11/10/2006   11/24/2006   12/1/2006 In Memoriam

Happy Thanksgiving!

We are, of course, thankful for many things and foremost among them is our relationship with Harvey. So, here is a special Thanksgiving weekend update.

Last I sent email, Harvey was on his way to his first chemotherapy treatment, having just been positively diagnosed with lymphoma. Since then he has his ups and downs, more of the latter than the former, but is hanging in there.

His first week after the first chemo treatment has probably been the worst so far, this time around. The first couple of days were okay, but then once the chemo really started kicking in, things got worse. We did what we could to make sure he was getting food into him, including forcing him to eat at times. But we had to back off on that, as later in the week he developed some serious nausea and diarrhea.

The worst day was just before what was supposed to be his next chemo treatment, a week after the first. Because of the intestinal issues, he had become relatively dehydrated. A blood test showed that the initial chemo had already done some good, with his calcium level back to within the normal range, as well as a good creatinine level (well, reasonably normal for Harvey anyway...it's always been slightly elevated, since his first round with lymphoma five years ago). Blood counts were low, but acceptable.

But with the dehydration and relative lack of eating, on the oncologist's suggestion we decided to postpone his next chemo treatment a few days and reduce his prednisone dose somewhat, in case it was partly the cause for his weakness.

The oncologist prescribed an antibiotic to try to help the intestinal symptoms, given the likelihood that the diarrhea was related to some opportunistic bacterial infection. Also, before Harvey and I went home, they provided some additional fluids, subcutaneously. The antibiotic did help clear things up, and over the weekend we continued to encourage Harvey to keep drinking.

I also noticed that while at the vet, Harvey in spite of his resistance to eating his usual meat diet, was reasonably happy to eat dog treats. So, we started incorporating dry food into his diet as well, hoping that he would more willingly eat that. Harvey had received from a friend a gift box from the Three Dog Bakery, which is always nice to get but in this case was especially timely, as it contained a couple of kinds of healthy, dry dog treats. Debra also went to the pet supply store and picked up some all-natural, low carbohydrate dry dog food and treats.

Harvey continues to be somewhat unpredictable in what he's willing to eat. But the dry food has been reasonably successful. For many "meals", we can get him to eat a fair number of treats and kibble voluntarily.

One of the issues with respect to Harvey's cancer treatments has been the question of whether he will be using doxyrubicin (adriamycin). This is a particularly potent chemo drug, which is both good and bad. The bad part is that it is known to cause damage to the heart, and it's advised that cancer patients limit their lifetime exposure to the drug, to avoid heart failure. Harvey had a cardiac exam (including ultrasound) to try to assess the health of his heart, how much (if any) damage had already occurred from previous doses of doxyrubicin, and the risk of using more of the drug. Unfortunately, the test results were not favorable toward using it.

The cardiologist noted a slight arrhythmia. In and of itself, that doesn't necessarily mean there has already been heart damage. There are other reasons he could have the arrhythmia, but it is possible that he's already had as much doxyrubicin as he could take. It turns out that there are methods of getting doxyrubicin that aren't as harmful to the heart. It can be taken with a drug called Zinecard, which protects the heart from the drug quite well (but also appears to protect the cancer somewhat, reducing the efficacy of the doxyrubicin). There is also a lipid-encapsulated form of doxyrubicin, known as Doxil, that allows the heart to not have to deal with so much at once, and which doesn't reduce the efficacy of the drug.

But neither of those is completely without risk even so, and between the existing possible heart symptom and Harvey's age (the chance of heart failure goes up with age), we've decided to leave the doxyrubicin out of the treatment for now. We may revisit that later, especially if we see signs that the cancer isn't responding well to the chemo, and/or if we get a follow-up cardiac exam that suggests the arrhythmia was a temporary problem (caused by dehydration, for example). But for now, we'll be substituting a different drug, actinomycin, in place of the doxyrubicin.

Anyway, with him eating somewhat better, the intestinal symptoms cleared up, and him continuing to drink reasonably often, Harvey was cleared for his postponed chemo treatment, which he got Monday this week. The first day or so was fine, but by Wednesday Harvey was obviously feeling very sick again. He didn't have any serious symptoms, but was very resistant to eating any food and was acting very "mopey".

Based on the previous week, we expected Thursday to be similarly bad, but by then Harvey was already starting to perk up. The oncologist had reduced his second chemo dose slightly as compared to the previous one, so this was probably at least in part responsible for his better response. In any case, I had given him the whole day off on Wednesday with respect to making him eat, and by Thursday he was actually willing to eat a morsel here and there.

He refused our Thanksgiving Dinner pot roast, but he was willing to eat his regular meat dinner, hand-fed of course. And of course, the occasional treat we offered to him as well.

Today he has been doing even better, and I fully expect to be able to get a second six-ounce meals of meat into him later this evening, along with his usual treats and cheese-wrapped pills. And to our great satisfaction, he continues to be reasonably willing to keep drinking his water, to try to stay well-hydrated (though at this point he has no unusual water loss, it's still a good idea to try to keep his fluids up).

At this rate, Harvey is likely to continue to improve somewhat over the weekend, and hopefully will be strong enough for the chemo treatment scheduled on Monday to take place. A little insulting to him, I know...get him stronger, just to make him sick again. But we are used to this cycle. On the bright side, this Monday will be the last of the weekly treatments for awhile. After his chemo on Monday, he gets a two-week break, and remains on a two-week schedule through early February, when one more "one week later" treatment occurs (after that, he goes to a "once every three weeks" schedule, which is even better).

As many of you know, during Harvey's first round of chemo, the very first chemo treatment put him into intensive care, and he wasn't strong enough to face a second treatment for a month after that. So already, we are ahead of that game. Going against us we have Harvey's age but in our favor we have our past experiences to guide us. Overall, I feel that Harvey has been doing fairly well, all things considered.

Thank you for your continued interest and concern, and I look forward to being able to report more good news in a future update.