The last day of therapy...

AP here:
For about a year and a half now Tonka and I have gotten in the truck every Tuesday morning and made our way to Bestgate Rd. in Annapolis. There we would spend an hour with two of the smartest and nicest people, Diana Huey and Chris Fritsch. These two ladies have been his rehab specialists every step of the way with his neurological issues doing cold laser and nerve glides with him and putting his rib back in place when it would pop out. They have never given up on him and researched and brainstormed all the way till now trying to figure out and help him walk again.
We would pull in the parking lot and I would back up the truck in a strategic space that allowed the back end to dip down just a bit to make getting him up and down the ramp easier. There was a space of time where he could not help me at all. Those days he wore his help em up harness and I would pull right up to the door and Diana would come out and help me lift him and carry him in.
Everyone there has always made him feel so comfortable and loved (kinda like Norm from Cheers). The other specialty staffs were always giving him treats and hugs and he loved rolling through the lobby to "see" everyone. This Tuesday started out no different as Chris and Diana came out to the truck to help get him up and into his wheels and we headed in for therapy.

Happy Boy!

I'm not sure what made me make the decision but I told them going in that this would be his last session. I think in the back of my mind I know the time is really getting short and I want all his "lasts" to be happy ones.

That is killing me you know "the lasts" -everything I do suddenly has a time-stamp on it as something we will never do again.

So the word went around the facility and Dr. Roa (who is an amazing surgeon and an equally amazing person) popped in on the therapy session to say goodbye. He chatted with Tonka for awhile and scratched his ears and his chin and I know Tonka appreciated it as much as I did.

When therapy was done we rolled out the door and his friends were there to say goodbye.

 

Lots of Love

Gloria and Sonia  had gotten together and come up with the idea to make me something special and so Sonia's mom made the most awesome Tonka hat for me.

Tonka Hat

Such an awesome gift....

Aunt Gina gave him some words of advice

Diana, Chris and his Aunt Gina walked us out to the car and helped get him in the truck. It was so strange and very sad to be leaving a place that has been such a big part of our lives for the past two years. Even though the reasons for being there have always been medical in nature its always been a happy and safe place for us.





On the way home I decided that perhaps we needed some breakfast so I stopped and got us a bacon, egg and cheese sandwich.                                                              

Bacon?

I love bacon...

Nap time

Once home it was time for a nap. It's hard work and very tiring being so spoiled!

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.

Home

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

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...
.

Tonka update

AP here:
Tonka and I returned to the CVRC at 7:30am this morning and the minute he got out of the truck he started sneezing blood everywhere. They hurried him to the back to take care of him and I setup camp for the day in a corner chair. Dr. Gonzales http://www.atlanticvetintmed.com/pages.aspx?content=35 was not free to talk to me until about 11:00. They put Tonka and I into an exam room and he checked him out and made him sneeze a few times. He then explained how the rhinoscopy procedure would go and what they would be looking for. He was very thorough and wanted me to understand that it would not be a fix for the nosebleeds unless they found a cause such as a tumor, polyp or foreign body. He would take some biopsies to send out to a lab to look for other cases such as fungus, allergies or a blood disorder. There is a rare platelet disorder that is found in Otterhounds and Great Pyrenees. http://ahdc.vet.cornell.edu/clinpath/modules/coags/Glanz.htm . Since Tonka had trouble with his femoral artery and bleeding during his heart surgery he wanted to make sure I understood that the scope procedure could become messy. He wanted to do a clotting test before doing the procedure and take some skull x-rays. I started to think that perhaps we should wait and do another week or so of medicines and see it that would stop the nose bleeds but it also seemed like it was the perfect time to do it if we were going to do it. The Cardiology center CVCA is part of the same group and Tonka's heart surgeon Dr. Rosenthal happened to be working at that location so I consulted with him as well.  In the end we had the procedure and this is the update:
No nasal tumors, no polyps, no foreign body,l no obvious cause of nosebleeds
Took biopsies to send out for infection and possibly some rare platelet blood thing that Pyrs can have.
He did real well with the anesthesia - heart was solid- some bleeding still so can't come home till tomorrow.

Now we wait

Yay for the Eyeball - Boo for the Nose

AP here:
I spoke to Dr. Woodburn this morning and he felt that we should have a rhinoscopy done to try and figure out what is going on with these nosebleeds. I called the internal medicine department at Chesapeake Veterinary Referral Center (CVRC) and scheduled it for 8:00am Wednesday. Tonka's recheck for the pressure problem in his good/bad eye was also today and we got to Dr. Weigts office at 3:30. As soon as he walked down the ramp from the truck he started to sneeze and blood went everywhere. He bled down the ramp, down the sidewalk and into the office. The staff hustled him into a room and Dr. Weigt put some drops of Epinephrine in his nose and stopped the bleeding. Once that was over she numbed his eye and took his pressure and it was down to 10 which is the best news we have had in a while. The debris in the eye is also down so the medication is working. We can drop the pred. acetate down to once a day again but keep the azopt twice a day. Once we got home Tonka's kids came up and visited for a few minutes and then he took a nap. Around 5:45 he got up and went outside and after a minute he started sneezing and the blood started pouring. I tried for about 15 minutes and couldn't get it to stop even with some epinephrine so off to the ER we went http://www.aavec.com/. They checked him out and we all agreed that he should get the scope done Tuesday instead of Wednesday. After a complete blood work up and chest x-rays they let me take him home for the night and we are to return at 7:30am to transfer him from the ER's care to Internal Medicine.