Hazmat gloves & poop bags

A dog owns nothing, yet is seldom dissatisfied. ~ Irish Proverb

My biggest fear about subjecting my dog to chemo treatment was the unknown side effects.  I heard that chemo doesn’t affect dogs the same way it affects humans, and I also heard that they don’t push dogs as far with chemo as they push humans.  Both proved to be true for us, and Superdawg Asa tolerated it quite well… with a few quirks:

It’s dangerous

As I previously mentioned, Asa has been taking maintenance chemo at home everyday since he finished his IV treatment in the fall of 2010.  It’s called cyclophosphamide (a type of metronomic chemotherapy), and I should have noticed that the vet oncologist’s slang term for it is “cyclotoxin.”  Yes, I am administering a hazardous substance at home on a daily basis.  A compounding pharmacy in North Carolina ships a supply of pills to my house each month, and they come with a month’s supply of those blue hazmat gloves.  The bottle and the accompanying literature warn me not to touch the pill without the gloves on, and they instruct me to dispose of the gloves immediately in a sealed plastic bag.

It stinks

Holy overwhelming, smelly dog poop!  Let’s be honest – it doesn’t smell like roses to begin with.  All dogs have stinky waste and toots, and it’s just part of their “charm.”  Well, throw a bunch of hazardous chemicals into your dog’s body, and it takes on an entirely new level of dizzying grossness.  I can’t begin to describe the smell, and I’m sure you don’t need a detailed description.  It’s just gross.

Leave no man behind

Confession:  One reason I bought a house as a single girl (instead of a cute condo or townhouse in the cool part of the city) was to get a big backyard where my dogs could run and play and poop freely.  No more leash walks just for doing “bizness,” no more picking up after them every single time, not for this girl!!

Life’s little way of putting you in your place:  Since chemo makes Superdawg’s poop toxic, guess who’s back to scooping and bagging?  In her own backyard no less!  My neighbors now think I’m weird, but they never ask.

Even more fun:  Stinky, toxic poop must be double-bagged and safely disposed of.

Under a microscope

All of the above add up to laughs and inconvenience.  The bigger challenge for me has been the emotional toll of the monthly oncology checkups.  When your dog is poked and prodded and sampled and examined so often, they find things.  Lots of things.  Even more so because Superdawg is well past the average life expectancy for a dog his size.

For example, he was diagnosed with a heart arrhythmia, and the wear and tear on his kidneys has been exacerbated by the NSAID he takes to complement the chemo.  On a good note, though, the heart problem is controlled by a small pill twice a day, and his kidney issues (which could have been helped by the kidney diet dog food they prescribed but he wouldn’t eat) have been mitigated by fish oil pills.  Yep, the same ones you take for your brain and heart and whatever other reasons.

I get way more information than I bargained for at these monthly checkups.  I honestly can’t decide if it’s good to know every little thing that goes wrong.  I focus on the issues that cause him discomfort or pain or could be fixed by a non-invasive intervention.  I’m not willing to subject him to another surgery or uncomfortable experience.

Tell me about your experience:

1. How have you found humor or encouragement when dealing with your dog’s cancer?
2. What side effects has your dog experienced?  How did you handle them?
3. What are the monthly recheck appointments like for your dog?  For you?

Asa goes to chemo

(Photo by Alecia Lauren.
www.alecialaurenphotography.com)

Why does his hair look like that? ~ my nephew, age 5 at the time

Deciding to do chemo was an agonizing choice.  If I said no, Asa and I would only have 2-ish more months together before the cancer was supposed to metastasize very quickly.  If I said yes, we would potentially get a few more months together – likely no more than 6 months - and chemo wouldn’t be an actual cure.  “This kind of cancer always metastasizes,” I was told, and there aren’t any other “optional” organs like his spleen.  Its favorite next targets are the liver and the heart – both dealbreakers.

I thought and stressed and thought and cried, and it all came down to the fact that I wasn’t ready to accept defeat and do nothing.  To me, the chemo was a Hail Mary pass, not just something to delay the inevitable.  (At the risk of bragging, my dog turned out to be Tim Tebow.  Our Hail Mary pass found a talented receiver downfield, and we’re now just a few days shy of 19 months since his diagnosis)

So we went for it – 5 IV treatments of Doxorubicin at the vet school, spaced every 2 weeks.  Then we started daily metronomic chemo pills at home, starting 2 weeks after the 5^th IV treatment.

