Monday, April 02, 2012

Letting Go

As regular readers know, I've been dealing with my dog Kobe's cancer for the past few weeks. On Friday, I found out that her cancer was inoperable, and that there wasn't a realistic chance for an extended remission.

After talking with a number of friends (I want to single out Don Yates, Jeff Nolan, Jackie Danicki, and David Wolkin for their many messages of support, though so many have written in) and discussing the matter further with Kobe's oncologist, we've decided to forgo radiation treatment.

Even though her doctor was confident that radiation treatments could shrink the tumor and buy Kobe an extra few months, there is virtually no chance of a durable remission, which means that we'd be buying (at most) an extra 6 months of life at the cost of a series of painful treatments that would consume 1-2 months of that time.

Here is what I wrote to her doctor:
Given the current situation, I’m inclined to decline further treatment. Kobe has lived a long and happy life, and is terrified by doctor’s visits. I can see the aftereffects for days after each visit, especially when she receives sedatives. I realize that this means that we will likely have to euthanize Kobe in the next several months. We would love to have her as long as possible, but given the small delta between her untreated survival time and her survival time with treatment, I think we would prefer to make every one of her final weeks as happy and comfortable as possible, and to euthanize her when clinical symptoms occur, but before she is seriously suffering.

For me, it comes down to likely survival time. I’m selfish enough that I was interested in aggressive treatment when that treatment might buy her several years; if the likely additional time is about 6 months, and a month or two of that time would be impaired with treatments (it’s hard to take her to the dog park with an Elizabethan collar), it’s no longer a good tradeoff in my mind.

We’ve had 11 great years. I’d rather have 11 great years than 11 great years and one difficult one.
Her doctor graciously replied:
You clearly have a good understanding of the disease process and the survival/toxicity issues. I wish there was a curative option here, or even a good possibility of a remission that would be durable in the long term. I am so sad that the hospital visits make her anxious, and there would certainly be plenty of visits in the near future should you decide to treat. Given the risk to benefit balance for Kobe as an individual, I wholeheartedly support your decision- the last thing we want is for her to feel anxiety or pain.

Please let me know if I can be of help to you in any way- Kobe is a special little girl, and she is lucky to have found a family who loves her so much.
Now, all we can do is help Kobe enjoy her life as much as possible so that she can go out on a high note.

The cognitive dissonance is especially difficult because Kobe shows no sign of being sick; she is as happy and energetic as ever (if a bit puzzled by all the attention and treats we've showered her with recently).

Because the primary symptom of the final stages of the disease will be trouble defecating, I celebrate each morning when I take Kobe for her walk, and she poops out another normal load. Ironically enough, each poop tells me that I have her for at least another day.

Her doctor told me that we may only have a month or two. We're going to make the best of it.

While this has been an incredibly difficult process, in the end I'm grateful that we found out in time to really spoil Kobe and give her a fantastic sendoff. I'm planning to take a ton of pictures and videos, including videos of her favorite walk routes so that we'll have good memories to last a lifetime.

As I wrote two weeks ago when this saga began, "Once you can't use uncertainty to hide from death, the best course of action is to live well." We intend to follow that philosophy.

Here's a video of Kobe meeting a new friend in Mitchell Park. I took the video right after we found out that her cancer was inoperable.



5 comments:

Jeff Nolan said...

Chris,
I am glad that you wrote about this, although profoundly sad about the experience leading up to this point.

The specialist care you sought out is the best available and the emotion and effort you have put into understanding what is happening and what the options are means that your decision is sound.

Kobe will tell you when it's time.

Chris said...

Jeff,

I was very impressed by the competence an caring of the staff at Sage, where Kobe was diagnosed. It was clear that they understood the importance of treating the emotions as well as the disease, and they couldn't have been more supportive at every stage.

Warrick Taylor said...

Chris - really sorry to hear about Kobe and makes me dread the day when we face the inevitable with our dog. Thanks for posting.

blue_moose said...

Chris,

I've been a long-time frequenter of this blog but have never posted until now. I wanted to offer you my condolences. All great things come to an end - I assume that she's named after the legend who is also on the decline.

Chris said...

Thanks for the well-wishes Warrick and Blue Moose. And yes, Kobe is named after Kobe Bryant, for whom the end of a storied career is in sight. Nothing is forever.