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October 22, 2013

Thanks to some medicine heroics in response to Lilly’s neurological setback Saturday, October 12, 2013, Lilly did seem to stabilize and improve slightly. Starting Thursday, October 17, however, she seemed exhausted and as if she felt like crud — often hunkering down on her bed, not moving, even if cajoled. Tom decided that she looked like a barnacle on the hull of a ship.

Lilly also sometimes cried or groaned — almost imperceptibly — under her breath, and her steroid pot belly seemed worse.

So, while we visited our primary care veterinarian Friday for Lilly’s latest urine culture, I had her check Lilly for pain. She found none, but she agreed that Lilly looked worse than the last time she’d seen her, as if she just wasn’t quite herself.

The timeline of events looked like this:

  • Saturday, Oct 12, neurological setback began with Lilly becoming increasingly wobbly and weak.
  • Sunday, Oct 13, we doubled Lilly’s steroids and gave her cytarabine injections 2 days early.
  • Monday-Wednesday, Lilly started to look steadier and a little better.
  • Thursday, Lilly started acting like she feels icky.

Then, things got weird.

(The photos are kind of gross, so if you want to look, click through above. If not, I didn’t want to subject you to them.)

I was worried. There was a new distance in Lilly’s eyes that scared me. I truly feared we were seeing the beginning of the end. I sobbed a lot, thinking that some BIG decisions would have to be made in the coming week.

Keep in mind that I was emailing our veterinary neurologist with updates and photos the whole time. He would have me check this or that and report back, and my answers always meant that Lilly was OK.

5 Hours in the Veterinary ER

But, when Lilly still seemed not good Monday morning, word from the neurology team came, telling me to get Lilly in for some urgent blood work.

Unfortunately, they were already booked solid and had a couple new emergency transfers coming in, so Lilly and I headed to the ER — in the same hospital as our neurologist — for help.

The ER team (and others) checked the following things:

Lilly’s vitals (all normal, except for higher than usual blood pressure). Lilly has taken blood pressure meds since February 2012, but sometimes it’s still higher than we’d like it to be. Not scary high, but high.

Lilly’s complete blood count (CBC) because we feared bone marrow issues, which can be a side-effect of cytarabine, and we feared low platelets (since bruising could mean not-good clotting and therefore bleeding). Again, red cells and platelets normal, though signs of possible infection (white cells).

Lilly’s neurological status (nowhere near normal, but seemingly stable)

Lilly’s blood chemistry to check her vital organ function (all good, except for high liver values across the board). Lilly’s liver values have been steadily climbing due to the strain of her treatments.

To cover ALL our bases, I also OK’d them to do an abdominal ultrasound to:

  • See what Lilly’s liver and other organs looked like
  • Check for blood or fluid in her abdomen
  • Make sure there were no ugly surprises looming (like a tumor anywhere).

The liver looked “bright,” which typically means it’s stressed from steroids not infection. Otherwise, everything looked normal. Completely normal. No tumors, no bleeding, no fluid buildup. Nothing.

What All That Means?

weds 10-16-13 a

Simply put, that means our worst fears were NOT realized. Lilly’s bone marrow was NOT damaged. She was NOT bleeding internally. She was NOT suffering total organ failure. She was NOT in any imminent danger … despite feeling like crud.

It was easy to assume that perhaps Lilly still feels icky from these ongoing bladder infections. BUT, then, her urine culture results from Friday’s tests came back clear.

So, where is the infection the CBC hinted? No idea. Maybe the liver, despite what the ultrasound shows, but the antibiotic they would use for that is the same one Lilly has been taking for weeks.

We’re all kind of stumped about possible infection and about why Lilly seems to feel not her best. In a complex case like this, there are just SO MANY moving parts.

Sometimes, there are signs — head chattering, head bobbing — that indicate inflammation in the back of Lilly’s brain. That alone can make dogs feel barfy or dizzy. One working theory is that when Lilly hunkers down on her bed, she may simply be trying to get the room to stop spinning. 

Action Plan

Since steroids are making her liver issues worse, we will VERY carefully wean her back down to her normal dose and see where that gets us. I’m on HIGH alert, however, for any signs that she begins slipping neurologically.

A Bit of a Rant

Let me be clear on a few things:

  • Lilly continues to eat, drink, and eliminate normally (for her).
  • She is happy to see us every morning and to engage with us throughout the day.
  • She is happy to play with toys (though, until the swelling in her mouth improves, she cannot have any food-stuffed KONGs).
  • She often seems mostly herself.

Since last Thursday, however, she has hunkered down on her bed and looks like she doesn’t feel well. I’m constantly aware of possible pain or “suffering” … as is our entire veterinary team.

I will not let her suffer. I will not let this go on “too long,” if things truly become dire.

So to the people who sometimes accuse me of being selfish for “keeping Lilly alive” or who question my motives, I’ll say simply this:

While I appreciate your interest and concern, the most polite word I can muster for asking me such things is RUDE.

No one knows this case or Lilly better than I do. No one. I have not, nor will I ever, make any decision that isn’t in Lilly’s best interest.

I spend all day, every day, giving her the BEST LIFE possible — despite her illness. She has FAR more good days than bad days. When that changes or when we have proof that Lilly has passed into a new stage of her illness, my conversations with our amazing veterinary team will shift.

