Greyt Matters

So far so good with the Adriamycin that Sarge got this morning.  It was another injection, this time in his left front leg.  Good thing he has four legs considering all the IVs they are putting in his body.

Sleepy Boy

He was a little tired this afternoon, but he ate like a champ and we went for a long, energetic walk this evening.  But it is still too early to say that we are out of the woods with this treatment.

The discharge instructions said “Adriamycin can cause some gastrointestinal signs like anorexia (oh my!) and diarrhea.  This can happen a few days after the treatment…I am sending home Cerenia (note: $80 for 10 pills!) to use if Sarge starts vomiting and Metronidazole to use in case Sarge has diarrhea.”

But I’m hoping Dr. Hamilton got his statistics right when he said only 10 – 15% of dogs experience these symptoms.  Hopefully, Sarge has paid his dues with respect to complications and this drug will be reaction-free.

One thought to put aside: While on the walk tonight, Sarge appeared to find something in the grass that he proceeded to eat.  Hopefully, it will not come back to haunt us in the form of a bacterial infection.

So, with this round of Adriamycin, we finished the first cycle of drugs!  Yay!  Three more cycles of 4 treatments each to go.  :-0  Sarge also finished his Prednisone and his antibiotics so we have no pills to take tomorrow.  (Unless he starts vomiting or sending it out the other end.)

And no chemo next week.  🙂

I’ll close with a photo of the highlight of Sarge and Daphne’s day, every day: a stuffed Kong.

The Highlight of Their Day

I’ll know everything is right with the world as long as Sarge continues to enjoy his daily Kongs.

Assuming Sarge’s white blood count is normal tomorrow, he will get his first injection of Adriamycin.  I have to drop him off before 8 AM and leave him while they give him the drug.  It will probably be early afternoon before he is ready to come home.

Last week I asked the vet tech why this drug required Sarge to be there so long.  I assumed it was because it was a more risky drug, but she said they handle the dogs this way (with this drug) because it takes about 30 minutes to administer.

I will, of course, be a nervous wreck waiting to see if he has a bad reaction to this new drug.  When I first discussed the treatment protocol with Dr. Hamilton, he said 10 to 15% of dogs have side effects with Adriamycin, and those side effects are usually G-I in nature: loss of appetite, constipated diarrhea.  But there can be a delayed reaction, i.e., problems can show up 4 – 14 days after the treatment.  I guess I will be on pins and needles for awhile.  Not to mention waiting to see how his white blood count reacts.

The only good thing about being at the point of administering this drug is we are about to finish the first of four drug cycles, and we also get next week off!

Send positive thoughts and prayers Sarge’s way so he will have an uneventful first encounter with Adriamycin.

I really didn’t think there was any way it would happen by today, but Sarge’s blood counts were “perfect” (and his temp was normal) so he got another round of chemo this morning.  It was a repeat of the Vincristine, which is given as an injection.

After Vincristine no. 2

Normally I don’t see Dr. Hamilton during the chemo visits.  The vet tech comes up front and takes Sarge away to the “laboratory” in the back where they do their thing on him.  But today I made a special request to talk to Dr. Hamilton in person.

I told him I was freaked out by what happened last weekend, and I needed to discuss what I / we can do to prevent it from happening again.  I reiterated that we do a lot of walking in an urban neighborhood where the dogs discover all kinds of potentially yucky stuff, much of which they like to put in their mouths (e.g., licking other dogs’ pee) or near their noses (smelling other dogs’ poop).  If infections come from bad bacteria jumping out of Sarge’s G-I tract then surely it can’t be good to be “internalizing” the things that other dogs leave behind.

Unfortunately Dr. Hamilton said there is nothing I can do to proactively prevent a recurrence.  It was just one of those things that happened because Sarge had a bad reaction to the Cytoxan.  (I had a bad feeling about that drug from the start – who would name a drug something that sounds toxic?)

Dr. Hamilton said Sarge should not get an infection again because he will adjust the dosage the next time Sarge is scheduled to get the Cytoxan.  He will ramp it down so it does not smack Sarge’s white blood count so hard.  I will, of course, be a nervous wreck the next time the Cytoxan is scheduled, which may be November 10th if we stick to the schedule going forward.

So far, Sarge has had 2 of the 3 drugs in the cycle: the Vincristine hasn’t been a problem (knock on wood), the Cytoxan has blasted his white blood count, and we have not had the Adriamycin yet (scheduled for next Wednesday).  I hope the Adriamycin injection goes smooth as butter because I can’t handle another crisis.

