I took Mina to see Dr. Cliver today for a couple of reasons: I wanted Dr. C. to check out the lump in the loose skin under Mina’s chin, to check the left popliteal lymph node, and to determine if we need another lime-sulfur dip this week.

Oops, that’s more than a couple of reasons.

The results of the exam:

  • All of Mina’s peripheral lymph nodes are now enlarged.
  • The left popliteal lymph node is quite huge, the biggest of all of them.
  • The lump in the loose skin under her chin is mostly fatty tissue that’s common in older dogs, but you can reach up just slightly and feel that her mandibular nodes are enlarged.
  • Mina’s scratching has pretty much ended, so no lime-sulfur dip this week; it’s also too cold and rainy outside for her to dry off properly. I’m going to bathe her in the Malaseb shampoo this weekend to help her skin recover from the sarcoptic mites.
  • We’ll continue with the homeopathic protocol prescribed by Dr. Loops, and I’ll inform him of the changes in her condition, as he might want to change the protocol.

The only other option is one of the rescue drugs and, as I explained earlier, I’m not going to put Mina through that again. Dr. C. said that Mina looks happy, and she does and she’s still eating and she’s still having a pretty good time. I know that can’t last long, but for now it’s enough.

s.

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Mina and I just got home from her first post-chemo exam and CBC at her regular vet’s office. We took up far too much of Dr. Cliver’s time, I’m afraid, but there was a lot to talk about.

The first thing we did was discuss the results of her last visit to VIMP, the news about her remission, and the results of the skin scraping. Mina was scratching at her stomach with her back legs several times during our talk so we put her on the table to have a look.

Dr. Cliver thinks Mina might have sarcoptic mange, which cannot be detected with a skin scraping. She gave me a bottle of lime sulfur dip that I have to put on Mina today to try and help the symptoms. The cure for sarcoptic mange is large doses of ivermectin, but Mina’s immune system can’t handle that right now.

The next thing was to exam her lymph nodes. This is were things went really bad. The nodes on her right side, prescapular and mediastinal, are enlarged. Now, Dr. Cliver said this could be a couple of things … It could be a reaction to the skin disease or it could be an indication of a thyroid condition. The plan is to dip her in the lime sulfur stuff and we’ll return for another exam in a week (the CBC results won’t be ready for a couple of days). If there’s improvement, then we won’t aspirate a lymph node. If not, we’ll have to do that and send it off to a lab to find out if her cancer has returned.

I tried to hang on to a little hope that a couple of enlarged lymph nodes could mean something besides cancer, but after what we’ve both been through this year that’s a false hope. It was my greatest fear all along that once the chemotherapy protocol ended, the cancer would immediately re-assert itself in Mina’s body. I just cannot believe that it might be true. It’s more than I can take right now.

So, I’m off to put on some gloves and make our apartment smell like rotten eggs. And then I think I’ll do some work and try to think of something – ANYTHING – other than losing Mina to cancer before she’s even had time to enjoy her remission.

s.

Today Mina didn’t eat at all until around 9 p.m. She ate some liver treats, ate a half jar of baby food with the Forti-Flora mixed in, but that was all until I got the beef casserole stuff out of the oven. I knew she was hungry and she ate close to a quarter-pound of the beef, rice, eggs, pureed summer squash, garlic, and parsley mixture. She also took the last dose of Mirtazipine.

All day she’s been in a pretty good mood. She grabbed her squeaky moose for us to play with, she barked at the window when anyone walked by, she took walks and met some of her canine pals, and she took lots of naps.

Then, about a half hour ago, she came out of the bedroom and was restless. I asked if she needed to go outside and she walked to the door so out we went. She had a fairly normal looking bowel movement, then she started vomiting. Everything she ate came up in two big piles on the sidewalk (I cleaned it up best I could). Now she seems pretty tired and is resting.

Mina is clearly very sick. I called PWEVC and Dr. Smith wasn’t in and since she doesn’t have any more stomach contents, I’m not taking her in at this point. If she vomits again tonight then we’ll go.

I wrote Dr. Smith an e-mail message detailing Mina’s behavior and appetite the last two days and a full list of every med and supplement she’s taken in the past two days. I stated clearly that on Tuesday I want an ultrasound of her gut and that I’ll pay for it. I need to know if the cancer is causing all of this diarrhea and gurgling stomach and lack of appetite and vomiting. Because between her weight loss for two weeks and that e-mail message and now this vomiting, I am losing hope. In fact, I’d say it’s pretty much lost.

s.

Here’s the e-mail message that I sent to VIMP just a while ago.

Hi,

You know by now that Mina’s had diarrhea today. It’s 5:15 p.m. and she’s had four bouts of it, one of them indoors. This morning she was fine; normal, if small, stool and she ate breakfast with gusto. I did notice some loose stool on her last potty break before I left for work, but since she seemed to be otherwise well, I didn’t give her any Immodium.

Between 6:10 a.m. and 10:30 a.m., she had diarrhea indoors and my petsitter found it. Her second petsitter reported that Mina hadn’t eaten and seemed sorta down. By the time I got home at 3:45 p.m., Mina was perky, very ready to go outside, and energetic. She had another two rounds of runny stool that looked sorta like gelatin over the next hour. Right now, she’s resting after taking an Immodium dose, and seems hungry.

Kristy called and advised me to give Mina the Immodium. She mentioned that it’s been nine days since Mina’s last chemotherapy treatment, that this diarrhea may be caused by the cancer. That makes twice that this
gastro-intestinal cancer possibility has been raised. What I’d like is
something clinical, factual to back up this hypothesis and some idea
of what this means for Mina and how we’re going to treat it, please.
If last week’s weight loss was not a product of the
Adriamycin/doxorubicin and if this bout of diarrhea is not caused by
something she ate or her ongoing IBS (my own anxiety-related IBS has
been quite active for more than a week now), then I need to know what
we can do about it. I’m confused by the reports that she’s doing well
and then when she loses a pound and gets diarrhea, cancer is the
culprit.

