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(Keeping watch over the house together)

Another day starting with another call to the vet.  This time for an update on how Titan was doing with his tests.  The kind receptionist told us he only had his xrays so far but was doing well.  He even managed to make a new best friend with the office cat and the two were cuddling nicely on the bed of blankets.  His ultrasound was booked for 1pm and things were moving along.  I went to work later that day thinking positive.

As soon as I got to work there was a call from the vet that I missed, so I eagerly called back only to hear that vet who wanted to speak to me was in surgery.  I left my husbands number and although a bit concerned went back to work hoping it was just for an update.  A few hours later I got the call from Mike that the news was not good.  Titan had heart issues.  First, they found a small mass on the heart which was putting slight pressure on it.  The cancer had spread.  They also found an edema and a murmur in his heart as well.  The diagnosis was CHF (Congestive Heart Failure - early onset).  This was causing swelling and therefore we had no chance to move forward with life saving surgery.  As soon as I heard the news I knew he had been though enough and we agreed Titan would just come home and be kept comfortable for his last days surrounded by family.

"Congestive Heart Failure is a chronic progressive condition that affects the pumping power of your heart muscles.  CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently."

"Edema happens when your small blood vessels become "leaky" and realease fluid into nearby tissues.  The extra fluid builds up, which makes the tissue swell.  When the heart weakens and pumps blood less efficiently, fluid can slowly build up, creating edemas."

The next morning we set off to pick him up.  True to all things with Titan this wasn't made easy because we just happened to get a lovely snow storm.  The roads were awful and we passed a few cars in ditches on the way but Mike was determined to bring him home that day so he was driving carefully.  When we finally made it (one hour late) I was feeling sad, of course, about the future but also taking comfort in the fact that he was able to come home with us.  He isn't happy unless he is near his couch, and I knew this time was no exception.  We spoke with the vet about his new pain meds.  Back on the Meloxicam for anti-inflammatory (once every 24 hours), the Tramadol for pain management (once every 12 hours), and now on Gabapentin a nerve blocker to help with pain ( twice every 12 hours).  The vet was very nice and took her time explaining everything to us.  I asked about when we would know the time was right and she said "You know Titan best, you will just be able to tell."  In my heart I know this is true.  We did speak about euthanasia and cremation.  Caven Hills does not normally make house calls but they said because they know Titan so well and all about his case they would make an exception for us.  All together we were looking close to $600 for the procedure and cremation and an urn would be included.   I never thought I would be talking about this kind of information so soon and it still sounds weird talking about it now.  I am also looking into another vet my aunt used when her sweet boy Finn passed.  This vet also comes to the house but helps you determine if you and the pet are actually ready.  This makes me feel a bit more comfortable about the whole process but it will be more expensive.  That phone call is to happen tomorrow when me and my husband are both available.

Finally after all our information was gathered we we able to see Titan.  He came out and again there was tail wags and I even got a cuddle.  I was so happy to just have him in my arms again.  I don't like knowing he isn't close and I know what is to come will just break me.  But like I said, for now we just are enjoying the fact that he is here with us and we cuddled him right up.  He even tried to take himself for a walk around the clinic before we left, he's so determined to show everyone he can do what he isn't suppose to.  The drive home was better and he spent it with his head in my lap for the most part, however this time he seemed to perk up and would try and sit out to see out the window.

Once home we did our usual loop around the yard and Ares walked along beside him tail wagging and lots of sniffing.  The two have bonded so well and I really appreciate them also getting some more time together.  I feel like Ares knows what is happening and he is being so good with Titan, walking with him making sure he's ok and watching over him in the house, making sure he gets cuddles.  We also went out and picked up food for Titan we thought he might like to eat to make sure he was spoiled with meal times.

