Cas had his 5th chemotherapy treatment on December 29th. Another typical treatment. I took him in on January 27th for his 6th and final treatment and the nerve-racking part: chest rads. Considering metastases
I have made it something of a policy to not entertain thoughts of metastasis, but I found myself really nervous at his 5th visit. It probably had everything to do with a woman I met in the waiting room. As all do, she inquired about Cas, smiling and telling us how sweet he is. She was there with her dog for her 6th treatment. Osteosarcoma.
She said, “but they found it in her lungs.” Still waiting to meet with the oncologist, she didn’t yet know what her options were. She looked at me as though she missed being where I was 4 weeks prior. Also, as if I were going to be in her situation in another 4.
That day, as Cas was being treated, I spent my time researching lung metastases and options for treatment. I discovered such useful things as inhalant chemotherapy and pulmonary metastasectomies.
Did you know that a dog can survive with about 55% of normal lung capacity? They have 4 lung lobes on the right side and 2 on the left. In some instances of lung cancer, you can have whole or partial lung lobes removed, aka pulmonary metastasectomy.
In fact, I found a very interesting, seemingly good, though not “for dummies” (i.e., a bit jargony and technical) book, Small animal clinical oncology, by Stephen J. Withrow and E. Gregory MacEwan. (You can read some of it through its Google books preview.)
Needless to say (though perhaps I already have), I got a bit carried away by my fears. I was reassured by the UC Davis staff that I could wait to take chest rads until our next visit, so I took Cas home and tried to Ctrl-Z my concerns and sleep it off with the kitten. (Bed hogs!)
The Last (planned) Chemo Visit
The funny thing is that I wasn’t nervous at all that day. Rob confessed that he was, and it was very mildly contagious. For the most part though, my nerves were dormant.
We dropped Cas off. The plan was to get chest rads and, if all was clear, administer his final dose of Carboplatin. They would call when he was ready to go.
After about 2 hours, I assumed that his lungs were normal. Otherwise, they would have called already. (Right??) About another hour passed, and the call came.
“Castor’s ready to go home,” a brief, yet loaded statement.
Dr. O’Brien came out to chat with me after I had Cas back, sitting in my lap.
(I exchanged emails with Dr. O’Brien the week prior where I complained about one of their tech’s attitudes at visit 5 and told her I wanted time to chat about how to proceed at his next visit. She was extremely friendly, kind and apologetic about my experience with the tech. She was very approachable and had the sweetest things to say about Cas.)
She told me the good news, that his lungs had no sign of metastasis. (Woo hoo!) He had his 6th dose of chemo, and now, we would just need to check his lungs every 3-ish months.
I asked her if there were any other treatments I should consider. For example, another dane osteosarcoma survivor, Nova the Great, was put on a daily dose of Piroxicam and another chemo that she didn’t continue using, due to sensitivity. Dr. O’Brien didn’t think there was any evidence in the literature to support that route. She said there was nothing more to do, in her opinion.
She said we had already done the best for Castor. Now, we just keep enjoying our time together and come visit our old friends at Davis every few months. (YAY!)
As for symptoms of metastasis, I read that they can exhibit flu/cold symptoms. O’Brien said they can but might not. A recent client brought in her dog, saying “he just seems off.” Indeed, in that case, it had spread to his lungs. She said that usually people will just sense that something’s wrong.
(I am considering putting him on Artemesenin, but our alternative medicine vet, Dr. Rice, suggested we wait until his body has a break from the chemotherapy. We will talk about it at our acupuncture visit in early March. I’ll post about it then.)
I can’t express how happy I am that Cas doesn’t have to have chemo anymore, that his lungs are clear, that he is happily, hoppily by my side every day. Though I enjoyed our Davis day trips together, I’m sure he’d much rather romp at the park and have me work next to him on our apartment floor. Sounds good to me too (we have a lot of comfy pillows).
The best thing I heard that day and in many, many days surrounding it was something O’Brien slipped in a tad nonchalantly. After she told me the results of his chest rads, she said, “so we consider him to be in a full remission now.”
It’s been a long 5 months; it really seems more like a year. I feel like I’ve spent more quality time with Cas, more time really appreciating him since his surgery than I did at any time over the previous 6 years.
It really only took 2 months for him to be his usual, playful self.
I remember the first time I saw him running on 3, chasing after a chocolate lab, trying to sound all ferocious. It was awesome.
I never thought he’d be running like this so soon:
I spent some time watching some videos of him as a quadruped the other day. The video that really took me back is probably not so exciting for you to watch, but it really stirs me up.
It’s the day we left San Francisco for Santa Barbara. I took him to his park, Collingwood, as usual. It was our last walk home from the park, and I was weighed down by the finality of our departure. I wanted to capture his adorable prance, because I knew I’d never see it again.
It was pretty heavy as was, but I also had “Adia” stuck in my head. Some soundtrack for that morning. Jeez. Drama Queen, huh?
This is no sob story, though. In fact, I learned that Castor can prance on 3 legs. Happy Day!
It was weird, at first though, to see him walking around so casually in these videos. It really struck me how much more difficult it is for him to just walk around. Not that he knows that. You can’t tell these non-humans that it’s supposed to be hard. They just don’t listen.
He’s happy as ever. I honestly think that, aside from his puppyhood days on Summerland Beach, he’s never been happier.
Shortly after watching him on 4, I saw his tripawd-ed-ness as strange for the first time. It was one of the weirdest experiences, looking at him and just noticing the oddness of his stance. I saw that something was missing for the first time. This was the first time that I really noticed.
