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Every Day is a Good Day  Appendices

Berry Pix!!!

Pets with Cancer Lifeline

Berry's Diagnosis & Treatment

Berry's Top 10 Treatment Tips

Every Day Table of Contents

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The ACVIM registry lists one or more oncology specialists at the following veterinary schools, many of which have teaching hospitals associated with them, and private facilities.

Auburn University

Colorado State University

Cornell University

Kansas State University

Louisiana State University (Baton Rouge)

Michigan State University

North Carolina State University (Raleigh)

Ohio State University

Purdue University

Texas A & M University

Tufts University

University of California (Davis)

University of Georgia

University of Illinois

University of Minnesota

University of Missouri

University of Pennsylvania (VHUP)

University of Tennessee (Knoxville)

University of Wisconsin (Madison)

Washington State University (email vetmed.wsu.edu)

Animal Medical Center (New York, New York)

Gulf Coast Veterinary Specialists (Houston and San Antonio, Texas)

Red Bank Veterinary Hospital (Red Bank, New Jersey)

When we first created dogdoggiedog.com in January 2001, we set up links to information we could find. In updating the dogdoggiedog.com site over the years, we’ve learned that many sites either become stale or change their web addresses. In particular, secondary pages within sites tend to be removed or reorganized and web addresses for specific information became invalid. Knowing this, my initial thought was not to include links. But since even a good search engine will not reveal all of the sites below, and it takes a lot of time to negotiate the web from one source to another, we’ve included materials here, to let you know the pages are out there, at least as of Fall 2004.

These sites are collectively the most authoritative source of information. Some are focused on the more scientific aspects of treatment; others on the information the human client may need to know about the treatment process. Some link to the web sites of other veterinary teaching hospitals web sites, but this is inconsistent.

Auburn University. http://www.vetmed.auburn.edu/index.pl/oncology_info

Colorado State University. http://www.csuanimalcancercenter.org/

One of the most comprehensive sites. Extensive glossary of cancer terms.

Cornell University. http://www.vet.cornell.edu/cancer/cuha.html

University of Florida.  http://neuro.vetmed.ufl.edu/neuro/AltMed/Cancer/Cancer_AltMed.htm

Kansas State University. http://www.vet.ksu.edu/depts/VMTH/oncology/index.htm

Louisiana State University (Baton Rouge). http://www.vetmed.lsu.edu/oncology/

Michigan State University. http://cvm.msu.edu/vth/

North Carolina State University (Raleigh) (www.cvm.ncsu.edu)

Ohio State University. (no site located for Ohio State University Veterinary Hospital)

Purdue University. http://www.vet.purdue.edu/vth/noframe.htm

Texas A & M University. http://www.cvm.tamu.edu/oncology/

Tufts University. http://www.tufts.edu/vet/sah/harrington.html

University of California (Davis). http://www.vmth.ucdavis.edu/vmth/services/oncology/oncology.html

University of Florida. http://www.vetmed.ufl.edu/sacs/Oncology/treatmentprotocols.htm

University of Georgia. http://www.vet.uga.edu/hospital/smallanimal/index.php

University of Illinois (www.cvm.uiuc.edu)

University of Minnesota (www.cvm.umn.edu)

University of Missouri. http://www.vmth.missouri.edu/

University of Pennsylvania (www.oncolink.upenn.edu/)

VHUP’s information appears on Oncolink, which deals with both human and animal cancer treatment. The small animal materials can be accessed by searching for "companion animals" or "canine oncology".

