Porter’s Hypothyroidism Diagnosis

You can see some of Porter’s hair loss on his chest in this photo (the pink area right behind his red tag)

Porter began to to display signs of hair loss in September 2022. As it increasingly became worse, I took him to our veterinarian to have blood work done. The results were consistent with Hypothyroidism. This is now the second endocrine system disease that Porter has. Porter is already on a boat-load of medication for his epilepsy and his Addison’s disease, but treating the hypothyroidism is a must. Since nearly every organ in the body is affected by the thyroid, if left untreated hypothyroidism can result in high cholesterol, decreased immune function, a slowed heart rate, and neuromuscular issues. Porter began taking Thyro-Tabs immediately to help combat this disease.

What is Hypothyroidism?

Hypothyroidism is a common endocrine disease in dogs that results in decreased production of thyroid hormones. Thyroid hormones are produced by the thyroid glands, which are located on either side of the neck near the throat. These hormones serve an important role in metabolism. When the glands are not producing enough hormones, the dog’s body functions slow down. 

Dogs with hypothyroidism usually have either inflammation of the thyroid glands or degeneration (deterioration) of the glands. Fortunately, thyroid tumors are fairly uncommon in dogs. 

When it does occur, hypothyroidism is most common in middle-aged dogs, with medium-to-large breed dogs being more commonly affected. Golden Retrievers, Dobermans, Dachshunds, Miniature Schnauzers, Cocker Spaniels, and Irish Setters are among the breeds more predisposed.  

Symptoms of Hypothyroidism in Dogs

Dogs with hypothyroidism often show one or more of the following clinical signs: 

  • Weight gain: This often occurs without an increase in appetite. Many pet parents note that their dog seems to be gaining lots of weight even though they don’t eat that much food. 
  • Lethargy and laziness: Your dog may prefer to sleep and lie around all day rather than run and play. 
  • Heat-seeking behavior: Because of their low thyroid hormone and resulting low metabolism, dogs with hypothyroidism constantly run a little cold. Your dog may prefer to lie near the fireplace or on the heat vent to try and stay warm. 
  • Chronic skin and ear infections: While allergies are relatively common in dogs, chronic skin and ear infections may be a sign of an underlying issue with hypothyroidism. 
  • Dry and brittle hair with a thinning hair coat: Sometimes a dog with hypothyroidism will lose hair from their back on either side. They may also lose hair from their tail, giving it a rat tail type appearance. 
  • Increased pigmentation of the skin 
  • Inability to regrow hair after it’s been shaved 
  • Hair loss

There are other, less common, signs of hypothyroidism that some dogs develop. Dogs may have reproductive problems, or develop issues with their nervous systems, including nerve pain or dragging their hind legs.  

Dogs with low thyroid may have small, white fat deposits on the surface of their eyes or end up with an eye condition called dry eye, where they don’t produce enough tears. Some dogs even have thickening of the facial skin so the muscles of the face droop.  

Causes of Hypothyroidism in Dogs

The two most common causes of hypothyroidism in dogs are inflammation of the thyroid gland (lymphocytic thyroiditis) and degeneration of the thyroid gland (idiopathic thyroid gland atrophy).  

While we are not sure why these two conditions spontaneously occur in some dogs, we know there is a genetic predisposition. Another rare cause of hypothyroidism in dogs includes cancer. Fortunately, these other causes are only responsible for a small percentage of hypothyroid patients.  

Majority of patients with hypothyroidism have either inflammation of their thyroid gland or degeneration of their thyroid gland, and both conditions can be managed with medication.  

How Veterinarians Diagnose Hypothyroidism in Dogs

Your veterinarian will start with a physical examination of your dog, including a thorough medical history.  It’s important to share any unusual behaviors you’ve noted in your dog and be sure to include a time frame of when you first noticed these behaviors or physical changes.  

