DECEMBER 2, 2013: Dobson is our 7 year old neutered male yellow Labrador Retriever. We got him as a puppy, and he has been healthy his entire life. This past summer (2013), we noticed a small sore on the skin of his throat. At first it looked like a puncture, then it seemed to heal up, then it became a lump that oozed blood a bit. We took him to our regular vet in October 2013 to have it looked at. The lump was about the size of a pea, or a little bigger. The vet X-rayed his chest and abdomen (both were clear) and on November 2, 2013, she surgically removed the lump and got good margins around it. Diagnosis was a Grade III mast cell tumor.
She referred us to a veterinary cancer center in Portland, OR. Dobson started chemo on November 20, 2013. We are going with the oncologist's recommendation of chemotherapy -- Vinblastine (IV) every 3 weeks for 6 treatments, with each treatment followed 10 days later by a course of Cytoxan and Lasix (pills). Plus a supplement powder called Onco Support sprinkled on his food. We also had an ultrasound and fine needle aspiration of his spleen and liver, which showed no sign of the cancer spreading. And we transitioned him to Blue Buffalo Wilderness salmon recipe kibble, which is higher in protein and fat than the kibble he had been on and is also grain-free. He made the switch with no problem. He has also been on Temaril-P (contains prednisone) and Benadryl for several years to address itchy ears, etc. These can also help treat his MCT cancer (diagnosed last fall).
DECEMBER 2, 2013: As of this writing, Dobson has had his first Vinblastine treatment and is finishing his first course of Cytoxan and Lasix. He became a little restless after we started the Cytoxan, with the restlessness coming mostly at night. A Thundershirt and Pepcid AC seem to help with this. He hasn't had any other issues, and no side effects from the chemo.
FEBRUARY 10, 2014. I'm glad to see the Fight Dog Cancer website back up! Dobson has been doing great. No side effects from the chemo, and no new lumps have been found. He has a couple more IV Vinblastine and oral Cytoxan treatments coming up, then we'll discuss whether to change or discontinue chemo meds. Folks might notice that I changed Dobson's profile photo. I'm not much of a photographer, and the old photo made him look skinny. The new photo shows Dobson (in the rear) with his brother Caddis (in front), wet fur from playing in their baby pool last summer.
MARCH 6, 2014. It's now 4 months since the MCT tumor was removed from the skin folds under his neck. Dobson received his 6th dose of IV Vinblastine today and will start his 6th course of Cytoxan pills 10 days from now. He's still doing well and has had no new lumps. We'll have complete bloodwork and a urinalysis done in about a week and are considering starting him on a different oral chemotherapy drug. No decision until the oncologist sees the bloodwork.
APRIL 8, 2014. Dobson's oncologist says that there have been no new MCT lumps and there's no sign of the cancer spreading, so we can say he's "in remission!" He is done with Vinblastine and Cytoxan and is now on Chlorambucil. If things go well, he'll probably be on Chlorambucil for the next year or so. Bloodwork is good. He'll have an ultrasound in May or June, which will be six months from his last ultrasound. He is feeling good and still has a normal energy level. The vet and I are very happy. :)
APRIL 22, 2014. At this writing, he's been on oral Chlorambucil once every day for two and a half weeks. No side effects as far as I can tell, and his blood work is mid-range of normal. He may even be getting stronger because he sure is pulling me along at the other end of the leash these days. (Maybe I should ask the vet if that's normal? LOL) There is a compounding pharmacy here in our local area that makes up the capsules specifically for him. I think the dose is based on his weight. So that makes me even more confident about the treatment. He is also still on Temaril-P (for itchiness and it also has prednisone in it) gabapentin (he had pain in the past from a ruptured disk), Benadryl (for itchiness allergies), Onco Support powder (cancer supplement), grain-free kibble (Blue Buffalo Wilderness) and grain-free treats. He has lost a few pounds, which was one of our goals, and now is at ideal weight. I think the weight loss may be due to switching to homemade dog treats that are smaller and probably less fat than the treats we bought at the pet store. All in all, he's doing great.
JULY 17, 2014. He's still doing great. He's still on Chlorambucil (one capsule once a day) and the other meds I mentioned in my April 22 update. No side effects as far as we can tell. He went in this week for blood work and a check-up. He has a fatty lump on one thigh but the oncologist aspirated it and it's fine. Dobson enjoyed riding to his vet appts in my Miata with the top down and splashed around in the kiddie pool when he got home. He's a happy guy.
SEPT 2, 2014: As of today, it has been 10 months since Dobson's surgery to remove the one Mast Cell Tumor that he had. He will have bloodwork and a check-up next week, and an ultrasound in November. He's still doing well on Chlorambucil.
