This journal is mainly the original text published during Nunya’s experience with nasal cancer. Anything that has been added to the original will appear in green.
To cut to the chase, my dog has cancer. She has a tumor (nasal carcinoma) in her nasal cavity running from behind the canine teeth to her sinuses on the left side. Today was day one of radiation treatment but before I go into that, let’s try to get some of the emotions out that will prevent the rest of this blog from being useful. My wife and I are sad. I am angry. I feel we never once hesitated to go to a vet or vet specialist when caring for Nunya over the last 12 years. How could something so big get missed? I feel like I let Nunya down in my decision making and now she is paying the cost. I think Ali and I are both confused and fearful. Did we do the right thing by trying to prolong her life or are we making her suffer because we will miss her so much? Is there a magic moment when you know it is time to euthanize your friend of 11 years?
I found Nunya at the pound in Waco, Tx where I was studying bioinformatics and trying to find my beautiful wife Alison. I remember the day vividly for 2 reasons, the first, because I was looking for a three legged dog and they only had one who just dragged his gimp leg. And the more important reason was just a magical feeling when I saw Nunya. She would be my dog.
Fate or dumb luck, I do not know, but Nunya helped me navigate the waters in my younger years. Always staying close, always staying loyal and always up for a 2am Jeep ride. There is no better time in a man’s life to have such a faithful companion than when he is just starting to go out on his own. She followed me through every stupid decision, good day or bad day, because she believed in me (or my ability to hunt and gather from Walmart.)
I have so many great memories of her loyalty from standing guard after surgery, to sleeping beside me on a concrete floor, to even trying to protect me from the loud UPS guy, the list is endless.
She really became part of my identity and I strongly feel had influence on meeting and marrying my wife. For that alone, I owe her the treatment.
Whew, now that part is over, one more note: I mention cost below. This might vary from place to place. Paying this amount of money for a pet is a personal choice and may not be the right decision for everyone. My goal is to be as honest about the experience as possible to help inform anyone else dealing with the same issue. After this experience, I would recommend people who want their animal to have this kind of care investigate pet insurance. I am fully aware that the care she is receiving is not normal and while I personally do not agree, I respect other peoples’ opinion that a dog or cat with cancer should just be put down. Only time will tell if I will change my mind after this experience.
The ordeal started about 4 weeks ago with some bloody sneezes. We took her to her local vet who did about $400 in lab work and x-rays and sent us home with some pills. The thought was that the problem stemmed from allergies. This plan actually worked for the next three weeks and she was incident free until ‘bloody night’. Nunya is really good about notifying us of a problem. She came right over to Ali and I, then gently put her paw out and sneezed blood on us. On one of the sneezes a chunk of tissue flew out (1/4 the size of an eraser). At that point we were out the door and at the doggy ER (because of course this happened at midnight). Very little help… $400 later we are referred to a specialist for her first CT scan (view the scan). Scan happened, they found a huge tumor but couldn’t give us any info until after the results from the 20-25 biopsy sites (ouch). For anyone who gets to this point with their animal – skip the specialist and go to the super specialist. They will have to redo all the blood work and CT scans. The blood work cost $300-400 and the CT scans cost $750-1250. The whole biopsy ordeal at the first specialist vet was $2,000 for blood work, CT, scope, and biopsy.
Almost immediately after the blood night incident, she started having problems breathing and sleeping since her nose was blocked and most of the air needed to go through her mouth. She started sneezing, coughing and a weird panic breathing thing. We found the best solution to calm this down was neosynephrine sprayed in the nose, back rubs, and car rides. For some reason, when she is in the car she breathes out of her mouth normally.
That was a horrible week of waiting but we finally got the news this last Monday (week later) that it was time to see the oncology team at Texas A & M.
Downside, they didn’t have an appointment available until the 15th which was weeks away. Well that was unacceptable. Nunya needed care weeks ago. So we started searching for loopholes and found out from the great staff there that if the dog goes to the A&M ER, they can get fast tracked to seeing a specialist. We were in the car and on the way to College Station within an hour. Nunya was admitted through the ER and stayed overnight for diagnosing. They determined that her tumor was advanced enough that we should start on treatment soon.
I cannot speak highly enough of the Doctors, interns and students at Texas A&M Small Animal Clinic. Before starting treatment, we spent at least 45 minutes to 1 hour discussing the process and the potential side effects of the procedure. The quick run down of the scary: hair falls out and then grows back strange, radiation burns, super radiation burns where chunks of the skin can open up and potentially require surgery to close, voids in skull from the where the cancer destroyed bone that will not grow back – the voids can get infected and require a lifetime of antibiotics and potential surgery, blindness, loss of smell, and death.
Several appointments, lab tests and horrible haircuts for ultra sounds later, we are back at where I started, Day 1 of radiation. Nunya will receive 20 weekday treatments of radiation using a precise plan calculated by the Doctor – I believe it is called Tomotherapy. This treatment required a $4000 deposit, with the remaining $4000 to be paid at the completion of treatment. Each day, she gets dropped of in the morning, put under anesthesia, zapped by radiation machine and then woken back up. We have the option to leave her overnight or to pick her up and bring her home. We opted to bring her home, which I think was the right choice for us. Finding the right balance between the stress of an overnight stay and a 1.5 hour car ride will be a challenge. Nunya is very much a homebody so we know she will be more comfortable with us at home, but we don’t want to put her through any unnecessary stress of traveling if she is not feeling well.
We did not discuss chemotherapy as a treatment option and I think we were past the point for a surgical extraction. So our options: 2 months of painful nose destruction and death or Radiation that does not sound fun but could prolong her life up to 19 months (we are pushing for two years). We did discuss changing Nunya’s diet and it was decided that it was best to leave well enough alone (they were familiar with the same low carb diet recommendations seen online).
TomoTherapy: Radiation Treatment
After Day 1:
Her demeanor seemed a lot better today. She was generally happy and walking around even with the catheter and 50 percent of her hind leg covered with the stretchy medical tape. You could tell that her mouth was sore. Eating was a real problem. Anything that required the use of her tongue to grab was impossible. We tried a few things when the dog food would not go down and eventually ended up hand serving her bacon, ground meat, and green beans. Probably not the healthiest but it was the only thing we could get down.
