Maximum's Courage - A story of canine courage and strength
Cancer is a disease that has affected thousands of peoples' lives in one way or another. When you hear the word cancer, instinctively, you think human, but this killer lies in wait for not only humans but our most beloved companions as well. In large and giant breed dogs, Osteosarcoma , also known as bone cancer, is a very common and very aggressive killer. As in humans, canine cancer is merciless and has no boundaries. Both the young and the old are affected and in the canine species, the younger dogs are at risk for the most aggressively spreading cancer.
19 months earlier, if you would have told me I would be on this journey with my best friend and most loved Black Labrador, Max, I would never have believed it.
His journey has not been ordinary and he has had many hurdles. If not for the wonderful doctors at The University of Madison Veterinary Teaching Hospital, his chances of being pain free and having good quality of life for any period of time would be nonexistent. With their help and support, as well as the support of our many Tripawd friends, we have chosen a path for Max that will allow him to live comfortably until the cancer no longer allows it. Today we are dedicated to Max's quality of life and cherish every day that we have with him.
Canine Cancer needs awareness and research, and I pray that Max's story will bring hope to those people and their dogs that are also being affected by this horrible disease. We have been blessed to have Max in our lives and have learned many things along the way.
Since the day Max picked us as his forever family he has always been a very active and energetic dog...
... A serious love affair with his tennis ball fostered constant running and playing. He was never without the ball. As Max grew older the play sessions became longer and more vigorous. Over time, Id noticed a difference in his gait when he ran. It was nothing that I could really put my finger on, but there was something strange about the way he moved his hind leg. No one else in the family seemed to notice, so I let it go. Unfortunately, as time went on, Max began having frequent episodes of pain and limping. I thought that he may have pulled a muscle in his leg since he was always jumping in the air to catch his tennis ball. Each time it happened we used our best human judgment and made him rest for a day or two. He was never happy about that and nearly drove us crazy using his personal secret weapon, the HIGH PITCHED bark. Labradors are a handful when they are bored and Max made SURE we knew that resting was not an acceptable level of activity! Each time after resting for a day or two he seemed to be fine and we would continue to run and play like normal. That made Max very happy and we were thankful to have some peace and quiet again!
My family and I are fortunate to live in a wonderful country setting in the Midwest surrounded by fields and wide open space. Max's favorite place to chase his ball is in a field near our home. There are lots of animal smells, an occasional deer to chase and lots of room to run. On a beautiful Saturday afternoon, my son Alex and I decided to take him to the field for some exercise. When we got there, Max flew out of the car and took off like a crazy dog. My son, Alex, can throw the ball much further than I, and is Max's favorite playmate. They ran and chased in the usual way until we felt that Max had reached his limit and Alex's arm was sore. If you have ever owned a Lab, you know that it's up to their humans to decide when enough is enough. If left up to them they would go until they dropped. We gave the stop command, collected the ball and headed for the car. As I watched Max trot ahead of me, his rear legs suddenly gave out. The event was brief and he was back up in a flash, but a few steps later it happened again. Alex and I exchanged worried looks and took off running toward him. By the time we got there he was up again and trotting toward us. We got to the car, gently lifted him up and he made himself comfortable. He didn't seem to be in pain and when we got home, jumped out of the car on his own. For the rest of the day we watched him closely, but he seemed fine and life went on as usual.
Max and I have a morning ritual. I get out of bed and lay down on his mat with him and scratch his belly. He loves to have his belly scratched. A week or so after his legs gave out he was lying on his bed in our room. As I scratched and rubbed his belly he stretched and made his usual funny Labby noises, but as I got closer to the lower end of him near his leg he let out a deep growl and gave me a look as if to say 'no more'. I thought at first I was hearing things since Max is a gentle and loving dog and had never shown any signs of aggression. After hearing it a second time, it gave me pause. Most dogs, and especially Labs, are very stoic and rarely show their pain. The growling, or as I fondly refer to it now, the warning, was my signal that something was very wrong. I let it go the first time, thinking I may have just hit a tender spot or he just had a sore muscle, but made sure to tell everyone else in my family to watch for it. As time went on the warnings became more frequent and the growling more pronounced. It was time to find out what my boy was trying to tell us. I took him to our local vet who did a thorough examination and x-rays. She confirmed with a hands on examination that Max was definitely in a lot of pain. Her diagnosis according to the x-ray and exam was Hip Dysplasia and she immediately referred us to the University of Madison Veterinary Teaching Hospital for a consultation with an orthopedic specialist.