University of Wisconsin (Madison). http://vmthpub.vetmed.wisc.edu/sa_services/med/oncology/default.htm

Washington State University. http://www.vetmed.wsu.edu/depts-vth/

Websites associated with Private Facilities or Foundations

Animal Medical Center. http://www.amcny.org/department/donaldson.htm

Gulf Coast Veterinary Specialists. www.gcvs.com/oncology/index.htm

Red Bank. http://www.rbvh.net/services/oncology.htm

We’ve been selective here and included a small number of sites that we think convey lots of useful information.

http://www.labbies.com/cancerintro.htm. Extensive materials.

http://www.perseusfoundation.org/oc.html. Comprehensive materials on cancers, chemotherapies, locating oncologists, clinical trials, various tests, and alternate feeding practices and non-traditional cancer treatments.

http://www.pyrbred.org/lymphoma.html. The first high quality owner site I found after my dog was diagnosed. Multiple remissions.

www.haileybell.homestead.com/HaileysStory.html Well written owner’s site with useful links. Multiple remissions.

www.bernese.biz/samson1.htm Well written owner’s site with link to detailed article on Integrative Treatment of Canine Cancer at:

www.sparkyfightsback.com This site is an advertisement for a book, which may contain useful information.

http://www.cvm.tamu.edu/oncology/glossary/glossary.html

http://www.csuanimalcancercenter.org

http://www.perseusfoundation.org/oc.html

We asked VHUP about the cost of chemotherapy in February 2000 when Berry’s treatment began. The estimate we were given was about one thousand dollars for the initial staging and an additional two thousand dollars for the first year’s treatment, assuming no side effects. While those two estimates were reasonably accurate in our case, the cost varies widely based on the type of lymphoma, the drug protocol, the treatment setting, and other factors. Ask your oncologist for a breakdown.

For Berry, here is a more detailed answer based on our records. 

We identified three basic components of cost: 

· the cost of diagnosis, staging/re-staging and the drug protocols; 

· the cost of treating side effects; and 

· the cost of the regular dog care issues that probably would have arisen anyway

but which assume urgency when your dog is in chemotherapy. 

Finally, if you aren’t successful in communicating with your dog’s treatment team, you may also have some "unnecessary" expenses -- costs associated with work that is redone or tests that were not needed.

Be realistic going in. It is true that canine chemotherapy does not cause the extreme side effects typically seen in humans, and many veterinarians will tell you side effects are "uncommon". But our conversations with other owners (and our informal "eavesdropping" in the VHUP waiting room), as well as other owner stories we have read on the internet, reveal that many dogs do experience one or more side effects. Whether that happens to your dog will depend on which drugs are prescribed and your dog’s unique response to them.

Assume that your dog will have at least some side effects that will require additional treatment outside of the basic chemotherapy protocol. By expecting and watching for side effects, in addition to increasing your dog’s comfort, you may be able to limit your costs by avoiding expensive emergency treatment. Emergency treatment often involves doctors who are not as familiar with your dog or his chemotherapy, and who may be over-inclusive in their search for a diagnosis. As a result, it can be expensive. An example from Berry’s case: if anti-nausea medicine had been prescribed at the time of Berry’s first vincristine treatment, we might have avoided the trip to the Emergency Service. And if we or the Emergency Service had clearly understood that the timing of the gastrointestinal side effects associated with vincristine can vary widely, Berry could have received hydration therapy and anti-nausea pills. Instead, he had an overnight in the ES, and more x-rays and ultrasounds as the doctors looked for a foreign object.

Our records reflect the following approximate costs:

Diagnosis, staging (Day 1): $800

Re-staging (at 4 months): $1,100

Basic treatment for one year (routine tests, drugs, office visits): $2,000

Emergency treatment of vincristine side effects: $1,200

Regular dog care issues (campylobactor, hot spot, coat problems): $350

Total after 12 months: $5,450

We think this number will vary widely for other owners. It may be less if you do less staging or re-staging ($1,900 total), your dog has fewer reactions or side effects ($1,200), or is in a different treatment setting. It could be more, possibly significantly more. After the first month, Berry’s treatment was smooth sailing – he went into remission, did not come out, and stayed on the same protocol, in which visits to VHUP steadily decreased over time.

Berry's treatment in his second and third years was relatively inexpensive, in part because he had fewer office visits and drugs. Periodic restagings, his sterile hemorragic cystitis, and the testing in late 2001 that concluded he was out of remission, were the only major expenses. At the end of his life, we spent a significant amount and money trying to determine what was wrong, and whether or not it could be addressed.

Example 1:    November 10, 2000

Berry – Penn Vet Treatment - November 10, 2000:

Berry has been in chemotherapy for his lymphosarcoma since February.

