A Bag of Food

I bought the large bag of dog food this time. I want to tell you this right off. I want you to know that I bought a bag of food that should last at least 6 weeks. I want you to know that I trust that Bailey will eat every kibble from this bag, and that I will have to buy yet another large bag after that.

Until now, and with full intention, I have avoided posting detailed updates about Bailey’s health status. But, as Bailey has continued to beat the medical odds for so long, several people have asked for more details about how she is really doing. And all of these requests undoubtedly have come from sincere concern for Bailey’s health, or true awe about her survival. Both are warranted: awe as Bailey continues to be very happy and appears so healthy long past all expectations, and concern as there are nevertheless signs of declining health resulting from both cancer and age. So, for the first time and for whoever is interested, I offer this report on these two realities of Bailey’s health.

Bailey (standing) with two 6-year-old Goldens

It is human nature to give ten times more weight to bad news than to good news. Knowing this, I want to emphasize how amazingly well Bailey is doing—and not just for a dog with a cancer that everyone expected would have killed her months ago, but for any 13-year-old Golden. Most Golden owners that see Bailey underestimate her age by several years. A few weeks ago I shared on Facebook and showed many others the following image of Bailey with two other Goldens. No one guessed that the other dogs are less than half Bailey’s age. But even more important than appearance, Bailey continues to be comfortable the vast majority of the time, she continues to be active even if less than she was a few months ago, and she continues to be interested in and excited by people, food and life in general. Most important, she continues to be very, very happy. Let me say that again and please remember this as you continue to read—Bailey continues to be alert, comfortable, and very happy. This is one of the two realities—the one that led me to buy that large bag of food.

Still, at 13, Bailey passed the median lifespan for Goldens’ nearly a year ago. Plainly put, she is an old girl and, as such, she suffers some of the same ailments as others her age. Her peripheral vision has been narrowing for a couple of years, and the clarity of her focus is now decreasing as her pupils become increasingly clouded. And then there’s the arthritis in her front elbows—the arthritis first noted in early adulthood but which posed no functional issues until it advanced significantly last year, leading to the start of a prescribed NSAID just before the cancer diagnosis. And this therapy was very successful, having produced the near miraculous relief that afforded us that incredible “last” month (Four Weeks), and four additional “last” months… so far!. But as time and age seems to always win out, Bailey’s arthritis has again advanced to the point that her front legs are stiff and unbending most of the time. Stairs have become both difficult and risky, and (whether for pride or comfort) Bailey rarely lets me carry her. After a couple of minor falls, however, she does now wait patiently for me to “spot” her going up and down stairs. And on a few occasions she has reluctantly looked to me to carry her—I still allow her to make this call only because the crestfallen look that always follows saddens me more than anything else we have yet encountered.

So Bailey is an old girl who struggles with some of the same issues that confront most old dogs and most old people. But, Bailey is an old dog with cancer and this makes things less clear. Is the current  symptom du jour just a condition of aging or a seasonal allergy or a routine upset stomach? Or is it the result of a new or expanding tumor? It is simply not so clear anymore.

Bailey’s cancer is spreading. I learned this fact shortly before her 13^th birthday when a chest X-ray revealed two clear nodules in her lungs and a less definitive shadow on her spleen—two organs frequently involved in the course of hermangiosacrcoma. And it would be typical for this type of cancer to have spread even further, but I cannot be sure having opted out of additional imaging since the results would alter neither treatment nor eventual outcome. So, while I have no way of knowing what other organ systems may be involved, the chest X-ray made clear that Bailey’s cancer is spreading. That is one of the few things that has been clear ever since.

Knowing that it is metastasizing, and knowing how aggressive and lethal hermangio’s are, everything out of the norm now has to be seen under the shadow cast by the reality of cancer. Bailey had a bout of repeated diarrhea with some blood in her stool… fear a colorectal tumor but treat as and hope for typical digestive tract upset (which it turned out to be). On occasion, Bailey stares into space and appears disoriented. Granted that she has always been my goofy dumb blond, but she had never previously just stared idly at nothing until jolted by some distraction (usually, the repeated sound of her name leaving my mouth with increasing volume). Hmm… run-of-the-mill disorientation that comes with age, or a brain tumor? And her hearing took a marked and troubling dive in just a few days.  Now, when standing out of her sight, Bailey no longer responds when I call her name or clap my hands unless done very loudly. If within eyesight, she reacts quickly at lower volumes and responds immediately to hand gestures. Yes, this type of hearing loss is common in older dogs, but given the very rapid rate of the decline, it well could be the result of metastasis to the brain—also typical of hermangio’s. Very little is certain anymore.

