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)