How Do You Say Good-Bye?

On May 11, 2017, I dispatched Kevin to the southern terminus of the Pacific Crest Trail, and that night my power went out at my house.  While waiting for the power to come back on, I could hear the utility workers in my back yard.  Understand that I have no overhead power lines near my house, nor do I live on the corner.  There was no reason for these men to be in my back yard.  The next time I talked to Kevin I told him what happened, how it made me feel, and that I was going to get a dog.  

On May 15, 2017, I went with a friend to the local animal shelter to look at the dogs.  The next day,  I went back with another friend and Abby found me.  Kim said Abby watched me with a hunger in her eyes to please me in anything she did.  I filled out the paperwork, paid the fee, and brought her home.  Well, first I went to the pet store and picked up some necessary items, like dog food, water bowl, Greenies, and a few other things to make life for Abby more comfortable.  She loved riding in the car, she loved being with me regardless of where I was, she loved going for walks, she just flat out loved me.  

Abby had a few tells to let me know she was happy--rolling in the grass, jumping up and down, or just running around, and last but not least, her tail curled over her back.  You could ask her if she wanted to go with you, and she'd jump up--never putting her paws on you, just jumping, tucking her front paws close to her body.  Once you let her out of the house, she'd run straight to the car, ready to jump in.  

Her manners were impeccable.  She had a gentle mouth when taking treats from your hand, she would jump but never put her paws on anything, and she never got on the furniture at our house.  If she saw another dog get on furniture at someone else's house, then she was okay with getting on the furniture, but only on a limited basis.  

She was quite the alpha, but in a rather quiet way.  When I first got Abby, Kim had a dog that was about six inches taller and maybe 20-25 lbs heavier.  Abby would quietly growl Kim's dog off her bed and take it away from her.  She was also a herding dog and would herd me toward whatever she wanted--the pantry where her treats were, the door to go outside, or to even go for a walk.  Once I had a friend come over with her children, Abby barked at the children for the whole hour they visited, then when it was time for them to go, she herded the children into the car.  When one of the children tried to get out, she wouldn't let that child out.  She was pretty funny at times. 

Kevin was on the Pacific Crest Trail when Abby first came to live with us.  He came home for a short while when the trail became impassible. Before I went to the air port, I got some plain hamburgers for Kevin to feed Abby as a way of introduction.  Closer to home, Kevin decided to get a sandwich at Arby's.  He took a piece of bacon off his sandwich and fed that to Abby.  During the week that he was home he often fed Abby food from his plate.  On his way back to the trail, Kevin said, "We've got to stop feeding Abby our food."  Abby became a first class groaker.  Any time we were eating chips or crackers, she was right there to share.  

Over time, Kevin became disgruntled with the food Abby was eating and decided she needed "real" food, so he began cooking for her, ground beef and rice, ground turkey and rice, ground chicken, mashed potatoes, and the easiest to fix for her was tuna, yogurt, or cottage cheese.  She never liked kibble for the first few years we had her.  No matter what kind I tried, she just wouldn't eat it.  She wanted canned food, so that's what she got.  A couple of months ago, I was helping a friend unpack her boxes in her new house and we found some old kibble and Abby ate it right up.  So for a couple of months she ate kibble happily, along with her other regular foods.  

Abby loved going. . . going on walks, going in the car, going wherever I was going, it didn't matter.  She would go with Kevin on his training hikes on Beezley Hill.  She'd run ahead of him and then come back or she'd follow him.  But one memorable time, Kevin came home without her and told me he lost her.  We both went back up to the Hill to find her, I was at the south end and Kevin was at the north end. She finally came out of one of the trails with the hugest smile on her face.  She was having the time of her life.  It wasn't Abby sleeping in the doghouse that night, it was Kevin for letting her get lost! 😂

Abby defined play on her own terms.  Fetch wasn't her best game, though you could throw a ball and she'd chase it.  She'd just not return it to you.  She might drop it in your general vicinity, or she'd take it somewhere else entirely. When we had treats in our pockets, she would do anything we asked of her, sit, stand, lie down.  She never got the concept of "stay," though.  She wanted to be right beside us always.  To her these things were the play she liked best.  