Thanks for your understanding. This is really eating a hole in my gut
right about now and that doesn’t help Mina one bit. We’re very
connected and she knows, no matter how much smiling I do, that
something’s wrong.

Sheryl

s.

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.

Since last Tuesday when we visited the PWCEV because Mina was vomiting, she hasn’t recovered. Her spirits are very low and she’s eating very little. I just gave her some pancakes from my plate, which she enjoyed, but she’s made no move on her own food.

Yesterday I went to work but left after four hours because her Auntie LoLo reported that she was listless, uninterested in going outside, and depressed. I’d spent the morning trying to get work done but found myself crying quite a bit and feeling utterly destroyed. On my way home I determined to straighten up because Mina doesn’t need to see me like that. I walked in the door, genuinely glad to see her, and she tried to jump up to greet me. We went walking all the way to the leasing office where she got more attention (and some of the lemon cupcakes I’d made on Tuesday).

Since then she’s laid on the tile in the doorway and drinks very little water and eats very little. She did eat her breakfast yesterday somewhere between 10:30-11:30 a.m., but she didn’t eat again until midnight and didn’t finish it all. This morning she’s eaten only pancakes and a biscuit from Auntie Sue.

See, I want to do things that she enjoys so we went for an early morning drive in the country. We used to do this often, before gas prices got so high, but haven’t in a couple of years. I called and woke up Auntie Sue and Uncle Robin and, presumably, Cousins Amber and Pearl and drove to their place. Mina perked up quite a bit, drank a sip or two of water, ate the biscuit and then rested on the cool tile in the sun room. Since we got home she’s again retired to the tile in the entryway and hasn’t moved at all.

She takes her medicine in the Pill Pockets, but nothing seems to help her condition. I don’t know if it’s the cancer making a big increase in her body, or if she’s giving up. I think it’s doubtful she’ll be given any more chemo, she’s simply too weak. I think by the end of today I’ll need to carry her up and down the stairs because she struggles to get down.

I don’t know what to do. I’m going to see Star Trek at noon so I’ll be gone for about three hours – maybe she’ll eat? I’m going to ask my neighbor to check on her and text me if there’s anything wrong.

This can’t be how it ends.

s.

Mina had an appointment today at VIMP with Dr. Chiapella. I’ve never met Dr. Chiapella, I wouldn’t know her if I saw her. But because my telecommute day is Thursday I thought it would be easier to schedule Mina’s chemo treatments that day. We’re changing it to Tuesday next week and going back to seeing Dr. Birnbaum.

After all that happy pep talk by Dr. Smith on Tuesday night at the emergency vet clinic, today at VIMP they delivered a painful blow.

Mina spies another canine today at VIMP

Mina spies another canine today at VIMP

First, Dr. C. isn’t sure if Mina’s vomiting on Tuesday night was caused by the Vincristine she got last Thursday. Her LVT didn’t say what else it could have been. I mentioned that I’ve read many accounts online of dogs getting very sick on the third or fourth day after the Vincristine IV and that it was, for some, the worst part of the chemo protocol. My comment was shrugged off – as usual.

Next, I was told that in order to treat Mina’s cancer effectively they need to administer the next drug, Cytoxan, right way … BUT maybe she should rest over the weekend. Seems reasonable, right? Until the LVT then informs me that waiting AT ALL puts Mina’s life in peril and it’s my decision so it’s actually ME putting Mina’s life in peril. Then she tells me that some dogs have to wait as much as 10 days between chemo treatments. I guess their lives aren’t as perilous as Mina’s.

Then, she lowered the boom. An ultrasound was performed on Mina – I was not told about this in advance, in fact they rarely tell me what they’re doing to her when they take her away to the mysterious treatment room/lab – and her spleen has not changed since the original ultrasound on April 21. This news was delivered with photos of the ultrasound and a dire prediction that Mina may not be responding to chemo and the implication that the doctor may not want to continue treating her.

WELL FUCK YOU.

I’ve had it with a doctor that every other vet I meet calls “brilliant,” but has the bedside manner of the damn Grim Reaper. THAT IS NOT WHAT WE NEED. THAT IS NOT WHAT WE NEED.

We need a doctor who will be frank with me about Mina’s health but at least tries not to be so coldly clinical that every pronouncement is like a death sentence. So, starting Tuesday I’m switching my telecommute day so that Mina can be treated by Dr. Birnbaum.

I left VIMP feeling like they’d just started digging Mina’s grave. We drove to our regular vet’s office – it took a freakin’ hour in heavy traffic – to get refills of prednisone (Mina’s dosage is being reduced) and Tramadol. While there I saw Dr. Nolan and just went off on the news from VIMP and how I don’t like dealing with Team Grim Reaper and that I’m not going to deal with them anymore. I never want to be told I have a choice of giving her chemo now, just two days after a violent reaction to the previous treatment, or hold off for a few days and be made to feel like I’m responsible for her death because I want to delay in order for Mina to feel better.

I am not giving up, damn it. I’ve just become the nosiest, most opinionated, questioning client they’ve ever met. I’m never leaving that office again without knowing EXACTLY what Mina’s options are for survival and I’ll know BEFORE they take her away what they plan to do.

And if it takes listening to The Downward Spiral to be in a testy, confrontational mood when I get there – then that’s what it takes.

s.