Chemo Week Update

Mina is, as usual, feeling poorly during Adriamycin/doxorubicin week. She’s barely eating a little chicken when I hand feed her, but she did eat an entire jar of organic baby food this morning.

There was a small puking incident before the mobile groomer lady came, but it was just yellow foamy stuff. She still took all of her peanut-butter coated pills and supplements and drank some water.

Kristen had her all groomed and back home in less than an hour. Mina’s hair color is definitely darker than it used to be, more like an Airedale than a Wheatie. She’s very thin, too.

We’re going out for a bit, not sure where we’ll end up. Maybe the winery, mabye just a drive. Mina will feel better by Monday and then we can work on fattening her up.

s.

 

If You Want a Different Answer

Last night was bad here in the cancer ward. I tried so hard to hide my feelings from Mina, but I might as well try to hide the moon in a paper sack. She knows when something’s wrong and she put on such a brave face for me.

I did get a response from Dr. C. at VIMP. I’m not going to post it here but I sent it to close friends, one of whom shared it with her partner and they agreed with my interpretation. It started with an arrogant and completely unnecessary bit about the doctor’s credentials and went into an explanation of the stages of canine lymphoma. All information I’ve already dug up for myself and that I know. Nothing like following a little arrogance with condescension, eh?

Let’s get this straight: When you ask questions about something this vet tells you, it’s clear that you’re stepping on her professional toes. I should think after 37 years of treating cancer patients that she’d be accustomed to answering all sorts of questions. I guess not.

The note explains that Mina had massively enlarged lymph nodes in her GI tract, but doesn’t give any indication of whether or not those nodes are affected by the chemotherapy treatments. Then she explains that Mina needs to take some pro-biotic supplements and that she shouldn’t have any anti-oxidants, which I also knew after my meeting in May with Dr. Lundquist, the holistic vet, because they “promote cell proliferation of all cells, especially cancer cells and can disrupt the effect of chemotherapy in
targeting the cancer cells.”

This particular sentence was incredibly upsetting: “Therefore Dasuquin MSM, and any anti-oxidants should be discontinued.” WHAT THE HELL? Since when is Dasuquin MSM an anti-oxidant? Mina’s been taking it as a bone/joint supplement for months and months and Dr. B. knows that and it shows up on her list of meds in every single discharge paper!

Oh, there’s more: “We never tell people that we will cure or even provide long term remission with Stage 4-5B/5B malignant lymphoma.”

Well, that’s news to me! I know her cancer can’t be cured, but I remember my initial meeting with Dr. B. when she told me that Mina had a good prognosis for remission with chemotherapy.

After reading this note a couple of times, I was devastated. It was cold and uncaring so I called VIMP and asked Dr. B. to call me to discuss it. That message got back to Dr. Smith and he called me about two hours later. He must’ve been working at the emergency clinic last night, and he’s the business manager for VIMP. I was glad to hear his voice.

Dr. S. told me that he approved the note and just wanted to clarify with me the process of cancer staging. All I can say is that they need a persuasive writing course in that clinic because what I read wasn’t educational, it was condescending and downright rude. Perhaps I’m overly sensitive, but they should KNOW that their human clients are under a tremendous strain and write and act accordingly. Taking a writing course for “How to Be the Best Grim Reaper Ever,” is NOT effective.

He told me that Dasuquin MSM is not an anti-oxidant, which means the sentence above was very poorly constructed. I searched all over the interwebs looking for evidence that Dasuquin is an anti-oxidant and couldn’t find anything.

When I told him that I want Mina’s gut ultrasounded so I can know the condition of those lymph nodes, he informed me that Dr. B. performs “little ultrasounds” on Mina all the time at no charge to me. He said sometimes the vet just wants a look at what’s going on inside so they perform an ultrasound and Dr. B. does this with Mina. There have been no notes on her discharge papers about any ultrasound since June 23, but he assures me that Mina gets them frequently. He suggested when I bring Mina in for chemo next Tuesday that I tell the tech that I want an ultrasound of Mina’s gut to find out what’s happening to those nodes.

