Chipper

Five weeks ago I had my laparoscopic oophorectomy. Shockingly (or perhaps not so shockingly since the new puppy came into my life four weeks ago), it has taken me this long to write a blog post to inform all you non-Facebook readers how the surgery went and to provide additional information on the findings from the final pathology (which I have not shared broadly with anyone). My left ovary was about two to three centimeters bigger than it should have been. An intraoperative biopsy was performed on the left ovary which confirmed that the growth (which was inside the ovary) was metastatic colon cancer. About one cubic centimeter of that cancerous tissue was immediately handed over to a courier for transport to a laboratory across the river in New Jersey where portions of it were successfully implanted into five mice, a very good number I am told. I believe my mice have been moved since down to Baltimore to the main laboratory. I will know in a couple weeks where the graft of my cancer cells into these mice has taken hold and, if so, they will be cloned for personalized experimentation. While the right ovary looked normal, out of an abundance of caution, it was also removed, together with my fallopian tubes. As the final pathology would later reveal, appearances were deceptive and the right ovary tested positive for metastatic colon cancer as well. All else looked normal in the abdomen, including all organs located therein as well as my peritoneum. Forty milliliters of ascites – fluid – was found, however. The word “ascites” terrifies me; I often hear it associated with end-stage cancer, where hundreds of milliliters can build up in the abdomen as the cancer overruns the body. Fortunately the pathology report declared the ascites to be negative. The surgeon also flooded my abdominal cavity with saline, then withdrew it and had it tested for cancer, something that was also done during my post-HIPEC diagnostic laparoscopy in October 2014. That saline was negative for cancer, as it was in October 2014. If indeed there is no cancer in my abdominal cavity, then it certainly indicates that the HIPEC surgical treatment from March 2014 has withstood the cancer assault well.

It was the best news I could have asked for under the circumstances, minus the cancerous right ovary. But then again metastases to the ovaries are often bilateral, and, besides, what is the difference really between having one cancerous ovary versus two? That’s how you start to think when you’ve been living with metastatic cancer for a while… Oh, what’s the big deal with another tumor? Oh, what’s another affected organ? I’m being facetious, kind of.

My surgical recovery was about as uneventful and painless as they come. I don’t even think I took one Percocet. Surgery started around 1. I was home by 8 that evening, and all I showed for those hours were a hunched over stance when I stood and three tiny bandages covering three tiny holes. Oh, and I had trouble peeing for the first 12 hours, an after-effect of the catheter placed during surgery. I marvel at how they were able to remove two organs, one of which was grossly enlarged, through those tiny holes. In case you are wondering how exactly that was possible, the surgeon chopped them up. And to prevent cancer from spreading everywhere (which is what would have happened if she had cut them where they lay), she detached the ovaries, lifted them into a bag which she had inserted under my skin, performed all the chopping inside that bag and then sucked the entire bag out through one of the three tiny holes. Medical science is simply amazing.

I continue to be baffled by how the scans either missed this massive growth in my left ovary all this time or how the cancer managed to grow so quickly to the point of detection in the span of six weeks, which was the period between my last set of abdominal MRIs. The doctors can’t answer that question either. Really reassuring… My oncologist is less inclined to believe that the cancer grew that rapidly and so is therefore thinking that the scans missed it. And obviously, the cancer in the ovaries was resistant to months and months of treatment. Also very reassuring… This time I am really being facetious.

I restarted treatment ten days after the surgery. Since the Erbitux was clearly not working anymore (neither in my lungs nor obviously in my ovaries) and rather than going on to the last FDA approved drug for treating colorectal cancer (which doesn’t seem all that promising to me), I decided to go back to Irinotecan which is part of Folfiri, and which I had chosen to stop after I appeared to be cancer-free in September 2014. I’ve also decided to dump the 5-FU, which I’ve been on nearly non-stop since August 2013. I’m assuming at that this point, that drug has lost its effectiveness. I have reintroduced Avastin, which I’ve also been on pretty much non-stop since October 2013, not so much because I believe it has much heft anymore, but because it produces so few side effects, I don’t feel it to be detrimental to my body.

The three treatments I’ve had since the surgery have been uneventful. I have been experiencing pain in my hips and knees. I cannot determine if the pain is bone or muscle related. Since it seems to be bilateral and disperse, it’s unlikely to be metastases to the bones. Perhaps, it’s attributable to the sudden loss of all the estrogen that was once produced by my ovaries. Perhaps, it is due to weight gain from the steroids and my failure to go to the gym for months and months. Or perhaps, I can blame it on all the hours I spend on my feet now taking the dog out in my efforts to housetrain him. My next set of scans is scheduled for next week, which will include a lumbar sacral MRI, so we will see.

