Normal? (Gulp)

Isis is licking off Indiana's breakfast.

Things are going shockingly well here. Life, in Indiana's mind, is back to normal. (With the exception of bandage changes--she does hate those) She is feeling good, eating well, getting around probably slightly better than normal (but still having trouble getting up). Maybe she knows she has a hole in her back. I know she knows she has a bandage on it. Indy has always hated wearing anything, be it bandages or clothes. This is why I walked into the hallway last night to find her fast asleep with her bandage pulled off and all the honey licked off. Booger.

Months and months ago, my family and I decided to spend the Thanksgiving holiday at my parents' cabin on a lake in central Illinois. Jim and I try to take the dogs there 2-3 times a year, to relax, and to get a change of scenery. It's kind of my happy place, a place that represents togetherness and family, and a lack of stress. We've never spent a holiday down there, but have been talking about it since my aunt died in 2009. Holidays in our own homes bring back too many memories, not that memories are bad. But the loss is still fresh enough that recreating the holidays, but without one of the essential parts, is just too painful. We knew we'd enjoy the holiday more by creating something new.

Our plans were thrown into question last week when Indiana got sick. We weren't sure if we'd still be able to go. But with Indiana's miraculous upswing, and the fact that her illness and our treatment of it wouldn't require an emergency vet visit, we realized we'd be safe to keep our plans.

The bandages are going with. So are all the medicines and treatments that are keeping her alive and healthy. But so are my parents, and their dog, and our best friends, and their dog. (And yes, for those keeping track, that's 6 adults and 4 dogs, all in a 900 square-foot, 2-bedroom cabin). And we'll be creating memories: new, happy memories.

Life throws you curve balls. Life is hard. Sometimes life sucks. But we soldier on. What was once normal no longer is, but we adapt and create a new normal.

This may be our last Thanksgiving with Indiana, but we don't want to dwell on the sadness of that. Instead, we'll be thankful to spend this holiday with her, making new memories and filling the time with love.

Keep on Keepin' On

So much fighting spirit!

Big developments over the weekend: the skin over the tumor fell off Sunday morning, and most of the tumor did too.  There's just a tiny bit left.  (And I haven't looked at it yet this morning, so, who knows?)  The last time I looked at it, which was last night, the mass was maybe the size of half a mushed-up kiwi.  (Does that make sense?  It does to me.)  And this is down from its large grapefruit size on Tuesday. 

I am astonished.

What we are left with now is a large, gaping wound.  It's probably 4 inches in diameter, so, I guess, fairly big.  But without flappy skin and a large tumor, it's actually pretty easy to clean.  Nolvasan, Manuka honey, bandage.  Repeat, repeat, repeat. 

I started a website to post pictures of the progress of the tumor.  Because of this experimental drug we're using, I wanted to keep track of the tumor's death.  I also wanted to keep track of how well the tumor responds to the Manuka honey, because I've heard it can do amazing things.  Anyway, I set up the page but haven't made the link public other than to mention it, once, on Facebook.  (If any of you want access, let me know, and I'll share it privately)  I'm not one to hide who I am or what I'm going through.  I blog about what's going on, and I post VERY frequent updates to Facebook to share with 215 of my closest friends.  But the pictures?  I was afraid to show that.  I still am.  I'm secure in what I'm doing, in the treatment choices that Jim and I have made.  But I'm fragile, people.  I'm an artiste.  We don't like being questioned or, God forbid, disagreed with.  What if the pictures got out and people didn't understand?  What if they thought I was letting my dog suffer?  That I was allowing her to be in pain?

I know what we're doing is right.  Indiana tells me every day, and, believe me, I'm looking for her response.  But I'm getting through this by sheer will and the love and support of more friends and family than I can count.  (How did I end up with so many wonderful animal people in my life?  I am overwhelmed!)  But I don't have room for negativity or disharmony right now.  If people think I'm wrong (and thankfully, no one has expressed that view to me), I don't want to know.  Which is why I'm keeping the photos semi-private for now.  Maybe I'll get brave later.  Who knows.