On June 8 he was restaged His appointments were spread out based on the test results.

On October 13, Berry was given Vincristine.

On October 27-30, he received Cytoxan at home.

Berry has been doing well and has good energy at home.

1. He should be receiving vincristine today.

2. His last bloodwork was on 9/15/00, about 8 weeks ago. Please do a CBC today. Dr. Barber indicated that cutting out prednisone (done in late September) might result in recurrence of disease, so we’d like to check on how he is doing.

3. Over the last month, Berry has lost much of the long hair on his tail and his rear. He also seems to be scratching more than in the past (we haven’t seen any fleas) . Any idea if this is a long term effect of the medication, or nutrition, or the result of regular coat changes? His current diet is Nutro Natural Choice Lamb and Rice, with some squirts of Foster & Smith Vitacoat (which says it contains fatty acids, vitamins A, D and E and various minerals) and Metamucil (psyllium husk fiber).

1. Berry has a small subcutaneous mass (about the size of 2 grains of rice) on his left side. It has been there since we got him last year and has not changed in size or shape. This mass has been aspirated twice now by Penn on 5/19 and 7/20; please do not aspirate it again.

2. Berry also has a lipoma under his neck. This was previously evaluated (see 5/12 discharge) as a benign mass; as instructed, we are monitoring it for changes in size.
3. Berry has had a hot spot on the left side of his cheek/neck. It cleared up in the past two weeks and we are no longer applying Panalog.

Example 2:    May 10, 2002

Berry, VHUP, 5/10/02:

Berry was first diagnosed with lymphoma in February 2000; his chemotherapy treatments were discontinued in August 2001 and he was in remission until December 2001. Now he is out of remission and is receiving leukeran and prednisone. The prednisone is also being used to treat a bladder condition (cystitis) and he is taking phenylpropanolamine for an incontinence problem. Berry is being seen today for re-check and a bone marrow.

Berry is still doing well at home and has good energy. We haven’t seen any further evidence of blood in his urine. He had one accident in the house this month (after eating some spicy Indian food – I’m wondering if that could have irritated his bladder – needless to say, he shouldn’t have had it in the first place!).

Questions

1. A bone marrow is to be done today. Please use the shoulder area if possible. Berry has scar tissue on his right flank at the February 2000 test site; as a result, this location was judged to be unusable at the time of the first re-staging in June 2000. Roxanne knows.
2. Need refill on leukeran; also Interceptor and flea and tick preventive.
3. Need fecal. (We are all going to "Camp Gone to the Dogs" in June and need to bring evidence of a clean fecal!)

Note:

Berry also has a small lipoma under his neck. This was previously evaluated as a benign mass; as instructed, we are monitoring it for changes in size.

Who was Berry The Dog? Whoever else he was, he was certainly a dog with lymphoma. He probably had it from the day he came home to us from the Golden Retriever Rescue. To understand what that means, we here give you an idea of Berry’s life – and his quality of life.

In 2000, Berry graduated from obedience school on the day we received his lymphoma diagnosis. We tried to pack a lot into that year. As the year progressed, he celebrated his 4^th birthday in a party hat and learned to "shake" and to catch food thrown to him. In fact, Berry turned out to be a food rascal who ate an entire fresh baked rhubarb pie that he counter-surfed when we turned our backs for 10 minutes. He loved the beach, where he played in the waves in the Atlantic, beat out his pal Cody retrieving sticks in the ocean, dug halfway to China in the sand, and chased a horseshoe crab. Although we lived in the city, Berry had a very active outdoor life in Philadelphia’s vast urban parks and many planned outings. He accompanied his buddies Cody and Pal for long walks in the Wissahickon, Tinicum Wildlife Refuge, and at Jacobsburg State Park (where he was video-taped diving at his favorite swimming hole); romped at the DVGRR annual reunion picnic, and practiced his superior water entry in Bill and Linda’s pool. He celebrated his one-year anniversary with us by stealing the cake Lois had bought from "Bone-Appetit", and distributed holiday gifts at VHUP disguised as a reindeer. He slept on the beds; rolled in the dirt (and the snow); become a devoted patron of the culinary arts; shredded dozens of stuffed toys; yowled in concert with passing fire engines and police car sirens; hunted down stray chicken bones on scores of blocks of sidewalks; licked hundreds of plates; and absorbed more petting and brushing than any other dog on planet Earth (with the possible exception of your own doggie, dear reader).