The good news from Dr. Hamilton is that Sarge is in “complete remission” already.  🙂  Of course, my question to him was, can we stop the chemo, and he said no.  😦  He said we need to make it a “durable remission,” which means we continue with the protocol.  I asked if he ever stops chemo early, and he said only if it is not working.

The other piece of good news that got lost in the wash is that Sarge has Type B (Better) vs. Type T (Tougher) lymphoma.  I learned that via a phone call last Friday afternoon before all hell broke loose with the high fever.

So how is Sarge doing today after the chemo?  Great!  He’s been eating normally, and he’s had good energy.  He gave me a little scare when he started licking his front leg excessively this afternoon, which can be a sign that the chemo has leaked out into the surrounding tissue.  But in this case, he was licking the wrong leg for that scenario.  He was licking the place where he had the catheter from this past weekend’s hospital stay.  They gave him today’s chemo in his left rear leg, which he ignored all afternoon.  Best I can tell, the front leg may have been itching or something as it tried to heal up.  But it was all red and I was a little worried.  We went for a walk and it seemed to get less red.  He hasn’t bothered with it since we got back so I guess all is well.

This treatment process is going to drive me over the edge.

Look at that face

Sarge spent two nights at the animal hospital this weekend where they worked to get his temperature under control.  When I dropped him off Friday night, his temp measured 105.1 degrees.  I talked to Dr. Hamilton Saturday morning, and Sarge’s temperature was down to 104.7, which was better but nowhere near normal.  Dr. Hamilton made a comment that 104.7 was better than 105 or 106, so I’m guessing that Sarge’s temperature must have spiked in the 106 range.  Scary.

So there was no chance Sarge would be springing that joint on Saturday.

(Dr. Hamilton also said Sarge vomited sometime Friday night, but it only happened that one time fortunately.)

Saturday afternoon I spent about an hour and a half with Sarge during visiting hours.  By then, his temp was down to 103.3, which is considered the high end of normal, so he was definitely making progress.  As you might expect, he had not been eating, and he would not eat the canned food the vet tech brought in for me to try and feed him.  The good news is that he scarfed down half a can of food when the vet tech returned him to his crate.  I also made a run to the nearby Publix where I got Sarge half of a rotisserie chicken, which he ate with some enthusiasm Saturday night and Sunday morning. 🙂

Dr. Hamilton called Sunday morning to report that Sarge’s temperature was down to 100.2 degrees, which was great news.  He said Sarge was not back to normal but he thought Sarge would heal better at home since he was very stressed out in the crate at the hospital.

So I picked him up around 10:00 AM this morning, and I brought my big boy home where he has been resting comfortably.

Recovering from scary high fever

He is obviously exhausted but he has eaten more chicken as well as a little bit of soft dog food.  He also needs to pee quite frequently and in large volumes because his system is working to eliminate all those fluids they gave him over the weekend.

Dr. Hamilton wants me to bring Sarge in for his regular chemo treatment on Wednesday where they will check his CBC again.  If the blood count is not low, then Dr. Hamilton plans to give Sarge his next chemo treatment, which is another round of the Vincristine.  I asked if we should give Sarge a week to recover, and Dr. Hamilton said that, even though this episode was kind of scary, letting the cancer take control would be worse.  He told me that Sarge’s lymph nodes are back to normal (yay!), and he wants to make sure we do not lose ground.

Sarge’s CBC was extremely low when he checked into the hospital Friday night.  Is there any chance his count could be back to a normal range by Wednesday?

Sigh…

Dr. Hamilton did not want to give Sarge his scheduled chemo treatment today because his white blood count was too low.  😦  Not scary low, but too low for the Vincristine.  The vet tech said this is not uncommon at the beginning of treatment because they are trying to find the right dosage for the individual dog.

So they sent us home with some antibiotics to help prevent “opportunistic” bacterial infections.

Overall, since the chemo started, I think Sarge has been doing great.  The only thing I noticed over the past couple days was he seemed to run out of energy by the time we were ready for bed.  Usually during the work week – when he gets to rest and relax all day while I am at work – he is still full of energy when I turn out the lights.  For example, as I am getting ready for bed, he usually comes upstairs and spins around in circles and barks for a last bit of fun.  The last couple of nights, however, he just came upstairs and laid down on his bed.  Other than that, he has been going on long walks, eating like it is going out of style, and pooping and peeing in fine fashion.

The vet tech said his white blood count should be back to the normal range by next Wednesday when we will try again.

And we remain in suspense over the results of the PCR test (the B for Better vs. T for Tougher type of lymphoma).  The vet’s office is going to call and find out what happened to it.  We want a big fat B!