 

She loved to be petted and tolerated being brushed.  Scritching behind her ears or at the base of her tail made her so happy, but belly rubs and chest rubs were her thing.  Even until the day she left us getting chest rubs and belly rubs made her feel happy and loved. 

She was ten years old when we got her, She had had a hard life before she came to live with us.  She had lived in the basement of a house with a man with dementia.  When he died, her owner, the man's daughter, moved to a smaller house and couldn't keep Abby.  She was given to a neighbor who mistreated her, then gave her to someone else who already had a dog.  Because of physical limitations, the woman who received Abby had to surrender her to the animal shelter, where she found us a week later.  All the time we had Abby, she didn't trust men very quickly, and particularly didn't trust men with facial hair.  Only in the last few months that we had her did she not react to men with facial hair (except for the lawn mower guy who had a very long beard).  

The paperwork we got from the animal shelter said she was Belgian Malinois and Labrador Retriever mixed.  She did do a bit of herding, but not much, however, she HATED the water.  If she had to have a bath, she would resist, kicking and digging in her heels the whole way.  Then she'd be disgruntled with us for at least an hour afterwards.  We did do a doggie DNA test on her, and she tested to be Siberian Husky, Labrador Retriever, and Shiba Inu.  Basically, she was a mutt.  

If I ever left the house without her, she would let me know in no uncertain terms that kind of behavior was NOT acceptable.  She would mope and pout, even though leaving her behind for a couple of hours was the best thing for her, especially if it were too hot outside. She didn't care, she wanted to be with me.  

One of Abby's favorite treats was a Milk Bone dog biscuit covered in peanut butter, which was followed by a Greenie dental chew.  Then we found out she liked Goldfish crackers, but too many of those upset her stomach.  Learned that one the hard way.  

One thing Abby learned was where all the dogs lived in the neighborhood--Larry, Jake, Opie, Gemma, Buddy, and Blue--and who had treats for her.  Because I carried treats with me on our walks, all the other dogs knew they'd get a treat when they encountered Abby.  Make no mistake, Abby let them all know who was boss.

In her desire to be where we were, we'd take her with us and then open the door to the car and connect her leash so she could get air and stay comfortable without running away.  A couple of memorable times, she got loose and sat by the door of the business where we were until we came out.  One time, it was at church and the usher who was counting attendance wrote down how many people were in the sanctuary, the nursery, and one dog by the door. She made an impression. 

Abby didn't mind fireworks, but she desperately despised thunderstorms.  Soon after I got her, I came down with a stomach bug and we were having a dilly of a thunderbumper,  I was in bed, and while she didn't try to get on the bed, she was as close to me as she could possibly get, and she burrowed under the covers that had eased off the bed.  She stayed there for the duration.  Only her tail was visible. As she got older and her hearing waned, she didn't mind them quite as much.  I don't think it was the noise as much as it was the air pressure vibrations that bothered her. 

She LOVED LOVED LOVED snow.  Being a double-coated dog, colder temps were her heaven.  She would rather sleep on the bare floor than on her cushy beds.  But, oh my goodness, when it snowed, she was Queen of the Mountain on our snow drifts.   Snow was her happy place!

Lately when Abby wanted my attention, she'd use her snoot to bump my arm.  Usually that meant she wanted to go outside, unless she wanted a dog biscuit or her green chew instead.  She could be relentless in gaining your attention.  

She liked to crawl under Kevin's legs, especially if he had them propped up on something while he was sitting on the sofa.  One time Kevin had his ball cap on his knee.  Abby knocked it off and looked so proud of herself.  

About two years ago, Abby started limping and wasn't her usual graceful self.  We stopped taking her for walks, thinking it was a sprain or something that needed rest.  She became depressed, so we took her to the vet to find out he didn't really know what was going on with her, but he guessed she might have a degenerative spinal condition.  He said to do what makes her happy, she didn't seem to be in pain.  As time went on, she became more clumsy and more content to lie down and rest.  One of  the things we started noticing is that her tail drooped as if it were too heavy for her to carry it.  Where once we could scritch just above her tail and make her so happy, it was as if she didn't feel it anymore.  

