November 28, 2016

I miss this life with you // 012

"There are no happy endings. Endings are the saddest part, So just give me a happy middle and a very happy start." -- Shel Silverstein, A Light in the Attic

November 26, 2016

Pir's diet and supplements - kidney disease and cancer

In my previous posts about Piri and his cancer journey, I mentioned a few times about how, knowing what I know now, there would be some things I would do differently. One of them being his diet and adding supplements that improve overall health. 

Piri was my brother's dog and was cared mostly by my parents (they all lived in the same home) for the first 7 years of his life. I am not sure what food he was on, but I think it was one of the brands that you can buy from a grocery store.

When he came to live with me in 2006, at the age of 7, I began to read dog forums and decided to switch him over to Science Diet. I thought I was switching him over to something better. I can't recall exactly, but I don't think there were many outlets to learn about holistic and natural food for dogs back then. Either I am right and times have changed or the information and outlets have always been there and I have just become more aware and proactive about learning in the recent years. I think though the 2007 pet food recalls triggered something in the pet consumer, which gave rise to more people seeking a better diet for their dogs. (We receive an email notification still from Dog Food Advisor whenever there is a recall. You can also sign up here to receive updates).

I too tried to switch over to Wellness around then. Unfortunately Piri didn't do so well. We switched him over slowly and gradually over a span of few weeks, and while he was adjusting fairly well during transition period, when we had completely switched him over he was having so much gas. We decided to put him back on Science Diet (he got a 5.8 oz can for breakfast and dinner and had dry food out all the time for free feeding, which he ate when he wanted throughout the day) and everything returned to normal. 

With treats he got 2 (sometimes 3 for special occasions) per day - mostly Science Diet but he did well eating others like Wellness, Blue Buffalo, Greenies and such. He also got fruits and vegetables. His favorites were apples, watermelon, mangos and carrots. During the fall he enjoyed chestnuts. Piri did get chews in the beginning but later on they made his gums bleed so we ended up not giving it to him. 

Piri was put on two supplements at the age of 7 - Cosequin for his joints and fish oil, which we got from the vet's office. It was mainly for his itchy, flaky skin. He also had very bad hot spots when the weather got hot. I can't recall when but after being on fish oil, his skin dramatically improved and he didn't suffer from hot spots until most recently when he wasn't able to take fish oil well because his appetite had dramatically waned from being old and sick. 

Two years ago, when we met other dog loving friends in Virginia, I decided to try again and switch Piri's food, this time to Blue Buffalo. By then I had realized that Science Diet wasn't all that great of a diet but was hesitant in switching over because he wasn't having any issues with his current food. His stool was perfect. He went at the same time every day without fail. And he NEVER missed a meal. So why change? I reasoned, "Because I wanted something better for him."

So we did as we had with Wellness and began to slowly and gradually switch him over. And it was the same -- he did well until we completely switched over and then he was plagued with diarrhea for the next few days. 

Then during an annual senior wellness exam at the Vet's office he was diagnosed with kidney disease. 

I am not suggesting that the new diet caused kidney disease. Starting from a couple years back he was gradually losing weight. I showed my concern to the vet but he said it was because he was getting old. His urine test "kind of suggested" that he can be on the borderline of having kidney disease but it wasn't concerning. I remember later recalling this conversation and being so furious. It didn't bode well in the deep mistrust I had developed already from having encountered one too many frustrating experiences at the vet's office.

For the next year, Piri would be put on Hill's Prescription K/D diet. He did well on it during the first few months but then he began to not like it. He didn't want to eat. He skipped meals. This to some folks may not be as alarming because there are finicky eaters out there. Dogs will eat when they are hungry. Just let him be. But Piri was never like that. He never missed a meal. He always loved all kinds of food. So it was alarming to me because it was really out of his character.

I began to add low sodium chicken stock, white bread and boiled egg whites for taste (the egg for nutrition). That got him to eat his food once again but it wasn't consistent and there were days when we still struggled. 

