Sunday, March 1, 2009

The Perils Of Pepper

So you may recall me mentioning Pepper, the dog of my BF, the dog who introduced me to Border collies (and thence induced me to fall in love with them), my step-dog. Pepper is, as they say, a classy bitch. She is a full-on, working-bred stock dog, serious and intent when it comes to work, disinclined to suffer fools gladly, yet always ready for a game or a cuddle. She is friendly enough to people in general, but has her favorites, and will quickly abandon even a good game with a stranger in order to spend ordinary time with one of those she likes best. She is kind to her sheep without letting them push her around, she is bold and willing to conquer new skills, she is tireless as a sidekick. There is in her amber-brown eyes an undeniable courage and intelligence, and behind the quick mind and strong will is a sweetness that is offered only to those she deems worthy of this regard.

I will say that in her youth Pepper's idea of cuddling was more of a casual affair; she liked the attention, all right, but should there be any hint that something more interesting was in the offing - say, a game or a trip in the truck or airplane, or a chance to go to the sheep - she would without hesitation abandon the petting and be off like a shot onto bigger adventures. She liked her cuddles for a few minutes, and then she was done and would go off and do something else, and sleeping on the foot of the bed was a "sometimes-only, and only if you don't move around too much and annoy me" kind of proposition.

Pepper is 13 now, though, and she's mellowed. She's still up for a game or a trip in the car or a go at the sheep (although encroaching deafness makes this less useful and more dangerous to her than it used to be), but she's become more judicious. Instead of following me everywhere, for instance, or racing up or down the stairs should I look like I'm even thinking of going that way, she positions herself strategically in the house so she can watch me go from room to room, and only gets up to follow if I call her or if I do, in fact, do something interesting. She's more inclined to sleep on the bed, and significantly more into the petting and cuddling than she used to be. Fools don't bother her as much as they used to - although she is still capable of expressing, at a glance, the most profound disgust imaginable, should some ill-mannered puppy or other time-waster cross her trail.

With age has come its rewards, of patience and restfulness and the pleasure in simple things. But age has its down sides as well.

Early in the year, while D was out of town (and hence Pepper was staying, as she does when he is gone, at my house), I happened to glance over at her, curled on the futon while I was working at the computer. Nothing amiss; she was sleeping, her feet tucked under her chest, cat-like, her head laid on a dog-pillow I had there for just that purpose. But I glanced back a second time and a third, wondering: What is it that's bothering me about this? And on that third glance I saw it: her left wrist had a small asymmetry to it.

Hmm. Pretty subtle. Am I making that up? I got up and disturbed Pepper's rest by stretching out her leg and having a look. No, I'm not making it up. There's a mass there, maybe 6 millimeters across, maybe 3 millimeters thick, adherent to the underside of the skin, but otherwise movable. Thin, but distinctly different from her other tissues.

Well, hell.

I emailed D in Hong Kong (or wherever he was at the time) immediately and received his prompt permission to do whatever I thought was best. So the next day I took Pepper to work and aspirated the mass. Under the microscope I found a number of cells, varying in shape, but all with some disturbing features. Some had a prominent chromatin pattern, some had two nuclei, some had multiple nucleoli (all of which, I assure you, are not normal-cell features, and all of which are disquieting.) But I am not a pathologist, so I sent a slide off to be read by one. The report came back as a mesenchymal cell tumor of some type undetermined... but definitely a malignancy.

Damn. Pepper, my darling, beloved step-dog, who I adore so much and to whom I owe what can never be repaid, has cancer. Pepper, D's only dog, his perfect sidekick for 13 years. He loves that dog.

So I gave the results to D and we talked over what to do. At my urging we talked to the surgical specialists in Anchorage, in case they had better options for her, and because I knew they would be able to be completely objective - a task I was not certain I could accomplish perfectly, given my emotional involvement with the dog. The good news about her tumor type is that it is one that is unlikely to spread to other body parts. The bad news is that it tends to send tendrils out from the main body of the mass, making it difficult to get clean margins, especially in that position: there is precious little tissue to spare on the wrist, a high-motion joint with relatively tight skin. I was uncertain that I could get clean margins (short of amputating her leg), and I wondered if the surgeons might have a better shot at that.

The surgeons were excellent, as I knew they would be, and advised D clearly, giving him his options without the blurring of the line that I feared my emotional involvement with Pepper might entail. Ultimately their advice was essentially identical to mine - although they were able to answer questions about skin grafting that were beyond my expertise - but I felt better knowing that I wasn't giving D options that included an emotional bias.

Ultimately, the decision had to rest with D - Pepper is his dog, after all - and he elected to have the surgery done at our clinic. He left it to me if I would do the surgery of have Dr. J do it; in the end I asked Dr. J to do it. He has 30 years' experience on me, and while I might have done as good a job, I didn't want to leave that to chance. I wanted Pepper to have the best shot we could give her.