A breath later, I left that fleeting moment outside of the dog park where I found it, and we went in to play.
And as with most days, it was the best part of mine.
Okay, so I’ve become a bit of a knitting addict over the past year. It’s true. This time of year, though provides a great reason to indulge in my addiction.
I made my mom this cute hat and scarf. The hat is from a pattern I bought, and I designed the scarf to match. My first cable project was a success. Yay! My mom loved them too. I still have to get pictures of her in them.
(Yes, I am posing funny. Good call. =P )
We all had a lovely time together on the Christmas. I am not religious, but it’s wonderful to have a day to focus on gratitude for loved ones and to spend lots of quality time together. And since the 25th is already part of a tradition in that vein, I decided I’d go with it.
Plus, both from lack of funds and aversion to super-consumerism, our house managed to have a great balance of presents, goodies, and QT.
So, we had a few presents, some lovely lights, and made food all day. This chocolate candy cane cake (from Cook’s Illustrated) is unbelievably moist, rich, and addictive. Thankfully, all the dairy and sugar hurts my belly if I eat more than a little. So, moderation wins this time!
We had a special house guest for the holidays too. Olivia, the (thank-the-lords potty trained!) persian. (I’ve had some bad uriney experiences with others of her breed.) She was a doll, and she learned to tolerate the kitteny advances of Hoshi pretty quickly.
I let Cas sleep in…okay, and myself. After all, I was up until 3am wrapping presents, though to be fair, I didn’t start until 1-ish. Plus, most of that time was occupied with present – a Tartine bread book. (Aside: Tartine is the best bakery I’ve ever encountered. If you’re in San Francisco, you MUST try it. Yes, you may spend some time in line. So worth it, though. We get bread from them every week. Yum!) I created a cute little carrying book cover using a Bi-Rite handle bag. (I bet you can’t wait to see it unwrapped…)
I pretty much lost steam after that one, but luckily, there were only a couple more to wrap. A few for Cas and one for Hoshi, the kitty sis.
Cas sniffed out one of his gifts right away. Bully stick! Score!! (gross. I know, but he loves ’em.)
(The video’s a bit long, but I know some of Cas’s family wanna see every second. Really. It’s not that I don’t want to take the time to edit it. I don’t know why you’d even think that. Ridiculous, really. Many people want to see all of this… Really. They will.)
Our dane meet-up group had a secret dane deer gift exchange, and Castor scored big time! A large, green box arrived a few days before Christmas, and we finally got to see what was filling it. OMG there were 1,000 toys inside. Cas’s emotions ran the gambit – curiosity, excitement, boredom (as I struggled to detach all of them from the box), glee, and finally, overwhelm (see: right).
There were so many, after they were all freed up, he froze, eyes glazing over. Time for a break, it seemed.
So, I put them all away except for the fuzzy one that he just loves to nibble on. Nibble, nudge, nibble, nudge, … ad nauseum.
Hoshi’s turn! We got her a cute little brown mouse that makes chirpy noises every time you tap it. She was less curious than I’d expect from a cat, but eventually she wrestled a bit with her new, chirpy friend/foe.
A week later, after assuming that she must have lost it, she reunited herself with it as I was trying to sleep. It turns out it was hiding just behind the head of my bed… Did I mention that it chirps incessantly? (Just listen to the soundtrack of the Castor video above.)
Anyway, she doesn’t leave it alone now…unless of course, we hide it from her. (Wah ha ha.)
On to people presents. Well, Rob got some yarn, sweetness note cards, and, as I mentioned, an awesomely packaged bread book. 😉
I got some Addi turbo knitting needles (yay!), a Mary Oliver poetry book (ahh…), and a “curiously awesome” Koi toy. It’s a fish that lights up when in water. Think of it as a plastic, fish-shaped, color-changing, floating candle-replacement for a curiously awesome bath time experience. (It is pretty awesome.)
After all the cheer, toys, goodies, and way, way too much Aimee Mann and Sinatra Christmas songs (yes, possible), we all veg’d a bit. We watched Angel on the couch with Cas.
Afterward, he retired to the floor cushions next to his bed. It seems he likes variety. Even if that means scrunching into a tiny ball to experience it. He has tried to curl up on our little 16×16 couch cushions before. No joke. What a goof.
I had such a beautiful time. Even without snow! I hope you all experienced oodles of warmth, laughter, and color too. ♥
The best part of this holiday has been reconnecting with loved ones from afar and spending time with those here, especially Cas. I have never been so continuously grateful to have him in my life. Every day. That’s the one great thing that’s come of his battle with cancer…You know, the thing he beat the S out of, the thing that is G-O-N-E…
At three weeks, I took Cas’s blood again for All Pets to run a CBC. Assuming his numbers would be fine, I was not concerned with getting antibiotics from Davis ahead of time. The doctors had reduced his dose by 15%, after all.
I had to wait until Friday to get his CBC results, due to Thanksgiving.
It seems Cas is just really sensitive though, because his WBC was down again. This time, it was 770, even lower than the last time (when a dose reduced by 10% left him at 980). (Ugh.) So, I picked up a few days worth of Clavamox from All Pets* to get me through to weekend until I could speak with someone at Davis.
Another drop off
Monday, I spoke with Dr. Obrien at UC Davis about his numbers. She definitely wanted him on antibiotics; ideally he would have been on them since Wednesday or Thursday. I explained that he had been on them since Friday afternoon but that I they were about twice as expensive here. She said that since he’d been on them for a few days and his numbers were likely rebounding by now, I could discontinue them.
