Schmoopy Calcium Levels

03.03.15 – Calcium = 11 (within normal range) (Creatine Kinase high at 416 (range = 10-200)
06.20.16 – Calcium = 10.7 (within normal range)
12.07.16 – Calcium = 11.4 (within normal range)
04.10.17 – Calcium = 12.8 (above high normal)
04.27.17 – Calcium = 15.3 (above high normal) (earlier this week, SubQ fluids, Lasix & diuretic in an effort to get Calcium under control)
04.27.17 – Ionized Calcium = 1.41 (above high normal) (IV fluids)
04.28.17 – Ionized Calcium = 1.4 (above high normal)
05.01.17 – Ionized Calcium = 1.3 (on morning of surgery (prior to surgery)) (within normal range)
05.10.17 – Ionized Calcium = 1.43 (above high normal)
05.16.17 – Ionized Calcium = 1.88 (above high normal) - This is the highest it has ever been
05.17.17 – Ionized Calcium = 1.64 (above high normal) but less than yesterday.

05.18.17 – Ionized Calcium = 1.44 (above high normal) but going down.
05.19.17 – Ionized Calcium = 1.36 (slightly above high normal)
05.23.17 – Ionized Calcium = 1.12 (slightly below normal)
05.29.17 – Ionized Calcium = 1.87 (above high normal)

Friday, June 9, 2017

The love of my life...Schmoopy's story

Silveroak’s Love of Kate’s Life


March 30, 2007 ~ May 31, 2017

I have had many pets over the course of my life and while I’ve loved each and every single one of them, Schmoopy was different; Schmoopy was my “Heart Dog”, my canine soul mate.

Although it seems like yesterday, it was 10 years ago in August, on my way to the annual car week that culminates with the Pebble Beach Concours d’Elegance, that I made one important stop after flying into San Francisco…I went to meet Ruth [Sampson] and pick up my four and a half month old puppy.  In addition to all the excitement around getting a puppy in and of itself, I was so ecstatic to be able to bring my own puppy to the very dog friendly town of Carmel, CA, which was where we would spend the week.

This new puppy was a bit shy at first and probably a bit apprehensive about leaving his loving home to go off with strangers.  After a two-hour car ride and getting settled into where we were staying, right in the heart of Carmel, I strutted this new pup up and down the streets trying to acclimate him to sounds, people, kids, other dogs, and leash walking.  He made such a big hit that we never seemed to be able to walk more than a couple of steps at a time.  I was happy for all the greetings and lots of gentle touches.

When back at the B&B I noticed this cute, little fluff ball seemed to follow my every step...and the place wasn't that big that I could venture far away, but still, right at my ankles.  It turned out from this day forward I always had close company whenever in the vicinity of this pup, no matter what I was doing...even when using the bathroom, for applying my make-up, doing my hair, or other unmentionables.  Even when I showered, I found this pup curled up on the bath mat waiting patiently for me to finish.

He also decided that he would not go for a potty walk with anyone but me. (Talk about conflicting emotions, on one hand I thought this was the sweetest thing; on the other hand I realized that also meant I would be the one to have to get up throughout the nights. LOL.  (I would happily do that for the rest of my life if that meant having him longer))

I don't know how and I don't know why but this dog seemed to make a conscious decision to choose me at just four and a half months old, but he did. 

He captured my heart and in no time, he became the love of my life, in the purist form, hence his registered name.  As for his call name, for those that aren't intimately familiar with Seinfeld, “Schmoopy” is an over-the-top term of endearment that was so fitting for this love of mine.

In 2008, subsequent to the unexpected loss of another dog, Sassy joined our family when she was eight weeks old (She was a year and three months younger than Schmoopy).  I was absolutely amazed at how incredibly tolerant, gentle and patient he was with this little rambunctious puppy, with razor sharp teeth, I might add.  He was absolutely phenomenal with her.

