Day 78: Roo soldiers on

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All I can go on is my own personal experience, but in that experience nothing has ever been this hard. Not getting taken out of a mud hut to be shot in the middle of the night deep in one jungle, or getting captured by committed war criminals in another one, nor escaping from them, not my admittedly brief jailings, detentions in five countries and ejections from a couple of others, not paralysis, not being crushed under a jeep, not acrimonious divorce, not shame or regret or loss. Nothing has come close to trying to nurse Roo back to whatever health she might still have ahead of her. Many of you reading this have done it, and you know. And doing this singlehandedly in this tiny camper has been the hardest thing I’ve ever done. It is a 24 hour preoccupation, a constant struggle to try to mitigate the problems that come up constantly and seem to change by the hour. The only thing to do is to watch closely and try to address symptoms, but you never know for sure what the trouble is and you can’t ask.

Roo had a terrible time bouncing back from the chemo treatment she received two weeks ago. She was never in pain and she never seemed especially distressed, though that could have been because was too lethargic and rundown to express more. The worst of it seemed to have been the way the chemo upset her stomach. She had loose stool for nearly two weeks and at the tail end of the doses of anti-nausea meds she was getting she began to look worried, as if she was expecting something she had hoped was done with to come back. She refused food for a few days. The nausea and feeling like she had been poisoned, which she essentially had been, must have been overwhelming. But how brave she was. You would have been as proud of her as I was. You would have gotten more proud of her every day. I did.

For about ten days she had some small issues of incontinence, which upset her and embarrassed her and no dog likes being soiled. When it happened, she would pick her head up, looking surprised and confused. She didn’t realize it had happened until she felt it in her fur and on her skin. From what I read in the cancer dog forums, this is common.  When I washed her – not an easy thing to do for a dog who is too weak to stand up – she would slowly wag her tail, the only times for days when she did, a wag of embarrassed gratitude, and then she would be relieved, standing with her hind legs in the tub and  relaxing, her head dropping and her eyes closing as she felt the warm water and my working everything out of her fur and do her best to stand still and lift her tail. Once she was rinsed clean, those moments of relief were the best ones she had for days. 

For five of those days, the only fluid she got was from a bag hanging from the shower curtain and through the needle I put in her back. Being able to do that in the camper was a huge relief to me. There is nothing to it, and in 15 minutes a liter of solution is administered and the problem of dehydration is gone. 

In the mornings, Roo managed to go outside for a few minutes. She was always old to get outside and flung herself on the grass and wiggled to scratch her back and lie around and listen to the sounds and see who might be in the trees, but after that and some quick chores she was tired quickly. After I lifted her back into the camper she would stay there for the rest of the day. During the worst of it, she wouldn’t move until the next day, not so much as to shift positions, and then I cleaned her the best I could where she lay on the floor whenever the need arose.

After that first week, she began to surprise me by suggesting that she wanted to go for a walk. I would help her into the car and we’d drive to the frog pond where she splashed around for half an hour or so. Then one day she didn’t want to get in the car and walked to the end of the driveway instead. We walked for about a half an hour, down to the cool stream nearby. She wanted to go farther, but I knew it would be too much and she didn’t argue about turning back. It was probably too much as it was. She could hardly get up again after that. She still can’t.

The following paragraph contains a spoiler alert, so those of you who have not yet seen Roo’s favorite example of squirrel cinema may want to skip it. The movie, which is eight hours long, is all shot on one location. A camera is pointed at a cutting board in someone’s backyard. It is covered with bird seeds and a few peanuts. A squirrel rummages through the seeds. It squawks and chirps. Once in a while the squirrel runs off to fend off a lurking crow who would like some of the seeds but who never works up the courage to chase the squirrel away, which one would think would be easy enough to do. The crow doesn’t think so. Sometimes the squirrel notices one of the peanuts and picks it up. Recognizing the treasure, it carries the peanut off. You might think that would be the end of the movie – an enigmatic ending leaving it up to the viewer to make of what they will – but the parade of life goes on and is never interrupted for long. There is, just as in real life, always another squirrel ready to take the place of the last one. The cinematography is perfect for a dog, evidently just a cell phone on a stick that is never moved at all. You might think that a movie like that could warp your brain. The squirrel, or squirrels (it’s hard to tell how many of them there are), never once shut up, and while that makes the film difficult to have running for the hour and twenty minutes at a time that have so far been all I can take, it’s exactly what a dog likes. I’m sure when Roo feels better she’ll write a 20,000-word essay on it for an obscure French film magazine.

