Lal Bahadur Vodka (1999-2009)
May 9, 2009 | 13 Comments
Lived life to the fullest.
The Vokster turns 10
April 28, 2009 | 3 Comments
Happy B'Day!
Please hold good thoughts for him!
A not-so-great couple of days
April 23, 2009 | 1 Comment
It has been a really rough couple of days. The tumor in Vodka’s shoulder has been slowly getting bigger - even with the increased Palladia dose, it seems like we’re just seeing more side effects than effects. He’s been hit with really bad diarrhea, probably the worst so far 
Plus, we saw a little bit of blood in his poop yesterday, enough to warrant a panicky visit to Redwood. Dr.Robinson did a rectal exam - came clean, but there are 2 small lumps on the outside of Vodka’s poophole that look really weird. And one of them was a bit bloody. I’ll probably know more about what these are when we visit the oncologist tomorrow. Till then, just hoping it isn’t something really weird.
And to make things worse, I think one of the dermal tumors may be coming back *sigh*. Which makes us think that Palladia may not really be working anymore. *bleh*. We’re meeting an alternative treatment vet on friday - she’s been using Neoplasene on a patient for a different form of cancer, we’re wondering if Neo can still be used as part of Vodka’s treatment.
In the meantime, we’re still scheduled for surgery next week - whether we get to use Neo saline on the tumor bed or not is still up in the air. If we do that, surgery will be later in the week. Else, we might as well get it done earlier - probably monday.
Hold good thoughts, please?
'elow!
Still fine tuning the dosage
April 17, 2009 | 1 Comment
These last few days, Vodka’s been handling the Palladia dose pretty well, but we haven’t been seeing the kind of response we’d like. The tumor seems to shrink the first day or two after the Palladia dose, but seems to get bigger by the third day The net result is that the tumor seems to be a wee bit bigger this week than it was last thursday. *bleh*.
So, we’re trying to rework the dosage and frequency to come up with a sustainable schedule that can control the tumor and let the Vodka-monkee be his crazy self. The Pfizer folks seem to recommend reducing the dosage frequency first before tweaking the dosage itself. This isn’t necessarily a firm rule, just a vague guidance that we don’t necessarily have a lot of data to back with. So, we’re going to up the dose to 130 mg (from 115 mg) but stick with the once-in-three-days frequency. We’re hoping this will help control the tumor a bit more, maybe even shrink it a bit.
In the meantime, Dr.Tamara Walker (the surgeon) took a look at Vodka’s shoulder today - we’re thinking a debulking surgery is a good idea - if we can take the mass out, then the chances of controlling the mast cell disease with Palladia or some alternate treatment protocol is potentially better. It is somewhat stressful to contemplate surgery again, but debulking the tumor seems like the appropriate strategy right now.
So, what are we considering for treatment options going forward?
- Palladia is still on the table as long as we can find a dose that controls/shrinks the tumor in the next week or 2.
- Neoplasene is another option - Dr.Walker hopes to chat with Dr.Hershey tomorrow or monday about potentially applying Neo on the tumor bed during surgery - this technique sounds scary but has been used in several cases when debulking a tumor.
- Another option is Noscapine - we’ll need to import this from an Israeli or European pharmacy if needed.
- The latest one I’m looking into is Nitrosylcobalamin (NO-Cbl) - this is a B-12 analogue that induces the expression of an apoptosis-inducing ligand and its receptors. On reading a couple of papers about this, I emailed Dr.Joseph Bauer - the researcher who patented this compound for more information about the clinical trial. Currently, there seems to be a waiting list, but I’m trying to dig up more info on how to get on it, etc.
In the meantime, the Vodka is prancing around - he had a great acupuncture session with Cindy a couple of days ago, he spent quality time with his buddies at ACS earlier today and he’s been getting obscene amounts of ball time. Mucho goodness! 
Vodka Fox (circa July 2007). Photo Courtesy: Stephanie & Shawn (Dog-e-Central)
Tags: MCTs > neoplasene > nitrosylcobalamin > noscapine > Palladia > surg
Working that Palladia
April 8, 2009 | 2 Comments
About 8 months ago, Vodka’s pressing needs seemed to be ball-time, walks, hanging out with pals and yummy treats. And some of mine involved making sure he got all that 
Things are somewhat different now. Weelllll, his needs are the same … mine, however, are a bit more heavyweight - exploring every option possible to keep him healthy and happy!
