Post Cancer Treatment Update

I realize I haven't provided an update on Emily's saga since I went back to work.  Well here it is.

Emily finished her chemo on Sept 5th.  We had a few delays due to late delivery of the drugs, a couple of bouts of tummy troubles (Emily has had a sensitive tummy since she was a pup when there was ground corn in her diet) and then right before the 2nd to last chemo treatment Emily got a big 'ol UTI (Urinary Tract Infection).  That UTI has been more trouble then her cancer!  But I digress.

I'm going to do a separate post about Emily's post chemo care.  I found when we were nearing the end of her treatment there was very little written about what to do next.  Emily's amazing and wonderful vet Dr. Courtney Sherlock and I figured it out.  I want to do a separate post so that if dog owners in the future are looking for this topic they may be able to find information about our experience when they do a search.  I'm a geek to the end.

So now it's been 2 months.  Emily is not the same girl she was before the cancer and/or the treatment.  She became an old dog overnight.  Her eyesight was never very good and she's been developing cataract for years.  She's just gotten over an ear infection that seemed to seriously affect her hearing although I'm still quite sure half the time she's ignoring me.  That hasn't changed.  She's been ignoring me her whole life.  She sleeps a lot and when she's asleep she's sound asleep.  I vacuumed the other night right around her and she didn't move!  That's new.  She also doesn't run upstairs when I sear something on the stove.  That used to send her running (usually because the smoke detector goes off shortly after - it's in the wrong place, it's not my cooking I swear).  These days she beats herself out easily. 

Okay now all the good things.  Emily is so full of joy.  I've never seen her little stub wag as much as it does these days.  After her treatment ended it was like her body knew and suddenly she was back to being the carrot junky she always was.  During treatment carrots were off the menu because they were too high in carbs and remember, cancer cells live off of sugars which carbs are.  She still loves to play ball in the yard and walk her duck around the house.  Her appetite is veracious.  She sings, cries, howls while waiting for her supper.  She is a complete and total snuggle bug, wanting to touch me all night long.  She does snore more than ever and has active dreams which often result in repeated kicks during the night.  Now it's just harder to wake her to get her to stop. 

Emily has also changed from being a determined working dog to a social butterfly.  In the past she would be more quick to react to a situation and do her job (protect/defend).  Now she's sits back and assesses if there's something in it for her.  She eats up attention whenever she can get it.  No more aloof Bouv!  At the vets, in the exam room she was all waggly stub for the vet and all the girls even though she was anxious. She never used to be anxious at the vets but after 26 chemo treatments her opinion of their establishment as changed.  Luckily they are moving so maybe her negative feelings will stay with the old place. 

Her biggest struggle aside from the veracious appetite is due to the UTI and some kidney issues, both of which are completely clear now.  She has become somewhat incontinent.  She can't hold it when left alone for longer than a couple of hours.  I put puppy pads around when we go out but of course she rarely hits them.  My neighbor comes out to let her out at regular intervals when we're gone for longer periods of time but it seems hit or miss.  It's fine as long as Emily sleeps the whole time we're gone but if she gets up she has an accident.  I was home with her for 2 full days last weekend and she didn't run for the door to go out as soon as she got up so we think it might be anxiety.  She does look for someone when she wakes up and I see her more and more relying on Ollie.  And Ollie is okay with that.  We were at the cottage a couple of weeks ago and Emily fell off the dock.  As she swam to shore Ollie walked out to meet her.  It was quite cute and Emily was quite proud of herself for solving her own problem.

Total cost for this treatment was over $7000 of which the insurance covered 80%.  That does not include the cost of her homemade diet and treats which is costing me about $120 a month. The treats are for both her and Ollie.  Treats include veggies, cooked chicken hearts, cooked beef heart, frozen chicken wings and necks. 

I take every day as a blessing knowing that some day she'll be gone.  Although I don't think that day will be very soon.  She just had a complete blood work up and urinalysis and she had had a ultrasound 2 months ago.  All clear, everything is normal.  The vet used the word 'excellent' more than once!  So was this worth it.  Yes it was.  Yes it was indeed. 

Ms Emily as a Cheerleader for Halloween.

Ollie as a Rufferee and Emily

 

Me and Ms Em doing selfies at the cottage.

Feelin Groovy!

Just a quick update on Emily.  She's doing really, really well.  Great appetite, tired but playful and cheery.  Last week at the vets she was the real Em, all over the place, interested in everything, the vet tech (who is also named Emily!) had to chase her around the vet office to get the IV out of her.  She tires quickly but when she's going she really gives 'er! 

Currently she snuggled up in my lap while her beef cooks for her meals.  We're 2 days late getting her chemo this week due to a late delivery of the drug to the vets.  It's the nasty Doxirubicin.  I've got her as well fortified as I possibly can.  She's eating the cooked ND diet sprinkled on her meals which are full of protein in the form of meat and yogurt, as well as eggs with a little garlic, turmeric, cabbage, broccoli, spinach, peppers (veggies well cooked so the canine gut can digest it!) and supplements of FortiFlora (a vet product that has the optimal probiotics for dogs), arginine, glutamine, gloucosamine, digestive enzyme and her daily multivitamin.  I'm making sure she get 2 - 4 ounces of organ meat a day.  It's full of iron and other nutrients that are good for blood development.  Her white blood cell count was a little low last time.  I also make sure she gets some of her cabbage juice to help fortify the gut.  She's also getting some pumpkin, just a tablespoon, once a day to help keep her bowels functioning well.  After she is well over any side effects from the Duxirubicin I'll put the pumpkin on hold as it's high in sugars/carbs.  It's a bit of an experiment at this point...  I'll do an update of her diet as a blog post in the near future. 

Emily's eating has changed as she's gone through treatment.  One thing I do is keep everything separate and labeled with the date cooked.  That way if she's off one thing I'm not worried about wasting a whole pile of food or giving it to Ollie who doesn't need it.  If she's off something I can freeze it to keep it until she is back to her full appetite. 

Things have gotten so much easier.  Thank goodness!

Feeling secure that I've made the right choice for Ms Em,
CJ, Emily and Ollie

Why We Do What We Do.

No one has asked me why I've chosen to treat Emily's cancer.  Well at least no one has been brave (or stupid) enough to ask me to my face...  Here is why I've chosen to fight Emily's cancer.

This is the pure joy that has been part of Emily's life for as long as I can remember.  She destroyed one other duck when she was a pup but she's had this one ever since.  How may dogs have a 9+ year old toy!?

Here is another reason why I've made this choice for Emily. 

