Last update: August 5th, 2013
I felt it necessary to start a new page on our fight against Nunya’s nasal tumor because we have learned some bad news on 6/21/2013, that starts the final chapter of the story. Nunya’s tumor is back. The fight is over. There is nothing we can do to get rid of it. So unfortunately, the focus for me has shifted from a mind set of attack, attack, attack to let’s make sure Nunya is as spoiled as possible for her remaining 3-6 months.
Nunya’s runny nose had not cleared up, so Alison took her for a third visit to A&M where they did another CT scan of her nose and they identified a mass that almost fills the entire left side. They presented Alison with a chemotherapy option that could potentially slow the growth but will not stop it. Since there are little to no side effects from this shot of chemo, Alison went ahead and Nunya was juiced up in the back.
Nunya’s runny nose is a little bit different this time. More snot on the right and blood snot on the left.
The magic of tomotherapy only lasted 7 1/2 months for us but I would have to say I would do it again. She has had several perfect months and even now as the cancer is regrowing in her nose, she appears happy and in really good spirits.
I never lost touch with the reality that Nunya would die within a short period of time but for my own selfish reason, I imaged after tomotherapy, I would be one of the lucky pet owners whose dog passes naturally in the night while sleeping (does this even really happen). I thought maybe worst case we would get some organ failure or something else that would be a definitive sign that it was the correct time, but it looks like in the end, the crushing pain from the cancer will get her. I now have three months to prepare myself for making the call on Nunya’s life at the right time for her and not for me. In the end, it is really a small price to pay for her loyalty and companionship.
Nunya is nudging me now so I think it is time to start the spoiling at Petsmart.
Medicine – Nunya received a Chemo injection on 6/21/2013. According to the doctors there should be no side effect to this first round. It cost about $400. With the shot, we got an instruction sheet that basically told us to not touch her poop or throw up without gloves (ok – we will not disagree). Basically, for 48 hours, all fluids are not friendly to people or other animals. We suspended walk schedule during this period. She will need to have a blood test by the local vet in 2.5 weeks and then will go for the next chemotherapy shot, which does have some side effects (nausea / vomiting).
- Ondansetron 4 mg tablets – Anti-nausea – Give 1/2 tablet by mouth every 8 to 12 hours for nausea.
- Denamarin tablets (S-adenosylmethionine/silybin) – Liver supplement – Give 1 tablet by mouth one time a day on empty stomach.
- Ursodiol 250 mg tablets #15 – Liver supplement – Give 1/2 tablet by mouth every 24 hours until directed otherwise.
Dr. Grayton at Texas A&M – We just wanted to mention how wonderful she has been with answering questions and giving us straight answers.
Status – As of 6/25/2013 – I would rank Nunya at a 2 out of 10 on a scale where 0 represents Nunya at best non-cancer state and 10 being the days starting Tomotherapy where Nunya could not breath without huge effort and the tumor was the largest. The last time we saw Nunya jump from a 1 to a 10 in about 2 weeks. We are praying that is not the case.
We received the “Discharge Notes” from the last appointment – These notes have always been appreciated as you can get hit with a ton of information at once.
The plan for Nunya’s chemotherapy is to alternate between the two drugs which would administered once every 3 weeks for a total of 5-6 doses for each drug. This means a total of 10-12 treatments will be given to Nunya as part of this therapy protocol. It is estimated that each treatment will cost between $300 – $400.
We started Nunya’s chemotherapy protocol today with the drug carboplatin, which is a platinum-containing compound used in treating some cancers in animals as well as humans. Some possible side effects include:
1. Nausea and/or vomiting 3-5 days after treatment.
2. Low white blood cell count, possibly predisposing to infection.
Please call your veterinarian or the Veterinary Medical Teaching Hospital if you observe any of these signs.
Doxorubicin is the chemotherapy drug that Nunya will receive at her next appointment and is a drug in the antibiotic class used to treat some cancers in animals as well as humans. Some possible side effects include:
- Gastrointestinal upset, nausea, and/or vomiting, usually 3-5 days after the treatment.
- Damage to the leg if accidentally given outside the vein. This is prevented by carefully placing an IV catheter for drug administration.
- Hair loss in dogs with continuously growing hair (i.e. Poodles, Terriers and Old English Sheepdogs).
- Low white blood cell count, possibly predisposing to infection.
- Heart problems if more than 6 doses are administered.
Please call your veterinarian or the Veterinary Medical Teaching Hospital if you observe any of these signs.
The full document is 6 page – if you are interested or if it will help your situation, I will email a copy.
Nunya still seems very happy and alert. She is sitting at the same place status wise as last week. She now has blood coming from both sides of her nose which I cannot imagine is a good thing but she doesn’t seem phased. We need to ‘clean’ her nose at least once a day due to the crusting up of the sneezes. Gross but she breathes a lot better.
