Damned if you do, damned if you don't

Veterinarians see a lot of mast cell tumors. Mast cells are full of histamine, the stuff that causes allergic reactions (in small doses) and anaphylactic shock (in large doses). A lot of dogs will get solitary mast cell tumors, and these usually are low grade - unlikely to metastasize and cause problems - and are cured with surgical excision.

Sometimes cats will get multiple mast cell tumors in their skin. There are usually too many to even think about cutting them all out. There is also very little published in the medical literature about treating them.

As luck would have it, I had 2 cats with multiple cutaneous mast cell tumors at the same time. We tried controlling them with cortisone (dexamethasone) but the tumors were growing and were itchy. One orange cat had lumps and bumps all over his head - he looked like he had leprosy. It was time to try chemo.

My boss does a lot of chemotherapy, and after talking to several veterinary oncologists, the consensus was to try CEENU orally followed 2 weeks laterby vinblastine injections.

The orange kitty got his first pill, administered by me in the hospital. The next week he had lots of mast cell symptoms - vomiting, itching - and the tumors continued to grow. The owner did not even see any palliative effect from the chemo pill, and after supportive care didn't help, elected euthanasia. It was a good decision, but I wondered if she would have had a better response if we'd been able to give her the vinblastine, too.

The black kitty got her first pill the day before the orange kitty, and came back last Thursday for vinblastine. We checked her liver and kidney function as well as her blood count; everything was fine so I gave the injection.

On Friday the owner called me and said her cat was a little lethargic and eating less. I assured her that was expected, but to verify that the kitty was indeed eating through the weekend.

On Sunday, the cat crashed and went to the emergency hospital. The doctor there told me she looked like "death warmed over." Her blood count was terrible - she was severely anemic and had NO white blood cells. The chemo can often suppress the bone marrow, and this was happening to her. Despite supportive care, the cat continued to decline and was later euthanized at the emergency hospital.

I feel terrible for this cat and her owner. I feel badly that I gave the injection that caused her ultimate death (although it was the drug and dose recommended by an oncologist). It is tough when we have a disease with no good options for treatment, and sometimes the chance for cure has terrible consequences.

Terrible Terrific Twos

Two year olds are notorious for being a raw collection of emotional impulses, and lately Colin has fit that bill too well. When he wakes up he immediately starts demanding TV (which we limit to 1 hour/day). When I decline he starts his howler monkey impersonation. And so it goes, all day.

But, he is one handsome devil and says some charming things, and that totally redeems him. Like after the crying he comes up to me and says, "I got snot!" Usually he brings a tissue with him.

He'll bring me his toy trainT (I don't know why but he says it with a T at the end) and asks me to figsk it (fix it). I say, "Watch, Colin," while I put it back together, and he says, "That's amazing!"

One night I sang his lullabye then kissed him, saying, "I love you so much!"

"Why?" he said.

"Because you are so cute and you are my baby," I told him.

"No, I a BOY."

I said, "Well, you're my baby boy."

"No, I a TINY boy."



In other updates, potty training is progressing well, and Montana has been almost normal for the past 2 weeks.

Broken Arch

Colin jumped up and down for more emphasis, "I wanna watch Lil Einsteins AGAIN!" Unfortunately, on the last syllable, his little foot came down on on of the toy metal airplanes that belonged to his dad as a kid. Colin had just put them down on the floor, and the miniature metal tail went into his arch. He cried in pain and broke my heart, although I was glad for once it was not my fault (too often it seems I accidentally close little fingers in drawers, etc, and it kills me!).

The cut wasn't too deep, and his tears were soothed quickly by the prospect of a Dora Bandaid (he asks for them 20 times a day and I say, "No, that doesn't need a bandaid." This time, I was offering it without being asked).

Now when he walks, he mostly holds the heel of the hurt foot up. He looks like an imitation of the Greek statue doing Discus, or if he's excited and jumping up and down, like a toy poodle up on its back legs!