Back on track to the tumor, and, more importantly, the dog:  tumor = small/almost gone; hole left = kinda huge; dog = eating well, bright and perky, and completely kick-ass. 

Oh, how I love her so.

Hope, or, When Will I Learn

The Princess and The Papa

Cancer is always a roller coaster.  I learned that five and a half years ago, and, it seems, it's still true today. 

Though Indiana's been feeling pretty good, despite the soon-to-be-gaping hole in her back, it's always hard to tell what's going on inside a body.  Bleeding?  Organ failure?  Other tumors?  Plus, when you open up a large wound on the body of a living organism, other organisms, i.e. bacteria, want to live there.  So despite the fact the the tumor itself is not going to kill Indiana, secondary infection might.

In my head, and, well, in my eyes--this tumor looks nasty--I've been wondering how much time we have left, and this is the consummate question for any parent dealing with cancer.  How much time do we have?  I've known forever that this is variable, and often dogs can do much better than their stated prognosis; I've seen it many times.  But when it's your own pet, all previous knowledge is lost.  Advice you've given to others over the course of almost six years?  Out the door.  Suddenly, you're back to square one, turning to your support system for help.  You can't remember anything, and you're scared all over again. 

So after speaking with both of our vets over the last few days, I had a really unclear picture of where Indiana is headed.  What's going to take her, in the end?  Systemic infection?  Kidney failure?  Anemia?  And how quickly?  Any day?  Any week?  Any month? 

During a visit with our primary vet today, we discussed wound care and put a plan in place for keeping infection at bay.  The tumor will be losing its protective skin any time now, which isn't necessarily a bad thing.  We want the whole darn thing to slough off.  Gross, I know, but it's our best chance for survival.  But it opens up a huge wound--I'm anticipating about 4" in diameter--which will be difficult, though not impossible, to keep free of infection.  Twice-daily debridement with Nolvasan, followed by a healthy slathering of Manuka honey, and thrice-daily bandage changes are the plan.  This doesn't sound like a lot of work on paper, but I understand that wound care is terribly time-consuming.  Essentially, I'm clearing my schedule for the near future to deal with this. 

The best part?  My vet told us to expect an open wound for at least two months.  My reaction?  "We have two months?" I seriously didn't think she'd last that long.  Apparently, if we keep her free of infection, she definitely could still be with us.  I was floored.  And thrilled.

I know that our time with our girl is limited.  I know that at any time things could change.  I know that keeping the wound from becoming infected will be harder than it sounds.  But I am up for the challenge.  And so is Indiana.  How could I ever have doubted that?

Continuing the Fight

Can't tell she's sick, huh?

Indiana has cancer. 

She's actually had it--well, we've known about it--for over a year.  At the time, it was a tiny little dot on her back.  Like a tiny grape under her skin.  Biopsy came back as an unspecified sarcoma.  The prognosis seemed good, as these types of cancer tend only to metastasize locally.  We opted to leave it alone.  Consults with both a kidney specialist and a cardiologist left us uneasy.  Anaesthesia is hard on the body.  What would it do to a 12-year old dog with a heart arrhythmia and kidney disease?  In consulting with an anaesthesiologist, the best she could tell me was that Indy had only a "slightly higher" risk of death from anaesthesia.  I didn't find that comforting.  In the presence of a localized, small tumor, it seemed prudent to avoid that path that potentially lead to instant death.

Now, 13 months later,  I am of course questioning that decision.  I knew where leaving the tumor alone could lead.  Did  I choose this for Indiana?  Did I give her cancer? 

A good friend said some very comforting words the other day.  She told me that at that juncture, where we had to make a decision, we were given two bad choices.  There wasn't a good, clear choice.  I didn't pass up a good choice and choose a bad one.  I chose the path that, while it might not end somewhere good, was a happier path with a quality of life.  But honestly, neither path had a happy ending.

Knowing all of this, I still struggle.  As parents, as good parents, we should always question our own decisions, to learn and to make sure we're always thinking of our pet's best interest.  It doesn't mean I won't feel guilt along the way, even if I know in my heart I did the right thing.  We want our pets to feel happy, to always protect them.  That's not always easy or even possible. 

