Seeking Thankfulness on a difficult day

Today I'm starting this post by seeking to remember all that I have to be thankful for.  This Thanksgiving is going to be a rough one and it started in just about the worst possible way.

I'm thankful for my family which is close and caring.

I'm thankful for good friends that are there when you need them.

I'm thankful for having the opportunities and hopefulness that those around me provide.

I'm thankful for friends and the environment that exists at Breath Together Yoga that enable me to find peace when life provides challenges.

I'm thankful that I have the resources to not be confined in my choices.

I'm thankful for the 11 years I knew my late wife and the wonderful experiences that we shared.

Lastly, I'm thankful for my 2 late Akita's who brought such joy and happiness to not just me, but everyone they saw or interacted with.

And thus the reason I'm writing this post and concioiusly seeking all those things I am thankful for.  As some of you know, I've been having a lot of trouble getting Cassie to eat while she's been battling her lymphoma and it seems to have gotten worse over the last couple weeks.  This past week we tried two different types of appetite stimulants along with a couple types of anti-nausea medications.   Nothing seemed to be working.   Tuesday evening I took Cassie in to see the vet as it seemed to be getting progressively worse.  I couldn't tempt her to eat anything.   She got some new medicine and they gave her some fluid under her skin.  Wednesday morning things weren't getting better and she was lethargic and she didn't seem to have done much moving overnight.   I reached the vet early Wednesday afternoon and they suggested I take her to Adobe Los Altos and have her admitted.  Something was going on and she needed close monitoring and they would be able to give her IV fluids and other medication.   

Once at Adobe Los Altos the IV fluids and medications seemed to be helping.  She became more alert and it seemed we were on the right track.  At 10:30pm I received a call from the ICU doctor.  Cassie had gotten worse.   Between 8:00pm and 10:30pm her abdomen had become tender and she was experiencing pain any time she was touched.   She was standing more and not settling down.  The vet did a scan and there was fluid collecting in her abdomen.  A sampling was taken of the fluid and it showed inflammatory cells and clear indications of an abdominal infection.   Cassie had developed sepsis due to something going on in her belly.  This could be caused by a perforated intestine, a necrotic lymph node or something unknown.  This is a grim situation.  Major surgery was required to determine what was causing the fluids to build and the infection.  In a healthy dog, surgery of this type had a less than 50% chance of success.   For a dog with complications like cancer the odds of success are well under 25%.  It would be a long, painful and difficult recovery from the surgery, but then Cassie still had the cancer to deal with.  

I reached out to my friends Heather and Trey who live nearby and I'd had dinner with earlier in the evening.  They accompanied me up to the hospital to see Cassie and be with me when I had to make the difficult decision to end Cassie's pain and discomfort.

Cassie passed away quietly around 12:30am this morning (11/23/2017).  It was much more sudden than I expected, but this is the the nature of sepsis.  I was told up front when the lymphoma was diagnosed that there is a risk that the intestine could be weakened by the cancer and could perforate.  The last scan was so good that I didn't expect this result.

Cassie was an amazing animal.  She was a gorgeous show stopper and always attracted attention where ever we went.  She was quite the diva, but she loved the attention.  Over the last 6-8 months she had become more outgoing and actively approached people (mostly women; and no I didn't train her to do that).  It seemed like she was really opening up.  I'm going to miss her a lot.  She was definitely daddy's little girl.

I'm thankful for the time I had with this wonderful little girl.  

I'm thankful for her ability to know just when to be affectionate and give her special kisses.

I'm thankful for all of you who have been asking after her these last few days and months.

I'm thankful for all the opportunities that life continues to give me.

I'm thankful for all the great memories that Cassie, Theo and Laurie have provided me and enable me to move forward with good thoughts and perspectives.  I seek to find gratitude for their time with me and find comfort in knowing I did everything I could for them and we made our lives a better place with each other.

Sometimes this place has good news

I know I've  been leaving everyone hanging, but I didn't have any real productive news to give.  Each following Cassie's chemo her blood levels were too low to take the next round, so we delayed another week for the next treatment.  So instead of 4 weeks it took 7. 

Here's the good news.  Cassie had an ultrasound today and the doctor was unable to find the thickening in her intestinal wall.   Also, the lymph node shrunk significantly.  I think it was originally 3.25 cm and it's now a little under 2 cm.  Not quite a 50% drop, but close to that.   Needless to say, I'm quite happy.


