More Delays....but things move on

Millie continues to do well and, thanks to her friends, has an ever-widening wardrobe to show off...

 She just finished the most recent of the set of four treatments, after not being able to receive treatment last week because of low white cell counts. Now...a two week hiatus before beginning the final set of four treatments.

Her energy and spirits remain good. She is tired of taking pills and gets better at extracting them all the time. But she runs and plays at the park and Doggie Daycare and is our same lovable Millie.

Dr. Fulmer has decided that the dips in white cell count are always following the same drug treatment, so for the final set of treatments, they are going to adjust the dose.

Millie had a great stay at Four Paws while K and I were in New Orleans....but Kyle pined for her. We got back on Monday, but couldn't pick her up till Tuesday...Kyle lay in her spot on the bed and brought one of the stuffed hedgehogs they both love up to keep him company....disgustingly cute.

Finally, a little video clip, showing how Millie still has the stamina to run at the park.

How quickly time flies

1 month has passed since the last post. As the saying goes...no news is good news. With the holidays approaching it has been a bit of a whirlwind. The good news....at this time Millie is in complete remission. The treatments continue and we are passed halfway. All this month her energy level has been high and her appetite normal. The only treatment frustrations are that she has had to delay several treatments due to marginally low white blood cell count. That makes the treatment seem longer to get the the last one. Also...for those of you keeping count...every time there is blood work to check for blood cell count...there is a bill. So from first consultation to now...including extra blood work and extra antibiotics when the count is low.....probably an extra $800. I don't feel that is too excessive from what we were originally quoted...merely giving you all the details. Over the last month I had hoped to get some film footage of Millie running at the park so you can SEE how great she is doing.....but I often forget the camera or she is shy once the camera is rolling. We are hoping to get some footage posted soon.

A New Coat!

To help Millie through the winter months, her best doggie friend Scarpa's mother made this smart looking coat for Millie. She took to clothing right away at the dog park this past weekend, running and playing...."just as if she had always lived in a land of bibles." (Mark Twain)

The Story Goes On...But How Would You Know?

I have been really bad about posting. It has been a rather busy month, both work-wise and personally (we celebrated our anniversary and my birthday) And I suppose it's true that anything...even cancer treatment can become routine. I feel particularly bad I haven't shared this photo, showing Millie and the great team at VEC we visit most weeks now. Notice how happy and relaxed Millie is....she just can't figure out why Dad is playing with the black box instead of her!
They continue to be wonderful with Millie and Millie has been as good and patient with the process as she has from the beginning.

She also has not lost as much hair here as she did over the next several weeks. The irony is, although she has not lost a single pound, the hair loss on her face has actually given her a little of that emaciated look we associate with human chemotherapy patients:

The sides and underside of her nose are almost bare and she has lost so much hair around her eyes she looks like she has black eyes. Her skin has always been variegated and the hair loss has really revealed that. She still is cute, though!

The timing seems to be bad as well, going into winter.
Millie usually adores cold weather, and particularly snow....will just bury her face in it...this winter, she may need a coat! We are assured that when the treatments end, the hair will grow back! Till then, vacuuming daily!

We are now exactly in the middle of the full course of treatments, in the midst of her "break" before starting the beginning of the third set of four four-treatment sets. The last treatment of this past set was, once again, the Doxirubican.  This time, we prepared and treated with antinausea and antidiarrheals from the start. She had a little dip in appetite, but no vomiting or diarrhea and her energy level has remained good.

We also dealt with a separate problem which was not caused directly by the chemo, but perhaps may have been exacerbated by her fatigue from the treatments. Millie has had a few spats of incontinence, which has never been an issue for her, but is not unusual in spayed females of her age. After a checkup and discussion with Alex (and one more incident) we decided to put her on medication for that....so far, so good!  It is worth pointing out that dogs definitely learn.....Millie has quickly gotten really good at avoiding pills in just about anything...even peanut butter, the magical canine pill elixir!  

Here at the halfway point...I must say I have not for one minute regretted our decision to do this. There have been hurdles but it has been remarkably smooth most of the way and Millie's energy and happiness level  have remained high. The only thing I really wanted for my birthday? For Millie to be here for my next one!

