This was one happy Raven owner yesterday afternoon when I took Raven for her second blood test after the marrow transfer on the 5th of this month. Last week there wasn’t any movement in her white blood cell count and that was to be expected. This week Ken anticipated that the marrow should have kicked in and starting churning out some white blood cells. Yesterday he came out with a big smile on his face and let me know that the marrow had taken and was now working well. Her WBC was up to 2. Which isn’t a lot for most dogs but for Raven who has always had low WBC counts this is normal. Her platelets were at 33 which is fine, a little low for a competitive agility dog but he was more interested in the fact that the count had increased from 25 last week to 33 this week.
Everything else in normal range and he said that in terms of her marrow transplant the time frame for when there were going to be serious complications or risks had passed and that she was now essentially just a normal dog. He did say that her immune system could still be compromised but that things like that were easily identified and treated with medication.
I don’t think I stopped smiling all afternoon, it was really a big relief to have got through this and to know that she has no more chemotherapy to go through and that this, really, was it. Apart from some regular blood tests Raven is pretty much back to the dog she was before this disease ever latched onto her.
So I was kind of quietly ecstatic to take her to training last night. She attacked all her obstacles with her usual enthusiasm, decided to test me on my start line rules and had fun barking at me when I got in her way. She barked her head off when left in the crate when I trained the others and was most pleased with herself whenever it worked and she got taken out again to do some work. Although I’m quite sure she doesn’t see it as work.
She is running in a team on Saturday at the fun agility teams event to raise funds for cancer research. I have sent her team at Murdoch an invite, it would be great for them to share in the joy she gets from agility and to see what they have helped her live for.
So it has now been ten days since the marrow transfer. We haven’t been incident free unfortunately but by the same token the incidents have all been manageable.
Raven is doing ok. Today has been an off day for her. It’s odd she kept her dinner down all night and then for some reason the food wasn’t moving from her gut and she threw it up this morning (a good 8 hours later) and has had a bit of a heaving episode around lunch time today. She’s still keen to eat and drinking well and is fine apart from this little upset.
Yesterday she was great and I took her out for the first time since the transfer and we went for an hour and a half walk with the other two. They enjoyed themselves immensely and came home tired for once.
The only other minor panic we had was on the Wednesday of last week, 6 days after the treatment. She was not interested in food at all Tuesday night and felt like she had a bit of a temperature. I wouldn’t have worried too much about this but late that evening Spryte started making a huffing noise. No coughing though. But at 5am she woke everyone up with what sounded very much like the Canine Cough cough. This is where Simone started to get a little worried because Ken has specifically said ‘Don’t take Raven near any ill or coughing dogs’. Great! There were quite a few expletives running through my head then I must admit. I spoke to my colleague at work and then emailed Ken at about 6am, taking the day off from work in case I needed to take her in.
Ken got back to me around 8.30 and asked me to take her temp. I did so and it was 39.4 so she had a fever, not a bad one but one that prompted Ken to ask me to bring her in. So I did and by about 10am she was admitted and I’m not afraid to say I was quite concerned at this stage.
By 11am Ken had emailed me to say her fever had dropped and that she was eating. Yay!! By 2.30 he emailed me to say her temp was normal and that could I come and get her because she was eating too much! Needless to say I was very relieved. He cancelled my Thursday appointment and took bloods from her whilst she was there to do a full blood chem. Analysis and check her kidney function. As far as he was concerned everything was as he expected, low RBC virtually zero WBCs and Kidney function all normal. He couldn’t tell me when the marrow would start functioning…or rather he couldn’t give me an idea about when the WBC were going to start to show up again, he just stated that by this time next week he would expect a difference in the WBC count so that she showing a closer to normal count.
Turned out Spryte did not have CC, she coughed once more that night and then that was it. Nothing else. I kept her separate from Raven to be sure but it seemed to have passed. I think maybe she chewed or eaten something that didn’t quite agree with her throat.
So far so good…once we passed the 7 day point I did relax a bit more knowing the chances for complications occurring were becoming more unlikely each day that passes. So she has an appt 4pm Wednesday just to get some blood from her to do the same test. This will go on for a month and then once a month for a year. A small concession really in the face of everything else she had been through.
She is is just twitching to get out and do some training and I will take her back next week and see how she goes. According to Ken she should be back to normal by now and should be doing all the usual things she normally does. So can’t keep her away from agility for much too longer!
Autologous meaning that the marrow is provided by the patient not a close relative. These are the only BMT’s that Murdoch Vet Oncology do so there was no debate really about which approach to take.
Tuesday May the 27th.
