Gil is one of my most devoted listeners. He is blind and has had a succession of guide dogs for 25 years. He recently discovered that his Black Lab Evie, who was barely five years old and the most beloved of all his guides, received the terrible news that she had lymphoma. She died within a week of receiving chemotherapy and Gil could not understand how this happened. I wanted to help answer some of the medical/oncological questions so as to give him some peace of mind and allow the grieving process to proceed.

Gil came to me because he believed that her sudden death appeared to have been caused by the chemotherapy drug Elspar used in conjunction with Oncovin — perhaps administered incorrectly, since he had been told she was a great candidate for treatment because she was otherwise in supremely good health. I needed to help him understand what happened that ended the life of his young and brilliant guide dog. This is more than the loss of a beloved pet, although Evie was all that to him, as well. This dog was such a valuable asset and worker that she traveled with him over 100,000 air miles all over the world to help foster independence for the blind with hand held GPS systems. Her talent and work ethic were invaluable to him and coming to grips with what has occurred required more information than his own vets gave him. Gil wanted to get peace of mind for himself, but also hoped that whatever we learned might help other people in similar situations. I turned to two of the smartest people I know: veterinary oncologist Dr Brian Huber, who runs the chemotherapy company Oncura Partners, and Dr. Donna Spector, a board certified veterinary internist and the Official Second Opinion Vet of my radio shows.

Gil’s dog Evie had been in excellent health except for a day of vomiting, after which Gil felt her all over and discovered that she had enlarged lymph nodes in the groin area. He went that day to his vet who did a needle biopsy showing lymphoma. He then went to the Animal Cancer & Imaging Center (ACIC) in Michigan for an evaluation. That biopsy showed multicentric lymphoma (B cells) stage 111a.

The examining vet said the dog’s heart, lungs and body condition were all excellent and made her a great candidate for chemo. They quoted an 8-14 month remission after the first treatment and that further treatments could gain longer amounts of time, but predicted that this dog would exceed the first predicted time.

Because of travel time, Gil elected to have his own vet administer the Univ. of Wisconsin at Madison protocol, which was sent to him and the vet by ACIC, and is considered the standard treatment universally used for lymphoma. After the IV administration of Oncovin, Evie’s white blood cell looked good 3 days later. She had no fever and the lymph nodes had returned to normal size and were no longer swollen enough to measure. She had responded very well to the chemo. At this point, the Elspar was administered, and Gil now wonders if that was the correct protocol? Could it have been lethal? Because 5 days later Evie suddenly became deathly ill — 104 temp, drinking profusely, no white cells at all in her blood — and she was dead within hours.

When Gil called to get information, what he heard distressed and confused him. The Vet Tech at ACIC told him (incorrectly as it turns out) that ACIC “did not use the U of W protocol, they never used Elspar in the first treatment, only used it later in the protocol as a rescue drug if things were not progressing well.” Gil’s own vet could not explain Evie’s sudden death. She also did not give him confidence, in retrospect, that she had known what she was doing every step of the way.

Dr. Brian Huber’s reply:

From your comments I am suspicious of acute tumor lysis syndrome — it is not common, but an emergency when it does occur! But realize all my comments are generalizations, as I have NOT seen patient, nor the blood tests or Staging tests for this cancer patient. I am ONLY going on what you provided (and this might be inappropriate information if I had more patient data available).

As far as the Univ. of Wisconsin Lymphoma protocol — the current standard in the industry is to use the Elspar in the UW Short Course lymphoma protocol. Elspar and Vincristine (Oncovin) are often used together on the same day in a healthy patient or separated by 48-72 hrs in a sicker type patient beginning chemotherapy. Sometimes the reason some facilities have not been including Elspar is because of the previous shortages in the market, and they got used to doing without! There was one study that questioned the use of Elspar in first line chemo for Lymphoma, but it is still being used MORE than not.

A patient can have a severe allergic reaction to Elspar therapy — but this is most common on the second or third time Elspar is used in a patient, not the first time, so I doubt that was the cause of the sudden decline.

There MIGHT have been a delay in identifying the pets condition post chemotherapy — especially if the veterinarian did not have immediate access to the oncologist, or the pet owner just assumed the pet was feeling bad due to the chemotherapy only and was not informed of the signs and symptoms of ATLS, which is what I suspect was the cause of her decline. The description of it follows, but basically it happens in dogs whose cancer responds very well — too well and too quickly — to the chemotherapy so the cancer cells all die off at once and the body is overwhelmed by having to cope with eliminating it all.

