Rusty's Cancer Chronicles

I have posted previously that Rusty had developed “Fanconi Syndrome”, which is an impairment in the function of the kidneys that causes certain compounds which should be absorbed in the bloodstream by the kidneys to be excreted in the urine instead. Fanconi’s syndrome is generally an inherited disease that affects the proximal renal tubule and causes abnormalities in sodium, glucose, calcium, phosphate and amino acid retention. The disease can also be mimicked by certain toxins and drugs (Chemo) that affect the proximal renal tubule and interrupt normal functioning.  Rusty is losing glucose, amino acids, uric acid and phosphate into his urine.  This explains his increased water consumption and frequent urination.  It also explains his weight loss as he is dumping nutrients into his urine.

A couple of weeks ago I sent an email to Dr. Gonto, who developed the Fanconi Syndrome protocol in 2003, to see if he had an update to his protocol.  I was not sure that I would reach or hear from him; boy was I surprised.  Dr. Gonto is an MD (surgeon) who has pursued treatment protocols for Fanconi dogs; he is currently is monitoring about 300 dogs throughout the world.  He responded immediately; we exchanged several emails and Dr. Macy sent Rusty’s test results for the past four months to Dr. Gonto.

I received this response today from Dr. Gonto “I agree COMPLETELY with where Dr. Macy has this dog and would change NOTHING”. He went on to say since Rusty had “induced Fanconi” that it would not be necessary to put him on any supplements, especially with his sensitive stomach; that we should “just watch and see”.  This was very good news for us; to have both Dr.’s in agreement with Rusty’s treatment protocol is very reassuring.  We will continue to monitor Rusty and Dr. Macy has him on a sixty day follow-up schedule for lab work, both for the Fanconi and to watch for the return of his cancer.

There was an article a few days ago from Dr. Susan Ettinger, (who is part of Dr. Dressler’s cancer treatment web site) from her attendance at the 2nd World Veterinary Cancer Congress in Paris; “A new side effect for Lomustine is being reported: kidney toxicity. We don’t yet know how common it is, but I will be double-checking for this in my own patients.”  I have offered to have Dr. Macy send Rusty’s test results and diagnosis history to her for evaluation.  Dr. Macy had Rusty on Lomustine for twelve months in the fight with his very aggressive cancer.  We are waiting for more results to come out, but this pretty well confirms that Rusty’s Fanconi Syndrome was “induced” from the Chemo treatments.

With the warmer weather, Rusty is drinking even more water; he is still only going out once during the night, but is very anxious when we get up at 5AM to make a run to his box.  The longest time we can be away during the day is 2 or 2 1/2 hours as he can’t hold it any longer than that.  One of the suggestions that Dr. Gonto made was that we should not use “Pill Pockets” in giving Rusty his pills; they have noticed that in some cases that the Pill Pockets neutralizes the medications.  I now use Velveeta cheese which Rusty eagerly waits for before his meals.  We are still feeding him three meals a day along with several treats and his weight has been stable for the past couple of months.

Rusty’s last check up, on March 9^th , was all good news; no sign of the cancer returning and his lab results showed that all of his kidney readings are at “normal” levels.  April 25^th will be the 27^th month anniversary of his amputation.

Rusty had his November monthly follow-up visit with Dr. Macy on Wednesday; Dr. Macy had decided last month to do more extensive tests on his liver this visit, as the test results have continued to decline over the past several months.  Rusty has also continued to lose weight, even with the increase in his meals, which was a concern to Dr. Macy.  Rusty had to fast before we took him in for the first round of tests; after his blood was drawn we took Rusty home and fed him double rations to get the liver, stomach, etc. functioning.  We took him back two hours after being fed for another set of blood tests.

During the past few weeks Rusty’s intake of water has increased dramatically, including having to go piddle during the night (like his Dad); we took a urine sample with us.  When they ran the tests on the urine, Dr. Macy and his tech came running out to the waiting room and accused us of “spiking” the sample, as the results were off the charts.  We obtained another urine sample, using their sterile container, when we took Rusty home.  When we returned, they ran the tests again and the results were still off the chart.

All of the tests were being sent to an outside lab for analysis and they hoped to have the results today.  We had an extensive conversation with Dr. Macy this evening, as the lab results identified two new issues that we now need to address.

