Dec 28, 2010

Presence on the 25th

Okay, so I've become a bit of a knitting addict over the past year. It's true. This time of year, though provides a great reason to indulge in my addiction.

I made my mom this cute hat and scarf. The hat is from a pattern I bought, and I designed the scarf to match. My first cable project was a success. Yay! My mom loved them too. I still have to get pictures of her in them.
(Yes, I am posing funny. Good call. =P )

We all had a lovely time together on the Christmas. I am not religious, but it's wonderful to have a day to focus on gratitude for loved ones and to spend lots of quality time together. And since the 25th is already part of a tradition in that vein, I decided I'd go with it.

Plus, both from lack of funds and aversion to super-consumerism, our house managed to have a great balance of presents, goodies, and QT.

So, we had a few presents, some lovely lights, and made food all day. This chocolate candy cane cake (from Cook's Illustrated) is unbelievably moist, rich, and addictive. Thankfully, all the dairy and sugar hurts my belly if I eat more than a little. So, moderation wins this time!

We had a special house guest for the holidays too. Olivia, the (thank-the-lords potty trained!) persian. (I've had some bad uriney experiences with others of her breed.) She was a doll, and she learned to tolerate the kitteny advances of Hoshi pretty quickly.

I let Cas sleep in...okay, and myself. After all, I was up until 3am wrapping presents, though to be fair, I didn't start until 1-ish. Plus, most of that time was occupied with present - a Tartine bread book. (Aside: Tartine is the best bakery I've ever encountered. If you're in San Francisco, you MUST try it. Yes, you may spend some time in line. So worth it, though. We get bread from them every week. Yum!) I created a cute little carrying book cover using a Bi-Rite handle bag. (I bet you can't wait to see it unwrapped...)

I pretty much lost steam after that one, but luckily, there were only a couple more to wrap. A few for Cas and one for Hoshi, the kitty sis.

Cas sniffed out one of his gifts right away. Bully stick! Score!! (gross. I know, but he loves 'em.)

(The video's a bit long, but I know some of Cas's family wanna see every second. Really. It's not that I don't want to take the time to edit it. I don't know why you'd even think that. Ridiculous, really. Many people want to see all of this... Really. They will.)

Our dane meet-up group had a secret dane deer gift exchange, and Castor scored big time! A large, green box arrived a few days before Christmas, and we finally got to see what was filling it. OMG there were 1,000 toys inside. Cas's emotions ran the gambit - curiosity, excitement, boredom (as I struggled to detach all of them from the box), glee, and finally, overwhelm (see: right).

There were so many, after they were all freed up, he froze, eyes glazing over. Time for a break, it seemed.

So, I put them all away except for the fuzzy one that he just loves to nibble on. Nibble, nudge, nibble, nudge, ... ad nauseum.

Hoshi's turn! We got her a cute little brown mouse that makes chirpy noises every time you tap it. She was less curious than I'd expect from a cat, but eventually she wrestled a bit with her new, chirpy friend/foe.

A week later, after assuming that she must have lost it, she reunited herself with it as I was trying to sleep. It turns out it was hiding just behind the head of my bed... Did I mention that it chirps incessantly? (Just listen to the soundtrack of the Castor video above.)

Anyway, she doesn't leave it alone now...unless of course, we hide it from her. (Wah ha ha.)

On to people presents. Well, Rob got some yarn, sweetness note cards, and, as I mentioned, an awesomely packaged bread book. ;-)

I got some Addi turbo knitting needles (yay!), a Mary Oliver poetry book (ahh...), and a "curiously awesome" Koi toy. It's a fish that lights up when in water. Think of it as a plastic, fish-shaped, color-changing, floating candle-replacement for a curiously awesome bath time experience. (It is pretty awesome.)

After all the cheer, toys, goodies, and way, way too much Aimee Mann and Sinatra Christmas songs (yes, possible), we all veg'd a bit. We watched Angel on the couch with Cas.

Afterward, he retired to the floor cushions next to his bed. It seems he likes variety. Even if that means scrunching into a tiny ball to experience it. He has tried to curl up on our little 16x16 couch cushions before. No joke. What a goof.

I had such a beautiful time. Even without snow! I hope you all experienced oodles of warmth, laughter, and color too. ♥

The best part of this holiday has been reconnecting with loved ones from afar and spending time with those here, especially Cas. I have never been so continuously grateful to have him in my life. Every day. That's the one great thing that's come of his battle with cancer...You know, the thing he beat the S out of, the thing that is G-O-N-E...

Oh, how I love this boy!

Dec 14, 2010

The Fourth

At three weeks, I took Cas's blood again for All Pets to run a CBC. Assuming his numbers would be fine, I was not concerned with getting antibiotics from Davis ahead of time. The doctors had reduced his dose by 15%, after all.

I had to wait until Friday to get his CBC results, due to Thanksgiving.

Another drop off
It seems Cas is just really sensitive though, because his WBC was down again. This time, it was 770, even lower than the last time (when a dose reduced by 10% left him at 980). (Ugh.) So, I picked up a few days worth of Clavamox from All Pets* to get me through to weekend until I could speak with someone at Davis.

Monday, I spoke with Dr. Obrien at UC Davis about his numbers. She definitely wanted him on antibiotics; ideally he would have been on them since Wednesday or Thursday. I explained that he had been on them since Friday afternoon but that I they were about twice as expensive here. She said that since he'd been on them for a few days and his numbers were likely rebounding by now, I could discontinue them.

She also told me he was more anemic than before (i.e., his red blood cells were down too), so they would consider lowering his dose slightly more than last time. However, she also didn't want to lower it much, as a lower dose could affect efficacy.

Over the weekend, it started getting colder here. And drier. I assumed that's why Castor coughed periodically throughout Saturday night, but it worried me. To some extent, when treating cancer, I imagine anyone can get ensnared in the waiting game. Waiting for metastasis.

I wholeheartedly assume, stubbornly at times, that that will not happen to my boy. However, signs of even slight respiratory distress are not kind to me. Beyond that, he's more susceptible to infections while his WBC count is so low. That concerned me too.

He coughed a bit the following day, but by Sunday night he was back to normal. I told Dr. Obrien, but she didn't seem worried, especially after telling her how high his spirit and happy his attitude is.

It's quite amazing to me that he seems entirely unaffected by the chemotherapy, save the first evening, but on a cellular level, he's rather sensitive to it. Thankfully, it doesn't stop him from enjoying himself.

Obrien said we could take chest rads this week, if I wanted to, but she would be surprised to see anything after only 4 weeks. (The last set on November 4th was clear.) I told her I'd monitor him; she said to call her right away if anything worsened.

Thursday, December 2nd

Fortunately, Cas was back to normal. Nothing worsened. And we were back at Davis again.

A different drop off
This was a rather uneventful and short trip. We dropped him off and went to our mainstay of sustenance (veggie burger and garlic fries place). Shortly after getting to Mishka's for some work time, they called to say he was ready. It was very quick.

One thing I don't love about UC Davis so far, is that I feel, at times, that I'm inconveniencing the busy Docs. When I email Dr. Obrien questions, for instance, she answers them in a terse manner. While I prefer Dr. Cadille's responses though, Dr. Obrien does answer every question. I am confident that all the doctors and hospital technicians pay careful attention to his case and that he gets great care there.

When we picked up Cas, I asked to speak with Dr. Obrien. We chatted for a few minutes. After the team (that's awesome, btw!) discussed Castor's case, they decided to leave his dose alone. They didn't want the chemotherapy to become less effective. Rather than lower it, we would just put him on a prophylactic course of antibiotics at 3 weeks. This time, it's Baytril.

So, I can check his blood levels at 3 weeks again, but I don't have to. He'll be covered; we're assuming his WBC count will drop low again. And we'll continue, on course, in 4 more weeks.

Only two more to go!

