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Forrest's Road to Recovery
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The Rainbow Bridge



Member Since:
25 April 2007
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21 December 2023 - 12:14 pm
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Kati, you are so right, it's really exhausting to be so up and down. Your final note shows you are adapting a really great attitude:

Fingers crossed this strategy works of just waiting till he says it's time to move and lean into R&R, massage, hot and cold compresses, etc in between.

YES! I think the reduced Gabapentin dosage will help him get that balance between pain relief and sparkle. It just takes time.

We recorded a new tripawd talk yesterday with the president of the International Veterinary pain management Association, Dr. Grubb. We asked some questions with you and Forrest in mind. Rest assured, what you are going through now is really normal and not unusual, even when we described what's happening to Dr. Grubb. I will try to get that recording to you by tomorrow, stay tuned.

Just a quick thought, and you probably answered this before, but he doesn't have any signs of incision infection does he? His behavior doesn't sound like it but I thought I'd throw that out there.

That's a good cannabis product. But I believe the Brighter Days Cannabis Oil manufacturer has gone out of business. Stock up on it.

Virginia







Member Since:
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22 December 2023 - 10:55 am
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Forrest's Fan Club checking in on him.....and you ♥️

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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22 December 2023 - 2:20 pm
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Thanks for checking in Sally sp_hearticon2 and Rene, very much looking forward to listening to the talk with Dr. Grubb - thank you for thinking of us! 

As for the incision infection, no concerns there - when we went in to have Dr. C take a look at his back leg limp he mentioned the incision is healing very well. He has barely even had any bruising. 

Yesterday was another day of ups and downs... he is sleeping a ton right now, I'm not sure I'd call it "lethargic" as when he wakes up he is alert and doesn't seem as heavily medicated as he was on the 600mg gaba dosage, so I think we've made the right call to reduce the gaba during the day. However, his is still barely wanting to get up and move around. I'm having to bring his food and water directly to him and he won't stand up to eat, will just eat lying down. I'm adding lots of liquid to his meals because he's not too keen on plain water right now.

Before bed we felt like he was possibly showing some more pain signals after a full 24hrs of only 300mg every 8 hours, so we decided to give him another 300mg for his evening dose in hopes he'd be comfortable throughout the night. He made his way into our bedroom to sleep which he hasn't done since coming home from surgery and wasn't super typical before surgery either. He was breathing pretty loudly and though not outright crying, there was an underlying drone of a slight whimper and this went on for nearly an hour before we decided to try and give him the metacam again since that was the only thing he'd been getting every night previously but hadn't had that evening. He quieted down pretty well after we did that. 

This morning he was pretty tired, didn't show any signs of wanting to get up to go outside/eat/get water. I added chicken, rice, greek yogurt, bone broth and water to his breakfast to entice him to eat (which he seemed quite eager to eat.) When I gave Dr. C an update this morning he said that Forrest seems a bit more down than typical for this stage... he's a bit concerned with his appetite - he felt that even when the dog isn't getting around so well, their appetite is usually still decent without needing enticing. He has asked us to stop the metacam until his appetite improves and wants us to try the methocarbamol, so I'm going to pick that up today. He is still drooling a bit more than usual/licking his lips, and I've noticed there will be larger wet patches on his bed under his nose (which has been dripping a bit)/jowls after he has been sleeping in one position for a period of time. 

After his breakfast, we brought Forrest outside (with some prompting) and he had a big pee. We then sat outside for about 20 mins and he seemed to like the fresh air. He was starting to shake a bit (even though it's like 10 degrees celsius outside) but when we tried to take him inside from the backyard, he showed hesitation and wanted to go around the front of the house - to our surprise, his gait seemed a LOT better once he started moving (not as strong as the first few days and still favouring that back left leg, but his tail was wagging again and he was moving on his own reasonably well). Once he got to the front yard he had a big poop - seemed a little wobbly after that, laid down outside for a few minutes and we then got him inside where he is now resting in a patch of sun on the floor. 

