Thursday, March 06, 2008

waiting for a diagnosis

About a week ago, I was scratching Ginger’s ears and neck and I felt some lumps in her throat. Her lymph nodes, I’ve since learned. I figured she had an infection or something. I didn’t really notice them for a few more days, so it slipped my mind. Then I noticed them again—they didn’t seem to be getting any smaller. I asked Stanley what he thought, and he agreed that they were enlarged.

Ginger, in Natick, Christmas 2007

Since one of Ginger’s teeth is cracked, we just assumed it got infected, or maybe something from a tick. We took her to see her vet, Dr. Re at Strawberry Hill Animal Hospital, yesterday. Dr. Re found more enlarged lymph nodes in her legs and mammary area, and said there were several possibilities, including lymphoma, a kind of cancer that Goldies are particularly prone to. So Dr. Re aspirated the lumps to send samples out for testing. We were supposed to hear today, but had gone out to dinner with our friend George by the time Dr. Re had a chance to call. Her message just said she’d call in the morning to talk about what to do—since she didn’t say, “It’s not cancer,” we assume that’s what the diagnosis is. I’m still hoping we’re wrong. So if it is cancer, lymphoma, it is treatable, according to articles we read on vet sites on the Internet. Something like 85% go into remission for about a year after chemotherapy, which, the articles all say, dogs seem to handle well. Waiting sucks. It’s going to suck even worse if we’re right about the diagnosis. She just turned seven years old. I can’t stand this.

posted by lee on 03/06/08 at 04:42 AM
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Saturday, March 08, 2008

another journey i didn’t ever want to make

Right now, I’m kind of numb. On Thursday, Dr. Re, Ginger’s vet, called. Ginger has lymphoma:

The lymph system is the body’s “other” circulatory system, circulating white blood cells and most importantly, lymphocytes. These are specialized cells involved in immune function found throughout the body. In normal healthy dogs, these cells are manufactured in the bone marrow, go through a life span of around 30 days, and then die off and are re-absorbed into the body or eliminated through the waste channels. In Lymphoma, the regulation of production is lost and these cells proliferate in large number, or they lose their programed life cycle and continue to live on, overwhelming the other blood cells. High white blood cell count and swollen lymph glands are the characteristic signs of this disease, followed by lethargy, loss of appetite and leading eventually to death unless treated.

When we found Ginger at the Westport Connecticut Humane Society in October 2001, they said she is a Golden Retriever, but had no papers. Whether she’s a purebred or not doesn’t really matter to us—we chose the dog, not the background. But we’ve discovered that goldies face some problems that most other breeds and mutts don’t, and one of them is a 1 in 8 chance of developing lymphoma. As I said to Stanley, that’s why, when we brought her to Dr. Re last week, she just knew what was wrong. We could see it in her face.

We saw Dr. Re Friday at noon, Ginger in tow. She briefly laid out our options, ranging from making her comfortable until she dies to treating it aggressively and seeing if we could get her into remission. Without treatment, she’ll die in a couple of months. With treatment, we can give her a year to two years of life—a good quality of life.


