Help Charmer Fight Canine Cancer

With a tremendously sad heart I write that I had to send Charmer to heaven yesterday.  In brief, Wednesday after I took the fentanyl patch off him because he was acting weird, both extremely lethargic and distressed, no eating, bloody liquid stools, I thought he was having a fentanyl overdose.

So I took him to my after-hours vet, who determined Charmer had a fever, but the vet wanted me to go back to the surgeon for pain management care as he was afraid to prescribe meds.  All the vet did was do a stool check on Charmer which I thought was stupid to do for a dog that has cancer and has a fever.  In hindsight I should have told him to run a blood test, but actually since Charmer’s tumor is inoperable and bleeding so much, I don’t think that would have helped much.

But as I sat in the vet’s office waiting for the stool results, I immediately phoned the surgeon’s office that was about to close in 10 minutes and got them to slip me in the next morning to see him.

The vet gave me kaopectate for Charmer, as the stools were okay otherwise for parasites!  Yeah, check for parasites on a dog that is suffering terminal cancer and just got morphine and could be overdosing. Lame.

Anyrate I did give Charmer the kaopectate, but I also was observing how he kept bleeding from the tumor anytime he lay on the side of the tumor.  But I had hoped the surgery would remove that problem; now there was nothing but hoping he could hang in there long enough for another miracle with the vaccines.

When I put him to bed in his pjamas and blankey shirt and climbed in with him, I saw he was excessively licking like his paws, which I have to stop because it could make him bleed.  But I then saw he was instead licking at a deep spot of blood he just made. 

I had gotten 6 pillow cases earlier in the week to make fast changes of the bloodly pillow cases so his darling self would not be bothered with the blood stains and fall asleep with a new unbloodly pillow case on his pillow.

When I woke up to get him to the appointment, I was upset to see he had under him the largest stain of deep blood yet.  I took that pillow case with me as I wanted to see if the surgeon had any way to stop that ongoing bleeding.

Well when I took Charmer outside, his stools were all black and then he actually vomited, projectile vomiting, twice, brown liquid stuff.

Wouldn’t you know it that the Animal Hospital could not find my appointment when I went there with the surgeon.  It turns out it was their mistake and they fit me to see the oncologist instead. 

Her male nurse came in first and I asked him to check Charmer to see if he was having some kind of platelet or problems with all of his bleeding, as well as told about the fever, other symptoms, and asked about long-term pain management that did not involve narcotics.

The male nurse told me that the vomiting sounded like vomiting of blood.  Any rate he drew the blood with me holding Charmer.  The hospital was busy so they asked me to sit in the waiting room.

Well, the oncologist came out to give me the sad news that I was right about my worry if all of Charmer’s ongoing tumor bleeding is causing him problems.  She said he was a critically ill dog that had a severe low platelet count.  She said he was a dog that had to be admitted right away, or if I choose to take him home, I had to sign a release.  However, she told me there was nothing they could do for him.

I have read, though, that blood transfusions etc can help low platelets after chemo, or something that can, as this does happen routinely to chemo dogs.  She told me yes, but that since Charmer had an inoperable tumor, he would keep bleeding every day, and require a blood transfusion every day, and those costs $2000 each.  Because of that there was nothing they could do that would fix him.

I asked if she had anything that could make him comfortable until I could put him to sleep, and she said morphine.  But I refused that because I did not want his last hours to be spent doped up, not himself.

Just in case he got bad really fast, a couple of days I had pre-ordered a casket for him, and it was scheduled to arrive by yesterday afternoon (thurday).  Charmer was clearly severely ill.  He hardly wanted to move; he kept his head down.  He would drink water if I brought it to him, some, and I even got to insert into his mouth dollop size pieces of soft food he ate a little.

I didn’t want to see my baby suffering any longer,especially if he was weak from blood loss.  I have been weak myself from blood loss from a past botched surgery, and I know firsthand how horrible those feelings can be until you get help.  But Charmer was going to get no help.

So I was forced to call a vet that made house calls for euthanizia.  And I was forced, while my little baby lay in the house alive, to dig a 3 foot hole for his little casket, on only 4 hours of sleep, and in less than 2 hours, without any kind of physical fitness in me at all. 

I had to rush to take last minute pictures of him, unpack the casket that arrive 2-1/2 hours before the vet was to come, and in sheer exhaustion, try to spend a few quality minutes with my boy, who was so ill he had no interest in companionship, before I had to carry him to his death.

