2.  Avoid cell phone usage at all costs!  If you need to retrieve phone numbers or information from it in order to complete the application that is fine, but put the phone out of the way immediately after getting the necessary information.

3.  Your cell phone ringer should be off before you even get into the office.  Do not listen to ipods or mp3 devices, even while sitting in the waiting area.

4.  You do not have to wear a suit when applying for general labor work.  But your clothing should not be tight, revealing, dirty, ripped, feature cuss words or pornographic images.

5.  Use your manners, be respectful and do not talk over anyone at the place you are applying to.

Rant 1.  A young man comes into the office on his cell phone, dressed in jeans and a worn out white t-shirt.  He stands in front of my desk grunting into the cell phone, looking around the office, acting like nothing is going on.  I completely ignore customers who do not give me their attention, but I can sense he is looking at me.  Then he says into the cell phone, “Dis a white lady behind the desk.”  He then hands me his cell phone.  After I don’t reach out and take it, he asks if I could talk to this person.  I ask who is on the phone and he, after pausing and looking confused, says “uh, it’s uh…I don’t know” and mumbles some more.  I take the phone and ask who is calling to which the reply is  a 30 second long explanation that the guy knows one of the managers here.  THEN he adds that he used to work here.  Finally, he adds his name.

The one on the phone continues on about the manager’s instructions that we schedule an appointment with this gentleman at 5pm, and goes on and on about the same shit he’s already said.  He goes on that he used to work here and he is recommending this young man to apply.  I put an end to it by saying OK and giving the phone back.

They talk a few more minutes and after ending the call the young man stands in front of my desk and says nothing.  He just waits, looking stupid.  So I ask him if he has applied yet?  No.  I get an application out and escort him into the conference room where he will be out of my way to complete the application.  When he comes out, he continues standing around stupidly.  I tell him the manager will not be in today since it’s Thursday and schedule him for an appointment Friday at 5 pm.  This time slot is my preferred interview time because it takes the manager about 25 minutes to get through the interviews and since I leave at 5:30 pm I don’t have to hire them on the spot, even if the manager likes the person.

Rant 2.  I had just hired a young lady, about my age but much taller.  Very pretty girl, but wore clothing which would have made me blush to wear.  After she was finished with her paperwork, she asked if she could buy a couple t-shirts to wear to work (we give all employees  an apron, but if they prefer t-shirts they can buy one for $5).  I brought her two shirts and told her it would come to $10 total.  She reaches into the skintight cheap slut dress she is wearing and pulls a twenty out of her very-visible bra.  My mouth falls open and my upper lip rolls in disgust.  The bill is sweaty.

I can’t get into a credit math class yet because my placement test scores are so low.  In fact, I have to take Mat101 and Mat102 before I can get Mat110 for credit; this would eat up two semesters before I could take a for-credit math class.  I am thinking seriously about taking Peter up on his offer to help me study in order to retake the test and get into a better class.  The issue is that I was never that great in math and I’m afraid that if I don’t truly understand the basic concepts I will fall behind and never catch up.  Then I won’t be able to understand Chemistry and go on to be The Greatest Scientist in the history of the 4.5 billion year old planet!

So I called Dad.  He says that once you “Get IT” it just makes sense.  He was super at math and always excelled at it; I don’t remember ever liking it and quite possibly just gave up on it because I didn’t care.  I wish I’d gotten that math-ability gene from him.  Then again maybe it is inside me, it has simply remained dormant.  Dormant until now!

So he thinks I should go for retesting after packing in some condensed cram sessions with Peter.  After talking to him, I feel better about this, about my dormant math-abilities.  I texted Peter to bring me home some math for slow students workbooks (I know I’m not slow! just dormant) today so I can retest this week after work some night.

On a side note, I feel so excited at just having talked to my advisor, “Thompson”, because he is going to register my english class tonight or tomorrow. YAY!  After discussing with half-asleep Peter the other night, I decided to take both classes on Tuesday and Thursday nights so I will have the other three weeknights to study and study and study, respectively.

I recently started reading The Disappearing Spoon and Other True Tales of Madness, Love and the History of the World from the Periodic Table of the Elements by Sam Kean.  What a fascinating book!  I am halfway done with it after only two days and I can’t put it down.  I very highly recommend this book!

So he’s been on the Wisconsin Protocol (WP) since February, when we initially found out he has lymphoma.  It was going extremely well all this time- his lymph nodes shrunk to normal, no tumors detected inside his little body. He had normal appetite and energy, was his usual pre-cancerous, loving, sweet little boy-self.

A few weeks ago, suddenly, the vet detected his lymph nodes were growing and semi hard.  After an ultra sound and a follow up, they gave him Vincristine.  No progress.  They gave him Doxorubicin, which is the strongest drug on the WP.  Today was his follow up to that and no difference.  Apparently, he has stopped responding to any of the drugs on the WP.   They have decided to give him Elspar, in hopes that this drug will help bring his lymph nodes back to where they were a month ago- normal.  This was not the scheduled drug this week, though it is still a part of the WP.  I understand that Elspar isn’t a strong drug, but it targets the lymph nodes, so we’re hoping that it does the job.