She also told me he was more anemic than before (i.e., his red blood cells were down too), so they would consider lowering his dose slightly more than last time. However, she also didn’t want to lower it much, as a lower dose could affect efficacy.
Over the weekend, it started getting colder here. And drier. I assumed that’s why Castor coughed periodically throughout Saturday night, but it worried me. To some extent, when treating cancer, I imagine anyone can get ensnared in the waiting game. Waiting for metastasis.
I wholeheartedly assume, stubbornly at times, that that will not happen to my boy. However, signs of even slight respiratory distress are not kind to me. Beyond that, he’s more susceptible to infections while his WBC count is so low. That concerned me too.
He coughed a bit the following day, but by Sunday night he was back to normal. I told Dr. Obrien, but she didn’t seem worried, especially after telling her how high his spirit and happy his attitude is.
It’s quite amazing to me that he seems entirely unaffected by the chemotherapy, save the first evening, but on a cellular level, he’s rather sensitive to it. Thankfully, it doesn’t stop him from enjoying himself.
Obrien said we could take chest rads this week, if I wanted to, but she would be surprised to see anything after only 4 weeks. (The last set on November 4th was clear.) I told her I’d monitor him; she said to call her right away if anything worsened.
Thursday, December 2nd
Fortunately, Cas was back to normal. Nothing worsened. And we were back at Davis again.
A different drop off
This was a rather uneventful and short trip. We dropped him off and went to our mainstay of sustenance (veggie burger and garlic fries place). Shortly after getting to Mishka’s for some work time, they called to say he was ready. It was very quick.
One thing I don’t love about UC Davis so far, is that I feel, at times, that I’m inconveniencing the busy Docs. When I email Dr. Obrien questions, for instance, she answers them in a terse manner. While I prefer Dr. Cadille’s responses though, Dr. Obrien does answer every question. I am confident that all the doctors and hospital technicians pay careful attention to his case and that he gets great care there.
When we picked up Cas, I asked to speak with Dr. Obrien. We chatted for a few minutes. After the team (that’s awesome, btw!) discussed Castor’s case, they decided to leave his dose alone. They didn’t want the chemotherapy to become less effective. Rather than lower it, we would just put him on a prophylactic course of antibiotics at 3 weeks. This time, it’s Baytril.
So, I can check his blood levels at 3 weeks again, but I don’t have to. He’ll be covered; we’re assuming his WBC count will drop low again. And we’ll continue, on course, in 4 more weeks.
Only two more to go!
They also listened to his lungs, per my request. She said they sound fine; he looks great. It’s so wonderful to hear such good news. Castor is still doing extremely well! =)
He’s such a goof too. Watch him telling the Big C to stay away:
*Note: After checking prices for Clavamox 375mg tablets at my old vet, also in SF, I was astonished by how much All Pets charged me. I knew Davis was ultra low, but two other hospitals in town, including SFVS, which is known to be pricey, charged $2.45 and $3.60 per pill. All Pets charged me $4.50 per pill! Outrageous, in my opinion. The “practice manager” said she’d look into the prices, at some point, but that right now, that was a “fair price.” It is beyond me how that’s a fair price for them, and another clinic about 5 miles away manages to sell the same meds from the same manufacturer at almost half the price. I called with a good attitude. I tried to be fair, explaining that I really love their clinic but was feeling rather upset about this price discrepancy between them and other local vets. I am not a happy customer now. Bad customer service. Bad manager. I never once felt that she was speaking from a service place, understanding place, or a friendly place. I felt like she was talking very carefully around the issue and not validating any of my feelings. Bad.
I have an update for the Or Alternatively… ordeal. After a round or two of phone tag with me, Rob was able to connect with Dr. Fong on the phone two weeks ago. (Yeah, I’m behind.) Rob told him of a couple of our concerns, explaining our overall unsatisfactory experience at his consult.
Basically, he told him we felt uncomfortable asking questions after several of mine were left unanswered and that he seemed to not be present. His response?
It was as good as it could have been. First, he apologized that we didn’t have a good experience. Then he spent some time going over a few examples that Rob gave, including the giving of treats to Castor. He asked if Castor was okay after the visit. (Fortunately, he was.)
Before getting off the phone, he offered to speak with someone at SFVS about getting us reimbursed for some of the consult. He also provided Rob with his email address, offering to answer our questions by email if that was more comfortable for us. He did both of these things without prompting, which deserves to be noted.
Though I’m told there was a bit of defensiveness at first (who wouldn’t be?), Dr. Fong validated our feelings, apologized, and offered solutions for us. That is good customer service. I will still take Castor to the new alternative veterinarian in Pacifica for future acupuncture, mostly because I still don’t feel entirely confident that I will be fully able to communicate my needs to him. I really appreciate Dr. Fong’s response, nonetheless. (I received terrible customer service from my regular vet in SF the same week, which made me appreciate his even more. More on that later.)
Maybe he was just having an “off” day when we came in, and maybe not. Either way, I have no complaints about how we left things. Hopefully, I can get better information from him via email. I might as well try.
I received a beautiful email from a woman, Shelly, introducing herself and her boy, Solomon, to me about 2 months ago. She had been an avid viewer of Cas’s videos, as she was preparing for her boy to have an amputation. Cancer strikes again! (grrr…)
Solomon is an adorable fawn dane too. He lost his rear left leg exactly one week after Castor. (awww…) We decided to organize a 2-dog Tripawd Great Dane Meetup. (woo hoo!)
Thursday, November 18th
At 10 years old, he’s getting along fabulously. Castor was his perky, prancing self too. It’s so great to form communities around our special, and even, special-er, beloved dogs.
