Gadget’s Cancer Journey, in Words and Pictures

In May, 2009, my service dog, Gadget, was diagnosed with lymphoma. The next day, we started chemotherapy. We went to the vet every week for his treatments. He died six months and one week later, of mast cell cancer, on November 19, 2009.

Although I was totally wrapped up in his care, aware of the tiniest details that shifted from day to day. After he died, I was shocked by what I saw in some of the pictures in his last months. The photos so clearly recorded not just moments in our lives, but when Gadget shifted from living with cancer to dying of cancer, even though I wasn’t aware of the shift when it first occurred.

At the beginning of our cancer journey, changes in appearance were largely superficial. His left eye, whose abnormal appearance had brought us to the vet, never expecting the cause would be lymphoma, retained a subtle, but distinctive, ring around his cornea, even after it was otherwise asymptomatic. It didn’t affect his vision or cause him pain. It wasn’t something a stranger would notice, but I, who had looked into those eyes every day for eight years, always saw it.

Though I love this picture of him, I can't help but notice the ring at the edge of his iris, vestige of lymphoma.

His coat, which had been a wiry, gray/silver brindle, also changed. He lost his harsh outer coat and was left with just the soft undercoat, which became a uniform charcoal.

Gadget laughing at life, before cancer struck, his coat in its full Bouvier glory.

However, during the first few months of our battle with “the beast,” these outward changes remained meaningless to me. Gadget went into remission right away on the Madison-Wisconsin chemotherapy protocol, and he showed every sign of being happy, feeling great, and not being aware he was sick.

He loved his new homemade cancer diet of meat, eggs, and vegetables, all drenched in salmon oil. He didn’t even mind the gazillion supplements that were mixed into his food.

More importantly, he and I spent lots of time together, just enjoying life and letting him be a dog. We went to the pond, his favorite place, every day that I could get out of bed to take him. His favorite time to be there was Friday at four o’clock, when his doggy play group met.

Gadget and Tessa take a break from playing to cool off and have a drink.

Gadget, Cider, Tessa, and Shay (Tessa's person) head home after a good romp.

He even had his first (and last) birthday party, which he truly enjoyed. He was thrilled by the great food, the guests (canine and human), the games, and all the attention.

The birthday boy awaits his cake.

Bobbing for Biscuits (homemade liver cookies!) was just one of the joys of the day.

Then, in September, he developed a little bump on his neck, below his right ear. It grew so rapidly that I saw and felt it change on a daily basis. From my recent crash course on canine cancer, I knew this was a very bad sign and suspected a mast cell tumor (MCT). Indeed, that’s what the needle aspirate proved it to be. While battling (and winning against) lymphoma, Gadget had developed a second form of cancer. I was surprisingly unfazed when we received the news. I was ready for it and was simply impatient to get to treatment and cure, for MCTs, if caught early and excised completely, are usually considered cured. We scheduled him for surgery.

The aftermath of surgery was a nightmare, unlike anything I’d ever experienced with an animal that had gone under the knife (including when my previous service dog, Jersey, had lost an eye to glaucoma). Gadget had to spend the night at the hospital — the only time we were ever separated for a night. Betsy went to visit him and said he was crying the whole time. She spent hours trying to comfort him, even sleeping in her car in the parking lot when the staff asked her to leave for a while.

The next morning, I couldn’t get there fast enough to bring him home. I sat impatiently in my powerchair outside, waiting for him to be brought out. Carol, my PCA, reported that Gadget was still crying as they unhooked him from his tubes and bandaged him for discharge. We thought Gadget was in emotional distress, that he would perk up as soon as he saw me.

When he emerged, the side of his head and neck were shaved, with a huge incision that stretched from just below his right ear to the bottom of his neck, almost a foot long. I had been prepared for that and got over the shock quickly. Moreover, I was pleased with how neat the stitching was and how well the wound appeared to be healing. The skin was already fusing. What I was not prepared for was that Gadget was still moaning in pain, even when Carol brought him outside and he saw me.