(Chicken, liver, steak, beef cubes, pizza, and beef liver treats)

(Ares wanting to do everything his big brother does)

(They have each other's back)

When you look up information on this breed everything tells you they have short life spans.  You go into owning a dane knowing that.  You read all the time that the top 3 killers of this breed are bloat, bone cancer, and CHF.  You hope you get that full life span but I have read many people going though the same experience as us, often with danes even younger.   It is a hard breed to fall for, but the years you do get out of them is full of adventure and laughing and happiness and so much love.  They touch the lives of everyone they meet and I've had so many people tell me about lovely memories and share photos.  Titan has left a mark on many hearts and he will be so so missed.   Believe me when I say how worth it owning a dane is.  I would not change a thing.  I just wish we were able to have a few more adventures together and a lot more cuddles.  We will take what we can get for now.

(The best friends hanging out) 

(Giant dogs leave giant paw prints on our hearts)

(Having a moment with his Auntie and listening to her loving words)

(Forever holding paws together, best buds)

We found out....again

(Making sure everyone still knows it's his couch before we head out to the vet)

Today started with a phone call from the vet.  A lady by the name of Audrey who was very kind and is the director of the Caven Hills Vet Clinic.  She took on Titan's case herself and promised the best care possible.  First she got down to business.  Titan did have some sort of bone cancer, 85% bone compromised.  She would like to do tests such as xrays, blood work, ct scan, full heart work up, ultrasound, and bone biopsy.  She told me to talk this over with my husband and to come into the clinic for 9pm tonight.  That was when her shift finished and she would be able to spend whatever time we needed talking to her and getting answers.  She also told us that after everything Titan had been through she would only charge us for his pain meds, not for any tests or for Titan to stay there the few days she would need to get the tests done.  What a relief as this normally costs almost $2000 and we were only going to pay $350.  I agreed and felt better about having some sort of game plan.

Next I had to think about our options.

Option A:  We do the tests and it comes back that the only spot that has any issues is his ankle.  We can amputate.  However, we need to really think about how Titan would get around on 3 legs and if this would give him mobility again.  We wouldn't want to do this and find out Titan continues to just lay on his blankets and not want to do anything.  Also budget, what prices are we looking at as the amputation also comes with chemo treatment as well to insure no spreading of the cancer.  A dog Titan's size, this could get pricey.  

Option B: The cancer has spread to other parts and we just make him comfortable for the last little while.  Not what anyone wants, but we wouldn't want to put him through any more pain or discomfort.  Plus we need to consider quality of life.  

To be honest I don't like either option.  I wish this never happened and we weren't facing such a horrible choice, but here we are.  We need to keep moving forward and think of the best possible future for Titan.  

The day passed quickly as I just spent it napping beside Titan while Ares snored away on the couch beside us.  We had lots of cuddles and we even shared a fortune cookie.  That he would eat!  He took his meds like a good boy and let me feed him his pate.  We went outside for a nice chilly walk around his yard and he made sure to sniff everything.  Then Mike was home and it was time to go back to the vet.  We once again made the long drive to the vet with me and Titan cuddled up in the back, his head resting on my lap the whole way.  He didn't even cry this time.  I told him what was going to happen and started crying and he licked my face and the tears away as if to say "It's ok mom".  When we got there Titan was once again eager to jump out of the van and show everyone how well he moves around on 3 legs.  He even decided to sit on the bench himself this time instead of on dad's lap, such a brave boy. 

When we finally got called in and we met with Audrey she was so understanding and took to Titan right away.  We looked at the xrays and could see how it was missed when we first went into the vet.  There was a small odd spot in the bone that unless pointed out wouldn't be noticed, 6 vets were called in to see if they caught it at first glance and none did.  Then fast forward a month and you can see from this xray how quickly the bone was eaten away.  

(The fuzzy area that looks like it's pushing through the bone is abnormal growth and the cancer we are dealing with)

We went over all our options together and all the info about the tests again.  I really felt confident about doing the tests first to make sure we have all the info in front of us to make a proper decision.  So with that we had to once again hand over the leash (really not easy to do this time) and let Titan go with the vet.  They said after all he's been though they didn't want to keep him in a kennel, so he would be on a bed of blankets in the office where someone will always be around to share their lunches.  I knew right there he would be just fine for a few days.  There was even a tail wag.  

The ride home tonight was hard, both Mike and I had tears in our eyes, but took comfort in knowing we are doing what we can.  We also were given an xray of Titan's heart which I love having.  It's a big heart for a big dog and I'm sure it's full of love.  

