Sickness, more diarrhoea and listless

We went down to Southampton last night, and Jazz was sick twice on the way back. He'd obviously been eating grass in the garden, as what he brought back was mostly undigested grass.

Today, he's been very subdued (despite the excitement of having packers in for tomorrow's house move), and still has diarrhoea. We saw Emma (for the first time) at the vet's tonight, and she suggested we try feeding him on plain chicken (might have to hand-feed him), and try the Canikur again, even if we have to grind it up and add it to his food.

As he is SO subdued, and particularly as we're moving tomorrow, she suggested that if he's still looking sorry for himself, we might like to consider taking him to Henley tomorrow and leaving him there for observation. Meanwhile, she's taken blood for the histology re next week's Vincristine, and to check his kidney, liver and other organs.

Not surprisingly, as the little he has eaten in the last couple of days has come back up again, his weight is down ... to 21.5kg, but he's not dehydrated and his temperature is normal.

More diarrhoea

The usual Wednesday diarrhoea seemed to clear up, and Jazz was eating like a dog possessed again on Thursday onwards, but he's definitely got the runs again.

Spoke to Justin, and he's suggested trying him on Immodium (yes, nip down to the supermarket for it) at 0.2mg/kg weight 2-3 times per day, which at the moment for him is 0.2x23kg = 4.6mg. Immodium comes in 2mg capsules, so each dose is 2-3 capsules. Justin suggested trying him on 1 to start off with, increasing to 2, and if he's still loose tomorrow morning, call before taking him in. He doesn't really want him to have his Vincristine if he's still got diarrhoea.

A pattern is emerging

Jazz is staying dry through the nights again now.

It seems as though we have a regular pattern starting:
On Monday he goes for his Vincristine injection and drip
On Tuesday evening he starts to get a bit of diarrhoea (whether he's on the Tagamet or not)
On Wednesday he still has diarrhoea and doesn't want to eat anything much at all
On Thursday he's back to normal and eating enthusiastically again

His weight was down again on Wednesday, to 22.8kg

Second Vincristine injection with drip

Jazz was quite funny with Helen yesterday, showing every sign of not wanting her to come near him with the clippers and canula, which is unusual for him. We were in the small treatment room though, and I don't think he likes it much in there. Or maybe he didn't enjoy being on the drip last week. He didn't put up much of a fight though.

Weight was down a bit at 23.3kg

Anyway, so far he's showing no evidence of ill-effects. There was a small drip in last night's nappy (but less than the previous two nights), and he's drinking OK.

He had to be persuaded to eat all of his breakfast this morning though.

He had his Prednisolone and Leukeran this morning, and today's the first day of alternating drugs, having had the Prednisolone every day for the last week.

Another small leak

Jazz's nappy from last night showed evidence of a small leak again.

Breakfast went down quite well, although I had to call him back to his bowl to finish up the last few grains of rice.

An empty bowl

Having said that he's been eating normally, we've usually had at least a scattering of grains of rice left after each meal. (Meals these days are part Hill's tinned k/d plus one part chicken to two parts rice, in proportions 1:2:3 for Breakfast:Lunch:Dinner.) We've been cooking the rice with garlic and chilli powder, and then mixing more in with it after cooking to try to make it more appealing.

Today, I got the blender out to chop up some fresh chilli for the latest batch of rice, and while it was out, decided to mince the chicken and mix it in well with the rice.

To be fair, he was keen to eat to start off with, but whether it was mixing in the minced chicken, or just the minced chilli and garlic in the rice, tonight was the first time he's completely cleared his bowl for a month or so. (Well, OK. He did leave ONE grain of rice!)

He seems to have stopped moulting like mad too, although he's still looking scrawny. His coat is looking shinier again though.

Small leak

Oddly, Jazz appears to have leaked slightly in last night's nappy - just a little patch, neither here nor there.

He's still eating well though.

Dry again and eating normally

Jazz had another dry night, and also ate all his meals yesterday, plus breakfast (his least favourite meal) today. So, maybe it was just the diarhhoea that was putting him off his food.

A dry night again

Jazz's nappy was dry this morning! Hooray!

Histology good; kidneys holding out

The Canikur has worked - the diarrhoea has cleared up now, and he's producing solids again.
I've looked up Tagemet on the 'net, and find that one of its side-effects (in humans, at least) can be diarrhoea, and also that the dose may need to be adjusted for those with kidney problems.

Fiona rang with his blood test results at 7:30pm (she WAS supposed to have left by lunchtime to go on holiday, but didn't get away as planned!). Histology is clear, so no problem going ahead with the next Vincristine dose. Kidney-related tests show the Urea minimally down and the Creatinine minimally up.

I asked her about the issues with Tagamet. First, although there are potentially problems with human renal patients, the same doesn't appear to be true in animals for some reason, and they actually use it with renal failure in dogs and cats to deal with the stomach acids that tend to be related to kidney problems.

However, she has suggested that we don't give it to him after next week's Vincristine dose, and make sure we have some Canikur in case we need it. (The Canikur is just to be taken if he needs it, not proactively.)

