carver miller 1995-2009

it's time

with the saddest of hearts I share with you that carver will be released with the assistance of our vets at home tonight at 7 p.m.

for months now, I have asked my friends who have lost dogs "how did you make the decision?" everyone replied "you will know" but I didn't believe them until now.
Carver has been losing strength in his back legs for about a month or two now. By last Monday c was unable to put any pressure on his back left leg, the same side of his body as the amputation. He needed assistance to do the shortest of walks. After a long night in the yard with c, Elizabeth came inside Tuesday morning at 6 a.m., and said it is time. I knew fully in my heart she was right. I called the vets that day, and made the appointment for Sunday, wanting to spend the weekend with him before we let him go. what we were not expecting was for carver to decline so quickly. by Friday night carver could no long get up on his own, or stay standing on his own. walking is completely not an option.

we have spent the last 36 hours or so always with carver, mostly in the yard, where we have set up a bed. he has a hard time getting comfortable, and is awake much of the time, panting. when he sleeps, he does so heavily. friends have been stopping by to spend time with us and to give carver their last pats, to say goodbye and to wish him a good passage.

with the advice of my teachers I have been doing tonglen practice with carver, a Buddhist practice that involves breathing in his pain and fear, and breathing out to him calm, warm, loving energy. I also have been reciting chants to him, with the aspiration that he be reborn into the human realm. it is said that if an animal hears the Dharma, that they purify their karma, and can be reborn into a higher realm, into a human who then hears the Dharma, and works towards the end of suffering for all. I am grateful to be able to take refuge in my practice at this time, when otherwise there is really nothing to do. I feel like I am actually doing something, where as otherwise I would feel totally helpless.

I have spent the best parts of these days talking to carver, letting him know how much I love him, and that we will be fine, and that it is o.k. to let go now. I tell him stories of our lives together, remembering him as a puppy, as a feisty teen, as the beautiful graceful, regal dog he became.

my therapist reminded me of something important the other day-that although I am feeling the loss of all of him right now, that really I have lost so much of him over the year, that i have been grieving this whole 15 months as I have lost things one by one. i remember when the tail went from being held close to his body, to not being able to wag at all. i do not know when the howling with the sirens ended, but I miss that so much. it has been months since carver has been able to jump on the couch. yesterday I was remembering so many cozy afternoons, both of us sleeping on the sofa, his feet entwined in my legs. its been over a year since carver could sleep in the bed with us, his long body diagonal across the bed, his long legs outstretched, pining down the covers so I was left chilly in the corner. how could I miss this? but I do.

I have loved this time taking care of carver, slowing down, letting everything else that I could drop away. the most simple of acts, cleaning his fur, massaging his legs, hand feeding him when he could not get up to eat. offering him fresh water. sitting on the porch in the sun when we could no longer go for walks. we have had 15 months, so much longer than we ever thought possible. we have entered into our second spring, when our first goal was just to get to the first. I have so much to be grateful for.

first, for my dear friends, who have been such a source of love, strength and support, not to mention understanding when I had to cancel plans, or when i got to the point where i could not even make them. to my boss and co-workers, for being so understanding when i came in 3 hours late, left early, or arrived completely sleep deprived and pretty much useless, if I arrived at all. for my wonderful friends at bonecancerdogs.org and their sister yahoo group-I could never have imagined being able to feel so supported and cared for by a group of people I have never met, but they have been there for me every step of the way, calming me down, giving excellent advice, mailing me their leftover medication when their own dogs had passed. and for my online friends, you who have stumbled onto our blog, and have followed our story and sent such lovely wishes.for my Sangha friends, who never treated carver as anything less than a fully sentient being, who listened and practiced with me, and who will practice tonglen for carver in the days to come, all wishing for him to have a safe passage, and a joyful rebirth. for Dr. walker, who said it could be done, and saw him through it, for Emily & miaja, our home visit vets, that answered every email as quickly as possible and called just to check in. not having to bring carver into a doctor's office was an amazing comfort. to Dr. moses, the pain management specialist over at Angell memorial, who made carver as comfortable as possible these past few months, allowing for us to have that precious time to be able to care for him, and to begin the process of excepting the end.

I could not begin to express the gratitude I feel for having Elizabeth in my life, carver's other mom, who held me up, praised me for what i was doing, asked all the right questions and made all the phone calls I was too afraid to make, and who loves carver as much as I do, with a sweetness that is beautiful to witness.

it is 6 a.m. now, and carver is asleep in his bed in the yard. the sun has been rising as I write this, the birds greeting the dawn. my last day on earth with carver has begun. let it be a peaceful one for him, and for us.