1. What is acute tumor lysis syndrome? Is it a life-threatening emergency?

Acute tumor lysis syndrome (ATLS) is a condition of acute collapse that may lead to death soon after administration of a chemotherapeutic agent to an animal with a chemosensitive tumor. Although uncommon, it certainly presents an urgent situation. In short, chemotherapy results in the acute death of large amounts of tumor and release of cellular contents that may be acutely toxic. This emergency situation is under recognized in veterinary patients and is becoming more common with the widespread use of chemotherapeutic agents. Therefore, when a case is suspected, a complete history and physical examination is taken as an intravenous catheter is placed and blood samples are obtained for subsequent analysis.

In dogs and cats this syndrome has been associated with lymphoma and leukemia. ATLS may occur after effective chemotherapy in animals with rapidly growing, bulky, chemosensitive tumors. The patient often is presented with a history of acute decompensation over a short time — sometimes to the point of imminent death. Rapid diagnosis and therapy are essential to reduce mortality rates.

2. What factors predispose animals to ATLS?

Rapid tumor lysis may cause acute release of intracellular phosphate and potassium. This release of electrolytes causes hypocalcaemia, hyperkalemia, and hyperphosphatemia. Hyperuricemia is also seen in people, but this is not a concern in veterinary patients.

ATLS is most common in animals with some degree of volume contraction and a large tumor mass that responds rapidly to cytotoxic therapy. In addition, septic animals or animals with extensive neoplastic disease that infiltrates the parenchyma are predisposed to ATLS. Veterinary patients at highest risk are volume-contracted dogs with stage IV or V lymphoma that are treated with chemotherapy and undergo rapid remission. ATLS is most often identified within 48 hours after the first treatment.

3. How is ATLS diagnosed?

When ATLS is suspected, the history should document the recent administration of chemotherapy to a pet with lymphoma, leukemia, or other chemoresponsive tumor. A rapid, thorough, and complete physical examination should be performed to identify telltale signs of cardiovascular collapse, vomiting, diarrhea, and ensuing shock. The accompanying hyperkalemia may result in a bradycardia and diminished P-wave amplitude, increased PR and QRS intervals and, rarely, spiked T waves on electrocardiogram. Biochemical analysis of blood may confirm the presence of hypocalcemia, hyperkalemia, and hyperphosphatemia. In the presence of elevated serum phosphate levels, hypocalcemia develops as a result of calcium and phosphate precipitation. Without effective treatment, renal failure may occur; therefore, concentrations of blood urea nitrogen and creatinine should be monitored closely. Fluid therapy should be initiated as soon as an intravenous catheter is placed.

4. What is the treatment for ATLS?

The ideal treatment is prevention. Identify predisposed patients that have heavy tumor burden, a chemoresponsive tumor, and volume contraction. Because the kidney is the main source of electrolyte excretion, metabolic abnormalities may be exacerbated in the presence of renal dysfunction. Identification of patients at risk and correction of volume depletion or azotemia may effectively reduce the risk of ATLS; chemotherapy should be delayed until metabolic disturbances such as azotemia are corrected.

If ATLS is identified, the animal should be treated with aggressive crystalloid fluid therapy. Further chemotherapy should be withheld until the animal is clinically normal and all biochemical parameters are within normal limits. The fluid rate should be adjusted to meet the needs of each patient, as directed by monitoring of body weight, heart and respiratory rates, central venous pressure, ongoing losses such as vomiting and diarrhea, and urine output.

I then replied to Dr. Huber and his replies are italicized:

Dear Brian — I am really grateful for your swift reply, and fully understand that I gave you only bare details so your responses are taken with that in mind. Gil felt that a gross error may have been made in dispensing the Elspar at all. From what you say, that is not the case and also there was a 3 day wait before administering it the first time.

Elspar IS indicated in the vast majority of Lymphoma patients. The discussion around to use or not to use is ongoing! Like I said before, you will find as many that do use it in the initial protocol step, and about equal number of oncologists that now wait to use it for dogs that come out of remission. I can say with confidence that we will always want this drug in our therapies because of its effectiveness in decreasing the Lymph node sizes (internally as well as the nodes on the outside that pet parents see). The challenge is to properly evaluate the patient in front of the Dr at the time. There is no one ideal protocol or drug for any patient (side effects are usually very unpredictable) or the patient’s cancer. We like to think that we can neatly classify how patients respond and what their long-term prognosis should be, however, after working with oncology pet patients over 20 years I can say this is just not the case.

For my own education, and to pass on to others, is ATLS something that can be predicted?

NO! That is the frustration; it is mostly seen in pets with large tumor burdens of HIGHLY responsive cancer like Lymphoma (particularly). Even with the large tumor burdens the vast majority of pets do NOT develop ATLS. I can say that ATLS does not always read the book, meaning I have seen it reported as much as 5-7 days post chemo (especially the Elspar and Vincristine dosing on first cycle of this protocol.