During this time I had many people tell me that I was giving him crap food; ingredients that were harmful. I knew that. I felt guilty already, but I didn't know what to do. And reading on a kidney disease discussion forum from people who said "they would never give their dogs that stuff", I felt I was letting Piri down big time. That I wasn't good enough to care for him. That I was literally killing him. At the same time, I was scared to give him meat (high in protein, which we are told is bad for dogs with kidney disease, although many would disagree) and he was doing ok on prescription food. Perhaps it was still keeping him alive. Perhaps this crap food was what was keeping him going.

There were days when we still gave chicken and boiled white rice with vegetables and fruits and boiled (or baked) Korean sweet potatoes for taste, but his main diet was Hills Prescription K/D (and we went through all the flavors in both wet and dry food -- original, beef, chicken, lamb, the stews, you name it). I would later change my view on K/D diets and rely on homecooked meals for Piri (this after having learned immensely through DogAware). 

Piri was taking fish oil and Cosequin all this time, but we had added three new supplements -- Solid Gold Seameal, which was introduced to us by a friend. We read a couple of accounts from people who said their dogs didn't like it too much, but Piri had no trouble eating it with his food. We also added Dr. Harvey's Coenzyme Q10, which is for cardiovasular health but we started to give it to him because it also benefits the kidneys (and we later found out that it is helpful for dogs with cancer.)

Fish Oil and Coenzme Q10 have been two supplements we relied heavily on. The final supplement added was VetriScience Renal Essentials (Piri took the chews but it looks like the tablet form is only available for dogs now). We were only able to keep Piri interested on the Renal Essential for a few months as his appetite wasn't always there for him to take it on a regular basis. 

Then last summer, Piri came down with a nasty case of Urinary Tract Infection. I thought I was really going to lose him. After numerous trips to the vet's office and going through a whole host of medications, Piri finally came back around. And we struggled once more to get him to eat something. There was no way he was going to eat his prescription K/D food and so we tried different brands like -- I and Love and You, Merrick, Just Food for Dogs. But nothing worked.

We ended up ignoring everything related to protein and phosphorous intake for Piri to maintain his kidneys (except the food we ordered from Just Food for Dogs, which was made specifically for dogs with kidney disease) because we needed him to eat something. When nothing worked, I ended up trying Green Tripe from Merrick (we had wanted Solid Gold Green Tripe but at the time they were trying to find a new reliable source and needed to go through a research and development phase to start producing Green Tripe cans again. No stores carried them but now they are back in stock -- Solid Gold Green Tripe is also listed as a commercial food diet acceptable for dogs with kidney disease as it is rich in nutrients and relatively low in phosphorus). Green tripe lasted for a few weeks until his appetite changed once again, this time back to prescription K/D diet. 

Then early this year when he was diagnosed with cancer, everything changed. Everything we were doing in terms of kidney disease diet took a back seat. Now we were solely focused on giving him a cancer diet -- meats, quality protein, high in fat, no carbs. 

We quickly realized that coming up with a diet that fit his cancer, kidney and later pancreas needs proved difficult as one illness needed something the other couldn't have. 

It was around this time when we switched everything over to a homecooked meal. We bought everything organic. New commercial dog foods that helped when he wasn't feeling his homecooked meals were Weruva Dog in the Kitchen pouches, Open Farm and Wysong. During the last couple of months, Piri would end up preferring Ceasar wet food, which I gave to him reluctantly, and would pass up on so much more -- Fromm, Taste of the Wild, Zignature, The Honest Kitchen, Earthborn, just to name a few.

New supplements were once again introduced (Piri was still on coq10, and fish oil but we switched over to Nordic Naturals, and we switched out Cosequin for Ark Naturals. He was no longer taking Solid Gold Seameal) - Goat's Milk, Turmeric, Bone Broth and Turmeric, Coconut Oil, Spirulina, which was suggested by a friend on Instagram.

