Here we are at Wednesday, a week and a half after Raven’s diagnosis. So far I am very pleased with how she is going, there’s room for even more progress but that would be like a lottery win I think. She had her 2nd chemotherapy treatment Monday. I took her into work on Monday morning, the kids were very impressed. She lay up the front of the classroom on her blanket whilst I was teaching. From time to time she’d wander around seeking some pats from many willing hands. I took her into Murdoch straight after that and filled in her weekly update chart this covered whether she had an episodes of vomiting, diarrhea, appetite reduction, lethargy or sleepiness levels plus her weight (I also had typed up a one page report of how she went during the week, based on her general well being, diet and exercise). The nurse who checked her in spoke to me as I asked a few more questions. I found out that her Lymphoma is B-Cell type so that was good (it is the one that responds better to chemo rather than the T-Cell type) and that when they take her blood that morning before treatment they check her white blood cell count and hope that it is around 2. The nurse said if it was 1.9 or 1.8 then it would be up to Ken Wyatt’s discretion as to whether they push ahead with treatment. So I left her there around 10.30am with the promise that I would be seeing her at 3.30 to pick her up. She didn’t like being left there, definitely wanted to walk out the door with me, but eventually she went with the nurse on lead without causing too much fuss.
He had asked how she went exercise wise and I told him that she had come to training with me both nights and done a few jumps and a simple course. I explained that we had been to Geraldton on the weekend and that she had originally been entered in 8 runs, 4 on the Saturday and 4 on the Sunday. I scratched her from 3 of the runs each day and took her out to do one run in the Masters Agility class each day. I figured if she wanted to have a go she could, she had been rather frustrated watching Cypher do his runs, so I surmised that if she felt well enough and wanted to run with me we’d have a turn. I am becoming more and more convinced that the positive and optimistic attitude towards her health that will help her overcome this includes her being able to participate and enjoy her life as she normally does and with agility always being such a big part of her life I truly believe she would definitely feel that something was amiss or wrong if she couldn’t still partake in this activity that has been a huge part of her weekly routine. So we lined up on the start line and before I’d even given her the OK to go I found myself just smiling at her like an idiot thinking how lucky I was to be able to share this with her. We took it easy and she seemed to do the same, I handled her in a much more laid back fashion than usual. My relaxed attitude nearly contributed to an off course and caused a very wide turn but by the end she was flying in front of me and we finished the course clear for 5th place. She was having a ball! She got a whole egg out of my bacon and egg toastie for her jackpot and she thought that was great! She was fine after the run, certainly not too tired to stop barking instructions to Cypher round his next few runs! The next day we had another go at Masters Agility, she had travelled very well, slept well and was eating like a horse so I figured she was up for it. We had a couple of wobbles round the course, she got stuck at the end of the chute, weaver entry had a slight glitch but I was just having a ball running her cherishing every second. She ran clear again for 4th place this time just behind Nifty, Jess and Terra. It’s amazing, whilst my handling was far from exact and sharp, I was just so relaxed, not caring if we ran clear or not it seems to have added an element of control that is sometimes missing from our runs! She was really responsive and tuned in. I was so glad I had made the long drive, despite Cypher having weave pole issues all weekend. At least he managed two clear very nice runs in Open and Masters Jumping at the end.
So the nurse was happy to hear that she had felt well enough to be active on the weekend and he kept my report in her file.