Indeed, the only symptom that is clearly a product of the cancer is the arrhythmia caused by the tumor on her heart, along with the labored breathing it produces. These were the symptoms that originally made me suspect that something was wrong back in December, and which appeared only occasionally at first.  In mid-March, however, Bailey had the first of two series of very bad days—days when her arrhythmia became quite pronounced and her breathing became labored for extended periods. For several days, she was not at all comfortable and not at all happy—leading to my first serious thoughts about euthanasia (Is it Time?). And while Bailey did recover from this episode, she did not regain her former level of functioning. A new normal had been established in which the irregularity of her heartbeat was itself now regular. Activity would now be limited to no more than a walk around the block, and that only on a very good day. 

June 25, 2013 - Bully stick joy

Within the limits of this new normal, however, Bailey continued to be happy, alert, interested and hungry. And she continued to insist on strolling the 1-1/2 blocks to the dog park nearly every day to interact with both canines and humans—though mostly humans.  Her activity and energy had both declined, but her happiness and interest in life had not.

Three weeks ago, Bailey suffered another series of very bad days. As before, her arrhythmia had become very pronounced and her breathing was very labored—this time, however, disrupting her sleep and sapping her of the breath and energy required to stand or walk more than a few steps. Although her appetite continued to be good and her output normal, she was clearly neither happy nor comfortable, and she was struggling.  By the forth day, I not only considered if it were time, but had decided that if there were no improvement by days end, I was going to bring her to her primary-care vet—not to the urgent care animal hospital for an attempt at treatment, but to the one vet who saw Bailey since near the start of her life, to see to the end of her life.

This time, Bailey must have gotten the memo. She started walking a little more, and her energy and activity continued to rise gradually through the afternoon, the evening, and for the next two days. Based on our prior experience, I was expecting that her recovery would be limited to a new new normal, but within three days, Bailey was back to where she was before. But only for a few days. Then came the periods of disorientation. Then came the rapid decline in hearing. And then came an ongoing if gradual increase in periods of labored breathing.

June 27, 2013 - A little wrestling

The reality is that whether from cancer or age, Bailey’s health is declining and at some point, whether from cancer or an age-related problem, she will die. But, that is just one of the realities. Bailey is truly amazing and she regularly proves that I underestimate just how amazing she is.  She continues to insist on going to the dog park, even if struggling for air and even when so stiff that walking is painful. On occasion, she has even surprised me with a spunky, if brief, wrestle with a puppy, as she did just yesterday. So, one reality is that her health is declining and she is approaching the end of her life. But the other reality is that she still wears a huge smile most of the time, she is still comfortable, she is still interested in life and, most important, she is still very, very happy. 

Oh, and she continues to eat away at that large bag of food.

My Father and My Dog

Sunday was the birthday-that-was-never-supposed-to-be, and easily the best birthday that Bailey has ever had. It was a wonderful day for many, many reasons. But leading up to it, I could not help but recall the birthday-that-never-was when I left Bailey with friends, as I visited my father for the last time. I have been thinking a lot about my father lately and how he handled his illness, decline and death.

My father was a man defined by many roles. He was a businessman, a husband, a father, a Jew, a liberal democrat and a dog lover (and spoiler). Above all, however, my father was a social being and a practitioner of the nearly lost art of gab. He lived for off-the-cuff social interactions and he was always ready with a subject to chat about. Be it a humorous anecdote, a family story or strong opinions about politics, he was a master at starting conversations and keeping them going. He would draw you in instantly and, before you knew it and without any intention, you would find yourself touting your own stories or arguing for your own opinions. As free as my father felt to vigorously say whatever he thought, he also reveled in hearing other points of view. When with him, you never felt lost for something to say and always felt welcome to speak your mind. As much as he loved to gab, he also loved sharing the gab. My father was definitely a social being—which is what made him such a good businessman, husband, father, Jew, democrat, dog lover and many other things.

Although I am certain that he would relegate it as the least important to his self-definition, my father also played one other very major role during the last fifteen years of his life—that of a patient with a terminal illness. He knew since the beginning that his condition was both chronic and terminal, although he acknowledged (even to his own family) only the chronic component. He refused to be defined by his illness, he refused to give up socializing, and he refused to have others interact with him as a dying old man. He never let his pain or fatigue prevent an opportunity to entertain or go out with friends and relatives, and rarely did he cancel a date due to his illness. As he did with any other topic, he readily gabbed about the management of his own condition with just about anyone. But, he rarely let anyone outside of the immediate family know about the pain and lethargy he experienced episodically at first, but nearly all of the time and with increasing intensity during his last two years. Almost no one knew about the morphine patches he wore as he gabbed with them over Chinese food or while walking the dog. Almost no one knew how he would collapse from overwhelming exhaustion no sooner than he would jovially say goodbye with one last anecdote. And almost no one knew about the morphine drip awaiting him in his bedroom that, during the last 6 months, he surrendered to for a little relief from the pain that had been building while he joked and chatted with them.