They also listened to his lungs, per my request. She said they sound fine; he looks great. It's so wonderful to hear such good news. Castor is still doing extremely well! =)

He's such a goof too. Watch him telling the Big C to stay away:

*Note: After checking prices for Clavamox 375mg tablets at my old vet, also in SF, I was astonished by how much All Pets charged me. I knew Davis was ultra low, but two other hospitals in town, including SFVS, which is known to be pricey, charged $2.45 and $3.60 per pill. All Pets charged me $4.50 per pill! Outrageous, in my opinion. The "practice manager" said she'd look into the prices, at some point, but that right now, that was a "fair price." It is beyond me how that's a fair price for them, and another clinic about 5 miles away manages to sell the same meds from the same manufacturer at almost half the price. I called with a good attitude. I tried to be fair, explaining that I really love their clinic but was feeling rather upset about this price discrepancy between them and other local vets. I am not a happy customer now. Bad customer service. Bad manager. I never once felt that she was speaking from a service place, understanding place, or a friendly place. I felt like she was talking very carefully around the issue and not validating any of my feelings. Bad.

Dec 10, 2010

An apology goes a long way

I have an update for the Or Alternatively... ordeal. After a round or two of phone tag with me, Rob was able to connect with Dr. Fong on the phone two weeks ago. (Yeah, I'm behind.) Rob told him of a couple of our concerns, explaining our overall unsatisfactory experience at his consult.

Basically, he told him we felt uncomfortable asking questions after several of mine were left unanswered and that he seemed to not be present. His response?

It was as good as it could have been. First, he apologized that we didn't have a good experience. Then he spent some time going over a few examples that Rob gave, including the giving of treats to Castor. He asked if Castor was okay after the visit. (Fortunately, he was.)

Before getting off the phone, he offered to speak with someone at SFVS about getting us reimbursed for some of the consult. He also provided Rob with his email address, offering to answer our questions by email if that was more comfortable for us. He did both of these things without prompting, which deserves to be noted.

Though I'm told there was a bit of defensiveness at first (who wouldn't be?), Dr. Fong validated our feelings, apologized, and offered solutions for us. That is good customer service. I will still take Castor to the new alternative veterinarian in Pacifica for future acupuncture, mostly because I still don't feel entirely confident that I will be fully able to communicate my needs to him. I really appreciate Dr. Fong's response, nonetheless. (I received terrible customer service from my regular vet in SF the same week, which made me appreciate his even more. More on that later.)

Maybe he was just having an "off" day when we came in, and maybe not. Either way, I have no complaints about how we left things. Hopefully, I can get better information from him via email. I might as well try.

Nov 24, 2010

Seeing double

I received a beautiful email from a woman, Shelly, introducing herself and her boy, Solomon, to me about 2 months ago. She had been an avid viewer of Cas's videos, as she was preparing for her boy to have an amputation. Cancer strikes again! (grrr...)

Solomon is an adorable fawn dane too. He lost his rear left leg exactly one week after Castor. (awww...) We decided to organize a 2-dog Tripawd Great Dane Meetup. (woo hoo!)

Thursday, November 18th
At 10 years old, he's getting along fabulously. Castor was his perky, prancing self too. It's so great to form communities around our special (danes), and now, even special-er (tripawd danes), beloved dogs.

They didn't play much together. Solomon was a tad nervous in a new environment, and Cas can't leave his rope alone some days. Still, it was great for us moms to chat about our challenges, our joys, and our gratitude for these amazing pups.

We didn't get great video footage of them playing; we were too busy enjoying ourselves. (Totally worth it!) Still, Cas is always ready to be photographed, it seems.

Though Shelly and Solomon have had a difficult time, first getting misleading (or at least incomplete) information about Solomon's condition in April, things are looking up now. Solomon's condition was reassessed after they moved to California in August. The oncologist in Berkeley recommended amputation, something Shelly originally thought impossible.

The great news is that Solomon actually had a different type of bone cancer, chondrosarcoma, one that they think surgery will cure. They keep checking the lungs for lesions, but the outlook is good. Great, huh?! Go Solomon!

I showed Shelly a few things Jackie, the PT, showed me, including muscle massages and how to strengthen Cas's back leg with modified squats so as not to hurt his knee. While we were there, might as well take a rest.

After the fun, I watched Solomon while Shelly brought the car closer to the entrance of the park. He was so worried. So was I! I kept worrying he would bump his head or trip over things, pacing back and forth. I forgot he and Cas aren't exactly the same. Solomon sees everything just fine. =)

Cas and I look forward to many more play dates with this sweetheart, who is so damn lucky to have such a dedicated mom.

Of course, her and I are luckiest.

Nov 21, 2010

Three down, three to go

I got to vet tech it up again the week before Castor's 3rd chemo appointment. Since Cas hates going to the vet so much, I decided it'd be really good for him if I could take his blood at home for his CBC. My wonderful vet clinic said they'd send it to the lab for me. So, Cas was spared a fearful trip, and I got to brush up on my tech skills. (Fun! I know it may sound weird, but I miss it.)

It went great. Cas is one of the best patients ever. The results this time were better, but not good enough to be sans antibiotics. This time his WBC count was just below 1,000. Oh well, we put him on the gold-priced Clavamox again, and waited for Thursday. He is still not having any noticeable side-effects from his treatments. He is perky, hungry, happy, and pooping like a champ. (That's right!)

Thursday, November 4th

One of the very best things about our trips to Davis is cuddling up with Cas in the car. In Auntie Robyn's Element, we get to nap in back, but this time Cas managed to snuggle up while I drove my car. Adorable Boy!

Another four weeks, another dose of carboplatin, but this time, Cas was up for chest rads too. Though my mantra is positive thinking our way to victory over this disease, I couldn't keep my nerves on board. I was anxious this visit. Only a bit though.

His CBC was normal as expected, so they gave him another treatment. This time, to try to avoid the big leukocyte drop, the doctor lowered his dose by 15% of the original.

She explained that since he barely dropped below 1,000, he shouldn't need antibiotics again. His numbers should hold above that with this further decrease in chemo. Sounds good to me since Clavamox is ridiculously expensive. Plus, I could do without shoving my hand into Castor's mouth twice daily.

We left him with the professionals and went to work at our favorite Davis coffee shop, Mishka's. I waited to here the (pretty) assuredly good news. He was only there for a few hours, and the tech called me to come back.

"He's ready to go home."

I usually appreciate brevity, but settle down there tech. "How were his chest rads?"

"The doctor can talk to you about them when you get here."

Lameriffic (not to be confused with lamériffic). Okay, well off we go.

Cas came loping out to us, and the Doctor soon after. And his chest...looks...GREAT! No lesions!!! Sweetness to the millionth power. She explained that everything looks great; he's a great patient, and so on.

Before we left she asked if we had any pictures or videos we could give to the surgeons. Apparently, they are so impressed with how well he gets around, because of his size (and eyesight, I imagine), that they want to have something to show other clients. That was the second best thing I'd heard all day.

Four more weeks until our next visit, and we'll check his lungs again at the 6th treatment, assuming all goes well until then.
I took Cas home, let him sleep it off. He is like a lump of bricks the night of chemo. He dreams like crazy, and I let him have 90% of my bed.

Despite his fatigue, he always eats dinner and always plays like a goof the next day.

I love this boy!

Nov 10, 2010

Or alternatively...

As I've said, I want to do anything and everything that will help Castor fight off the rest of this disease (which, let's face it, is probably gone already ;-) ) and be as happy as he always has been. After such praise from Jackie, the PT, and urging from my mom, I decided to make an appointment with an alternative medicine vet.

My friend, Mike, took his dog to one in San Francisco to treat her lymphoma. He had no complaints. Granted, his memory of this time and of her treatments is fuzzy to the point of nada. Anyway, with two recommendations, I chose to see Dr. Fong at San Francisco Veterinary Specialists.

Tuesday, October 19th

Oh where, oh where has my doctor gone?
I did not want to deal with another vet hospital visit almost as much as Cas didn't want to go. However, we must investigate all options. I definitely want to try acupuncture. As this was Castor's first visit, I was warned ahead about the initial $166 consult with Dr. Fong. (Ugh, but ok.)

We arrived on time to the building and were given a garage door opener to find park in a spot in their garage. However, we drove through the garage only to see that all the spots were full. So, I had to drop Cas off, and then go find parking. It took a while.

Once we were in the clinic, they took us to a large set of carpeted stairs, asking, "Is he okay to walk up the stairs." "No," I said without hesitating.

No problem, though. They had a mechanical lift contraption for taking heavy boxes and heavy doggies up the stairs. It was so incredibly slow though. I mean, I took a stair every 10 seconds as I stood next to the lift holding Cas.