Dr. Macy said that Rusty “flunked” his liver tests.  Rusty has a “mild portosystemic liver shunt”, which are abnormal veins that enable blood from the intestines to bypass the liver.  The effect is ammonia and other toxins are not metabolized or removed from the blood.  The majority of portosystemic shunts are congenital.  Rusty’s shunts are not serious enough to require surgery; we can offset the effects of the liver by feeding him small high protein meals several times a day.  No large meals!

Rusty has also developed “Fanconi Syndrome”, which is an impairment in the function of the kidneys that causes certain compounds which should be absorbed in the bloodstream by the kidneys to be excreted in the urine instead. Fanconi’s syndrome is generally an inherited disease that affects the proximal renal tubule and causes abnormalities in sodium, glucose, calcium, phosphate and amino acid retention. The disease can also be mimicked by certain toxins (see liver above) and drugs (Chemo) that affect the proximal renal tubule and interrupt normal functioning.  Rusty is losing glucose, amino acids, uric acid and phosphate into his urine.  This explains the increased water consumption and frequent urination.  It also explains his weight loss as he is dumping calories into his urine.  Fanconi Syndrome can be treated using potassium citrate along with other dietary supplements.

Rusty has to go back in tomorrow for a specialized test to determine the dosage of potassium citrate that he will need.  Dr. Macy is not overly concerned at this time as he thinks that he can control the liver and kidney issues with diet and medications.  Rusty has had his share of challenges during his young life.

The good news from this visit is there were no signs of the cancer returning; it has now been 22 months since his diagnosis and amputation.  Rusty has had the fewest number of episodes of vomiting and diarrhea the past few weeks since his battle with cancer began.  He has been off all meds and supplements and his appetite was normal; he was also happy, full of energy and looking his best since the amputation.  You would not suspect that something was amiss from looking at him.  Unfortunately, the next day after his tests, he again had another siege of vomiting and diarrhea; his weight has dropped to 30 lbs and we are feeding him four + meals trying to stop any more loss.

 

 

 

 

 

 

March 23, 2011

Friday the 25^th marks the 14^th month of Rusty’s amputation; it is hard to believe that it has been over a year since his battle with cancer began.  This update is a little more difficult for me to write as Rusty seems to be entering a new phase in his battle with cancer.

When we saw Dr. Macy in early January, things were going so well that he put Rusty on a three month follow-up schedule.  The only problem that Rusty had at that time was some elevated liver enzymes, which were attributed to the medications that Rusty had pilfered from a friend’s purse at Christmas.  Rusty enjoyed not having chemo treatments for the months of January and February we were glad that he was not suffering from nausea or diarrhea and his appetite returned to pre chemo days.  He enjoyed his walks & rides, but he seemed to tire more quickly than normal.

In early March Rusty began having bouts of vomiting and retching, his first episode appeared to have blood in the vomit, so we rushed him to our regular vet’ office.  (Dr. Macy lives in Colorado and comes to the desert twice a month)  It was 6PM on Friday evening and his regular vet was not in and he was seen by the only vet in the office, who seemed to be in a hurry to go home.  He looked at the vomit that we had brought in and said that it was something that he had eaten and gave Rusty a shot and put him on a bland diet for ten days.  Rusty continued to have occasional boughts of vomiting and when Dr. Macy was in town last week we took Rusty in to see him.

Dr. Macy did blood work on him, which the other vet did not do, and Rusty’s liver enzymes were off the chart; his initial diagnosis was most likely Pancreatitis.  Dr. Macy sent a vial of blood to a lab that specializes in Pancreatitis diagnosis and the results came back yesterday that it is not Pancreatitis, but inconclusive as to what is causing the elevated liver enzymes.  We are to keep him on the medications and strict low-fat diet that Dr. Macy prescribed until he is back in town on April 7^th.  Dr. Macy is not ruling out the return of cancer, but he is hoping it is a result of something else.  If there are no changes in the liver functions at that time, Dr. Macy will probably have us take Rusty to San Diego for diagnostic scans.

Obviously we are very concerned; we know that our time with Rusty is limited but he has been doing so well the past several months that we were hoping that his time with us would be closer to the three years of his original prognosis rather than the one year.

One of his medications can cause nausea and last night at 3AM I heard him making noises from the nausea; he got out of his bed and came over and licked my arm.  I massaged his tummy for 10 or 15 minutes and he seemed to relax and went back to bed.

I will update again after our next appointment with Dr. Macy on the 7^th.