Happy Day

When I was in vet school, I went to lots of weddings. All my peers were in their 20's, and they were all getting married. At my summer job, they called me the "Wedding Queen," because I was always asking off to go to a wedding. I became a wedding connoisseur; when I returned to work I would give my critique of the music, bride and bridesmaids' dresses, music, food, and cake. Back then, I liked my weddings a little grand but tasteful.

The wedding we attended last weekend was one of the best I've ever been to. It was not grand in scale but it was in sincerety. There were two people who waited a long time to get married (so long they each thought they might never tie the knot!), then had exactly the kind of wedding that suited them - keeping the traditions they liked, but tossing those that didn't fit them (like a forced first dance together, which neither would have been comfortable doing).

A good wedding reminds you of the promise of love, the camraderie of a life spent together, and of the joy of a well-matched companion. It makes you forget the strife of a silly argument you may have had with your own mate recently, and makes you want to hold their hand. It makes you glad you got to share this special moment with the newlyweds.


Giddy after the ceremony.

Part of what made this wedding so great was how effortlessly it came together. Of course, like many weddings I've been to, it could've become a big ball of stress if they had let it. It was held at a great B&B in the Hill Country, very remote and rustic. There was great music provided by a singer and his accoustic guitar. The bride looked beautiful in her elegant dress with roses in her hair - you'd never guess that when she showed up that morning to the hair salon (that she'd booked weeks before) there was a little note taped to the door that said, "Sharon has the flu and won't be coming in today." Instead of panicking she and her mom just went to another salon in town and found someone else to fix her hair -- and it looked fantastic.

We were also so honored that other than immediate family, the photographer, and the guitarist, we were the only other guests. And the food was great!


Best wishes, D. and D.

Our New Baby

There she is, in beautiful blue stone metallic, our first new car! We have waited a long time for this one. Its a Toyota Highlander Hybrid. Anthony has been negotiating for it since November, and he got us a great deal for a hybrid. Anna was quite enthusiastic when she first sat in it, "It smells so good! And the seats are so soft! I like the bright open windows!"

Yes, well we like the gas mileage and the low emissions. And it has so many cool features! Storage everywhere, side airbags, and an optional fold-up 3rd row of seats. And it can GO!


With the electric motor and gas engine, if you step on the accelerator, it pushes you back in your seats and speeds up! Zero to sixty in 7.2 seconds. Incredible power - when you need it. There is a little graphic in the dash that shows you where the power is going while you drive - arrows pointing from the engine and the battery when you accelerate, or just from the battery if you are just moseying along. Then the arrows show power going TO the battery when you brake or coast down a hill. It can transition among these from second to second.

So, even with all that get up and go, you tend to drive conservatively, round about the speed limit, coasting to that red light instead of speeding toward it then braking. Even speed demon Anthony has said it has changed the way he drives!

Some argue that the extra expense for the hybrid option is not going to be worth the long pay-out time (if you compare how much money in gas you'd save, it takes a couple of years to pay for itself). But we reckon gas is soon going to be over $3 a gallon. It doesn't matter to us, anyway, about how long it will take to make back our investment - we intend to have this car for a decade, and we like feeling like we are making a responsible choice for the environment, leaving a smaller "footprint."


Hybrid!

Thanks, everyone, for your kind comments about Montana-banana. Please know that she had a good day today, practically normal.

What we've been dealing with

The hybrid is here! We picked up our new car on Saturday. It will get its own post.

I also need to post about the lovely intimate wedding we went to Saturday night, with pictures.

But mostly, my brain is occupied with Montana. She is losing her mind, it seems, literally, as it is being pushed out by the tumor. She had been doing great since Christmas, then last Tuesday had 6 grand mal seizures in about 36 hours. Since then, she's had many petit mal seizures - not the full body tonic-clonic fits, but little tiny ones. Her face will twitch, and its like watching lightning pass over a stormy sky. She's always been clumsy, but now she stumbles when she's standing still, just looking at you.