It was pretty amusing, but also made us even later getting into Dr. Fong's exam room. He made some comment, under his breath, "We're starting about 30 minutes late, but..." and trailed off. Not a great first impression, though I understand his frustration.

I'm not sure what one expects from a $166 consult. I'll tell you that I've had two $150 consults for Castor in the past 3 months. They were each at least three times as illuminating as this one. For a quick recap, skim the following, else read it in full.

He started by informing me that how well they do and how long they make it depends on how strong their will to live is. That is usually related to how strong their connection with their owner is. He observantly noticed, "He seems to have a fairly strong will to live now."

Um. What could I say? How about, "well, duh?" (Yes, you're picking up on sarcasm. I do do that occasionally.) I appreciate that perhaps Fong sees many dogs that are doing really poorly. For instance, Mike's dog had advanced lymphoma. She was in bad shape when he saw her, and the disease moves aggressively. However, one must be able to adjust to the patient at hand. It felt rather inappropriate for him to even bring this up. It felt like he was not very present.

One of the first questions he asked was, "Does he have diarrhea?"

"Now?," I ask.

"Ever," he replies. I explain that he doesn't now, but he's very sensitive to food. If, for instance, someone sneaks him a treat, he may have bad diarrhea for a few days. To further support my thesis that Fong was not there with us, about 20 minutes later, he gives Castor a treat. Then another. And one more before we've left. (Seriously?!)

Now, either he was not even listening to me, just going through the motions, or he was testing my theory that treats give Cas the big D. You can decide for yourselves.

In fact, that was a theme throughout this visit. It amazes me, because I associate alternative medicine with energy work and mindfulness. Though he mouthed related concepts, it never felt like more than lip service.

So cooooold
He explained that in Chinese medicine one tries to find a balance between warm and cool in the body. Typically, we (animals included) either run hot or cold. For Castor then, we want to choose foods, which are classified as heating or cooling, that will help bring him into balance. He explained that some dogs always bury themselves under the covers or sleep curled up. Alternatively, dogs may lay flat out, avoiding cover. Those could be symptoms of a dog being cold or over heated, respectively.

Then he asks, "So, what do you think Castor is? Hot or cold?" Don't even get me started on how subjective and wishy-washy that question is. Seriously. But then I'm supposed to decide. I figured he would have some way of contributing to this assessment, and I have a reason for that thought.

When I moved from Santa Barbara, I decided to finally go see this Chinese medicine doctor in Los Angeles that my friend had been urging me to see. He had testicular cancer years before, and was convinced of the powerful effects of his care, including herbs and acupuncture. I had a visit on my way out of California. I don't remember much of it, but I do remember his diagnosis. He sat in a chair next to me, examining my forearm and running his hand over my back, sans touching. He kept saying, "so cold. So cold. Like ice water."

"I am always cold," I thought. I believed it. Somewhat anyway.

Well, I didn't continue on that path for myself, but here I am with Dr. Fong. Less impressed. I guessed he might be on the hot side. So, he proceeded to explain which foods are cooling, said he'd send me home with a list.

I wanted to get his opinion of the food I currently feed Castor - 1/2 Innova (adult), 1/2 Canine Caviar (split pea & venison). I have asked both Dr. Cadile and Dr. Obrien for their opinions. Dr. Cadile especially, gave me thoughtful feedback on the ingredients. (Innova is a great food* and the ingredients in the other sound wonderful, though they don't offer much in the way of carbohydrates.)

And Dr. Fong's response? He reiterated that he wouldn't change his entire diet, just supplement it with some of the cooling foods, for which he would give me a handout with recipes. Upon looking at the ingredient list for Caviar, he just said that we didn't want Omega 9's but Omega 3's were good. The only other thing he said was venison and chicken were both warming proteins.

Given that food is a big component of his counsel, I am underwhelmed with such base responses. More of that to come...

Eventually, after a lot of thought and deliberation with Rob, we think Castor's pretty balanced. Maybe he can be slighter warm, but nothing too obvious. Sometimes he curls into a ball. Other times, he lays flat out. He pants, but he also lays in the sun. Being 130 pounds, he certainly doesn't burrow under the covers, so that diagnostic tool was out from the get go.

For the time being, I will not be changing his diet.* I may get another opinion, and I will look into it further. I am still curious. Until I have time for more research though, he can be warmed with venison. It's winter time, anyway.

Do you have any more questions that I can avoid answering?
Perhaps some of you have noticed that I like to soak up all possible information from veterinary professionals. Also, I do not like to be spoken to like I can't understand complicated conditions or concepts. I value open and fruitful communication with people, especially those I pay to help Castor.

Let me give you some highlights of this type of exchange not in action. (Of course, I am paraphrasing, but I have a pretty awesome memory.)

Dr. Fong explained to me that we want to support the entire body, but in particular, the kidneys, because they support the bones. Since he had bone cancer, we need to provide extra support to that system. I wondered, as I am like to do, if there was extra support to provide to the lungs, since that's the most likely place of metastisis. I asked:

Q: Are there areas or organs that support the lungs or respiratory system? And do we provide extra support there, via acupressure, acupuncture or supplements, to decrease chance of metastisis in his lungs?

A: (A pause and what may be a teeny weeny chuckle followed by...) Well, the lungs actually support the skin. In Chinese medicine certain organs support specific organs, and the kidneys support the bones. ...

You get the idea. An iteration. Nothing new, i.e., no answer.

He mentioned several times our object being to support his immune system during his time with chemo, because the body needs extra support. I felt a contradiction there, so I asked:

Q: The oncologists have warned me not to use antioxidants much or at all to avoid interfering with the chemotherapy. After all, the goal is to break down the cells, to suppress the immune system. How does that fit in with the type of support you are suggesting?

A: He acknowledged that common concern. He said, however, that we must still support his body. He used the analogy of a brick house. If you take a few bricks out, it's okay. But if you continue taking them out, one at a time, eventually the house topples. We want to avoid that destruction, so we must put bricks back even while the oncologists knock some down.

Fine, but that is not an answer to my question. I asked and followed up with more very specific medical questions. Were his antioxidants targeting different kinds of cells? The Carboplatin targets fast-growing cells (e.g., cancer and those in the intestinal track). Do his supplements target certain cells or systems? What are they doing?

And there were a few more that unfolded similarly. He did not answer many of my questions. Honestly, I don't know why.

At a few points during our consult, Dr. Fong paused, saying, "Do you have any questions about anything?"

And each time, I thought, "Um. Yeah. Could you answer one of the several I've already asked."

I was seriously stumped. I felt incapable of asking any more questions. I felt inhibited. I felt disconnected.

Let's not ignore the big dog in the room
Though the doc met Cas at the bottom of the stairs, I still found it odd that he didn't come over to him when we came into the room. Every vet I've ever been to has come over and greeted Cas. In fact, they usually smile and say how great he is, or something similar.

Dr. Fong didn't interact with him at all until he came over for the "exam." The quotes are to indicate that what followed barely qualifies for that label. He looked at his gums and tongue, commenting on their color. It was pretty healthy, though a tad on the purple side (a sign of heat, I think). I don't think he listened to his heart or lungs or did any other typical checks.He looked over Castor's structure a bit and asked how he got along on 3. He gently pressed his thumbs down along side Castor's spine, testing his muscles for pain. I requested he give Castor acupuncture treatment. Thinking Cas seemed slightly painful in his lower lumbar region, he put a needle in that area, and he put others in various places.

He did provide me with some information on acupuncture. It's done to remove blockages in energy. In Chinese medicine, the (or perhaps one?) goal is to help the body's energy flow freely. The problems we have, including Cancer, are caused by blockages in this flow. I assume increasing obstructed energy flow is what lifts their energy post-acupuncture.

I mentioned acupressure points when he was casually (bordering on carelessly) placing the needles. He said something to the effect of yes, there are some points in the feet that can help with pain. He didn't show me any. Ever.

I felt like there was absolutely zero interaction going on between Dr. Fong and I. The only time I felt warmth from him was when he joked with Rob and I about something un-vet related. I believe it was a gender stereotype joke about how I was the boss in the house. [Wink. Nudge.] (Can you imagine how amused I am by those?)