We had an extraordinary life together.  We traveled to so many places together, and shared so many wonderful adventures together from running on the beach, swimming, hiking, biking, kayaking, stargazing, to just cuddling together or singing a couple of his favorite songs together (yes, that’s right, singing together (smile)).  He loved Carrie Underwood’s “Before He Cheats”, which is how I first learned that Schmoopy could howl.) 

Peter, my significant other has been a part of our lives for the last four years.  Schmoopy was reserved with most others but he genuinely loved Peter too.  I was elated. Peter is a wonderfully kind, gentle soul that met Schmoopy’s sense of what all humans should be like.

Schmoopy was a gorgeous dog that walked with his head held high, his tail up over his back and a smile on his face that was infectious.  He had a huge personality and so many fell in love with him.
Unfortunately in April of this year what was originally suspected to be a urinary tract infection quickly turned out to be a very rare, very aggressive cancer - Anal Gland Adenocarcinoma that was metastatic (had already spread).  The next month and a half we were consumed with taking care of Schmoopy, while doing as much research as possible, and specialty consults both locally and across the country.  We were desperately seeking a possible treatment protocol to extend Schmoopy’s life, and of course, not at the expense of his quality of life.  We made sound decisions and acted without delay.  It was such an overwhelming time.  Trying to sort through all the medical jargon, the countless holistic recommendations from caring individuals, the conflicting opinions between traditional doctors and more progressive doctors was beyond challenging.  We wanted to do the best for Schmoopy, and admittedly I couldn’t bear the thought of really losing him.  We had hope.  We clinged to hope.  We acted swiftly; we had to.  

The problematic symptom was Schmoopy’s blood calcium was elevated,  When elevated, he clearly wasn’t well.  In fact, early on in this short-lived journey, I really thought I would have to face putting him down but after sub-cutaneous fluids and IV fluids, he seemed to bounce back as a brand new Schmoopy…my old familiar, happy Schmoopy!  I couldn’t believe it when I saw him!  I was so happy!  I couldn’t believe the difference fluids made.  It was truly remarkable!  Knowing that at some point, hopefully in the far off future, I would have to make the decision to put him to sleep, it also caused me to feel somewhat inadequate in my ability to be able to determine whether or not it would be the right decision when that time would come.  (In other words, even when they look terrible, is it a simple remedy like fluids to help them bounce back?  I didn’t want to make a hasty decision only to learn that I could have done something else.)

Once his calcium was under control, Schmoopy underwent surgery where the primary tumor (which was quite small) and the swollen lymph node where it had spread were removed.  The surgery went well.  We were soo happy!  When we picked him up he was so happy to see us.  We were elated.  The intent was to control the spread which would alleviate the cancer from producing the hormone that caused the blood calcium to increase.  Unfortunately, the blood calcium started to increase about 10 days afterwards.  Sigh.  We planned to go through chemotherapy as we were told it would give a high probability of extending a good quality of life for Schmoopy that would likely give him a year and half or more, with minimal side effects.  We were told that dogs tolerate the chemotherapy protocol discussed quite well.  Without it, the future was bleak.

On May 19, 2017 Schmoopy had his first chemo treatment.  The first couple of days were not great but he seemed to get back to somewhat normal after a few days.

We took the dogs and a good friend of ours to a beautiful rental house in West Virginia.  Schmoopy did well.  He was good.  He was happy.  He was eating…until he wasn’t.  Things started to turn after the weekend.  His appetite no longer good.  I knew what that meant (it meant the calcium was up again).  We quickly brought him back to the vet for IV fluids.

May 31st, just 12 days after his first chemo treatment, was a horrific day for us and one we weren’t expecting to come so soon.

I knew at some point I would have to face letting Schmoopy go but I was ill prepared to face that decision on the eve of May 31, 2017.