She's acting out, too. I was always so proud of the way I could leave her with a quiet word in the office at work with the door open, and she was so good and obedient. When she has petit mal seizures, she wanders through the clinic. If I shut the office door, she'd howl. If we tethered her, she chewed through the leash. She chewed up a textbook at work, and when left in my van, chewed up some sunglasses, my phone charger, and even part of the dash. This is the car we are about to sell, but how can you be mad at her? Its so frustrating, I don't even know who to be mad at. She was never destructive, not even as a puppy.

Other times she's OK, and she'll finally rest. Then at night we hear her toenails as she pace, pace, paces. She's always loved her kennel, but now when we leave her in it, she pushes against the door, trying to escape, and we come home to a dog with a huge raw area on top of her nose. Its killing me, these sick reminders of her mortality. I foolishly hope this behavior will soon pass, and we'll get some more quality time.

I promise I'll write some happier posts soon.

A Rat's Tale, with a little bit of a preachy ending

My friend Enricka loves rodents, especially rats. I know what most of you are thinking: vile pestilent creatures with disgusting long naked tails. But, rats are actually quite intelligent and very social, forming groups with each other and with humans. (Enricka tried to convince Anna to get a rat, but she had her heart set on a hamster.)

Enricka loves her rats and gives them excellent lives for the short time they are with her. That's the problem with rodents: they only live about 2.5-3 years before breaking your heart (dying, usually from cancer).

Lucretius (center rat in above picture, white) has acutely developed diabetes. Enricka had noticed that he'd been losing weight and drinking a lot -classic symtoms- when she found glucose and ketones in his urine. Glucose is there because there are such high amounts in the blood it spills over in the kidneys into the urine. The ketones were a more ominous sign. Without insulin to get glucose into the cells to power them, the body starts to catabolize proteins. The byproduct of this is ketones, which also means the patient is also likely getting acidotic (very sick).

Enricka was ready to give her rat insulin, but how much do you give a 50 gram rat? She found a published dose of 1 unit, but that sounded like a lot to me, since we routinely give 10 lb/5kg cats 2 units. "Give him 1/4 unit," I told her, "Hypoglycemia would kill him a lot faster than hyperglycemia." If blood sugar gets too low (hypoglycemia) you get seizures, organ failure, death. She gave the little dose, but he was still listless.

Later that night, Lucretius was worse, so she started researching the web. Enricka is a real scientist, so she was researching scientific journals, not just anecdotal websites. She found out there was a paper about diabetes in rats at the library at UT, so she had her boyfriend drop her off and circle around to wait for her (no parking). But the library was closed, so she went home and paid $50 with a credit card for the article.

The article said to give 7 units of insulin to rats. SEVEN UNITS! This is a ton! I'd never start off a dog or cat on SEVEN units. Enricka said as she gave the injection her hands were shaking.

The next day, Lucretius started improving, eating again, and as you can see from the photo, playing with his brothers. Apparently because of the rats' body weight to surface area ratio, they need a much higher dose of insulin.

I know many people would not pay $50 to save a rat that could be replaced at the pet store for less than $10. But I've seen people pay thousands to save dogs and cats that they got for "free." Witness our dog Terlingua. The thing is, it doesn't matter what the species is, if you have a bond with an animal, that is real. It never ceases to amaze me how people will sit in judgement of someone spending big bucks on veterinary care, but no one judges someone who spends their disposable income on new golf gear, or at the Harley-Davidson store, or on a luxurious weekend getaway.

If you have a relationship with a domesticated animal, and that animal is dependent upon you for everything, and in return they provide companionship, affection, devotion, etc, you have a responsibility to provide good care for that creature. We should all be so lucky as to be looked after by a person as caring as Enricka. LONG LIVE LUCRETIUS!