We've been through a lot with Indiana in the last five and a half years.  She has proven herself to be a fighter, and indeed, even in this dark, scary time, she continues to fight.  Her eyes tell me so.  But it breaks my heart to see the open wound on her back, the hair shaved away.  I probably will never see it grow back.  As the blood oozes out of the holes in the tumor, the smell of death and decay oozes along with it, turning my stomach.  I am sick at not only the mass of deadly cells on her back but also at my own weakness.  I shouldn't be afraid of the blood, of the smell, of the torn skin.  But I am.  It gets harder every day, and I have to talk myself through removing the bandages in the morning, unsure of what I'll find.  I am angry at my weakness.  I am ashamed.

It's also hard to come to terms with the fact that we are in an endgame.  What parent doesn't want their child to live forever, even if we know they can't? 

This morning, when Jim and I awoke and walked into the living room, Indiana was lying on her bed, very still.  Jim approached her first, and as I got closer, I saw she was breathing but not moving.  We looked at each other, fear and heartache in our eyes.  We tried to rouse her, and she was slow to do so.  Was this her time?  Was this the end?  No, it wasn't.  Indiana was simply sleeping peacefully, exhausted after a busy day prior.  She eventually woke, and over the course of several hours, she walked outside, sat in the grass to survey her kingdom, and ate a hearty breakfast with much aplumb.  She even took her pills. 

Were we overreacting?  Sure.  But we also both know that our time is limited more than ever before.  I can't think about that much, because I know my heart will break into a thousand pieces if I do.  My coping mechanism?  Making Indiana's life perfect.  Jim and I are completely focused on creating a happy, peaceful home, free from stress.  Making the most of every day.  Of every moment. 

Some things in my life will have to go.  If it causes me stress, it has to go.  I can't bring that into my home.  I know that will make some people in my life unhappy.  But I am fortunate to know a huge number of animal lovers, who understand what I'm dealing with.  And ultimately, I don't care.  I have to make decisions that I can live with.  I alone have to deal with the consequences of my actions.  When Indy is gone, I need to make sure I can do that.  I will look back on my decisions and question them, dissect them.  Some will be good and some will not.  But I have to know that I gave all I had to her, that I fought just as hard as she, that when it came down to it, I gave her everything I had to give, as she has done for me every day of her life. 

We are down, but we are not out.

A Lazy Copy and Paste of My Facebook Update

I just got back with Indiana from a vet appointment with another vet. I ran into a friend who used to be Indy's vet over the weekend. (She only stopped being our bet because she moved away). Long story short, she saw my posts about Indiana's tumor and offered to give Indiana injections of a drug she is starting a trial on. It is pretty cool and seems like it could have fantastic implications for both humans and animals. Anyway, we went up to the suburbs to start the first of four weekly injections.

The trip was actually pretty great because (1) my good friend and personal vet tech Amanda went with us, (2) Indy had eaten well just before we left and was feeling really good, (3) another friend, who is a Reiki Master, was our vet tech, and we go to chat with her while Indy got Reiki, and (4) my vet friend is amazing.

She believes that Indy's tumor is just that--all new tumor growth. The quick advancement could mean that the tumor has become aggressive. She told me that Jim and I should begin to prepare...which I think we have already started to do anyway.

The tumor opened up some last night, causing an open wound and thus some bleeding. If we can keep it under control, the bleeding shouldn't be a big deal. If we can stop the tumor from growing, we should be able to minimize the risk of infection, which is our biggest long-term worry. I realize that wound care will be a part of the rest of her life. This is a bigger deal for me than for her. I know she's ready for a fight, and so am I.

I am hopeful that this new drug can help reduce tumor inflammation but will also help her arthritis. Indy is alert and happy and is able to walk and eat with gusto. I know our time is limited, and this is hard to wrap my mind around. I apologize in advance for being a bad friend/daughter/employee/mother to my other animals as I move into this new chapter with Indiana. I know I'm going to struggle for a while.