They didn’t play much together. Solomon was a tad nervous in a new environment, and Cas can’t leave his rope alone some days. Still, it was great for us moms to chat about our challenges, our joys, and our gratitude for these special pups.
We didn’t get great video footage of them playing; we were too busy enjoying ourselves. Totally worth it! Still, Cas is always ready to be photographed, it seems.
Though Shelly had a difficult time, first getting misleading (or at least incomplete) information about Solomon’s condition in April, things are looking up now. Solomon’s condition was reassessed after they moved to California in August. The oncologist in Berkeley recommended amputation, something she thought was not possible before.
The great news is that Solomon actually had a different type of bone cancer, chondrosarcoma, one that they think surgery will cure. They keep checking the lungs for lesions, but the outlook is good. Great, huh?! Go Solomon!
I showed Shelly a few things Jackie, the PT, showed me, including how to strengthen Cas’s back leg with modified squats so as not to hurt his knee. While we were there, might as well take a rest.
After the fun, I watched Solomon while Shelly brought the car closer to the entrance of the park. He was so worried. So was I! I kept worrying he would bump his head or trip over things, pacing back and forth. I forgot he and Cas aren’t exactly the same. Solomon sees everything just fine. =)
Cas and I look forward to many more play dates with this sweetheart, who is so damn lucky to have such a dedicated mom.
I got to vet tech it up again the week before Castor’s 3rd chemo appointment. Since Cas hates going to the vet so much, I decided it’d be really good for him if I could take his blood at home for his CBC. My wonderful vet clinic said they’d send it to the lab for me. So, Cas was spared a fearful trip, and I got to brush up on my tech skills. (Fun! I know it may sound weird, but I miss it.)
It went great. Cas is one of the best patients ever. The results this time were better, but not good enough to be sans antibiotics. This time his WBC count was just below 1,000. Oh well, we put him on the gold-priced Clavamox again, and waited for Thursday. He is still not having any noticeable side-effects from his treatments. He is perky, hungry, happy, and pooping like a champ. (That’s right!)
Thursday, November 4th
One of the very best things about our trips to Davis is cuddling up with Cas in the car. In Auntie Robyn’s Element, we get to nap in back, but this time Cas managed to snuggle up while I drove my car. Adorable Boy!
Another four weeks, another dose of carboplatin, but this time, Cas was up for chest rads too. Though my mantra is positive thinking our way to victory over this disease, I couldn’t keep my nerves on board. I was anxious this visit. Only a bit though.
His CBC was normal as expected, so they gave him another treatment. This time, to try to avoid the big leukocyte drop, the doctor lowered his dose by 15% of the original.
She explained that since he barely dropped below 1,000, he shouldn’t need antibiotics again. His numbers should hold above that with this further decrease in chemo. Sounds good to me since Clavamox is ridiculously expensive. Plus, I could do without shoving my hand into Castor’s mouth twice daily.
We left him with the professionals and went to work at our favorite Davis coffee shop, Mishka’s. I waited to here the (pretty) assuredly good news. He was only there for a few hours, and the tech called me to come back.
“He’s ready to go home.”
I usually appreciate brevity, but settle down there tech. “How were his chest rads?”
“The doctor can talk to you about them when you get here.”
Lameriffic (not to be confused with lamériffic). Okay, well off we go.
Cas came loping out to us, and the Doctor soon after. And his chest…looks…GREAT! No lesions!!! Sweetness to the millionth power. She explained that everything looks great; he’s a great patient, and so on.
Before we left she asked if we had any pictures or videos we could give to the surgeons. Apparently, they are so impressed with how well he gets around, because of his size (and eyesight, I imagine), that they want something to be able to show other clients. That was the second best thing I’d heard all day.
Four more weeks until our next visit, and we’ll check his lungs again at the 6th treatment, assuming all goes well until then.
I took Cas home, let him sleep it off. He is like a lump of bricks the night of chemo. He dreams like crazy, and I let him have 90% of my bed.
Despite his fatigue, he always eats dinner and always plays like a goof the next day.
As I’ve said, I want to do anything and everything that will help Castor fight off the rest of this disease (which, let’s face it, is probably gone already 😉 ) and be as happy as he always has been. After such praise from Jackie, the PT, and urging from my mom, I decided to make an appointment with an alternative medicine vet.
My friend, Mike, took his dog to one in San Francisco to treat her lymphoma. He had no complaints. Granted, his memory of this time and of her treatments is fuzzy to the point of nada. Anyway, with two recommendations, I chose to see Dr. Fong at San Francisco Veterinary Specialists.
Tuesday, October 19th
Oh where, oh where has my doctor gone?
I did not want to deal with another vet hospital visit almost as much as Cas didn’t want to go. However, we must investigate all options. I definitely want to try acupuncture. As this was Castor’s first visit, I was warned ahead about the initial $166 consult with Dr. Fong. (Ugh, but ok.)
We arrived on time to the building and were given a garage door opener to find park in a spot in their garage. However, we drove through the garage only to see that all the spots were full. So, I had to drop Cas off, and then go find parking. It took a while.
Once we were in the clinic, they took us to a large set of carpeted stairs, asking, “Is he okay to walk up the stairs.” “No,” I said without hesitating.
No problem, though. They had a mechanical lift contraption for taking heavy boxes and heavy doggies up the stairs. It was so incredibly slow though. I mean, I took a stair every 10 seconds as I stood next to the lift holding Cas.
It was pretty amusing, but also made us even later getting into Dr. Fong’s exam room. He made some comment, under his breath, “We’re starting about 30 minutes late, but…” and trailed off. Not a great first impression, though I understand his frustration.
