Josie is a bottomless pit. If it is on the floor, she considers it fair game. She’s stolen food out of the hands of toddlers, rummaged compost piles, even tried to steal Bear’s meds. Because of this, I typically limit her food to just half a cup twice a day. It used to be three quarters of a cup twice a day, but at that time she was 50 pounds and needed to drop some. The reduction worked and she looked great around 45 pounds.
Since the start of treatment, her weight has fluctuated. The biggest change was caused by the Prednisone – she dropped three pounds right away. How do I know it was the Pred? As soon as we switched her to Piroxicam, her weight bounced back up – no change in food. When she switched back to Prednisone – her weight dropped again. The oncologist adjusted the dosage and her weight loss appeared to stabilize. But it has continued to trend downwards.
Why all this talk of weight? Josie had her monthly checkup yesterday. Technically, it was three and a half weeks – scheduling conflicts caused it to be earlier than normal. I was ok with that, because I had noticed her slight change in behavior over the past two weeks. Between the diarrhea, constipation and the nosebleed, Josie’s eating habits have changed. Significantly.
When the diarrhea started, she didn’t want to eat. She started again when it resolved itself, but not as eagerly as before. Same thing happened with each instance of diarrhea/constipation. But it started to get a bit worse – she’d eat half of her food and leave the rest. She’d finish it before it was time to refill the bowl, but for a bottomless pit, its a drastic change.
Then this week happened. She refused to eat. I’d put some water in with her dry food – she’d just stare at it. I mixed in some green beans and green bean water. She loved the water and lapped that up – grabbing some food along the way. But for the most part, leave a lot in the bowl. She even took to picking up individual pieces and rolling them around in her mouth before spitting them back out. When her nosebleed kicked in to full gear, I determined that was the cause of her lack of normal eating. She probably wasn’t feeling well.
Despite each individual cause (or what I assume is the cause) of her inappetence being controlled and getting better, her eating was still off by the time we made it to the oncologist. I was nervous about her weigh in – knowing this would reveal the truth.
Her last weigh in (06 July): 42.4 pounds
Her current weigh in (29 July): 40.2 pounds
Over two pounds in a little over three weeks. It was noticed and became the number one topic of conversation between me and the oncologist.
The best part of the trip – we got to see Dr W again. I really like her as an oncologist and this visit just reminded me why.
First, we discussed the GI issues, lack of eating, weight loss. She’s pretty sure it is all caused by the Palladia. Then we discussed the possibility that it isn’t even working. The nosebleeds and her third eyelid being visible are all indications that whatever this is (remember- we don’t really know) is still progressing despite the Palladia. And all we are really doing is making Josie sick and not helping.
I’ve re-run this conversation over in my head a few times because I’m a bit upset by it. I had mentioned the third eyelid to Dr H when we were there last as well as a discussion on the nosebleeds and she made it sound like it was normal and was going to happen regardless. But now, Dr W is giving me a more realistic interpretation of the symptoms – Josie is just getting worse. So here I’ve been giving her this medication, which upsets her stomach so much she refused to eat and it isn’t even helping. Not to mention the cost. I did mention that the third eyelid kinda waxes and wanes – depending on the day. And given she was recovering from a nosebleed the day before, it might still be flared up due to that. She did seem a bit more encouraged by that, but there is a good chance we’ll be having a conversation next time about whether it is worth continuing down this road.
So where do we go from here?
First – stop Palladia
Second – get her to start eating again. She gave me some suggestions. Her exact words were: “What’s something she really likes to eat? Give her that.” “She eats everything,” was my reply. She shook her head and chuckled, knowing the type of dog that will eat anything. “Anything” doesn’t really narrow down the helpful options, so her suggestion was cat food. She also gave me some meds to help calm Josie’s stomach: Ondansetron and Cerenia.
Third – antibiotics. There is the chance Josie has an infection around the tumor site that is causing some of the symptoms. Doing a round on antibiotics could help knock it out. It is actually pretty common to include antibiotics during metronomic therapy, especially with nasal tumors. The nasal passages are perfect spots for infections to start.
Fourth – continue the Pred and Chlorambucil.
I’m to call them with an update early next week. If she starts eating again, we’ll discuss starting the Palladia again, possibly at a smaller dose.
As we left, I scheduled Josie’s follow up appointment. I made sure to request Dr W. I was told, “If she doesn’t have a consultation, you’ll see her.”
WTF? That really bothered me, but I was too busy looking over all the new meds to argue. I really like the oncologist – but the practice, I’m beginning to not like.