The five weeks since the surgery have found me pretty much MIA from this blog, Facebook and, to a lesser degree, my friends and family. Unlike prior periods of reclusiveness, this one was not because I was in some dark cancer-induced malaise. The intense anxiety and stress in the weeks before as I learned of the ovarian metastases, dealt with the accompanying pain, decided to proceed with surgery, pushed for the scheduling of that surgery and then waited for the surgery, had left me completely drained and utterly fed up with all things cancer. I wanted to push cancer and everything that has come with it, including this blog, away, and just pretend for a little while that I was like everyone else, and that included not musing about life and death, not writing, not talking about it, not, not, not. A couple times, I tried to write, but nothing good came forth. Denial and feigned normalcy were what I craved.  I am not one who believes in denial or pretension. For the last nearly three years, I have always chosen to confront my disease head-on, to live it, embrace it, forcing myself to walk through the fires and feel the pain, in the belief that I would emerge from the other side stronger and wiser. But not this time. Running and hiding was what I wanted. It was what I needed as part of some kind of mental and emotional recuperation.

My little Bichon Frise puppy, Chipper (named after the Atlanta Braves player, Chipper Jones – Chipper came from Atlanta and Josh is a fan of the Braves), facilitated that objective. Two days after my first post-surgical treatment, as I was crashing from the steroidal high, Josh, I and the girls drove to the airport, searching for an obscure building in the bowels of LaGuardia, to which little Chipper was brought. He was adorable, all white fluff with dark black eyes and velvety floppy ears. And I was terrified as I clutched his crate in the passenger seat, wondering how I was going to have the energy to take care of yet another living thing and a living thing that was even more foreign to me than a newborn baby had once been, no less. He came home and almost immediately pooped onto our wood floors as I lunged to place a wee-wee pad under his butt; I wasn’t fast enough. That night he cried incessantly, waking me up every hour. I would take him out of his crate, he would suddenly run from me (a sure sign that he was about to do his business), I would run after him with a wee-wee pad, he would pee or poop not on the wee-wee pad. I would clean up the mess and put him back in his crate, and then the cycle would restart an hour or two later and on and on this seemed to go over the next few days. I was exhausted thanks to the sleep deprivation and the treatment, on the verge of hysterical tears, convinced that I had made a serious error in judgment by getting this dog and wondering if the breeder would take him back if I begged.

Housetraining was made much more difficult by the fact that we live in an apartment building and by the vet’s directive that I not take him outside (or at least his paws couldn’t touch the ground) because he wasn’t fully vaccinated and it would be  another seven weeks before he would be. The streets are apparently rife with deadly canine diseases. As per my dog trainer’s recommendation, I kept the dog in his crate and would carry him out every couple hours into the stairwell on a leash where I laid down a couple wee-wee pads. With the leash, I kept him on the pads, but Chipper refused to do as I wanted. He would sit, lie down and roll around. I would sit on a step while he lay on a pad, bored, waiting. I spent hours in that stairwell, fruitlessly waiting. And apparently, Chipper was waiting too because invariably the moment I put him back in his crate, he would pee or poop. And so it went.

After a week of this, I decided to willfully disregard the vet’s instructions and I carried him outside – I didn’t know this but when you carry a dog, he won’t eliminate on you, just as he would never eliminate on his mother. And miracle of miracles, he peed and pooped almost immediately! I decided that venturing outside with him within a limited area where there are few dogs and most of the dogs are from my building and are therefore more trustworthy health-wise was of minimal risk and a risk that I had to assume because my sanity hung in the balance.

Once I started walking him outside, I discovered something extraordinary, at least it was extraordinary for someone like me who came from an animal-hating family grossed out by the thought of dog saliva on furniture, clothing and human skin and horrified by the thought of picking up a dog’s excrement and who really got this dog for Josh and the kids as emotional support for when I die. What I learned was that people LOVE dogs, at least most people. When my children were babies, I got the occasional smile from a stranger gazing at my adorable offspring, but on the whole, few people care about cute babies. But a puppy? Unbelievable! Young, old, black, white, brown, business men, garbage collectors, construction workers, Goth girls, tough guys – everyone from all ages and all walks of life and every part of the world has stopped to pet and play with my dog. We engage in conversations about their dog at home, about how they are still grieving their dearly departed dog, about how they wish they could have a dog.

My nurse practitioner (another one of those dog fanatics who prefers dogs over babies), upon learning that I had gotten a puppy, insisted that I bring him to the cancer center when I came for treatment. I was a bit reluctant because I was nervous about potential complaints, as was my oncologist. But my nurse practitioner blew off Dr. A.C.’s concerns and told me to do it anyhow. I was concerned about leaving Chipper home alone for so long so I did as I was told, carrying him in a little bag that I tried to hide as I sneaked past the security guard. The waiting room was packed with at least fifty people, as usual. But what was not usual was the sudden burst of energy and life that swept through the room when people realized there was a puppy in their midst. Staff came out of the internal offices and exam rooms, squealing with delight. Patients and their caregivers smiled and stared and some even rushed over to pet and hold the dog. It was unreal. And little Chipper took it all in stride, basking in all the attention and then sleeping on me as I received my infusion. He did not bark or cry or do anything remotely troubling once while at the cancer center. I should mention though that there were a few people in the waiting room who did not look at all excited to see the dog. In fact, I might even characterize their expressions as ones of incredulity and disgust. They were the Chinese people, the ones of my parents’ generation. I could relate.