WOW 15 days have passed no posts. Well sometimes life gets in the way of good intentions. Lets get caught up. After the storm of stomach issues with the one drug....she had a FANTASTIC weekend at the park. Her energy was way up. She had a week of no treatment as the schedule goes several weeks on and 1 week off before you start the next cycle. In the last 2 weeks though I have noticed significant hair loss. I have been told by others....if I didn't point it out to them....they would not know. However being her Mom I notice and the rugs and couches notice as well. She started cycle 2 last week and refused to eat part of the weekend so clearly her stomach is still being bothered a little. We have some medication for that and within 24 hours she was eating again. This week 9/30 when she went in for her treatment....her white blood cell count was too low so this treatment will have to be pushed to next week. We were also given a prescription for an antibiotic so her body can fight off germs that right now her blood cells cannot. Her energy is still great though and watching her she seems to feel fine....tail wagging.....ready to go.

Back To "Normal"-Reflections on a Cheese Wrapper

It is perhaps a measure of how bad the last few days have been Millie that I was delighted to find a chewed cheese wrapper on her blanket tonight. This means that Millie was feeling well enough to rummage in the trashcan (a habit from her street days she hasn't entirely given up) Although still low on energy, Millie is back to eating her regular food and sleeping without needing go out every 45 minutes. There were many paper towels, a lot of Nature's Miracle and a lot of culinary experimentation over these days....I joked with Kimberly that Millie was telling the other dogs at the park that they should try not eating: "It's AMAZING what they will feed you!"  Dad and Millie did split a hamburger at one point, gravy got added to food...also cheese...we tried eggs. Very little went in....what did was not there long. And I don't think I really appreciated to irony of oral medication for nausea till now...that would not stay either. (a side note on Kaopectate, which we tried because my mother had success with it for their dog....it doesn't stop the diarrhea, but it does make it darker and harder to clean)  But now we are on the other side (after an added $200 vet visit) and we will approach the Doxirubican with much more preparation next time. Still on track to start the next course on the 22nd.

murphys law

Clearly I posted a little too prematurely the other day. We have endured about 36 hours of liquid from both sides of Millie. No food staying down. Plenty of baths for our sweet girl. The Oncologist does not work on Mondays so we did not see the doctor until today. The good news is that the sickness is simply a reaction to the most recent chemo med used. Her white blood cell count looks good and her UTI is completely gone. She was given a shot of liquid to help rehydrate (and she was only marginally dehydrated) they also prescribed some meds to help with both the coming and going. Moving forward when she has the appointments that require the tough drug...they will go ahead and prescribe some of the other meds so she doesn't feel so bad from the start. So tonight we are still taking it easy but she has eaten a little and kept it in so I will be thankful for that.

Please eat

At this time Millie has not actively been nauseous or had diarrhea....however she continues to turn her nose up at food. I had bought the same company food for her this last purchase but in the senior formula hoping it would give her some added vitamins. After the first 2 days of eating it...she just simply won't. I have tried adding broth, gravy, steak whatever and can still only manage to sometimes get her to eat a minute amount. I tried to purchase the old food and it seems Purina has reformulated all of the Purina One foods and she won't eat this either. I'd like to say that it is simply the food she does not like but she also turned down a cracker with peanut butter which is unheard of for her to do. We gave her another anti nausea pill. I have seen little improvement. I know she has liked to steal the cat's food on occasion and I did manage to get her to eat a half cup of cat food. I went to the store and bought a brand we have used in her past and she would not eat that either. Her energy level this morning prior to going to the park was up but she has tired quickly today.

Rough Times-Next Chemo

Following the last chemo treatment, Millie's energy level was noticeably lower and she had two days in a row where she was reluctant to eat. We gave her the anti-nausea medication a few days and everything seemed to level out. She also had one little incident of incontinence. This latter fact led both us and her docs to suspect that the UTI might still be playing a role as much or more so than the chemo.

Today Millie went in for her first doxorubicin treatment. She was a little low energy today and her white count was down a bit, but not so low they wanted to delay treatment.  (her energy level may be in part due to being up a lot during the night because of constant thunderstorms) Now that she has completed her antibiotic treatment for the UTI they did an ultarsound and found the forward wall of her bladder a little thick, so they got a urine sample and sent it to be cultured. This way if the UTI reasserts itself, we will know what we are dealing with.


Today took a bit longer since they have to place a
catheter and administer the doxorubicin over a 30-45 minute period. It is worth noting that these treatments cannot be much fun for Millie and yet clearly the staff treat her with great compassion and affection....she always comes out wagging and not in the least fearful of them.

The docs consider her to be in partial remission right now and seem to expect full remission by our next visit...Millie gets a break now, we don't go back till the 21st!

