I took this photo of Butch on Thursday, thinking it might be his last one. I am overjoyed to tell you it won't be.
The tumors on Butch's gums that I wrote about here and here continued to grow, and about 10 days ago they began to bleed. A lot. The vet had told me Butch might chew off the tumors if they grew long enough to catch between his teeth, but I had expected that to be a one-time event. I did not expect the bleeding to be a continual occurrence.
I was laundering his bedding (and mine that he touched and imprinted with his muzzle) once or twice a day, continually cleaning blood droplets and saucer-sized bloody drool stains from the carpet (hats off to Stainmaster® for performing as advertised), and washing Butch himself several times daily because he frequently wiped his mouth on his forelegs. Because of his blindness, Butch navigates through the house by touching his muzzle against familiar landmarks, such as walls and furniture. With his bleeding mouth, he had become a walking ink stamp.
The only good news during that time was that those tumors must have contained no nerves, because Butch appeared to be feeling fine. He was enthusiastic about meals and snacks (his that he ate and mine that he begged for) and went about his business--as much business as a nearly 14-year-old dog can manage--in good spirits.
In fact, he seemed to be feeling well enough that I thought he wouldn't fall apart during a short car ride, so on Thursday I enlisted Kim's help in getting him in the car so the vet could take a firsthand look at what was going on with his mouth. She found more than we had expected. In addition to the tumors on his gums, there was a large, black mass on the roof of his mouth. The vet suspected melanoma.
We discussed options.
Doing nothing was not an option because Butch's continual bleeding was weighing more heavily on me than I like to admit. I've cleaned up my share of urine, feces, and vomit in the years I've owned dogs, and even some blood on more than one occasion, but this constant dripping from a roving source was beginning to feel like Chinese water torture. As much as I love Butch, I was starting to find the situation intolerable. I'm being as honest as I can here, even though I'm ashamed of those feelings and believe that Butch deserves better than that from me.
A second option was surgery to remove as much of the tumors as possible and cauterize the remaining blood vessels to stem the bleeding. I didn't think Butch was a good candidate for surgery. He's so old now, and he has a history of problems with anesthesia. Would it be fair to him to put him through the pain of another surgery this close to the end of his natural life span?
That brings us to the third option: euthanasia. A number of people told me after Butch's eye-removal surgery in 2005 that it would have been kinder to "put him to sleep," but he's had six and a half pretty good years since then, so I've never regretted that choice. At the age he is now, it's a different story, and I gave it serious consideration. My daughter Kelli summed up my ambivalence about this option when she said I was struggling with this decision because I wanted to be sure I was doing it for the right reasons and not as a matter of convenience. That was exactly it. And the truth was that all that bleeding was bothering me; Butch didn't seem to be the least bit concerned about it.
The vet assured me that the surgery would be fast and easy. It would quell most, if not all, of the bleeding. I asked about cost, and she quoted a price that was exceptionally fair and reasonable. She couldn't, of course, guarantee that Butch would survive the surgery, but she laid out her plan to give him the best chance possible.
The next day, Friday, we gave him that chance. I dropped him off tearfully, knowing the odds were against him.
The vet called after the surgery to tell me that Butch was awake, sitting up, and was trying, not successfully yet, to wag his tail. They had removed the epulis (tumors on his gums), which had also involved removing two teeth. That was the good news. The bad news, she told me, was that the mass in his palate was melanoma, and they couldn't get it all. She said the melanoma was quite invasive and there is a danger that it will grow into his sinus cavities. "That," she said, "will be it." She estimated that Butch might live as long as three to six months, though his time could be shorter than that. She said to give him a week to recover from the surgery; after that, we should have a better idea of the quality of life he'll have for the remainder of his days. If Butch does well, there are inexpensive medications that have been shown to slow the growth of melanoma, and they should also keep Butch comfortable. On the other hand, if Butch seems to be suffering at the end of the week, we can stop it then. She said they'd keep Butch under observation for a few more hours, then I could pick him up and bring him home.
I couldn't believe how good Butch looked. He seemed strong and tugged at his leash, ready to get out of there. He came home without much fanfare except for enthusiastic greetings and all-over sniffs from Levi, Lucy, and Oliver, then made his way to the backdoor to go outside and relieve himself. By the time he came back in the house, he had reoriented himself, knew exactly where he was (well, as exactly as he ever knows), and began nosing around in the kitchen. It was suppertime by then, and he was obviously hungry.
Butch's first few post-surgery meals were limited to chicken broth and small amounts of rice. He ate every bite and was clearly unhappy about the meager quantity, so as soon as we knew for sure that one meal had settled nicely in his stomach, we fed him again. He cried a little that first night, but I was never sure whether he cried from pain or from hunger. His mouth bled a little that first night, too, but not nearly as much as it did before. I was encouraged.
By yesterday Butch showed no signs of pain and could eat a full quota of his new regular diet. He will never again in his lifetime be able to eat anything of a harder consistency than oatmeal. The tumor in his palate is fragile, and any slight pressure on it will cause it to bleed. That means the spoon-feeding has to stop, because the hard metal edges of the spoon can cause damage. Fortunately, Butch has been hungry enough that he hasn't hesitated to push his muzzle into the bowl and gobble for all he's worth.
Butch is what he can never have again: one tough cookie.
Today he is eating well, sleeping well, showing affection, and asking to go outside when he needs to. When he comes back in the house, he waits patiently for a treat, and he doesn't seem to mind that the treat is soupy or soggy. The bleeding hasn't yet stopped entirely (a certain amount is to be expected after oral surgery), but it has diminished to manageable, non-repulsive proportions. A short time ago, as he slept, I pulled out a tube of braunschweiger (liver sausage), which is what I'm using as both a disguise and a soft coating for his pills. As soon as I opened the wrapper, I heard his toenails hit the floor, and in seconds he was standing beside me, sniffing expectantly. If he's doing this well two days post-surgery, I think there are more good days than bad ones in his future.
As my daughter Kim pointed out to me, the prognosis of a three-to-six-month life expectancy for a dog Butch's age, especially if those months are likely to be comfortable ones, is not too bad.
(First published at Velvet Sacks on January 15, 2012.)