You see, just five hours earlier I was picking Schmoopy up from the hospital and meeting with his oncologist, Dr. McNeill. (Schmoopy had been in the hospital getting IV fluids in an effort to reduce his blood calcium levels (a complication of the cancer. Anal Sac Adenocarcinoma (ASAC) tumors produce PTHrp (parathyroid hormone-related peptide), a protein that causes blood calcium levels to rise. The problem with elevated blood calcium levels is that in addition to causing Schmoopy to not feel well, if it’s too high for too long it can cause kidney damage/failure. So, managing his blood calcium was very important.) I could generally tell when his calcium was high by symptoms he exhibited (nauseous thereby resulting in a decreased appetite, lethargic, consuming large amounts of water and urinary incontinence).

Picking Schmoopy up this particular evening was different from other times. Based on the few times before, normally after IV fluids, Schmoopy seemed like a completely new dog again – full of life, happiness, excitement – just like my normal Schmoopy. In fact, I was always amazed at the immediate noticeable difference the fluids seemed to make. This time however, the fluids were unsuccessful in bringing down his calcium but a tiny bit so when Schmoopy came in the room, although happy to see me, a far departure from his normal enthusiasm. I could tell he didn’t feel great but that was to be expected because he never felt well when the calcium was high. I was concerned; very concerned that the calcium barely budged. So much so that as I spoke with Dr. McNeill, I asked him if I needed to consider letting Schmoopy go. I asked directly and bluntly on purpose as I always wanted to make sure I kept Schmoopy’s potential for quality of life front and center and in case any Dr. had a hard time bringing this up, I wanted to make sure I didn’t avoid the topic. 
I brought this up in many discussions as a means to check point my decisions along the way. (While Schmoopy had an aggressive cancer, we were given a high probability of a year and a half or more of good quality of life post treatment (surgery and chemotherapy), (3-4 months without treatment)). 

Dr. McNeill responded confidently, “Oh no, we’re not at that point yet.” as he compassionately hugged me. He then followed with, “We’re going to try this nasal spray form of Calcitonin to bring down his calcium and if that doesn’t work, I have a few other tricks up my sleeve. Let’s give this a couple of days and then recheck his blood.” Dr. McNeill also told me to expect to see some bruising on Schmoopy’s legs as a result of his low platelet count.

Peter and I went home with Schmoopy concerned and disappointed about the calcium but with a feeling of hope per our discussion with the Dr. 

As we observed him for the next few hours, he didn’t look good. The most lethargic I had seen him since this whole ordeal began. He would get up, take a few steps and then plop right back down. He wouldn’t eat, which I expected. He never ate when his calcium was high.

At 9:00pm I was to administer several medications as I typically had (anti-nausea pills, etc.) however when I opened his mouth I was taken aback by the color of his gums…very pale, almost white. 

I said to Peter that we need to bring him back right away. As Peter picked up Schmoopy to carry him out to the car, I noticed Schmoopy’s belly was bruised too. I didn’t feel prepared for this. I wasn’t sure if this was what the Dr. was referring to in our discussion earlier or if this was worse than he knew. I was disappointed in myself that I hadn’t thoroughly inspected Schmoopy before leaving the hospital earlier.

Shortly after getting checked into the emergency hospital again, the Doctor working that evening ran Schmoopy’s blood and so many of the blood levels were extremely low. She told me he would need a blood transfusion and plasma. 

I asked the dreaded question of this Dr. as well…”Do I need to consider letting him go now?” Her response, “Yes, that wouldn’t be a bad decision”. Panic, fear and confusion set in for me. How did we end up here when just five hours earlier Dr. McNeill said so confidently we weren’t near this point yet. What happened? How did this happen? What would Dr. McNeill advise right now? Did Dr. McNeill expect this? I felt completely unprepared for this moment at this time. If they had told me that he was having kidney issues due to the calcium, I would have understood that, I would have felt prepared for that, it would have been a logical decision I had to make. 