For those of you who don't know I lost my last 2 dogs to cancer.  In both cases it was hemangiosarcoma which has a poor prognosis even if caught early.  I lost Willie in a matter of days and Dakota in a matter of hours. Dakota left us exactly 10 weeks before I noticed the lumps in Emily's neck.  I didn't have a choice to even consider treatment.  God wanted them home. (You'll notice in Emily's video that there is a white urn on the bookcase behind her, that's Willie.  Dakota's dark wooden urn is next to her.)

I've had a wonderful furry face in my life since I was 9 years old.  There were a couple of years I was dogless and when I look back they were probably the most difficult years of my life.  Dogs just make life better.  No matter how bad your day has been, no matter how you feel or what's going on, having a dog to come home to, to have that unconditional love is such a gift.  My life is just more full because of the wonderful creatures who've shared it with me.  And who continue to share it with me. 

Emily is ready to go for her treatment tomorrow.  I really do think all the challenges she's faced have been related to that massive GI bleed she suffered the week before her first chemo treatment due to the introduction of Prednisone and an Antibiotic together.  Her system was compromised and never fully recovered before we started the assault with the chemo.  She could end up with chronic Irritable Bowel Syndrome until this is all over.  We'll watch and treat it as necessary.  Right now she's having a nap after enjoying her pork/liver/cabbage/Hill's ND diet for breakfast number 2.

Gearing up for tomorrow's treatment,
CJ, Emily and Ollie

Oops. Sorry. It's all my fault.

Well I screwed up royally this past weekend.  I had taken out some chicken thighs to de-skin and boil for Emily.  Things defrost super slowly in my fridge so I had left them out on the counter.  By the time I went to cook them the skins where almost room temperature to my touch.  The thighs themselves where still a bit frozen inside.  I took the skins off and had to keep sticking my hands under warm water just to get the skins off all the thighs.  I was taking the skins off so that when I cooked the thighs they would be a little leaner for Ms. Em. 

However........  I have always given the dogs fat and skin bits when I've been breaking up big pack, big pieces, deskinning or deboning meat.  So I put the skin aside to put in Ollie's meals.  He sees what Emily is getting and his plain old kibble just won't do.  I have to add a little something to make it more interesting.  Luckily it only takes a little tidbit of something yummy or a bit of meat juice and he thinks he's got a feast! 

So I had this leftover chicken skin and Emily wasn't eating any veggies since her last chemo session on Tues (already know where I'm going with this??) so I thought, "hey, how about I mix some of this raw chicken skin with some veggies and maybe she'll eat it".  Guess what? She picked out the chicken skin and left the veggies behind.  (and you know she was thinking - "I'll show that crazy bitch!" cause she's a bouvier and I'm pretty sure that's what they think all the time anyway.)

So that was Saturday.  Sunday she has some runny poo.  I gave her some Kaopectate which is liquid and a nightmare to give.  More ends up on Emily, the floor and the walls then actually gets down her throat.  And then we had more runny poo.  Notice how I'm calling it runny poo and not diarrhea?  Yup, denial.  It ain't just a river in Egypt.

She ate fine and everything else was good, including her mood.  Monday morning I got up and Ollie had the runs too.  Kaopectate for everyone!  He had one more bout and he was done.  Emily got worse.  Still in denial.  I should have called the vets by this point but I half assumed they were closed for Easter Monday.  Monday night she went downhill fast, needing to go outside about every half hour, unsteady in her hind end, trying to lay out in the cold, damp yard.  It was amazing to see how easily Ollie's healthy system could handle the bacteria versus Emily's immuno suppressed cancer system trying to handle the same thing.  This is why we cook Emily's food or she gets fish directly from the freezer.  The one exception is her chicken wings which go right from the freezer to the fridge to defrost, only a couple at a time and she's limited to 2 per day.  So far they haven't cause her any problems and I had been watching that for the first couple of weeks. 

We went to the vets Tuesday for Emily's week 7 treatment and agreed with the vet that it was not wise to overload Emily's system that was already dealing with diarrhea by subjecting her to chemo.  So due to my stupidity Emily has to wait a week for her next treatment. 

Moral of the story is Cancer dogs are immunosuppressed.  All the precautions I've read about are worth taking.  Period.

Luckily one dose of the Metron and she's doing great.  So we caught it soon enough that her system hasn't been totally taxed.

Trying not to add to the dog's suffering,
CJ, Emily and Ollie

Week 6 Vincristine

Just a quick update to share how Emily is doing.  She handles her week 6 treatment of Vincristine very well.  I gave her the anti-nauseant for 2 days after her treatment.  She went off veggies, peanut butter and sardines but still ate smelts so go figure.  Today she had her multivitamin in peanut butter, she's had her ND diet every day and is eager to eat so I didn't bother giving her the Cerenia (anti nausea pill) today.  They make her very drowse and they are very expensive so I don't want to be handing them out whilly nilly! 

Yesterday she was playing with her treatball and lost her footing while in the kitchen.  I heard her whine and when I went in her 2 back legs were going in different directions and she couldn't get up.  It was very frightening to see.  Emily as a Bouvier, is a working dog and can get very focused on a task.  We have to monitor her and make sure she doesn't over do it.  She had beat herself out yesterday and was still trying to work even though her body was ready for a rest. 

One thing I have noticed now that Emily is no longer on the Prednisone is that some of the foods I thought she liked she was only eating because the Prednisone was making her ravenous.  I thought she liked pumpkin but since her Prednisone was reduced and now no longer part of her treatment, she turns her nose up at it.  Which is fine.  I only gave her pumpkin to try and regulate her bowels. 

Overall it's happy days around here.  I think the dogs may have a marrow bone to enjoy on this sunny Good Friday (I'm pretty sure the no meat rule only applies to humans!) although I may save it for Easter Sunday as we're going to brunch and may need something to entertain the dogs with after when all I can do is lay around and moan from the over eating...

Enjoying the long weekend,
CJ, Emily and Ollie

A Normal Sunday!



We're enjoying a peaceful, relaxed Sunday afternoon around here.  It's so nice to have a couple of 'normal' days.  

 

Emily enjoying a nap.  I realized she should be wearing a yellow bandanna for cancer.  I'll have to get some fabric and make her one.  Note she's lying on a mat!  I think she's starting to embrace the mats which not only help her get up although that steadiness is greatly improved, they also help her with pressure points where the fur is gone.

 

Ollie is waiting for his cup of tea and a cookie (not really but I always think that when he sits on the couch and hangs out with us)

Emily is eating everything at the moment.  She's getting all her supplements.  I'm trying to get her well fortified for her next round of chemo.  I hadn't really thought of the chemo treatment as occurring in rounds, I was seeing it more as one continual treatment.  So when she crapped out week before last I was in a panic as I saw it as a reaction to her treatment overall instead of her body being in overload as we finished the round. 