At first the Goat's Milk and Bone Broth with Turmeric served as an appetite stimulant for Piri when he wasn't feeling his food. It was also filled with great nutrition for Piri. But he would get tired of them in a couple of months.

Piri was on and off with Turmeric and Spirulina, which both came in powder forms and eventually stopped taking them. And he became sick of coconut oil rather quickly. 

And then came the liquid herbal supplements -- Milk Thistle, Mellit, Es Clear, Tripsy, Turmeric, Maitake and Rehmannia 8. By this time, it was hard to give supplements and medicine in pill format (and powder as well) to Piri and liquid forms proved to be easier to administer.

When I look at our story arc, I can't help but think we started on some key supplements too late (too much - over supplementing, too late). I can't help but regret not having switched over to a good quality diet and kept his teeth clean. 

We never missed a comprehensive annual exam but when I look back I feel as though we could have done a better job of maintaining his health through good food and supplements. 

Some people can look at his whole story though and see it in a completely different light. Piri lived to be 17. Whatever he was eating was fine. Holistic, natural or not, Piri lived to be 17. Any pet parent would be lucky to have their dog live that long.

That is true. We were so lucky. But seeing him so sick and thin as a rail during his golden years broke out hearts, and we only wish we could have done a little more to maybe have prevented his illnesses.

Perhaps it wouldn't have. Perhaps it would have. But if given another chance, knowing what I know, I would have been a bit more conscious about what I fed Piri, early on, way before he was sick. I would've been proactive and not reactive by switching to healthier options only when he was diagnosed with kidney disease and cancer.

Some of the dog food products we came to love while researching for Piri when he became ill were: 
  • Open Farm
  • Wysong
  • The Honest Kitchen
  • Weruva 
But I have also realized that homecooking for Piri has also been extremely rewarding and it gave me a peace of mind (picking out quality ingredients and sometimes using vegetables grown from our own garden). While I hesitated with giving him a homecooked meal when he wa diagnosed with kidney disease, I do believe it is manageable. I do believe starting him on sub-q fluids early helped tremendously.

I have looked into a raw diet (commercial) but switching Piri over to that seemed too risky because of his age and he wasn't fond of freeze dried raw toppers. We have heard wonderful things however with raw diets.

Supplements that we relied heavily on were:
  • Fish Oil
  • Glucosamine
  • Coenzyme Q10
Supplements I wish we had started him on earlier, on a rotational basis are:
Costs can be a big concern when trying to feed our dogs quality food and provide them with quality supplements as well. In terms of food, I think rotational feeding can be helpful (so that you are not buying one expensive brand exclusively all the time) and we have found that offers good prices. 

If cost is still a concern, perhaps researching, speaking with your vet (or a holistic vet) and choosing one or two absolutely needed supplements that will help your dog now and in the long-run could be a starting point.

I am not an expert on pet nutrition and diet and so it is important that you really do your own research (and there are so many sources out there now) and consult with your veterinarian. While natural supplements are good all around, sometimes there are also precautions to take (for instance, Turmeric can be known to be a blood thinner). 

However, perhaps I don't have a clearer understanding and experience in having multiple dogs or larger sized dogs who eat more. And perhaps worrying about cost is just a different level than the worry that I am even imagining. I am always open to how to's from pet parents who have gone through this and has made it work with their large dogs in an effort to always educate myself 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. 

November 21, 2016

2 ways to give back to cocker spaniel rescues

Do you shop on Amazon on a regular basis? Or will you for the holidays? 

There are two cocker spaniel rescue organizations that we support with all our hearts and hope that there is a way for everyone who shops on Amazon to give back and show their support as well. 