So, accordingly, Dr. J excised a long oval from the medial aspect of Pepper's wrist, including the tumor and as much associated tissue as he could reasonably take without compromising the joint or the circulation to her foot. That meant that it was not possible to close the skin entirely; even if you could stretch it that tight, doing so would constrict the circulation and the foot would slough, so some of the incision had to be left open. That left a line of sutures above and below the open area, under some tension, and an open area about the size of a quarter over the highest-motion part of her wrist. I set a splint on the leg to keep the wrist strait, to avoid popping the sutures through excessive motion. The wonderful and artistic J looked at it critically and said, "Do you think D would object to hearts on Pepper's splint? It's February after all, and then it would be a Valentine's splint."

"D isn't sentimental about Valentine's day, but I think it would be adorable," I said, settling the matter for J. "But we'd better put an airplane on it, too, so it won't look too girly when D takes her to the hangar. I don't want all the other little dogs to laugh at her because her mother dresses her funny."

So J cut out Vetwrap hearts, and I made a Vetwrap airplane, and we applied them to her splint while Pepper was waking up from her anesthetic.




Pepper adapted with surprising speed to her splint, learning immediately that she could scoot it along the floor in a rapid shuffle instead of picking it up and clunking it down, for which reason she was as mobile post-op as she was pre-op. I sent her mass off to be checked for margins and a more concrete diagnosis, and Pepper went scooting about her days in good cheer (although she was not a giant fan of the plastic galosh that had to be applied when she went outdoors, in the interests of keeping the splint dry). The histopath report came back a few days later: big margins to the sides of the mass, narrow margins to the deep side - but clean. That's good news, much better in fact than I expected. That means there's a decent chance the surgery was curative.

Meanwhile, Pepper had a splint change (a different airplane this time) and then graduated down to a lighter wrap. This was a bit confusing for her; at first she walked on three legs, waving the now-un-splinted leg in the air as if uncertain if it was okay to use it without the splint. Once she began using the leg, she was lame for several days (as a consequence of being in the splint, which enforces different weight-bearing on the limb, over-flexion of the shoulder and under-flexion of the wrist). Having already had an underlying subtle and intermittent lameness of the shoulder on the operated leg, that was more pronounced than I had hoped, but she grew more and more sound as she went along in the lighter wrap. Now she is back to normal gaiting on that leg - and as for her surgical incision, you can see for yourself.




Yesterday, when we were hammered with snow, she spent the afternoon running around in it, biting snow, chasing my big Finn dog through the drifts and making him behave himself - no mean feat, I assure you. He's a big goofball. He can't help himself. Luckily Pepper is equal to the task of getting him lined out and making him act right. AND she wins the Queen-of-the-mountain competition every time.



Pepper likes to bite the snow.




Sometimes the snow bites back!




Ha, ha, you missed me!


I am Queen of the Mountain, neener neener boo boo! (The mountain in this case being a great huge snow berm from plowing runways on the lake.)


Not bad for thirteen, eh?

15 comments:

Dragon43 said...

Great story. Slow healing due to a lack of available skin is much like what we had with Missy Face.

Loved the airplane shots.....

Are you working the RACE this year?

She sounds like a wonderful dog....

Holly said...

What a great story about a beloved dog. I too, worry about my elders, got 2 of them. Pepper is a lucky girl to have someone like you to care for her.

inaradog said...

I keep hearing more and more people talk about their beloved dogs getting cancer. It's terrifying. So glad Pepper is doing well!

AKDD said...

Dragon, nope - not working the race. My boss is, though; he's probably on his way to Iditarod as we speak. And yes, Pepper IS a wonderful dog! Thanks for noticing!

Holly and Inara, thank you, too. Unfortunately, cancer is the leading cause of death in older dogs. On the other hand, many cancers are curable - unlike, say, chronic heart or kidney disease. Cancer is a terrifying word - but taken as a whole, cancer is one of the more curable of the chronic diseases.

I'm just keeping my fingers crossed on this one. Looks good so far!

Beth K said...

This brought tears to my eyes! It must be very difficult sometimes seperating your medical and emotional self from cases so close to home like this!!

I love that you included pictures. Thank you!!

My BC Bula does the same thing with the snow. She loves to catch it - but sometimes gets to close and gets a shovel in the mouth...i much prefer her jumping for the snow than the horse poop when I clean stall...

Carole said...

I'm so glad that Pepper is doing well. I lost my beloved terrier cross this week to transitional cell carcinoma and was holding my breath as I was reading your entry, dreading bad news. Thank you for providing a happy-ending story.

