Friday, August 11, 2017

Our Journey With Mast Cell Tumors: a Very Dear Boston Terrier

ivan at the south rim- argus


July 2, 2004 - July 14, 2017

Perhaps the story of Ivan's mast cell tumor, which eventually ended his life, can provide assistance or comfort to another pet owner going through the same thing. In the past year I learned more about mast cell tumors than I ever wanted to know. Essentially an allergy in tumor form, it's comprised of mast cells, the body's natural response to allergens, but in such an abundant and overzealous state that it's a bit berserk and prone to becoming cancerous. It's a sadly common condition in Boston Terriers like Ivan, as well as fellow smush-faced breeds like Boxers, Pugs and Bulldogs. Mast cell tumours also occur frequently in Beagles, Weimeraners and Golden Retrievers. I even know folks with Ferrets who've had to deal with this issue.

They're a pretty common problem. They aren't always a death sentence. In fact, most times they're not.  Frequently they can easily be surgically removed, and frequently they don't spread. As the vet put it, "Mast cell tumors are always malignant, but not always metastasizing."

Googie Ghosttown Ivan
Route 66, Amboy, California, February 2007

What a sweet, handsome silly-head.
Ivan was a prince among dogs, so full of pure joy and great gusto. Boston Terriers are known as the "American Gentleman" since they come ready-equipped with a tuxedo.

Big Face Ivan

The Ivan story begins when I was a kid.

My dream of owning a Boston Terrier was inspired by a vintage cast-iron doorstop my grandma owned. Such a handsome, 1930s -lookin' pup. Tough, unwavering, that little metal Boston Terrier. It enchanted me. It wasn't until I was 32 years old that the dream became a reality. I saw a "Boston Terrier Pups" sign hanging somewhere in my view, the kind with the pull-off phone numbers. I called and soon after was headed out to Rimrock, AZ about 20 miles from home, to meet a little male pudgeball called "Winston", the last unclaimed puppy from the litter born July 2nd, 2004. He was not quite 8 weeks old and not quite ready to leave his mom. We paid a deposit for him and upon returning from a trip to Chicago we picked him up in a dentist parking lot in Cottonwood.

ivan as a puppy, sept. 2004 

He was bashful at first, but it wasn't long before he was in his full, exuberant goofball glory.

Yosemite Ivan
Yosemite National Park, California, 2005
Ivan was a great traveler and joined us on all of our adventures. He was an excellent road tripper, hiker and kayak passenger. He even flew on a plane and went through airport security. He aced it all.
He went to Utah, California, Florida, Texas, New Mexico, Colorado. He hiked canyons, scaled mountains and cooled down in rivers, He got salty on seashores. He slept in tents and cabins and strange motels in odd towns.

Wherever we went, Ivan always attracted admirers because he was such handsome, beautifully brindley, well-built and friendly guy. And there is such affection for Boston Terriers from folks who have had one in their past, or just have a genuine fondness for them as a breed. I mean, we thought our Chihuahua Floyd was the cutest thing ever but he was chopped liver next to Ivan when it came to outside admirers. People didn't give Floyd a second glance. It was Ivan they wanted to touch and talk about.

dogs on table 2 

dogs and their portrait2

For a long time it was just Ivan and Floyd, one year his senior.
And a big cat. Clyde for a long time. Then when Clyde died there was Ned.

all the pets on a tuesday afternoon

But as far as canines, it was that way for almost 10 years, that dynamic duo, Floyd and Ivan.

In 2013 Hazel the Chiweenie showed up. 

group portrait 

And in early 2014 there was suddenly Simon. 

size order 

We were a four dog family! (?) ! It was a bit nuts sometimes. But, they were a pack and loved each other. Even with the tangle of leashes and everyone sometimes going in different directions, all four went with us everywhere. We planned ahead, picking pet-friendly trails, lodging and locations, paying extra surcharges when necessary.

6 24 my new favorite group photo of the dogs - at colorado river along utah highway 128 

Ivan was such a good sport. He never complained about anything.
And he put up with all of my artistic shenanigans!

hair of dog 2

blue-eyed ivan

Ivan's only flaw, perhaps, was his immediate dislike for strange dogs. He got really intense and a bit aggressive towards other canines he didn't know. In the park this was sometimes a problem. We had to hold him back and pull him away. He never bit or hurt anyone, but sometimes the look on his face just seemed a lil' deranged.