I really had no idea what to expect.  I had read a great book ("Help your dog fight cancer" by Laurie Kaplan) and numerous sites but I still wasn't prepared to see Emily so sick.  Like I mentioned in my last post, they say dogs handle the chemo much better than humans.  Which is a whole level of hell I simply can not imagine.  I've never been around anyone actively going through chemo.  At least as we go through this round I'll be more prepared and not think this is the end of Emily's time on earth.  I'll remember how she has bounced back this time.  She's still not 100%, she does still have cancer after all.  She tires more easily and occasionally she looks at me like she's a little confused and she's not completely steady on her feet but she's Emily and I can clearly see her in there.

I had a thought today.  Emily has huge cataracts on top of the fact that her eyesight has never been great.  She seems to lack a degree of peripheral vision.  I looked into her eyes today and said "Emily you're going to live to a ripe old age, blind and a bit confused".  I don't know why I thought that.  I guess because she'll be 10 by the time this treatment is over and if she lives another year that will put her at 11 which is a good for a Bouvier.  Anything after that will be gravy.  I have always worried that she'd end up blind or with a significant loss of sight as she ages.  Today I just had a strong feeling that we'll see that, that she will be here long enough.  I just hope the chemo treatment doesn't leave her with too many long term effects.  I know they have refined it over the years but still... 

Enjoying the good days and preparing for the next round of ups and downs,
CJ, Emily and Ollie (who still doesn't know what all the fuss is about!)

Sheeee's Baaaackkk

Well almost.  After 4 days of projectile diarrhea, then a day of nothing, then another bout of diarrhea now it's been over 3 days with nothing.  I'm worried she's constipated but it is normal for her not to have any bowel movements for a couple of days after the massive diarrhea she had.  So I'm now on poop watch.  Seriously.  This is my life.  And I wouldn't trade it for the world.

I did manage to get her bathed and groomed so at least she looks good.  She's balding in spots.  I clipped Ollie and made one of his nails bleed.  Bouviers have a notoriously high threshold for pain so I never even knew I got him until I saw all the blood.  It keeps bleeding so after finally getting the house and the dogs cleaned up after Emily's anal gland debacle, now there are blood spots everywhere. 

The house is also a state (newfie expression) because every night I have to cook up a can of Emily's Hill's ND Diet.  It's a commercial product developed by Hill's with Dr. Ogilvie, the original researcher for the canine cancer diet.  It's pretty gross right from the can.  Emily has never, never had can food before so that alone is a big change.  After a suggestion from the vet office (thanks Andrea!) I discovered Emily will eat it quite eagerly if I spread it out in a pan and cook it until crispy.  The smell is disgusting!!!  I mean nasty!!  I'm doing this nightly to help ensure Emily is getting the supplements and balance she needs.  She's still getting over half of her daily diet from my homemade mix.  So on top of the food I'm cooking already....

I have a question.  If chemo is supposed to be so much easier on dogs than humans than what kind of hell is it for humans?  3 more rounds to go but this week we're off and it's such a nice break.  4 more full days of happiness and joy before we pump her full of poisons again. 

Just hanging in there,
CJ, Emily and Ollie

Peace has been restored - to Emily's intestines!

We are finally on the other side of the diarrhea hell and other associated side effects of the Doxorubicin.  That was awful.  Emily had diarrhea for 4 days to the point where it was projectile and bright red.  Sadly this is not the first time in my life I have seen this and I knew it was to be expected due to the irritated state of her system.  Her anal glands completely let go on the morning of day 4(Sat) again not a surprise given how hard her system had worked up to that point.  Anyone who has dealt with anal glands knows how bad it is.  Needless to say, every blanket and mat now needs to be washed.  Emily was laying in it at one point so she's a stinky mess even though I did sponge bathe her. 

Emily didn't eat for 48 hours and barely drank at all on day 3(Fri).  That was the biggest panic, she wasn't drinking but she was still outputting fluid.  We watched closely for dehydration and thankfully she never got there.  We also watched her temp which never went outside the normal range of 99- 102F.  Last night Emily ate 9 saltine crackers and 5 chicken hearts.  You never saw a happier person then I was when she took that first cracker out of my hands.  This was after offering her everything (and I mean EVERYTHING) in the house.  I said a little prayer to St. Francis Assisi, the patron saint of animals cause I thought it couldn't hurt even though I'm not Catholic.  I figured he wouldn't hold that against Emily. 

The biggest fright during this whole episode was when Emily went outside and try to lay down in the cold snow and did not want to come in.  Dakota did that the night he died. She did this constantly for 2 days (including in the middle of the night) I kept tell her it was not her time but there was a little voice inside my head that wondering if we were fighting a losing battle.  I was laid off work a couple of weeks ago and I'm sure it was so I could spend time with Emily.  But was it to spend time with Emily and get her through this fight or to spend time with her as her time to go is near?  These are the things that go through your head when you are sleep deprived, stressed, scared and just plain freaking out. 

This episode got Mom on the internet researching things like the new med, what we could be doing and what to do in the future.  I've being doing that all along but Mom is not used to accessing the internet like that.  It was good to have the help.  Information is power.  Once we started researching and reading we added Pepto Bismal to the fight.  I checked my book "Help your dog fight cancer" by Laurie Kaplan.  It also recommended Pepto so I felt good about our decision to add it in.  And truthfully, I really think it helped push things in the right direction.

The Mirtazapine did nothing to stimulate her appetite so I think we'll forgo that one in the future.  She missed a Prednisone dose but once she ate the crackers and chicken hearts I got it into her. 

The next time she gets Doxorubicin on week 9, we'll be proactive and treat the side effects before they start.  I'll work this out with the vet clinic but we read that others have had better success by treating the side effects starting immediately after treatment instead of waiting to see if they happen.  The chances of her having less side effects next time are slim to none. 

Now we're going to celebrate St. Patty's day and be extra thankful.  Currently Emily is only eating beef and chicken hearts (her desire to eat crackers has thankfully passed since they are total carbs!) but that's fine.  I figure her body needs the iron and B12 that beef is full of to rebuild at this point.  We'll worry about veggies and supplements later.  She lying by me now and I must say... bath is high on the priorities list!  Yikes!  Today she rests, rebuilds and we all revel in the joy that she's feeling better (did I mention she went for her balls out in the yard, on her own like she does when she's normal?!?!).  Tomorrow we fumigate!