I will spend the day with this aspiration in my heart for carver, for myself, and for all of you

may we know happiness and the root of happiness.
may we be free from suffering and the root of suffering.
may we not be separated from the great happiness, devoid of suffering.
may we dwell in the great equanimity, free from passion, aggression and hatred.
may we all know profound brilliant glory.

thanks to e and her iphone

success!

carver seems to be feeling better all around. he slept through the night last night, only stirring to come into our room to sleep some more in there. out for a short walk this morning with no hesitation. rice for breakfast, and yogurt. I got home this afternoon from an appointment at 430, a little late for me, but c seemed fine. we spent about 40 minutes outside in the snow, some laying in snowbanks, but we did walk around a bit, and then all the way around the house! a normal, healthy bowel movement ( i know you do not want to hear about this, but this is a big triumph for me!) and he is now cozy with me on the floor. deep breath. happy for this moment of peace, for the worry to loosen its grips and to enjoy the simplicity of our lives, the floor, the cozy blanket over both of us, the evening news.

carver comes alive!

carver loves the snow. I keep trying to take pictures but apparently all aa batteries in my house are spent. anyway, carver had a good walk today after a terrible, scary night. but I am getting ahead of myself. I got home about 3 yesterday, the snow storm just moving out after leaving a solid 10 inches of snow on the ground. carver and I immedietley headed outside. the new normal being that carver only goes into the yard to relieve himself, and then back up the stairs, I was shocked to see carver head right into the yard. we walked to the back fence and back, lay in the tallest snowbank he could find, did some sniffing of a neighborhood dog. when it was time to go in, we headed towards the steps-but instead of going up, carver headed down the shoveled side walk. we walked all the way down the street, turned onto parkwood terrance, and made it to the steps of our neighbor mary & al's house. I think he would have kept going, but I turned him around, knowing we we re getting close to carver's acupuncture appointment.

janice came at 530. she put in over 30 needles, working the whole spine, both hind legs, including the ankles, then back to do the lumbar spine again. carver comfortably turned over a couple of times, and seemed alert and in good spirits. she said he seemed better than the last time she came, which was probably 2 1/2 weeks ago. she also confirmed the fact that we are in "the next level", or something like that. closer to his death. it is something I have acknowledged to myself, but there is something about hearing it from someone else that really brings it home. janice just lost her own 14 year old dog. she has been such a good support for both carver and me.

after the appointment, carver wanted to go outside. he seemed anxious, panting . carver has had diarrhea for a couple of days now, and I figured he needed to go again. he walked to the back of the yard, and squatted. I decided to try & move his tail out of the way-he had been soiling himself ever since this started, and I thought we could try to avoid it. I moved his tail up about 1/2 and inch, and he screamed in pain, leaping away from me and laying in the snow. I was in a panic, shocked and left feeling awful and frightened. I took him back in, but he continued to pant and cry, shaking so hard sometimes his teeth chattered. I felt overwhelmed with guilt and fear that I had made his pain peremenently worse. we immedietly gave him his next dose of tramadol and tried to calm him down. a heating pad on his lower back, he finally fell into a fretful sleep. carver continued to have diahrrea, and we went out several times during the night, about every two hours, until we both finally fell into a deep sleep in the living room around 330 a.m.

I took carver out around 8 this morning before I headed to work. still sick, he did what he needed to then cried for me to help him right up the stairs. I left for work feeling sad and nervous.

when I came home carver was sound asleep. I fed him some yogurt while he was still laying down, and gave him his afternoon meds. he drifted off again. I could stand it for about 30 minutes, but then I started to worry again. what if he was in so much pain all he could do was sleep? I poked him until he woke up, roused him with rice in his kibble bowl, then shook his jacket until he stood up. we begun the trip in the yard, where he walked to the back yard again. he spent some time in the snow, sniffing the air. but then, jsut like yesterday, he was on the move! we made it almost to the jamaica way and back. carver's back legs look very weak, but that does not stop him from walking in the deepest snow he can find! he really seemed to enjoy his time outside. we were out for about 45 minutes, him running down the shoveled path, then tossing himself in the snow. he still seems a bit sick, but his change in diet will hopefully do the trick. I am just grateful he seems to not be in pain, that I didn't break some part of him last night, and that he can still enjoy himself out in the world. my attitude towards the snow has totally changed!

