Into the Light My Friend

Cody Hansen April 26, 2001 - January 22, 2013

My last day with my beloved Cody was as perfect as it could have been. The night before he had been in so much pain that he need an injection of morphine to go to sleep. We had slept soundly, together curled up on a mattress I placed on the floor. I woke up early with a sense of dread mixed with nervous anticipation; was it really going to be the day that I said good bye to him? When owners ask me how will they know when it is time, it always sounds a little trite to respond with "you will know," but most of the time if you allow yourself the opportunity to listen to your heart and read your pet's body language you do know when it is time. I knew I wanted to give him the gift of happiness and peace and a pain-free, anxiety-free passing. I knew I didn't want to end up at the emergency hospital in the middle of the night with him in a panic and me in tears with someone I didn't know. I had the opportunity to guide the situation. I reached out to people I felt might be able to help and was so grateful for the response. By noon I had a plan that I was comfortable and at ease with. That morning we took a walk in the open space by my house and Cody played fetch in his wheel chair. What a gift that wheel chair was because it allowed him to do the thing he loved best - chase the ball!

The cat gets in on the action

The other necessary thing do to that morning was pass a urinary catheter to empty his bladder. The night before I had pulled the urinary catheter that had been placed at the hospital because it might have been part of his discomfort. Passing a urinary catheter is a relatively easy thing to do, but does require sterile technique and expertise. Most owners with paralyzed dogs learn how to express their pet's bladder with external pressure and they get quite good at it. Repeated catheterizations are not ideal because the likelihood of a urinary tract infection is quite high. Basically there's no great solution for a dog that cannot urinate. There are surgical ports that can be placed that may or may not be appropriate considering the patient, owner, and circumstances. The reason the dogs cannot urinate is because the nerve that controls the relaxation of the bladder sphincters is damaged. Cody's was definitely not working properly.
We spent the morning playing fetch in the sun. My cat was happy to join us outside, and although did not appear interested in the ball, had a good time frolicking in the sun with Cody and me.

Playing ball in his wheel chair

Cody had an appointment to swim that afternoon, but before we went swimming I took him to the emergency and specialty hospital to get his bladder emptied again and say good-bye to his oncologist. Empty bladder, big hugs, tearful sighs and we were on our way.
Cody got to swim for an hour and a half. We played classical music and took pictures. My big beautiful pup was at ease in the water. He was suited up in a float coat and float rings around is neck and pelvis, so all he had to do was dog paddle, letting his back legs just hang. His concentration on the ball was so focused, so intense that not even a squirrel running through the room would have broken his stare. It was a delight to watch him in his element. I recall his very first swimming lesson when he was just a puppy. There was about 5 minutes of panic and adjustment, then we couldn't drag him out of the pool! Get near water and Cody would be diving in.
Then it was time to leave the pool. Again with the big hugs and tearful good-byes we made our way home.
Cody was put to sleep on the lawn that he had played ball on so many times. He was surrounded by loving family members. I held his head in my arms while he held onto his ball. I buried my face in his soft fur and whispered to him how much I loved him and that he was a good boy.
My grief will ease with time I know, but there are many things that trigger the memories. It is important to allow yourself to grieve for as long as it takes. My family and friends have been a wonderful support during this difficult time. His ashes and mementos are on a shelf with my other pets that have passed away. I hope that they are all playing together in that place where pet's souls go. I look forward to playing with them again.

This is the thank you card that I made to send to all the wonderful people who helped me and Cody.

3x5 Folded Card

View the entire collection of cards.

A Turn for the Worse

Cody's wheel chair was a godsend, but he was having trouble urinating in the cart. I would put him in it and he would posture to pee, but only little squirts of urine would come out. I figured that the pressure from the leg harness was occluding his urethra because when I took him out of the cart he urinated fairly well. So I set to work adjusting the cart; up, down, legs bigger, legs smaller... you name it that darn cart got taken apart and put back together multiple times per walk. No amount of trouble shooting seemed to make a difference. And, an email to the wheel chair company about the problem was, well...rather disappointing to say the least. "I'm sorry to hear that the dog is having a trouble using the bathroom." Gee thanks. Needless to say, I'm not impressed with the customer service at Walkin' Wheels.

He got his cart on Friday and could mostly walk on his own, he was just unable to get up by himself. By Sunday he was unable to walk; his back legs seemed to be totally paralyzed, and by Sunday night he was in a panic - dragging himself around the house, panting and very agitated. The trouble shooting began with taking him outside to pee - no luck, nothing, not a drop. Oh geesh. This meant I would have to pass a urinary catheter and empty his bladder that way. Sometimes you can manually express your pet's bladder with gentle pressure on the abdomen, but that wasn't gonna happen with my 80 lb dog with a super tense belly. No way. So it was off to the emergency room for a urinary catheterization. Yep, the bladder was huge when we looked at it with the ultrasound. My poor pup had probably not been fully emptying his bladder for about 2-3 days.