August 30 Back On Track

As Kimberly posted, they did not treat Millie at her last appointment because of low white cell count....not really unusual at this point. Today we were scheduled back and her white count was back up. So she was given the third treatment (Vincristine) and sporting a pink bandage, we were back home, where Millie's feline brother Kyle was waiting and concerned:

Week 3

Starting the week...Millie and I went to the dog park and all was well. Her energy level was moderate and still enjoyed herself digging and socializing with the other pups. Her energy level remained moderate this week so I did not feel she needed to run off any excess energy at 4 paws. Her UTI has subsided although we still have some more days on the antibiotic. She has been weened off the Prednisone. Wednesday morning she had no appetite. I put the food in her bowl and she just sat next to it. Could be multiple things....sour stomach from the antibiotic, adjusting to being taken off the Steroid.....sense of smell could be off (dogs generally won't eat what they can't smell) or maybe the whole Earthquake and impending Hurricane is upsetting her. Todd spoke with the Doctor and agreed it could be many possibilities and did not feel like it was a big concern yet. She did nibble at her food a little in the morning. Todd gave her an anti-nausea pill and she ate dinner no problem. On Thursday 8/25 Millie was scheduled for her next chemo treatment. However her white blood cell count was a little to low. We will need to postpone the next treatment until next week. Looking at her right now.....you would not even know she is sick. She is doing very well. She doesn't like storms so the hurricane this weekend will be stressful for her.

August 18, 2011 2nd Chemotherapy Treatment

The day began with Kimberly telling me that Millie had blood in her urine again...apparently the UTI was back.

I called and left a message with Dr. Dahlgren, who called me back later. We had discussed when she treated the first UTI that if it didn't go away, then she would switch antibiotics. But it had gone away quite readily and now was back. She wanted to hear how Dr. Fulmer felt that treatment would impact the chemotherapy and since I would be seeing her at 3:15, we left it at that.

They checked Millie's white count, which was good. The Lymph nodes were reduced in size and her overall health was good. An ultrasound of her bladder did show that it was quite inflamed and because of that, they decided to treat her with a different antibiotic and not to try to get a urine sample because it would be unnecessarily painful. Kimberly and I both have commented on both this and the no biopsy...it's wonderful to see the doctors temper their medical choices with such concern for the patient's well-being.

Another great thing: HUMAN DOCTORS TAKE NOTE-(I have in mind those doctors whom I have had trouble getting to look at another doctors test results!) Barely more than an hour and a half passed between the time I spoke with Dr. Dahlgren and our appointment with Dr. Fulmer...yet when we got to there THEY HAD ALREADY SPOKEN and discussed Millie's UTI!

This ended up being a longer visit, only because Dr. Fulmer took a great deal of time to talk with another dog's "mother" who was undergoing chemotherapy and was having some issues. I was perfectly OK with this delay, and Millie came out wagging and happy, almost like she is after Day Care. Today she got Cyclophosphamide and a diuretic to help push it through her system. Ordinarily, this would cause more frequent urination, but between the UTI and the Prednisone, it was unlikely we will notice any difference from her already elevated peeing activity.

August 10, 2011 The First Chemotherapy Treatment

It was anticlimactic....after all the time we had spent deciding, it went so quickly. I don't think we were there 30 minutes. We signed in, they took her back, checked her white count, and then gave her the Vincristine and we were back home:

I snapped a quick picture of her with her bandage and then it came off. And all was well....we had begun the chemotherapy voyage.

The percentage of dogs who have ill side effects from the Vincristine is less than 2%

Millie was peeing more frequently, mostly because she was still on the Prednisone (we were beginning to taper off the dosage) and was maybe a bit less energetic....but otherwise, she was our Millie!

August 3-7 Making the choice

(Obviously I started the this blog after the whole process began for us...and I will make the last two "old" entries today...and hopefully stay up to date after that)

So then we had to decide what to do. Before we knew more there was the concern that we would do it for the wrong reasons....that being so desperate to keep Millie around, we would put her through unnecessary pain. Our research and talks with veterinarians had put that to rest. Absent complications, chemotherapy is generally not anywhere near as unpleasant for dogs as it is for humans. And we knew that all we would be doing is buying time. Lymphoma doesn't get "cured"....you simply hold it at bay. Dogs who go into remission and remain cancer-free for 2 years are pretty rare. Anything better is almost unheard of. Realistically, we we contemplating an 18 month extension if everything went perfectly. Millie would still be dying....but then, aren't we all?