Your vet may want to run some basic bloodwork and a urinalysis to establish your dog’s overall health. If your dog has changes in their skin, your vet may want to do skin scrapes or smears (sample collected by either gently scraping the surface of the skin with a scalpel or by pressing a microscope slide to the skin) to look under a microscope and rule out any secondary skin infections.  

Hypothyroidism is diagnosed with a blood test. Your veterinarian will want to draw blood from your dog to either test in their clinic or send off to an external laboratory for testing.  

Most commonly, this disease is diagnosed by running a screening test called a total thyroxine level (Total T4, or TT4). This test determines your dog’s main thyroid hormone level. If it is low, and your dog has clinical signs of hypothyroidism, this is suggestive of a diagnosis.  

Many veterinarians will then run additional blood tests, either a free T4 level or a full thyroid panel, to confirm the diagnosis of hypothyroidism. Sometimes dogs can have a low total T4 but not necessarily have hypothyroidism. Occasionally, a dog can have a total T4 that is at the low end of the normal range but still have hypothyroidism. These confirmatory tests can be especially helpful in such cases.  

Treatment of Hypothyroidism in Dogs

Hypothyroidism is treated with an oral medication called levothyroxine. This medication is a synthetic form of the thyroid hormone your dog is missing. It is important to note that hypothyroidism is treatable but not curable.  

Your dog will need to stay on their thyroid replacement hormone for life. This pill comes in several different strengths, so your veterinarian will select the appropriate dose for your dog based on weight. They will likely want to re-check bloodwork in one month to ensure no dose changes are required.  

Untreated hypothyroidism can shorten your dog’s life span, as nearly every organ in the body is affected by thyroid hormone and by the metabolism. Dogs with untreated hypothyroidism develop high cholesterol, decreased immune function, a slowed heart rate, and neuromuscular signs.  

These neuromuscular signs may include unsteadiness, a head tilt, and even seizures. While hypothyroidism responds well to treatment, untreated hypothyroidism can have a negative effect on your dog’s quality of life.  

Recovery and Management of Hypothyroidism in Dogs

Management of hypothyroidism in dogs requires lifelong therapy with oral thyroid hormone replacement. Tolerance of medication may change over time, so your dog may require dose adjustments from time to time. It is recommended that you have your dog’s blood thyroid levels checked every 6-12 months to ensure they are still on the appropriate dose of their medication. It is very important that your dog not be given too little or too much thyroid hormone in the long term.  

Once your dog’s thyroid levels have been restored to normal, your dog may lose weight as their body condition improves and will likely have more energy. While it can take months for your dog’s hair to grow back, they will likely experience an improvement in their skin and hair coat over time.  

Hypothyroidism may result in decreased tear production in dogs. Monitor your dog’s eyes for any development of green-yellow discharge. Talk to your veterinarian if you notice any changes in your dog’s eyes.  

Hypothyroidism in Dogs FAQs

Is hypothyroidism curable?

Hypothyroidism is manageable, but it is not curable. It is usually treated with lifelong oral synthetic thyroid hormone replacement (levothyroxine medication).

Can medication be overdosed?

Thyroid medication can be overdosed, and it is very important that your dog is on the correct dose of medication to manage their hypothyroidism.  

Your vet will start your dog on a standard dose based on your dog’s weight and will want to repeat bloodwork in one month to ensure the dose is correct. More than one re-check appointment is possible to get the medication dosage correct. 

Metabolism and tolerance of the medication may change over time, requiring periodic dose adjustments. It is recommended that your dog’s thyroid levels be re-checked every 6-12 months. Signs of an overdose of thyroid medication include excessive weight loss, irritability/hyperactivity, increased drinking and/or panting, and lack of sleep.  

How long do dogs live with hypothyroidism?

Dogs with hypothyroidism can live normal, healthy lives when the disease is managed with medication. While the disease is not curable, it has an excellent prognosis and patients generally respond well to treatment. Medically managed patients have a normal life expectancy.