We have seen this movie many, many times.

The wound on Roo’s arm finally looked like it was healing yesterday. A good, solid scab built up for the first time. Overnight she managed to get her e-collar off, though, and she licked it back down to blood.

Stupidly I said, “You didn’t! You didn’t lick that arm, Chuggie Che Beker! OH, ROO, WHY DID YOU LICK THE ARM?!” If you don’t think seeing that didn’t reduce me to tears, you’re wrong. I was so hopeful that that wound was healed, and subjecting her to the e-collar for the last several days was all for nothing.

Roo is still weak. She hasn’t wanted to go for a walk for the last two days, but today she had to be rousted into the car and off to see Dr. Mason for another round of chemo and another cold laser treatment on the wound. It had to be done. She only has a few more rounds of chemo left, as she’s on a shortened chemo protocol because of the lymphoma vaccine she will be getting and which has extended the lives of patients with the type of cancer she has. Maybe she will get some time to be Roo again.

How much time, though, no one can say. Roo is in clinical remission, but lymphoma always comes back. Not knowing whether the discomfort and sickness of chemo is a fair bet on her behalf is the hard part.

Day 69: Maybe the two hardest weeks so far

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What a lousy time Roo has been having. First her leg injury on July 24th, just when she was in a good period between chemo treatments. Two days later, chemo, and it made her mildly ill. Just as she was starting feel a little better, she had to go back in for a dose of the worst of the chemo agents – doxorubicin.

Doxorubicin is the one that made her desperately ill the last, and only other, time she had it. She was so ill, and so, of course not eating or drinking, that I took her to the hospital, where she was given fluids, and where she had massive explosive diarrhea. The poor girl must have had that building up inside her.

This time, we’ve premedicated her with Cerenia, an anti-nausea med for dogs; Zofran, the same anti-nausea med humans use; metronizadole, an antibiotic used to control diarrhea; omeprazole, an antacid; lomotil, for diarrhea; mirtazipine, a SSRI drug that stimulates appetite; and Pepto Bismal for indigestion.

The chemo drugs don’t achieve their peak effectiveness until several days after the dose, but Roo tends to get sick from them right away, and later on the day she had the doxorubicin she was already feeling bad. By the next day, Wednesday, or five days ago, she tapered off eating and drinking. All her hydration since then has been by subcutaneous fluids I’ve been giving her in the camper. In five days, only on three occasions has she delicately lapped a few drops of water from the bowl. She ate a little on Saturday – a cat food-sized can of Prescription Diet a/d late in the evening and four chihuahua Milk Bones.

Still, she doesn’t seem to be too distressed. She’s not panting. She must just be feeling beat all to hell, and, in spite of the anti-nausea meds, nauseous. And what little poop she produces is liquid. So, her gut must be taking the brunt of it.

I’ve been trying to get her interested in eating everything I could think of. I’ve cooked her ground turkey, beef, bought her a rotisserie chicken, tried buttering toast for her. Every once in a while she’ll surprise me and take a little. I don’t know if it’s enough to live on. She does not seem to be losing any weight.

Boredom must be killing her. We are in the camper all day and all night. I was showing her YouTube videos of squirrels, dogs, cats, birds, anyone who makes squeaking noises, but I did so much of that that I ran out of data on the cell phone and won’t have any more for another 10 days, so that’s out. I think I’ve done a good job of keeping the bad news from her, and though her illness is the worst of it, there’s been nothing but bad news lately, and it’s getting to be too much. 

Today, I kept floating the idea of going swimming. She didn’t want to at first, but eventually she decided it sounded like a good idea and stood up. We went to the pond, and for 45 minutes, moving slow, she prowled around in the water looking for frogs. She pounced on a few, but most of the time she just waded and felt good in the water.

When I give her her sub q fluids through a needle in her back, I sit on the floor with her and gently comb her with a slicker brush. She loves that. Fifteen minutes later, there’s a big lump of Lactated Ringer’s Injection on her back, and generally she falls asleep after that.

