Saturday, June 29, 2013

The Crash

AP here:
The ER at CVRC is a busy place but it is the best place for Tonka when he is in distress. Most all of his specialists are there and everyone knows him. So when he had the multiple instances of diarrhea and was weak and dehydrated it was the place for him to get the best care.

We arrived around 5:00pm on Monday June 3rd and he would not be leaving till Tuesday June 4th at 7:00pm. They had taken him back and started him on IV's and his Aunt Gina came to sit with me and make sure he was OK. She also came to make me go get dinner with her since she knew that I would be spending the night there and would not eat otherwise. They put my boy in one of the nice large condos with lots of comfy bedding.

In the Condo
This is where I would also be spending part of my night and most of the next day. It was a little surreal being there again overnight as it was just a month earlier I had been there for 2 nights when he had his surgery.

Sleeping with Me

The next morning his care was transferred from the ER staff to the Internal Med./Oncology staff.
Diana who had helped me carry him in the night before was kind enough to bring me coffee and a muffin for breakfast when she came in to work. Since it was Tuesday morning it was also his usual therapy day so all his therapists were there and came by several times to pet him throughout the day as well as his Aunt Gina and his surgeon Dr. Roa.

I went back to sit with him whenever they would let me and I stayed cuddled in the condo with him for a good part of the 20 some hours we were there. At lunch his therapist Chris went out and got me a sandwich and sat with him while I went out front to eat it. Everyone was super about taking care of him and me and giving him lots of love. It is both a blessing and a curse that he is so well known there by everyone. We are fortunate that we have the resources locally for the kind of support and medical attention he needs.

In the afternoon his oncologist Dr. Peterson talked to me about his blood work which was pretty normal and wanted to do an ultrasound to see if they could come up with anything else that could have caused this. Since the last chemo dose had been Friday and he tanked early Monday the theory was it was not the meds that had upset him. The chemo meds are supposed to clear the body within 48 hours.  I agreed to the ultrasound and when it was done it also looked normal the only thing was a little thickening of the intestinal wall in a spot but after consulting with Dr. Roa it was agreed that was from he surgery. Tonka may be a big boy but he is a very sensitive guy when it comes to meds and this had not gone well. Part of the medicine protocol was Metoclopramide which helps move food through the system. I had given Tonka his heartworm meds Sunday morning which consists of two squares that look like treats (heart guard) and the smaller one had passed through completely intact. I think perhaps the medicine worked a little too well.....

It was now past 24 hours of being on fluids non stop and both of us were ready to go. They wanted to keep him overnight again but I said no and promised to keep him hydrated. Now that he was no longer in distress the best place for him was home.

Going Home

I had wrapped up his tail with an ace bandage after his third bout of diarrhea as I was out of vet wrap and Caitlin had bought some with her and re wrapped it for me. Once home I kept his tail wrapped for a few more days just in case.

He could not seem to get comfortable and would puff his cheeks out and sigh as well as twitching and jerking a bit. He was still hating to lie down on his left side and his breathing was not getting any better. I was hesitant to put him back on his meds for his allergy/sinus problem so I waited a few days to make sure he was OK and eating well. I kept him on Flagyl for the diarrhea for next seven days. On that seventh day we went to see Dr. Philips for acupuncture, we had tried it before for his lameness but now I wanted to see if it would stimulate his appetite and perhaps make him relax. I showed Dr. Phillips how he had an issue laying on his one side and how he was jumpy around his ribcage. She agreed that something was definitely off and that he was not his normal happy self. We discussed maybe having a full MRI done to figure out
1. does he have a tumor in his nose and it is not allergies or sinus 
2. is something broken and making him uncomfortable
That night he had a full blown seizure. It had been two years since he had one and it caught me off guard. It was 11:30 at night and I called the ER and spoke to one of the Dr.s that had seen him the week before. We agreed that since it was only one and under 5 minutes long we would wait to see if he had another one before rushing him in. Running down his list of meds the only one that could have possibly been a cause was the Flagyl. He was postictal for about 20 minutes and during that phase he knows nothing not even his name. He kept trying to stand and walk which completely broke my heart. I had to keep repositioning him to stay down and he was flailing frantically.  When he did come back to being fully himself he was very hungry and thirsty. I had been sleeping on the floor with him for only 1/2 of the night but after the seizure I went back to sleeping with him all night.

He was very jumpy and snoring a lot and then one night I could not wake him up. His face was contorted in a horrible grimace and his breathing was very labored. He stayed like that for almost an hour and then sat up like nothing had happened. I got him some water and he then laid down and slept normally the rest of the night.

This became a nightly occurrence so I took a video and sent it to someone who could maybe tell me what this was. The answer came back perhaps a different form of seizure. Every vet I talked to about this felt that perhaps his breathing and strange activity was being caused by a tumor in his nose that was now pressing up into the brain. It was time to decide a course of action

Friday, June 28, 2013

The Chemotherapy Whirlwind

AP here and it has been exactly one month since we started down the road of chemo. It has been a crazy time and one that has kept me busy trying to figure out the best recourse for my boy. It has also been very stressful and I felt the need to shut everything down while we were trying to get back to some sense of normalcy. A lot has happened and not all of is related to the cancer. I am going to try to catch the blog up with the events of the last month with the next several posts so please bear with me.

