Tale of Tails: Clifford Part 1

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Clifford

A touching story submitted by our reader Tina F. about the love of her dog Clifford and their fight with cancer.

Clifford came to me 1/27/05.  It was a bitterly cold night and I had just finished dinner with my friend at El Matador.  We were walking to our car when I saw this large dog running in the parking lot.  I said to myself, “That’s the biggest, reddest dog I have ever seen”.   I saw that he had what appeared to be tar on him and no collar or ID. I called to him and he approached me.   The next part was a true Disney moment: he sat down next to me, leaned into my leg and lifted his paw, pawing gently at my leg.  I knew I could not leave him there and attempted to get this 90 pound dog, now known as Clifford, into our car.  A small crowd started to gather and a large man came up and lickity split, lifted him into the car.

When we arrived home, I made him a nice meal, gave him a warm bed and a relaxing massage that immediately led to peace-filled dreams for Clifford.  I did not intend to keep him as we had a cat and considered our lifestyle much more conducive to this independent, non-committal way of life.  We really did not know what we would do with this massive, energetic dog anyway.

So, my husband put flyers up, ads in the newspaper and checked at the humane society, dog warden and rescues to see if someone was missing a big, red dog.  There were no replies at all.  A patron of the humane society saw Clifford with my husband in the parking lot and asked if he could have him.  My husband called me at work to check, but I told him I had to say goodbye first, so he would have to wait.  We took his contact number and debated for several days.  Then decided, we just couldn’t handle a dog and this man seemed to be a good dog owner, so we dropped Clifford off at his home, drove the 45 minutes back to our house in tears, walked through the door and immediately turned around and picked him back up.

Clifford’s personality and spirit were as large as his big ol red head!  He filled our lives with much joy and yet he wasn’t a really easy going dog by any means.  He was a red dog filled with spirit and fire. A mix of something like Akita/Chow/Rott.  He loved most people, but would certainly protect us when need be.  He became quite reactive to things such as other dogs and most vehicles especially school buses, UPS trucks, mail trucks.  Walking him was not an easy venture and would actually be quite stressful as I became hyper- vigilant to our surroundings, trying to avoid any of his triggers; otherwise, would be pulled from stem to stern as he lunged at his impending “enemies”.  He was responsible for breaking 2 of my fingers, one that required a pin and 2 surgeries.  I have a constant reminder of my strong willed boy, every time I look down at my permanent “kinky pinky”.

We experienced most of the dog trainers in this area and tried most of the techniques that are available.  Many of which I would never do to my dog now that I know better.  We arrived at using counter conditioning, distance and positive reinforcement to start to manage and eventually “cure” him of his reactivity to vehicles while we were on walks.  Over the years, we accomplished victory on our walks by finally getting to the point where we could walk him against another dog without his earlier displays of aggression.  We were able to not only improve our quality of life in this manner, but took on an even greater challenge of entering training classes and eventually competing in Rally Obedience trials, winning many ribbons.  I am most proud of these accomplishments, not for the sake of the ribbon, but for the sake of our relationship.  We found a way to truly communicate and trust each other and to excel in what originally started as a humble goal to merely “go for a walk in the neighborhood”.

I have wonderful memories of teaching him lots of cool tricks: wave, roll over, crawl, sit pretty, spin, weave between my legs, circle around me: all of these put together and created a dance routine that we did to “Stuck like Glue”.

He also LOVED agility.  We never competed per se, but he learned every bit of the equipment with very little instruction on my part and plowed through it all with reckless abandon.

About 2 years ago (3/11), he started to develop occasional limping and frequent bouts of stiffness when transitioning from a down to a stand.  He also started to favor his right elbow and his left hip.  We took him to our vet at the time and treated him for arthritis with glucosamine supplements and occasional Rimadyl and Tramadol for pain. This seemed to help for a while and  we went on like this for several months.  In November, 2011 we had xrays done that did reveal an elbow spur on the right side and some mild hip dysplasia.  Blood work revealed chronic pancreatitis which we treated with a very low fat diet.  So for about a year, we continued with this pain management protocol.  His pain, stiffness and limping became worse and in August 2012, I took him up to Dexter, MI to the Animal Rehab Facility and tried acupuncture and laser therapy.  We did not notice any improvement however, the vet gave him a very thorough exam and tested his gait and range of motion.  (Interestingly, looking back on this record, I now see he had significant decrease in his ROM in his right shoulder). September, 2012 we started him on Adequan injections with our vet.  This gave significant relief in pain and we saw his energy and mobility return to what he had when he was young.