Appointment for blood test

Went back to see Fiona this morning for his blood test. He's had some diarrhoea since Monday's injection (which the Tagamet was supposed to prevent). He very kindly left a sample outside the surgery, which Fiona duly inspected (before I cleaned it up after our appointment, of course). Her diagnosis was this was large bowel-type diarrhoea, rather than stomach/gut-based which is what the Tagamet is supposed to prevent. She's given us some Canikur (kaolin and electrolytes), which are like dog biscuits, to be given 3 twice a day until it clears up.

Jazz is off his food a bit at the moment, particularly in the mornings. The weather is hot though, so that's probably contributing. Weight today was 23.6kg, so it's having a definite effect on him too.

Fiona's has taken twice as much blood as usual (and plans to continue to do so), so that she can send half to the lab for the histology relating to his chemo, and test the other half to monitor his kidneys.

The Canikur seems to be having some effect already. He produced only a small amount of the runny stuff at lunch time, and no accidents.

He's also having more trouble with his bladder - unable to last as long between wees as he had been prior to the Vincristine injection. He certainly can't now make it through the night (as he had been for a week or more) without making use of the nappy.

Resumption of chemo

Jazz has had his first Vincristine injection of his second course of chemo. I left him with Fiona (having personally acted as nurse / vein raiser to insert the canula before I left) just after 9:00, and collected him at around 12:30. During that time he had both the Vincristine and a couple of hours' worth of fluids. Weight today was 24kg.

They sent him home with the expected Prednisolone and Leukeran, plus some Tagamet. The Prednisolone is to be taken every day (4.5 per day) for the next week (starting tomorrow), and then reducing to every other day. The Leukeran is to be taken every other day right from the start (2 per day). In addition, 2 Tagamet to be taken twice a day, at least an hour after other medication for 3 days after each Vincristine injection, starting tonight.

The plan this time is to give him an 8 week course of Vincristine once a week, and then to switch to a different regime from last time: one week of Vincristine, Prednisolone and Leukeran, and one week off everything. (Last time we kept going with the Leukeran and Prednisolone, and the Vincristine injections dropped to once every three weeks.)

So, to cope with all this, I now have a complicated diary of drugs and vet's appointments on the kitchen wall.

He seems mostly OK in himself, although he was a little odd when I took him to the park late this afternoon. He'd chase after the ball, and then couldn't quite seem to work out what to do once he'd picked it up. It was quite amusing to watch his sudden apparent brain/memory failure - it wasn't the sort of thing that seemed alarming. And on the other hand, he was perfectly alert to everything else going on in the park. There's certainly no sign of the kidney-failing dopiness that we saw after his last two doses of Vincristine.

Kidneys still improving slightly

Latest blood test shows urea down slightly to 16.7, but creatinine up slightly at 183.

Asked Fiona whether I should start the Prednisolone before his Vincristine (to get him drinking more), but apparently the Vincristine works best when the cells are actively dividing, and Prednisolone inibits this, so better to kick start with the Vincristine on Monday.

About to go back on the chemo

Fiona has now spoken to Gerry (the cancer specialist), who recommended putting Jazz back on the chemo ASAP, resuming with the same regime (i.e. Vincristine, Leukeran and Prednisolone). None of the drugs have any known detrimental effect on the kidneys (if anything, they can affect the liver), but we do need to make sure he's getting fluids through him to force the kidneys to keep doing some work, rather than getting "clogged up". Meanwhile, we've stopped the antibiotics and potassium supplements. (For the first time in ages, he's not taking any drugs at all!)

Jazz's skin and coat have taken a turn for the worse since he's been off the chemo (or possibly since he's been ON the kidney-friendly diet). Before, his coat looked really healthy and glossy, but now it looks dull, and his skin is flaky (the poor boy looks as though he has dandruff).

However, his bladder has definitely been better in the last couple of weeks. In the last couple of weeks he's made it through the night with a dry nappy almost every night. In the last couple of days though, we've had one accident when we went out for 3-4 hours and forgot to put a nappy on him, and the night before that he didn't make it through the night and the nappy got used. He's also had a bit of diarrhoea in the last few days.

During the last week or two (barring the last couple of days), he's been very bouncy - the best we've seen him for months.

When Fiona examined him, she found that his lymph nodes were slightly enlarged again, so that definitely means we put him back on the chemo. The lymphoma could be the cause of (or contributory to) the bowel problems. He's also started "stress panting" again just recently, which we haven't noticed for a while. Fiona's theory was that this was to do with pain in his bladder. I suppose this could still be true if he's struggling a bit more to hold it. His urine is very yellow - this is both good and bad news - good because it shows his kidneys are doing something, and bad because it confirms he's not really drinking enough.

So, we'll be going in for another Vincristine injection on Monday morning. To try to make sure it doesn't knock his kidneys for 6, we'll also have him on a drip for a few hours to make sure we get some fluids through him. The plan is that I'll take him in and stay with him while they put the canula in, then I'll leave him there and he'll half half an hour of fluids, then the Vincristine and then another couple of hours or so of more fluids, and I'll collect him after that. Also, the Prednisolone should make him thirsty, which is good under the circumstances.

Fiona has taken blood samples (to check the kidney function and - I think - histology re the lymphoma). She's also taken a urine sample ... or to be more accurate, one of the nurses did when we left the building ;-)

He weighed 24.25kg at this visit.