So now we wait, with Ares who did go looking for his brother when we got home, and we call the vet in the morning to get an update on the first round of tests.  Keep sending those positive thoughts everyone, they are much appreciated at this time.  

Fourth Week At Home

(Showing off his new dog tag he got for xmas)

I am crying as I write this but this week has been hard.  We have had set backs.  Titan will no longer put weight on the leg and there is swelling again in his hock (ankle) area.  He still won't eat and we are continuing to force feed him.  He doesn't seem interested in his activities any more and just wants to be near us to sleep.
We have to go to the vet.

On Christmas day we ended up calling the vet to make an appointment and were able to come in that night.  Once again the idea of trying to get Titan into a car while he fights us every step of the way was frustrating so thankfully Mike's sister let us use her van again.  I can't thank her enough for this.  We helped Titan get outside and around the front of the house and into the van.  It took two of us to lift him, but he has lost so much weight now that I can actually pick up his back end on my own.  He was 160 lbs and now is at 145 lbs.  I climbed into the back with him and we cuddled on the floor because Titan was scared, and off we went on the long trip to Caven Hills.  I was so nervous, did the metal plates not take?  Has the surgery area collapsed and failed all together?  Is there just an infection we can use antibiotics for?  Has he broken a bone trying to use the leg too fast?  My mind was spinning the whole way there.

When we arrived at the vet Titan was eager to get out of the van and if it wasn't for Mike being there to catch him he would of jumped right down.  He hopped on three legs into the clinic and didn't fight us.  He even stopped to sniff everything on the way like he was on a walk.  And then we waited for our turn, Titan sitting on dad's lap and being a good boy.

The vet came and called us in, a different vet again, and right away noticed how Titan wouldn't use the leg.  His first thought was failed surgery.  He felt is leg and noticed a swollen lymph node.  He told us he was worried about maybe an infection but we should do xrays to be sure.  Of course we agreed and once again I had to hand that leash over and watch Titan walk down that hallway with the vet.  It makes me sad every time, but he goes like a brave boy.  So back to the waiting room to wait....and wait...and wait some more.  It seems like forever when your mind is spinning with questions.  Finally our names were called in.  We had just gotten in the room when the vet met our eyes and said two very scary words.  Bone Cancer.  I felt like I got slapped in the face and my heart just stopped.  I think we were both in shock, how could this happen?  His last scans had been fine and it's only just been a month.  The vet said that the last xrays were looking at his knee and not lower down so it wasn't seen.  Well why didn't they look at the whole leg I wanted to shout.  The vet said that he saw lesions in the leg that he thinks might be bone cancer but it wasn't your typical star burst pattern.  He would take extra xrays and send them to Titan's Radiologist to get a for sure answer as to what is going on.  The vet also told us that he would not sedate Titan this time as he discovered a heart murmur, small but there, perhaps brought on by all the stress of the last month.  At this point I just wanted to fall to the floor, my sweet boy in a matter of a month had the worst possible outcome.

We went back to the waiting room and waited for Titan to come out.  Another long wait.  When he finally came out those doors and saw us that tail started wagging and he was so happy to see us.  He is such a good boy and I think he knew he wouldn't have to stay there.  We were given two different types of pain meds for Titan to take.  Meloxicam (once daily) and Tramadol (once every 8-12 hours). The drugs make Titan drowsy but he isn't in any pain.

The whole ride home Titan just rested on my lap like the first time we brought him home.  We just cuddled and the ride was very quiet, both Mike and I lost in thoughts of worry.  Once home Titan again got out of the car eagerly and made it into the backyard and up his ramp to his nice warm bed.  All that activity made him exhausted and he went right to sleep while we sat with him for the night.

The next day I woke up and went right into researching again.  The different websites I looked at are:

http://www.petmd.com/dog/conditions/musculoskeletal/c_multi_osteosarcoma

http://wearethecure.org/learn-more-about-canince-cancer/canine-cancer-library/osteosarcoma/

http://www.akcchf.org/canine-health/your-dogs-health/bone-cancer-in-dogs.html?referrer=https://www.google.ca/

http://www.peteducation.com/article.cfm?c=2+2087&aid=465

Every website basically tells you about bone cancer (osteosarcomas), what may have caused it, how to treat it, and about quality of life.  I knew before we bought Titan home that large breed dogs are prone to bone cancer, especially Great Danes who are often referred to as the Heartbreak Breed.  It's something that was always in the back of my mind but that stupid small part of you always says "it won't happen to me, my dog is too young."  Well after reading some of the causes a sentence caught my eye.