SEPT 12, 2014: Checkup and blood work came out great. One fatty lump, which the vet aspirated and confirmed was just fat. Yay!
NOVEMBER 5, 2014: This week Dobson celebrated the one-year anniversary of the surgery that removed the Mast Cell Tumor. So far, no sign of new tumors, just that one. He has an ultrasound and biopsy of the spleen in two weeks to see if the cancer has spread. Hopefully they'll say he's still in remission. Fingers and paws crossed.
NOVEMBER 21, 2014: Yesterday was the one year anniversary of Dobson starting chemo. He is still taking a Chlorambucil capsule once a day, in addition to Benadryl twice a day, Temaril-P once a day, gabapentin for an old back injury (unrelated to cancer), and Onco Support sprinkled on his breakfast kibble. He had an ultrasound and a biopsy of the spleen yesterday, which we are now doing every six months, and an exam to check for lumps. The results of the biopsy came in today and his spleen is still clear. The veterinary oncologist says he's still in remission. No sign of new Mast Cell Tumors or spread of the disease. This is going to be a happy Thanksgiving this year!
JANUARY 22, 2015: Dobson is still going strong and still in remission. No new lumps. He had a checkup at the onco vet today, and it went well. His blood work showed that his platelet count appears to be at the low end of normal. So when he goes back in two months, they'll want to see if his platelet count has gotten lower. She said low platelets can be caused by Chlorambucil. He has been on Chlorambucil for the past 9 months. He is staying on Chlorambucil at least until we see the blood work in March.
MARCH 22, 2015: We went in for a 2-month checkup and CBC bloodwork. Dobson is anemic; his red blood cell count has dropped significantly since his last CBC 2 months ago, and his platelet count is lower, too. This could be due to long term use of Chlorambucil (the generic for Leukeran), which he has been on for nearly a year, or it could be due to MCT cancer. Looking back at my notes, I see that when we started using Chlorambucil in April 2014, the onco vet said he could take it indefinitely unless he has problems with it (such as lethargy, decreased appetite, and low blood cell counts). And she also said we might want to consider discontinuing it after 12-18 months to see if he's "in the clear", and to think about whether the risk of continuing the drug would outweigh the benefit. At this point, it looks as if he is having blood cell problems but we're not sure of the cause. So we will discontinue the Chlorambucil for 2 weeks and have his blood rechecked at that time. Then we'll discuss what to do next.
MARCH 23, 2015: I talked with the other onco vet (in the same practice) today. She said we could lower the dose of Chlorambucil but the best course is to take a break from Chlorambucil for one or two months, to give his bone marrow time to recover. While his platelets are low, the bigger concern is the drop in his red blood cell count. His iron is good, and the type of anemia he has is not due to low iron. (I didn't think to ask her the name of his type of anemia.) I asked about any recommendations for dietary changes or supplements, and she said a well-balanced diet is best and maybe a little more protein than what he's currently getting. The main thing he needs is time to recover. I'll take him in for a CBC blood count in 2 weeks and we'll see where we go after we see the results.
APRIL 4, 2015: It's two weeks since he went off Chlorambucil. We went back today for a blood receheck and exam. The bloodwork is improving re: red cells and bone marrow. So I assume the anemia is related to long-term use of Chlorambucil. His weight is good, and stable. He has a couple of lymph nodes near his jaw that are larger than on the other side, so the onco vet sent samples to the lab. She's concerned because the mast cell tumor that was removed in Nov 2013 was in the throat area and was a Grade III. When the results come back we'll make a plan for treatment. Meanwhile, I have started adding cooked turkey to his diet.
APRIL 9, 2015: Dobson had an abdominal ultrasound, fine needle aspiration of the spleen, and chest X-ray today. The results aren't all in yet, but we do know that the lymph node that was aspirated on April 4 had MCT cells in it. We're planning to have surgery soon to remove the affected lymph node and will consider putting him back on chemotherapy, possibly a Vinblastine-Cytoxan regimen like he had in 2013-14 that seemed to work so well for him. He's in good spirits, loves his walks (though he starts to pant at about the 3/4 mile point), and is behaving normally. We'll switch to using a harness on walks to avoid putting pressure on the submandibular lymph node, which is by his jaw below his ear.
APRIL 13, 2015: Good news. The ultrasound results are in. It was "unremarkable" and the spleen, liver, kidneys, gall bladder, etc. are all normal. Aspiration of the spleen did not show spread of the cancer. So it seems that the only place it has spread is to that one submandibular lymph node. We have scheduled a consult with a surgeon for April 20 and plan to have the lymph node removed on April 21.
