On Cancer

In a slightly less humorous turn of events, Izzy was diagnosed with presumptive cancer at her last annual visit back in September. I brought her to the vet with two concerns: alarming halitosis, and a strange growth on her right hind paw. I left the vet with two additional concerns: a chipped canine tooth (thanks to last spring’s thunderstorm fiasco) and a rather significant amount of weight loss. Her vet and I discussed the pros and cons of getting a 12-year-old dog's teeth cleaned, and we decided to run a “full senior screening” blood panel first and wait for the results before worrying about her teeth.

A week later the blood results were in which showed a small elevation in calcium. Her vet emphasized that the elevation was very minimal, but she asked me to bring Izzy back in for a recheck and a brief follow-up exam. Mary and I brought her back after school the next day, and the two of us sat in the waiting room while the technician brought Izzy back for the exam. 10 minutes later, the same technician asked us to go back to an exam room to talk to the vet in person. I’ve spent enough time in doctor’s offices at this point to know that “the doctor wants to talk to you” is never a harbinger of something good, and I said as much to Mary as we followed the technician to the exam room. After another brief wait, Izzy’s vet came into the room and closed the door. She explained that she had rechecked her blood and that the original results were accurate, her calcium was elevated. And since elevated calcium can indicate one of two types of cancer, she followed up the blood work with a rectal exam and discovered a “firm nodule the size of a pencil eraser in her left anal gland.” She continued to explain that it was not conclusively cancer until it was biopsied, but that in order to biopsy the growth it must first be removed.

Let me be crystal clear right now in case it’s not obvious: my dog is the only constant source of joy in my life. I can think of exactly 3 days out of the last 13 years where I second-guessed my decision to rescue her from the Falls Road SPCA in 2007. Granted those were really bad days when, according to my friend Shelly, Izzy deserved to end up in a freezer (one of those days is detailed in another blog, to read it click here). But other than that, she has been the most consistently loyal, entertaining, and adoring companion I could ever ask for. Which explains why, when her vet mentioned cancer, my face started to burn while the air seemed to disappear around me. I felt like a fish flopping about helplessly on the shore after the tsunami receded. Mary’s eyes bore into me, almost willing me to cry, but then I heard myself speak and I sounded calm and rational and far away: “She is almost 13 years old, do you think surgery is the best option at this point? Her overall quality of life is paramount to me.” She assured me that yes, given Izzy’s otherwise good health, she’d definitely recommend the surgery. She told me to schedule an appointment with the oncologist on my way out and we said goodbye.

Izzy pre-ultrasound waiting for her morning treat
(she needed to fast and did not understand)

I’ve been blessedly lucky that none of my immediate human family members has dealt with cancer at this point, so I can only imagine how exasperating the healthcare timeline must be for humans. From the time I heard the word cancer until Izzy’s actual surgery, we waited a mere 2 ½ months, but it felt like 2 ½ years. During that time period, she had an appointment with her oncologist, an appointment in Syracuse for an ultrasound to check for metastasis, and an appointment with the surgeon.

Mercifully, per ultrasound results, there was no obvious evidence of metastasis in her lymph nodes or other vital organs and her surgery was scheduled for early November. In the meantime, my friends and I had planned a 10-day trip to California, and although I was hesitant to leave my dog for that long, there was no rational reason to cancel our vacation plans. I hoped a vacation would help kill the time, and one of my travel companions for the trip was my favorite compassionate-yet-logical vet friend, Ellen. She not only understood my concerns, but also was leaving behind her own beloved cat with cancer. So I tried to suppress my anxiety and enjoy myself in California. It was a trip I had been planning for over a year and Ellen and I were meeting up with my sister (from another mister), Sonya, and several of my other favorite people in the world on the West Coast. Still, I could not help missing my four-legged sleeping companion with vile breath.