Above Charmer, less than an hour before he was euthanized.  If you know him, you could see the suffering in his eyes. 

He had his head hanging down before I took that picture and it took all I could to get him to lift his head so I could snap a final picture of him looking at me.  He wears around his neck my own personal scapular I had been wearing for over a year and took off and put on him so he could be euthanized with it on; not that he needed to wear a scapular to get into heaven, but it was the minimum I would do for my little furry son, set him apart from being just a dog, and put on him my most precious holy object as my most final loving gesture of the best protection I can give him in his passage from this world to the next.  

Right now, a full day later, I am trying to cope; but one way is by denial.  I can’t yet talk about him verbally in past terms, it is too painful.  I talk about him as if he is here now.  I carry around with me the clippings from his precious little paw hair and ear hair I took right after his euthanisia, and take moments to breath in his scent.

I have spent some of today, looking for local pet breavement specialists, and seeing what my health insurance covers to help me deal with the awful grief.  I then spent an hour shopping at amazon for a dozen books on dogs survive death, do dogs go to heaven, proof of survival for dogs, surviving the grief of your dog, as I will need a boatload of that kind of hope to get through this. 

I am also going through the pictures I had my husband get develops at our local store rush today that I took of Charmer yesterday, and keeping some of them on my computer so I can switch from time to time to some of the pictures that let me look into his eyes, see his beautiful little furry body. 

The most important thing to me is I do not want him to become a memory, like all my other pets.  I am fighting that as hard as I can.  I actually hope I have the same good fortune as Ana Nicole Smith who only spent 5 months of grieving her son before she collapsed and passed on herself and hopefully joined the arms of her son.  Believe it or not it makes me hopeful that through natural causes I too might not have to grieve too long and can be once more looking into his deeply loving eyes so confident of my own intense love for him.

I know I did everything I could, and that helps a little, but that is all.

First off, I have to say one thing about the surgeon, he is honest.  I appreciate honest, but I didn’t like what he had to say.  I came in with my list of 20 questions, ready to ask them, but Dr Aronsohn said he first would tell me what he had to say about it and maybe that would cover a lot of the questions up front.

He told that when he looked at Charmer’s mass last week, he said to Dr Dibernardi that it was an aggressive mass.  He told me what I already, unfortunately, know about malignant melanoma, that it is a very aggressive kind of cancer that usually spreads to other parts of the body.

I asked him if he had removed this kind of mass in the back of the mouth.  He told me that he had, but not of the same kind of cancer, but ones that were slow growing.  He said that what Charmer needed was a way for his body to fight off the cancer that would grow back or appear else where.

I asked him if this were his dog, would he do the surgery.  He told me with a solemn face that no, he would not.  I then asked him what would he do for his dog?  He said he would put his dog down.

I asked him he didn’t think he could remove it?  He said if it had invaded his eye socket and some other area I can’t remember, that it would be inoperable.  He said only a cat scan would tell him that.  But he commented that he could visibly see the tumor from where he was.

He said if it was not in those places, he could do the surgery.  But he said that even when they remove tumors totally, they appear again, elsewhere, or in the same place, that metastasis part.

I told him then that Charmer was to participate in a University of Wisconsin trial for a melanoma vaccine that got the immune system working.  I told him that it worked for 40% of the dogs, that I was looking to buy Charmer 3 to 6 months without the tumor to see if he would be one of those dogs that responded.

I told him, however, that the vaccines take 1 to 2 months to work, if they are.  So a dog needs to have the tumor small enough or under control, so the dog can live long enough for the immune system to work, if it will.

I told him I understood that it would grow back, but I was looking to get him extra time, but right now he wouldn’t have it with the tumor the size it was now.

He asked me when I first saw the tumor and I told him the day before Christmas it was the size of a grain of rice.  He made a face of surprise and said, a grain of rice?

I then told him how I first thought he had a tooth infection and that the vet had instead said no it was a tumor.  I told him then how I had scheduled a biopsy, and after the biopsy that Dr Dibernardi said we had to wait 2 weeks before beginning the radiation.

Now that got a surprised look from him.  He asked me why we had to wait, as if that was odd and not the thing to do that could have cost Charmer precious time.

I said that the oncologist said Charmer had to wait 2 weeks for his biopsy to heal because the radiation would interfere with healing. It seemed to me that Dr Aronsohn was not buying that, but said nothing else.