Gadget wailed and groaned, unlike anything I’d ever heard. He only stopped when the van’s engine turned over, and we backed out of the parking lot. At that point, he sighed and rested his head in my lap — as he usually did on the way home from chemo. He knew we were reunited and going home, and that seemed to calm him. I thought we’d gotten over the worst.

He rode with his head on my lap, a comfort to us both.

Again, I was wrong. When we got to the road, he started moaning again and didn’t stop. He cried, continuously, throughout that day and night.

It was torturous. I barely slept. His cries grew louder and louder, until he was practically screaming.

I kept calling the hospital, pleading for help. They suggested increasing dosages of his antihistamines and pain medications, which made a minor difference for short periods. But he grew increasingly restless and agitated.

Finally, a vet tech heard him screaming in the background during a phone call.

“Is that him?” she asked, aghast.

“Yes!” I said, caught between relief that someone there finally “got it,” and frustration that it had taken so long for the staff to respond to my desperation. I had already called them, beside myself, described his wailing and pacing, several times. Had they thought I was exaggerating?

Having heard Gadget’s distress “in person,” the tech had a new sense of urgency in her voice as she put me on hold to consult with a doctor. She came back and said it was possibly the lidocaine patch he was wearing on his foot causing a bad reaction. She said that some animals didn’t tolerate the drug and became agitated and restless, in which case the wailing was not from pain, but from this bad reaction. We didn’t know if this was the culprit, but I was desperate enough to try, even if it would mean having to take him back to the hospital for intravenous pain medication instead. I cut the patch off his foot and tried to clean the area as best I could. I was in such a hurry to get the damn thing off that I had forgotten to put on gloves, which I’d been instructed was necessary to prevent me from getting dosed with the drug, myself. It was only when my fingers started tingling and I felt the beginnings of numbness and nausea that I remembered and quickly gloved up before continuing. The tech had told me it would take several hours for the drug to leave his system completely, so I might not notice a change in him for quite a while.

Within a couple of hours, Gadget was much calmer. I was limp with relief as his wails receded and he was finally able to rest. I gave him more of the other pain medications, and soon he was comfortable. He still had to wear the Elizabethan collar, but he was serene again. The results came back from the pathologist — the tumor was a grade two malignancy that had been removed with clean margins. The oncologist said we should consider him cured. At the time, hearing the word, “cure,” made it all seem worth it.

I don’t have any pictures of the little lump that required such a huge incision, of Gadget’s abject misery, of him bumping into doorways and furniture while wearing the E-collar. I was too busy taking care of him to think of documenting it. Besides, we tried to take pictures of happy times, the times we wanted to remember. The MCT was just a “bump” in the road, he was cured, and I didn’t look back.

Betsy began to take many more pictures in the couple of months that followed, pictures that reveal a Gadget who never returned completely to how he’d been before. New problems kept cropping up — all seemingly unrelated. A limp caused by arthritis in his toes. A very bad cough (which, again, his specialist did not take as seriously as I thought she should). And then, another bump. This one was on top of his head, next to his left ear.

Gadget still looks "normal" and engaged, sniffing Betsy's breath. However, he was starting to get a little "quieter" at this time, and only a few small patches of his coat shows its gray, wiry brindling; the rest is the soft, charcoal undercoat he was left with at the end.

I showed it to the vet at his next chemo appointment, and she said it was nothing to worry about, just a wart. However, the “wart” grew and changed very quickly. It became crusty, then opened and oozed. I knew — though I desperately hoped I was wrong — that it was another MCT. Sure enough, when the vet next saw it, she was not so blithe. She also was more attentive to my concerns about Gadget’s cough, which had become a severe hacking that kept us both awake the previous night.

Gadget’s doctor aspirated the lump and took chest x-rays. The x-rays showed a small something, which the oncologist had not expected, but she thought it was likely not serious. However, she was unsure, so to be on the safe side, she sent them to a radiologist for a second opinion.

When she called me with the results it was one blow after another: The lump was another MCT, and the chest x-rays showed an enlarged lymph node, and a small area of pneumonia and a consolidation in one lung.