She was a very good candidate for chemotherapy: young, in good health, no major organs involved and we had caught it early. As for the money....it would be hard, no doubt. The thing I couldn't get out of my mind was that the amount we were talking about was what we had spent on trips and vacations. We had probably spent more for our trip to China. Millie means much more to us.

Kimberly has said that at this point she was pretty much 49% do chemotherapy and 51% make her comfortable and enjoy the time we have. I spent a  lot of time floating back and forth across that line. Kimberly felt we were in tune enough to let me choose...and she felt that I would carry a lot of the extra burden, not just financially, but time-wise as well...I would be taking her for treatments. Ultimately I chose a place...we would do it....one aggressive course and then accept what came.

For those of us who like God and the universe to let us know we're on the right path, after we had chosen, the sign we got came in the form of checks from my parents....which would pay for almost half of the cost.

So I made the appointment....it could have started sooner, but I did not want to leave Millie and have wait for hours in a cage at the VEC, I wanted to take her and have her leave with me as soon as it was done. So August 10th became the date for the first chemotherapy treatment.

Morning of 2nd Chemo appointment

This week Millie went to Barker Field to play with her usual friends that she sees every weekend. Her energy was zapped pretty fast but she seemed good. Later in the week we took her to her usual Doggie Day Care 4 Paws in the Fan. The staff there said she was still Spunky. This morning as I took her for a walk...her UTI has returned. Today will be Millie's 2nd chemo appointment. Millie's Dad will be taking her and addressing the UTI specs today as well.

More on the First Appointment

There was concern on my part on how Chemo would affect Millie. However, the doctor agreed with most of the on-line information that we found......quality of life for dogs undergoing chemo is very good. Generally they do not suffer the same problems as humans. There is no hair loss, nausea is rare. I asked about limiting her physical activity and was told that was not necessary. If she wants to swim or go to the park or whatever....the doctor would not tell us to limit her activity at all. So what we were comparing......an affordable steroid treatment only which she would feel good during until her body no longer responded to the steroids and then there would be a fast decline giving us 3- 4 months OR an expensive aggressive chemotherapy where her quality of life would also be good during treatment, possibly go into remission with a hopeful 18 months.

August 2, 2011 Our First oncology appointment

We met Amanda Fulmer, the only board certified veterinary oncologist in Richmond, today. It was both as expected and not. The biggest surprise was also the most disheartening: my expectation was that she would want to do a biopsy...and she didn't.....didn't feel it was necessary. I was thrilled for Millie to not to have to go through the painful procedure....but...for the doctor to think it was unnecessary really hammered it home....she really did have it. Our sweet Millie had Lymphoma.

The options were almost as straightforward as we expected: we either did chemotherapy or we didn't, the only real modification was we could either do a full aggressive course of chemotherapy or a shorter, less aggressive one...this didn't really seem like much of an option to either of us....it was potentially less effective and the only upside was it would cost less.

Which brings us to cost.

The full aggressive course, which I feel that both Kimberly and I knew was the only way to go if we decided to do it, would cost around $5000. The VEC gave us very detailed breakdowns, showing what each treatment would cost as we rotated through Vincristine, Cyclophosphamide, and Doxorubicin in four week intervals with a rest week in between. It worked out to about $1227.00 a month. The individual treatments varied from a low of $242 and a high of $379.


There was also little doubt that Millie's eye issues were Lymphoma related....the glands around her eyes were swelling. This we did not have to make a decision about, at least. Whether we decide to do chemo or not, Prednisone would begin immediately. But this also started the clock....if we didn't start chemo quickly, the steroid had the potential to interfere with treatment later.

Amanda and her assistant were understanding and informative and that played a role in our later choice. But that was the big step ahead....a literal life or death choice.

July 31, 2011 A Scary View of the Future

The eye did not seem to get better and Millie now would occasionally worry at it a bit. Even more troubling was that her other eye now seemed to be affected as well. Late Sunday night, we decided to take her to the VEC because we did not want to risk any permanent damage to her eye.

After a very long wait, they stained her eye and inspected for damage and found none, but did see a bit of discoloration in the cornea. They gave us antibiotic ointment for her eye and a collar to keep her from scratching at it. There was discussion that this could possibly be related to the Lymphoma, something I had rejected as ridiculous to that point.

At this point it was August 1st and we were 24 hours and change away from returning to the VEC to meet with the oncologist.

July 30, 2011 Warning signs begin

With an appointment scheduled with the oncologist for the following Tuesday, Kimberly and I began researching everything we could find and occasionally discussing it.