She really hates her pain medicine, Tramadol. It must taste horrible. We have shoved it in everything and cannot mask the taste. It tastes so bad that Nunya will not eat the food we tried to shove it in again (I think this is how we killed her favorite snack of cheese). We have resorted to using a pill shooter to get it down her throat. The experience is horrible.
Tonight we also had to rinse the newly put in catheter; which was really simple compared to the Tramadol. Nunya really didn’t seem bothered by it.
She slept most of the night without moving or coughing too much. So day 1 was an overall win.
Day 2-5: The first week of radiation therapy was mostly uneventful. There were few side effects, and we noticed an immediate improvement in Nunya’s breathing. The only side effects we found were her being lethargic (normal for her after anesthesia) and a reduced appetite. We felt that her appetite was reduced more due to discomfort and just not feeling good after anesthesia more than anything. We started cooking beef, chicken and broccoli for her and she seems happy. The improvement in breathing came after treatment day 3; which was really unexpected. I am not sure if they were zapping the right places or the swelling in her nose was going down but she really looks and sounds a lot better. She had a vascular port put in her neck so they would stop poking at her legs. She really doesn’t seem to mind the stitches but the giant life preserver she has to wear is ridiculous to her. It does beat the cone type anti scratch collar though.
The port is huge under her skin. Looks like a Frankenstein bolt on the right side of her neck. We don’t know the cost of the port yet. She can no longer wear a standard collar with it so we looked for a harness for her. Petco had the best option in soft harnesses ($22).
Day 6-13: The Glory Days. She looks wonderful. No loss of hair and appetite back to normal. We had a great three day weekend with her and it felt like all was normal. There was more sneezing this week, and it got pretty gross. The vet had warned us that she would start to cough and sneeze out some of the tumor and mucus that was in her nose. She sure did, and it got everywhere. We recommend putting down old sheets or towels on your furniture, in your car, or wherever else the dog normally goes. As strange as it sounds, the gross coming out almost felt like a victory and that we were winning in some kind of disgusting way.
Day 14-15: Radiation sucks. The burns just appeared out of nowhere. I thought it would be a gradual thing where she lost the hair first then get a sunburn then blisters. Nope… it went straight to horrible red and yellow blisters below both eyes. We are trying to stick to her medication schedule as closely as possible but you can tell she is in pain. She is shaking and just sitting and staring at random walls. We alternate between to different creams, Silver Sulfadiazine ($20) and Xclair ‘Radiation Dermatitis Symptom Relief’ cream ($80) that are supposed to bring relief to the burn areas. She is being really great about us sticking our fingers in her oozing burns and waits at least 5 minutes before sneaking off and rubbing it off.
She is having a problem eating dry food again. We assume this is because she has similar burns in her mouth. We switched her to canned science diet and that seemed to do the trick.
Emotionally this period has been the roughest, as seeing the visible damages from the radiation treatment on your dog is hard to take. It makes us at times question whether we’ve made the right decision in going forward with her treatment. We still feel that we are doing the right thing and are hoping that the final outcome will be a much increased lifespan and good quality of life. It is just hard knowing you are putting your pet through pain and not being able to explain to them why you are doing so.
Day 16-19: Still bad. The radiation burns have gotten much worse. The area of exposed raw skin has greatly increased and is now under both eyes. Hair has completely fallen out in two large areas. The skin is pink and irritated, and looks painful. We are still putting on the creams religiously to help soothe the skin. After a few days of doing this the skin still looked bad, so they also prescribed an antibiotic to take as well. The poor dog is on so many medications right now.
Some new behaviors have started as well. Nunya has been housebroken for well over a decade and has not had an accident inside in many years. But, over the past two days she has used the bathroom inside twice. One time she peed in the car on the way to the vet office. The next day she peed in our house. Neither time did she make us aware that she had to go outside, which is what she normally does. We are not sure if she did this because her schedule is off with the early morning vet visits and that threw her, or if it is medication related and holding her bladder is harder, or if she is doing this out of nerves (she hates going to the vet) or spite.
She is still in pain too. When she is picked up from the vet, she whines for about an hour. Once she gets home she will just sit around and stare at nothing. Her appetite is also reduced again. We give her an anti-nausea medicine but that doesn’t make her eat more. She will lick at the liquid in her dog food but just picks at the solid parts. She will eat some meat and vegetables if we hand feed her. Mostly she just lays around and sleeps. We are very much looking forward to the last day of radiation treatment.
DAY 20: WOOHOO! The tomotherapy is now complete! They sent Nunya home with a certificate of completion and a nice bandanna around her neck. The consult with the Dr was overall positive with a lot of warnings. The worst news is we don’t really know if it worked yet. The radiation will continue to shrink the tumor for the next week (hopefully). The downside to that, is the acute side effects can begin after treatment stops. Poor Nunya is already sore.
They suggested leaving the port in her neck forever, which means she cannot wear here NunStrong collar.
We go back in 2 weeks to do a quick check up (no ct scan yet). Exact notes from the Doctor:
Congratulations to you and Nunya for completing her TomoTherapy! As we discussed previously, acute side effects after radiation can begin soon after treatment, and may last for several weeks after treatment is completed. Short-term effects frequently resemble a very bad sunburn or “road rash”. You may see hair loss, change in skin and hair color in that area, or ulceration of the skin. You are already witnessing the the radiation dermatitis syndrome underneath both of Nunya’s eyes. Continue to apply the creams and give the antibiotic to prevent infection. Indication of infection would be green, white, or yellow discharge from underneath her eyes. Nunya may appear sensitive or painful around her left eye, nose, and mouth.
Long-term changes are also possible and may affect the bone and lymphatic structures, although this is decreased with definitive radiation protocols (as Nunya had) when compared to ‘palliative’ radiation. Some longer term effects might include the slight possibility that the mineral in the bone in the area can be replaced by fibrous tissue and become soft and predisposed to fractures. Nunya will also always be predisposed to rhinitis (infection of the nasal tissues) for the rest of her life, since the tissue in her nose will never be completely normal anatomically again after the tumor destruction and the radiation effects—so she may need intermittent antibiotic treatment. The majority of the ‘acute’ radiation side effects should be resolved, however, in about 4-6 weeks after completion of therapy.
