Greyt Matters

Okay, I confess.  I tried to bail out of the final chemo treatment.  I called the oncologist Monday afternoon and left a message saying I was thinking about calling it quits.  He called back on Tuesday and talked me into finishing the protocol.  I told him that I was concerned that the marginal benefit of this final treatment (of the harsh Adriamycin) would not be greater than the marginal cost.  He’s already had 15 treatments.  Could this 16th be all that important?  He assured me that it was definitely worthwhile.  He recommended that I keep the appointment, and he would determine if Sarge needed another week to recover or if he would go ahead with the treatment but at a reduced dosage.

As it turned out, Sarge got his treatment at a reduced dose.  Instead of 15.5 units, he got 14, which does not sound like a big reduction but it dropped the price by over $100.  So I don’t know how this dosing calculation works.

The oncologist also sent us home with lots of meds: 5 days of Cerenia (anti-vomiting, anti-nausea), 14 days of Prednisone (anti-inflammatory steriod), as needed Mirtazapine (anti-depressant, appetite stimulant), and 14 days of Pepcid (acid reducer).  We’ve finished the Cerenia, and I stopped the Mirtazapine a week after the treatment.  We are still taking the Prednisone (which unfortunately I forgot to give him this AM) and the Pepcid.  I was concerned about stopping the Mirtazapine cold turkey, but he seems to have done fine with it.

Sarge was feeling a little low and his appetite was depressed for the first few days after the treatment, especially in the mornings.  I  cooked a lot for him, e.g., ground beef meatballs with chopped spinach and grated carrots, macaroni and cheese, and chopped up mixed vegetables for one meal.   I also would get up every day and lay out this buffet of foods and see what he would eat.  What about this?  What about this?  We managed to find something he would eat at all meals (e.g., cottage cheese and a hot dog for breakfast), which was a big relief.  We hit bottom in terms of his appetite this past Saturday, but it got better every day after that, and we are pretty much back to normal now.  🙂

He has been shortening our walks a bit but he has been quite feisty in the house.  Lots of barking and spinning around in circles.  I’m assuming that his energy level will only get better too.

That's my boy!

On the phone before the treatment, the oncologist said Sarge may very well surprise me by how long he lives.  I tried to pin him down with a prediction when I went in to pickup Sarge, but the oncologist would not give me a time frame.  We will just be taking it one day at a time.

You have no idea how glad I am that this is over and that he is doing well.  Yippee!

It's time to celebrate!

Sixteen down and ZERO to go! 

Woooooooooo hoooooooooooooooooo!!!!!!!!!!!!!!!!!

Sarge is on an anti-depressant as of Friday.  :-0

I was expecting to pickup an appetite stimulant, so I was surprised to read the bottle and see anti-depressant.  My regular vet had suggested Mirtazapine when I took Sarge in to have him examine Sarge’s back legs.  I mentioned that Sarge’s appetite was decreased, and that’s when Dr. Fowler recommended that I try Mirtazapine.  He said it was an appetite stimulant but that it also made the dog “feel better” (and he pointed to his head).  Now I know what he was talking about.

Mirtazapine is a human anti-depressant and some of the side effects for people are increased appetite and weight gain.  Vets prescribe it for the beneficial side effects, and the mood enhancement comes as a bonus.

I was driven to call the oncologist about Sarge’s loss of appetite this past Friday morning when Sarge turned away from his morning meal, which was this yummy looking (and very expensive) steak soft dog food topped with rotisserie chicken.  At that point, I was seriously thinking about stopping the chemo before the 16th treatment because I was afraid of what the last round of Adriamycin would do to him and his appetite.  It would not be good if we stopped the cancer but then Sarge starved to death.

So I called the oncologist’s number and left a message about trying Mirtazapine (or something like it), and they called back and said I could go ahead.  They called in the prescription, and we started the drug Friday night.

After that first dose, I could see an improvement in Sarge’s appetite in just a couple of hours.  Plus he seemed more alert.  Things seemed to be going really well over the past couple of days, but when I got home this evening (Sunday), Sarge was laying on the floor near the door, and he did not get up to greet me.  He just laid there.  Oh no!  Flashback to the night of the high fever.

What to do, what to do?  I decided to test him by suggesting a treat.  Bingo!  He jumped right up and ran into the kitchen.  🙂

He’s been laying around this evening while I made some yummy turkey meatballs with spinach, rolled oats, and shredded cheese (with a side of baked sweet potatoes).  He ate his dinner (kibble topped with the yummy stuff) with enthusiasm.  And we also went on a long and perky walk tonight (with Sarge as navigator).  So I think he is okay.

I read online that drowsiness is the most common side effect of Mirtazapine for dogs.  So I guess that is what is going on.  I’m assuming that it may take some time for his body to adjust to the new drug.  I wonder if I will have to wean him off it when we think it is not needed.

Note:  We are still doing the 15 mg of Pepcid, which hopefully is helping with the sour stomach.

I hate to put Sarge on these extra drugs but I was also hating to see him not eating.  I’m also hoping the Mirtazapine will revive the Sarge “spark,” which I’ve been missing for many weeks now.

