I want to tell you a little bit about her personality, so you can understand her better. Murcie was filled with a vitality that bounced out of every step she took. She was too smart for her own good and always aware of everything going on around her. Perhaps, the epitome of what a boxer personality should be like. Like most pets, she had us wrapped around her paw from the very beginning. She was always dominant and forceful in what she wanted and what she thought she should be getting. I know that I should have regulated her behavior better. Her biggest flaw was her hostility against other dogs (wholly my fault). Regardless, anyone who met her, knew that she had spirit
I haven’t had kids yet. So I can’t speak about the bond that you would have with your own flesh and blood. I don’t mean to diminish that bond by saying that the bond I had with Murcie was very much maternal. I won’t ever get to see her grow up and have “kids” of her own. My time with her was terribly limited compared to the time you typically have with your kids. However, I did care for her when she was sick. I was responsible for her enrichment. I did worry about her when I went out of town or wasn’t there to care for her. The profoundness of our relationship wasn’t that I treated her like my child. Certainly, she did not see me as a motherly figure. The shocking thing that only another pet owner can understand is the bond that can develop between our two species. I do believe that she cared for me. I know that she thought of me as part of her family. It is crazy to think that she could read my moods and studied my habits so well that she could pick up what I was going to do with only a few movements.
Pet owners joke that we wish that our pet companions could speak to us. That they could tell us what they are thinking and feeling in the same way a person can. I feel less and less that this would be a good idea. What would we lose by adding verbal language into the mix? The wonderful level of communication that passes between a pet and their owner is truly unique. They know us in a way that is wholly different from any other human because they must. We have our own type of communication that can only come from an intelligent animal who enjoys being around people enough to learn our idiosyncrasies and adapt accordingly.
This all started this past November. Murcie sneezed and a giant strip of green snot came out of her left nostril. Contrary to popular belief, she was not a snotty dog. The only time she really drooled was when I broke out the rice or after a walk when it was hot outside. She started sneezing more and more and the snot was an ever-present, annoying friend. I started her on antibiotics and an antihistamine, thinking it might be some sort of sinus infection. Sometime in early December, we started her on a steroid and changed to a different antibiotic. We also took radiographs of her skull. In those radiographs we saw an opacity (fuzziness) to her sinuses that was consistent with the mucous and discharge she was having. There was more on the left side, where her discharge was more consistent. We found some inflammatory cells when we looked at the discharge under the microscope. She might have improved a little on the steroid. Ultimately, she did not improve enough.
Around Christmas she developed a new symptom. Congestion. She acted like it was difficult to breathe out of her nose. As soon as I could, I took her back up to the clinic and we anesthetized her, collected a sample of the discharge to send off for culture. We also inserted a rigid endoscope probe into her nose to see if we could see anything obvious. We saw mucous and mostly healthy tissue. This type of scope is limited since the sinus cavities aren’t just a straight shot from the nostrils. Plus, the scope doesn’t bend. We flushed out her sinus cavities, and radiographed her skull and chest again. The skull radiographs were about the same. The chest radiographs showed some indication that she had some sort of breathing issue going on, but nothing concerning.
The fungal culture came back negative. The bacterial culture came back with three different types of bacteria. We started an oral antibiotic and an antibiotic that we nebulized her with, and an injectable antibiotic. We also switched her to another antihistamine. Through this entire process, sometimes I thought she might be getting better, but most of the time she didn’t. Her discharge went away and then came back clearer. This was mid January. Around this time she started having difficulty sleeping. This mostly manifested itself when I would nebulize her and she would fall asleep with medicated steam billowing around her face, body slung across my lap.
We stuck true with this treatment for about a month before we decided to re-evaluate her and schedule an appointment with an internal medicine specialist. Somewhere along the lines she had started losing weight because she wasn’t eating consistently. Always a lean dog, it seemed like I woke up one morning and she was suddenly bones. When I started supplementing her diet with canned food that I would feed her by hand, she ate voraciously. She was hungry, but in some way her inability to breathe through her nose was making it hard for her to eat her dry food. Her doctor examined her from head to toe, looked into her eyes for retinal changes (some fungal infections can manifest in some manner in the retinas), listened to her chest for abnormal lung sounds (there were none) and evaluated everything else in between. There was nothing else for us to do.