Ali and I are very thankful that we had a wonderful 4th of July with Nunya at Alison’s family farm. Nunya was thrilled to be out running around and she was happy to chase anything that moved. She still had her normal amount of sneezing but it did not seem to get in her way. This coming week, we have to go for a ‘pre-chemo’ blood test. We had to get a ‘post-chemo’ blood test and everything looked normal (except her higher than normal liver values – which have stayed consistent throughout the treatments). Ali and I are a little nervous about this round of chemo (Doxorubicin mentioned above) as the side effects can be a lot more envolved. I think we have mentally committed to this treatment but we will have to re-evaluate post treatment.
Yesterday and today have been a little rough. We think Nunya stepped on a splinter during farm day that caused an infection in her back paw. We didn’t notice until her foot was pretty swollen. Ali took her to the doggy ER (because of course it is Saturday night) and they lanced and drained the paw. The stress from the procedure increased her blood pressure and her nose started bleeding a lot from the cancer side. They put her on an antibiotic and they told us to watch if the swelling returns. The doctor also mentioned that the swelling could also be a sign of the cancer spreading but by the end of the visit he was pretty sure he saw a splinter. Nunya had to go back into the ‘beach ring of shame’. Fast forward to today and now she is limping on her front paw too. So it looks like we are returning to the doctor tomorrow. Until then we are carrying her around and keeping her on the pain medicine. We don’t regret the Farm Day adventure as we know she had a great time, but it has turned out to be extremely complicated and expensive. See the Pics.
We are still being plagued by the splinter. We took Nunya to her regular Vet this morning and they gave us some new stuff to soak her foot in and they recommended that we up the dose of tramadol we give her. We are not fans of having to dope her up because it really takes the day away from her (she will sleep 8 hrs straight) and it seems unfair if it is not really needed but I think today is an exception. The nose bleeding has reduce back to its normal level. Thursday she goes for her next chemo treatment at Texas A&M.
Today was a bad day. There is no way for me to tell the story without Ali and I coming off completely crazy. As I am thinking about it now, after 90% of the clean up is done and Nunya is sleeping in a Tramadol induced nap, I can’t help thinking WTF am I doing and where do I go from here.
The day started normally, Nunya bounced between my office and Alison’s. All was well until it was around ‘frinner time’ (what we call first dinner – Nunya’s food gets divided into three portions breakfast, ‘frinner’ at 5:15ish and dinner at 8:30ish).
That is when the 3-hour nosebleed started and we had our 3rd trip of the week to the vet (it’s Tuesday). This nosebleed was unlike what we had seen since starting treatment. It started at the caliber of the ‘my dog sneezed cancer on me night’ and proceeded to get 10 times worse. Nothing we were doing would make it stop. All medicines were ineffective. One clot would form and it would be blown out seconds later. When I would try to wipe away the blood I could feel it pulsing out with her heartbeat. All we could do was pet her, look her in the eyes and tell her that she was a good girl in hopes that she would calm down. She didn’t seem to be in pain, but the volume of blood on her, the floor, the walls and us, was definitely upsetting her.
For some reason all of this happened in the hallway, which only helped to make the blood splatter more dramatic.
Ali made a quick call to the Vet and we were able to get in to see her normal Doctor (amazing the care that they gave her and their willingness to stay late). It was at the vet that everything hit. Nunya is bleeding out of both sides of her nose now; granted 99% of the blood comes from the original cancer. Her breathing is starting to be forced out of her mouth due to blockage. With the drastic progression in the last two weeks, we realize that Nunya will not be with us this time next month. We were now discussing where we would have her put down. Yes, we still plan to take her to College Station on Thursday to see about the next round of chemo but I can’t help but think too much damage has already been done. I told myself from the beginning that I would not euthanize her for my convenience (or delay it for my convenience) but I honestly have no clue what I am doing.
The problem with the nosebleeds is it evidence of destruction but not of pain. She loved the car ride, even though she was bleeding all over me. I really hope we can look to the vets for some honest answers over the next two days (blood work tomorrow, chemo Thursday).
Two good days. For us the good days are much harder to write about than the bad. It feels that if we don’t wait to the last minute to write something, we will jinx ourselves. Since we are not really sure what happens next it can be anxious at times.
Couple of new developments:
- We have developed some nosebleed skills. Nunya mostly bleeds from one side. That side is almost completely blocked by the cancer so most of her ‘sneeze force’ comes from the movement of her head (she leans her head back then quickly rushes it forward all the way to the floor). If we quickly put our hand under her chin, she does not do this. It also keeps her from leaning forward. No force is require – just the back of your hand touching her chin. Combine the no thrashing with the 10% epinephrine and we have a magical combination that normally will form a clot. We haven’t had to perform the trick individually yet so that will be the true test.Sounds like I am stating the obvious – but Nunya picks up on our mood related to the nosebleed. We try to keep it calm and reward her after the bleeding stops.
