Remembering Bow

Several of you have been following the ups and downs of the past year of the journey Bow and I have had with her brain tumor.

That journey ended on March 30 when it was clear that she had, at best, only a couple of weeks left. Most of her days were spent sleeping and when she was awake she would either spin constantly, pace the house with her head down so disoriented that she bumped into walls and furniture. When I called her or asked her to sit, she would spin around trying to find me, often managing to halfway sit in her best effort to please but often facing away from me and not sure where I was.

She could still walk, but just barely. And on the sunny days that used to be her absolute favorites, the bright light made it impossible for her to move as she hung her head and closed her eyes.

Although we’d gone six weeks without seizures, her level of medications had reached a point that they would soon become toxic and there was the very real chance that she could have violent cluster seizures in the middle of the night that would have been an agonizing farewell that I knew would haunt me for the rest of my life.

Her primary vet, most dog-savvy friends, and her two specialists all agreed that it was time to say goodbye. Horrible as this farewell was, it had the peace, dignity and loving touch that was befitting of Bow. I had debated having it done at home or at the specialist’s office and finally opted for the latter. It is a beautiful facility that feels more like a resort than a clinic, and she was comfortable and felt safe there right through the moment of her last breath as she rested her head on my knee.When she was diagnosed with the tumor in February 2010, we were told she had maybe two months left. The stereotactic radiosurgery done at UC Davis managed to make her first tumor go into complete remission, but a new, larger one developed in December. To do initial radiation would mean exposing the tissue treated last year to a level of radiation that all of the doctors agreed was not worth the level of risk.

The support I have had since her departure, especially from the BRAT community has been overwhelming. The grief has been enormous, but I keep thinking about all of the incredible gifts Bow gave me during our two and a half years together. I had not had a dog in my adult life, and she was a tremendous teacher.

In the future when I make a home visit for potential basenji adopters, I will know all of the right questions because of all that Bow taught me to look out for. And in that moment, I will know that she is there.

When I am asked to evaluate a new basenji coming into rescue, I will be confident determining its temperament, manners and behavior because she showed me the full range of what to expect from a basenji. And in that moment, I will know that she is there.

Once I have reached the point where I know the time is right, and I feel I’ve received a sign from Bow on the other side of the Rainbow Bridge, I know I will be able to bring a new basenji into Bow’s home. When we take our first walk, and there is a tug on the leash or a reaction to another dog walking by us, I will know just what to do because of all that I learned from Bow. And in that moment, I will know that she is there.

When I am with another creature – be it a basenji or a human – and I become frustrated and want to demand respect and have my authority recognized, I will pause and remember all that I learned from Bow. I will take a breath, remember to act with the same gentle, consistent and patient leadership that helped Bow feel confident and willing to obey. And in that moment I will know that she is there.

In my darkest, most discouraging moments when I feel that all is hopeless I will remember the most important lesson I learned from Bow. She let me know that I still had the capacity to give and receive unconditional love. She may not be by my side, but the love we shared is no less present than it was on our last day together and it is something that I know I will eventually be able to share with another basenji. And when another pair of almond eyes look up at me willing to make an attempt to trust me and see if we are prepared to share a life together, I will remember all that Bow taught me that will give me the confidence to be a good guardian. And in that moment I will know that she is there.

Cancer Chronicles: Staying Well, Staying Positive

Last month's post and the news about Bow's tumor was grim, but it was encouraging to get so many supportive messages.

She had a seizure in early January which was hugely discouraging, but she was put on a low dose of phenobarbital (an anti-seizure drug) and prednisone (a steroid). Not only has she gone more than a month without a seizure (she has had only one to date), but her energy level and alertness were back to normal within barely 12 hours. Besides struggling a bit going down the stairs and having muscle wasting around her forehead, she is back to her old self.

My primary vet keeps using the term "Let's keep her comfortable for the time she has left." But she too has been very encouraged by how stable things have been the past six weeks. She got a blood test a couple of weeks ago, and all her levels are right where they should be, and we cut back the prednisone to half level.

Our life is happy for now, and we cherish each day together. This coming weekend we will take our Canine Good Citizen certification. Whether we pass or not isn't the biggest issue. The fact that we have come so far in training over the past two years is reward enough. When Bow arrived two and a half years ago, she was very dog reactive and would chew on her leash, spin and put up her basenji Mowhawk if we saw another dog even half a block away. Today she can pass even the yappiest Chihuahua with relative calm, looking at it condescendingly but not lunging and walking ahead on a calm, loose leash.

UPDATE: Bow passed the Canine Good Citizen certification today! We'll write all about it in next month's post.