Sarge ventured into uncharted territory again as he had his first Cytoxan chemo pill today.  The discharge instructions warned of the possibility of blood in his urine since the drug can be irritating to the bladder lining.  To prevent it from sitting in his bladder, they also gave him another pill that makes him pee: Lasix.  So he is getting a double dose of pee pills with the Lasix and the Prednisone that he has been on for a couple of weeks.  I guess Sarge and I will be getting up in the middle of the night tonight to empty our bladders.

At one point this afternoon, Sarge did cry out like he was in pain, but I let him outside to pee and he relieved himself of a rather large volume.  He hasn’t cried out since then so I am assuming it was a “man, I have to pee” kind of cry.

Overall he has been doing great this afternoon and evening.  He had enough energy to go for an extra long walk, and he was doing the “bark because I want to play” stuff tonight. And I have not seen any blood in his urine, thank goodness.

Sarge notches two rounds of chemo on his collar

Daphne and Sarge wait patiently for their nightly snack

We saw two greyhounds at the animal hospital this morning; Jake had something going on with his eye, and Lily was recently diagnosed with bone cancer. 😦 It’s sad to see other hounds who are hurting but I think Sarge gets some level of moral support from their presence.

I definitely feel a bond with the other dog owners who are seeing Dr. Hamilton, the oncologist. Everyone tries to put on a brave face, but you can tell there is a lot of emotion going on behind the tight, sad smiles.

It was a fun weekend for the dogs: a Wendy’s hamburger for dinner Friday night and a road trip to Newnan on Saturday where we got to hang out with a bunch of greyhounds and their humans.  It was the annual “bring-your-greyhound” meeting of the Southeastern Greyhound Adoption group.

SEGA

Sarge and Daphne were thoroughly exhausted when we got home from the greyhound meeting and we all slept soundly Saturday night.

On Sunday, our good weekend was topped off with some much needed rain.

Sarge had his first treatment of the Vincristine today, which is technically part of the first round of chemo. (The plan calls for Asparaginase and Vincristine in week 1, but Sarge had the Asparaginase last week when he was first diagnosed.)

So that makes one treatment down and 15 to go. Yikes!

And so far, so good…no, so great! I will try to make this my last photo of his throat (at least for awhile), but look how beautiful it is!

Eight days after 1st treatment

I know we are in the early, heady days of dramatic improvement and that there will be low moments to come…but we are lovin’ what’s happening so far. 🙂

I worked at home today so I could watch Sarge after the Vincristine treatment, and he has been fine. He snoozed most of the afternoon, ate a stuffed Kong and his dinner, and went for a couple of relatively short walks.

Here he is in the ultimate pose of relaxation and recovery:

Relaxing after 1st Vincristine Treatment

The discharge instructions said I should take his temperature if he starts acting funny, e.g., decreased appetite, lethargy, etc. If the temp is over 103.5 degrees I need to call Dr. Hamilton or Dr. Fowler’s office. Knock on wood that that does not happen now or in the future.

They also said I needed to monitor his leg where the IV went in to make sure nothing funky is going on there. I read online some scary stuff about what can happen if the chemo seeps out of the IV and into the surrounding tissue. I’m happy to say that his little shaved leg is doing just fine.

Daphne also spent the afternoon relaxing. Here she is in one of her typical poses, i.e., the Pike position:

Daphne in the pike position

No one can say these dogs don’t know how to relax…

Here are some more progress photos.  Four days have past since Sarge’s first chemo treatment, and his throat is noticeably less swollen.  🙂

Starting point

One day after 1st treatment

Four days after 1st treatment

So far, Sarge has not really had any negative side effects except for being a little tired for a day or two after the treatment. He also had loose stool for a couple of days (with a little bit of blood). Since then, the poop’s been lookin’ good!

I’m thinking the next batch of stuff, Vincristine, is a little more toxic than the Asparaginase that he got last week. But they say this round should not be bad in terms of side effects. Here’s hoping Sarge is typical in that respect.

Sarge seems to be adjusting to the Prednisone too. Even though he is still on the high dosage, he can make it at least 7+ hours (i.e., overnight) without an accident now…knock on wood. (To his credit, he only had that one accident in the house so far. For a few days, we were getting up in the middle of the night so he could relieve himself, just in case.) I can now sleep from 11 PM to 6 AM, which is pretty close to normal. Plus the area rugs are back on the floors now, which makes Sarge and Daphne happy since they both loathe the slick wood floors.

Fun factor over the weekend: A car ride to Grant Park this morning where we took a long (hour plus) walk before the heat got too bad.