Fuck You Canine Lymphoma!

19 Jul 2013Steve Schwarz

I’m not one for a lot of cursing, but I think this calls for it. For those of you following Agility Nerd on Facebook you’ll have seen Meeker’s illness and diagnosis play out over the course of the past couple weeks. I’m taking my posts from FB and rewriting them here along with the latest on Meeker’s health.

It all started the night of July 3rd when Meeker wasn’t too enthusiastic about his dinner. I figured he was tired from playing outside in the heat and the stress of the noise of fire crackers. The next morning and night he didn’t each much, but could be coaxed to eat treats and canned dog food. My plan was to see our vet first thing Friday morning after the holiday.

So I brought him in to the vet and he took blood for tests. He had been on doxycycline for 18 days after a tick was found on him and he had a slightly enlarged mandibular lymph node (blood work at that time showed him normal and all the tick panels came back negative). After running the blood samples on the 5th things were definitely not normal and not looking too good for Meeker. I wrote on FB:

Meeker needs your thoughts and prayers tonight. Apparently the doxycycline he was on for the tick that attached to him and a swollen lymph node has done a number on his liver. He's not critical but he's resisting eating, running a mild fever, quick shallow breathing, and elevated heart rate. He's overnight at the vet's tonight and we're hoping he'll start eating more tomorrow morning as his system continues to flush and recover. Waiting for the midnight call from my vet. I'm so worried about my little Meek.

As you can see the original thoughts were a reaction to the doxycycline and that had damaged his liver.

Saturday July 6th

Checked in with the vet on Saturday morning and posted to FB:

Thanks everyone for being so supportive. He is perkier this morning and ate a can of I/B. Drank water. Threw up a little. Blood tests show some movement in the right directions. Meeker has high ALT/BIL readings (indicating liver issues) but also very high ALP (indicating galbladder/pancreas). Working with an internist he might have a "sluggish galbladder" so no food by mouth for 24 hours to rest it/verify - only IV fluids. He's on two IV antibiotics, anti nausea/antacid. If no improvement an ultrasound specialist is lined up to come out tomorrow afternoon to look for gallstones and/or pancreas issues. The long holiday weekend is really making this more difficult. So glad my vet checks him all night long every 4-6 hours to see how he is doing.

Nancy was with him in the morning at the vet’s office. And after numerous phone calls found Blue Pearl Animal Hospital in Northbrook, IL had an ultrasound specialist would could check out his abdomen and take biopsies if necessary if Nancy took him there immediately. So Nancy drove out from the city picked him up and raced him in. I met her there. The found the liver and spleen were enlarged and some abdominal lymph nodes were enlarged. They took needle biopsies. Initial visual inspection gave a working diagnosis of lymphoma. Prompting me to post:

Here’s are Meeker’s finding from the ultrasound doctor(s):

Abdominal Ultrasound: Free fluid in abdomen, enlarged mesenteric lymph nodes, enlarged liver and spleen.

At this time we aspirated Meeker’s mandibular lymph node and the enlarged lymph nodes in the abdomen. Samples being sent for pathologist review. Results due Tuesday.

Open diagnosis: suspected lymphoma.

Brought Meeker back to our vet. Before we even worry about the future we need to get him stabilized and eating on his own. So he is on IVs with antibiotics and antacid/anti vomitting meds until tomorrow morning when we try feeding him again and another round of blood tests to see where he is.

He looked brighter upon arrival at the ultrasound vet and tired when we left after the procedures. It is a lot for the little guy. Going to meet the vet at his midnight rounds to see him again.

Sunday July 7th

We spent all day at the vet’s office with the vet - our dogs have a personal physician. That night on FB:

A real mixed bag of news. Learned some things today. Now have 2 pancreatitis results back as negative. Syringe feed homemade, no fat, chicken broth, some I/B canned food to try to support his liver. Got Endurosyn and liquid milk thistle in to him and let him rest for 1/2 hour. He’s on anti nausea/antacids. Pushed one of his antibiotics and within seconds he vomited everything up with lots of yellow bile. So he is now allergic to that one. He’s tolerating the Baytril.

4 hours later using frozen chicken broth “cubes” to keep him from gulping water. Repeated all above and hand/force fed 1/2 can of IB (his red blood cell count is getting pretty low since he won’t eat). This time all stayed down. So took him home with a schedule of 4/5 feeding/drug times tonight each day. Nancy is a huge help when we are feeding him.

So badish news is his mandibular lymph node has a large egg sized/shaped lump under it - likely the lymph node and not the thyroid… Wasn’t there/noticeable yesterday. So noon tomorrow we are doing a thorax/chest xray series. Hoping to see all is clear. Then we wait for Tues AM for pathologist report on biopsy cells.

In response to some questions:

Blasto tests are taking 10-12 days to get results - have blood sample prepared and will send out based on x ray tomorrow. Due to doxy treatments shouldn’t be lepto and tick panels came back negative.

So we are very short on sleep from driving in to the vet for night calls. Love my vet - he has been calling specialists across the country ever since Friday checking and double checking test results, verify tests to perform and he pretty much puts his life on hold to take care of our dogs.