I’m not sure what one expects from a $166 consult. I’ll tell you that I’ve had two $150 consults for Castor in the past 3 months. They were each at least three times as illuminating as this one. For a quick recap, skim the following, else read it in full.
He started by informing me that how well they do and how long they make it depends on how strong their will to live is. That is usually related to how strong their connection with their owner is. He observantly noticed, “He seems to have a fairly strong will to live now.”
Um. What could I say? How about, “well, duh?” (Yes, you’re picking up on sarcasm. I do do that occasionally.) I appreciate that perhaps Fong sees many dogs that are doing really poorly. For instance, Mike’s dog had advanced lymphoma. She was in bad shape when he saw her, and the disease moves aggressively. However, one must be able to adjust to the patient at hand. It felt rather inappropriate for him to even bring this up. It felt like he was not very present.
One of the first questions he asked was, “Does he have diarrhea?”
“Now?,” I ask.
“Ever,” he replies. I explain that he doesn’t now, but he’s very sensitive to food. If, for instance, someone sneaks him a treat, he may have bad diarrhea for a few days. To further support my thesis that Fong was not there with us, about 20 minutes later, he gives Castor a treat. Then another. And one more before we’ve left. (Seriously?!)
Now, either he was not even listening to me, just going through the motions, or he was testing my theory that treats give Cas the big D. You can decide for yourselves.
In fact, that was a theme throughout this visit. It amazes me, because I associate alternative medicine with energy work and mindfulness. Though he mouthed related concepts, it never felt like more than lip service.
He explained that in Chinese medicine one tries to find a balance between warm and cool in the body. Typically, we (animals included) either run hot or cold. For Castor then, we want to choose foods, which are classified as heating or cooling, that will help bring him into balance. He explained that some dogs always bury themselves under the covers or sleep curled up. Alternatively, dogs may lay flat out, avoiding cover. Those could be symptoms of a dog being cold or over heated, respectively.
Then he asks, “So, what do you think Castor is? Hot or cold?” Don’t even get me started on how subjective and wishy-washy that question is. Seriously. But then I’m supposed to decide. I figured he would have some way of contributing to this assessment, and I have a reason for that thought.
When I moved from Santa Barbara, I decided to finally go see this Chinese medicine doctor in Los Angeles that my friend had been urging me to see. He had testicular cancer years before, and was convinced of the powerful effects of his care, including herbs and acupuncture. I had a visit on my way out of California. I don’t remember much of it, but I do remember his diagnosis. He sat in a chair next to me, examining my forearm and running his hand over my back, sans touching. He kept saying, “so cold. So cold. Like ice water.”
“I am always cold,” I thought. I believed it. Somewhat anyway.
Well, I didn’t continue on that path for myself, but here I am with Dr. Fong. Less impressed. I guessed he might be on the hot side. So, he proceeded to explain which foods are cooling, said he’d send me home with a list.
I wanted to get his opinion of the food I currently feed Castor – 1/2 Innova (adult), 1/2 Canine Caviar (split pea & venison). I have asked both Dr. Cadile and Dr. Obrien for their opinions. Dr. Cadile especially, gave me thoughtful feedback on the ingredients. (Innova is a great food* and the ingredients in the other sound wonderful, though they don’t offer much in the way of carbohydrates.)
And Dr. Fong’s response? He reiterated that he wouldn’t change his entire diet, just supplement it with some of the cooling foods, for which he would give me a handout with recipes. Upon looking at the ingredient list for Caviar, he just said that we didn’t want Omega 9’s but Omega 3’s were good. The only other thing he said was venison and chicken were both warming proteins.
Given that food is a big component of his counsel, I am underwhelmed with such base responses. More of that to come…
Eventually, after a lot of thought and deliberation with Rob, we think Castor’s pretty balanced. Maybe he can be slighter warm, but nothing too obvious. Sometimes he curls into a ball. Other times, he lays flat out. He pants, but he also lays in the sun. Being 130 pounds, he certainly doesn’t burrow under the covers, so that diagnostic tool was out from the get go.
For the time being, I will not be changing his diet.* I may get another opinion, and I will look into it further. I am still curious. Until I have time for more research though, he can be warmed with venison. It’s winter time, anyway.
Do you have any more questions that I can avoid answering?
Perhaps some of you have noticed that I like to soak up all possible information from veterinary professionals. Also, I do not like to be spoken to like I can’t understand complicated conditions or concepts. I value open and fruitful communication with people, especially those I pay to help Castor.
Let me give you some highlights of this type of exchange not in action. (Of course, I am paraphrasing, but I have a pretty awesome memory.)
Dr. Fong explained to me that we want to support the entire body, but in particular, the kidneys, because they support the bones. Since he had bone cancer, we need to provide extra support to that system. I wondered, as I am like to do, if there was extra support to provide to the lungs, since that’s the most likely place of metastisis. I asked:
Q: Are there areas or organs that support the lungs or respiratory system? And do we provide extra support there, via acupressure, acupuncture or supplements, to decrease chance of metastisis in his lungs?
A: (A pause and what may be a teeny weeny chuckle followed by…) Well, the lungs actually support the skin. In Chinese medicine certain organs support specific organs, and the kidneys support the bones. …
You get the idea. An iteration. Nothing new, i.e., no answer.
He mentioned several times our object being to support his immune system during his time with chemo, because the body needs extra support. I felt a contradiction there, so I asked:
Q: The oncologists have warned me not to use antioxidants much or at all to avoid interfering with the chemotherapy. After all, the goal is to break down the cells, to suppress the immune system. How does that fit in with the type of support you are suggesting?