When I made the appointment with the internal medicine specialist, I was a blank slate. I knew that a tumor was a possibility, but I don’t think I ever really took the idea seriously. I was still considering some sort of foreign body or something else that we might have missed. The internal medicine specialist recommended a CT scan and biopsy of the tissue (all under anesthesia), which is what I was expecting.
This is her CT image. The image is taken as if you are looking at her in face. The red arrow points to a round, grey circle. This is her eye. You’ll notice an identical one on the other side. The blue star shows where her mouth is. The perfect white circle is the trach-tube that was inserted for her anesthesia (just to help you visualize where all of this is). The white outline between her eyes and where the trach-tube is, that kind of looks like a flower, is her sinus. The upper part that looks like two petals that extend up and over each eye are her frontal sinus (purple arrow). The lower part that is located closer toward her mouth is her lower sinus, in her nose. The whole inside of this area should, for the most part, be black. Black indicates air. As you can see, the tumor inside her sinus fills up almost the entire lower sinus. When they used a more flexible endoscope, they were able to visualize the tumor in the area of the back of the throat (where your nose drains when it runs). So they were able to get a good sample of the tumor itself.
I was predictably devastated at this point. Regardless of what the tumor was or what we decided to do about it, this was the end of her life staring at me in black and white. It took two days for the pathology to come back on the samples we sent out. They also took blind samples in each nostril and those came back clear of anything but inflammation. The tumor itself was named a Chondrosarcoma. This type of sarcoma originates from cartilage and can be also found on the ribs, legs and in the nose. Not meaning that they would have it in all places, but those are other places that it can be. Knowing that I wouldn’t be able to make an appointment with the oncologist until the following week, I did a little Dr. Googling. This didn’t really make me feel better. I won’t bother describing the things I found since it will just confuse things. This entire time she wasn’t getting any better. Her exhaustion was getting worse. Her nose also started bleeding slightly from the biopsies.
When I met with the oncologist he basically told me that surgery wasn’t an option because it was too invasive. I was nervous about any kind of surgery from the beginning since I knew it wouldn’t be an easy thing for any party involved. I admit that I was a little relieved that I didn’t have to confront the possibility of surgery because to be honest, I would have done it had the circumstances been different. He said that chemotherapy doesn’t usually work in these types of tumors. They recommended radiation. For radiation, there are two types. Definitive and Palliative. To make things short, Definitive is a small dose of radiation over 18-21 treatments (a few weeks). The goal is to completely shrink the tumor (not get rid of it completely). It has a lot of side effects and might buy her a year to a year and a half. Palliative is radiation in a slightly larger dose over 5 consecutive treatments that is suppose to shrink the tumor enough to make her comfortable. It has lesser side effects and is suppose to buy her 4-10 months. He mentioned that this type of tumor rarely has metastases (starts migrating to other internal organs). Dogs typically succumb to this cancer because of the symptoms that the tumor causes.
I have a good friend that works at a specialty clinic in San Antonio who had also offered to review her case. She seemed optimistic about surgery (her surgeons perform frontal sinus tumor removals with success) and echoed the thought that chemotherapy doesn’t usually work. She also said they don’t recommend using radiation with this type of tumor since they haven’t seen good success. She called a specialist at Texas A&M to see what he thought about radiation. He echoed the recommendation against radiation. As soon as they saw the CT images, surgery was out of the question. They agreed that surgery would not be indicated.
This left us without any kind of surgical option. We had gotten our hopes up a little when she talked about how they operated on the nasal tumor located in the frontal sinus (between the eyes). I was starting to think about how I would orchestrate a trip to San Antonio for the surgery and how many days off of work I might need. As nervous as I was with the original thought of surgery, that dangerous little thing called hope had snaked into my brain. Now, we weren’t left with much.
Our option was pretty much radiation. I had already decided that I did not want to do Definitive. The symptoms scared me and the intensity of the treatments (the amount of them and all had to be under anesthesia) freaked me out. Now, we weren’t certain if the smaller amount radiation would even work. Plus, I wasn’t sure if it would be worth it for 4-10 months gained, only to have to go through this all over again (congestion etc).
** It didn’t really phase me that we had two differing opinions from the specialists. Often, the opinions can arise from clinical experience and other factors. Sometimes it can be hard to assess an overall response to therapy for a specific type of cancer since you need a large test pool all being given the same types of treatment. I took away from the entire experience that radiation –might- work and it might not. We wouldn’t know until after therapy had begun whether or not it would work.