Ellen, Kristen, Matthew, and my sister, Sonya

While in California I was surrounded by so much beauty – both the environmental and human types. And I was simultaneously distracted by so many wheelchair malfunctions (for more details click here) that I was able to keep my mind from obsessively worrying. When we returned from the West Coast, I had less than two weeks left to wait before the surgery. The morning my mom brought her in for the surgery at Colonial Veterinary Hospital, I made sure to let Izzy lick my face extra-vigorously and said about 300 silent prayers on her behalf. The surgery was not until 5 PM, and the surgeon said he would call me afterwards. If everything went according to plan, we could pick her up within 48 hours. In the meantime, I went to school for the afternoon and tried to stay distracted by editing college application essays and helping students identify central themes in the book Things Fall Apart. I prayed that Izzy’s fate would turn out better than Okonkwo’s.

Day 3 in the hospital

My phone did not ring until close to 7 PM, but it was good news: Izzy was alive and recovering, and the surgeon thought he got good margins. Per my request, in addition to removing the tumor, he had also removed the unsightly old lady wart that protruded from Izzy’s left side. He told me to call the clinic in the morning to check on her and he hoped she would be ready to come home by the following day. As it turned out, she was not. Nor was she ready to come home the next day, or the day after that, or the day after that. Post-surgery, Izzy was stricken with the most dreaded of possible side effects: fecal incontinence. Two words that should never be used in the same sentence. I called Colonial twice a day for six days, and twice a day I heard about her lovely disposition and ravenous appetite, before hearing about her uncontrollable diarrhea. Given the fact that Colonial is staffed 24/7, and that technicians were able to bathe her and sterilize her incisions after every “accident,” I did not pressure my mom to go pick her up; sometimes I know my limits. Fecal incontinence does not fit into the schedule at the Hooks’ household, especially with two other dogs and only one able-bodied human.

As the days added up, I was secretly starting to worry that fecal incontinence would continue indefinitely, and I would never get my dog back. When I vocalized my concerns to the surgeon, he seemed genuinely shocked that her recovery was so fraught with difficulty. I thought back to my original conversation with the oncologist in late September about Izzy’s quality of life being paramount, and I started questioning my decision. Then I flashed back to my appointment with the surgeon in October; he did warn of potential fecal incontinence, but said it was extremely rare – especially with such a small mass in such an otherwise healthy dog. As two days turned into three days and three into four, I continued calling Colonial until even the technicians recognized my voice. They graciously invited me to come visit her in the hospital, but it seemed too cruel – she would think I was there to bring her home and then I’d turn around and leave her again. So, I continued to wait, and after six days I finally got some encouraging news during my morning phone call: Izzy still had diarrhea, but she had no accidents overnight. I consulted with my mom, and we agreed that – if Izzy continued with no accidents throughout the day – she could come home that evening.

Thankfully, Shelly – who might be the only person who loves Izzy almost as much as I do – agreed to accompany my mom and me to pick her up. It was later in the evening when we arrived at Colonial, and the waiting room was empty. The three of us headed back to an exam room to wait for a technician to retrieve Izzy and give us the (extensive) discharge instructions. When the door finally opened, we were presented with a very excited, very skinny Izzy with a cone on her head. The second she saw us she started wiggling and squinting her eyes and wagging her tail, and she left a trail of pudding poop in her wake. The technician did not seem to notice, but I saw my mom’s eyes start to bug out of her head and I had a sinking feeling that we might be bringing Izzy home too soon. But at that point it was too late, the damage was done, Izzy already knew that she was coming home. The discharge instructions began: first there was anti-septic wash for the incision site, which needed to be thoroughly cleaned at least twice a day, and then there were antibiotics, pain meds, anti-diarrheal meds, a probiotic powder and prescription dog food. The instructions continued, and I could see my mom’s stress level elevate with each directive: one medication was administered every six hours as needed, the other was every twelve, the probiotic powder could be split between both meals or put in one, but it could not be given at the same time as the antibiotic, and we needed to make sure that Izzy was always on a leash even if she just went into the back pen to pee, and under no circumstances could she jump on furniture until the sutures were removed.

