Although Hannah continues to be her usual happy self, yesterday evening was a sobering time in this journey for my wife and I. I had just come back from our evening walk and had to tell Patti that Hannah had vomited twice during our walk. Not to be gross, but she vomited her entire dinner, which was especially unusual considering we took our walk a full three hours after she ate. Without the discovery of her cancer, we may have brushed aside the incident as a random occurance, but anything at all that happens with her now makes us wonder if it's related to her metastatic cancer, and that brings us both down in a hurry. 

Hannah has always had a sensitive GI tract but her vomiting episodes have definitely increased over the past six months and she has lost a few pounds as a result. I had Dr. Wissel perform an abdominal ultrasound on her a month ago and we didn't see anything concerning, but if this continues I may have our internist take a second look. Although I would not move forward with stomach surgery on Hannah even if her ultrasound revealed an issue, the information a second abdominal ultrasound would provide could still help guide my medical approach with regards to her treatment, as it's important to me that my decisions related to her care are well informed and based on facts. Because hospice care for one of the sweetest dogs I have ever known is such an emotional space, facts help tremendously to guide my decision making, and an ultrasound is a non-invasive procedure that doesn't require sedation so there's really no downside to doing one if her vomiting continues. It would not cause Hannah any pain or distress, and the information it provides could help me do a better job of medically managing her symptoms. 

Although Hannah's vomiting is not ideal, it is still so sporadic that daily management of her symptoms with medication is just is not needed yet. There are many people who would elect to start medication, but that is generally not my approach. I am a minimalist with medication and prefer to use drugs only when I know they will help and are needed. In Hannah's case, starting medication now would mean that I wouldn't be able to tell if she was doing better due to the medication or if it was just coincidental, so I will begin medication only if her vomiting becomes a frequent problem. In the meantime, she is back to her normal self this morning as I am writing this, which puts a big smile on my face. It brings me back to enjoying life one day at a time and not looking forward very far at all. Doing so would just bring me down and take the enjoyment out of living with Hannah today. 

Until next time,

Dr. Hawk