We packed a lot into 2000 because we weren’t sure how much time Berry would have. In 2001, Berry’s health was stable, and we added other dogs to our home and even took a vacation. Berry learned to play with "Dubs", a German Shepherd we fostered briefly after her rescue from Fairmount Park in January; celebrated his 5^th birthday on April 22; put up with (and maybe even learned to like) Ottohound, the GWP who came home to us in April; romped all summer as a founding member of the Chester Avenue Dog Park; luxuriated at "Spa Woislaw" in August while we went to Norway; bravely led the way through the new dog door into the back yard; went to Tinicum Wildlife Refuge for long walks and occasional unauthorized duck chasing; posed for photos at the annual Animal Welfare Association’s 2001 Putt for Pets Tournament on September 10; was named Director of Homeland Security after scaring a burglar away in October; visited with residents of Park Pleasant Nursing Home at the Grand Opening of the Chester Avenue Dog Park; celebrated 2 years in his new home; and dissected innumerable stuffed toys (good-bye to Sherman, Little Man, Brown Bear, Reindeer, and all the rest).

In 2002, we got more complacent and didn’t keep such detailed records, but Berry continued to have a blast, especially that summer. In June, he and Otto spent a week at Camp Gone to the Dogs in Vermont, where Berry took long walks in the woods with the dog pack and tried sheep herding, weight pulling, and lure coursing while Otto did agility, tracking and obedience. Berry went to an "All Goldens" pool party at Bill and Linda’s in August and put more polish on his diving skills. He invested some time at Lois and Richard’s mentoring the next generation -- Hannah "Banana", a rescue Golden pup taken in by the Koskeys shortly after Miss Amanda Jones died. In November, he enjoyed the first of many long walks in the brook and woods (and rolls in the snow) at his beloved namesake BerryBrook in Vermont. He established his place there on the "big sofa" and was content with new routines – the morning trip to the community store, a pee near the barrel, and breaking a trail in the snow. Most importantly, Berry kept the Chester Avenue Dog Park safe all year, vigorously guarding it from the trolleys passing to and fro on Chester Avenue.

Late winter, spring and summer of 2003 were filled with many trips to BerryBrook, where Berry learned the trails, found coveted deer bones left behind by hunters, swam at the "Dip" in Taintor Brook, barked at the neighbors’ horses and cows, and wallowed in the mud at Swamp Donkey Flats. At BerryBrook, he was wet, dirty, and happy; he loved the brook, the lawn, his porch, and his sofa. Back in Philly, he continued to defend the Dog Park, and did pet therapy at Park Pleasant Nursing Home where his arrival was eagerly awaited by his favorite regulars – Rasheem, Matt P, and Mr. B. The summer of 2003 was more low key as Berry began to be slowed by renewed chemotherapy and multiple health problems, but he still loved his home, Vermont and the dog park.

Great dogs are experienced as such by the people who live with them every day. We resisted the temptation to fill this handbook with stories about Berry that did not illustrate specific points about chemotherapy treatment. But since Berry is in fact the inspiration for this guide, here are three little stories about what a great dog he was. They talk about three distinctive things that made Berry Berry: his superior water entry; his love of food and "food opportunities"; and his adventuresome spirit.

***

Berry loved my friend Greg from the first, but Greg wasn’t so sure about Berry. Greg couldn’t understand why we had agreed to bring Berry home when I had been waiting for months for a boisterous "big red dog" like Greg’s Cody. Berry certainly wasn’t Cody – Berry was calm, strawberry blonde, and short – not just compared to big Cody, but short for a Golden. Berry turned out to be handsome: he had enormous paws, and once he filled out and shed his brittle coat, he was broad and barrel chested and soft as velvet. But in the beginning, he was just short and skinny. Greg’s first nickname for him was "Tiny", soon followed by "Little Berry-Dog".

