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!

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