Monday, January 19, 2009
Lily is the puppy that I didn't want my husband to get because I was intimidated by American Bulldogs. Now, I can't imagine life without her. We brought her home at the age of 8 weeks and our "guard dog" was on duty in less than 24 hours. She wanted to be with us every minute of the day. As a awkward, teenage puppy, Lily was mischievous, rambunctious, somewhat destructive and extremely shy. We decided to breed her when she was 2 years old and she had 18 puppies, earning the nickname "Big Momma". As Lily matured, some of her craziness vanished along with her shyness. She became an extremely loyal, loving and obedient dog. The dog that I thought was supposed to be so tough does an excellent job of guarding the house and the vehicles. However, when she is not preoccupied with her job of "lead guard dog" , she can be somewhat of a diva. She can be extremely stubborn and she does not like to go outside when it is hot or when it is cold. If it's raining she does not like to get her feet wet. Her favorite activities are going on walks, eating, riding in the car and "girls day at the spa" with her puppies, Rosie and Britney. Lily is now battling cancer for the second time. In March of 2005 she was diagnosed with stage II mast cell cancer. The lump was surgically removed and followed up with 6 months of chemotherapy. The mast cell cancer has not returned. I was on vacation in July of 2007 when the kennel that Lily was boarded at called me to tell me she was limping. I told them to use their own judgment about whether or not to take her to the vet because I was going to be home in a couple of days. After I picked Lily up at the kennel and brought her home, she seemed to be fine. I never even saw her limp. I did go ahead and make an appointment to take her in to the vet based solely on what the trainer at the kennel had told me. I will never forget the shock and disbelief I felt when the veterinarian told me that Lily had osteosarcoma. The veterinarian was telling me that my beautiful girl, who appeared to be so healthy, had only 3 or 4 months to live. I knew all about osteosarcoma in humans (primarily teenagers) because I had done a clinical rotation at St. Jude Children's hospital years before when I was a pharmacy student. Yet, I was not educated about osteosarcoma in dogs because I had small dogs ( Boston Terriers) for most of my life. I wasn't the one who had decided to get an American Bulldog and I had not done the research. Lily was referred to an oncologist in Denver and I also got a second opinion at The Animal Cancer Center at Colorado State University. Both oncologists agreed that the probabililty of Lily having osteosarcoma was about 95%. I decided to have Lily treated at CSU and the battle was on. After going over all of the statistics and the risks, I was told that Lily was a good candidate for the limbspare surgery due to the location of her tumor (right distal radius). I was also warned that there was about a 20% chance the cancer could return in the same leg but that a recurrence would not affect her longevity. I decided to give the limbspare surgery a try and I knew we would have to go to plan B if the cancer returned. Lily's standard greeting, whenever I came home, was to stand up on her hind legs and hug me with her front legs. I just couldn't imagine not having the "Lily hugs" and I was worried about how a dog with such broad shoulders was going to get around with only one front leg. Lily had her limbspare surgery on Aug. 13, 2007. The surgery was followed with a 3-month recovery period where she was only allowed limited activity and 5 rounds of carboplatin. The oncologists were hesitant to use doxarubicin because of its cardiotoxicity and they thought Lily's heart might already be slightly enlarged. Lily's recovery went along pretty well until the oncologists took a x-ray in Jan. of 08 and saw that the cancer had recurred. Lily's leg was amputated 4 days later. She recovered without complications and I could not believe what an excellent job the surgeon had done. This time the oncologist thought it was best to go ahead and risk the doxarubicin and closely monitor her heart, so she had 5 rounds of that drug. Lily and I made it pretty well through the first 11 months of her osteosarcoma but her battle became much more difficult in the summer of 2008. In June of 2008, I took Lily in for a chest x-ray and the oncologist told me that she had one lung met in her right lung. Lily was started on the metronomic protocol (piroxicam, doxycycline and cytoxan) and I was told to return for another chest x-ray in one month. If the lung met was slow growing I might have the option of having it surgically removed. I returned for another chest x-ray in July and I was told that the lung met in the right lung had doubled in size and that Lily now had another lung met in her left lung. This meant that surgery was no longer going to be an option. The oncologist also said there was no point in keeping her on the metronomic protocol because it was not working. I was devastated and when I asked the oncologist how much longer she thought Lily had to live and she told me 2 months. I had been planning on