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Quality of liFe - end of life decision points (Sebastian)
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15 January 2018 - 6:05 pm
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Today was a mixed bag - Sebastian was excited to go out for a short walk early this afternoon and did great. Today was very windy/blustery, so we stayed inside most of the day and sat around. Sebastian laid around in one spot most of the day, even with everyone home. His mom thought his eyes were showing "signs" as he laid about during the day.

However, he was excited for dinner and finished his food as usual and went outside for a quick bathroom break and we came back inside. He's now back to resting on the couch and looks like he won't be moving anywhere soon. 

I suppose we could be entering that time where one refers to a quality of life. I want him to stay with us forever, but I don't want him to reach the decompensation point that I've read about either. I have a feeling trying to figure out what that looks like is going to be impossible. Seeing him chase squirrels one day and then resting all day the next. If he gets to the decompensation point, it could be that dramatic. Sitting here, I hope that's not the case now. 

I've read the post Knowing when it's time, but I do have one quick question... I know it's all about quality of life and one measure is number of good days vs number of bad days, but how does one distinguish between a lazy day and one of those bad days? I'm hopeful Sebastian is having a lazy day, but I want to be able to identify Sebastian's time before he reaches the decompensation point, as all dogs are so good at hiding their pain/hurt.

If anyone has any insight, I would be greatly appreciative. Thanks. 

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15 January 2018 - 6:49 pm
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I think that it gets to a point where it's more than just one day.  For us, obviously Murphy was slowing down - he was 11 1/2 and it had been over 4 years since his amputation surgery.  We had been gone on vacation for 2 weeks (I was SO worried something would happen while we were gone!!!), and when we came home I thought he seemed thinner than he had been before we left.  He had an appointment with the rehab vet and she also made a comment about him losing "muscle mass."  He had an episode or two of some diarrhea that day, too.  That was a Thursday.  He seemed a little "off" on Friday  ... sort of hard to describe.  I think I told Paula that he seemed sad to me.  He was laying around a lot more, and it seemed like when he was breathing, his cheeks were puffing a little bit.  On Saturday we had to go out of town for my great-aunt's 98th birthday, so I had my son check on him while we were gone for the day.  On Sunday he needed encouragement to go outside at all - but when he was outside he just plopped down on the deck, he didn't go out to the yard at all and he never went potty at all.  He still had an interest in food - so don't use that as your guide.  On Monday morning I called to try to get him in.  They were booked and it was difficult, but I insisted.  The only type of appointment they had was one where I could take him in & leave him for the day, they would get to him between other appointments.  By noon the vet called to say that Murphy had a large tumor in his spleen, most likely a hemangiosarcoma, and that it was probably already bleeding some because his blood count was low.  We took our other dogs up that evening and said good-bye to him.  

I hope that helps some.

Donna

Donna, Glenn & Murphy 

Murphy had his right front leg amputated due to histiocytic sarcoma at 7 years old. He survived 4 years, 2 months & 1 week, only to be taken by hemangiosarcoma at 11 1/2 years 6/12/17  
Read about Murphy's Life on Three Legs

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Virginia



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15 January 2018 - 7:29 pm
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Honest to goodness!!   After I responded to all those great videoe yesterday I almost came back a bunch of times to write a PS, but kept getting sidetracked!  And this is what I was going to say:

PS  NOW DON'T BE SURPRISED IF SEBASTIAN IS  A BIT OFF THE NEXT DAY AND JUST WANTS TO REST!!   THAT IS PERFECTLY NORMAL AFTER HAVING  SUCH A GOOD DAY WITH A LOT OF ACTIVITY!!  

Yep...that's EXACTLY what I was going to PS.  So I just did it.....a day late! 🙂 🙂

During this part of the journey, dogs often have some good days and some less good days.  It's sort of a new normal.  The "less good days" wont frighten you as much once you recognize that's all they are.

So this does not surprise me at all!   And, based on what you've described, Sebastian is just having a lazy day and js preferring to stay inside where its warm.  We ALL have those days!   I KNOW you don't want him to suffer if at all possible.  Sebastian does not appear to be "suffering"' or facing immediate decomposition.   We would all rather be "a day too soon than a day too late".  Ideally, we would like "it" to be at just the "right" time. 

Don't let the worry of "when" override the joy of the fact that "it's not today"! 