BTW, the June 23 ultrasound note reads: “Spleen was normal size and texture had improved as well. Internal lymph nodes were small in size.”

Now, I have to gather that when Allyson comes out to tell me that Dr. B. is “extremely pleased” with Mina’s progress and that “everything looks good” that must mean EVERYTHING, right? Including those internal lymph nodes? If that’s the case, then how can those same lymph nodes be causing Mina’s diarrhea? Do you see my confusion?

You can also see why I’ve never mentioned Mina’s blog URL to anyone at VIMP. I want this to be an honest record of our experiences with canine lymphoma and chemotherapy. I want anyone who stumbles across this blog in the future to understand that this is incredibly hard, that it’s a daily struggle, and that sometimes the vets working for you have the bedside manner of the Grim Reaper and the communication skills of a laboratory researcher. This is why I chose Dr. B. over Dr. C. and this is why, for the rest of Mina’s treatment at VIMP, I am not dealing with Dr. C. or her staff. Mina needs some pro-biotics? Fine, I’ll get them from Dr. Cliver and Dr. Nolan, her regular vets.

This is twice now that Dr. C. and her LVT have put me, and Mina, through hell for no apparent reason. I’m not going to allow it to happen again. Maybe I sound unreasonable and ungrateful to some, but I don’t give a shit. I’m going to do what’s best for Mina if that means insulting a few lofty professionals along the way.

s.

 

Another So-so Day for the Mina Bean

I wish Mina were sailing through this doxorubicin week like she sailed through the last one. But it’s always different with chemotherapy and I’m doing my best to roll with it.

Mina clearly wasn’t interested in eating much yesterday after breakfast. Auntie Sherrie fed her a jar of baby food, Uncle Robb said she was perky during her walk but there was still food in her dish from earlier in the day. When I got home after stopping at Whole Paycheck for more carcass and veggies, I tried to hand feed her but she wasn’t interested.

The weird thing is that she was very perky on our walks and very interested in meeting canines and humans. She met a little sort of chihuahua mix, named Puppy, on our way home from an afternoon walk and was genuinely engaged. I didn’t notice any drooling, but later in the evening I started to notice that she was changing her positions a lot. I just needed that one indication that she might be nauseated to whip out one of the two remaining Zofran tablets and dip it in peanut butter for her. About an hour later, while I was still dismembering chicken corpses, she came out the to kitchen asking for some fresh food.

I had toyed with the idea of adding some pureed organic squash to her beef mix, but nixed that idea because it’s also possible that the chemo drugs are messing with her taste perceptions again. So figured we’d better keep it simple for a while longer. I mixed two local farm eggs, some dried parsley, and garlic powder into the ground cows and baked it. She seemed to really like it.

This morning we took a short walk, just long enough for Mina to find a place to poop, then I put some shredded chickens into her dish. Not interested. I sat down beside her on the tile entryway and, at first, she turned her head away when I offered it to her. But after a few more tries she was eating it out of my hand, then she got up and moved to another spot in the living room. I sat next to her and kept feeding her until she’d eaten almost everything in the bowl. I doubt she’ll eat again until I come home this evening.

Tomorrow, I’m taking her out to the Sanctuary with me to meet up with everyone after they finish the chores. I’ll take along a treat, too, but I really want them to meet Mina because they are so kindly asking after her every week. It’ll be a stimulating outing for Mina on a day when the doxorubicin will peak in her body, so I’m hoping she’ll be able to enjoy herself without noticing any nausea or other bad feelings. I have one more Zofran that I’m saving for tomorrow if she needs it. I’m sure I can get another prescription for the last quarter of chemo that starts on August 11.

s.