Nunya is a very sweet dog and a wonderful patient! Thank you so much for entrusting Nunya in our care!
After the TomoTherapy:
11/05/2012 – 4 Days Post Tomotherapy: The burned area on her face has continued to grow (as expected). Nunya has tried to scratch at her face but we are doing our best to keep that down. I am betting we have to go to the anti-scratch cone or the ring within the next couple of days. It is a little more crusty than before – not sure if this is a negative or a positive.
We did have an amazing weekend with her. While she still hyperventilates if we try to walk, we was pretty active and went on a couple of car rides with Ali and helped with some steam cleaning.
11/16/2012 – The burns are starting to look a little better. Most of the scabs are gone and the flesh looks a lot less red. Her appetite is back and she has finished her antibiotic. She hasn’t needed the Tramadol in a few days. The one negative during this period – she seems to be more congested and sneezing a lot more. So far, the sneezes have not contained any blood. We are looking forward to her check up on Monday.
11/19/2012 – Nunya had her two week check-up today. The vet said she looked good and overall gave a good report. Our main concern had been her constant sneezing and hyperventilating. These were symptoms that started just before the cancer diagnosis. The vet said she was not very concerned about the sneezing/hyperventilating though. She said it was most likely due to post-nasal drip, which is an effect of the radiation. We should monitor Nunya and if the symptoms majorly worsen, or if she starts bleeding from the nose or mouth, we should let them know. Otherwise she should be fine. We still don’t know how much her tumor was reduced by. That answer will come in about two months at her next check-up, when they will do another scan on her.
The next step will be to start chemotherapy on her. This will consist of a daily pill regimen that will include the chemo pill (Cyclophosphamide), a diuretic pill (Furosemide), and an anti-inflammation medication. The vet says that Nunya shouldn’t have any noticeable side effects, other than increased thirst and urination. The chemo treatment is something that Nunya will likely be on long-term. The vet said most dogs who go on it will be on it for about a year to forever. That was not fun to hear, but if it increases her lifespan and helps prevent the cancer from coming back we are game. There are no guarantees of how effective her treatment will be in the long term, but it is the best chance for her so we will do it. The chemo pills need special handling and require gloves to administer. I am pretty sure Nunya will love that.
Update later in the day – We were called by the vet later on in the afternoon to go over a blood test finding from earlier in the day. Nunya’s liver levels were significantly increased from her readings about a month ago. The vet did not have an explanation for why this occurred, so wants to do an ultrasound to see what might be going on. The chemotherapy treatments will be delayed until this new problem is sorted out first.
11/22/2012 – Results but no answers. After an ultrasound (~$500) and a really bad hair cut, we learned that her liver looks good (which is great news). But we don’t have an explanation for the previous blood work results. We are waiting a week and then bringing her to the local vet for another round of blood tests. Nunya handled the ultrasound like a champ. She was a little groggy afterward but was active and hungry by 5pm.
11/30/2012 – Two more weeks. Nunya had her second blood test done on Wednesday and we got the results today. Liver functions are looking a lot better but still not where they need to be. It was recommended that we delay chemo and have her tested again in two weeks. Overall, she seems to be doing well. Sneezing a lot still but no blood and less snot.
We did have two positive events happen this week:
1. We passed the ‘She has two months to live’ point, which is how long her life was estimated to be had we not pursued treatment. While this marker was always an estimate, it was an important marker for us in evaluating if we did the right thing with her tomotherapy treatments.
2. She smelled the cable man. Seems silly but small victories still count. Internet was being flaky and Comcast had to come out to test the line. Nunya was closed off in my office with me while the guy was working. Nunya’s hearing is not what it was 5 years ago, so it was not expected that she reacted to the knock on the door or the noise of the man walking up and down the hall. To my surprise, she lifted her head and started audibly sniffing and immediately knew someone was in the house (got the full bark alert). This observation came as a huge relief because one of our concerns with the treatment was that Nunya’s sense of smell might be diminished. *I should note that the hygiene of the repair man was great – we could not detect any smells coming from him.
12/08/2012 – So far so good. There really has not been much change in the last week. Nunya has been in a really good mood and has had a great appetite. She still is sneezing and doing the strange reverse sneezing occasionally but the regularity has been pretty much consistent. She has lost more hair around her nose and a spot on her head. We have not seen her scratching so we are not really sure why we still see the increase in hair loss. But there is a positive on the hair front – some of the ‘first loss’ areas are starting to grow back thin amounts of white hair. Next week is the follow up blood test. She is still on the liver medication, taking both Ursodial and Denosyl to help improve her liver functions. We also put Aquaphor cream on her exposed skin patches to help heal the dry skin.
12/18/2012 – Still doing well. Nunya had to have another blood test last week to check her liver levels again. The results came back showing more improvement, and her levels are close to normal. The oncologist said that she can start on her chemotherapy medications now. The meds were ordered and should arrive in about 3-5 days. She will then need to have her blood re-tested in about two weeks, and a follow up visit with the oncologist in six weeks. Nunya has been doing well otherwise and seems to feel good. Some hair is growing back sporadically in her radiation burn patches as well. We have even started taking her on short walks outside, and she is able to walk around without sneezing/hyperventilating.
12/29/2012 – We had a great Christmas with Nunya. She has been doing well. Still sneezing and reverse sneezing occasionally. She has been feeling up to daily walks around the neighborhood. We are still waiting on one of the chemo drugs, but we anticipate her starting the combination of pills this week. Her bald spots are filling in quickly with golden blonde hair (even in the places that were white hair before). The doctors told us that it was a possibility that if the hair came back it would be different.
1/1/2013 – First dose of chemo. Nunya had her first chemotherapy medication today. She takes Cyclophosphamide and Furosemide once daily. The directions say to give it in the morning as it will cause frequent urination. Nunya lets herself outside through a doggy door, so hopefully that will not be an issue for her. The Cyclophosphamide directions say to wear gloves when handling the medication. Kind of an unnerving warning. Nunya took both meds like a champ, however seemed to have a hard time getting the Cyclophosphamide down. It is a bigger pill, so we’re not sure if it is hard to swallow or if it tastes bad. Hopefully taste will not be a deterrent because she will be on these for the foreseeable future.