I'll share one thing about my journey with Happy Hannah during a similr phase as you are having with Sebastian.  First of all, I can tell you that my Happy Hannah got to a point where she was definitely tiring a lot easier than what I see going on with Sebastian at all!!!  She got REALLY tired REALLY quickly.   But my Happy Hannah didn't mknd lazing around or just laying in the sun, or under a shady tree.....as long as we were togetherheart   For me, when I realized that Happy Hannah could not seem to sleep at night, that was a "sign" that I needed to really observe her when she tried to sleep.   Sure, she was EATING, drinking wagging, etc.  She never had thst "look" that some people see and she never seemed to go downhill in such a dramatic way that I "knew".. .. But when she couldn't sleep comfortably because (I guess) the mets were hampering her breathing and she couldn't sleep but for very, very, very  short periods at a time without sitting up and trying to readjust for a better breathing position.   From that point forward,, I felt anytime would be "okay".

I think I'm kinda' rambling and apologize.

I can only say that, from the videos of Sebastian, I'm not surprised at all that he's having a lazy day or two.  He certainly still seems to have a lot of "good days" in him!! 🙂

Speaking of videos......MORE!  Even if it's a video of hi just taking a nap, we loved videos of Sebastian!

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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15 January 2018 - 7:37 pm
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Thank you both - I've been trying to come up with the signs that will let me know when he'll be ready, and food has been one I have had trouble with, because it seems he'll always be up for a snack or meal. If he gets to the point where he's resisting food, then he'll obviously be past that decompensation point. I rather him have a nice meal before he heads off for the bridge.

I just have no idea how to tell a lazy day from a bad day. I'm pretty sure today was a lazy day - I appreciate your insight thinking the same thing.

And don't worry, I'm only typing this now since he's resting. When he's alert and awake, I'm with him in the moment. 🙂
Thanks again!

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Virginia



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15 January 2018 - 8:01 pm
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Okay, I had to chuckle just a little about the "send-off" meal.  I never knew Happy Hannah to miss a meal.....not even right after her amputation!  In fact, had she decided not to eat, like you and Sebastian, I might have thought my "decision" would have been waaaaaay too late!!!  

Like you, I always wanted to be able to have a great celebration meal for her send off.  So my solution was simple.  I merely gave her a great "send-off" meal every day for about  three or four months!! 🙂 🙂   Steak, ice cream, cheese pizza, and of course, a couple of M&M's a day.  She liked the green ones 🙂

So get ready Sebastian, I think you're about to have some really good meals coming up.....and for quite awhile too!! 🙂    Run squirrels, run!!!!!   You may be on the memu!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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16 January 2018 - 11:19 am
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I know it's all about quality of life and one measure is number of good days vs number of bad days, but how does one distinguish between a lazy day and one of those bad days?

It's so hard to say, it really depends on the individual animal. Our Jerry had many days just as you described. I think what helped us see the 'bad days' were when he lacked the willingness to do the things that were important to him. Play ball. Catch popcorn in the air. Destroy his Barney doll. He was never a big eater, so appetite didn't play into it. The last indicator was when he urinated in his own bed one night after a rapid decline in his stamina and strength. It wasn't an odd occurrence, rather the incident fit into all the signs of a dog who was ready to leave this earth. Both of us agreed that when he reached that point, it was time. We are still glad we made that call when we did. Any longer might have resulted in a far worse farewell.

Decide now what things mark Sebastian's quality of life indicators. Choose a 'line' that if crossed, you will know it's time. Also have your last vet visit in mind...who will help him transition to the Bridge, and where. You don't necessarily have to make the appointment, but just know who you will call so when you reach that point, you can keep a clearer head.

We don't often see these things right away, so it's important to be on top of it. A Penny Jar might help too.

Finally, if you want to consult with a hospice vet, we highly recommend it. Build that relationship now, let them get to know your sweetie and when it's time, they can help make it easier. 

Some links for you. ((((hugs))))

Quality of Life Scale Tips with Pet Hospice Expert Dr. Alice Villalobos

Pet Hospice and Euthanasia with Dr. Sheila Kirt

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

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16 January 2018 - 12:14 pm
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When Tripug Maggie was diagnosed with her second cancer (oral melanoma) I decided not to do aggressive treatments. One of the things I did right away was to define for myself her minimum quality of life and I wrote down the 'line' that I would not cross. I couldn't use appetite- hers was non-existent due to kidney failure.  Her energy level was diminishing, but she still took herself outside to lay in the sun- one of her very favorite ways to pass the time.  She was getting sub-Q fluids at home every other day- I learned how to do it so we didn't have to go to the vet all the time.  She tolerated it quite well- but I knew if it became a struggle it wasn't worth it. She had become incontinent but meds controlled it pretty well.  If the meds stopped working though it would be time.  She was miserable when she peed on herself in her sleep and woke up soaking wet.