(Photo of Cory here.)

datista said...

This struck a little close to home, as Dad's 12 year old English Setter, Blaze, was recently diagnosed with mammary cancer. We caught it when it was tiny, about a lima bean sized bump, and did a mastectomy. She also had a tumor on the back of her knee and a cyst on her chest taken off, and the (benign) tumor on her hind leg was sending tendrils into the underlying tissue.
With any luck both our old gals will be around a while longer.

And while it sounds like Pepper is gracefully sliding into old age, Blaze is getting dementia and enjoying a second puppyhood whooping up on my 2.5 year old mutt, running around like an idiot and jumping up on the couch to knock the pillows off (only old dogs get to sleep on the couch so the younger dogs claim the pillows). :D

I need orange said...

How lucky that she lives with a vet and got her problem noticed so early!!!

My dogs love biting the snow, too.

To the point where we can't leave them out when we are shoveling in the yard, as they will bite the shovel in their impatience for it to lift snow.........

They have to be satisfied with the snow we fling over the fence to them.

So glad Pepper got a good report.

We have had a cancer diagnosis three times for five dogs......... So far..........

kingsley's person said...

Glad to hear that pepper is doing well and so well taken care of by you.

Loved the cut outs on the splint. Made me smile

AKDD said...

Beth, it's true that sometimes it's hard to compartmentalize like that. I've gotten better at it with much practice, and when it's my own dogs I know in my heart what is right to do. The toughest is when it's NOT My dog, but one as dear to me as if it were. It isn't my decision, so I have to consult another's heart about what is best for them to do, at the same time as leaving mine out of it.

Carole, thanks for the link to Cody's photo - what a doll. I love the mismatched ears. I'm so sorry for your loss. I can only imagine how hard this is for you.

Datista, I hope that Blaze's surgery gives her a long, disease-free second puppyhood! Bless her heart.

INO, it WAS lucky - lucky that she just happened to be sleeping with her feet tucked like that and that I just happened to glance at them that day. The mass was thin enough that with her wrists strait I would not have caught it. It was just a little profile popped out on the side of that one wrist, that didn't quite match the other one. I needed that skyline view to see it.

I'm in the same boat as you with older dogs... of the four dogs I've lost in the last 15 years, three have died of cancer. But 30 years ago, they could all have died young of diseases we now cure, so in that sense perhaps I'm lucky.

Meanwhile, similar to your dogs, Pepper DOES (very rarely) get popped in the mouth by the snow shovel... D watches pretty closely, but sometimes she does the stealth-sneak under the plane's tailfeathers, approaches from behind and gets clipped on the follow-through. Mostly she's pretty smart about it, though.

AKDD said...

KP, glad you liked the decorations. J is really good at making them. Nowadays they have pre-made cut-outs for splints nad wraps, which are very cute, but not custom-made the way J's are. I must tell you that it is NOT easy to do a cut-out that looks like a plane, though... the Vetwrap likes to stretch and/or fuse at inconvenient times. I wasn't sure it looked enough like a plane to be recognizable, so I made the little wing decorations to underscore my point. :D

AKColleen said...

I had no idea all this was going on! I am so glad to hear that everything is going all right. Makes me miss Wyatt, though. :(

Barb said...

I'm so glad she's doing so well. When you first wrote about noticing a swelling on her wrist I thought "osteosarcoma" and when you described the mass as being confined to the skin I was so relieved! I'm glad it wasn't that. Here's hoping she has many more wonderful years!

And I LOVED the splint decorations!

MaskedMan said...

From across the room, you noticed a discontinuity of approximately one-eighth of an inch thick by roughly a quarter of an inch across.
Under fur.
When you weren't even looking for it.

Admit it: You have superpowers. You're some kind of X-Man (X-Woman?) mutant with the ability to observe the unobservable, aren't you?

AKDD said...

Colleen - I'm with ya. Wyatt was a stone sweetheart. And what a grin that dog had!

Barb - thank God it WASN'T an osteosarcoma. Buddy, the BC I got from D (and originally Pepper's "brother") also got cancer, but he had an incurable kind that (no matter how big your margins) can't be excised. I am very grateful to Pepper, A) for choosing one of the most curable chronic diseases out there (cancer, as opposed to, say, heart disease); and B) for choosing a kind that is potentially curable; and C) for picking a spot to grow it where it could be excised. Good dog! Two biscuits!

MM - well, I didn't see it *consciously*. It was my subconscious, saying "Look! No, I mean LOOK. You're not getting it, look again. There. Now ya see it? Duh." After a while, your brain gets to where it picks out little asymmetries and other subtleties and uses your subconscious mind to kick it up into your awareness, even when you're not looking for it. If that's a super-power, I'll take it! Damn useful one to have, in my line of work! :)