Sunday, January 31, 2010
It seems with each chemo treatment of Vincristine, Jack has a harder time with it. Rather than the usual “Vincristine Funk” of lethargy, Jack really became ill from it this weekend. He was fine on Thursday, but really wasn’t feeling good on Friday and even vomited for the first time since we started chemotherapy in October. He refused dinner on Friday night – also a first. In addition, Jack had diarrhea and was generally one unhappy boy!
By Saturday evening, however, all systems were returning to normal and Sunday was the average “funk” day of sleep but he was otherwise happy with a good appetite. As of tonight, we appear to be back on track.
A couple of weeks ago he had his check-up with his cardiologist, Dr. Hosking, for progress on his underlying heart disease. Although most things were stable, she determined that he now has pulmonary hypertension sufficient enough to warrant medication. Sadly, the medications that exist for this condition do not yet have generic equivalents and so they are very expensive. Granted, if Jack was human with this condition and had insurance, the cost would still be expensive but do-able. The cash price of this drug is over $500 per month. Ouch.
We are looking to see what options may exist, and Jack’s oncologist, Dr. Rebhun, is checking with the cardiology department at UC Davis to see what they prescribe for their patients with this condition. Jack is certainly not the only dog with pulmonary hypertension, and we are not the only people who consider $500+/month to be cost prohibitive! We don’t give up easily, so we’re gong to pursue every alternative we can think of. Stay tuned.
And finally – today marks 16 weeks since Jack was diagnosed with lymphoma. For those who have been following along, you know that he was only given 4 – 6 weeks to live at the time of diagnosis. So far it’s been an amazing journey with plenty of peaks and valleys, and as we look back we can say with certainty that we have no regrets and look forward to every new day that Jack is still with us.
Wednesday, January 27, 2010
Jack's chemo treatment today went off without a hitch. His blood test results were good - anemia has stabilized or slightly improved, his platelets are well within the normal range, and his white cell count remains normal. All good news!
We have learned that the white cell count is the most critical for chemo patients and the thing that apparently is the most likely to change throughout the treatment protocol. If it falls below normal, we have to suspend chemo until it recovers. Despite Jack's many health issues and his "mature" age, his white cell count has been in the normal range since day one, which is why we've never had to postpone a chemo treatment. The only numbers that did suffer were his platelets and those associated with anemia, but both have either recovered or at least improved slightly.
By the way, Jack's weight also remains stable. Although he's a few pounds more than he should be (just like his Mom and Dad), we're not too concerned because cancer dogs often lose weight. Honestly, each time he gets on the scale and it's the same as last time, it's a bit of a relief! Now, if only I could feel the same way every time I get on the scale...
Tuesday, January 26, 2010
Wow! There’s just no other way to describe Jack’s walk today.
Linda, Jack, and Jenny headed to the mailbox this afternoon, thinking that’s as far as Jack would want to walk. As we’ve posted before, the mailboxes are about 2 blocks away. On Sunday afternoon, Jack didn’t want to walk much at all, and Linda actually thought that perhaps we had reached the point where Jack couldn’t go for walks anymore. Still, today he insisted on going with Linda and Jenny, so we thought the mailboxes would be our maximum destination.
As we walked up the street, a UPS truck came up from behind and passed us. Jack pulled on his leash with all his might, trying to gallop after it. That got the adrenalin flowing! We turned into the park just behind the mailboxes, and he started trotting toward the sagebrush (just beyond the grassy park). The trails make a large figure 8, with our mailboxes at the south end. Usually we turn left at the bottom of the 8 but this time Jack decided to go right. Linda let him off his leash, and he walked all the way to the other end at the top of the 8! He needed no coaxing at all. For those of you who know our trails, this is the part that runs along behind the houses.
If we had left it up to him, Jack would have kept going and made the full figure 8, but Linda didn’t really feel like getting out to the furthest distance in the sage brush, only to have him wear-out. So they came out at the north end and walked back along our street on the sidewalk.
