Jazz's last day

Jazz enjoyed Christmas Day, but today he simply didn't want to / couldn't get up - ironically it's the CDRM that finally seems to have got to him.

We already had an appointment booked with Fiona for his next treatment today, but decided that this should be his final visit instead. 

He went very peacefully, although not without tears from all of us, including Fiona.  We'll all miss him.  He was a very special dog. 

New treatment plan: try increasing chemo frequency

Jazz was bright today, and eating and drinking normally. We went out for a short walk around the block too.

Fiona called this evening, and we discussed his ongoing treatment. Neither of us feel it's appropriate to change to a different drugs regime at this point (apart from anything else, other available drugs have more side-effects, and he's already had some severe reactions to other chemo drugs). However, we feel that the chemo is not lasting him for the full week now, so we're going to try the Vincristine every 5 days instead of every 7. This is not normal treatment (but then, if he was on normal treatment, we'd have been able to cut the Vincristine down by now, and when we tried dropping to every two weeks he got ill).

There is a risk that by treating more often, we'll start to attack good cells (such as the gut and bowel) as well as the cancerous ones, but since he's apparently feeling wiped out for two days a week now, when the Vincristine's "run out", we'll give it a try and see what happens.

Not for the first time, this really is starting to feel like the beginning of the end.

Enlarged lymph nodes

Because we were going out on Friday night, and I didn't want to leave Jazz on the drip with Ed dog-sitting, I booked Jazz in for a day at the vet's for his chemo and drip. He was VERY subdued all day, just lying on his side in the kennel, ignoring everything that was going on (even though there were workmen there removing the old portakabins in preparation for the building work that starts next month).

He was still very subdued on Saturday. In the afternoon, I noticed that he was very swollen around his neck and behind his jaw. (He's obviously decided that poodle impressions - the clipped legs for the chemo - are old hat now, and decided to look like a bloodhound instead.) This weekend, Helen was on duty, and she suggested I should give him an extra steroid injection in an effort to reduce this. (We were at Bridget's for her birthday this time - Jazz seems to be making a habit of making sure we're not at home when he gives us frights now.) Inspection by telephone seemed to show that it was the lymph nodes that were enlarged.

On Sunday morning, the swelling seemed to have reduced slightly - the lymph nodes were still about the same, but the jowly look was starting to go, although he was still pretty subdued. Slightly worryingly, we realised that some of the snoring we'd been hearing was while he was still wide awake. Concerned that his breathing might be impaired, I spoke to Helen and she offered to check him over. She confirmed that the swelling is the lymph nodes, checked his chest (as his breathing sounded laboured), but found it clear. She took his temperature (normal), looked down his throat (not obstructed) and generally gave him a thorough check. The good news is that the lymph nodes are quite mobile, and can get a lot bigger before they'll start to seriously block his airway. The snoring is because they're quite close to the larynx. She'll speak to Fiona tomorrow, and one of them will call me.

He got quite a lot brighter by the evening, asking to go out and demanding food in no uncertain terms, although there was still no sign of the lymph nodes reducing in size.

Because of the swelling, I've taken his collar off and replaced it with his racing harness.

Swimming and swelling

Jazz's blood was tested for kidney function this week - the first time for a month or so - and his kidneys are deteriorating, so Fiona decided that we'd try giving him 2 litres of fluids by drip this week instead of the usual 1. The first bag went through on Friday evening (luckily, it was flowing well) and the second on Saturday morning.

On Saturday afternoon, we went down to Southampton for Mark's birthday, and gave Jazz a short (11 minute) swim. He wanted to go in the pool, but was obviously struggling and tired by the end of the session, which is why we stopped when we did.

When he got out and I showered him, I noticed a largish lump under his left "armpit" - the same leg that we'd used for the chemo and drip this week. My initial assumption was that he had another tumour there. Then, in the next hour, his left foreleg swelled up, and fluids were "leaking" through the skin.

I rang the vet for advice (Justin was on duty this weekend). He suggested that it could just be the drip fluids "overflowing", and to keep him moving, massage the swollen leg, and bandage it progressively from the foot up. The massage and bandaging helped, but the leg would swell up again soon after stopping massage / removing the bandage. We decided not to go out with Lynn and Mark after all, and took him home and put him to bed.

In the morning, the leg was still swollen, although it didn't seem to have been causing him any discomfort at any point. I completely bandaged the leg fairly tightly, and left it bandaged for a couple of hours. After this, the swelling stayed down. The swelling under his armpit had gone too, so no tumour recurrence after all.

Another good week

Well, apart from the fact that Jazz came back from his chemo last Friday with raging diarrhoea (which, it turned out, he'd had all day), he's had a good week. (It cleared up that evening though.) His weight is fairly stable, and he's been sleeping most nights through 'til around 6am, usually with a dry nappy. I've tried asking him to stretch it another hour or so, but sadly he's not having any of it. He's stopped jumping into the car though.

Fiona rang with his blood test results this evening. His white cell count is down, but not enough for Fiona to think it would be better for him not to have the chemo this week, so we'll be seeing Helen tomorrow as planned, and just keep him on the antibiotics.

A good week

Jazz has had a good week so far (touch wood). There's been no sign of diarrhoea, and on Wednesday he even jumped (and I mean in one go - none of that pathetic "can't quite manage it" scrambling) into the car. For the last two weeks or so I've been having to lift him into it.

He's been eating well, and had gained a kilo to be 23.25kg on Tuesday evening.

He has been getting us up at unpredictable times through the nights to go out though (despite being in a nappy), and his urine is quite clear, so I have a suspicion that the next crisis might be with his kidneys again unless we can manage to do something to avoid it.

He's going in for another Vincristine injection and drip today.

Much better today

Jazz is now pretty much back to normal, and even managed to produce some solid output while he was still at the vet's, but we have an emergency drip kit for the weekend away, just in case.

I also have some antibiotics to inject tomorrow and Monday, and we're booked a blood test for Tuesday evening, and next Vincristine for Friday in the hope we can gradually move his treatment so that he can be on the drip at home on Sundays, but with the blood test early enough that he can go in again next Thursday if necessary. Fiona's hoping the antibiotics will help to stretch it to Friday this week and Saturday next week.

Fingers crossed!

Some improvement

Jazz exploded on the way out to the car leaving the vet last night, but hasn't been since (except one outing at 5am for a wee). Fiona gave him a precautionary long-lasting anti-biotic injection yesterday, and he's had his Vincristine.

As far as prognosis is concerned, we're probably counting in weeks or possibly a small number of months before we lose him. It's difficult though, because although the diarrhoea is obviously quite tiring when he gets it, he doesn't appear distressed by it, and between times he's bright as a button ... although obviously less active than he used to be. And of course, he has this amazing capacity for bouncing back after apparently quite major setbacks, so it's going to be really difficult to decide when one of these is not going to be recoverable. It's going to be a rollercoaster ride for all of us (and Fiona includes herself in this), but ... we'll deal with that when we get there.

In the meantime, he's back at the vet today for his usual post-Vincristine drip. (As the cancer and diarrhoea are not being co-operative enough to manage to hang on so that we can push that out to weekends, he has to go in for this rather than have it at home, which we'd prefer.)

Looks like he'll be well enough for us to go away to Flyball at the Paws in the Park extravaganza at Canford, Dorset this weekend (well, tonight actually). It's possible that Vee (one of Lynn's customers) will be the vet on call there, so I've suggested that our emergency kit should contain a canula, giving set, drip, etc., but that we don't need to leave a canula in (which is something we were considering yesterday). If he needs it, I'll get the vet on call to insert it.

Fiona did also say she might include some more anti-biotic, and since I'm such a dab-hand at subcutaneous injections now, that might be better by injection than pill too - just to make sure it really does get into his system.

Rollercoaster

Jazz got diarrhoea again late last night, and was up every couple of hours during the night. Rang Fiona this morning, and she suggested bringing him in for the magic drip again to give his guts a rest. Also, if they can chase the blood test results through the lab quickly enough, he could have his next Vincristine today too.

Blood test

Back to the vet (Justin this morning, although it transpires I could have seen Fiona in Twyford ... hindsight is a wonderul thing!) for his pre-Vinscristine blood test.

Everything still looking good, and he's put a LITTLE bit of weight back on: 22.2kg

Getting better

Made a much more professional job of this morning's injection, and Jazz is eating like a horse and producing normal output :-)

Still OK but not eating much - and my first injection

Jazz had another fairly solid poo again early this morning. He didn't want breakfast though (half-and-half k/d and sensitivity control), but he did eat it later in the day.

I gave my first subcutaneous injection this morning. Took me a couple of goes to get it right, but I'm sure I'll improve with practice. Luckily, Jazz didn't seem to mind.

Things are looking up again

Jazz hasn't had any diarrhoea or vomiting while he's been at the vet's today. Also, when I went to collect him, Fiona said his gut's feeling much better too. She hasn't managed to speak to Gerry (the cancer specialist) yet - he was consulting when she called him, and she was operating when he called back.

Not surprinsingly, she's recommended that he goes back to weekly Vincristine, so we've booked him in for Friday morning, as we're due to be away at Paws in the Park next weekend, so we can do his post-treatment drip there.

Yesterday, Fiona had given Jazz an injection of Dexadreson steroid, on the basis that it was doubtful whether he was absorbing the oral Prednisolone. It was within an hour or two of this that he started to get visibly better, so she's given me some more, with some syringes to give him every other day in place of the Prednisolone. (I was due to get some more Prednisolone for him in any case.)

So, it's now down to whether the Vincristine can overcome the cancer in his gut (assuming that's what's been causing the diahhroea and vomiting), and whether his gut can recover enough to start absorbing food again. And of course, we have to get him eating enough too.

For the moment, he's still losing weight though - he was 21.85kg when I collected him. I've got some more of the tinned Sensitivity Control food for him, as that's what he seemed most inclined to eat yesterday.

Finally, by way of celebration, he produced a pretty solid poo on the way out to the car. Yippee!

A pretty good night

Jazz ate a reasonable amount of food last night - the Sensitivity Control tinned food by preference.

Andy slept downstairs with Jazz last night, and so far, so good. Jazz got him up a couple of times, but only for a wee (all those fluids). He's had a bit more to eat this morning, and still no more diarrhoea or vomiting.