When the technician finally stopped talking and left the room (to get another medication incidentally), Shelly and I tried to assuage my mom’s concerns. I tried to reassure her that I understood all of the directions and that everything was written down in the discharge instructions. Meanwhile I could not reconcile the Izzy in front of me with the Izzy from seven days ago – she looked like she had lost about 10 pounds, her rear end was pink and inflamed, her tail was shaved so she looked like a rat and she had anxiously nibbled the towels in her crate so aggressively that the area between her lips and her nostrils was red and raw. She reminded me of a kindergartner with Kool-Aid all over her face. Nonetheless, I tried to convince my mom (and myself) that we could figure everything out at home and that Izzy’s sphincter function would soon return to normal. I paid the bill, and the four of us headed home.

Shelly sat in the back of the van and held onto Izzy to keep her from jumping on the seat, and less than five minutes into our ride home she had two accidents. I was relieved that the floor of my van is not carpeted, but that fact did not change what I saw as a bad omen for the rest of the evening. Incidentally, while Izzy had not had an accident in the house or car for over 12 years, she did not seem particularly ashamed of herself. My mom pulled the car into my driveway and opened the garage door, and the second we let Izzy out of the back of my car, she dragged Shelly straight to the shelf that holds the tennis balls and started prancing in place and looking up at the box of balls and looking at us, up at the balls and back at us, back and forth. Something about that moment, even though she had just pooped in my car, reassured me that she was going to be fine. She might be emaciated with fecal incontinence, but she still wanted to play ball in the dark. Once in the house and off the leash, she immediately trotted to the back door and asked to be let out. That was also a good sign, I thought, even though she left a small poop splooch or two along the way. Shelly came to our assistance and followed behind Izzy with the Clorox wipes, and then helped us problem solve the next inevitable obstacle: where should Izzy sleep? Where to put a dog with a leaky sphincter?

A discontent Izzy in my bathroom

Shelly considered lining her crate with trashbags or towels, but quickly abandoned that idea once we realized she could barely fit in the crate while wearing the cone of shame. Ultimately, we decided to cover her bed with towels and put it in the bathroom adjacent to my bedroom. I figured after six nights in a crate next to other hospitalized dogs, the bathroom floor on her plush bed would be luxurious. I figured wrong. After Shelly left and I was settled in bed for the night, and after Izzy had gone out for the last time (and had her incisions thoroughly cleaned by my mom), my mom closed the door to the bathroom and attempted to retire to her own room for the night. Izzy’s noises elevated slowly, starting as occasional pathetic sounding yelps, but ramping up to a full doggy temper tantrum within minutes. I could hear her banging up against the door with the plastic cone as she graduated from pathetic yelps to high-pitched, almost piercing barks. I heard my mom’s footsteps through the house, and she opened the door to the bathroom and moved Izzy to the other side of the house in the laundry room. Once again, it took only a matter of moments for Izzy to successfully articulate her sense of doggy injustice. Panting dramatically, she was eventually returned to my room where she stood at the foot of my bed accompanied by my increasingly displeased mother.

Temper tantrum, please notice the Kool-Aid lips 

“What do you suggest we do with her? It is after midnight, I’m not doing this all night.”

Before she even finished the sentence, Izzy jumped onto my bed. She immediately curled up with her cone on my legs, and sort of looked up at my mom as if to say: “Took you long enough to figure that one out.” Defeated, my mom shoved an old blanket underneath her, turned off the light and left my room in disgust.


The rest of the night, or at least what was left of it, followed suit – Izzy needed to go out once in the middle of the night but mostly made it through the next eight hours without incident. It was a stressful first 48 hours home after an already stressful 2 ½ months, but I am happy to report that over the next two weeks, her sutures remained intact, her diarrhea subsided, her sphincter control returned and my mom expertly followed her extensive medication protocol – including frequent antiseptic cleansing to affected areas. Most importantly, six months post-surgery, her quality of life seems unchanged; she still tramples over my mom’s shih tzus daily while she races to get a morning treat, she still begs to be fed as if she is on the brink of starvation, and she still wants to play ball – every single day, no matter the weather. The older she gets, the less obedient she seems, but the only thing that matters to me is that as of today, she is cancer free, and she remains full of the shenanigans which make her both the best and worst dog of all time. 

"Porch ball" with Shelly