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.