Camp Cocker Rescue (based in California)
To support Camp Cocker Rescue, go to their website and click on Owen's picture. It will direct you to Amazon's site using their code as their affiliate. A portion of the proceeds will to towards the wonderful work they do (and I believe the percentage they get back is higher than if you choose them on AmazonSmile, which is 0.5%). You can also shop their wishlist and donate goods and supplies. 

OBG (Oldies But Goodies) Cocker Spaniel Rescue (based in the Washington D.C. area)
To support OBG Cocker Spaniel Rescue, click on this link to shop AmazonSmile and select OBG to receive a portion of the proceeds. 

We have been switching back and forth between these two links to do all we can to support. If there are other rescues or cocker spaniel rescues in your area you can most certainly choose them as well while you shop AmazonSmile. 

I know some folks are also members with eBates or Swagbucks and you'd like to receive a portion back for yourself while you shop. But if I'm correct, sometimes not all merchandise is qualified for cash back, in which case, using links that give back to rescue groups is no problem at all. But there may be other times when you can just forgo getting a cash back for yourself to help others in need. Rescue groups are all volunteer driven, they rescue dogs who are sometimes in high kill shelters, they are neglected and need medical treatment and are also looking for forever homes. If you are shopping anyway, why not shop and give back at the same time -- during the holidays and all year round. 

We hope our friends will consider. Say that you're in! (and high five to those that are!)

Happy Friday, everyone. 

 // Today is day 38 since Piri crossed the rainbow bridge. 오늘은 피리가 떠난지 38일 되는날.

November 20, 2016

The cost of treating Piri's cancer

Our cancer treatment journey with Piri was a heck of an expensive one.

During our consultation session with our oncologist, she let us know that cost is usually the deciding factor for many families. But she let us know that whether we pursue an all out treatment plan or not, we ultimately knew what was best for Piri. And I feel that this is true for all pet owners. That whether we pursue a multifaceted treatment plan or one that is completely holistic based or one that focuses on keeping the pet comfortable without pursuing any type of treatment, we make these decisions knowing what is best for our animal companions and for us. And in the end, the fact that our pets were so loved carries us through to the last remaining days. 

While our treatment costs were high, we only have about three months left in paying off Piri's vet bills. This is only possible because throughout the year, every month, we didn't let the our vet bill pool grow bigger, and instead we used any extra income we had coming in to pay off our debt. We kept our personal expenses low, we didn't eat out or go out at all (no happy hour, movies, shopping sprees, keeping our grocery bills to $100 or lower per week and cooking all our meals, etc) and while we did treat ourselves here and there (because our well being, happiness and keeping stress levels down was also important), we made use of sales and discounts to keep overall expenses down. 

Sometimes we took on more hours at work during some months - Yangkyu sometimes working well into the night and into the weekend and me taking in more guest dogs where I could, without compromising Piri's care. There were many stressful and long days and nights but ultimately we made it work. I think I can look back now and feel somewhat proud of the fact that we were able to make it work, but I can say that it wasn't a walk in the park either. That it took a lot of patience, sacrifices, controlling stress and believing in each other and really having love carry us forward (I know, it sounds so cheesy!). We were also privileged in a sense where we both had jobs that gave us leeway to pay off vet bills in the thousands. It was stressful, but it wasn't impossible. I think we can say that it can be possible for all families and individuals, but not everyone has the luxury or the privilege, which we must acknowledge and be aware of. 

We also had pet insurance, which helped somewhat. Although, some may disagree. And I know this is going against everything I wrote in this scathing piece about pet insurance. 

At the time, we were denied continuous coverage from our pet insurance for Piri's kidney disease because after a year, it was considered a pre-existing condition. If we had enrolled Piri in something called Continuing Care by the time he was 8, we might have been able to lift that pre-existing condition. But we didn't enroll Piri in insurance until he was 10, which would've made the Continuing Care option too late for us anyway. Fundamentally though, this health insurance operated by the ASPCA did not make sense to me because it would ultimately exclude pets adopted when they were past the age of 8, rendering the insurance useless should they need continuing care well into their golden years (I mean how do you encourage senior pet adoption when you can't come up with more accessible services that help senior pet care when they are ill?).