APRIL 23-24, 2015: Dobson's lymph node surgery was canceled this week because his anemia has gotten worse. His red blood cell count has been down lately and then it went down significantly between his pre-op blood draw on Monday and a follow-up blood draw on Tuesday before they were to put him under. On the advice of his surgeon and his onco vet, I took him to the Dove Lewis emergency vet hospital in Portland, which has the best capacity around here to do blood transfusions. The ER vet tested his packed RBC count at under 14. That's low. Over the course of Tuesday afternoon and overnight, he received transfusions of 2 units of RBCs, which brought his packed RBC number up to the mid-30s. After bringing his number up, he could be anesthetized for a bone marrow biopsy to try to identify what's causing the anemia. The ER hospital called in a mobile internist to do the biopsy and consult on possible causes of such a sudden drop in his RBCs. Bone marrow issues are likely the reason for a gradual change in anemia, and they think he may have a GI bleed that caused the sudden drop in RBC count. A GI bleed or ulcer can occur if MCT cells release histamine in the body and receptors in the stomach go into action in response to the histamine. He came home Wednesday evening and is doing okay. We're waiting for lab results and have him on some new meds (in addition to his regular meds) to reduce stomach acid and coat the stomach in case he has an ulcer/GI bleed, as well as a few days' supply of pain meds to help with pain he may be experiencing from the bone marrow biopsy. We're keeping a close eye on him, checking the color of his gums, and keeping to the med schedule. Once the lab results are in and once we see if the RBC count stays up over the next few days, we'll make a plan with the surgeon and onco vet. The results of the bone marrow biopsy showed no sign of cancer spreading to the bone marrow. We're having various blood tests done over the next few days. Not sure if the lymph node surgery will be rescheduled -- it probably will, since we know the node has MCT cells in it -- but we won't put him through it unless the benefit will outweigh the discomfort of recovery from surgery. Not sure about doing chemo again but we'll see what the onco vet says and will ask her if it will address the MCT issue without adversely affecting his bone marrow and RBCs. Maintaining his quality of life is our primary goal.
Dobson is a great dog. The vets have all called him "tough" and have been amazed that he looks as good as he does with his blood count being so low. While he certainly is tough, he also still smiles, vigerously wags his tail when we come home, and jumps in bed every morning for a little snuggle time before the day needs to start. It's hard to believe that there is anything going on that would slow this guy down.
APRIL 30, 2015: Dobson's bloodwork (red blood cell count) has been holding steady this week after the transfusions, so he was able to have his surgery today. The lymph node that was aspirated and had MCT cells in it a few weeks ago seemed enlarged at that time but was quite small today. It's likely that the node was getting larger and smaller the way skin MCTs do, getting big or irritated, then releasing histamine and then reducing in size. The salivary gland next to the lymph node was a lot larger than the one on the other side. So the surgeon removed both the lymph node and the salivary gland and sent them off to be assessed. We'll get the histopathology results in about a week. Dobson was kind of woozy when he got home but is more alert now. He also lets us put a cold pack on the incision to control any swelling that may occur. We're relieved that the surgery went so well, and we're all happy that he's home.
MAY 13, 2015: It's two weeks after his lymph node and salivary gland removal. Tests showed MCT cells in the lymph node but salivary gland was cancer-free. The incision healed up well. We started him on IV Vinblastine today and will follow with Cytoxan and Lasix pills 9 days from now. It will be an 18 week course: 6 Vinblastine treatments and 6 rounds of Cytoxan and Lasix, repeating every 3 weeks. This is the protocol he was on when he was first diagnosed a year and a half ago, and it seemed to work well for him. Ther vets can't figure out for sure what caused his red blood cell count to drop so dramatically a few weeks ago. It may be that he has a GI bleed or ulceration but he doesn't show the typical outward signs of a GI bleed. We'll continue giving him Sucralfate (Carafate) and Prilosec OTC to protect his stomach and reduce acid. His blood cell counts are pretty good, RBCs a little lower than they were after the transfusions, so we'll keep an eye on his bloodwork, too. He's feeling good, and though his energy level is fluctuating a bit, he still makes me work to keep up with him on walks.
MAY 29, 2015: We've been worried lately because Dobson has had loose stools, been kind of lethargic or "punky", hasn't wanted to get out of bed in the morning a couple of times, and his red blood cell counts are going down. A fecal test showed he has Giardia. Thank goodness! I can deal with Giardia, and we have him on antibiotics and a dewormer now. These won't address the blood issues, but at least he seems to be feeling better!