I asked him how much a ct scan would cost, while thinking to myself that I had read another person had written online that it had cost them $1500 to have a ct done on their dog.

He said $1000 as that included anesthesia.  He said if they did the cat scan and found that it was not invasive they then could proceed with the surgery.  I asked him if doing it with the surgery then would reduce the anesthesia cost in the surgery quote he gave me.  He told me that the anesthesia was billed per hour and that Charmer, if he was a candidate for the surgery, would be under 3 hours of anesthesia from doing the cat scan to the surgery itself.

He told me he would call after the cat scan results to let me know the situation.  If it shows invasion then no surgery.  And he said I would then talk to Dr Dibernardi.

Wow… Before he had come in I had said prayers to give me nerves of steel, but as I sat there feeling a panic attack trying to come on, I didn’t feel any steeling of my nerves.  So either heaven was out to lunch at my request time, or I needed a lot higher dose of nerve steeling than God had sent down.

If Charmer didn’t look at me with such life in his eyes and happiness as he enjoyed barking at the dogs in the reception room, it would be easier to euthanize him if it came to that.  But the image of his precious face looking at me, cute as can be, with his little head with the shape of the top of a small heart, and his beautiful little gleaming almond shaped black eyes, makes it seem criminal to snuff his life out.  Even when I think of the bleeding mass in his mouth.

I have already written to a few people before I posted here, and I was encouraged to at least go through the ct scan.  I feel that way too, as even if the worse news came, at least I can live on with the clear conscious that I tried my best, and I know for certainty nothing more could be done, without having dragged Charmer on some painful losing treatment schedule.

I ask for anyone reading this now to please say a prayer for Charmer, for some miracle to occur that he does not have invasive filtration.  And I am also going to put in some prayers requests to some prayer warriors on that note.  I am not going to take this sitting down, to fight the good fight.

11-1/2 hours from now I will be sitting with Dr Aronsohn, DVM, asking him if this were his dog would he do the surgery.  I am also following the advice of Dr Kerri Schwartz from Montgomery Texas who told me, just in case to withhold food from Charmer tonight if the surgeon can do the surgery right away, as every day counts with fast growing tumors.

Dr Schwartz, along with several other people from around the world, have been providing me with excellent personal support, advice and their own experiences with their dogs that have gone through the same cancer as Charmer or the same procedures.  Without their help, I would still be lost and confused.

The last 3 days a lady from California has been sharing with me the story of her dog that had oral cancer and how she did undergoing a radical risky maxillectomy.   Her experience has been a great help to me in understanding what to expect afterwards at home.  I am happy to report that her dog is now 9 months past her maxillectomy, happy and well, and back to chewing on rawhides, completely impervious to her now slightly crooked nose that her upper canines are gone.

Dr. Schwartz lost her dear dog, Piggers, to melanoma.  She, too, enrolled Piggers in the same Wisconsin Study Charmer will be in, as well as the New York study, but she told me that Piggers already had the cancer spread to her lungs when she started.

I hope that Charmer does not experience metastasis in his body during the wait of the surgery and starting the vaccines.  But a veterinarian researcher at Wisconsin told me that even then, in the dogs that do respond,  the vaccines have been shown to halt the growth of the mets (metatasis) and even shrink them, some completely.  So at this point I do have hope.

I have to now find a way to print out my list of questions for the surgeon tomorrow that Dr Schwartz actually helped me to put together with a couple of really excellent questions to ask to decide if this is right for Charmer.  I say find a way to print it because my printer’s ink cartridge is bone dry and the replacement cartridge I ordered hasn’t come yet, so I will be doing a rain dance over that bone-dry cartridge while I shake and wiggle it over the garbage can to root loose enough print powder to print the 1 page.

Right now, though, it doesn’t seem there is any other hope besides this drastic surgery to heal Charmer, other than a bolt of light shooting down from heaven onto Charmer’s face and evaporating the mass from his mouth.

My mission tonight with Charmer is to stuff his belly with one good, high calorie food that can carry him through his initial surgery, if it takes place tomorrow.

The worse thing about this is all of the delays to get him timely treatment.  Now it seems clear he will need that maxillectomy surgery, where the surgeon takes out part of his jaw bone, only because of the fractured rear molar.  I ran out of sunlight to take a picture inside of his mouth, but it is not pretty to look at.

