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Hospital News and Views

A Vet’s Pet-The Hope and Doubt Ends

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A Vet’s Pet Battles Cancer
The Hope and Doubt Ends

A little over 2 weeks ago D.J. pulled me into the Oncology Center to see Dr. Richardson and everyone there commented on how great he looked compared to his earlier visits. Two weeks later he could barely walk to his appointment from the parking lot. He was doing well, then developed a cough, then faster breathing, his hind legs became weak, he stopped eating.
At his last visit to the clinic we decided to stop chemotherapy because his lymphoma was not responding to the treatments. They thought his cough, rapid breathing and fever was due to pneumonia but chest X-rays and blood work did not agree. No one new why his hind end was so weak. We decided to try a treatment that would hopefully keep the lymphoma from progressing and maybe the other symptoms would improve.

His health declined significantly over the next 3 days. The new medication could take 3 to 4 days to work so we waited. He continued to have a fever so I treated him with multiple antibiotics and waited for them to take effect. I added pain medication and waited for this to help. We waited and hoped. There was no sign of improvement.

There came a moment while waiting, and it was very sudden, when all hope was lost and there was no longer any doubt that D.J. was dying. I was able to make the decision to euthanize D.J. I said good bye this morning

A Vet’s Pet’s Cancer and the Toy Defence Squad

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D.J.’s cancer results in the formation of The Toy Defence Squad

The first round of chemo had made D.J. feel much better than he had in weeks. He was interested in toys again. I am unsure if this is due to him feeling better or the fact that there are toys at our house again. We have had dog toys only briefly since Blue the Lab joined our family about a year and a half ago. Blue can destroy any toy in seconds. D.J.’s plush Tuff Turkey, that he had carried and slept with for over 2 years did not survive the arrival of Blue. We have tried many “guaranteed” tough toys all of which have lasted, at most, minutes. Our house has not had plush toys, the kind D.J. likes, for many months.

D.J. and Blue are very good dogs so at Christmas, Santa brought them some new toys. Blue got the super tough, designed for aggressive chewers, guaranteed to last, will replace if wrecked ones and D.J. got a Hide-a-Squirrel, a plush hollow tree trunk that holds 3 squirrels. There are several holes in the tree through which a pet can retrieve the squirrels. It was love at first sight for D.J. He carries it everywhere with him and loves to squeak the squirrels.

Blue’s toys are long gone so he now has his eye on the Hide-A-Squirrel. D.J. is sick and loves his Hide-A-Squirrel so we have decided that it is his and his alone. This has resulted in the formation of the Toy Defence Tactical Squad (more precisely the Hide-A-Squirrel Defence Squad) in our home. Always on alert, the team springs into action to save D.J.’s coveted toy from Blue the Destroyer. At meals, while doing homework or watching T.V. the usual silence or conversation is frequently interrupted by someone yelling “Blue has the toy” and we all leap into action to rescue the Hide-A-Squirrel. In the early days we were not perfect. We are down 1 squirrel and the other 2 have wounds. The tree trunk has more holes than it came with but D.J. can still carry it and sleep with it. Some great news came when I discovered our clinic supplier carried this toy and a new one is on order. The holidays depleted their supply so it is back ordered but expected soon. Until then The Defence Squad continues to be ever alert for any potential threats to the Hide-A-Squirrel.

D.J. is now half way through his second round of chemo and the treatment is not working as well as we all hoped it would. His lymph nodes are getting larger and he is starting to have trouble breathing. He still enjoys his food and his Hide-A-Squirrel but is a little slow on walks. His treatment last week was done at home but this week we see Dr. Richardson again and will have a better idea of how things are going.

Saying goodbye to our friend Molly

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As Thornton Wilder once said, “The highest tribute to the dead is not grief but gratitude.”

We want to take this time to share our gratitude to our beloved Molly, who had an instinct to know when someone needed her. She would often make an appearance in the waiting room, or even open the doors into the exam rooms to offer companionship and support.

Her presence will be greatly missed.

The Seven Days of Christmas after Chemo

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Last Thursday D.J. underwent his 4th round of chemo. All the chemotherapy medications he has and will receive have potential side effects which include loss of appetite, vomiting and diarrhea. We were supplied with medications to treat nausea and diarrhea after his first treatment but had not yet needed to use any of it. This fourth treatment, doxorubicin, was more likely to cause gastrointestinal upset so we were instructed to start the anti-nausea medication immediately. He probably didn’t help things by eating a box of chocolates after the treatment.

