Sometimes this place has good news

I know I've  been leaving everyone hanging, but I didn't have any real productive news to give.  Each following Cassie's chemo her blood levels were too low to take the next round, so we delayed another week for the next treatment.  So instead of 4 weeks it took 7. 

Here's the good news.  Cassie had an ultrasound today and the doctor was unable to find the thickening in her intestinal wall.   Also, the lymph node shrunk significantly.  I think it was originally 3.25 cm and it's now a little under 2 cm.  Not quite a 50% drop, but close to that.   Needless to say, I'm quite happy.


I guess it's good news that next week Cassie will start another round of chemo.  It will be the same protocol, but no prednisone.  The dose will probably be a bit lower since it seemed to hit her pretty hard the first round. 

She is also eating pretty normally again, so I'm happy about that.

Princess Cassiopeia "Cassie" goings on

Cassie at  3 weeks

If you've followed this blog, you know that I don't come here to tell tales of goodness and hope.  It's unfortunate that I'm here for the second round this year.  I'd hoped that by the time this forum was needed again it would be an old and decrepit archive.  

Some of you know some of what I'm about to share and for others it will be a complete surprise.  I waited to make this posting until my parents returned from their vacation.  There was no need to cause them distress, concern and worry when there's nothing they could do.

Cassie at 11 weeks

What's going on

I'm going to use the summary words provided by the oncologist at Sage to explain it, but this started about 6 weeks ago when Cassie wasn't eating normally for a while and I eventually took her in for what I thought was probably stress related GI issues.  It ultimately didn't resolve and we ended up doing an ultrasound which showed an enlarged abdominal lymph node and a thickening of one section of her intestine.  I'll use the words of the Sage oncologist from here.....

Cassie is super beautiful. She has been very picky with her food, and has been losing weight. An abdominal ultrasound showed multiple abnormal loops of bowel and enlarged internal lymph nodes.
Based on a needle aspirate, Cassie has been diagnosed with lymphoma, which is a cancer of the white blood cells. Since lymphoma is a systemic cancer, it is best treated with systemic chemotherapy. The standard of care for lymphoma treatment is a CHOP chemotherapy protocol. For all dogs treated with CHOP protocol chemotherapy the average survival time is about 1 year. Dogs with intestinal lymphoma are unfortunately much harder to treat, with average survivals in the 2-3 month range.
The L-CHOP protocol is a multi-drug chemotherapy regimen with 17 treatments in 25 weeks. Our goal is to provide Cassie with a good quality of life while she is undergoing chemotherapy, and she will be dosed appropriately to attempt to minimize side effects. Chemotherapy is generally well-tolerated in dogs, but gastrointestinal side effects (vomiting, diarrhea, decreased appetite) and bone marrow suppression (low white blood cells) are occasionally observed. Medications can be prescribed to alleviate these symptoms if they occur. About 5-10% of dogs will have a chemotherapy side effect severe enough to necessitate hospitalization, usually related to an infection requiring IV fluids and antibiotics.
Today (9/30), Cassie received her first chemotherapy drug, L-asparaginase. This is a "gentle" drug since she is feeling a bit under the weather right now. We will start her more traditional treatments at her next visit. This drug can rarely cause an allergic reaction, so monitor Cassie for facial swelling, hives, vomiting, or diarrhea.
Please monitor Cassie closely for any vomiting, diarrhea, lethargy, decreased appetite, or anything abnormal for her. If you notice any of these side effects, please call us. As discussed, in rare cases, as the cancer cells die, dogs can feel sicker and some even need hospitalization.

Cassie winning Feb 2017

When lymphoma affects the intestines, there is a risk of weakened intestines perforating. When the intestinal contents leak out, this is a life-threatening emergency. Monitor Cassie for signs of abdominal pain or weakness. [...] Cassie will be due for vincristine any time this coming week.

I will be doing the chemotherapy at Adobe as I can still consult with Sage and Adobe is where Cassie is familiar and one of my dog sitters work there.  As most of us know, we never know how well cancer will respond to chemotherapy.  I'm hoping for the best.   If you look up canine lymphoma you'll see that there's B-cell and T-cell types.  T-cell is the most aggressive form and intestinal lymphoma is usually this type.  I could have another aspiration done to determine the type, but it would have no impact on what we do.  Hence, why poke Cassie any more than needed and we are moving forward with treatment.  Cassie received her first chemotherapy treatment on Wednesday (10/4).

What Does this mean for me

Am I allowed to simply say this is pretty fucked up??  Well, I've done it any way.

I still plan on traveling and doing those things I have planned.  I'm fortunate in that the I've found someone that is willing to stay with Cassie for my next trip to the Caribbean. One of the vet techs at Adobe knows Cassie well and while her work means she'd be away too much while I'm gone, she's said she will be available for questions and assistance while I'm gone. I need this trip now more than ever, but I do wish the timing was better.

Jan 2010 ( 6 months old)

I'm getting great support from my friends and will renew and become a more frequent visitor again with my counselor.  This is going to be another strange phase for me.  I've had Theo and Cassie to be around when Laurie passed and then Cassie was around when Theo passed.  It's going to be a big quiet house if things don't turn around with Cassie.  I'm fairly active with a singles group and I plan to keep that up along with lots of yoga.  Being extra mindfulness is going to be a huge part of my adaption once again.

Good Night Sweet Boy

You were a loyal protector and companion for almost 12 years.  You were Laurie's guardian and ever watchful companion.  Alas, you also fell victim to cancer just as Laurie did.



Over the last several weeks Theo's bone cancer has continued to progress.  I slowly increased his pain medication little by little every 5 or 6 days through this past Wednesday.  This last increase helped ease his discomfort, but he was clearly not in touch with the world and he slept most of the day only moving if it was time to eat or someone came by to visit.  This is no life for a dog and it would be selfish of me to keep him any longer.  It's time for Theo to join Laurie and sleep the painless sleep.

I met with the doctor this morning and he agreed that we could play with medications, but he said this is bone pain and there's only so much that can be done and other drugs would be at least as likely to make him as sleeping or out of it.  So, with his support I made the difficult decision.

It's been a tough week for me, but I've had good friends and counseling to get me through.  Cassie is ever present and there for me as I struggled to assess Theo and do the right thing.  Theo has been a constant presence in Cassie's life and she doesn't really know what life is like without him.  We will rely on each other for support and comfort in the coming days and weeks.

Here are a couple of videos that the dog walker produced of Theo.  They are public facebook, so you should not need an account there.
https://www.facebook.com/seespotrunsanjose/videos/1223716084390327/
https://www.facebook.com/seespotrunsanjose/videos/1223663477728921/