A 6 mm size molar tip has floated to nearing the center of his palate from the mass carrying it there.  I can tell that it rests on his tongue when he closes his mouth.  Creepy and awful.  I know I would be freaked out if that was inside of my mouth, and that is with my having full knowledge what it was.

The earliest appointment I could get with the surgeon is this Monday morning, and that is only to consult.  I really hope that if he says he is confident he can get rid of it with a good result for Charmer afterwards, as far as quality of life, that the surgeon gets it done the next day, because each day I see this thing growing and spreading across his palate.

I wonder how in the hell the surgeon is going to close up his palate if the tumor creeps too far?  I would think this is an emergency due to the time factor.  But it seems as if Charmer and I are falling between the beaucracy at this clinic, to make an appointment, wait until the next avaiable appointment, yadda yadda yadda.

Of course I am scared about this kind of radical surgery, but, trust me, the tumor is much more scarier to just leave in there, to do God knows what!?

I read the story of a border collie mix that had a different kind of oral cancer, but had to undergo a maxillectomy of the front upper jaw.  The dog recovered within a matter of weeks from the surgery, but did need to have at-home morphine to deal with the pain.  I hope that Charmer can have a similar happy surgical end.  I am just really worried about all of the time delays, where in the meantime this tumor just creeps along!  Cancer does not wait for anything or anybody!

2:58 pm I got the call from the Animal Medical Hospital that Charmer was ready to be picked up.  I was anxious as I didn’t know what condition he would be in.  Would he be in bad shape from the anesthesia as he was after his biopsy?  Would he have any pain from the procedure, having his jaw propped open?

When we got to the Animal Hospital, we were pointed to go to the Checkout line, where 2 other pet owners were standing to pay their pets’ bills.  In this hospital you pay first before they release your dog.  No money, no doggie!

After we paid the $893 radiation bill, which included an inhouse evaluation of Charmer for maxillectomy major by the surgeon, the checkout clerk called in the back for Charmer to be brought to us. 

Well I was amazingly happy to see him happy and bouncy, in better shape than when he had come in!

In the photo above he hadn’t yet spotted me and was coming down the hospital hall, passing the front desk.  The radiation technician, Lisa, was leading him over to me.

Lisa, from what Dr Dibernardi had told me, has had 20 years working as a radiation technician.  Lisa told me that Charmer had even eaten a little bit of canned w/d and a/d mixed together.

I asked her if I would notice any kind of changes in his tumor.  She told me generally not with the first treatment, but with the other ones. But she then joked, “You could end up telling me that it shrank by 50% by the end of the week, you never know!”

I was glad to learn that Dr Dibernardi had arranged for the surgeon to look at Charmer while he was doing the procedure, and give his evaluation of a possible surgery.  I had hoped to see if the surgeon could do it next Tuesday when Charmer has his next radiation, but Dr Dibernardi, thank God took care of that on her own.  I left with an estimate of the surgery that I can bring in when I meet the surgeon in person next Monday.

Now I am not committed to a major surgery, I want to see if the surgeon would feel this would be beneficial and a wise surgery to do, and not along the level of trauma the race horse, Barbaro, suffered without any resolution of his problem.

Also, if it turns out that the tumor does indeed significantly respond to the radiation alone, and if the surgeon feels that the surgery would not have any significant difference, that will also determine the course of treatment.

The surgeon quoted a price range of $2427 to $2912, and that would require a 3 day hospital stay.  Already that doesn’t sound good, the 3 days, that is.  But it is a major maxillectomy, so that would make sense.  If it would involve feeding tubes, I don’t think so!  But Dr Carmona told me a couple of weeks ago that it is surprising how well dogs do recovering from that kind of major jaw surgery.

I just came back from dropping Charmer off for his first radiation treatment at the Animal Medical Center.  Charmer had fun barking at all dogs in the waiting room, and people as they strode by.  Before I left my house, I took a look inside of Charmer’s mouth.  I could hardly sleep last night, fretting about how his tumor has grown 50% in size in the last week.  When I originally saw it the day before Christmas, he had about 2 small growths on his palate, each the size of a rice grain.

Now those growths have grown together and are 1/4 on the way to the center of his palate!  His rear molar has been partially dislodged by the tumor growth, so part of the teeth are loose in the tumor.

I suspect this sudden tumor growth has to do with the fish oil I gave him that is loaded with vitamin e.  Vitamin e is a blood thinner, and, guess what?  Tumors feed on blood, and this tumor has lots of veins.  Dumb me did not think about this happening but after the fact.

