Hi all, 

I hope that everyone has had a good start to the year. I wanted to provide an update on Forrest as it has been about a month since we last checked in. Unfortunately, this update is shared with a heavier heart than some of my previous updates..

Last I checked in, we were about to begin the Yale vaccine trial and were scheduled for chest x-rays prior to starting that journey - we received the all clear on the x-rays as of Jan 23rd, so we proceeded with the first dose of the vaccine and scheduled in for the second dose to be administered 3 weeks later on Feb 13th. We were thrilled that his chest x-rays still showed nothing remarkable, and it felt like despite the higher dose of pain meds he remained on to manage the phantom limb episodes, he was overall improving every day. He had good energy for walks, hikes, and even had been swimming a few times. When we'd take him to the dog park he was running and playing with his friends and everyone we met was just astounded at how well he has been adapting to life on three. We were really starting to feel like we might be one of the lucky ones that gets more time. After all, we had done everything right - amputation, chemo w/ carboplatin, $400+ a month on the best cancer fighting supplements we could track down, weekly physio, 8 hours round trip x2 for the Yale vaccine trial - didn't we all deserve to reap the benefits of these efforts? 

But sometimes, life has other plans. About two days prior to Forrest's second dose of the Yale vaccine, I discovered a small hard lump had formed on the back of his mid neck. It was somewhat close to where we were told the vaccine had been administered, so we thought it might be a sterile abscess forming as that is a known side effect, but is ultimately harmless and resolves on its own. We had the oncologist at BARC check it out when he got his second shot, and she agreed that might be the case but said to maybe have it aspirated just to be sure. We had his third chemo appointment scheduled for the next day with his regular oncologist (Feb 14th) and they also checked it out. They weren't so convinced it was a sterile abscess, but also said let's wait and see if it changes at all because for now she didn't think it was remarkable. Felt like any old lump an aging pup might get. However, caveated this with if it "doubles in size" then be sure to get it tested. 

One week later, he's doing great after chemo as he has for all the three previous doses, but the lump has grown from 1.5cm to 2.2cm and we're starting to get concerned. We returned to Boundary Bay on Feb 22nd to have the lump aspirated and were told we should get results by yesterday, Monday, Feb 26th. Over the course of the last few days we were also feeling like Forrest was showing some signs of slowing down - walks he was fine on a few weeks ago were now making him a bit tired and he'd stop to just lie down in the grass more frequently. In the evenings there were moments when he seemed a little uncomfortable, unsettled and just unlike himself. But then he'd snap out of it and get a burst of energy at the park, running at full speed, or he'd bring me a toy and want to play tug of war at home. We chalked it up to him just being a bit tired and he'd bounce back. 

We waited all day yesterday until around 5pm we got the call - the pathologist said, with near certainty, this is a sarcoma and we suspect osteosarcoma metastasis to the skin. Our oncologist expressed her sincere surprise - feeling the lump, she didn't think that is what it would come back as. Additionally, skin metastasis typically happens in multiples all over the body and currently Forrest has only developed the one lump, so the presentation is unusual. However, the pathologist didn't leave much room for any other possibility in their report, so we're now operating under the assumption that the disease has progressed and the prognosis is not great. We've been given a couple months, and I know that is just a number and really means nothing - he's on his own journey, he's not a statistic - but coupled with the visible signs of him slowing down the last couple days, it's incredibly difficult to not see it as a foregone conclusion. 

Our oncologist explained that with skin mets, you could remove them but the likelihood is that they come back quickly and in multiple locations (in ten years she has only seen one dog where they removed and it didn't come back, and that dog passed to osteosarcoma mets elsewhere 4 months later). She also recommended that we do not proceed with the 4th and final dose of carboplatin because it's clearly not having the intended effect, so why continue putting him under any undue stress. We could explore oral chemo options, but she advised against that as it only has a 10-20% chance of slowing the cancer down a bit but comes with increased risk of side effects, which again in a dog that is in the final stages of the disease why put them through that? I think I agree with this, but I do still battle with the guilt of not doing everything we could, and I guess the 'What if that is what saves him?' But truthfully, there is no saving him - this disease will eventually take him from us, despite every grand effort we have made. For the time we have left I think the best thing we can do is just love him fully every single day and acknowledge that any additional effort would be for us, not for him, and that just isn't fair. 

I think we've ultimately decided this - for now, no more damn vet visits, including physio. We've felt from the start that it wasn't doing much for him, and he honestly hates it so why continue putting him through that when that time could be spent sitting by the ocean and watching the waves, sniffing the wind, and chewing on sticks? We are undecided whether we'll do another round of chest x-rays.. maybe at the 4month mark, supposedly the 'prognostic' ones, just to know whether it's in his lungs. But really what will this do for us at this point? Maybe it would make the final decision easier, but I'm just not sure. 

So here we are, 11 weeks post amputation, faced with the reality that our time is close to up. We've known from the start that home euthanasia is our preferred option, so we'll have to start looking into hospice vets in our area that offer this. But how on earth do you know if you've picked the right person? And how will we truly know when it's time? What are the signs that their fight is up? He's so stoic, but it breaks my heart thinking that he's suffering even a moment longer than necessary... 

I am also heading to London, UK for 8 days from March 9th-17th for a pre-planned work trip, and I would be lying if I said I'm not feeling an immense amount of guilt at leaving for any length of time in what might be his final days. The worry of him going downhill quickly when I'm not here is eating me alive. But I'm trying to remind myself that life has to go on, and finding some normalcy is good not just for me but also for Forrest. 

Well, another longwinded post from me, but truly this space has been so therapeutic during the stages of our grief and I'm grateful to have somewhere to turn to just write it all out. I've added a recent photo that Jamie took that instantly became one of my favourite photos of Forrest ever taken. Also a video of him at the beach a couple weeks ago - blink and you'll miss it, but there was a rainbow in the sky and it just felt like a sign of hope - that even in the darkness, you can find the light. Forrest has taught me that every single day. 

Forrest ❤️

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