If this Mirtazapine really helps Sarge, I may have to get my own prescription.

One for Sarge, one for me.  One for Sarge, two for me…

Woo hoo!  In two weeks, we are done, done, done!

Sarge had his last round of Vincristine this morning.  Overall, he has been doing fine today:  lots of snoozing, a couple of walks (including one to the pet store down the street where I spent $28 on very expensive dog food and treats), and two Kongs for snacks.

I asked the oncologist (via a written note – haven’t seen the man in months) if I could give Sarge a glucousamine supplement to help with his joints, and he said that would be fine.  It will not interfere with the chemo drugs.  In particular, I asked about that Missing Link and he said “no problem.”  Sarge’s back legs seem to be doing better than they were last week but he is still weaker in the back-end.

I asked the oncologist if he thought the weakness in Sarge’s back legs could be the cancer and he said that he did not think so.  Whew!  I didn’t think it was either, but paranoia reigns.

The end of treatment always seemed so far away so I never bothered to ask what happens when we are done with the treatments.  Since the end is just around the corner, I remembered to ask the vet tech what happens after round 16.  Is there any kind of follow-up appointments?  She said that I would meet with Dr. Hamilton when I come to pickup Sarge after the 16th treatment and at that time we would discuss follow-up.  She expected that I will be bringing Sarge back for an exam about 6 – 8 weeks after we finish the protocol.  I told her that I was anxious about giving Sarge another round of that Adriamycin since his appetite still hasn’t fully recovered from the last round.  She said they could send me home with something stronger than Pepcid to use as a prophylactic.  I want my boy to be the enthusiastic eater that he has always been.  I can’t deal with two picky eaters.

One thing I noticed today while we were walking back from the pet store…Sarge’s gums on one side were bleeding a little bit.  😦  I have never had his teeth cleaned and, needless to say, they are not in the best of shape.  But I have never noticed them bleed before.  Maybe his mouth hurts, which is making him less interested in eating.  Waaaaa!!!  I just want everything to be normal.  No more problems!

I used to be much better at dealing with stress.  Now I just want to crawl into bed and pull the covers over my head.

I’ve had Sarge on the 15 mg of Pepcid per day for most of the past two weeks, and I think it is working.

Sarge’s appetite has been decreased since he had the Adriamycin on January 19th; not terribly decreased but he definitely has not been eating with his usual enthusiasm.  As a result, I have had to get very creative with the meals over the past few weeks.  (Remind me to post the recipe for doggie meatloaf, which I made – and sampled – this past weekend.  Quite tasty.)

His appetite has slowly gotten better over the past couple weeks, but last night we seemed to have a bit of a breakthrough.  Sarge actually came into the kitchen when I was making their Kongs, and it seemed like he might be interested in our usual “throw the kibble on the striped carpet and use your sense of smell to track them down and eat them” game.  We’ve played that game just about every night since I got Sarge, but he has not been interested in searching down the kibble over the past few weeks.  Last night he ended up not wanting to do it either, but he did come in the kitchen and show a little interest.  Progress.

The best thing is that he ate several small batches of kibble mixed with goodies for his late night snack.  And he ate each of the batches with enthusiasm!  I was very happy to see that.

Note to self: I’ve been giving Sarge his Pepcid at night before we go to bed, and I’ve served it with his late night snack.  Well, I just read on 1800PetMeds that I am supposed to be giving the Pepcid on an empty stomach because food decreases its effectiveness.  Oops!  Maybe we will see even more progress if I don’t serve food with the Pepcid.  Given the frequency of Sarge’s meals though, I don’t know when I’ll be able to manage a Pepcid on an empty stomach unless I stop his late night snack.

I was going to ask the oncologist if I could up the Pepcid dosage to 20 mg per day, but 1800PetMeds made me reconsider.  It says “Use famotidine with caution in animals with heart, kidney, or liver disease,” and “When given with azathioprine, famotidine may further decrease white blood cell counts.”  Sarge is not taking azathioprine, but chemo, in general, tends to decrease white blood cell counts.  And you know I’ve been obsessing about the “cumulative cardiac toxicity” of the Adriamycin.  So…..I will not be asking to up the dosage of the Pepcid.  We should be able to improve the effects by moving to the “empty stomach” approach.

And, oh yes, what about the weakness in Sarge’s back legs?  I took him to my regular vet this past Thursday, and he thought Sarge did not have a neurological problem and he also did not think Sarge has that lumbosachral stenosis.  Thank goodness.  The vet did, however, detect that Sarge has some tenderness on his spine about 6 inches up from his tail.  I believe he said that it seemed to be musculoskeletal in nature, and that it could be arthritis.  He started to prescribe a pain med, e.g., Deramaxx but I asked if we should do that given that Sarge has two more rounds of chemo left to go.  He reconsidered because he said the Vincristine can be hard on the stomach.  So then he recommended that we try giving Sarge supplements of glucosamine.  I did a little searching, and this “Missing Link Plus with Joint Support” seems like it might be worth a try.  I am going to ask the oncologist about it tomorrow.

I’m very glad that Sarge seems to be feeling better now.  Just in time to have another round of chemo.  Poor boy.

Hang in there.  Only two more to go.