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.

Lymphoma confirmed

Jazz's biopsy confirms the lymphoma, so we'll be going to see Fiona for his first treatment tomorrow (out of normal surgery hours, but she thinks it's best to start as soon as we can).

Still, the confirmation of the diagnosis means we can get on with the treatment now, so at least we know where we are.

One week later ...

Well Jazz went back to the vet today after a week's worth of antibiotics and no distinct improvement in his appetite or reduction of the lump in his neck (enlarged lymph node).

As expected under the circumstances (i.e. no effect from the antibiotics), he was admitted for X-rays, and to have the enlarged lymph node removed to be sent off for biopsy, etc. He is now back home and is fine, although still somewhat bemused from the effects of the anaesthetic and with a bald patch and stitches under his chin.

I'll have to wait about a week for the official diagnosis when the results of the biopsy come back from the lab, but the vet is almost certain that he has Canine Lymphoma (i.e. cancer of the lymph system)... although she'd love to be proved wrong. The good news is that it's generally quite manageable with drugs (i.e. chemotherapy, which doesn't have the same sort of potentially devastating side-effects that it often does in humans). Depending on the grade of lymphoma (which the biopsy results will tell us) Jazz could have anything from 2-3 months (if we're REALLY unlucky and it's very advanced) to another couple of years left in him yet ... which would take him to a very respectable age for a dog anyway (he's about 12-13 now). Without treatment we'd be looking at a couple of months or less.

Sadly, chemo isn't cheap, so I'll be raiding the piggy banks :-(. In dogs, they generally use a combination of 3 drugs, one of which (Vincristine) has to be given intravenously - so that which will involve a weekly visit to the vet at first, plus an extra visit halfway between injections every week to take blood to test that the dosage is correct. On top of that, he'll have a couple of different tablets (Cyclophosphamide and Prednisolone - a steroid) to take at varying intervals. After a month or two, if things goes well, the frequency of the injections will be reduced to once every 3 weeks, and then depending on how that goes, these will later either be further reduced to once every 6 weeks or perhaps stop altogether, just continuing with the oral drugs.

The other good news is that because one easy way to detect/monitor lymphoma is by feeling enlarged lymph nodes near the surface of the skin (which are therefore relatively easy to spot - Jazz now has some enlarged nodes that weren't detectable a week ago, apart from the one that was already enlarged last week and has now been removed), it's also fairly easy to judge the effectiveness of the chemotherapy and determine when the lymphoma is in remission by observing the reduction in size of the lymph nodes. Treatment can then be adjusted accordingly.

Having had Jazz on a diet designed to keep the weight off him to look after his joints for the last 3 years, I'll now need to change that for a high-protein, high-fat, low-carbohydrate diet (rapidly dividing cancer cells thrive on carbohydrate, but fat tends to inhibit it, and anyway he's probably going to lose even more appetite than he already has, so he'll need the fat). Hill's do a prescription (tinned) food designed for this, but even my vet reckons it's prohibitvely expensive for a large dog, so I guess I'll have to get as close as I can with normal complete foods and supplement the rest. According to some of the websites I've found, supplements of Vitamin C, Vitamin E, Selenium, Garlic and Argenine can also help, although in some cases they're helping with the effects of the chemotherapy rather than the cancer itself.

He's due to go back for a post-op checkup on Thursday evening, and then again about 10 days from now to have his stitches out. We won't be starting any treatment until we get the results of the biopsy about this time next week to be sure of the diagnosis, but I think we can fairly safely predict getting pretty well-known at the vet's for the foreseeable future.

On a more positive note, everything I've seen on the web suggests that the best thing to do for him (apart from the drugs and change of diet) is to keep life as normal as possible ... so once the wound's healed, (and I asked the vet about this specifically,) he'll still be allowed to go swimming :-)

I found some useful information at Canine Lymphoma

Feeling a bit off colour

Jazz has been "not quite right" recently. He's not been very interested in food (but then he's always more interested in stuff going on than his dinner, especially if we're not at home, which we often weren't over the holiday period), and not chasing the ball as enthusiastically as usual in the park.

There have been a few other things too, which I would have discounted if they weren't all together: sometimes his gums have bled if he had a rawhide chew, for instance. His breath has been smelly. He's also been huddling strangely in his crate in the car when we were traveling, which isn't like him.

So today, I took him to see Fiona the vet. She examined him and said that his lymph nodes were enlarged. There was no obvious sign of dental problems. She took a blood test and sent me home with some antibiotics for him.

The blood test showed that all his major organs are working well for a dog of his age, but his white cell count is low. This could indicate that the enlarged lymph nodes are a sign of lymphoma, or that he has been fighting off some infection or other and is struggling to produce enough white cells to do it. We'll see how the antibiotics go, and take him back next week. If there's no change, she'll keep him in to take a biopsy of the lymph gland.