Chemo starts again

So we went and saw Ken Monday, Raven, Tim and myself. We took an hour and a quarter to discuss all the options and the outcomes and the implications and the permutations of various treatments. Basically the three main options were – step down from the first treatment plan and administer doxyrubicin (strongest chemo drug) every 3 weeks for 6 treatments. This was never considered as for me it had certain drawbacks that I didn’t want to contemplate. A it is a heart muscle damaging drug and really they need to have a very good reason for giving it more than 8 times (Raven has already had it 4 times with the last cycle of chemo) and B It would never give her a chance of a cure only remission and statistically speaking the remission would be less time the second time around. So less than 10 months basically before the cancer would be back. We pretty much ruled that treatment option out immediately. Second option choice was the exactly the same as last time. And again whilst it would put her in remission there is no chance of cure now (as opposed to 15% with the first round) and of course her remission would be less. 10 months is not very long so an even shorter period than that is just not an option for me. She has just turned 8, whilst not young for a Border Collie I wouldn’t describe it as old either, more late middle age. Contemplating this healthy looking and to all intensive purposes, perfectly well and happy 8 year old Border Collie being dead in months is just inconceivable to me. So we looked at the final option and the ‘top of the range’ treatment I guess you’d call it. The Autologous Bone Marrow Transplant. Sounds impressive doesn’t it? Well when you consider what they do then I guess it is.

This treatment involves the following. Exactly the same as her first round of chemo the first 8 treatments go the same way. She goes in once a week and is given her usual chemo cycle, Vincristine, Cyclophosphamide, Vincristine and then Doxyrubicin. A four week cycle. She goes in for two of those 4 week cycles having a week off after the Doxy. All things being well she should be in full clinical remission by then, nodes all normal and no signs of abnormal cancer cells in her blood work. One week after the doxy on the second cycle I will administer injections twice a day under her skin. This drug is extremely expensive but necessary in order to put her bone marrow production into overdrive in preparation for the marrow harvest. So then at the end of that week she goes in for her usual chemo however they put her under a full general anaesthetic and with two vets working on her over two hours they withdraw 160ml of bone marrow from her shoulder. Hopefully just the one shoulder on rare occasions they’ve had to use both. They then give her usual Vincristine that day as per the first week of her chemo cycle. One week later she comes in for the Cyclophosphamide however this time they give her double the normal dose. This dose effectively wipes out her entire bone marrow supply thus leaving her without any immunity. I still take her home that day as per normal however I am given two weeks of antibiotics to place her on to reduce any potential for infections to develop. I asked if she comes home in a bubble but apparently that’s neither necessary nor practical! Two days later, once the Cyclophosphamide has cycled through her system and is no longer present they reinfuse what is hopefully completely cancer free marrow back into her via slow intravenous infusion. After that they see her each week for a month to check her blood, then monthly for a year and then every two months for a year.

Approximately world wide 40% of dogs appear to be cured by this process. Those are odds I am willing to take. When it comes down to it though if she happens to be one of the unlucky ones who drops out of remission months after this I’ll still be glad we tried. At least then I’ll know I have absolutely done everything within my power to extend her quality of life.

Of course as Ken stressed, this procedure is no walk in the park. Along with the possibility of cure there are also risks (Immune mediated thrombocytopenia – where your immune system attacks the platelets that help clot blood, sterile cystitis, sepsis, nausea, allergic reactions during marrow transplant and others) and these were all outlined in the literature we received informing use about the procedure. Of course I asked about her already compromised immune system, given her atopy and he did say that they may impact on how quickly her immune system is back to normal after the marrow transplant. We asked all sorts of questions about what to do at home in preparation and her usual habits and Ken seemed to think that her resistance to all the usual infections out there would not be an issue. I asked about her naturally low white blood cell count (in all her treatment so far she had only ever reached 6 once all other times we were looking at 3 or below) and the impact that may have, his reply was that it is possible - if her low WBC count is due to a low number of stem cells, then that may mean they harvest less and recovery takes longer. I asked about how they check when her immune system has recovered and he stated that testing the immune system in general is very difficult in a laboratory. A low neutrophil count, which is the WBC they monitor is a good indicator of risk of bacterial infection. The other WBC including memory T cells that protect against anything that your body learns resistance to (including vaccination) is unharmed by treatment.