Palladia the chemo drug recommended for Tonka - nice enough sounding drug, the name kind of rolls off the tongue, sounds sorta harmless, like a vacation spot or something. As with all new things and my boy I did my research and joined a few canine cancer groups online and started asking for any feedback from those that had used it. I came up with a mixed bag or reactions, some people loved it, others hated it and due to some rare side effects feel it ended their dogs time early. I was still battling with Tonka's inability to breathe very well and the various medication he was on for that so I was not sure if I wanted to jump in right away. I decided to wait a week and try to get his allergies under control and get him off some of the meds before beginning. Everyone was OK with that and so we went back to our normal routine of therapy and underwater treadmill for the week.

Lately he had been not wanting to lie down on his left hip and seemed to be having a hard time rolling up on his side without help so I was hopeful that he just had rib out again and therapy would help. He did seem better after his therapy session and so we kept up our routine and had a treadmill session a few days later.

He did really well in the treadmill and I know he enjoys it because he can actually run and move his legs like nothing is wrong. It was nice to get back to our routine and everything seemed to be getting back on track except his sense of smell. He was still so congested that I wanted to postpone chemo one more week but was advised that I needed to start immediately as the tumors were an aggressive type. The weekend came and went and his sense of smell was no better but it was now Chemo week so the Tuesday morning of May 28th we headed to therapy with an oncology appointment right afterwards.

Therapy did not seem to help much and he was still in pain while we were waiting in the lobby. Dr. Roa came through and he did a quick check of him but couldn't find anything. Then Dr. Klaser arrived for his chemo consult and we discussed that he seemed to be in pain lately and she suggested an ultrasound of his belly as well as the blood work he was already there for. We hung out for awhile till they were ready for him and all his friends came by to say hi and to give him attention. When they took him back for his blood work and to check his abdomen I sat in the lobby and semi successfully tried to keep it together.Dr. Klaser returned after his exam and we talked about the fact that he is just not himself and seems in pain. She did not see anything on the ultrasound and his blood work was fine so the only thing left was to pick up the chemo meds that afternoon and start them the next day.

I took him home and made him comfortable and put some ice packs on his neck and ribs and he was soon fast asleep. That afternoon I drove back to CVRC and picked up his meds and received the instructions on what to give him and when. The biggest 2 things to look for were diarrhea and vomiting and anything more than once was a red flag.I drove home with his little blue bag of pills and a lump in my throat.

The thing about chemo meds is that the medication can be present in the urine, feces and saliva so anyone handling those things should wear gloves. Since Tonka is incontinent and has to be expressed manually that meant that Caitlin and I had to wear gloves and dispose of his pee pads and poop bags in sealed plastic baggies. I put boxes of gloves in strategic locations and covered the carpet with contractors sticky back plastic to make sure if there were any accidents the mess would be minimized.

Of course the next morning (the first day of chemo) Tonka decided to not eat anything for breakfast.When I say anything I mean anything - nothing would entice him not even his favorite treat. I ended up scrambling a couple of eggs and he did eat some of that but I was not happy giving him all that medicine on a partially full stomach.

the list of meds...
4 pepcid AC's twice a day - before meals
Metocloprimide - 3 a day
Palladia -90Mg on Mon/Wed/Fri

At this point he was already on Hydroxyzine and Amoxicllian for his stuffy nose and his daily thyroid med. If you follow the blog you know he is a sensitive moose when it comes to medications so I was worried that this was all too much. He was doing really well and other than not wanting to eat much everything seemed normal. Then I went and jinxed us by saying that out loud to a few people. The rapid descent started on June 3rd at 12:30am when I heard him whining. Tonka has never whined a day in his life. Barked yes but whined-no. The poor guy had pooped all over his bedding and in trying to get away from it he had literally dragged his back end through it. I cleaned him up enough to stand him up and he immediately pulled me towards the shower. The only thing Tonka hates more than  water is being dirty. I got him into the shower and cleaned up the best I could with no rubber mats on the bottom to keep him from slipping. Usually I have time to setup the shower to bathe him with mats and his shampoo and towels close by. I got him out and had to lay him on the floor to go get towels and pick up his soiled bedding, he was not happy about that but I had no choice. I got down clean bedding  and towels and then lifted him and maneuvered him back onto them. the instant I started to lower him he had another episode of diarrhea It was now 1:20am I managed to get a pee pad under his hind end and lay him down on the plastic covered carpet while I picked up the bedding and put down clean stuff once again. I knew neither of us had the strength for the shower again so I put a towel over the pee pad and got a bucket of warm soapy water and a washcloth and set about cleaning him up. Once that was done I moved him back to his bedding and put a fresh pee pad under him and used the blow dryer to get him semi dry. He went again at 3:00am and at 4:15 and each time I repeated the clean up process. I emailed the oncology group as this was a chemo med day and I wanted them to know what was happening. His Dr. responded at 5:00 to withhold the chemo for the day and they would call me a little later.

