Reposted from this entry
. I have obviously been talking with her every day, but not very much here or on Facebook. I just don't really find myself able to talk about it much in those other settings. I don't know if that's because I'm dealing with it by not dealing with it, or what... but please focus here or Facebook and I'll repost what Mudge shares. Or better yet, you can follow her directly.
We finally got the diagnostic report from Ra's procedures last Monday, as you well know. Last we knew, from Dr. B. was Ra would be on the Chlorambucil (the chemo drug) once/daily for six weeks, then every 72 hours thereafter depending on his clinical response. Dr. B said he would call right away to get the drug ordered and to us so we could start treatment.
Go in on Friday for Ra's first B-12 shot. Ask about the Chlorambucil--he's not gotten ahold of any yet, nor has he ordered any, and will make more calls for it later in the day. Sigh. We really wanted Ra to start this treatment regimen ASAP in order to keep the pre-cancerous cells in check and not have them develop into CANCER! WTF?!!?!
At least, in the good news department, Dr. B gave us six weeks worth of pre-filled syringes of B-12 for Ra for us to administer at home rather than bring him in once a week and get him all riled up with a ride to the vet and a vet encounter (which he hates) when we can do it at home and avoid all that stress on him. It's administered sub-cutaneously, so it'll be easy for J to give to him every Friday...Dr. B even gave us a bit of a deal on the B-12 shots. :)
So I call the Dr. B early yesterday afternoon--Chlorambucil still not ordered, largely because Dr. B left the office early yesterday for a wake for the family member of one of his techs. What the everlasting fuck?!?! Decided we couldn't wait any longer, so I asked the tech to ask Dr. B (who was predictably swamped with Saturday morning patients) if we could at least order some of the med from VCA Aurora, if they had it. He said that would be fine, so we called VCA Aurora and, thank Bast, they had the med in stock. Thank Bast, and for many reasons...
VCA Aurora continues to impress. They didn't have anybody from the internal medicine department or the pharmacy in the clinic because it was the weekend, but Dr. Mac from ER heard what was going on and was willing to personally dispense us at least 6 pills to get us through about two weeks worth of treatment so that we could pick it up right away. Six pills for two weeks? Turns out Dr. B either misspoke or misunderstood the Tx instructions--Ra is to get the Chlorambucil every other day for six weeks, not every day! I read the Tx summary copy we got from Dr. B and yep--says EOD, which is every other day to my understanding...Sigh, now I'm worried about Dr. B's ability to treat Ra for Dr. M over at VCA Aurora! UGH!!
We were able to talk to Dr. Mac when we picked up the med to ask her some basic questions--when to dose, with or without food, potential side-effects to watch out for. She was WONDERFUL!! Turns out she's also an internal medicine doc in addition to being an ER doc, so she was able to give us all the information we needed! :) She explained she was only willing to dispense two weeks worth of the med because she wants us to closely monitor Ra for any negative side effects and didn't want us to pay for too much of the med in case he ends up unable to tolerate it and ends up needing to try another med. It's to be taken in the morning with his 5mg of prednisone, preferably with food, but since he's got a tendency to vomit his feeds if he's fed too soon after medication, we're to try giving him the two meds about an hour before we feed him in the AM.
Because he fights us with the potassium supplement in particular, Dr. Mac suggested we not give Ra that particular med on the mornings we give him the Chlorambucil so he'll be more apt to not fight the Chlorambucil pill on those mornings because it's so important for him to get that med in him with minimal fuss. She also suggested we try compounded liquid version of the potassium so Ra's not taking as many pills at once, to give him a break on so many pills. She initially suggested we try compounding it ourselves by crushing the pills and adding the crushed pills to chicken, tuna, or clam juice, but given that Ra's on a hypoallergenic diet that idea might not be the best one and that we should wait and talk again to internal medicine proper on Monday to order the liquid from the VCA pharmacy...
Side effects we can expect from the Chlorambucil are GI upset, immuno-compromise in the form of bone marrow suppression, lack of appetite, decrease in white and red blood cells. Standard stuff for chemo treatment. They'll build over time as his blood saturation of the drug increases. She emphasized the importance of the monthly CBCs to monitor these things.
I asked about Rx foods--he seems to like the W/D alright so far, but what if he starts to reject it? She said we'd have to work with Dr. M from internal medicine to make the decision, but there are a number of other high fiber/low fat Rx diets that could work for him if needs be. That was good to know, just in case.
We think it's taken Dr. B so long to get us any Chlorambucil because it's pretty pricey--the six pills we got from VCA cost $125! Holy Hannah!! I'm thinking it's a combination of the med not being terribly common and that Dr. B is trying to find us the best deal possible for the med as well--he's a cheap bastard and tries to pass the savings onto his clientele. That being said, getting us SOME of the med should've been a priority and that he thought it was a once/daily med vs. every other day is a bit disconcerting and concerning. I'm starting to think Ra's care should be taken over by Dr. Lehal and associates at Brookville Animal Hospital, which is much closer to home an they seem to have it together a bit better than Aurora Cat Clinic. It's something J and I will have to discuss, definitely. I know we both want Ra to get the best and most competent care possible. Not to say that Dr. B is incompetent in any way, it's just that he's made not made any points lately, especially about being incorrect on the dosing regimen on the Chlorambucil. I just don't know...
Ra got his first dose of the Chlorambucil this morning. He wasn't happy about not being fed right after he got his pills like he normally is, but he managed okay. Waited to feed the other two monsters until Ra ate because, when hungry, Ra has a tendency to scavenge off of Lars' bowl. I though the Young Ones were going to explode, they were SOO HUNGRY!! :/ Whatevs, they managed to wait, so it was all good. Now we wait and see how Ra reacts to the Chlorambucil...