Drought

I know I thought of at least 3 topics for a post today, but now that my kids are in bed, my mind feels as holey as the "circle cheese" (swiss) that Colin begs for. My brain is as parched for ideas as the land around here.

Its been days since we've had rain in Central Texas. There was a freeze about a month ago. After suffering through heat that lasted into October and November, I thought winter had finally arrived. However, it didn't last. The days are shorter, but not much colder. "All the leaves are brown, and the sky is grey..." All the vegetation is dead, and we get clouds but no precipitation.

The crisp dead grass makes ideal tinder for wildfires. We've had a lot in the state, some even in our small suburban town (though thankfully none near the house).

However, it might rain on everyone's MLK parade tomorrow. Anna will be home from school, and I'm hoping it will be day of indoor crafts and Uno. Everyone pray/do your rain dance for us.

Happy De-Lurking Week

Apparently it is Delurking Week -- as in, if you are a frequent reader of a blog, but never post a comment, here's your arbitrary reason to post a comment and introduce yourself. I have many loyal commenters out there (you know who you are, and I love you for your consistent feedback), but I know others are out there. I see you on my blog statistics website, and it thrills me to see again and again places like Couer d'Alene, Reston VA, Pleasanton, Atlanta, and Weyerhauser (to name a few).

I would have loved to have had a reason like this to introduce myself at the last birthday party I took Colin to. It was his most favorite playmate from his Friday daycare place, so I really wanted to take him. I got there and realized that although there were tons of adults I knew NO ONE. Anthony always does the daycare drop off and pick up so I didn't even recognize any strangers. The hostess was nice but BUSY. I get a little shy in these situations. I smiled and made lots of eye contact, but everyone else seemed to already know someone and I really couldn't get into any conversations. Also, Colin kept needing more food or someone to go with him to play on the playscape (he's going through a shy stage himself). After a while I just started focusing more on him, anyway. Finally, 2 of the other moms from his daycare recognized him and introduced themselves, and I finally got some small talk action.

So here's your invitation to click the comment button, introduce yourself, and open the dialogue.


Delurk!

Mullet No More

Yesterday I combed Colin's hair before we went out. The mop was such a mess that Anthony asked me moments later, "Aren't you going to comb his hair?"

It was way overdue, but I finally cut it today when he asked to watch Dora. I tried not to think too hard about what I was doing as the blond curls fell.

In case you needed a reminder, here's the before (I was just back from a jog, thus the red face):


After:

Anthony likes the result. Anna said, "Wow, Colin, you really look like a boy!"


Heartbreaker.

Homemade Pedialyte

"Why is the stuff so expensive?" Anthony asked, after forking out over $5 for a liter of Pedialyte. I don't know, since really it basically is just sugary salty water.

The pediatrician who saw Colin on Tuesday said he was in that grey zone of dehydration, where he could go the the ER for a bolus of IV fluids, or we could just push the Pedialyte at home. "I know what I'd do," she said, and we agreed, not relishing the thought of arriving at the ER at 5 pm and waiting for them to stick a catheter in Colin's little arm.

Then I remembered that our usual pediatrician had a recipe for homemade electrolyte replacement solution in her book. I also knew a good source of KCl (potassium chloride) was Morton's Lite Salt -- and it costs only 88 cents!

We are truly in awe at how much diarrhea the gastrointestinal tract of one 2-year-old can produce. I don't want to gross the childless out too much, but suffice it to say that it sounds like a veritable FOUNTAIN when it hits the diaper. And when you open the diaper, that's what you get, a fountain. Our hands are chapped from washing and the washer/dryer is tired.

The homemade stuff worked: Colin drank it readily, and he is back to his perky self.

HOMEMADE ELECTROLYTE SOLUTION

4 cups water
1/2 tsp salt (or better, Morton's Lite Salt)
2 tbsp sugar
1/2 tsp flavored gelatin for flavor, optional

Colin likes his plain with a little juice -- delicioso!

