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...
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Surgery and Recovery

AP here:
First I apologize about not posting sooner but the past week has been a little stressful and anything but routine. Wednesday May 1st was Tonka's surgery date and we arrived at 7:15am to check in. Instead of taking him in the back and making him wait in a kennel they allowed him to stay in the lobby with me on a blanket. Of course this was perfect for him as people coming to work or coming to see the Doctor's got to stop and fuss over him.

Hanging in the Lobby

Diana came and got him to go back to see the cardiologist and made sure that everything was set for him for the day. Since Tonka has had heart surgery he had to go back and have the cardiologist listen to his heart to make sure everything sounded good and give the thumbs up for anesthesia.  She came back with him and everything was a green light for surgery later in the day.  He had go back again a little later to have his legs shaved and prepped for the IV's. In true Tonka style he decided to have a nosebleed while they were getting him ready - he can never make anything simple. They wheeled him back out to me with a towel to help stop and wipe the blood away from his nose and at that point he decided to take a nap.

Ready for Surgery

I had to wake him around noon to take him back for surgery so we wheeled to the prep room and I kissed him on the nose and told him I would see him soon. I also said out-loud to no one in particular "please don't let anything happen to him".
It was a very long surgery and was nerve wracking as the hours ticked away. Thank goodness for his Aunt Gina who kept giving me updates and the friends who stopped by to help try to keep my mind occupied on other things.

It was very late in the afternoon when I got to talk to the surgeon Dr. Roa and found out that he had discovered 3 tumors instead of the 1 they knew about. Two of them were in places that were tricky to remove and so he had to scoop them out and then hand sew which took a lot of time.

We are very fortunate to have the support of a lot of people and I cannot thank them all enough for looking out for us. Brittany and Gina made sure I had lunch and coffee while I was camped out and Chris showed up Wednesday night with a homemade dinner and dessert that was delicious.  I spent the night in the truck just in case something happened overnight as I did not want to be too far away. Becky was his vet tech for the first 2 nights and was very patient with me calling several times to check on him. All of the staffs were so helpful and always positive and Shannon was always there for me late in the day to chat and see if I needed anything.

Thursday morning my wonderful friends Eileen and Patty dropped off orange juice, muffins, bananas and chips to make sure I had breakfast and some snack food. Around 8:45 Dr. Roa came to the lobby and took me back to see my very drugged boy. He was so stoned on pain meds it took him a few minutes to catch on that I was there.

Hey Mom!

 

I got to sit with him for a little while and sing him his favorite songs till he fell back asleep. 

Out

 On the way back to the lobby I asked the Dr. when I could come back and see him again and he said to try around 3:00. I spent the morning in the lobby with a very sweet Doberman (Riley) that was there for the day for a chemo appointment. At 3:00 I went up to the desk and asked if they could call to the back and see if I could see him. They buzzed back and told me to wait just a minute someone would be up. I was standing there waiting when Dr. Roa himself came up with Tonka in his wheels and said lets go for a walk. I was so surprised - it was amazing - he was happy as could be wheeling through the lobby and out the door. We walked him to the back of the building and into a grassy area so he could get some fresh air. I was just in awe - here was my boy that just underwent this extensive surgery the day before up and smiling.

The Amazing Dr. Roa

Happy, Happy Boy

His Aunt Gina came out back and gave him some hugs which made him even happier. Dr. Roa and I took him back in and to his comfy spot in the recovery area and I sat with him for a bit while they hooked him up to his IV's. It wasn't long till he was fast asleep with his head on a big pillow.

Good Night

I resumed my position in the lobby feeling very relieved that he was doing so well. I was told I could see him again at 7:00 so I settled in to wait.

At 7:00 when I went back he was sound asleep so I kissed him good night and returned to the lobby.

Friday morning I got to go back really early and cuddle up with him for awhile.

Hugging the pillow

Later he was definately more alert.

But not for long....