Was there some level of vigilance the dispensing vet should have/could have exerted to catch this reaction sooner?

Maybe, but there must be a complete evaluation at the time the pet is acting sick — a full comprehensive blood panel, blood gases and IV Fluids — aggressive therapy is needed. Again, many doctors assume that what is happening is a “normal” post-chemo reaction and then pet is crashing when actually brought back into hospital.

Evie was eager to play, chasing a ball, entirely “healthy” — and then crashed, but she had been given the Elspar five days before, so now it leads me to think her sudden death was caused by ATLS. Once there is an ATLS reaction, is it somewhat irrelevant how quickly you respond since the reaction has already taken place?

No, if caught in the stages of electrolyte abnormalities and patient is supported with proper therapies — most of these pets will survive this crisis. Most then go on and continue treatment protocols.

Meaning that if she had gotten into the vet immediately when symptoms appeared — and the vet had recognized it as ATLS and jumped right on it, there could have been a chance to pull her through. Personally, I think it is best to stay with your own vet after cancer diagnosis and let them handle the treatment, but only if Oncura Partners were supplying the protocol and medications for the treatment — and then there is 24 hour back up for the vet. I believe this is your business model: pets can stay closer to home, be treated by familiar doctors, but they in turn don’t have to second guess anything because Oncura has done the planning for them and provides emergency advice, as well. It is what I would have recommended to Gil if I had been involved sooner.

In a way yes, but we do need family doctors that are willing to be involved with patient care to this level. (As you may know, there is a wide variance of doctor abilities and desires to practice the higher level of medicine — in veterinary and human fields.) What we do provide with Oncura Partners is the Oncologist interaction on all case decisions and therapies. We have an emergency management system in place that would have walked this doctor through steps of management and testing needed right away. These Emergency cases go to the top of review and alert to our Oncologists to respond to immediately. This does not always guarantee great outcomes — but it does allow patient care to be as seamless as possible and we have tried to cover all the “Unexpected” potentials for oncology case management. Oncura Partners is finalizing the integration of “PhaSeal” closed administration system products. This is the best safety system for hospitals now available (Human or Vet). This is not a direct issue for Pet parents — but increases the potential comfort level of Veterinarians considering offering cancer management services to their clients.

Thank you for your time and wisdom, Brian. I also want to say that this is another reason that pet insurance is essential because we know cancer is widespread — and in this case, lymphoma is the most prevalent kind of cancer. I am grateful to Jack Stephens not just for introducing me to you, but for founding Pets Best insurance because otherwise people would go bankrupt diagnosing and treating cancer (or not even be able to embark on it, with all the attendant guilt and sorrow). As you know, Pets Best pays 80% of the bills, including a second opinion vet, whom I would also have recommended to Gil.

I then shared all this correspondence with Dr. Donna Spector, who I believe would have been able to work with his vet (by phone and/or email) and given that doctor and Gil the information, advice and emotional support to get the best possible care for Evie. Here are Dr. Donna Spector’s comments in bold:

Although Elspar may not add to the length of the initial remission it is often used in dogs that are not feeling well with their cancer because it works so quickly. If my own dog was suffering from lymphoma and was vomiting, not eating and generally feeling crappy I would want a drug that could help turn that around quickly and Elspar is capable of that. If a dog like Evie is feeling fine and dandy with their lymphoma just enlarging their lymph node then maybe I would consider holding on to Elspar until later on. It is very dependent on the dog and how it is feeling on the day of diagnosis/treatment.

I understand that this gentleman is really questioning the handling of his dog but when it comes to Elspar there really isn’t a right or wrong way to use it and the more opinions he seeks will just muddle the issue for him. You would have oncology specialists argue on both sides of this “to use” or “not to use” Elspar coin so it is tough to say it was used “incorrectly.” Currently it is still listed in all protocols as an initiation drug. Also the ultimate signs this dog developed are not likely due to Elspar, like the low WBC (white blood count) and fever are not consistent with Elspar side effects as it does not suppress the bone marrow — that most likely came from the Vincristine (Oncovin). If this dog had an excellent response to Vincristine and all lymph nodes were already decreased in size the tumor lysis (destruction of the tumor cells) had started before Elspar was ever given. So whether it was used or not used may be a moot point it may not have even been the problem in this particular dog.

From Christine:

I think it was Laurie G. that originally posted the info on the Exercise Induced Collapse (EIC). She might have triggered her memory because my agile Boykin Spaniel is one of the positively IDd for AFFECTED DNA. It’s listed in the OFA databank as Carolina’s Duck Duck Goose. Feel free to use him as an example if you want.

