June 13, 2016

These past few days

What in the world happened these past few days? 

Just a week ago Piri was coming off of his recheck with the oncologist and we were all on a high that his cancer hasn't spread or has grown back in his mouth. The only point of concern was a dramatic increase in his amylase level. Previous levels were 300 then 585 then 781 and during his recheck it was at 2,784. The oncologist said this could indicate pancreatitis. 

We agreed to ordering more lab work to confirm pancreatitis or not. Based on the blood work our oncologist had done last Monday, she just could not tell whether the spike in his amylase was due to his chemo treatment {or some other factor like his kidney disease} or if something was really going on with his pancreas.

If he has pancreatitis then he would not be a candidate to receive chemo treatment anymore because it could kill him. 

If he doesn't have pancreatitis then we had the option of continuing with his chemo at a lower dosage {since he has lost weight since the start of his treatment and his current dosage of 20mg would be too much}. 

It was also suggested that we stop chemo until we get to the bottom of this first. 

We were looking to deal with more decisions but all in all it was an A+ kind of day. That's what the oncologist said, "This is an A+ in my books." 

Everyone was happy. We were looking to celebrate on Thursday and Friday when we had days off from dog sitting.

Then just two days later everything went downhill. 

On Wednesday morning I found Piri shivering a little. He has done this in the past and ended up being fine. It was either his arthritis or he was cold because he had gotten a shave down. I thought it was one or the other. 

Then when our DogVacay guests left at 6 pm, Piri began to shake violently, not being able to move and had his limbs tucked under him as if he needed the comfort or he was just trying to protect himself. 

We rushed him to the ER, which thankfully is within the same medical facility where he gets treated for cancer and so all his records and latests tests and notes are accessible by any vet tech and doctor there. It was recommended that he stay overnight so that he can get continuous IV fluids and also medications. 

Blood tests were run on Monday with the oncologist but the ER doctor recommended the same tests be run again and while we were reluctant at first we agreed, along with an urine test, which we were told he would get on Monday via a needle but we found out at the ER that the oncology department could not get a sample {we were not told this - just one of many communications issues I have with the oncology department}. I would remember this moment days later when I wondered if they were able to get a urine sample on Monday, maybe we would've caught his infection earlier... I hate what ifs. 

We were able to say bye to Piri before we left him there. He was in such pain that he couldn't move or get up or look at us. 

I cried all the way home and remembered his urinary tract infection from a year ago when it completely wiped him out and I thought I was going to lose him. We had caught that infection late as well. He was eventually put on Convenia and Baytril and Piri rallied back. I wondered if he had urinary tract infection again, or some sort of infection he just could not fight off.

It was a quiet house without Piri that Wednesday night. I was afraid this was a preview of what may, no, what will inevitably come in the future. It was dreadful. 

The doctor called late at night and let us know that they did indeed find bacteria in his urine indicating urinary tract infection. I let him know that he had it in the past and was on Baytril for it {I did not mention Convenia as I had forgotten Piri also received a shot of that as well}. The doctor suggested that we put him on Baytril until his urine culture results come back. 

The next morning I called to check on Piri and then Yangkyu and I decided to just visit him instead. He looked so much better - shaking still but up and about on his own. We decided to discharge him then and take him home with us. 

Before the discharge, the doctor did say that his urinary tract infection may be a secondary issue and that he may really have pancreatitis as his amylase level had spiked yet again to 6,000 based on blood work done on Wednesday night when he was admitted. After speaking with him extensively we decided that we wanted to still discharge him and wait for a firm confirmation on his pancreatitis first and just focus on getting him better from the infection. 

At home his dramatic increases in his amylase levels was baffling me. To be honest, I didn't think something was wrong with his pancreas. I kept thinking about when his levels spiked and wondered if it had anything to do with what I was feeding him. Just within Monday to Wednesday, a spike from 2,000 to 6,000. I didn't feed any fatty foods - only bland. Eggs maybe? Then I thought, Manuka Honey. I had told the ER doctor on Wednesday night that I had rubbed Manuka Honey on his gums before rushing him over here. I wanted him to know as a reference and also if it may not mix well with any tests or fluids or medications he may decide to give him. The doctor did not suspect so but he also didn't know too much about benefits of Manuka Honey to dogs.

I looked up Manuka Honey and read that it has live enzymes and also amylase. I relayed this over to the oncologist to consider as we still wait for a confirmation on whether his has pancreatitis. We were told it would take up to 36 hours for results to come back {this was late Monday}. We are still waiting a week later.

With my worries about Piri's amylase levels and possible pancreatitis at bay, I focused on Piri's recovery from his infection. He was home and comfortable but he wasn't eating. He did receive sub-q fluids and was drinking well via a dropper. We were back for quick trips to the ER on Thursday, Friday and Saturday late night so that Piri can take his antibiotic in an injectable form. 

