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Archive for July 19th, 2012

Dog Blog: Living with canine cancer (2)…..

Posted by indigodream on 19 July, 2012

This diary starts just over a month after Lou first started snoring – what a ridiculously innocuous start to such a difficult journey….

Week Commencing 4th June

Lou now has so many shaved bits that she looks like frankenstein’s monster hound – but lying on her side with her tongue hanging out is normal greyhound behaviour!

Lou was being lovingly cared for by Sally and Kevin from Greyhound Homer  while we were taking part in the Queen’s Diamond Jubilee Pageant – I was very worried about her (and the other hounds!) , but I did enjoy the brief respite from her care. This week I was impatient to start the radiotherapy, though Lou was now swallowing and breathing normally – and no more snoring! We are getting used to the fact that Lou is low after the Vincristine but she does recover within 24 hours.

Between them, Poppy and Lou continued to have the odd urinary accident, the odd bout of diarrhoea and Lou, once, managed to catch three dogs beds in a spectacular bout of vomiting. Although I grumble (a lot) about the constant washing of dogs beds, carpets and of the dogs themselves, it is a willing service – no different for sick, elderly dogs than for their human equivalents.

I spent the weekend preparing a meticulous care package for Lou’s stay in hospital the next week  – clearly labelled drugs, a detailed drug administration chart, detailed notes from me on her care, comprehensive medical notes from our local vet and her chemotherapy protocol from the RVC. I was absolutely determined that she was going to get the best care while in hospital (the VRCC this time).

What I learnt:

  • Not to panic the second time I see an expected reaction to a drug e.g. Vincristine (I still worry the first time!).
  • I am an OCD control freak geek when it comes to other people looking after my hounds!

Week Commencing 11th June

I dropped Lou off in vet hospital in Essex – I felt like a criminal – it’s bad enough feeling like a poisoner every time I administer her chemotherapy tablets!

Lou got on well during the week, though I worried about her, and rang for updates every day. I remember that Poppy was delighted to have unchallenged top-girl status for a week!

Lou did well in hospital, but when I picked her up on Friday she wasn’t well at all – even the radiation oncologist seemed worried, though Lou had had a dose of Vincristine along with the radiotherapy that morning. Once again I fretted over whether we had made the right decision to treat. I got Lou home and she immediately tottered upstairs and slept for the rest of the day. I was very worried, but amazingly, by 10pm she got up for her dinner and had perked up considerably. She was on top form over the weekend – we were so relieved.

What I learnt:

  • the house is very quiet without Lou!
  • Giving the specialists detailed written instructions is a good thing – even if Jerome the oncologist thought I was a bit eccentric!

Week Commencing 18th June

If Lou is well enough to roach (lie on her back with feet in the air like a dead cockroach!) then we have some hope…

Truly terrible week – Poppy died on Wednesday morning, then on Wednesday afternoon Lou started having difficulty swallowing – this was the start of a horrendous delayed reaction to the radiotherapy (the delay between treatment and reaction is normal). We had been warned that she might develop mucositis – “when the gums, tongue, cheeks, throat or other mucus membrane-lined tissue in the radiation treatment field become inflamed…. The mucosa will get very red, and may ulcerate or blister during the second week of full course radiation therapy. Bad smell to the breath (halitosis), drooling, and difficulty eating can occur”. Yes, that would be what Lou’s got then…

Lou got steadily worse for the rest of the week, with excessive (and I mean EXCESSIVE) salivation mainly in the form of large amounts of frothy, sticky drool which impaired her breathing and her swallowing. She continued to deteriorate, despite doubling the dose of steroid and giving her precautionary antibiotics. The steroids made her obsessively hungry but she couldn’t swallow, so each bowl of food took around 40 minutes of patient feeding, a spoonful at a time, so that she wouldn’t choke while trying to take in too much for in one go. The action of lapping water was obviously very painful for her – she stopped drinking – so her food had to provide calories AND fluid. We had to delay her chemotherapy and the radiotherapy that was due the following week. I was frantic with worry, despite reassurances from the vets that her cancer had not returned and that the reaction would subside soon – huh, not soon enough for me!

What I learnt:

Week Commencing 25th June

Lou was still very unwell at the beginning of the week but then, very slowly, she started to improve – the drooling stopped and finally, on Thursday, she started swallowing properly again. We decided to re-instate her chemotherapy and booked her in for radiotherapy next week. I have worked really hard to keep her fed and hydrated since she developed mucositis – she has been steadily losing weight since she first had cancer but I felt my hard work had been rewarded when Lou had gained a little weight – from 34.1kg to 35.7kg – nowhere near her pre-cancer podgy self (38kg) but there’s no harm in that.

I learnt that:

  • Dogs do recover from radiation “sickness”
  • Mucositis is very unpleasant but there are practical things that can be done to make the dog more comfortable
  • You can keep a dog hydrated with liquid food, even when they’re not drinking water
  • It is a good thing to keep asking questions and to nag the vets for answers

Week Commencing 2nd July

Lou had her second and final course of radiotherapy this week. As we might have predicted, she was not well when I picked her up on Friday having had radiotherapy and chemotherapy in the morning. She is showing early signs of mucositis (reluctance to swallow, lip-smacking) so we’re probably in for a difficult week. But I am prepared, having learnt so much from the last episode! I was disappointed to find that she’s lost 2.5kg this week and is now 33.4kg – this is a healthy weight for her, though she looks very skinny compared to what she was. Because lymphoma dogs are prone to rapid weight loss I’ll need to do my best to ensure that she doesn’t lose any more.

