8 February 2011 -- Wow! Two Lunches !!

We had our blood and urine tests yesterday, still awaiting results from oncology as to how we're doing.

However, we talked to Dr. Tripp about pain control and she agreed he needed something more (without saying Greyhounds are wimps about pain ... she said Greyhounds are wimps about pain .. and I'm not saying a thing). We added Gabepentin (Neurontin) and it's had a big impact. We slept through the night and after a kind of so-so attitude at breakfast, all of the sudden, he was in line for lunch and then in line for lunch again. Whoopee!! (Hey, it's the small victories that make my day; you should have heard me after adding coconut to his food turned him from toothpaste to bouncy poo in less than a day ... egad, 'bouncy poo' ... I'm actually waxing on and on about poo!!)

All in all, he seems much happier and calmer with the addition of this drug. We're keeping an eye on the Fentanyl patch as it will 'wear out' in the next day or so. He's still taking about 150mg Tramadol, so we haven't crossed the Rubicon quite yet. I'm planning on replacing the Fentanyl patch when it stops working. The problem is, due to differing metabolism in dogs, they don't know when that will be. It could be three days, it could be five days ... it could be they don't want to share that information as a panicked owner with a dog in pain in the middle of the night puts $300 in the till (tsk, tsk, that was a nasty, cynical shot).

We have an appointment Friday to take out the stitches. The wound is closing beautifully and as of this AM (8 days post-operative) his bruises are all but gone. He did have some negative skin reactions to everywhere the tape has been, but I've been staying after all those areas with baby wipes.

He has scraped himself a few times going up the stairs (we have a ramp to go down, but he REFUSES to go up it!) and he's almost fallen a couple times, the trick is trying to get him not to try too much, too fast.

Along those lines ... our BIG accomplishment yesterday was lifting our leg to pee -- it may have been a little shaky, it may not have been the most graceful thing I've ever seen, but he managed it -- out there on two pins, just like Mommy !

6 February 2011 -- Back to Zen Dog

He's much better this AM after a rocky 48 hours or so. The new Fentanyl patch has kicked in and he's much more comfortable. The problem is that his appetite is fairly depressed. He did eat a can of chicken this morning, and some freeze dried lamb treats, but he's really not interested in eating. HOWEVER, good pain control is what we wanted and having achieved that we're HAPPY campers!!

Also gave him a Pepcid which may have helped settle him as well as he's prone to upset tummy anyway. Our pee and poo are a little down as well, but hey, nothing in the front means far less out the back (that's all technical talk by the way, send the kiddies to their rooms!).

He's still eating the K9 Immunity, seems to like a the taste a lot. He's figured out that peanut butter may hide "mysterious nasty tasting little white things" so we've had to resort to pill pockets to get our pills down. We have an appointment with the oncologist tomorrow so hopefully we'll find out exactly where we are. To have an amputation and chemo the same week -- amazing he's made it with so few problems. We slept about five hours last night, which is a record for the last two weeks. And a mommy with more sleep is a lot more patient!

4 February 2011 -- Primum non nocere

I hope this picture doesn’t freak any of you out, but I can’t get over how beautifully he is healing – he’s going to have an “S” shaped scar, for “Superdog”, I am quite certain. His healing has been amazing in terms of the surgical site.

There have been a few other potholes in the road, however.

First and more importantly, Razzle is doing very well. That isn’t do say we haven’t had a few problems the last 36 hours. As the Fentanyl patch wore off? Down? Razzle became more restless, unable to be comfortable. I called last night (Thursday) and asked if we could increase his dose of Tramadol, as I felt he was having trouble managing his pain. We gave him an additional 25mg (he’s taking 100mg as the baseline dose) and that seemed to help and he slept mostly through the night with only a couple interruptions. But he was still clearly unhappy this morning and his temperature was fluctuating wildly. So, we flew off to see his surgeon, who looked him over and decided the drain to the amputation site and the rest of the patches and covers and bandages could come out and off. He was instantly relieved to have all that out and off and gone. A happy naked dog left the clinic.