The news that Max may have hip dysplasia was devastating to us, and we were optimistic at what the outcome would be. We did lots of research on the disease, called the breeder, and grilled the vet (who probably thinks I'm a crazy lady but has never come right out and said it!).
By the time our appointment came around, I felt that I was ready to talk intelligently about Max's issue. I left our home and began the first of many hour and a half drives to UMVTH. When we arrived, I was amazed at the large number of dogs and cats in the waiting room. What a place! It's like the Mayo Clinic for animals! As we sat in the waiting room, I looked around me. Everyone had a story to share about their pet and I remember thinking how sad some of them were. Broken bones, torn ligaments and even cancer. I was surprised how many dogs were there for a chemo treatment and I honestly never even knew that was a possibility! My heart went out to them and I was relieved that as bad as it was, Max only had Hip Dysplasia.
Usually, at our local vet Max shakes and is very nervous, but here he seemed to be his normal happy self. That may have been because he was too busy trying to visit with everyone and drag me wherever he wanted to go!! Max wanted to play and after 20 minutes I needed to sit. Being human, the socialization was just too much for me!!
After an especially strenuous attempt to pull him away from another dog, I came to the conclusion that I would either need to sit ON him or get him away from the middle of the action! After a quick beg for a treat from the receptionist, we found a quiet spot at the far end of the hallway. I breathed a sigh of relief and tried to focus on the issues at hand. Soon, our name was called. A vet technician named Jerri Anne weighed Max and took us to the examining room. She went through the usual questions, took his temp, (which he wasn't all that fond of) and we met who we now call our favorite orthopedic surgeon, Dr. J. A very kind person with a calming English accent, Max and I liked her immediately. He gave her kisses and tried to show off for her by doing his best 'happy labby' imitation. Dr. J explained to me in detail what she would be doing and what she would be looking for.
First off she would be examining his hips and then move to his legs to check for any abnormalities. The examination went well, but when performing the drawer test, by bending the leg a certain way to determine if the bones are hitting each other, on his left hind leg, Max snapped and growled at her. This was a defining moment for Max'.they have muzzles there and he was quickly introduced to one! In a way, I think he was relieved. He is not a mean dog and usually after growling at anyone, he feels bad and has to make sure you know he didn't mean it by licking your face. By having the muzzle, he didn't have to worry about controlling the emotion elicited by the intense pain he was feeling.
Aside from that incident, Max was very well behaved for the examination and seemed to trust what Dr. J was doing. Unfortunately, at that particular point the pain was just too much for him. After the exam was over, Dr. J explained that she would be taking him back to x-ray and that it would be 2 hours or so before we would have any results. This must have been the day for defining moments, I suppose, because I had an almost uncontrollable urge to run after them. I already knew how much I loved Max, but watching him walk away and knowing that something was very wrong, I realized just how deep that love went. With a heavy heart I went back to the waiting room and sat with all of the other pet owners. I sat, I squirmed, I worried, tried to read a magazine, drank coffee, paced and went crazy until finally 3 hours later Dr. J came to get me. Back in the examining room she showed me the x-rays. Our vet had been wrong about the Hip Dysplasia. Max had a torn posterior cruciate ligament.
Cruciate ligaments keep the end of the femur and tibia bones from moving back and forth against each other. Dr. J recommended TPLO surgery to repair it and although the recovery period was 8 weeks of very minimal movement, the rate of recovery for dogs having this surgery is very high. We discussed the pros and cons of the surgery, the cost, and the importance of the recovery period. I called home and discussed it with my husband and to my relief his response was one of complete support. The decision had been made and soon Max would be on the road to recovery. What a relief! It was two days before Halloween and Max's surgery was scheduled for the next day. I left him with Dr. J and once again, had that urge to go back and get him and tell her that if he stays, I stay, but common sense took over as I realized I'd be of much more use to him at home than in a jail cell!