Thanks to everyone who has expressed their concern, love, and support thus far. It means so much. Truly, it does. Indy, Jim, and I are so fortunate to have so many people in our lives who are willing to help and support us.

Indy is a tough girl who has cheated death more than once. We're not writing her off yet.

Cancer and Things

I will admit that this picture has nothing to do with my post.

But it's cute.  And Isis is in it, which is rare.

Indiana is doing really, really well.  I've written about that a few times recently, and it never ceases to amaze me.  She's got so much energy (for a 13-year-old, arthritic dog), and she's eating like a champ.  And taking her pills.  The other day, though, she chewed a big bald spot on her back.  Ugh.  Just when we'd gotten her hair grown in.  So now she has a small skin infection on her back, but the good thing is that the bald spot made our vet take a closer look at Indy's tumor.  We noticed earlier this year that it had grown.  We were pretty disappointed, but we knew that we had the option to debulk the tumor if need be.  But upon closer inspection, my vet discovered that the tumor actually had a hematoma on top--most likely the source of the "growth."  So, sort of yay on that account.  Hematomas are pretty harmless, and other than giving her a homeopathic med for it, we're basically leaving it alone, to reabsorb on its own.  At which time, I hope to find the tumor still at it's original size.  Fingers crossed.

Thursday marks Indiana's cure date for cancer #1.  That's right, you heard me.  Cure.  Cure. 

Cure.

I can hardly believe it myself. 

I promise a blog filled with pictures, insights, stories, and, if I'm doing my job right, a few tears.  After all, cancer #1 made me who I am today, the kind of mother I've grown to be, the person I am evolving into.  That day, June 30, 2006, was one of the worst days of my life.  I relive it every year.  But maybe this year will be easier, knowing we've finally conquered the beast.



Four Weeks In

We just finished up four weeks of Poly-MVA with Indiana.  The company recommends two months of treatments before evaluating the effects, though my vet loves it so much as a supplement, that she says we can keep Indiana on it forever. 

I can't say that I've seen much of a change in the tumor thus far, though it hasn't grown.  Indiana definitely has more energy and is getting around fairly well for an almost-13-year old.  She's also (thankfully) eating really well--and a raw diet at that.  Actually, five of my six animals are now eating raw as part (or all) of their diet.  Yay!  Our one holdout is Mr. Squiggles, who has never, ever liked raw. 

We've not made any decisions yet on what we'll do when our two months is up.  We're only halfway in.  But I have a feeling that as long as we can afford it, we'll continue the Poly. 

It's Tough, But Not Really

This post is written with apologies to Dr. Becker; I listened to you, I really did.  I took the rest of your advice, just not the part about not blogging about it.

Indy's been doing really great.  I can't quite explain why (though I suspect it has something to do with the decrease in stress in her life), and I certainly didn't expect it (though I did hope for it with all my heart).  She's really a fighter, and you'd think that after all these years, I'd be used to it.  It slays me every time. 

We had our twice-monthly visit with our vet on Tuesday, and Dr. Becker was pleasantly surprised when Indiana stood up to greet her when she walked in the room.  She was getting around really well, and several staff members commented on it as well.  I felt such a surge of pride that my girl was doing so well.  I stake no claim on that accomplishment; it's all her doing.

Anyway, Dr. Becker and I discussed running tests on Indiana, or, rather, not running tests on Indiana.  Dr. Becker feels (and can she read my mind? Because this has been in my thoughts for weeks) that we shouldn't run any more "unnecessary" tests on Indy; i.e. basically only treat symptoms.  (And test her kidneys, because we can alter her fluid intake to make her feel better, if necessary)  On a bigger spectrum, that means no more cancer tests at the U of I or Purdue. 

As Dr. Becker pointed out, this goes against everything I have learned as a parent in the last four and a half years.  I have learned to be proactive, to catch things before they become a problem.  And now, I'm going to stop looking for problems...especially cancer?  In a word, yes.  Indiana's stress tolerance is really low these days, and after all she's been through, she deserves to live as stress-free as possible now.