Diarrhea Hell and Insurance Heaven

Well I have some good news and not so good news.  The not so good news first.  Emily has had diarrhea for well over 48 hours now.  Last night neither of us slept much, she was up every 1.5 hours or so.  I had called the vets yesterday and they had prescribed a probiotic for her diarrhea.  They did have a stronger pill in mind if that didn't work.  Emily's vet is hesitant to put another chemical in her body at this point so we went with the more natural probiotic first.  I do like this approach.  Unfortunately it was 9pm last night when I realized the probiotic hadn't worked so we had to wait overnight for the stronger pill, Metronidazole.  I picked that up this morning along with an appetite stimulant, Mirtazapine in case Emily doesn't eat today.  She has eaten the last 2 days but only a little and she's been very, very finicky.  This morning she showed no interest and I know that means she won't eat.  One the one had that's not a bad thing as her system needs the rest to heal but on the other hand since she is in cancer treatment she needs to keep her tank fueled up.  The vet did tell me she could have her anti-nausea pill daily if necessary so she had it again today making it 3 days in a row after her treatment that she's had the anti-nausea pill.  That was over 2.5 hours ago and she's still not keen to eat.  She keeps trying to lie down in the snow outside and we have to really work to get her inside.  It's too wet and cold to let her lie there for long.  She did attempt to chase her balls a little and she made a half arsed attempt to bark at the fence.

Now the good news.  Emily's PetCare insurance called to offer to up her insurance coverage.  Usually once a pet has a condition you are screwed, what you got is all you're getting.  Most policies will not cover any pre-existing conditions so if you try to change a policy even within the same company you lose coverage on any issues the dog has had before.  I had enough coverage for Emily to cover just under half of the estimated cost of this chemo protocol.  With the increased coverage I now have enough to cover the entire treatment for a premium increase of less than $175 total over the time period of the treatment.  What a relief. 

Currently Emily's have a nap and I think I may have to join her.

Just hanging in there,
CJ, Emily and the ever so patient Ollie (who's enjoying all the extra treats a bit too much...)

Post Chemo #4 Doxorubicin

So today neither dog is eating.  I do believe they would like to trade dishes which I would actually do if Emily's weren't radioactive.  Ollie does not need to be licking up her slobber the day after chemo!  Ollie refuses to settle for his plain old kibble while that's all Emily wants.  It's way too high in carbs for her but for some reason that's her comfort food when her tummy is upset.  She has had a decent amount this morning overall but she's eaten half or less of everything I've put down then walked away.  I'm hoping the Cerenia (anti-nausea) kicks in.  I'm not throwing out chicken, steak, veggies, supplements, etc!  So in the fridge right now is her regular mix in a bowl ready to serve, another chicken only with veg mix also in a bowl ready to heat and serve, and her chicken mix with kibble.  There are also containers of her protein mix, veggie mix, a container of brown rice, a container of pumpkin which she seems to prefer fresh from the can, not thawed from frozen, doggie only yogurt and doggie only peanut butter.  It's hard to find the human food in there.

Emily also has diarrhea.  This is the first time she's had it due to her treatment.  She has a little soft/runny poo before this treatment but I'm pretty sure that was due to her having cottage cheese for the first time ever in her life.

Overall her disposition is good, after she had her last diarrhea in the yard she then went for her balls for a little play time!  Now she's off next week.  Maybe she'll get bathed and groomed.  It's going to be a real treat to get to some good quality time in and know we don't have to drag her off to another chemo treatment because of course her best day all week is the day before chemo. 

Chemo Treatment #4

Today was Emily's fourth chemo treatment and it was the most dangerous one in the protocol, Doxirubicon.  She could have had an allergic reaction, her pee will be orange or red for the next couple of days and, most importantly, this one can cause heart damage.  There is a limit to what she can have over her lifetime and it has to be tracked.  This was one of the reasons why I was so eager to get Emily on the L-Arginine supplement.  It's good for cardiac health.  She did fine.  They gave her benadryl to manage any possible allergic reaction which she seems to NOT have.  So that's good.  We are just watching for a cough. 

We also came up with a possible recourse to deal with the nausea.  She has a post chemo anti nausea pill that she gets 24 hours after her treatment.  If she's showing signs of nausea the next day I can give her an additional pill!  I love a plan.

While Emily got her treatment and Nanny hung out with her at the vets (Emily is a serious Nanny's girl).  I took Ollie, who Nanny can't console at all when he want to be with his Momma, to the park for a big walk.  It was really nice to spend some time with him outside of Emily's cancer. 

Emily was in excellent spirits when we got to the vets.  She was cheerful, energetic and very social.  It's hard to pump poison in her system when she's feeling so well.  Big picture, trying to focus on the big picture.  This evening she's just tired.  And her Prednisone came down again so hopefully that will help again with a decrease in her appetite (She's still really whiny but only at one point during the day) and help with her steadiness.  She's also been panting a lot.  We're watching that. 

Supplements and Post Appetite Loss Update

Emily's appetite has returned to normal.  Now I just have to get her pill schedule back to normal.  Right now she's reversed, Prednisone in the AM and Prilosec (for her stomach) in the PM.  She had a huge breakfast with all her components, meat mix, veg mix and garlic turmeric mix, no problem.  Yesterday she got her supplements.  I've added a multivitamin, Centrum Forte, and 1000 mg of L-Arginine and 2 tsp of L-Glutamine in powder formula.  When she eats the ND diet she really only needs half of these but she's hit or miss on the ND diet so until I'm sure she's going to eat it I prefer to give her the full dose.  Thank god Santa brought me a mortar and pestle for Christmas.  The most use it gets is smashing up her pills to sprinkle on her meals. 

Aside from the Multivitamin, Arginine and Glutamine, Emily also get digestive enzymes with each meal, 1 glucosamine/chondroitin tablet per day, 10 wild salmon pills (yup, 10... plus she gets fatty fish during the day!) and 1 tsp of flax seed oil drizzled on either yogurt or cottage cheese.  Both yogurt and cottage cheese have active bacteria cultures which are not only excellent for digestive health but also general health overall, for both our dogs and us!  Watch for additional ingredients.  I like to see nothing else but milk and active bacteria cultures. 

There are a lot of options out there for supplements and you can make yourself crazy.  One important warning - You must be sure they don't interact negatively with the chemo or any other meds your dog is on.  Consult your vet.  But be aware, a lot of vets aren't well versed in supplements so do your homework if you aren't confident.  I have an entire vet office consulting and researching on Emily's case so I really like consulting them after I've done my research just to be sure I haven't missed something.  I'm sticking with the basics as recommended by Dr. Ogilvie years ago and still supported by conventional research.  Arginine, Glutamine and the Omega Fat pills in the form of Wild Fish Oils are the most important. 

