December 7th 2009 3:31 pm
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a diary entry is long past due. Six months is a long time. Geez, falling down on the job, are we?
Short & simple: so far so good. Every 3 weeks we make a trip to Bay Area Vet Specialists in San Leandro (we recommend them highly!) for a dose of high-level chemo, combined with a daily regimen of eastern and western meds and supplements. What's not to love about taking meds with raw meat? Who doesn't love steak tartare? Okay, it wasn't steak every night, but the Primal raw diet is pretty tasty. [Ed: dog's perspective about the Primal, not human's ]. The high-dose chemo lasted for 6 administrations. After the 1st dose, the tumor shrunk, and it's remained the same size (small) since.
Let's take a moment here to express our appreciation and gratitude to the members of the vet community for the scientific advances made to chemotherapy. Let's temper that with a little reality. For the first five days after the infusion, all's well. Day 6 and 7 are a bit of a challenge - Bar the barn door Katie, the cows are escaping!! and escape they did - it was Perth Amboy at low tide, Chernobyl and 7-Mile Island rolled into one. Throw open the windows and doors, set up the wind-tunnel fans and leave the city because being down wind would singe nose and eyebrow hair. hmmm, lovely imagery, eh? Fortunately it was really only those two days during the 3-week run that were challenging.
Maybe a little luv to the humans. A wonderful trip to Sea Ranch with the most perfect weather ever and great friends, and a fair number of weekends trips don't suck. Plus, a change in diet to raw food? Sweet. Our lives have continued on as they should - could spend more time at the beach, would like more ball throwing, should get more food.
Luv to my peeps, thanks for the messages and well-wishes. All the words of encouragement are received & heard. No dog is an island.
July 8th 2009 2:09 pm
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Marcel loves playing ball and can catch a ball at 25’ in mid-air or maybe off one bounce. A couple years ago, he was diagnosed with mild-to-moderate arthritis and hip dysplasia. While he could still chase balls, we had to limit the upright jumping to make it easier on the joints. He started taking glucosamine, chondritin, and omega-3 – more for the wet food that encouraged his interest than anything else, I’m sure. He still loves chasing the ball anytime, anywhere someone will throw it, the beach, a field, or our backyard. He has no interest in chasing squirrels or birds.
Sassy is a natural bird-dog. She can spot a bird, squirrel, or cat at 100 paces, goes into the birding ‘pose’ and then pulls on the leash fiercely. We wonder what would happen if she ever got the chance to make the chase. Although other times she’s so intent on leading the pack (we’re slowly training her out of that!) that she’s passed right by a cat on a car or wall.
Sassy is learning the concept of retrieving a ball. She’ll chase after it, bring it back, but won’t release it and wants to take it inside to horde at her bed. When Marcel catches the toy first, if it has a rope (Kong), she’ll grab it right out of his mouth. Fortunately, he’s a gentleman and doesn’t put up a fight. She tends to be more of a locomotive, plowing through anything to get at the toy - we have the broken branches and knocked down plants to prove it.
Marcel & I met with the oncologist on Monday to discuss chemotherapy. There are not a lot of chemo options for canine cancer in general, and even fewer for cardiac hemangiosarcomas. Marcel will start with Adriamycin. Seventy-five to eighty percent of dogs have zero to mild side effects, including nausea and vomiting for a half day, about 20% of dogs have strong side effects and 2% have violent side effects, for which they need emergency care. As always, our first concern is quality of life. Therapy is usually 4 treatments 3 weeks apart, with regular lab work. It can be harsh on the white blood cells, so they’ll need to be maintained either by delaying treatment a week, or by drugs.
If Marcel tolerates the Adriamycin, he will then have a secondary, and maybe tertiary, drug piggybacked to attack the cancer from a different direction. If he can’t handle the primary drug, there are alternatives available. Once the Adriamycin therapy has run its course, there are other drugs available that can be administered. A new drug on the market is Palladia (not the 1080i high definition music television network that shows music-related content from MTV Networks – I had to Google “palladia cancer”). It has shown to be effective, yet it’s outrageously expensive, as are most new drugs. I guess they need to recoup R&D…Pfizer, are you listening?
We are also making an appointment with a holistic, non-Western medicine doctor. While their initial training earned them the DVM, they have gone beyond that to include Chinese medicine, acupuncture, acupressure, and other holistic treatments. Our specific interest is in ‘yunnan baiyao’ supplements, used to normalize blood flow, enhance poor circulation, heal internal bleeding in injuries and bleeding ulcers, invigorate the blood and enhance healing. There is a possibility the tumor will start bleeding into the pericardium from the chemo treatment, which is pretty serious. The yunnan baiyao may help prevent or limit this from happening. We’re also open to other options.
When all is said and done, these treatments are not going to cure Marcel’s cancer. The best we can hope for is to stave off it off for a few months to spend more time with him. In the meantime, we take long walks, throw the ball, all the stuff that dogs like to do.