He did seem like a nice-ish person, but only when he was present. Maybe he was having a bad day. I don't know.

As I've said before (see: last paragraph), one MUST feel empowered to ask questions. One must continue to ask, until they understand. I did not feel that with Fong. That means, he cannot be our vet. It's unacceptable, regardless of who is to blame.

That will be $10,000 for the herbs and analogies, please.
(I exaggerate, but still.) Everything is expensive in San Francisco. True story. Still, I fell ill from shock at the price tag on our underwhelming visit to SFVS.


As I mentioned, the consult was $166. The acupuncture was $100. The rest was three herbs he told me to start Castor on, one for immune support and two fighting cancer. I wanted to try them, for obvious reasons, like "why not?" It would have been nice to get an estimate, as every other vet has given me in the past, especially when things may be prohibitively expensive. Oh well, at least now I know.

Two supplements for cancer were Artemisinin and Chih-Ko and Curcuma, and Immugen was for immune support. Artemisinin is used to treat Malaria, and Dr. Cadile told me it was a very promising area of research for canine cancer. Unfortunately, she tells me, there has not been a clinical trial completed yet. (I have to say that Dr. Cadile has been incredibly helpful, warm, and always ready to respond to my inquiries. All that despite the fact that I will probably never spend another cent at the hospital where she works. At least not on Castor. I wholeheartedly recommend her!)

At Castor's dose, the Artemisinin was about $80 for a 10 day supply. That's at the $73/bottle price SFVS charges. Online, through the company's website, the same bottle of Artemin100 is $42.50. (Currently, they have a special for buy 3, get 1 free too.) So, SFVS is marking up by almost 100%. Ridiculous.

I may use it. I may not. But I will definitely order it myself online.

The Chih-Ko and Curcuma is a Chinese herbal cocktail used to treat cancer. I don't know anything else, beyond Dr. Fong's prescription. I'll keep asking and looking for more information. Honestly, I can't remember what he said about it. Something, but not much.

Finally, Immugen by Thorne is an immune support supplement. I've said enough about this above. The jury's still out on whether it's a good idea or not to give this in conjunction with chemotherapy.

After discovering all of this, I returned the supplements to SFVS. So, I only spent $266 there in the end. And too much time. The acupuncture was worth the fee.

As for the rest, I plan to call Dr. Fong (and/or the owner of SFVS) to discuss my experience. I plan to ask for some or all of my money back for the consult unless he has a reason for his absenteeism and offers to further explain things that need explaining.

I will update on responses, if I get any. As it stands, I wholeheartedly discourage you from taking your pet to Dr. Fong. As for SFVS, they are incredibly expensive. Even for San Fran? I don't have anything to compare it with at the moment.

Please, try again

I want to make clear that I do not think my experience with Dr. Fong is indicative of alternative medicine doctors, including veterinarians. It was unfortunate to have a stereotypical encounter. But that's all it was. One encounter. There will be more, and I look forward to them being much more fruitful, especially in comparison to the alternative.

Saturday, October 30th

Go Sanity!
About a week after our less than good visit, Jon Stewart and Stephen Colbert hosted the Rally to Restore Sanity and/or Fear. Rob and I took Cas to play with Scarlet and Mike pre-satellite rally in SF.

He played a ton, just like when he was on four. It was such a great day. Warmed by Castor's play, inspired by laughs and sane speak (Thank you Jon, Stephen et al.), I'm ready to enjoy another week.

In the spirit of sanity, I will say that everybody has bad days, even veterinarians, one assumes. I imagine some people have enjoyed their visits with Dr. Fong and felt in good hands. I didn't. Is he the worst vet? I highly doubt it. In fact, I worked for a insanely unethical veterinarian in Santa Barbara, CA, who could be in the running for that distinction. He lied to clients, didn't follow sterility procedures, and emotionally abused his staff regularly. (If you're in SB, feel free to email me to make sure you don't see him.)

In contrast and based on first impressions, I'm sure Dr. Fong actually cares about his patients. Still, our visit to SFVS was not up to my standards.

The most important thing is to know what you want, and don't settle for less.

*Though Innova has been a great food, as I mentioned before, I do plan to stop buying it. Their company was purchased by Proctor & Gamble, a company that experiments, unnecessarily, on animals. I am not against all animal testing, flat-out, at the moment, but I am against dumping Tide detergent or nail polish into bunnies eyes. Or whatever similar cosmetic testing goes on there. NOT okay! I don't care how great the food is; I can find as good or better sans the barbarity. Grrrr, P&G...So, while P&G is not Hitler, it does suck!

Nov 1, 2010

A little massage with his chemo

I know, I know. It's been a while since my last post. I know life just isn't the same without my (potentially lengthy) stories about Castor, but it's been one of those 3 weeks that is busy busy. I try to keep the actual dates posted before the stories though. (You're welcome. =P )

**OH, and I'll add pics and video to this later today.

Thursday, October 7th

And then, we were off to Davis again...weee!

To be honest, I don't mind our excursions. It's a whole day to be with the boy, to work casually from a cafe I don't spend enough time in to be sick of, and I get to take naps on the way home with Cas in Dabs's backseat.

Too bad Robyn has school this week. No napping for me, but Castor's getting what he needs. Plus, there's garlic fries waiting for me!

20 questions for the PT

We went first to Oncology to have a CBC done. This time, as expected, his levels were back to normal. After the blood test, we waited for our physical therapy appointment. He would have chemo administered afterward.

Jackie Woelz, the physical therapist, is very warm and very accessible. Every person I mentioned his physical therapy appointment to at Davis immediately replied, "Oh. Jackie's so great, isn't she?!" Indeed, she is.

We talked about his situation and our typical routines - diet, exercise, home set-up - for a long time before she assessed Castor. She let us stay in the courtyard just outside of her building the entire time. Castor loved that. He soaked up the sun while we chatted.

She started with one simple question. "What do you want to get from this visit or from physical therapy?"

I want to do whatever I can to help Castor stay as healthy as possible in his 3-legged body. For this visit, that means I want to figure out any exercises and stretching I can do to keep him flexible, strong, and sans pain. I mentioned that I wanted to be shown stretches to do for him each day to keep the range of motion in his joints ranging on.

I had a lot of questions for her. Like:
  • What stretches should I do?
  • Are the stairs okay to do as we have been?
  • Should he have acupuncture?
  • What about chiropractic adjustments?
  • How long should I take him out to play and exercise?
  • Isn't he cute in his, i mean, is this a good harness for lifting and assisting him?
  • How do I know if he's too tired?
  • How much should I limit his activity, if at all?
  • Anything else I should know? (This is a good question in general. After all, they're the experts.)
I have the, perhaps annoying, tendency to cut vet professionals off a bit. It's just a consequence of my preparedness and research combined with my itty bitty amount of patience. They seem forgiving.

So, after minimal prompting I explained that yes, I had covered all of our slippery surfaces in the house. Yes, I raised his food and water. Yes, I had cut back and altered our pre-amp play time and walks.

Namely, no more urban hikes up and down the hills of our concrete neighborhood. We also don't typically hang out at the dog park for an hour. Most days, we go out to a grassy park in the morning for 30 minutes and in the afternoon/early evening for another 20-30 minutes. She was very pleased. Grassy ground? Check. More frequent, shorter trips out? Check.

It's not good for Cas now, as it wasn't as a giant breed puppy, to go out for "warrior weekends." He needs regular, moderate activity. And that's what he gets.

There is one sign to show me when his body's tired. She said to pay attention to the turnout in his rear leg. When his quad muscle is feeling fatigue, he may turn his paw out for support. That action locks his knee, which prevents his leg from buckling. However, it's dangerous for his knee. When that starts happening, it's time to go!

And getting out of the house? Fortunately, I had video on my phone to show her our trip down the stairs at home. I explained that though it sucked to have stairs at all, we were trying to minimize the impact on his joints and avoid and falling accidents by using both his Ruff Wear and Walk About harnesses.

She thought his trip down the stairs was great. (YAY!) She said it was really good that he dropped his head down so low, which would help keep him balanced and take weight out of his rear leg. It's really a result of his extremely poor vision. (Does he see at all now? I do not know. Not much, if any.)