I've read the articles about depression, but I'm starting to wonder if that is playing a big role here. He just seems so sad - no interest in his toys, doesn't want his bully chews, hit or miss if he'll seem excited/greet us when we get home, and often just looks really down. It's heartbreaking. I just want my best friend back. smiley6

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23 December 2023 - 2:49 pm
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I'm scared to say it, but... I think we may have finally turned a corner?? I don't want to get my hopes up too high, but Forrest is doing a LOT better than he was! He was showing some glimmers of improvement yesterday throughout the day, but it was after we finally got our hands on the methocarbamol and gave him 750mg at 5pm yesterday that it seemed to really make a huge difference. About an hour after administering, he was resting really peacefully and I could see him stretching out those achy back legs that he had previously been keeping tucked in pretty tight. He wouldn't let me fully extend them even 48 hours ago, so this felt like a really good sign. 

His appetite is also coming back quite strong, really pleased with that! He is eating his kibble without me needing to add anything more enticing (though I've been giving him half a serving with water added to make sure he hydrates and will eat that without prompting, and then after I do a 1/4 serving of kibble and add some good stuff like boiled chicken, yogurt, and bone broth!! he looooves that). My only concern there is that he isn't going for his water bowl much at all, but he is finishing all the liquid I'm adding to his meals so hopefully that is ok for now. He is peeing normally, so I'm trusting he is getting enough! 

Today has been a total 180 - for the better! He is smiling, wagging his tail, and when he went outside this morning his mobility was REALLY good. Trying to keep him from overdoing it again, but he was really eager to do a small lap around the neighbours house and was getting on great. Can still see a hint of the back leg being favoured, but leaps and bounds from where he was before the two doses of methocarbamol he's now had. It finally feels like we've cracked the code - 300mg gabapentin 3x/day and 750mg methocarbamol 2x/day. Fingers crossed this continues to provide him with the right mix of pain management and helps relax his sore muscles. 

Here's a video of his jaunt around the neighbour's house - don't worry, this only lasted for a minute before we had him back taking it easy! 

On the mend ❤️

He'll still show some pain signals (a little whimper maybe) an hour or so before his gabapentin dose is due, but overall he is a lot better than he was and in those instances I'm just giving him the pill a bit early to stay ahead of the pain. The nausea signs seem to be mostly in check, but occasionally he'll start drooling a bit more again and seemingly have the hiccups? Any concern to be had there? Here's hoping for daily improvements throughout the holidays. Merry Christmas to all who celebrate!sp_hearticon2

The Rainbow Bridge



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23 December 2023 - 5:04 pm
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Kati, he's doing a lot better that's for sure. It's good to see him getting fresh air and being more enthusiastic about food. You sound good too! 

The nausea and drooling .... I'm wondering if it could be GERD from something he's eating? See:

How to Help Symptoms of GERD in Dogs

 

Yes, stay ahead of that pain as you are doing, it seems to be working. Also, now that he's more enthused, see if he will eat without being hand-fed OK? A little tough love can go a long way. He might be at that stage where he will benefit from a tiny bit, just to see if it helps this improvement continue (paws crossed!).

I have to run now, sorry for the quick note. Will be back tomorrow.

Merry pawlidays!

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28 December 2023 - 11:54 am
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Hi all! A belated Merry Christmas to all who celebrated, and a Hoppy Pawlidays in general smiley4

Haven't updated in a bit, we took a few days off to just try and be present - turn off the computers, put down the phones, stop with the doom-scrolling and fervent research (okay, maybe that one was just me...) Forrest is doing better every day so it was lovely to just stop and enjoy it for a while. We had a really nice Christmas, Forrest was acting like his old self -- begging for ham and turkey at my feet during the holiday dinners, he showed us he could get back up on the couch no problem, he started playing with his toys again and just in general his personality has really been coming back. He even unwrapped his gifts himself like he has done in years past, always brings such a smile to my face! 