Cancer Chronicles: Continuing Challenges

December was not a good month for Bow and me when we went for a follow up MRI at UC Davis. Those who have been following her story may recall that after being diagnosed with a brain tumor in March (which she has probably had more than a year), we went to UC Davis for stereotactic radiosurgery, and her tumor went into remission over the summer and fall.

The news was not good when we returned in early December. The original tumor is still mostly in remission, but there is a new tumor in another area. The muscle wasting that came last spring returned, but she has felt fine up until last Thursday when she had a first seizure. I had held off having her take prednisone because of the side effects. However, this was serious enough that I agreed to start her on it and an anti-seizure med. We go back to the vet January 21 to check her blood levels. So far, she has responded positively to both meds and actually has more of her old energy.

Each day seems to bring both hope and concern. She has already beat the odds several times, and I am doing my best to take it one day at a time and focused on ensuring the best quality of life for her every step of the way.

Cancer Chronicles: The Joys of Remission

As those who have followed out story know, back in April Bow was diagnosed with a brain tumor, and stereotactic radio surgery began in May. Before we learned about this option at the UC Davis vet school, most sites that we visited gave a life expectancy of two months after diagnosis.

Although we entered the surgery with glimmers of hope, Bow had so much muscle wasting by the time the treatments began I was not certain if she would go blind in her right eye or lose it. We were warned that this was a strong possibility.

By late April, she could barely hold her right eye open in dim light and could hardly keep it open at all when in bright sun. The photo below was taken around that time, and her muscle wasting is quite evident. It continued to get worse into early June, with a large indention above her eye and similar wasting in her jaw.
As July approached, her wasting stopped, and I was not sure if I was imagining it or she was actually improving. By August, people who had not seen her since the spring all remarked on how much better she looked. She no longer had to squint in the sun, and although her right eye was slight receded in her head, it was back to full size.

At the end of August, we returned to UC Davis for an MRI to see if there was good news "inside" as well.

As Dr. Kent showed us the two MRIs side-by-side, it was hard to believe what had happened this summer was anything short of a miracle. A straight on MRI of her eyes in April showed the muscles of the right eye looking like a collapsed balloon. Then we looked at the one taken in August. There were two perfectly symmetrical eyes. Then Dr. Kent showed the two MRIs of the tumor. In April, there was a large tumor in her brain that continued down to her optical nerves which was causing the muscle wasting. The August image showed the large tumor still had remnants but was not longer a mass. In the optic nerve region, there is no sign at all of a tumor.

The photo below was taken this week and shows the dramatic difference from the photos above three months ago.
We have the option to return again in December to see if there is further remission. I have kept telling myself that the tumor could come back, that our time with our pets is always a wonderful but limited time, and there are no guarantees. But looking back to April when my heart with what I thought would be having to soon say goodbye to Bow, I am grateful to have had such great care and support from the BRAT community.

Cancer Chronicles Continued

It's hard to believe that it is almost four months since Bow was diagnosed with a brain tumor and we have since gone through radiation therapy, a steroid regimen and daily eye drops. Considering that most of the articles I read said that life expectancy after such a diagnosis is two months, I am grateful that she is even still alive. The fact that she is feeling fine, has her regular energy and appetite has been incredibly encouraging through the whole ordeal.

The only visible indication of the tumor has been muscle wasting above her right eye and her right cheek. By late April, these were quite severe and the vets prepared me that this might be permanent. The muscle mass has restored about 60 to 75 percent over the past month. This is a very encouraging sign that the tumor is likely in remission. We have a follow up MRI in August that will tell us for sure.

We all know that our time with our fur kids is limited, but the thought of losing an otherwise perfectly healthy in her prime was really devastating. The team at UC Davis has been incredible, and we feel so lucky to have such an incredible resource reasonably close. We keep our fingers and paws crossed for good news next month and thank all in the BRAT community for such great support. We hope also that Bow's story brings hope to others when they receive a frightening diagnosis and know that there are resources out there to get through health challenges.

Update on Bow

The many warm wishes and concern I have received about treatment of Bow's brain tumor over the past two months has been a great support through a traumatic period. I don't want to jinx it by saying too much too soon, but by the standard odds she would not even be alive today if I had given into the standard odds.

Her radiation treatment was completed May 14, and she has continued to be happy, healthy and energetic. We had a follow up check up last week. The ophthalmologist said that there is no damage to her eye because of the brain tumor. All of her vitals continue to be good. She still has considerable muscle wasting on the right side of her face. This might not reverse, but it might reverse completely. There is no sign advancing muscle wasting which is encouraging.

The biggest concern is that she has been on the steroid prednisone, but that has now been cut back by 50%.

The team at UC Davis has been so tremendous, and it has been an enormous to have such a great resource an hour and a half away. There is even a canine dermatologist there who has no connection to our case, but she comes out to see us and give moral support every time since she has a basenji and just want to be part of the basenji support team.