Ginger appears to be a good candidate for aggressive treatment since she’s not yet sick from the cancer. We caught it very, very early—she didn’t have the lumps, or if she did they weren’t noticeable, when Stanley bathed her on February 23 (before heading to Natick to watch the Oscars). The only way she wouldn’t be is if she has, I think, the T-cell form instead of the B-cell form, as the T-cell form is particularly virulent and does not respond to chemotherapy. Mostly, we don’t want Ginger to be in pain. There would be no point to prolonging her life if she is going to be miserable. But from everything we’ve read, from what the vet said, most dogs respond very well to chemotherapy and have an excellent quality of life. She’s a good dog and we love her, so of course we want to keep her alive as long as possible. She makes our lives fuller and I, for one, couldn’t have gotten through Stanley’s surgeries and other problems without her. She kept me sane. We owe her life for all she’s given us. Yes, it’s going to be expensive—thousands of dollars, from what we’ve been able to discover. We can’t really afford it, but what else can we do? So we’re going ahead with treating her—if we can give her at least one more summer on the beach in Oscoda, it will be worth it for all she’s given us. We have an appointment at 10 a.m. Monday with the oncology vet, at the Veterinary Oncology & Hematology Center here in Norwalk. It is headed by Dr. Gerald Post, whom Dr. Re praises highly. There Ginger’s cancer will be staged and they will outline treatment options and we’ll get started. I already know I will have to document this whole journey in order to get through it—writing it all out here helped me get through Stanley’s operations and his near-death brushes. Also, I read a lot about diet and immunotherapy (I’ve read a lot already—bless the Internets ... ). Ginger needs a high-protein, high-fat diet, low in carbs since carbs, apparently, feed the cancer. We got some IAMs puppy chow for her, as that is one of the brands recommended on—it’s first ingredient is chicken vs. a grain or corn. We also purchased a month’s worth of K-9 Immunity (painfully expensive)—the one-month kit. It came this morning. Giving her the pills is fairly easy—I just poked them in the middle of a piece of string cheese and Ginger gobbled them down. I have to give her nine of these per day. The fish oil capsules were a problem—she ate the cheese and spit out the capsules. Stanley said to put them in her wet dog food—that worked just fine. The immune factor tablet is supposed to taste like liver—after hesitating, she finally chomped it down. I gave her half this morning and will do the other half this evening—but the instructions say they can all be done at once so that’s what I’ll do starting tomorrow. A new daily ritual. If it helps, it’s worth it. I will ask her vet about it on Monday—they also offer immunotherapy as one of the treatments so they’ll know more about it. I want to try everything that works—I’m shooting for a two-year remission at least. Why not? She’s only seven years old and other than the cancer, very healthy. I’m going to put a donation button up—if readers want to contribute to her treatment, I welcome the donations. In exchange I promise to faithfully document everything, including costs, so that others facing this will know what to expect, what works for us, what doesn’t, pitfalls and victories, everything. I don’t expect any donations, but they sure would help. We’ll find out more on Monday how much this is going to cost us—the estimate, anyway. So my ten-year, get-out-of-debt-including-the-mortgage-plan takes eleven years—Ginger is worth it.

posted by lee on 03/08/08 at 09:27 PM
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Tuesday, March 11, 2008

she started chemotherapy

We went to see the vet oncologist yesterday—Ginger’s doctor is Amanda Elpiner. Ginger seems to like her, though not as much as she likes Dr. Re. Dr. Elpiner filled us in on what lymphoma is, treatment options, costs, things like that.

She said at this point, they stage the cancer, which is determining what organs are affected and whether or not she’s acting sick. Staging is taking bone marrow (while Ginger is under anesthesia), doing an ultrasound, and determining which type of lymphoma Ginger has: b-cell or t-cell. T-cell is the more virulent form. Complete staging costs $800, and other than determining which type of cancer cell Ginger has, does not determine treatment. The initial drug, Elspar, is what would be given for either b-cell or t-cell. We already knew we wanted to most aggressive treatment option.

While on one level I would like to know all of the staging details, thinking about Ginger, what I really want is for her not to be prodded and poked and stuck with needles and put under anesthesia any more than is necessary for treatment. Stanley and I decided to forgo the staging and spend the money on treatment.

Treatment is not cheap. It’s going to cost us at a minimum $6,000—could even be up to $10,000 depending on how long she needs treatment. It’s once a week for six treatments, every other week for six treatments, then every third week for the rest of the year. Or something like that. That’s for the treatment—food and supplements will add to the bill, though we’ve always opted for higher premium foods so the food bill won’t be that much higher. I guess we won’t be taking any luxury vacations or cruises any time soon. Treatment, if it’s b-cell and all goes well, can get her anywhere from one to three years of remission, 10% to 30% of her expected lifespan. We’ll know the cell type by Wednesday or Thursday.