 

You’re Damn Right She’s Worth It

“I can’t think about that now. If I do, I’ll go crazy. I’ll think about it tomorrow.” –Scarlett O’Hara in my favorite movie “Gone With the Wind”

I just signed the loan papers to continue Mina’s chemotherapy. Sure, it’s not as much debt as my former student loans but it’s an awful lot. A scary lot. It is, however, enough to get her through the remaining eight chemotherapy treatments in the protocol.

After that, I’m not sure what will happen to us. If Mina’s not in remission at the end of the protocol then I’ll go back to her regular vets and let them guide me through whatever comes. Remission rates are typically listed on various canine lymphoma Web sites at 70-84 percent of dogs treated with remissions lasting 6-9 months, sometimes longer.

That’s all I want. I want Mina to feel good and enjoy her life for 6-9 months or longer before the cancer comes to claim her. Remission is described as the absence of cancer and I’m not sure when her cancer vets will declare that for her. I thought, as you’ll recall from an earlier post, that we were close at one point but then she stopped eating well and Team Grim Reaper was ready to call it quits. Her last exam and tests had good results but still not good enough.

So on we go for another nine weeks. In the meantime, Mina is eating well and tolerating all the new supplements and she seems perky. I love her so much.

s.

 

If the Cancer Don’t Kill Ya, the Chemo Will

Mina’s cancer seems to be in a retreat, but physically she’s not doing well. Down to 47.7 pounds as of Tuesday and she hasn’t eaten since then, either. Nothing seems to tempt her but bison bites and she can’t live on those. I’ve been heating her Chow Now in the microwave because she seemed to prefer it warm, but that’s not even working since Tuesday evening.

Then there was the debacle over the e-mail I sent demanding better estimates for Mina’s chemo expenses. I apologized, ’nuff said, moving on now.

We’re also having problems with pilling Mina. Last night I gave her some peanut butter with her pills and one of the smaller tablets got stuck on the roof of her mouth. I was able to remove it, but now she looks at the spoon very suspiciously. This morning it appears one of the capsules, either milkthistle or Keflex, melted in her mouth or throat and that was a couple of minutes watching her make faces and rub her tongue around and smack her lips. I gave her some more peanut butter and that seemed to help get the bitter taste out of her mouth. She’s on to every trick now and really doesn’t like being pilled manually. Yesterday, she bit down on my thumb with her back molars and that really hurt.

Mina is taking too many drugs and not eating enough. Period. I have to give her the medicine but it makes her nauseated so she doesn’t eat and that makes her feel worse. So today I’m calling VIMP, at Dr. Smith’s suggestion, so they can prescribe a stronger anti-nausea drug. The Metoclopramide just isn’t cutting it for Mina.

It’s been a hard couple of weeks, lemme tell ya. Still no word from the bank on my loan application.

s.

 

Oh, the Indignity of It All

Sometime in the night I awoke to an odd sound – sort of a ::flapflapflap:: sound. I got up and turned on a light and looked for Mina. She was curled up in a corner of the plastic-covered couch, sleeping. I gave her a kiss and went back to bed.

Around 3:45 a.m. I heard the sound again, got up again, and found Mina on the opposite corner of the couch and that’s when I smelled the pee …

Poor baby had pee on her back, her legs and her tail. I got her off the couch and onto the sheet/blanket/towel-covered floor, and got a warm, soapy washcloth and cleaned her up. I did find some patches of hair missing with those black spots on her skin so we’ll show that to the VIMP vets on Tuesday. I don’t think yeast is supposed to make her hair fall out in spots.

After I cleaned off the plastic couch cover it was nearly 4 a.m. and time to get up so we went outside in the still-pouring rain and Mina had to be coaxed to the grass to pee. She was already half wet so I don’t understand why she balked.

When we got back inside I dried her off and she laid down with her head between her paws and her ears tucked back and looked so … embarrassed. I gave her a little extra almond butter with her pills and tried to assure her that I really don’t mind cleaning up all the pee. I swear she rolled her eyes at me.

s.