Now that Cody was definitely neurologic it was time to see the neurologist. I had set up an appointment for Tuesday, but because he couldn't urinate it was now an emergency. In this situation, if he didn't have cancer I would have assumed that he had herniated a disc. The symptoms and progression of symptoms were pretty classic for a herniated disc - progressive weakness progressing to paralysis. If this ever happens to your dog, get them to the emergency ASAP. The reason not to wait is that performing surgery in a timely manner can mean the difference between your dog walking again or being paralyzed for life.

Since my dog had cancer there was some question as to whether the problem was a herniated disc or perhaps spread of his osteosarcoma into his spine or spinal cord. The neurologist confirmed my suspicions. My options at this point were to consider some more imaging to see if we could find out exactly what was causing the spinal cord damage. We took radiographs, but they did not confirm anything. At least if there had been a bone tumor in the spine we might have seen it. Or if a disc had ruptured, the space between the vertebra where the disc is suppose to be might have been smaller (you can't see the disc itself on x-rays, because it is not dense enough). No answers yet. An MRI would have been the next step. I opted not to do an MRI. The reason was that it wasn't going to change the treatment plan. At this point with a herniated disc a pet owner needs to decide if they will proceed with an MRI with the plan being to go to surgery immediately after the MRI. Even if it wasn't the osteosarcoma effecting his spinal cord and is was just a herniated disc, the likelihood that Cody would walk again was dubious considering his concurrent cancer. He just didn't have that much time left. We went home. He with an indwelling urinary catheter, me with a heavy heart.

That night my poor dog suddenly became very painful after eating his dinner. Again, trouble shooting the situation, I figured his pain medications had worn off. He ate dinner, then refused his pill pockets (that's what I hide his pills in, and he loves them!). Situation critical! Finally I got all his medications into him with cheese! Just a quick comment here about owners and their quirks.... they love to tell vets the nitty-gritty details of what type of food they use to get medications into their dogs. We just smile and nod... So you can just smile and nod here...

It was a very traumatic night for both of us. My normally zen happy dog was suddenly sitting up with his front legs stiff, eyes wide, ears back and shaking. It just ripped my heart open to watch. After the medications started to kick in and after I did an acupuncture treatment he was able to calm down and sleep a little, but he still wasn't comfortable. A call to the ER yielded a recommendation to pull the urinary catheter in case it was making him uncomfortable. That didn't really help much. It took a trip to the ER, more medications and a shot of oxymorphone (a type of morphine) to get both of us to sleep (he got the shot, I was just emotionally and physically exhausted).

Seeing my dog in such pain made me realize that it was time to give up the battle. I did not want him to suffer in that kind of pain for a moment longer. I also did not want to wait for another crisis situation, where he would be in a panic and I would be distraught, to euthanize him. I decided that we would have a great last day doing all the things he loved doing and that he would go out as happy as possible.

Cody Gets a Sweet Ride

Cody in his new Walkin' Wheels

Yes they make wheel chairs for dogs! Because I'm in the business I forget that this fact is surprising to some people. A few days ago Cody started getting weaker in the back legs. I decided it would be a good idea to look into getting him a wheel chair. He was no longer able to get up by himself. I was having to lift up his hind end for him. Once he was up he was able to take a few steps, but then he was just falling down. I figured I would need something to save my back and Cody needed something so he could be mobile.
I should mention that I have been using a harness called the Help 'Em Up harness. This harness is really great for hoisting the rear end of your dog.

Cody in his Help 'Em Up harness

I really wanted to get the wheel chair quickly, so I asked my veterinary community for advice and was directed to Walkin' Wheels. Their web site is very easy to navigate and understand. They have created a good product that can be ordered on-line and delivered by next day air if necessary. It took one measurement and a breed description and viola I had a doggy cart on the way!
The cart is a beautiful thing! It has given Cody some freedom and the ability to chase his ball again!

The Fun Stuff!

It's all about quality of life, not quantity of life when it comes to pets. I'm trying to take Cody swimming as much as possible because it is something he really loves.

Cody with his swim coach

We are also spending lots of time just hanging out in the open space behind my house. My cat has taken to coming with us on walks also, so the three of us are just hanging out a lot these days.