So, Ginger has been on K-9 Immunity for three days, got her chemo drug yesterday, and was put on prednisone for a month (descending dosages, to taper her off), to get the swelling of the lymph nodes down. Her lymph nodes have already gone down quite a lot—I was shocked at how much and how fast. Pleased too.

Ginger, of course, turned into dead weight when she was supposed to go into the back room for her treatment. Stanley and I had to drag her back there while they did the cell test and gave her the first injection. She shied away from Dr. Elpiner when the doc tried to examine her—like she does with Dr. Re. But, after her treatment, the door opened and she came running over to us, in pretty good spirits. She then went into Dr. Post’s office to see who that guy was, and she liked him, wagging her tail like crazy. Then went back into Dr. Elpiner’s room to say goodbye to her, tail wagging. Trotting around the place like she’s an old pro already. I hope it’s not a battle to get her in next week—there will be times when I have to take her by myself and there’s no way I can lift her. So hopefully she’ll remember the nice people who petted her afterwards rather than the before stuff.

Today, she’s been sleeping a lot. She was really mean to Slink last night, so we’ll have to watch for prednisone-induced personality changes. She seems tired rather than sick, though her nose is warm and dry. And the prednisone makes her drink a lot, which makes her have to pee a lot and when she’s gotta go, she’s GOT TO go. Clients will, I hope, understand when I suddenly have to put them on hold to let her out.

Oh, and I discovered the best way to give her pills is to stick them in the middle of pieces of string cheese. I put the fish oil in a small can of wet dog food—those are too big for the cheese. And I have to keep remembering that she’s right under my chair—she’s taken to curling up as close to my ankles as she can get. (Here is a photo Stanley took of Ginger curled around my chair. Click to enlarge.)


Jeopardy is starting—I should go see if Stanley is awake—he had a new post installed for his new replacement crown and came home from the dentist with a bad headache, so I told him to just go lie down. Which he did—he rarely corks out during the day, only when he really doesn’t feel well.

posted by lee on 03/11/08 at 09:20 PM
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Friday, March 14, 2008

found out the cell type

And it’s B cell. Which is the less virulent form of lymphoma. Which means the prognosis is better—the vet told Stanley that this type usually responds well to chemo. Ginger seems full of piss and vinegar today, and her lymph glands seem back to their normal size.

Just a quickie update!

posted by lee on 03/14/08 at 06:59 AM
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Monday, March 17, 2008

john adams on hbo

We watched John Adams, parts 1 and 2, this evening. I was really looking forward to it and I wasn’t disappointed.

The things that I noticed right away were the details of the house interior and the streets of Boston—the cloth over the entry door to keep out the winter drafts, the grubbiness of the Boston streets. I love it when movie makers pay attention to details such as this—it bodes well for the history part of it.

Since I haven’t yet read John Adams by David McCullough, though it’s on my list, I never knew that Adams defended the British soldiers accused of murder for the Boston Massacre. In fact, I never realized that the whole incident was provoked. I’m looking forward to the entire series.

It was also interesting to see what tarring and feathering really involved—it’s pretty barbaric. I never really thought much about it before. And the trial was interesting—what a difference from how trials are conducted now. I’m not sure if it’s an improvement. Stanley made a comment about people in this country not taking too well to occupiers.

I’m not crazy about David Morse portraying George Washington—first off, he sounds like he’s got too much cotton stuffed in his cheeks, like he can’t handle the make-up. Second, I’ve never been crazy about David Morse, period, plays everything a lot on the too morose side. But Paul Giamatti and Laura Linney are really good in their roles so far. And Tom Wilkinson as Benjamin Franklin is great.