 

Vomitus Maximus

We’re having a rough time here in the Cancer Ward.

Last night, as I was getting ready for bed, I found two puke deposits in a corner of my bedroom behind a dining table chair. Two piles of rice and Sunshine Burgers, no liquid, no brown stuff, no “coffee grounds,” just Mina’s dinner. It cleaned up easily, at least.

This morning I couldn’t sleep past 3 a.m. so I took Mina out in the pouring rain for a quick pee, gave her the famotidine, then tried to go back to bed. No luck. We went outside around 4:45 a.m. and about halfway through our walk Mina vomited again. This time it was the usual yellow, foamy stuff that she’s been puking up her entire life, and two partially-digested Dasuquin MSM tablets. That makes three episodes of vomiting and one diarrhea for this chemo week.

I need some good information on what to feed Mina. I’m getting advice from good people but none of it’s working for her. I can’t keep feeding her whatever I think she’ll eat. She needs solid nutrition and something that will stay down and I need to know WHY she’s not eating. Is it the chemo or the cancer? Is it Mina herself? WHAT? She’s lost at least two pounds this week from the looks of her and the feel of her bones. This cannot go on for 19 fucking weeks – she won’t survive the damn chemo if she’s a skeleton.

CLEARLY I’M SOMEWHAT ANXIOUS LATELY. That’s not helping either of us. Maybe Dr. Lundquist, the holistic vet we’re seeing on Friday, will have some answers. I dunno what to do. I just don’t know what to do. Neither of us is eating right, we’re both massively stressed and anxious, I’ve been home for FIVE DAYS just cleaning up pee and worrying about what to feed Mina and I believe I’ve reached the end of the rope.

help

 

Somehow, I Knew We Wouldn’t Get Out of It Scot-free

Yesterday, after three and a half hours at the vet’s office and a trying chemotherapy infusion, I could tell that Mina was very tired. She ate a couple of times yesterday afternoon, but that’s about it. She ate some snacks, she ate a few of my tortilla chips, but mostly she laid down and slept. We did manage a walk to the leasing office earlier in the afternoon.

This morning she ate a little of the gravy I made for her yesterday, and the last of the yogurt, but none of the Chow Now. She has not requested a snack. We took a short walk at 5 a.m. and she had a lot of business to do, but her perkiness level is definitely down, as is her appetite. I rather expected this because the doxorubicin is one mean chemical. I did more reading online yesterday and found it’s the Big Gun in the cancer arsenal for humans and canines. I found only two accounts of dogs who’d been successfully treated for lymphoma using a modified Wisconsin protocol where side effects from the doxorubicin were reported.

Sad-eyed Mina with yogurt on her nose

One side effect of chemotherapy that I can’t seem to find online is staph infections on the belly and around the vulva. This is driving me crazy. I complained to Dr. Smith yesterday that there are more of them every day and he said that with her suppressed immune system he wasn’t surprised. He sent me home with some gauze-like cloths soaked in Chlorhexidine, some dry cloths, and told me to clean her a couple of times a day and keep applying the Neosporin. Mina licks that off, of course, when I’m not looking, but this morning she’s just resting in the entryway so maybe she doesn’t even feel energetic enough to lick off the ointment.

In better news, her urinary incontinence has decreased sharply. I think this is a combination of the ever-decreasing dose of prednisone and possibly her ability to control her muscles a bit better. There are no more giant “leaks” on the towels and blankets, just little ones that are easily managed.

She also spent some time at the open living room window yesterday, barking at anyone who passed by. In general, though, I think the doxorubicin is kicking her ass a little and I’m not surprised. I hope she feels better in a few days, although this stuff will reach its peak in her body around Sunday.

s.