Why do I think it is the vitamin e?  Because since I spotted the tumor, it had been slowly getting larger, slowly.  Then, bam!  Within 24 hours of my giving him the fish oil loaded with vitamin e, the tumor suddenly grew a perceptible 1/6th in size.  Again, dummie me did not make the connection, and was giving him the fish oil in his food another 2 nghts.  Well, as each day passed, his tumor would again add a significant size, till in 4 days time it had added the size of a walnut which can be viewed in his pictures gallery.

I was wracking my brain trying to figure out why the sudden growth spurt?  I was also trying to figure out why the sudden blood spotting when his surgery seemed to be healing so well the first 7 days.

That is when a light bulb went off in my head:  I remembered when my husband had prostate surgery.  He kept having persistent bleeding the first 2-1/2 months.  We were going nuts trying to figure out why he kept bleeding, and started to try to eliminate dietary as the cause.  Finally we found that the vitamin e in his vitamins was the culprit.  We eliminated the vitamin e and the bleeding stopped within a couple of days.

Since then I have been to surgeries with family members or myself, where the medical community now advises pre-surgery to not have any vitamin e as this will increase bleeding.

That is when I connected the problem my husband had to the bleeding Charmer suddenly had since I started the fish oil.   That is when I looked at the ingredients in the fish oil and saw the vitamin e had been added.

I immediately stopped the fish oil, which I had been giving as recommendations as a good source of omega-3 oils.  Within 48 hours his blood seepage stopped, just as my husband had experienced.  But it wasn’t until a day after that, that I realized that the blood thinning properties of the vitamin e probably had open a flood gate of blood to the tumor, which blossomed under it.

If I only had thought of that in advance, I never would have given it to him.  And the tumor was growing steadily then, visibly by day.  So I got some vitamin K in hopes to cut off the vitamin e’s effect on the blood supply.  Fortunately within 24 hours the tumor stopped growing.  But sadly it has gotten in that time to almost 50% larger than it was a week ago.

That means that all the mass that my veterinarian had cut out on the side was replaced by new one, and what was on the palate just tripled in size so that Charmer is repeatedly making chewing motions with his mouth as he tries to get the mass out of his mouth.  But of course he can’t.

Before that new growth, the tumor had been a manageable size that wasn’t bothering him nor was it visible at all in his cheekbone, when he had his mouth closed.  Now it is a clear bulge that is very uncomfortable to him.

So I was distressed when Dr Dibernardi told me yesterday that the radiation probably would not shrink the size of the tumor.  A week before this sudden growth spurt that would not have been a problem, but now, problem.

That was news to me, and I had a hard time grappling with that revelation.  I told her if it didn’t shrink, something had to be done otherwise because he is having trouble with it.  I asked her what about debulking the tumor.  She told me it would not work with him.

I then asked about the possibility of a radical surgery if the tumor did not shrink.  She felt it would not be an option.  Then I asked what kind of options were there, because he was not comfortable.  She said there were some kind of medications that could be given.  I don’t know if she was inferring to doxycycline which can shrink a tumor by reducing the blood supply, or just palliative pain and corticosteroids.

Since that revelation yesterday, I brought my shocked news to the endless love forum seeking any feedback from other pet owners that had dogs with the same melanoma.  I got pretty much the same feedback to seek another opinion and to seek the opinion of a surgeon, as my doctor is an oncologist, not the surgeon.

I had first been opposed to radical surgery because I am afraid it could be too traumatic for Charmer in the same way that Barbaros, the race horse’s, last surgery was too traumatic for him to recover from.  I certainly would not subject Charmer to such a trauma.  So I had declined Dr Dibernardi when she first met with me and asked if I wanted her to bring in a surgeon colleague for his opinion on radical surgery.

***I just had to stop a moment to accept the express delivery ups package from upco.com that has the enervite and dyne dietary supplements for Charmer.  Dyne is a liquid supplement that supplies high calories for a dog that is unable to ingest enough calores, and enervite is the same type of thing, but in a tube and looks like liquidy malt-colored toothpaste.  I did a palate test to see if it tastes yucky, but found it actually tastes good, and passed the taste test with my other 2 dogs that are not ill***

Back to today’s drop off story: But now that the tumor blossomed too quickly too large in the last week, and now that Dr Dibernardi informed me that the radiation most likely would not reduce the size to my surprise (and I say surprise because i have read in books on pet cancer I have gotten this past month, as well as online that even palliative radiation can noticeably shrink tumors), I now have to figure out what to do get that mass out of his mouth.

