More on Palliative Care

October. The Lymphoma came back strong -- in Zoey's liver. She felt crappy and would not eat. One particularly bad morning she literally collapsed in the parking lot of the veterinary clinic and could not get up. She kept going blind. Her biopsy site got infected and developed an abscess. And so on. Not our most favorite month of 2017.

It would have been understandable if we had elected euthanasia at that point.

This is Zoey yesterday...

Zoey has a really outstanding veterinarian and so when I presented last month with a very sick dog -- and a desire to have hard conversations -- she engaged with honesty, intelligence, and compassion. I explained it like this -- I see treatment like a bridge. If the treatment is a bridge to remission with more happy days, we want to stay on it even if the bridge is not exactly a fun one. But if the bridge dead ends in a really crappy place -- we are done.

Sometimes you cannot know what kind of bridge you are on right away, and that is when you square up and carefully take steps. We knew that Lymphoma *could* go in remission again, and so that speaks to the importance of knowing what disease you are dealing with -- some diseases are pretty clearly a really bad bridge. But you cannot assume, and that is why Zoey had a biopsy when she presented with *just* liver symptoms -- if the previous chemo had crashed her immune system enough to start yet another type of cancer (histio, for example), we would have been in a very different place. 

And so we stepped. 

Chemo started again. We figured out the blindness issue -- low dose blood pressure med took care of it. Cerenia -- what a great drug for fighting nausea in a dog -- but even with that, Zoey would not eat much at all. We offered about every food even as Zoey continued to turn up her nose and lose weight -- about 11 pounds. It was not an easy bridge.

The physical side is only one component of palliative care; a commitment to quality of life means emotional well-being must also matter. When providing palliative care to a dog, there is no *small thing.* Everything matters. Zoey doesn't like the waiting room -- so she never goes in there. Her left leg is harder to draw blood from -- and so we use the right. She doesn't like to be away from me -- and so she isn't. She likes her tech to feed her cookies -- and so she does. And so on. Quality of life is made up of a myriad of small things.

But palliative care can be terrifying. That balancing act between Benefit and Burden is like dancing in a small space between two sheer cliffs. Trying to establish goals for care when so much is unknown sometimes feels like you are shooting at a can in the dark. When you start across that treatment bridge, you are holding your breath and just waiting for the whole thing to collapse and send you spiraling into that Dark Place of loss and grief and regrets.

I actually understand why some just say, "I can't do the bridge" because yes, it is every kind of horrible. 

But as a team, we did step on that shaky bridge with the goal of assessing whether that bridge went to a remission or a dead end. And we were clear that if we did not see that remission within a few days, we were most certainly on the dead end bridge.

I am glad we weren't.

There are more bridges ahead, and yes -- one is that dead end bridge. I know that. But that is not today's reality. This is...



by Robin Korotki on Sat, 11/25/2017 - 07:01

You have "Zoeys back". You will know when the battle is over. Having been there with prostate cancer with a special boy, the dance was really hard yet Lightning and I weren't ready to quit. You are a great mom who knows Zoey, glad you still have some good times left.

by Kay on Sat, 11/25/2017 - 07:23

So good to see Zoey on her extended journey through life. It takes bravery to keep searching for the right bridges. Zoey is lucky to have such a loving and persistent guide.

by Jill on Sat, 11/25/2017 - 08:20

Hugs to you and Zoey. Or please give her whatever she loves for me - a belly rub,
ear rub, or her ball. ❤

by CA Heidi on Sat, 11/25/2017 - 09:12

No matter what, we are dancing with you. ❤️


by Cathi Dovico on Sat, 11/25/2017 - 11:22

Mary Ann,

Ask your vets about a new drug that's been on the market for about a month now called ENTYCE it
is an appetite stimulant and might be good to have in your arsenal of things for Zoey if needed.

Wishing you an Zoey all the best.

by Mary-Ann on Sat, 11/25/2017 - 12:52

Thank you. We have discussed that new drug already but Zoey is eating well again (thank goodness -- up about eight pounds already :). FYI -- Tara's people tried it with her to no effect. Anyone else have good luck with it?

by Terri Z on Sat, 11/25/2017 - 14:08

Sending Zoey my love and missing and her brother. Do well sweet girl.

by Kathy L on Sat, 11/25/2017 - 16:25

Thank God her mom knows that! How wonderful to see her doing so well.

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