three months

And 300 visitors! Thanks everybody! Dave told me he wants to wish Aunt Tina a special belated birthday! Happy 29th, for the fifth time!!!

Dave's visit today went well. His white blood count was slightly decreased, but it was fine to receive his chemo. His eye is fine, his weight is maintaining, and he is still in clinical remission! He has to start an antibiotic (again) to prevent infection from the chemo, adriamycin. He is off next week, so we don't have to take him for bloodwork unless we see signs that he's not feeling good - loss of appetite or lethargy. He's a bundle of energy right now, but he'll probably slow down tonight. Hopefully?

His meds:

Adriamycin administered @ Penn

Eye meds: cosopt, xalatan and methazolamide

TMS antibiotic, 480 mg, 1/2 tab every 12 hours, starting Saturday 5.3

Zofran for nausea, 8 mg, 1/2 tab once a day for 4-5 days

One of the things I hadn't mentioned here is his increased snoring at night, scratching and licking during the day. I suspected, and his doctor confirmed, that it's due to seasonal allergies. We can give him benadryl as needed.

draft day

Today is one of Mike's favorite days of the year: NFL draft day. Dave enjoys it, too, because it usually entails lazy men sitting on the couch for a number of hours, with chances of delicious morsels of food being dropped. Some may say their time is too precious to sit and watch a rather monotonous seven hours of football coverage, but not Mike and Dave. They love it!

Dave has had a great week, but we seemed to tire him out a bit. We've been walking, playing out back and enjoying the 80+ degree weather for part of the week. I think he'll be happy when we're back at work Monday.

uneventful visit

Today's visit matched well with Dave's week - uneventful! His lymph nodes are normal and the bloodwork and eye are still looking good. He got his treatment, and we were out of there in record time... under three hours! His main vet was back, and again remarked how well he's doing. I had to ask if it's indicative of longer remission times, and she gave me what I thought would be the answer: they have no way of knowing. I'm trying to manage my hope, but when he's doing so well, it's difficult.

Next week is his last week of the induction cycles. Nine weeks to go of the cycle, and then nine weeks of the vaccine. After the end of the induction cycle, he starts consolidation (week 16, on May 13th), where he'll get doses of doxorubicin every other week. It's the 'strongest' chemo that he's had, but he has fewer side effects than the Elspar. With a little anti-nausea medicine, he tolerates it fairly well.

vacation!

Mike and I are off this week. We had been talking about going on a trip before Dave's diagnosis, possibly to Sonoma or New Orleans. Now we're happy just going to West Philly! Dave will be a very happy boy, for the first half of the week, at least. Then he'll probably get a bit sick of us being around all of the time. We went for a nice long walk this morning, and I could tell that he's out of shape. We need to build up his endurance for those hot summer days!

awww :(

I just took a look at my old posts. In several of the pictures, it's very apparent that Dave had more whiskers over the past few months than he does now. Poor guy!

so far, so good

It's only been two nights since chemo, but Dave is doing well. No GI issues, the eye is looking good, and the gimp hasn't come back! As referenced in Tuesday's post, he was a 'berry' good boy. I took this as we were leaving with my cell phone. The yellow collar around his neck is not a collar, it's actually his ID. Just like humans getting a bracelet in the hospital, Dave gets a collar with his name, address, phone number and patient ID number. Another interesting fact is that the brick and stone building in the background isn't part of the animal hospital, it's actually one of the fraternity houses!

The vet that we've spoken to for the last two weeks is a resident, and she's great! She consulted with the director of the clinical trial, and they decided that Dave can have the diet additions. Mike isn't too happy about the wet food, both because of the expense and general PITA of feeding wet food: the smell, the stains it leaves on dogs' mouths and the bad breath that can result. Dave enjoys it, and we've been supplementing with spinach, swiss chard, sweet potatoes, pumpkin and other goodies. He loves the hard boiled eggs! We can't give any of the supplements because they want to be sure that any results that we see as far as longer remission times are due to the vaccine rather than anything else. We decided to err on the side of traditional medicine in that case, so Dave will be enjoying us cooking for him while still receiving the vaccine.

somebody was "berry" good!

After seven hours (a new record, I think), Dave is home and doing well.

All good news today! He is still in remission, and his lymph nodes, bloodwork and rest of his parts are all normal. The vet had no real insight on the leg issues last week, other than the possibility of an allergic reaction. It's completely gone, so they had no way to see what he was doing. There were some concerns with his eye because of the cloudiness and redness, but when his eye pressure was tested, it's still normal!

His meds for week 12 overall (week two of the third cycle):
vincristine injection @ Penn
cytoxan 25 mg 1x/day starting tomorrow, until Saturday 4.19
eye meds: cosopt drops, xalatan drops and methylzolamide pills (they spell it differently each time)

better day

Today was much better. On Friday night, Mike found a small wound on Dave's paw. I don't know if we missed it before, or if it was new, but he cleaned it and put Neosporin on it, and now Dave is back to walking normally. Thank goodness! We worked in the yard a bit and he had no problem running and sitting in the grass.

