Smokey, also remembered

I've been reading a fantastic book, Rabbit Health in the 21st Century. The author knows a lot about rabbits, partly through her experience rescuing them and partly through paying ungodly amounts of money to save them from disease. So while we're all depressed anyway, here's the story of her rabbit Smokey (his brother Murray is pictured above), who lost a two year battle with cancer. I cried a lot after reading it and had a panic attack, but it was worth it:

"Smokey was a gray lop who entered our lives and stole our hearts in April 1994. His family was moving and decided not to take him--if we didn't want him, someone who raised rabbits for food would 'dispose of him.' When he came to us he was four years old and had been severely neglected. He lived alone in an outdoor hutch. He had horrible malocclusion which no one had noticed. He cowered in the back of his cage and trembled when I held him. Within a month, however, he was chasing me around the back yard. It was such a joy to watch Smokey come out of his shell.

The following February, Smokey developed a stubborn ear infection. He bravely endured nine months of vet visits, antibiotic treatment, and ear flushes before finally being cured. He was a model patient--never fighting his medication and never acting sick. He and I really bonded during those nine months of medication--and Smokey became my first House Rabbit.

On December 4, 1997, Smokey was diagnosed with cancer. He had a huge mass in his mouth. I mad it clear that money was not a consideration if there was hope for quality of life; however, I would not let him suffer. Dr. Bradley recommended we try surgery, and euthanize him if that seemed best once she got in there. Before the surgery, I kissed Smokey and told him how much I loved him and wanted him to get better. I also gave him permission to go peacefully.

Dr. Bradley removed as much of the tumor as she could, but, sadly she could not get it all. She was amazed at how well Smokey came through the surgery. She wanted to keep him overnight, but agreed to let him come home. Later I was sure, in my heart, that he would not have survived if I had left him. He would have given up, thinking we had abandoned him. Smokey came home with Baytril and Prednisone, which he was to be on for the rest of his life.

As soon as we got home, I opened his carrier. Before George could get into the house, Smokey had run--still wobbly from the anesthesia--to his pellets and tried to eat. Of course it was much too soon, roughly four hours after the surgery. But it was a wonderful indication of how much he wanted to fight for his life. I set out a saucer of canned pumpkin (one of his favorite foods) and left him to rest.

A couple of hours later he came running--still a bit wobbly--out to the living room to be with his family. I spent much of the evening on the floor next to him, syringe-feeding him small amounts of Gatorade to keep him hydrated. At 10:00pm I sat on the floor next to Smokey with a fresh saucer of pumpkin. I continued feeding this way until he had eaten about a tablespoon. Twice during the night I got up and hand-fed more pumpkin.

The next day, Smokey's biopsy results came in, confirming our worst fears. Smokey had a spindle cell carcinoma--very aggressive and fast-growing. After consulting with local specialists, Dr. Bradley recommended chemotherapy with Doxorubicin, with treatments planned at four-week intervals. She was very open about the risks, which included cumulative cardiotoxicity, meaning that Smokey might die during the treatment itself. However, Dr. Bradley reminded me that if we did nothing he would almost certainly die, and probably soon. Smokey would be anesthetized during chemotherapy, so if death occurred, it would be painless.

We scheduled Smokey's first treatment for December 12. During the week between surgery and chemotherapy, Smokey was quieter than before surgery but very sociable. He gained strength each day and his appetite was better than it had been in months. The night before chemotherapy, Smokey went back to our bedroom and played under the bed--something he hadn't done for a long time. Once again I wondered if I was doing the right thing.

Dr. Bradley met us at the specialists' office on December 12. She administered the anesthesia and monitored vital signs while the specialist administered the Doxorubicin. Before they took Smokey away I told him, as I had before surgery, that I knew he was brave and strong and could get through this, but that if he was ready to give up, this would be an easy way for him to go. The Doxorubicin had to be given very slowly, so it was almost an hour and a half before Smokey was back in my arms. Dr. Bradley said he did great during the treatment but crashed coming out of anesthesia. They got his temperature back up with makeshift hot water bottles made from rubber gloves.

Smokey showed no ill-effects after chemotherapy. He was a bit quieter and his appetite was down slightly for the first couple of days, but he bounced back quickly. Ten days after chemotherapy--just before Christmas--we took him in for blood work to check for immune-system problems that would make additional chemotherapy inadvisable. The results were good and we scheduled his second chemotherapy for January 9.