However, he did have dog pals beyond our home, like our friend's Pointer mix, Loosey who he had a crush on, and our buddy's Miniature Pinscher, Harrison, whom he adored.

pals 4 sure 

He also knew and loved Chad's folks' dogs, Blossom and Mary.
So it wasn't really a "problem". Once everyone calmed down about that crazy face he made (us included) and they got to know each other a little he was fine.

all 5 dogs!

Really, any dog who ever met Ivan ended up adoring him. He was everyone's favorite.
Case in point: when puppy Simon showed up it was obvious early on who he considered his favorite big brother.

sleepy time close up 

ivan and simon in the kayak

And now to the sad part of the story.

The mast cell situation can be perhaps traced back to Ivan's funny allergies. He was the only dog I ever knew to get hives! The first time it happened he came in from the yard with his entire body covered in odd bumps and his face all swollen. We don't know what he got into but took him to the vet immediately. Benadryl soothed him back to normalcy. He got hives maybe two or three times over the years and we were never sure what set them off-- a bloom, a bug bite, something he ate? It happened in places other than home, too, notably once along a road trip home from Utah. There was no common thread or clue.

Around the time Ivan turned 12, in the summer of 2016, we noticed a new thing --a swelling on his belly, like a big mosquito bite in the crease next to his penis. It seemed to ebb in size and color. Some days it got bigger and redder and other days it receded some and looked benign, like a fatty lump. When he was a young dog he'd had a benign tumor removed from his belly so we thought it might be more of that.

mast cell tumor

The tumor's strange and changing behavior indicated to the vet it might be a mast cell tumor, so she aspirated it with a long needle and microscopic view of the cells confirmed it. I had read a bit about this condition already since mast cell tumors are so common in Boston Terriers, so I wasn't surprised.

Due to the delicate location of the tumor, adjacent to all of the complicated structure of his penis, his "advanced age" and his bracheocephalic (smushed) face, Ivan was not a great candidate for surgery.
The young vet suggested instead we "manage" the tumor with a daily dose of antihistamines. Our other option was to drive two hours to Phoenix to consult with a surgeon we didn't know and spend thousands of dollars to have this elderly dog operated on. This did not sound like a great option for Ivan or for us.

He got Benadryl once a day at lunch, and sometimes two if the tumor was flaring up. It usually helped. We had no idea what the histamines in the tumor were responding to or what his actual allergies were. He already had been on a grain-free diet for a long time, but we also stopped feeding him any fish as that supposedly aggravates mast cell tumors.
We also added Vitamin C powder (Ester-C capsules broken open over his food), and gave him CBD oil.

For a couple of seasons the tumor was more or less "managed".
His regimen of supplements and Benadryl mostly worked.

Until it didn't.

mast cell tumor- very aggravated 

In April of 2017 the tumor got very angry very quickly, in a matter of a day or two, and swelled up far beyond what it ever had before.Ivan, normally never one to complain, seemed miserable and in pain. We were in a panic for him.

sad ivan, malignant mast cell tumor

At the vet I asked for a second opinion from a more senior vet in the office--the one who had removed the benign tumor from his belly during his younger years but had since been relegated to taking over all of the "big dog" patients, leaving the small dogs to the younger vet.

The older vet agreed to "debulk" the tumor in early May, with no promises that the mast cells hadn't already extended beyond the area she could surgically remove. Truly clear margins were not an option for him due to the location, which risked him becoming mutilated and/or incontinent. If the tumor was a medium or high grade in pathology it was fairly certain it would return, and possibly even angrier than before.

For Ivan we thought it was worth the gamble to give him a better quality of life. Whether he survived the surgery or not, the situation as it was was unsustainable. Having the mass removed was moving forward. It was doing something...anything...and we had huge hopes it would help him.

As it was, we were dealing with this tumor's wildly fluctuating behavior daily. Ivan had to wear a cone almost all the time to stop licking the tumor (aggravating it worse). Steroids were prescribed and that kicked the swelling down some prior to surgery. The thing about steroids though is they're kinda terrible.
1. They cause acidic stomach which meant he had to add a Pepcid-type med to his regimen (at a different time than the steroid which the antacid negated the absorption of) and
2. They also made him so thirsty, causing him to drink and piss a ton. A few times he peed his bed while sleeping, or peed on the living room carpet during the night. We'd wake up to him looking so forlorn and humiliated by this. It's against a good dog's nature to urinate in the house, even when he can't control it.

