By Elly and Dante with the cooperation of Tom Hendrickx.
Our story begins on June 18, 2010. Our girl is in a deep sleep in her basket. The doorbell rings. She straightens up and sprints for the front door. Suddenly she stops and falls over. She lay motionless for a moment. You immediately think of the worst. You gently take them in your arms. She regains consciousness, looks dazed for a moment, gives a deep sigh and not 10 seconds later everything is back to normal.
Because she has had a small heart defect for several years, which is perfectly controlled by medication, you start looking for the cause of that fainting in that direction. A visit to Ann, our vet, shows nothing special. You keep a closer eye on them in the days that follow, but everything appears to be normal. What we do notice is that she is a little less active, gets tired faster while walking, sleeps a little more. You think ok, she must have overshot herself during that sprint to the front door – after all, she’s not a young lady anymore – we’ll take it a bit easier. Other than that, nothing is going on.
Everything goes well for more than five months until she faints again for no reason at the beginning of December. Again the same scenario and just as quickly back to normal. Blood is taken this time during the visit to our vet Ann Drieskens. The blood test shows that she has too few white blood cells. Ann tells us that this can have various causes, ranging from an infection, whether parasitic or not, to cancer in the worst case. Over the next few days, she faints a few more times. The result of a subsequent blood test shows that the situation is rapidly deteriorating. Urgent action is needed.
We are referred to veterinarian Tom Hendrickx in Hasselt for further investigation.
Vet Tom :
Spike, a very sweet Jack Russell Terrier, had been known for two years with a leaky heart valve, perhaps that was the reason for the sporadic fainting? She was almost 10.5 years old at the time. However, after several heart examinations (x-ray of the chest, EKG, ultrasound) there appeared to be no demonstrable heart failure that could explain the complaints
Where did the fainting come from? The preliminary blood tests showed a strange, steadily decreasing trend in white blood cells, but otherwise there was little evidence. This was the only hold we had. Unfortunately, in veterinary medicine we do not have tumor markers in the blood, as they exist for humans. That is a common misconception among pet owners : as a veterinarian we cannot detect cancers in the blood !! This is a serious shortcoming in our work as veterinarians, especially when you consider that we see so many cancer patients…
We decided to also look at the abdomen with the ultrasound machine. There were very subtle spots on the spleen and in the liver. Punctures of both organs (which Spike admitted without anesthesia, by the way), yielded little additional information. However, impurities on the spleen during an ultrasound examination often mean that there is reason enough to proceed with the removal of the spleen. This was not an easy decision for Spike’s owners to make. There were more questions than answers.
A quick decision is required. Spike is in worse shape than it first appears. She deteriorates rapidly in the following days.
The period that follows is one of joy and sorrow, of hope and fear, of love for your animal, a period in which you get to know yourself a little better, a period in which you have to make decisions that you would rather not make , of sleepless nights in which you question everything, a period of many tears that you have to go through.
As a veterinarian, I was very grateful to Elly and Dante for the confidence they placed in us to opt for that operation, despite the counterarguments (which are always there – age, heart problem, poor blood values, you name it…). This operation turned out to be the cornerstone of all further steps in Spike’s treatment and was therefore of paramount importance.
The operation is scheduled for December 23. Because her white blood cells have dropped dangerously low, she has to be brought in the night before. She received the necessary medication and some blood through an IV to strengthen herself for the operation. With a scared heart we left her there. We asked if we might have to stay with it. This was not necessary, there was permanent surveillance, she was in good hands. However, this was not obvious to us. It was hard for us to leave her there alone. She was never a night of it
home as long as we had her. Just when she was so sick and needed us we left her alone. Would she make it through tomorrow? She was very weak and looked at us with pitiful eyes. With a lump in our throats we each said goodbye to her. The return journey to Lommel passed in silence. Tears ran down our cheeks. The feeling of powerlessness and incomprehension prevailed.
After a sleepless night we received the redeeming phone call from the veterinary practice. Spike had spent the night well and rested and was well enough to undergo the operation.