By Christmas he had settled into a routine and I couldn't have asked for a better patient. Smokey took his medicines willingly. I had become comfortable giving fluids and Smokey often groomed himself during the process. George and I stayed home as much as possible, and when we did go out, we left Smokey loose in the whole house with the TV on for company. Friends and family who visited us over the holidays were amazed at how good he looked. All of them said that you never would guess by looking at him that he was being treated for cancer.

Because Smokey's temperature had dropped sharply during the first treatment, for his January 9 treatment I packed a bag with instant heat packs, soft towels, and hot water bottles. Dr. Bradley had a little more trouble finding a vein this time, but otherwise she felt the treatment had gone better than the first time. We got to bring Smokey home immediately, and Dr. Bradley felt certain the mass had not grown any and perhaps had even gotten smaller.

Again, Smokey showed no serious side-effects from his chemotherapy. His appetite and energy levels were down slightly for the first few days but returned quickly. Ten days later when we took Smokey in for blood work some of the immune-system values were down. We decided to wait five weeks for the next chemotherapy and do blood work again first.

On January 27 Smokey suddenly stopped eating. Dr. Bradley saw what looked like an abscess in his mouth along with some regrowth of the tumor. She put him on Septra along with the Baytril, had me give Banamine shots twice a day, and told me to syringe-feed him as much as possible to put some weight on him. We scheduled surgery for Friday, January 30 to drain the abscess. As always, Smokey was a wonderful patient for those three days. He took the new medications willingly and actually enjoyed his syringe-feeding.

When Dr. Bradley got into Smokey's mouth, she discovered that his tumor was much larger than before but had grown across the mouth instead of down the throat, so she was able to remove more of it. She did the blood work and sent a sample of the mass for analysis. Results of the blood work and biopsy were not encouraging. There was no indication that the chemotherapy was helping and RBC values were continuing to fall. After again consulting with specialists, Dr. Bradley recommended a more expensive drug, Carboplatin, that did not have cardiotoxic side-effects but did often produce anorexia. This concerned me because Smokey wasn't eating well and was beginning to lose weight.

We scheduled chemotherapy for February 20 to allow Smokey time to recover from surgery. At my suggestion, we began regular weekly checkups. We kept Smokey on all previous medications and added Pet-Tinic vitamins, a low dose of Rimadyl to make him more comfortable, and Epogen injections to help boost RBC. I continued to syringe-feed three times a day, cradling Smokey in my arms as though I were feeding a baby.

Both doctors thought Smokey's first chemotherapy with Carboplatin went very smoothly. The procedure went much faster, as this drug did not have to be administered as slowly. Dr. Bradley said his color came back much faster than before and the oncologist said the treatment had done as well as he had seen in any animal.

A week later, at Smokey's regular checkup, Dr. Bradley noticed a small regrowth of the cancer. It had been exactly four weeks since his last surgery and we both knew the new chemotherapy had not yet had time to work. We scheduled surgery for the following Tuesday, March 3, hoping that since we were catching the growth earlier this time the mass would be smaller and the surgery shorter. Because the surgery was less invasive, Smokey recovered quickly. We continued with all medications and syringe-feeding. On March 13 we did all blood work again and scheduled chemotherapy for March 20. Again the treatment went smoothly, with no serious side-effects.

Around the first of April, Smokey's appetite began to decrease and he lost more weight. Dr. Bradley expressed concern about all the medications he was on, especially the combination of Rimadyl and Prednisone. Reluctantly, I agreed to take him off the Rimadyl. More than anything, I didn't want Smokey to be in pain. Almost immediately, I felt that Smokey was uncomfortable. Dr. Bradley reluctantly put him back on Rimadyl and discontinued the Septra. I began syringe-feeding more frequently to keep Smokey's weight up.

We had tentatively scheduled chemotherapy for April 17. However, the Monday after Easter, when I was giving him medicine, I noticed a new mass and scheduled an extra checkup for Wednesday. Dr. Bradley confirmed the new mass and we cancelled chemotherapy, scheduling surgery instead.

