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Sunday, July 20th, 2003 ...
Lucille was three then; Rex, four ...
Tuesday, June 9th, 2009 ...
Lucille is nine now, and Poor Sick Rex, ten ...
As I write this, my Poor Rex Pug is lying at my feet, with his chin resting on my foot; his little sister, Lucille, The Bad Little Black Pug, is lying next to him and the Kat-Thing, Melda, is lying in my lap, purring and twitching her tail ...
And that said, this last Sunday night, after we'd all gotten into bed, Poor Rex snuggled up next to me, as is his wont; it's my wont to read for a while before falling asleep.
As I lay there reading, rubbing his head and neck ... He loves to have his head rubbed 'til his ears flap; "Look At me!!! Look At Me!!! I'm Flyin'!!! I'm Flyin'!!! I'm Flyin'!!!" ... I told him that he was a Good Pug, the Best Pug, the Best Pug Ever (I tell Lucille the same thing) and that I loved him.
As I did so, I felt a lump on his neck, buried in the thick fur of his ruff.
It was perhaps the size of the nail on my little finger.
Needless to say, I didn't get much sleep that night; finding a lump on one's Beloved Rex Pug when he's being treated for cancer is, at best, more than a bit upsetting.
The next day, yesterday, Monday, 1 June, his G.P. performed a needle biopsy of it.
The results came back early this afternoon ...
Positive.
It's a second Mast Cell tumor.
Again needless to say, this is not at all good, and Poor Rex and I were back at his G.P.'s again late this afternoon for a blood draw; he's having a Buffy Coat test performed.
A positive result on this test will indicate the presence of circulating Mast Cells in his bloodstream, which in turn is indicative of the presence of Mast Cells in his bone marrow.
If the test result is positive, his prognosis is terminal and, in that case, his oncologist does not recommend removal of the second tumor; she feels that doing so would be pointless.
For those who might want to see it, here's a picture of the tumor ...
Alarmingly, his G.P. and I noticed the presence of a shaved patch on his neck, immediately adjacent to the tumor ...
As his G.P. conjectured, and as was subsequently confirmed, his neck was shaved for a blood draw from his jugular vein when he was in the I.C.U. last week.
Given the proximity of the tumor to the location of the blood draw, it is unlikely that it was detectable a week ago; had it been, the veterinary technician who shaved his neck and performed the blood draw would almost certainly have noted its presence.
The prognosis for patients with more than one Mast Cell tumor is not good and, all other considerations aside, the prognosis for patients with rapidly growing Mast Cell tumors is less so.
I will post the results of his Buffy Cell test here when they become available.
And, with that, the four of us are off to bed, to read, and to wish that we could all close our eyes, lift up our heads and flap our ears until we flew away to a better place than this ...
Poor Rex, he deserved a better old age than what he has ... and a better life than the one he's had ...
Is One Sick Pug ...
Poor Rex had his first appointment with his oncologist a week and some ago, on Wednesday, 20 May.
While she didn't feel that radiation therapy of the now non-existent site of his tumor was either necessary or appropriate, she did feel that chemotherapy was recommended as the best means of preventing a recurrence of his cancer, either on the margins of the original tumor site, i.e., on what's left of his left front paw, or ... the worst possible case ... elsewhere, i.e., as metastatic cancer; metastatic mast cell tumors typically present as lung and/or liver cancer ...
Accordingly, on that date, Wednesday, 20 May 2009, he got the first of six 30 milligram doses of Lomustine (CCNU); the remaining five doses will be administered at three week intervals.
While he initially seemed to be tolerating it quite well, this last Tuesday, 26 May, he was quite visibly seriously ill upon awakening; his apparent adverse reaction was confirmed when he refused his breptuss (that's "breakfast," for those of you who don't speak Pugonian) ... he had to be coaxed to eat a few crumbs of ground beef (organic, of course, and fished out of the ground beef and brown rice that he's been eating, but that's another tale for another time), two of which he spat out ... and then proceeded to piss, repeatedly and copiously, like the proverbial racehorse.
So, of course, off we went to see his G.P.; we eventually wound up at the E.R. & 24/7 Critical Care Facility.
Rex's G.P. had determined that the Lomustine had kicked in ... Big Time. His white cell count was about as close to zero as it could have been and still be at all measurable; for all practical purposes he had no immune system of which to speak.
None.
While this was encouraging in that it demonstrated that the Lomustine was doing what it's supposed to do, i.e., quite effectively and ruthlessly killing off rapidly dividing cells, it also, of course, left him defenseless prey to any and every opportunistic infectious organism that he might encounter.
Or that he might be harboring, which is what appears to have been the case; while we're still waiting for the the definitive lab work, his doctors are virtually certain, based on other test results and on the four degree fever that he was running, that he's had a sub-clinical, i.e., asymptomatic, bladder/urinary tract infection for an indeterminate time that was kept in check, and at the afore-mentioned sub-clinical level, by his otherwise healthy immune system, and you can probably figure the rest ...
Yup; take One Sub-Clinical UTI, add One Dose of a Vicious if Short-Acting immunosuppressant and you get One Sick Pug.
One Very Sick Pug.
One Extremely & Near-Critically Ill Pug, in fact.
Rex spent Tuesday night, Wednesday and Wednesday night and most of Thursday in the Puggy ICU on IV fluids, receiving massive doses of two different antibiotics.
By late morning on Thursday, his white cell count, while still what would be, absent him being on chemo, alarmingly low, was on its way back up and his temperature was back to normal.
He's back home now and, while he's visibly and markedly improved, he doesn't have a whole lot of energy.
His doctors tell me that had I waited so much as a day ... or even perhaps but twelve hours ... before having him treated, he would have been critically ill and his survival would likely have been in question.
His oncologist tells me that in over ten years of practicing Veterinary Oncology and prescribing Lomustine for "thousands" of dogs, she's only ever had two patients get sick as a result of being so treated.
Rex makes three.
Assuming that he continues to improve with no further ill effects, we're going to start him on broad-spectrum antibiotics beginning with each additional dose of Lomustine, said antibiotics to continue for ten days.
Of course, I have the option of simply discontinuing his chemotherapy, but both his oncologist and I feel that it's in his best interests to complete the course, that this will afford him the best chance of avoiding a recurrence of his cancer, metastatic or otherwise.
In other news and as anticipated, the amputation of "most half his front foot," coupled with his increasingly bad hips, has resulted in him having some not inconsiderable mobility problems, i.e., he's pretty fair-to-middlin' lame and is likely to stay that way, poor fella.
While there's more, it's time to take both Rex & Lucille, his little sister (yes, she's a Black Pug) out for Last Call and then to bed. Before we head off, though, here are a couple of pictures of the both of 'em ...
Sat On Their Pug Bench
Like Bookends
A Newspaper Blown Through The Grass
Falls On The Round Toes
Of The High Shoes
Of The Old Friends
Can You Imagine Us Years From Today
Sharing A Pug Bench Quietly?
How Terribly Strange To Be Seventy
Old Friends
Memory Brushes The Same Years
Silently Sharing The Same Fear...