We had his official surgery recheck/suture removal yesterday and all went well. The incision is healing really nicely. We also got the histology back from the tumor/leg that was removed - confirmed osteosarcoma, but a positive is that there was no sign of cancer in the lymph nodes which is GREAT! Unfortunately Dr. Crawford wasn't in yesterday, so we saw another surgeon at the clinic who was equally lovely. She did have some suspicions that the back left leg injury might be cruciate related, but said if it is it's very early stages and likely a partial tear. She's hopeful that continuing to take it easy with him and reintroduce exercise slowly could allow for whatever is going on to heal on its own. We're also cleared to start rehab as soon as possible, so we're looking into what is available for that. We'll continue him on 300mg gaba 3x/day until end of the weekend then try weaning him to 300mg 2x/day, in combo with the methocarbamol for another week or so. We're bulking up his supplements as well, here is what we've got him on:

 

Fortify CBD 1000 mg - 0.5ml daily (@Rene - I spoke with the people we buy this from and they confirmed that Brighter Days is still producing, so fingers crossed we're good here!)

Myos muscle formula - 12g daily (He LOVES this stuff - very eager for his meals with this addition)

Omega 3 fish oils - 2250mg daily

Cosequin - 2 pills daily 

 

I'm also going to look to add a mushroom complex in to help with his immune system. Very open to suggestions! His appetite has returned to normal and he isn't showing many signs of nausea anymore, so glad to have sorted that out. 

The only last update I've got is that we were able to snag an earlier chemo consult, so he is now going in for his first treatment (assuming his labs suggest he's a good candidate) on January 3rd! Our original appt wasn't until the 16th, so we're happy to have gotten in sooner. Will keep you all updated on how he does with chemo, crossing our fingers he tolerates it well. He's such a strong, brave and resilient boy. 

Here's a couple pics/videos from the holidays I thought you might enjoy. Scroll through as I bulk uploaded! 

Christmas pup!

Opening presents!

 

Thanks for everything as always, so incredibly grateful for this community. Wishing a wonderful start to 2024 for you and yours!

Kati, Jamie & Forrest sp_hearticon2

The Rainbow Bridge



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28 December 2023 - 12:34 pm
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Awww the hoppiest of pawlidays to you and Forrest as well! LOVE the video and photos!!

I'm so glad you were able to focus on being present the last few days.

But seriously what a RELIEF everything is on a pawsitive and upward trajectory! And an earlier chemo appointment too? Dang the universe is really looking out for you guys. So happy to read this, thanks for letting us know. smiley_clap

Yes, even partial tears can be medically managed in many cases, especially in dogs who are not giant breeds like Forrest. Our Jerry had a suspected partial tear as well. It's what got us on the road to learning about rehab therapy's benefits. So yeah, take it easy and slow, he should do fine!

Interesting about Brighter Days. I'll let you know if I hear anything differently from my cannabis colleagues. 

Have a great day!!!

Virginia







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28 December 2023 - 3:16 pm
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  Forrest was acting like his old self -- begging for ham and turkey at my feet during the holiday dinners, he showed us he could get back up on the couch no problem, he started playing with his toys again and just in general his personality has really been coming back. He even unwrapped his gifts himself like he has done in years past, always brings such a smile to my face!  

This gave us all a big smile on our faces!!😁   The videos made our smiles  even bigger....if possible!☺   Forrest is quite the gentleman  when it comes to opening his Cristmas presents.  He did it with such focus and precision.   😎

Goodness knows you are doing everything  possible to keep Forrest fit, happy and with a strong immune system. Such a lucky boy to have such strong, loving, devoted  advocates for him.

Thanks for the Merry Christmas update and happiest of New Year tomyou all.

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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4 January 2024 - 10:12 am
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Hello and Happy New Year from Forrest and family! 

A few updates to share - first and foremost, Forrest is still doing well overall. His back leg with the suspected partial cruciate injury is getting on same as before, doesn't seem to be getting any worse, so we're hopeful that with continued rest and gradual increases to exercise we can keep any further degeneration at bay. We also have his first rehab appointment (Rene, we decided to go with Boundary Bay for this as well) next Tuesday, Jan 9th. He'll go 2x/week for the first couple weeks, and after that I'm not sure the exact frequency but would imagine maybe weekly/bi-weekly. They have hydrotherapy, cold laser, therapeutic exercises, electrotherapeutic treatments, etc all available. We've also been able to reduce his gabapentin to 300mg 2x/day in addition to the methocarbamol 750mg 2x/day, so happy about that. We'll keep it consistent for another week or two and then try drawing down further.