Taking a walk with the cat

Emotional Rollercoaster

After our consultation with the oncologist, where I left with my head swimming with information about the various cancer treatments for osteosarcoma, I settled in to just trying to enjoy Christmas and time with my dog. Not a day went by though that I wasn't considering the options.

The decision making process went something like this:

I should take the most aggressive approach and help Cody beat this! We can deal with an amputation! We'll get a harness and even a doggy cart if we have to. I know good rehabilitation centers where we can get physical therapy. Cody won't miss his leg! I checked out Tripawds.com, a great web site and blog site for canine amputees. We can do this! The chemotherapy will stop the cancer in it's tracks! I gathered surgical estimates and thought about scheduling surgery for early January. His surgeon was going to be on vacation, so we would have to wait; bummer because the sooner the better. Oh wait... he has chest mets, and he is orthopedically challenged in the other 3 legs... maybe an amputation isn't a good idea.

This might be a good place to show some pictures of the hardware my dear pup is carrying around. Ya see Cody drew the short straw, so to speak. He got cancer in his "good" back leg (the left). He has no hip joint on the right because of a failed total hip replacement when he was a young dog. Since that time he has never really used his right hind leg much except to help with balance. Now with the left leg being bad, he has been forced to use the right leg, but it's not very functional

Ok, so amputation is out. That means palliative radiation and injectable chemotherapy. There! A decision. A plan. We can move forward. I scheduled appointments for chemotherapy and radiation for early January.

Throughout this process I had been talking to every veterinarian that I know about the options. Just to not leave any stones unturned I reached out to another expert. This veterinarian used to work at University of Florida doing stereotactic radiosurgery (SRS). He is now in my neighborhood and I have a good fortune of being able to refer cases to him. We discussed Cody's case and he felt that Cody might be a candidate for SRS. He would contact the head radiation oncologist at Colorado State and have her call me. Wow! I was thrilled. This procedure is as good as amputation, but it's radiation so Cody would get to keep his leg and we would kill the tumor!

At this point things got really complicated. I contacted Colorado State about a consultation. I probably used all available technologies that weekend to try to get Cody's records and radiographs to the proper people.  Fax, e-mail, text messages and phone calls! Saturday and Sunday went by.... 2 days are agonizing when you're trying to plan something like this. Monday morning (Jan. 7th) I spoke to the chief radiation oncologist. She hadn't seen Cody's radiographs yet.  She thought that SRS might give Cody about 6 months. Unfortunately they were overbooked and didn't have an opening until the 16th. Of course that is a really bad week for me to leave California because I have a work commitment that I cannot cancel. We discussed the option of driving him out and leaving him for treatment, then coming back to pick him up. Ok, I figured I could do that if this was really going to be the right thing for Cody. The price tag for SRS is approximately $5500. With that and the logistics I wanted to be super sure that this was a good treatment plan. The chief radiation oncologist called me back that evening with some bad news... she had the opportunity to look at Cody's radiographs and felt that with the metastases in the chest, Cody probably has about 2 months, and therefore didn't recommend I make the trip for SRS.

I was devastated. This meant returning to the palliative radiation + chemo plan. It felt like I was giving up. I cried for 3 days. It didn't help that Cody was sick from his first dose of chemotherapy. He stopped eating and started vomiting about 2-3 days after chemo. He bounced back and seemed really good after radiation. I decided not to continue with the injectable chemotherapy and try oral Palladia (an oral chemotherapy). However, now his neutrophil count is low, so we cannot start Palladia. When an animal is getting chemotherapy, the bone marrow is suppressed and doesn't make as many white blood cells as it normally would. The neutrophil is one of the several different types of white blood cells that fights infection. When the neutrophil count is low the animal is at risk for developing infections that can be life threatening. We have to wait until his neutrophil count comes back up before we can start Palladia.

Cody had more chest radiographs taken on Jan. 9th when he went for his first radiation treatment. Since we had been making big decisions based on his chest x-rays (not going to Colorado) we thought it might be worth checking to see what things looked like now since his last x-ray was early December. It had been a month and I again got my hopes up that if things didn't look worse that I might still consider going to Colorado. Well, unfortunately things looked worse. The nodules are bigger and easier to see and now Cody has some fluid accumulation around his lungs (pleural effusion).

Sometimes the decisions just get made for you in a sense. I'm resigned to the fact that my dog has osteosarcoma and it is a bad cancer and as far as I know there is nothing I can do at this point to cure my dog. Now I need to take some attitude lessons from my beloved dog. Live in the present and enjoy the little things! We are doing what we can to make Cody as pain-free as possible and doing all the fun things he loves to do!