We decided to drive straight to Hasselt, just to be close by if something went wrong during the procedure. We had just lit a candle at the Heilig Paterke van Hasselt when we received a call from the practice. The procedure was successful and Spike was recuperating. We could come in an hour. We were able to see her briefly, she was still fast asleep, but gave a fairly calm impression. Tom gave us some explanation and then drove home with a feeling of peace. We were happy that it all went well.
During the operation, the entire spleen was removed and we also took a biopsy (block) of the liver. With the naked eye we saw no external abnormalities in either organ. The recovery from the operation went well. Spike was actually a strong little dog.
For Spike’s further therapy, we needed to know exactly what was wrong with that spleen. Histological examination is so incredibly important for any growth, nodule, or questionable organ. The samples were sent to Dr. Hilde De Cock of the AML in Antwerp.
The next day, we were allowed to go get her. It was Christmas Eve. She was still very weak. The operation had demanded a great deal of strength from her. The planned Christmas party with the children and Christmas Eve with the family were cancelled. Everyone agreed with us. Spike’s recovery came first. I still remember Tom’s words: “Take them home quickly, this is not a dog to be left alone here. She will heal faster in your familiar environment.” It was the first Christmas without family. Everything revolved around her. We celebrated Christmas intimately with our girl. It’s the last Christmas with Spike. The following days she brightened up visibly. After a few days she jumped back in and out of her seat, she ate very well and was full of energy again. Even her blood cells had returned to a normal arrow within a few days. Luck smiled on us. Our little girl was full of energy again.
What was special was that at the first blood test after the operation, the white blood cells, which had dropped dangerously low, had immediately risen back to normal values. The spleen is an organ that plays a role in the processing and disposal of blood cells (a kind of container and recycling park for blood cells). It is an organ that a body, be it human or animal, can easily do without.
Less than a week later, the results of the spleen examination came. That result showed that Spike suffered from lymphoma. Our house of cards came crashing down. How much time is left for her? Will she suffer a lot? what else can we do? is this it then? It can’t be true, just look how lively and playful she is. You don’t want to accept this. We then had a long talk with Tom. He then explained to us what options there were and what we stood for. What he did say right away was that sooner or later Spike would lose the battle against cancer. He clearly didn’t give us false hope.
Lymphoma – or lymphoma – is a cancer that originates in the lymphocytes. These are white blood cells, which under normal circumstances do their job perfectly in our body’s defenses. However, when these cells become tumors, lymph node cancer develops. The most typical form occurs when only swollen lymph nodes occur in the throat, shoulder, groin, back of the knees… Sometimes the liver and spleen are also involved. We consider lymph node cancer as a systemic cancer, ie. the whole body is involved from day 1. That is why we do not speak of metastases in this cancer. In addition, there are also forms of lymph node cancer in which only the skin or only the gastrointestinal tract is involved. Presumably there are many more forms at the DNA level than we know so far.
In Spike’s case, it was an untypical form of lymph node cancer, because the lymph nodes were not actually swollen and because the tumor cells occurred in small islands in the liver and spleen. In addition, this was a T-cell lymphoma, a more malignant form compared to a B-cell lymphoma.
What were we going to do now? Doing nothing was not an option, she would only have a few more weeks to live. Our Spike was much too precious to us for that. She wasn’t just our dog. She was a full lid of the family. Now that our children had moved out, she had become more and more “our little girl”. She was there everywhere, in the house she was literally the sunshine and suddenly all this would be gone. We could not and should not allow this to happen.
Then we wondered, what would we have done at the time if we were told that one of our children… As a parent you grab every small chance, no matter how small, every small percentage to save your child. We followed our hearts and decided to go for it anyway. Some will think, it’s hard to compare your child to your pet. But that’s not what it’s about. We just want to say that when you love someone dearly, who also gives you so much love and affection in return, it is very difficult to accept that he or she will no longer be there tomorrow. You don’t do this for yourself, but simply out of love for a living being, hoping to save it.