Friday afternoon he was more like his own self as they were weaning him off of the big pain meds so that he could come home on Saturday

Happy Man

Friday night I waited for Dr, Roa to get finished surgery so I could ask him about Tonka coming home on Saturday morning. CVRC houses 6 practices in one building and one of those is the ER it became very apparent how much like a human ER it is on a Friday night with how busy it got. I got to meet with Dr. Roa and unfortunately Tonka had vomited and that is something to be very careful with after abdominal surgery so there was a chance I would not get to take him home like I had planned. I went back to say goodnight and tell him no more getting sick. Of course being Tonka he just laughed at me.

OK Mom

Trying to stay optimistic I drove home anyway and outfitted the truck with the bike hitch so that we could use Tonka's big stroller to get him home. Instead of lifting him into the truck I thought it would be easier on everyone to put him in the stroller and lift it in and out. I got everything loaded up and slept for a few hours before heading back.

Saturday morning I was there early and they let me go back and cuddle up with him and he and I fell fast asleep. Dr. Roa actually woke us up when he came by to check on him. 

He told me that we would see how he did throughout the morning and he would let me know by 9:30 if I could take him home. I took up my seat in the lobby and did some work on my laptop and sure enough around 9:00 I was told he was going home. I signed all of his discharge papers and they went over his post op instructions with me and gave me his medications.  I went out to the truck and put the stroller together and wheeled it in to get ready for him. Dr. Roa came out a little while later with Tonka in tow. He then helped me get him from the wheels to the stroller and we lifted the stroller in the truck. Dr. Roa gave me some last minute instructions, answered some of my questions and after I gave him a huge hug Tonka and I headed home.

Loaded in the Truck

Snoozing on the way home

Once home we wheeled around back and parked the boy on one of his favorite blankets to snooze away the afternoon.

Home

I really cannot thank everyone enough for the help and support through this. I am truly grateful!

Tonka Tonus Clonus!

I have taken to calling Tonka by his new name- Tonka Tonus Clonus.

If you follow the blog you know that he has an outstanding issue left over from whatever happened to him 8 months ago. The lack of a diagnosis or prognosis has left me with trying to understand his symptoms and controlling those. This is essentially what his therapists Chris and Diana work on every week. I have added acupuncture back in the mix with Dr. Philips and everyone is on the same page.

I wrote an article for Dogster about Tonka and someone (who does not know Tonka, does not know me, and I am assuming is not a Veterinary Neurologist) commented to the fact that if I loved Tonka I would have euthanized him so he did not go through all this misery. In order to be very clear to everyone I am going to try and explain what is going on with Tonka symptom wise so that you can understand that he is not in any pain, nor is he miserable.

First a picture of Tonka at the park NOT BEING MISERABLE

 

Tonka has something going on called Clonus which refers to repetitive, rhythmic contractions of a muscle when attempting to hold it in a stretched state. If you have ever had your eye twitch you will understand the feeling, not painful just annoying. It is a common sign in neurological conditions and is usually a sign of damage to the nerve tracts above the place where it is initiated. Tonka suffers from clonus and what is known as hypertonicity in his hind leg.

Every muscle has tone which refers to the amount of neurological input the muscle receives. Hypertonicity refers to the neurological system sending too many signals or a signal that is too strong to the muscle which makes it rigid. The inverse of that would be hypotonic or not enough signal and a “loose or floppy” muscle. In Tonka’s case we have a muscle with too much tone creating a joint that does not bend or straighten smoothly.  This also means he does not lift enough to always clear his toes off the ground and so he scuffs.

We created a little video to show you what I mean. Notice he is not in any pain even when he goes to sit and lie down; he just has to maneuver a bit.

 

The other leg had these exact same symptoms and disorders and they were resolved with therapy. I have faith that this leg will do the same.