I am not okay with his living months, years with this big mass bothering him.  So I made an appointment with the specialist surgeon in the same facility so he can give me his honest opinion if a radical surgery would be beneficial for Charmer, and not a bad choice as it was a bad choice the last time for the race horse, Barbaro.  I have that appointment next Monday.

Dr Dibernardi met with me briefly out in the waiting room, along with the technician who would be perfomring Charmer’s radiation today, and let me know she would be referring me to have a consultation with the surgeon.  She was just surprised that I wanted to see one, letting me know that such a surgery would involve removing his jaw bone, and would cost in the ball park of $3000.

I told her that I had to at least consult with a surgeon, and that if I had to end up euthanizing Charmer down the line because the tumor got too large, at least I would have peace of mind I had tried all options and at the very least had talked to a specialist surgeon.

At that time, Lisa, the technician, came to get Charmer.  She asked me what he liked to eat as they like to feed the dogs when the radiation is over and the dogs come out of anesthesia.  I warned her that Charmer is very hard to feed, even for myself.  Before the tumor he has always been a picky eater, and I could present to him the yummiest prime beef, and he would have to give it a good sniff before deciding if it was anything worth eating.  Then once he decided it was a super treat, he would be eagerly following me for the possibility of more.

But since this tumor, he will only rarely accept even the yummiest of treats from me because his mouth is in pain.  So I have a lot of doubts he will be interested in anything less than cooked people food, and I doubt that the animal hospital has gotten to that level of feeding.  I told them pretty much that, but if he was going to eat, it had to be something very soft because of the tumor.

So I watched my little baby go off on his first radiation treatment, not willingly of course at first, but then he did give into the technician’s kind prodding.

Lisa told me it would probably be longer today then such treatments normally are because it is his first session, and gave me a ball park time of 3pm-ish.

Shortly after I got home, the research veterinarian at the University of Wisconsin gave me a call to answer the questions on the forms I had.  She calmed me that I would not have to worry that they would run out of vaccines or that the study would be closed off to new dogs at any point, because it is a rolling study.  That’s great, because a dog must wait 2 weeks after the last dose of radiation or chemotherapy to participate.  The reason for that is that chemo and radiation interfere with the immune system, and that would render the effects of the immune-stimulating vaccine worthless.

Okay, now it is time to feed my doggies at home breakfast as they were left on hold as I dashed off with Charmer for the drop off.  I didn’t want to feed them in front of Charmer who couldn’t eat before the procedure.

Today Charmer had an appointment to see Dr Dibernardi, his oncologist who will be doing his radiation treatments.  I had faxed her earlier a 4-page long list of questions.  Well there were 8 questions on it about the radiation and then a page asking her to give me an estimate on the Canine Melanoma treatments, with me outlining what the study required to be performed at each visit.

Yep, I was very nervous about possible bad side effects from the radiation related just to focusing a radiation beam to his upper palate area.  In the yahoo groups endless love for owners with cancer dogs, I had read a couple of people whose dogs either went blind or suffered cataracts from the radiation.

Dr Dibernardi told my husband (pictured above with Charmer) and me if he lived past 2 years, Charmer would get a cataract in his right eye which is the side the tumor is on.  I am not a happy camper with that, but it is much better than two cataracts.  Total blindness though, I am not okay with.

Still I asked her if the cataract could be surgically removed and she said yes.  I am getting the vibe from her she does not expect that to be a problem as she doesn’t expect Charmer to live that long.  Well, I hope to prove her wrong.  But even so I will be quite glad if he is around with me for another year or longer.

Just today as I looked at Charmer prancing into the yard, barking at a couple of ducks fighting in the lake, how glad I was that I didn’t just put him down at the diagnosis of cancer, because I really was grateful for each day I had him around. 

I do enjoy him so much that my last few days have been richer.  Why plunge myself prematurely into terrible grief without even trying?  To me the greatest crime I can do is to not try if there is any shred of hope for a positive outcome and my pet is still relatively comfortable.  Temporary disabling times like recovering from surgery is no reason to lose hope and euthanize my dog.  I have resolved that as long as I see that Charmer is enjoying his life and not in any irreversible pain or unresponsive, and I can have the means to give him whatever treatments he needs, I will not jump the gun and lose hope and put him down.