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Dog Blog: Living with Canine Cancer (6)

Posted by indigodream on 1 November, 2012

Thursday November 1st 2012

Hurrah!

Sleeping is a big part, sorry, the biggest part, of a retired greyhound’s day, so as long as Lou can enjoy her snoozing then she’s doing all right!

Today is our first cancer milestone – when we decided, back in May, to treat Lou’s cancer, we had hoped against hope that she would live long enough to get to her 10th birthday – and here we are!

I feel that there should be bells ringing throughout the county to celebrate, but the fact is that Lou’s life with cancer has been a rollercoaster ride. We lurch from crisis to crisis, but what keeps us going is the fact that in-between she is cheerful, eating well and  able to sleep comfortably. She can’t walk very far any more, but she doesn’t seem to miss her extended rummaging sessions and she’s never been one for chasing balls or playing with toys so I think she still has quality of life.

What I want to share in this post is our BIG decision to stop Lou’s maintenance chemotherapy – we’ve had to make a lot of decisions – each one has involved a very individual journey and only time will tell whether we’ve taken the right path…

When I last posted in August, Lou had an enormous ‘ulcer’ at the back of her throat which was infected with MRSA, but the good news was that there were no signs of the cancer in her throat. This suggested that the intensive phase of her treatment – both high-dose chemotherapy and radiotherapy had put her cancer into remission. Lou has been in remission for 16 weeks.

Of course, the cancer is only one aspect of Lou’s health, while we’ve been concentrating on that, we’ve had to pull back on the therapies that keep her arthritis under control. Because of interactions with her cancer medication, we’ve had to stop giving her anti-inflammatories; because of the cost we’d stopped her physiotherapy sessions. In addition, in the middle of August she developed a strange ‘blister’ on her shoulder, which promptly got infected with MRSA and, within days, was a full thickness ulcer which took the best part of a month to heal.

We can tell how well Lou is feeling by how close she lets the boys get to her – when she’s well they get sent packing – quite emphatically – but when she’s ill she can’t be bothered and the boys get to share the sofa and other luxurious beds!

Regular readers will have probably worked out that our “Autumn Odyssey” has been a bit fraught because Lou has had more than her usual levels of pain – mainly because she’s so stiff and clumsy on the boat steps. Eventually, though the blog hasn’t caught up yet, we cut our holiday short by a few days – this takes us up to September 21st and the start of the journey which has led us to withdraw her chemotherapy…

w/c 24th September:

Lou was extremely stiff and painful after our holiday – we had a long discussion with her vet, and with full knowledge of the potential risks, we took a chance with a 3-day trial of anti-inflammatories. The idea was to reduce the “achey” pain, which her other painkillers just don’t do, and reduce the inflammation in her joints. There were two main risks:

  • Anti-inflammatories interact with steroids and can cause serious gastro-intestinal side-effects e.g. ulceration and bleeding
  • Anti-inflammatories may interact with the methotrexate (chemotherapy cytotoxic i.e. cell killer) to cause all sorts of problems though many take them together without any problems.

Lou was already on a drug to protect her gastrointestinal tract and we hoped that this would be enough to protect her. We started the anti-inflammtory drug and, for 2 days, she was doing very well – her mobility and general cheerfulness improved. Then, on day 3, disaster struck – in the evening she became unwell and overnight she had several bouts of black tarry diarrhoea – the colour is from partly-digested blood and a sure sign of bleeding somewhere in the gut. I rang the emergency vet, who sleepily told me it could wait until morning – I was a bit vexed because I knew, from past experience, that she would be admitted and would rather have had them do it at 4am than worry about whether she was going go into shock from loss of blood before I could get her an appointment later on! Never mind, at 10am she was admitted to doggie hospital for fluids and treatment to patch up the gut ulcers and hopefully stop the bleeding. She was in for 2 days before being well enough to be discharged.

At this stage we HAD to take her off the anti-inflammatories,but we also took her off her cytotoxic (cell killing) chemotherapy; we had to keep her on the steroids but we swapped to an injectable form, which would be less wearing on her gut. For information, long-term steroids CANNOT be stopped suddenly as they have a profound effect on the body’s metabolism and rapid withdrawal can cause equally rapid death!

W/C 1st October & W/C 8th October

Sploshing is good – Lou loves to paddle!
We review our decision to keep her going about ten times a day – but as long as she can enjoy food, sleep, a splosh and lots of fuss we know she’s doing all right…

I’ll confess that after last week’s events I thought “this is it, Lou can’t recover” but within a few days of being home she was actually better than she had been since before the cancer was diagnosed. It’s probably no co-incidence that we decided to re-start her physio sessions around this time, in spite of the cost (don’t ask).

We then had an unprecedented 10 days without a visit to the vets! But on 11th October, I was back – Lou had signs of a kidney/bladder infection and we needed to review her medication and discuss our plan going forward…

Now, this next bit is ridiculously technical – I’m a pharmacist and I found it technical – but here’s the ‘dumbed down’ version of what Lou’s oncologists (chemotherapy and radiotherapy) and our vet concluded:

  • Lou had such an intensive course of treatment at the start of her condition that there’s little evidence to show that a few more months of maintenance chemotherapy would make any difference. Her radiation oncologist said that nowadays it’s not unusual for them to omit the maintenance chemo altogether if the intensive treatment has done its work.
  • The RVC oncologist said that there was no point in keeping going with the steroid if we were considering stopping the cytotoxics (long technical explanation to go with this – leave a comment and I’ll email you if you want it!)

