation come to know, it’s the period shortly after the final treatment that’s especially distressing, as the treatment site may experience significant skin irritation. In G-Dog’s case, it looked like he’d suffered a major chemical burn: the entire treatment site looked angry, inflamed, and was peeling several layers of what appeared to be diseased skin.

By then we had him on at least 3 different pain medications and anti-inflammatories, but when one afternoon, while I was on a conference call, I heard him whimper on the floor behind me, and I immediately knew that something terrible was happening, as he’s normally such a docile and even-tempered pup.

I rang off the call as soon as I could and called his oncologist, who had me bring him to the clinic right away. They debrided the entire area and gave him additional medication. When I picked him up that afternoon, the area looked — there’s no other way to say this — beautiful, all pink and healthy-looking and fresh. They’d basically removed all of the diseased/damaged layers and exposed healthy, healing skin. That and the additional meds improved his mood considerably, and he healed quickly. He was cancer-free for 18 months! The only lingering effects of the treatment and the cancer were a temporary, slight limp after he’d been sitting or lying down for an extended period of time, and complete hair loss at the treatment site. Otherwise, it was a swift recovery, and he showed marked improvement with every subsequent 3- and 6-month checkup with the oncologist.

That is, until December 2018.

At his 18-month checkup, they discovered that the cancer had come back. Not only that, but it had spread to his lungs as well. Based on the recommendations of his oncology team, we proceeded with a series of 4 chemotherapy treatments at a rate of about once per 3-4 weeks. Much like his experiences with radiation therapy in 2017, G-Dog tolerated chemotherapy very well, with zero side effects that we could tell. We were so optimistic that he would come through all of that with flying colors, and that he would soon be back to his happy, cheerful self, so it would be an extreme understatement to say that we were devastated to find, during his post-chemotherapy evaluation, that the tumors in his lungs had only grown larger. The oncologist recommended a series of chemotherapy treatments using a different kind of drug, but cautioned us that this treatment would likely not have a positive outcome, and that we must, at all times, always keep G-Dog’s quality of life uppermost. She added that it was very likely that G-Dog would start feeling the effects of the cancer “within 3 to 4 months,” and that once that started happening, we should shift him to palliative care and prepare for the end.

I won’t go into detail about what this news meant to us. We’ve had G-Dog since he was about two weeks old, when P. and I had taken in the entire litter from the city shelter on behalf of a local rescue group and fostered all 8 puppies (plus their mom!). All of them were adopted, and we decided to keep G-Dog and his sister M-Dog I’ve loved him from the beginning, watched him grow from a tiny black potato with eyes that rarely opened, to a frisky, playful and mischievous little tween, to the mature, calm, yet sensitive and gentle adult he is now. To me, he is and will always be a puppy, so to hear that we would lose him years and years before we expected to was an anticipatory grief that shredded our hearts.

Right around that time, though, P. was offered his dream job in a hospital at a small mountain town in the West, famous for its stunning views and enviable outdoor lifestyle. Not only that, but he would enjoy a three-day workweek (known as “3-12’s”, whereby he would work 3 12-hour days) and a commute of less than 15 minutes! At the time, he was working in a major metropolitan hospital and suffered through a commute that generally lasted no less than an hour each way, most of it in bumper-to-bumper traffic through congested neighborhoods.

Since I work from home full-time, it was a no-brainer, especially since it would mean giving G-Dog and his siblings the chance to enjoy a more active, outdoors-focused life. It would mean giving G-Dog the opportunity to go mountain hiking for the first time, and make the very best of what we had been told were his last months.

We moved at the end of April, and within 2-3 days after we’d settled into our new rental home, we took G-Dog to the nearest oncology clinic: a major veterinary research hospital about 300 miles away. It’s quite a trek, but there are no other oncology clinics near our new home. It’s one of those times where words can’t even begin to express just how grateful I am that I have a well-paying full-time job that provides me with the flexibility to do things like take my pup to a specialty clinic hundreds of miles away, while still being able to do my job.

To make a long story even longer, G-Dog’s new clinic turns out to be one of the finest veterinary oncology clinics in the country, if not the world, and while they confirmed all of the diagnoses of his previous oncologists, his new team gave us a glimmer of hope: they had just launched a brand-new clinical trial testing an immunotherapy treatment for dogs with cancer, and G-Dog met all their requirements! And because it’s a clinical trial, just as with human trials we would not have to pay for any of the treatments other than the initial tests to confirm his eligibility.

So that’s what he’s been doing for the past month. Every Sunday, he and I pile into the car and drive the 300 miles through winding mountain passes to the clinic for his Monday appointments. It typically takes me about 5-1/2 to 6 hours, including a brief stop for more coffee and a pastry at a Starbucks roughly halfway.

Depending on the length of his appointment, we’ll either return to our home town Monday after afternoon, or we’ll stay an extra night and return Tuesday morning. We stay at a lovely, moderately-priced Hilton hotel that donates a portion of its proceeds to that same veterinary oncology center, plus they don’t charge patients a pet deposit, so overall it’s a pleasant stay if we don’t think too hard about why we’re there.

That’s what we did this weekend. This time, P. came with us as he was off Monday and Tuesday, and we returned home on Monday afternoon. Next week is G-Dog’s week 4 of the trial, and his appointment will take up the entire Monday, as they’ll need to do x-rays to see if the treatments have resulted in improvement.

Although it’s still 6 days away, I’m already starting to get anxious about what we’ll hear. If it turns out that he isn’t experiencing any improvement, we’ll need to have a discussion with the oncologist about next steps, and at the moment those “next steps” are so unclear that all the possible options are running through my brain, and none of them lead to a happy, long life. That, and the fact that we’re closing on our new house next Thursday as well, and there’s been a snag in the paperwork such that we’re not 100% it’s going to happen, well…my anxiety levels are through the roof.

That is all to say — hundreds of words later — that this morning I woke up after that exhausting drive not really wanting to think about my long to-do list, about the ongoing struggle to get the right paperwork for our closing, about G-Dog’s illness and the uncertainty of his treatments, about work or an upcoming business trip or, really, anything else that reminds me of how crushing life can be and how “juggling” it all can sometimes mean deliberately wanting to drop all the balls and cry.

Book with cup of chai

So that is what I did today. I cried a little, but mostly I did just the bare minimum of what needed to be done, i.e., get some missing paperwork over to the lender, and then spent the rest of the day doing the one thing guaranteed to soothe my jittery soul and make me forget everything but a good story for just a little while: I read, with a hot cup of rich chai in a sweet ceramic cup by my side. For just this afternoon, under a sunny sky, life was good.

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