But the reason we got pet insurance in the first place was that it was an investment for us should there ever come a time when Piri would need unexpected surgery or treatment if he was ill. To be honest, I wasn't expecting anything like cancer or kidney disease. But I figured there might be something in the future. And I was scared that vet bills would be through the roof. And insurance did help. Throughout the years, we were able to claim and get back a portion of the bill (up to 80% with ASPCA insurance). When we first started pet insurance we paid $35 a month (it's more expensive for senior dogs). The fee steadily rose throughout the years and most recently we were paying $70 a month. 

However, after the incident with Piri's kidney disease, we contemplated on whether we should cancel. Other people suggested how they save a little every month so they can have an emergency fund in case their dogs needed to go to the vet. This is a very good and smart thing to do, but when your dog's vet bills range in the thousands and when the sickness is so bad that he goes in every other week, unless your fund already has thousands and thousands of dollars saved (because you started when your dog was a puppy or you are able to put in a lot every month), it wouldn't be all that helpful.

The thing that I found most helpful about pet insurance during this time was that even though his illnesses were eventually considered pre-existing after a year and it doesn't cover holistic care (ours didn't, but other insurance companies might), was that it covered emergency room visits and all the new illnesses that arose from kidney disease and cancer. 

Guys, I could sound incredibly naive, but I did not expect Piri to get of a host of other illnesses that arose from his current medical issues, all of which were new and eligible to be covered under his insurance. Things like urinary tract infection, pancreatitis and pneumonia, which eventually took his life. 

Here are some numbers.

Total cost for Piri's cancer treatment journey, which includes a visit with the cardiologist to see if he can be a candidate to go under surgery to remove his lump (in January), the actual surgery to remove the suspicious lump and three teeth (in March), his second lump removal surgery (in August), two biopsies, two fine needle aspirates, numerous oncology visits, chemo refills, vaccine shots, medication refills and holistic treatments came to a total of $13,936.42* (from January to October 2016). Of the $13,936.42, insurance was able to pay for $3,217.86. We also received unsolicited financial assistance from a couple of our friends and also a super generous DogVacay client totaling $550. Our overall out of pocket treatment cost for Piri was $10,168.56. And as I mentioned before, we have about 3 more months to pay everything off. 

Further breakdown is as follows: 

Just oncology visits alone was $7,067.74 (this includes medications, vaccine shots, etc.).
Palladia (his checmo) at 10mg was $74.40 (tablets which covers 2 weeks of treatement)
Melanoma vaccine shot was $661.73 per shot (Piri received the four initial shots and died before the 6 month boosters were due)
Oncology recheck visits were $115 per visit 
There were also other blood panels that needed to be done, oral exams to check regrowth, fine needle aspirates, sedation costs, etc. Because when you go through chemo and decide to get the melanoma vaccine, you don't go in for oncology visits to just get those treatments. It means you have to get regular blood panels and other tests done to see if your pet's organs are functioning properly to continue with treatment. 

While being treated for cancer, Piri was rushed to the ER twice for urinary tract infection and pneumonia. The total to treat illnesses that arose out of his cancer (whether it was directly related or because his body was too weak to fight them off) was $3,275.56. Insurance covered $1,911.33.

Piri's end of life cost was $315. Insurance covered $211.26.

Total hospital bills for Piri's cancer and new illnesses that occurred after his cancer diagnosis and end of life costs was $17,526.98. Of this, insurance coverage was $5,340.45. Our overall out of pocket payment was $11,636.53 (this total includes the $550 we received from friends). This doesn't reflect his ongoing treatment for kidney disease (Enacard - $13.20 for 30 tablets - for his blood pressure related to his kidney disease and also sub-q fluids, which he got every other day. Needles, two bags and two lines cost $125.34. 1 bag and 1 line was good for three sub-q fluid sessions). 