It might not be “manly” to admit, but I almost lost it last night when I pulled in to the driveway at 2 AM after visiting Meeker and saw the blinds in the living room pushed to the side just like Meeker does when he hears the car pull up - just can’t imagine there might be a day when he isn’t there looking back at me. Otherwise I flip between anger, frustration and sadness.

The not knowing is what was so hard at this point - he was so sick it looked like we might loose him.

Monday July 8th

We all bitch about our jobs from time to time but I’m pretty damn lucky. My bosses were/are very supportive, even with two big projects of mine coming due during this period, they let me flex my time and work from home the whole week. Here’s FB for Monday:

He mostly keep all his food down last night after our force feeding. Threw up a little in the morning. Got all his meds in him. Another blood test and he is dehydrated and albumin is very low since he wasn’t eating while we were resting/testing his pancreas. So fluid is building in his abdomin - aka “dropsy”. Really need to get his protein levels up so his blood improves.

Chest/abdomin x-rays were clear - good!

With some nudging got pathologist report 12 hours early. The mandibular lymph node is likely just over active. The body cavity ones are very likely showing signs of lymphoma but it wasn’t “confirmable” or whatever they call it.

More nudging and got him in for an ultrasound guided “cut biopsy” of the body lymph nodes. Regardless they will start prednisolone post op. Results during the day tomorrow and a review with their oncologist. Dr. believes pred should reduce a lot of his acute symptoms - especially since blood work shows his liver is OK to handle it.

They plan on keeping him 2-3 days to stabilize him - I didn’t expect more than overnight - so I’ve let a message with my vet to see if he agrees. I’m not sure I want to turn his immediate care over to someone else. Especially since they are very much of a “take the dog in the back” kind of place. I much prefer being there with the Dr. and supporting my dog…

So began the week long period of driving to the hospital three times a day and spending time with little Meeker. I was spending the rest of the time working and trying to get some sleep. Nancy was researching and taking care of the other three dogs.

Tuesday July 9th

This was another tough day:

Liver biopsy inconclusive but likely lymphoma. His platelets are too low and there is too much fluid in his abdomen to try an x-cut biopsy on his liver to find the true type of cancer - too big a risk that we wouldn’t clot and he’d bleed out.

His condition is definitely worse. He is only just aware of his surroundings and immediately lay down when we saw him and he just put his head down. You can see he has a real inward look in his eyes. We gave him lots of love and massage but he was just laying there. Just breaks my heart.

We are starting chemo immediately with the hopes his liver will bounce back in the next 24-48 hours and his condition will improve. It is the best option the oncologist can come up with. Pretty much nothing else matters at this point.

Wednesday July 10th

From FB:

After we left yesterday afternoon Meeker almost crashed. The vet tech told us he became unresponsive and appeared to have stopped breathing. They brought him around. The oncologist had just received the latest blood results and his ammonia was a little high - which can account for his being out of touch - poisons in the blood getting to the brain. So they gave him several dextrose(?) enemas to leach the ammonia from his blood. He came around and was much more normally responsive. This is also a sign that his liver wasn’t functioning properly.

Some folks are suggesting treatment options, I do appreciate them, but remember - he is really on the edge right now. The meds he is on are trying to kill the cancer cells in the liver, without doing in the liver itself, and we are fighting the poor state of his blood. He won’t eat and is barely keeping down very small quantities of water. So adding things to the treatment is likely to tip him out of his delicate balance.

So last night and this morning he was definitely looking better. He knows where he is, who we are, hears other sounds, and doesn’t have that inward look in his eyes. He is mostly keeping down water and isn’t craving water anymore. They are trying to cut back on the IV because his blood is so dilute that fluids are continuing to collect in his abdomen. A switch to hypertonic saline is having a positive effect on that count. The enemas also drew out some fluids.

Latest blood tests show his ALT and bilrubin are still high but dropping - a good direction.

Treatment wise it looks like the pred and the initial chemo drug are having a positive effect. The oncologist is debating whether to start the next chemo drug - he really wants to be aggressive but can Meeker handle it?

They are trying to get him to eat real food - but he still resists (we’ve brought in all the goodies - chicken, sausages, cheeses, green tripe, chicken ice cubes, at least a dozen things). They will likely start trying to syringe feed more than sugar solution soon. They cut back on some meds because he is getting some diarrhea. Also cut out a very small dose of opiate pain killers since some BCs are very sensitive to them - like our Milo.

This afternoon he still looked OK - but very sleepy. He isn’t resting well - only a few minutes at a time. We lay him down and he got a few minutes more. A nice improvement is his breathing is much slower and deeper now - not the fast shallow breathing of the past couple days.

Thursday July 11th

We almost missed Flyer’s 2nd birthday! Felt so bad for Milo, Petey, and Flyer during this intense week. They got some exercise, but Petey really picked up on something not being right. The stress also caught up with me:

Gave Meek a small dose of the next chemo drug to try to kick his liver in to gear. He is still vomiting a little and has diarrhea. They force fed him last night and he held it down for about 6 hours. Now going with a different IV antiemetic. Reduced his oral glucose since it also contributes to the diarrhea. Liver enzymes are still going in the right direction. He is drinking and not craving water - but a little dehydrated due to the diarrhea.