1/6/2013 – A week in. Almost a week after the first dose and all seems to be going welling. Urination has increased and sleeping a little bit more. Hard to tell if it is the cold outside and the warm bed sucking her in and not the medicine (I am guilty of spending a lot of time in bed with her this weekend.)
1/13/2013 – Another week. Nothing major to report. We have another blood test scheduled this week to see if the chemotherapy medication is bothering her liver. I believe we head back to College Station in two weeks to have the nose scanned – we are both a little nervous and anxious about that test.
1/16/2013 – Blood test results came back and the Veterinarians at Texas A&M said that they looked good. Liver functions are still looking improved. Nunya is to stay on all current meds and her next appointment will be the big CT scan on Feb 12th.
2/2/2013 – TODAY is Nunya’s 13th birthday and we are extremely happy to have her here with us. Today has been filled with treats and Ringos.
2/12/2013 – Great news today! Nunya had her first CT scan since finishing the tomotherapy treatment and the scan shows that her cancer is gone! There were no detectable tumors to be found on the scans. There is the possibility that tiny cancer cells or tumors still exist, however Nunya is considered in remission. We were so happy to get this news.
Nunya will continue to take her chemotherapy meds for the foreseeable future, and probably the rest of her life. This is to help prevent new cancer growth or spreading. She seems to tolerate the meds well so this is not a problem. Another blood test was done to see if she needs to stay on her liver medications. We should find out those results soon. The doctor discussed Nunya’s sneezing and reverse sneezing and said that that will likely continue for her lifespan, but that it is nothing to worry about unless she starts sneezing blood again. The scans showed how some of the small bones in her nose got dramatically reduced by the radiation treatments. This means that she probably doesn’t filter air as well when breathing as she used to, causing the reverse sneezing. This could make her more susceptible to infections, so we will just have to keep an eye on it and act quickly if we suspect she has any type of infection. We also need to have regular vet exams done every three months, then have CT scans every six months to monitor her progress and make sure the cancer is staying away.
Overall though this was the best possible outcome, and was the news we were hoping for. We had already thought that going through with the treatment was worth it but this helped reinforce to us that we did the right thing for Nunya, given her particular case.
3/9/2013 – Just a quick update to say Nunya is doing well! Thanks @bobirakova for your kind words and input!
4/6/2013 – We are extremely happy to say that Nunya had another good month. The tree pollen gave her a little bit of issue about a week ago. I think it is again due to the lack of ‘filtering’ structure in her nose. She would sneeze then start licking at her nose until we wiped it – little gross.
5/5/2013 – We are still very pleased with her health. Still sneezing regularly but nothing that slows her down. She has an appointment on the 15th at Texas A&M. We are hopeful that all will go well and that they might have a suggestion for the sneezing.
5/15/2013 – We had been worried about Nunya recently. Over the past week she has seemed like she was having more difficulty breathing, and you could hear a wheezing sound and a congestion sound when she breathed. She was sneezing more than usual, and was snoring heavily when sleeping. We were scared that maybe there was a blockage or tumor growing back. We took her for a follow up appointment at A&M and they examined her and took radiographs. The doctors suspect that Nunya just has rhinitis flaring up. Rhinitis is basically an inflammation in the nasal passage that can cause the congestion and post nasal drip that she has been experiencing. They put her on antibiotics (Amoxicillin/Clavulanate) for two weeks to see if that improves her symptoms. Hopefully this will take care of her breathing issues and all will go back to being well again. The vet suggested we do another CT scan in another three months, and we can do it even sooner if her breathing problems do not improve with the medication. The scans and blood work look good for now, so we are hoping we are just dealing with an inflammation or infection that will clear up soon.
6/15/2013 – We are still battling the congestion. Nunya seems to not mind so much and is at full activity. She has been taking an antibiotic for about four weeks now. The cancer side continues to produce blood snot and the non-cancer affected side is crusting up with snot. She has been a trooper while we have had to clean up her nose with tissues. She seems to have some difficulty breathing due to congestion at times. We give her an antihistamine to help, but that tends to make her sleepy. We will be calling the vet on Monday to see if they can recommend anything else to help with the congestion.
Previously a second page:
I felt it necessary to start a new page on our fight against Nunya’s nasal tumor because we have learned some bad news on 6/21/2013, that starts the final chapter of the story. Nunya’s tumor is back. The fight is over. There is nothing we can do to get rid of it. So unfortunately, the focus for me has shifted from a mind set of attack, attack, attack to let’s make sure Nunya is as spoiled as possible for her remaining 3-6 months.
Nunya’s runny nose had not cleared up, so Alison took her for a third visit to A&M where they did another CT scan of her nose and they identified a mass that almost fills the entire left side. They presented Alison with a chemotherapy option that could potentially slow the growth but will not stop it. Since there are little to no side effects from this shot of chemo, Alison went ahead and Nunya was juiced up in the back.
Nunya’s runny nose is a little bit different this time. More snot on the right and blood snot on the left.
The magic of tomotherapy only lasted 7 1/2 months for us but I would have to say I would do it again. She has had several perfect months and even now as the cancer is regrowing in her nose, she appears happy and in really good spirits.
I never lost touch with the reality that Nunya would die within a short period of time but for my own selfish reason, I imaged after tomotherapy, I would be one of the lucky pet owners whose dog passes naturally in the night while sleeping (does this even really happen). I thought maybe worst case we would get some organ failure or something else that would be a definitive sign that it was the correct time, but it looks like in the end, the crushing pain from the cancer will get her. I now have three months to prepare myself for making the call on Nunya’s life at the right time for her and not for me. In the end, it is really a small price to pay for her loyalty and companionship.
Nunya is nudging me now so I think it is time to start the spoiling at Petsmart.
Medicine – Nunya received a Chemo injection on 6/21/2013. According to the doctors there should be no side effect to this first round. It cost about $400. With the shot, we got an instruction sheet that basically told us to not touch her poop or throw up without gloves (ok – we will not disagree). Basically, for 48 hours, all fluids are not friendly to people or other animals. We suspended walk schedule during this period. She will need to have a blood test by the local vet in 2.5 weeks and then will go for the next chemotherapy shot, which does have some side effects (nausea / vomiting).
- Ondansetron 4 mg tablets – Anti-nausea – Give 1/2 tablet by mouth every 8 to 12 hours for nausea.