After my father died and others learned more about the course of his last two years, they would ask why he hid it from them; why he did not let them know that a visit would be too much. And they each would add that they certainly would have understood and would have gladly spared him the discomfort. But that is exactly why he covered his pain and hid his exhaustion. He wanted these interactions, he wanted these chances to gab, he wanted these small moments of joy. He hid and minimized his illness not because he was a martyr in any way, but because these small, casual interactions were his best medicine; it was what he lived for. So he would put up with the pain—perhaps even feel less of it—in order to gab and mingle.  And it worked. My father lived at least a couple of years longer than his doctors or research would have predicted.

Bailey (with Norman) at age 12 yrs-11.5 mos.

Nearing the ninth anniversary of his death, I could not help but think about my father as I watched Bailey rejoice in the best birthday ever—the birthday that was never supposed to be.  Although I do not presume that Bailey has made any conscious choices about how to define herself or her interactions in the face of a terminal illness, her behaviors nevertheless remind me so much of my father. Like him, Bailey is very much a social being and continues to live for the small joys of simple interactions. Even on very bad days, she springs to her paws and excitedly greets guests. She cajoles them to pet her, give her treats, and to interact with her. She becomes excited and remains that way throughout each visit, no matter how arrhythmic her heartbeat becomes, and no matter how much she struggles to get sufficient oxygen. And during her party, she played with the children, attended to food (that she might possibly borrow), and gleefully remained alert and attentive as she bounced and bounced and bounced. She was full of life during those few hours and, for the first time in many weeks, I did not hear her gasp for breath no matter how excited she got--and she was was excited throughout. Of course, as has been the case after nearly all interactions the last few months, and exactly like my father would do, she collapsed with a loud groan no sooner than the last guests left. She had expended every bit of energy that she had, and she hurt from the swelling and stiffness in her front shoulders. But while her guests were here, she demonstrated none of this and, perhaps, even forgot the fatigue and pain herself.

My last two conversations with my father (I’m not sure which was the last) were about how, according to him, George W. Bush was a complete damn idiot (I could not disagree), and about Bailey’s work as a therapy dog (he had been visited by one the day before). This was on the day of Bailey’s fourth birthday, the last day my father would be conscious, and less than three days from his eventual death. I did not know then that Bailey’s birthday-that-never-was and her birthday-that-was-never-meant-to-be would be forever linked with my father’s death. And I did not know then that this was the least important way that I would associate my father’s and Bailey’s illnesses and deaths. I am proud of the way that my father chose to live his last months in the face of an increasingly exhausting and painful illness that he knew would soon claim his life. I am glad that Bailey appears to be living her last months the same way. And I am humbled to have had the opportunity to learn about living and dying from both of them.

Three Months and a Day

Upon finding the tumor, the veterinary cardiologist told me that Bailey most likely had only 4-6 weeks to live. Her oncologist confirmed the prognosis, but added that she had known a couple of dogs that made it to three months. She cautioned me not to hope for this, however, as such longevity was truly the exception.  So I planned for four weeks and prayed for a little more. But this proved to be an error in my judgement, as I forgot something important about my dog. Bailey has always been the exception to the rule.

From being born one of 13 pups—an exceptionally large litter even for a breed known for large litters—to tenderly raising her own small liter of adopted kittens.  From being at the top of every socialization and obedience class to, at age 11 months and against advice, taking her Therapy Dogs International certification—and easily passing. From being an 11-year-old who still played like she was 6, to now dumbfounding other Golden owners who think she is younger than their 9 and 10 year-olds—even at nearly13 years, and even with a fatal diagnosis. And at just being goofy and silly and absurd—Bailey has always been very, very exceptional.

Bailey at 12 years, 11 months

It has now been three months and a day since she was diagnosed with a terminal mass on her heart. I did not hope that Bailey would live this long as I was told by knowledgeable professionals that this would be a very rare exception. I should have trusted my experience with Bailey instead. I should not have been surprised that, again, she would be one of the rare exceptions.