They have done a total of 12 BMT’s at Murdoch now. About 6 of those dogs presented like Raven with the standard form of lymphoma and still clinically well and healthy. 5 of those dogs are still in full remission doing well, for one the cancer came back after a couple of months. The other 6 all presented with aggressive and unusual forms of lymphoma and all much further along the stages, therefore most of those have dropped out of remission. You have to take into account though that not all those BMT’s were recommended by Ken, and the fact that these were last ditch attempts to buy even just a little time for the dogs and their owners. Owners who clearly had the means and didn’t have to care about the money factor.

It certainly isn’t cheap – the bone marrow harvest day alone is $2,500. All up by the time you finish paying for all the drugs, visits, procedures and treatments you are looking at around the $10,000 mark. It really doesn’t matter to me as I look at it like this, I am fortunate enough to have a stable income, I can’t take my money with me when I die, and even if I have to pay off debt for a few years at least I’ll know I did absolutely everything to extend Raven’s quality of life. That to me is the most important thing.

Raven went in Tuesday and had the Vincristine at a slightly reduced dosage due to the history of Neutropenia related to the Vinc. She had 0.6 instead of 0.7. She came home as happy as usual and was severely sulking when she realised she wasn’t coming to training that night. She had a bit of an upset tummy Wednesday night after training but that has settled down. Despite a slight weight drop (she dropped to 15.5) and a bit of a subdued attitude she has been fine. Our next hurdle is just making sure she stays on track with her scheduled chemo appointments and getting her into clinical remission as soon as possible. Short term I want to get a bit more weight on her, which is kind of hard to do when you have to avoid animal fats which feed cancer cells. But I am on the look out for raw healthy foods to feed her. She is basically on the BARF patties and veggie mash we make for her but I think I should up her raw meat intake, she hasn’t had chicken wings or carcasses for a while so I’ll start buying those again. She’s still on her fish oil caps and her Sasha’s blend, think I’ll look at adding further vitamin and mineral supplements again. So far so good, her nodes actually feel smaller than they did last week before chemo and I can’t feel the one in her left pre-scap that I felt last Monday. It’s only been one treatment so early days yet but the signs are good.

So that there is the latest lymphoma update. We ultimately hope to have another good couple of years with her but I know I have to be realistic. We may just be one of the lucky ones. And boy if I could employ the world to sift through those marrow cells harvested to get rid of every single cancer cell I would! But the machines that do that are out of reach from veterinary science so far. Give it another hundred years Ken says. Sure Ken, so could you cryogenically freeze us all in the meantime so we can come back when that’s all organised please? Thanks :-)

Sometimes...

Sometimes the world is just shit. A little shout out to a fine film by the name of Pay It Forward (go watch it if you haven’t) but also a pretty good summation of my reaction after getting off the phone to Ken Wyatt (Raven’s Oncologist) Thursday afternoon. As my gut instinct told me, Raven’s lymphoma was confirmed as having returned March 13th 2008. Stupid cancer. Seriously if I had three wishes only, one of those wishes would be to get rid of all forms of cancer forever. It’s a hideous, insidious disease that doesn’t discriminate in any way, shape or form. She will beat it back again. Of that I have no doubt. Now it is just a matter of selecting our treatment option. If we go the exact same route that we took last time no doubt she will go into remission again however our chances of cure have gone from 15% to 0%. So now we will be considering other options. I won’t know what till we see Ken Monday and discuss everything in detail. The good thing now is that since Raven’s diagnosis in May of 07 Murdoch has performed at least 12 bone marrow transplants in that time frame. If we choose this she will no longer be a guinea pig for the treatment and that’s reassuring for me however irrational my previous fears were regarding her being the first patient to undergo it at Murdoch. We shall see though. In the meantime apart from her slightly abnormal lymph nodes Raven is just fine, her behaviour, her attitude and her general health is absolutely normal, she was running round like some mad young dog last night at a fun agility event and unless I told you – this dog has cancer you would be none the wiser. Just like she is. I plan on keeping her that way. So that’s my rather sobering Raven update for now.