This past month has been a very quiet period for Rusty; the most significant event, other than his big night, was his nine month Ampuversary on October 25^th!  He went in for his monthly checkup with Dr. Macy on November 5^th; the best news was that his blood platelets have not dropped any further since the previous visit.  The liver readings showed some degradation, but were still within acceptable limits.  His reaction to the oral Lomustine chemo treatments has been very positive; a little nausea the first morning and then back to normal.  He gained another pound this past month, which is six pounds since surgery, and Dr. Macy said that we had to hold his weight at this level.   Any further weight gain will begin to put stress on his remaining leg and joints.

With the days getting shorter we are going for our walks much later in the morning and earlier in the evening.  The cool nights (in the 40’s) are dropping the water temperature below the level that the solar heating can recover from during the day and the water does not warm up enough for us to swim.  I plan on installing a floating blanket tomorrow which should reduce the night time heat loss and we can get back to swimming, although Rusty does not seem to miss the swimming.  With the cooler temps Rusty is much more active but still runs out of energy fairly quickly; Dr. Macy says that this is pretty normal for the amount of Chemo he is on.

Last Saturday night, November 6^th, was Rusty’s big night with our presentation to the Sun City Pet Club.  Rusty’s Doctors and two of the techs joined us for dinner before the presentation; Rusty was so happy to see his Dr.’s in his home rather than in their offices.  After dinner we all went to the clubhouse for the presentation and Rusty worked the room greeting everyone and gave a kiss to all 58 pet lovers who had come to hear his story.  I opened with a PowerPoint presentation of Rusty from the time we first saw him at four weeks to current photos, showing that he has remained the same happy dog throughout his fight with cancer.

Dr. Huber, his Oncologist Orthopedic Surgeon (one of only 36 in the country) walked everyone through the diagnosis, tests & scans that were needed before he performed the amputation, complete with a slide show (leaving out the very bloody photos).  He explained the challenges that he faced in removing Rusty’s leg & a portion of his pelvis, while avoiding vital areas (the tumor was pressing against his penis & anus) and keeping the tumor intact to obtain safe margins around the tumor.  The actual surgery time was 4 hours and 57 minutes, excluding prep time.

Dr. Macy his Oncologist (one of only a handful in the world that are both MD’s & DVM’s and Board certified Oncologists) followed with his analysis of Rusty’s lab results and the Chemotherapy treatment program that he prepared for him.  He shared with us for the first time that Rusty’s Fibrosarcoma tumor was one of the highest levels and most aggressive tumors that he had ever seen.  He told us after the presentation, in private, that when he first saw the lab reports that he had doubted if Rusty would survive beyond 30 days.  This was a bit of a shock to us and makes us even more appreciative of the extra time that we have had with Rusty.

After his presentation of Rusty’s treatment, Dr. Macy discussed the early warning signs of various types of cancer and the advances that are being made in canine & feline cancer treatments.  He also explained that researchers are now using canine cancer studies in the treatment of humans as a dogs shorter life span mimics how cancer will behave in humans over a longer time period.

All of the presentations were well received, no one fell asleep or left early, and very much appreciated by those in attendance.   We have received many thank yous for sharing Rusty’s story and arranging for his Doctors to address the club.  All of us were exhausted after the meeting, especially Rusty; he slept almost all day on Sunday.  I have included a few photos from the presentation.

Rusty’s next appointment with Dr. Macy is December 3^rd.  Dr. Macy is keeping his fingers crossed that Rusty will make it to his one year Ampuversary on January 25^th.  He is optimistic that if Rusty crosses that threshold, it will greatly improve his odds for another one or two years before the cancer returns.  He is planning on keeping Rusty on the Lomustine through January unless his blood work shows further declines in the platelets or liver functions.  Rusty is due for his Bordetella booster shot this month and Dr. Macy has not reached a decision if he should have it; there is some risk to Rusty with the Chemo treatment and since we don’t take Rusty to the dog parks he feels the exposure to it is fairly low.  With the return of our perfect fall weather and our friends who go away for the summer, our social activities are picking up which means more visitors for Rusty, which he really enjoys.

October 1^st was the beginning of a new plan year for our PetPlan insurance policy which was good timing as we had maxed out the annual limit in September; PetPlan also reduced our co-payment to 20% from the previous 30%, which was good news.

