Samantha Ho (Sam) an animal lover, and has documented her journey, challenges and struggles of taking care of a senior dog - as an aspiring Vet-to-be and final year vet student at the University of Edinburgh with a strong passion for nutrition, Sam partners with Chuku's Kitchen, as a Small Animal Nutrition Educator.

At Chuku's Kitchen, we share this because we want to create an open community, build awareness, drive transparency and  by sharing her journey in hopes of inspiring hope to those who may be facing the same 

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It was July when the alarm bells first started sounding for us. Cocoa, my 13 year old shihtzu (turning 14 in February 2024!) had a small increase in her SDMA levels during her annual blood tests (SDMA is a more sensitive marker for kidney dysfunction as compared to the conventional measurements for urea or creatinine concentrations).

Chronic kidney disease is one of the most common health problems in geriatric dogs and cats. It starts by the slow death of kidney cells, also known as nephrons, often just due to accumulations of collateral damage as the animal ages. As nephrons are not able to be regenerated, the rest of the remainder have to pick up the slack of filtering urine to ensure that not too much good stuff (water, minerals such as sodium and potassium, sugars etc), is lost and that the bad stuff like toxins (urea and creatinine amongst others) are filtered out. And unfortunately, this causes even more nephrons to die off and the cycle repeats. Over time, less nephrons work and the good stuff can’t be fully reabsorbed and the bad stuff can’t be fully filtered out, leading to an accumulation of toxins in the bloodstream and a dilution of urine, which is why vets can diagnose kidney problems by checking BUN and CREA on blood tests. This preliminary diagnosis of kidney dysfunction can be further confirmed with other tests such as urinalysis, which looks for presence or absence of substances such as protein, glucose, signs of infection amongst others in the urine, and urine specific gravity measurement, which checks how dilute or concentrated the urine is. Unfortunately, CKD is not reversible or curable - it can only be mitigated for, and most patients eventually die of kidney failure.

Then in August, i discovered a black nodule on her face that I panicked about and immediately brought her in to see our vet. That nodule turned out fine, a benign old age thing, but our vet discovered something much worse at the same time - a small mass about the size of a pea, just under the skin, on the inner surface of her left knee. X-rays were taken, and we discussed the possibility of bone cancer, also known as osteosarcoma. I opted to wait and see - osteosarcoma typically affects large to giant breed dogs, with one veterinary oncologist even estimating that only less than 15% of osteosarcoma patients she treated were small and medium breed dogs. Unfortunately, by the time October came around, the mass had grown to the size of a golf ball, and Cocoa had suddenly started to limp. Our vet immediately referred us to a specialty hospital and it was clear to me that the whole leg had to go.

Osteosarcoma is not just any type of cancer. It is one of the most aggressive cancers in dogs. By the time the cancer is visible; with clinical signs such as limping, radiographic signs of bone loss and swelling amongst others; the cancer has already spread. Most dogs who undergo aggressive treatment (radical surgery + intensive chemotherapy) have only a mean survival time of 1 year, and less than 25% make it to 2 years.

My veterinary education has prepared me well for the clinical aspects of the situation. Within a weekend of the referral, I had a full 7 step treatment plan worked up. I researched what complementary medicines and therapies we could try, especially in light of her kidney disease which had only gotten worse from the day it was discovered. And yes, I also started planning for our eventual goodbye. I didn’t even spare any energy to cry or grieve or even sleep - whatever energy I spent doing any of those activities could be spent reading up more and seeing what else we could try.

The amputation surgery came and went, and Cocoa was to stay at the hospital overnight for monitoring. The next day, when we went to collect her, she was shivering and shaking and so miserable. And that was when I let out one sob, and then the dam sealed over again.

Cocoa was confined to a baby crate for 2 weeks. The first couple of days she did nothing but sleep. I’d made it as comfortable as I could for her - a water fountain, a memory foam cushion as a bed, a pee tray for her to do her toileting in. I diligently gave her her meds 3 times a day - antibiotics, painkillers, anti anxiety meds to keep her calm, and put all of my work on pause so I could take care of her.