Her last day started out normally--she took Kevin for an early morning walk, and visited the next door neighbor, begged treats from me, ate a full bowl of cooked ground beef, a couple of Milk Bones, and was generally having a good day.  I let her out to go potty or wander around and found her at the base of the two steps leading into the patio door, unable to stand on her own.  I got her up and in the house, but soon she needed to go back outside but collapsed again.  When we got her in the house, she couldn't move past the kitchen.  We tried to make her as comfortable as possible.  She lay there for about two hours all told, sad, frustrated, and just not herself.  About 4:00, she had a seizure and then started crying.  Kevin was working outside raking up weeds.  I hurried to get him to take Abby to the vet.  We got her loaded up in the van on her "car bed" pillow and before we reached the highway she was gone.  The last thing she did was one of her most favorite things to do--ride in the car with us.  

How do you say good bye to someone who has been part of your life daily for five and a half years? It's been a month now and I miss her presence in the house, the jangle of the tags on her collar, her staring at me when she thought I'd stayed in bed late enough, her snoot nudges, and even her silent but deadly farts. 

The Peaceful Zebra

 

A funny for the day.  I woke up this morning to find the clock reading 12:57 for the time.  I thought I had really slept long and hard when all that had happened was that there was a power blip.  It was only 8:57.  Blessed are those who can laugh at themselves, for they shall never cease to be amused. 

Yesterday was my day to go get my shots.  It was an ordinary day with a dog who wanted to go along with us and sit in the car, except for the times when I was shopping and Kevin didn't want to go in the stores (not surprising, except for grocery stores he doesn't like shopping).  Kevin and Abby would walk around the parking lots while I am otherwise occupied. 

When I get my shots, I have to wait until I get to the clinic for them to release the medication and get it to room temperature from the refrigerator where it is kept. My regular nurse is on maternity leave, so I had stand in nurses giving me my injections.  I was in the infusion section waiting for my medication to warm up when my doctor walks by and asks how I am.  I answered, "I'm peaceful."  She replied, "I need you to come and tell me that every day/"  

One of the things that happens with my medication is that it can clog up in the needle and set up like cement. When that happens, a new needle is required.  I will ask my nurses if they have extra needles in their pockets--better to have extra needles and not need them than to need them and not have them.  In spite of that, yesterday was a new adventure in needles,  The nurse had some extra needles in her pocket, but alas, she didn't have enough.  Two nurses ended up using three needles each for a total of six pokes in my derriere.  On my way out, I tell my doctor and  she said that we may have to change to a different format of the drug just to circumvent my overuse of the needles.  I think I overshot my quota, no pun intended. 

What I Do With My Time

A friend of mine used to be highly involved in Relay for Life and would collect things that could be auctioned to raise money for cancer research.  That's when I made my first Chemo Survival Kit.  I am not treated with chemo infusions, but I have a rudimentary understanding of what that entails.  With a little research, I found some things that would be a comfort to someone going through chemo, so I put them into that kit.  

Fast forward a few years, and I started making kits and taking them to my oncologist appointments. So, you ask, how many kits did I make?  Two a month.  Unfortunately that is not even a drop in the bucket for the number of new chemo patients every month in my clinic.  I asked the doctor how many new chemo the clinic gets in a usual month.  The clinic serves five counties with satellite offices in three counties.  In a month there are 100-120 new chemo cases diagnosed depending on when screenings happen.  That's 1200-1500 new cases in a year.  In the few years I have been doing this, I average two kits a month, and sometimes I do extra when a friend finds out about someone they know who has cancer.  

What's in a kit, you ask? 