But the biggest 'line' for me was having to use pain meds routinely to control the tumor pain. Maggie absolutely freaked out on pain meds, there was no life quality for her there.  In fact because the tumor pain became intense on what turned out to be our last night I gave her some tramadol to try and make her comfortable. It did work for the pain, but she did not sleep for 12 hours and acted like something was chasing her.

When I called the vet to make the appointment we did discuss trying different meds to get the pain under control without causing the anxiety. Also since she had kidney failure and a suspicious lesion on her liver the stronger pain meds could cause organ issues.  At best, if we could find something that worked, it would buy us a week or two or three. 

The bottom line was that no matter what we did she was not going to beat the tumor, she was not going to get better.

Karen and the Spirit Pug Girls

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

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16 January 2018 - 2:02 pm
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With your love for Sebastian and your awareness of his needs, I think you will know it in your heart.

I lost Rosie so quickly to an aggressive disease that didn't even give me a chance to plan. We helped her over the bridge in the middle of trying to save her. I could not control her pain and I refused to see her suffer with no end in sight.

I lost my Chocolate Lab Pepper to congenital heart failure. She was only 9. The doctor gave her a year, it took 4 months. She started having Grand mal seizures. First they were spread out, then they were any time she got excited. She came out of it and was mortified when she saw she had lost her bladder control. That dog had a bladder of steel and never ever had accidents. One night she was laying in the living room and she started having difficulty breathing. She tried to get up but she couldn't. I talked to her and she looked at me and wagged her tail, but she looked so helpless. I took my stethoscope and listened to her heart. It kept going up and down, back and forth, just out of control. I could have tried to wait it out, but she was just so tired. The kind of tired that you know is time. She had looked that way more and more, in my heart enough was enough.

When the sparkle is gone and it doesn't come back, when he loses his want to wander the yard, I won't say chase squirrels because he may want to but not be able to. When you see him uncomfortable and you cannot ease it and it just stays that way. I really believe in my heart that you will know. You are so very smart and know your baby inside and out. It just happens and something inside warns you, but it's not like worry because it doesn't go away. 

He is such an active boy, I think it is fair to say he will need more rest as time goes by, and there is nothing wrong with that. I think it is like what Karen is telling you. You look at the options and even with the options the quality of life becomes poor. It isn't a temporary poor, it is one that you know they can't recover from.  

Sheesh, I am not trying to ramble, sorry. It is so hard to give a definitive answer to such an important question that has no definitive rules, they are all different. Trust your heart, trust your intelligence, trust your love and you cannot possibly go wrong. Every day now is a gift. I hope it is the longest lasting gift you have ever had! Sebastian is still happy, glowing, and very much alive. You are doing what a lot of people don't get to do, spending this wonderful time with him pain free and happy! 

Have faith in yourself, you have more than earned it!

Big hugs,

Jackie heart

Hugs,

Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry

Huckleberry's Blog

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16 January 2018 - 2:43 pm
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If you haven't already, read the two-part series about how we knew when to say when with Jerry, and the many comments for even more feedback from others.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

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16 January 2018 - 3:26 pm
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I just went over and read your story how we knew when to say when . That was beautifully written and it really sums it up so well. I hadn't bumped into that yet I guess. It describes in words what is so very hard to say, thank you.

Hugs,

Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry

Huckleberry's Blog

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16 January 2018 - 4:36 pm
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Nothing to add except that I think everyone here has given such wonderful advice and it shows how much everyone cares for their pets.  I am convinced that you will do the absolute best thing for Sebastian. He is so, so loved and you are so dedicated to his happiness and well being. Those who have had to do this before will help guide you, but we are ALL keeping Sebastian in our hearts.

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Virginia



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16 January 2018 - 5:38 pm
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Yrs, so well said  by everyone with such heartfelt compassion.   The comments reflect a TRUE understanding of the heavy vurden we carry when given the "opportunity" to give the gift of release.  Yes, it IS  a burden, but it is alao a "gift".  It IS an "opportunity" in a somewhat distorted way, because  sometimes things happen that are unforseen that involve pain, or a crises trip to the Vet, etc.