The second big update is that Forrest had his first chemotherapy appointment yesterday! We're working with Dr. Herrera at Boundary Bay and she seems fantastic. She has recommended 4 rounds of Carboplatin with CBC recheck between the 10-14 day intervals after minimum his first 2 doses, but can discontinue those rechecks if he's not showing any concerning WBC/platelet drops. We'll also do a recheck lung xray ~3 months after his initial diagnosis, which would bring us to early-mid March. She also has sent a referral to BARC in Seattle for us and I'll be calling them today to inquire about getting Forrest into the Yale vaccine. It's low cost and she said she has a few dogs that have done it, and no side effects to note, so may as well give it a go, right? 

Little less than 24hrs post treatment and Forrest doesn't seem to have any major side effects yet - he's had 3 meals and not shown any aversion to eating. He's a bit more tired today, but he was restless throughout the night so I'm not surprised. Wondering if he was maybe a tad nauseous overnight and unable to settle as a result, but hard to say for sure since no signs of it this morning. We'll cross our fingers this continues and his CBC stays strong. 

The last update I'll share is one that is very close to my heart... prior to Forrest's initial diagnosis, his bloodwork showed moderately elevated ALP (alkphos/alkaline phosphatase) which, for anyone who has done as much research, reading, obsessing as I have, you'd likely have come across the literature that high ALP can be a poor prognostic factor for dogs with osteosarcoma. Initially I spent many hours mentally spiraling over this, searching the forums for stories of dogs that had high ALP and went on to beat the odds (didn't find much). So when speaking with Dr. Herrera yesterday, we asked about it and she explained that the thinking here is that if the ALP is high, it could mean that the bone breakdown associated with OSA is causing elevation in B-ALP (bone alkphos, different than the liver ALP). If the ALP stays high following the amputation, it could mean that there is evidence in the body of additional bone breakdown that is perpetuating the increase, i.e. bone metastasis that they cannot find because it hasn't fully come home to roost yet. This is why dogs that continue to have high ALP following amp tend to fare worse because it likely means there is more cancer in the bone that they didn't remove and disease progression would be faster. Of course, ALP is also associated with any number of liver enzyme changes and elevation can happen in aging dogs regardless of an OSA diagnosis, so it's not been confirmed as a guaranteed negative prognostic indicator. 

All that to say, we had them retest his ALP during his bloodwork pre-chemo yesterday... and Forrest's ALP has returned to completely normal levels!!!! I know we can't know for sure that this means he won't fall into the subset of dogs who fare worse because of this indicator, but in some ways (and in combination with clean lung scans, clean lymph nodes from the histology), it feels like a step in the right direction. It's a glimmer of hope, and I'm holding onto that for dear life. 

That's all for now, still just living day by day. Forrest has been more hyper the past few days and wanting to play with his toys with us which puts a big smile on my face. I can tell he is itching to get in the car and "go somewhere" (he has always associated the car with his favourite walks on the beach, hikes, etc.) Maybe we'll drive him to the beach this weekend, even just to smell the ocean air if we can't walk too far just yet. 

Hope 2024 is kind to you all, thanks as always for being on this journey with us sp_hearticon2

Kati, Jamie & Forrest 

Virginia







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4 January 2024 - 10:50 am
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Way to start off the New Year with a good update from Forrest!!!  And I think this definately  calls for a trip to the beach.....with pictures and video please!!

Thanks for sharing the information about ALP levels. Yeah, not a definite conclusion on what an elevated level means anynore.

But what is definite is you have nothing to worry about as his levels are okay!!👏👏

The fact that Forrest's cruciate situation is no worse, to me that's pretty darn good news.

Now take this FWIW, okay?  It's my understanding that, when trying to resolve a cruciate issue conservatively, one thing you don't want for a vet to do is to constantly move and rotate the knee to check progress. THis can undo some of the scar tissue that was built for stability. Again, take that FWIW..   If I recall, I was told this by a rehab specialist, or maybe even my vet, not sure which.

You have every reason to have some hope and all the signs are definitely a step in the right direction! Give that sweet boy some extra treats for us, okay?