 

My Question About the Protocol Answered

I wrote to Dr. Smith yesterday asking if the change in Mina’s chemo protocol was a last-ditch effort to shrink her spleen or if it’s an opportunity to take advantage of the small progress she’s made? I mentioned that Dr. Birnbaum, in our initial appointment, said that if Mina wasn’t showing signs of progress after five weeks that we’d discontinue the chemo.

He wrote back around 1:45 a.m., during his shift at PWEVC. Here’s part of his response: “The main reason for altering the chemo protocol is to be more aggressive with regard to the spleen. She has made progress with regard to her peripheral lymph nodes and overall clinical status. We are extremely committed to Mina’s chemo. It is too early to make conclusions.”

See, this is why I like having him on Mina’s team – you can contact him and ask questions and get straightforward answers delivered without a hint of Grim Reaper. Mina likes him, too, and hers is the most important opinion.

Good day yesterday, very perky, took three longer walks, she ate well, still doesn’t like having her supplements added to her food but she eventually eats it all. I’m off to my chiropractor this morning because I haven’t been since March and everything is misaligned. Thanks stress! you dirt bag.

s.

 

Someone’s Being Manipulated and It’s Not Ol’ Four Paws

So, after leaving behind a sad, not-eating Mina yesterday morning, I start getting reports of how perky she was and how all her breakfast was gone before noon. When I got home -late because of traffic and a brief stop at Whole Paycheck- I found a perky Mina ready for a walk and an empty food bowl. She continued to ask for food right up until bedtime, around 9:30 p.m.

Hmm …

Mina on her bed a few months ago

This morning I had the same experience – Mina wasn’t interested in eating and she sat with her pred head in her skinny paws and stared at me with her big, brown eyes. Today I’m not buying it. She’ll eat at some point and she’ll eat all afternoon and evening. This is all good because all of the chemo drugs cause a reduced appetite. I thank Dr. Smith for the Remeron prescription that’s keeping her appetite high.

She’s not terribly energetic while we’re indoors, but she’ll take a decent walk once we’re outside. It’s nothing like the walks we used to take that could last for 30 minutes or more, but for a dog who’s lost five pounds since the beginning of March and has seriously reduced muscle mass, mild anemia and CHEMOTHERAPY, I think she does pretty well.

Speaking of chemo … I had a little crisis yesterday about whether or not to give her the monthly treatment of K9 Advantix. I’d found a couple of Web sites claiming that any spot-on flea and tick treatment can be fatal to dogs, especially immuno-deficient dogs such as Mina. (Remember, chemotherapy kills ALL cells, even the good ones.) What I couldn’t find were any medical or veterinary Web sites making these claims. One product that features cedar oil as an insecticide was prominent on a couple of these sites, but it didn’t take me long to figure out that all the positive raves came from a single source or were written by a single person.

I called VIMP and I called Village Veterinary Clinic (Mina’s regular vets) to get the scoop. VIMP called back after Dr. Birnbaum read the information that vets get for K9 Advantix and said it doesn’t get into the bloodstream or major organs. It’s strictly subcutaneous. Mina’s been using it for years with no problems and we cannot afford a tick-borne illness. It would kill her and she’s already had Lyme Disease, so she needs a reliable flea and tick preventative because we live in an area that has a huge tick population.

Next, I talked to Dr. Nolan at Village Vet. She has heard that Frontline and Advantage were blamed in a small number of canine deaths, but she wasn’t sure that the topical treatments were to blame. She said she doesn’t believe these treatments cause dogs to die and that I needed to weigh the risks and decide which is greater.

I chose to give her the K9 Advantix. She seems fine today. I’ll keep an eye on her skin and her behavior and if anything goes awry we’ll go to PWEVC to see Dr. Smith.

Mostly I’m concerned about keeping her drinking and peeing to prevent the “Cytoxan cystitis,” her elevated white cell count, and those little sores on her belly that I keep washing and treating with Neosporin twice a day. Chemo is exhausting even when you’re not the patient, lemme tell ya.

s.