Thanksgiving is one of my favorite holidays because I love to cook. I didn’t get to do as much with the meal this year, as I was busy working steadily into Wednesday evening with dogs and their guardians. When Thursday finally came, my attention was brought back, not to the meal and its preparations, but to my own dogs.
Travis was not having a good morning. Every step was an effort, every down brought a deep groan. We had been watching his pain level closely, knowing the drugs would have to come sooner rather than later. They came Thanksgiving morning.
Giving him something for the pain seems like such a simple and common-sense decision, but in Travis’ case, it’s much more complicated. Quick pharmacology lesson. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat acute and chronic conditions involving pain and inflammation. After administration, the drug is biotransformed (broken down) in the liver to create inactive metabolites (small waste products of the process) that are processed by the kidneys and eventually eliminated. Our pain medicine of choice, Gabapentin, is also partially metabolized by the liver.
Here’s the problem: Travis has a hepatocellular carcinoma covering more than 50 percent of his liver. He’s dying of liver cancer. Chances are fair that something other than the cancer will take him first, but treating his musculoskeletal pain with meds that are metabolized by the liver is akin to shortening his life. Kathy and I had discussed how we would address his pain when it came, but taking the action was initially more difficult than I expected. Consciously reducing his days was not a decision to be made lightly.
A recent visit with a client was as enlightening as it was difficult. Karen was struggling with a similar but much more dire decision—a decision that likely will come for Kathy and me in the coming year. She called me about a quad cart for her boy, Benny, a 15 year-old Border Collie/Springer Spaniel mix who is quadriparetic, weak but not paralyzed in all four limbs. He’s tired but loyal to his mom who lost her partner to a cascade of cancer-related complications eighteen months prior. Benny is her rock and he’s holding on for her. We talked for more than an hour about Benny’s role in her life, how dogs express pain and mental distress, life after death for animals, ceremonies, knowing when the time was right and letting go. We spent fewer than 10 minutes discussing the quad cart.
As I thought back to my time with Karen and Benny, I was reminded again about quality over quantity. It’s a simple concept and easy to say, but more difficult in practice. But there are times in life when the most difficult decision brings you the most relief and sometimes, joy.
We gave Travis Gabapentin and Previcox (an NSAID) on Thanksgiving morning. By midday, he was moving more comfortably and completely enthralled with the smells of turkey, gravy, potatoes and squash wafting from the kitchen. Even after our food coma had passed, he was bright, alert and seeking attention like he had six months ago. He was a different dog.
As the weekend progressed, it was clear he was ready for more. On Sunday, we took the boys to Catalina State Park for a short hike. Travis walked more than a mile, conquered about 50(!) natural steps with the help of his seeing-eye person Kathy, and kept a reasonable pace throughout the hike. He was an active member of the family again and he was enjoying it. The whole family had a nice nap that afternoon and both Travis and Harley were ready for an evening walk after dinner.
I never imagined being thrilled with shortening my dog’s life, but if he enjoys it this much, I’m more than happy to keep him comfortable, engaged and active in our family’s activities. I want his days with us to be full, happy, productive—and hopefully, joyful. He’s given Kathy nearly 13 great years and me an inspiring and educational 14 months.
I’m only sorry I wasn’t listening closely enough and more trusting of what Travis was trying to say. “Help me live well now. I live in the present and want to enjoy it. The future, no matter how short, is only relevant to you.” I hear you, little one, and I’m paying attention this time.