This was an amazing walk for Jack. He hasn’t walked on that stretch of trail in many months – probably since last spring or summer – and he clearly enjoyed himself. Jack continues to teach us to take each day as it comes and to just live in the now. As one of our readers, Lynne, reminded us, that’s why “today” is a gift we call the “present.”
Monday, January 25, 2010
We started giving Jack Metacam again for his arthritis. Our experiment to see how long he could go without it – after an acupuncture treatment – ended on Saturday when he was visibly hurting. It took a couple of days on Metacam and he seems to be okay again… not as stiff. He still really thinks about lying down and we can see that his hips hurt, but he’s getting around easier and he’s able to stretch again.
This coming weekend will be 4 months (16 weeks) since diagnosis. It’s hard for us to believe. We agonized over the decision about whether to do chemo, and in hindsight we see it was exactly the right decision for us. He still goes everywhere with us, still enjoys his meals, still plays with Jenny, and still takes his two favorite toys (the “flip-it” and his Kong) outside to enjoy... which means carrying them through two dog doors (one from kitchen to patio room and one from patio room to the yard) and lying in the grass to happily consume their contents. He still follows us through the house from room to room and barks with reckless abandon while we’re fixing his meals - to be sure we get it right.
Jack and Jenny stopped by Linda’s office last Thursday afternoon to say hello to everyone. Several people remember the day Linda’s co-worker picked him up in the desert and brought him to the office hoping to find him a home. He has been a fairly regular visitor and is known to almost everyone, but he hasn’t stopped in since his diagnosis. Everyone commented on how great he looked. I think some people were expecting to see a sickly-looking dog but instead he checked-out everyone’s trash bin looking for leftovers and generally acted like a normal, mature dog.
Jack has Chemo Treatment #11 this week – Vincristine – so we anticipate the “Vincristine funk” this weekend. Having treatments every-other week has been a pleasure and I know Jack is happy for it.
Saturday, January 23, 2010
Jack responds extremely well to his treatments with Dr. Beebe. So well in fact that we decided to see how he would do without taking any Metacam for his arthritis. We were curious how long it would take before we noticed any signs that the stiffness or discomfort was coming back. Answer: today. So Jack got Metacam with his dinner tonight, and should be feeling much better by tomorrow. He had a pretty active day yesterday – helping John clear snow off the patio, driveway and sidewalks, and today the sun was finally shining so we took a nice ride to Markleeville for lunch.
Tomorrow is 15 weeks since diagnosis, and if the weather holds off we’ll see if Jack wants to celebrate with a walk in the park.
Wednesday, January 20, 2010
We braved the elements yesterday and made a trek over the mountains to see Dr. Beebe in Sacramento. A series of storms is pounding us this week and all of the highways have chain requirements, unless you have a 4WD. Thankfully, Jack’s fleet includes a Subaru Forester, so off we went.
Let’s just say that coming home yesterday over Highway 50 was the winter wonderland you see on Christmas cards. The trees were plastered with snow, the scattered cabins had feet of snow on their roofs with a few lights here and there in the windows, and there was no one on the road but us!
Dr. Beebe (http://integrativeveterinarycenter.com) is treating Jack primarily for his anemia with an herbal remedy and for his arthritis with acupuncture. She did the electro-acupuncture and Adequan injections again yesterday and he responded very well. Tonight his eyes are bright and he’s a very happy boy. It’s absolutely worth the trip down there for these kinds of results. We’ll take him again every two weeks for a couple of months so he can get the full benefit of these treatments. After that, we should be able to go on a slower maintenance program and see her once a month.
Really, when you consider his prognosis back in October, the fact that we’ve reached this point and are even talking about a longer-term maintenance program is remarkable! I asked Dr. Beebe yesterday what she would recommend once Jack comes out of remission, and her answer was “How about we do everything we can to keep him in remission?” I like that attitude. Once he finishes his chemotherapy regimen, we’ll see what she can do to help us stay in remission for as long as possible.