- Denamarin tablets (S-adenosylmethionine/silybin) – Liver supplement – Give 1 tablet by mouth one time a day on empty stomach.
- Ursodiol 250 mg tablets #15 – Liver supplement – Give 1/2 tablet by mouth every 24 hours until directed otherwise.
Dr. Grayton at Texas A&M – We just wanted to mention how wonderful she has been with answering questions and giving us straight answers.
Status – As of 6/25/2013 – I would rank Nunya at a 2 out of 10 on a scale where 0 represents Nunya at best non-cancer state and 10 being the days starting Tomotherapy where Nunya could not breath without huge effort and the tumor was the largest. The last time we saw Nunya jump from a 1 to a 10 in about 2 weeks. We are praying that is not the case.
We received the “Discharge Notes” from the last appointment – These notes have always been appreciated as you can get hit with a ton of information at once.
The plan for Nunya’s chemotherapy is to alternate between the two drugs which would administered once every 3 weeks for a total of 5-6 doses for each drug. This means a total of 10-12 treatments will be given to Nunya as part of this therapy protocol. It is estimated that each treatment will cost between $300 – $400.
We started Nunya’s chemotherapy protocol today with the drug carboplatin, which is a platinum-containing compound used in treating some cancers in animals as well as humans. Some possible side effects include:
1. Nausea and/or vomiting 3-5 days after treatment.
2. Low white blood cell count, possibly predisposing to infection.
Please call your veterinarian or the Veterinary Medical Teaching Hospital if you observe any of these signs.
Doxorubicin is the chemotherapy drug that Nunya will receive at her next appointment and is a drug in the antibiotic class used to treat some cancers in animals as well as humans. Some possible side effects include:
- Gastrointestinal upset, nausea, and/or vomiting, usually 3-5 days after the treatment.
- Damage to the leg if accidentally given outside the vein. This is prevented by carefully placing an IV catheter for drug administration.
- Hair loss in dogs with continuously growing hair (i.e. Poodles, Terriers and Old English Sheepdogs).
- Low white blood cell count, possibly predisposing to infection.
- Heart problems if more than 6 doses are administered.
Please call your veterinarian or the Veterinary Medical Teaching Hospital if you observe any of these signs.
The full document is 6 page – if you are interested or if it will help your situation, I will email a copy.
Nunya still seems very happy and alert. She is sitting at the same place status wise as last week. She now has blood coming from both sides of her nose which I cannot imagine is a good thing but she doesn’t seem phased. We need to ‘clean’ her nose at least once a day due to the crusting up of the sneezes. Gross but she breathes a lot better.
Ali and I are very thankful that we had a wonderful 4th of July with Nunya at Alison’s family farm. Nunya was thrilled to be out running around and she was happy to chase anything that moved. She still had her normal amount of sneezing but it did not seem to get in her way. This coming week, we have to go for a ‘pre-chemo’ blood test. We had to get a ‘post-chemo’ blood test and everything looked normal (except her higher than normal liver values – which have stayed consistent throughout the treatments). Ali and I are a little nervous about this round of chemo (Doxorubicin mentioned above) as the side effects can be a lot more envolved. I think we have mentally committed to this treatment but we will have to re-evaluate post treatment.
Yesterday and today have been a little rough. We think Nunya stepped on a splinter during farm day that caused an infection in her back paw. We didn’t notice until her foot was pretty swollen. Ali took her to the doggy ER (because of course it is Saturday night) and they lanced and drained the paw. The stress from the procedure increased her blood pressure and her nose started bleeding a lot from the cancer side. They put her on an antibiotic and they told us to watch if the swelling returns. The doctor also mentioned that the swelling could also be a sign of the cancer spreading but by the end of the visit he was pretty sure he saw a splinter. Nunya had to go back into the ‘beach ring of shame’. Fast forward to today and now she is limping on her front paw too. So it looks like we are returning to the doctor tomorrow. Until then we are carrying her around and keeping her on the pain medicine. We don’t regret the Farm Day adventure as we know she had a great time, but it has turned out to be extremely complicated and expensive. See the Pics.
We are still being plagued by the splinter. We took Nunya to her regular Vet this morning and they gave us some new stuff to soak her foot in and they recommended that we up the dose of tramadol we give her. We are not fans of having to dope her up because it really takes the day away from her (she will sleep 8 hrs straight) and it seems unfair if it is not really needed but I think today is an exception. The nose bleeding has reduce back to its normal level. Thursday she goes for her next chemo treatment at Texas A&M.
Today was a bad day. There is no way for me to tell the story without Ali and I coming off completely crazy. As I am thinking about it now, after 90% of the clean up is done and Nunya is sleeping in a Tramadol induced nap, I can’t help thinking WTF am I doing and where do I go from here.
The day started normally, Nunya bounced between my office and Alison’s. All was well until it was around ‘frinner time’ (what we call first dinner – Nunya’s food gets divided into three portions breakfast, ‘frinner’ at 5:15ish and dinner at 8:30ish).
That is when the 3-hour nosebleed started and we had our 3rd trip of the week to the vet (it’s Tuesday). This nosebleed was unlike what we had seen since starting treatment. It started at the caliber of the ‘my dog sneezed cancer on me night’ and proceeded to get 10 times worse. Nothing we were doing would make it stop. All medicines were ineffective. One clot would form and it would be blown out seconds later. When I would try to wipe away the blood I could feel it pulsing out with her heartbeat. All we could do was pet her, look her in the eyes and tell her that she was a good girl in hopes that she would calm down. She didn’t seem to be in pain, but the volume of blood on her, the floor, the walls and us, was definitely upsetting her.
For some reason all of this happened in the hallway, which only helped to make the blood splatter more dramatic.
Ali made a quick call to the Vet and we were able to get in to see her normal Doctor (amazing the care that they gave her and their willingness to stay late). It was at the vet that everything hit. Nunya is bleeding out of both sides of her nose now; granted 99% of the blood comes from the original cancer. Her breathing is starting to be forced out of her mouth due to blockage. With the drastic progression in the last two weeks, we realize that Nunya will not be with us this time next month. We were now discussing where we would have her put down. Yes, we still plan to take her to College Station on Thursday to see about the next round of chemo but I can’t help but think too much damage has already been done. I told myself from the beginning that I would not euthanize her for my convenience (or delay it for my convenience) but I honestly have no clue what I am doing.