I returned at 3.30pm to pick her up and this time a different nurse came and discharged her. She came out with her bum wriggling and tail going madly very happy to see me. She looked no different from when I dropped her off apart from being happy now and having a small patch on her other front leg shaved. The nurse told me it had all gone well; she had the treatment fine and was ready to go home. I asked about the blood test and her white blood cell count and he told me it was low but Ken had decided she was fit enough for treatment. I asked how low and the answer came back – 1.4. Internally I was a bit alarmed at this recalling what the Nurse had said that morning, and basically said “Wow and he still did treatment!?!” The Nurse nodded and said Ken obviously felt that she was fit and healthy enough to take that risk. Which I was glad for because otherwise her treatment plan would have been delayed by a week but I was still surprised. I emailed Ken the next day asking about it. He agreed that he had made a judgement call based on the fact that he thought she was doing well (lymph nodes have reduced somewhat and she had gained 0.3 of a kilo) but also that my concerns about her being more susceptible to infections should not be too deep because the length time the WBC is low for means in general, infection cannot take hold. The only problem might arise from bacteria that already exists in the gut and that I should let him know straight away if she has any appetite reduction or is more sleepy than usual. So I took her home and she seemed a little tired but nothing out of the ordinary. She had a slight episode of upchuck of some yellow bile at around 7.30pm but that was it and an hour later was busy getting a good sized meal down her. She slept the whole night through Monday night and was toileting normally. So far that little episode is the only evidence of the chemo treatment.
I of course have still been scanning, browsing and reading lots of information and I also emailed Ken asking about the creditability of some of the documents I had come across.
I had found some very interesting reading from the World Small Animal Veterinary Congress held in Prague last year 2006. Check this page for a few the of latest findings and theories;
I have a list of questions to email Ken with now (I am trying to space my emails out so I don’t seem like a completely neurotic dog owner!). I emailed Ken initially with the following question; Should I or can I give her additional Arginine supplements (at the moment her sources would only be poultry and seafood – sardines and tuna) as well can extra Glutamine and Cysteine be given?
I had read in the documents at the website a study or two had suggested positive findings with regards to the use of these supplements. Ken replied (very promptly!) that the author of the papers was well respected and whilst the information he provides has logic currently there is very little evidence (simply due to lack of studies) to back it up. That said he also stated that it would do no harm to give these supplements at 1/3 the dosage on the bottles. So I am looking into purchasing these supplements right now.
My other questions that I need to pose include;
- Can Raven’s serum levels of docosahexaenoic acid be tested to see if they are elevated? That way I will know if the supplementation I am currently giving with the n-3 fatty acids (in the form of fish oil capsules) is working. It also helps with lowering her plasma lactate levels.
- When she enters remission will her lactate and insulin levels decrease to normal levels? These levels are a major part of what causes her to feel tired right now when exercising.
- Should I give Trimethoprim/sulfadiazine to reduce her GI toxicity when she needs to have the doxorubicin treatment? (This drug is the most toxic of the four drugs in her protocol)
- And the most serious/biggest implication question for Ken; does he think that the autologous bone marrow support that allows chemotherapy dose intensification would be worth doing given the increased toxicity risks?
That last one is critical, everything I have read about the treatment of transferring bone marrow has so far been definite that the chances of cure and longer remissions are far greater than without the bone marrow support. It sounds like a drastic procedure and the toxic effects can be far greater due to the much higher dosage of chemotherapy. It is something we have to seriously think about and probably enter into long discussions about between ourselves and with Ken. So far I am highly impressed with the treatment both myself and Raven has received at Murdoch. The Nurses and the doctors (both Ken Wyatt and the intern Amy Lane) have been nothing but patient and absolutely on the ball with all queries and concerns. Their prognosis, whilst guarded, is undeniably positive and their attitude is optimistic. This had helped alleviate my concerns considerably knowing that Raven is in good hands when I leave her there each Monday.
So that is where we are currently at, as I mentioned we’d have won the lottery if all signs of the cancer immediately disappeared and she was on her way to a confirmed cure however all things considered I feel she is doing very well. Her lymph nodes have decreased in size, she has put weight on, she is not experiencing toxicity from the treatments. I’d really like to see her WBC back to a more normal 2 next week but we shall see. She has the Vincristine again next Monday, then the doxorubicin the following Monday.They do not do a test to confirm remission until her 9th treatment, and thankfully (because whilst I know biopsies are not a big deal I still feel an aversion to them) they only need do an Node Aspirate where they take a sample of cells from the lymph nodes via a needle to test for the presence of cancer cells.
I’d just like to say a word of thanks to all those people who have emailed, messaged, left messages here – it means a lot to know that so many people are wishing for a positive outcome for my girl. If psychic vibes play any part she is well on her way to beating this cancer!
Stay tuned for the next update!