She was familiar with and said the Ruff Wear harness was great, with one caveat. She didn't like the under part. Especially with a dog Castor's size, the slender straps that for the underside of the harness are not very supportive. I have worried that they dig into his (massive) chest. He sometimes makes an airy, grunty sound when we catch him as he hops out of the car, like the wind's being knocked out of him.

The other Ruff Wear model, the double back, has a full size underside, in the shape of the top. She recommended that, if possible, noticing however, that it is a bit heavier. She showed us one, and it's much heavier duty. I may invest in one, or she suggested I try altering his harness by attaching some heavy fabric to the bottom straps. A good excuse to practice sewing? Perhaps.

Walk, Stay, Sit, Lie
After all of the talking, Castor was ready for a rubdown. But first... We had him stand and walk to show Jackie how he do. She said he looked great!

He has great extension in his rear leg as he walk/hops. She examined his spine and said it was minimally curving with his new structure. It barely curves at the end to accommodate his new tripod posture. Upon running her thumbs down along his spine, she also didn't think he was in any notable pain.

She seemed very impressed with and happy about his physique and movement.

I explained that I was re-teaching him to do down dog (adho mukha svanasana). Thankfully, I taught him that last summer. I thought it'd be great for his shoulder movement. She agreed, though only because I explained that Rob supported his rear with the WalkAbout harness during his attempts. Cas is getting it; he can do almost anything for a carrot!

I also mentioned squats. Should I be having him sit and stand and sit and stand and... to build up his rear leg muscles. She was not keen on this idea. It's hard on his knee and his joints. She gave me a modified exercise though. Positioned behind Castor, she bent her knee on the ground under him. She had him sit on her thigh, which is halfway to the ground. Then stand. It's like people sitting down into a chair during physical therapy. Much better.

Massage me already!
Finally, (says Cas) we got him on his side. (Another command my smart boy knows ;-) ) I explained the stretching book I'd read along with some of the exercises. She was not familiar with it, but did recommend the book "Four Paws, Five Directions," for a guide on acupressure points. (HaHa! My mom's been suggesting that for more than a year now.)

To make a long story less long, she is more a fan of massaging than stretching dogs (and one would assume, cats, ferrets, and horses too). When she tried to, for instance, extend Castor's front leg (shoulder extension), he resisted her, big time. And my boy's strong!

Basically, if your animal patient resists, you can really hurt them. If I work on Cas for a while, just rubbing his muscles deeply, he relaxes a lot. Then I can usually stretch him for a while. She said the massaging part was plenty to keep his muscles supple and long.

So, I will not be stretching him, unless he asks for it. Instead, I'll be requesting a few down dogs after we get back in the house and his muscles are warm. Then at least once daily, I'll give him a good rubdown.

The most important muscles to keep supple are his triceps, trapeziuses, and his rear leg muscles. She also said I could gently to moderately draw my fingers or thumbs down along either side of his spine. NEVER on his spine.

And What Else?

She wholeheartedly recommended acupuncture. She has many clients who receive acupuncture and have had tremendous success with keeping up their energy, for example. She says she can guess by seeing them if they've just had a treatment or are in need of another.

She gave me the names of two people her clients have used for acupuncture, one in SF and one in Berkeley. There is someone who does home visits near Davis too, but that's not so pertinent to us. I will make an appointment with the SF doctor next week.

As above, she suggesting hitting acupressure points too. I was referred to the book mentioned above for that.

Castor and I get A+'s
Other than that, keep it up! That was her recommendation. He looks GREAT! I'm doing great! Everything is great! We will see her if and when he needs more help.

She said, "you both get A plusses." It was partly for assessment, and partly encouragement. Sweetness. I haven't had one of those since I started grad school.

FANTASTIC. We couldn't be more pleased. And grateful.

And just when he thought it was over...
And as if to reinforce Castor's love of Jackie, we took him to see the poking, prodding docs in the other building again. =\ We dropped him off for his chemo treatment.

We left for lunch. Fries! Yum.

We came back about an hour later. Thankfully, they were quick and on top of things.

He was given 90% of his initial dose. Hopefully, his WBC count would stay above 1,000 this time. I would have another CBC done in 3 weeks this time around. And they would see us next time.

Everyone says he looks great. Well, yeah he does. My little 3-legged rock star!

Oct 22, 2010

Playing with his kind

Saturday, October 2nd

We went to our first Bay Area Great Dane meet-up since Cas's surgery
the weekend after our non-chemo Davis trip. This was a joint meetup with the Sacramento group, so there were about 30 danes there! Cas was reunited with some of his Dane friends. Sweetness.

It was quite a trek for him to get up over the hill to the Dane's spot at Point Isabel, but he did it happily. He played a bit, stood a lot, and reveled in all the attention. It was a big workout for him, but he did great!

And we both (okay so me more than him) got to nap it off on the drive home.

I made him sit for a break in the middle. That way he could rest and I could make weird faces. Can you find the bed head in this picture? =P

He is gaining confidence every day, though he is a bit nervous when dogs are running fast near him. Last week on our morning park trip, two huskies were running around in huge circles when Cas decided to make his way toward me in the center of the park. Well, they ran right behind him, FAST, and Zoe ran right into his nub. (Zoe is an adorable husky who I can't help but think of as Hoshi in a Husky suit. Hoshi is my sweet grey kitty.)

He started yelping and crying and looking back at his hip. It was horrible. Absolutely horrible. I ran over and put his bum on my lap to take all the weight out of his back leg. He kept crying. About a minute later he was hopping tentatively around again.

He was fine. I think he was more scared than anything. He's still a tad trepidatious when dogs run crazy-style around him. Understandably so.

He has resumed his marking all over the park again, so I know that he's feeling like the big dog around here again. Just watch him show this stick who's boss.

Oct 14, 2010

Castor almost has seconds

Thursday, September 30th

No second chemo yet
I took Castor for a blood test two weeks post-chemo to check on his white blood cell (WBC) count. The oncologists have to monitor the levels to make sure they don't drop too low. The normal range for a WBC count in the dog is around 6,000 to 17,000 leukocytes (a blood component by any other name would smell as ...well...bloody?) per microliter.

At Davis, they will not administer chemo drugs if the WBC count is below 2,000. If it's below 1,000, they put the animal on an antibiotic course to safeguard against any infections that might arise, given their low immunity.

Castor's CBC (complete blood count) was normal at the two week mark, so we went to Davis on the 30th for his second chemo treatment. Again, he was to get treatments every three weeks for a total of six treatments.

Rob, Robyn, and I dropped him off and ventured into the six-block area of downtown Davis to find sustenance. The plan was for the hospital to run a CBC prior to treatment, treat, and go home. It takes a couple to a few hours each time.

It was on the short side of that when a tech called to let me know Cas was done. Almost rhetorically, I asked, "so everything went fine?"

"No, we couldn't treat him today," he says.

"Ha ha," I thought. I do like smart asses, so I just chuckled. Just to make sure though, "are you kidding?"

"No, really. His white blood cells were too low to treat him today."

My heart sped up, and suddenly my fancy for garlicy fries vanished. (Poof!) And though I waited patiently for further explanation, the line was mute. It turns out he needed an invitation to provide further details. Odd.

After failing to be reassured Cas was alright, I decided to just speak with someone (else, preferably) in person. We finished eating in about 2 minutes and left for the hospital.

After speaking with someone (else - yay!) when I picked Cas up, I felt better. Apparently, some pets' counts dip down again around the three week mark. The tech explained that his body can uptake the chemo again from his kidneys as it's being processed causing that second dip in the numbers.

His WBC count was about 700, so they sent us home with Clavamox...again. =\ It doesn't seem to be worryingly abnormal. It just means he'll have to be on a once-every-four-weeks schedule. We would have to go for another visit next week.

Fortunately, we already had an appointment with the physical therapist the following Thursday. Unfortunately, Cas would have rather not visited with the oncology staff again. Oh, well. We've already agreed to roll with the punches, to expect the unexpected.

On the bright side, we learned more about chemotherapy and what to expect from Castor. I was also reminded of the power of support and solidarity.

Being there, wherever there is
In the waiting room, we met a couple with a beautiful mastiff, just diagnosed with Cancer. He had a seriously large tumor on his spleen. ("I've never seen a tumor that big with a dog still up and about," said the vet, clearly oblivious to the impact of her unnecessary candor.) Talking to them took me briefly back to the first day I found out about Castor's tumor.

