Posted by: Adrianna | July 8, 2010

Doxorubicin today!

So Elliott’s CBC was pretty good; he was mildly anemic but not too bad, so he was cleared for the doxorubicin. He had a chemistry, too, which fortunately showed a tiny improvement in liver values and unfortunately showed a spike in BUN.  His last test showed a mildly elevated BUN (in the low 40s) which was ok because he is on a super high protein diet.  Today’s was 60, and as his creatinine is normal the oncologist is worried that he has bleeding in his GI tract.  This can be caused by pred and the chemo agents (which can all cause cell death in the GI tract) probably aren’t helping.  So she wants him on an acid-reducer (at least Pepcid, omeprazole is even better).  We are decreasing his pred every week so that should help too.

I’m not too stressed out about it because he is feeling pretty great KNOCK WOOD and the lack of physical evidence (no tarry black stool) somehow makes me feel better.  Of course, that doesn’t mean anything, he could still be bleeding, but I’m just trying not to get bent out of shape about it.

One reason I was a little worried about his chemo administration today because they needed to put an IV catheter in rather than just give an injection. (This is because doxorubicin causes horrific skin and muscle injury when it goes outside the vein.  Don’t google for photos, seriously.)  He has been good for the injections, but IV placement is more involved and he has panicked in the past.  He truly does panic–he doesn’t show any aggression, he just tries frantically to get away and he’s big enough to trample people (and hurt himself) in the process.

But he did great.  I have to say I am very, very lucky to be working with this onco team, because they have been terrific in terms of using positive methods of behavior modification.  It’s unusual, unfortunately, for vets to take the time to do this (and many don’t have even the most basic knowledge of behavior mod principles) but this team does.  They make him a big fluffy bed on the floor (major points to any vet that doesn’t make a big dog lie on a table) to start with.   One person is dedicated to rewarding Elliott with single pieces of kibble for lying still during the venipuncture and throughout the chemo administration, one person barely-and-gently holds his rear leg, and the third does the venipuncture and runs the drug.  The past two times, after they were done he just stretched out and slept a bit.   Now I love Elliott, but he is the high-strung-when-not-at-home-with-mum type so this is a real feat.

There are, of course, a few things going in E’s favor.  One is that he has been reward-trained for all of our lives together.  This means that he already knows the deal–if he wants something, he can earn it, and he just needs to figure out how.  He quickly learned that lying quiet and still earned him the kibble so he does it.  He is also food-motivated because of the steroids, and many animals (esp ones coming to our hospital, who are usually sick) just aren’t.   (I will still argue there are ways to create a more positive experience for the animal and that a lot of vets don’t do this, unfortunately.) Regarding the food motivation, I’m hopeful that after a bunch of good experiences, he will be more relaxed and be much easier to handle, food or no food.

One last thing.  I noticed that Elliott has become pretty heat-intolerant and actively seeks the cold.  It was very hot here this week, of course, but it cooled off a bit last night so I opened the window and turned off the AC just to get some fresh air.  It was probably 78-80 degrees and breezy.  He wouldn’t stop panting, though, so I finally turned the AC back on (set to 76) and he laid in front of it most of the night.  Tonight, too, I’ve left it on for him and he’s lying in front of it snoozing.  He was always pretty good with the heat–we never had AC before this year, actually–but apparently not anymore. Go figure.

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