Thursday, February 28, 2013

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..

Wednesday, February 27, 2013

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....

Monday, February 25, 2013

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...

Saturday, February 23, 2013

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.





Thursday, February 21, 2013

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.

Wednesday, February 20, 2013

Let's Bring Everyone Up to Date

A friend of mine had asked me to post Emily's new homemade diet that I started her on to help fight Canine Lymphoma.  This friend has been a strong proponent of the raw diet but due to her current circumstances can't feed it to her dogs.  She hasn't been happy with the commercial products out there and was curious when I mentioned I was doing a well researched homemade diet for Emily that could easily be adjusted for my non-cancer dog, Ollie.  I was going to post this recipe on my cooking blog (thegourmetgoddess.ca) but thought perhaps it needed it's own space. 

So I've decided to start a separate blog to share Emily's entire experience with Canine Lymphoma.  I've found the best information on-line regarding every aspect of Canine Lymphoma.  It's really helped prepare me from the first time I felt her enlarged lymph nodes in her neck right through diagnosis and now as we go through treatment. I'm an informed leader of Emily's pack. And right now she needs a pack! It takes a pack to cover all the aspects of treatment and care.  I'm very grateful for her pack but that pack has included the Internet.  So here's Emily's story.  On the Internet.  For everyone.  I hope it helps you too.  Mostly I think it will help me to have another outlet to share.  So thanks for listening!



Over Christmas Emily was very whiny.  She was demanding of my attention and was constantly looking for treats.  I thought this was off but didn't have anything concrete to take to the vets but in my heart I knew something was up. 

Emily has always had a big Adam's apple.  I know that sounds funny since she is a girl but years ago I mentioned it to the vet and was told it was nothing, which at the time it was nothing.  When I felt her over Christmas and thought her neck felt large I wrote it off to her large Adam's apple.  Were her lymph nodes enlarged then?  I didn't really feel them that closely. 

Jan 16th I again felt that her neck/throat was large and had a good feel, comparing her to Ollie.  Yup, there were 2 large lumps on either side of her esophagus.  I knew that couldn't be good, checked the Internet, and made a vet appointment.

Jan 18th the vet told us it was likely lymphoma but we had caught it early which was good.  We had just lost Dakota 10 weeks early with Hemangiosarcoma which came on suddenly.  He was fine when I went to work, had his supper as usual and within an hour was in distress.  He was gone within 7 hours.  It was heartbreaking.  All I could think was that at least with Emily I'd have time to prepare myself, to say goodbye. 

The Handsome Little D (his street name)


I went home and got on the Internet.  Hold the phone!  Lymphoma is 90% + treatable!  Most dogs live another year or two after treatment.  But without treatment they die within 4 - 6 weeks.  Okay, lets get treatment going!

It took 2 needle aspirations and finally a biopsy to get a confirmed diagnosis.  By this point I'm having nightmares that the cancer has taken over and it's too late to treat her.  Two and a half weeks after our initial vet visit and finally we started treatment but only with Prednisone until the biopsy results came back and confirmed what I already knew.  Emily had lymphoma. Three and a half weeks after that initial visit, Emily had her first Chemo treatment.  It seemed like a lifetime when I kept reading over, and over again that without treatment most dogs are gone within 4 - 6 weeks...

Come back and I'll share what I did in the meantime while sitting around waiting for the official diagnosis.  I'll share her diet.  I'll also share what she's been through.  When they say it's an emotional roller coaster, they ain't whistlin' dixie!