I was grateful to be in a less hysterical, more familiar place. I found a place of acceptance, which allowed me to find a path of care and treatment. The optimism with which I managed to imbue Castor's and my path has made all the difference.

Still gently wafting his head in disbelief, the mastiff's friend said, "it's just not fair," after I told him why Castor was at the hospital. I could only smile and say, "it's so great that we get to help them through it though." Of course, despite my sincere gratitude, I could hardly keep my tears in their tear duct home.

Then, I decided to let them roll on down. There's nothing wrong with expressing these emotions. It's not about defeat or grief. It's all about love.

It was good to feel my love, feel their love, and share our burdens, if even for a few minutes. As Cas hopped out to me, wholly excited, full of love, and dragging the tech behind him, they both said, "that's the prettiest dane I've ever seen."

My thoughts and prayers are with them all. ♥

Sep 21, 2010

Fade to color

I haven't been that inspired to write about Castor's and my experiences lately. It seems that this ordeal has faded into the background quite a bit. A good thing, for sure. Still, I don't want to get complacent and stop being grateful for time with my boy. Hasn't happened yet.

The fact is that Castor's mostly adjusted to tripawd life. And me to it. Now, it's time for me to readjust to my life. Certainly, that entails spending lots of time at home with him; fortunately, I work from home 90% of the time. However, I also have begun to leave the house more regularly to work nearby.

Many say to me that Castor's lucky to have me, that I'm doing everything I can for him. I believe that and appreciate the thoughts. I know that I have handled these transitions really well. My veterinary background, including our friends still in the business of saving animals, my fortunate work situation, and my immense support system are to thank.

I started worrying that I was also tapping into my survival instincts of long-ago. You know those people who "thrive" in crazy, stressful situations? Children who grow up in alcoholic homes can become unfeeling, controlling perfectionists who seem to have unimaginable situations under control, when really they are just sweeping the floor to spite the people shitting in the house. Or something like that. I don't think that's what I'm doing now though.

I am not in denial. And certainly, I've been feeling a lot. Am I a bit controlling? Well, honestly, yes. Especially with regards the boy. (And how to brew tea, how to clean the bathroom, where to keep the blankets, ... Yep, there's lots to let go still!) However, progress has been made. Lots of it.

This time around, I seem to be not losing it or clinging to it, but rather focusing more deeply, with an almost intuitive sense for how to navigate the chaos. Now, I am staying present for the ups and the downs.

Speaking of vertical movements
The stairs are an obstacle best overcome by two people. With Rob's help, Castor travels up and down our stairs with ease. Rob's shoulder on the other hand...Well, Castor takes the last four steps in one big leap. I'm working on changing that, but he doesn't seem to understand. Hitting bottom probably never felt so soft.

Here's us taking him up and down. It might not be too clear, but sometimes he's just pawing at the ground. Usually I use the Walkabout rather than just carrying his rear.

We're casually looking for a new place to live sans stairs; however, most places are not nearly as fabulous, small, crappy, more expensive, in less desirable areas, or most commonly, still have stairs. Also, we love our landlord, Dr. Color.

The only real problem currently is that it requires two people, one strong enough to carry most of Cas's weight. He seems to carry 80-95% of his weight in his front legs now, especially going down stairs. He attempted a handstand the other day, floating his back leg of the stair for a couple of seconds. That's my little yoga doggie (Dogi??).

Getting the house in order
We have finished making the house tripawd friendly. They tend to slip a bit more than on four paws, so we had to sufficiently cover the hardwood floors. I discovered a new use for yoga mats. We bought a couple to place over random slippery floors. Bonus: walking on cushy yoga mats feels awesome too.

I also found a cheap-ish way to raise his food and water bowls. I bought two seven-gallon buckets, and Rob cut big holes in the lids to hold stainless steel bowls. The bowls fit snugly, and although the buckets are not so attractive, that will soon be fixed too. I found a pleasing fabric to place over them. I just have to sew them up a bit. Sweetness.

I still want to buy him these ridiculous(ly cute?) socks for wearing in the house, but I've thus far resisted the sweet, consumptiony urges emanating from deep within my bowels. Useful? Probably. Needed? Not really. My mom did get him some Ruff Wear booties though, for outdoor trips.

I have just begun to let Cas stay home alone too. Sure, for only an hour or less, but I'm easing into it. The I only time I left him alone, for an hour, after we were back in San Francisco, he licked his suture enough to cause that tiny infection. Since his suture is healed and no infection lingers, it's safe now. (Go Clavamox!)

Why so somber?
I'm used to Castor being remarkable for his beauty and sweetness, but not for what he's lacking. I completely forget that seeing a dog hopping around, missing a leg, especially one as big as Castor, is arresting. Then someone at the park puts on their pouty face and asks, "Aw. What happened?" That's actually not so common, thankfully.

I welcome people's reactions and questions. I would much rather talk to people about such things. Awkwardness, discomfort, and pain often come from silence. (Another lesson from my adventures in childhood.) Fortunately, most people are willing to ask questions and many don't seem altogether unfamiliar with tripawds.

Still, it's a tad jarring when people seem sad about his new architecture. To me, he's Castor. He's not different at all. Certainly not diminished in any way. Clearly, things about him are different, but I don't even think of him as having had four legs. Difficult to explain, I guess. (Or I'm just failing at an easy task? Either way.)

Do you ever feel a sense of loss when thinking about the times you didn't have hair under your arms? Maybe it's like that. You don't even think about it, right? I really don't mind shaving.

Perhaps that's a weird analogy. Be that as it may, the only "Aw, I really miss ..." moments I've had have been thinking of our hour long walks up the hilly neighborhood. No biggie.

Speaking of hair, Castor's hair is growing back. (Like that transition?)

I must say I adore his little nub. Before if I ever wanted to stop Castor in his tracks, I would just rub his inner thigh. He would stop immediately. He loves it. Now, if I rub the inside of his left hip, he lifts his little nub out. It's adorable!

So there you have it. Castor can do no wrong in my eyes. That's unconditional love.

Partner yoga
I've started Castor's stretching and strengthening routines. I'm still figuring out the details, and we're starting off slowly. After we go out for a short but exhausting walk/run in the afternoon, I have him do two to three squats, i.e., have him sit and stand. I have Rob hold his walkabout harness to help ease his rear's descent, if need be. He's doing great. I reward him with carrots, of course.

After that, I have him lay down on his left side, so I can start by stretching his right rear leg. I am reading The Healthy Way to Stretch Your Dog, a book about...well, can you guess? Since it's important to stretch when the muscles are warm, I want to work the back hip first.

From there, I stretch his right shoulder and elbow. The I get him to flip over. (That's the hardest part!) It's not a great to flip Danes over their backs, so I have him sit up to change sides. Anyway, he's so good about it all. I'll put up some videos of specific stretches once we've seen the physical therapist at Davis. Then I'll know I'm not screwing it up. =)

After our first session, he got super playful. Enjoy this cuteness!

Go get 'em!
Oh, yeah. Cas is back to playing. He fell once and almost a few times, but he's getting it. He's running after dogs, running after Rob, and tossing sticks around. So cute.

The most popular comment pre-amp was, "you got a saddle for that thing?" (Nope, you aren't the first one to think of that. ha!) The number one comment now is, "it's only been three weeks?!" If you are facing the amputation question, it has been my experience that they figure it out. These creatures are so unbelievably resilient. You will be amazed. Certainly, if your loved one faces other challenges - arthritis, other compromised limbs, etc. - then it might not be so easy, but Castor's near blind and totally rocking it on three!

He's been feeling so good for the past week and a half. The chemotherapy didn't cause any side effects that I noticed. The night after he seemed a bit uneasy. I thought he might be nauseated. No diarrhea, no vomiting, and no missing meals though. By day four, the Carboplatin should be out of his system too.

For the first three to four days we had to be careful with his urine, i.e., avoid getting on our skin. The problem with that is whatever gets on his skin will inevitably get on mine. (He sleeps in my bed.) So, I had to try to keep it off him. The problem with that? He pees on cement at least once daily, and it splatters like crazy.