That was the first time I broke down with the vet. Until then, I had tried to be organized, clinical, and in control. I took notes, I reported, I researched, I instituted protocols. However, when I found out about the new tumor and the abnormalities in Gadget’s lung, I couldn’t hold back the tears.

“Are we just rearranging deck chairs on the Titanic?” I sobbed. “Is there any point in continuing?”

The vet was extremely sympathetic. I could tell she felt terrible delivering so much bad news. She said she did think it was worth continuing to treat because overall Gadget still had a good quality of life. While it was possible that the lung abnormalities indicated a return of lymphoma or a spread of mast cell cancer, it was also possible that it was simple pneumonia and would respond to a strong antibiotic. It seemed worth it to try the antibiotic and see what happened.

The antibiotic did help — right away. The vet and I were overjoyed. Gadget’s cough went away, and for a few weeks, I thought we’d dodged a bullet. I knew he had another tumor growing on his head, but I was waiting to decide whether to put him through surgery again until his lungs were totally cleared up. I believed we were still in the fight.

At this point, I found out later, Betsy and my friends and family all realized that Gadget was dying. I didn’t. His appetite was good, he was eager for walks, he still wanted to work, he ran wild at the pond.

Yet, there was the occasional time his appetite wasn’t quite as robust as before, so I gave him his supplements in peanut butter, instead of mixing them into his food. And yes, there was the very slight limp that arose from too much running to be aware of. But he was still active, still wanted to work and play, still seemed happy. I was too deeply immersed to see the pattern. Or maybe I wasn’t ready. Probably both.

The pictures tell a different story. We have a lot of them from this period onward, taken by Betsy. She tells me I asked her to take more pictures of him. I don’t remember doing that. Subconsciously, I wanted to capture the time we had left, but I didn’t let myself think of that.

We're tired (but I try to hide it for the camera). Normally, Gadget would have been much more excited to be allowed on the (new) couch.

Then, at the end of October, Gadget’s cough came back, and suddenly we were finding little bumps all over him. They were tiny, and if we didn’t already knew what we knew, we probably wouldn’t have worried about them. But by now, the writing was on the wall. We mapped them to bring to his next appointment, and counted 17 in all.

The night before his appointment, he became somewhat lethargic, and his abdomen suddenly swelled. We took him to the vet the next morning, knowing something was terribly wrong. The vet took one look at him, and I could see defeat. She listed all her concerns. She wanted to do an ultrasound, and if there were internal abnormalities — if he had come out of remission — to take needle aspirates. It was not an invasive procedure — it was relatively quick and required no sedative or anesthesia. A needle aspirate was less painful than a blood draw. I readily agreed. We had been down this road at diagnosis.

The results were bad, but inconclusive. His internal organs were riddled with cancer — misshapen and discolored, with numerous tumors throughout his abdominal cavity. What we didn’t know was whether it was lymphoma or mast cell cancer. It was not a typical way for lymphoma to come back, but lymphoma could do almost anything. However, the vet said it was also not completely typical of MCT.

It made a difference to me to try to find out which cancer it was, because if this was a lymphoma relapse, we could try a chemotherapy rescue protocol. There was reason to hope he might respond well to that, as his lymphoma had responded so well to chemotherapy in the past. However, if it was MCT, there was very little to be done by this stage. The doctor sent the cells she’d aspirated to the pathologist to try to get a determination of what we were dealing with.

Again, the news was bad. The cells were large, round cells, highly dysplastic (abnormal due to advanced cancer). Because they were round cells — which both lymphoma and MCT have in common — and because they were so abnormal (without nuclei), the pathologist couldn’t be sure which cancer it was, but he was leaning toward MCT. I asked Gadget’s doctor what her opinion was, and she also said MCT, though she couldn’t be sure. I was devastated.

We decided on one last chemo attempt — a drug that could work for either MCT or lymphoma and was totally noninvasive because it was given orally, as capsules. By this time, I knew nothing would save him. I just hoped it might beat back the cancer enough to make him feel better. The vet even agreed to pill him outside in the parking lot, so he wouldn’t have to be separated from me (or me from him), and he wouldn’t get smelled up by the chemicals inside the hospital and need a bath when he got home. This was also his introduction to Pill Pockets, which he loved, and which I came to rely on for many pillings during the remainder of his life.