Monday, January 18, 2010
We had a good appointment this morning with Jack’s cardiologist, Dr. Hosking. We haven’t talked much about his heart disease because this website is about his lymphoma. In fact, Jack has several things wrong with his heart that we’ve known about since July 2008, most of which were stable for a year and then got worse by July 2009 when he had to go on two heart medications. We thought it was progression of his heart condition that was slowing him down when we found out he had lymphoma.
Of course, deciding whether or not he could handle chemo was based largely on concern that it would negatively impact his heart. We didn’t want to speed up his heart disease, but if we hadn’t done chemo, Jack would have been gone by Thanksgiving. Looking back with the hindsight given to us after 14 weeks since his diagnosis, we can happily say we made the right decision. But trust me, it was a tough decision to make for fear we would further harm his heart.
As it turns out, he still has not reached congestive heart failure (HOORAY!) and most of his problems are pretty much stable (double HOORAY!). Dr. Hosking actually used the term “Stable Mable” which is what we wanted to hear. However, the right side of his heart is now becoming enlarged (left side has been enlarged for a while) and his tricuspid regurgitation is worse, which means he has pulmonary hypertension. Dr. Hosking is looking to see what options we have for medication that won’t completely break the bank.
After our appointment, Jack, Jenny, and I took a drive to Reno for a walk before the snow storm, and to have lunch with John (we are enjoying the holiday… John is working). As I drove home from Reno and thought about our visit with Dr. Hosking, it occurred to me that Jack’s heart disease is progressing as heart disease does, and this is probably the news we would have gotten today with or without lymphoma. I don’t think the chemo hastened the progression and it certainly didn’t throw his heart into irreversible trauma or shorten his life.
So despite some progression of heart disease, our boy is still here… he’s still in remission… he still enjoyed his walk in Reno… and he still enjoyed his car ride, barking at every UPS truck or UPS truck in disguise (i.e. FedEx) that he could see.
I also want to mention one of the ways we measure time in his house. One of Jack's heart medications, Vetmedin, comes in bottles of 50 pills. At 2 per day, each jar lasts us 25 days. We order them from Drs. Foster and Smith. I placed an order in early September and accidentally ordered 4 bottles – I usually order 2 at a time. When I realized my mistake, I thought “Uh-oh. We’ll never use all 4 bottles. He won’t be here that long.” I even made contingency plans for where to donate the left-over medication to a rescue organization with a dog who also has heart disease.
I ordered those 4 bottles before his lymphoma diagnosis when I thought we were only dealing with heart disease and the risk of sudden heart failure due to his arrhythmia (which is better, by the way!). When the lymphoma diagnosis came and we opted for chemo, I knew we’d never use all 4 bottles…
We’ve now gone through those 4 bottles and I had to order more! We’re almost done with Bottle #5, about to start Bottle #6, and I’ll soon have to place yet another order for 2 more.
Life is good.
Sunday, January 17, 2010
It’s hard to believe another week has raced by – Jack handled his cyclophosphamide treatment very well with only a little fatigue over the weekend. Today marks 14 weeks since diagnosis, and the lymphoma remains in remission. In fact, Jack is doing well enough with his cancer treatments that we’ve scheduled a check-up with his cardiologist for tomorrow. Jack has been fighting some fairly serious heart disease for quite a while, and when he was diagnosed with lymphoma we had to re-focus our efforts. We’re anxious to see the results of his tests and are hopeful that there has been no further deterioration or weakening of his heart over the last three months.
For those readers that have been following along, you will remember that we visited UC Davis last December 5th when the UC Davis Vet Aide Club was holding their fundraiser – pet photos with Santa. We had a great time, and met some really great “future” veterinarians. At the time, one of the girls started taking photos of Jack, somebody gave him a Santa hat, and it was nothing but fun. We have kept in touch, and she recently sent us the photos. This photo was just too cute not to share – it’s Jack with Ali Wunderman (Vet Aide Club member) in a photo taken by Anjolie Daryani (Vet Aide Club member). Anjolie also asked if they could use a photo of Jack in their calendar this year. As soon as we have the link, we’ll put it up so any readers who would like to support the UC Davis Vet Aide Club can order one.