Grammom visited yesterday, and brought canned pumpkin and fresh sweet potatoes. We gave Dave a small snack of pumpkin and spinach yesterday, which he thoroughly enjoyed.

We're getting ready for Tuesday's visit. We're hoping for normal bloodwork, good eye pressure and a complication-free dose of vincristine. Dave has not had problems from the vincristine/cytoxan combination in the past, so we'd like to continue with that trend! I think we'll be giving him a bit of preventative nausea meds after, just in case.

pictures

To eliminate the wall of text down there, some Dave pictures:

not feeling well Wednesday

and...

Dave's business end! I may try to capture his paw issues on a little movie for Penn.

holistic?

It feels like I haven't posted in ages. This isn't a very "up" week for me.

Dave hasn't vomited or had diarrhea since Wednesday, and has transitioned back to his kibble. However, he now takes it a little warm broth. He is almost back to himself, but the hind paw problems haven't gone away. It's a sensitivity in his paws. He's using a normal range of motion, and not hesitating to run, jump and exert himself. But, as soon as he gets on the grass, he's lifting his paws up and trying to avoid contact for too long. Yesterday, Dave seems to have injured himself a bit on his left back paw. He has a cut, so we're doing our best to keep it clean, while keeping him happy by going outside.

We saw the holistic vet Thursday night. She was very nice, though Mike was a little surprised with how the appointment went. She is extensively trained in Eastern medicine, so she spoke a lot about energies, pulses, and some other concepts that are, well, completely foreign to us. Because of Dave's trial, he can't take any supplemental immune boosters. The vaccine is supposed to take care of that. We're taking a list of everything that she wants us to do, which is mostly diet changes, on Tuesday so they can look it over. She would like us to switch him to a high quality wet food; it's the same brand that he's on, Innova EVO, but the red meat formula, which he will gobble up, I'm sure. She said that dry food a "hot" food because of the way it's made: compressed, no moisture. Apparently cancer is a hot disease, and it's better for Dave to have the "cold" wet food. Dave's pulses (not pulse!) were excellent; she said that his were really strong for a dog with lymphoma on chemo.

I'll be honest, the unfamiliarity I have with this makes me a little hesistant to buy into the theories... However, in simple terms, it's diet changes. She also wants us to add dark, leafy greens, sweet potatoes, canned pumpkin, hard boiled eggs and blueberries to the food. Dave LOVES sweet potatoes, so that won't be a problem. She suggested adding kelp and turmeric as well. It's almost like cooking for him, but that would require organic grass-fed beef or venison, and it would be quite pricey. She gave us a higher quality fish oil, and recommended three supplements that are made up of herbs. She doesn't sell the supplements, they're available at Wegmans and Whole Foods, so she has no vested interest there (several people asked about that). We're going to be asking about all of this. I can't imagine that the foods would be a problem, but the supplements may be. She also wants us to give him at least 20-30 minutes of exercise a day, as people with cancer who are active generally do well and handle their treatments well. I need to do more reading on all of this, but I figure that it really can't hurt to change his diet to meat, fruits and vegetables.

worried

I hate this.

Dave had a good night, with no vomiting or diarrhea. However, we noticed that he's having issues walking. He used to do this little kick out thing because he had a nail that would fall out all the time, and it was sensitive. Now he's alternating doing it with both legs, especially when he is outside. He spent a lot of the night before going to sleep and this morning licking his paws. I examined them, and didn't see any signs of trauma. He chose to jump into bed and onto a chair, so it seems like more of a sensitivity issue rather than his legs not working. I'm going to leave a message for the vet this morning. I'm wondering if it is an allergic reaction that's finally coming out, as the paperwork says to look for paw swelling. I don't think that his paws are swollen, since they look about the same as the front ones, and none of them look overly puffy or inflamed.

Oh, and we did give him the benadryl last night as a precaution. I'm trying to balance my reaction. I feel like I've always overreact about his medical problems in the past, but now I'm concerned because I feel like I'm underreacting. Bleh.

**UPDATE**
The vet called me back already (8 am), which makes me feel a little better. She said that she doesn't know what the leg problem could be, as it would be unusual for a patella or hip problem to just appear with no prior signs. She advised to continue the benadryl, also. She said that we could bring him in to Penn, but that taking him tonight to his scheduled appointment would be fine as well. She said that because he's eating and the vomiting has stopped, and he's relatively bright and alert, that she's not overly concerned. She reiterated that reactions to Elspar are very unusual, but that's not to say it's not possible. This is his last dose of Elspar for the cycle, so there aren't future risks. She said that hopefully by the end of the day and tomorrow, that we'll see these symptoms going away. Hopefully...

interesting

Dave's having GI issues again. I read the posts from March 4th, his last dose of Elspar, and it's almost word for word with what happened: he got us up in the middle of the night with diarrhea, and vomited and pooped while we were at work. It makes me feel a bit reassured, I suppose. He ate his chicken and rice this morning and tonight without hesitation.

