Reacquainting Myself with Anguish

The discovery of Hudson's new tumor has reawakened my soul deep dread of what is to come.  I asked him last night to just give me five more months.  I keep telling him if he can just make it to the date of his diagnosis, it will be enough for me.  That’s a lie.  No amount of time will be enough.  Hudson is my baby.  He was the first Dane we ever adopted and he has been a mama’s boy since the moment he arrived.  I don’t know how to exist without him.

Hudson isn’t currently on any chemo.  It’s been over a month since his last IV chemo treatment, and his oral chemo meds haven’t arrived.  He’s been extremely tired lately and has to be tempted off the couch to go outside.  Occasionally, I see flashes of my goofy boy.  He will toss his toys around, or play with the ten pound Min Pin that we are fostering.  He’s not in pain and he’s not ready to go, but I’m beginning to get glimpses of what the end will be like.  I’m not ready.

On my way home from work, I broke down in the car because of the words of a song…

Lord, make me a rainbow
I’ll shine down on my mother
She’ll know I’m safe with you
When she stands under my colors
Oh, life ain’t always what you think it ought to be, no
Ain’t even grey but she buries her baby
The sharp knife of a short life
Well, I’ve had just enough time

Chest X-Rays and the Oral Chemo Choice

Hudson and I went to AHSC last night to get chest X-rays and a CBC.  It was very snowy, so it ended up taking us 1/2 an hour to get from our house to the office, which is normally a 10 minute drive.  Hudson was quite comfortable since he was wearing the coat his foster mom from RMGDRI made him over five years ago.

As usual, since I'm a worrier, I was stressed about the x-rays.  My stomach was in a knot all day.  I'm sure Hudson was feeling my concern, since he promptly peed on the floor at the Oncologist's upon our arrival.  He'd gone potty before we left home, so it's very likely it was a response to my stress. I try to maintain calm around him, but failed miserably this time.  (Then I start to worry that my worrying upsets him. It's a never ending cycle.)

If you will recall, at Hudson's initial time of diagnosis in June, he had zero visible tumors in his lungs on the first set of x-rays.  The 2nd set taken three months later in September, showed 7 tumors had grown in his lungs ranging in size from 0.5cm to 2.5cm.  The 3rd set, taken a month later, showed that 6 of his tumors had shrunk by 25-50% and that the biggest had disappeared all together from the x-ray.  Fast forward two months, to the chest x-rays taken yesterday.

The six remaining tumors have all decreased in mass.  Five are visibly gone (but likely not microscopically) and one was reduced by 75%.  Unfortunately, a new one has shown up.  It is approximately 4 cm (try looking at that on a ruler.  It almost stopped my heart.)  Fortunately, it's not in a bad location in the lungs and Hudson remains asymptomatic.  Our hope is that the new metronomic oral chemo protocol will either help to reduce the size, or at the least, prevent it from growing larger.

Our chemo meds are in the mail and will be taken daily.  (Previously, I had said that it would be every other day for the Metronomic Protocol, but recent findings show that daily meds are best.)  The most common side effect (30% likelihood) is bladder irritation, so we have to be certain to provide plenty of fresh, clean water.  We will also need to pay attention to how frequently he is urinating, as well as whether there is any blood in his urine.

Chemo the 8th - The End of IV Chemo

Hudson had his final IV chemo today.  His white cell counts were where they needed to be and everything checked out great.  His breathing and his heart sound good.  He goes back in three weeks for new chest xrays and to determine the oral chemo protocol we want to follow.

There are two oral chemo protocols out there.  Traditionally, vets follow a metronomic protocol.  This protocol combines medications (Doxycycline, Rimadyl, Cyclophoshamide and a few others) to work on slowing down the blood supply to cancer cells.  By starving the cells, you limit the growth they can achieve.  The tumors are not likely to get smaller while on the metronomic regimen, but the point is more to prolong quality of life by preventing or delaying further growth.

The second protocol is only beginning to gain a following.  It utilizes Tyrosine Kinase Inhibitors, and combines Palladia, Kinavet and Rimmadyl.  Tyrosine kinase inhibitors (TKIs) are a class of chemotheraphy medications that inhibit or block the enzyme tyrosine kinase.  Tyrosine Kinase basically acts as an on/off switch for cell replication and growth. this on/off process can become disrupted, often due to a mutated kinase, and actions become unregulated.  This can lead to uncontrolled growth and division in the cell, which could lead to cancer.  These mutated cells often lead to oncogenes, which are genes that help turn a healthy cell into a cancerous cell.  Tyrosine kinase inhibitors treat cancer by correcting this deregulation. How this is done varies depending on the medication.  Toceranib (Palladia)  inhibits EGFRs (I have no idea what that is), preventing that signal from being stuck “on” and creating uncontrolled proliferation.  The gist of tyrosine kinase inhibitors is that they allow for targeted treatment of specific cancers, which lessens the risk of damage to healthy cells and increases treatment success.

TKI's have not been fully proven yet in canines, they are (for giant breeds anyway) four times the cost of the metronomic protocol, and dogs on TKI's are 50% likely to experience severe GI side effects, like vomiting and diarrhea.  In contrast, the metronomic protocol has a 20% change of side effects.

Dr. Jansen is going to go over these options with us in detail while Hudson is getting his chest xrays and will provide us an estimate of the cost at that time.  Based on what I know so far, I'm honestly leaning toward the metronomic protocol.  I freely admit that cost is an aspect for me at this point, but my primary concern is the side effects.  Hudson is already 7 ½ years old.  Danes typically live 7-10 years.  I would LOVE for him to get to 10, but I don’t want him to be miserable on the way there.  Traditional IV chemo is given every 2 ½ weeks.  Hudson feels a tired and maybe a little nauseous for 2-3 days following chemo, then he gets two weeks of happy healthy days.  On oral chemo, he would get pills M/W/F of each week.  He’d feel bad virtually all the time.  Dr. Janson explained that his dosages could be adjusted to keep him feeling the best possible, but I don’t want the time he has left to be the best possible.  On the metronomic protocol, he has the same side effects odds as normal chemo.  Normal chemo never really upset his stomach.  He never had diarrhea and we can proactively treat for nausea.  He was just a little tired. 

Dr. Janson said that she is leaning the same way as I am on this one.  We can try metronomic first.  If after a few months, we notice growth in his tumors, then we can try the TKI’s.  Obviously, I’ll be doing a great deal more research on this over the next few weeks.

Hudson's favorite oncology tech came running after us to make sure Hudson got his "graduation" present.  J