Today Emily has had a raw from frozen, straight from the freezer beef marrow bone, 2 play session in the yard with her balls, a huge breakfast and is now enjoying a well deserved nap.  I need to get her in the tub but she's had such a rough week and is just now feeling like herself so I hate to torture her (or I might just be procrastinating...)  We'll see how the rest of the day goes.  Staying on top of her grooming while she is feeling okay really is the best idea.  She's just so damn peaceful and content at the very moment.

Emily's First Bout with Appetite Loss

Well it's been a stressful 17 hours.  I think we're on the other side now but Emily experienced her first solid bout with appetite loss.  Yesterday afternoon she had a snack and her antibiotic around 1:30.  She was very tired, lethargic and uninterested.  Although she did follow me around, laying down where ever I was.  Supper time she didn't even go into the kitchen.  Nothing interested her.  I had salmon, sardines, smelts, chicken wings, her cooked homemade food, just the meat mix out of her food, just the veggie mix of her food, cooked cabbage, cabbage juice.  She totally went off fish and still isn't interested in fish.  Thank goodness there is none in her meat mix!  In fact, moving forward I think I'll do one protein at a time instead of a mix of 3 or 4.  Her veg mix is also just veggies.  I did up a egg white mix with the turmeric and garlic so all of her food is separate components.  This is proving to be quite beneficial as at this point Emily will only eat the meat mix and will turn away from the dish if the veggie mix is present at all.

Late last night we managed to get a bit of her kibble in her.  This would be the kibble that she no longer gets because she's on the special canine cancer diet.  Guess what - what they eat doesn't matter one bit if they won't eat.  I was so worried that this was the start of a slippery slope.  So I was so glad she was taking a bit of the kibble.  She only ate a little but I guess to her it's comfort food.  I had defrosted and cooked a plain chicken breast which is also her traditional comfort food but no dice.  I didn't dare try and give her any of her pills but I was stressed that she was missing a prednisone dose because it is not a drug you should abruptly stop. She also wasn't drinking which was an even bigger concern.  However she was still peeing a good bit.

This morning after her morning bathroom outing she headed to the kitchen.  It took some trial and error but she finally settled on some cooked chicken and brown rice warmed up a bit.  She ate the whole bowl which was a 4oz chicken breast and 1/4 cup rice.  She also had some kibble.  I ran and got another chicken breast out of the freezer and microwaved it but she was done.  I popped in her Prednisone and counted it a successful breakfast.

She is now going to the kitchen occasionally and we pull out everything we can think of until she finds something she likes.  She managed to get her Sucralfrate which I really should have popped in her last night since it's one of her stomach pills but I was totally dumbfounded that she wasn't drinking I really didn't want to shove anything down her throat.  Today that fear is gone!  We even managed her antibiotic mid afternoon after another snacking session where she ate the meat mix.  Her current favorite food is thawed chicken wings.  It's her first choice but we were able to persuade her to munch away on her meat mix (ground pork. turkey leg meat, beef round, beef liver). 

What a horrible, scary experience.  After her chemo session she gets an anti-nausea pill.  After her first session one of the vets and I had a discussion about how aloof she seemed.  In hindsight she was still recovering from her massive GI bleed that she had right before her first chemo treatment.  On top of that she had her first chemo treatment.  Her poor system was struggling to get ahead of itself.  I kept saying "there was no joy in mudville" as she seems to have no joy in her.  So the vet
recommended only giving her half of the anti-nausea pill.  This week I thought that was a good idea because clearly the chemo treatment had left her tired and lethargic and I didn't want the anti-nausea pill to make it worse.  Yeah, never again.  Better tired, lethargic and a bit stoned then not eating!!!!!  She can't regain her strength without fuel. 

By the way, the only 'trick' to get her to eat that worked was the warming of her food.  But it wasn't just any food, it was her comfort food, chicken breast and rice.  Leftover cooking juice from the meat, veggies, cabbage didn't work.  Frozen fish treats didn't work.  Note to self - always, always keep chicken breasts in the freezer!

Post 2nd Vincristine Treatment - Tired!

The only word to describe Emily post chemo treatment #3 is tired and maybe a little stoned.  She had the Vincristine which she also had on week 1.  Her appetite took a nose dive week 1 but we are yet to see that this time.  She lacks the energy to be constantly asking for more food like she has been as a side effect of the Prednisone.  The quiet is almost a welcome change as long as she still eats her meals and allows me the chance to cook up  her weekly homemade diet without her under foot, whining the entire time.  She did thoroughly enjoy her homemade breakfast.  Last night she was slow eating her can of ND diet but she did it in 2 sittings.  She turned her nose up at peanut butter this morning!!  First time ever.  And of course I had her sucralfrate (to protect her stomach) pill already buried in a wad of peanut butter.  I stuffed it in a chicken heart and she had it no problem.  You have to have a selection of tools in your feeding arsenal when traveling the canine cancer journey. 

One thing that may help her stomach and the impending nausea is cabbage.  Emily loves cabbage which is a shock.  She never had it before she got sick.  She loves the core to crunch on, loves it cooked up and she loves the leftover cooking juice to slurp up.  It needs to be cooked down quite a bit so the canine gut can digest it and absorb the nutrients.  That's why the leftover cooking juice is so valuable.  It has the nutrients!  I simmer all Emily's veggies and I keep all the leftover juice for her to drink.  Ollie loves it too. 

I haven't mentioned the importance of filtered water (when not slurping up leftover veggie juice).  I have read that the cancer canine can't handle the toxins in regular tap water like you and I can.  So we got a brita.  Truth be told... I'm loving the filtered water.  I'm a big water drinker but I don't like water kept in plastic containers because there has been a correlation between plastics and cancer.  But with this brita and using it to fill the dogs water bowl twice a day, water never sits in the plastic for long! 

Chemo Treatment Week 3

Here is the pic I promised.  Emily's got her St. Patty's day bandanna on!



 She doesn't pose like Ollie does.

Emily was energetic this morning and ready to go.  The vet was really pleased with how her blood count had rebounded to normal levels.  I had suspected they had.  So Ms. Emily got her treatment. 

I picked up some mats and put them around all the places Emily has been laying or having problems getting around like the bottom of the stairs.  Currently she is lying in the kitchen where there is no mat.... seriously I don't know why I bother.  Ollie was making use of one of the mats so I guess all is not lost.