I have CC’d Paisley Stevens Knudsen, president of the Boykin Spaniel Club (AKC parent club) and also Terrie Tomlinson, Chair of the Boykin Health Committee. Terrie also has Labs and has a lot of knowledge on EIC. She was instrumental in identifying the EIC disease in the Boykin Spaniel — which until that point was mis-diagnosed as a variety of mystery illnesses. Terrie is also in direct, frequent contact with the University that does the EIC DNA testing. These 2 ladies might be of some help on the subject if you need anecdotes or other info.

I would be very interested to listen to the podcast sometime — please let me know when it will be available!

Christine Prince
Boykin Spaniel Club of America
Education & Communication Outreach Ad Hoc Committee

Dear Christine, Paisley, and Terrie:

Thank you for forwarding the email to me. I hope you will listen to Dog Talk® this Saturday (July 3) when Dr. Philip Padrid will be on the show to discuss this and other related topics. If you’re unable to listen on Saturday morning, a podcast will be available later in the day, on July 3. Click on the Dog Talk® link for more information.

–Tracie Hotchner

Tracie,

I had talked to you a few months ago right after Christmas and was on your show, regarding my Shepherd mix, Lucy, who died suddenly in my back yard the day after Christmas. Your time with me on the phone and being able to spill myself on the show briefly was a help. Today marks the 6th month to the day that Lucy passed, and while it’s still rough sometimes, I’ve come mostly to terms with it and how things played out.

Unfortunately, yesterday, I had to have my 2nd dog, Retriever-mix, Roxy, euthanized. She was Lucy’s companion for nearly 13 years, but finally her battle with Lymphoma and a heart illness took it’s toll and she was no longer able to perform basic functions. It was a sad ending for me, as while I loved Roxy dearly, in a way, she was also a living link to Lucy as well since they were literally like Thelma and Louise when growing up together. While Roxy lived, a tiny bit of Lucy lived on in her personality. With her death, not only did I lose her, but the last bit of “living” Lucy passed as well. It’s very sad, but at least unlike Lucy’s unexpected death, this time I had a heads-up on what had to be, and it was not unexpected.

My point in writing about all of this is that when I made the decision to have Roxy euthanized, I chose an in-home pet euthanasia service here in the Atlanta area, as there was no way I could take her in to the Vet’s office (which terrified her) to have this done on a metal table surrounded by strangers, and none of my local Vets will do house calls for this. Did some research and found one with some good customer testimonials. The cost was high for me considering my very basic income ($379.00), but it was very much worth it as the Vet and her assistant who came to my home were extremely nice, sympathetic, and caring. They took their time, checked Roxy first, agreed it was well past time for her, and gave me time to be alone before the shots were administered. They then stayed a while to make sure I was going to be ok before they left.

I’m sure the NYC/Long Island areas have these services, and hopefully they are all staffed by caring people as well. I just wanted to pass this story on to you because in-home pet euthanasia might be a topic you may wish to discuss as an option for pet owners on your show if you’ve never done it. I feel it’s well worth the money to do it, as the pet can pass in the most comfortable environment possible, and it’s much less stressful for the Pet owners as well. I have one remaining dog and should she have to be euthanize at some point due to illness, this is the route I’ll take with her as well.

Greg

Dear Greg,

Thank you for the email. I apologize for the delay in responding. It’s a rather hectic time!

First and foremost, I’m so sorry to hear of your loss. The loss of a pet companion is always difficult. You’re in my thoughts.

While it’s wonderful that Roxy was able to remain at home as she lived out her last days, I’m surprised to hear that your regular veterinarian did not perform the euthanizing. So many Vets today do provide a house call service under such circumstances and often times it’s done for free.

All pet health issues are expensive. Have you considered pet insurance? It’s such a good investment and has saved pet owners literally millions of dollars. Most insurances will also cover the cost of euthanizing a pet which can be costly. If you log into my website, you’ll find information about Pet’s Best Health, which is the company I use.

Wishing you the best,
–Tracie Hotchner

I love you on your new show WOR. It’s cute how the information that you give is so new to the group that is listening to that show.

Anyway, as you may guess I listen by podcast, sometimes many weeks later, and often out of order. So you were talking about possibly switching your pet insurance recommendation away from Pet’s Best to another company. But, then you said you switched back.

However, because I listened out of order, I’m not too sure about what came first the chicken or the egg, kinda thing. Can you talk about that again on the show?

Thanks for all that you do. Harley, is a healthy happy 10 year old kitten thanks to you and your awesome advice about nutrition.

On the January 30th DOG TALK® I explained why I stayed with Pets Best — reliability, transparency and customer service. And I do continue to recommend that everyone get insured — and use my discount code AP5252 for Pets Best when you CALL to get a quote — much better than the internet to be sure of what you are getting.