I guess it's good news that next week Cassie will start another round of chemo.  It will be the same protocol, but no prednisone.  The dose will probably be a bit lower since it seemed to hit her pretty hard the first round. 

She is also eating pretty normally again, so I'm happy about that.

Princess Cassiopeia "Cassie" goings on

Cassie at  3 weeks

If you've followed this blog, you know that I don't come here to tell tales of goodness and hope.  It's unfortunate that I'm here for the second round this year.  I'd hoped that by the time this forum was needed again it would be an old and decrepit archive.  

Some of you know some of what I'm about to share and for others it will be a complete surprise.  I waited to make this posting until my parents returned from their vacation.  There was no need to cause them distress, concern and worry when there's nothing they could do.

Cassie at 11 weeks

What's going on

I'm going to use the summary words provided by the oncologist at Sage to explain it, but this started about 6 weeks ago when Cassie wasn't eating normally for a while and I eventually took her in for what I thought was probably stress related GI issues.  It ultimately didn't resolve and we ended up doing an ultrasound which showed an enlarged abdominal lymph node and a thickening of one section of her intestine.  I'll use the words of the Sage oncologist from here.....

Cassie is super beautiful. She has been very picky with her food, and has been losing weight. An abdominal ultrasound showed multiple abnormal loops of bowel and enlarged internal lymph nodes.
Based on a needle aspirate, Cassie has been diagnosed with lymphoma, which is a cancer of the white blood cells. Since lymphoma is a systemic cancer, it is best treated with systemic chemotherapy. The standard of care for lymphoma treatment is a CHOP chemotherapy protocol. For all dogs treated with CHOP protocol chemotherapy the average survival time is about 1 year. Dogs with intestinal lymphoma are unfortunately much harder to treat, with average survivals in the 2-3 month range.
The L-CHOP protocol is a multi-drug chemotherapy regimen with 17 treatments in 25 weeks. Our goal is to provide Cassie with a good quality of life while she is undergoing chemotherapy, and she will be dosed appropriately to attempt to minimize side effects. Chemotherapy is generally well-tolerated in dogs, but gastrointestinal side effects (vomiting, diarrhea, decreased appetite) and bone marrow suppression (low white blood cells) are occasionally observed. Medications can be prescribed to alleviate these symptoms if they occur. About 5-10% of dogs will have a chemotherapy side effect severe enough to necessitate hospitalization, usually related to an infection requiring IV fluids and antibiotics.
Today (9/30), Cassie received her first chemotherapy drug, L-asparaginase. This is a "gentle" drug since she is feeling a bit under the weather right now. We will start her more traditional treatments at her next visit. This drug can rarely cause an allergic reaction, so monitor Cassie for facial swelling, hives, vomiting, or diarrhea.
Please monitor Cassie closely for any vomiting, diarrhea, lethargy, decreased appetite, or anything abnormal for her. If you notice any of these side effects, please call us. As discussed, in rare cases, as the cancer cells die, dogs can feel sicker and some even need hospitalization.

Cassie winning Feb 2017

When lymphoma affects the intestines, there is a risk of weakened intestines perforating. When the intestinal contents leak out, this is a life-threatening emergency. Monitor Cassie for signs of abdominal pain or weakness. [...] Cassie will be due for vincristine any time this coming week.

I will be doing the chemotherapy at Adobe as I can still consult with Sage and Adobe is where Cassie is familiar and one of my dog sitters work there.  As most of us know, we never know how well cancer will respond to chemotherapy.  I'm hoping for the best.   If you look up canine lymphoma you'll see that there's B-cell and T-cell types.  T-cell is the most aggressive form and intestinal lymphoma is usually this type.  I could have another aspiration done to determine the type, but it would have no impact on what we do.  Hence, why poke Cassie any more than needed and we are moving forward with treatment.  Cassie received her first chemotherapy treatment on Wednesday (10/4).

What Does this mean for me

Am I allowed to simply say this is pretty fucked up??  Well, I've done it any way.

I still plan on traveling and doing those things I have planned.  I'm fortunate in that the I've found someone that is willing to stay with Cassie for my next trip to the Caribbean. One of the vet techs at Adobe knows Cassie well and while her work means she'd be away too much while I'm gone, she's said she will be available for questions and assistance while I'm gone. I need this trip now more than ever, but I do wish the timing was better.