Tuesday, January 12, 2010
In anticipation of Jack’s chemo Treatment #10 this week (pills he takes at home for three days), we went for a blood test and overall check-up today with Dr. Schneider. Good news! His anemia is better, his platelet count is up, and his white blood cells remain normal. He still appears to be in remission and his blood pressure is good.
It just doesn’t get any better than that! So we’re on target for chemo this week. Next Monday, he has a check-up with his cardiologist, Dr. Hosking, who hasn’t seen him since September (pre-diagnosis). We have some anxiety about that visit because we’re hoping his heart disease is no worse. There certainly are no outward signs of any change.
By the way, Jack has a new friend in New York who found our website and contacted us. She’s an adorable miniature schnauzer named Betsy… who has her own website! Her Mom asked if she could put a link to our site on her site, and of course we said yes. Check out Betsy at: www.betsyboo.net.
Sunday, January 10, 2010
Jack has responded well to his treatments with Dr. Beebe. We have noticed an improvement in his mobility and interest level, but his stamina remains low. We’re pretty sure having the extra week between chemo treatments is also contributing to his well-being. In fact, Jack was feeling so good this weekend that we decided to take a day-trip down to Sacramento and Davis to get out of the fog that has settled into our area for the last few days. As we drove up into Hope Valley we enjoyed blue sky and bright sunshine. When we made our ‘rest stop’ in Placerville it was sunny and 60 degrees. The only problem with our plan was that Sacramento was fogged in too. Oh well. Jack got a great ride, a nice walk on campus, and a side of roast turkey from Pluto’s out of it all. Today he stumbled a little bit coming down his steps out of the car, and seemed stiff at first but once his hips loosened up he trotted around more than we’ve seen in a long time. He’s definitely ‘interested and engaged.’
Today marks 13 weeks since diagnosis. What an amazing journey it has been for us all. Now that we’re in the third cycle in his protocol, and the treatments are every other week rather than weekly, there hasn’t been as much to write about so our blogging has slowed down a bit. Going forward we’ll continue to post several times a week providing updates as things come along. This week he has his blood test on Tuesday and Treatment #10 (Cyclophosphamide) beginning Wednesday. We’re going to be looking for improvement in his red cell count this week since the numbers were low on his last test.
And thanks again to everyone who has been following along with us and sharing words of hope and encouragement – it is deeply appreciated.
Thursday, January 7, 2010
Today was our trip to Sacramento to see integrative vet Dr. Beebe (http://integrativeveterinarycenter.com). She hasn’t seen Jack since November 16 – only a few short days after that awful nosebleed incident. Jack’s Grandma (Linda’s Mom) went along for the ride, and we pulled out of the driveway right on schedule at 7am. There was a bit of snow on the roads but nothing too bad, and we ended up getting to Sacramento by 9:35 for our 10:30 appointment.
How to kill time? Coincidentally, Dr. Beebe’s office is a short distance from Squirrel Park, which is actually named East Portal Park. We’ve visited this park for many years and it has always been one of Jack’s favorite places – it’s literally crawling with squirrels and is a very nice and very clean city park in a nice, older neighborhood with huge old trees.
Today it lived up to the nickname Squirrel Park and Jack and Jenny had a good time chasing after squirrels, pulling Linda first in this direction, then in that direction… It was an unexpected surprise today and tired him out before seeing Dr. Beebe.
She was very pleased that Jack has finished his weekly chemo treatments because this will allow us to do some good holistic work between treatments. We are thrilled to have found a vet like her who has been doing this for 20 years and who fully understands and appreciates the need for western medicine, while being able to support Jack’s health needs and help him through his treatments with a holistic approach.
Dr. Beebe was concerned about his arthritic hips and could see immediately that he needed some additional care. She gave him some small injections of Adequan, (http://www.adequancanine.us/) which specifically supports cartilage health and helps to stop or even reverse the affects of arthritis. In fact, last summer we met a lady and her dog at Squaw Valley who told us her dog wasn’t able to walk at all until his vet gave him Adequan, so when Dr. Beebe mentioned it, we were happy to try it.