About the Author Roxanne Hawn

Trained as a traditional journalist and based in the Rocky Mountains of Colorado, USA, I'm a full-time freelance writer for magazines, websites, and private clients. My areas of specialty include everything in the lifestyles arena, including health and home, personal finance and other consumer interests, relationships and trends, people and business profiles ... and, of course, all things pet related.

I don't just love dogs. I need them in my life. Seriously.

  1. Went through this type of thing when my shepard/chow mix had a bad reaction after her combo shot when she was 12. She started having seizures that we were able to keep under control with meds until she was 14 1/2. It was a battle, with lots of visits to the ER vet. But we wouldn’t change a thing about our decisions. You and only you (and Lilly) will KNOW when it’s time……Lilly will let you know in her own way. Hugs to you both.

  2. That was an amazing and yet upsetting story. My heart goes out to you and your dog but keep up the fight and hope for better days ahead.

  3. Thinking of you and Lilly, as always…

    And never for a second have I questioned your love of Lilly and that you have done and would do what’s best for her. I’m sorry about those rude people, but know that there are many of us out there who have your back.

    Sending hugs.

  4. Sending good thoughts, Roxanne. Things like this are very personal decisions, and no one has a right to judge what you are doing, but I suppose there will always be people out there who think it’s their right to state their objections without thought.

  5. I always just “sit” with you and Lilly and Tom. I send you love and support. I know that it is often difficult for others to hold a place of compassionate concern. It is annoying when folks offer their unsolicited advice, however well-intentioned they believe themselves to be. I resent the time and energy I spend thinking about their words, time and energy I need for whatever situation I am facing.

    I know that Lilly is receiving the best, most compassionate care from you and her team. Your process is a demonstration of faith and love. I try to consider what you would do with decisions for my guy.

    May this day hold beauty and peace for you all.

  6. You are doing what is best for Lilly. I always keep in mind that I am not there and am not seeing her like you are. So for those folks that are saying mean things, they need to keep their thoughts to themselves.

    Give her hugs from us.

    Monty and Harlow

  7. I follow you constantly…rejoice when things are going better and worry with you when they are not. My favorite vet always told me as long as there was quality of life…then that’s what we would focus on…and I think you do a wonderful job with such a special girl….Love and prayers to you all because yours truly is a family affair! <3

  8. Thank you for clarifying where you stand on Lilly’s treatment. I’ve never said anything, but admit there was a time or two I sort of questioned it in my own mind, but I haven’t followed Lilly as long as many have. I was glad to see how you feel. I was probably more sensitive after losing our two-year-old border collie to medical issues. You hang in there Lilly, you have wonderful, loving caregivers!

    1. Thanks, Nora. I do appreciate that you (and likely many others) have wondered about this. And, I appreciate that you haven’t asked. ;o)

      I certainly have had my own doubts in cases I’ve seen with friends. The closest I’ve ever come, however, to asking about it is asking friends (people I know in real life) about their criteria for making a euthanasia decision for their pet.

      Our criteria are pretty specific. The end is likely going to look like 1 of 2 things: Either Lilly is going to have a MAJOR inflammation breakthrough (like the one in August 2012), despite everything we’re doing. OR The side-effects of treatment are going to become too great. *That* is what I feared we were seeing Monday, but it turned out NOT to be the case. I suppose there is some wacky thing that could come up and change everything, but I really do have quality-of-life discussions with our veterinarians regularly. I told our entire team of veterinarians Monday that I feared this was the beginning of the end. I told them that I DO NOT want Lilly to suffer, and when the test results came back so good, each of them told me essentially, “We’re NOT there yet.”

      This probably sounds morbid, but I often lie awake at night and think about what my last words to Lilly will be. Until then, however, I spend the better part of every day, making her life as good as possible — even with her many limitations.

  9. I sure hope Lilly starts to feel better soon. Poor girl must feel like she’s got a hangover with the room spinning like that!

    I hope people back off with their judgments. I wish I could have done the same thing with Sebastian that you’re doing with Lilly. I think it takes enormous amounts of strength to fight for your girl to have the best life possible despite the scares that come along. I admire all that you do for her.

  10. Roxanne, Don’t let those who question your motives bother you. As long as she is happy and is not suffering then it would only be selfish of you if you denied her the chance to enjoy life as much as possible.

    When Lilly is ready to give up the fight she’ll let you know. I had a cat (17 years old) that told me it was her time but I couldn’t bring myself to put her down. In the end she probably suffered more than she should have. I also had a border collie mix that got sick and was diagnosed with stomach cancer. The vet assured me that she was not suffering so we took her home and pampered her as much as possible. She died on her own about 4 weeks later.

    So as long as Lilly isn’t giving up on life, I admire you for not giving up on Lilly.

  11. I’m sorry to hear that in addition to everything you’re going through that you also have to deal with rude people. Lilly is lucky to have you. You are concerned and caring and it’s obvious to those who read your blog regularly, that you have Lilly’s best interests at heart. Hang in there -sending you and Lilly good thoughts.

  12. People need to learn to mind there own business.
    Lilly is a trooper and if she is willing to fight for her life ,thank you for all that you are going thru,

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