Krisann will pick him back up in a few minutes along with a lot of literature on three Rescue Treatments we will decide between.  One of them is Mustard Gas, it is given every other week and costs $700-$800 per treatment.  Now, this is financially out of the question for us.  Even if we could afford it, it sounds terrifying and we wouldn’t be likely to choose it.  Whatever we decide, it will begin on Friday.  The other two options for Rescue that we have are administered every 3 weeks.  The drugs are very strong, and have side effects to the liver that prevent them from applying large doses, or more often than at three week intervals.  I am a little concerned because Atticus has had liver troubles in the past.

What sucks is that the cancer got used to the drugs we used so quickly.  It’s scary how cancer functions and ravages a tiny little dog like him.  Cancer is a scary word in this culture.  But  understanding how it works and what drugs do to it, how it works in the body- at least the very little understanding I have picked up from this experience- it is so heartbreaking, absolutely terrifying, I just HATE it.   It has brought me to the conclusion that every other time in my life that I used the word HATE, I was mistaken.  I have never HATED anything before, but I HATE those cancer cells.  I hate the way they grow so quickly, and how they spread to his organs…

I put my palms on him and quietly think positive thoughts and send him my immunity to help his immune system fight harder.  I think he just enjoys the attention- his tail is always wagging.

Oh, he is doing so amazingly well!  He could seriously be the poster boy for Doggie Chemo.  He has completed his first full course of the drugs and last week was his break week where they only ran his blood counts, no drugs.

On the 15th (just this past Tuesday) the vet praised his progress and his lack of side effects from any of the drugs.  He got a higher dose of Vincristine that day and other than a slightly lighter appetite, he has been fine.

We bought him a huge ball to play with (he likes those huge rubber ones that are at lease 2′ in diameter) and he got so into it last week he popped it!  He is chasing the cats all over, sleeping under the covers when it’s cold, drinking water like a sponge…

He is an amazing dog and we are SO proud of him.

So, cyclophosphamide- the vet gave it by mouth. They gave us a Diuretic to encourage him to pee and prevent the side effects discussed below (excerpt from Lymphoma: Which Chemotherapy Protocol and Why? by Ruthanne Chun, DVM, Dipl. ACVIM (Oncology):

Cyclophosphamide, an alkylating agent, may be administered
orally or intravenously. When given orally, absorption
is excellent and bioavailability is as good as with intravenous
administration. The potential for myelosuppression and gastrointestinal
upset after cyclophosphamide is moderate. The
specific side effect of major concern with cyclophosphamide
is sterile hemorrhagic cystitis (SHC), which occurs secondary
to elimination of irritating metabolites through the urine.
SHC may occur after oral or intravenous administration.
This side effect is not cumulative; it may happen after the first
dose of cyclophosphamide. Because there is no effective treatment
for SHC, prevention is key. Administration of a single
dose of furosemide at the time of cyclophosphamide is reported
to greatly diminish the development of SHC. Also,
simple management issues such as allowing the patient out to
urinate frequently for 3 days after drug administration and
encouraging intake of plenty of fluids may prevent SHC.

The following excerpt is from http://en.wikipedia.org/wiki/Cyclophosphamide:

Cyclophosphamide is converted by mixed function oxidaseenzymes in the liver to active metabolites^[12]. The main active metabolite is 4-hydroxycyclophosphamide, which exists in equilibrium with its tautomer, aldophosphamide. Most of the aldophosphamide is oxidised by the enzyme aldehyde dehydrogenase (ALDH) to make carboxyphosphamide. A small proportion of aldophosphamide is converted into phosphoramide mustard and acrolein. Acrolein is toxic to the bladderepithelium and can lead to hemorrhagic cystitis. This can be prevented through the use of aggressive hydration and/or mesna.The main effect of cyclophosphamide is due to its metabolite phosphoramide mustard. This metabolite is only formed in cells that have low levels of ALDH.

Phosphoramide mustard forms DNA crosslinks between (interstrand crosslinkages) and within (intrastrand crosslinkages) DNA strands at guanine N-7 positions. This is irreversible and leads to cell death.

Cyclophosphamide has relatively little typical chemotherapy toxicity as ALDHs are present in relatively large concentrations in bone marrow stem cells, liver and intestinalepithelium. ALDHs protect these actively proliferating tissues against toxic effects phosphoramide mustard and acrolein by converting aldophosphamide to carboxyphosphamide that does not give rise to the toxic metabolites (phosphoramide mustard and acrolein).

The articles sound scary but Krisann says he he is peeing a lot and drinking a lot also which makes me feel good.

He continues to do really well, his appetite is endless, no unusual eliminations, no fever, rash, furloss…He is doing great on chemotherapy!

I didn’t notice any side effects after that.  His energy was ok, no fever, vomiting or diarrhea.  He does have room-clearing gas, which is a likely side effect from the chicken & rice we’ve been adding to his regular meals.

