So everyone knows by now that our dearest Hurley has been diagnosed with Stage 5A lymphoma. Please click here for original post.
On his first visit he had several tests to confirm the full spectrum of his disease, including a physical exam, blood work, ultrasound, and X-ray. The full diagnosis is Stage 5A lymphoma as it is in his neck/chin area, two front shoulders, two rear 'knees,' abdomen, spleen, and blood. The oncology residents
and treating oncologist have said it is the most
common cancer in dogs, and that chemo has a high sucess rate.
A week ago I dropped him off for his second round of chemo. Before administering any medications, they first do a full physical exam and second order bloodwork to check his platelets and lymphocite count. I was shocked when the oncologist called me around 1PM to tell me that he was already in partial remission!!!!!! We were so excited. So he really responded well to the first chemo drug he was given.
He has been having some diarrhea at home still, but other than that no nausea and acting like his usual self. I asked about changing his food but because they don't know if its a response to his cancer or the food they don't want to change it now. In addition to his anti-diarrhea med he has fortiflora for his food now, which we just sprinkle on it and is supposed to promote GI balance.
He is now allowed on the couches and in bed with us. No more rules for this guy. SPOILED ROTTEN ~ MORE THAN USUAL!
Yesterday the drug he was supposed to receive in his third treatment is abbreviated "doxy." It is the most potent of all the drugs. When administered over time, it can have a negative affect on the heart. Although the doctors had heard no murmurs or arythmias in any of his previous exams, they gave us the option for him to see a cardiologist and have an EKG before receiving the drug. We opted for a big YES PLEASE. Better safe than sorry. I dropped him off around 9AM. A tech called me not long after to tell me that 1) his physical exam looked good and his heart sounded strong, 2) the lymph nodes in his neck, "knees," and abdomen had actually grown back up in size since his week 2 treatment. Also, his "inguinal" lymph nodes (I think in his abdomen/groin) were normal last week and swollen this week now. So I immediately freaked. Ultimately, he did not respond well to week #2's treatment. He had not seen the cardiologist yet but she wanted to call me with that news and they were soon after taking him in for his EKG.
I forgot to ask about the results of the B cell vs. T cell (T is less responsive to treatment) test that he received in week #1 so I called back and after a couple of hours called again and they paged the doctor. She confirmed that yes, he did in fact have B cell - which is good in terms of responding to treatment; but also those particular lymph nodes I mentioned had increased in size somewhat again, and new ones were swollen. When I was on the phone with her he was in getting his EKG.
So a short time later the phone rings again and its the oncologist AGAIN. I knew it was an "OH SHIT" moment. Although his physical exams revealed nothing they could hear, his EKG revealed both a murmur and an arythmia?!?!?! WTF. Murmurs are rated 1-6 and his is a level 2 in his aortic valve. They also identified some abnormal beats so he does in fact have an arythmia. Between the oncologist and cardiologist, however, they believed he was strong enough and his heart muscles were contracting well enough to proceed with his doxy treatment (and his white cell count revealed also that he was OK for treatment). There is another drug that is similar that they could administer but it doesn't have the same potent effects - and since they were both comfortable with it, and knowing his lymph nodes had increased in size again and new ones were swollen, I said YES to moving forward with it. They were drawing blood as a 'biomarker' (called a baseline troponin I value) to evaluate his cardiac function. There is a count in that blood value that can better identify his heart's condition vs. an EKG so they will have that as a baseline along with the EKG for tests and treatments moving forward. The tropinin I is a type of protein that can elevate after cardiac damage or degeneration, suggesting cardiac disease. His levels yesterday were normal but they will continue to monitor those values to evaluate his heart condition throughout treatment.
Next week I will bring him in for bloodwork and a physical only, and he has a week off from treatment.
From there, in week #5 he starts bi-weekly chemo - one week he will receive a combination of drugs from the 1st and 2nd weeks; then doxy which is administered alone. Each time he goes in he will get his usual physical and blood counts done, but before each doxy treatment they will do this different 'biomarker' blood test to evaluate his heart and see if he's stable enough to receive the doxy that week.
I am so worried. He is a strong dog and he is a fighter like his Mama but I am just devastated and am afraid this is a set back after such great progress in week #1. I am trying really hard to take it one day at a time. It is so difficult to be home without him here - I am NEVER home when he is not here and I can't stand it.
There is a clinical study going on but he would have to be hospitalized for 6 straight days and have regular biopsies of his lymph nodes. I talked to the doctor about it briefly but it sounds like WAY too much for him OR us to handle being away that long, and too stressful for him. We are not going to pursue this option. I asked the vet to send us home with some information on it, but based on what she told me on the phone I am not even going to read it - it is just not an option to have him gone for 6 days going through constant testing and stress.
It melted my heart when Chris went to pick up Hurley and as soon as he walked in the back door Bentley yelled "HI, BUDDY!!!!!" He was so happy. Hurl slept in bed with us most of the night and seems a bit tired so far today, understandably so...
I don't know how I'm going to make it through the next 6 days of unknowns, until next Thursday's testing...
~E
No comments:
Post a Comment