I switched to hospice mode — palliative care. My goal was to keep him comfortable and happy for as long as possible, at home. No more trips to the vet. He got to eat whatever he wanted. He didn’t have to take supplements or meds, unless they would make him feel better. On prednisone, the end-stage treatment for canine cancer, Gadget perked up, his appetite came roaring back, and I tried to do everything I could to bring him joy.

Since his favorite activity was going to the pond, especially to play with the other dogs, we set up a special play group for him. I thought it would probably be his last — his abdomen was grossly distended and he was wobbly and tired.When I met my friends and their dogs in the parking lot, we didn’t know what to expect, and I was teary and frightened, grateful for their love for Gadget and support of me.

Gadget surprised us. He had a terrific time. He had always had a rather obnoxious crush on a yellow Lab named Cider, which he expressed by trying to hump her. Sure enough, Gadget took off — a little slower than usual, but just as game — and mounted Cider, who easily wriggled out from under him. We all laughed. I quoted Monty Python in Gadget’s honor: “I’m not dead yet!”

Visible from this angle is Gadget's shaved, bloated abdomen, which did not keep him from playing, swimming, and trying to put the moves on his favorite blonde (on the right, waiting for her cookie).

As it turned out, Gadget enjoyed two more play groups before he died. He was slowing down, but he still liked eating and going for walks.

Gadget near the end, obviously tired.

Eventually, his only true passion and excitement was in going to the pond. When it became too far for him to walk there, Betsy or a PCA drove us. As soon as he jumped out of the van, he’d be off, sniffing and marking, then heading down to the water — no matter how cold it was — to wade in up to his armpits and drink and drink.

Even in his last days, Gadget races ahead of me at the pond.

So it was that his last great adventure, the night before he died, took place at the pond. A night that was both wild and serene, when the weight of decision was lifted, and we shared a truly special experience. But that’s a story for another post.

Looking at these photos of Gadget when his spark was beginning to fade is painful and confusing. Partly, I feel the simple and terrible sadness of seeing him when he was less than himself.

Partly, it’s the questions these pictures raise: Was I so focused on treatment and care that I lost sight of what he needed most? Was I still holding on for him near the end, or for myself? Was he happy those times he rallied and seemed to be enjoying himself, or was he just putting on a good show? It all comes down to the question, should I have released him sooner?

Yet, when I try to imagine doing any of it differently — the chemotherapy, the supplements, the alternative treatments, the weeks of hospice — I can’t see making other choices. I have absolutely no doubt that without the chemo, he’d have died within weeks of his lymphoma diagnosis, a couple of months at most. Chemo was good to him; he almost never had any nausea, lethargy, or other side effects. In fact, we often stopped at the pond on the way home after a treatment for a run and a dip. We had several months of our working partnership and loving companionship, thanks to chemo. I can’t fathom missing that whole, beautiful summer of soaking up every joyous, precious moment with him.

Obviously, if I’d known that the MCT on his neck was just a tiny manifestation of a many-headed hydra that was taking over internally, I wouldn’t have put him — or myself — through the hell of that surgery. But I couldn’t have known. And at the time, surgery seemed like such a quick, clean option — one with a much higher likelihood of success than the half-year of chemotherapy we were slogging through for an 80 percent chance for an additional six months of survival.

Even at the end, when I knew he was dying, how could I have robbed him of his play dates, of his cherished treats and meals, of his pride at opening the refrigerator or my bedroom door, of all the time he spent letting himself be loved? How could I have killed him before I absolutely knew it was his time?

I couldn’t have done it any other way.

The pictures tell a story, yes, but they do not tell the story. They can’t tell the whole story. And neither can I. Gadget was the only one who truly knew what he was experiencing, and I could only guess and interpret then, and I can only question and yearn and remember now.

I let go. I remember. I yearn.

I remember. I yearn. I let go.

I yearn. I let go. I remember, again.

I don’t regret any of my choices, but I yearn. I yearn. I yearn.

-Sharon

Please share your memories and mental snapshots of Gadget in the comments.