But Little Berry-Dog had a trick up his sleeve. A few weeks after Berry’s arrival, Greg and I set off on a tramp in the woods, with Cody and Berry sniffing and snouting in the lead. As we followed a creek upstream, we reached a dam behind which lay a large pond. Greg threw a stick into the pond for Cody to retrieve. As Cody began to wade into the still water, Berry ran along the top of the dam. Then, he set his feet, and in a sudden, astonishing move, launched himself off the dam into the pond – front paws extended, hind legs tucked, tail like a flag. A superior water entry. Little Berry-Dog was transformed in Greg’s eyes – A brave dog who loved the water.

Along with eating pears and chasing trolleys, diving into water for a thrown stick was Berry’s passion. He would keep at it until you hauled him away. He had a style. He planted his enormous front paws, leaned back, and then launched forward. Try as we might to photograph him airborne, we mostly got images of the cannonball splash Berry made on impact, the stick visible in the still water just beyond his point of entry. I treasure the few images of Berry caught in flight – they capture his abandon, his sheer joy, and his determination to succeed.

Goldens are known as good feeders, but Berry was legendary. He was a champion counter-surfer and could turn the kitchen upside down for a single kibble of dog food that had skittered under a chair. A bitter chemo pill disguised in bread or peanut butter was never rejected. And the fate of caninekind – perhaps of the planet -- depended on his getting that last scrap on your plate. It became a game with Greg to see what Berry would eat. Berry loved meat and potatoes, but also fruit and vegetables, even weird ones – cantaloupe rind, watercress, celery root, beets, and turnips; his only known refusal was uncooked rhubarb. He would lick a plate until it shone, eat your muffin wrapper if it fell on the floor, and stick his whole head into an ice cream container to harvest every last drop, emerging with sticky ears and eyebrows.

Berry and DC had food rituals. DC taught Berry to catch food thrown to him – "catch’ems"—and scarcely a morsel hit the floor thereafter. But his passion was pears. Their movement in the kitchen must have given off some sort of high frequency signal to Berry. If a pear was handled, Berry appeared immediately, in his perfect, military-straight sit, waiting for his share – his "quit rent" -- the core. As he waited, the pear drool formed in a long string down toward the floor. And when DC was too slow, the "Pitiful Paw" was deployed to emphasize Berry’s impatience. VHUP called him an "indiscriminate forager" and it was true: during any urban outing, chicken bones in fast food bags discarded on the sidewalk called Berry’s name like the sirens of Greek mythology. We had to pry them from his teeth or risk yet another trip to VHUP’s Emergency Service. But his ultimate food find was at BerryBrook, our place in Vermont: a treasure trove of fresh deer parts discarded by hunters. The biggest, a deer leg put up into the crook of a tree by DC, was religiously visited thereafter by Berry. Deer Hoof is now a place name there in the woods, always to be associated with Berry.

The Call of the Wild

Berry was a dog’s dog, determined, persistent, and always up for the hunt. For all that he loved his family and his home, if Berry got loose, he was gone, a dog on a mission. He escaped at the most inopportune moments, always to pursue his private canine agenda.

It took a year for Berry’s foster mom Lois to tell us how she had learned that Berry "liked to scoot out". It turned out that on the very day in 1999 when we agreed to take Berry home once the Rescue's paperwork was completed, Berry escaped from Lois. After we had gone home, as Lois opened the door to Halloween trick or treaters, Berry slipped out and ran across the busy street, careening in the darkness among the kids with their bags of goodies and up into the light of neighbors’ porches. He had been with Lois less than 10 days, and she said she wondered how she would explain to us that she had lost our new dog before we had even taken him home.

