Raven Update!

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!

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.

Of Agility Champions, Bone Marrow Transplants and Puppies

Wow. You know it’s been a long time between updates when you have to check back on your blog to remember what you last wrote about. Things have been busy I must admit.

So trialling update first:

Saturday April 27^th was the Southern River Dog Club Trial – Spryte did three cracking good runs, going well in Open Jumping apart from redoing the weavers (NFC), and did two very nice runs in Novice Agility and Jumping, all still NFC with a couple of small errors in each. Raven had a bar knocking day I believe, taking a bar down in each run apart from one where I think I may have pushed her over a wrong bar. Cypher had a couple of clears and a couple of bars down. Highlight of the trial was WA finally has another Agility Champion – in the form of a tri coloured Border Collie named Terra, owned by Kriszty Cumming. Terra also turned 4 this day as well as acquiring an addition to her name Agility Champion Bellview Foxy Lady.

May 11^th – this was the Thankyou Trial, put on by the CAWA Agility Committee which involved two trials, you entered the morning one and then had your entries mirrored for free in the afternoon one. I asked Kriszty if she would handle Raven for me in Masters Agility. I had been feeling a little frustrated with our lack of success which I felt was mostly due to my inadequate handling. At Southern River Raven seemed like she’d had a shot of caffeine prior to our Masters Agility run and I felt like I was about 10 steps behind her in everything. So Kriszty ran Raven in Open Jumping to warm up first and ran a respectably clear 3rd place although we both noticed Raven was being very polite and not going at her usual speed. We were not sure if this was gonna work because if Raven runs clear in Masters she does need to do it at her usual frenetic speed if we were going to finish off those passes needed for Agility Champion. Kriszty then took her in for Masters and Raven suddenly broke her start and I *knew* then and there she was back to her usual speed, they made it around half way before Rave had an off course and took a couple of bars down. I had pulled Raven out for bars down in Masters Jumping and Open Agility that morning too. In the afternoon trial we’d decided to try again since her speed had picked up with Kriszty. She ran her in Open Jumping first and pulled her out when she dropped a bar. We then walked Masters Agility and decided that because it was a fairly free and flowing course of the simpler variety which usually meant a lot of clears in the class that I would run her since if we were going to try for first place we would need her at her maximum speed and she does run the fastest when I handle her. The course was going great till the fourth last jump from home when she knocked a bar. I pulled her out, frustrated but quite pleased with how I was handling her better. Spryte had some cracking good runs today, she did have one bar down in each of the Novice Jumping but was posting the fastest times which I was very happy about, at one point she did a 136m 16 obstacle course in 14.77 seconds so I was quite pleased with the confidence that showed. She’d gone clear in the morning too in Open Jumping, just about equalling Raven’s time which was great as the distance challenge wasn’t easy (big brother Cypher couldn’t do it!). Cypher managed two clears in Masters Jumping, one clear in Masters Agility and a clear in Open Agility. AGAIN the highlight of the trial? Raven's SP partner Nifty picking up his final leg for Agility Champion - Sue Hogben and Nifty finished it in fine style with a 1st place in Masters Agility in the morning: Another tri coloured Border whose name now reads: Agility Champion Guirmere Nifty Lad.