Tracie

Hi Tracie — I enjoyed listening to your show tonight! Very informative and thanks! I just would like to know the name of the product that you mention about ticks and fleas? The once a month treatment you said repels and kills the parasites? And also the good insurance company for dogs you mentioned on the air. I rescued an 18-month male German Shepherd (Wilson) who was abused, and I am trying very hard to socialize him with other people and dogs, but it hasn’t been easy!! But I took him away from the previous owners for they were considering putting him to sleep! Thanks for your help, and keep up the good work on your show!

I wrote him back: Thanks for the very nice note. The show is brand new so I am thrilled that you found it and that it’s to your liking. I look forward to continuing to bring you new ideas and guests to share information every week. And I want to salute you for giving Wilson a new home — what a good soul you are! And what a gorgeous boy he is — I’ll put his photo up in my Dog Talk® gallery on my main website www.TracieHotchner.com. It is such a challenge to help socialize a dog who didn’t get the right upbringing but patience and perseverance will win the day eventually.  My book THE DOG BIBLE has a lot of information and advice about re-homed dogs since that is how my own pack of dogs developed. I know you’ll find great satisfaction in helping Wilson feel more at ease in the world.

In answer to your questions, the name of the truly fantastic topical application against fleas and ticks is Vectra 3-D.  My dogs have been on it for 8 months now without a tick being successful in latching onto them, even in the hills full of deer in Vermont!

You may need some help in encouraging your vet to carry it. If you ask and they do happen to carry it, you are “golden” — but if they do not have it and need to have more information in order to carry I, please let me know so Dr. Elizabeth Hodgkins can call from Vectra to introduce your vet to it. Please let me know either way.

And the pet insurance company I just switched to is Petplan. I think they have the best coverage and most efficient way to file claims.  To find out more, call 866-467-3875 and press EXT 2411 to talk to Fabrice for a quote (I am making a donation to the Humane Society of the United States for every listener who signs up — which the company itself does, too). The smartest time to get coverage is when your dog is young and healthy as Wilson is now — with no pre-existing conditions. That means that is anything does happen his vet bills will be covered. I recommend doing what I did and getting a policy with an 80% reimbursement (to keep your premiums more reasonable) but Fabrice at EXT 2411 will help you figure out what is best for you.

Again, your enthusiastic words meant a lot and I hope you’ll keep listening and get other pet-loving friends to listen to the show, too.

Tracie

The Dog Bible

So I was truly delighted that Bob became the FIRST Dog Talk® listener to switch to Petplan insurance from Pets Best, which I had previously recommended. There were changes in the coverage Pets Best was offering and a number of listeners told me they had problems with claims (including myself — when Scooby Doo’s torn ACL ligament was not covered because I had “only” been with the company 10 1/2 months and I had no idea they required an entire YEAR of coverage before knee surgery would be covered). So I have been looking for a company I could wholeheartedly endorse and found Petplan, which is the oldest, and world’s largest (covers 40% of ALL pets in the United Kingdom!) insurer of animals.

I also really admired Petplan for their charitable relationship with the non-profit animal group I am proud to be associated with — the Humane Society of the United States (HSUS), to which they give a donation for every policy written. I have declared that for every one of my listeners or readers who signs up for Petplan I will make my own donation to HSUS. I want to support those who stand by HSUS despite misinformation and sometimes misunderstanding of their mission.

Hi Tracie – Heard your show this morning on iPod and immediately looked up Petplan insurance, and switched to it from Pet’s Best. It is a great plan and I really like the idea of the 100% reimbursement option at a reasonable cost. Almost did not do it, since you said Petplan supports the Humane Society of the United States and I am opposed to the HSUS alliance with Michael Vick (Mr. “I feel sorry for me — not the dogs I killed — so I will make a phony apology”) It was really was a big shock to me, but the insurance is worth it, in my opinion.

Ciao – from Bob & Smokey

Thank you, Bob, for your confidence in my advice and opinion where Smokey’s welfare is concerned, and yours as well. I am truly humbled by your willingness to join forces with Petplan, despite the fact that this company supports the work of the HSUS. As you know from listening to my show for years, I am an ardent supporter of the HSUS so the fit for me with this pet insurance company was perfect. In addition, Petplan also has the most inclusive coverage with no breed discrimination and very easy, straightforward claim procedure without a bunch of forms to fill in.

As far as Michael Vick goes, I hope you did listen to the full hour show I did a couple of months ago with HSUS president Wayne Pacelle in which we discussed the Michael Vick case and how HSUS is using him to help stamp out dog fighting in the inner cities. (mp3) As I explained on the air, it makes perfect sense to put Vick to work talking against dog fighting to young men in rough neighborhoods. Who else can reach these at-risk young men than someone who shared their experience — did the crime, did the time, and now is doing community service to spread the word of how wrong dog fighting is, with the backing of the HSUS.

