Your official scrapbook is officially complete. I added some pictures and a couple of blog posts, wrote in all of the journal spaces, added all of the sympathy cards and condolence e-mail messages to finish it up. It sits now on the dining table by your pink footprint plaque that you made with Auntie Sue a couple years ago. I look at it a lot.
Have you noticed that I’m trying not to cry so much when I talk to you? I don’t want to make you sad every time I talk to you so I’m cutting myself off before the tears come. It seems I’m OK talking to you during the day but at night I get weepy. Sorry about that, sweetie.
Oh, I sent your “formal portrait” to my friend Samuel, in Nairobi. Our friend Paula took it to him when she went home after her DC visit. He loves it! He told me he’s going to frame it and hang it in his house and take a picture of it. I’m so proud of the influence you had on people during your life and even after you’ve gone.
Mostly, I miss being able to rub your belly and give you big hugs and kiss your face. I miss you kissing my nose and coming over to sit quietly near me when I have food that you find appealing. I still look up at the windows when I come home every day, hoping to see your furry face at the glass.
Whelp, that went much better than I imagined. My faith in Dr. B. is restored. My confidence in Mina is unchallenged – she is tough, much tougher than the chemotherapy and all the things that go along with it.
The VIMP budgies but one ...
Here’re the highlights from the discharge report:
Physical exam: bright, alert, stable weight, tiny popliteal lymph nodes, no other nodes palpable.
Weight stable at 48.3 pounds
CBC: normal WBC count (11,400), normal HCT (39 percent – not anemic), normal platelets – adequate for chemotherapy
Brief Abdominal Ultrasound: Spleen appears normal size and texture with no masses, nodules, or mottled pattern. There are some slender mesenteric lymph nodes visible but not enlarged or irregular. Small intenstinal tract measures normally with no focal GI masses or obstructions. Stomach wall measures normally and is contracting well. No gastric masses or polyps seen. Colon measures normally.
Vincristine was administered in the right cephalic vein today (0.37 mg IV).
Here are Dr. B’s notes about Mina’s gastro-intestinal issues: Intermittent gastrointestinal upset (vomiting, diarrhea) – cause open. Possibilities include chemotherapy side effect, inflammatory bowel syndrome, diet related, stress, other. Dr. Birnbaum does not feel tht GI lymphoma is likely due to lack of severe GI signs and normal appearance of intestinal tract on utrasound. Cannot completely rule out microscopic cancer in the GI tract without a biopsy, however.
That said, Dr. B does not feel that a biopsy is necessary. I consider that last sentence the standard medical disclaimer.
On the diet related front, it’s possible that changing what Mina eats all the time causes her stomach a little trouble. This week, she’s eating a little chicken and is totally enamored of Yves Tofu Dogs. I have to come up with something else that’s yummy for her. Any ideas out there?
Allyson did apologize for the confusion and distress caused by Team Grim Reaper’s “different style.” They were wrong, plain and simple. She reiterated that Dr. B and her team know Mina because they’ve been treating her for four months now and they’re more familiar with her reactions to drugs, etc. I wonder if they rather resent the trouble caused by one poorly written, arrogant, and rude e-mail message?
Anyway, it’s a good report and Dr. B. is very pleased with Mina’s progress. Now to get through Vincristine week without any major problems!
**UPDATE**VIMP called to confirm our appointment and I asked about the ultrasound. I stayed on hold while the tech checked with Dr. B. It’s all set. Mina will have her usual CBC, physical exam and ultrasound and the appointment will take about an hour and cost anywhere from $75-$150 extra. If it gives me the answers I need, it’s money well spent.
It’s odd but VIMP has not called me today to verify our 9:30 a.m. appointment for tomorrow. Hmm …
Still no response from Dr. S. to the e-mail note I sent yesterday. I guess I’ll just ask for that ultrasound when I get there tomorrow. I honestly don’t know what to expect anymore and I don’t know Mina’s status at all. It’s all a confused mess thanks to TEAM GRIM REAPER.
Anyhoodle … Mina and I drove up to Skyline Drive in Shenandoah National Park yesterday morning. We took the back roads to Front Royal and entered the park and headed up the mountains. We were not prepared for this trip – no sunblock, no DEET – but I did bring Mina’s waterer and my own Klean Kanteen filled with filtered water.
It was nice up there – humid and about 80 degrees. Every time we got out of the car to look around, we were swarmed with bugs. An invisible, neon sign that reads “EATS” must have appeared above my head as I seemed to be the only one swatting at bugs. It was a beautiful drive, not very crowded at all, although I did notice that all the lodges and campgrounds were full.