He's going back in to be admitted for his drip today, as I'm at work and Andy's on a course, so no chance of doing it at home; besides, he may need their help today.

Not good news, but OK at home tonight

Jazz was still agitated for another couple of hours last night before he settled down for the night. He did eat some chicken though.

I slept downstairs with him and he got me up a couple of times in the night.

This morning he went in for his drip and Vincristine. I called and spoke to Fiona around 5pm and she said he's been quite bad today, with fairly frequent and watery diarrhoea again, the last time with blood in it. He also vomited up last night's chicken. He has been eating a bit through the day though. He's been quite subdued, and Fiona offered to keep him in overnight. She also said that unless the Vincristine helps, there's probably nothing else we can do about the problem with his gut (although she will check with Gerry for ideas), so if he doesn't improve we may have to consider putting him to sleep before too long.

I decided to go and see him and decide whether to bring him home when I got there.

When I arrived, he was in his own "room" and seemed much brighter than I was expecting, and pleased to see me, so I decided to bring him home for the night. So far, he's been quite quiet, but doesn't seem to be in any discomfort. I'd guess he's just exhausted from the diarrhoea. So far tonight we haven't seen any more of it though, so that's at least 4 hours since he last had to go. He's eaten some of the Sensitivity Control tinned food that they've been giving him at the vet's.

Feeling sorry for himself

Jazz seemed a little better yesterday, and ate OK (as long as I didn't "poison" his food with Canikur), but still had pretty loose diarrhoea. He's been getting us around 6am to go out though.

Today he seems to have been worse again, degenerating to liquid output. We went to see Fiona for his blood test anyway, and he threw up while we were there. She felt at his tummy and says his gut wall is feeling pretty thickened and solid. It seems that the lymphoma may have spread there. She'll check his blood as best she can in-house (both for general organ function and a best effort at the red and white cell count), and if the results are OK she thinks it's best if we bring forward his next Vincristine to tomorrow without waiting for the detailed lab analysis that she can't do there.

When we went out to the car, he was restless and didn't want to stay in it, but didn't need to be out of it either. On the way home, he pawed at the mat and at one point huddled in a most peculiar way, but I couldn't see quite what he was doing without stopping the car, and by the time I could stop, he'd stopped whatever it was that he was doing.

When we got home, I took him out to the garden, and he wandered around aimlessly for a while. He wouldn't settle, so we came indoors, and he kept wandering around indoors too for about half an hour, before insisting on going into his crate (even though I'd taken all the bedding out to wash it).

Fiona's just called to say his white cell count looks OK, his red cell count is a bit down (i.e. he's a bit anaemic), but that's been the case for a while now anyway. His kidney parameters have gone down a bit. That could be because he hasn't eaten today, or possibly because I've been trying him back on the puppy food for the cancer again. Fiona's now wondering whether the Metoclopramide injection she gave him may not have been such a good idea, because as well as acting on the vomiting centre in the brain, it also promotes gut action, but there's nothing for it to act on. Best thing for it is food and/or paracetamol, so will try half a tablet of soluble - whole if we can get it down him in a bit of cheese or something, or dissolved in as little water as possible and syringe it down his throat if necessary.

Anyway, we'll admit him tomorrow (and again on Friday, of course) for the Vincristine, and the drip will help his kidneys anyway.

Yet more diarrhoea

Jazz got me up at 3am to go out for a runny poo. He's eating a bit, but not much.

Getting better

Jazz is better again now - he started eating on Sunday.

Still not right

Jazz got me up at 6:00am for a wee, but didn't want a poo until about 7:45am - when his efforts were mostly unproductive and runny.

I have managed to persuade him to eat a bit of chicken, with powdered Canikur, but not a full dose yet.

I've been giving Jazz 1 Imodium tablet per day to keep the diarrhoea at bay. Yesterday, as he'd been pretty solid for a few days, and not wanting to bung him up, I skipped a day.

This morning, he had his Imodium again (as he's due for Vincristine on Monday), plus his Prednisolone and Leukeran. Andy and Lizzie were with him in the garden for a while around midday, and he'd been eating a bit of grass. Then Andy took Lizzie home, and when he came back about an hour and a quarter later, Jazz had had liquid diarrhoea in his crate. Around 3:30 he vomited a couple of times - producing totally undigested chicken, noodles and K/D from breakfast, plus grass.

Called the vet for advice on what drugs to give him from the collection I have available . As it happened, Fiona's on call today. She suggested that I try to get some Canikur into him (kaolin and electrolytes), and I also went to collect some vials of metoclopramide and tagamet in case he continues to vomit (particluarly as we're off to Southampton for Grandad's 90th birthday party tomorrow). She's also topped up the Canikur, and has given me some Lectade electrolyte powder to put in his water to counter the effects of the diarrhoea.

He's now eaten a bit of cooked chicken and had some more Imodium too, plus a dose of Canikur (which took some persuasion - with or without Mars bar!).

The future of home drips

Jazz had another blood test today, to check ready for next week's Vincristine treatment (and Sharon reported that his lymph nodes are feeling normal).

I also had a chat on the phone with Fiona later about the practicalities of having him on the drip at home. Basically, it needs to be on a day when I'm not working, which means Sunday or Monday. Fiona's happy that he can go in for his treatment on a Saturday (which is a semi-normal working day for them anyway), as a) he's an undemanding patient, and b) I'm used to acting as veterinary nurse for vein raising to insert the canula, so they can just hook him up to the drip and add drugs as and when it's a little quieter. As to Sundays (if there's any problem with the canula), they expect to be there for at least an hour or two most Sunday mornings, so that's not really a big deal.

She'll also speak to Gerry about the overall drug protocol (originally, he'd been due to drop to a timetable of alternating weeks - one week on and one week off ALL the chemo drugs) after 8 weeks of once-weekly vincristine. However, we'll need to review this as we dropped to once-fortnightly vincristine a couple of weeks earlier than planned because of his stomach upset.

Accidents

Jazz has been having a few bladder "accidents" throught the night recently. Sometimes, rather than get us up, we come downstairs to find wet bedding rucked up in his crate. Of course, we don't know whether this is because he's just not asking us for some reason, or because he just loses bladder control and finds himself with a wet bed.

Proactive drip a success

Well, the proactive drip seems to have worked: we've had no sickness, and only very minor bowel looseness today. Hooray!

First day on the drip at home

Got out the doggy bag of drug vials, syringes, fluid bag and giving set, mircropore tape, wadding a vetwrap to put Jazz on his drip, and rigged up a frame over his crate (actually a folding coffee table stand, on end) to hang the bag from.

Had a bit of trouble getting the drip started, but got help over the phone from one of the nurses, and got it going by using one of the syringes to withdraw some fluid from the bag (via one port) and adding it (via the drugs port) at the other end. I had tagamet and metoclopramide to give him via the drip too.

He had a couple of times during the day when he got a bit agitated - as a response to one of these I took him out in the garden and sat with him for a bit, with his drip bag hanging from a tree branch. And obviously, he needs reasonably frequent attention to make sure he hasn't squashed or kinked the tube and stopped or drastically slowed the flow (which was to set at 1 drip per second).

Having been rather slow at times all day, so that I'd been wondering whether we'd get through it all before bed time, at the end of the day the bag suddenly ran out before he'd had his last dose of drugs, so I ended up taking him to the vet so they could administer them using their ad hoc fluids bag to flush them through. I also learned how to do a subcutaneous injection in case I need to administer other drugs in future.

It's clear that this probably isn't something that we can do for him when he's just got Andy with him (especially as Andy will be working), but we'll sort something out about that later.

Blood test OK, so Vincristine again

Jazz went in for his Vincristine injection and drip today, and Fiona has also agreed that we can try having him on a drip at home tomorrow, as he's such a good patient, and at least that means that he's spending another day less of his life at the vet. If there's a problem with the canula and I have to take him back in, then we haven't really lost anything anyway. We've got another week booked off work this week to get some work done on the new house, so will be able to find out whether this is a viable option longer term.

So, she's left the canula in his leg, and added anti-coagulent to stop it clogging up overnight, and I have been taught how to connect up and adjust the drip, and how to add drugs (tagamet and metoclopramide) to the drip etc., so we'll see how it goes tomorrow.

Recovered, and with new treatment plan

Called in to see how Jazz was, and he's a lot better (not quite as bouncy as last time he had the magic drip, but (according to veterinary nurse Debs) he offered a paw and was happy to eat, and he's not "depressed" like he was yesterday.

Unknown to each other (until they got together) Fiona and Helen both decided that he'd be better on Vincristine once a fortnight instead of once a week, as spending 2 days out of 7 in the vet on a drip isn't much fun. And I suggested that we should try putting him on a drip proactively the day after treatment (instead of leaving it until he feels awful 2 days afterwards) to see if that helps.

We're all off to Stratford on holiday today, so I'll get a blood test done while we're away, with results to go back to Fiona, ready for next treatment on Monday (which will be 1.5 weeks after the last one, but Mondays are easiest, and we should also be off next week to try the "day after" drip too).

Back into the vet for another drip

Jazz got me up at 6:45am to be sick. He was then sick again at 8:00am, so I took him back into the surgery to go back on the drip again, and once more they kept him overnight.

Vincristine again

After a couple of blood tests that showed white cell suppression, the latest one was OK, so Jazz has been in for another Vincristine injection (with half a day on a drip as well as is usual now).

Sickness, more diarrhoea and listless

We went down to Southampton last night, and Jazz was sick twice on the way back. He'd obviously been eating grass in the garden, as what he brought back was mostly undigested grass.

Today, he's been very subdued (despite the excitement of having packers in for tomorrow's house move), and still has diarrhoea. We saw Emma (for the first time) at the vet's tonight, and she suggested we try feeding him on plain chicken (might have to hand-feed him), and try the Canikur again, even if we have to grind it up and add it to his food.

As he is SO subdued, and particularly as we're moving tomorrow, she suggested that if he's still looking sorry for himself, we might like to consider taking him to Henley tomorrow and leaving him there for observation. Meanwhile, she's taken blood for the histology re next week's Vincristine, and to check his kidney, liver and other organs.

Not surprisingly, as the little he has eaten in the last couple of days has come back up again, his weight is down ... to 21.5kg, but he's not dehydrated and his temperature is normal.