As I drove home I thought about all of the things that I would need to do before Max came home. The night passed slowly and I was up at 3:30 am wondering how my boy was doing. I got ready for work and arrived 30 minutes early. I knew that the surgery was scheduled for 9 AM and I was having a hard time concentrating. Finally, Jerri Anne called to let me know that Max had just gone in. When he got out of surgery she called me every hour with updates and made sure that I understood completely what was going on. She was not only concerned about Max, but she was concerned about me too. You don't find that kind of dedication and caring very often.
The bone in Max's knee had been restructured and a plate and screws put in for stability. Dr. J called me later that night and gave me a final update. The news was good and Max would be able to come home the following day as long as everything stayed the same. The next day was a long one and I felt like work would never be over. As soon as we were able, my husband and I left for Madison to bring Max home. I was nervous, as most would be that he would injure his leg or something unforeseen would happen when we got home, but Dr. J assured me that he would be fine as long as we were careful and kept him calm. We had to take him out on a leash to go to the bathroom and make sure that he never attempted to run or jump. Typical recovery time for TPLO surgery is 8 weeks. This was to allow the bone to heal around the plate and screws so the entire knee and surrounding bones would remain strong. Max was officially on lockdown.
In the first 6 weeks after the surgery Max did well. He put weight on his leg about 50% of his walking time. At about 4 weeks he should have begun to use the leg one hundred percent but he was still using it just for balance and the occasional step. I was concerned, but not overly, since all dogs heal differently. I was giving Dr. J regular updates as well and she seemed happy with the progress.
Max's routine had become pretty normal again except for the no running, jumping or climbing stairs part and he was happy to go to work with my husband Greg every day. At 8 weeks he would go back for x-rays to make sure that everything was healing properly and if so, would get some of his freedom back.
Somewhere between the 6th and the 7h week I noticed that he had stopped using his leg altogether. He wasn't using it for balance or even putting it down when he urinated. I was planning on calling Dr. J the next day, but when I went to pick him up from my husband's office after my work day was over I immediately knew that something was terribly wrong. Max looked at me with such pain in his eyes and expression of pleading on his face, that my stomach turned. I wasn't even in the door before I was asking my husband how long had he been like this and WHY DIDN'T YOU CALL ME???? In my experience with the male species (and I live in a house with all males, even the cat and dog) the nurturing thing is not their strong suit. They may notice that something is wrong, but the brain cell that should trigger the 'oh my gosh we need to check this out' reaction is missing. Greg's response (and his co workers, who is also a guy) was that yes, he's been groaning a lot today and moving from floor to pillow and back again all day long. The alarms instantly went off in my head. HELLO!!! CLUE PHONE!! Not normal. I took Max home and gave him some of his pain meds we had left from after the surgery. That entire night he moaned and moved around, never able to find a comfortable place or position to lie. Looking at the leg, the muscle seemed to have atrophied significantly overnight and it was just a painful limb hanging useless on his body. He was non weight bearing, seriously lethargic and wouldn't eat or drink. He only wanted to lie outside on the ground in the freezing cold'and I mean freezing cold. We were at 20 degrees or less. We had to carry him in from outside because he would not get up. Knowing what I do now, I think the cold made it hurt less. As a matter of fact he still does that on occasion when he is having a painful day. I use it as a measure and act accordingly.
I called Dr. J immediately the next morning and she suggested we bring him in for some x-rays and an examination. On the drive to Madison he whined and cried the entire way. I was so thankful to be able to get him out of the car and to a place where he could lie down and relax. Finally, once again they called our name and we went to the exam room. All of the usual procedures were performed and then I told Dr. J what I knew. She agreed that something was very wrong and took Max back for x-rays. After several hours of sitting in the waiting room I had become so familiar with, the vet tech Jerri Anne came to get me. I could tell on her face that something wasn't right, but being the optimist that I am, I said 'good news, right?' She responded with a look that I can only describe as pity mixed with terror and said 'no, not so good'.
We entered the exam room and I was surprised to see another doctor, whom I was not familiar with and no Dr. J. He introduced himself as the Director of Orthopedics and said that Dr. J was with another patient. He then proceeded to show me the xrays and give me the diagnosis.
If I said that I was caught off guard, it would be an understatement. The diagnosis I received was the last thing I expected. In fact, it hit me like a freight train''the doctor's voice, the sound of the words. I was incredibly unprepared for what was being said. Even now as I think back on it, the details come back to me very clearly. What I was prepared for was a broken bone, a dislodged screw, another surgery for bone repair, but ABSOLUTELY not what I was hearing. Over and over I kept repeating in my head, NO, it can't be, there must be some mistake! Yet, here I was, with the x-rays, Jerri Anne, and the Director of Orthopedics, hearing the words tumor, osteosarcoma, and chemotherapy.