Included in any kit are:

• An afghan—either crocheted or made from polar fleece.  
• A hat
• Peppermints to aid in quelling the nausea
• A book to read while receiving treatments
• Plastic flatware—to keep from increasing the metallic taste chemo provides
• A satin pillowcase—feels better on heads that are losing hair
• A notebook and a pen for journaling, doodling, making lists, keeping up with all your cards and gifts
• A nifty tote bag to keep it all together and to take with you to your treatments

I include this list with a note that explains my own cancer journey and that every stitch on any item is a prayer for their healing and recovery.  This is not a cheap endeavor but I try to make it as economical as I can.  I buy the best quality yarn for the best price I can get.  I get heavy fabric remnants for the tote bags (usually those are 50% off, so there is a good cost savings).  I buy the books at the thrift store.  The plastic flatware comes pre-wrapped from when we get take-out.  I buy the satin on sale as much as I can, sometimes I can find that in the remnants as well.  Sometimes I will see tote bags or overnight bags at the thrift store that are cost-effective.  I get joy from doing this and because I am a patient, I am anonymous.  It gives me smiles to think I might have given someone else a smile in a tough time.  

So I spend my spare time crocheting, praying, and sewing the kits.  

 

It's Time to Put Off Decisions

 Just for starters, I love my gastro-enterologist.  He responds to my questions with phone calls, and then explains them in easy to understand terms.  But before he calls me, he reviews my case and what's been going on with the other doctors.  So for all my zebra friends, I wish you all to have such a doctor.  

So here's what's up:  it's not feasible right now to have a TIPS procedure,  I am borderline enough to qualify for the procedure, but medications and paracentesis will control the situation with my ascites for now.  When it gets to the point where I need paracentesis at least once a week, then TIPS will make more sense.  How do I feel about this? I am content to wait because I want what's best.  

In other news, the Carcinoid Cancer Foundation's newsletter announced that the monthly injections I get will soon be available in tablet form that I will be able to take daily.  The drug, an octreotide (generic name), Mycappsa has been granted orphan status by the Food and Drug Administration, which will make it available more quickly.  It was developed in Ireland (Go, Ireland!) and is finding its way to the US.  What this means for me personally is that I will be able to give up the 19-gauge needles in my backside every month (an insulin needle is 31-29 gauge--the smaller the number, the bigger the needle). 

It seems that life is three steps forward and two steps back, but that's true for nearly everyone I know.  I am content with that.  

Relying on Wisdom

In April and May, I had tests done to see if the ascites were perhaps caused by portal vein hypertension.  I had an appointment scheduled for late June to get the results of the tests and to see what could be done next.  The portal vein hypertension readings would either put me in line for a TIPS procedure or relegate me to continued paracentesis.  Before I could go in for the appointment in June, I got a call saying that the doctors had no answers yet, could I come in July 28th.  So, two months after my last test, I finally get some information, not necessarily the answers, but more to go on.  

Dr. V. explained that there were several factors to consider before deciding to go in for a TIPS or not.  

• MELD score--mine is 15, which is below the cut off of 18.  The MELD score stands for Model for End-stage Liver Disease.  This is also the score that puts a person in line for a liver transplant or not
• Portal Vein Hypertension--yes, I am on the borderline, but enough over to consider that it is a factor in my ascites.  
• Varices in my stomach--varices are also called varicose veins.  The TIPS could alleviate the pressure on the varices and allow them to go back to normal.   
• My interesting architecture.  We are all fearfully and wonderfully made, with intricate parts fitting together in unfathomable ways.  I am just have a more interesting and challenging architecture for how I was put together.  I'm nothing if not complicated. 

While I was waiting for these results, I did not just sit and twiddle my thumbs.  No. no, no, . . . Kevin and I went to Eugene, Oregon, to see the World Track and Field Championships with our daughter and her boyfriend.  My immune system is fragile enough that I didn't want to be in such a crowd, so I stayed at our Airbnb and did the cooking while the rest were enjoying the competitions.  They got to see world class athletes doing what they do best, and then Kevin and I got to see some friends we hadn't seen for a while and catch up on their lives. That filled most of a week's time for us.  

So here is where I am now.  I need wisdom to determine the right choice on the TIPS option, and this is where my faith needs to stand strong.  TIPS will require a one-night hospital stay. I have sought advice from my oncologist, and I need to ask a couple of questions from my gastroenterologist before making a final decision, but I need to make the right decision.  So that's where things stand today.  I need wisdom.  