Some people may still look at the numbers and say that pet insurance isn't really worth it. For us, ultimately in the end, it was. Any type of financial support for us was helpful.

If we were to take away anything from our experience it's this: 

1. Choose a good pet health insurance plan and really know what they are offering. I think I read somewhere that only 2% of American pet owners have pet insurance. The lowest compared to other countries (it was on a Trupanion pet insurance pamphlet, I believe). I thought that was staggeringly low. I am not in any way advocating for pet insurance in this post, but when we look at the full picture, we think it was more helpful than not (including the fact that it helped pay for 1 year's worth of kidney disease treatment). The thing is, we knew why we wanted pet insurance, but didn't fully understand what we were signing up for. There are very good pet insurance companies out there and if you do your research and ask pointed questions (what is actually covered, will illnesses that arise in the future be considered pre-existing once the plan renews after one year, etc.) you can find one that will benefit your pet immensely.

2. If insurance still isn't something for you, then create a fund where you save every month for an unexpected illness or surgery (not a regular visit or a low grade treatment). Sometimes it's really hard to figure out how you can breakdown your salary even further to find ways to save monthly for your pet (trust me - there was a point in my young life when I was making $24,000, $26,000, $28,000 working as a community organizer and then $30,000 a year and with rent in Queens, NY, paying into my insurance, taxes, basic living expenses, there wasn't much left to do anything else), but if you can, you won't regret it. 

3. Ask for help. For us, we had several people who were willing to help pay for Piri's medical bills. We never started a gofundme or indigogo page because as I said before, while it was stressful, it wasn't impossible for us. I didn't want money that could potential help another dog go towards something we would be able to manage. But I can tell you that I have contributed to other people's call for help in paying for their pet's medical bills even while I was going through paying for Piri's medical bills (going through it myself, I understand their struggle and I want to help any way I can. I know that any amount truly goes a long way). There are many people out there willing to help if you ask. But please pay it forward, when you are able to, to another person who may be in need of some financial support.

4. Research other options like programs and funds for families to help pay for vet costs and life saving treatments. 

5. Take care of your dog. I said this in my last post but there are a lot of things I would do differently with Piri if I had known what I know now with his food, supplements, maintaining better teeth and gums, not over vaccinating and using harsh chemicals to prevent ticks and fleas, etc. And perhaps even if I did everything "right", he would've still ended up with cancer. But it would leave out a lot of what ifs. We are so in tune with healthy living and eating for ourselves and there is no reason why it shouldn't extend to our pets as well. Ultimately, we can avoid a lot of trips to the vet if we pay attention to overall health and well being by changing how they eat and keeping up a healthy daily life style.

I am not sure if this post was at all helpful. I am not sure if I was trying to show you how costly treatment is or different ways you can pay for treatments. In the end, it is perhaps more just our personal story and take aways from it. 

November is almost over. Thanksgiving cannot be this week already, but it is. I still hope to get a few more posts in regarding Piri's cancer journey and it may well flow into the month of December. 

I hope you'll continue to stick around and read them. 

Thank you.

*We were denied coverage for Piri's cardiology visit because they claimed that it was pre-existing according to previous notes from our primary vet where she suspected Piri was having a mild heart murmur (we fought this and said that he was never officially diagnosed util we saw a cardiologist but it was not enough). Also, because the oncology visits were so expensive, we had already reach the limit of coverage by May and were no longer qualified for future claims within the same insurance period. I feel we could've been covered for more but such limitations prevented it. 

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. 

November 17, 2016

A moment I will never forget

This was taken on July 20, 2014.

It was the day we moved into our home that we purchased together as a family. We were ecstatic during this time, not only because we were happy to finally have a place to call our own with a backyard for Piri to play in, but we were also expecting a baby. Our little family was going to be a family of 4. And we were so ready for this next step and so happy because we had always planned for us to grow together, with Piri.