Kimberly had a a very traumatic experience with her previous pet, Ginger, who developed a non-specific autoimmune disorder very suddenly and had to be put down years before she had expected to even have to deal with it. I could see the shadow of those multiple vet visits, the hard choices, and the financial burdens in her eyes every time we talked about it...and even when we didn't. In just a matter of days, Ginger went from perfectly OK to sickly and lethargic and the only potential regimen for keeping her alive involved regular transfusions for the rest of her life and before she had time to really deal with the turnaround, she had to make the decision to put her down. And she still has days when she weeps for her.

We both could surprise Millie by bursting into tears when she would simply come and nuzzle with us and even when we didn't, the tears never seemed far away.

Our "discussions" were not exactly Socratic discourses, either. She would suddenly say: "You want to do the chemo, don't you?" and I would say: " I don't know....I don't know yet what it will mean...I need to hear what the oncologist has to say." and then hours would go by till one of us brought it up again. This does not mean we avoided it....but we had a real understanding of what our worries were and knew that we agreed on the important points: we wanted Millie around as long as possible....that might not be very long no matter what....and we wanted whatever time she had left to be as painless and happy as we could possibly make it.

And then: Millie came home from visiting the dog park in the early morning, one of her favorite weekend pastimes, with a puffy eye. Her left eye was slightly closed, but examining it revealed no injury, redness or foreign object...nor did it seem to trouble her. Our assumtion was she had gotten something in it briefly and it was OK, but we kept an eye on it.

July 26, 2011 The Visit

After leaving Millie in the morning for tests and X-Rays, I came in and met with Dr. Dahlgren and while I sat on the floor of the exam room with Millie resting on my leg, we talked about the future.

The only good thing is that we had caught it so early....but early turned out to be a relative term. And the X-Rays did not show any obvious organ involvement...also good.

Q-If we had not stumbled upon it, when would we have started seeing symptoms?
A-Probably within a month.

Q-Once she becomes symptomatic, if we do not do chemotherapy, how long does she have?
A-Maybe 2-3 months.

Alex was very clear and very sympathetic. She acknowledged how it was hard to look at Millie right then and believe the time could be so short. But once it begins, lymphoma moves quickly.

we only had two options: Treat the symptoms and keep her comfortable....and wait for the end. Or try chemotherapy, to try to extend the time we would have with her. If we opted to not do chemotherapy, then we would start treating with Prednisone and keep upping the dose to battle symptoms....but steroids have their own side effects, and Alex cautioned that if we opted for steroids now, and later decided we wanted chemotherapy, the chances of success were reduced. She also acknowledged that Chemo was expensive, something that my research had already uncovered. She felt like we were probably looking at around $5000.

I had her go ahead and make a referral to the oncologist, because I felt that however unlikely we felt the chemo option might be, we needed to have that input before deciding.

July 25, 2011 The Diagnosis

The cytology report was NOT inconclusive...it was undoubtedly lymphoma. I scheduled Millie for X-Rays and blood work.

The Beginning: Accidental discovery Thursday, July 21, 2011

We were preparing to depart for Virginia Beach so I could do my annual AV Tech job for MCV's Pediatrics At The Beach conference.

We had booked Millie to stay at Four Paws for the weekend and Kimberly took her, intending to drop her off on the way to work. When she got there, she discovered a slight red tinge to Millie's urine and brought her back home so I could take her to the vet. Our assumption was there was a urinary tract infection.

I called and arranged to drop Millie at the vet for a check...they called later to confirm a UTI. But Millie's vet asked to speak with me. In examining Millie, she discovered that all her lymph nodes (those that are accessible by hand) were very enlarged. Her concern was that this possibly indicated Lymphoma. After discussing options with her, I gave the go ahead for a cell aspiration test. Basically they use a needle to draw cell samples from a node to be sent for testing. The issue with cell aspirate tests is that they are often (anywhere from 50-75% depending on whom you believe) inconclusive, leaving actual biopsy as the only way to be certain. I was concerned, but not overly so...I thought it was possible that the infection was causing the lymph node reaction and that it would pass after the antibiotics prescribed were finished and the UTI gone. In the back of my mind, I did recall that Kimberly had noticed one of Millie's lymph nodes in the back of her rear leg ( not knowing what it was) and being concerned, but we decided it didn't merit a vet visit when we found the identical structure in her other leg. That actually could have been our first warning, but we did not recognize it at the time.