Five Weird Things About Me

Its a meme, from the Library Lady.

1. I drink hot tea every morning. People think its coffee in that travel mug, because that's what Americans drink, but they're wrong. Its Yorkshire Gold. I pour the milk in first, because that's how my Auntie Olive told me the Queen drinks hers.

2. I have a stunted, shortened right index finger (just the tip). When I was 2 years old and staying with my grandmother while my parents were on a trip, I cut it on glass. My grandmother put a bandaid on it, tight as a tourniquet. I pitched a fit when she went to remove it, so she left it on, for days. When my mom returned a few days later, she immediately took it off, but it was already shriveled.

3. I kinda like doing puppy tails and dewclaws. Certain dog breeds have docked tails, so good breeders take them to the vet at a couple of days of age and we cut off their tails and extra toes. In my defense, I use local anesthesia so the puppies don't feel it. I also like pulling gross infected teeth, but you knew that.

4. When I shower, I lose a lot of hair. It all gets all tangled up in my fingers, and I don't want it to go down the drain and make a big clog. So, I wrap it around my finger into a little circle and toss it over the shower wall. This way its a lot easier to find and throw away than a bunch of loose hairs. Which reminds me, when I was 13 I started losing my hair (a side effect of a prolonged fever)and I had to count how many hairs I lost every day to see if it was normal (you normally lose about 100 hairs/day!).

5. The summer before vet school started, I had a job where I washed the dirt off of grass root samples, 8 am to 5 pm, Monday through Friday. It was for a research project measuring root production from different fertilizer levels. The best thing about this job was it was outside, under a shade tree, and I got to bring my dog to work every day. Also, it was mindless. At the end of the summer the other people who worked there told me they were cautioned never to talk to me about how sucky that job was, because the researcher was afraid I'd quit.


I hearby infect: Emily, Stephanie, Kareen, Angie, and Leigh-Ann. After posting your 5 weird things, leave a list of those that you infect.

Hopefully, you won't get infected with something severe like Rotavirus, which poor Colin has. We are having a hard time orally replacing the incredible amount of fluids he is losing, but so far, he's hanging in there. Poor guy has a red, sore bum, though, and it is torture for him for us to clean that sensitive, sore area everytime he had diarrhea, which is like 12 times a day (but of course would be so much worse if we left it on there).

Happy New Year's Eve

Cheers!

We had dinner on New Year's Eve at home with Anth's parents. Colin rallied a little, and actually ate some rice at the table with us. He saw us drinking wine with dinner, and asked for "Tocktail, too, please." I got him a little cordial glass and filled it with Pedialyte. He liked that, and asked for a refill about 20 times. Shortly after eating, he fell asleep on the couch.

Anna, however, was ready to PARTY, so we let her stay up and celebrated the New Year with the East Coast at 11 pm. While waiting for the countdown, she entertained us with long tales that she made up on the spot.

"This is my horse, Princess. I have to take care of her because her Mommy died."

Oh, what happenned to her?

"She had a tumor in her head, and she lived in the desert where there are no doctors, and she died. Her daddy died, too."

What happened to him?

"He had a tumor here, in his nose."

(I guess after having 2 dogs with cancer Anna thinks that's what kills animals. She's not far off - its the #1 cause of death in dogs).

After the morbid stories, we broke out the champagne. Anna served her guests some of her gingerbread cookies and snuffles (her mispronunciation of truffles - the chocolate kind).

Finally, it was time to count down the crystal ball on TV, just like Oma told her would happen:


Counting down the New Year!

Afterwards, she was so wound up it was hard to get her to bed, so I layed down with her. An hour later, Anthony woke me up and I stumbled to our bed.

Finally, some Christmas photos

On the road to El Paso


Wind Generators outside Ft. Stockton


Christmas Cookies


Singing with Grandad


Christmas Eve


Anna with her new Teddy Bear and Montana


With Auntie Emily


Giggling with Nana


Christmas Dinner