 

After the treatment.

 

Day 1- D.J. was fine.

 

Day 2-D.J. was OK for most of the day but was reluctant to eat his evening meal. He ate when we added some macaroni. I wasn’t convinced his decreased appetite was entirely due to chemo. Earlier in the day, I had planned to bake some last minute Christmas cookies and had left a 1 1/4 pounds of butter on the counter to come to room temperature. When I started to bake I couldn’t find the butter. As I searched my husband informed me that when he came home from work he had found a shredded plastic bag on the floor. We have 4 cats and 2 dogs and I think one, some or all of them ate my butter. Based on past events, D.J. was the most likely suspect. If he did eat the butter, along with the chocolate a few days ago, he could have pancreatitis. The clinical signs of pancreatitis would be the same as the side effects of chemo and supportive treatment would be the same. We were already doing what we could for both problems.

 

Day 3 (Christmas Eve)-D.J. was very sick. He would not eat. He looked uncomfortable. He developed diarrhea. That evening he vomited the meal he had 24 hours earlier. Chemo or pancreatitis? I continued to treat him for nausea and diarrhea.

 

Day 4 (Christmas Day)-D.J. was still not eating and seemed very tired. He managed to wag his tail and open and chew his Christmas present for a few minutes but then went back to bed. He wouldn’t eat anything and continued to have diarrhea. Reluctantly, we left to attend our family Christmas. When we came home we offered the dogs some of their Christmas treats and D.J. ate 1 dog cookie. We all agreed that this was our best present of the day.

 

Day 5 (Boxing Day). D.J.’s appetite was back and he was eating so quickly he was choking. There seems to be no middle ground regarding appetite in labs. He seemed to feel better but still had liquid diarrhea.

 

Day 6- Normal appetite, abnormal stool but playing all day with his new toy.

 

Day 7-Normal appetite, formed stool, long walk, the squeaking of the new toy is driving me crazy.

 

D.J. had 2 terrible days over Christmas. I am unsure whether this was due to chemo or eating a pound of butter or both. He is scheduled to receive doxorubicin 3 more times. I am hesitant to do this to him again. I will be discussing treatment success and life expectancy if we exclude doxorubicin with Dr. Richardson next week.

 

Day 7 reminds me of why I chose to treat D.J. He is happy, playful and the best dog ever (chocolate and butter incidents already forgotten).

Good half days and bad half days; A vet’s pet battles cancer

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D.J. went back to the oncology center last week for his third treatment. I was able to give him his second treatment at home so Dr. Richardson had not seen him since his initial visit. We started with a review of how he was doing. I was able to report that his appetite had not changed, he looked like he was losing weight, he seemed to pant excessively in the evenings and overnight and he was ataxic (wobbly) on his hind legs. I learned that the weight loss and panting were side effects of the steroid he was taking. The dose was decreasing weekly and he would soon be off this medication which would alleviate these concerns. And, the ataxia was a side effect of the first chemo treatment Vincristine. He was due for this medication again today but it was decided that due to the hind end weakness he would get vinblastine instead.

 

After his exam Dr. Richardson was able to report that his lymph nodes had decreased in size by 60% which was an excellent response to the treatments and his blood work was normal. He got treatment #3 and we went home.

 

Three days later was the best day he had had in many weeks. He lead us on our walk and played. I realized that I may have been attributing his slowing down over the past 2 months to age but it was probably lymphoma.

 

By the evening of that great day he wasn’t so well again. He was constantly panting, pacing and seemed restless. I discovered one of this lymph nodes was huge again. The nodes under his jaw (the ones that get huge when a person has mumps) were the size of grapefruits before starting his treatments.  They had decreased to the size of golf balls but one was now a grapefruit again. Unlike before it was painful to touch. He also had a fever. I suspected his lymph node was infected and this was confirmed at an unscheduled visit to his oncology team. He is now on antibiotics and steroids again. This steroid isn’t making him pant as much. He is improving but slowly. There is a chance his infected node will rupture which would require surgery.

 

He is scheduled for surgery or treatment #4 tomorrow. If he is able to have his treatment it is the drug with the most potential side effects, doxorubicin. As we head into the holidays I am thinking this may not be our Merriest Christmas.

Hope and Doubt,a vet’s pet battles cancer

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Two weeks ago, I discovered lumps on my dog’s neck and knowing this was lymphoma I doubted whether D.J. would be with us for Christmas.