I wanted to thank Jen-Jen for the wonderful articles she emailed me.  They were packed with information about doggie lymphoma, diagnosis, treatment and outcomes…One article discussed the usage of doxorubicin and multiple other drugs (the chemo approach we have chosen for Atticus).

As expected, it has also been found that those dogs experiencing
greater side effects tend to have a better overall
response to treatment.
Body area has traditionally been used to calculate
drug doses, resulting in smaller dogs being given a higher
dose than larger dogs and, as such, tending to have better
survival rates.

I haven’t stopped thinking about this since I read it.  No, Atticus is not having side effects, but the side effects MAY indicate something stronger going on inside him- possibly working harder to combat the tumors.  On the other hand, he is small and may be getting a higher dose unless they are basing it on his body area…

This is something we need to discuss with the vet, whether we could increase his doses of medicines just a bit, but monitor him closely to ensure side effects are not inhibitive.  Some side effects are tolerable if it helps him in the long run.

But we are just looking for remission, not a cure; and I don’t want him to suffer.  Need to read some more…

How does this drug work?

Vincristine is a type of chemotherapy drug known as a vinca alkaloid. It is thought to work by interfering with cancer cell growth when they are dividing into 2 new cells. This eventually leads to cell death. Because cancer cells divide faster than normal cells, they are more likely than normal cells to be affected by this drug.

The following is from http://en.wikipedia.org/wiki/Vincristine

Mechanism

Tubulin is a structural protein that polymerizes to actin microtubules. The cell cytoskeleton and mitotic spindle, among other things, are made of microtubules. Vincristine binds to tubulin dimers, inhibiting assembly of microtubule structures. Disruption of the microtubules arrests mitosis in metaphase. Therefore, the vinca alkaloids affect all rapidly dividing cell types including cancer cells, but also those of intestinal epithelium and bone marrow.

Side-effects

The main side-effects of vincristine are peripheral neuropathy, hyponatremia, constipation, and hair loss.

Peripheral neuropathy can be severe, and hence a reason to avoid, reduce, or stop the use of vincristine. One of the first symptoms of peripheral neuropathy is foot drop: A person with a family history of foot drop and/or Charcot-Marie-Tooth disease (CMT) may benefit from genetic testing for CMT before taking vincristine.^[1]

A different asparaginase is marketed as a drug under the brand name Elspar for the treatment of acute lymphoblastic leukemia (ALL)^[2] and is also used in some mast cell tumor protocols. ^[3] Unlike other chemotherapy agents, it can be given as an intramuscular, subcutaneous, or intravenous injection without fear of tissue irritation.

Mechanism of action as a drug

The rationale behind asparaginase is that it takes advantage of the fact that ALL leukemic cells are unable to synthesize the non-essential amino acid asparagine, whereas normal cells are able to make their own asparagine; thus leukemic cells require high amount of asparagine. These leukemic cells depend on circulating asparagine. Asparaginase, however, catalyzes the conversion of L-asparagine to aspartic acid and ammonia. This deprives the leukemic cell of circulating asparagine.

Side effects in drug use

The main side effect is an allergic or hypersensitivity reaction; anaphylaxis is a possibility.^[2] Asparaginase has also been associated with pancreatitis. Additionally, it can also be associated with a coagulopathy as it decreases protein synthesis, including synthesis of coagulation factors (eg progressive isolated decrease of fibrinogen) and anticoagulant factor (generally antithrombin III; sometimes protein C & S as well), leading to bleeding or thrombotic events such as stroke.

I love reading this kind of stuff and figuring it out.  Understanding exactly what all these drugs are doing, how the cancer works, etc. makes me feel like I have a better chance fighting it.  Plus, isn’t it fascinating to think of how someone comes up with a drug that does this?  Who would even think of it??  Amazing minds…Thank you!!!

I am glad to have something to be optimistic about because a few days ago I was struggling to find a single happy thought in what seemed to me to be a bottomless pit of despair.  Krisann dropped him off this morning at the vet to receive “Elspar” (l-asparaginase) which he was supposed to get yesterday but they were out of.  She will pick him up after her shift at the coffee shop.  I will miss his renewed excitement when I come home from work but I think it’s a good time because the elspar can cause allergic reactions.  Since he will be at the vet all day, they will keep an eye on him until Krisann can pick him up tonight.

Giggles:

1. Turns out he is a total chemo-flirt!

2.And, we’ll have to start taking his temperature.  Not funny, you say?  We’re going to have to do it rectally!  I have a regular digital thermometer which can be used rectally.  And yes! I do have the little thermometer covers (condoms?) to prevent germs (or poops in this case) from transferring mouth to butt, LOL!

Teardrops:

1.  I was thinking about a wedding we have coming up in August and hoping that he will be here (even though we’ll have to send him to Mom’s for the trip.)

We have worked on a tentative budget and it is tough right now and will continue to be until these first two intense months are over.  The following months are going to be spaced out more and will be easier to handle.  I am so happy that we are able to do this for him- I realize that this is a luxury and not everyone with a pet who suffers from lymphoma is able to give them this opportunity, or sees fit to do so…I’m glad to have him around, doing so well.