Which was why we chose to explore Palladia. We approached this with plenty of misgivings - a Phase III clinical trial drug … an unknown entity, no support group to work with, very little information about contraindications … not a great place to be in. We really hoped that surgery to debulk the tumor, followed by Neoplasene would be the protocol of choice. But we couldn’t really find a vet who supported this and was comfortable trying the Neo salve or injectable. So, we gave in and went with Palladia instead.
Most of you must be aware of our Palladia roller-coaster ride - great response but strong side-effects. Very frustrating. Today, I saw a comment from a pooch-parent whose dog also has MCTs - systemic, in the lymphatics and he is on Palladia. I’m going to attempt to address several questions that Billie Sue had about our experience with Palladia:
Dosage & Frequency
Vodka weighs about 86 lbs and was initially on 130 mg of Palladia every alternate day. This worked great for about 2 weeks, then the side effects showed up - nausea, general inappetance and GI unhappiness. So, we pulled Vodka off Palladia and let his stomach heal. Then, we restarted at 115 mg thrice a week - we went through 2 doses of this before it hit him again. So, we pulled off for another week to let him recover.
As we were rethinking this whole Palladia strategy, we found that the tumor was growing again. Bummer. So, we decided to try it again. This time, we chose to dose at 115 mg, but once every three days. I’ve read a few papers that talk about cancer cells being more active around midnight-2 am. Based on that, we’ve chosen to give him the Palladia in the evening after his PM meal.
Also, he gets one Metoclopramide (Reglan) pill about 30 minutes before the Palladia dose, and gets 2 more over the next 24 hours, spaced 8 hours apart. The goal is to “pretreat” the GI system and prep it for dealing with nausea and inappetance. Vodka got his third dose of the current round of Palladia earlier this evening.
Side effects:
- Nausea/Inappetance - The Metoclopramide dose is expected to help with this. We’ve seen that the Palladia side effects hit hardest 12-36 hours after the dose - we’re hoping that prepping the GI system will alleviate some of this. Vodka is also on Seacure - a predigested (and super stinky!) protein supplement - comes in capsule form. This was recommended by an acquaintance on a cancer group who is a RN - she’s seen this help chemo patients deal with inappetance issues.
- Diarrhea - Vodka had a few instances of bad poop over the last few days. We chose to treat this with Imodium. Metronidazole instead of (or in addition to) Imodium is another option.
- Digestion issues - We’ve been giving Vodka a digestive soother (slippery elm + L-glutamine + fructo-oligo saccharides). We also have this homeopathic remedy Nux vomica on hand to deal with nausea/vomiting. We’re hoping to restart him on Essiac tea and have Bentonite clay detox on hand. He’ll probably start getting the Bentonite on the 2nd off-day (the day before Palladia dosing) so as not to minimize the impact of Palladia.
- Pickiness about food - This is a tough one. I feel like Palladia totally messes with Vodka’s sense of smell and taste! With the current dosing strategy, he seems to like his Orijen kibbles quite a bit, especially with an egg cracked atop. He sometimes eats his meat, other times, he walks away. To work around this, I’ve started baking his meat and veggies into treats - he really seems to enjoy these baked goodies! I just mix a can of food or wonk of meat (ground beef or turkey or chicken) with an egg, a little oil, some herbs like parsley, alfalfa, licorice, ginger and some spelt flour (since we’re trying to stay away from wheat) and drop spoons of these into a muffin pan and bake at 350 F for 20+ minutes. We’ve been able to use these as “pill-pockets” to get those gazillion meds into Vodka!
- Tachypnea (rapid breathing) - We’ve seen some of this, it existed even pre-Palladia because of prednisone.
- Tiredness/Hind limb weakness - The Palladia Phase II trial mentioned instances of this. Vodka has not been tired, but I’ve noticed that when he poops, he’s a bit slowly recovering his ass from the hunched position. He’s on Tramadol for dealing with arthritis and general pain and that seems like a decent solution.
Supplements:
- K-9 Immunity, Transfer Factor - Vodka used to wolf these down, but lately it has been hard getting them into him. Until I stretched my baking skills to start making him treats! We now stick the pills into treats - seems to work. So, can these be given alongside Palladia? No one really knows. But, we’re thinking about staying away from diluting the Palladia dose with any other supplements - so the plan is to start dosing these on the Palladia off-days.