We drove until we reached VA 211 and headed down the mountain. That road is like a wild mouse roller coaster, which I thought was kinda fun but it annoyed Mina because the tight turns made it hard for her to stand up and hang her head out the window. Boy howdy, it was hot when we got down to normal elevation. I turned on the air and closed the windows, but Mina wanted the windows down so we had both fresh air and bought air at the same time. I didn’t get any pictures because taking pictures of mountains with a cell phone camera is just lame.
We rested the remainder of the day, but Mina did eat some last night. I cut up an Yves Tofu Dog and put it on top of her beef and chicken and she ate it all. Then she ate a couple of jars of baby food and NO PUKING. In fact, she has normal bowel movements now. I don’t hear any more gurgling in her stomach and her gas has subsided so perhaps whatever was bothering her (cancer or IBS, we just don’t know) has subsided. She ate some more chicken before going to bed, too.
This morning we drove to my office to pick up my laptop. I stayed home today because I want to make sure that Mina is feeling OK. She seems pretty chipper, even taking a couple of walks outside in the heat. She hasn’t eaten much today, just some chicken and half of a tofu dog, but that might be the heat. Mina has historically lost weight during the summer months because she just doesn’t eat as much. Or it could be like my friends Jill and other have suggested and this is just a very low spot on the chemo roller coaster. I hope it improves this week.
Here’s a picture of Mina and one of her friends whom she rarely sees, Chance. He’s older like Mina and they always get so excited when they see each other, but Chance’s human always pulls him away too soon.
Mina and Chance
And here’s a shitty cell phone cam video taken today of Mina on a walk. Notice how near death she looks …
Nothing is certain, very little is known, more tomorrow …
Mina isn’t eating enough to even stabilize her weight this week, much less post a gain. She ate some chicken and rice twice today, plus some pita chips while we were out at the winery today, but that’s all.
Should've faced the mountains for the pic but was keeping an eye on the Bean
I have to conclude that it’s possible that Team Grim Reaper is correct and her gastro-intestinal problems are caused by the cancer. Why it’s causing her problems at this late date is beyond my comprehension, especially after having such a strong chemotherapy treatment. I had hoped today’s outing to our regular vet in Warrenton (to pick up Tramadol and some Forti-Flora, a pro-biotic recommended in the evil e-mail message) and to the winery would cheer her up and stir her appetite, but no. She enjoyed the drive to both places and enjoyed wandering around the patio at the winery but getting her to eat is difficult.
For myself, it’s been an awful 10 days. My own IBS is very active and my anxiety level is very high. I’m sure Mina is keenly aware of all of this and maybe it’s causing her IBS to rile up, too, but her cancer vets are convinced it’s the cancer. Everything they wrote in that horrible e-mail note is eating away at me every minute of the day. We may have won because we will no longer have any contact with Team Grim Reaper, but the damage they’ve done is extensive.
Mina today at Barrel Oak Winery in Delaplane, Virginia
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.
Y’know, one of these days I’m going to learn to take what Team Grim Reaper tells me with a grain of salt. It’s just hard, very hard, not to freak out when one of them tells you that it may not be worthwhile to continue the chemotherapy. I haven’t slept more than 4.5 hours a night since last Thursday because of that one phone conversation.
Well, Mina is scheduled for her Vincristine IV for next Tuesday. She had a good check up today and Dr. Birnbaum is pleased with her progress. Here are the highlights:
NO WEIGHT LOSS! Mina gained one-tenth of a pound, which isn’t much, but I decided before the appointment that if she didn’t lose any weight we’d call it a victory.
No palpable splenomegaly; prescapular lymph nodes are small but palpable at about 1/2 cm; two left submandibular lymph nodes are palpable at 1/2 cm. No change from last week’s exam.
CBC results: Stable mild anemia at 34 percent with a normal white blood cell count at 9,900.
Urinalysis revealed NO overt infection. Rare WBC on sediment, trace blood and protein, and dilute urine with a specific gravity of 1.015. There is 50 mg/dl of glucose in urine.
Blood glucose was normal at 85 mg/dl.
Mina will finish up the Keflex for the UTI on Thursday. I gave Dr. Birnbaum a note about the diarrhea and Mina’s history of tummy troubles and told her what she’s eaten, etc. They didn’t seem to think it was related to the cancer, but most likely to what she’s eating. I hope it clears up this week.