More diarrhoea

The usual Wednesday diarrhoea seemed to clear up, and Jazz was eating like a dog possessed again on Thursday onwards, but he's definitely got the runs again.

Spoke to Justin, and he's suggested trying him on Immodium (yes, nip down to the supermarket for it) at 0.2mg/kg weight 2-3 times per day, which at the moment for him is 0.2x23kg = 4.6mg. Immodium comes in 2mg capsules, so each dose is 2-3 capsules. Justin suggested trying him on 1 to start off with, increasing to 2, and if he's still loose tomorrow morning, call before taking him in. He doesn't really want him to have his Vincristine if he's still got diarrhoea.

A pattern is emerging

Jazz is staying dry through the nights again now.

It seems as though we have a regular pattern starting:
On Monday he goes for his Vincristine injection and drip
On Tuesday evening he starts to get a bit of diarrhoea (whether he's on the Tagamet or not)
On Wednesday he still has diarrhoea and doesn't want to eat anything much at all
On Thursday he's back to normal and eating enthusiastically again

His weight was down again on Wednesday, to 22.8kg

Second Vincristine injection with drip

Jazz was quite funny with Helen yesterday, showing every sign of not wanting her to come near him with the clippers and canula, which is unusual for him. We were in the small treatment room though, and I don't think he likes it much in there. Or maybe he didn't enjoy being on the drip last week. He didn't put up much of a fight though.

Weight was down a bit at 23.3kg

Anyway, so far he's showing no evidence of ill-effects. There was a small drip in last night's nappy (but less than the previous two nights), and he's drinking OK.

He had to be persuaded to eat all of his breakfast this morning though.

He had his Prednisolone and Leukeran this morning, and today's the first day of alternating drugs, having had the Prednisolone every day for the last week.

Another small leak

Jazz's nappy from last night showed evidence of a small leak again.

Breakfast went down quite well, although I had to call him back to his bowl to finish up the last few grains of rice.

An empty bowl

Having said that he's been eating normally, we've usually had at least a scattering of grains of rice left after each meal. (Meals these days are part Hill's tinned k/d plus one part chicken to two parts rice, in proportions 1:2:3 for Breakfast:Lunch:Dinner.) We've been cooking the rice with garlic and chilli powder, and then mixing more in with it after cooking to try to make it more appealing.

Today, I got the blender out to chop up some fresh chilli for the latest batch of rice, and while it was out, decided to mince the chicken and mix it in well with the rice.

To be fair, he was keen to eat to start off with, but whether it was mixing in the minced chicken, or just the minced chilli and garlic in the rice, tonight was the first time he's completely cleared his bowl for a month or so. (Well, OK. He did leave ONE grain of rice!)

He seems to have stopped moulting like mad too, although he's still looking scrawny. His coat is looking shinier again though.

Small leak

Oddly, Jazz appears to have leaked slightly in last night's nappy - just a little patch, neither here nor there.

He's still eating well though.

Dry again and eating normally

Jazz had another dry night, and also ate all his meals yesterday, plus breakfast (his least favourite meal) today. So, maybe it was just the diarhhoea that was putting him off his food.

A dry night again

Jazz's nappy was dry this morning! Hooray!

Histology good; kidneys holding out

The Canikur has worked - the diarrhoea has cleared up now, and he's producing solids again.
I've looked up Tagemet on the 'net, and find that one of its side-effects (in humans, at least) can be diarrhoea, and also that the dose may need to be adjusted for those with kidney problems.

Fiona rang with his blood test results at 7:30pm (she WAS supposed to have left by lunchtime to go on holiday, but didn't get away as planned!). Histology is clear, so no problem going ahead with the next Vincristine dose. Kidney-related tests show the Urea minimally down and the Creatinine minimally up.

I asked her about the issues with Tagamet. First, although there are potentially problems with human renal patients, the same doesn't appear to be true in animals for some reason, and they actually use it with renal failure in dogs and cats to deal with the stomach acids that tend to be related to kidney problems.

However, she has suggested that we don't give it to him after next week's Vincristine dose, and make sure we have some Canikur in case we need it. (The Canikur is just to be taken if he needs it, not proactively.)

Appointment for blood test

Went back to see Fiona this morning for his blood test. He's had some diarrhoea since Monday's injection (which the Tagamet was supposed to prevent). He very kindly left a sample outside the surgery, which Fiona duly inspected (before I cleaned it up after our appointment, of course). Her diagnosis was this was large bowel-type diarrhoea, rather than stomach/gut-based which is what the Tagamet is supposed to prevent. She's given us some Canikur (kaolin and electrolytes), which are like dog biscuits, to be given 3 twice a day until it clears up.

Jazz is off his food a bit at the moment, particularly in the mornings. The weather is hot though, so that's probably contributing. Weight today was 23.6kg, so it's having a definite effect on him too.

Fiona's has taken twice as much blood as usual (and plans to continue to do so), so that she can send half to the lab for the histology relating to his chemo, and test the other half to monitor his kidneys.

The Canikur seems to be having some effect already. He produced only a small amount of the runny stuff at lunch time, and no accidents.

He's also having more trouble with his bladder - unable to last as long between wees as he had been prior to the Vincristine injection. He certainly can't now make it through the night (as he had been for a week or more) without making use of the nappy.

Resumption of chemo

Jazz has had his first Vincristine injection of his second course of chemo. I left him with Fiona (having personally acted as nurse / vein raiser to insert the canula before I left) just after 9:00, and collected him at around 12:30. During that time he had both the Vincristine and a couple of hours' worth of fluids. Weight today was 24kg.

They sent him home with the expected Prednisolone and Leukeran, plus some Tagamet. The Prednisolone is to be taken every day (4.5 per day) for the next week (starting tomorrow), and then reducing to every other day. The Leukeran is to be taken every other day right from the start (2 per day). In addition, 2 Tagamet to be taken twice a day, at least an hour after other medication for 3 days after each Vincristine injection, starting tonight.

The plan this time is to give him an 8 week course of Vincristine once a week, and then to switch to a different regime from last time: one week of Vincristine, Prednisolone and Leukeran, and one week off everything. (Last time we kept going with the Leukeran and Prednisolone, and the Vincristine injections dropped to once every three weeks.)

So, to cope with all this, I now have a complicated diary of drugs and vet's appointments on the kitchen wall.

He seems mostly OK in himself, although he was a little odd when I took him to the park late this afternoon. He'd chase after the ball, and then couldn't quite seem to work out what to do once he'd picked it up. It was quite amusing to watch his sudden apparent brain/memory failure - it wasn't the sort of thing that seemed alarming. And on the other hand, he was perfectly alert to everything else going on in the park. There's certainly no sign of the kidney-failing dopiness that we saw after his last two doses of Vincristine.

Kidneys still improving slightly

Latest blood test shows urea down slightly to 16.7, but creatinine up slightly at 183.

Asked Fiona whether I should start the Prednisolone before his Vincristine (to get him drinking more), but apparently the Vincristine works best when the cells are actively dividing, and Prednisolone inibits this, so better to kick start with the Vincristine on Monday.

About to go back on the chemo

Fiona has now spoken to Gerry (the cancer specialist), who recommended putting Jazz back on the chemo ASAP, resuming with the same regime (i.e. Vincristine, Leukeran and Prednisolone). None of the drugs have any known detrimental effect on the kidneys (if anything, they can affect the liver), but we do need to make sure he's getting fluids through him to force the kidneys to keep doing some work, rather than getting "clogged up". Meanwhile, we've stopped the antibiotics and potassium supplements. (For the first time in ages, he's not taking any drugs at all!)

Jazz's skin and coat have taken a turn for the worse since he's been off the chemo (or possibly since he's been ON the kidney-friendly diet). Before, his coat looked really healthy and glossy, but now it looks dull, and his skin is flaky (the poor boy looks as though he has dandruff).

However, his bladder has definitely been better in the last couple of weeks. In the last couple of weeks he's made it through the night with a dry nappy almost every night. In the last couple of days though, we've had one accident when we went out for 3-4 hours and forgot to put a nappy on him, and the night before that he didn't make it through the night and the nappy got used. He's also had a bit of diarrhoea in the last few days.

During the last week or two (barring the last couple of days), he's been very bouncy - the best we've seen him for months.

When Fiona examined him, she found that his lymph nodes were slightly enlarged again, so that definitely means we put him back on the chemo. The lymphoma could be the cause of (or contributory to) the bowel problems. He's also started "stress panting" again just recently, which we haven't noticed for a while. Fiona's theory was that this was to do with pain in his bladder. I suppose this could still be true if he's struggling a bit more to hold it. His urine is very yellow - this is both good and bad news - good because it shows his kidneys are doing something, and bad because it confirms he's not really drinking enough.

So, we'll be going in for another Vincristine injection on Monday morning. To try to make sure it doesn't knock his kidneys for 6, we'll also have him on a drip for a few hours to make sure we get some fluids through him. The plan is that I'll take him in and stay with him while they put the canula in, then I'll leave him there and he'll half half an hour of fluids, then the Vincristine and then another couple of hours or so of more fluids, and I'll collect him after that. Also, the Prednisolone should make him thirsty, which is good under the circumstances.

Fiona has taken blood samples (to check the kidney function and - I think - histology re the lymphoma). She's also taken a urine sample ... or to be more accurate, one of the nurses did when we left the building ;-)

He weighed 24.25kg at this visit.

Kidneys improve again

Urea and creatinine are both down again, which is good news. No sign of the lymph nodes enlarging either.

However, since it does look as though there's a possibility of him recovering something approaching near normal kidney function (which is truly amazing, considering the state he was in a few weeks ago), Fiona's going to consult the cancer specialist again to see what he would recommend regarding treatment.

Considering Jazz's reaction after his last Vincristine treatment, we're assuming that we won't resume chemo unless his kidneys get much nearer normal, but Fiona will ask about that too. Also, we need need to change the drug regime.

Weight at this visit way back up to 24.85kg (a bit too heavy, really).

More swimming, and moulting

Went down to Southampton for Father's Day, and of course, took Jazz swimming.
As he was fine after his last swim, we let him do his full 30 minutes again this time.
We've started to notice over the last few days that he's been moulting a bit. That seemed to have stopped since he went on the chemo (the opposite of what humans expect with chemo), so I guess that means the chemo's wearing off. Anyway, something about the water or the swimming clearly did something: after his swim he looked as though he'd spent ages with a hairdresser getting a spiky hair-do.
Lynn and Andy and I spent the next 2-3 hours grooming him, and removed a full carrier bag of compressed fur. It seems as though he's caught up with 4 or 5 months' worth of not moulting all in one go!