But what if the tests show cancer, you ask?  Indiana has maxed out on the most common chemo drug, doxorubicin (thanks to cancer #1), and I doubt her frail system could handle any other chemo drugs at this point.  We've already started her on Poly-MVA, the most "drastic" of our options.  Plus, we won't put her under anaesthesia for surgery.  So, armed with the potential knowledge that she has yet another form of cancer, what would our options be anyway?  It seems selfish to put her through all of the tests with no benefit gained. 

As Dr. Becker so elegantly put it, every decision we make at this point is about respecting Indiana.  Respecting her needs, but more importantly, respecting her wants. 

Maybe to some pet parents, it sounds like we're giving up on her.  We certainly are not.  We are armed with a powerful arsenal of holistic medicines and Chinese herbs as well as a crack team of veterinary specialists.  I live every day at her disposal, making sure she gets healthy foods, but ones she loves and will eat.  I painstakingly hide her pills and powders inside tasty tidbits, so she thinks she's getting yummy (yucky) things like liver sausage.  And, as we've learned is so important, I listen to what she is telling me, making sure she is happy, calm, and as mentally stimulated as she can be.  She has so many needs, yet so few wants, and it's my job to make sure she gets them.

Beginning the Experiment

(Indy getting electro-acupuncture)

Today Indy went to the vet for her twice-monthly electro-acupuncture treatment, which seems to be really helping her. While we were there, we discussed with our vet the possibility of starting to treat Indiana with the cancer supplement Poly-MVA.

I first heard about Poly-MVA early in Indiana's treatment for her first cancer. As she was doing well and the chemo worked to eradicate the cancer, our vet decided to hold Poly in reserve until we really needed it. In speaking with a vet friend over the weekend, she recommended using Poly on Indiana, for the sarcoma on her back. So while Indiana isn't in a crisis right now, we are looking for ways to slow the cancer without conventional treatment, as well as make her life as comfortable as possible. With the recommendation of our friend, and the okay of our vet, we decided to go ahead with the Poly.

I'll be documenting our experience with Poly-MVA, partly because, well, I have a pet blog, and also because I want other cancer parents to learn from our experience. Maybe it'll help, and maybe it won't, but either way, my posts about it will be honest and true to our lives.

I spoke with a consultant over the phone to order the Poly. Some things I learned: Poly can have a detox effect in the first few weeks. This scares me, because Indiana has done detox before, and it's always frightening to watch. Luckily, the consultant said we could increase her daily dosage of milk thistle (Poly, like most drugs and supplements, is metabolized in the liver--milk thistle has a tremendous ability to lessen the load on the liver) should detox symptoms occur. These symptoms include diarrhea and lethargy. I will no doubt be keeping a close eye out for these symptoms, though we're starting Indiana on a small dose and working our way up.

Also: Poly-MVA energizes the body's cells and therefore can give the dog more energy. Ideally, it is given three times a day, with meals, but the last dose needs to be given a few hours before bedtime so as not to disrupt the dog's sleep pattern. We've been feeding Indy three times a day for the last four and a half years, so that part isn't a problem. But we sometimes feed her right before bed, which isn't probably advisable once we start the Poly. So that'll require a minor adjustment on our parts.

Another thing I learned: Poly is staggeringly expensive. For a dog Indiana's size (70 lbs), one month's supply costs about $600. The company recommends trying the supplement for at least 60 days before discontinuing it (though improvements can be seen in the first month). I imagine she'll be on the max dose for those first several months, and then perhaps go on a lower "maintenance" dose, but I didn't have the heart to ask. If it's working, it doesn't matter. I'll pay any amount.

Some things I learned from our vet: Poly is completely safe. It's essentially lipoic acids (antioxidants) and B-vitamins. Studies have shown it to be more effective against carcinomas rather than sarcomas (which Indiana has). But it has other benefits beyond killing cancer cells. According to her, we have nothing to lose except money. That's good enough for me.

