Piri began his chemo treatment on Monday, March 28, 2016, after his oncology consultation visit with Dr. Beck at the Hope Center. His chemo came in the form of a pill called Palladia that he would take every Monday, Wednesday and Friday. He was put on 5 mg for the first week and depending on how he tolerated it, the dosage would be bumped up to 10 mg.
One of the things we grappled with during the consultation session was when we should start the treatment. We were leaving for Key West in just two days - should we wait until we came back or should we start it right away?
I read stories of dogs who didn't have any side effects of chemo and were able to withstand it well. I hoped that would be the case for Piri - I think I may have placed superdog qualities on him at this point, because he had always been my comeback kid. But my heart was also desperate. I didn't want to lose a single second. Yangkyu said maybe we should wait until after we were back from Key West, but I said let's start right away.
The first 24 hours after taking his first chemo dosage, we didn't see any discomfort. He was his normal self. There were no changes.
Early Wednesday, I stayed up making all of Piri's homecooked meals to take to Florida and we set off before sunrise. Piri slept all the way to North Carolina and when he woke up, he threw up.
The thing with caring for a senior dog with medical issues is that you learn to be prepared, especially when traveling. Even though 99% of the time Piri had done so well in the car even when he wasn't feeling well, I prepared for a scenario where I may need to do a little clean up. I prepared a wee wee pad that I unfolded so it could be open and ready to catch anything, wipes for him and for my hands and plastic bags to throw things out in.
While I was cleaning him up, Yangkyu was already pulling out of the ramp to stop at a rest area. There, we walked Piri for his pee and potty break and he ended up having diarrhea. He drank some water. We cleaned him up more, washed our hands and I called Dr. Beck and left a message saying that Piri was experiencing side effects in the form of vomiting and diarrhea. We were instructed to stop his Palladia (his second dosage was due on this day) and they told us to call back if his side effects continued.
Piri did well for the rest of the drive. We enjoyed our evening in St. Augustine. He appetite wasn't the greatest, but he did eventually finish his food.
We all slept well. In the morning I found him sleeping on his blanket on top of his bed, but quickly realized that he had soiled on it in his sleep. Remember the bit about being prepared? Well, I also brought Piri's shampoo and his towels in case he needed to be washed. And that is exactly what we did. We double bagged his blanket and decided to wash it when we got to Key West.
The first couple of days in Key West wasn't good. Piri had stopped throwing up but he was having bad diarrhea and his appetite was gone. He was weak and the first full day in Key West was spent in and out of grocery stores trying to figure out what would get him to eat. I was on the phone with the oncologist once more and they prescribed three supporting medicine which they called into a local CVS in Key West. They were -- Metronidazole for his diarrhea, Odensetron for his nausea and Mirtazapine to stimulate his appetite.
I read the side effects of these medications and I got so angry. I think this was the first time I felt exasperated in giving Piri more medicine.. something that is supposed to be given to make him feel better but one that comes with a laundry list of other possible side effects. What was I doing? What is going on? These questions rang loudly in my ears as I was left feeling so confused and guilty. Every little decision I needed to make felt extremely difficult and I felt wholly unprepared and unfit to make them.
I did hesitate and hold off in giving Piri the supportive medicine, but when he wasn't getting better and after a second time he had soiled on the second blanket we had brought for him, I gave him the Metronidazole to control his diarrhea. And after not having a bowel movement for about a day, his stool came back normal and the Mirtazapine brought his appetite back. We enjoyed the rest of the trip and came back home.
Once back, the oncologist wanted to put him back on chemo again, and this time she instructed us to give him his supportive medicine, but to stop giving him the Carafate (to prevent ulcers), which the oncologist suspected might have contributed to his nausea and stomach upset.
After being put back on chemo along with his supportive medicine, Piri did surprisingly well, and the oncologist bumped his dosage to 10 mg after a week.
However, Piri doing surprisingly well only lasted a short while.