The problem with the nosebleeds is it evidence of destruction but not of pain. She loved the car ride, even though she was bleeding all over me. I really hope we can look to the vets for some honest answers over the next two days (blood work tomorrow, chemo Thursday).
Two good days. For us the good days are much harder to write about than the bad. It feels that if we don’t wait to the last minute to write something, we will jinx ourselves. Since we are not really sure what happens next it can be anxious at times.
Couple of new developments:
- We have developed some nosebleed skills. Nunya mostly bleeds from one side. That side is almost completely blocked by the cancer so most of her ‘sneeze force’ comes from the movement of her head (she leans her head back then quickly rushes it forward all the way to the floor). If we quickly put our hand under her chin, she does not do this. It also keeps her from leaning forward. No force is require – just the back of your hand touching her chin. Combine the no thrashing with the 10% epinephrine and we have a magical combination that normally will form a clot. We haven’t had to perform the trick individually yet so that will be the true test.Sounds like I am stating the obvious – but Nunya picks up on our mood related to the nosebleed. We try to keep it calm and reward her after the bleeding stops.
- We received some more answers that, I think, will help us in our decision-making. Nunya received a stronger chemo injection, Doxorubicin, which we believe is the best shot at either reducing the tumor or keeping it at bay. Dr. Grayton (again we must mention how much we appreciate her time) pretty much spelled out that if the cancer does not react to this treatment in the next week, we know we are at an end with the treatment and we can expect the continued rate of growth. The cancer will spread, Nunya will switch to mouth breathing and we will look for signs of loss of appetite, weight loss, change in mood, and change in energy. When that happens, it will be time. If Nunya does see some relief in the next week, that also gives us a plan. We continue on the treatment – watch the side effects from the next dose and re-evaluate then. Both endings are pretty much the same but for some reason it feels like the ‘plan’ provides us with more clarity.Beyond the chemotherapy, Nunya was given prednisolone to see if that will help reduce inflammation in her nasal area. She has also been prescribed more antibiotics in hopes of keeping the congestion down. We are kind of at a trial and error stage, seeing what she will respond to best.
Tomorrow is a big day for Nunya. We head back to Texas A&M to receive her second “strong” chemo injection of Doxorubicin. The results over the last two weeks have been mixed. She has been in a great mood, happy to eat her food, happy to chew on any project we give her, and very excited to go on her nightly walk. We have had an increasing amount of congestion from the non-cancer side. It seems to be a mix of 95% snot and 5% blood. The snot is very thick and hard for her to clear so for the last 24-48hrs she has been half breathing out of her mouth (it is very possible that the cancer is also now causing blockage on this side).
We do expect to see side effects with this next dose – which is a big worry.
Nunya had another chemotherapy injection today. Before the appointment we met with the oncology doctors and discussed her progress and treatment options. We had been concerned about the increased wet congestion and breathing difficulty she has been having the past few days. The doctors gave us the option of doing another Doxorubicin injection or trying the Palladia chemotherapy pill. They had previously not wanted to go with the Palladia due to Nunya’s liver levels being elevated. There is a chance though that she will respond well to it and have positive medical benefits, so it might be an option to try if the injections are not helping.
We decided to do another Doxorubicin injection at this time, as last time Nunya tolerated it well. We want to give it another good try and see if it is helping with the tumor. It is hard to tell if her increased congestion was due to the cancer progressing quickly or if it was just the Doxorubicin effects wearing down. We decided trying the chemo injection again this time will help to figure out if it is doing a good job helping the tumor or if it is more ineffective. We go back again in two weeks for another consultation and treatment. We will decide at that time whether to try the Palladia or stick with what we are doing now.
Nunya’s medications were also changed up a bit to see if we can get control of the inflammation and congestion. Her dosage of Prednisolone was increased for the inflammation. We also discussed congestion relief and are going to try Guaifenesin (Mucinex non-combo) and Ceterizine (Zyrtec). We will mostly need to experiment with the two and see if we get good results with one or the other. Side effects should be minimal, mainly drowsiness and increased thirst and urination.
The appointment overall went well and Nunya seemed fine after getting the injection. She got home and immediately ate a lot of food. She didn’t seem to be in any pain. She took a nap on the couch and slept well minus some congested breathing problems.
We are one week post-second chemotherapy injection. We have not seen improvements like we had hoped. Nunya’s breathing is still getting worse. She makes a constant gurgling/snoring sound when breathing. Sleeping is very hard for her as she constantly wakes herself up. Sometimes she will try to breathe out of her mouth, but she tends to pant more instead of learning how to slow mouth breathe yet. We have also noticed a decreased amount of the congestion crust in her nose and increase in reverse sneezing. While maybe this is good, we actually fear it is not so good and that the tumor is starting to block most of the nasal passage so that even snot is not getting out. We will have to see what the vets think at her next appointment.
The good news is that Nunya still seems happy minus the breathing trouble. She enjoys working on her dog chewy projects, and will sit outside and sun herself. We are still able to go on nightly walks too. Nunya had another blood test done yesterday and the results came back as good.
We are having a really hard time transitioning from nose breathing (about 99% blocked by cancer now) to mouth breathing. Anyone have any suggestions? When we go for car rides or walks she naturally switches and doesn’t get the ‘panic’ pant.
We are entering the final chapter of the experience with Nunya’s nasal tumor. Nunya and Alison met with the staff at Texas A&M in an emergency appointment due to her labored breathing. Nunya was unable to get any sleep at all last night, and it was obvious she was uncomfortable. Two options were presented, the first being another round of radiation/tomotherapy that would consist of 10 sessions for $3-4,000 that should open up her breathing. We were warned that she has already received a lifetime time dosage of radiation and that most likely the burns would be severe and she could have massive destruction of the remaining structure in her nose. Option two is pain management with Tramadol until plans were in place to put her to sleep.
At the end of option one, we would most likely see the regrowth of the tumor at the same rate. So, while Alison and I have always believed that we would do anything to extend her life, we feel this treatment option is not prolonging her life in a positive fashion. After experiencing the burns after the first course of tomotherapy, we feel that having severe radiation burns does not seem to be worth the extra week and a half to two weeks. It has been made clear that the 10 day treatment is not a cure. Having her undergo anesthesia everyday for ten days was also an increased risk due to her breathing problems. The best case scenario would be improved breathing, reduced tumor, and a couple of extra months of life, at the same time still having the physical side effects from radiation. The potential benefits just do not seem worth the risk or the pain she would have to go through.