The next day lymphoma was confirmed but blood tests and X-rays seemed to indicate nothing else was wrong (although lymphoma is a major wrong thing). I was hopeful that with treatment he may be that ‘average’ dog that survives 12 months and we might have him for 2 Christmases.

Over the week between his diagnosis and first treatment his health declined. His lymph nodes became enormous and he was very tired all the time. I began to doubt that such advanced disease would respond to treatment.

The first treatment went well with no noticeable side effects. His lymph nodes shrank remarkably and quickly and with in 48 hours he seemed to be his old self again. I was once again hopeful and thought maybe he was one of the 25% of dogs who would live 2 years with treatment.

The nodes got a bit bigger as we approached treatment 2 one week later. He was tired again. On the day of the second treatment he didn’t eat his supper. He is a Labrador Retriever and has never missed a meal. He was eating again by the next day but was tired. I noticed he had lost weight. The treatments were working but not winning and he didn’t seem well most of the time. I wasn’t so hopeful and wondered if chemotherapy was the right choice.

Yesterday, he played tug’o’war with his buddy Blue and today he kept the pace on his walks. Treatment #3 is tomorrow and is a repeat of the first treatment which seemed to go well. We will try another dose.

As the chemo battles the cancer, and D.J.’s body battles both the disease and the treatment I will continue to feel hope and doubt. I hope the treatment, D.J and hope win.

 

After the first Chemo treatment

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Today is 4 days after D.J.’s first chemo treatment and he seems to be back to his old self.

 

During the week between his diagnosis and first treatment there was a noticeable decline in his health. He was lethargic and had difficulty eating due to the size of the lymph nodes on his neck. Our appointment with Dr. Richardson at the Ontario Veterinary College Oncology Center couldn’t come soon enough.

 

At our appointment I learned about the proposed treatment protocol and D.J. had an exam, blood work and an ultrasound. The blood work determines whether or not he can have the scheduled treatment and will be repeated before each treatment. The ultrasound was an investigation to make sure he had no other concerns and to assess the size of his internal lymph nodes. Ultrasounds will be repeated and changes in the size of his nodes will determine his response to the treatments.

 

Despite being unwell for his first visit, he still required sedation for his ultrasound. He is a super nice dog, but even at the best of times he doesn’t like being held still. When he had his chest X-rays last week at my clinic, my associate exited the room shaking her head. Apparently, even when sick he is strong. Although the sedation knocked him back for a few days, within 24 hours of his first treatment his lymph nodes were smaller.

 

He has continued to improve every day and today seems to be himself again. The only adverse effect other than the slow recovery from the sedation is that one of the medications makes him drink more and therefore he needs to urinate more. He had 1 accident in the house. Everyone assured him that it was OK and not his fault and gave him treats.

 

He will be having 1 treatment weekly for 8 weeks. First he had an injection of vincristine. Next week he will get an oral medication, cyclophosphamide. Week 3 is another injection of vincristine and week 4 is an injection of doxorubicin. This 4 week cycle is repeated and then continued with 2 weeks between treatments.

 

There are many factors that affect the decision to have a pet undergo this type of treatment: side effects, remission rate, and life expectancy. I decided to treat D.J. because he had no other health problems and there was a good chance that the treatment would achieve remission and he could survive to a natural life expectancy. I will not continue with treatments if they make him unwell or he becomes unwell because they are not working.

 

There are a few other determinants of treatment that I did not consider before embarking on this journey. The entire 6 month protocol costs $5000. And each visit to OVC will require 5 hours of my time. Finding $5,000 is a challenge but finding 5 hours every week is almost a bigger challenge. Fortunately, the costs are paid at each visit and not as a lump sum and qualifying to participate in some of the ongoing studies subsidizes some of the costs. As for time, I have had a few friends offer to take D.J. to his appointments.

 

To have D.J. seem healthy again with no side effects from his first treatment makes the investment of time, money and emotions all worth it.

A Vet’s Pet Gets Sick – After the initial diagnosis

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This is what happens when you diagnose a pet with lymphoma:

 

  • The very next day he seems to be lagging behind on his walk.
  • The very next day he seems to be eating more slowly.
  • He gets way more attention from everyone in the family.
  • He gets more treats and develops diarrhea.
  • Every time he coughs it is very concerning.
  • He hears how good he is all day long.
  • His bed doesn’t seem cushy enough.
  • He needs his water refreshed more than once daily.
  • The other dog gets in trouble for playing too rough and too much.
  • He gets checked on in the middle of the night.
  • He is excused from a much needed bath because he doesn’t like them and is a bit smelly for his introduction to the oncologist.