I mentioned earlier in my post about how we learned to prepare ourselves when traveling with a senior dog with medical issues. This started when Piri was diagnosed with kidney disease and our knowledge pool got bigger once he developed cancer. It also expanded to local day trips.
On April 16, we took Piri to the Sakura Matsuri festival in DC. As soon as we arrived, we got his carrier out and Yangkyu lifted Piri and put him inside. I noticed a stain on Yangkyu's pants and realized that Piri had an accident. I looked in the backseat and his blanket was soiled.
Anticipating some clean up that we may have to do, I already had a roll of paper towel, several water bottles, wipes, plastic bags, wipes and hand sanitizer for us. But a new learning lesson emerged here -- always check if there is an accident before getting Piri out of the car and to bring an extra set of clothes.
We spent a good 30 minutes or more cleaning everything. We decided to throw away his blanket inside the backseat of the car and inside his carrier. We carefully took Piri out of his carrier and had him stand on the side walk while Yangkyu washed off the stain on his pants and sanitized his hands. We then used a combination of wet paper towels and wipes to clean off Piri. We made sure we washed our hands in water, with hand wipes and sanitizer. We double checked for any other signs where his accident might have rubbed off. When it was all clear, we decided to stay a little while at the festival before heading back home. It was hard to have fun though. Our new reality was sinking in fast.
After this incident, Piri continued to have loose runny stools, diarrhea and lack of appetite. Metronidazole wasn't working that well because his body got used to it. There were countless of times when the vet techs at the oncology department told us, "Give Piri Metronidazole when he has diarrhea. But stop once he stool is back to normal. It is an antibiotic and overtime his body won't respond to it anymore." This baffled me to no end because Piri needed to be on Metronidazole 24/7 because as soon as we stopped giving it to him, his diarrhea was back instantly.
These were times when I ran the laundry 4 times a day because he was soiling on his bed cover, blankets and scooting (and smearing his waste) on the bath mats we had out on the wooden floors to help him from preventing from slipping. Every time he would move around and shift his blankets to make what I used to call his "comfy spot", he would lose control of his anal muscles and he would have an accident. That meant having to run the washer twice -- first time in hot water with vinegar and the second with hot water in detergent. I wanted to make sure it was extra clean (I do this with our bath and kitchen towels as well and all our bath mats from time to time). It would also mean a trip into the bath tub to clean him up every single time.
On top of this, I would be in the kitchen cooking up all different types of things to get him to eat something. Anything.
Chicken, rice and vegetables.
Turkey, rice and vegetables.
Beef, rice and vegetables.
Canned food. Not just one kind, but 5 different kinds.
My kitchen looked defeated. I sometimes felt defeated. So much clean up to do with sometimes so little energy to do it. Every time I would sit to take a breather, something else needed to be taken care of. On some days, even though I had enough energy to carry me through the day, I didn't look put together. One these days, I afraid that clients would see me and lose confidence in my care for their dogs.
During this time I had kept our DogVacay guest to a maximum of two, sometimes one, and I accepted reservation requests on a case by case basis. My reasoning was that I needed to give my undivided attention to Piri and also to my guest dogs. And sometimes I didn't have the bandwidth to take care of more than two dogs, including Piri.
There was also the matter of Palladia and the level of harm it may cause to people and possibly to other dogs in the same household in the form of when Piri would go pee or potty or have accidents in the house.
The information paper we received from the oncologist's office and also what the Internet will tell you is that extreme caution should be used when handling Palladia. Things like make sure you wear gloves, wash your hands, dispose of it properly, don't handle it if you are pregnant and don't crush or break it in half because it has potential to become an airborne powder and may be inhaled, are listed as some of the precautions. We went over our administration process in our last post.
You will also find information that caution should be taken when handling waste from a dog on Palladia as some traces of it may be found in their urine and stools. There is a whole other list of cautionary things you can do like dilute the area where you dog peed, wear gloves when picking up dog stool, if your dog had an accident make sure you clean the area and sanitize it while wearing gloves. Kissing and cuddling your dog on Palladia should continue and is not harmful in any way, but if you have other dogs at home who tend to lick urine of other dogs, they should be kept away from the area of the grass or it should be diluted.