She has the dire rear again – predictable with all she’s been through. She is not eating very well so I feel as if she’s losing weight before my very eyes! After a week of amazing peace and quiet with the lazy boys (I’d forgotten what it was like), the mantle of care soon settled heavily onto my shoulders again…..

I learn that:

  • I like to be prepared – I have anticipated that Lou might have mucositis and feel much more confident that I know what to do and that it will get better with time and tea!
  • Ty is hopeless without a top girl around to motivate him – this was his first week without Poppy or Lou – he has moped throughout! Ollie is fine – nothing bothers Ollie!
  • New symptoms still make me panic!

Skinny Lou! She’s 33kg here – it’s the right weight but for the wrong reasons – the red marks on her neck define the radiotherapy field..

Week Commencing 9th July

Last Saturday night Lou was showing some of her old spirit – demanding fuss and shamelessly lying on her back with legs akimbo – the sign of a happy hound; but by Tuesday she was starting to show signs of more severe mucositis – but in a different way. She was pacing, restless and swallowing convulsively – water, food and any plant in the garden that she could chew. I locked her indoors and she started chewing Richard’s armchair then went for a power cable – cue an emergency visit to the vet on Tuesday, plus a follow-up on Wednesday, and another on Thursday and Friday. There is some debate as to whether this compulsive looking for something to chew/eat is being caused by nausea (looking for something to make her sick) or by pain/discomfort in her throat (looking for something soothing). It’s very hard to judge, but the consensus is that we are doing all that we can and we just have to let the radiation reaction run its course – which includes it getting worse before it get better. We’ve a tough 7 – 10 days ahead of us – well, Lou has….

On Friday, Lou’s mucositis was still developing but it is not as severe as last time. Although she’s a bit unwell, we decided to push ahead with the last dose of Vincristine – this means that the intensive phase of her cancer treatment is over. She can then go onto maintenance therapy and will finally have a chance to recover from the rigours of the intensive treatment – at times it’s been rough but I’m keeping my fingers crossed for a long remission. The radiation oncologist, and our local vet, are convinced that she is now in remission and that the cancer in her mouth/throat is dead. Sadly, though, it is certain that she has dormant cancer cells elsewhere in her lymphatic system which will express themselves at some point. Lymphoma is common in dogs, but Lou, of course, has an exceptionally rare form! One of the few studies done in dogs with this type of cancer, treated with chemo- and radio- therapy, found that the mean survival was around 3 years; the median was around 2 years. If Lou has a happy life for that long then these 10 weeks of intensive treatment and associated side-effects will have been well worth it.

Week Commencing 16th July

Although Lou’s mucositis is not as obviously severe as last time, it seems to be taking ages for her to perk up. Her throat is obviously sore and she’s just not herself. I was determined not to panic but by Monday afternoon Lou was flat out and her gums/tongue were so pale they were almost white! Cue an emergency visit to the vets, who found that she was dehydrated – Lou was admitted for IV fluids – they kept her in for 6 hours. Lou was much happier when she came home and she was a bit more perky by Tuesday. I’m not exactly feeling guilty, but I can’t help thinking that her getting dehydrated is down to poor nursing on my part.   She is quite enjoying having water syringed into her mouth at regular intervals; her food now floats in meat stock – yum yum!

But overall she is just not recovering from the side-effects of her last round of radiotherapy – back to the vet on Thursday for more investigations – watch this space…

What I learnt:

  • “Constant vigilance” as they say in the Harry Potter books!

Looking forward..

So, we know that Lou will be living with cancer for a while yet  – even the worse case scenario gives her 2 months – though we’re obviously hoping for much longer. Every day we have asked ourselves whether we’re doing the right thing in putting her through treatment – what has kept us going is the prospect of a long remission, during which, we hope, she will be well and happy. Richard’s perspective here: The sore throat has troubled Lou and was not good, the Vincristine injections knock her back for a few hours, it does take her time to recover from being knocked out (it always has) but otherwise she has tolerated the treatment very well, at times she has been really really bright.  The other night when her sore throat was troubling her I let her out at 3am, she tottered outside, saw a beastie intruding in the garden, wheel spun on the pavement, leapt down the steps, thundered down the garden and came back really pleased with herself. Without treatment, Lou would have been dead by now, that is not easy to write and does affect our viewpoint but we have tried very hard to consider her quality of life and put that first.

One of the articles that we read said that it was very important to remember to “LIVE” with cancer – I never realised how much of a challenge that could be. Lou has been acutely unwell since the 19th March, when she cut her foot and subsequently got MRSA before developing cancer at the end of April. I’ve become so used to nursing her, to her being unwell, to looking out for and dealing with new symptoms, that I’ve forgotten what it is like to relax and just enjoy the company of a well and happy Lou.

I will have to remind myself to have a good time with her every day from now on….

Ty wondering whether he can get away with licking the last dregs of Lou’s liver ice-cream from that pot…

It’s ok Ty, Lou’s not looking! Make sure you get every last bit now…

Ollie has heard that hounds can be affected by human stress but has decided that he wants no part of it – he is easily the laziest, most laid-back greyhound ever born!

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