"Some studies have shown a slight increase in the development of osteoscarcoma among dogs that have experienced a blunt bone injury."

Titan just had his knee surgery that removed some of the bone, did that set this chain of events into motion?  And when I read further, if this is bone cancer, most websites say the best option is amputation.  After everything we just did and paid for are we looking at amputation?  Quality of life after is about a year, rare cases maybe longer.  I am devastated.  Heartbroken.  I keep going between "Maybe it's good we got the surgery and then saw this and were able to catch the bone cancer early" to "Maybe we should of never got the surgery at all and Titan would be ok, is this our fault?"

Right now all we can do is prepare ourselves for the worst case scenario and wait for the vet to call us in a few days with the results. Until then Titan is resting in his bed of blankets and getting lots of love and attention.  We are happy to know that the knee and surgery are itself healed properly and we did everything right with his recovery.  If it wasn't for the swelling of the hock area he would most likely be using the leg now.  I am hoping with all my heart that this isn't bone cancer and that we can have Titan back to normal again soon.  Our very special boy.

Titan's leg week 4:

 (The area that is swelling and our concern now)

Third Week At Home

(His nose was cold)

This third week into recovery has us stressed.  Titan still is not eating his food in any form that we offer it.  He will eat my food, the stuff that's not good for him, whenever we offer it.  There is so much frustration because I can't figure out why he will eat one day and not the next, and we can't figure out what he likes or doesn't like.  For example, one day he will eat some of my bagel with cheese on it.  Then, two days later, turns his nose up when offered the same thing.  One day he will eat raw beef and then the next day he refuses it until it's cooked, and then the next day he won't eat it cooked or raw.  There is no rhyme or reason to his diet right now.  We tried not giving him anything and thought along the same lines as most people "He's a dog and will eat when he gets hungry" in the hopes he would figure out he had to eat his food when we offered it to him.  Two days later he still hadn't eaten and was very weak, so being worried I tried to offer him his original food, the Acana kibble, just to see if he might go for it.   We did have some luck with this after I added Cheese Wiz into it.  That worked for a few days and then he turned his nose up to that too.    You can see that he is losing weight and I'm also worried how this is affecting his recovery as bones need proper nutrients to heal.  So we are back to force feeding him.  He gets offered him food first and if he refuses to eat then it gets made into the pate.  We took Titan off the raw food diet for now because we didn't want to try force feeding him that and then later on have him relate it to bad memories and not eat raw food ever.  Ares on the other hand has successfully transferred to the raw diet and is doing well on it.  

Progress with Titan's leg is going slow too.  He still will not put weight on the leg when first standing up and still only toe touches most of the time while outside.  It is hard for him to get around with the snow and freezing rain we have been having but I have noticed that after a little time walking around the yard he will start to stand on the sore leg and it looks like it's being used correctly.

  (Using both hind legs to stand)

There is still lots of cuddling with him and Ares and with mom of course, which I think helps keep him happy.  I was worried about him being depressed after the surgery because he wasn't allowed to walk so I'm very grateful to Ares for making sure his brother is ok.  This week we were able to start very small walks with Titan to try and get that leg strong again.  He's allowed to go for three 5-10 minute walks a day.  Mike was able to walk him down about 10 houses to the mailbox and back.  We had hoped this would also get his appetite up, but no such luck yet.  Titan seems determined to get back to his walks so hopefully once we have more routine in his day that will help with the food issue.

 (What I come home from work too, everyone gets a purple blanket)

 (Double-decker danes - they love to know the other's close by)

(Mom cuddles make everything ok)

In the mean time everything else is the same, we play our mind games daily and he's getting really fast at finding all his treats in the snuffle mat.  Titan loves to be in the snow and eat it so he's even getting outside in the yard a bit more to keep the boredom away.  And all of Titan's wounds have pretty much healed and the fur is coming in nice.  Won't be long before he's back to his old handsome self I hope.