 Ivan, 4/28/17 

We put all of our positive energy into his operation. I started a fund for the surgery (nearly $700) selling 14 Ivan portraits for $50 each. I sold them faster than I could paint them because our friends and family are awesome. Everyone wanted an Ivan portrait. Everyone wanted to contribute to the good energy and power of positivity. I ended up painting more than 14 Ivan portraits due to the demand. His surgery was more than paid for. It was quite overwhelming the emotional and financial support we got from folks for Ivan.

Focusing all of my extra energy on making the paintings was also a good distraction during the weeks leading up to the operation.


Ivan's surgery was bumped up a week, from May 15th to May 8th and all went well.
He survived the anesthesia and came home looking very strong! The doc did a great job. Neat surgical scar, tidy and quiet. We were so happy.

Post surgery- Ivan


About a week after the surgery the vet called with the pathology report on the tumor. As she suspected, it was very "high grade" (which though sounds good is exactly the opposite in this case) and chances were probable it would return. This was very disappointing to hear, though not unexpected. It did take the wind out of my sails a bit. I tried not to think of it, as if ignoring it I could somehow "block" the tumor from coming back. "It's not gonna come back," I thought conjuring up all of the positive energy we had created and had been shared with us, like a force field.

Ivan got his stitches removed and no longer had to wear a cone. He was like a normal dog again....for now.  We loved on him and hugged him and brought him along on all of our adventures as usual, as if every day could be his last. (This in fact, is how we loved him every day of his life so it was truly nothing different).

Ivan and Chad

He had a good month or so before I noticed odd swelling stirring up again in the vicinity of where his tumor had been. Along the scar line there was now a small constellation of lumps, like an island chain. Like Hawaii. No longer one specific lump, or one specific side, it was now the entire area. It seemed to flare up and then subside. Flare and subside. It was the same but now somehow worse. We got a supply of steroids for him to use when it swelled and they worked for a little bit.
Until they didn't.

I continued to research options. There is some new drug called Palladia that we can't even get in the Verde Valley yet, but besides that its track record was pretty bad. Like 10% chance of success. I did lots of reading. We even tried something I found recommended online from a holistic vet: a mix of Asian herbs called Xue Fu Zhu Yu Tang, or "Drive out Stasis in the Mansion of Blood Decoction."
Hell, why not?  I mean it was like Andy Kaufman in Man on the Moon-- we tried conventional medicine, alternative medicine, holistic medicine, surgery, supplements. We gave it our all. 
But in the end, we failed Ivan. We tried not to second-guess ourselves too much, but I wondered if we'd been more aggressive about surgery early on might we have nipped it in time?

ivan- post surgery follow up

The tumor indeed had come back and mutated into some big overall swellings surrounding his penis on both sides now. Back on the steroids, back with the cone on his head (though this time we got him a comfier "donut").

We called friends more than once to "say goodbye" but Ivan always made a comeback. We were hopeful. He wasn't ready to go yet. 

However, over the course of his final month the "good periods" got shorter and farther apart.
The swelling, discomfort and painful times got longer and closer together. The steroids no longer worked. Then came the day when he had a hard time walking up the front steps and the look on his face just told me it was time for this to be over.

Ivan's not doing so hot

Last photos of Ivan
Ivan's last day
Tears poured from our reddened faces as we took Ivan out to the car to head to the vet to have him euthanized. 
Chad, standing by the driver's door, reluctant to get into the car, since that meant we would drive away to Ivan's death: "I'm not ready to let him go."
"Me neither!", I cried, while trying to be strong and logical (and convince myself),"We'll never be ready! But he's suffering now and we have to let him go."

The vet said we were the best kind of pet owners because we made the right choice for what was best for Ivan even though it was such a difficult choice. She said she knew how much we loved him. She knew what a sweet dog he was and said everyone at the office loved him. Still, her kind words, while a soothing balm for our sadness didn't make it any easier for us. He was very subdued, like he knew, like he was ready to go, laying across my lap. First they installed a needle port in a vein. The doctor administered the first shot, one to relax him, followed by the shot that would end his life.  I was holding him when his heart stopped beating.