flying to Memphis the next day if Lily was stable. Now there was no way I could go off and leave Lily if she only had 2 months to live. I decided to drive to Memphis with Lily and my Boston terrier, Daisy. While we were in Memphis, we had the pleasure of meeting Luke, Murphy and Hudson. Lily's health declined more in August of 2008. She no longer wanted to go on walks and I noticed that her left front leg was swollen. I took her back to CSU and she was diagnosed with hpertrophic osteopathy. The oncologist prescribed rimadyl and tramadol. (She also received an I. V. infusion of pamidronate in August and another one in September.) A short time later, Lily's back legs began to swell also. The veterinarians kept increasing her dose of tramadol until she was at the maximum dose. The vets later added gabapentin in with her tramadol and rimadyl. Lily and I had some really rough days in August and September. Lily was in pain and she did not want to walk. I had to buy a wagon and put her in the wagon, take her outside to go to the bathroom, put her back in the wagon and bring her back inside. I also bought a harness from tripawds.com because lifting a 90-pound dog was difficult for me. I asked my friends at church to pray for Lily. ( One friend told me that she didn't think there had ever been so many people praying so hard for one dog.) There were some days where Lily did not want to eat and the entire refrigerator was stocked with food just for Lily. Then one day, I couldn't even get Lily's medicine down her so I took her to my primary veterinarian and asked them to give her a rimadyl injection. The next day, Lily had an appointment at CSU and they gave her a rimadyl injection also. The rimadyl injection lasted for 24 hours and I noticed that Lily seemed to improve after that. I started taking Lily in for rimadyl injections twice a week and she seemed to improve a little bit. As a pharmacist, I was familiar with pain management options for people and I was really frustrated at how limited the options for dogs seemed to be. I finally started to consult some veterinary pain management specialists and Lily saw 2 different pain specialists at CSU. The wholistic pain specialist massaged Lily and gave her an accupuncture treatment. Lily began to improve some. Then the anesthesiologist added ammantadine to her other drugs and the improvement was significant. I continued to take Lily to CSU for accupuncture and laser therapy and by the end of October, Lily no longer needed the harness or the wagon. She began to walk, even run, down the street to the neighbor's house who always gave her dog biscuits. By November of 2008, Lily seemed to be feeling really good. I was not doing so well though, because I didn't know what the status of her lung mets was. I called CSU and told them that I wanted to have a chest x-ray done and that I wanted to be sure there was not something else that could be done for Lily. I dropped Lily off for the chest x-ray and when I returned to meet the oncologist I was trying to prepare myself for the inevitable bad news that I was going to receive. When I walked into the examination room the oncologist was smiling and I was really confused. Then she showed me Lily's x-ray. The lung met in the left lung had disappeared and the lung met in the right lung had decreased in size from 7 cm to 6 cm. She smiled and asked me if I knew what that meant. I knew exactly. Lily was a candidate for surgery. The oncologist then went on to say that the veterinarians did not have an explanation for why Lily's lung mets had improved. I was told that her case even stumped Dr. Withrow, the veterinarian who started The Animal Cancer Center at CSU 30 years ago. Then the oncologist told me that they could do the surgery the next day and asked me if I needed time to think about it. I told her that I didn't need any time to think about and that I would bring Lily back the next day. I took Lily back the next day (2 days before Thanksgiving). The plan was to do a ultrasound of her abdomen and if everything looked okay they would proceed with the surgery. Then we ran into one final obstacle. They found a mass the size of a tennis ball on her liver. I had to make a decision about what I wanted to do. If the surgeon removed both lesions, it meant that Lily was going to have 2 huge incisions that were perpendicular to each other. I made the somewhat frightening decision to proceed with the surgery. When I picked my girl up on Thanksgiving Day, she looked like a patchwork quilt. Lily had a smooth recovery and the lab results for both lesions that were removed came back positive for metastatic osteosarcoma. Lily had a chest x-ray on Christmas Eve that came back met-free and she has had 2 rounds of carboplatin and gemcitabine given 4 hours apart on the same day. Lily's surgical oncologist says she is hopeful that the osteosarcoma is back down to a microscopic level and the medical oncologist said that Lily is now in uncharted territory. Lily's primary vet, one of her oncologists and one of the pain managemetn speacialists have all referred to Lily as a "miracle dog" on separate occasions and I am thankful to have a little more time with my girl.