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Livermore, CA




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4 January 2024 - 2:00 pm
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What a great update!

Looking forward to a report about the rehab visit- I know it did wonders for my little rear amp Tripawd after she hurt her remaining hip.  Elly has been on three for more than 8 years, she is now 9 years old.  She lost her leg after a car accident when she was 7 months old.

I don't remember if I mentioned this before but you might ask the rehab vet about a muscle supplement called Myos. Of course check with oncologist also, sometimes they don't like diet changes during chemo.  Elly didn't really start to improve until she started taking it, it might help Forrest build strength in that leg which would help.

 

Karen and the Spirit Pug Girls and Boy

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

The Rainbow Bridge



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4 January 2024 - 5:55 pm
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WOOHOO! smiley_clapWhat a way to kick off the year, I'm so happy things are on the upswing today and he's staying there even with chemo. YAY!

You do such a great job reiterating what the vet has suggested. Do you take a lot of notes during your conversations? It sure seems that way, and we appreciate that because we learn so much--especially about the ALP! If you ever want to write a guest blog post about that topic hint hint smiley2. You're right, because we focus more on the actual amputation/recovery than cancer challenges, there isn't a ton of info here. But every bit helps so thank you for sharing that info. I'm glad that you have one less thing to worry about. 

Good move on sticking with Boundary Bay for the rehab and chemo! It's nice to have access to so many specialists and all under one roof. So much of this journey is about relationships and having them all in one spot is awesome. 

I hope you guys get to go on some amazing adventures soon! Can't wait for those pics. You're almost ready!

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5 January 2024 - 8:54 am
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Thanks for all the responses, lovely to hear from you three! 🙂 Forrest and I are so appreciative to have your ongoing support. 

@sally - the comment about not rotating the knee too much makes total sense to me! I had actually been doing a bit of that myself the first few days in trying to identify where the pain was coming from, and I've since stopped doing that and instead focus more on just gentle massage from whatever position he's holding his leg in comfortably. Seems to at very least relax him, if not directly help! 

@karen - We're also very excited about Forrest starting with rehab! Really the only remaining concerns I have right now for him are his back leg, as well as some possible phantom limb pain he's been showcasing since we decreased his gaba dose 4 days ago (I've reached out to our surgeon, Dr Crawford, for insight about this and whether we should return to the higher dose until it subsides). Funny you should mention Myos, we actually have had him on this for about two weeks now! Not only do I think it's helping his back leg, but he also LOVES the taste!! When he was having a poor appetite for a few days previously, it was one of the first things that really started getting back to eating and drinking normally from his bowls vs. me hand feeding him. We'll absolutely be keeping this in his daily regiment! 

@rene - thanks for the kind words!! I don't take any notes when we're with the vets, but I spend an inordinate amount of time doing my own pre-research so I think the terms and specifics stick in my head a bit better as a result. Not sure I'm fully qualified to write a blog about the ALP stuff or what is required for those, but you never know, could give a crack at it! I know it was a big mental burden for me during this process, so if it could help anyone else feel more reassured or educated then I would be happy to consolidate whatever layman's knowledge I've acquired thus far. 

Re: the phantom limb pain - we changed Forrest to 300mg gaba 2x/day vs. previously 3x/day back on Jan 1st. Since then, we've observed a few times per day he will let out a little yelp and get up from resting quite quickly, or absent the yelp but still jump up quickly with ears pushed back. The last two nights since his first chemo dose he also has been quite restless, wandering from room to room and seemingly unable to sleep comfortably for long periods. It's quite disruptive to both me and him, clearly! Outside of these episodes though he seems quite comfortable and doesn't show any signs of localized pain when palpating over his body, incision, back legs, spine, etc. As mentioned, I sent an email to Dr. C this morning to get his advice, but do you think it would be prudent to return him to 300mg 3x/day since he wasn't showing the phantom pain at all on that dose? 

Pics from the beach to come this weekend for sure! sp_hearticon2

The Rainbow Bridge



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5 January 2024 - 3:54 pm
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Hmm I would wait to see what Dr C says about the gaba, but it seems like if he wasn't having those phantom pain symptoms at the previous dose then going back to it makes sense.