 

Getting to Where I Am Now

(zebras in a stable)

Last summer I received an email from the Carcinoid Foundation with an offer from the National Institute of Health/National Cancer Institute out of Bethesda, Maryland.  The offer was for a review of my medical records and a tumor review to see what other treatments I could possibly use in addition to/conjunction with my current treatments. Dr. Jaydira Del Rivero, one of the top Neuroendocrine Cancer  doctors in the United States was overseeing the tumor reviews.  I spoke about this offer with my oncologist who encouraged me to apply for the review.  After a telephone interview that picked my brain for information from the last eighteen years, I was accepted and was asked to sign releases for my records to be sent.  It took until early November last year to get all my records and images to the NIH/NCI for the review.

Two weeks after all my records were sent in, I was told the best option is the Cap/Tem* series of oral chemo (the Cap portion would go for two weeks a month and the Tem portion would be the last five days of the Cap portion).  My oncologist  recommended that I begin with the Tem only to see how well I tolerated it. She sent in the prescription to the mail order pharmacy and I started with my first round of Tem in December.  

In February, I was struck with a nosebleed that lasted 24 hours and resulted in my platelets plummeting to a dangerous low--nearly needing a transfusion.  Here's the thing about platelets--too many and blood clots can occur, too few and blood doesn't like to clot. Because of the platelet issue, the doctor decided it was too risky to add the Cap portion of the oral chemo, and I had to postpone February's  Tem for a week, until my platelet count came back up to a safer level.  I've done weekly blood counts from then until June when my oncologist felt they were stable enough I could go to once a month blood counts. One of the major blessings (I know you will say every blessing is a major one and there are no minor blessings and I agree) is that my clinic has a satellite office here in Ephrata, where I can drive for five to ten minutes and get my blood drawn instead of the half hour it takes to go where I see my oncologist. 

One of the gastroenterologists I had seen was concerned for the amount of radiation I was getting from my CT scans and felt that two CT scans a year were too much.  My oncologist said that the CT scans were getting hard to read because of the ascites, so she would order MRI's instead--at a much lower radiation level.  

My last MRI showed stability in my tumors, but no shrinkage with the Tem.  My oncologist then recommended that I discontinue the Tem as the risk-reward ratio wasn't worth the effort.  So here I am today, still stable, but not doing oral chemo.  And I'm okay with that.  I'm okay with not losing a week to the chemo, not feeling blah all the time, and not messing up my sleep cycle--because it did mess with my sleep quite a bit.  Would I do it again knowing now what I didn't know then? I think so, simply because I needed to find out what I didn't know.  Does it change how I feel about my situation, in some respects, yes it does.  I feel like I tried on the chance there would be change.  That there wasn't any change doesn't disappoint me, I'm happy to be stable.  

*Cap=Capacitabine aka Xeloda; Tem=Temozolomide aka Temodar

Today's funny:  What do penguins get for lunch at the zoo? Half an hour, the same as the zebras.  

More Humorous Encounters

I was having a Y-90 treatment, which required me to hold my breath several times during the procedures.  The technicians and nurses were the ones who tell me when to hold my breath and when to breath again.  At this particular treatment, I was told to hold my breath once and was never told I could start breathing again.  It became painful, to say the least.  The techs and nurses just said, "Oops!"  But they were apologetic about it.  

Fast forward to last week when I had my semi-yearly MRI.  The voice comes into the headphones telling me, "Breathe in, breathe out, breathe in, please hold your breath."  After the few seconds it took to do the scan, the voice comes back to say, "Please, continue breathing."  It hit my funny bone that they were so polite to ask me to do something so necessary for life itself.  

Today's humor came when the doctor's office called me to tell me that one of the three doctors was out of town and there needed to be a collaboration before they saw me.  Could they reschedule? Sure, why not, I'd rather have answers than just a "Hi! How are you?" visit.  So tentatively I've been rescheduled for four weeks out.  But instead of Dr. S (the one I was supposed to see tomorrow), I'll be seeing Dr. V, then the nurse said, but it could be Dr. R who does the actual procedure when it comes down to that.  😆🤷