Thank you to everyone within BRAT for sending well wishes. And Bow is doing her part for BRAT too. On the way to our check up, we did a home evaluation visit for a potential adopter. Bow was a good girl and gave the woman a good once over and a sniff of approval. We hope that this will soon result in another basenji finding a forever home.

Finding Hope When Bad News Arrives

It might sound like a serious contradiction to say in the same sentence that my basenji girl has a brain tumor and that I am grateful and fortunate. After nearly a month of being on an emotional rollercoaster ride with this issue, I feel that we are incredibly fortunate as we face and address this traumatic issue.

In mid-April, I took Bow to our primary vet for follow up visit on her recent dental work and to have an abnormality in her right eye. The vet was concerned and said that there was a slim chance that it could be related to a tumor but to monitor it for a few days and recommended one of the top canine ophthalmologists in the Bay area. After seeing no progress and her eye lid drooping, I felt it could not wait and took her to the ophthalmologist who was deeply concerned when she saw muscle paralysis on several spots on the right side of her face. She recommended us to a neurologist who then sent us to have an MRI. There was a clear abnormality in her brain between the optic nerve and pituitary gland. There was the chance of it being a tumor, lymphoma or an nerve infection. Since a biopsy would be almost impossible except for permanently removing the eye, she suggested a spinal tap. Over the next few days we had to wait on the results. She shared the potential treatments which included chemo, radiation or letting things take their course and hope for the best and keep her comfortable. The possibility of the renowned UC Davis veterinary school was brought up as a possible resource.

In the meantime our primary vet recommended Dr. Michael Kent, an oncologist at UC Davis who has been doing work on canine cancer with stereotactic radiosurgery, a process that has been very successful with humans but is very new with animals. In fact there are only four or five places in the world that offer it, and UC Davis has only had it since November.

Last Monday we had our first visit with Dr. Kent and his team. To say that UC Davis feels like the Mayo Clinic for small animals is an understatement. After doing extensive research on Dr. Kent, I was convinced that he was brilliant and on the cutting edge of veterinary medicine. What I was not prepared for was that he is so personable and humble. I was hugely impressed that we were greeted in the lobby not by a technician or nurse but Dr. Kent who himself who introduced himself humbly as just “Michael”. He was able to explain the process, risks, side effects and potential benefits of the surgery. While the dogs that have been through it so far have done well, he qualified that they have only a few months of history. I have my qualms about exposing an otherwise happy and healthy dog to radiation and anesesthia, but not addressing it seems negligent. There is also the cost to be considered. At UC Davis, it costs around $6,000, not inexpensive, but most private clinics are charging $12,000 or more and would require flying or several days of driving to get there.

In short, and in my lay version of what happens with this therapy – we had a CT scan last week which will provide a map of where the radiation will hit her brain. Dr. Kent spent 12-15 hours after our visit preparing for the procedure. She will have three treatments this week as opposed to 12 or more treatments with traditional radiation. Because of the detailed map of the brain from the CT scan and the fewer number of treatments but at higher levels of radiation, it is considered to be more effective and less invasive. We will then monitor results, and she will return in three months for an MRI to see what has happened with the effected area.

There is still a great deal of uncertainty and concern in this process. She might suddenly go downhill, have a reaction, not respond to the radiation. She has had significant muscle wasting on the right side of her face that might be permanent, and she could go blind in her right eye or lose it. We are closely monitoring it and putting in artificial tears 3-4 times a day. On the other hand, there is reasonable hope that the radiation will cause the tumor to go into complete remission and that because optic nerves can be resilient, they might go back to their original capacity.

As I write this, we are just back from UC Davis where Bow had her first radiation treatment without any complication. She is enjoying her regular 4 – 6 p.m. sunbath in the front sitting room, albeit with an IV catheter.

There has been great support from the BRAT community, friends, family, coworkers and others. We appreciate the many kind and supportive words as we remain optimistic but realistic about the uncertainty of the days ahead.

Below is a video of Dr. Kent talking about his work and the Morris Animal Foundation.

UPDATE: At 4 p.m. CST on May 12, we are back from round two of three radiation treatments with no complications and one more to go this Friday. We remain hopeful and have reason to hope for the best but are prepared to face bad news. As a cousin in Riverside County put it today on my Facebook link: "Keep up the optimism! Your love for Bow is a journey, not a destination... enjoy the journey however long it lasts!"

UPDATE II: Bow completed her radiation Friday afternoon without any complications. She continues to have normal energy and mobility. I know to take it one day at a time and cherish each day, but I continue to be optimistic while grounded in the reality that all animals are mortal. Thanks for all the support and well wishes from the BRAT community.