Thank you very much for the support you have shown. It means the world to us. While we may not have responded to every note, every word and every thought is relished and appreciated.
July 2nd 2009 10:22 am
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Over the past week, Marcel has been in great energy. Once the fluid was drained (“tapped”) from around his heart, he’s back to his normal self. We’ve all been going for nice long walks once or twice a day, and the 2 poodles have been chasing the balls in the backyard…lily plants be damned!! Sassy might be stronger, but Marcel is smarter so while Sassy is bouncing around the ball-thrower, Marcel races ahead to the back of the garden to catch the ball. More than once she’s snatched the ball right out of his mouth, he’s such a gentleman. While we were in SF this week, we stopped in for a brief visit at Collingwood Park, the only thing Marcel wanted to do was hump Toby and chased him relentlessly. If you don’t know you’re sick or feel ill, then why act that way? This weekend we’ll go on one of our favorite hikes in Tilden Park, up Quarry Trail. It’s a beautiful path with stunning views in all directions, west (ish) to Oakland & Berkeley and beyond to SF & Marin, east (ish) to San Pablo & Briones Reservoirs and beyond.
After long conversations between ourselves, doctors and internet research, we feel the life-expectancy prognosis does not warrant surgery and chemo. Therefore, we have decided to not follow that route, and instead provide the pericardiosentesis “taps” as needed. After a tap, Marcel will feel like a million bucks and be his regular laid back, playful self. In the days leading up to the taps, he’ll be a bit sluggish. At this point it’s difficult to know how often he’ll need a tap, and over a period of time, the taps will be closer & closer together until they’re no longer effective. This could be weeks or even 2-3 months.
In the forthcoming weeks we’ll make every effort to visit some favorite haunts from the past nine-plus years, and introduce them to Sassy. I was living Glen Park/Sunnyside when I first got Marcel, so Glen Canyon Park is on the list. Marcel has spent lots of time at Fort Funston with both his original SF dog walker and me. We might even let Sassy off the leash for the first time. Dolores Park was a favorite haunt for several years once we left Glen Park and moved to the Castro.
Thank you for all the notes, calls, texts, tweets, DMs, etc. Nick responded to one of these messages best,
‘The love of friendship really is like chocolate chip cookies that just came out of the oven. It's warm and comforting and can make you feel good even when you don't want to. Thank you.’
Thank you for your support.
June 26th 2009 10:46 am
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Marcel’s tail is more up than down today. Once he heard me getting ready for the morning walk, he jumped off the bed and trotted out to the kitchen. Sassy & I went for a quick walk, almost run, around the block. Marcel was excited to see us – me – return for our much more mellow stroll. He’s bouncing around, chasing the cats, and engaged in the household.
We have been offered three options from the vet. Option 1 is surgery & chemo; option 2 is pericardiocentesis palliative care; option 3 is to do nothing. Option 3 is not for us. Surgery and chemo includes a 1-2 week recovery from cardiothoracic surgery and chemotherapy is 1 day every 3 weeks with 4-6 sessions. Pericardiocentesis is draining the fluid from around the heart to relieve the pressure every couple of weeks. They did this procedure yesterday there is a definite upturn in his activity and energy level. He’s almost himself again.
If we followed option 3, Marcel would have 4-6 weeks to live. If we followed option 2, the timeline could be up to 3 months at most, with the “taps” increasing in frequency from every 2 weeks to almost daily. The vet shared a story of a patient who came in one morning and was back that evening. Option 1 may yield an average of 4-6 months to his life. There are some rare cases where a dog has lived up to a year. A further complication to the surgical option is that the tumor has already started to extend into his heart, which would not be able to be removed. Most dogs do not have a negative physical reaction to chemo, maybe a little nausea or vomiting, but it is, in general, an outpatient procedure.
The visit clarified in startling detail the seriousness of his health. We’ve been holding on to a grain of hope that there would be more options, that outcomes were better. A study published in 2005 “Survival time was significantly longer in the 8 dogs that received adjuvant chemotherapy (mean, 164 days; median, 175 days) than in the 15 dogs that did not receive chemotherapy (mean, 46 days; median, 42 days).” 164-175 days ≈ 5-6 months. Four years later, the outcomes aren’t much better. This is an aggressive cancer.
Our primary concern is his quality of life. If we pursued option 2 with the pericardiocentesis taps, the days leading up to the taps he would be out of breath, listless and uncomfortable. These days would slowly increase. The taps are done with a local anesthetic and are (relatively) painless.
After chest surgery the patient feels like they’ve been kicked in the chest, and he’d be at the vet’s for 2-4 days, then quiet at home for 1-2 weeks. The chemo used has a low incidence of discomfort, but 20% of dogs can’t take them, but there are other chem drugs available. Marcel is not a big enthusiast of the car, any car.
