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).