We wrapped him up and a cloth bag we'd brought and held him close as we exited the side door of the veterinarian's office. As soon as we reached the fresh air outdoors we were suddenly nearly incapacitated in bottomless sobs, the kind coming from some deep place below the earth. Oh Ivan. Poor Ivan. He didn't deserve to go out like this. He deserved to die like an old dog-- blind, arthritic, bony, slow, tired, and in his sleep. Ivan, though technically elderly and in his twilight years, never acted like an old dog. He was youthful and rambunctious until the tumor took that from him.

ivan 2007 ivan 2017
Ivan 2007 and 2017
For many Ivan was the best and most beloved of all of our dogs. Friends adored him. Chad's mother said, "Ivan was always my favorite." We were so outnumbered by pets it didn't fully occur to me the huge place he took in our lives and home until he was gone. His burly personality and energy was a balancing force to three tiny dogs and one big cat he shared our house with.

When we got home from the vet we put Ivan's body on a sheet in the yard so the other dogs could say goodbye. Floyd, age 14, lingered the longest. He and Ivan had been together a long time. Then we buried Ivan under a eucalyptus tree in the side yard, in a hole we'd dug a month earlier and in a cantaloupe box we'd saved to use as his coffin. We buried him with his food bowl, a favorite toy, and one of Chad's favorite photos of him, snapped at Yosemite National Park when he was 1 year old.

For days after he died I was still looking for him, still grabbing his leash by mistake, at lunchtime still looking for the 4th dog food bowl before realizing I'd buried his bowl with him and he was gone.
Sometimes it felt like he was still there, bursting out of the front door.

rest in peace, Ivan

But, every day he seemed a bit further away. I thought, "Soon every last hair of his will be vacuumed up and all of the dog blankets will be washed clean of his scent". 

The dynamic of our home shifted without him. His absence casts quite a shadow. 

In general our happy memories keep us buoyant. I try not to think about it too much, but every now and then something random strikes. A sweet photo or a poignant memory or the realization Ivan is not standing in front of my breakfast plate watching me eat as he did every morning before I left for work.
He also used to use his front foot to tap me like a button when he wanted attention, pawing at me as if to say, "Hey. Love me."

I certainly can't listen to the Flaming Lips "Do You Realize?" without completely losing it.

"Do you realize?
That everyone you know
Will die.
And instead saying all of those goodbyes,
Let them know you realize that life goes fast.
It's hard to make the good things last.
You realize the sun duddn't go down.
It's just an illusion caused by the world
Spinning 'round."

Ivan, you were the best. What a good boy. 
Always game for any adventure, always the first one to bound out the front door, always staring at me while I ate my breakfast. Always wanting to snuggle next to me while I watched the news. Snoring, farting, Howling at the phone when it rang.
We are so happy to have had you in our lives for so many years.
I am sorry we couldn't give you more time, friend. 
But the years we had, oh what fun they were. 13 is a long time. 
Your legend will live on forever, in the memories and photos and paintings that make us smile.

When we were going through this with Ivan I wished I had found a story like this, about someone's journey with this horrible health problem. It would have provided me some comfort and perspective during the struggle. That's why I wrote this. To help provide some comfort to another suffering pet-owner. I hope this story helped you, dear reader.

13 years of Ivan

ivan sox

Flagstaff to Chicago on the Southwest Chief: Part 1

Riding the rails cross country is somehow both familiar and completely foreign. Though the landscape may remind you of road trips past, the tracks wander loose from highways and veer into the unknown, through canyons, backyards and farm fields. And though many elements are the same as airline or bus travel (cramped bathrooms and sloppy sinks, sitting next to strangers, long hours and delays) a train trip is a completely different animal; its own wild and romantic universe.  

Amtrak’s Southwest Chief only tops about 60 mph at its quickest, a speed ideal for humans to process, so the first few hours of the trip east to Chicago is an easy preamble. I stretch out, decompress from the previous night’s nervous arrival in downtown Flagstaff.

First leg of the train trip- Driving to Flagstaff, 50 miles.
It’s a scenic 62 mile drive in a vintage yellow car from Clarkdale, anxious across a blazing hot summer valley and then calmingly cooler up the rim into the high country. 
Train #4 arrives from the west around 4:00am, when it’s on time (which is seldom). Due to the wee hour and nerves about hitting an elk in the dark or having a mechanical breakdown and missing my train, I drove up the night before and lay my head in a tiny room at the Weatherford Hotel til train time.  Amtrak has a long term parking , free, and a short walk from the depot in an unwatched, fenceless lot behind a bus turnaround. We’ve lived in Flagstaff and know it tends to be full of wandering weirdos especially during the summer season. I put faith in the universe that a hobo won’t take up residence in my Karmann Ghia during the week it’s left unattended, but it’s hard to walk away. I check the locks too many times. I stop and gaze back to it as it gets smaller and smaller, with just a street lamp to keep it company.

