Dr. Smith called a little while ago in response to a v-mail I’d left at VIMP because we didn’t have an appointment on our discharge orders. He wants us to meet him at VIMP at 8 a.m. on Tuesday so he can do Mina’s CBC. He’s been consulting with Dr. Birnbaum and wants to be part of Mina’s treatment and I’m fine with that. We both like him.

If Mina’s white cell count is within normal limits, then we’re going to skip the scheduled Vincristine IV and, instead, administer the last drug in the first quarter of the protocol, doxorubicin.

Dr. Birnbaum wants her spleen to shrink more. Mina has an aggressive cancer and they want to attack it aggressively. God, this scares me. If it doesn’t work then it’s likely her vets will recommend not continuing with the chemotherapy. That scares me. We’ve had such a good few days that I was getting hopeful again and I feel like, now, all hope rests on this one treatment.

Here’s some information on doxorubicin that should curl your hair:

Adriamyacin (Doxorubicin). Adriamycin works by impairing DNA and hinders cell division in cancer cells. This drug is commonly regarded as one of the most effective chemotherapy drugs, but it also is widely reported as having potential for significant harmful side effects.

Here’s the info on side effects from the link above:

Doxorubicin is given only as an intravenous injectable. It is given slowly over a 10 minute or so period in an IV drip rather than as a single quick shot. It is very irritating to the skin so that those who work with it must wear gloves, gowns and protective goggles or masks.

If the injection does not go intravenously and some doxorubicin leaks into the tissue surrounding the vein, an extreme reaction occurs in the tissue. (This can happen if multiple attempts at catheterizing the vein leave some leakage points in the vein, or if the pet chews the catheter part way out during the administration.) The tissue in contact with the doxorubicin will die and rot away, leaving a large unhealing wound. Because of the DNA-poisoning nature of doxorubicin, this wound may actually expand or may simply not heal. Amputation may be required. If the tissue exposure is treated immediately with special flushes and cortisones and special wraps, this disaster has a chance of being averted. In general, a well-seated IV line is a priority when doxorubicin is administered.

Acute allergic reactions (causing facial swelling, hives, vomiting, and possibly heart rhythm problems) are common enough that most patients are pretreated with diphenhydramine, a common antihistamine, to block any such reaction.

SIDE EFFECTS

Because doxorubicin attacks rapidly dividing cells it is also toxic to normal cells with high division rates: hair follicle cells, bone marrow cells, and intestinal cells. It is also toxic to muscle cells, particularly heart muscle cells.

Doxorubicin is famous for “cumulative cardiotoxicity.” This means that there is a maximum amount of doxorubicin a patient can take during its lifetime before its heart will be poisoned. The heart dilates, becomes incapable of effective pumping, and does not respond to therapy. This obviously is a side effect that must be avoided, which means that the total number of doxorubicin treatments is limited no matter what the cancer is doing. The total dose of doxorubicin widely held to be the “ceiling” is 240 mg/M2 (M2 = square meters of body surface area, a more accurate form of dosing than going by weight) but toxicity can be seen at small levels. Many oncologists will ultrasound the patient’s heart to assess function prior to delivering a dose of doxorubicin.

Bone marrow toxicities are common with most chemotherapy drugs as this is one of the areas where the body normally has many rapidly dividing cells. Red blood cells, which carry oxygen and remove carbon dioxide, are made here. The white blood cells that make up our immune systems are born here. The platelets that allow our blood to clot also arise here. Usually it is the white blood cells and platelets that are most vulnerable. Monitoring tests are needed because if a line of cells becomes suppressed, the oncologist may need to postpone a drug dose, modify a dose, or change to another treatment to make up for the missing blood cells.

Upset stomachs, generally short-lived, are not unusual 2 to 5 days after doxorubicin use. Nausea is usually controlled with medication.

Patients on doxorubicin will have trouble growing in fur over shaved areas. Whiskers are often lost and do not regrow.

In cats, doxorubicin is also a kidney toxin and blood test monitoring is needed to make sure kidney function remains acceptable.

Urine will look especially orange for a day or two post-administration. Owners should avoid handling this urine (wear gloves).

Now, you know why this drug scares me. It’s what we all know about chemotherapy – it’s almost as bad as the disease.

Pray for Mina.

s.