Still improving

Today's blood tests show that Jazz's kidney function is improving.

He's back to eating normally for him - i.e. take it or leave it.

Swimming and food inhalation

Jazz had a lovely swim yesterday. We put a buoyancy jacket on him to be on the safe side, but he showed all of his usual enthusiasm, and didn't want to stop at the end of the 20 minutes' or so swimming time. We didn't think we ought to let him do any more than that.

Lynn and Andy managed to get loads of pictures of him in the pool, which is great, as most of the ones we've taken of him swimming have been a bit naff. Shame he was wearing the jacket, but can't have everything.

He's still positively inhaling his food (he had THREE tins of k/d plus some chicken and rice yesterday - Lynn couldn't believe what she was seeing), and he's back up to 23.5kg - I've weighed him on my scales and Lynn's and they both agree.

Blood test shows some improvement

Urea down significantly, from 27 to 17 (top end of normal is 9.6). Creatinine (which tends to lag by a week or two) is slightly up.
Phosphorous is still normal (this imbalance is the bit that tends to make them actually FEEL ill).
Potassium is a bit low (which can create muscular weakness), so Fiona will give us a supplement for that.

Bood test and discussion

Jazz went for his blood test tonight, and we had a long chat with Fiona. She'll have the results tonight, but we're out, so Fiona will call tomorrow. We'll need to discuss what happens next in the light of the results, so there's not much point in her talking to the answering machine.

His weight is steady at 21.85kg.

She’s prescribed some precautionary antibiotics, because with kidney failure the urine is more dilute and less sterile, and particularly with his bladder and sphincter muscle problems there’s an increased chance of picking up an infection. He’ll be on these indefinitely now.

She’s put the continuing diarrhoea down to a number of abrupt changes in diet as we’ve lurched from one crisis diet to another over the last week or so, so hopefully that will settle down soon.

As far as food is concerned, her advice is that we shouldn’t worry too much about what he eats, as long as he keeps eating. Obviously the Hill’s k/d will be best for him, but if he doesn’t fancy that, anything will do. The main priority is that he doesn’t lose too much more weight.

I asked her about swimming, and she said that in his case, the greatest risk is probably of picking up a water-borne infection, but the antibiotics will minimise that anyway. As it’s something he enjoys, she said that if he was her dog she’d have no hesitation in taking him.

We mentioned the apparent weakness in his back end and the possibility of CDRM, but she thinks it’s more likely that it’s just muscle wastage, particularly as he hasn’t had as much exercise as usual recently (starting with the lead walks after his operation to remove the tumour). He’s certainly not scuffing his feet, which is often an indication on CDRM.

We asked about signs of impending kidney failure to look out for. In some dogs, it’s uncontrollable nausea, where they just can’t keep anything down; in his case, particularly since the lymphoma is generally debilitating, she thinks it’s more likely that he’ll wake up one day and everything will just be far too much effort. As long as he’s taking an interest in cats and barking at the postman, he’s probably doing OK.

Apart from me requesting it, she told us that she wants to be the one to put him to sleep when the time comes. Unless she’s in some distant part of the country, she’s generally available and will do everything she can to fit in with what we want and what he needs. If we want she’ll do it as a home visit, but I'm not sure I could bear that. She will put a note on the system so that that when we make that call, the staff will all know that they should contact Fiona if possible, without us having to make a fuss about it.

On the good side, he’s so used to going into the surgery and having needles stuck in him that at least the process itself won’t be traumatic for him.

They don’t do cremations themselves, but do have somebody that they use and trust, and we can have his ashes.

Steady as he goes

Well, there's no obvious change in Jazz one way or the other. He's been in with me again and very calm today.

I have had a chat with Fiona (who has also seen the short letter I wrote to her, and agrees that all things considered, it's probably time to stop treating aggressively and let him go).

The Hill's prescription kidney-friendly diet he's on has reduced protein compared with carbohydrate & fat (i.e. pretty much the opposite of what he needs for the lymphoma). Also, the protein is of "high biological value", i.e. the amino acids are very close to the dog's own, so there is very little to waste and excrete. It also has additional potassium, and suitably balanced calcium and phosphorous. (With kidney failure, phosphorous tends to rise and calcium levels tend to fall.)

Other sources of appropriate protein are WHITE chicken breast (for some reason, the amino acids in brown chicken meat are very different), white fish (such as cod or coley), or cottage cheese. If feeding these, feed with rice in the ratio of 2 rice : 1 protein by volume.

Meanwhile, we'll stop giving him Leukeran and Prednisolone for the time-being, to give his kidneys a rest and see what happens. We've got a couple of weeks before he's due his next Vincristine injection to decide what to do about that.

In view of his kidney condition, trying the Metacam for his bladder is a big no-no, so we've abandoned that plan.

We're due to see Fiona for another blood test tomorrow evening (and will presumably get the results on Friday). Once we have the results of that, we can formulate a treatment plan. I suspect that this will be to concentrate on keeping his kidneys as healthy as possible and to treat the lymphoma as best we can without aggravating the kidneys.

Fiona thinks that we'll have a better idea what to expect after another week - 10 days ... which obviously implies that he has at least that long. Without the results, and knowing that Jazz defies all prior medical knowledge, she (currently) thinks that we could possibly still be talking months rather than the days we were fearing.

In for kidney treatment

Jazz wouldn't eat more than a few hand-fed mouthfuls this morning, but then he's not a great fan of breakfast, and anyway he had his Leukeran last night, and that always seems to put him off his food.

We took him to the vet to leave him there for his treatment today. The good news is that he has actually put a bit of weight back on and is back up to last Thursday's weight of 21.85kg, but he's still got diarrhea.

As ever, they were lovely, and said that we can go and visit him during the day if we want to, or call at any time for an update. Actually, I think he'll stay settled better if we don't visit, but may change my mind if they need to keep him overnight (which I don't think is likely).

Blood test shows renal failure

Justin called this evening to say that the blood test shows that Jazz has "moderate" renal failure, i.e. enough to cause concern. Dialysis IS an option, but not a realistic one in view of his age and his lymphoma. However, we can give him some fluids to help flush the kidneys through and see how he responds to that.

We'll take him in for that tomorrow. Fiona's not back in until Wednesday. I want to write her a note to tell her what we want to happen when the time comes - partly because otherwise I'll forget something, and partly because if I tried to tell her the tears will no doubt make me incomprehensible.

On the good side, he has been eating today, hasn't been sick again except the once on Sunday, so maybe things aren't quite as dire as they look. Even so, I think we're probably talking a maximum of a few weeks nows.

A bit brighter, but still losing weight

Jazz has been eating a little better today, and looks a lot brighter, but I took him to see the vet (Justin) today anyway. HIs weight was down again, to 21.25kg. Justin's given him a check and taken blood to test. He's also prescribed Metoclopramide which should hopefully help his digestion, and also improve his appetite.

Meanwhile, it looks like we're going to be feeding chicken, cheese and rice for a while, as Jazz is distinctly unimpressed by the dried food he was on.

Less dopey, more calm, but still not eating much

Well, we managed to get Jazz to eat some chicken and rice in small portions yesterday afternoon and evening, partly by hand feeding. This morning, he wouldn't eat anything, so we tried force feeding him the tinned stuff from the vet with the syringe, but he brought it back up again, together with some of yesterday's undigested rice. He's also had very runny diarrhea.

Today he's seemed calm rather than dopey, and the weakness in his hind legs seems to have mostly gone, but there's something about his eyes at times that has made me think we may not have him for much longer. At least there's no sign of yesterday's bewildered, drugged look.

The weather was lovely - warm without being too hot, so we took him for a gentle walk at one of our favourite spots by the river at Remenham, where he paddled in the river, and we all laid on the grass for a while and watched the world go by.

Later, we played with his ball in the park for a short while. He was eager to play, but predictably very laid back about chasing the ball.

He has eaten some more chicken and rice since this morning, again with some hand-feeding and encouragement, but nothing like enough for a dog of his size.

I'll take him back to see Fiona tomorrow.

Urine sample shows traces of blood and tissue; Jazz is very dopey

Fiona called last night (Friday) to say that the urine sample didn't have any trace of infection in it, but there were traces of blood again, and bits of tissue which are probably bladder wall lining, so thinks that it will be worth trying the non-steroidal anti-inflammatory (Metacam). To do this we'll need to reduce his Prednisolone over time from his current dose of 4.5 tablets every other day.

So the plan is:
Saturday, Monday, Wednesday 2.5 tablets
Friday, Sunday, Tuesday 1.5 tablets
Leave a few days, and then start the Metacam on the Friday. Any benefit should be apparent in 3-4 days.

I also asked her about his sluggishness / dopiness, and she said it's not an uncommon side-effect of the Vincristine (although, as ever, Jazz isn't "normal", as usually it tends to show up more when treatment starts, and gradually drop off). It shouldn't be anything to worry about unless it lasts more than 48 hours.

Later, he wasn't interested in food at all, except for the chicken that I mostly hand fed him.

He was still dopey this morning, and more alarmingly, his back legs seem weak and when I tried to give him his tablets (in what is usually "me, me, me, now!" meat paste), he really didn't want it. I did eventually manage to get him to take it, and rang the vet. Justin was on duty, and rushed off his feet. Anyway, when I finally spoke to him, he suggested that as long as Jazz isn't being sick, there's nothing to be gained by rushing him in - he COULD be admitted for the weekend for monitoring, but he'd probably be happier with us anyway of course.

If he's still like it on Monday, then I should take him in, and we'll take more blood to test his liver function (on the grounds that the extended reaction may be due to reduced liver function meaning that he's not metabolising the drug as well as before). Fiona walked into the surgery partway through the conversation (even though it's her weekend off!) and her main concern is to keep getting food into him, so I'll go and pick up some really slushy stuff that we can syringe into him if necessary.

In the meantime, he's so subdued that he's been happy to lie on his bed behind my desk all day and completely ignore all the customers that have been in the shop. He also hasn't been at all bothered any time I've needed to go out of his sight, which is most unlike him anywhere outside of home or his car cage. I have managed to hand feed him a bit more chicken though, so that's something, I suppose.