The question came: what now? do nothing ? palliative treatment ? or chemotherapy? Basically the cards were bad. Nevertheless, after consultation, a treatment with chemotherapy was chosen. This choice of whether or not to treat has many more aspects than just the dry scientific facts. Emotional, family and other factors often play an important role. I will never forget the words of the owner of another 14.5 year old dog who also had lymphoma, who told me: “I can’t just say, we don’t do anything anymore; you just die…” (his dog is almost 15.5 years old by the way!).
Putting him to sleep was perhaps the easiest solution, but not an option for us at that time. Spike’s condition had improved so much that even the vets suggested not to opt for that right away. Afterwards we would be left with the question of what if, and probably get the guilt of not having done everything for it. After some research on the internet, we came across the success story of Ben, a Rottweiler, who also had lymphoma and was also being treated by Tom. Ben was successfully treated with chemotherapy and has now lived more than three years longer. After another thorough conversation with Tom, our decision was made. We chose chemotherapy.
Clear agreements were made. Spike’s quality of life was number one. Under no circumstances should she be in pain. Tom promised us that unlike humans, a dog usually doesn’t get sick from the chemo and barely notices it. We also agreed that if the first chemo did not work immediately, or our dog would still be ill, to stop the treatment immediately and switch to comfort therapy. The appointment for the first chemotherapy was made. With a scared heart we started it.
The intention was to baxter Spike 6 times. After this we would see where we stood. As mentioned, animals tolerate chemotherapy well, without the known side effects of vomiting and hair loss, as in humans. That was also the case with Spike. What was special was that Spike felt well quite quickly after the first chemotherapy treatment, even better than the months before. We must bear in mind that, despite the surgical removal of the spleen, the liver was still riddled with tumor cells. I still feel that we were able to drastically reduce these tumor cells with the first chemotherapy. This immediately improved Spike’s quality of life. The initial problems of fainting also disappeared for a while.
The treatment went much smoother than we expected. The whole thing took no more than 10 minutes. Spike responded very positively to the medication, as if nothing had happened. Chemo worked very well. Spike was full of life again, ate very well, liked to go for a walk again, played with the ball, ran in the woods as before, our Spike was clearly back. The results of the interim blood tests were also ok. White blood cells returned to normal levels. She also had no fever at all. Everything went positively. Even the observance of certain precautions in the first days were not too bad.
In the back of our minds we knew she couldn’t be cured, you could only hope that the quality of life would stay that way for a long time. How much time she would still be among us, 6 months, a year, two, you can’t predict that, unfortunately there is no crystal ball for that. We could only hope. We said to each other, every month there is one more, and they say that one year is equal to seven dog years, so we count like that now.
From then on we also started working more intensely with her. She was of course pampered a bit more, sometimes got a chicken fillet or some pasta with some chicken broth to strengthen even faster. She put up with everything and even came half chillenjoy all those goodies. She was active as usual, walked enthusiastically, did very well, we were happy to see her evolve so well. We started making plans for after the 6th and final chemo.
Unfortunately, after the 4th chemo, Spike deteriorated a bit, she was tired more quickly when walking, stayed more in her basket. You secretly hope that she will recover, you think “she’s in a slump”. But shortly before she had to receive the 5th chemotherapy treatment, she started to faint again. The cancer reared its ugly head again. Her blood values had dropped sharply again. She was too weak to get that 5th chemo.
As a cancer treating veterinarian, I view these therapies as putting hurdles against a disease that wants to spread. The aggressiveness of the cancer determines how quickly the cancer jumps over these hurdles, and thus how successful the treatment is.
From that moment on, the treatment became palliative and thus shifted to comfort therapy; i.e. pain relief and ‘feel good’ medication.
From then on it went downhill pretty fast with our girl. She was eating less, walking was becoming increasingly difficult, she slept a lot. The cortisone did its job properly, she had some good moments, but we saw in her eyes that the zest for life was gone. She quietly gave up.