As I attempted to process what they were telling me, I was even less prepared for their solution. It was like being hit twice by the same train. Amputation, they said would give my boy a good quality of life for as long as the cancer allowed. AMPUTATION???? I couldn't even say the word. My handsome, proud boy, so full of life and love'.and you want me to cut off his leg? How will he walk? How will he chase his favorite tennis ball?? What if people stare?? Will he still be able to be around other dogs?? Why didn't we see this when the TPLO surgery was done?? WHAT DO YOU MEAN AMPUTATION?? The thoughts in my head were spinning and I had completely lost all of my composure. At some point, after the doctor knew I wasn't listening anymore, he left the room. I'm sure he breathed a long sigh of relief because by that point I was an emotional disaster. I have no idea when Dr. J came back in the room, but she and Jeri Anne attempted to get me to regain some sort of composure. They were very compassionate and Jerri Anne was crying right along with me. She had a similar experience with one of her Labs and knew the emotions I was feeling. Those are moments that I'll never forget and they equal the emotion and distress that I felt when we discovered that my father had cancer. I had lost my father 4 years earlier to lung cancer that metastasized to the bone. I knew all too well how awful the disease was and the pain involved as things progressed. Disbelief, anger, helplessness and mind shattering grief was swimming around in my head and I kept wondering how I would ever have the courage to tell my son and my husband.
Again, I had to leave Max, so that a biopsy and some x-rays could be done first thing the next morning. Close examination would be done on his lungs and other bones to determine if the cancer were anywhere else. The lungs are the most common place for this very aggressive cancer to spread to and unfortunately, the younger dogs are the most susceptible to the aggression of the cancer. Since Max was only 19 months old there was a very good chance they would find it there.
Dr. J assured me, with kind words and a hug that they would give him some morphine for his pain and make sure that he had a restful night. Crying uncontrollably, I gave Max hugs and kisses, told him how much I loved him and left.
I walked out of the hospital and got into my car. As I think back on it now, I realize that I had no business getting behind the wheel of a car, but I just wanted to go home. Home where it was safe and I could grieve in the privacy of my own bedroom. But first I had to deliver the news to my family.
I don't remember much of the drive. I got lost in Madison after leaving the hospital and later found myself about 30 miles East of where I lived, headed toward Chicago. I must have missed my exit on the toll way and through the tears and grief didn't realize it. I just kept thinking, please, God, not my Maxi, too.
I finally arrived home safely and my family was waiting for me. My husband Greg had called at some point during the drive and I broke down completely and told him what I knew. Greg and I have both lost family members to cancer in the last 5 years and both of them at relatively young ages. The news that our dog seemed to be next was not easy for us to deal with, let alone tell our children about. I was completely exhausted when I got home and spent a short time answering all of the questions that Greg and our youngest son Alex had for me. The question that really stuck with all of us though, was why didn't they see the cancer when they did the TPLO surgery and what should we do now? I have always been an advocate for euthanasia when animals are suffering, but the doctors were telling me that by taking Max's leg off, the pain would be gone. Did we want to put him through another surgery? What would the pain level be from that? How long would he live? Would he be able to get around ok? Were we really keeping with our philosophy that you do what's right for the dog, or were we being selfish? There were so many unanswered questions.
Dr. J called me the next morning at work with news of the x-rays. They could find no evidence of metastasis in the lungs. The results of the biopsy would not be back for 2 more days. I was so thankful for the news and once again burst into tears. Dr. J made sure we understood that just because we couldn't see the cancer on the x-ray didn't mean it wasn't there, and if we chose to pursue the amputation and chemotherapy Max had a good chance of living pain free for up to a year. She asked me if we had come to a decision yet and I said no, we really hadn't had time to process it all. We had many unanswered questions about the surgery and the option of chemotherapy afterward. She said that any questions we had about the actual amputation surgery she would be happy to answer and suggested that when we came to get Max, we talk to an oncologist. I agreed, knowing that I wanted to be sure I had explored all of the options available.