- We received some more answers that, I think, will help us in our decision-making. Nunya received a stronger chemo injection, Doxorubicin, which we believe is the best shot at either reducing the tumor or keeping it at bay. Dr. Grayton (again we must mention how much we appreciate her time) pretty much spelled out that if the cancer does not react to this treatment in the next week, we know we are at an end with the treatment and we can expect the continued rate of growth. The cancer will spread, Nunya will switch to mouth breathing and we will look for signs of loss of appetite, weight loss, change in mood, and change in energy. When that happens, it will be time. If Nunya does see some relief in the next week, that also gives us a plan. We continue on the treatment – watch the side effects from the next dose and re-evaluate then. Both endings are pretty much the same but for some reason it feels like the ‘plan’ provides us with more clarity.Beyond the chemotherapy, Nunya was given prednisolone to see if that will help reduce inflammation in her nasal area. She has also been prescribed more antibiotics in hopes of keeping the congestion down. We are kind of at a trial and error stage, seeing what she will respond to best.
Tomorrow is a big day for Nunya. We head back to Texas A&M to receive her second “strong” chemo injection of Doxorubicin. The results over the last two weeks have been mixed. She has been in a great mood, happy to eat her food, happy to chew on any project we give her, and very excited to go on her nightly walk. We have had an increasing amount of congestion from the non-cancer side. It seems to be a mix of 95% snot and 5% blood. The snot is very thick and hard for her to clear so for the last 24-48hrs she has been half breathing out of her mouth (it is very possible that the cancer is also now causing blockage on this side).
We do expect to see side effects with this next dose – which is a big worry.
Nunya had another chemotherapy injection today. Before the appointment we met with the oncology doctors and discussed her progress and treatment options. We had been concerned about the increased wet congestion and breathing difficulty she has been having the past few days. The doctors gave us the option of doing another Doxorubicin injection or trying the Palladia chemotherapy pill. They had previously not wanted to go with the Palladia due to Nunya’s liver levels being elevated. There is a chance though that she will respond well to it and have positive medical benefits, so it might be an option to try if the injections are not helping.
We decided to do another Doxorubicin injection at this time, as last time Nunya tolerated it well. We want to give it another good try and see if it is helping with the tumor. It is hard to tell if her increased congestion was due to the cancer progressing quickly or if it was just the Doxorubicin effects wearing down. We decided trying the chemo injection again this time will help to figure out if it is doing a good job helping the tumor or if it is more ineffective. We go back again in two weeks for another consultation and treatment. We will decide at that time whether to try the Palladia or stick with what we are doing now.
Nunya’s medications were also changed up a bit to see if we can get control of the inflammation and congestion. Her dosage of Prednisolone was increased for the inflammation. We also discussed congestion relief and are going to try Guaifenesin (Mucinex non-combo) and Ceterizine (Zyrtec). We will mostly need to experiment with the two and see if we get good results with one or the other. Side effects should be minimal, mainly drowsiness and increased thirst and urination.
The appointment overall went well and Nunya seemed fine after getting the injection. She got home and immediately ate a lot of food. She didn’t seem to be in any pain. She took a nap on the couch and slept well minus some congested breathing problems.
We are one week post-second chemotherapy injection. We have not seen improvements like we had hoped. Nunya’s breathing is still getting worse. She makes a constant gurgling/snoring sound when breathing. Sleeping is very hard for her as she constantly wakes herself up. Sometimes she will try to breathe out of her mouth, but she tends to pant more instead of learning how to slow mouth breathe yet. We have also noticed a decreased amount of the congestion crust in her nose and increase in reverse sneezing. While maybe this is good, we actually fear it is not so good and that the tumor is starting to block most of the nasal passage so that even snot is not getting out. We will have to see what the vets think at her next appointment.
The good news is that Nunya still seems happy minus the breathing trouble. She enjoys working on her dog chewy projects, and will sit outside and sun herself. We are still able to go on nightly walks too. Nunya had another blood test done yesterday and the results came back as good.
We are having a really hard time transitioning from nose breathing (about 99% blocked by cancer now) to mouth breathing. Anyone have any suggestions? When we go for car rides or walks she naturally switches and doesn’t get the ‘panic’ pant.
Nunya’s Nose Bleed – The pictures may be graphic. Our goal is to be as informative as possible about the entire process.
Nunya’s Facebook (Yes – I know it is silly but it is easier to update from multiple devices and hopefully will allow others to share their pictures)
Nunya’s Runkeeper (Holds us to a daily walk – with the exception of post Chemo days)