He was fairly stable during the day, but clearly still not comfortable all the time. We’ve been eating well (cooking his Darwin’s with a couple eggs and some spinach or broccoli seems to be going happily gobbled down with peanut butter globs concealing drugs) and having really spectacular pees and poos (even bouncy poo thanks to adding coconut to every meal).

This evening, though while monitoring his temperature, it was up over 102.8, so we flew back to the vet. His muscles were tense, he was panting more and more heavily and he was in a lot of distress. Leaping to the most disastrous conclusion because that’s always such a productive habit (NOT), I was sure he was developing an infection from the Cisplantin therapy. Well, that what happens when you practice medicine without a license, you don’t have a clue what you’re talking about. Very nice vet, Alison R. at Animal Medical Center was quick to see he was in pain and our problem was the loss of the Fentanyl patch and he needed DRUGS! She gave him a shot, added codeine to his protocol and replaced his patch (HURRAH said Razzle). That was about an hour ago and he is sprawled on his bed zonked out of his mind and in dreamy happy vapor trail druggy land.

So, I learned a lot today. Hopefully, we can manage his pain more effectively going forward and I am going to be more proactive with ensuring his pain is managed before we worry about anything else.

Razzle has had lots of wonderful visitors the last few days, but has he goes into his “possible infection” phase from day 5 to day 10 of his chemotherapy, so the visitors will be cut down and we’ll try to keep his as quiet and germ free as we can.

I was thinking about pain tonight. Neither the ancient nor modern versions of the Hippocratic oath promises to “do no harm”. That's not surprising really. It is a standard that is impossible. For one thing, it could freeze a physician into not acting at all, as any action might cause possible harm and therefore to act could be to harm. Yet neither does either version of the Oath provide a requirement for the practitioner to “alleviate pain”. Yet, this is why the vast majority of us seek medical care of any kind. There are many admonitions in both versions of the oath, but they still fall short of the mark of what I think we expect or want from healing. The physicians best effort, to end suffering where they find it, to educate and to put the wants of the patient on an equal footing with the needs of the patient, might be a rational start.

While I may find how Razzle has faced his pain courageous, even inspiring, it is, at the core of it an experience neither he, nor any creature with access to modern medical care should ever have to endure. To be ill is stressful and frightening enough, pain is an additional torture that should never be added to it. He was not in acute distress and we were quickly able to resolve the dosage problems we had fallen into; but we all failed him in not being more constantly alert to this most paramount of needs – has his pain been alleviated?

Something well worth remembering, especially when we are talking about the inflicting of non-physical pain. There is neither a rational reason, nor, in the end, any excuse for inflicting pain of any kind, be it emotional, spiritual or physical. Those who find such actions entertaining, or amusing, or a part of their character for any reason should realize there is enough pain in the world without conjuring more; create and let loose that monster and it will destroy you.

2 February 2011 -- Our First "Meal"

Just had a soft egg with lots of butter and three Etta treats (liver) mixed in. We had our first MEAL!!! HUZZAH! He's been eating the Etta treats and the K9 Immunity Plus (you'd think he wouldn't want anything that was good for him, would you, but he also ate a Pet Tab!). He had not been interested at all in food, except for about 5 tablespoons of peanut butter during the night, the Etta treats and the K9 Immunity Plus. So, this egg is a BIG victory (one does not live by peanut butter alone -- well, most people don't).

We took a trip outside again (the Cisplatin treatment really has diuretic aftershock, he's not going as much as they said, which was every 2 hours, but he needs to go every 3 1/2) He just went right down the ramp (thanks Mikey and Brad) and out the down stairs (4) like a pro! Could NOT be more impressed.

Was concerned between 0300 and 0630 this AM that he was having trouble with the Fentanyl patch. I found that if I held him and massaged the muscles of his foreleg and head that he calmed down and wouldn't enter the crying out phase of the reaction. Since they tell me that it's like having a hangover, the only thing I could think to do was massage -- after all, what do you want when you have a hangover? Dark, quiet, understanding and a good massage to ease that headache (his muscles were in knots).