The above information was reposted from:

A Week in the Life of a Superhero

Lager wearing the Superman costume gifted to him by his Aunt Jackie

Lager is an extraordinary pup with an astonishing background. (It’s sometimes hard to believe that our boy was assigned to keep the U.S. Embassy in Baghdad safe)! His bravery and resilience is inspiring. By the time he was 3 years old, he had already traveled to more countries and states than most people visit in a lifetime. Despite his disciplined working career before we met him, Lager quickly adjusted to civilian life and showered us with much love and affection. Beyond his serious working mode, Lager also has an extremely goofy and jubilant side. His pure, genuine passion for life is contagious. He gets excited about anything and everything. The smallest of things makes him literally jump for joy…so much so that I often joke that he is the real-life Tigger. He has taught us to be happy and thankful for everything – big and small – and to remain positive and joyful through whatever life throws our way. His love of life fuels him to do everything with 250% effort and enthusiasm. He’s “got heart” like no other…and I know in my heart that Lager will face this new challenge and overcome any obstacle that may attempt to stand in his way of continuing to enjoy life to the utmost degree. If heroes are measured by the strength of their heart, Lager is definitely a Superhero in my eyes.

10/10/22: Lymph Node Cytology and Radiograph Results

Lager’s oncologist, Dr. Olivier Campbell, called the morning of October 10th with a positive report! The cytology results of Lager’s mandibular nodes showed that the lymph nodes were reactive and no tumor cells were observed, which is great news! In addition, the radiologist’s final interpretation of Lager’s radiographs showed nothing significant! The next step is to meet with the dentistry specialist to plan surgery. Dr. Olivier Campbell asked how Lager was doing. I laughed and said, “He’s just as crazy as ever. You would never for one second know that he has cancer, and he reminds me everyday that mindset is everything.”

10/10/22-10/11/22: Chase Away K9 Cancer’s “Chase Away 5k”

Thank you to everyone who shared with me that they signed up for the Chase Away K9 Cancer 5K to walk for Lager. We did this 5k in two parts and I was lucky enough to be able to meet up in person with some friends and their pups to complete this 5K!

Chase Away 5K: Part 1

On October 10, 2022 we met friend and fellow Pointer Rescue, Organization volunteer Jen along with her foster pups Vera & Virgil …and our friend Heather with her pups Kayla and Ellie from Team Salty Paws at Amico Island Park in Delran, NJ. We also were walking for our Pointer pal, Virgil, who is battling hemangiosarcoma.

Virgil, who is also battling cancer, gave me a nice hug before the 5K!

Chase Away 5K: Part 2

On October 11, 2022 I met friends, Jen and Sherra, at Union Lake Wildlife Management Area to complete the 5K. This time Jen brought her two Pointers, Pearl and Brandy.

10/13/22: Surgery Consultation

Prior to Lager’s appointment, I wrote down questions in order to prepare my self for the consultation:

  • Is your anesthesiologist board certified?
  • Can you explain how the operation is performed?
  • What are the risks and possible complications for this operation?
  • Will Lager need special diet after his operation?
  • When does Lager need stop eating and drinking leading up to the surgery?
  • What medication will Lager be sent home with after surgery?
  • Could you tell me about your experience with this operation?
  • How can I contact you if I have more questions?
  • What can I expect during Lager’s recovery?
  • What restrictions will Lager have after surgery?
  • How do most dogs who have to have a partial mandibulectomy usually recover?
  • Will Lager’s life and lifestyle change after this procedure? Will he still be able to dock dive?
  • Are there things I can do to prepare myself, my home and/or Lager for this procedure?
Surgery consult with Dr. Jennings

On October 13, 2022 I met with Dr. Michael Jennings at Blue Pearl Pet Hospital to discuss Lager’s surgery. Dr. Jennings was so kind and explained in detail the surgery Lager will need. Dr. Jennings shared that unfortunately, Lager does need a partial mandibulectomy which will most likely include removing the portion of the lower jaw that incorporates the 2 canine teeth and incisors. I immediately broke out into tears upon hearing this, and Dr. Jennings was beyond compassionate and reassuring. Dr. Jennings said that the location of this tumor combined with being oral papillary squamous cell carcinoma (a sub-category [lesser version] of squamous cell carcinoma) is actually best case scenario in the big picture.