 (Elbows are looking so much better!)

 (Enjoying refreshing snow instead of his dinner)

 (Nose got covered in snow from playing "Find The Treat" in the snow)

(A job well done snuffle matting means a well deserved nap, apparently in said mat)

Titan's leg week 3:

(Here you can see how he won't stretch it out like his good leg yet and you can also see the spot where the fentanyl patch was, ouch!)

Second Week At Home

 Our second week has been progressing well, everything except getting him to eat.  Titan is starting to use his leg a little more and gets around easier outside.  He is asking often to go out now and is able to stand a little easier on his own each day.  When he first stands he still holds the sore leg up and won't put any weight on it.

(Titan waiting to go outside)

Once he gets outside it's another story.  He moves so fast now and we have to keep him on a short leash to make sure he doesn't get too excited especially when someone walks by and he wants to bark and run along the fence with them.  He still doesn't put all of his weight down on that leg but he is at least using it to hobble some what so the muscles are getting used. 

 The food department hasn't improved.  We decided to start the raw food diet this week because he keeps turning his nose up to his kibble.  We were very excited about this and had high hopes he would dive right in and start a normal eating routine again.  After speaking with the lady at Country Lane Raw Foods (http://www.clpr.ca/raw-food.html) and hearing about all the benefits of this diet and how easy it is we got a few parcels to try.  For Titan's weight (160 lbs) he will have to eat 3 lbs of raw food a day.  The 3 lbs tube will be cut in half and he will get a half in the AM and half in the PM.  It looks like this:

(My arm to compare size)

We will start him off on the chicken and after two weeks of his body adjusting we can add in the other proteins and extras he needs.  This diet will be cheaper for us in the long run, and for the same price of the kibble which lasts us one week, this raw food will last us two weeks.  We were told if he doesn't go for it right away to just leave it down and eventually he will eat it.  The kind lady said "No dog will let themselves starve".  I just looked at Mike and smiled because she hasn't met our Titan.  And of course our Titan had other ideas and turned his nose up once again.  The good thing is we don't have any more medications to give him now so we don't have to force feed him and hopefully after a while he will be hungry enough to try it.  He's going on day 2 of not eating and I am getting worried.  You can see that he is losing weight and I have given both a dish of raw food and a dish of kibble and left them out.  He won't eat either one.  He will take chicken and things we are eating from us so I do hope he will stop his hunger strike and eat his own food.  If this continues we are going to the vet.

Otherwise Titan is starting to act like his normal self again and lets Ares snuggle right up with him. They even try to share the little baby mattress we got Titan, and almost manage to fit on it together.  And when Ares isn't around Titan finally feels comfortable getting himself on and off his bed for sleeping so we've started calling it his low couch and he seems content to sleep there.  He does still look longingly at his big couch and I know it won't be long before he's up there again.

We've also started some games to keep Titan busy through the day.  The snuffle mat is coming along.  I wasn't able to finish the whole thing and only got half done with the fleece I have, but so far Titan loves it!  We use beef liver treats or hot dogs for him to find.  He loves to use his nose and looks so proud when he finds one.  We also use some boxes to hide treats and he has to figure out a way to get them out.  He likes this game too because he can tear apart the boxes and get some frustration out.  And of course we review all of our tricks and try some new ones.  There is lots of grooming as well which calms him down and puts him to sleep.  Titan is still sleeping often which I am ok with for at least one more week to really give that leg time to heal up nice.  

 (What it looks like from the bottom, the weaved pattern)

 (Enjoying finding his hot dog treats)

 (Tearing apart the box to get his treats)

So from what our guide from the vet says and from what we can see Titan is on track with his recovery.  Everything except for the eating.  So this week if we can overcome this hurdle everything will be great!  Here's hoping! 

Titan's leg week 2:

(The stitches are starting to come out) 

(The swelling is pretty much all gone now, just need the fur to grow back in)

(The sores on his elbows are healing up nice and shouldn't bother him much longer)