Jan 2010 ( 6 months old)

I'm getting great support from my friends and will renew and become a more frequent visitor again with my counselor.  This is going to be another strange phase for me.  I've had Theo and Cassie to be around when Laurie passed and then Cassie was around when Theo passed.  It's going to be a big quiet house if things don't turn around with Cassie.  I'm fairly active with a singles group and I plan to keep that up along with lots of yoga.  Being extra mindfulness is going to be a huge part of my adaption once again.

Good Night Sweet Boy

You were a loyal protector and companion for almost 12 years.  You were Laurie's guardian and ever watchful companion.  Alas, you also fell victim to cancer just as Laurie did.



Over the last several weeks Theo's bone cancer has continued to progress.  I slowly increased his pain medication little by little every 5 or 6 days through this past Wednesday.  This last increase helped ease his discomfort, but he was clearly not in touch with the world and he slept most of the day only moving if it was time to eat or someone came by to visit.  This is no life for a dog and it would be selfish of me to keep him any longer.  It's time for Theo to join Laurie and sleep the painless sleep.

I met with the doctor this morning and he agreed that we could play with medications, but he said this is bone pain and there's only so much that can be done and other drugs would be at least as likely to make him as sleeping or out of it.  So, with his support I made the difficult decision.

It's been a tough week for me, but I've had good friends and counseling to get me through.  Cassie is ever present and there for me as I struggled to assess Theo and do the right thing.  Theo has been a constant presence in Cassie's life and she doesn't really know what life is like without him.  We will rely on each other for support and comfort in the coming days and weeks.

Here are a couple of videos that the dog walker produced of Theo.  They are public facebook, so you should not need an account there.
https://www.facebook.com/seespotrunsanjose/videos/1223716084390327/
https://www.facebook.com/seespotrunsanjose/videos/1223663477728921/

What's going on with Theo -- An update 2 weeks into chemo

Theo and Cassie on Feb 12, 2017 after a walk in Willow Glen

I realized I should probably post an update on how things are going.  If I've talked to you in person during the last week you know most of what I'm going to say here.

Theo started pill based chemo (Toceranib  aka Paladia) 2 weeks ago.  All his bodily activities have been normal, although it may have a slight reduction in appetite, but it's hard to tell since pain is more of a factor for his appetite.  In general Theo is eating and drinking well, but if he is in discomfort/pain he'll resist eating his food with green beans.  Removing the beans is all it takes for him to eat though.

Theo telling Heather how much he appreciates her visit

Unfortunately, Theo's pain has continued to grow as has his tumor.  In the two weeks since the vet oncologist saw him the tumor has showed progression and I can see that it's grown from it's original size (the ?benefit? of the area around it being shaved).  Earlier this week we went from 2 Tramadol twice a day to 3 pills 3 times a day.  This made a marked change in his behavior and he was much less whiny and appeared more comfortable.  Starting Friday I've begun to wonder if we need to increase the medications again.

We saw the doc on Friday and he said we can go to 4 x 3 if we need on the Tramadol, but it may make Theo groggy.  After that we can add in gabapentin.  Again, this will likely make him groggy.  So we have a couple levels of pain management we can work with.

Theo the happy boy Feb 18, 2017

It's not clear at this point if the Paldia is having much impact.  The doc likes to give it a month to decide if we should continue.

The amazing thing is that Theo's demeanor has generally been good.  If he's not walking he's sweet and loving and the same old boy.  When he walks though it's really tough.  He's still able to get around and is still making a nightly trip to sleep by me.  I am about to go on a brief work trip and I expect that when I come back I'll start sleeping on the first floor so he won't make the trip.  It's a balance between my needs and his.

Post Radiation Follow-up for Theo

Good news and bad news for Theo.  The bad news is that there is progression, but the good news is that it's mild and there are no major changes.  Given the progression I decided to begin a pill form of chemotherapy called Palladia.  The doctor said it has a 30% chance of slowing or stopping the progression.  I figure that's worth the price of admission (which, being chemo, isn't small; but we're talking about Theo).  They are running a blood panel to make sure things are OK, but the expectation is that I will start Theo Friday night.

Here is the report from the doctor