OK, so after reading all about the possible side effects of the various drugs used for Mina’s lymphoma treatments, and Berry the dog’s reactions to some of them, I’m kinda freaked out. The one that’s coming up on Thursday is Cytoxan (cyclophosphamide). Here’s the info from Berry’s Web site:

Cytoxan is an alkylating agent that interferes with the replication of cells. It is a nitrogen mustard and is related to gases used in chemical warfare. Cytoxan is given in pills, which must be handled with extreme care. Cytoxan is an inactive drug in the capsule. It is activated in your dog’s liver, where it is broken down, and then it is broken down again in the bladder. It is extremely important for dogs to receive ample water while on Cytoxan so that the drug wastes can be flushed out of your dog’s organs. Your dog also needs to be let out often to urinate while taking Cytoxan to remove the waste products from his bladder as quickly as possible. Detailed information about Cytoxan is available at: http://www.marvistavet.com/html/body_cyclophosphamide_.html.

From what I read on that link, you can’t even touch these pills with your fingers, which makes me wonder how I’m supposed to give them to Mina? I would assume it’s bad if the pill touches the inside of her mouth? Will a Pill Pocket work? I’ll write down my questions today so I have them for our next visit to VIMP on Thursday.

Also, I may not be entirely out of the chicken cooking business, UNFORTUNATELY. I can’t seem to find a doggie snack for Mina that’s not full of grains and stuff she doesn’t need. She’s not bugging me for snacks now because she eats four to five times a day, but it’d be nice for her Aunties Lori and Sherrie to have something easy to give her. Any ideas? Hints? Suggestions? Today, we have some chicken breast in the fridge that she can have for snacks, but I’m not looking forward to doing that on a regular basis because I’M TIRED OF DISMEMBERING CORPSES IN MY KITCHEN.

So, this morning we were up after about five hours of sleep to go outside in the pouring rain. Gotta hand it to Mina, she’s tough because she managed to do all her business while getting soaked as I stood in the breezeway and watched. She got a nice rub-down with the towel when we got inside, something she particularly enjoys. Pills, food, laundry, carpet spraying, pack lunches, eat breakfast, finish laundry, get ready for work, leave a sad-eyed Mina behind. I wish I could set up a little corner for her here in my office but this is not a non-human animal-friendly workplace.

Generally, she seems better, even broke out the trot for a bit this morning and yesterday. She still sleeps an awful lot, but she did invite me to play a couple of times yesterday but wore out after just a few minutes. She’s still eating enough for three Wheaties, though, and still drinking lots of water but I’ve noticed that’s tapered off. She’ll need to drink tons while taking the Cytoxan, so I may employ Colleen’s sneaky method of getting her elderly pooch, Tosca, to drink by putting a little chicken broth in the water. Eww.

s.

So … Mina is just about off the boiled dead chickens. I put only a tablespoon in her breakfast of mashed potatoes, chicken Chow Now, Udo’s Choice Pet Essentials, and Udo’s Choice 3, 6, 9 Oil. I don’t plan to give her any more boiled dead chickens after today so the remainder will go downstairs to my neighbor’s dog, Turk. He really likes Mina, but right now she can’t handle much enthusiastic behavior from her friends. A nuzzle and a little sniffing is Mina’s speed at the moment.

I still have to cook the chicken Chow Now, but I no longer have to dismember chickens and skin them in my kitchen. You have no idea what a huge relief that is for me. The Chow Now stinks while it’s cooking but a stick of incense gets rid of the stink. Mina seems to love it.

Today, we’re going to boil and mash some gigantic sweet potatoes for her carbohydrate needs, and we’re also driving out to ECOW in Amissville, Virginia to pick up a case of chicken Chow Now. I’ve cleaned out my freezer and moved things around but still not sure how I’ll store 24 16-ounce cartons of it. I may have to beg some freezer space from a neighbor for a while.

I read about prednisone side effects this morning to see if there’s a reason that Mina is drinking a bit less water the last couple of days. She’s peeing less, too. Maybe that’s because I’ve been home for four days and she gets to go out a lot, but her next chemo treatment is highly toxic (you can’t even touch the pills with your hands) and she needs lots of water to avoid cystitis.

The tile entryway is her new favorite spot to nap.

The tile entryway is her new favorite spot to nap.

Then I found a very cool Web site written by two parents whose beloved Golden Retriever, Berry, was a lymphosarcoma patient. I’ve added it to the links over on the side. They wrote a little book titled, ” Every Day is a Good Day: Berry The Dog’s Guide to Living with Lymphosarcoma.” I’m on the second chapter, “Surviving the first month of treatment.” It’s some scary shit, but the treatment of lymphoma in dogs has changed tremendously in the nine years since Berry was diagnosed. The interesting part for me is that Berry had the same diagnosis as Mina, including cancer in the bone marrow.

So far, KNOCK WOOD PEOPLE, Mina hasn’t shown any side effects from the Vincristine. She’s still eating enough for three Wheaties every day, and drinking a fair amount of water. She rests a lot so I think the lethargy side effect is present but, even so, we took two walks yesterday to the leasing office and back. She was bright, alert and sniffing all over the place during the walks.

s.