a quick carver update

carver has shown some improvement since he began his new pain regiment last friday. he has been walking in the house more, going into my office, where e and I are now sleeping on the futon. the room is closer to the living room, and I laid beds for him on the floor that go from the door to our bed. he tens to spend half the night in there, then back to the living room. our whole apartment is swathed in fabric and memory foam.
anyway, he seems to have less trouble getting up, is more alert, and continues to eat well. on the downside, his cognitive disorder (lets just call it Alzheimer's from now on) has been kicking in. wednesday and thursday were the worst, with carver barking & whining from about 4pm on until he fell sleep late in the night. I have to be next to him on the ground in order for him to calm down. this is cozy, but there are chores to do, and after a few hours I end up feeling cagey. the stress of it has taken it's toll. I really thought i was cracking up friday morning, when carver was crying because I was in the kitchen doing dishes. e got up early and laid down with him so I could finish. the weekend has been much better though. friday night and all day Saturday he has been calm, with us home, and he has seemed more like his normal self. being outside helps him always, so we have been spending a lot of time on the front porch, me reading & him barking at the neighbors. we were blessed with a few warm days but today the snow is falling again, and by tomorrow night we are suppose to have over a foot. carver usually loves the snow, and I hope this is still the case. as for me, I feel like i would give up my soul to see a crocus popping its head out of the ground. I need spring, this winter has been a long tough one all around. I checked in with the vets on wednesday-dr. m said she was surprised to see improvement to quickly, and to keep on the regime for a couple more weeks and see how it goes. c is still not wanting to walk outside at all for recreation, and does not seem to interested in the world beyond the porch, with the exception of an occasional passing dog, or a sniff at near by garbage. I really am a but anxious at wanting to up some of the meds and see if we can get him walking, but if we cannot listen to and trust the pain management vet, then who can we? another strange symptom has popped up as well-he is chewing on one of his hind legs, tearing the hair out. I spray it with bitter apple in the morning with bitter apple (which I tasted-I didn't think it was too bad, but carver disagrees) which does the trick, but my curiosity gets the best of me. is it pain? or a strange side effect from one of the drugs? boredom? hallucination? who knows. I have an email out to dr. m, and will hear from her tomorrow.
but, for now, things are quiet and peaceful. carver is sleeping next to me on the floor, very cozy. we have had a good morning, and have the day stretched out in front of us.

we received another offer of left over meds from a friend on the yahoo group bonecancerdogs
I continue to be amazed at the compassion, generosity, and support I receive from these amazing people.
If you have a minute, take a look at brian's blog
brian just passed a few weeks ago, and his people kept an excellent blog of his story.

pain management

I have been meaning to write an update for days now, but I think on some level I was waiting to see how things were going before I dared.

carver went to see a pain management specialist at Angell Memorial hospital in Jamaica Plain. it took me awhile to decide to make the appointment. e and I have had some not so great experiences at angell over the years (one including a test-crazy intern, a $500 bill, and our finding out in the end that all we needed was an extra litter box for our elderly cat [which a non-Angell vet had to tell us]). a few months after the amputation surgery I had made a silent pact with carver-no more vet visits, no more invasive tests. but the home visit vets (maija and emily) had recommended her, and carver was obviously not doing well, not wanting to walk at all. about a year ago I had set aside money for the end of carver's life. i have guarded that money with a tight fist, but finally realized that if I did not spend some of it, the end could be coming sooner rather than later. so, appointment made, and off we went.

our awesome neighbor friend ryan drove me, e & c up the street to the hospital (it is literally up the street, about a 5 minute walk, if carver could still walk). we met with dr. M last friday. she is a wonderful person, really present. the appointment started with loads of questions, about his diagnosis, surgery, recovery, treatment, and current decline. she did a physical exam and then asked us if we wanted to do x-rays, which we did, just 1 view of his lower spine. we wanted to rule out the possibility of the cancer having spread to his spine and to eliminate the possibility of there being a mass in or around his spine. the x rays showed no cancer returning, but what she suspected, which is lumbar spinal stenosis. basically some of his lower vertebrae have shifted their angle, and are pressing on the nerves of his spine.

the big surprise of the appointment was that she also diagnosed carver with canine cognitive dysfunction, or ccd, or doggie Alzheimer's, if you will. this explained the staring at the walls and barking. more on this in a moment.