Looking back through the blog, I spotted Lynn's comment about the similarity to CDRM in his back legs from last time he went swimming. Must remember to mention that to Fiona.

Vincristine injection number 7 and urine sample

Jazz has been off his food more than ever in the last couple of weeks. I can't remember the last time he emptied his food bowl, so I wasn't surprised on Monday when he went for his blood test and I weighed him at only 21.8kg.

On Thursday evening we saw Fiona for his 3-weekly jab, and he was down even more to 21.55kg. I also mentioned that his urine seems to smell different / stronger, so she took a sample for testing to see whether he's perhaps picked up an infection (if the sphincter muscles are strong enough to stop the bladder leaking, then bacteria can get in too).

Meanwhile, she's found a different urologist, and they had a long chat but most of the things she suggested were things that we've already tried. One possibility is that we could try a non-steroidal anti-inflammatory, but to do that we'd have to wean him of the Prednisolone, so we'll wait for the outcome of the urine test before we try that. Fiona will call when she's tested it.

Also, as they've been fine so far (with one exception at the start of treatment), she's suggested that he probably only needs a blood test before every other injection from now on.

One day, Two shows - Agility at Reigate Cow Pie, and a demo at Burghfield

On Sunday May 8th, we went to the Cow Pie country show near Reigate.

There was an agility ring, so Julie took Jazz round it. Despite it being many years since he last did it (or perhaps because!), Jazz seemed to remember how to do all the apparatus.


Over the first jump. Now for the weave-poles...


What's next?


Nearly finished

In the afternoon there was a flyball demo by the Bandits at the Burghfield Fayre, which Jazz was very interested in watching, though he didn't take part.

(Posted by Andy)

Vincristine injection number 6

Jazz had another Vincristine injection yesterday evening.

Today he's been a bit subdued, which may be a reaction to the drug, I suppose.

Blood test for this week's chemo, but no response from Prof Holt

Took Jazz in for his 3-weekly blood test, prior to this week's chemo.

Fiona still hasn't had any response from Prof Peter Holt, so will chase him again, or see if she can find somebody else to ask about Jazz.

She didn't have any particular comment on the fact that he's had a touch of the runs over the past few days, so we'll see how he goes. His bladder seems to be much the same as ever.

Fiona did come across a bladder muscle relaxant drug at the conference, which might help him to fill his bladder up before needing to empty it, but she's not sure if it's available over here, as the speaker was American. Also, we'd still need to address the problem of him leaking without being aware of it.

Meanwhile, we've given up on the bitter spray, which didn't work, and tried putting him in a muzzle overnight (on the grounds that it's less restrictive in the crate than a "lampshade" collar). I was quite surprised that he's taken to that OK.

His next vincristine injection will be done on Thursday, assuming the blood test looks OK (Fiona's in Twyford on Thursday this week, and as he's so easy, is happy to do it there).

His weight today was back down to 22.55kg

Abandoning supplements to see what happens

Suddenly had a thought that maybe the supplements Jazz is getting are having an impact on his incontinence, so for the time-being, I'll cut everything out, just leaving him on dry food and chicken (plus prescribed medication), and see what happens.

Back to check the wound and other things

Jazz went back to see Fiona today, because there's a small bit of open wound right on his elbow. Also, he's taken to eating his nappies overnight, and we've occasionally found a hint of pink when repositioning a new nappy.

Fiona had a look at the wound, and decided that although it's opened up a little, it's granulating nicely (new skin and flesh is forming), and the skin's too tight to drag back together again to stitch or staple. In fact, rather than stitching again, she removed another stitch either nice of the open bit to encourage it to heal up as it is. We've booked him an appointment for next Thursday evening to have the rest of the stitches out. As long as it has scabbed over OK by then, she'd be happy for him to swim when he goes down to Southampton on weekend of 17th.

We now have some bitter spray to put on his overnight nappies to discourage him from eating them. The last thing we need is a blocked intestine to add to everything else!

As to the possible recurrence of blood in the urine, we'll just keep an eye on it for now.

No answer back yet from the urology Professor at Bristol (Professor Holt?), as he (in common with many other self-respecting vets) is at a conference this week. Fiona will be there tomorrow, but didn't think she'd be able to collar him for help there ;-)

Weight down to 22.9kg. He's not been eating terribly well again.

Wound healing nicely

Jazz ignored Fiona's advice about severely restricted excercise and greeted the postman rather over-enthusiastically yesterday morning ... more or less vertically and well off the ground!

We went for a check-up with Fiona last night, and true to form, he's not reacting as expected ;-) (I suppose we should have expected that!)

At least this time it's a nice surprise in that the operation wound is healing much better than Fiona would have expected (especially after all the complications with the same operation 2 and a half years ago). As far as we can tell there are no ill effects from his close encounter with the postman. Actually, the wound looks lovely and clean, so I don't think there's any more need to bandage it overnight, as he hasn't shown any signs of worrying at it.

She's now happy for him not to be on severely restricted exerice any more - trotting on the lead or flexi is fine, as long as he doesn't go chasing balls or romping with other dogs.

I think the incontinence drug is helping a bit, but we'll try upping the dose from 2 to 3 times a day to see if that helps too. It's a bit difficult to tell, as we haven't had all that many opportunities for him to be in the house without nappies in the last few days. The leaking seems to be reducing, although his bladder capacity is still small, even if he does seem to be slightly more in control of it.

The day after surgery

As we really needed Jazz to sleep in his crate last night, I decided that bandaging the wound overnight was a kinder choice than making him wear a lamp shade in a confined space.

Jazz woke us up around 1:00am last night, sounding really sorry for himself. I was worried that he was in pain, but luckily, it turned out that he was just uncomfortable and wanted to go outside because his nappy had slipped and he needed a wee. After that, and with a fresh nappy he was fine for the rest of the night.

Today, the leg's seemed quite a lot less stiff than it did last night. Getting up and walking around doesn't seem to be bothering him, although we're not encouraging too much of it. I took the bandage off first thing and trimmed away the blood-matted fur to discourage him from licking at it, and it all looks rather cleaner now. As requested by Fiona I haven't tried to clean it up any more than that though.

The dopiness from the anesthetic has worn off, but he's got a lot of healing to do, so not surprisingly has been sleeping a lot today. That's probably just as well, as he can't worry at the wound while he's asleep.

He's had the first dose of the Propalin this morning.

Lump removed, plus a drug to try for the incontinence

The lump felt much more solid to me today. On Saturday night it felt like a satsuma with lots of air under its skin - sort of squishy. This morning it was more like a softish rubber ball.

Perversely, yesterday when I took him out, it was lovely to see that he was as normal as I've seen him any time since Christmas, positively jumping up and down in his old tigger fashion, wanting to chase a ball. He was a little bit slower running after it than he used to be, but otherwise really seemed his old self. Fiona also commented that he was looking really healthy this morning.

As soon as Fiona saw (or rather, felt) the lump she said it would have to be removed, which is what I expected. So, I left him there for the day. He's lost some weight again - not surprising as he's been intermittently off his food again. Today he was 23.4kg.

One of the vets has been off sick with chickenpox, so although she has spoken to a Urologist about his incontinence, she hasn't yet had a chance to fax off to them the details of his case. However, in the meantime, Helen (one of the other vets at the practice) suggested trying him on Propalin, which is a drug that acts on the smooth muscle, and particularly the sphincter muscles. It's normally used for post-spaying bitches who develop incontinence, but seems worth a try. There's no reason not to use it in tandem with the chemo, and we should see in a few days whether it makes any difference.

It seems I was wrong about where the previous lump was: once his leg was shaved, Fiona found the scar from the previous operation, so it has come back in exactly the same place (which is what I was told to expect at the time of the last one).

Like the last one, this lump was quite tightly attached to the tendon, so although the rest of growth had fairly well-defined edges, Fiona had to make a decision about how much other tissue (and particularly tendon) to take away with it. One extreme - to make absolutely sure that it wouldn't recur - would be to amputate the leg. The other extreme is to take as little as possible, but without being absolutely certain of having got rid of all the potentially cancerous cells. The middle ground, i.e. taking more tendon away to be sure of getting all the tumourous cells seemed not to be a good idea, because his healing will be slowed down by the chemo and he may well have ended up with a permanent limp. So she decided to take the least invasive course.

We should assume that it will come back, but it's difficult to predict how soon. However, Fiona thinks that although it's extremely unlikely to be as long as another 2.5 years (the last one was in October 2002) it's more likely to be 12-18 months rather than 4-6, so hopefully not until very much more towards the end of his life anyway.

While he was under, Fiona took the opportunity to check his bladder again, and was able to inflate it a little more than last time, but still can't find any cause for the incontinence. The good news, though, is that there was no blood in the urine they drained off.

She hasn't been able to prescribe him the usual post-operative pain-killing drugs because of the chemo, but did give him another injection just before he came home this evening. Also, although the Prednisolone (steroid) will slow the healing, it will also have an anti-inflammatory effect, so should help to reduce the pain.

She hasn't bandaged the wound at all, as she wants it open to the air to try to help the healing process. He's clearly still dazed (as you might expect after the anesthetic), and uncomfortable, finding it painful to bend the leg, but he's worked out how to swing it out to one side to hobble along. Since being home, the wound has leaked a little blood, so if it gets any worse, I may need to bandage it temporarily. I've also been told to give him absolutely minimal exercise - i.e. outside to wee and no more. So, having been out in the garden for most of the day since the weather's been better, he'll have to be back indoors in nappies for a while.

We're due to go back for a check-up on Thursday evening (just before Easter). Fiona will be covering in the Twyford surgery then (presumably because of whoever's off sick), so for a change we'll be able to use the local surgery instead of Henley. As healing will be slow, Fiona has no intention of removing the stitches for at least 3 weeks.

It's strange that he's been afflicted with two completely unrelated types of cancer, although some dogs (and people) do seem to be genetically predisposed to tumours in general, so I guess it must be all that inbreeding ... mongrels are SO (not) susceptible to that!