October 19^th

I was waiting until after our monthly appointment with Dr. Macy before updating Rusty’s blog and then our temperatures finally dropped into a comfortable level and I got busy on some deferred projects. Also, it has been a pretty routine time period for Rusty since my last update and I did not have much to write about, but we are not complaining!  Rusty celebrated his 8^th month Ampuversary on September 25^th without any fanfare and is still doing well, although his energy levels had been decreasing over the past three months, but now that our weather is cooler he seems to have regained some of his energy.  He still enjoys swimming but for a shorter time and he gets out of the pool on his own, waits to be dried off and then goes in the house; before he would not go in the house if we were in the pool.  We are letting him decide if he wants to go in the pool; some days he shows no interest in going “surfin’” and we give him a day off.

His blood work on October 6^th showed another drop in the blood platelets (from the effects of the chemo on his bone marrow), they are still in the safe margin, but barely; Dr. Macy said that it they continue to drop he will take Rusty off of the Lomustine.  As you are aware, putting poison in their systems to battle the cancer definitely has its downside; Dr. Macy indicated that because of the clear X-Rays from last month, he might consider a less lethal chemo drug for Rusty as he would like to continue holding the cancer at bay for as long as possible.  Dr. Macy is not a strong supporter of alternative forms of cancer treatments, saying the studies at CSU have not shown any significant benefit from them.
When Rusty was due for his last chemo treatment he was not feeling well when he got up, would not eat his breakfast and spit up his water after going for a walk.  We gave him an anti-nausea pill and he was much better by the end of the day and we administrated the chemo around 7:30PM.  We gave him another anti-nausea pill the next morning and he had a very quiet day, which is pretty much his normal reaction after the chemo treatment.  I know that we are doing the right thing for him as when he is feeling okay, which is 95%+ of the time, he is such a joy, and is so happy and enjoys each moment to its utmost; it just hurts to see him having to suffer through the off days.

Our HOA has been over seeding (planting winter rye grass over the summer Bermuda grass) of our golf courses, green belts and dog parks which has necessitated that we use a different green belt area (they do the over seeding in sections, so that something is always open) for walking Rusty. The over seeding also wrecks havoc for those of us with allergies as they grind up the old Bermuda grass and I have been suffering for the past three weeks.  Fortunately the grinding is done and the new grass is coming in beautifully.  Walking Rusty in a different area we have meet several dog owners who are not familiar with Rusty and are amazed how well he has adapted to his handicap.  They are also impressed with his personality and love of people; of course Rusty is enjoying meeting new people and being the center of attention.

Dr.’s Huber & Macy have agreed to make a presentation to our Sun City Pet Lovers Club on their diagnosis, amputation and Chemotherapy treatment for Rusty.  They will also discuss the early warning signs of cancer and the advances that are being made in the treatment of both feline & canine cancers.  We probably have close to 1,000 pet owners in Sun City and the club has really been promoting the presentation and a large turnout is expected.  I am making a PowerPoint presentation of Rusty’s photos from the age of four weeks to current along with his X-rays, etc, from surgery.  Rusty will be the only dog present and obviously the center of attention.

Next Monday, the 25^th will be Rusty’s nine month Ampuversary!  Nine months ago we were not sure that he would still be with us at this time.  We have been in unchartered waters, at least for us, but it has been a wonderful and gratifying experience and worth all of our time and expense.  We continue to marvel at how well Rusty handles his handicap and appreciate his love of life; we know it all could change in an instant and enjoy every day that we have with him.  Rusty’s next appointment with Dr. Macy is November 5^th.

Wednesday, September 15, 2010

On Wednesday, August 25^th (which was Rusty’s seven month Ampuversary) we headed to the Central California Coast to celebrate Rusty’s Grandmothers’ 89^th birthday.  We gave Rusty his oral Chemo treatment on Tuesday which was a day early, but we wanted him ready for the trip on Wednesday.  It is 350 miles from the desert to my mother’s which is a long ride for him.  We stopped in Ventura which is the half-way point for an In-N-Out burger, including a patty for Rusty, and a chance to stretch all of our legs in a park area before getting back on the road.  He was a little nauseous for a couple of days from both the Chemo and ride, but quickly recovered.

My mother appreciated that we were there for her birthday and really enjoyed having Rusty there with her.  On Sunday we asked her to keep Rusty for several hours while we did some shopping and enjoyed a nice lunch.  She was pleased that we left Rusty in her care and had some of her friends come by to visit with Rusty.  We showed her the video of Rusty Surfin’ and left a DVD that she can loan to her friends; she was amazed at how well he is doing. It is going to be very difficult for her when we lose Rusty; she said tonight that she misses him and when he was there it gave her a reason for getting up and dressed rather than staying in her pajamas.