I called the vet anyway today due to his low white blood count. It was the same oncologist who saw him yesterday, and she was surprised about the reaction. She did say, as it stated in his paperwork, that his blood count was only slightly low, and advised that we give him 25 mg of benadryl in case it's an allergic reaction. Since we're becoming experts at this, we decided to hold off on the benadryl and give him nausea medicine first. The benadryl will make him drowsy, and I'd like to see his "true" activity level rather than a medically induced one. I know I should be following her advice, but being that we've been through this with the Elspar before, I feel like we're making the right decision.

Dave has his new holistic vet appointment tomorrow night... maybe she'll have some advice that will assist us.

mixed feelings

It's week 11! This is the beginning of Dave's third and final 'cycle.' After this, he'll get chemo every other week for a total of seven weeks, taking us to June 24th. Then the vaccines will start for another nine weeks. I felt like the past five weeks flew by, which is where the mixed feelings come in. He's done well thus far, but we have a ways to go, and we don't know when (if, ideally) the cancer will come back.

According to Mike: he was in a rambunctious little mood today, trying to get to an English sheepdog in the waiting room. He also was very interested in a cat in a carrier who was meowing to let him know to keep his distance.

I received a call from a new doctor only an hour or so after Dave had been dropped off letting me know that his white blood count was low. Usually the lowered count is seen after they initially start chemo, but it can be a side effect throughout the treatment. It's potentially dangerous, but the vets were not overly concerned. His neutrophil count was "slightly low," according to his paperwork, and coming off of the stronger chemo could have contributed to it. This could be an explanation for the picky eating, and we'll be watching him for other symptoms that are indicative of illness - GI issues, lethargy, etc. Maybe I'll have to learn how to take his temperature??

The problem with the low blood count was that they usually won't give chemo so as not to make them sicker. Even though it was week one of the cycle and he has gotten Elspar, Dave was due for a different drug, methotrexate. After the vets consulted with the clinical trial director, they decided to give him Elspar again. This is allowable for the trial, and shouldn't affect his WBC negatively. The big concern I had was how the change would affect him long term, and I was assured that this was an acceptable substitution. Sure enough, when I checked his trial paperwork, it's right there in black and white. I was sad to read that they've closed new admissions to the trial. It makes me so grateful that we have this opportunity...

Dave's eye pressure was good again, and the opthalmologist was happy with how well it's turned around. His weight is stable, and he's otherwise healthy - the lymph nodes "feel great" according to the doctor. No sticker this week, as he didn't take home any meds, but his discharge paperwork does state that "Dave was a very good boy today and we loved seeing him." I love it!!

some changes

Since last week, things have stayed good. Dave is being picky with eating, sometimes eating his kibble, sometimes waiting until we add a little chicken broth. In the last two weeks, that's the only issue that has come up. Not too bad. No GI issues, the eye is looking great and his energy level is very high. He's been snoring more lately, but I have no idea if that's in any way related.

We're in the process of making a change in his regular vet. When we first adopted Dave, we got recommendation from a lot of owners and thought we were choosing his vet carefully. I was a bit of a hypochondriac, taking him for the vet for almost anything perceived wrong. In the first two years, he was probably there eight times. I don't think I've EVER seen the same vet twice. It's not that it's a big practice, but the turnover in vets, front desk staff and techs is ridiculous. We found two nice doctors there, but when we tried to request them for another appointment, they were no longer with the practice.

Another issue I had was their treatment of Dave's eye. His eyes were always very red and I made a point of asking about them every time I took him in. About two years ago, one of the vets said that it could develop into glaucoma, but that we had nothing to worry about at that time. I asked about an opthalmologist, and was told it wasn't necessary. At follow up appointments, I asked, and was repeatedly told it was allergies and an opthalmologist didn't need to be consulted. I felt that my vet's advice was accurate and that I didn't want to be the overprotective owner. I feel very guilty about this now, seeing as it's one part of this whole thing that could have been prevented.

We go to a wonderful, locally owned pet store for Dave's food. The link is on the side. Several of the workers there really helped a few years ago when we went there explaining we wanted to help him age gracefully. We got him on a very high quality food (Innova EVO poultry mix), with no grains and whole vegetables. It's the closest we could get to a raw diet. We also switched out our sugary, carb-y treats for more healthy ones, which Dave didn't mind at all. The staff there recommended a holistic vet last year, and we never bothered to switch him, for whatever reason, and were thinking about switching before his vaccinations prior to his diagnosis.

Even though it may seem counterintuitive to switch vets when, given his initial prognosis, he may only be with us for another six months to a year, we felt it was the best thing we could do for him. He has an appointment this upcoming week, and the tech I spoke with said that many owners in our situation do the same thing. As an added bonus, the vet is a mile from our house, as opposed to the 15 or 20 his old vet was. I wish I had known about this earlier!

Finally, after this loooong post, I celebrated turning 30 this week! Dave enjoyed opening presents, as he always does, and we enjoyed decorating him afterwards.