Appointment made for tomorrow to check out the lump

Well, I rang the vet, and Fiona answered, so I told her we'd found a lump like the one he had a few years ago, but on the other side. Like me she was rather surprised that with all our prodding and poking we hadn't seen it before, so I'm guessing that it's come up pretty quickly. She would have been happy to see him today if I'd wanted her to, but neither of us think a day either way is going to be critical, so she's booked him in for 9:40 tomorrow morning.

She mentioned aspirating the lump, but as it seems most likely that it'll be a tumour like the last one, she's assuming that he'll probably be admitted, and asked me not to feed him in the morning. This then gives her the option to remove it straight away if appropriate.

Found a lump

Andy found a lump under Jazz's right armpit as we were fitting his overnight nappy tonight. It feels just like the tumerous one he had under his left armpit 2-3 years ago :-(

It's ironic that this was how we might have expected the cancer to reoccur after the first time, and instead we got lymphoma at first. Of course it's possible that it's not tumerous, but I think it's unlikely.

I'll call the vet's in the morning to see if I can book him in to see Fiona on Monday ... there doesn't seem much point in treating it as an emergency, but I'll see what they say when I call.

Swimming and knickers

We visited the family in Southampton at the weekend, and for the first time since Christmas, Jazz went swimming in the Doggypaddle pool. As he always has in the past, he made a beeline for the door to the pool building as soon as he was let out of the door that gives access to it, so he clearly hadn't lost his enthusiasm for it.

As he hasn't swum for a while, and, of course, he hasn't been well, Lynn suggested that he should wear a buoyancy jacket this time. We also restricted him to a total of 15 swimming minutes (he normally does 30), and made him take some rests out of the pool too, rather than swimming almost non-stop as he usually does. His back legs were a bit wobbly on occasion when he got out, but nothing too serious. Lynn suggested that it looked more like a CDRM kind of wobble than his usual getting tired stumbles, but I'll worry about that if and when it really becomes a problem. (CDRM is a degenerative disease of the hind limbs associated with older German Shepherds. This would fit with his increasing slight reluctance to jump into the car these days - but then that could also be down to feeling reluctant to stretch because of the nappy straps too.) More importantly, he was clearly enjoying himself as much as ever.

To allow Andy and I to go out for the day on Monday, Jazz stayed there with mum and dad overnight, making the most of having free access to a garden. He spent most of the day lying just outside the back door, just coming into the kitchen once in a while to make sure mum was still there.

As he made it through the night with the benefit of a whole nappy - running the full length of his tummy (rather than the half-nappies that fit better during the day), we've now decided to give up sleeping downstairs with him, and so far that's been fine.

Last week I ordered some doggy knickers, aka Simple Solution Diaper Garments, from PetPlanet. These are normally used with bitches in season to protect the house from blood. As suggested, for a male dog I ordered the next larger size, but they were too loose to hold anything in place, and in any case were more fiddly to fit than the toweling strips and elastic straps we're currently using. They also don't really reach far enough forward to hold a decent sized bit of nappy in place anyway, so I'm afraid they've gone back to where they came from.

Chemo going well, but still incontinent

Jazz had another Vincristine injection yesterday evening. He weighed 24kg.

As his recent blood tests have been stable and not giving any cause for concern, Fiona doesn't think there's any need to have any more until just before his next injection is due in 3 weeks' time. (We've only had one blood test all along that showed we were overdoing the treatment.) Three weeks will be at Easter, so his blood test and injection will be on Tuesday morning and Friday evening instead of Monday morning and Thursday evening this time, so Andy will have to take him for the blood test.

He's still off his food, but as he's not losing weight, Fiona's not worried about it for now. It's possible that the Leukeran may be suppressing his appetite a bit.

Meanwhile, his red cell count suggests that he's no longer losing much (if any) blood in his urine, so the problem we have is really now incontinence rather than cystitis. As he's clearly not following anything that could be considered a normal pattern for cystitis resulting from the chemo, Fiona's now thinking in terms of finding a urinary specialist for advice.

Although the nappies now mean that we can now get about 3 hours of sleep at a time rather than an hour or so, either that's more difficult for the body to cope with, or it's just all the disturbed nights catching up on me. Either way, I'm starting to feel exhausted over the last couple of days, so I'm hoping Fiona comes up with something so that Andy and I can both finally get back to normal sleep patterns.

Another blood test, and Cystitis 6 weeks on

Well, it's now 6 weeks since Jazz first got cystitis as a result of the first chemo treatment.

On a couple of days this week, he's given us some optimism by starting to behave a little more normally from time to time (such as chasing a ball a bit, and coming and sitting in front of us with "that look" when he's wanted to go out sometimes, instead of just lying there and panting), but I'm afraid to say that it hasn't been a steady improvement :-(

On the whole, things are pretty much the same - he seems in control of his bladder during the morning, but around midday the drips and leaks start, and that's usually our cue to start using the nappies for the rest of the day. He's still off his food too. On the good side, being in nappies does seem to help him get through the night - and the day, for that matter - with fewer trips outside.

We were back at the vet's for another blood test this morning. He weighed 23.7kg today.

His bladder still feels much the same as last week, i.e. better than it has been, but not noticeably better than last week. The lymph nodes are all reassuringly small though, so that's good news. I mentioned that he seems to be off his food now (he just doesn't want to eat much - he's not picking out the "good" bits and leaving the boring bits, or anything - he just doesn't get to the bottom of the bowl very often). Apparently, Prednisolone is an appetite stimulant (they're not quite sure how it works, but it acts on the brain somehow), and his dose was halved about a week and a half ago. This makes a lot of sense, as he was positively inhaling his food for a while, which is most unlike him. Fiona thinks it should settle down after a while, and he'll get back to his normal state (i.e. he'll eat as long as there's nothing more interesting going on). She did take his temperature again, just to check that there was no other obvious reason for him not to be eating, and once again it was spot on normal.

As to where we go from here with the chemotherapy, the Prednisolone and Leukeran should continue at the current dose (i.e. 4.5 and 2, respectively, every other day) until we get to 12 months from the first treatment. Assuming the blood tests don't dictate anything different, the Vincristine injections will continue once every 3 weeks for a while, and then perhaps drop to once every 4, again until we've been going for a year (i.e. until January 2006).

... and the cystitis WILL get better ... honest! Well, according to Fiona, anyway. If not, or if there seem to be any long-lasting effects, such as more permanent loss of bladder control, then she may need to start researching the effects of cystitis as a side-effect of the Cyclophosphamide in humans (on the grounds that it will have been used many thousands more times on humans than on animals, so there's more data to go on). I asked her about nappy rash, but she doesn't expect it to be a problem, mostly because modern nappies are pretty good at preventing it. If it does set in, then she's successfully used Sudocrem (i.e. the same stuff you use for babies) on dogs for other things before, or a bit of vaseline would also help. I've just ordered some canine Hygiene pants and pads from Pet Planet, to try instead of the home-made towel-and-elasticated-straps nappy arrangement. We'll see if they're any easier to use.

Meanwhile, Fiona obviously really has a bit of a soft spot for Jazz. For no particular good reason, she gave him a cuddle and a kiss today. I'm sure that's not normal behaviour for a vet!

We have booked an appointment for his next Vincristine injection on Thursday evening. Fiona will call when she gets the blood test results in the next day or two, to either confirm that we should come for the injection, or suggest someting else, according to the results. We'll also need to get some more Leukeran and Prednisolone this week (which I forgot to mention this morning, but did mention last week).

Bladder improvements

We had another visit to the vet this morning - a free one this time, which is most welcome given that the bills have already hit 4 figures for the last two months :-(

This one was primarily just to check his bladder, and at last Fiona says it's starting to feel a little less rigid, so my fingers are well and truly crossed in the hope that things are actually starting to pick up at last. He seems to be leaking less (both in quantity and frequency) since we stopped the Amitriptyline. We've already had some false alarms when things started to look better and then got worse again, so I daren't be too optimistic.

Jazz's lymph nodes are all still down, and he weighed 23.95kg today.

On the down side, his appetite has dropped off again in the last day or so, but hopefully that's a temporary thing, as he's been virtually inhaling his food recently ;-)

I suggested that it might be worth stopping the antibiotics to give the "friendly" bacteria a chance to reassert themselves, and after checking his temperature (which was spot on normal), Fiona agreed.

Meanwhile, we're continuing to use the nappies (now held in place with slightly elasticated straps and bum-bag style buckles which are much easier to use than the bandages) whenever he doesn't seem to be aware that he's leaking. Last night I used one overnight for the first time, and actually got 5 hours at a stretch without him asking to go out. It seems that either he's just more comfortable when he's leaking into a nappy rather than wetting his fur or bed, or perhaps he realises that he's not going to be soiling his own bed, so doesn't worry about it. Either way, he seems happy wearing them, and we're happy if he's not dripping everywhere.

So, here's hoping that he's finally starting to get better at last. It's now been 5 weeks, so it's about time!

Chemo moves on; Cystitis much the same

Well, the boy was a bit better on Saturday, and worse again on Sunday :-(
Since then he's had some good days and some leaky days with no particular pattern.

Andy was away for the weekend (some excuse or other about a Stag Do ), and I was inspired to improvise a nappy / incontinence pad for the boy, using a strip of towel wrapped around him, securing another folded up bit of towel to catch the leaks. It worked quite well, so after our visit to the vet on Monday morning I bought some cheap disposable nappies and some ladies' incontinence pads to try. I'm pleased to say (because it's the much cheaper option) that half a nappy does the trick nicely. I've been using cohesive bandage (e.g. vetwrap) to hold the lot in place, but it doesn't last more than a few re-wraps before getting pretty mangled, so need to find a more robust solution for that bit. Jazz, bless him, doesn't seem to mind it a bit and just takes it in his stride. He's such a good, tolerant patient, thank goodness.

I also ordered some strips of rubber matting to protect the carpet, and with these down the place looks SO much more homely (not!), but at least we shouldn't get any more drips on the carpet (not generally considered a benefit by potential house buyers, we find!) Not sure the smell of rubber helps though, but hopefully that'll wear off soon.

We visited Fiona for his weekly (so far) blood test on Monday. Everything's still going fine as far as the chemo's concerned, so that's good news, and we won't be having more Vincristine this week. We really have reached the next stage in his treatment for the Lymphoma.

His bladder was still very thickened and there's really nothing else we can do about this for him now, except wait it out. Fiona offered to lend us some vet-bed for his crate (it wicks away the moisture to keep him more comfortable through the night or any other time we need to confine him there without nappies). Unfortunately, she didn't have anything big enough there at the time, so we'll pick that up from the Twyford surgery tomorrow morning.