Still no ETA on when he can come home - he really needs to keep oral meds and food down first. The state of his liver is contributing to his stomach problems.

He is looking OK - he is very sleepy now - and sleeps with nice deep breaths. Hopefully that means he is recharging.

I’m a different story. The stress of this experience seems to have given me the flu. I had some of the worst shivering I’ve ever experienced last night when I went to bed - I think I pulled a leg muscle! Feeling real dopey and have some post nasal drip. Combating it with Airborne, mucinex and I’ll take a Nyquil before bed.

Friday July 12th

Just a day of visiting with some slight improvement.

Saturday July 13th

I was stunned when I got the call on our way in to the hospital that he’d kept food down for almost a day and they thought he was stable enough to come home!

Here he is in the driveway - he never liked getting his picture taken:

Meeker Home!

The hard part was coming up with the schedule of drugs/feedings to build up his extra scrawny self - but a late evening phone call got it all straightened out.

Monday July 15th

From FB:

He is looking and acting more and more like his old self.

He is keeping food and water down and now we are working on fixing the “other end”. His stools are pretty loose - just the good side of being diarrhea. So we are taking him off lactulose; which was being used when his liver wasn’t working and he was getting ammonia build up in his blood and making him confused - but it is also a stool softener. Since his liver is functioning better now he shouldn’t need the lactulose.

Other than that it is a complicated schedule of pills and meals. There we were with multiple advanced degrees trying to figure out the proper ordering/timing of them all and his feeding so they didn’t have bad interactions. Finally worked it out with the nurse and doctor.

Nancy is so wonderful cooking chicken breast and giving him many small meals during the allowed feeding windows. We don’t want to overwhelm his GI tract and his liver with large meals.

Some of the complication is his stomach is mildly ulcerated so he needs sucralfate on an empty stomach to help it heal and then some down time to let it work.

All the fluids left in his belly do kind of make him look like he is going to have puppies soon But that swelling is slightly decreasing too.

Wednesday July 17th

From FB:

So Meek’s “other end” is fine now that he is off of lactulose, well formed and a little soft (I’m sure you wanted to know…). He is eating bigger meals (up to 1/2 cup at a time) with mixes of poached chicken, his kibble and homemade chicken broth. The pred is making him drink/pee more. His bloated belly is definitely improving.

Now that he isn’t so bloated it is much more obvious how not eating real food for 7 days has ravaged his body. He is bony. I’m actually glad he was 2-3 lbs overweight before this started - his wonderful muscle tone is almost all gone. Last night I noticed his tongue was even pinker than before and I pulled up his lips and his gums were almost white. He had seemed a little less energetic yesterday so we were worried he had become dangerously anemic. Upon discharge he was anemic to begin with RBC % around 30%, the cancer did a number on his liver and possible his bone marrow, we knew that.

So around 9 PM we took him back to the emergency vet. They spun down his blood and his RBC % was at 20%. He was still behaving fine, just breathing a little more and more likely to lay down. We checked him around 2 AM and he didn’t seem any worse.

Got him in to the oncologist this AM, ran a full CBC and his RBC is still around 20%. No sign of blood in his stool and no sign of internal bleeding. Apparently, low RBC isn’t uncommon in chemo dogs, especially with much liver damage. A transfusion has too many dangerous side effects to “just do” so we will keep monitoring him and then will do another CBC when he gets his next chemo treatment on Friday AM. They were really impressed with how much better he looks now compared to how he left there!

So a possible iron shot (painful) on Friday. Until then we are continuing with bio available proteins and RBC building foods (whole eggs, liver, etc.). For folks asking he is on Denamarin for his liver among other meds.

Thursday July 18th

All the liver boosting foods Nancy has been cooking for Meeker have done something. He looks better in the morning:

Meeker looking good

Hi bloated belly continues to shrink and he is getting a waist and his belly is tucking back up. But he is still quite bony. Nancy’s increased his calories and you can feel some fat over the bones starting to come in place.

Oh and I’m almost all the way over my flu too.

Friday July 19th

So we took Meeker in for another blood test today and his next chemotherapy treatment. I had incorrectly posted the protocol our oncologist is using on FB, he is actually using the CHOP protocol. Here is an article describing COP/CHOP protocols. We have to keep him from peeing/pooing near the other dogs as the chemo drug will still be potent in his urine during the next 24-48 hours.

Even the kind of morose vet was trying not to sound too happy at how Meeker looked this morning. The good news is his RBC % has moved up to 25%! He can have some exercise - but no agility! So we are just going to take this one step at a time as we learn how to help Meeker get well and how he tolerates his treatment.

Oh and one of the things no one actually talks about when it comes to treatment… money. So far Meeker’s emergency room and first few chemo treatments have totaled just over $9,000.

Thanks to everyone who has had so many supportive and kind words to say for our Meeker!

Update - 2013-Jul-23

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