This lasted about 6 weeks and the limping and stiffness returned.  We decided to get a 2nd opinion just to see if there was anything we missed.

12/10/12:  more xrays were done – this time hips and elbows which revealed now MODERATE hip dysplasia and right elbow dysplasia.  We were given Meloxicam, Gabapentiin and Tramadol.

12/15/12: He developed pancreatitis again with bloody diarrhea.  We had to delay his pain meds until we were able to manage his GI issues.  This took another 7-10 days during which time, he now started lifting that right front leg, not able to bear weight upon it.

12/31/12: I insisted on getting one more xray of his right front limb and this time include the entire limb from toes to shoulder.  There it was, an ugly aggressive lesion in his right humerus, most likely OSTEOSARCOMA.

We were told that the prognosis of this disease was quite poor and the treatment options were limited in a dog with bad hips and arthritis.  xrays were sent to OSU for their opinion which included a bone biopsy to be sure of the diagnosis.  In their experience, there were only a few things that it could be: osteosarcoma, or 2 other cancers that were more treatable all requiring amputation of the limb for “cure”; a bone infection from a fungus.  We decided to get a blood draw to see if it was a fungal infection.  I was sure hoping for this as it could be treated then with medication.  Unfortunately, the fungal tests came back negative.

1/8/13: We went to Southfield, MI to Michigan Vet Specialists and met with the oncologist there. Clifford’s records were reviewed and the opinion was that this was an Osteosarcoma.   The options were reviewed and consisted of:

  1.  amputation with chemo = possible survival of one year; approximate cost $8,000.00 – $10,000.00
  2. palliative radiation that would help with pain control, but not really treat the cancer =  possible survival of 4 months; approximate cost $2,500.00
  3. palliative pain management with medication

We decided on option #3.  We did not want to put him through a lot of pain and stress considering his hips were not good, amputation did not seem to be a viable option and I was not sure about putting him through the stress of 5 days of radiation.  Driving up there 5 days in a row, having him anesthetized each visit and the stress of it all.

1/17/13: appointment to discuss above with my current vet

Having worked in the field of oncology and palliative care for humans for over 20 years, I believed in comfort care and symptom management.  I spent many hours of my working day massaging cancer patients as well as those at the end of their lives.  I saw how massage and proper combinations of pain medicine were able to manage patients’ pain and allow them a comfortable and peaceful end of life.  I wanted this for my boy!

I wanted to keep him as comfortable as possible for as long as possible. And when the time came that we could no longer do this, I  wanted to pursue home euthanasia.  I did extensive research and found little to nothing in this area that fully addressed  palliative care and home euthanasia.  In the meantime, I found several resources across the country and spoke to a mobil vet in the Ann Arbor area who performed home euthanasia.  She was very helpful with several suggestions re: pain management and palliative care in general, but did not travel this far south.

My search continued and I found several books that were helpful and then I came upon Dr. Alice Villolobos who specializes in Oncology and Palliative Care for Dogs. She is located on the west coast and was available for phone consultations.

1/24/13:  I had 1.5 hour long consultation with Dr. V and found her to be very compassionate, knowledgable and aggressive with pain management.  She had many tools in her toolbox, including an arsenal of pain meds to treat pain; nutraceuticals to treat the cancer and support the immune system; a quality of life scale to measure and track his quality of life; many resources to assist in emotional support.  Our first priority was treating his pain that seemed to be getting worse day after day.   She suggested a medication protocol for pain.  She also agreed with gentle massage, except at the site of the tumor; energy work and to keep him as quiet as possible so he did not fracture this limb. She also talked about his quality of life and encouraged us to continue doing things that he loved even if we had to modify these.  This was difficult as we loved to do things which required a degree of mobility that he no longer had.  My sense of loss was severe – just a few weeks before this diagnosis we were in an agility class: running through tunnels and jumping over modified heights, running through the tire and over the teeter; we were going for long walks in our favorite parks and competing in rally obedience competitions –  now he was barely able to walk 3 or 4 feet before needing to lie down.

1/25/13: appointment with our vet to implement Dr. V’s suggestions re: meds

I decided to have a Celebration of Life for him and invite his favorite people.  Clifford loved people and had a smile that he reserved for some of his favorites (all of whom were on the party list)  As one of his friends said, “ He has the best smile.  He smiles with all his heart.  His smile is so big that both his eyes have to close just to make room for his grin”.