I've started doing a little more reading up on Poly-MVA, something I'll be doing a lot of in the next few weeks or months. It seems like an amazing supplement, and while I don't want to get my hopes up, it has the potential to really help Indiana, not just with the cancer, but with her overall health. I appreciated that the Poly-MVA consultant was careful to make sure I knew that Poly-MVA doesn't work in every case. So they're not trying to sell a "miracle drug," which makes me trust it more.

Our precious bottles are making their way to us as I type this and should (weather-willing) be here by the weekend. We'll start Indy on it ASAP, and I'll update frequently about how she is feeling while on it, and side effects (good and bad), any changes in the tumor, and general impressions about the supplement itself.

As always, I am learning as I go. Count Poly-MVA as just one more thing I've learned from my dog.

Decision Made.

Jim and I, with the help of our primary vet, Dr. Becker, finally made a decision about Indiana's cancer. We consulted with more doctors than most people even know exist for pets: Two cardiologists, a nephrologist, an anaesthesiologist, and an oncologist.

The cardiologists and nephrologists were (tongue-in-cheek) not helpful, because they told us that Indiana basically is at no higher risk for surgery than any other twelve-and-a-half year old dog, heart- and kidney-wise. So that didn't help rule anything out.

The anaesthesiologist, while one of the nicest vets I've talked to, basically scared the crap out of me. It is, essentially, her job to think of everything and anything that can go wrong during surgery and take measures proactively to stop them. And I did tell her up front that I wanted to know exactly what we were looking at. She did ultimately say that Indiana was a candidate for surgery and she most likely would survive anaesthesia. But there were still some concerns from her perspective, which I understood. Putting a dog with chronic kidney disease, a right bundle branch block (an electrical issue in her heart which causes her heart to send out confusing messages), and a mass in her right atrium will give an anaesthesiologist pause. Moms and Dads too, apparently.

All of those health issues aside, Jim and I know undergoing anaesthesia is hard on any pet, but especially for older ones. Indiana was simply sedated several years ago, and it took her days to recover. Imagine what anaesthesia would do to her. While the possibility is likely remote, there is still a small chance that she could die on the operating table. I could have a live dog one morning, and in a manner of hours, she could be dead. That is a horrifying thought for me and Jim.

So we took the difficult step of asking the oncologist, "What if we don't do anything at all?" Only 5% of soft-tissue sarcomas metastasize systemically, meaning 95% of them pretty much grow in place. Given that Indiana's is on her back, it wouldn't impede breathing or walking. The biggest issue would be that once it grows too large (and who knows what too large is?), the mass would eventually split and ulcerate, leaving a big, gaping wound and opening her up to infection. But some soft-tissue sarcomas grow slowly, and others grow quickly. If we were lucky enough to have a slow-growing tumor, it might never grow big enough in what lifespan she has left to cause a problem. When the oncologist did the biopsy, she removed a lot of tissue, so the mass isn't even palpable right now. That's a good thing. She said we could wait to remove the mass when it grows back to its original size.

After consulting with all of these specialists, I met with Dr. Becker last week. She was amazed that the tumor was so small, given that it was biopsied about a month ago. You really can't even feel it, just a small scab. After talking over everything, we decided to wait. We won't be doing surgery right now. There is a possibility the tumor will never grow at all, or it might grow very slowly. If it ever gets back to its original size, we'll revisit our options at that point. But for now, it doesn't make sense to take her life in our hands to remove something that might not be a problem.

Jim and I feel good about this decision. It feels right. I worried I would feel like we were giving up on her, but I don't. I feel like we're giving her a good quality of life, and leaving her the heck alone. She doesn't even notice the tumor. We may be back in the same place in the future, having to make a choice about surgery, but for now, I know this is the right decision. For me, Jim, and for Indiana.

Looming Decision

The last two weeks have been so Mr. Squiggles-focused, which has been great. Confusing, hectic, shocking...but also great. In the back of my mind though, I do know that Jim and I still have to make a decision regarding Indiana's cancer.