We're in the process of investigating a multivitamin for Emily.  I'll do up an information post about food and supplement tips tomorrow. 

Ready for Treatment Week 3!

Well Ms. Emily is certainly a lot stronger and much more like herself than she was this time last week.  We should be good to go tomorrow for her 3rd treatment after having to delay it last week.  Her whining has decreased dramatically, her appetite has almost returned to normal(from ravenous) and she's interactive and more cheery.  She's still not 100% herself.  She's still having a hard time getting up and that hasn't really improved but I'm going to get some mats to put around the house tomorrow.  I have all laminate floors and in the last few weeks she's had a hard time getting her footing under her when she tries to get up from a laying down position.   

We've got cookies made for the vet office to show our appreciation for all the effort they're making regarding Emily's care and our whole family's well being.  This includes putting up with Ollie who goes into the vets with Emily each week for his weigh in and then leaves when it's treatment time.  I'm watching his weight because a couple of months ago he had gained weight for the first time in his life and since then he's lost 13 lbs which is great.  Don't want a beef boy and with all the different treats he's getting along side Emily we need to keep a close eye on it.  But he is a real attention hog and they have to deal with him before they can get to Emily.

I've got a little surprise for tomorrow, I'll snap a pic and share it later!

Kisses!

Yesterday I got some Emily smooches!  They were the first smooches in weeks.  Emily is not a big kisses kinda girl but in the last few years she has been known to give a polite kiss or two.  She was whining yesterday but had just been out and had recently eaten so all I could think was that she wanted to get up on the couch but Ollie was in the way.  I made him move (that never happens but he lately he's been spending all day on the couch which is odd for him) and she got up, ears went back and I got 3 of the most delightful kisses!  Sigh, there's hope...

Then last night she actually picked up her rubber lamb and flicked her indoor ball.  As you may remember we have had some outdoor ball play in the last couple of days which is huge progress but that was the first time she touched her indoor ball in weeks.  I almost cried.

And finally, the best part of her current state of being - she didn't wake me up at around 4am.  It was actually Ollie who got me up at 5:30am which is my fault because he was last out at 9: 30pm and he needs to go out later than that to make it to 6am.  Emily had a massive breakfast of her homemade food and we all went back to bed.  The only reason we got up at 8:45am was because Emily heard her Nan getting up. 

She is mostly just whiny with my Mom these last two days.  But she's always been way more whiny with Nan because when she whines Nan automatically gives her a treat.  Emily has her Nan very well trained.....

Ah quiet

Ms. Em is finally having some quieter days.  Earlier this week I thought we'd all go nuts.  I guess it takes a couple of days for her to feel the effect of the prednisone reduction.  Oh she's still hungry as a horse but she's not as all consuming ravenously hungry.  (yes, there is a difference)

Emily's energy level is a bit better too.  She's got a little pep in her step.  She's also a bit more steady although I did nearly knock her over trying to clean a back paw. 

Now if she would just take her duck for a walk, I'd say all was right in the world.  But she has cancer so all is not right in the world.  Hopefully her blood count will be okay for treatment on Tuesday. 

I've added some pumpkin to her diet.  Bit of vitamin K, a good dose of beta carotene and it helps regulate her poo.  Even though you'd think it's a sweet starch veg and therefore high in carbs it's not.  I only add a bit with her cabbage, cauliflower, brussel sprouts, broccoli, spinach, and/or red peppers.

Emily is napping now.  Somehow that seems like a good idea since she had me up at 4:30am, again at 8am and then again at 9am when I gave up all hope of ever catching up on my sleep.  I'll sleep when she's in remission!

Exhaustion is my middle name

The last two days I've been totally exhausted.  If Emily is awake, she's whining for food.  This is after her prednisone had been reduced by half.  And she is still really, really unsteady.  She wants to eat every couple of hours, day or night.  Since she only gained .2 lb last week I'm worried that her feeding plan is not enough so I've up'ed her intake and am spreading it out.  I'm out of the ND diet so I cooked up some brown rice to add to her homemade diet.  The ND diet is a bit higher in carbs than conventional wisdom indicates for lymphoma patients but it does give her some of that bulk so I'm trying to replace that and brown rice has polysaccharides which are thought to be beneficial for fighting the cancer.  The ND diet and Dr. Ogilvie both use rice.  Emily gets less than half of her daily intake from the ND diet so she's getting a lighter carb load.

I've also added a bit of pumpkin.  It's surprisingly low carb for a starchy veg and full of beta carotene and vitamin K, both of which are important in the cancer fight.  Although to be honest I really started using it because Emily had a case of the runs and then only had a very, very small poop and I'm afraid she's a bit constipated.  Pumpkin will absorb liquid, which she is still drinking buckets of, and regulate her bowl/poop production.

Right now when Emily naps, I nap.  And any food she does get in between meals I make into an event, take up her dish, freshen her water and serve her whatever snack/treat she's getting spread around her dish.  After she eats it, she has a drink and then settles for a bit. 

Just a week and a half left of the prednisone and hopefully the appetite will return to normal and she'll get some steadiness back.

Just hanging in there..

Chemo Protocol Week 3

Well it didn't happen yesterday.  Emily's bloodwork came back with her white blood cells too low.  Her platelets were down and so were her red blood cells.  So no Chemo this week, we'll try again next week.  It's just as well, she really has been lethargic and quiet.  Although that's probably all due to her blood count being so off.  I still believe this is all tied to the massive GI bleed she had 4 days before she started her first chemo treatment.  She had started on Prednisone and an antibiotic at the same time, 3 days later - massive vomiting of blood and then tarry stool.  When I say massive I'm not kidding.  I don't freak out easily but if she had been a 200 lb human I still would have been freaked at the sheer volume.  Her stomach has since settled.  One thing I discovered is that cabbage has vitamins and minerals that are excellent for the health of the stomach lining.  She's been getting a good dose of cooked cabbage which she loves! 

While she didn't get her chemo treatment yesterday she did get her scheduled reduction in Prednisone. Thanks be to heaven!!!  All the side effects we are seeing are most likely related heavily to the Prednisone.  She's thirsty, pees a lot, unsteady on her feet, tired, moody (aloof and not as happy) and ravenous.  When I say 'ravenous' I mean there are times when there is absolutely no way to satisfy her hunger.  I was worried she had gained 5 lbs just in this past week but luckily she only gained .2lbs and she has some room to gain a couple so she's fine.  There are times I've actually run out of ideas as to what to offer her to try and satisfy her hunger.  Luckily she seems to find the ND diet satisfying when she's in that 'ravenous' mode.  Quite a change from the week before when I couldn't get her to eat the ND diet. 