But the decision was ultimately ours, so here’s what I worked out (with the help of Lou’s excellent local vet):

  • the urinary infection was treatable – he gave her an injection of antibiotic which is known to sting – Lou made the biggest drama ever and screamed the place down! She would need oral antibiotics for a week.
  • Her white blood count was lower than it’s been for a while – this may be because of the haemorrhagic gastroenteritis (the gastrointestinal bleeding that put her in hospital) but it may be because of the drugs – it does explain why she might have an infection.
  • The steroid might be contributing to the low white cell count, it’s also affecting her liver, and, this surprised us both, the oncologist says it might be behind the leakage of protein from her urine. This shocked us because steroids are used to treat leaky kidneys! It’s also the biggest barrier to using anti-inflammatories, which, at this stage, may be the more useful treatment. It will take a month to gradually withdraw the steroid!
  • She could stay on methotrexate (cytotoxic chemotherapy) but there is a potential interaction with the anti-inflammatory and is can cause blood in the urine (not helpful with her tendency to bladder infections) so we’ve decided to keep her off it for now.
  • She seems to get on ok with the Leukeran (her other cytotoxic chemo drug), which she has once a fortnight, and it has no interactions with her other drugs so we’ll keep her on that for now to potentially mop up any emerging cancer cells.

Lou’s cancer is so rare that there is no precedent from the research – this means that we can focus on her wellbeing. Withdrawing most of her chemotherapy means that we will be able to treat her arthritis more effectively, and that is causing her the greater problem at the moment. Of course, withdrawing the cytotoxics may give her a shorter remission from the cancer, but even THAT is not predictable – the radiotherapy by itself can produce remissions of 12 – 18 months – far longer than with chemotherapy alone.

W/C 15th and 22nd October

Lou’s birthday roach – hurrah!

Lou has been better in herself than she has been in months BUT I did say that we lurch from crisis to crisis – we’ve had to deal with altogether too many poo and wee accidents this week – all a precursor to her becoming very ill on Friday 19th – the vet said she had a temperature of around 104 degrees (in old money!) and obviously had an infection somewhere – not sure where, but the treatment’s the same regardless. We put her back on two types of antibiotic – she was so ill on Friday night that once more I though “this is it”. But by Saturday afternoon she’d perked up again and was back to eating, sleeping comfortably and taking an interest in coming for walks in the car (albeit her limit is about 15 minutes of bobbling before her legs start to shake). She was back to racing Ty up the garden, sleeping through the night without incident, eating like a small horse and on Sunday afternoon she insisted on coming for a more intensive walk with the boys and did really well.

I took her back for a checkup with a different vet on Monday, and although Lou seemed well in herself, the vet found that she now had a sore throat and a heart murmur. Lou was ill overnight on Tuesday so we went back to the vet today – the heart murmur has disappeared but Lou’s panting (especially after any exercise) was a concern. The vets are all worried – there are any number of things that might have caused her recent symptoms, but what we’re dreading, of course, is the return of her cancer. She has lymphoma, a cancer of the white blood cells, which may recur anywhere in the body, not just where it started in her throat. Luckily Lou is not bothered, although she has episodes of not feeling very well, overall she’s quite cheerful!

Lou spent the first half of her birthday begging nicely for food, but the vet had banned her from eating because she was going to have an anaesthetic in the afternoon – poor Lou! Then she was admitted for a scope of her throat and some x-rays – her vet decided against the heart scan – the murmur hasn’t reappeared and there’s not other sign of cardiac problems so we won’t worry about that for now!

She came home at 8.30pm and is flat out – she’s wobbly and sleepy after the anaesthetic and sore after being pulled around the x-rays, but she’s comfy on her bed and will be better by tomorrow (we’ve been through this a few times before!). Overall there’s good news – there is no sign of cancer (Hurrah!) but she still has that troublesome ‘ulcer’/plaque at the back of her throat, though it’s better than it was in August. The plaque is probably infected, she also has an infection at the root of one of her canine teeth and the x-rays show that her knee is seizing up with arthritis. But all that is manageable – especially when she’s withdrawn from the steroids and can start back on anti-inflammatories.

So, in summary, we have an ill dog but not a dying dog – I’ll take that as a win.

It’s not quite how I envisaged that we would celebrate her 10th birthday and our first cancer milestone, but hopefully we’ll be able to celebrate at the weekend when she’s recovered from the anaesthetic – we can then look forward to our next milestone – Lou’s “gotcha” day (6 years) on 20th December….

4 Responses to “Dog Blog: Living with Canine Cancer (6)”

  1. Sue said

    There is only one word really “WOW”
    You really are a saint sue, I don’t know how you deal with all this, you are amazing.
    And a very happy birthday Lou, that comes with a couple of woofs from Meg and Penny pup too xx

  2. Kevin said

    WOW indeed! You’ve got a heart as big as a bucket and then some Sue!!

  3. Kath said

    You two deserve a medal! On top of which you must be exhausted. We do feel for you and think about you often – not that that helps in any sensible way 🙂
    Kath (nb Herbie)

  4. indigodream said

    You’re all very kind – I think that we only do what any dog owner would do – we are tired though – can’t remember when we last had an uninterrupted night’s sleep – never mind!

    And you kind thoughts mean a great deal to us – I’m sure that positive vibes can get through in some mysterious way 🙂

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