I hope you can separate your justifiable emotional reactions to Vick — what he did was heinous and a court found him guilty and sent him to Leavenworth prison — from the practical issue of whether there is a way to use Vick to make a positive difference in stamping out dog fighting in our cities. (By the way, it was solely the work of the Humane Society of the United States, which prompted the very legislation that allowed Vick to be tried and convicted). The HSUS is not attempting to be judge and jury for Vick’s dog fighting past — that has already been handled — instead, HSUS has devised a way to put a real person up in front of these kids in tough neighborhoods full of pit bulls and explain that what he did was wrong and that dogs need to be our friends and companions, not tools for violence.

On November 21st I do have Wayne Pacelle, the head of HSUS, coming on my new radio show Tracie Hotchner’s DOG TALK & CAT CHAT® on WOR 710 at 10 PM (EST). We are going to be discussing this issue. I hope you will call in to 212-766-7100 if there is anything you want to ask Mr. Pacelle or express to us on the air.

The following week I will have Def Jam founder Russell Simmons — who is a vegan, animal-loving man dedicated to educational issues — coming on the show to discuss his support of using Vick to stop other young men from going down the path he did.

But most of all I want to thank you for your trust in my advice and your swift decision to sign up for Petplan. I did the same thing and requested the reimbursement from my previous pet insurer that by law they have to pay of unused premium.

Just thought I’d forward a couple of more pictures of Gracie to you. We are looking forward to having Gracie featured on your show next month as Dog of the Month. This is so much fun and such an honor. Furry Friends Rescue is also excited that one of their “alumni” is going to have her story shared on your show!

Also, I wanted to let you know that I have successfully purchased a Pets Best Insurance policy for her. She is very healthy but is also nine years old, so I never dreamt that I would be able to afford a pet insurance policy for her, due to her age and size, but for a nominal monthly premium I now have peace of mind that whatever medical problems we will face in the coming years, I will have financial help in meeting Gracie’s medical needs.

I have also recently purchased two more of The Dog Bibles to give as gifts to two friends who have recently adopted dogs and I have told several friends about your show’s availability through podcast so they can listen in and hear your advice (not to mention Gracie’s 15 minutes of fame!)

–Laurel

Max’s battle with cancer ended at 7 p.m. this evening. Unfortunately, cancer won and took my Max from me. He fought with every ounce of strength he had in his very tired body. He wanted to stay with me. But he just couldn’t fight anymore, and I had to give him the peace he deserved. I will love and honor him forever.

Upon returning home, I found the little girl, Heather, who comes to play with my dogs, sitting on my doorstep crying. She had in her hand a paper she said she wrote this morning before leaving for school. Nothing I can write here now can honor the memory of Max more than what this amazing little girl wrote about him. I share it here with you:

Max is one of a kind. Max is now a three-legged dog that makes him even more special. Also, that Max has a long nose makes him special. You could play tug of war with Max, and if you threw the ball he would go and not leave it until he had that ball in his mouth. Max is that dog that is so friendly to anyone even if you don’t know him. When he hears something, he perks his ears up and listens. Max is that dog that you could look down at and say what a dog. You could say so many things about him but it wouldn’t be enough. Max would be so good if he wanted something like a treat or a toy he would just sit there and watch until you would give it to him. Max went through a lot of things, and that is also why he is so special.

Max is 10 years old like me. We had a birthday party for him and Gabriel and the rest of the crew came over to Pam’s house. I made Max a t-shirt that said he was the best dog in the world and I wrote to him on the back. I made him his cake, and Max got the first piece. Max’s birthday is February 8th. He was getting old. I found out on the 8th of June something I didn’t want to hear. Have you ever read the book Marley and Me? Well, Marley did everything different. Marley would jump on people. Max would stand in front of you wagging his tail waiting for you to pet him. There is only one thing that happens the same. If you read the book you will probably cry because I did, and just beware because it is sad. I wrote this all in memory of Max in every Good Amazing way (because there was nothing bad about Max). You would not want to forget Max, the one of a kind dog, because he will remember you forever, too. I also wrote this to remember his birthday, and to say that you could NEVER in history replace HIM in the WORLD. So MAX, THE BEST DOG IN THE WORLD will ALWAYS be here with us FOREVER.

Love Heather

Out of the devastation of losing my Max, some extraordinary beauty has come into my life. This essay from Heather is just one beautiful example.

I am going to sleep now. It will be the first night I will sleep in my own bed in a very long time. In the morning I will try to figure out how to live without Max. It will take awhile, but I know my boy will show me the way.