She’s okay for the rest of today. I’ll keep nursing her for 24 hours a day for as long as it takes, but I have to admit, it gets hard.

[That picture is of Chig in the water today.]

Day 65: The Doxorubicin Blues

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Most dogs don’t have a bad reaction to L-asparaginase, a protein-based chemo drug. Roo got that on Friday. By Saturday she was starting to feel the effects. Not until last night did she even want to go for a short walk. When she did, though, she pooped and it looked good for the first time since Friday.

She started this morning feeling pretty good. She ate a little chicken and jumped in the car without wanting to be helped. Her leg injury is clearing up quickly and she wasn’t limping. I felt bad about having to rush her, but the camper had to be taken to the dump today, and it seemed like a good idea to get it over with before we went to the vet, because Roo was scheduled for doxorubicin, and that was the chemo drug that really took a bite out of her the other time she had it.

By the time we got to the vet, Roo was turning treats down. Dr. Mason went to get some that were even tastier than the standard cookies, and Roo turned those down, too. Other than that, she didn’t seem to be doing badly, and though the doxorubicin is scary, we proceeded with that. Dr. Mason also did some cold laser therapy on Roo’s damaged foreleg.

By the time we left the hospital an hour and forty-five minutes later, Roo wasn’t feeling great. She had a big yellow bandage on her foreleg and another flowery one on the chemo site on her back left ankle. It was the most murderously hot portion of the afternoon, around two and up to 94 degrees and still and humid. Roo pooped, and that didn’t look good. 

One thing I’ve learned nursing Roo is that this cancer treatment is complicated stuff and there’s no point in second-guessing when it’s too late. The doxorubicin is onboard. I can only hope that all the premedication for nausea, appetite and diarrhea that she didn’t have last time until the sickness had already set in are going to help.

This evening, she’s turning water down and won’t eat anything. After a huge amount of coaxing I managed to get her to come outside for a few minutes to see if there were any chipmunks. Soon she’s going to stop believing me when I tell them they’re there, but it’s pretty much all the ammo I have to get her interested. She only lasted four or five minutes, not enough to empty in case she needed to. She was too tired, feeling too beat up. I’ve given her her second dose of the drugs an hour and a half early, in case the problem is nausea, and now she’s sleeping. I have subcutaneous fluids for her, and if she keeps refusing water, I’ll poke a hole in her later and give her that.

Otherwise, this is a little like waiting for a bomb to go off. If her reaction is anything like it was last time, which I doubt, because she’s getting the all the drugs that helped her then, she should start feeling better in a few days, and she won’t be getting another dose of chemo for two weeks.

In the meantime, I spend as much time as my knees can take on the floor with her. She gets upset if I leave her before she drifts off to sleep. She’s waking just now and looking at me. I hope she wasn’t looking at me just a few seconds ago when I checked the weather for thunderstorms that are supposed to get here tomorrow. I don’t think so. But I don’t know. I don’t know anything. I wish I did.

[That’s an old picture of Roo, from way back when she was bitten by a snake, but she hasn’t changed a bit. She’s still my little puppy.]

Day 63: A little of this, a little of that

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What a few days it’s been. Dogs aren’t supposed to get sick right after chemo, but, as Dr. Mason said, Roo is a Bubble Girl, as in the Bubble Boy on Seinfeld. Everything drug bothers her.

She hobbled into the clinic for the Elspar chemo on Friday. Her leg injury wasn’t improved since her visit the day before, but she had to go, and in she went. I made a mistake when we came out. Next to the animal hospital there’s a little woody area with the scents of a million dogs, and Roo likes to go there. But, with her leg injury I hustled her into the car. Big mistake, because when we got back to the camper, she decided she didn’t want to go after all, and she wouldn’t leave the camper again until the next day. That meant that if the chemo was going to trouble her gut, as some of the treatments have in the past, she would be starting on a full tank. Hardly ideal. But once Roo makes her mind up about something, that’s it, and she decided to put everything on hold.

By Saturday, she was starting to feel nauseous and get indigestion. She didn’t want to go out but ultimately had to. Her leg was stiff and painful – but improving, which was a more of a relief than I know how to communicate. 