The only dark spot in this report is that they found mild glucosuria with a normal blood glucose which is likely early renal disease causing loss of glucose through the kidneys. Mina’s kidney values were normal on blood work from May. I’m to consider running blood work to check kidney values in the near future, depending on her progress.
Allyson, today’s LVT and one whom I really like, said this is normal aging stuff but we need to watch it. I’m going to search for a kidney support formula to see if I can help stave off the inevitable. It would suck to save Mina from cancer only to have her suffer with a long bout of renal disease, even though I know lots of dogs live with it for a long time. So if you know of any proven kidney support supplements, please recommend them to me!
Dr. Birnbaum did the blood glucose check for free today. I think we’re kissing and making up. I need to remind Mina not to have any crises on Thursdays when Dr. B. isn’t in the office. I understand that Dr. C. is considered brilliant in her field, but she and her team cannot deliver news without it sounding like a damn death knell. They truly are Team Grim Reaper and I’m glad Mina’s not on that team. Dr. Smith reminded me that he’s in the office the next three days if I need to call. It’s a good thing they all like Mina, s’all I’m sayin.’
Oh, and there are TWO new budgies at VIMP and they’re all four in a bigger cage now. They are very chatty – it’s a party in there.
New budgies are bright blue and pale yellow/green.
We also met Ray the Blind Dog and his mom today. Ray and Mina share the same vet at Village Veterinary Clinic. He was the sweetest boy, very eager to sniff you over and meet you. I have him some of Mina’s liver treats and he loved them. He’s a rescue, probably rejected by hunters who inbreed their dogs and didn’t want to care for a blind one. Don’t get me started on hunters …
Turns out Mina had a pretty good appetite yesterday, just later in the evening. She finished off her breakfast around 7 p.m. and as I’d just finished cooking a batch of Chow Now, I gave her some more. She gobbled it up in no time. Mina also ate a carton of plain organic yogurt and quite a few bison bites. She definitely likes eating when it’s cooler.
This morning I gave her a bit less for breakfast than usual, having learned my lesson about feeding her too much before a chemo treatment. She ate a few spoons full of yogurt and took all her pills – a total of SIX now with the Keflex. It’s getting expensive to keep giving her almond butter for pilling, and VIMP thinks it might be too rich for her tummy, so they suggested cream cheese or butter.
GROSS.
I asked if vegan cream cheese made of tofu was OK and VIMP said that’s fine. So today, I made her a batch of “Rich Tofu Cream Cheese” from the Uncheese Cookbook. It’s made of cashew butter, firm silken tofu, lemon juice, “mild sweet syrup of any kind” (I chose the Southern option – light Karo), fresh lemon juice, salt, and a pinch of nutmeg. Does it taste like cream cheese made from suffering cows? I don’t think so, but it’s pretty tasty. We’ll try it out on Miss Bean when she takes her afternoon meds – Meto and Keflex.
Today’s exam at VIMP doesn’t make me happy. Yes, Mina got her planned Vincristine IV at the reduced doseage but the popliteal and prescapular lymph nodes in her left leg are now less than 1 cm. Last week they were less than .5 cm, so they’ve grown. The LVT, clearly a member of Team Grim Reaper, didn’t have an explanation for why Mina’s spleen is still normal but she has a couple of peripheral lymph nodes that are getting larger. What the fuck, people? You must have some sort of explanation for this?
The VIMP budgies don't like the paparazzi.
Mina has lost another .6 pounds. Again, I seem to be the only one who’s freaked out because she’s BONY SACK. The TGR member told me that because her weight losses are incremental they think it’s just the cancer.
So. Her anemia is improved and her white cell count is normal. They did not know about her trip to PWEVC on Friday so I gave them the reports that I carry in Mina’s Cancer Notebook. The urinalysis today at VIMP indicated the specific gravity has gone from 1.026 to 1.015; PH from 8.0 to 6.0, some red blood cells present in Mina’s urine but no overt bacteria, so a likely resolving infection. A brief abdominal ultrasound revealed her spleen has “shrunken to normal size and the texture has improved as well. No overt abnormalities seen in the urinary bladder.”
Today when the LVT saw me pull out notes and charts from her e-vet visit, they must’ve been impressed because they gave me her urinalysis and CBC results with the discharge report. First time I haven’t had to ask for those documents. We report next Tuesday at 7:30 a.m. for her half-day stay and doxorubicin injection.
We’re gonna need a bigger notebook. And more money.
It's OK to Talk About the Cancer 