So here we are a few hours later, after trying to get her to sleep with tramadol and only having luck if we physically hold her mouth open. We have scheduled her euthanasia for tomorrow around 12pm. We have less than 24hrs. This is a hard reality to accept, but after seeing her discomfort and breathing difficulties over the past couple of days we know that there are no more good options. We are going to do our best to spoil her and love on her in the time we have remaining. It is hard for us, but we believe is the right thing to do by her.
We would like to thank everyone for the supportive messages and condolences we have received after Nunya’s passing. It really means a lot to us to see the impact Nunya’s story had. We miss her very much and it has been hard adjusting to not having her around. We logically know we made the right decision that the end had come for her, but emotionally it is easy to second guess ourselves.
We will be writing a final update in the near future that describes in detail Nunya’s final days, the symptoms she experienced that made us realize the end was here, and even the details of her passing. Right now though the feelings are still too fresh and we want to be able to objectively write down our own experience, so we will take some time to gather our thoughts. We want this blog to continue to be as informative as possible for others facing unfortunate similar situations.
Nunya received her last chemotherapy injection, Doxorubicin, on 7/25. We already knew at that point that her breathing was not getting better, indicating to us that the tumor was continuing to grow and not reduce in size as hoped. The plan was to do the Doxorubicin again since it is a stronger chemo treatment, and she tolerated it well previously. If there were no signs of improvement, then we were going to try the chemo pill Palladia to see if that got better results.
One week after the Doxorubicin injection Nunya’s breathing was still not improving; but instead was getting worse. We could tell she was having trouble sleeping, as her snoring would constantly wake up her and us up throughout the night. She would sometimes breath out of her mouth, but the mouth breathing was more of a rapid panting. She wouldn’t breathe out of her mouth very long – it was more like a panic reaction to not getting enough air. We also noticed that there was less crusty snot on the outside of her nose. We took this as a bad sign, as we thought it meant that less was able to pass to the outside of her nose. The good part though was that Nunya still seemed happy and not in pain. Her appetite was good, and she still was able to enjoy going on walks and working on rawhide bones. We still planned on going through with the next chemotherapy round to see if we couldn’t get some improvement.
On Saturday, 8/3, we noticed a sharp downturn in Nunya’s comfort level. Daytime was not so bad, as she would be distracted with her chewy projects and following us around. That night was miserable for her though. Nunya seemed barely able to breathe out of her nose at all. If she put her head down, it seemed like air would get completely blocked and nose breathing could not happen. Sleep pretty much was impossible for her. Any time she attempted to put her head down, she would almost immediately have to jerk it back up in order to get any air. Sometimes she would switch over to a rapid panting out of her mouth. After doing this for a little while you could tell her mouth was starting to get dried out. She did not get any sleep at all Sunday night. We tried giving her Tramadol to help with sleep. It normally knocks her out, but this time even a 50MG pill did not get her to sleep.
Alison called A&M first thing Monday morning and was able to take Nunya in to the office for an emergency visit. We knew that Nunya’s health was rapidly declining, so we asked if there were any last-ditch things we could try to bring her some immediate relief. We knew that another round of chemotherapy was not going to be helpful, as that could take days for even a slight improvement, if possible, to happen. It was apparent Nunya did not have days left at the current rate.
An option to do another round of radiation treatment was presented. She could do ten rounds of daily radiation, similar to her treatment before. Cost would be approximately $3000, plus another CT scan. The positive side of doing radiation was that it could bring her quick relief and a reduction of the tumor. The negatives were that radiation side effects could be more pronounced the second time around, including skin burns and the possibility of holes developing in the roof of the mouth. Another concern was the risk of anesthesia complications was higher due to breathing difficulty. A final concern was that Nunya had already received a lifetime dose of radiation with her previous treatment, so receiving more radiation could be toxic. The radiation would bring results much quicker but it would still be several days to a week before shrinkage would occur. Here are the notes from the vet about the radiation option:
Nunya was brought in to see us for worsening clinical signs from her nasal carcinoma. Unfortunately, the only option we could offer that would provide some (potentially) fast relief would be another course of radiation therapy. Since she has already received radiation, we may not see as much response that we saw from her first round of therapy. There is also an increased risk of reaching toxic levels of radiation since Nunya has already had her maximum allowed dose. She may experience more side effects such as desquamation in the mouth (like a pizza burn to the roof of your mouth) and on top of the nose (like a sunburn to the skin), decreased appetite, weight loss and loose stool. More severe side effects that may occur are fistulas (holes) that communicate with either the oral cavity or the environment. These can form after radiation because the bone of her nasal sinuses has been compromised by the cancer and radiation. We are offering Nunya a palliative dose of radiation, meaning we will only be giving her lower doses over a shorter period of time (i.e. over 10 days), and we would need to perform another CT scan on Nunya to re-map her tumor in case it has spread. Another concern with giving radiation to Nunya would be the anesthetic risk that is involved with this therapy. We have excellent anesthesia staff that provide the best care possible for our patients, but since she has current respiratory issues, that does make her at an increased risk for complications.
We took Nunya home after the visit to discuss how we wanted to proceed. We talked it over but decided against doing the radiation treatment. While we wanted to do anything in our power to make her comfortable and give her the best shot, we were not sure that Nunya would be able to make 4-7 more days without sleep. Additionally for us, the potential negative effects of radiation outweighed the positive effects. Nunya could get improved breathing but at the likelihood of painful burns and nasal/mouth destruction. There was also the stress of putting her through another ten sessions of anesthesia and radiation, which was unpleasant for her last time. Given the fast return and the speed of growth of Nunya’s tumor, it could start growing back very quickly again since the second dose suggest was not to get rid of the tumor entirely but just open her airway enough for comfortable breathing. Weighing all these factors, we did not feel that the radiation option was right for her. There would be too much pain for the potential relief. We struggled with the decision, as we knew that radiation was our last hope of helping her. Without it we knew that Nunya did not have much time left. As painful as it was to process, we knew radiation was not the right course for her.