- Curcumin - These go in every day - twice or thrice a day. Dr. Dressler suggested that these be mixed in with soy lecithin for better absorption - so, I’m going to start doing that. And maybe mixing it in with some virgin coconut oil - that has got to be tasty!
- Glutamine - This is a must. Everyday. It is supposed to help protect the GI system, plays a major role in protein synthesis and assists in immune function.
- Green Tea extract, NAC, Medicinal mushrooms - Hoping to dose these on Palladia off-days.
- Chinese herbs - We’re currently using Xue Fu Zhu Yu and Stasis Breaker. It has been hard to get these into Vodka giving his eating finickiness. But we try to get in one dose of these a day if possible.
Unfortunately (like with most other chemo drugs), there is little evidence of contraindications when using alternate treatments in conjunction with Palladia. Our attempt to stagger some doses is to potentially offset this. So, we continue our dosage dance hoping we can work this Palladia the right way.
These treats double as pill pockets!
Good wishes to Han, the black lab who also has MCTs - hope the Palladia works its mojo!
Tags: digestion > MCTs > Palladia > side effects > Supplements > treatment
The dosage dance
April 3, 2009 | 3 Comments
Vodka had Palladia again today. In the last week without Palladia, the tumor in his shoulder has grown bigger. Really sucks Especially since the unpredictable food response continues:
- He’s still picky - what works for one meal does not always work for another
- He drank tons of water right after he gobbled up food yesterday AM and ended up regurgitating some of it! Oy. Luckily that didn’t affect him any further - he continued to eat and drink and play the rest of the day.
- His poop isn’t back to being stellar.
The good thing is that he’s eaten well this last week in spite of it all - many thanks to Stephanie’s creative cooking!
We’ve been talking about Palladia dosing with all of Vodka’s doctors - obviously, determining the right dose for him is still work in progress. We’ve now chosen to try the lower dose of Palladia (115 mg) every 72 hours (3 days). And we’re hoping to give him Metoclopramide (Reglan) over the course of a day right after the Palladia dose for protecting his GI system.
So, we’re continuing to fine-tune a multi-pronged strategy for coping with side effects here:
- 3 doses of Metoclopramide over the 24 hours after Palladia - for dealing with GI motility issues
- Metronidazole - for dealing with diarrhea
- Nux vomica - a homeopathic protocol for coping with nausea/vomiting
- Digestive soother - composed of slippery elm, l-glutamine and fructo-oligosaccharides for coating the stomach
- Carafate - for coating the stomach
- Tagamet - for protecting the stomach against histamine release
- Probiotics - essential for maintaining digestive flora
A couple more supplements I’ve ordered that will hopefully help here:
This is a predigested fish protein concentrate that has worked really well to alleviate symptoms of IBD and Crohn’s disease. An acquaintance on an animal cancer alias is a RN who works with human cancer patients - she’s apparently seem good results when chemo patients use Seacure for dealing with nausea and inappetance.
Clay is one of the most effective natural intestinal detox agents out there. Bentonite is the commercial name for montmorillonite clay (named after the region of France it was originally found in). Liquid Bentonite works well in flushing toxins from the intestinal system. Plus it is inert - a good thing since it just passes through the body undigested. Think of it as this giant sponge that harmlessly traverses the digestive system picking up all the irritants that need to be purged from the system.
The one potential downside is “flushing” of medicines. Clay works similar to activated charcoal - the timing of dosage needs to be played with to avoid flushing out essential nutrients and medicines from the body. So, we might need to give this to Vodka between meals, away from other meds that need to be properly absorbed into the system and have the clay focus on flushing out the stomach toxins instead.
2nd Metoclopramide dose - 3:30 AM (?!!). And another one 8 hours from now.
Photo Courtesy: Stephanie and Shawn (Dog-E-Central)
Keep those good wishes rolling!
Tags: bentonite > diarrhea > herbs > homeopathy > inappetance > nausea > Palladia > seacure > side effects
This dog eats muffins …
March 30, 2009 | 3 Comments
… and eggs!