Seeing the lab results should have facilitated a logical decision making process on my part and likely would have had it not been for our discussion just hours before this moment. Although it was late, I insisted the ER Dr. call Dr. McNeill. I felt I needed him to be engaged. I wondered if he forgot to tell me about this situation as a potential and what to do if we found ourselves in this situation. I thought back to our conversation about the bruising and wondered if I was to expect to see what I was seeing or if this was far worse than what he thought. 

There’s no other way to say it other than I felt completely ill prepared for what was happening in those moments. Please understand that my confusion and feeling ill prepared was truly just relative to that moment in time and was a result of the two things really…1) the incongruent nature of the conversations in the span of five hours and 2) Not having any conversations about the potential for Schmoopy’s blood levels to get SO low that it would be life threatening. 

I wondered if I hadn’t asked all the right questions; was this simply an implied expectation that I was ignorant to? How in the world was I so unprepared for this situation? I prided myself on being a good care taker to Schmoopy; a thorough care taker, guardian. I thought I asked about potential side effects and how to address them, manage them, etc. Why couldn’t I recall anything about this particular scenario? Why was Dr. McNeill so confident that we weren’t at the point where I had to consider letting Schmoopy go? Why was all the discussion around Schmoopy’s calcium and not his blood levels? What was going on?? Ack! Sigh.

Given that the ER Dr. was unable to reach Dr. McNeill, I, we (Peter and I), had to make this decision without his input.  I was so afraid that if I made this decision that he would have said I should have done the transfusion and plasma, that I just needed to get Schmoopy through the “hump” and then his bone marrow would recover and start making blood cells again.  I also spoke with Ruth to share what was going on and to get her opinion as well.  It was all so overwhelming and excruciatingly painful.

A friend of mine so eloquently put into words what I was experiencing; It feels unnatural to choose the moment to end the journey. The wiring in us chooses life, survival.  The merciful spirit in us honors a more expansive existence beyond the pain and suffering of the flesh.“

I called my mom who rushed over so she too could say goodbye to my sweet love, Schmoopy. We kissed him, kept telling him how much we loved him, and kept petting him as he peacefully “went to sleep”. I haven’t cried that hard in a long time. I was in a world of my own, as if no one else was around. As hard as it was I know it was the right decision.

We did everything possible to try to get ahead of this cancer in an effort to give Schmoopy more quality time but this insidious disease took over.

As I had time for everything to sink in over the subsequent week and a half, I still had questions. I sent an email to Dr. McNeill:

“Hi Dr. McNeill,
While coming to terms with our loss of Schmoopy over this last week and reality settling in, I found myself left with some questions now that I have had some time to digest everything. 

In the end, specifically on the evening that we had to let him go, I felt ill prepared for that moment. Not because I didn’t realize that at some point it would come to that, but mainly because just 5 hours prior when I met with you to pick up Schmoopy and I asked you if I needed to consider putting him to sleep then, you compassionately hugged me and confidently commented, “Oh no…we’re not there yet”. 

I left with comfort and a good sense of hope. When I saw Schmoopy’s gums at 9:00pm and Schmoopy’s bruising that evening I found myself unsure of things because I recalled you telling me that he would have bruising due to his platelets being so low. My confusion was that I was unsure if what I was seeing was what you told me to expect or not. I felt ill prepared in those moments and ill prepared for his blood levels getting so low to the point that there really was no choice. 

Can you help me better understand what happened beyond the simple statement that the chemo effects bone marrow production which causes low platelets? I tried to make all the right decisions by way of Schmoopy but in the end I feel I really failed him. 

My mom thought I was crazy for even considering putting him through chemo but I wanted to keep an open mind and take in the current medical perspective. I elected to go the chemo route based on my understanding from our dialog that most dogs respond well and have very little to no side effects. I realize most is not all, and let me say up front, I’m not looking for blame, I’m really looking to better understand what happened. With all the medical jargon, I really didn’t understand all the lab results in the end. It’s not my field of expertise. I didn’t even know to expect this. I didn’t know to expect this to the point that it would take his life. 