He weighed 24.3kg, so I think we're getting the food about right.

The blood test results show that his white cell count is still up at a healthy level. He's still slightly anaemic, but nothing to worry about.

From today we only have one day's worth of the Amitriptyline(the anti-depressant) left, so I asked Fiona whether we might as well do without it: I can't see that it's had any positive effect on him (and am wondering whether it's the cause of him leaking 'cause it's making him too laid back), but I was a bit concerned about changing more than one thing at once, since we're also reducing the Prednisolone (steroid) dose to every other day from today too. She was of the opinion that we might as well see how he goes without it over the weekend, so I haven't given him any more this evening.

Meanwhile, we've been splitting the garlic between his breakfast and dinner, but it doesn't seem to be making any difference. Fiona's sure that the Leukeran shouldn't be affecting his bladder, and anyway the link between him taking that and the next day being a bad one seems to have been broken. I got a Pro-Biotic yoghurt drink for him instead of live yoghurt this week, which he's been having half with breakfast and half with dinner.

I have noticed that I now find myself thinking in terms of his cystitis as a semi-permanent condition, rather than something I'm expecting to get better "in the next week or so". I hope I'm wrong. Surely it MUST get better some time soon?

Friday was a bad day ...

The bladder leaks started earlier than normal, were more profuse than normal (more flooding than dripping), were more frequent than normal (about every 15-20 minutes at one point), and lasted late into the night. Normally he wakes us every hour or so to go out through the night. On Friday night / Saturday morning he thoroughly wet the floor of his crate and didn't wake me until about 4:30am :-(. At least after that, things seemed to get back to what passes for "normal" at the moment. Of course Jazz had his first dose of the Leukeran on Thursday evening, so I don't know whether that may be related. We'll see how he is on Sunday, after the next dose.

I've been wondering if there's anything in his drug or supplements or feeding regime that makes a difference according to the time of day for the general pattern. Breakfast is pretty much the same as dinner, but smaller - because he's never been a great fan of the concept of breakfast. He gets JWB Chicken and Rice puppy food, with chicken, cauliflower and broccoli. Drugs and supplements are mostly the same morning and evening except:

• Prednisolone (steroid / anti-inflammatory) - mornings only, to simulate the body's normal workings


• Live bio yoghurt (to replace the good bacteria killed off by the antibiotics) - mornings only


• Cortaflex (Glucosamine) - evenings only, nothing to do with the chemo or cystitis


• Garlic clove - evenings only

Then I remembered that he hadn't had his garlic on Thursday night. I can't see why that might make a difference - or at least such an immediate difference, but I was ready to try anything. So on Saturday morning he got half of his daily garlic clove, and yoghurt in the evening too.

The morning was pretty "normal" except that I took him to work where he stayed in the car. (Luckily it wasn't bitterly cold as it often has been recently. We even had some weak sun.) I went to let him out pre-emptively within the hour through the morning 'til 2:00 when I finished work. A couple of minor damp patches appeared, but signifying no more than drips really. Through the afternoon, we got drips, but mostly he gave notice of wanting to go out - a major improvement on Friday, so maybe the garlic really does make a difference that quickly.

He's had half today's garlic dose again this morning, so we'll see how it goes.

Tomorrow morning he's back to the vet to have another weekly blood test. If we then reduce the chemo, that'll be the last one for a little while. It won't seem right not going to the vet's twice a week!

Fourth Vincristine injection, and red blood cell count improving

Jazz weighed 23.7kg today.

His lymph nodes are still down, so unless anything changes next week, this should be the last of his weekly Vincristine injections - we should be able to reduce them to once every 3 weeks from now on. Also, at the end of this week we can reduce the Prednisolone to every other day - although that may have a negative effect on the cystitis, so we'll have to see how it goes.

We've noticed that there's a daily pattern to how his cystitis has been affecting him for about the last week: through the night and during the morning, he seems in control of his bladder and can tell us when he needs to go out. Then during the afternoon and evening until about 9 or 10pm, he seems to have less control, and often leaks - sometimes without even seeming to be aware of it. Fiona admits to being baffled as to why this should be the case. It seems a bit similar to Irritable Bowel Syndrome, except that in IBS, the bowel gets a rest overnight, which why it's more under control in the morning. In Jazz's case, he's up all night, so there's no rest period to explain why he's better in the morning.

Meanwhile, his red cell count is coming back up, which means either he's not losing as much blood in his urine now, or he's well enough to be producing enough new ones to replace them. Either way, it should be a sign that things are starting to improve. Fingers crossed!

New drug to replace the Cyclophosphamide

Went into the vet to pick up some more of the Amitriptyline (tri-cyclic). The blood test results have come back and show that his white cell count is fine, so Fiona has given me some Leukeran (Chlorambucil). This comes with a label that says we should wear gloves when handling it (the link explains that this is to do with potential harm to foetuses), and it should be kept in the fridge.

The dosage is 2 tablets every other day, so we started this evening, and he should get it on odd-numbered days during February and March (until and unless I get new instructions from the vet).

Yet another blood test, plus X-rays

It's Valentines Day. Jazz hasn't noticed, but luckily Andy remembered, so I wasn't too upset :-)

That aside, we were back at the vet for another blood test this morning.

Afterwards, we took him through for an X-ray. This time I got to wear a dead sexy lead apron and collar. He was very good, bless him, lying nice and still on the X-ray couch while the vet and nurse arranged him and wrapped what I can only describe as lead-filled socks over his neck and legs. Then we all beat a retreat for the photo.

Unfortunately, this didn't show up anything, so I stayed with him while the pre-med took effect, and then left him there for an hour or so while they anaesthetised him, inserted a catheter, inflated the bladder and took more pictures.

When I got back, Fiona said she'd only been able to get 150ml of air into his bladder, so no wonder he's having to go out so often. There's no sign of bladder stones, and also no sign that the blood in his urine is coming from his prostate gland. However, the bladder wall is very inflamed (it's about 1/4" thick at the moment), which will be affecting its elasticity.

As there's no other apparent cause for the cystitis, it looks as though he is just very sensitive to the Cyclophosphamide after all, so we'll just have to stick with the drugs that we can give him, and wait it out. He's on antibiotics to prevent seconday infection and tri-cyclic anti-depressants which help with analgesia and calming, and the Prednisolone will keep him wanting to drink and so get fluids through him. The Prednisolone is also anti-inflamatory.

We have enough antibiotics to last until our next visit on Thursday, but will need to pick up some more tri-cyclics tomorrow evening, as they didn't have many in stock last week. Fiona wanted to hold off on the new drugs (the replacement for the Cyclophosphamide) until we get the results from today's blood test.

Cancer specialists suggest checking for other causes of cystitis

The cancer specialists called the vet and spoke to Sharon today, who then spoke to me.

They have suggested that we should eliminate any other cause of the cystitis as it's very rare (although not impossible) for the Cyclophosphamide to cause it so quickly. However, it's possible (and he thinks more likely) that it could have triggered something that was already underlying. He suggested that we try him on some tri-cyclic anti-depressants (as the Valium didn't work), as these have an analgesic in them that acts on neurological pain. He did also say that it may be a matter of trial-and-error to find something that works. (And of course, as the Cyclophosphamide should be working its way out of his system, maybe it'll clear up by itself anyway.) The tri-cyclics will probably take up to a week to start working.

So the plan now is that when I go in for his regular weekly appointment on Monday morning, we'll plan to x-ray his abdomen too. If he'll stay quiet enough, we'll do this without sedation. If that doesn't show anything, the next stage will be to insert a catheter and inflate the bladder and see if that helps to show anything. (This is the point at which he'll probably find it uncomfortable - I'm sure he would anyway, and the cystitis will make it more irritating, I'm sure. Assuming he won't stay calm enough, they'll have to sedate him then.) If THAT doesn't show anything, then they can also introduce a colouring agent which will contrast more with the air and show any blockages or anything that might be present.

If none of that shows anything, then we can work on the assumption that he's just very sensitive to the drugs and stop worrying about anything else that might need treatment.

In the meantime, I've been to collect the Amitriptyline tri-cyclics and some more antibiotics to start him on them tonight.

Back on the treatment

The last blood test showed the white cell count is back to normal, so Jazz had his next Vincristine injection this evening (with yours truly back in the white coat and gloves along with the vet and nurse).

Fiona's going to send another fax to the cancer specialist to see what he says about his cystitis this time, as it's now nearly 3 weeks since he had the Cyclophosphamide and it's dragging on a bit.

He seems to be settling into a pattern over the last few days: overnight and in the mornings, he is a aware that he needs to go out, about once every hour to an hour and a half (or sometimes he manages even longer between trips outside). Then, as we move through the afternoon, he starts to have accidents, and doesn't even seem to be aware that he needs to go out. This (for us) is the more upsetting bit, although we've got covers down to protect the carpets! The intervals get shorter too - sometimes even as short as 20 minutes.

He's lost a kilo in weight again, although he's eating well, so it looks as though I've cut down a bit too much on the food once he got back up to weight.

Another blood test, and a bit of good news

This morning's appointment was for another blood test to see if the white cell count is back up to normal so that we can restart treatment.

The good news is that his weight is now back up to 24kg - more or less normal for him.

The story so far - 2 weeks after first treatment

Well, it's been a really long two weeks, and the first week was by far the longest.

One of us has been sleeping downstairs with him every night so we can let him out. Having initially thought that this might only last a few days, we were now told that the cystitis is likely to last as long as the drug that caused it is still in his system. As the dosage interval for that is three weeks, it'll probably be 3-4 weeks in all. We've got a routine going now - I'm home on Mondays anyway, and have booked Wednesdays off. Andy's working at home on Tuesdays, Thursdays and Fridays.

Fiona's been talking to the canine cancer specialists, and they haven't ever seen such an acute cystits reaction before either. They've recommended (obviously) that we try a different drug when he would have been due for the next dose of Cyclophosphamide. The alternative is one that he'd take every couple of days, so fingers crossed that the cystitis will clear up then, and we can start to get back to something approaching normal.

