Thursday, June 05, 2008

Stages of a Canine Autologous Bone Marrow Transplant - An Owner's Perspective

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.

Stage 1

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.

Stage 2

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.


Emily, Maggie, and Angel said...

I saw your link on the lymphoma e-mail list... I really hope this is a CURE for Raven! That will be so wonderful! The idea of a cure is just so appealing when compared to just treating the disease for some period. I hope she starts keeping food down... the fact that she eats it in the first place seems like a very good thing! I look forward to more updates (and will go back and read more of your posts here).


Carolyn Biondi, USA said...

Sending woofs and wags Raven's way for a cure! Nice pic of all the hospital staff with Raven too.