6-17- hotel weatherford long exposure- 24 seconds

The Weatherford Hotel is a Flagstaff classic. Built in 1899, it exhibits so many wonderful historic features: tall ceilings, transom windows above the doors, comforting smells (reminding me of many old buildings I have known and loved), creaky staircases, lovely downtown vistas, wrap-around balcony, great location. I loved all of this. Flagstaff is a college town and the hotel and bar staff is young and friendly.  I stayed one night in room 59, adjacent to the Zane Grey Ballroom. The management had warned me when I booked this room that though it was their most economical it was also potentially their noisiest. That said, the room wasn't noisy because of the Zane Grey Ballroom-- though that bar did slowly start to build to a crescendo around 11:00pm, it was a steady, flat din that didn't bother me. Mainly the room was noisy due to the Charlie's bar below. There was a thumping baseline of loud music and crowd sounds, though as customary in downtown Flag, the worst noise is people shouting on the streets til 2:00am. That's what happens everywhere in downtown Flagstaff. I worked at the Hotel Monte Vista up the street years ago and we received the same complaints from guests then. Young people having tipsy conversations at amplified volume on the sidewalks late at night. All of downtown is like that. There is no train noise to speak of, just loud humans shouting to each other. Despite the clatter and commotion outside the open summer window, the experience of spending a night at a classic hotel was not negateds. Eventually those bar folks do simmer down and stumble home. After 2:00am the streets grew quiet.

6-17 hotel monte vista neon- sx70

Before bedtime I enjoyed a Lumberyard Red Ale (brewed just the other side of the tracks) on the balcony with some new friends, Flagstaff locals who invited me to sit and talk with them. Nice cool mountain breezes and fun conversation about changes in town we'd seen since the 1990s. The Weatherford is classic Flagstaff, a focal point for visitors and locals alike.  I had fun hanging out at the Weatherford for one short summer night. It is a "real" place.  And one beer, at 7,000 feet, is equivalent to 2 beers at 3,500 feet, my usual elevation. 
Right to my head. 

At pre-dawn I gathered my gear for the short walk to the train depot, with my printed e-confirmation in hand. The boarding procedure is kinda whack. Nobody checked my ID or suitcases at any point on this trip, which made me nervous in a TSA/Homeland Security kinda way. Sure it's a pendulum swing way back in the other direction from airport security-- I didn't have to get x-rayed or take my shoes off...but do they really know who is riding that train and what they're carrying with them? Seems like a serious security breach bound to happen.

6-18 morning at flagstaff train station waiting for the southwest chief train 4 (late!)

The train is late by nearly two hours and the sun is up by the time it arrives. Traveling solo I'm curious about how I'll be seated and the people I will meet. A few passengers exit, Flagstaff their destination, freeing up seats for the dozen or so travelers waiting track side. The conductor directs those heading to Chicago towards the rear of the train, the final car for the final destination of Train #4. They have a process, a shorthand, to keep track of passengers and departure points. People exiting in New Mexico and Colorado were seated more towards the front, Kansas and Missouri towards the middle and folks bound for the Windy City at the very end of the line. 

My ride to Chicago

I was assigned a window seat next to a father traveling with his grade-school age sons. Kelly, a former Marine, an artist and sometime poet and rapper, rode Amtrak to California every summer to collect his sons for their annual summer visit to Berwyn, Illinois. They were on the second leg of the trip, back to Chicagoland. 
Trey, Kelly and Jaden

Handsome, polite and friendly, gentlemanly Kelly was the ideal person to be seated next to on a train ride, and I enjoyed talking with him for hours, til I developed a kink in my neck from looking sideways back at him in his aisle seat. His sons were seated across the aisle. Further up, a young bohemian mom traveling to Maine with her young daughter. Behind us, a wacky older woman, chattering endlessly about her trip to the Kiwani Club national gathering in Indianapolis. She was both overly social as well as socially awkward, as she's lecture people on various topics or butt into or trample atop conversations already taking place.