On a brighter note she had a wicked time last night – enjoying her two runs to the max (clear in jumping and a whole bunch of DQs in Agility because I didn’t go back and fix a missed weaver but boy they were fast DQs LOL!) and having fun in a tunnelling event and the 36 weave competition. Cypher also enjoyed himself with a clear in jumping, one almighty missed a frame contact in agility complete with enthusiastic ‘Woof!’ and he had a go at the tunnelling and weaving event as well. Spryte, I think had the most fun, she was flying on the jumping course and handler had a ‘bad handler’ moment telling her to ‘get out’ when she didn’t need to, so she did and I nearly caused a refusal but she saved my butt and tried so hard to clear the bar with an upright in her face, the bar was always gonna come down, however I was so pleased with her effort. She’s really starting to step up and do obstacles without as much support from me which is just what I wanted. In Agility she nailed the weaves with a badly lit entry and an incredibly appealing dog walk off to the side I was absolutely proud of her for that. We had a hiccup with a refusal at a tunnel entry but other than that she was clear….and having so much fun she jumped into my arms at the end delivering a face full of kisses. Sometimes the cuteness is just overwhelming. Who could resist a face like that? *Points below* I have also posted some pics we took yesterday to commemorate the rare occurrence of all three dogs being bathed, trimmed and groomed on the same day – Spryte is 19 months old, Raven is 8 years old and Cypher is 3 years old.

Spryte

Raven

Cypher

The Motley Crew

Of Updates and Heatwaves

Righto. Time for a blog update. Yes real life obviously did not stay this side of normal and I am a few days overdue. Lots of news to report it’s kind of daunting to think where I should start! The Western Classic perhaps? Well we had some rather spiffy courses to run and we had judges from Queensland,Tasmania and South Australia so a very national flavour in terms of course design.

Spryte – had her debut in her first official competition and the Novice Agility course by Barbara Murfet was a very nice first course for her. Absolutely nothing wrong with the course design or the dog who worked beautifully for me. I had a case of ‘Holy crap she’s really trialling for the first time’ nerves and completely forgot that this is a dog I have actually trained the table with properly. She got on the table and I froze. You know how when under pressure dogs revert back to default behaviours, humans have the same issue. Or at least this human does. I stood there not moving, freaking out that I had a ‘Raven’ on the table and of course blocked the next two obstacles very nicely from Spryte’s line of sight. Hence we had two lovely handler enabled refusals. But I was still extremely pleased with the way she worked. Her speed is coming on very nicely, literally in leaps and bounds and her obstacle performance is on it’s way to complete proficiency. Then Novice Jumping with Peter Hofto – also a cracker of a course, slightly more technical than the agility one. This required much more tighter handling in a couple of parts and this showed our weaknesses when I turned close on bars and she brought a couple down. Showed up very nicely exactly what things we should be working on.

Cypher – Picked this weekend to try out the zero percentage pass rate feeling. Nothing I could have done really. Masters Agility (Judge: Roger Green) he missed a dogwalk contact – I was completely stunned by this, as it would bring his grand total of missed dogwalk contacts in trialling to 2. Then I believe he took a bar down as well for good measure. I didn’t notice it much as I was still in aftershock from the missed DW! Open Jumping (Mr J Ryan judging) – one bar down. Open Agility (Judge:Roger Green) he decided the distance challenge wasn’t enough and decided to take his own obstacles moving laterally away from me. Plus took one bar down. I’d decided he must have been saving it for Masters Jumping (Mr J Ryan judging). We were three easy bars from home when he took the third last bar down. I admit I was a little frustrated when I asked if anyone wanted to swap their dog for Cypher. Ah well.