The diagram below shows the projected approximate portion of Lager’s jaw (below the red line) that will be removed during his surgery:

Lager’s surgery will be an attempt to remove the mass along with a margin of normal tissue and bone. The degree of removal is based upon Lager’s anesthetized oral exam and dental x-rays. In Lager’s case, Dr. Jennings suspects it would include the front of his lower jaw, hopefully keeping the back of his mandibular symphysis (chin). Once removed, the resected portion will be reevaluated to both confirm the tumor type and to check the edges for evidence of tumor cells. If clean margins are achieved, the papillary squamous cell carcinoma will not likely recur and Lager should be cured. However, if when reevaluated the tumor is determined to be squamous cell carcinoma (not the papillary subtype), Lager may require follow up chemotherapy or radiation therapy if the tumor characteristics indicate more aggressive behavior.

Dr. Jennings shared that after oral surgery, dogs generally do well, and although there will be a learning curve of how to place the tongue, and pick up food/objects, dogs adapt quickly and efficiently and continue a high quality of life. Pain is controlled prior to and following surgery, and most dogs return to eating and acting normally without any significant issues. Dr. Jennings is confident that with Lager’s drive, that he will adapt and likely will be able to compete in dock diving next season as well.

“MOM! You’re embarrassing me with your notebook full of questions!” ~Lager

Quite Frankly the Best Boy Ever

Lager was such a good boy at his surgery consult, so we stopped at Philadelphia Pretzel Company for a pretzel dog. Lager enjoyed a few bites as a reward before returning home.

10/14/22: Partial Mandibulectomy Surgery Scheduled

We received confirmation on October 14, 2022 that Lager’s surgery is scheduled for October 31, 2022. Lager will not be allowed to eat hard food or put objects in his mouth for up to a month after treatment, depending on his recovery. There is a possibility that he may initially struggle to eat food and will most likely have to be hand-fed. He may also have difficulty drinking water, and positioning his tongue normally for the first few days following surgery. In the next two weeks leading up to his surgery, Brian and I will be doing our best to prepare our hearts and our home for the temporary changes and challenges that Lager may face. We believe it is important to appropriately equip ourselves in all aspects in order to have the strength to project positivity and confidence for Lager to absorb, and to preserve a sense of normalcy for him. Any prayers, positive thoughts, and good vibes will be greatly appreciated this Halloween and the few weeks following.

Lager in a cape gifted to him by his Aunt Jackie, who’s dog wore this cape

The Rainbow in Our Clouds

The continued support, prayers, and positivity that friends and family near and far continue to shower over our family has undoubtedly kept us all in good spirits and brightened our cloudy days… we can’t thank you all enough. We are also beyond grateful for the private messages, comments on posts, and heartfelt gifts.

Lager’s Cousin James made Lager a card and he listened intently as James read it aloud to him.

Team Salty Paws gifted us with oral cancer awareness decals for our vehicles!

Oncology Consultation: Keep Calm and Prepare

Consultation Prep

Keeping calm is not my strong suit. Hearing the “C” word when our veterinarian confirmed Lager’s cancer diagnosis weighed heavy on my mind, but the uncertainty of what would follow was even more difficult for me to handle. Securing a consultation appointment with the oncologist of our choice was the easy part. Waiting for that day to arrive, however, was torture. Time could not pass quickly enough to reach that date and get more information. To help keep anxiety and fear in check, I focussed my efforts on preparing for the first appointment:

  1. Oncology appointment
    • When scheduling the oncology appointment I asked the following questions:
      • What will be covered during a consultation appointment?
      • Do I need to bring anything with me to the appointment?
      • What’s the best method of transferring notes and pathology results to you from Lager’s primary veterinarian?
      • Does Lager need to fast for this appointment?
    • There is no cancellation list for the doctor we chose, so I called on a daily basis, joking with the front desk staff that they would get to know me more than they’d like! The staff was understanding and my persistence paid off…I was able to catch two cancellations and move Lager’s appointment up twice during the torturous waiting period.
  2. Research
    • I educated myself on the basics of Lager’s diagnosis, making sure to remind myself that each case is different and to be mindful that I don’t let what I read completely freak me out while waiting for Lager’s appointment with the oncologist. Researching enlightened me on oral papillary squamous cell carcinoma, treatment options, and presented new terminology that I needed to familiarize myself with prior to the consultation.
  3. Notebook
    • When I’m nervous, I do listen, but nothing (and I mean nothing) will sink in. I knew discussing Lager’s diagnoses, tests, prognosis, possible surgery, etc would be upsetting …making it difficult for me to process the information at that time, and to correctly relay the important details to Brian. If I can’t precisely remember and process the information the oncologist is delivering, it will be near impossible for me to take the steps needed to get the best care for Lager.
    • I prefer to write my notes rather than type them.
      • As an old-school retired teacher, I am a firm believer that despite modern technology, whenever possible – handwritten notes enable you to remember and comprehend the information more efficiently.
      • Eye contact is important to me – especially post-Covid when one or both people may be wearing a mask. Personally, it is easier for me to maintain eye contact with someone while writing on paper versus typing on my phone.
      • I’m the Queen of Typos (as I’m sure most of you already know from my prior posts – and most likely this one!) .. I’m not the best speller to say the least, but I can decipher my handwritten misspellings much easier than the “creative” auto-correct choices my phone or iPad makes for me
      • No worry about getting a low battery alert on my phone…there will be plenty more to worry about, so taking one issue off my list is a win!
    • Although some people I know have recorded their consultations, I am not comfortable with doing so
  4. List of questions specific to Lager’s diagnosis
    • What stage and subtype is Lager’s oral papillary squamous cell carcinoma?
    • What is the typical percentage of chance this type of cancer has metastasize? What additional tests (if any) will be performed to rule out the spreading of this cancer to other areas?
    • What are the treatment options you recommend and how does Lager’s stage/subtype impact his options?
    • What are the potential downsides, including common side effects that I can likely expect, as well as rare but more serious complications?
    • When would he begin treatment?
    • What is the cost of the treatments? Follow up appointments?
    • What is the prognosis with the different treatment options?
    • What is the recovery time of treatment/surgery?What oral surgeon do you recommend to perform any surgery needed to remove the mass and any other areas that it may have invaded?
    • Is Lager currently in pain?
    • Is he allowed to have soft toys before and after his surgery?
    • What supplements, dietary changes, lifestyle changes, etc can I do to further support Lager
    • Will Lager have any short or long term restrictions before/during/after surgery and/or treatment?
    • Should I cease all vaccinations for Lager at this time?
    • If I have further questions what is the best email address or phone number to call to clarify points or to further discuss information presented in this appointment?
  5. Show support for Lager

Oncology Consultation Appointment

October 4, 2022

Lager sported his oral cancer awareness bandana (highlighted later in this post) and I put on the hat that Margarita wore when we went to her oncology consultation.