This obviously got me worried.
I thought about closing Piri's Place for the time being. I thought about alerting all our clients and letting them know that Piri was on chemo, that these were certain types of precautions and these were the steps we were taking to reassure that their dogs were still safe with us.
But I didn't. And coming out with this now may cause some nervousness and concern among people, which I understand and apologize for.
We didn't tell our client base not because we were afraid we were going to lose business. This is my biggest worry that I have in coming out with it now. That people may think this way. As hard as it may be to believe, I don't do DogVacay to make lots of money with a business mindset. Perhaps it is a societal norm that people have when it comes to judging people running businesses (that people do it for the money and marketing and protecting their reputation is important), but this isn't my norm.
I didn't alert my client base because I didn't want to cause unnecessary concern and worry and send everyone in a state of panic. I don't regret my decision, only because I felt (and still do) confident of the precautions we took. We were always thinking two steps ahead and were on top of things.
I checked with our oncologist four times - two times over the phone and two times in person - on what I can do to make our home safer for our guest dogs. I let them know that we were diluting the area that Piri was peeing in and we were catching his stool on newspaper. All four times we were told that since Piri's dosage was extremely low that we didn't have to worry about the aspect of his waste being harmful to other dogs. The UV rays would kill any traces of chemo left in his waste should and if there were any. We didn't even need to dilute the area where he peed and we didn't need to catch his stool on newspaper. We still did though, especially since catching his stool with newspaper also proved to be easier when his stool was loose and runny. We always used a double bag to throw out the newspaper. And we always wiped Piri's pee and potty area and paws (all our guests as well). We also never had any lickers but we were extra cautious of the possibility as well. The only time the oncologist office told us to be careful was when we were administering Palladia to Piri.
And as I mentioned before, the blankets and bath mats in which he was having accidents on were being washed as instructed - in hot water - and I was doing them in two cycles with vinegar and then detergent.
Piri eventually came off of chemo -- I believe on June 28th (maybe earlier, I can't quiet remember). But there was also a couple of weeks inbetween March and June when he also was off of it. At the end of June though, Piri had developed a stubborn form of UTI that needed three different types of antibiotics which he was taking in a month span. After that he developed what the oncologist thought was pancreatitis, or at least early stages of it, and Piri was no longer a candidate to receive chemo because it would kill him for sure. At this point however, we had decided to not put him back on chemo treatment even if his liver enzyme levels improved. This is also the time when we noticed that Piri lost significant weight - his rib cages started to show.
About a week of being off of chemo, everything came back to normal. His stool was perfect again. His appetite waxed and waned but all the side effects had gone and it was good to see Piri being himself again. We didn't have a single accident.
Knowing what I know now, would I put Piri on chemo again if I had the chance?
Depending on how I am feeling, I still go back and forth from a definite no to a more long winded answer.
And today I am leaning towards a more long winded answer.
Knowing what I know now, I would've included more holistic supplements to Piri's diet. I would've paid more attention to keeping his teeth clean. I would've paid more attention to what kind of food and treats he was given. I would've started well in advance to get needed supplements that help keep his immune system healthy and give him foods and supplements that are known to prevent cancer and other illnesses. I wouldn't have over vaccinated him and ran titers more often. I wouldn't have put him on Frontline and would have instead opted for a more natural flea and tick prevention treatment, (since we weren't always in the woods, hiking and camping). I would've done more to educate myself and not have been so content and complacent when Piri aged so gracefully into his senior years. These are some regrets (or learning lessons) I have.
In future posts, I plan to write about the financial aspect of treatments and the different supplements that Piri was on prior to his diagnosis and after as well, some online resources that helped me gain a different perspective in keeping dogs safe and well, and more. I hope you'll stick around for those stories as well.
Thank you for reading.
November is Pet Cancer Awareness month. I decided to write a few posts throughout the month of November to share Piri's cancer journey. Thank you for following along.