Raven – Masters Agility, cracker of a time and no off courses yet two bars down. Open Jumping – she had a great time in the distance challenge figuring that if I was moving away from her laterally she should just go through the bars instead of over them as that meant she returned to me much quicker. Think she had about 3 down by the time I stopped her, told her I wasn’t playing, thanked the judge and withdrew. Open Agility – fastest time on the night, one bar just tapped off the uprights. Think I was going to be surprised by this point if I actually pulled a clear round so I just laughed at Raven’s joy and berated the time keeper for telling me she had the quickest time by two seconds…I think she took some evil delight in informing me. Masters Jumping, I think we got through this with one bar down near the end. And that was that. Classic Individual Agility and Jumping trials over for another year! I had run Andrea’s Sheltie Rumour and both times we had one fault so I seriously was completely jinxed that night.

Sunday night was the Obedience. I did have Cy in CCD but was utterly bored out of my mind waiting till he came on at something like quarter to 11 that night so scratched him. Raven got into the UD ring at 9.30pm and we had a lovely practice round withdrawing halfway through the signals heelwork. It was only ever going to be a practice round since I hadn’t realised I’d entered her till a few days before and had done zippo training with her. So she got the seekback, did her own Raven Interpretation of the directed jumping which included far more reps of the jumps than just boring old two. Why go straight out to a box when you can have fun taking a jump on the way out? I’m sure she just thinks that exercise is a completely lame Novice jumping course. Nailed her articles so was pleased with that, did some nice slow pace heelwork in signals and then must have just been coiling herself tight during the slow pace because when I went back to normal pace she unsprung in a major way. So we withdrew thanking the judge for his patience and his good humour. I haven’t found a judge yet who has managed to supress a smile at her very evident enthusiasm for all ‘active’ tasks in UD. At this stage, gaining a UD may be off our short term goals to achieve. I’ve decided she needs some fairly intensive training for it and unless someone would like to offer to take her in and get it done I’m thinking I may just skip the UD getting part all together. Any offers? *vbg* She’ll work for anyone if she thinks they are good for treats….only comes with moderate to severe badly trained habits that I’m sure any competent trainer could overcome in five seconds and to make up for that she has about 10 times more enthusiasm than any Obedience dog needs. She’ll make you laugh I guarantee it.

Monday night was the teams event and I tried to keep my odds good by placing my three dogs in three separate teams. It worked fairly well finishing in the top four in both the Agility event and the Jumping event. Cypher’s team mostly had a good night. Cypher decided he can keep all the bars up, running clear in the Jumping and having only one fault in the Agility with an A frame contact. It was fairly close and I made a mental note to work contacts all week with him. His team finished 4th in the Agility. Spryte had a ball and we did parts of both courses very nicely and some parts not so nice. She did do something new to me though…all of a sudden she shot off to what she thought the next obstacle was without me even moving there. Then she came back in really quickly and I had to dodge her to avoid tripping on her. She’s definitely gaining in confidence with every run but I need to make sure that’s tempered with self control. It’s great that she is feeling confident and sassy enough to pick out obstacles to do as it indicates her drive to do obstacles is increasing but I need to be pairing that with handler focus as well. Her team The Spice Girls, consisting of two shelties (Rumour being one) and of her and Spice, Andrea’s young NZHD came third in the Jumping so we were very chuffed having two brand new baby dogs on that team! Raven – well she had a ball. Especially on the agility course, I was chicken with the table and didn’t move and she was pointing the wrong way and so jumped off the table one side, saw me going the other jumped on the table again and then ran to the next obstacle. I was laughing from that new little move and didn’t handle the rest of the course at all well and she realised I had stopped handling altogether on around her second circle lap of tunnels and jumps. She came back we finished the course and I couldn’t do anything except grin at her complete and utter enjoyment with not a care in the world. She redeemed our performance in jumping by running clear though. And that was the end of the Classic. At least I didn’t come home completely empty handed picking up a couple of placements with the teams. The courses were great too, I must try and get copies of them to practice at training.