Smokey's surgery was scheduled for 10:30am. At 4:30am I syringe-fed him. Around 8:00am he ate most of 1/4 slice of bread and tried to eat some pellets for the first time since the beginning of April. Sick or injured rabbits habitually refuse food, and Smokey's effort to eat showed how much he wanted to stay with us. However, Dr. Bradley was very discouraged after surgery. The mass was larger than ever before. It went all the way across the roof of the mouth and back part way into the esophagus. She was amazed that he was even able to swallow during his feedings and felt that we were beginning to exhaust our options. She suggested that we stop treatments completely or, if we continued, that we put him under anesthesia at least monthly so she could get a good look at the mouth.

Smokey never really bounced back from that surgery. However, he remained sociable and patiently endured the fluids and medicine he was given. Because of the weight he had lost, I syringe-fed him four or five times a day. He continued to accept that eagerly, ate bread on his own, and begged for his yogurt. Still, I knew things were bad.

George went with me to Smokey's April 24 checkup. Dr. Bradley immediately noticed that one side of Smokey's face was swollen and filled with fluid. Using a needle, she took several samples for analysis, and for the first time during his treatments, Smokey flinched in pain. It broke my heart. As gently as she could, Dr. Bradley told us that it was time to start thinking about saying goodbye. She put him back on Septra, added Lasix to help with the fluid buildup, and had me put warm compresses on his swollen face three times a day. We scheduled a follow-up appointment on April 29.

Throughout all this, Smokey remained somewhat active and extremely social, continuing to spend time wherever we were. By now he was eating almost nothing on his own, though he still welcomed his syringe-feeding. Twice I carried a jar of his gruel into the living room to finish stirring while watching TV, then set the jar on the floor, waiting for a commercial before going back to the kitchen to fill the syringe. Both times Smokey went over to the jar and tried to eat from it--clearly letting me know he was ready to be fed.

Despite frequent syringe-feeding, Smokey had lost more weight by April 29. On May 1 he had his final surgery. The mass was big again, with evidence of abscessing. Dr. Bradley removed what she could. Either gum tissue or cancer had completely covered his lower molars, explaining why he could no longer chew even bread. X-rays showed abnormality in the jaw, indicating that the cancer was spreading there as well. We all knew we were at the end of the road. We could keep Smokey comfortable as long as possible, but knew we were no counting our time together in days.

I arranged to work at home most of the following week, knowing it would probably be our last week with Smokey. Tuesday evening, for the first time, I found myself really force-feeding the gruel. Smokey could no longer swallow it and nearly choked before I realized it was time to stop. After he recovered, I tried a little canned pumpkin, but even it was too solid. I decided that from that point on I would feed only baby food--and only when Smokey wanted it. The remainder of his life would be lived on his terms.

Wednesday Smokey eagerly ate the baby food and we had a wonderful evening with him. Thursday morning he still begged for food, but ate much less. He seemed to be having trouble breathing. I gave him Lasix, which helped a little, but his breathing remained labored. Around 1:00pm I knew it was time to put him down. I carried him to the living room to sit by the door in the sun one last time. Then I got a shallow box and lined it with soft towels. I set Smokey on the towels, but he refused to stay. He ran across the room and hopped on his favorite shelf. He knew what was coming, and even at that late stage he was not ready to leave us. I lifted him gently back into the box and carried him to the car. On May 7, 1998, Smokey made a peaceful exit from this world as I held his head, stroked him, cried, and told him how much he was loved."

Slothrop: That's so deeply sad. And brave. And sad. Quit breaking my heart, world. 

Ass-Headed Bottom: Quit breaking my heart, Koko! More on old video-games, fewer dying rabbits, por favor. I read that whole sob-story, and in the end it was still about a rabbit, Watership Down-style. A bunch of hraka, if you ask me, heartless bastard that I must be. And Slothrop, stop mixing together the disastrous shit that should be breaking your heart with the mawkish shit that deep down you secretly want to break your heart. Maybe Koko's going through a moment in which she can't quite tell the difference--we all go through such moments and eventually they sort themselves out--but you, my esteemed teacher of metrics--should know how to measure mutability. There are disasters--Wall Street snorting up the average American's life-savings, for example, or what happened to overweening Frank Sobotka--and then there's willful nonsense--bunnies going the way of the blighted world.