Bad news, though. When she finally pooped, it was soft. Not diarrhea, but worrisome. She was going to have to start immediately on metronidazole, an antibiotic to fight diarrhea. She also didn’t show much interest in food, and inappetence in a cancer dog is a bad thing. For that, another pill, mirtazipine. I could only hope that the load of medications piled on top of the chemo would help her feel better instead of worse.

After she pooped she lay down n the grass and I gave her a long makeover with a slicker brush, which she loved. Roo is a hunter and a field and stream dog. Even though she gets rinsed, dried and brushed every day, her coat had some catching up to do. I brushed her for about an hour. The amount of hair that came out was spectacular. I don’t think it’s from the chemo.

Saturday was the worst of it. I cooked her ground turkey and rice with mushed pumpkin and beef broth and she ate some of that. Later in the day she ate a few cookies and soft jerky treats, but she was upset and obviously a little chemo sick. Her meds (rimadyl, omeprazole, Cerenia, Zofran and Pepto Bismal as well as the aforementioned mirtazipine and metronidazole) gave her some relief, and by Saturday night, she managed some sleep. 

This morning, Sunday, she went out and was feeling better. She was still a little wobbly and her leg was still hurting, but it was much better. At the moment, I’m probably most grateful for that. To be honest, that leg injury had cast a pall over her prospects, or, at least, over the way I viewed them. Now that the assumed soft tissue injury appears to be the culprit, judging by how fast it’s improving, she’ll be in better shape for her next chemo on Tuesday.

Roo needs a lot of attention when she’s not feeling well. She wakes up constantly and looks at me with a dejected stare until I get down on the floor with her and hold her and tell her things.

“Look how soft your fur is, now Chig,” I tell her, proud of the transformation I had brought about by brushing her for so long. “You look just like a little rabbit. Some little rabbit is going to see you and mistake you for her mommy and hop right up to you and then you will catch that little rabbit and how sorry I feel for that poor little rabbit, Chig.”

She likes the subject and slings her arm over my neck to get me to stay on the floor telling her things. When I do, I leave out the part about having to get dosed with doxorubicin on Tuesday. I have a feeling that would ruin it all for her.

We’ve got one hell of a week coming up.

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Day 61: That leg of Roo's

I’m a little too beat to write much, but Roo’s leg was hurting a much to want to get in the truck to go to the vet, too much to take a pee, too much for anything else (and it’s now 36 hours). Eventually she agreed to come outside, and with some help she got in the truck which in turn started to run rough. I didn’t think we’d make it, but we did.

We were up all night last night. Roo developed indigestion and I’d run out of Pepto Bismal, so there was no getting it to stop without staying on the floor with her and calming her. That always seems to work, but it stops working the second I try to get up. So there we were.

Roo was supposed to get the doxirubicin chemo today, but with the pain in her leg, the vet changed it to L-asparaginase, which has made her feel bad, but not as viciously as the doxirubicin, in the past. She’ll have to get the doxirubicin on Tuesday.

She had an x-ray, and nothing showed up on that, so a soft tissue injury is still suspected. Roo is for all intents and purposes lame in the right rear leg. She can’t hold it off the ground, so every step is painful for her. She won’t go outside, though she did once to say hi to Virginia and her sister when they came home late in the afternoon, but she was in too much pain to take advantage of being outside to empty herself.

She had to have benadryl for the chemo treatment in case of an allergic reaction, and between that and all the other dope she’s back on, she’s in a pretty downhearted mood tonight.

This leg injury is about the worst thing that could have happened to Roo. I’m not sure how this affects her long term prospects. I try not to think about it, but all that doies is make it into another one of the things I have been thinking about non-stop for the waking 21 hours of every day for the last two months. I was going to look for something to watch on Netflix, but decided to check if there were any new squirrel videos on YouTube instead. That kept Roo’s attention for a while. Gave her something to do. Something to look forward to. I told her we’d find the park in that video, which is loaded with squirrels, and go there and kill every one of them in a colossal spree once she was up to it. I think she knew I was lying. Maybe too many of the things I’m telling her these days are lies. Finally she went to sleep.

The first time Roo got Elspar it didn’t make her feel sick. The second time it did. This time, who knows. The vet said Roo had to have a chemo today or the, “cancer could get ahead of us.”