I’d like to go into a little detail about her quality of life and why this entire situation caused so much stress (aside from the obvious). We were forced to assess a lot of information in a short period of time because of her quality of life.
The last several weeks of her life were so very difficult. I have never had to deal with an end of life situation for one of my own pets before. I didn’t really know what to expect. I had seen countless clients and aided them through the process, but I never really anticipated how things might transpire, years from now when I had to confront that for my own pets. I anticipated (hoped) that I would eventually euthanize an elderly pet who had succumbed to some sort of disease. That the path would be clear and obvious. That after a full life I would be able to gently usher her into the next one when the burden became too much to bear.
This experience was nothing like that. Murcie was always a healthy dog. Annual bloodwork allowed me to monitor her liver and kidney function. Dental cleanings ensured her teeth remained healthy and strong. Her only “defect” was osteoarthritis in one knee which we managed with a combination of supplements and laser therapy. I had already mentally prepared myself for a serious tumor (she had some cancerous ones removed in her life) many years down the line, since she was a boxer after all. I never anticipated that she would get one that both significantly limited her quality of life and had limited treatment options. Something that started out as nasal discharge, in months progressed to a life-altering diagnosis. The tumor that had grown in her nose was blocking that particular airway. So while she wanted to feel good, while she wanted to be herself, the inability to sleep at night (or at all) made her exhausted during the day and took that vitality away from her. Even though she was hungry, she couldn’t eat well. This resulted in weight loss. And even though the last two weeks I had been supplementing with hand-feeding her canned food, it wasn’t enough. A week after feeding her enough food for a 75 pound dog, she hadn’t gained back any of the weight lost. Two weeks after, showed her at that same weight. We hated to watch her “ghosting” around the house, restless and unable to rest, knowing that she didn’t know what was wrong with her. It seemed impossible that she would be so exhausted that she was falling asleep standing up, almost face-planting several times in a cycle that was as unbearable to watch as I imagine it was to feel. We were so worried that at night, she would fall off the bed because she would often perch on the edge of it, swaying and falling asleep. I hated seeing her personality be affected (she was a little more touchy and sensitive during this time period) because she wasn’t getting the adequate rest that she needed. I felt guilty any time that I would take her on a walk (there weren’t many after she became congested). Even though I knew that she enjoyed it on some level, I felt like I was expending precious energy that she couldn’t recover. Even breathing itself was uncomfortable for her. A common posture for her was standing with her front legs kind of wide, hunched like she wasn’t able to get a good breath, back legs bowed. Occasionally, she would jump up and sit beside me, huddling into me a little, in the way she would when she was younger and sick, wanting some sort of comfort. It hurt that there was nothing I could do. It was my responsibility to take care of her, help her through things that she couldn’t understand. There was very little that I could do to ease her suffering.
After deciding against radiation, we put her on anti-inflammatories to see if they would help improve her quality of life. They helped a little, making it a little less unbearable. Ultimately, it couldn’t ease her enough to let her rest, which was my biggest concern. She acted a little happier, and we were gifted with rare glimpses into her normal personality (playing with a toy, chasing after Enzo a little, playing with Ronnie’s feet) enough to let us know how much she had changed and how much we missed it. We didn’t want her to suffer any longer, knowing that there was nothing we could do to make it get better.
The thing that breaks my heart about this situation is that she was so young. I had done everything right. Immunizations were on time, heartworm preventative dutifully given, many other types of preventative care that would be considered above and beyond. This was suppose to ensure a long life, right? I had even undertaken a renewed interest in some behavior modification. I had mapped out a training schedule for her that started out beautifully. As a pet owner who would do so much to help her pet, I was faced with something that I could not do anything about. The euthanasia was just as difficult as I expected. With her until the end, I found it hard to part with her even though she was no longer there. In an eternal sleep, she looked much like I wanted to remember her when she really slept, relaxed, calm and secure. Despite how sad I was and am, I felt a sense of relief that let me know we made the right decision. Relief that she isn’t suffering anymore. Regardless, my emotions are still hung up with grief. They mourn her short life. They mourn the health that she once had. The only gift that I had to give her at the end was to give her a little bit of dignity on the way out. To end the fatigue that I knew went down to her bones.
Murcielago, you captured our hearts and will forever be remembered.
We love you.