Yeesh. It has been 4 days since the last Palladia dose. And Vodka’s appetite is nowhere close to normal. As of yesterday, he was still poopy (in terms of quality, not frequency :)) and a bit nauseous. And he seems to have a mental block about eating most meats!!! Not interested in turkey anymore - the turkey love lasted about 4 days. Still no chicken unless the cute ladies at Eastside Dog give him some treats. Beef isn’t big on the list either. Neither are those fancy canned dinners. Or the once-loved peas and sweet potatoes! His current love - eggs. He’ll probably eat a whole dozen scrambled! And he wants baked goods. Yes, the pooch has decided to go high maintenance on me!
A couple of days ago, I baked spelt muffins with organic baby food (beef vegetable pilaf) and eggs. He wolfed down six of those in no time at all! And now I’m wading through my Tassajara bread book trying to come up with gluten-free and meat-filled versions of their breads - that’s going to be interesting! Maybe it is time to start a doggie food blog!
Beef'n'Spelt Muffins, anyone?
The pickiness continues. And I’m thinking we should hold off on Palladia till his belly is back to 100 % - atleast till Vodka wants to eat all his meals, even if he doesn’t quite want to climb on counters looking for more food!
Food is exciting again!
March 25, 2009 | 1 Comment
After a couple of scary days, Vodka’s belly seems to be settling down. About time too. It was pretty unsettling to see him turn his face away from food. This is the same dog that climbs on counters to steal food, gets into a milk box to drink up cartons of milk and buttermilk, even gets into mail packages to eat half a box of Canine Transfer Factor (it had chicken liver flavoring in it!).
We still don’t know why he was hit so hard by unappetance, it could just be Palladia build-up. Or maybe, if we’re lucky, this is a one-off thing and we can manage the side effects going forward. The good thing is that he didn’t really lose any weight through all this, guess we still managed to get some food into him! Karen did stick one of those fancy subcutaneous IV pouch thingies into Vodka’s shoulder on monday since he seemed a little under-hydrated. But even by the time she saw him, he had started eating again, albeit quite pickily.
Vodka’s appetite isn’t back to its manic proportions yet, but he’s doing pretty ok right now. We visited Dr.Meleo this morning and she had a hard time believing that this pooch had refused food for a whole day - I guess it is hard to buy that when he’s sitting at your feet begging for more treats!
So, what’s with Mr. Smell-everything-a-hundred-times-before-eating? So bizarre! He smells everything over and over, walks around the food before finally deciding if he wants it or not! Currently, boiled chicken is on his off-list. But turkey is so hip! Homemade chicken jerky works … maybe! Peas rock. As do sweet potatoes. No chard or bok choy - too healthy! I think he’s got some lingering nausea courtesy of the Palladia and this is making him super picky about all foods. He was even refusing cheese over the weekend! Vodka refusing dairy? That was scary!
Since he’s been responding so well to Palladia, we figured it was worth it to rework the dosage to avoid intense side effects - his dose is down a bit (from 130 mg to 115 mg) and he’s only going to get Palladia thrice a week instead of every alternate day. We’re hoping this will help keep most side effects at bay. In the meantime, we’re armed with Cerenia and fennel tea and alfalfa and yucca and more for GI goodness
Hmm … maybe I should elaborate a bit about the herbs we’re trying to use to stabilize Vodka’s GI system:
Fennel seeds
This was an easy one to start using - we grew up using fennel seeds as a digestive - either as fennel tea or just as a post-dinner nosh with some betel nuts and other seasonings. I’ve been soaking 1-2 teaspoons of fennel seeds in boiling water till it cools and then straining the water out. We basically spoon the tea into Vodka’s mouth - atleast a couple of spoons at a time.
Fennel seeds are great for dealing with digestive problems, especially for dealing with flatulence, acid indigestion and cramps.
Alfalfa
Alfalfa is insanely rich in nutrients - Vit A, B12, C, D … name it, it has it! It also has a zillion trace minerals like magnesium, calcium, phosphorus, potassium and more. And it has antioxidants and phytonutrients. Hmm … maybe I should just be eating this as a meal?
Alfalfa is pretty rich in fiber - a good thing for digestion. Plus it is great for detoxing and can improve liver health. We’ve been using powdered dried alfalfa - mixing a spoon of this into Vodka’s food as often as we can.
Yucca
Yucca has saponins - great anti-inflammatory agents. So, this was something I’ve wanted to give Vodka for his arthritis anyway. My herb bible ‘All You Ever Wanted To Know About Herbs For Pets‘ also recommends this for dealing with GI issues.