I don't feel like we're any closer to making a decision than we were nearly a month ago when we found out about the cancer. U of I wanted to do the surgery within 2-4 weeks, but I am not prepared to make a decision and don't want to rush into it. There are so many things I still need to know: how long with the surgery take? If we don't do the surgery, what can we expect? Some of the questions are difficult to ask, as it feels like we're giving up on Indiana. If we don't do the surgery, and the cancer becomes a problem, how can I live with that? But if we do the surgery, and she dies on the table, or if she never fully recovers from it, how can I live with that? I feel like we don't win no matter what we do.

I have spent the last four years talking with others dealing with cancer, through our cancer foundation as well as through the online support group I've been active with. I've said a million times, "Any decision made with love is never a bad one." Have I been wrong? Have I been lying? It's so easy to give advice, but much harder to take it. I wonder if that advice has ever given comfort to a parent? Would it give me comfort, if I really, really listened?

Everything in Flux

The worst case scenario has come true. Indiana has cancer. Again.

Jim and I (and of course Indiana) successfully battled leiomyosarcoma--and it's still gone--only for Indiana to survive long enough to get another, completely different, type of cancer. While the first cancer was an extremely acute case that put her life immediately in danger, this cancer is different. Everything is different.

On Thursday, September 30, we were told that Indiana had a Stage 1 Soft-tissue Sarcoma. It's a small, quarter-sized tumor on just to the right of her spine, though not actually attached to any muscle. U of I wants to perform surgery within the next month, and four years ago we would have taken this option eagerly. But this time around, our course isn't so clear.

Indiana has a host of health problems, partly from being 12 years old, and partly from having gone through chemo four years ago (ironic, isn't it?). Though arthritis (from being old) is HER biggest complaint, kidney disease and a heart arrhythmia (from the chemo) are OUR biggest concerns. We worry that anaesthesia could put too much strain on her heart and kill her on the operating table. Or that it could screw up her kidneys even worse.

Typically, I'm not the kind of person who vacillates in making a decision. I'm strong-willed and opinionated. Even if I take some time to make a choice, I probably have a particular way I'm leaning in my mind. But not with this. I am absolutely, 100% torn. If I had to make a decision today (and thank goodness I don't), I would be lost. Because I AM lost. Indiana is telling me she still wants to fight. She feels great, and the light in her eyes gives me hope. But I can't let her die on an operating table, either. But how can I let an evil monster like cancer just grow on her body?

Jim and I have the beginnings of a plan. I've already made an appointment to see Indy's nephrologist (her kidney specialist--an amazing man), and today I'll be calling her cardiologist (also a wonderful guy), and making arrangements to get a second cardiology opinion. I've already spoken with our vet, Dr. Becker, who encouraged us to get as many opinions as possible, but she isn't necessarily pro-surgery, and I respect that. I'm not sure I am either. I am comforted that our plan involves a visit with Dr. Becker in three weeks, where the three of us will make a decision together. Hopefully before then, my heart and my brain will decide what we want to do.

I am so heartbroken about this, I don't even know what to do. In the last four years, I have made every conceivable change in Indy's life--the best food, the best doctors, the best supplements, the best proactive care--and still, she gets cancer again. I am going through three of the five stages of grief all at once--denial, depression, and anger. I don't want to hear, see, or think the word "God," because I am now convinced he doesn't exist. It's stupid, I guess, but I am tempted to avoid Facebook for all of the status posts my believer friends make referencing God. They really do make me a bit sick, because I can't believe he even exists, because if he does, he has absolutely forsaken me.

The denial part is my inability to really process this. I KNOW my dog has cancer, but I haven't really allowed myself to absorb that idea or really think about what it means, because to do so means to allow my soul and my spirit to be crushed yet again. It's been damaged so many times in this past year, I'm not sure it can handle it again. So that's why I'm depressed too. I was depressed before this diagnosis, and the cancer is really the icing on the cake.

I hate that I couldn't prevent Indy from getting cancer again, and I hate that I don't know how to help her. I am so lost, and so sad, yet I know I have to keep going, to fight for my precious baby. I have to remove myself from much of the "real" world, because honestly, I don't have enough left inside me to be able to fight this cancer and be a regular person. I hope all of my friends and associates will understand. I don't really have much of a choice. At least that is clear to me.