1/27/13: 8 years to the day he found me, we had his party that included cake and party favors for the humans and low fat treats for him!  He ran from person to person smiling all the while.  At one point, he looked up at me, and I said, “Yeah buddy they are all here for you.”  20 people came to his party and each one loved how Clifford was enjoying himself so abundantly that day.  This boosted his spirits tremendously.

Unfortunately his pain was mounting each day and got significantly worse after his party.  I was giving him medication 8 times a day to accommodate his aggressive schedule.  He developed  a GI bleed from Maloxicam. We were never able to try any of the supplements or the other cancer treatment meds Dr. V.  suggested as his GI tract was too sensitive.  It took us a long time before his GI bleed resolved, which meant  he had to be without a very powerful pain drug.  His pain management was very poor and this now started to affect his quality of life.  Even though up to this point, he had a great appetite and attitude. Dr. V. suggested we add Nubain injections to his arsenal of pain medications.  We were unable to get this drug as there is a shortage of it in this area. She then suggested Fentanyl patches.  The vet office we were currently going to reached their limit and suggested it was time for us to say goodbye.  They would not prescribe the patches, but did give Tylenol #3.  I felt let down at this point, because as someone coming from the human Hospice world, I knew that many times there needs to be a lot of “tweaking” of pain meds: trying different types and titrating doses to reach maximum pain management for the patient.  Dr. V. who had lots of experience with this, was suggesting more aggressive pain measures than the current vet was willing to do.  I was not willing to say goodbye just yet as I could see Clifford still enjoyed being with us and felt much comfort in his life still with us.  But, I could not bare to see him continue to suffer.  We were even contemplating the radiation therapy for pain management.  I did not know his pain would advance so quickly and so aggressively, so I made an appointment back at Michigan Vet Specialist for radiation on 2/12/13.  I was really not sold on this option though as I promised my boy I would not put him through a lot of stress. On the other hand, seeing his pain progress was more than I wanted either of us to bare.

So, I was feeling frantic knowing I still had two vital pieces of this journey that were not yet in place: effective pain management and home euthanasia.  I wanted a vet who would go with us to the very end, including maximum pain management as well as providing a peaceful passing at home.

Friday, 2/8/13: We went back to our original vet who agreed to place the Fentanyl patch on Clifford.  The dosage had to be calculated, his beautiful red hair had to be shaved and the patch applied.  It was crucial that this stay in place and not fall off, so we had to wrap him up in a Tshirt or ACE wrap to keep it on. They also agreed to provide home euthanasia.  I felt so much better after this appointment and he was much more comfortable with the Fentanyl patch on board.  He rested quietly and comfortably all night and the next day.

Sunday, 2/10/13 1:30 am: Clifford had a very difficult night.  He was very restless and I had to help him stand and walk.  He wanted to go out into the living room.  He looked at me with lifeless eyes.  I wondered if he had too much medication in his system or if he would indeed die that night, or maybe he was telling me he was done!  We waited for my husband to get home from work at 2:30 am. I spent the hour playing soft music, singing and gently, slowly stroking him.  When my husband got home, Clifford didn’t even try to get up to see him and we decided then that we would cancel the appointment for radiation and schedule our vet to come and euthanize him.

Sunday, 2/10/13: After returning him to bed, he slept well for several hours, woke up and seemed to have a pretty good appetite and a little better attitude.  I invited a few of his most favorite people over knowing that this would be his last time with them.  He had lamb for dinner:)  He slept all night long and never moved from his spot next to me in bed.  I listened to his soft, sleepy breath sounds all night knowing this would be our last night together.  I snuggled my spine up to his to feel his warmth and reached my hand deep into his fur – relishing each moment that passed.

 

Coming soon: Part 2 – Monday 2/11/13: Clifford’s last day

 

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3 Comments

  1. What a sad story. How hard this must have been to go through that. We had a dog that died from cancer too – sometimes the medicine is harder to take than the illness. I hope that you find it within you to get another dog – they will help you heal.

    • Thank you Mary!
      It definitely was a difficult thing to go through and still can’t believe he’s gone sometimes. We do however have 2 other dogs – sweet in their own way but certainly not my boy!! I told my husband after Clifford died, that if we did not have the other 2, I would need to get another one – their energy fills the house for sure:)

  2. He was so beautiful inside and out. I love the “Disney moment.” His smile is missed.

    I was disappointed with the palliative care options and wonder why their are not better options readily available. Great job fighting for him Tina, tracking down specialists from around the country and getting Clif the kind of care he deserved. The cynical side of me says the reason is money. Maybe the push for procedures over palliative care comes down to money. I don’t know though.

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