During the holidays, we always took time to thank Berry’s friends at VHUP. With Berry dressed as a reindeer and my hands full with his leash and presents, we went down to VHUP one December afternoon. I hadn’t learned from Lois’s Halloween story and made two mistakes that nearly took a tragic turn: I took Berry’s regular collar off when I put his holiday costume on, and I did not secure the backyard gate as we left. Neither would have mattered if I had retraced our steps and closed the gate when we returned home. But by then it was dark, so we came in the front door instead of the back. And after removing Berry’s costume, instead of putting his collar on, I was distracted by a wreath that needed to be moved to the back porch. I opened the back door and, in the moment it took to carry the wreath ten feet, Berry was gone – out the door, out of the yard, into the city, in the dark, with no identification whatsoever.

Seized by sheer panic, I jumped in my car. "THINK LIKE BERRY!" my brain screamed. "Head to Greg’s, for Cody’s duck!" As I crossed the major street in our neighborhood, along which the trolleys run, I glimpsed Berry running west along the sidewalk – at full throttle, tail aloft, oblivious to the danger all around him. I quickly turned the car, but he was gone. I searched frantically at Greg’s, and everywhere in between, enlisting neighbors’ help, but no Berry. After all our efforts to save Berry from lymphoma, I had lost him through sheer carelessness! Empty handed, my panic deepening, I circled home, praying he would retrace his steps. There on the front porch was Berry, full of glee, in the arms of our neighbor Bernadette, who had found him running up the middle of our street, toward home, and called his name.

Just as Lois did not tell us about Berry’s Halloween escape, DC didn’t tell me about Berry’s Chester Avenue trolley chase until after Berry’s death. Berry loved the Dog Park, but over the time he went there, he became MUCH MORE interested in its proximity to the trolley line than the other dogs. At the first sound of an approaching trolley, Berry would rush to the front of the park and position himself at the appropriate end of the fence to greet the east- or west-bound trolley. Then, as the trolley trundled by, Berry would follow its path, and, reaching the far end of the park, would bark – arf, arf, arf – not alot, maybe about three times, but enough to dispatch the trolley on its way. If the trolley was eastbound, he would often turn and run to the side gate of the Park, just in case it was open and he could escape and actually chase the trolley down Chester Avenue. The gate had only been open once, of course, but the concept had lodged in Berry’s brain.  This was the type of  thing he was really good at remembering

As Berry enhanced his trolley-guarding skills at the Park, he became more attentive to them in other settings. At some point after Berry’s Christmas adventure on Baltimore Avenue, I realized it hadn’t been about going to Greg’s house – it was about chasing the Route 34 trolleys along the Avenue. If we passed a trolley on the way to VHUP or the Park, or while walking in the neighborhood, Berry stood at attention. We learned that if we arrived at the Park and a trolley was approaching, it was best to wait until it had departed before opening the car or there would be a struggle. So DC’s story, told during our first trip to Vermont without Berry – a long ride devoted to telling and re-telling Berry Stories – did not surprise me.

One afternoon, at the end of a good Park session, DC was loading Berry and Otto into the back of the station wagon, which was parked on the street perpendicular to the trolley route. In anticipation of closing the door, Berry’s lead went free, just at time moment when a trolley loomed in the disatnce. Suddenly. Berry was out of the car and dashing down the street, leaving DC with Otto and an open car. Running to the corner, DC watched aghast as the trolley moved rapidly down Chester Avenue, trailed by the barking -- not to mention ebullient -- Berry, his leash flapping along the street.. DC thrust Otto’s lead into the hands of a man talking with a friend on the street who (to DC's eternal gratitude) agreed to watch Otto while the chase for Berry preceded down the road.  A man in a car saw what was going on and (again to DC's eternal gratitude) said "hop in" and set off to catch the trolley.  30 seconds later the episode came to a joyful end.  The Trolley had stopped at a red light.  DC hopped out of the car and calmly picked up the lead as Berry barked joyfully at the back end of the trolley.  With Berry in tow, DC walked back to Otto, thanked his temporary dog watcher friend.. Soon, the trio was ensconced in the station wagon and headed back home.

The trolley passing by represented the "Call of the Wild" and Berry heeded the call when given the chance.  But he willingly rejoined DC as soon as his lead was picked up.  No regrets.  Just a great memory that we're sure was relived with great joy in many of his doggie dreams.... 

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