A: He acknowledged that common concern. He said, however, that we must still support his body. He used the analogy of a brick house. If you take a few bricks out, it’s okay. But if you continue taking them out, one at a time, eventually the house topples. We want to avoid that destruction, so we must put bricks back even while the oncologists knock some down.
Fine, but that is not an answer to my question. I asked and followed up with more very specific medical questions. Were his antioxidants targeting different kinds of cells? The Carboplatin targets fast-growing cells (e.g., cancer and those in the intestinal track). Do his supplements target certain cells or systems? What are they doing?
And there were a few more that unfolded similarly. He did not answer many of my questions. Honestly, I don’t know why.
At a few points during our consult, Dr. Fong paused, saying, “Do you have any questions about anything?”
And each time, I thought, “Um. Yeah. Could you answer one of the several I’ve already asked.”
I was seriously stumped. I felt incapable of asking any more questions. I felt inhibited. I felt disconnected.
Let’s not ignore the big dog in the room
Though the doc met Cas at the bottom of the stairs, I still found it odd that he didn’t come over to him when we came into the room. Every vet I’ve ever been to has come over and greeted Cas. In fact, they usually smile and say how great he is, or something similar.
Dr. Fong didn’t interact with him at all until he came over for the “exam.” The quotes are to indicate that what followed barely qualifies for that label. He looked at his gums and tongue, commenting on their color. It was pretty healthy, though a tad on the purple side (a sign of heat, I think). I don’t think he listened to his heart or lungs or did any other typical checks.
He looked over Castor’s structure a bit and asked how he got along on 3. He gently pressed his thumbs down along side Castor’s spine, testing his muscles for pain. I requested he give Castor acupuncture treatment. Thinking Cas seemed slightly painful in his lower lumbar region, he put a needle in that area, and he put others in various places.
He did provide me with some information on acupuncture. It’s done to remove blockages in energy. In Chinese medicine, the (or perhaps one?) goal is to help the body’s energy flow freely. The problems we have, including Cancer, are caused by blockages in this flow. I assume increasing obstructed energy flow is what lifts their energy post-acupuncture.
I mentioned acupressure points when he was casually (bordering on carelessly) placing the needles. He said something to the effect of yes, there are some points in the feet that can help with pain. He didn’t show me any. Ever.
I felt like there was absolutely zero interaction going on between Dr. Fong and I. The only time I felt warmth from him was when he joked with Rob and I about something un-vet related. I believe it was a gender stereotype joke about how I was the boss in the house. [Wink. Nudge.] (Can you imagine how amused I am by those?)
He did seem like a nice-ish person, but only when he was present. Maybe he was having a bad day. I don’t know.
As I’ve said before (see: last paragraph), one MUST feel empowered to ask questions. One must continue to ask, until they understand. I did not feel that with Fong. That means, he cannot be our vet. It’s unacceptable, regardless of who is to blame.
That will be $10,000 for the herbs and analogies, please. (I exaggerate, but still.) Everything is expensive in San Francisco. True story. Still, I fell ill from shock at the price tag on our underwhelming visit to SFVS.
As I mentioned, the consult was $166. The acupuncture was $100. The rest was three herbs he told me to start Castor on, one for immune support and two fighting cancer. I wanted to try them, for obvious reasons, like “why not?” It would have been nice to get an estimate, as every other vet has given me in the past, especially when things may be prohibitively expensive. Oh well, at least now I know.
Two supplements for cancer were Artemisinin and Chih-Ko and Curcuma, and Immugen was for immune support. Artemisinin is used to treat Malaria, and Dr. Cadile told me it was a very promising area of research for canine cancer. Unfortunately, she tells me, there has not been a clinical trial completed yet. (I have to say that Dr. Cadile has been incredibly helpful, warm, and always ready to respond to my inquiries. All that despite the fact that I will probably never spend another cent at the hospital where she works. At least not on Castor. I wholeheartedly recommend her!)
At Castor’s dose, the Artemisinin was about $80 for a 10 day supply. That’s at the $73/bottle price SFVS charges. Online, through the company’s website (so the same exact brand), that bottle of Artemin100 is $42.50. (Currently, they have a special for buy 3, get 1 free too.) So, SFVS is marking up by almost 100%. Ridiculous.
I may use it. I may not. But I will definitely order it myself online.
The Chih-Ko and Curcuma is a Chinese herbal cocktail used to treat cancer. I don’t know anything else, beyond Dr. Fong’s prescription. I’ll keep asking and looking for more information. Honestly, I can’t remember what he said about it. Something, but not much.
Finally, Immugen by Thorne is an immune support supplement. I’ve said enough about this above. The jury’s still out on whether it’s a good idea or not to give this in conjunction with chemotherapy.
After discovering all of this, I returned the supplements to SFVS. So, I only spent $266 there in the end. And too much time. The acupuncture was worth the fee.
As for the rest, I plan to call Dr. Fong (and/or the owner of SFVS) to discuss my experience. I plan to ask for some or all of my money back for the consult unless he has a reason for his absenteeism and offers to further explain things that need explaining.
I will update on responses, if I get any. As it stands, I wholeheartedly discourage you from taking your pet to Dr. Fong. As for SFVS, they are incredibly expensive. Even for San Fran? I don’t have anything to compare it with at the moment.
Please, try again
I want to make clear that I do not think my experience with Dr. Fong is indicative of alternative medicine doctors, including veterinarians. It was unfortunate to have a stereotypical encounter. But that’s all it was. One encounter. There will be more, and I look forward to them being much more fruitful, especially in comparison to the alternative.