Roo is nervous and a little grouchy. She’s sick of having pills jammed down her throat, though I do it fast and without any drama for her. She only has a few more to come tonight. If she can manage to sleep it will help her.

Day 60: Hospital today, hospital tomorrow

Overnight, Roo’s leg injury became more painful. She got some sleep, but in the morning was unable to place any weight on that right rear leg. 

I took her to the vet. Dr. Mason wasn’t there today, so Dr. Chretien saw Roo. He checked for an anterior cruciate ligament injury, and though he couldn’t rule it out conclusively, he didn’t think that’s what it is. There was no sign of a broken bone, and considering that Roo is going back tomorrow for chemo, there was no point in x-raying her, either. If it’s a soft tissue injury, which is almost certainly what it is, it wouldn’t show up on an x-ray, anyway. And the prescription for all of those would be essentially the same. Strict rest with minimal movement, a towel slung under her belly to help her keep the weight off when she does walk. She was given a shot of buprenorphine, an opiate, and a bottle of gabapentin capsules. 

We returned to the camper around 2 PM. Again Roo was a little embarrassed to need help getting out of the car. It was the only time today that she wagged her tail. 

As soon as she came inside she lay down. She hasn’t moved since. The drugs have knocked her out. She doesn’t even want to eat much.

She’s supposed to get her already delayed dose of doxorubicin tomorrow. That was the chemo drug that made her so sick the other time she had it. This time, we’ll be trying to prevent the sickness by medicating her in advance.

Meanwhile, Roo won’t get up or go outside. I don’t think she needs to, and this is the first time her penchant for going 20 hours at a time without peeing is helping. At least she’s not on that leg. But this injury multiplies the difficulties the coming chemo treatment might create.

Every time she wakes up and looks at me I spend time on the floor with her. That’s more or less how the afternoon and evening have passed. Every time I’m down there with her, if she’s lying on her side, she slings an arm over my neck. It’s enough to make a grown man cry.

The constant feeling of sadness and terror are getting to me. I can only imagine what Roo thinks. At least she’s not uncomfortable.

The picture below was taken on the day I met Roo. I’m not taking pictures of her right now because it always drover her a little crazy to have a camera pointed at her.

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Day 59:Adding injury to insult

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Roo hasn’t been feeling well the last several days. She wasn’t sick or in distress. Just tired and weak. She was supposed to have chemo on Tuesday, but it was postponed until tomorrow, Friday to give her a chance to get back on her feet. All three of her antibiotics were cancelled, and I knew that would help her. She always seems so uncomfortable on them. She had bloodwork done, and that looked good, with all values in the normal range for the first time since she got sick just shy of two months ago.

But she didn’t want to walk or go outside for more than the basic needs, and barely that, until today, when she showed interest in going to the pond, so we drove over. She enjoyed it, though she was still less energetic than she was a few days ago.

A half hour later she hurt herself. She started limping badly, her back right leg in pain. There are a few boneheads who smash beer bottles here, and though it’s rare – unlike in the west or south, where the land is carpeted in glass – that was my first worry (I pick glass shards up every day, but there are always more), but there was no cut. No thorns in her paw. Nothing I could see. Fortunately we were parked nearby and we limped to the car.

Roo hates nothing more than being helped into or out of a car. She can’t stand it. She always sits at the door and waits for just the right moment to jump in. The only way to hurry her is to ask if she wants me to help her. But this time she didn’t argue. When we got back to the camper, she stayed in the car and slept until it got too hot while I sat beside her and listened to the depressing Mueller hearing on the radio. When she was ready to come out, she didn’t want to jump down any more than I wanted her to. She stood on the seat slowly wagging her tail, with her ears down and a sheepish smile, embarrassed to be asking for the help.

She’s not uncomfortable unless she puts weight on it. I saw no point in taking her to the emergency room. After all, short of surgery, which Roo obviously wouldn’t have even if necessary, I don’t think, the prescription would probably just be too keep her off the leg, and she doesn’t want to move anyway. My buddy Jim is an ER doc, though he attends to the human, and he recommended putting an ace bandage on. He’s going to come over with one and wrap her up.

tonight Roo will sleep with both right legs, fore and aft, bandaged. And she’s scheduled for chemo – doxorubicin, the rough one – on Friday.