we discussed doing an mri to confirm the diagnosis of stenosis, and the option of surgery (both of which i declined)
we talked about quality of life, and she did help me by giving me the most basic of things to look for and consider-can he walk, go to the bathroom without assistance, I can't remember the other things, but it grounded me in a way that the number system that m & em gave me could not. it gave me some bench markers to pay attention to.

then we discussed meds. she started us on a program that has room to grow, lower doses of med that can be slowly raised. (i will write the protocol at the end of this post.) we discussed prednisone, which I had brought up to m & em, but the side effects of the drug sound like a horror show, including the need to first ween him off of the deramaxx, a process which he would have to take narcotics in order to stand. We have taken the prednisone option off the table for now. I left with the promise to check in with her early this week, and we will begin the process of tweaking the medication.

I walked out of the hospital feeling totally drained, and not a little confused emotionally. it seems like all the good news was mixed in with bad. it was great to see that the x-rays did not show any cancer, but the stenosis is a terrible thing. and in a way if we had seen the cancer returning, we would have a more clear view of what to do. I think a part of me wanted to know something concrete-something that would make our decision making more clear cut. the stenosis is degenerative, so we know things are going to get worse. and then there is the CCD. I was relieved that carver's crying in the evening was not due to built up pain. but still, it is heart breaking to hear him cry no matter what the reason, and the thought of him feeling afraid or confused makes me feel awful. I grew up with my grandmother, and took care of her for a time when she was succumbing to Alzheimer's. I was 14 at the time, and she would have had days where she was terrified, when she didn;t know where she was and wanted to go home, when she would speak only in Gaelic. I can only hope for a dog that it is a less terrifying, painful experience. I spoke with a friend in the bonecancerdogs yahoo group who shared with me that her dog with CCD got to the point where he did not recognize any of the family members.

So, onto a little good news. Carver has shown steady, subtle improvement over the past 5 days. he slept all day saturday, i think partially traumatized by the appointment. we began to put olive oil & some raw pumpkin into his food to help his digestion -he had been constipated since he began the gabapentin a week or soon ago. By sunday his digestion returned to normal. By monday we noticed carver was having an easier time getting up and rolling over. he showed interest in a neighborhood dog who came by to visit. carver even met me at the door when I returned home from work! I worked a double on tuesday, but ryan (who came by to take c out & give him meds-thank goodness for ryan!) & e both reported that he was doing well. carver even walked to the door of where e was sleeping to let her know he needed to go out in the morning. these all sound like simple things, but they are things carver has not done in a while. it is strange how quietly things change, what becomes normal when you are not looking, or when you do not want to look. if anything, seeing him improve gives me an idea of how bad things had gotten, and gives me a view of what "bad" looks like, for the future, when I will have to access how he is doing, in a big picture kind of way. I have begun to do daily assessments, trying to look objectively at how he is doing day to day, both physically and mentally. I find this process incredibly helpful, a way to check in with myself about him, separate from the moment to moment taking care of his needs.

I think the main thing I took away from the appointment was the fact that the odds are much greater at this point that we will have to make the decision to euthanize carver at one point in the future. I really was still praying pretty hard that it would not come down to this, that he would be able to live out his life and die a natural death. but I am know realizing that we are going to come to a point before that where we can no longer manage his pain, or that he will no longer mentally be with us, and we will have to step in. dr.m admitted that our situation is the hardest, where we most likely will not see him failing in the traditional sense, where he will stop eating, get weak etc-all the signals you would look for to know when "it is time". we will have to rely more on our knowledge of carver, and our ability to judge his pain.

to close this update I really want to emphasis how much I like Dr. Lisa Moses, and to recommend her to anyone in the Boston area. She was great with carver and even better with us. she is knowledgeable and compassionate, and has dedicated herself to relieving animals of pain. here is a link to her practice:

dr. lisa moses @ the mspca

oh, and a very important detail-she told us about the pharmacy at costco. we used their online pharmacy, and reduced carver's monthly medication bill from $250 to $50. you do not have to be a member to use the online pharmacy & shipping is free if you plan ahead and place your order early. this has been a huge relief. thank goodness for costco!

carver's new med regime

tramadol, 50 mg, 2 tablets, 3x daily
deramaxx 75 mg, 1x daily
gabapentin, 300 mg, 2x daily
Amitriptyline, 10mg, 1.5 tablets, 1x daily
melatonin, 3mg, 1x daily, to help sleep