Saturday, October 30th
About a week after our less than good visit, Jon Stewart and Stephen Colbert hosted the Rally to Restore Sanity and/or Fear. Cas, Rob and I took Cas to play with Scarlet and Mike pre-satellite rally in SF.
He played a ton, just like when he was on four. It was such a great day. Warmed by Castor’s play, inspired by laughs and sane speak, I’m ready to enjoy another week.
In the spirit of sanity, I will say that everybody has bad days, even veterinarians, one assumes. I imagine some people have enjoyed their visits with Dr. Fong and felt in good hands. I didn’t. Is he the worst vet? I highly doubt it. In fact, I worked for a insanely unethical veterinarian in Santa Barbara, CA, who could be in the running for that distinction. He lied to clients, didn’t follow sterility procedures, and emotionally abused his staff regularly. (If you’re in SB, feel free to email me to make sure you don’t see him.)
In contrast and based on first impressions, I’m sure Dr. Fong actually cares about his patients. Still, our visit to SFVS was not up to my standards.
The most important thing is to know what you want, and don’t settle for less.
*Though Innova has been a great food, as I mentioned before, I do plan to stop buying it. Their company was purchased by Proctor & Gamble, a company that experiments, unnecessarily, on animals. I am not against all animal testing, flat-out, at the moment, but I am against dumping Tide detergent or nail polish into bunnies eyes. Or whatever similar cosmetic testing goes on there. NOT okay! I don’t care how great the food is; I can find as good or better sans the barbarity. Grrrr, P&G…So, while P&G is not Hitler, it does suck!
I know, I know. It’s been a while since my last post. I know life just isn’t the same without my (potentially lengthy) stories about Castor, but it’s been one of those 3 weeks that is busy busy. I try to keep the actual dates posted before the stories though. (You’re welcome. =P )
**OH, and I’ll add pics and video to this soon, hopefully.
Thursday, October 7th
And then, we were off to Davis again…weee!
To be honest, I don’t mind our excursions. It’s a whole day to be with the boy, to work casually from a cafe I don’t spend enough time in to be sick of, and I get to take naps on the way home with Cas in Dabs’s backseat.
Too bad Robyn has school this week. No napping for me, but Castor’s getting what he needs. Plus, there’s garlic fries waiting for me!
20 questions for the PT
We went first to Oncology to have a CBC done. This time, as expected, his levels were back to normal. After the blood test, we waited for our physical therapy appointment. He would have chemo administered afterward.
Jackie Woelz, the physical therapist, is very warm and very accessible. Every person I mentioned his physical therapy appointment to at Davis immediately replied, “Oh. Jackie’s so great, isn’t she?!” Indeed, she is.
We talked about his situation and our typical routines – diet, exercise, home set-up – for a long time before she assessed Castor. She let us stay in the courtyard just outside of her building the entire time. Castor loved that. He soaked up the sun while we chatted.
She started with one simple question. “What do you want to get from this visit or from physical therapy?”
I want to do whatever I can to help Castor stay as healthy as possible in his 3-legged body. For this visit, that means I want to figure out any exercises and stretching I can do to keep him flexible, strong, and sans pain. I mentioned that I wanted to be shown stretches to do for him each day to keep the range of motion in his joints ranging on.
I had a lot of questions for her. Like:
What stretches should I do?
Are the stairs okay to do as we have been?
Should he have acupuncture?
What about chiropractic adjustments?
How long should I take him out to play and exercise?
Isn’t he cute in his harness…er, i mean, is this a good harness for lifting and assisting him?
How do I know if he’s too tired?
How much should I limit his activity, if at all?
Anything else I should know? (This is a good question in general. After all, they’re the experts.)
I have the, perhaps annoying, tendency to cut vet professionals off a bit. It’s just a consequence of my preparedness and research combined with my itty bitty amount of patience. They seem forgiving.
So, after minimal prompting I explained that yes, I had covered all of our slippery surfaces in the house. Yes, I raised his food and water. Yes, I had cut back and altered our pre-amp play time and walks.
Namely, no more urban hikes up and down the hills of our concrete neighborhood. We also don’t typically hang out at the dog park for an hour. Most days, we go out to a grassy park in the morning for 30 minutes and in the afternoon/early evening for another 20-30 minutes. She was very pleased. Grassy ground? Check. More frequent, shorter trips out? Check.
It’s not good for Cas now, as it wasn’t as a giant breed puppy, to go out for “warrior weekends.” He needs regular, moderate activity. And that’s what he gets.
There is one sign to show me when his body’s tired. She said to pay attention to the turnout in his rear leg. When his quad muscle is feeling fatigue, he may turn his paw out for support. That action locks his knee, which prevents his leg from buckling. However, it’s dangerous for his knee. When that starts happening, it’s time to go!
And getting out of the house? Fortunately, I had video on my phone to show her our trip down the stairs at home. I explained that though it sucked to have stairs at all, we were trying to minimize the impact on his joints and avoid and falling accidents by using both his Ruff Wear and Walk About harnesses.
She thought his trip down the stairs was great. (YAY!) She said it was really good that he dropped his head down so low, which would help keep him balanced and take weight out of his rear leg. It’s really a result of his extremely poor vision. (Does he see at all now? I do not know. Not much, if any.)
She was familiar with and said the Ruff Wear harness was great, with one caveat. She didn’t like the under part. Especially with a dog Castor’s size, the slender straps that for the underside of the harness are not very supportive. I have worried that they dig into his (massive) chest. He sometimes makes an airy, grunty sound when we catch him as he hops out of the car, like the wind’s being knocked out of him.