You should have seen me trying to get a pee pad under him outside. I followed him around in circles, hunched over, pee pad in hands. Just as he'd start to squat, I'd toss the pad down, he'd hear it, look back at me with indignation and start walking around again. It took about four times on average.

Too bad for you, there's no video - maybe next round. It was hilarious.

We were all happy to leave day four behind us. Without any notable problems with the chemo, he can continue getting the same dose, and we can keep kicking the S out of this cancer. Yay!

His next treatment will be September 30th.

(He snuggles with me in the car too! ♥)

Sep 15, 2010

Time for some therapy

Days 14 and 17, mostly - Sept 6th, 9th and beyond

Staple remover, stat.
Okay, not stat, per se, but it definitely was time to take the staples out on Monday, day 14 post-op. I have a staple remover (another artifact of my tech days) and did it myself. I planned to do it Saturday or Sunday, but I was a bit worried about the top where there was some irritation and it didn't look completely closed. The bottom was beautifully sealed and clean. Typically, they are taken out 10-14 days after surgery.

After noticing a little pink and bumpy irritation, I decided they may be doing more harm than good. (He's got a couple more layers of internal sutures anyway.) The staples definitely had irritated his skin in certain places, especially one area, near the middle, where I had been noticing a bit of yellow puss. It wasn't seeping from the suture so much as hanging around a bulbous skin protrusion just external to the suture. I had been warm compressing it for a couple of days, two or three times daily. It was getting better - shrinking - but still wasn't gone.

Over the next couple of days it kept healing. All of the other areas healed up nicely. On Wednesday, Sept 8th, there was still slight discharge around the middle part. The vet could look at it the next day though.

It's chemo time!
They say to start chemotherapy between weeks two and three post-amputation. I decided to set up an appointment with an oncologist at the UC Davis Small Animal Hospital, based on glowing recommendations from many vets and dog owners. Not only is the hospital state of the art, it also offers cheaper prices, a lot of personal attention, and opportunities to participate in clinical trials. At about 75 miles from home, the distance isn't so bad either.

Robyn (aka, Dabs) drove Cas, Rob, and I in her car, so once again, I got to ride in the back with Cas. We left at 9am and returned at 7pm. Long day. Also, a successful day, so no complaints here.

Let the shaking recommence
Although Castor was not pleased to be in another hospital, he seemed less terrified this time. It was probably a combination of lots of moral support and the size of the hospital diluting some of the scary smells. Less likely, he's getting more used to our visits. Regardless, I enjoyed his lack of teeth-chattering fear. (Shaking is sad but understandable. When the teeth get involved, it's heart wrenching.)

The exam and consult was long. Long but pleasantly thorough. A senior vet student took us back to an exam room and started by getting a rather comprehensive case history on Castor, not just on his osteosarcoma but everything from puppyhood on. She was friendly, accessible, focused, and clear. After she took his vitals (e.g., weight, temp, listened to heart and chest), the oncologist, Dr. O'Brien, came in to finish the exam and discuss his treatment plan. (Exercise: If Castor weighed 136 pounds pre-amp and 130 today, how much did his left leg weigh?)

On examining Cas, O'Brien said the, "he's in great shape," that I am, fortunately, so accustomed to hearing. His suture site looked mostly great too, aside from that bit of puss that wouldn't leave. He'll be enjoying a 10-day course of Clavamox now. (Weee...more antibiotics! [that's sarcasm tinged with gratitude.])

Our drug of choice
On to the chemo options. Basically, I could do none, do Carboplatin once every three weeks for six treatments, or participate in a clinical trial. The trial was monitoring dogs receiving either six doses of Carboplatin (as in my second option) or alternating doses of Carboplatin and Doxorubicin (Doxo) for a total of six treatments. Were Cas to participate, one of the two tracks would be randomly assigned to him. Unfortunately, there was no discount involved, and unfortunately the second, Doxo can have, usually after 6 doses, negative side-effects on the heart. Since Great Danes are already prone to having heart problems, he would have to have an ultra sound on his heart pre-treatment.

All in all, I left the conversation with nothing in the pros column for Doxo. In answer to my questioning, O'Brien said that there was no difference in survival rates between the two drugs noted in the current literature. Plus, Doxo is a bit trickier to administer. It requires an IV drip and can be very bad if it doesn't go directly into the vein. Worst case could lead to amputation. Of course, this has never happened there and is probably very rare. Still, another con for Doxorubicin.

Beyond that study, Jen had heard about a current clinical trial at Davis involving inhalant chemotherapy administered to post-amp osteosarcoma dogs. I asked O'Brien about it, but there were drawbacks to this study as well. On the good side, most of the treatment would be free. It is a purely experimental study using chemo administered as an inhalant, because osteosarcoma generally presents secondarily in the lungs. There were no previous data to look at though. Also, the doctor running the study is out of town until October. We all thought it best not to delay Castor's chemo.

So, I decided between the Carboplatin and the Carb/Doxo clinical trial. It seemed the only benefit to the trial was to be of service to the veterinary community. I definitely considered that when making my decision; however, given the heart concern and the potential added expense of the ultra sound, I opted to go with my original plan.

Honestly, by the time I went to the first oncologist, Dr. Cadille, I was pretty informed and tentatively set on a path for treatment - amputation and chemotherapy. I spent the week after Castor's (pretty sure) diagnosis reading a lot about osteosarcoma and speaking with Jen about surgical options. (Not to mention all the research that Dabs did, as well.) Still, I imagine that without that research, I would have felt sufficiently informed at the end of this Davis consult to make a confident decision on how to proceed.

Carboplatin, it is. So, now what?
After deciding on Carboplatin, we went into the side-effects. O'Brien reiterated the positive news that 85% of dogs experience no visible side-effects. The other 15% experience some nausea, vomiting, and/or diarrhea. Maybe 1% end up in the hospital. (For those of you who like anecdotal evidence, she'd only seen that at Davis twice, and they treat a lot of dogs.)

What's the difference? Why don't they lose all their hair and end up sick-as-hell, in bed until it's over? Well, she said, we treat dogs' cancer differently than humans. We worry more about quality of life, not wanting to sacrifice happy time for more time alive but feeling miserably. It makes sense, given the significantly smaller life spans of dogs than humans. The trade-off, I suppose, is that in humans we strive to eradicate the cancer. In dogs, perhaps, we just look to slow it down. Still, I think there is room for us, as humans, to give a little more weight to the quality of life issue when treating cancer in other humans. (There was an excellent New Yorker article, Letting Go, about this a few months ago.)

As for the potential, mostly gastrointestinal side-effects, they gave me Metronidazole (aka, flagyl) and Metoclopramide (aka, reglan) in case of diarrhea and vomiting, respectively. If he is to suffer these problems, it should happen around day three. If not, yay!

So, I am to monitor his mood, bowels, and desire to eat and let them know, at our next visit, if anything was out of the ordinary.

My dog is not average
That brings me to a topic I've already touched on, namely, median survival rates. Vets love to talk to me about this, it seems. (And it's not because they know I'm a mathematician. Rob inquired about the distribution of the data after O'Brien said, "median," and she backed away from the Land of Math very cautiously, perhaps so as not to arouse its predatory instincts by turning and running.) For completeness's sake, I'll say that O'Brien observed the survival rates of dogs with osteosarcoma after diagnosis as being:
  • 0-3 months without treatment; dog dies from pain, usually after breaking their bone
  • 3-6 months with amputation and no chemo; dog usually dies from lung cancer
  • 12 months with amputation and chemo
How do I interpret these numbers? Well, I assume my boy will have total remission. Period. If you want another anecdote, one that I find particularly useful, check out Nova the Great Dane. Her 19-month ampuversary was in June, and her lungs are still clear. You see, a median is just a certain type of average. A median survival rate of 12 months means that half of the dogs lived less than a year and half of them lived longer. It's that simple. There is no reason to assume Cas will fall on either side of that line, so I believe he'll follow after Nova. (Planting seeds of joy, remember?)

For instance, at the time of writing up one study of 35 dogs with osteosarcoma who were treated with Carboplatin and Doxo, 7 dogs were still free of lesions and 24 died from metastases. The median survival time of this study was 320 days. The longest surviving dog at that time, then still metastasis-free, was at 974 days post-amputation.

A median is a prophecy, not a prescription.