Arriving to Lager’s appointment…

Being a good boy in the waiting area…Lager wore his cancer awareness collar, oral cancer awareness bandana, and oral cancer awareness charm for his consultation (all gifted to him and highlighted later in this post)

Lager’s oncologist is Dr. Olivier Campbell (coincidently the same last name as our primary veterinarian, but no relation). Dr. Olivier Campbell was so patient and kind – he took time to answer all my questions and explain everything (he even drew pictures to provide a visual and help me to better understand). Here is what I learned at the consultation:

  • Lager’s cancer is a subtype (called papillary) of oral squamous cell carcinoma (this is good!). There are no particular “stages” with this type of cancer.
  • Oral squamous cell carcinoma is locally invasive and potentially locally destructive with a very low potential for metastasis – this is considered a low-grade malignancy.
  • This tumor type tends to invade the adjacent tissues, including the underlying bone in approximately 77% of cases. They can also occasionally metastasize to the regional lymph nodes and to the lungs. Tumors of the mandible (lower jaw) generally have a better prognosis than maxillary tumors (upper jaw).
  • Oral papillary squamous cell carcinoma has a lower chance of metastasizing, but it is still possible
    • if it does metastasize, it will tend to travel to the lymph nodes, lungs, and stomach. Ultrasound, x-ray, and aspirate sample will rule this out.
  • Surgery is the first line of defense against this type of cancer.
    • Surgeries of the jaw are usually well tolerated in dogs.
    • If a tumor is incompletely excised, radiation therapy can be considered to try to kill the remaining tumor cells in the area.
    • With local treatments, the reported median survival times range from 9 months to 3 years.
      • Lager’s prognosis cannot yet be determined until all tests are completed and mass removal is completed
  • Although Lager is is not displaying any symptoms, he is most likely having some level of discomfort, so playing with toys are not recommended at this time
    • While waiting for his surgery, if Lager begins to display signs of discomfort, there are oral pain medications, non-steroidal anti-inflammatory drugs and injectable medications to help with bone pain.
  • With this type of cancer, there are no supplements / dietary changes to add that have been proven effective as supportive additives.
  • Vaccines should be ceased at this time but can be resumed once Lager is recovered from his surgery.
  • Once surgery is complete, the oral surgeon will help us determine any restrictions moving forward
Waiting in the oncology exam room

Tests completed at this visit:

  • Cytology (mandibular nodes)
    • This test provides an answer in 80% of cases approximatively. Results are pending and should be obtained in 7-10 days.
  • Thoracic Radiographs
    • No evidence of radiovisible metastasis, but the radiologist will review Lager’s radiographs to ensure that no significant change is present. An update will be provided at the same time as the cytology.
  • Abdominal and Cervical Ultrasound:
    • Ultrasound of the cervical region reveals no enlarged lymph nodes and the mandibular salivary glands and thyroid/parathyroid regions are normal. There is no evidence of metastatic disease within the abdomen or at the cervical region.
      • Liver: No significant abnormalities.
      • Spleen: Prominent in size with normal in echotexture.
      • Kidneys: No significant abnormalities.
      • Adrenal Glands: There is a 0.7 x 0.9 cm, hyperechoic nodule at the cranial pole of the left adrenal gland most consistent with nodular hyperplasia. The remainder of the adrenal tissue is normal. A developing primary adrenal tumor is considered less likely. This may revisited in 2-3 months if symptoms arise, or if suggested by our veterinarian.
      • Urinary Bladder: No significant abnormalities.
      • Stomach: There is a large volume of echogenic ingesta within the lumen
      • Intestines: There is echogenic ingesta multifocally throughout the lumen.
      • Colon: No significant abnormalities.
      • Pancreas: No significant abnormalities.
      • Peritoneum: No significant abnormalities.
      • Mesentery: No significant abnormalities.
      • Lymph Nodes: No significant abnormalities.
      • Prostate Gland: No significant abnormalities

Visit Summary Notes from Dr. Olivier Campbell: Lager is an adorable dog. Unfortunately, he was recently diagnosed with an oral squamous cell carcinoma. In Lager’s case, the tumor subtype was most consistent with a papillary squamous cell carcinoma, which is thought to be potentially even less aggressive than other oral squamous cell carcinomas. On today’s visit, we discussed that we could characterize Lager’s health condition and the extent of his tumor with thoracic radiographs, cytology of the mandibular nodes +/- abdominal ultrasound, neck ultrasound to assess the retropharyngeal nodes. No evidence of spread of his tumor was observed upon imaging and the results of the cytology of the nodes are pending. The next step to consider to fight his disease would be to meet with a dentistry specialist to plan the surgical removal of the tumor +/- the lymph nodes if the tumor is detected in them. At home, please continue to monitor Lager as usual and contact a veterinarian if his condition deteriorates.