Meanwhile, although Jazz is feeling uncomfortable enough that he wants to go out frequently, it seems that he's not actually in pain when passing water, as far as we can tell. He is very subdued though. Fiona's a little concerned that with this extended bout of cystitis, he may not regain full capacity and muscle control of his bladder, so we're not out of the woods yet, but we'll cross that bridge when we come to it. We've now phased out the diuretic and muscle relaxant, and he's now on Valium (Diazepam, to be precise, complete with leaflet warning against driving or operating machinery, and with recommended dosage for helping anxiety in children who are bed-wetting, among other things). This is intended to help him stop worrying about needing to go. To be honest, I don't think it's having an awful lot of physical effect, but it's probably helping with his stress levels.

Luckily, Jazz is a model patient and takes all these pesky needles in his stride. He's now had his second weekly injection and second weekly blood test. The lymph nodes that were enlarged are now getting back to somewhere near normal (I can't find them any more, even with help from the vet). On Friday we got a call to say that this time the blood test results showed that we're starting to kill off the bone marrow as well as the cancer cells. So, back I went to the vet for more antibiotics (we'd completed the previous prescription the day before) to prevent secondary infections while his immune system is compromised. Our regular Monday morning appointment tomorrow will now be for another blood test instead of treatment. I've also been asked to take a urine sample this time. Collecting that will be a new experience that I'm REALLY looking forward to. That should be fun! If the results from that blood test show that things are back to normal, he'll get the next treatment on Thursday evening (which was originally booked for his weekly blood test). If not, we'll keep on doing blood tests until it is (and then presumably adjust the dose accordingly).

At his last visit on Wednesday his weight was continuing to go down (from 24+ kg originally to 22kg), but his appetite seems to have mostly recovered - provided we feed him "nice" things ;-). The pills are all going down well with Chilli Beef or BBQ Chicken meat paste (with most of the powdery ones ground up and mixed with the meat paste, and the others buried in it). Luckily, he thinks this is wonderful treat time.

It's now 2 weeks since the devastating dose was given, so hopefully after another week or so things will start to pick up.



Since his operation 3 weeks ago, Jazz is sporting a silly goatee beard above the patch they shaved (see picture). I really must get round to trimming that - it does look stupid. On the other hand, he's so fluffy that unless you're low down and he's looking up, you don't even see the bald patch under his chin. He's been wearing his racing harness instead of a collar so that it doesn't rub on the scar. He also has bald patches on his front legs for the injections (they're alternating legs to save the veins, and taking the blood for the blood test from elsewhere). I don't think he'd win too many show classes just now, but it still doesn't stop him wearing that "butter wouldn't melt" expression.

First blood test, Cystits and food supplements

Jazz went for his first blood test on Wednesday evening, and left a number of drips and small puddles on the floor at the vet's while we were there. We've had 2 or 3 accidents in the house too if we haven't gone out with him as soon as he asks.

On Friday morning I rang Fiona to try to find out what we should expect in the near future. I was told she wasn't in until evening surgery, but they'd pass my message on if she did pop in during the day.

At around 9:30pm she rang (that must be about the 3rd or 4th late night phone conversation we've had in the last couple of weeks - she's been very good). The good news is that the blood test results show that the chemotherapy isn't affecting his bone marrow which would have compromised his immune system. She was concerned, though, that his average time between pees is down from 2-3 hours a few days ago to less than an hour now, because there's a possibility that his bladder may not regain its normal elasticity and capacity. As to the immediate future, she said we should expect the cystitis to potentially last for as long as or a bit longer than the drug that caused it would be expected to be metabolised. As that drug is normally administered in 3 weekly intervals, the cystitis could last for another 2-3 weeks yet.

So, we're now trying an alternative approach to try to reduce his anxiety levels so that he doesn't feel the need to dash out and pee by giving him ... wait for it ... Valium! (Fiona says they use it for cats with cystitis too.) Apparently it's tricky to get the dosage right, and the evidence so far proves either that he's very sensitive, or tough as an elephant, depending on whether you look at the evidence of the immediate reaction to the chemotherapy drug (i.e. the cystitis), or his reaction to the sedation last Sunday night which should have knocked him out for the night and only lasted 4 hours.

Andy picked up the latest selection of medication this morning, and Jazz has had the first small dose of Valium (Diazepam, to be precise). So far, the effect seems to be that he sleeps more between pees, but isn't peeing any less often. It's possible that the muscle relaxant he's been taking to stop the cramps being painful is having an effect on that, so we'll try phasing those out soon, now that we've got the valium.

We have instructions to increase the dosage if it doesn't seem to be having much effect after 2-3 doses, so we'll see how it goes.

So, Andy and I are alternating work at home for the foreseeable future (in my case I'm off on Mondays anyway, and Wednesdays are half holiday / half work).

Meanwhile, sleeping downstairs and getting up countless times per night is getting pretty tiring, so we'll have to start sharing that a bit too before I collapse completely.

Apparently, he likes broccolli, cabbage and cauliflower, but not red peppers ;-) (all of which are supposed to be helpful at fighting cancer), and not surprisingly he thinks that garlic flavoured chicken is really good. He's even eating some of the dry food with it. The James Wellbeloved puppy seems to be as good as anything as far as the protein and fat proportions are concerned, so we'll go with that, combined with fresh chicken and the vegetables.

On top of those, he's getting supplements of Vitamin E, Vitamin C, Selenium, Argenine and Garlic to generally combat the cancer and boost the immune system, plus live bio yoghurt to counteract the antibiotics' tendency to kill of the good bacteria as well as the ones we don't want. He's also getting Cranberry tablets (you can't get dogs to drink the juice - they don't like it) for the Cystitis.

Coping with Cystitis - the first few days

I've been sleeping downstairs since he woke up from the sedative on Sunday night (or 3am Monday morning, if you prefer). Most nights so far he's been waking me up every 2-3 hours to go out which isn't too bad if I stay downstairs, but it was about once an hour last night, so I didn't get much sleep.

He also had blood in his urine again for a short while yesterday afternoon. We went for his first blood test (to check the effect of the chemo) yesterday evening, had his stitches out, and he's been given another (different) prescription for antibiotics to try to help clear up the infection. He's lost another kilogram, so last night he got the first portion of the chicken that Andy cooked for him yesterday, and even ate some of the dry dog food that went in the bowl with it.

First treatment and unexpected side effects

Jazz and I are just back from our 3rd visit to the vet in 24 hours. The Lymphoma diagnosis was confirmed on Saturday, and he had his first doses of Chemotherapy at 10:30 yesterday (Sunday) morning.

First, he had an injection of Vincristine (and we all got to wear white coats, and as I was holding him I had safety goggles too). He will need to have these injections weekly at first, for about 4-8 weeks, with blood tests between doses to make sure we're not overdoing it and affecting his bone marrow. So, we have a block booking for Monday mornings for the injections and Wednesday / Thursday evenings for the blood tests for the next 4 weeks.

Once the lymph nodes have shrunk back to normal and stayed normal for 3 weeks, we can reduce the frequency of the injections. At the moment, I can feel the nodes under his jaw very easily - they're about the size of large marbles.

Then he had his dose (in tablets) of Cyclophosphamide. This is given once every three weeks. Finally we were given Prednisolone tablets to give to him at home (4.5 every day). These are a steroid related to Cortisone.

Prednisolone tends to make them thirsty (and therefore need to wee more), and one of the known side effects of Cyclophospamide after prolonged use (usually a couple of months) is the possibility of Hemorrhagic Cystitis (i.e. Cystitis with blood in the urine).

After lunch we went to Holland & Barrett to stock up on supplements for him.

At about 9:45 last night (while we were having a very late dinner), Jazz started to whimper a bit and wanted to go outside. He had a wee and came back in, but wanted to go out again about 10 minutes later. This time he seemed to be trying to wee but not passing anything, and he just laid down, then got up and walked about a bit, and then threw up. Shortly afterwards we tried feeding him, and after he'd eaten a little bit and walked away from his bowl we spotted a very small puddle of urine with a little blood in it where he'd been standing, so that clinched it and I rang the surgery straight away. Fiona called back a few minutes later, and said he should come into the surgery, so we all met there at about 11pm. He threw up again on the way there. She was really surprised about the cystitis, having never seen or heard of it immediately after first treatment, and thought the nausea was mostly likely a reaction to the muscle spasms caused by the cystitis. (Unlike humans, dogs don't usually get nauseous on Chemo, although it's not completely unheard of.)

He had an anti-nausea injection. Pain relief was a bit more tricky as she didn't want to interfere with or react with the chemotherapy drugs. In the end she decided to give him the drugs they usually use for pre-med, but with more pain relief and less sedative. The idea was to give him a good night's sleep as well as helping with the pain. He was so dopey by the time we got him home (about 15 minutes' journey) that I had to carry him from the car. We sat up with him 'til after midnight, but he fell asleep within about 5 minutes of getting home, and never stirred again before we went to bed.

At about 3am I heard him whimpering again, so took him out and spent the rest of the night downstairs with him, and we had another 2 or 3 trips outside by 7am. By then, having hardly drunk anything that I know of during the night, he was peeing almost pure blood, and he was clearly upset every time he needed to go out, so I decided to take him back again as soon as the vets opened this morning.

Fiona was amazed that he'd only slept until 3am. She'd expected to knock him out for the whole night. The only thing we can do for the cystitis is to wait for the Cyclophosphamide to flush out of his system. She's given me some diuretics to help with this (to be started this evening, as we obviously need to get some fluids into him first), and he's now had the first of some muscle relaxant tablets to prevent the muscle spasms in his bladder, which should make him feel better. Almost straight away he's started drinking again, and his urine is completely clear too, so things are looking much better. So far he's still wanting to go out every 15-20 minutes, but that's good news now, as it should be flushing everything through.

We're due to go back to the vet for his blood test and the have the stitches from last week's op removed on Wednesday evening. He seems much more comfortable now, though not surprisingly, he's subdued and probably tired!! His bladder control is weak though. I've just found a small puddle on the carpet, and he's been right next to me as I've been typing this. He didn't give any clue that he wanted to go out. It may be that he's still feeling a bit dopey from the drugs, or he's just exhausted, or maybe the muscle relaxant is a bit too good.

As far as the chemotherapy goes, the drug he's reacted to is the one he gets every third week, so we have plenty of time to decide what to do next, although that does also mean that it'll take a while to get flushed out of his system too.