As I mentioned on two days ago on Monday, Emily has started playing out in the yard again.  She's still doing that and today she had a nice, pretty energetic bark at the neighbor dogs and then the neighbor, who she loves but still doesn't like it when he gets too near the fence.  Now she's tuckered out. 

So far today she's had 5 smelts, 2 sardines, a chicken wing, piece of carrots, a treatball with a handfull of kibble in it, couple tablespoons of her homemade diet mixed with yogurt.  And that's besides her 1.5cups of homemade food she had for breakfast.  I'm really hoping she'll start to feel the reduction in her Prednisone soon....

An Update on Emily's Last Update

We had ball play out in the yard!!!  Emily has this play activity she does where she holds one ball in her mouth and flicks another ball around with her paws.  Now truthfully this was the first day all her balls were not frozen into the ground and snow.  She chased them when I kicked them and pounced on them when she was batting them around.  I was thinking I really should get it on video.  It's hilarious to watch a Bouvier flick things like a cat!

She's still very food obsessed but it was nice to see a flicker of the old Em.

Emily and Prednisone - UGH!

Time for an update as we venture on this journey.  Emily has been through 2 chemo treatments and heads in tomorrow for her third.  In the meantime she's been on prednisone and I have to say I'm not a fan.  This drug has left her moody, thirsty, ravenously hungry, unsteady.  Bottom line, she's not my Emily.  Her hind end doesn't seem to listen to her requests.  Emily has a stuffed duck that she's had since she was a puppy.  She loves this duck and takes it for a walk daily, trotting around, tossing it as it hangs from her mouth.  Well, she used to.  She hasn't touched her duck in weeks.  And when she's not walking her duck, she's got a ball in her mouth.  Something else she hasn't done in a while. 

Currently she is lying by my feet, whining under her breath.  She's looking for more food.  I had read on-line that dogs on prednisone can experience such an increase in appetite that they'll eat anything.  At this point we're avoiding leaving her alone.  Luckily that we are in a situation where we can do that.  I don't know what I'd do if I had to leave her all day. 

These are the days when you wonder about quality of life and if we're doing the right thing.  She's not a happy girl but tomorrow her prednisone gets reduced yet again.  If we can just hang on until that she comes off that drug, another 2 weeks.  Perhaps then we'll see the old Emily again.

And then last night Ollie threw up on my bed. As luck would have it I have a bed pad on the bed and he hit is squarely.  One of the first things I read about the prednisone was that it was likely Emily would have urine accidents.  She has, on the bed but again I was prepared with the bed pad.  I'm sure the only reason Ollie puked was because he's getting a lot of the new various treats Emily is getting and it's just too much on his system.  We have to watch the increase in fish oils and good fats.  Emily needs them to fight/starve the cancer cells but Ollie could get irritated/pancreatitis.  As though I don't already worry about Ollie getting exposed to Emily's toxic, cancer causing output (pee, poo, puke) after she has her chemo treatments... 

Just trying to hang in there...

The Canine Cancer Diet

After the initial shock that Emily might have cancer, I remembered hearing something about a cancer diet years ago when I was researching canine diets in general.  I've always been big on nutrition for myself but I became a doggie nutrition expert when Emily got really sick from her kibble at age 6 months.  We are what we eat!

I discovered there has been some really successful research spearheaded by Dr. Greg K. Ogilvie.  The short version is that cancer cells live off sugars but can't process fat or protein.  So the canine cancer patient needs a diet low in sugars and carbs (another form of sugars) and high in protein and the good fats.  Once you know where the carbs are, it's pretty easy.  You want a ratio of 3/4 protein and 1/4 veg.

If you want to feed this to a non-cancer dog add some brown rice and blueberries.  I may start adding brown rice to Emily's if she continues to lose weight.  She's lost a little and I'm keeping a very, very close eye on it. 

This diet is cooked.  We could have the raw diet debate but here's where I stand.  I love the raw diet.  The only reason I had not moved my dogs on to the raw diet had been cost.  I had 3 large dogs and it would have been over triple the cost of their kibble which I've been happy with.  Thing with kibble is that it is all too high in carbs for Emily at this point.  I wanted something natural where I could control the carbs as well as the quality and quantity of all the ingredients.  As a cancer patient, Emily is immuno-suppressed which means she needs to avoid all infections, bacteria, virus, etc.  While there is evidence to suggest that the canine gut is immune to the standard raw food bacteria, etc, I have seen her get a nice case of the runs from raw bones over the years.  So I'm much more comfortable cooking her food.  Most experts, unless they are hard core raw diet feeders, agree it's better for a cancer canine to cook the food.  Even raw feeders will freeze the food first to kill at least a layer of bacteria.  The veggies must be cooked or pureed for the dogs gut to digest them.  So this is where I am on the topic of raw.  As you'll note some of her treats are raw but frozen first, I'm not strict with the cooked idea but for her large, multi-protein meals I do think cooked is safer.

I am trying to get Emily to eat Hill's ND diet.  Dr. Ogilvie worked with the people at Hill's to develop it.  It has been scientifically proven to improve the prognosis in dogs with cancer but Emily is iffy about it.  There are some important ingredients in it and if Emily continues to struggle with it I'll have to dissect what those supplements are and see if I can source them to add to her homemade diet.

Emily's Homemade Diet (75lb dog 2 cups a day for a week, + Hill's + treats!)
Ingredients:

• 1 lb each, beef, poultry, pork
• 200g or about 1/2 lb beef liver (organ meat is really important!)
• 2 cans of sardines or some other fatty fish like salmon (use only wild, not farmed) mackerel, smelts, etc.
• 4 eggs, separate the whites and yolks.
• 3 cloves garlic, minced (use fresh, not from a jar, I just read the additives that come in some of the jar versions... you don't need any additives!)
• 3 tsp turmeric
• 1 1/2 -2 cups diced fresh tomato
• Mix of broccoli, cauliflower, brussel sprouts, cabbage, spinach. 
• Digestive Enzyme
• Yogurt
• Fish oil (Emily is 75 lbs, she gets 10,000 mg per day.  It's a lot but probably the single most important thing you can do for your cancer canine's diet)

Instructions:

1. Set a pot of water on to boil.  I do the poultry first, bringing it up to a simmer and cooking it for 15 - 25 minutes depending on the size, until cooked through.  You only want a simmer.
2. Remove the poultry and add in the beef, unless it's ground you only need to simmer it to a rare.  Ground meat should be cooked through.
3. Remove the beef and add the pork, simmer until just cooked through.
4. Remove the pork and add the liver, simmering to a rare, you only need to cook the outside.
5. Remove the liver and chop everything up.  If you have cooked meat on the bone, remove all the bones.  They are cooked and will crack and could choke your dog.  Never give cooked bones.
6. Toss in the egg yolks, the heat from the meat will cook them and make a nice creamy sauce.
7. Toss in your fish.  If I'm using some salmon fillets, I do cook them but you can do that in the microwave.
8. Cook the garlic and egg whites in a bit of the leftover meat broth. Pour it over the meat mix.
9. Sprinkle turmeric on the mixture. Stir well. 
10. Sometimes I simmer the leftover meat broth down, let it cool, skim off any fat and then pour it into ice cube trays to have on hand if Emily is finicky about her meals.  I can defrost a cube in the microwave and pour over her food (especially if I'm trying to get her to eat the Hill's ND diet)
11. I use a separate pot to do the veggies.  I like to save the veggie juice for Emily to drink.  She loves it and cabbage juice is really good for the health of her stomach lining which can only help her appetite and it takes a beating during chemo.
12. For the above amount of meat you want at least 4 -5 cups of veggies.  Simmer them until well cooked.  Dogs don't digest veggies well so having them well cooked gets the job done before they enter the dogs system.
13. Measure out the meat mixture into your storage container one cup at a time.  I measure 3 cups meat mix and then add 1 cup veggie mix.  I continue doing this until the container is almost full.  Then mix it up and you're ready to go.
14. If there is more veggie mix then meat mix, I just freeze the leftover veg mix for next week. 
15. Before serving I add a dollop of yogurt and break open a digestive enzyme capsule and sprinkle it on top. 
16. Emily takes her fish oil pills out of my hand before her meals.  You can toss them into the meal or you may have to break them and drizzle them on the meal.

Treats are important.  Here are some of Emily's favorites

• Smelts!!  Frozen right from the freezer.  Both dogs love these and they have cleaned their teeth! 
• Sardines, canned
• Chicken wings, frozen then thawed in the fridge
• Veggies; peppers, cucumber, the occasional carrot (carrots are high in carbs for veggies. Emily used to have a 5lb a week carrot habit... but we've found some good substitutes)
• Hill's ND diet.  Seriously, if she's keen on a snack we'll pull out a can and start feeding it to her by the spoonful. 
• Frozen Wild Salmon fillets
• Once a week she gets a frozen raw marrow bone.  I have to remember to reduce her diet a bit as this is almost a meal for her. 
• Boiled Chicken Hearts.

Some Important Tips!

So you think your dog may have Cancer and are sitting around waiting for a confirmed diagnosis.  Here are some important tips to not only help you feel proactive but can also have you well prepared for the decisions, care and treatments ahead.  I want to clarify that the choices I have made for Emily are my choices and you will need to make your own.  No matter what you decide to do as you journey through this keep in mind that you have made the best decision you could at any point.  I have already had moments where I have wondered if I'm doing the right thing or if I'm being selfish by making her go through treatment.  I'm sure I'll revisit this debate often.  There are no absolute rights or wrongs.

Tip 1:  Finances!  Do you have Pet Insurance?  Time to check what coverage you have.  It's nice to think money is not a component in your decision making process but let's be real.  I have insurance but when all is said and done it will only cover less than half of the anticipated treatment.  You'll want an estimate from the vet for the cost of the entire treatment but they won't do that until they have a confirmed diagnosis (obviously!) in the meantime you can get together your financial picture.  Emily's treatment is going to cost $6500 -$7000.  That is just the initial treatment, not including what it will cost when she has a relapse which all but something like 5% of dogs' with lymphoma do.  For those of us in Canada who never really worry about health care costs for ourselves, these costs for doggie treatment can be a real shock.

Tip 2:  Keep Current!  Welcome to the Internet! It is a great resource for information about treatment, symptoms, care plans, etc.  However you need to be sure the information is up-to-date!!!  When talking about cancer treatment even 3 years can be out of date.  Currently the amount of research going into canine cancer is phenomenal.  I can say for myself, once Emily is finished with her journey I won't be coming back to ensure my information is up to date.  One of the benefits of this being a blog is that all the entries are dated so you'll know when it was posted.  Some of the information on various websites is not dated and it is easy to get confused.  When in doubt, double check!

The next three tips are related.  They are all about organizing the incoming info.  One binder with some folders, notepaper and chart would work great.  The message here is keep and track everything!! 

Tip 3:  The Notebook.  This brings me to my next point.  You'll find a lot of information on the net.  Time to start a notebook.  Write down everything!  Every conversation with the vet no matter how preliminary it may seem.  Little things mentioned now will be important to revisit later.  One vet mentioned that the commercial Hill's ND diet was a little too high in carbohydrates for her liking.  It was a comment made in passing when I wanted to get Emily on the cancer diet while waiting for a confirmed diagnosis. I'll discuss diet in depth later but my point is that you think you'll remember everything but you won't.  You'll also want to track time lines, treatments, symptoms, etc.  Write it all down!

Tip 4:  The Chart.  To take your notes even further you should start a chart.  You'll want to track input and output.  This is not only useful if you change your dogs diet but is also helpful if there is more than one caregiver.  Your dogs meds are going to change.  The best way to ensure you giving them the right amount and when is to have a chart. You will also want to track treats, weight and yes, output. 

Here's Emily's Sheet.

Emily Daily Intake	Date
	Tues	Weds	Thurs	Fri	Sat	Sun	Mon
Breakfast
Food 1.5c Homemade
Meds
Omeprazole/Prilosec 2pills
Fish Pills 3/4
Digestive Enzymes 1
Gloucosamine 1
Flax Oil (1/2 tsp)
Yogurt
Sucralfrate 2hrs from other meds
Cerenia 24 hrs after Chemo		***	***	***	***	***	***
Weigh
Supper
Food 1/2can ND w/??
Meds
Prednisone 1.5 pills
Fish Pills 3/4
Digestive Enzyme 1
Gloucosamine 1
Flax Oil (1/2tsp)
Yogurt
Sucralfrate 2hrs from other meds
Water Intake
Pees
Poop
Treats

Tip 5:  The Folder/Envelope.  Get a folder or envelope going to track hand outs from the vets, drug info from the pharmacy, and receipts.  I track every cost including diet.  No matter what you decide, knowing the actuals as you go along helps.  You'll also find that certain drugs/treatments are revisited so you'll want the info at your fingertips.

The cancer diet is coming!  Just as a teaser - Emily loves, loves, loves her homemade food.  Loss of appetite is a big issue for cancer patients so it's a real joy to see how much she is currently loving her meals and treats.