WHATEVER YOU DO.....AND IT'S HARD......DO NOT WASTE ONE SECOND PUTTING YOUR ENERGY AND FOCUS INTO SEBASTION "dying" WHILE HE IS STILL LIVING!!   That is a regret none of us want to love with.   You are soing an excellent job of continuing to make every moment count!  

  I know your Vet said "the end is near".   What if your Vet didn't say that, but said something like "No one can say how much time any of us have.   Go home and spoil Sebastian and love him and make everyday count."     I think your focus would be all about "living",   Sebastian's focus sure is on living!! 🙂   And I think Mojo's focus is all about living and haviw a good time woth Sebastian.  Continue to keep your energy in a celebratory, upbeat and confident state and your pups will definitely feed off that.

Lots and lots of hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

paws120 said
With your love for Sebastian and your awareness of his needs, I think you will know it in your heart.

When the sparkle is gone and it doesn't come back, when he loses his want to wander the yard, I won't say chase squirrels because he may want to but not be able to. When you see him uncomfortable and you cannot ease it and it just stays that way. I really believe in my heart that you will know. You are so very smart and know your baby inside and out. It just happens and something inside warns you, but it's not like worry because it doesn't go away. 

He is such an active boy, I think it is fair to say he will need more rest as time goes by, and there is nothing wrong with that. I think it is like what Karen is telling you. You look at the options and even with the options the quality of life becomes poor. It isn't a temporary poor, it is one that you know they can't recover from.  

  Trust your heart, trust your intelligence, trust your love and you cannot possibly go wrong. Every day now is a gift. I hope it is the longest lasting gift you have ever had! Sebastian is still happy, glowing, and very much alive. You are doing what a lot of people don't get to do, spending this wonderful time with him pain free and happy! 

Have faith in yourself, you have more than earned it!

Big hugs,

Jackie heart  

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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17 January 2018 - 4:10 am
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Since I only just went through this I thought I‘d give you my two cents on this, too. 

Manni died from a second osteosarcoma, not lung mets but as far as I know lung mets don’t cause pain as such? We got a confirmation of a tentative diagnosis in early August. I was told that the vets didn’t dare give a prognosis but that I should expect days rather than months. From that day on I basically expected the worst every day and looked for signs that things were taking a turn for the worst. 

People here digitally kicked my butt for that, rightly so, because Manni was still around and I should have just concentrated on enjoying every moment. I did that, too though. I tried very hard to make every moment count and take him on adventures every day. But, like you, my biggest fear was that I would „miss the right moment“ or even be too early. I knew that my dog was set to die from pain basically and all I wanted was do right by him. 

Manni ended up living another 4 months and I let him go when the pain meds didn’t last during the night, for two nights in a row. I had set a limit in my head of which pain meds and how many I was willing to give him. Like with Karen’s Maggie, Manni reacted badly to Tramadol and I knew I didn’t want himto spend his last few days completely beside himself. So I knew that, when all the medication I was willing to try didn’t work anymore, that would be the day. And it was. I know he must’ve been in some considerable pain these last few weeks but until then it was manageable-until it wasn’t anymore. 

Mind you: I don’t feel like Manni „let me know“ , I am pretty sure he would’ve gone on, because that’s the way he was. But I still knew it was the right time. And even in my grief now I don’t doubt that decision in the slightest. 

From my very personal view: educate yourself on what you most likely have to expect with the progression of the lung mets, talk to people here and talk to your vet, read up on the internet and judging from that info decide on what the line is for you. Trust me, you will know when you reached it. And when you’re done, enjoy the heck out of Sebastian, give him the time of his life and incorporate that he will need more periods of rest than he used to, because he is sick after all, but enjoy enjoy enjoy. I know how hard it is and the bad thoughts will probably never leave you but Sebastian doesn’t need to know that, does he??

one more thing: this „living in the now“ , enjoying what ever time you will get is sound advice. I really believe that. However, prepare yourself that the bond with your dog will grow even stronger so when eventually you have to say goodbye it’s going to hurt that much more. I didn’t think it would, but yeah, it really does. I still would not do anything differently. Nothing whatsoever. And that, for a change, is a good feeling. 