Goodnight, Max, my Love, my Heart. Sleep peacefully, my Angel.

I am going to sleep now. Tomorrow I will wake up and try to figure out how to live my life without Max.

Max the Golden

Dear Tracie,

I loved the show on Wednesday (as always!), but just wanted to let you know that Pet’s Best DOES seem to cover cats (and dogs) of any age, according to their website (you mentioned on your show that 12 was the cutoff for cats). Perhaps they used to have a cutoff, but it seems that now they don’t, thankfully! And thank YOU for directing me to Pet’s Best!This was under their FAQs in response to a question as to how old is too old to insure a pet:

You may enroll your dog or cat as early as 7 weeks of age. Like children, young dogs and cats have the highest risk of accidents. Since their immune systems aren’t mature they are more susceptible to infectious diseases. Unlike other companies we don’t have an upper age cutoff. As they grow older, our pets face the same risk of cancer, heart disease, kidney failure, and other problems of aging that we all do. An older pet may develop chronic disorders that require a lifetime of care and expense.

Oh, and i got THE CAT BIBLE and LOVE it!!! I can’t put it down…

Take care (and meows from the cats),
Kirstin

The Cat Bible

Max the Golden

Tracie -This has been another emotionally exhausting day. We had been playing ball with Max out in the yard and stopped throwing the ball when we realized the heat had gotten to him. But when trying to cool him off with ice packs to the armpit and groin didn’t seem to help, we took Max to the emergency vet clinic near us in West Islip. His blood pressure was very low, his white blood count over 40,000 and he had a moderately high temp. They had to bring him in on a stretcher, he was so weak. They put him on IV fluids and antibiotics and kept him overnight. They also did a chest x-ray which was normal so they took cancer out of the equation for the time being and treated him for dehydration. They wanted to stabilize him. I went home and stared at the ceiling all night.

Next morning I saw a different doctor. He said based on Max’s history we should do further tests to make sure the cancer had not come back. But first he wanted to bring Max in to see me to see how he would respond. Well, Tracie, Max came round the corner and practically pulled the doctor down trying to get to me. I threw myself down on the floor and my handsome 75-lb lap dog sat on my lap like he always does. We all laughed and remarked what a difference the supportive care had made. Max was excited and lively. The doctor still wanted to take x-rays of Max’s belly and repeat the blood work, even though he thought that Max had probably just succumbed to the extreme heat and had indeed been dehydrated. The doctor said it was just a precaution and I really wasn’t worried.

X-rays showed his intestines pushed back in his stomach. The doctor said this could be normal for Max but we should ultrasound it to make sure there wasn’t something there. I started to get a little worried but, for some reason, I was still optimistic. I went outside to call Julie at work to let her know what was going on. The doctor came out with the ultrasound picture in his hand.There was a mass. The size of a softball. And it was black which meant it was bleeding. Probably hemangiosarcoma, he said. It was between the liver and spleen and he wanted to do additional views to zero in on the exact location. If it was on the spleen, we could do a spleenectomy and Max would probably be fine. On the liver — that was a different story with not a happy ending.

I waited and chanted inside my head: spleen, spleen, spleen… please… please… please…

But, it’s on the liver.

This morning the ER doctor called to tell me the follow-up CBC showed Max is very anemic. This means the mass is bleeding into his belly. He faxed everything to Animal Medical Center in the city and had a telephone consultation with one of Max’s oncologists. I think Julie and I are going to AMC in the morning for them to do another ultrasound and possibly an MRI or CAT SCAN. I say “I think” because I have been lying with Max all day and he has become very weak again and I’m not sure I want to put him through anything else. If AMC feels that the tumor is operable, Max would have to undergo major abdominal surgery with extreme risks. This is not like the amputation and AMC is not sugarcoating it. Under the best circumstances, he may only get 4 – 6 months. Under the worst, he could die during the surgery and that is a very real possibility. If we do nothing, he will bleed internally until he can’t breathe and then he will go into shock. This could be tonight, in a few days, not more than a few weeks. Of course, there is always the “other” choice.

I go back and forth between sadness and anger. IT IS ONLY 3 l/2 MONTHS! We were supposed to get the summer. Max was supposed to run on the beach and swim after tennis balls and sticks. I sound like a 5-year old when I scream “IT’S NOT FAIR!!!” I sat in the chemo waiting room every other Saturday and listened to stories of cats and dogs who defied the odds and outlived their diagnoses. Max was supposed to be one of them.

But then I know that Max is 10. And we have had a 10-year relationship like none I have ever had with any human. We have had a wonderful, full life together. He has thanked me every day since the day I adopted him through LIGRR (Long Island Golden Retriever Rescue), and I have been privileged to have him by my side. I want to hold him until his last breath. He IS my breath. He IS my bones. He IS my heart.