A Vet’s Pet Gets Sick

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Last Thursday was my day off. The plan was to tackle a long around-the-house to-do list. I started the day as usual; feed the pets, run, feed horses, clean stalls, and then walk the dogs. I have 2 Labs, 10 year old D.J. and almost 3 year old Blue. I gave them a pet after our walk and my day changed dramatically. I felt a lump under D.J.’s jaw. I felt another one on the other side of his neck and a few more below these. Immediately, I knew I needed to test the lumps, run some blood tests, take chest X-rays but there was only one possible diagnosis for what I had found. D.J. had lymphoma and this was going to end his life.

I felt it all; my heart sank, I had a lump in my throat, my energy faded, my mind filled with too many thoughts.

I had talked the talk many times. Lymphoma is treatable but not curable.
Treatment options include:
• a 6 month multi-drug protocol can results in an 80-90% remission rate and an average life expectancy of 12 months including the 6 months of treatment;
• a single drug protocol every 3 weeks for 5 to 6 treatments for a 70% remission rate and average survival time of 9 months;
• oral palliative chemo every 3 weeks with an average 4 month survival time.
Having talked the talk, I now had to walk the talk and I had no idea what to do.

Is it fair to put D.J. through 6 months of chemo so I can have him a bit longer? Well, pets are supposed to tolerate chemo better than people do. Where would I find the time to get to treatments every week or two? I could probably do some of the treatments myself. An average life expectancy of twelve months isn’t very long. But 12 months means we might have him next Christmas and that is a long way away. We would have spring, summer swims in the pool and autumn bush walks.

With my head far to full of questions, I gave up on my to-do list and took D.J. to the clinic to start the testing. The roller coaster ride this day was going to be continued.

When I arrived at the clinic I was immediately informed that clients, whose dog I diagnosed with lymphoma a few weeks ago had called wanting their dog euthanized that day. She was no longer responding to palliative treatment. They requested me for the appointment but were informed that it was my day off. My associate would be helping them and they were scheduled to arrive at any moment. I was now there and wouldn’t hide. I decided to greet them, take them into the quiet room and explain why I was there. They took the time to give me a hug. I offered to try to do the appointment and if needed my team would assist. I shut down the pet owner part of me and helped them say good bye to their beloved pet.

I needed this roller coaster of a day to slow down.

The next event at the clinic was just what I needed. An internist was scheduled to arrive to consult on a complicated case. I stole a few moments of her time. She palpate D.J.’s neck. “You poor thing.” She also did not need any further testing to diagnose lymphoma. I told her I didn’t know what I was going to do. She put things in very simple terms. I shouldn’t think about a 6 month commitment to weekly visits and $5000. I should just try one round of chemo (3 weekly treatments) and see what happens. One round will show how D.J. tolerates the medication and will determine if the lymphoma responds to the treatments. Decision made. We will try one round of chemo.

I had to remind myself that I hadn’t yet confirmed the diagnosis. I planned to do blood work and X-rays but diagnosing lymphoma meant taking a sample of the lumps and submitting the sample to a pathology lab. I have worked with a local pathologist for 25 years but he recently stopped reading this type of sample. I really trusted his work. I sent him a message asking if he would consider reading this cytology for me. He answered by personally calling the clinic to say he would be happy to help. Without me knowing, arrangements were made that one of my assistants would drive the sample to the pathology lab and he would read the sample that evening so I would have results the next day. The support network was starting to form.

My family was still unaware of D.J.’s condition and the events of the day. That evening we had a family meeting the outcome of which I already knew. The usual decision at family meetings about pets is that since one of us is a vet that member should make the decision.

The report came the next day. It included some supportive comments and the words “no charge” but confirmed the diagnosis of immunoblastic malignant lymphoma. I called OVC (Ontario Veterinary College) Oncology Center and D.J. starts treatments on Thursday. I am expecting another day off full of emotions and questions.

Kittens Looking for Loving Home

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Meet Whelan and Olive. Both of these precious kittens are currently at our clinic and we are trying to find loving homes for them.

Whelan is the Orange and white kitten. He is 5 months old. He has been vaccinated, dewormed and neutered.

Olive is the Black kitten with splashes of white. She is 10 weeks old. She has received her first set of vaccinations and deworming.

Both are playful, curious and love lying around.

Please let us know if you are interested in bringing one of these little darlings into your home!