Sixteen days ago, at 2am on Monday morning, Allister threw up. This isn't particularly unusual for my house; it seems like someone is always throwing up. And isn't 2am always the time they do it? Heaven forbid they should puke at a reasonable hour, when you aren't trying to sleep.
He ate breakfast just fine that morning, and while he didn't tackle dinner with his typical enthusiasm, he got that down, too. Tuesday morning, though, he turned down breakfast, and by Tuesday afternoon when I got home, it was clear he wasn't feeling well: drinking, peeing, pooping, sure - but turning down meals and just listless enough that I called my vet and scheduled a visit for Wednesday morning.
Wednesday morning Allister turned down breakfast, but it was okay because we had a vet appointment, and we'd get this figured out, and everything would be fine. Allister sat quietly next to me in the waiting room, and patiently tolerated all the poking and prodding from the vet. I could tell that she was a little skeptical that he was as sick as I said he was. His exam was normal - a little dehydrated, but really not bad for a dog that hadn't eaten in a day and a half - and this particular vet had never met him. However, she brought him back for labs (Allister is my one dog that does better with blood draws if I'm not there), and at least four people stopped her to ask if he was alright. He wasn't barking! I think that's what really convinced her that he was sick.
His labs came back weird. Allister was a touch dehydrated, which should have brought his lab values up, but his potassium and sodium were low. He also tested positive for Lymes disease, but he didn't have any joint pain, a hallmark of the disease. He wasn't eating his meals, but he took kibble from me throughout the exam. He'd pooped yesterday and was drinking water fine. The vet was convinced something was wrong, but nothing fit. We discussed a variety of scenarios, including the possibility that the office's blood machine needed recalibration. After all, they were a clinic, not a lab. In the end, we redrew blood to send out and gave Allister sub-q fluids and a shot of cerenia (a potent anti-nausea med). We scheduled a follow up visit for the next day, and Allister and I went home without any answers.
My plan was to teach class Thursday morning and bring Allister to the vet afterward. But partway through class, I received an urgent call from the vet: "His labs are back, and they're much worse than we thought. He needs to be hospitalized as soon as possible."
We rushed to the Oakdale Animal Emergency and Referral Center where Allister was started on fluids and xrays were taken. The xrays showed a distended section of bowel the size and length of a bratwurst, a finding that strongly suggested a bowel obstruction. But he wasn't throwing up! He had eaten as recently as the day before! The emergency vet agreed that it was strange, and asked to do an ultrasound. The ultrasound took another hour or two to complete, but the results were back almost immediately.
The vet came into the room and sat across from me. "There's definitely a foreign body in his bowel. It's probably something organic, which is why we didn't see it on x-ray. His bowels are in pretty rough shape, though, and it needs to come out as soon as possible." She hesitated a moment, watching me. "We also found masses on his spleen and liver. They could be benign. But there's also a reasonable chance that it's cancer."
And I lost it.
(I feel bad for veterinarians - and doctors in general. They get little to no training on how to deliver bad news and handle sobbing patients. It's a really hard way to practice medicine.)
Hemangiosarcoma is an invasive, aggressive, and unfortunately, all too common cancer in dogs. It typically starts in the spleen and then spreads to the liver, then lungs, then heart. It's typically found in medium to large breed males between eight and ten years old, although it can be found in pretty much any breed, sex, or age group.
I'm fortunate to have an extensive support network, and I leaned on them heavily on Thursday. I sat with my husband and we tried to logically decide what to do like intelligent adults and not desperate owners whose hearts were breaking. We could let Allister go today. We could loose him within a week if the surgery didn't go well. We could lose him in three or six months from cancer. Possibly a year. Possibly six years. Or ten - if he didn't have cancer.
As we talked, I sat next to Allister, softly stroking his head and body. Asking him without words, in that way that dog people do, if he wanted to keep going. Or if he wanted to be done. And Allister thumped his tail and rested his head on my knee and told me that he trusted me to make the decision that was right for him.
The staples are coming out today, so I guess we're going to live a little longer.
I'm still not sure that I made the right decision. Actually, if I'm being honest, I'm a bit surprised with myself (us, really - this was definitely a decision we all made together). If you had asked me a month ago if I would choose to do expensive, invasive, and painful surgery on Allister when he very well might have an aggressive metastatic cancer, I think I probably would have told you "no." I think maybe I like Allister more than I thought I did. I know I don't want to lose him.
I have Allister's spleen sitting on my shelf (that's normal, right?). I can see the tumor on it, round and big as a marble - huge on such a tiny organ. I wonder if it's cancer, but I don't think I really want to know. Maybe he'll die in three months. Maybe we have ten years. You never know how much time you've been given.
But perhaps - if you are very, very fortunate - you get the chance to know what you've got before it's gone.