Before the 1^st IV treatment, our vet oncologist Dr. R.R. recommended a cardiac consult to make sure his heart was strong enough to withstand the chemo (it’s poison afterall).  Asa passed the cardiac tests, and I thought it was just more $$$ down the drain.  But…  a few months later, Dr. R.R. told me of another dog who was diagnosed with hemangiosarcoma and started the same chemo protocol at about the same time as Asa.  Her owner decided not to do the cardiac consult in order to save a little bit of money, but the dog’s heart wasn’t strong enough, and she died from heart failure brought on by the chemo…  So you’ve been warned.

Each IV treatment made for a long day.  We had to be at the vet school between 8-9am, so we’d leave home at 7.  They would perform a full physical, bloodwork, x-rays, and an ultrasound (which required shaving his torso from his armpits to his man parts – not a good look!).  After all those steps (including standing in line for the ultrasound machines behind emergencies and surgeries), they would put in the order for the chemo cocktail, which took additional time but couldn’t be requested from the pharmacy until he was deemed ok to proceed.

The price of the IV chemo medicine fluctuated.  Apparently the batches come in various bulk sizes, and of course, Asa just so happens to weigh too much for one size and too little for the next largest size.  For the first couple of treatments, there was another dog on the same chemo, so I learned I was splitting the cost of the medicine with that dog’s owner.  For the final 3 doses, we were going it alone – so the cost of the drug itself doubled.  Only a couple hundred dollars difference each time, but still, it was another variable in an unknown world.  I found it stressful because there were so many changing variables, and I didn’t know what would come next – or if he’d even survive to the next treatment.

I should probably dedicate an entire post to the oddities of canine chemo.  It was such a rollercoaster to go through, but now in hindsight with a dog that survived because of it, I have some handy (even humorous) insights.  So more on this topic next time...


Tell me about your experience:

1. What are/were chemo days like for you and your pet?
2. What risks and side effects were you warned about?  Which ones came true?
3. What do you know now that you wish you had known then? (about whatever topic you choose :) )

To chemo or not to chemo?

Scratch a dog, and you'll find a permanent job. ~ Franklin P. Jones

"Without chemo, he will probably live another 2 months. With chemo, he might live up to 6 months." Well, why would I subject him to the misery of chemo when it's only going to extend his life a few months???? I might have actually yelled something like that (with a choice word or 2 to emphasize my point) at Surgeon as he suggested that I have a sit-down with UGA vet school’s oncology department.

I did a lot of crying and somewhat pulled myself together, and a week later, Dr. R.R. the oncologist and I had that sit-down. It never hurts to have a convo and get the scoop, right? I mean, what if she might offer a miracle cure?? (nope! no such luck)

Her suggested course of action:

• Cardiac consult  to make sure his heart was healthy enough to take the chemo (chemo is poison, afterall)
• IV chemo Doxorubicin once every 2 weeks for 5 treatments (2 weeks x 5 treatments = 10 weeks)
• Daily NSAID pill at home to help the chemo’s efficacy
• After that 10 weeks, metronomic chemo - cyclophosphamide pill at home each day – and continue the NSAID… until the cancer metastasizes (the elephant in the room) 

Surgeon and Dr. R.R. – now one of my favorite people in the whole wide world – both gave lots of helpful info, but they were practical and sterile and honest about the pros and cons. That’s the right thing for a medical professional to do afterall. But I wanted some perspective on what it’s really like. I was still stunned that dogs could even get cancer!! And I sure didn’t comprehend yet that there was a whole vet specialization full of big words and drugs and poisons I couldn’t pronounce.

Then out of nowhere, 2 beautiful people - a knowledgeable vet friend of a friend and my colleague whose husband is a dog trainer - shed some light... chemo doesn't usually affect dogs the same way it affects humans. They usually don’t experience all the hair loss, nausea and diarrhea, lethargy, and the all-around rotten feeling. (Disclaimer: I don't know whether that's a medical fact or not, but it proved true for Asa) And the vet friend of my friend threw in some additional considerations for me to ponder:

• Can I afford it?
• How will it impact his quality of life?
• How will it impact my quality of life - financial trade-offs, all the visits to the vet school, setting a schedule around his at-home medicines, being available to let him outside more often (chemo can cause kidney issues if they don't go potty every few hours), delaying the inevitable loss of him?
• What maintenance regimen will they prescribe after the initial IV treatments?

So basically, a (not at all) straightforward, simple, everyday decision...............................

Tell me about your experience:

1. What factors informed your decision to pursue or not pursue cancer treatment for your pal?
2. Who was helpful in making your decision?
3. What is your dog's treatment protocol?