May 17^th and May 18^th – Geraldton trials. On the Saturday both the older dogs ran well in the final run of the day Masters Jumping, both Cy and Raven going clear in it, however I handled Raven quite conservatively and she was quite tired I think, it had been a long day so we picked up 6th. Raven had knocked one bar in each of her other runs (I withdrew her each time) and Cypher knocked bars in two and went off course in another. Spryte was in the competition Novice Agility class and she ran very nicely but missed the weaver entry, it wasn’t an easy angle for the baby dogs so I was still happy with her run. She had one bar down in Novice Jumping and in Open Jumping we got a little mixed up on course. Sunday went better for us. First up was Open Agility. I had made the decision that day that I was getting kinda tired of Cypher’s slow arse contacts in trials, aware that I had very nicely caused these to happen. Cypher’s contacts in training are near perfect four on the floor contacts. His times are all low and within the times for top level trialling dogs. There is no hesitation, he just drives straight into the spot and holds it until I say the release word. In trials I have released him early, as in I say ‘Ok’ as he gets his paws into the contact area. This has caused him to change his behaviour performance in the trial ring, he doesn’t drive, his body is a lot more upright, he doesn’t get down low, he slows down, he puts extra strides in, and I have had a few missed contacts. I released early with a view to getting his times on course quicker. What it has achieved is the opposite, I now have a dog who is not quite sure what he is doing in the trial ring on contacts, he’s wondering if I’m going to say ‘ok’ or if he has to lie down or maybe something else might happen. His confusion about what I am going to expect has led to slower contact performance at trials. So this day (Sunday) I’ve made a decision. For the next 6 months I am not going to care about his times on Agility courses I am going to insist on the four on the floor position before moving on in any of the contact courses. I started it today. The results were amusing initially. His first contact was the A Frame…I gave the command ‘Contact’ and as he was feeling fairly fired up he ran through the colour straight at me growling, barking and carrying on like he wanted to play tug with me. I stopped dead, he realised I’d said ‘Contact’ and promptly lay down facing the opposite way to the direction we were going. Heh. I moved off sent him into the weavers with an ‘Ok’ and kept running. He ran straight into four on the floor with the dogwalk and in Masters Agility his contacts were noticeably faster and all straight into four on the floor position. I’m hoping for the same thing tomorrow at GSDA. What I hope to achieve by doing this is having faster contact performance which will only rarely get released early at big events. We’ll see how it goes. In Masters Agility I found out that tugging with him as we walk up to the start line is probably a little too much stimulation for him, he took off like a bat out of hell and was so revved up felt the need to come in and bark at me close, like he wanted to herd me or something causing a refusal on a very simple bar, the fourth obstacle in. He did go clear in Masters Jumping and Open Agility though.

I’d made the decision with Raven that I was really going to try and focus more on my handling, making sure I was not distracted, that I had a concrete plan that I was going to try and execute without any regard for her bar knocking issues. It had been noted that perhaps I wasn’t treating course walking seriously enough leading to sloppy handling which then led to no clear passes. So…with that in mind I did my best to try and run the course exactly how I’d planned it. Raven was holding her start lines nicely today, she’d kept all her bars up in Open Agility I had front crossed in the wrong place though and caused an off course but I was still happy with her run. We went out and ran Masters Agility and it ran perfectly apart from the seesaw collapsing under her as she left it and a slight wobble on the last obstacle. But these weren’t enough to slow her down too much and we finished with a 1st place. One less Agility Champion pass to go. In Open Jumping there was a diagonal line of jumps down the centre of the course which had a very fast approach to them, too fast for Raven and she took a couple of them so we withdrew. Masters Jumping was our last run and again I walked it purposefully and set out to run it the exact same way. It worked beautifully and we finished with 2nd place to Sue’s Nifty, not by much so that was pleasing as Nifty is an awesome dog in Jumping, very efficient. Spryte had weaver woes in Novice Agility again unfortunately, just popping the last pole in what was otherwise a cracking good run. We scratched Novice Jumping preferring to be home before 9pm that night.

So all in all a good weekend, and worth the trek to Geraldton. We’ll be back in July for their triple header.

On the chemo front things are ticking along smoothly, Raven had her hopefully last ever dose of Doxorubicin on the 13th of May and she did experience a touch of colitis a few days later but nothing she couldn’t handle. We went and saw Ken Monday afternoon and he explained about the drug I was to inject her with for the next seven days so that her white blood cell count is elevated. I have to give her injections morning and night of HGFSH, Human Granulocyte Follicle Stimulating Hormone which is a synthetic hormone that tells the stems cells to reproduce at several times their normal rate. I was given four syringes of 0.5ml each and they obviously contain synthetic ingredients which can only be found in the bowels of some massively volatile volcano or perhaps on the moon because each 0.5 ml syringe is worth around $424 Australian. I kid you not. This stuff is more expensive than gold and probably high quality heroin truth be told. I panicked a little when told that i had to give her four doses from one 0.5ml syringe ARGH!! What if I slipped and gave the whole thing? Ken assured me that it would not have any affect on Raven’s health just that I may have lessened the effectiveness of the drug by not spreading it out as much. Which is also something I’d like to avoid given how much this stuff costs! But it’s all good, the injections have been going smoothly, I have been giving the right dose each time without any dramas and Raven is a very patient patient with me.

