Monday, September 16, 2013

Canine Lymphoma | Greyt Matters

Archive for Canine Lymphoma



M’s Sarge: 12/18/1999 – 7/23/2011




I had to let my sweet boy, Sarge, go last Saturday.


About 4 weeks ago, I learned that his cancer was back.  Since then, I had more and more difficulty getting him to eat, and he got down to 70 lbs., which is 5 – 7 lbs. less than where I liked to see him.   He started bleeding from his mouth on Friday, the 22nd, but I and the vet were hoping that it was just from bad teeth and gums.  But when I woke up Saturday morning, Sarge had problems walking and he would periodically just collapse.  I had a mobile vet come to the house at 11:30 AM and she helped him pass on.


Even though we did not know Friday night would be his last, we made it a good one: a Wendy’s double cheeseburger for dinner and around 10 PM we spent some time laying in a cool patch of grass on a warm summer night.


I am going to miss him terribly.




M’s Sarge







I Hate Cancer




I saw the oncologist this morning, and we went over Sarge’s options.


Really, I had to pull the options out of him.  He seemed to be subtly pushing the most aggressive treatment, i.e., do it all over again.  16 treatments.  6 months.  But I do not want to put Sarge through that again: 6 months of chemo for another 9 – 10 months of life (maybe).  The second option is a middle ground with less chance of reaching remission (60%) and with less duration of remission (4 – 6 months, assuming we reach remission).  It would involve a drug Sarge has not gotten before (lomustine) so I don’t know how he would react.  But it would only be given every 3 weeks up to 6 times.  He would also be on Prednisone with this option.  The third option is to give Sarge Prednisone (alone) and make him as comfortable as possible for as long as he can hold on.  This option is not expected to extend his life beyond 1 to 2 more months.


I have an appointment with Dr. Fowler on Tuesday to get his opinion.


At this point, I am torn between option 2 (the middle ground) and just letting Sarge ride through the rest of his days.


The oncologist is assuming I will return to the Wisconsin Protocol, so Sarge got an injection of l-asparaginase this morning, which is supposed to shrink his lymph nodes and make him feel better.  The oncologist also started him on the 5 weeks of Prednisone.  I made an appointment for the following Friday to start either the Wisconsin Protocol or the lomustine.  I have until then to decide what to do…and whether I will keep the appointment.


I’ll post later how we got to this point, which happened very suddenly.






Relapse




Today I found out that Sarge’s lymphoma is back.






Rabies vaccine today…




Sarge and Daphne went to see Dr. Fowler today; Sarge for his annual check-up and Daphne for a sore foot.


Daphne started licking a couple of the pads on her front left paw this past weekend, and then she recently started limping.  Dr. Fowler thinks she has a soft tissue injury although I have no idea how it happened.  (Kind of like when she sprained her back…you go to bed thinking everything is fine and the next morning we have injury!)  Dr. Fowler said I can give her a couple of benadryl and 3 baby aspirin to help with the pain.  I gave her the benadryl late this morning and she was knocked out for awhile.  I am going to wait until the weekend to give her the baby aspirin because I want to be here to make sure she does not have any kind of bad reaction.


Speaking of which…I was able stay home with Sarge about 3 hours after he got the rabies vaccine, but then I had to go into work because I have a huge presentation tomorrow morning and I needed to get ready.  When I left he seemed to be doing great.  Very perky and alert.  Even Dr. Fowler remarked that he looked great (and that his lymph nodes were normal – yay!)  But when I got home around 6:30 PM neither Daphne nor Sarge got up too greet me.    Sarge just laid on the floor on his side and he did not even lift his head.


I had groceries in hand (including a rotisserie chicken), and I figured that if that smell did not get him moving then we were definitely in trouble.  So I unloaded the groceries and then tested him by opening the Puparoni bag.  Up popped the doggies!  :-)   They ate their treat and then hung out in the kitchen while I dismembered the chicken.  After a few appetizers they both cleaned their bowls of kibble topped with lots of still-warm rotisserie chicken.


After that, they both conked out on their beds.


I took Daphne for a very short walk by herself, and then Sarge and I went for a longer one.  He seems to be doing okay, just a little tired.