Will this tea and essence of flower cure my dog's cancer?
I only jest. Really, I had plenty of things to talk about besides the chemo drugs. I want to make sure I do everything possible to help my dog's battle be won. Of course, a teaching veterinarian at UC Davis will have different views than, say, the Great Dane Lady, but the more opinions, especially differing ones, the better, right?

I'll be honest; I am a skeptic. That's who I am, and I love that about myself. I want to believe that people have cured cancer with many things, even an alkaline diet, but (in the case of alkaline diet, anyway) I tend to believe it was something else entirely. I have not been presented with evidence that a person's (or dog's) alkalinity can be altered enough to affect cancer cells, nor that feeding them no carbohydrates will starve their cancer cells but keep the others healthy. I will try herbal, holistic, or alternative (take your pick) treatments, but I do expect some evidence, some data, some something to show it's viable. Something, in fact, more than testimonials on the internet. (Sorry, but I know the difference between science and anecdotes. Both great for different things.)

Over the past few weeks, I have read or been told about many different cancer-defeating weapons and some supplements and treatments that just support bone and overall health. For instance, among other things, people have recommended I try:
  • high-fat, high-protein, low-carb diet
  • alkaline diet
  • Essiac tea
  • Milk Thistle Dandelion (non-alcohol formula only for pets)
  • Yucca
  • Vitamin D
  • probiotics
  • accupuncture
  • physical therapy
So, I asked Dr. O'Brien, as well as others, their take on some of them. Her responses, to quickly paraphrase, were the diets are crap. Physical therapy is a great idea. Accupuncture may help with his pain, but everyone thought he wasn't actually in pain anymore. "His pain is gone now," the senior student said. (She was very sweet and helpful.) I stopped his Tramadol (pain med given post-surgery) a day prior, and I am stopping his Metacam (an NSAID) for the time being. I'll just be using it as needed, if I see limping, etc., which I don't anticipate.

Milk Thistle Dandelion (MTD)
is actually used by them sometimes (in a drug mixture) for liver support; however, Carboplatin isn't filtered through the liver (like Doxo) but through the kidneys (or "the kids," as I affectionately refer to them). So, while it wouldn't hurt and in some cases does help, his liver is functioning great and none of his drugs are liver-taxing. Thus, no MTD for Castor yet. Probiotics are fine too, unless he's having bad diarrhea, in which case some docs opt to not risk the "good gut bacteria" getting outside of their domain via the blood system. No one really knows if they're good elsewhere in the body.

For diet, most commonly you will see "high-fat, high-protein." The idea is that carbs feed cancer cells, so you want to try to starve them a bit. The problem? All cells feed on carbs. So, per Cadille and O'Brien, theoretically it makes sense, but practically, there's no data to support it helping in a fight against cancer. At all. However, independent of this topic, I had decided to switch Castor from Innova to Canine Caviar after finding out that Proctor & Gamble bought Innova. (P&G have been longtime animal experimenters, which I do not support.) Canine Caviar (CC) seems to be a great, whole food-type, "holistic" and independently run brand. There are other great brands for sure, but I chose this one.

I started Castor's transition to CC right after finding out about his tumor, and before knowing the facts, so I chose the high-fat, high-protein Venison and Split Pea formula, which really lives up to its name (caviar prices!). No vet I've asked has heard of Canine Caviar, but I was told the ingredients sound great. ("Really high fat and protein though.") O'Brien and others have said Innova is a great food too. After Castor's slight post-op picky-ness, I decided to continue feeding him half-Innova, half-CC for the time being. I may switch to something altogether different in the near future. Not sure yet, though. For now, they're both great foods, and he is tolerating the high-fat and protein in the CC.

Assuming he's getting a complete diet, which he is, Vitamin D is not necessary. In fact, I was told that it can cause problems if he gets too much. No Vitamin D - check.

As for Essiac Tea and Yucca, these are two of the go-to alternative medicine (or whatever you want to call it) cancer remedies. My mom tends to lead me down this path and she has had success using such options on many of her animals for many years, including her dog who died of osteosarcoma. (Yes, this is an anecdote, plus it's from my mom. How biased can I get, huh?) So far, I haven't been told negative things about either. I intend to investigate, at least yucca, further soon. I'm most likely try these two alternative options on Castor thus far. I picked up some Essiac but haven't used it yet. As for yucca, the Canine Caviar I'm feeding happens to contain it already.

Finally, as I hinted to earlier, the alkaline diet seems, from my reading and conversations with vets, to be bogus. The body regulates it alkalinity to be within certain bounds. That can't be overridden, nor would we be necessarily dandy-er if it could be. No evidence to support and lots of evidence to the contrary equals me think hogwash.

The take-home message for supplements and food was feed a complete diet, don't let him gain weight (cause he's perfect now), and be careful with antioxidant-type supplements. The thing is that they help prevent cellular breakdown, but that's exactly what we're going for now. We want to breakdown the cancer cells. So, lay off the antioxidants for a while!

I did set up an appointment with a physical therapist. The vet and student raved about her! It is great to at least consult with a pt for your pet's new tripawd life. There are lots of home stretching and strength training that can greatly benefit them. I plan to start Castor's therapy and work-out regime right after our consult. More on that later

Blood, x-rays, and drugs
We left Castor with them for the treatment. It would take a couple of hours. They have to take chest rads (x-rays) to get a baseline for future sets. He will have two more sets taken during his six treatments. This set came out as clear as the last, i.e., very. (YAYAYAYA!!!!)

He also had a blood panel done. His blood looks great. Better than most, she says. =) He will have to have a CBC (complete blood count) done 10-14 days after this treatment. It's done to monitor his white blood cells, making sure they don't drop too low (i.e., neutropenia).

The Carbolplatin was then administered into his vein (no need for an IV drip with this one, remember).

We picked him up about 4pm. He came running out, tail a-wag! He adjusted so quickly to life on three. Everyone was impressed by his resiliency.

They said he was a fantastic patient! (I am not surprised.) We picked up his scripts, paid the bill (ouch, but not super ouch), and set up another appointment for the 30th.

On the way out, we spoke with the physical therapist briefly. She said it sounded like we were doing well, except for one thing. Oh, the horror on her face when we mentioned the 12 stairs at home. "I would move," she said. Simple, direct. Okay, I guess we'll look into it. For now, with his Ruff Wear harness (How cute is he in it?!) and the Walkabout harness for his rear that we just ordered (by her recommendation), Rob and I pretty much carry him up and down. He floats along the steps carrying between 0 and 15% of his weight. Good enough for now. (My boy hops and flies!!)

Always Questioning
One more thing. (I promise.) As a former vet tech, I appreciate being able to have meaningful, informative discourse with vet professionals about my boy. I got that from my first trip to Davis, as well as my discussions with Dr. Cadille and Dr. Wright. (Thank you all!) I can't say enough about making sure, if you ever go through something as involved and important as this, that you understand what your doctors are telling you. They are there for you; in fact, you're paying them for that support. So, don't ever feel bad about asking more questions, even the same ones again!

There was once, that I can remember now, that I felt my question was not answered at all by O'Brien; it was a little far afield though, so I let it go. (I was curious as to the different mechanisms of the two drugs of choice for osteosarcoma. So, alas, I am still curious, but those answers can wait.) Other than that, I feel very informed and supported. I have had all of my (many many) questions answered. I even email O'Brien and Cadille to ask more questions as they arise. They always get back to me quickly.

I never agreed that, "there are no stupid questions." Sometimes questions do seem stupid to those you're asking. So what? Sometimes people get sick of answering your questions. True story. And? That's fine. What's most stupid is making decisions based on information you still have questions about. If your doctor doesn't answer you or gives you reasons to feel uncomfortable asking, find a better doctor. So, speak up. Ask your questions.

Any questions?


p.s. - Here is the report I mentioned above, if you're interested: Kent, M. S., Strom, A., London, C. A. and Seguin, B. (2004), Alternating Carboplatin and Doxorubicin as Adjunctive Chemotherapy to Amputation or Limb-Sparing Surgery in the Treatment of Appendicular Osteosarcoma in Dogs. Journal of Veterinary Internal Medicine, 18: 540–544. doi: 10.1111/j.1939-1676.2004.tb02582.x (Enjoy!)