We also decided to make it a mini-vacation for all of us to get away from the heat of the desert; the last two weeks of August are usually the worst as the Arizona monsoons elevate our humidity which along with the high temps makes things very sticky.  We chose Cambria, which is about 30 miles north of my mother, for its dog friendly places and better facilities for a longer stay.  It was 117 on Tuesday in the desert and the temps on the coast ranged from the upper 50’s to low 60’s.  Rusty enjoyed the cooler weather and that we able to walk anytime of the day; one evening around dusk on the main trail we encountered five deer.  Rusty had never seen deer before and was in awe at their size and the way that they ran down the trail (jumping).

We stayed at the Cambria Pines Inn, which has a lot of trails for walking on and is close to the center of town.  They have a covered outdoor dining area with fireplaces and heaters that allowed us to have breakfast with Rusty.  We had planned on having a dinner there but with so many other choices in the area we never made it; we will do so next trip.  Cambria has one restaurant that was just featured on The Food Network (Linn’s) which was our favorite and we took one of their famous Olallieberry pies to mom for her birthday.  Rusty did very well for the first couple of days, and we were careful not to let him walk too far, but on the third day we were walking and he looked up at us and turned around to go home.  We let him take it easy for the rest of the trip; at my mother’s he could explore her yard and then could come in with us to rest.  Surprisingly all of us were ready to come home after a week; Rusty enjoyed the trip but missed his brother & swimming and we missed our adjustable beds.

We visited Rusty’s breeder who is in Atascadero, CA (which is about 20 miles from my mother) for her to see Rusty and for us to see Rusty’s brother who is one of her studs.  Rusty was the first born, and Becky had planned on keeping him but gave us our choice and we took Rusty.  Rusty is about 2” inches taller than his brother which she attributed to his being neutered; Becky was pleased to see Rusty but also very sad to see him missing a leg.  She said that if she had kept him, she would have been unable to provide treatment for him and would have put him down.

Again, we have the feeling that Rusty is with us for a special purpose, both for him and us; we are not sure why or how it is all going to play out.  Maybe he is just a “dog” or a messenger or possibly an “Angel”?  He has been a real blessing for my mother, whose health is failing.

Becky has offered us a replacement puppy when the time comes, which is very generous of her; we also discussed the possibility of taking one of her retired breeders.  We are not sure that we want to go through puppy hood again when we are in our mid seventies.

To help Rusty deal with our high temps we lowered the thermostat in a spare room off our family room and set a fan that blows at his level.  When he comes in from outside we tell him to go to his “cool room” and he heads in there until he has cooled off.  The pool is still the best place for him to cool down as the water temps are usually 86 or 87 degrees.  With summer ending our morning temps are cooling down and it is a great time in the desert to walk; it took us twice as long as normal on our first day back as everyone had to say “hello” to Rusty after being away for a week.

We met with Dr. Macy last week for Rusty’s monthly checkup; the timing was good as Rusty had started coughing and wheezing the last couple of days and we were concerned that the cancer may have spread into his lungs.  Great news; the X-Rays showed no sign of cancer in his lungs or abdomen!  Dr. Macy identified the problem as Bronchitis, most likely from swallowing too much pool water or the cooler weather from our recent trip.  Rusty is on antibiotics and no swimming for the next week (ouch!).  Rusty’s blood work was pretty much the same as last month, a few readings were a little lower but still within acceptable limits.  Rusty has lost a quarter pound the past month; however, his appetite was less than normal when we were on our trip which probably accounted for the weight loss.  After the results from the X-Rays and blood work, Dr. Macy was very pleased (he was also alarmed at the coughing and wheezing) that the cancer has not returned and will keep Rusty on the twice monthly oral Chemo treatments as planned.  The cost of today’s X-Rays put our year to date expenses over the annual plan limit of Rusty’s insurance coverage; fortunately, we start a new policy year on October 1^st and will again have 70% reimbursement coverage for his future expenses. Our next appointment is October 6^th.

Tuesday, August 24th

Tomorrow will be Rusty’s seven month Ampuversary and he is doing great!  He is full of life and enjoys almost every minute to its fullest!  He still has an occasional day that he is not very active nor eats until later in the day, but by evening he is usually back to normal and wants to play and eagerly eats his dinner. His diarrhea episodes have almost completely subsided and Dr. Macy cut his dosage of Budesonide in half.

Rusty’s endurance is still fairly low, maximum of 1/2 hour in the pool and only one lap around the lake in the mornings (1/4 mile).  Dr. Macy was comfortable with his current level, he said between the cancer, Chemo, desert heat and only three legs he was not surprised.  Our temps should begin to moderate in early September and are anxious to see if that helps his activity level.