So from here on, as we navigate this uncharted path, I will bank on my Golden girl. I expect that she will see yet another unexpected month, and that she will celebrate with us the birthday that was never supposed to be. And maybe she will see the summer. And perhaps, even though I realize this might sound delusional, perhaps she will make the stretch goal that I had set even before her diagnosis, of living through all of 2013.

Yes, I do realize that sooner or later one of these hopes will fail. But, after trusting the prognoses of the professionals only to see Bailey prove each one wrong, I have decided that the smarter money is with my exceptional dog. After months of “being realistic” and not getting my hopes up, I have decided that, given that it is Bailey we are talking about, it is smarter to be absurdly hopeful and exceptionally unrealistic. So, at 3 months and a day, I am absurdly hopeful about her future. And I am exceptionally unrealistic in thinking that I may continue to be absurdly hopeful at 4 months and a day, and even 5 months and a day. And I hope, in the face of absurdity, that I will be able to continue to be this unrealistic until there simply is not another “and a day”.

Until then… Well done, Bailey. Good girl, Bailey.

April Come She Will

After learning about Bailey's illness and prognosis, I hoped but had no expectation that she would be alive to see March. Her vets did not think it at all likely that she would make it to April, and I dared not  dream that. But I did hold on to one hope--a hope about which I wrote a few weeks ago:

I still hope that the next time I return to the dog beach on TR Island she will be racing ahead of me. I hope that the next time I look over the Potomac from there I will see her swimming toward Georgetown before turning back to the island. But, this week she was clearly incapable of the walking required to get to the beach.

This April 1st Bailey made all of the vets and me her fools--a role I was ecstatic to take on.

The river was very choppy and the tide so high as to completely cover the beach.  Bailey wisely stayed nearby, chewing on sticks and swimming close to shore.

No, Bailey did not do much racing ahead of me, and she did not swim half-way to Georgetown.  In truth, she was able to swim for only a short time, getting back to the car was difficult, and I fear that the exertion may have taken days off of her life. But, it was all worth it--more than worth it. Today Bailey greeted the month that she was never supposed to see by returning to her favorite place and, for a few moments, experiencing pure joy. I do not have the words to fully express my gratitude for this final last wish--a feeling that I am certain will last much, much longer than a few moments. Today, Bailey was as happy as any dog, or any person, could possibly be.

Good girl, Bailey. Well done, Bailey. 

Shhhh...

It has been some time—a long time—since I last wrote about Bailey’s and my journey. Lately, my creative energies and time have shifted back to songwriting and photography. This is true, but only partially so. As much as a conscious refocusing, this shift has been a flight away from writing and talking and even thinking about the path we have been on or where it might go. I am afraid to talk or write about it. Afraid of jinxing the incredible run of good fortune that we have had. Afraid of getting my hopes up. Afraid of being crushed when the streak ends. So I have avoided talking about it and I have avoided writing about it. Out of site, out of mind.

Instead I have written songs about love and life, and I have taken pictures of blossoms and children and kites. And I have developed backaches and headaches and stomach aches. It does not take a Ph.D. in psychology to draw some conclusions here but, having one of those, it is even harder for me to deny the obvious. It is never out of site, and never out of mind. Not really.

I hoped, but never expected that Bailey might see the beginning of March. No one providing care to her thought that she would possibly see the end of it. But here we are on March 31st and Bailey is laying beside me still breathing, even if heavier and more congested than in February. Still, she is alive, comfortable and very happy.

Yes, there was a stretch of exceptionally low energy and a few days that were not at all comfortable or happy. Yes her arrhythmia has gotten worse and she has more (still intermittent) periods of labored breathing. And, yes, we have had to adjust to a new normal where days are not judged as good or bad, but more as comfortable versus “please feel better.” Yet, within this new normal, Bailey is still happy most of the time, and still gets ridiculously excited by small things like the call for dinner, the sight of a neighbor or a knock on the door. And a visit with a friend not seen for a while, especially one with treats, is met with too much exuberance as the excitement now leads to gasping for breath. Yes, the old girl is still bouncing, just not as high and with a little more loss of air upon each landing.

So, now I write again. I will still remain silent about the future and I will still try not to entertain hopes for anything more than the rest of each today. But, I will not suppress my sadness that the path has trended downward and the ball is being deflated. And I will express my joy, gratitude and affirmation that Bailey continues to live fully and joyfully as much and as often as she can, and that she continues to bounce with excitement despite the immediate and potential costs.  

We have reached the end of March and Bailey is laying here beside me, resting comfortably, still breathing—even if a little heavier and more congested then in February. She is still happy and excited by life, and for that I am happy.