It took almost 2 months for her pathology results to come back; two weeks for her initial results confirming that the mass was cancerous, but it was not clear what kind of cancer it was, so we opted to go for further staining to see if it was either osteosarcoma or soft tissue sarcoma. A whole month passed before we finally got the results mid-December - she didn’t have osteosarcoma after all, but soft tissue sarcoma.

Unlike osteosarcoma, soft tissue sarcoma is not nearly as bad. Soft tissue sarcomas are an umbrella group of cancers of different types of cells, from muscle cells to nerve cells to joint cells. They all respond similarly to treatment and look pretty similar under the microscope too, which is why the diagnosis of soft tissue sarcoma is usually enough for a vet to choose a treatment. Given the grade (intermediate) and the slow growth of the cancer cells (low mitotic index), the oncologist recommended no further treatment aside from regular three-monthly checkups with our usual vet.

When I first wrote this article, we had not received her full histopathology report yet. But even now, I am exhausted and stressed. I’m close to giving up - I’m meant to be on a break from vet school precisely because of my health problems and severe burnout, and yet I’m working myself to the bone so that we can afford to pay for her fees. All of her care and the care of the other two pets, Puffin, my own cat and Patchy, the foster cat, is entirely up to me.

You’d think things would be different for me, given that I have the academic background to decide the best course of treatment for her. After all, I have finished the entire teaching course at one of the top vet schools in the world, and have only my attachment year to complete before I am fully qualified. In a way, I suppose that I do have it better than others, given that I know what I’m dealing with and I know what I can do. The weekend after she was diagnosed, I spent all of my waking time planning a 7-step treatment plan for the cancer + kidney disease. I booked appointments left and right, both with vets in Singapore and colleagues that I know overseas. Every conversation that I’ve had with the qualified vets has been met with agreement and acknowledgment that I know what I’m doing. To date, Cocoa has currently undergone these treatments - full limb disarticulation and amputation for her cancerous left hindleg, complete food change onto a board certified vet nutritionist-formulated recipe via Chuku's Kitchen, hypertension medication and additional supplements such as 2 types of mushroom powder, Greek yogurt for probiotics, microalgae, and a renal specific supplement prescribed by our vet.

In other ways however, the emotional distress of these diagnoses is exactly the same. The grief of losing my best friend after 5 years of being apart. The exhaustion from having to shuttle her left and right to different clinics and arrange my schedule around her countless appointments. The hopelessness, knowing that the cancer and kidney disease will never fully go away, that I have, at best, a couple of years left with her before I have to make the dreaded decision to end her suffering. Perhaps this grief is made even worse by my education, knowing that I’m going to be a fully qualified vet in a year and a bit, yet not even being able to cure my own dog, or even see her alive at that stage in my life.

But even with this heaviness and constant struggle for any semblance of joy, I can say that there are many things to be grateful for, even now. It isn’t osteosarcoma. I am here in Singapore with her whilst she’s battling all of these problems, rather than still being stuck in Scotland, worrying about her and even more powerless than I am now. I have a great team of vets and colleagues here and in the UK who have been so helpful and kind and sympathetic to the situation at hand. My family is willing to chip in for the vet fees, especially now that she’s unwell.

I am cognizant of many emotions in this messy, messy place in life right now. Suffering will come and has come, and I am powerless to stop it. But suffering will not best me, because every situation in my life can have a silver lining. Even when the time comes that Cocoa falls asleep for the last time in my lap, I will always know I did my best for her. I know that she is only one of the thousands of animals I will have an impact on when I graduate, and I solemnly swear to do my best for every one of those thousands of animals, just like I did for my own little lion dog.

References:

https://www.dvm360.com/view/an-overview-of-osteosarcoma

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=19840&catId=105943&id=8250202&ind=562&objTypeID=17

http://www.iris-kidney.com/guidelines/index.html