Apparently, yucca is insanely bitter. So, I’m planning on trying Dr.Fox’s suggestion for getting this into Vodka - soaking a piece of bread with the liquid and rolling it up in a wonk of ground meat before dropping it in Vodka’s mouth. Hmm … I’m hoping that’ll work
My chicken toy is so much better than real chicken!
Vodka is all excited about his rock star status - many thanks for all the emails and calls and wishes. Like I’ve said many a time, often it seems like all the goodwill is what is truly keeping him happy and healthy!
Tags: acs > Diet > food > nausea > Palladia > side effects > Supplements
The side effects start rolling in :(
March 22, 2009 | 3 Comments
After 2 weeks of a fabulous response to Palladia, Vodka’s body was finally hit by side effects. Over the last week, he’s been getting increasingly picky about food - he’s been nauseous, gets turned off by various smells, eats a little bit and then walks away All this from the chowhound who has never been known to stop eating!
Friday evening, Vodka ended up barfing everything he had eaten over the previous day. Like 3 lbs of food. Seriously. It was pretty sad. He kept running around and playing, but stayed away from food. Until that night, when he noshed on some kibbles.
Yesterday seemed a lot better - he ate kibbles, boiled chicken, sweet potatoes, oatmeal+yogurt through the course of the day, played a ton, ran 3+ miles, did lots of usual Vodka things. He had no supplements yesterday, just the bare minimum meds (Cimetidine, Carafate, Prednisone and Benadryl). We also skipped the Palladia - no sense hitting the body with it till his GI stabilizes!
Last night, I tried to give him his Avemar with kefir yogurt (instead of his usual full fat yogurt) and it was a struggle to get about 1/3 of it into him. *bleh*
And this morning? … He’s running around, played a bunch but wants *no* food! So far, I’ve tried boiled chicken + sweet potatoes and kibbles and he wants neither His poop is stellar, he’s drinking water, he’s playing plenty but he doesn’t want to eat. *sigh*
Eat, Vodka, Eat!
I’m stymied. In 10 years, I’ve never known Vodka to not dance around food, everytime he smells something, he usually comes running from a mile away! This is not fun at all.
Tags: avemar > nausea > Palladia > side effects > stomach
It fell off!!!
March 18, 2009 | No Comments
Remember the cutaneous tumor on Vodka’s back? The first one that came back in late January? The one that slowly grew in size over the last couple of months? The one that we shaved around so we could spray NasalCrom to reduce the histamine release? The one that I hated looking at (I hate all MCTs, actually!), the one that I despised feeling everytime I massaged Vodka?
It shrank back lots and fell off a couple of days ago!!
W00t.
Palladia has been working pretty well for Voks - it started shrinking the tumors a couple of days after we started him on it. He does have side effects though - pretty minor for the most part, but they’re there. A wee bit of diarrhea, some nausea, a little bit of tiredness. Plus the skin around his cutaneous tumor seems a *lot* paler than his flesh usually is. Then again, Palladia can cause pigmentation changes - wonder if this skin color is an effect of the drug.
Where the tumor fell off!
Sorry for posting a somewhat gross pic, I’ve been trying to stay away from those, but this one seemed bizarrely intriguing!
We might skip tomorrow’s dose - we’re meeting Dr.Gillings for the weekly checkup tomorrow, seems like a good idea for her to check Vodka before giving him the next set of pills. I’m hoping tomorrow’s CBC will be ok and he doesn’t have neutropenia or anything else.
I had started Vodka’s Palladia calendar the day he had his first dose. Today I edited that to add a long laundry list of all possible side effects mentioned in the Palladia papers - and I’m grading him on a scale of 1 (least severe) - 4 (most severe). So far, he’s had only 4-5 of these and most of them (outside of his chronic arthritis) rank a 1 - a good thing!
Vodka - usually Mr.I’ll-Pig-Out-On-Any-Food is now quite picky - seems like the Palladia has fine tuned his senses of smell and taste a little too much! He now balks at eating the flaxseed oil+quark or yummy meat mixed with the chinese herbs (Stasis Breaker and Xue Fu Zhu Yu) or supplements. Yeesh! I was despairing about getting some supplements into him until … I bought some tripe today!
Wow! Stinky tripe seems to be an eternal favorite with Vodka! He wolfed down his chinese herbs mixed in with tripe and even drank some tripe-y water mixed up with astragalus and milk thistle!
More updates once we meet Dr.Gillings tomorrow!
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