JUNE 7, 2015: We were afraid last week that we would lose Dobson. He was lethargic, didn't want to eat or take his pills, his gums were pale, and he still had loose stools. A trip to his regular vet found that his red blood cells packed cell volume (RBC PCV) was 16. So we took him to the emergency vet hospital, where he had an ultrasound of his GI tract to look for a bleed, and was given a transfusion of RBCs. The ultrasound was normal. The transfusion raised his PCV to 22%. But then he developed a high fever (106 F). With our consent, of course, they gave him an injection of the steroid dexamethasone sodium phosphate, which brought down his temperature. The PCV dropped to 16.6%, a delayed reaction to the transfusion in which his body attacked and destroyed the transfused RBCs.
The fever and RBC loss were scary. But the reaction, and his response to the steroid injection, gave support to the theory that the reduction in RBCs he has been experiencing over the past couple of months may be due to IMHA -- Immune Mediated Hemolytic Anemia -- and if that's what it is, there's a way to treat it. He has not shown the classic signs and symptoms of IMHA, and all of the vets who have seen him over the past 2 months have been working hard to try to figure out what's wrong.
Using steroids may allow his body to create and grow RBCs to maturity on his own, or at least be less inclined to destroy them. We know from the bone marrow biopsy a month or so ago that his marrow was/is producing RBCs, and they are most likely being destroyed in the bloodstream, not in the bone marrow. His RBC count was still low (eventually got up to 23% but then dropped again to 16%), so it was decided to give him 2 more transfusions of RBCs and more steroids. And some blood tests were ordered. RBC went up to 26%, and no reaction to these transfusions.
He was in the emergency hospital for 2 full days and nights. He's home now, taking oral Prednisone in an immunosuppressive dose (the Temaril-P he used to be on has been discontinued), as well as stomach-protecting meds he started on a month or two ago, and the other meds he has been on for a long time. (We also finished out the course of antibiotics and panacur for the Giardia.)
I took him to the onco vet the day after he got out of the hospital, and his RBC PCV was 42%! They had to check it twice! The only explanation we have at this time is that the steroids must be working and he must be generating his own RBCs. He's feeling better, and able to handle longer walks, and his gums are much pinker than they were before the transfusions. We'll take him in weekly for blood counts (more often if needed). The current plan is to keep him on this dosage of Prednisone for about a month (estimate) then reduce the dosage. Getting the anemia under control is the oncologist's highest priority (and ours). Then we'll likely resume chemo to deal with the Mast Cell disease that showed back up in his lymph node in April (the node has since been removed.) The Prednisone makes him thirsty so he drinks more often and has to go out to pee more often, but we can certainly live with that! We feel like we've got our dog back -- after almost losing him.
JUNE 29, 2015: We said good-bye to Dobson today. For the past few weeks he has been dealing with decreasing red blood cell counts probably due to IMHA (immune mediated hemalytic anemia), along with muscle wasting and increasing weakness, decreasing energy level, a boney appearance, and persistent diarrhea. The boniness, muscle loss, and weakness are a result of prednisone, which he was taking to try to prevent his body from destroying the red blood cells (IMHA). The vets and we were hoping to reduce or discontinue the prednisone altogether but there would have to be another immunosuppressant drug in place at an effective dose before he could be weaned off the prednisone, and he just ran out of time. The diarrhea may have impacted his ability to absorb meds, rendering them less effective. There was no evidence of Mast Cell cancer after the lymph node was removed a couple of months ago, but I can't say that his cancer history didn't contribute to his present condition, so I am listing his cause of death as "not sure" instead of "yes" or "no." His appetite was up and down, he had a hard time accepting/taking his meds, he was restless and couldn't get comfortable, he panted, he didn't have the energy to take walks other than very short ones. He lost interest in playing with toys and fetching a ball, things he loved doing his entire life. Overall he was having a very hard time and wasn't his normal self, especially on the last day. We decided to have him put to sleep while he still had some enjoyment in life and not wait until he was in pain or having difficulty breathing. A mobile pet euthanasia veterinarian came to our house today and helped us and Dobson's brother say good-bye to Dobson. RIP, Dobby Wobby. When you group members read this, give an extra hug to your pets, family and friends today. Thanks, all of you in this group, for your support and encouragement. -- Eann & Dobson's family
Consult with a veterinary oncologist. Make that person part of your dog's team. A vet cancer specialist can help you learn more about your dog's specific case of cancer. He or she can be a resource to discuss treatment options, dietary changes that can help fight the cancer, supplements, and the like. Don't assume that an oncologist is going to try to talk you into chemotherapy or other Western medicine. But don't dismiss those treatments without learning about them. And whatever treatment(s) you choose, the oncologist can help you know what to expect, what to look for in signs and symptoms, and what you can do to make your dog more comfortable. Check with your vet before you make changes to diet or add supplements, etc. -- to be sure they won't interfere with meds or cause other unintended problems.
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