Dr. Peterson called at 8:00 and I started him on metronidazole with instructions to not give him his Palladia and to see if he improved. We were good until 10:30 when the poor boy went yet again. It was my belief that there could not be anything left in him and I had to go to work for a few hours so I headed out. It wasn't long until that theory was proven wrong when my mom stopped in at 12:30 to check on him he went again but this time he also vomited. By the time Caitlin came for the day he was in bad shape. She sent me a text that his gums were tacky and he would not open his eyes for her so I rushed home. We put him in his stroller minus the wheels and handle and loaded him in the truck. I called the ER and told them we were coming in. His therapist Diana from CVSS met me at the truck and helped me carry him in. The next time I saw him they had drawn blood to test and had him on IV fluids.

Not a good start to our Chemotherapy experience...

Sunday, June 2, 2013

Tumors and Things...

AP here:
It has been one month since Tonka's surgery and I have been fighting my own private war with the results of what they found. I want to thank Liam and Ollie's moms for stepping in and posting such awesome and heartfelt posts in my absence. Tonka and I truly have amazing friends!

On May 1st 2013 Tonka underwent exploratory surgery to remove what we thought was one small tumor off of his small intestine and to make sure there were no others. There were actually 3 one up top at the section known as the duodenum, one in the middle section called the jejunum and one at the end which is known as the ileum. The surgery went well and he recovered very nicely. In true Tonka style he already acts like it never happened and is back to his normal routines.

The tumors were sent to Colorado State University to pathology to determine what type they were. It took a week to get the report back and unfortunately the news was not good. All 3 were the same kind and all three were cancerous. I made an appointment with Dr. Peterson at AVIM and Oncology for the soonest available which was one more week out. In the meantime I took the pathology report and started doing research.

I did not like what I found.

During this week of waiting I kept things sort of quiet and tried to keep positive but in my heart I knew this was not going to be good.

On Thursday May 16th Tonka and I entered CVRC like we normally would and all his friends from the different specialties stopped to say hello to him in the lobby and feed him treats. He got a check-up from Dr. Roa who said he was looking great and I ran into Dr. Rosenthal (Tonka's heart Doctor) and we had a quick chat about the surgery and the findings. As usual everyone was great and his Aunt Gina was right there with us for moral support.

Love the Peeps

We met with Dr. Peterson and she started by explaining how the visit was going to progress and then set about asking questions on his medical history. She then examined him and once that was done she sat down and went over the pathology report with me. It was exactly what I feared. I wont go into all the little details as the only things that really matter is that they were "undifferentiated sarcomas" and "stage 3".  The bottom line is that with chemo we might get a year. We discussed the options available taking into account my boy's sensitivity to medications and how exactly we would work his visits in with his therapy days. The biggest point we covered was quality of life for Tonka and having him happy and able to live out his days normally (well Tonka normal). I am not real sure how much I actually retained from the appointment because even though I tried to keep it together inside I was breaking. I am sure that is why they give their patients a very comprehensive packet to take home that recaps everything they went over.

We left the room and immediately went out the door, part of me felt bad not saying goodbye to all his friends but I also needed to get outside and breathe. I have a hard rule about not being upset around Tonka and I came very close to breaking that rule once in the truck. The ride home was very long and surreal for me but for Tonka it was just another ride home in the truck from a morning of hanging out with people and getting some love and attention. That is the beautiful thing about the Tonka Man - everyday is a good day no matter what is going on as long as he has some love and some cookies. Nothing to get worried or upset about - its all good in his world, I really wish I could be more like him.

The chemo option I am choosing is a drug called Palladia and is given in pill form. It can be stopped pretty much immediately and side effects are mostly gastrointestinal. If this does not agree with him we will stop and continue on for how ever long we have.The goal here is the same one it has always been and that is for Tonka to have a happy and normal life like any other dog.

My heart is completely torn. I am so, so sad and so damn angry that I cannot fix him. He is my heart and I have done everything I possibly could to protect him and keep him healthy and happy but I am helpless with this. It is so unfair and so devastating that it has been impossible for me to talk about this except with a few people.

T and I started this blog to educate people on life with a blind dog and we hope that it has helped people see that dogs with disabilities can have a happy normal life. I am going to try to keep up with the blog and share our experience with the chemo in hopes that we can help others that are going through this. I can't guarantee that I will always find the time or the words to write as often as I should.

I do have 2 requests at this time.
#1 Do not be sad around Tonka - he will get upset if you are upset
#2 (and please don't take this the wrong way)
Do not talk to me about it unless I specifically bring it up - I am trying very hard to live by request #1 and believe me if you think its hard for you to not be upset it is a million times harder for me.