She also gave Jack an acupuncture treatment with the needles hooked up to electrodes. Jack took it like a pro and was very relaxed. In fact, he was more alert and happy in the car on the way home after his treatment, than on the ride down.
The other concerns we discussed were his anemia and platelet count, both of which have been adversely affected by the chemo. Dr. Beebe said she will be able to help that with a good blood-supporting herbal supplement, and if all goes according to plan, we should start to see improvement in those numbers in only a couple of weeks. We hope so!
Meanwhile, she thought Jack looked good and agreed that he’s tolerated his chemo treatments as well as could be expected. She seemed pleased with his progress.
It was a great visit and we plan to see her again in a couple of weeks for another check-up and treatment. Let’s hope the weather cooperates!
Wednesday, January 6, 2010
Yesterday we headed out for a walk after work to enjoy the nice weather, and walked around the block behind our house. Jack trotted for the first half, but really plodded along for the second half. So today Linda decided to take Jenny for a good walk and leave Jack home to rest. He looked very tired and Jenny really needed a decent walk.
The minute Linda and Jenny headed quietly for the front door, Jack marched along, wagging his tail. Linda told him he should stay home and rest, but he would have none of that. They leashed him up and took him along… once again thinking a walk to the mailboxes would be all he could handle (2 blocks away).
He trotted almost all the way to the mailboxes and headed out into the park... sniffing everything along the way. They would have easily made it to “the dirt pile” mentioned in the Christmas Day blog, but the snow is melting now and the trails are quite muddy. Although not as far as Jack would have liked, they had a very nice time. On the way back out of the park, a UPS truck went by the mailboxes and Jack went nuts. He’s always had a “thing” for UPS trucks and still does. He and Jenny started barking and jumping around, and pulled Linda much of the way back home, trying in vain to catch the elusive truck.
Tomorrow is our rescheduled trip to Sacramento to see Dr. Beebe – the trip that was postponed from last week’s snow storm. And yes, tonight is the only night this week that we have the chance for snow, but it’s a slim chance and the snow level should remain high. Barring some freak blizzard, we’re going no matter what.
Monday, January 4, 2010
Jack’s feeling good today! He slept well last night and was animated for breakfast… feisty at lunch… and gave Dr. Rinehimer “the business” during his acupuncture session this afternoon. He certainly made her work for every needle she put in (he always gets 15). Since we got home this evening, he’s got a big smile on his face, his eyes are bright, and he’s in the middle of everything.
That’s my boy.
Sunday, January 3, 2010
HAPPY NEW YEAR! It’s been a busy Holiday season at our house, but things are gradually getting back to ‘normal’ – as ‘normal’ as living with a lymphoma dog can be… We managed to stay on schedule with acupuncture last Monday, and Treatment #9 (Vincristine) on Wednesday evening. This marks the start of the third time through the chemo cycle and by now we’ve got a pretty good idea what to expect. Vincristine is the toughest on Jack of all the treatments – it really zaps his energy. We call it the ‘Vincristine Funk.’ It usually hits full force by day 2 after treatment, and lasts until the afternoon of day 4 and this time was no different. On the bright side – severe fatigue remains the only noticeable side effect from the chemo. Jack’s appetite remains strong, his eyes are bright and there is no question that he is interested and engaged.
Today marks 12 weeks since diagnosis. This is truly remarkable when you recall that Jack was given just 4 – 6 weeks to live without treatment. From the beginning, Jack’s quality of life has been our number one priority and watching him continue to eat, beg for car rides, initiate play with Jenny, hop up on the bed in the morning for treats, and generally act like a dog all tells us that he’s doing as well as can be expected with chemotherapy.
Now that the protocol changes to treatments every-other week there’s a little anxiety that he may come out of remission. If so, there are still a few options available to us but we will cross that bridge when we get there. One of the greatest lessons we’ve learned from our dogs is to celebrate the ‘is’ not the ‘was’ or the ‘what if.’ So we enjoy Jack’s company every day, and every day is something special.