On Friday night when we were at the ER for Piri to get his Baytril antibiotic as a shot, Yangkyu suggested that we also give him his other medications that he was supposed to be on - Metronidazole, Ondansetron, Omeprazole, Enacard - all in shot form since we couldn't give it to him orally. The ER doctors previously had told us that if Piri does have pancreatitis then these medications can all help him. I hesitated because I didn't know where Yangkyu was coming from but I agreed. The vet tech let us know which medications were available via injectable form and the others she said she would try to pill it -- in other words, force feeding it. 

After having such a great morning and afternoon that Friday, all throughout the night and on to Saturday we were back at square one. Piri was miserable and shaking a lot more. He wasn't bouncing back like we thought he would. He had his limbs tucked under him again. Something was wrong. 

I suspected it was all those other medications we gave him. I asked Yangkyu why he suggested that at the last minute at the ER. I was annoyed. Frustrated. I shouldn't have been as Yangkyu was also tired - he's been working non-stop, all throughout the night, and he only wanted to make sure Piri was getting treated all around. He probably felt the tenseness in my voice and responded by saying that the doctor said that those medications would help him if he had pancreatitis and so he thought they were necessary.

Then I just blew up. 

Not at him.*** Not at me. Not at the doctors. But just at the damn situation. Lately, while I am still sad with all of Piri's medical issues, I'm more angry. 

I reminded Yangkyu about what I found via Piri's amylase levels and its relation to Manuka Honey and we had agreed to not worry about his pancreas until we had results confirming it. He forgot that we had this conversation. The thing that got me all confused was that Metronidazole, Ondansetron and Omeprazole are all support medicine for when Piri was receiving chemo. Piri has been off of chemo since last Friday. 

When Piri was in the ER they continued to give it to him as they suspected there was something wrong with this pancreas, and all those medications will help him. But what if he doesn't have pancreatitis? Why are we pumping him with drugs when it is not even confirmed that something is wrong with his pancreas? 

I just wanted to treat his urinary tract infection first and Yangkyu actually isn't a fan of medications and for him to suggest that at the last minute at the ER felt like it was out of left field. And you know the thing about the ER - it confuses the hell out of you. Just the atmosphere and having to feel like you need to make quick decisions.

The following night, Saturday, we were back again for a quick visit and after just getting his Baytril shot Piri was stable, had found comfort again. 

On Sunday I was able to crush some mirtazapine {appetite stimulant} with some pumpkin and cranberry and get it into him. Piri began to eat. First his favorite peanut butter filling cookie from Three Dog Bakery. Then some pieces of boiled chicken. Then the Vera chicken fillets which he used to go bonkers for before getting sick {pictured above}. And then some boiled hamburger patty in the evening. We decided to try and give him his Baytril as a tablet that night. I cut them up in quarters because they are too big to hide inside food. We needed to give him 6 quarter piece (which is 1.5 tablets). He ate the first three and wouldn't eat the last remaining pieces. I tried pilling it. I tried ham. I wasn't sure if we needed to bring him to the ER and somehow get the remaining dosage as a shot. I ended up crushing the rest, adding a little water and squirting it down his throat. 

It was terrible. He resisted violently. He bit me. He hated the whole experience. I did too. 

While he did spit out a few droplets, the rest he swallowed. 

I am not sure if that is still effective. I sit and worry right now whether we just completely botched his 7-day antibiotic treatment. 

During Monday's recheck with the oncologist, we found out that he had lost more weight. He was holding steady at 22 pounds for a while but now he was at 19. During the time when he wasn't eating when he first got his urinary tract infection, I thought he had lost more weight but we were relieved to find out that it was still hanging at 19.6. 

You can see his rib cages now. So clear and defined. We always prided on how well he walked even for his old age, but now you can see that he has a harder time using his hind legs and his back looks hunched. His hips are so terribly boney. 

After he comes off of his treatment of his urinary tract infection, and if get the green light to continue with chemo, I am not sure if we can. How can I put him through that after all this? 

But you know what scares me more? 

I can't bear to see him suffer when and if his cancer grows back inside his mouth. He can't eat well now but tolerates. If the cancer comes back, he will completely shut down because the tumor will be painful and uncomfortable. He will wither away to nothing but bones. Yes. I know. This will probably be the time when I will have to make the most difficult decision in my life. 

But, my reasoning is... if chemo can help him not feel that pain of having the cancer erode his body, I want to try. I want to try but then I don't. 

And so goes another day, and many more days, when I just wrestle with myself to come to terms with the unknowns and hope that the decisions I make are the best ones possible for the situation that Piri is in.

*** While I do appreciate everyone who reads and comments, please don't write anything to tell me that I have to keep calm and not fight with my husband and that we need to be there for each other for Piri. I feel like I have to put a little footnote here that when I say I blew up, it was really at the situation. No, we don't argue and fight about Piri and his medical issues. Yes, it is still stressful for the both of us, but we don't take things out on each other. And no we don't have marital issues or are on the verge of one. Please don't assume, project {situations like this may be a certain way to you and you may handle it in a certain way, but that doesn't mean that we are the same}, jump to conclusions or try to read between the lines {there is nothing to read - I am more detailed in what I write to avoid misunderstandings and assumptions because I hate them}.

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