The Meaning of Nothing

AP here:
Pondering the meaning of nothing.
I am not a big believer in nothing. I believe in cause and effect in which an action or event will produce a certain response to the action in the form of another event.
If you have ever studied philosophy or know anything about Karma you have heard of cause and effect - action and reaction.
In science this is one of Newtons Laws for every action there is an equal and opposite reaction, -something happens and something caused it .
In management cause and effect is used to predict outcomes and to locate potential problems within a process.there are even diagrams and charts to help narrow things down.
So what happens when you have an effect with no cause?

Something is causing Tonka's problems, something is having an effect on his ability to walk and balance correctly. I have spent 8 months now dealing first hand with this  "Somethings"   effects and am no closer to knowing what the cause is. Multiple Orthopedic Doctors,  Multiple Neurologists, many, many tests of different types and we have a big fat "Nothing" as the Cause.

The last place to look - his head and neck - was scanned using an MRI on Thursday evening.
His Canine Rehab Specialist (physical therapist) Chris came by to check on him and get the results first hand. She went over the results with Dr. McDonnell before I did and was with Tonka when they called me back. I could see her in the back on the floor with Tonka and was looking at her to see if I could get a read on whether I should be bracing myself for the worst. Dr. McDonnell then proceeded to tell me that Tonka has a beautiful head and neck and there is nothing visible that could be causing his symptoms.
Now I had joked with several people that this was my worst fear and you were going to have to pick me up off the floor if that was the verdict and here it was- a diagnosis of nothing.
I am sure my real reaction would have been puzzling to anyone not knowing the full story or the past 8 months.
I had just been told that there is nothing nasty lurking in his head and most people would be ecstatic and jumping for joy instead I was just dumbfounded. this was the last place to look - the answer was supposed to be here - good or bad we would know something.
Nope - nothing there - nothing to fix - no cause to his effect...

So what is the meaning of nothing? and just what do you do with nothing?

Chris and Dr. McDonnell had the only answer I can hold on to at the moment which is to "keep doing what we are doing". He has come a long way in 8 months so that is what we will do..

Therapy Rocks

AP here:
It has was a horrible weekend and a terrible start to the week. Tonka has been falling, crossing his back feet and just dragging his foot. We had therapy yesterday and this morning was still not great but this afternoon is a totally different Tonka.
Watch this video from the weekend.

Then watch this one from tonight.

Once again  Chris Fritsch and Diana Huey at CVSS have worked their magic.

Brief Medical Update

AP here:
For the past two weeks Tonka has been on a bit of a slide downward. he is still mobile but he is stiff in the back right leg which is his good (bad) leg and he has been falling quite a bit. It is almost as if the problem has shifted sides, not to the extent that we had in the beginning with the left but still presenting those same lame/weak symptoms. He does not pick that foot up high enough when clearing an object, it seems weak and has no traction and he collapses on that side when he does fall. He is hesitant to use the ramp and has been doing a little back and forth weight shuffle with the back feet while standing. He is not sleeping through the night and consistently and seems to have trouble getting comfortable especially lying on his side.
His amazing therapists of course are diligent about listening to my observations and checking him out thoroughly and are always brainstorming about what they can do to help him. I am always a little more positive when leaving therapy knowing that he is in such good hands. The people at CVSS are all so professional and caring as well as the other staffs from other practices within the building. I know that he is truly looked after anytime he is there.
A consult with an Orthopedic Surgeon, Dr. Roa and Neurology , Dr. McDonnell let us know that his therapists Chris and Diana are right on track with what they are doing for him and took their suggestion of adding a medicine called Gabepentin.
The Gabepentin should help if he is having what they call neuropathic or neurogenic pain which involves the reaction of the nervous system (brain, spinal cord and nerves) to injury. With neuropathic pain, the reaction in the nervous system to the pain actually makes the pain feeling worse and is commonly described as "burning", "electric", "tingling", and "shooting" in nature. This pain is usually worse at night and might explain why he gets me up so many times at night. I know it is not because he needs to go to the bathroom since he has no interest in going out if I open the door. He wants me to snuggle up with him and then he goes right back to sleep. He really is just a big baby.