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.