Hey anytime you are ready to write about the ALP findings that you discovered we are game for it! No pressure though, I know you have your hands full. You really do a great job with the research so you can have productive convos with the team. Bet they really appreciate it.

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19 January 2024 - 12:25 pm
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Hello Tripawds Family! Hope everyone is doing well. Wanted to let you all know that Forrest is doing great, detailed updates below.

Rehab: He started rehab on Jan 9th and is going in for his third session later today (was supposed to have two this week, but we got a big snow storm this past Wednesday and had to cancel as the roads were treacherous). In the sessions they are using therapeutic ultrasound, cold laser therapy, and the water treadmill. I asked about exercises for us to do at home but they didn't give us a whole lot... basically just getting him to go from sit to stand repeatedly?? To be honest, I'm not sure how much benefit we're going to get out of this, but we'll keep at it as we bought a 10 pack. Not cheap!! Vancouver/BC is just such a dead zone for good rehab facilities, seems almost no vets are CCRP/CCRT accredited which is a real shame. That said, the Myos supplement I think is helping a LOT - he really isn't showing much sign of pain in that back leg at all now, and one of the surgeons took another look during his first rehab appt and felt the cruciate was quite stable. 

Chemo: Forrest has done remarkably well with chemo - no nausea, GI upset and his WBC stayed within range on his first CBC. His platelets dropped to about 94,000 u/L (normal is 150,000 - <60,000 is cause for concern with increased risk of hemorrhage). He did have a small mysterious bruise appear on his abdomen shortly after the bloodwork which panicked me a bit given the low platelets, but it was really just the one and seemed to be somewhat trauma induced (had a small scabby area). We discussed with his oncologist and decided to employ a 'wait and see' approach, which proved fruitful and it healed up within 48 hours and no further bruising. Seems to be coincidental. We did opt to get his CBC bloodwork rechecked with his primary vet because it's way closer for us, but I sincerely regret that decision. I was VERY firm with them when I booked the appointment that our oncologist said we could only get the bloodwork completed by our vet if they were highly confident they could a) get us the results within 24 hours, and b) properly interpret the results and advise action as needed. They said they could do that no problem, and then when we got to the appt they said they wanted to send the bloodwork out to the pathologist to review instead of doing it on site and we likely wouldn't get it back for 48 hours as a result?! I was FURIOUS because it's extremely time sensitive if the WBC count showed signs of blood sepsis/infection. I pushed them to review onsite same day but I ended up having to send the result to Boundary Bay for an urgent review since they couldn't tell us much about the low platelets and what to watch for!! Will NOT be doing anything else with them related to his cancer care, and quite frankly might be looking for a new primary vet (this isn't the only time they've caused issues for us in his healthcare). 

Phantom Pain : We got confirmation from his surgical team that, though it is very rare, they believe Forrest is indeed suffering from phantom pain complex. They discussed a recent retrospective that suggested 20-25% of dogs experience some level of phantom pain post amp, and the more extensive cases of this (such as Forrest's) are best treated by slightly higher and consistent gabapentin dosages for 2-3 months, followed by a weaning period. We had some tough days figuring out the best cadence/dosage, but we've landed on 300mg 5x/day (5:30am, 10:30 am, 1:30pm, 7pm, and 9pm) - a bit random, but it seems to be minimizing it to maybe 3 episodes per day and FAR less anxiety in the evenings which is helping all of us sleep better!

What's Next: Forrest is headed across the border to BARC Seattle to receive the Yale vaccine on Jan 23rd! He will be getting thoracic xrays before treatment to ensure he is still not showing any signs of mets, so crossing our fingers for good results from that. Will keep you all in the loop. 

Other than that, he has been wanting to be a LOT more active lately so we've been taking him to our local dog park to play with his buddies in the evenings which he loves. He is running and playing with the best of them! He lies down for a break as needed, but it's truly astounding how mobile he is. No one can believe he is only 5 weeks post-op and he is so much happier getting the stimulation and socialization, which has been really great for our mental health as well. 

Here's some videos of his first time on the water treadmill - I'll post some pics/videos of him running through the snow later this weekend. 

Water treadmill

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