That afternoon, on the way to pick up Max, Greg and I weighed all of the options. We talked about the pros and cons, the expense, and how we individually felt about the situation. After an hour and a half of soul searching, we decided that the kindest thing would be to put Max to sleep. I wasn't 100% comfortable with that decision, but thought that it was probably a natural reaction to the subject at hand. Hard as the decision was, I wanted it to be what was best for Max and not for me. Max had been in some sort of pain since October and we couldn't let it continue. Greg told me that ultimately it was my decision and I had his support either way.
We arrived at the hospital and sat down with Dr. J. We told her that we were open to speaking with the oncologist, but that we were fairly certain we had made our decision. She answered our questions about the amputation surgery with a very positive approach. Her views on the subject were very pro amp and she said that most dogs, with the exception of some of the geriatric aged dogs, do very well after the amputation of a limb. At Max's age he should have no problem with mobility.
We had her bring in the oncologist who was also very caring and was willing to answer all of the questions we had. We learned many things about canine chemotherapy. Dogs don't lose their fur, they don't usually get as sick as humans, they do have to be careful of infection, but not on the level that a human does, and very often, dogs have no reaction to the chemo at all. We asked about the chances of it prolonging Max's life and what his quality of life would be like. He stated that every dog was different but after the treatments are completed some dogs live another year or more before the cancer spreads. Timing was important, he said, because at Max's age (then 20 months) the cancer spreads quickly. We inquired about cost and how often the treatments would be. Normal treatment would be 4 treatments of Carboplatin occurring 3 weeks apart. At the 3 month marker a chest x-ray would be done to check for any sign that the cancer had spread. We thanked him for talking with us and he gave us his card should we have any more questions.
At that point, Dr. J brought Max in to us and we prepared for the drive home. I looked at him, knowing that his time with us was coming to an end and started crying. Dr. J must have known what I was feeling because she said to me, 'think about the surgery. I think you would be glad that you did it'
The whole way home I thought about what she said and as I looked at Max I tried to envision him with 3 legs. We had been home for several hours and Max and I had finally settled down. He was sleeping, after taking his pain meds and I was trying my best not to cry again. The phone rang and I almost didn't answer it. I was not in the mood for someone to tell me how awful they felt about Max's situation. For some reason I had a change of heart and picked up the phone. On the other end was Dr. J's supervisor. She introduced herself and proceeded to talk to me for an hour about the benefits of the amputation surgery. She listened to my concerns and assured me that whatever our decision, the hospital would support us 100%, but she felt compelled to tell me how she personally felt about the process and all of the success stories she had seen. For some reason I really connected with this woman. She gave me the strength to make a decision that only a few hours before had me in tears and sick to my stomach. I believe what helped me most was when I asked her that if she were Max's owner, what would she do. Without hesitation, she said 'I would absolutely do the surgery'.
I had asked the question before, and even Dr. J didn't say those words to me. I understand that the doctors aren't supposed to influence people with their own opinions, but I think I really needed to hear someone say that. I thanked her for her support and for taking the time to call and hung up. It was like someone had taken 1000 lbs off of my shoulders. I called my husband and told him what had happened. He said to me that I sounded better than I had in days. I slept with Max on the floor that night, I curled up on his bed next to him and listened to him breathe. He licked my face as if to say 'good job Mom, let's do this'. I called Dr. J the next morning and told her my decision. She was happy and sounded relieved. The biopsy results had come in that morning, confirming the Osteosarcoma 100% and Dr. J said she would schedule him for surgery the next day. Later that afternoon, I loaded Max up once again and drove to UMVMTH. I left him in Dr. Js capable hands and drove home praying for the best.
Today we are post amputation 7 weeks and Max is getting along well. We have had a couple of other issues that we have had to deal with, but they are not related to the amputation. Max has had 2 chemo treatments with very little side effects and is back to chasing his tennis ball in the back yard and going on walks. The walks are shorter, but we enjoy them all the same. We still take him everywhere with us and that allows us a chance to increase awareness of cancer in dogs and to promote the benefits of canine limb amputation. In two more weeks Max will go for his 3rd round of chemo and have a chest x-ray to determine if the cancer is in his lungs. We are praying for the best and continue to cherish each and every day we have with him.
Article submitted by Paula D. (Max's Mom)
Written by Max's Mom