Raven goes in for what Dr Ken Wyatt described as the biggest stage for the dog in terms of the fact that the dog is under a general anaesthetic and is worked on for two hours by two vets. So Raven goes in and I am hoping all those injections I gave her have boosted her neutrophil count considerably. She is given a blood thinning injection early in the day and by 10.30am is under anaesthetic. Her neutrophil count went from an average of 1.5 to a count of 42. I was kind of expecting more, Ken had mentioned anything from 70 to 100 could be expected but then I realised that in terms of Raven she has never been what you call ‘average’ when it comes to her WBCs. And Ken was happy with 42, confident that that was high enough for what they needed to do. So he shaved a small patch on her right shoulder blade and with Amy’s help removed 165ml of marrow blood from her bone. She was then given her usual dose of chemo – Vincristine. She came trotting out with Ken on the end of the lead at 3.30 when I picked her with a small puncture wound on her shoulder and looking very happy to be going home. Ken said it all went well, no hiccups and he gave me some pain medication to take home and give her. He did say it took a bit longer than he anticipated but that she still came under the 2 hour mark which was good. Some dogs can apparently get that much marrow removed in half an hour. So she came home and we took it easy for a few days, did a little bit of training on Friday afternoon which she was VERY keen for and then we competed on Saturday at a trial. A trial at which she did very well however my head was obviously NOT on the job at hand because I managed to stuff her up several times. But she was still barking and carrying on like the agility obsessed dog she is…although I did notice that she was pretty tired instantly after a run, yet picked up pretty quickly whenever I made a motion to get her lead clipped on for the next run.
Tuesday June the 3rd.
So today she went in and it seemed like any other chemo visit. I dropped her in at 8am and she went through to have double the normal dose of Cyclophosphamide, the drug that attacks the marrow cells. Effectively this meant that all her marrow and thus her immune system was completely destroyed. The whole idea of this is really quite hard to grasp for the lay person I think. You would think that such a vital part of you being destroyed would be absolutely fatal but apparently it’s only fatal after a time and if you are not rescued of course by new marrow being injected back into you. So I went there to pick her up this day expecting a dog who could barely hold her head up and was hardly able to walk. She trotted back out same as usual at 2.30 looking like nothing particularly unusual has happened. She had an injection of antibiotic and anti-cystitis medication and I was given antibiotic tablets, anti-cystitis drugs and also anti nausea/vomiting wafers to give her. She was tired and a little subdued but was happy to be home. I kept looking at her marvelling at the utter war that was going on inside of her and yet on the outside, here is this to all intents and purposes normal healthy looking dog who has just been injected with a fatal dose of chemicals. I think it helps not to dwell on such thoughts and this would be the first time I was glad that we can’t understand dog because if she could communicate with me so explicitly I’m sure she’d be telling me about how absolutely crap she feels and there’s not a damn thing I could do about it apart from also feeling incredibly guilty for putting her through this. She was ravenous that night and ate a full meal which came back up at about midnight unfortunately. Seems her gut wasn’t quite back to normal. I was concerned about A: Not getting enough nutrients into her and B: The antibiotics/anti-cystitis not getting absorbed. But she was drinking well, toileting well and very bright and keen for food so I wasn’t too worried. Wednesday I tried some plain cooked chicken with her about 3ish. A tiny amount really and she kept that down for the most part until I tried to give her some more around 9. I obviously pushed her gut to far and she brought the whole lot up again at about 10. Again nothing else had changed – she was still keen for food, drinking well and toileting fine. So I tried not to worry too much.
Stage 3 – Final Stage – Thursday 5th of June
Today I dropped her in at 8ish explaining about the lack of food intake and how the anti-nausea/vomiting wafers were not having an effect. She hadn’t lost too much weight so that was good. I went in and picked her up at 2.30 and Ken saw me and answered my questions explaining that because of all these other factors (still wanting to eat, drinking well, still toileting fine) he was not concerned at this stage. He would be if by Sunday she still hadn’t managed to keep food down and that I should contact him if that’s the case. He was happy with how the marrow reinfusion went, they got the drip into her at about ten after taking bloods and it stayed in till about two. They ran some extra fluid through as well to help with hydration and making sure every marrow cell got put back. She did come out looking tired today, I think she’s pretty much fed up with being taken there and will be very happy to never have to spend another day there. We go back in Thursday next week for blood tests but that is just a revisit. Ken asked me to try with plain, low fat foods that are given in very small amounts. To split her meals into 5 or 6 very tiny amounts no more than a tablespoon or so and to maybe try broth if she’s keeping liquids down well. Which she is….she’s keeping all the water that she drinks down. So I will try with that tonight. And now all the procedures and treatments are done with. With all that we’ve done and with a bit of luck Raven is now cured of Lymphoma….or she at least has a very good chance of a long remission. It’s been a long and not altogether pleasant journey particularly for her. It’s interesting watching her interact with the staff at Murdoch, she knows them now, quite well and so they usually get a few wags of her tail with her ears back in greeting but that’s tempered by her very obvious recall of all the things they’ve had to do with her so she always greets them and then makes sure she heads towards the exit just so they know she’s not that enamoured with them to want to go with them. So by this time this week Ken is expecting Raven to be back to her usual self and carrying on her life like she was never afflicted. Fingers crossed it all goes that way for us.
Raven with Dr Amy Lane, Geoff, Dr Ken Wyatt and Merilea – last day of treatment.