Of course, I Googled “reaction to rabies vaccine” and all kinds of scary sites came up.  I tried not to look at the worst of them.  I did read that the vaccine stimulates the dog’s immune system, which did not sound too good to me since Sarge just finished 6 months of having his immune system bombarded by chemo drugs.  But neither the oncologist nor Dr. Fowler thought there was anything to be concerned about in terms of giving him the vaccine.  He has never had a reaction before so hopefully he was be back to normal in the next day or two.


I was just starting to feel super-greyt about how he was doing.  He was really returning to my “original” boy of pre-chemo days, but then we had to go and knock him down again.


Sarge is my super-duper trooper. :-)






Great check-up!




On Wednesday, Dr. Hamilton said Sarge’s lymph nodes were normal and that he looked great!  We are very happy!


Dr. Hamilton was not concerned about Sarge’s lack of desire to eat in the mornings.  As long as Sarge is not losing weight, then I guess Dr. Hamilton is not going to have a problem with it.  I just need to keep being creative (and coaxing) with the food. 


I fondly remember the days when I could throw down some dry kibble with a little water on top and he would lick the bowl clean.  But…you are allowed to become a picky eater after you have made it through 6 months of chemo.


Keep up the good work, Sarge!






Check-up on Wednesday




Sarge sees Dr. Hamilton on Wednesday for a 6 week post-chemo check-up.  Paranoia reigns!


I keep staring at Sarge’s neck and feeling it for lumps.  Sometimes it looks like his throat might be a little swollen, and I kind of feel his lymph nodes.  But I never really felt his nodes before so I can’t say they are any different, and the swollen-ness depends on the angle from which you view his throat.


Sarge still is not interested in eating in the mornings.  He walks away from his food bowl, which is filled with lots of extra yummy stuff.  (What dog walks away from turkey meatballs?)  I literally have to feed him from my hand.  He even boycotted his dinner Sunday night.


He did eat his post-breakfast meals with enthusiasm tonight (rotisserie chicken for dinner!) so he may have been overly tired from our weekend activities.


Also, he is relatively low energy compared to his pre-lymphoma state.


Otherwise, I would say he is doing good!  I hope Dr. Hamilton agrees on Wednesday.


We are planning a road trip to Florida in May so he needs to stay healthy for the visit to Grandma’s house (and her cats).






Three and a Half Weeks Post-Chemo




Doing good, doing good, doing good.  Sarge did regress in terms of his desire to eat in the mornings, so I put him back on the Pepcid about a week ago (10 mg).  I’ve been giving him cottage cheese and straight-up meat (chopped chicken or turkey meathballs) as his first meal of late, and we’ve managed to get that down every day.  By the afternoon feeding, he seems back to normal.  I hope his tummy feels better soon.


The only other obvious side effect of the chemo has been Sarge’s natural gas production.  It’s not excessive in terms of frequency but when he passes gas, it’s enough to clear the room!


Oh…and I gave him flea treatment (Frontline Plus) today for the first time since we went on the chemo journey.  I hate to put that stuff on them, but I found a tick on Daphne a couple of weeks ago, and she has been doing a little bit of scratching of late, so I couldn’t put it off any longer.  The initial chemo instructions said it was okay to do the heartworm and flea preventative treatments throughout the chemo; we were just to avoid it within 24 hours of the actual chemo.


Overall, life is good at the moment.  In particular, the weather has been beautiful of late, and Sarge has enjoyed being a sun dog in the backyard.



Enjoying a sunny day

Enjoying a sunny day







Sarge is Doing Greyt!




Okay, I confess.  I tried to bail out of the final chemo treatment.  I called the oncologist Monday afternoon and left a message saying I was thinking about calling it quits.  He called back on Tuesday and talked me into finishing the protocol.  I told him that I was concerned that the marginal benefit of this final treatment (of the harsh Adriamycin) would not be greater than the marginal cost.  He’s already had 15 treatments.  Could this 16th be all that important?  He assured me that it was definitely worthwhile.  He recommended that I keep the appointment, and he would determine if Sarge needed another week to recover or if he would go ahead with the treatment but at a reduced dosage.


As it turned out, Sarge got his treatment at a reduced dose.  Instead of 15.5 units, he got 14, which does not sound like a big reduction but it dropped the price by over $ 100.  So I don’t know how this dosing calculation works.