In the morning, Ginger gets her second chemo treatment. Not sure what drug this time. She’s doing really well so far, lumps are no longer noticeable and she has loads of energy—spent part of the evening rolling Twitch on his back and trying to get him to play with her. Twitch was one mad kitty. Not sure if this way expensive K-9 Immunity supplement is helping any (beta glucan therapy, whatever that is—near as I can tell it comes from mushrooms) or if it’s a lot of hooey, but she’s doing so well so far I don’t want to change anything just yet.

posted by lee on 03/17/08 at 03:25 AM
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Friday, March 28, 2008

this week’s drug is cytoxan

Ginger is still doing well. Last week’s dose of vincristine—besides turning her doggie farts lethal—lowered her white blood cell count. Not below the cutoff for the next round, but enough so that her onco vet asked us if we wanted to postpone the next treatment for a few days. We opted to go ahead with the cytoxan and feed her antibiotics and keep a close eye on her rather than disrupt the schedule. Since I work at home, I am able to watch over her. And trip over her. She keeps very close to me most of the time.

Cytoxan was administered with a diuretic—Dr. Elpinar told us we had about 20 minutes from the time of treatment to get her home and get her outside to pee. Ginger, of course, kept her own schedule and we had to make her go out. She’s on an antibiotic, half a dose of prednisone, her K-9 Immunity stuff, Omega 3s, and I just added flax seed oil.

Oh, and she overdid it running with Tattoo last Saturday and had a terrible limp for a couple of days, so I added glucosamine chondroitin to the list. The vet told us we shouldn’t give her aspirin while she is on prednisone because it will upset her stomach and gave us a painkiller that is safe with it. Seems to do the trick quite nicely. She isn’t limping any more—she usually does get over it after a couple of days, but this time she hurt so much on Monday that Stanley had to carry her down the stairs. So Tuesday, since she was still limping, Stanley dosed her with the painkiller about a half an hour before I got up so she could go downstairs herself.

The thing that’s making me crazy about this is Ginger has lost five pounds in two weeks. The vet says it’s because it takes a lot out of her to fight the cancer—and I know she’s right, but 5% of her body weight in two weeks seems like a lot to me. She started out at 86.5 pounds and is down to 81.5 pounds. It’s weird to go from worrying about her weighing too much (she was eating Beneful Healthy Weight!) to worrying about whether she’s eating enough to fight her cancer. (If only she could eat lots of Greenies every day—I still haven’t figured out what so addicting to dogs about those things!)

Update on the costs so far: $2,000 (two trips for diagnosis to her vet, intake and three chemo treatments by the oncology vet, K-9 Immunity kits, prednisone, antibiotics, and pain medicine. Oh, and high-end puppy chow, high-protein wet dog food, bones with vitamins, and lots and lots of string cheese. Stop ‘n’ Shop string cheese works best, especially if you take it out of the fridge about 30 minutes before you need it.)

In other news, we had a really nice time over Easter. I was going to use the time to catch up on stuff, but I was just too tired and barely checked my email.

And today we soft-launched the completely redesigned website for The Connecticut School of Etiquette: which I quite like so far. There are some glitches I need to work out and there is more content and photos and a bit of programming to add, but it’s a site the owner can pretty much update herself once she gets the hang of the interface and how it works. Done with ExpressionEngine, of course. The original design we put up quite a while ago—more than five years ago, I think—and while nice, it needed a redesign and needed to be easier to maintain because the owner’s business is expanding.

One of the things I need to do is make the black bar with the etiquette words at the very top of the screen work cross-browser. Looks fine in IE6 or 7, but has this annoying one- or two-pixel border at the top that shows the background pattern through in Firefox and Safari. Not sure yet how to handle this. Border and margin for the body are set to zero, so that shouldn’t even be there—I’ll check various CSS guru sites to see if there’s something I’m not doing that I should be. Every time I think I’ve gotten a handle on CSS, something new that doesn’t work right comes up and I realize I have miles to go—especially since I don’t want to use any hacks.

Friday I’ll be finishing putting together a database in Access. Among several other things. Work is not dull, that’s for sure.

posted by lee on 03/28/08 at 03:59 AM
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