Housetraining is going well, now that I know what to do. Chipper stopped crying during the night after three days and now sleeps through without incident. People told me having a puppy was like having a newborn baby. I don’t agree at all. When I don’t want to deal with Chipper, I stick him in his crate. He sleeps through the night and doesn’t require endless breastfeeding. I don’t need to change any diapers. He doesn’t cry  or bark.  When I take him out, I don’t have to bring tons of baby paraphernalia with me. He is much, much easier than a baby.

And the best part about him is his simplicity, the complete lack of complication. I have no expectations of him to be a Rhodes Scholar or concert violinist one day and he doesn’t chafe under or resent my demands. We don’t have a difficult relationship in which I have to lecture him about the value of money and how I can’t buy him a toy whenever he wants.. He has truly basic needs that are generally very easy to satisfy and which, I’ve discovered, I am capable of fulfilling. And he loves with an unconditionality and purity that is in its own way quite beautiful and inspiring.  It is in the performance of our daily mesmerizing rituals — me squatting with a plastic bag in hand to pick up his waste, me tossing a squeaky frog as he eagerly awaits to give chase, me brushing out the tangles in his snowy coat — that I find that he and his simplicity shield me from what I don’t want to deal with right now, from the shadows that wait on the sidelines, and he allows me to continue with my pretense for as long as I want.  And within those rituals, there is no cancer, no life, death, no future, no past, not even that day or hour or even minute, not even Josh or the girls or me; there is just that second, and then the next and then the next.  And there is just him.

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12 Comments (+add yours?)

  1. Cristina
    Jun 02, 2016 @ 17:48:32

    I am glad you have Chipper. I have two dogs who love me so unconditionally and makes me happy. Hope your scans are good next week.

    Reply

  2. RJ
    Jun 02, 2016 @ 17:53:43

    It really is incredible how people react to puppies. Glad he can bring others joy, and glad he’s now a part of your family. You are in my thoughts.

    Reply

  3. Tammy Malby
    Jun 02, 2016 @ 18:12:35

    I own 2 Bischons and think they are the best dogs in the world. There unconditional love puts a smile on my face. After chemo I come home and they instinctively know that there momma needs some love.

    Reply

  4. Chrissy Rice
    Jun 02, 2016 @ 18:15:50

    Oh I am so happy for you and Chipper … straight from Atlanta. Puppy kisses
    Chrissy

    Reply

  5. Doug Williams
    Jun 02, 2016 @ 19:55:01

    So glad you brought Chipper into your family. Now you know…dogs have magical properties. Looking forward to meeting him and seeing y’all this summer.

    Reply

  6. Karen
    Jun 02, 2016 @ 20:03:17

    I am so glad that you have Chipper. Bischons have a bright and spirited personality and are wonderful family members. I have a tea cup Maltese who is my sunshine. She gives me a reason to smile even when my body betrays me due to chronic illness. Tail wags and wet nose kisses to you and Chipper.

    Reply

  7. remklatt
    Jun 02, 2016 @ 21:07:21

    Hi Julie,
    I am a 39 yo mom of two young kids and I have advanced soft tissue sarcoma. I presented a year ago with a hugely distended abdomen full of tumour and > 2L of ascites (which also tested neg for cancer cells). Here I am, back at work, a year later. Partly for financial reasons, but mostly because I love my work. Anyhow, I just wanted to let you know that ascites isn’t always the end. I love reading your blog, and can relate to a lot of it.

    Reply

  8. Harriet Pritchard
    Jun 02, 2016 @ 21:14:07

    So glad you have a new puppy from Donna. Bichons have a way of crawling under your skin. They sense your thoughts before you even think them. They will always be with you. Don’t turn around to fast or you will step on them. Soon he will be in your bed enjoying every minute. Enjoy every minute with him.

    Reply

  9. kgdjoen
    Jun 02, 2016 @ 21:14:39

    I am so glad you have discovered the joys of a dog. They have been my constant companion since 1989 and I can’t imagine my life without them. They have gotten me through many tribulations and force me to get outside every day which is extremely important after surgery, etc. I’m happy for you that you gave time to yourself and just being.

    Reply

  10. Linda
    Jun 02, 2016 @ 21:36:47

    Loved your post as usual. Seems like Chipper is working that puppy magic. Animals bring us into a special zone. Miss you!

    Sent from my iPad

    >

    Reply

  11. Nicole
    Jun 02, 2016 @ 23:33:43

    I have read your blog from the beginning and have never commented. Thank you for your honesty and rawness. I have learned to be kinder, patient and more understanding with others as I don’t know what path others are on. Congrats on the newest member of your family. Thank You.

    Reply

  12. William Simpson
    Jun 03, 2016 @ 09:49:16

    Julie, Thank you for the update, I’ve been missing you! I know it’s not easy, but your writing inspires me and makes me care even more about you. Bill

    Reply

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