The oncologist also sent us home with lots of meds: 5 days of Cerenia (anti-vomiting, anti-nausea), 14 days of Prednisone (anti-inflammatory steriod), as needed Mirtazapine (anti-depressant, appetite stimulant), and 14 days of Pepcid (acid reducer).  We’ve finished the Cerenia, and I stopped the Mirtazapine a week after the treatment.  We are still taking the Prednisone (which unfortunately I forgot to give him this AM) and the Pepcid.  I was concerned about stopping the Mirtazapine cold turkey, but he seems to have done fine with it.


Sarge was feeling a little low and his appetite was depressed for the first few days after the treatment, especially in the mornings.  I  cooked a lot for him, e.g., ground beef meatballs with chopped spinach and grated carrots, macaroni and cheese, and chopped up mixed vegetables for one meal.   I also would get up every day and lay out this buffet of foods and see what he would eat.  What about this?  What about this?  We managed to find something he would eat at all meals (e.g., cottage cheese and a hot dog for breakfast), which was a big relief.  We hit bottom in terms of his appetite this past Saturday, but it got better every day after that, and we are pretty much back to normal now.  :-)


He has been shortening our walks a bit but he has been quite feisty in the house.  Lots of barking and spinning around in circles.  I’m assuming that his energy level will only get better too.




That’s my boy!



On the phone before the treatment, the oncologist said Sarge may very well surprise me by how long he lives.  I tried to pin him down with a prediction when I went in to pickup Sarge, but the oncologist would not give me a time frame.  We will just be taking it one day at a time.


You have no idea how glad I am that this is over and that he is doing well.  Yippee!






WE ARE DONE!






It’s time to celebrate!



Sixteen down and ZERO to go! 


Woooooooooo hoooooooooooooooooo!!!!!!!!!!!!!!!!!






Trying Mirtazapine




Sarge is on an anti-depressant as of Friday.  :-0


I was expecting to pickup an appetite stimulant, so I was surprised to read the bottle and see anti-depressant.  My regular vet had suggested Mirtazapine when I took Sarge in to have him examine Sarge’s back legs.  I mentioned that Sarge’s appetite was decreased, and that’s when Dr. Fowler recommended that I try Mirtazapine.  He said it was an appetite stimulant but that it also made the dog “feel better” (and he pointed to his head).  Now I know what he was talking about.


Mirtazapine is a human anti-depressant and some of the side effects for people are increased appetite and weight gain.  Vets prescribe it for the beneficial side effects, and the mood enhancement comes as a bonus.


I was driven to call the oncologist about Sarge’s loss of appetite this past Friday morning when Sarge turned away from his morning meal, which was this yummy looking (and very expensive) steak soft dog food topped with rotisserie chicken.  At that point, I was seriously thinking about stopping the chemo before the 16th treatment because I was afraid of what the last round of Adriamycin would do to him and his appetite.  It would not be good if we stopped the cancer but then Sarge starved to death.


So I called the oncologist’s number and left a message about trying Mirtazapine (or something like it), and they called back and said I could go ahead.  They called in the prescription, and we started the drug Friday night.


After that first dose, I could see an improvement in Sarge’s appetite in just a couple of hours.  Plus he seemed more alert.  Things seemed to be going really well over the past couple of days, but when I got home this evening (Sunday), Sarge was laying on the floor near the door, and he did not get up to greet me.  He just laid there.  Oh no!  Flashback to the night of the high fever.


What to do, what to do?  I decided to test him by suggesting a treat.  Bingo!  He jumped right up and ran into the kitchen.  :-)


He’s been laying around this evening while I made some yummy turkey meatballs with spinach, rolled oats, and shredded cheese (with a side of baked sweet potatoes).  He ate his dinner (kibble topped with the yummy stuff) with enthusiasm.  And we also went on a long and perky walk tonight (with Sarge as navigator).  So I think he is okay.


I read online that drowsiness is the most common side effect of Mirtazapine for dogs.  So I guess that is what is going on.  I’m assuming that it may take some time for his body to adjust to the new drug.  I wonder if I will have to wean him off it when we think it is not needed.


Note:  We are still doing the 15 mg of Pepcid, which hopefully is helping with the sour stomach.


I hate to put Sarge on these extra drugs but I was also hating to see him not eating.  I’m also hoping the Mirtazapine will revive the Sarge “spark,” which I’ve been missing for many weeks now.


If this Mirtazapine really helps Sarge, I may have to get my own prescription.


One for Sarge, one for me.  One for Sarge, two for me…





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