Can you better help me understand what happened? Is there a term for what happened in the end? Is it Thrombocytopenia?…/managing-thrombocytopenia-as…
Statistically speaking, how often does this occur?
Is there something that can be done to help prevent this or minimize this? Medication? Supplements?””

I know there’s no bringing Schmoopy back so some may wonder why I even bothered but I felt the need to further understand so I could learn from it in case I ever encountered a situation like this again and so I could also share my experience with others. I also felt the need to understand why we never had any conversations about this. I knew to expect the platelets to drop, blood cells to drop, etc. (and I understand when on chemo you end up with a lower immune system, etc.) I just really wasn’t prepared for this to get to the point that it was life threatening. We were so focused on the calcium; I thought that was my primary issue at the time. Sigh.

After sending my email to Dr. McNeill, we spoke. He commented that he was just as surprised as I was. He had not anticipated Schmoopy’s blood levels to plummet the way they did. When I asked how often that happens he commented, “I know this won’t make you feel any better, but this really never happens, very rarely.” (It actually did make me feel slightly better knowing this. I would have felt I failed Schmoopy ever more so if this was something that tends to happen and I didn’t know about it and I didn’t ask the right questions about it.)

In the end, Schmoopy unfortunately had a rare, very aggressive cancer – Anal Sac Adenocarcinoma. The diagnosis was [unfortunately] textbook based on all that I read…elevated calcium showing up in lab work is a typical sign (and a sign of how aggressive the cancer is.) By the time of diagnosis, it had already spread to the right medial iliac lymph node (which is “textbook”. The primary [anal gland] tumor was small – much smaller than the lymph node is spread to (which again, is typical). Make sure your veterinarian performs rectal exams during your dog’s annual physical.

What wasn’t “textbook” was the outcome given the treatment options we underwent. The potential outcomes seemed promising to give Schmoopy a year and a half+ of a good quality of life but that wasn’t the case. I do understand each dog; each situation is different.

The surgery went very well. There was an expectation that post surgery, calcium would return to normal levels however within 10 days it was high again. The expectation was that the calcium would return to normal levels post chemotherapy but it rose again within 10 days.

The good news is that Schmoopy did really well over Memorial Day weekend (a few days before I had to let him go). We rented a beautiful house in West Virginia and enjoyed the weekend with the dogs and a good friend of ours. I am so thankful and cherish those memories as I do all of my memories with him. He was happy that weekend. He ate well. He played. He sang. He caught his treats when I threw them toward him (a game we played). I’m so happy it rained that weekend because we spent most of it inside just hanging out together. 

Schmoopy was my heart dog; my forever dog. He’s a part of my soul and I am forever grateful for him and for choosing me when he was just four and a half months old.

I love you Schmoopy, with all my heart and soul…and I know you felt that, as much as I felt how much you loved me too.  I will forever be extraordinarily grateful for you and I will always miss you, each and every single day.  You are a part of me and always will be.  Not a day goes by that I don’t think about you.

I can’t even begin to express how much I miss you. Life just isn’t the same without you. 
Rest in peace my sweet love.  Until we meet again.

For anyone facing cancer with their beloved any of their beloved dogs, I highly recommend the following book:

“The Dog Cancer Survival Guide”
Dr. Demian Dressler

It helped me immensely in so many different ways.

I also want to thank the following people for the tremendous love and support:

Peter, my significant other
My mom
Countless friends
Dr. Chand Khanna 
(remarkable oncologist with open views on treatment protocols)
(I consulted with him on several occasions and was in process of switching to him as a result of his open mindedness on alternative therapies involving CBD oil but we never got to that point, unfortunately.  Truly remarkable, compassionate, highly respected Dr.  I plan to donate to a non-profit he is affiliated with in an effort to help him help others.)

Anyone else that is interested, here is further information:


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Canine Chronicle - Westminster 2010 Edition

Canine Chronicle - Westminster 2010 Edition
Page 275