The other Ruff Wear model, the double back, has a full size underside, in the shape of the top. She recommended that, if possible, noticing however, that it is a bit heavier. She showed us one, and it’s much heavier duty. I may invest in one, or she suggested I try altering his harness by attaching some heavy fabric to the bottom straps. A good excuse to practice sewing? Perhaps.
Walk, Stay, Sit, Lie
After all of the talking, Castor was ready for a rubdown. But first… We had him stand and walk to show Jackie how he do. She said he looked great!
He has great extension in his rear leg as he walk/hops. She examined his spine and said it was minimally curving with his new structure. It barely curves at the end to accommodate his new tripod posture. Upon running her thumbs down along his spine, she also didn’t think he was in any notable pain.
She seemed very impressed with and happy about his physique and movement.
I explained that I was re-teaching him to do down dog (adho mukha svanasana). Thankfully, I taught him that last summer. I thought it’d be great for his shoulder movement. She agreed, though only because I explained that Rob supported his rear with the WalkAbout harness during his attempts. Cas is getting it; he can do almost anything for a carrot!
I also mentioned squats. Should I be having him sit and stand and sit and stand and… to build up his rear leg muscles. She was not keen on this idea. It’s hard on his knee and his joints. She gave me a modified exercise though. Positioned behind Castor, she bent her knee on the ground under him. She had him sit on her thigh, which is halfway to the ground. Then stand. It’s like people sitting down into a chair during physical therapy. Much better.
Massage me already!
Finally, (says Cas) we got him on his side. (Another command my smart boy knows 😉 ) I explained the stretching book I’d read along with some of the exercises. She was not familiar with it, but did recommend the book “Four Paws, Five Directions,” for a guide on acupressure points. (HaHa! My mom’s been suggesting that for more than a year now.)
To make a long story less long, she is more a fan of massaging than stretching dogs (and one would assume, cats, ferrets, and horses too). When she tried to, for instance, extend Castor’s front leg (shoulder extension), he resisted her, big time. And my boy’s strong!
Basically, if your animal patient resists, you can really hurt them. If I work on Cas for a while, just rubbing his muscles deeply, he relaxes a lot. Then I can usually stretch him for a while. She said the massaging part was plenty to keep his muscles supple and long.
So, I will not be stretching him, unless he asks for it. Instead, I’ll be requesting a few down dogs after we get back in the house and his muscles are warm. Then at least once daily, I’ll give him a good rubdown.
The most important muscles to keep supple are his triceps, trapeziuses, and his rear leg muscles. She also said I could gently to moderately draw my fingers or thumbs down along either side of his spine. NEVER on his spine.
And What Else?
She wholeheartedly recommended acupuncture. She has many clients who receive acupuncture and have had tremendous success with keeping up their energy, for example. She says she can guess by seeing them if they’ve just had a treatment or are in need of another.
She gave me the names of two people her clients have used for acupuncture, one in SF and one in Berkeley. There is someone who does home visits near Davis too, but that’s not so pertinent to us. I will make an appointment with the SF doctor next week.
As above, she suggesting hitting acupressure points too. I was referred to the book mentioned above for that.
Castor and I get A+’s
Other than that, keep it up! That was her recommendation. He looks GREAT! I’m doing great! Everything is great! We will see her if and when he needs more help.
She said, “you both get A plusses.” It was partly for assessment, and partly encouragement. Sweetness. I haven’t had one of those since I started grad school.
FANTASTIC. We couldn’t be more pleased. And grateful.
And just when he thought it was over…
And as if to reinforce Castor’s love of Jackie, we took him to see the poking, prodding docs in the other building again. =\ We dropped him off for his chemo treatment.
We left for lunch. Fries! Yum.
We came back about an hour later. Thankfully, they were quick and on top of things.
He was given 90% of his initial dose. Hopefully, his WBC count would stay above 1,000 this time. I would have another CBC done in 3 weeks this time around. And they would see us next time.
Everyone says he looks great. Well, yeah he does. My little 3-legged rock star!
We went to our first Bay Area Great Dane meet-up since Cas’s surgery the weekend after our non-chemo Davis trip. This was a joint meetup with the Sacramento group, so there were about 30 danes there! Cas was reunited with some of his Dane friends. Sweetness.
It was quite a trek for him to get up over the hill to the Dane’s spot at Point Isabel, but he did it happily. He played a bit, stood a lot, and reveled in all the attention. It was a big workout for him, but he did great!
And we both (okay so me more than him) got to nap it off on the drive home.
I made him sit for a break in the middle. That way he could rest and I could make weird faces. Can you find the bed head in this picture? =P
He is gaining confidence every day, though he is a bit nervous when dogs are running fast near him. Last week on our morning park trip, two huskies were running around in huge circles when Cas decided to make his way toward me in the center of the park. Well, they ran right behind him, FAST, and Zoe ran right into his nub. (Zoe is an adorable husky who I can’t help but think of as Hoshi in a Husky suit. Hoshi is my sweet grey kitty.)
He started yelping and crying and looking back at his hip. It was horrible. Absolutely horrible. I ran over and put his bum on my lap to take all the weight out of his back leg. He kept crying. About a minute later he was hopping tentatively around again.
He was fine. I think he was more scared than anything. He’s still a tad trepidatious when dogs run crazy-style around him. Understandably so.
He has resumed his marking all over the park again, so I know that he’s feeling like the big dog around here again. Just watch him show this stick who’s boss.