In the beginning when we got married, as selfish as it may sound, I wasn't ready to become a mother. Or maybe to be more accurate, I didn't want to become a mother. To be completely honest, my heart was just full and content with Yangkyu and Piri. The three of us.

Then there came a point when my best friend had told me she was pregnant and that gave me a push to start trying. And by then, I welcomed the idea of becoming a mother. I imagined the three of us, Yangkyu, Piri and me, welcoming a new little person into our family and it just seemed so right. 

I can't count the years we've been trying. In the past, it was all about calculating and counting days (counting days till I ovulate, after I ovulate, my cycle, years trying, months trying). It's all a blur now. 5 years next spring? Yeah, that seems about right. 

In the beginning it was hard. You know, the whole dealing with infertility. But not just going through it physically, but dealing with everyone else who had an opinion or advice or even a solution. Somehow everyone had that one aunt whose friend's roommate's sister's mother went through years of infertility and after she stopped thinking about it just happened. Or they told me I am just stressing too much. I need to relax. Have I tried IUI or IVF? Who's fault is it? You can always adopt. Enjoy your time without a baby because it's really hard work. It'll happen when it happens. You're still so young

One time I had a conversation with someone who kept telling me not to give up and have hope and how he knew someone who went through the same exact thing (because every infertility experience is exactly the same, right?) and him and his wife eventually got pregnant. "So, Jane, don't give up and have hope."

After four years of this I had enough and I politely told him, "I know you are coming from a good place and you are trying to be there for me. But what you are saying to me isn't helping and is more hurtful. Please respect my feelings and what I'm going through." He listened as I explained that I may be that one person he is giving this advice to, but I had to listen to the same message from so many different people through the years. It isn't helpful. Infertility, when you look deep into it is more about having hope and not giving up. He listened to me and then said, "Ok. I see. Yeah. I didn't mean it that way. I understand. But Jane... just don't give up."

In the past I would've gotten very angry at his last comment. At this moment though, I just felt defeated. And invalidated. 

But among all these experiences - these well intended comments that didn't feel so well intended brings me back to this picture. This moment, which I will never forget. 

It was taken after we had moved into our new home. But just hours before, during the middle of the night, I had miscarried. It was one of the most physically painful experiences I had in my life. 

After coming back from the ER, I didn't get any sleep and got ready to move. I scrubbed and cleaned and moved boxes. I didn't know where this herculean strength was coming from. But then I crashed.

Piri hasn't snuggled with me often. He used to when he was younger, but as he aged, he preferred his own space or random neck scratches more than cuddling. But as soon as I laid down, Piri who was near the balcony door came to me slowly and carefully and laid right next to me and stayed there. I remember being surprised, and I cried, and I thanked him because I felt like he knew and the best support he could give me was to just be there by my side. And somehow, even though it was so incredibly sad, I knew that things would be ok. We were going to be ok because we had each other.

I mentioned from time to time that when Piri passed, it was more than just a dog dying. To me, it brought out all different kinds of emotions and memories. And it brought back our struggle with infertility. It was all of this. We were going through it together, the three of us. We had hoped so much to become a bigger family. And the thought that this was no longer a possibility shattered my heart. It still does.

I cried every month for the first 36 months when my pregnancy test came back negative. But that went away... eventually. Maybe I got tired. Maybe I learned to grow a tougher skin. Maybe it didn't matter anymore. Maybe I grew to be more positive. But I took it in stride. "There is always next month.." 

But when Piri passed, a part of me mourned for all those months I tried to keep positive. 

Piri's passing has been more than a dog dying. It was saying bye to a life I had known. A life I had hoped for. 

A collection of our infertility stories...
 // {Superstitious} Thoughts
 // Carrots 

November 16, 2016

The side of Piri's chemo treatment we rarely talked about

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. 
Just meat.
Just fruits. 
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. 

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