DockDogs World Championship

From 2015 to 2017 I was blessed to be Lager’s teammate in Dock Diving. It was a privilege to share the dock with him. We competed at the World Championship in 2015, 2016, and 2017. Right before the 2018 season began, Limoncello was diagnosed with Dilated Cardiomyopathy, and was not able to compete. I thought it would be best for Brian to take over as Lager’s handler since Limoncello’s diagnosis left Brian without a dock partner. Brian and Lager had a great run together before Lager had developed some insecurity on the dock beginning in 2019. Although they tried to work through it, Lager continued to hesitate on the dock. After we had Lager medically examined to be sure there were no underlying issues, we decided that change may be a good thing, and we once again switched back to me being Lager’s handler this year…I hadn’t realized just how much I had missed my teammate! Lager and I had an exciting season as we got back into the groove of competing together. Lager’s insecurity disappeared, and he earned himself an invitation in every discipline in which he competed!

In Lager’s best interest, we unfortunately will not be making the trip to Iowa this year. Although we are extremely disappointed that we won’t be competing at the World Championship with our dogs and that we will not see our friends, this is the best choice for our family, and most importantly, for Lager. We wish all competitors and DockDogs staff a safe trip, and are sending good vibes and positive energy your way. Don’t forget to soak in every single moment with your pups (and peeps!!) when you are there. Best of luck to all competitors… it’s your dog’s time to shine! Team Liver Killers will be looking for updates on social media and cheering you all on from New Jersey! We look forward to sharing the dock with you and your pups in 2023.

The Last World Championship Lager and I Competed in together as a team (2017)

I Get By With a little A LOT Of Help From My Friends

Saying “thank you” is not sufficient to capture my gratitude for all of you. In fact, there really are no words that can fully express my appreciation for the overwhelming outpouring of love, prayers, positive vibes, phone calls, post comments, text messages, private messages on social media, and generous gifts. You all have provided support and strength as we embark on a new Journey through uncharted territory…and somehow the these acts of kindness always seem to arrive at just the right time. Brian and I both want you to know that you all have lifted our mood, enhanced our hope, and comforted our hearts. I will forever remember this compassion and thoughtfulness, and vow to to do my absolute best to pay it forward.

Beautiful card that included a heartfelt written letter as well

Cancer awareness ribbon collar gifted to Lager

These Superhero capes were gifted to Lager to provide him superpowers on his Journey. The red cape pictured on the left is new. The blue cape pictured on the right belonged to a friend’s dog. My friend explained that she was not only purchasing a new superhero cape for Lager, but also passing along the cape of her beloved dog who has been blessed with an extremely long life…and that she wanted to share that with Lager in hopes that the cape would grace him with many more years beyond his Journey.

An amazing friend commissioned Ratjr Theos ( Portrait One ) to create this stunning digital painting of Lager.

A box of gifts arrived for the whole pack! The whole family feels the stress during difficult times – we are so appreciative that the rest of our pack is being supported as well! This is the first time I have ever seen a Limoncello (LimonSMELLo) dog toy!

I can’t wait to sit down and read through this one!

Eat Like a King

After a 5 hour day of being the bestest boy during all of his testing, Lager undoubtedly deserved a reward. We stopped at Burger King on the way home and Lager enjoyed a couple of fries and a few pieces of a plain cheeseburger.

Waiting With Hope

…And now we remain hopeful as wait for a scheduled surgery date, the final cytology results, and confirmation on the x-rays and ultrasounds. Overall Lager’s oncology visit was full of positives, and we are beyond grateful for that!