All in

Josie and I arrived exactly at 0900 on Tuesday.  They took us back into a room immediately, giving Josie no time to sniff the other dog in the waiting room.  Our wait wasn’t long and someone promptly joined us, stating “So, I see Josie is here to start metronomic therapy.”

Slow your roll.  I informed her I hadn’t fully decided – I wanted to speak with the oncologist first – make sure this is the right move.  She understood.  I did agree for her to run Josie’s bloodwork – it needed to be done regardless.

Within a few minutes, the oncologist came in to discuss Josie.  This was a much different experience than the first time.  She wasn’t rushed.  We discussed everything and she was extremely patient and answered all my questions.

First thing we discussed – the seizures.  She was quick to point out that the two I saw were just the two I happened to be around for – implying she’s had more than two.  I can agree with that line of reasoning.  After all, between work, errands, and commuting, I’m out of the house for 10 hours a day.  Add to that, 8 hours of sleep (really – I get a full eight hours (in an ideal world)).  That leaves 6 hours a day I’m with my dogs, or a quarter each day.  Chances are, these weren’t her first.

While we still can’t be sure this is cancer, nothing else would act like this.  Although I don’t remember her exact words, she said that it might just be such a minute cancerous process that it just doesn’t show up in the pathologist report.  So, let’s do the math on this.

JosieBlanket2.20030126

  • nosebleeds – check
  • eye discharge – check
  • mass in nasal passage – check
  • inflammation – check
  • destruction of cribriform plate – check
  • seizure – check
  • hard of breathing – check
  • biopsy shows cancer – nope

7-1.  I’m going with cancer.

So where do we go from here?  Step one: stop Piroxicam and switch back to Prednisone.  Since this is now effecting her brain, Prednisone will help with any brain swelling.  Also, we discussed Josie’s change in appetite.  Let me explain.  Josie LOVES food.  She loves it so much, I had to buy her a special bowl so it takes her longer than 10 seconds to eat.  That morning, I noticed she was slow to eat.  She’d eat some food.  Drink some water.  Eat some food.  Drink.  Eat. Drink. Walk away.  Come back a few minutes later.  Eat. Drink. Eat. Drink.  And sometimes, leave food in the bowl.  Very un-Josie like.  The Piroxicam might be effecting her, so Prednisone will help with this.  Just need a washout period between the two drugs.

Then we discussed the chemo options.  Metronomic vs injectable chemo.  I’ll probably post later more about metronomic, I find it interesting, but in short it is low dose chemo – designed to use the smallest dose to get results without damage.  Since we have no idea what type of cancer is attacking Josie, the oncologist couldn’t recommend injectable – because it would be a guessing game.  I wouldn’t have done it anyway.  It seems like swatting a fly with a sledgehammer.

But metronomic seems intriguing.  It’s goal really is to maintain quality of life.  That’s what I care about.  We discussed side effects, which hopefully should be minimal.  The bloodwork will be tested every 2 weeks at first – and should catch any problems we may have.  Other side effects would take years to manifest – not a concern for an already dying animal.

I also brought up the fact I have another dog.  Some of the warnings, specifically about coming into contact with bodily fluids, concern me.  The oncologist asked if my other dog eats poop.  I chuckled.  If you knew Bear, you would know why that is funny – he barely eats food.  And he definitely doesn’t eat poop.  So – little concern here.  As long as he doesn’t eat her poop, we should be good.

Fully informed, I weighed my options.  I’ve thought about metronomic for about two months, maybe longer at this point.  It seems like the best fit to maintain quality of life.  I did have the option of starting partial treatment, adding in drugs over time.  But she did recommend all of them, give us the best chance of results.

So I decided – let’s go all in.  If I’m going to do this – might as well do it to the fullest.  So I left with a bag full of drugs, a strict regimen, and more drugs to arrive via mail.

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