So that brings us to this weekend just gone. Raven, Cypher, Nifty, Sue and myself left for Adelaide on Saturday and landed in 39 degree heat. Just yummy. Not. We’d actually had thunder and rain for a couple days during the week. It had cooled somewhat so of course we up and leave for heatwave temps again. The trip went smoothly till Avis lumped us with a Fiat van (unlike the Toyota HiAce we had ordered and rung up to confirm THREE times before we left)…the Fiat Van has a name – Sauna Box. A fully enclosed cargo section with metal on all four sides and no ventilation. We drove to nearest shady spot at West Beach five minutes down the road and then refused to move until Avis replaced it with a Hi Ace. There was a ‘mix up’ apparently sounding remarkably like a lack of communication to me but we didn’t mention it. 2 and a half hours after landing we had our Hi Ace and all was right with the world again. We headed off to Highway 1, a very nice and full of dog people from all over Australia, holiday park. We settled in, had fish and chips for dinner and generally chilled out in the air con. We headed over to SACA park Sunday around 10.30ish. Adelaide bears a striking resemblance to a red dust bowl currently having been in a drought situation for some time now; everywhere is dry, rock hard and dusty. SACA park was no different. Trailers, cars and tent cabana gazebo land with every piece of shade snapped up we wandered the grounds for a bit checking things out as you do. WA has it very sweet that’s all I will say on that, there is no doubt in my mind that our grounds are the best in the country, though I won’t state that categorically until I see QLD and Tassie.

So the teams event was under a huge marquee used for showing at 1pm. The first agility course was by NZ judge Lyn Sayers and had some challenging technical points in it combined with fast flowing extended segments. It was fun to run and Raven ended up with two refusals only and no DQ which was amazing really given all the DQs happening. Turns out she was saving the DQs for the second round! I handled the lead out badly on Ashley Roach’s (NSW) course, so we picked up a DQ at the beginning, then one about halfway through the course, another one when she went over a jump after the weavers having missed one and I’m not sure where the 4th one came from. She had a real issue with the weaves in the second round and it took three attempts to complete them. I had no idea where she was missing one but she kept coming out on the wrong side. Not like her at all and I do wonder if the stick in the ground poles are an issue for dogs when they have been shunted and pushed aside by previous dogs. A number of Agility Champion dogs had issues with them. C’est la vie as they say. Some great runs by a number of dogs, notable ones were Ronnie’s two Jak and Cricket, a nice run from Wendy and Hollie and a couple of other 1 fault runs that were still very nice to watch. South Australia won overall and that was great to see Danni, Wendy, Darren and Michelle go up and get their prizes.

The following day was Monday and a double Jumping single Agility trial was held at West Beach as part of the Pedigree Autumn International. It was hot still but not quite as hot as SACA had been. We managed to keep the dogs quite cool under the verandah of the clubrooms. Sue and Nifty had a good day taking home 3 first places (both MJs and an OJ and 1 fourth place in the AM OJ).

Raven picked up a second place in Open Jumping and a clear 7th place in Masters Jumping, we wasted a couple of seconds whilst Simone tried to think quicker (and clearly failed given her time!) She had two bars down in MA and I screwed her second MJ run up by pulling her off a jump – I blamed the heat frying my brain then. In Open Agility she took one bar down the same as in her second Open Jumping run. She told me it must have been the heat then too. The photographer got some good shots of her mad running dogwalk in OA where I just took off on her as she finished the weaves determined to beat her to the end of the dogwalk. Check out this page: http://www.inmotionphotography.net/coppermine/thumbnails.php?album=318&page=34

Photos 38 to 41.