Hugs

tina 

Guardian of Manni the Wonderdog. -Or was it the other way around?
Osteo and amputation in Dec 2015. Second, inoperable, primary osteosarcoma found in June 2017.
The end of our adventures came Dec 10, 2017. 2 years to the day.

Manni's blog -dogblog-

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17 January 2018 - 7:27 am
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tinsch said
Since I only just went through this I thought I‘d give you my two cents on this, too. 

Manni died from a second osteosarcoma, not lung mets but as far as I know lung mets don’t cause pain as such? We got a confirmation of a tentative diagnosis in early August. I was told that the vets didn’t dare give a prognosis but that I should expect days rather than months. From that day on I basically expected the worst every day and looked for signs that things were taking a turn for the worst. 

People here digitally kicked my butt for that, rightly so, because Manni was still around and I should have just concentrated on enjoying every moment. I did that, too though. I tried very hard to make every moment count and take him on adventures every day. But, like you, my biggest fear was that I would „miss the right moment“ or even be too early. I knew that my dog was set to die from pain basically and all I wanted was do right by him. 

Manni ended up living another 4 months and I let him go when the pain meds didn’t last during the night, for two nights in a row. I had set a limit in my head of which pain meds and how many I was willing to give him. Like with Karen’s Maggie, Manni reacted badly to Tramadol and I knew I didn’t want himto spend his last few days completely beside himself. So I knew that, when all the medication I was willing to try didn’t work anymore, that would be the day. And it was. I know he must’ve been in some considerable pain these last few weeks but until then it was manageable-until it wasn’t anymore. 

Mind you: I don’t feel like Manni „let me know“ , I am pretty sure he would’ve gone on, because that’s the way he was. But I still knew it was the right time. And even in my grief now I don’t doubt that decision in the slightest. 

From my very personal view: educate yourself on what you most likely have to expect with the progression of the lung mets, talk to people here and talk to your vet, read up on the internet and judging from that info decide on what the line is for you. Trust me, you will know when you reached it. And when you’re done, enjoy the heck out of Sebastian, give him the time of his life and incorporate that he will need more periods of rest than he used to, because he is sick after all, but enjoy enjoy enjoy. I know how hard it is and the bad thoughts will probably never leave you but Sebastian doesn’t need to know that, does he??

one more thing: this „living in the now“ , enjoying what ever time you will get is sound advice. I really believe that. However, prepare yourself that the bond with your dog will grow even stronger so when eventually you have to say goodbye it’s going to hurt that much more. I didn’t think it would, but yeah, it really does. I still would not do anything differently. Nothing whatsoever. And that, for a change, is a good feeling. 

Hugs

tina   

Thank you Tina - for sharing your experience. A lot of what you said is true in our case. 

For what it's worth, I don't believe Sebastian is in much pain (yet). He is still able to go out for his daily walk around the block (more like a quick jog) and he gets up excited when someone comes home. 

As for pain medication, he had a bad reaction to carprofen several months ago, so he's taking metacam instead. He's also taking a cough tab once a day and some sanshedan with his meals. So far, I haven't noticed any breathing issues, except for an occasional hacking that generally happens when he's overly excited and gets up too quickly. But with the cough tabs, that generally only lasts a couple seconds and then goes away. 

I'm still nervous about a rapid decline - but we've made several arrangements already. His vet reached out to the oncologist and they didn't think metronomic therapy would be appropriate due to lack of success they have had with it, but they offered palladia, but everything I have read is that there are high percentage of those that have side effects. 

We'll see where our journey takes us from here. Thanks again!

Jon

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Virginia



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17 January 2018 - 10:10 am
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Tina, the wisdom you have shared is TRULY invaluable.  Here you are, yet again, still struggling with yiur own broken heart, reaching out to others  with such kindness.heart

Every single word you wrote Tina is a "how to primer" on the steps needed to take yourself to a place of making every moment count.

So Jon, in case you haven "gotten the message", consider yourself "digitally kicked in the butt" 🙂 🙂   Make no mistake about it, we know firsthand it's not easy, but it is sooooo important for Sebastian's wellbeing and for your wellbeing and the wellbeing of your day to day interactions with Sebastian and Mojo.

Hugs to all!

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

PS.  I used Karen's "line in the sand" process when it came to how much "treatment" I would, pr would not, pursue when Happy Hannah devloped mets.   It's such a good strategy for so many different aspects of this journey.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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