We watched Nunya all Monday afternoon and she continued to struggle with breathing. She had not had any sleep in over 24-36 hours at this point. She was clearly miserable. It was not going to get better for her either. We finally made the decision that we needed to schedule her for euthanasia. This choice was heart-wrenching. It felt like us giving up. We saw the signs that Nunya’s quality of life had become very poor and she was not enjoying the things she loved. Looking back, I remember all the caring advice we got about how to know when it is the right time and all those people were correct – you just know.
We decided that we would schedule the final appointment for Wednesday afternoon. We called our local vet to schedule it. In a previous visit about a month ago, we had asked our vet if she would be willing to come to our house to put Nunya down when the time came, and she said she would be willing to do that if able. When we made the call, our vet said that she was going out of town for a conference on Wednesday and would be out the rest of the week. She would be able to do it Tuesday (the very next day) though. Our vet was always wonderful with Nunya, and we knew that we wanted her to do it, and really wanted to do it at our house. We agreed that Tuesday was the day. It was kind of jarring for us to bump it up a day and realize that we had less than 24 hours left with Nunya.
We spent Nunya’s last day trying to do all her favorite things. We took her to the park to chase after ducks. We took her for a walk around the neighborhood, and went on an open-air Jeep ride. We gave her chew toys to work on, and even cooked her a steak for dinner. Nunya seemed to like the activities, but her energy was low and she got visibly tired quickly. Just a few days earlier she could walk around the neighborhood without a problem, however on the last day she was very obviously worn out just partway through. We stayed by her all day and made sure to give her lots of love and attention.
It turned out that scheduling the appointment for the next day was a good move. Nunya continued to barely be able to breathe throughout the day and night. She could not sleep at all. We would watch her put her head down and seemingly fall asleep while her head was leaning down, but then she would immediately be jolted up when she couldn’t get a breath. We tried opening her mouth and positioning her head in various ways to see if we could encourage mouth breathing but it just would not work. We could tell that Nunya was miserable.
By Tuesday morning Nunya had been awake for over 48 hours. She seemed very uncomfortable. We tried giving her food, but she was not interested in eating. She only half-heartedly ate half of a Milkbone treat, which was her favorite. She would not drink any water, even though her mouth seemed to be very dry. We had to coax her outside to try to use the bathroom. Quality of life was very obviously poor. We had to admit that in a small way it was a relief that her euthanasia appointment was scheduled for Tuesday instead of the next day. She would have been absolutely miserable waiting any longer, and we even suspect that she might not have survived a whole lot longer on her own anyway. Logically we knew that it was time for her to go and that it was the right time to put her down. Emotionally though, it felt like I was punched in the face.
Our vet came to our house Tuesday around Noon. We had requested a house visit as Nunya never did like going to the vet office, especially after all the treatments and procedures she had to undergo in the past few months. We didn’t want her last moments to be scary and stressful, and knew that staying at home would be the most comfortable for her. We were so grateful to our vet, Dr. Brannon, for agreeing to do an in-home appointment.
The vet came along with a vet tech assistant. They were very professional and prepared. They asked for an elevated surface to put Nunya on, which turned out to be our coffee table. We had planned on letting her stay in her doggie bed on the floor, but that turned out to not be the easiest way to work with her. The vet had brought a thick blanket for Nunya to sit on, so she was comfortable. We sat right by her and made sure Nunya could see us and we stroked her head to reassure her. They started by shaving a small portion of her front left leg so that they could insert a direct line into her vein that would be used to administer the drugs. At this point, I had to sign the mandatory paperwork sealing her fate (yet another punch). Nunya was first given a sedative that made her go to sleep. This milky white drug worked very quickly. We were actually not prepared by how fast it worked. Nunya was sitting there and just quickly relaxed all over and her eyes rolled back. She looked like she fell asleep, then got very still. Very quickly after the sedative kicked in, the vet administered the drugs that actually caused the death. The actual moment of death was not apparent, as Nunya did not really move once the sedative was given. The vet listened to her heartbeat for a few minutes (must have been under five minutes), then quietly let us know that it was over.
Her passing was peaceful and there did not seem to be any pain or discomfort associated with it, other than the needle prick for the injection site. For that, we were very grateful. It went as well as we could have hoped. Nunya did not seem to be scared, and stayed very calm the entire time.
We knew that we wanted to bury Nunya. Our vet came prepared with a cardboard box that she would fit in. They lined the box with plastic bags. After Nunya passed, she was wrapped in a towel and gently laid in the box. We put in a couple of her favorite chew toys with her and started the drive to the family farm and to bury Nunya next to other beloved family pets. I think most people will take this action as a little strange, but it is something I felt that we always needed to do.
It was very hard to lose Nunya. I thought I had prepared myself as best as possible for the event but the pain was nothing like what I imagined. With time, I know all wounds will heal. We wish we could have done more to help her in the end. I cannot fathom the loss of a spouse or a child (not that they should be compared).
For me, the strangest moments are the hardest. For example, if I accidently dropped food on the floor it was fair game for Nunya and I can’t help thinking about her each time I graze the ham in the refrigerator. There are smells and songs (Let Her Go – happened to be the last song on the playlist – probably could have planned that better) that bring her instantly into memory. I try to embrace that as a good thing and try to reflect on the amazing time we spent with her.
Two weeks later we still have not brought ourselves to remove her box, her beds and her bowl. There will come a time in the near future but are just not ready for it yet.
We have our moments where we feel guilt about our decision to put her down. Logically we know that the time was right and we made the right choice for her that prevented greater suffering. Emotionally it is tough though.
At this point, looking back we are glad we did what we did in treating Nunya. She was originally diagnosed with the cancer in September 2012, then passed away in August 2013. After her first round of radiation treatment, Nunya had about seven months cancer-free before the tumor came back. Once the tumor was back, it less than two months before she was gone. We are grateful for the extra nine months we got though. We both feel we would do it the same way given what we know now. We wish that her cancer would have stayed in remission longer, and in hindsight we wish there was a better way to monitor the tumor regrowth once it reappeared and to better determine what effects the different chemotherapy treatments were having. We tried to do our best by Nunya though, and did everything we could to make her as comfortable and have as good of a life as possible.