Theoretically her neutrophil count should go through the roof, normally for her it’s around 1, after seven days of this it should be up around 70 Ken said. So this Tuesday coming (the 27th of May) she goes in for the big procedure. Ken and another vet will work on her for around 2 hours, shave off a considerable amount of fur from her shoulder and extract around 160ml of marrow from her shoulder blade. This is of course done under a gaseous general anaesthetic, after that several tests will be commenced on the marrow extracted whilst Raven who is still under is given her usual does of Vincristine (hopefully the last one ever…this is the drug that has whacked her around the most). She goes home at 3.30 apparently as if nothing ever happened, just like a usual chemo day. She does have pain meds though because whilst dogs don’t tend to reveal it, in humans we know it is quite a painful operation so Ken automatically administers pain meds regardless of whether the dog demonstrates any signs of pain. Knowing Raven and how stoic she is she’d never tell anyone if she was in pain! This day will cost around $2,500. My credit card will need pain meds too I imagine.

The following Tuesday (June 3rd) is when I will probably start to freak out a little. This day she goes in and has double the dose of Cyclophosphamide than usual, At this point in won’t matter if her WBC is very low again. It is the dose that effectively wipes out all her marrow, every single cell and pretty much destroys any immune system she has left. I will be taking this day and the following Wednesday and Thursday off from work. The day for her goes exactly the same as any other chemo day. I drop her off in the morning and pick her up in the afternoon. After I drop her off in the morning I will head round to Robyn’s and drop Cypher and Spryte in for boarding for a few days. Then I will head home and, with a view to completely trying to distract myself from thinking about the possible complications that could arise, I will be cleaning the house from top to bottom, disinfecting, sterilising, trying to rid the house of as many kinds of bugs and germs as possible all in the hope that she doesn’t come down with anything whilst she’s got nothing to fight it with. I then go and pick her up, they give me a 2 week course of antibiotics to give her to help fight any infection. This day will cost around $600.

The risks are as below:

Risks:

1. Immune mediated thrombocytopenia (the immune system attacking platelets that help your blood clot) – 15%. This is rarely problematic other than requiring treatment to control it. It typically resolves after months. It typically occurs weeks or months after treatment.
2. Sterile cystitis – 15%. This leads to irritation and pain in the bladder. There is no treatment other than pain management. It typically resolves by itself in days, weeks, or months, and occurs soon after the double dose treatment.
3. Sepsis – 10%. Infection without an immune system is a serious complication and may require hospitalization. Theoretically a potentially fatal problem, most dogs recover quickly with antibiotics and intravenous fluids. It occurs approximately 1-2 weeks after the double dose treatment.
4. Mild to moderate nausea
1. 10% following the double dose treatment
2. 40% following the marrow transplant
5. Allergic reactions during marrow transplant – 5%. We will monitor and treat these as they occur. They are rarely serious.
6. Others <5%>

Benefits:

Approximately 40% of the dogs appear to be cured by this technique.

Fingers crossed Raven is in that 40%.

So that is all rather daunting and could be cause for some worry and concern but I’m taking a positive approach and believing that it will all go smoothly, Raven is one tough cookie who has heart enough to see her through this. I have sent off her Nationals entries this week, confirming my faith in her propensity to overcome adversity and will be so thrilled to be there in Melbourne at the end of August stepping up to the start line with her. It will mean more to me than just a competition, the mere fact that we just made it there will be so significant.

Cypher’s babies are now going on 6 weeks old and you can see them here at this page;

http://www.winpara.com/lexiecypher_5weeks.html

Girl #4 is staying with Robyn, the rest all have homes and I really hope their owners appreciate their puppies naturally inbuilt desire to play! I had a visit with them this week and even at not quite 6 weeks they were all mad keen tuggers and chasers and picking things up in their mouths. Girl #4 is quite the little madam and I think Robyn is a little concerned about the prevalence of little monster-like behaviour! I may have to have a play with her when she’s older *g*

Spryte came into season that Monday after Geraldton which was great because she really is like clock work. That is her 3rd season so far and pretty much 12 months to the day of her first season, so she is 6 monthly on the dot! Make planning things so much easier. I told Robyn she now has a year to decide who she wants to breed her to as she will be having a litter for Winpara next year after the Border Collie National. It will take her out of competition for the last half of 2009 but apart from possibly missing a Royal it’s no big deal.

On the more non-dog related front went and saw Ironman the other week….thoroughly recommend it to anyone for some entertainment. I wasn’t expecting it to be as good as it was and yet it thoroughly impressed. Off to Indy 4 tonight…we shall see – I don’t have huge expectations I must admit.