I’m not a big fan of pain (although am a fan of opioids), and can’t imagine subjecting another creature to the kind of distress that comes with chest surgery, especially if that patient can’t fully communicate how much pain they’re feeling. The most we could expect from this procedure is 6-9 months, that’s best-case scenario if the tumor were fully outside the heart. Since the tumor has started to extend into the heart and they wouldn’t be able to remove it, that increases the possibility that it won’t respond to treatment as readily, meaning cutting down his lifespan. It’s impossible to say. We need to decide immediately.
June 24th 2009 11:24 am
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Last week, while taking the dogs for their morning stroll, Marcel, being off lead as per usual, disappeared behind a hedge and scavenged something out of a bowl the neighbor had put out. After a stern scolding, we continued on our way. The next morning, he was a little slower than norm and had a fair bit of grass along the route, but nothing too unusual, as he’s always been prone to a sensitive stomach. The following day, I think we’re at Thursday here, during the morning walk, he just stopped and sat down. Sassy had been rather difficult that morning and I thought that he was responding to my scolding of Sassy because even during all previous stomach bouts, he’d not done that before.
Friday, he was still in a decline and off his feed, but having been used to previous episodes, this was still not terribly unusual. He got a short walk around the block and Sassy got her usual walk. Saturday, there was no improvement so we took him into the vet’s.
Obviously, with a history and presenting with stomach issues, that was the focus of the attention. Based upon the available evidence from the physical, x-ray and blood work, we made the initial conclusion that Marcel had eaten something bad, then eaten grass to either settle his stomach or throw up. The grass seemingly had created a mass in his intestines and potentially was infected. They prescribed him an antibiotic and sent him home.
Monday, we took him back to the vet for a 48-hour follow-up. He didn’t seem much any better. They took a second x-ray, which, I guess, looked different & better but not vastly improved, and there were some odd numbers on the blood work. They suggested he have an ultrasound Tuesday. The catheter was left in his leg in case we needed to take him into the emergency room that evening or he needed to have abdominal surgery the next day.
This is all scary stuff. The doctor was (gently) throwing out what she was seeing, and what the different options were. We were nervous, scared, surgery is a big deal, but it’s an abdominal procedure and generally easily recoverable.
Our next door neighbor had come over on Sunday with a couple of his buddies and they were throwing the ball for Sassy. Marcel played with them for a moment but immediately went back to bed. Nikko came over on Monday evening to check on Marcel and threw the ball for both of them, and Marcel chased it a few times, but called it quits and went to lay down. Sassy continued to chase the ball with Nikko.
Tuesday morning, Marcel was dropped off at the vet’s. A couple hours later I get a call. The radiologist wasn’t seeing anything of note in his abdomen, so they went further north and looked at his chest. Marcel has a tumor on his heart. I can’t even say it without tearing up. The doctor was talking to me, but I could barely understand half of what she was saying…an appointment with a specialist on Thursday…where’s San Leandro?...cardiologist, thoracic surgery, radiation, chemo. You can come pick him up at any time, he’s good to go home.
I called Nick, the situation is a little bit more serious than we initially anticipated. Are you able to extricate yourself from work this afternoon because I really need a second set of eyes & ears to take in the information the doctor’s sharing. I spent the next couple hours watering the garden, cleaning dishes, straightening the house…busy work that kept my mind off the matter at hand. I picked him up from BART and we went to the vet’s.
Marcel has initially been diagnosed with either “right atrial hemangiosarcoma” or “chemodectoma”. We have an appointment at a vet specialist group on Thursday to get more information.
On the drive home, Nick got a little glassy eyed, to which I said, ‘not in front of the child, we don’t want him to know how serious this is, please control your emotions.’ This brought us a good laugh.
Needless to say (but here I go), the last 24 hours I have spent feeling every emotion possible. My heart feels like it’s 100 pounds and too big for my chest, my eyes keep tearing up and there’s a lump in my throat. All kinds of thoughts are racing around, is Marcel comfortable, is he in pain, what’s too much attention/activity/food/liquid, what’s not enough, etc.
This morning after taking Nick to work, there he was at the door with Sassy, his tail up and prancing around like he always did, like he always does when I come in the door. We went for a short stroll up the street – the doctor said no exercise, he seemed perky enough to go out and it’s what he wanted. Even when he’s sick, Marcel doesn’t like using the garden to do his business, he’d rather go down the street, preferably another block. During the stroll, Marcel actually trotted for a house-length. He’s now asleep on the floor next to me. Whenever I get up for a Kleenex (okay TP, we’re out of lotion-soft Kleenex), he lifts his head.
We’re canceling our trip to Ohio for the family reunion in 2 weeks. All other activities are on hold until we get the news on Thursday. In the meantime, we’re going to have a lay down with the dogs.
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