Cypher was clear in four out of six runs which was much more than I was expecting given our zero percent pass rate the weekend before, the heat (he feels it quite a lot with his coat) and also his travel confinement for the previous two days. He picked up passes in the morning OA and OJ, and in the afternoon in OJ and MJ. Took the dogs to the beach afterwards, they had a swim and then we headed back to the holiday park. We enjoyed a leisurely lie in before flying home just after lunch yesterday.

So here we are at Wednesday. Last night when we got in I happened to be checking Raven’s lymph nodes out, like I usually do…every day much to her disgust. The right hand side one felt a little bit abnormal to me. So I checked in with Ken Wyatt today at Murdoch. He decided I wasn’t being paranoid this time, that there was a slight change which could quite well be an inflammatory response to her allergies playing up (she’s been very itchy on the same side of her face) or it could be ‘something else’. We refused to name it out loud. So he took a fine needle aspirate and told me to ring for the results tomorrow. That is the only change in her. He thoroughly checked her over, listening to her heart and checking all the usual areas. Apart from that one slightly changed node everything else is fine. Raven of course tells me nothing as her behaviour has been completely normal for her, running courses and generally acting like her feral self. Certainly not a typically refined and dignified 8 year old but more like a 3 year old on uppers, the heat seemed to have no effect on her at all…I was secretly hoping it may have given us just a little bit extra in the control department but no such luck. So now we wait. Till lunchtime tomorrow. I refuse to even think about any possible implications until then since there is absolutely nothing I can do right now. Although if it is something I think Adelaide will definitely have to come off our list of places to compete in as that is just too suspicious!

From just this trip alone I’ve decided that the Cool Champions Cool Coat is well worth the investment (I borrowed one Sunday off Sally – thankyou muchly!) and it actually worked. As in when I stuck my hand under the coat after it had been on Raven for a good 20 minutes it was definitely cooler than the outside of the coat. And she felt cool on her fur and skin to touch. I was pretty impressed. So I am looking at purchasing a couple but I am interested to see if anyone else would like to purchase one with me, if we order enough we can get a discount. If you do let me know via email – borderaussie@iinet.net.au.

Definitely a must have for hot weather trialling and we certainly do enough of that even in the evenings round here.

So that is it for now, I am going to update with some training stuff soon. Spryte’s progress with her contact training and Cypher’s jumping work. In the meantime some non dog related recommendations:

Go see Jumper with Hayden Christianson, who is improving with each movie he does. It’s a fast paced, high action, sci fi flick based in reality with some fantastic effects.

My other recommendation is this book: Spud by John Van de Ruit. It’s an absolute crack up and I haven’t laughed out loud as much reading a book since Gerald Durrell’s My Family and Other Animals.

Also for a good darkly comedic television series I have to vouch for Showtime’s Dexter, a thoroughly well written and delightfully black humour series about a serial killer with a moral code. This led me to Six Feet Under which is also rather addictive and out on DVD (five seasons) as it finished in 2005.

And these pics below are just for fun...for some reason the breakfast thing made me laugh.

And this just blew my mind as it is *NOT* photoshopped.

And here endeth massive update...comments, queries, rude suggestions? Anyone?

A Beagle and a Border Collie have fun at the Classic!

Yes, yes I have been slack! Trust me I will be updating in the next couple of days, three at the most....she says....hopefully....if real life stays this side of normal. For now here's a couple of photos from our Western Classic weekend. They are a little grey as they were taken close to dusk. But how could I resist the Beagle Batman impression by Tammy, our one and only agility Beagle in WA. Surely those ears have her at an advantage???

Tobarenny Tammy - run by Kerry McGillivray and a valued
member of the very successful Mix N Match team
(2 x BC's, 1 x Manchester Terrier, 1 x Duck Toller and one Beagle!)

And the SPRYTE! Making her debut in a teams event and
still a very Novice baby dog who had moments of brilliance,
helped her team The Spice Girls (don't ask!) to 3rd place in Jumping.

For more great shots go to http://www.yourdogphotos.com