I wanted to let you and your listeners know about Max because of the tremendous support I received through your talk show and your wonderful audience. I don’t know what tomorrow will bring. If you know of a miracle, please send it our way. I’ll update you when I’m able.

Max’s Mom, Pam

I wrote to Pam & Julie:

Oh dear me. What a setback and blow to your dreams. In making the decision, just do your best to see it from Max’s point of view. You already know that. But being in your arms is what he wants, he showed you that at the vet’s. My thoughts are with you, as always.

Pam gave me an update:

We took Max to AMC. They took additional views on ultrasound. Three oncologist surgeons reviewed the pictures and felt it was a single liver lobe that could be removed. All 3 agreed it is definitely operable. And it COULD give him another 6 months to a year. Max is scheduled for surgery this Tuesday May 5th. There are horrible risks. If they get into his belly and find that it is much worse than can be seen on ultrasound they will tell us, and Julie and I have decided, in that case, we will not let them wake Max up. Even if all is well, Max could die during surgery or from complications after. But he can’t live with this thing growing inside him, so we have to give him this chance.

It is expensive. Another $4,000. I have to call Care Credit today and hope to God I get the additional credit. I will beg and plead. Max HAS to get this chance.

Julie and I are going to make this the most wonderful weekend for Max. I wish the weather was better because we would carry him down to the beach. We are going to take lots of pictures and movies. I’m praying for a miracle but we have to be realistic and know that this could be Max’s last weekend. I am going to try not to cry any more in front of him. The doctors are hopeful. Julie and I will be hopeful. Max is a dog FULL of love and hope and happiness. So that’s the motto for this very special weekend – love, hope and happiness.

I’ll write you after surgery. Wish us luck.

Max’s Mom, Pam

I honestly don’t know how you and Julie have the strength to go through this. I am going to post our correspondence and then put it on Twitter so more people can be praying and sending good vibes and karma your way for Tuesday’s operation. I admire your emotional strength and faith in Max’s will to live and thrive. You are a stronger woman than I am and an inspiration to all of us who call our pets family. I couldn’t even trust myself to talk about this on DOG TALK® yesterday — I was just going to lose it on the air, I know that.  So instead am going to send this turn in Max’s story out by internet and maybe get even more people pulling for him

Blessings on all of you.

Tracie

Dear Tracie – I presently have VPI for my dog and have become disenchanted with it because of so many exclusions. I can’t always listen to your show on Saturday mornings as I am a music teacher and have students often at the same time. What are your recommendations for pet insurance?

Alden – you should be signed up for the podcast if you cannot listen live. You would have heard me tell everyone time and again that Pets Best has the most fair and generous policies of any company: after a $75 deductible per incident they pay 80% of 100% of all bills. No schedules. Read the email trail on my bulletin board with Max’s Mom Pam who is going through cancer amputation and chemotherapy with VPI paying only pennies on the dollar. Contact Pets Best immediately. Tell them you want the Dog Talk® discount – hear the exclusions that might apply but just as important is how much they pay on each claim.

Keep that music playing!
Tracie

UPDATE:

I sent the email about pet insurance to Dr. jack Stephens, who “invented” the concept of pet insurance and actually owned VPI until it was bought away from him by a big national company (which is when many of us who were customers noticed the benefits diminishing). I asked Jack for his comments on the email aobut 90% reimburesment and his reply follows. The thing I have been trying to stress to folks is that you hve to really shop & compare. If a company like VPI has an allowed “scheduled” amount for a service then if chemotherapy, for example, costs $3,000 and they say it should cost $300 they will pay 90% of what THEY think is an acceptable fee. Just look at my website for the story of Max the Golden with the leg amputation and his mom Pam who paid for insurance for all four of her Goldens with VPI and is heartsick over how very very little they are covering of Max’s actual costs. I will stick to my guns and tell you all that Pet’s Best is the only one I’ve found with no confusing calculations – they pay 80% of 100% of your bills, no matter what. Here is Dr. Stephens’ reply to my blog posting and response to Sarah’s comment:

Tracie,

Very well said. VPI pays 90% of a schedule, which is much less than average vet charge. Two other companies offer 90% of Usual and customary, but you pay more for it. The consumer pays for what they get, if they want low deductibles, no copay then of course there will be higher cost and restrictions. the more they co-insure or have higher deductibles the lower the premium.

There are many good options out there now for pet insurance, but they all have their idiosyncrasies, including PB. We try to give the most value and what the pet owner needs to take care of their pet. We have a higher calling: pleasing the vets and saving pets. But all of us want and have to make money.

Yours, Jack