On Monday, April 4, we took a last walk in the Kattenbos, her forest, the place she knew so well, where she loved to be. That morning, as always, she was very excited at the rattling of her leash. She went very confidently to the door, got into the car with determination, nice and excited, because that meant walking in the woods. Quickly ask Ann if it was possible. Let them have fun, said Ann, she will let you know if it doesn’t work. With the well-known spurt she dashed into the woods, sniffing, the obligatory pee, we had left. It all looked fine, but soon she made it clear that it was no longer possible. We picked her up and continued the walk with our girl in our arms, along the paths where she could otherwise run. We took a few more pictures with her head close to us. We looked at each other and knew, this was the last walk, it ends here. Our tears flowed freely.
Wednesday 6 April we visited Tom for the last time. She had slept a lot since Monday, hardly got out of her basket. Tom then said: “Don’t wait too long, now it can go very quickly, a maximum of a week, enjoy her last days intensely. Decide in time, so she doesn’t have to suffer.”
It is at those moments that you, as a veterinarian, have to accept the limitations of (veterinary) medicine; but it always feels like a defeat, no doubt. You then know that it is probably the last time you will see Spike.
The next day she had more zest for life again, a last flare-up turned out to be afterwards. Everyone has come to say goodbye to her. Our grandson Vince even brought a cookie and a cuddly toy. Her friend Tessa also stopped by straight from the school. She had made a farewell note for her playmate in class. That same evening Spike became very restless, she refused her medication and wouldn’t eat. During the night she fell ill. Now the time had come to put her to sleep, now she was in pain, and you don’t want that. We took her in between us and she gradually calmed down. In the morning around 7:30 am we called Ann. She herself could not come, she was on a course in Ghent. The conversation was quite emotional, also because Ann had a soft spot for Spike. Her friend Wim Vrancken, also a vet, would come by at 9:00 am. He had also known Spike for a while. She wished us good luck.
Our sons both came by that morning around 8 o’clock. Spike still reacted reasonably well. She straightened up, wagging her tail as usual, waiting for the pat to follow. Then she lay down again. A pat on her head, a look at daddy, see you later mom, that’s all that was said. They left without a word. They too had a damn hard time. We then sat down on Spike’s couch. She then crawled close to us, put her head in my hands, and left with a deep sigh. It was Friday, April 8 at 8:20 am. Wim was with us at 9 am as agreed and could only conclude that she had passed away peacefully. In a way, he was relieved that she had died of natural causes after all. Even though you know that putting him to sleep is the right decision, it is emotionally very difficult to have to do it in the end.
Her passing has made us realize how important she has been in our lives. The loss is great. The little things that were taken for granted for 10.5 years are suddenly gone. It’s cold and quiet in the house now. The grief over her deRead a few books on pet loss and bereavement. I found answers about what I felt, and couldn’t put into words, in stories of people who, bundled in a book, tell about their experience with the loss of a pet. Tears flow when reading all those poignant stories, but at the same time the realization grows that you are not alone with your grief. It gives some support.
Spike’s story was a special one in many ways. It was a story of searching, a story of hope, a story of joy, a story of sorrow, a story of respect for life and for death. I am very happy that I was allowed to be part of this story as a veterinarian. Spike is one of those animals that leaves a mark on your soul as a veterinarian.
On April 8, 2012, one year after her passing, we went for a walk in her forest for the first time, on the paths where she walked so much. It wasn’t easy, but gradually you will bring back the memory of those beautiful moments and the tears will make way for a smile.
To thank her for her love and loyalty, for all the beautiful moments and the joy of life we were able to experience with her, we wanted to give something back. That is why we undertook a hike to Assisi. We can also use this to give her passing a nice place.
Spike’s story is at the cradle of the Belgian Cancer Fund for Animals. In this way, Spike’s memory lives on in a special initiative.
We hope that many people, owners, can find some comfort or reflection in this story.