Rusty really enjoys his daily swimming!  When we return from our dawn walk around the lake, Jan gives him his breakfast and I usually do some projects around the house to give his food a chance to settle. Around 8:30AM we put on our suits and say “surfs up”; Rusty heads out to the pool where he jumps in and waits for us.  We are very lucky that he does not go into the pool other than when we are out in our suits; he still plays “cabana boy” and keeps the pool free of any leaves, etc.

Our appointment with Dr. Macy on August 11^th was pretty much all good news.  Rusty has gained another 1 1/2 lbs in the past month, which is a total of 3 lbs since he started gaining weight in June; Dr. Macy said that his muscle tone was excellent and he attributes the additional weight to his swimming.  He did not find any lumps or other indications that the cancer has spread externally. He felt that since there were no other signs i.e., coughing, breathing difficulties, vomiting, etc., which along with the weight gain, that the cancer has probably not spread internally, at least not in any significant amounts, and he recommended that we wait at least another month before doing any X-Rays or other internal scans.

That was good news for us; however he again cautioned us that 95% of dogs with a level three cancer diagnosis pass in the first 12 months after diagnosis and/or surgery.  He said that each month that Rusty shows no sign of recurrence it improves his odds of making it into the 5% that survive beyond one year.  His blood work showed some deterioration in liver functions which is probably a result of the Chemo treatments; he said that he is not alarmed about the changes as they are still within acceptable limits. He is hoping that eliminating the Vinblastine IV Chemo treatments will improve those functions.

Dr. Macy is keeping Rusty on the Lomustine and increasing it to twice monthly for the next six months; he said that the Lomustine has fewer side effects than the Vinblastine and he should tolerate it without any major problems.  Today was the 2^nd dosage for August and as usual he is having a quiet day.  The Dr. provided us with another prescription of Maropitant Citrate for nausea but so far Rusty has not shown any signs of nausea.  His next appointment with Dr. Macy is September 8^th.
Dr. Macy loved Rusty’s surfin’ video and was considering using it in some of his seminars!  We have a large “Pet Lovers Club” here in Sun City and I asked (at the request of the club) if he and Dr. Huber would be willing to come to a meeting this fall and explain the surgery and cancer treatment plan they have used for Rusty; he said that they would!  I will put together a PowerPoint presentation of my photos of Rusty from before surgery, surgery/recovery and return to normal life including his surfin’ video.

Saturday, July 31, 2010

As I write this, Rusty is recovering from his second year birthday party that we gave him this morning.  Twelve of his dog park friend’s parents celebrated his birthday with him; he was very appreciative to see them, as he misses them as much as their dogs.  Rusty was the perfect host and they all marveled over how well he is doing.  He even gave them a demonstration of his surfin’ ability, although with some hesitation as he has never surfed in front of a live audience before.  Rusty’s actual birthday was yesterday and we took him to In-n- Out Burger for his favorite fast food, two meat patties.  We decorated the house with doggy balloons, fire hydrant and a replica of his favorite Sun City dog park.

His six month Ampuversary was last Sunday the 25^th; we are still amazed at how well he has coped with everything that has been thrown at him during that time period.  All of his guests commented that his personality has not been affected with all of the things he has been through; he greeted everyone with love and kisses!  We can’t believe that six months have elapsed since Rusty began his fight against cancer. We are hoping for another six months, but will take each day that he is with us as a blessing.  He will see Dr. Macy on the 11^th at which time we will find out what his new Chemo treatment program will be.

Not much has changed since my July 5^th update; Rusty is still on the anti-diarrhea medication along with his Fibercon & a probiotic tablet  He has not had an episode for the past month and we are hoping he can come off the medication with the new Chemo regimen.  He has gained another pound and his appetite continues to be robust; his swimming is developing good muscle tone, especially on the remaining leg.  We have started limiting Rusty to a shorter time in the pool as we noticed that he shows fatigue in his remaining leg if he is in the pool more than 30 minutes; he would swim until he drops if we let him.  He still prefers to avoid the heat and his endurance still suffers from the combination of the Chemo and hot weather.  We take our morning walks before 6AM, when it is cool and the ducks & rabbits are out which he enjoys watching.  After the walk we take a two mile ride through the green belt area in our golf cart which does 26 MPH; he enjoys the air blowing in his face while cooling him down.