Delilah went in for her chemo treatment yesterday, but didn’t receive it. The blood test that precedes treatment showed that her creatinine count was still high, and the vet was concerned that the treatment she’s been receiving has been further damaging her kidneys.
As you may recall, when Delilah first fell ill, she was hypercalcemic (high blood calcium level) which is why she wasn’t eating and had no energy. Sustained hypercalcemia can seriously damage kidneys, and it was believed that she had escaped the initial bout without excessive damage. After these results, the vet explained that high creatinine levels typically don’t show in blood until at least 75% failure of the kidneys!
Between the time I collected Delilah from the vet and when I received an urgent phone call to bring her back in for another blood test, an oncologist was conferred who suggested she may be hypercalcemic again and she was relapsing. This is not what I wanted to hear!
I know that her time is limited – another 2-4 months according to the initial prognosis. But she’s been doing so well lately that I started to deceive myself into believing that it was all a sick joke and that she was, in fact, going to pull through! This morbid reminder of her illness brought me tumbling back to reality – she’s going to get worse soon, and I won’t be able to make her better.
So the vet pulled more blood to send off for an ionised calcium test, and the urine sample I clumsily collected yielded encouraging results – it was more concentrated than earlier in the day. The vet suggested that the oncologist may be premature in their assessment, especially since Delilah seems so well. He told me to enjoy the weekend with Delilah, and not to worry.
After what was a horrific week a month ago – with two indoor (and countless outdoor) gastrointestinal debacles – Delilah’s been really well. We have resumed a pre-cancer regimen involving long walks and treks to the Heath. There was the off day or two after her last chemo treatment, but nothing unmanageable nor uncomfortable. It’s been as if she isn’t even ill!
A couple of weeks ago, we were walking through our local cemetery/park, Bunhill Fields, when we were stopped by a stereotypically British gent, dressed in tweeds, who seemed to take a shine to Delilah.
“Who is this lovely lady?” he queried.
“This is Delilah.”
“Oh she’s beautiful. May I pet her?”
He gently bent over and happily patted Delilah’s head.
“This is the first dog I’ve pet today.”
“I’ve always said, if I can’t pet a dog by midday, it’s not worth getting out of bed!”
Last Friday Delilah transitioned to the COP protocol. As I explained in a prior post, the COP protocol is less intensive and supposed to minimize the likelihood of side effects. This week she’s been suffering through some nasty side effects…
It all started on Monday. Through the weekend she was seemingly fine. She had a bit less energy than the preceding days, but that’s to be expected when a pup gets a double-dose of chemo, right? On Monday I went to work at 9a like normal, returned at 130p to feed and walk her, then back to work before coming home at 7p… When I walked in, there was an awful stench coming from my bedroom. “Oh, no,” I mumbled, “She didn’t.”
An immediate walk yielded 2 uncomfortable liqui-poos for Delilah. She was clearly distraught with what her body was doing, and seemed to fell embarrassed at her loss of control inside. I did my best to console her and let her know that it was okay and that I was not angry with her. I was impressed that she managed to keep herself relatively clean in spite of the mess she left me…
We came back home and she immediately crawled into her bed. I called the vet to explain what happened, and hoping to get some understanding of what was going on. He explained that it can take up to 7 days for the side effects of chemo to appear, and that all I can do is feed her a bland diet and make sure she is hydrated. He started to say that as long as she isn’t vomiting, there was no reason for me to bring her in. As if on cue, Delilah then started to vomit. While I was on the phone. Right after the vet was consoling me with “at least she isn’t vomiting.”
He then started telling me of neutropenia and requiring blood tests and money money money… I said that I would keep an eye on her for the night and if she didn’t improve by the morning, I would definitely bring her in. I also had some anti-nausea medicine on reserve for situations like these which I would use, and also increase her anti-diuretic dosage. He approved of the course and we hung up. And then she vomited even more!
I then turned my attention to cleaning up her vomit, and then attempting to clean my room. I realized I was out of cleaning supplies, and then Delilah dutifully told me that she needed to go out again. I grabbed the bottle of soapy water I keep near the door and we went for a walk yielding another liqui-poo and another vomit. Seeing as she had seemed to expel everything from her system, I thought it safe to enter the local shop and buy cleaning product. Fortunately, I was right!
She managed to keep the anti-nausea down without vomiting, and after a couple of hours she attempted to eat a little bit of food. It was encouraging. She napped while I cleaned my room, and we had a quiet evening of cuddles…
I worked from home on Tuesday so I could keep an eye on Delilah and she definitely improved throughout the day. It wasn’t until evening that she passed any solids – but it was solid! I felt fortunate that she seemed to be on the mend and that the new protocol may have caused some discomfort, but it was short-lived and manageable. I was encouraged.
I stayed home Wednesday because I felt quite ill. I had felt a cold lingering for quite some time, and all at once it seemed to attack. Delilah continued to improve and started showing signs of energy that I couldn’t keep up with! While all I wanted to do was sleep, I was happy that she was feeling better. By the time evening arrived, I too felt slightly better.
Thursday was a scheduled day off for me. My good friend, Jamie Allen, was coming to town and we were going to do something. Anything. It was a beautiful day so we actually spent a large part walking Delilah around the mean streets of London. He had his camera in tow and was kind enough to share the footage he shot of Delilah. I quickly edited the video below, and I post it to illustrate how well Delilah was feeling.
We went out for a few hours without Delilah in the evening, and upon returning I immediately recognized a familiar stench. “Oh, no,” I mumbled, “She didn’t.”
I quickly took Delilah out where she again produced the familiar liqui-poo. We walked a little further and she vomited. And then more liqui-poo. Passing under a street light I noticed that this time she hadn’t been able to keep herself clean…
After cleaning Delilah and my room, she needed to go out again. It was 1a and we were spent. I passed out on the sofa and at 330a, I awoke to find that Delilah was waiting for me at the front door. At 6a she stood at my bedroom door waiting for me to take her out. At 9a, I realized that I would not be able to go in to work – again – and that the COP protocol was not making good on the minimized risk of side effects promise!
I spoke with the vet who again mentioned neutropenia. He said if we didn’t want to come in, he could prescribe antibiotics as her immune system is most likely compromised and may have a GI infection causing all of this distress. I suggested that if she does not recover like earlier in the week, that we would come in tomorrow…
Delilah has spent most of today laying in her bed not sleeping. She just lays with her eyes open, occasionally sighing. I tried getting her to eat all day with little success. She did eat a little bit about an hour ago, which is encouraging. She even ate the bit with the antibiotic in it! But she is clearly not recovering as quickly as she had on Monday. It’s all a bit hard to cope with…
My hope is that this is just a temporary hiccup that will not repeat. We clearly need to revisit chemo options and consider spacing out the dosages rather than doubling up every 3 weeks. Delilah’s body simply does not respond favorably to the toxicity!
In the meantime, I’m just going to watch this video, reminding me of why we put up with the bad days…
I realize that these posts have not been the most pleasant to read; it’s quite easy to get swept up in the doom and gloom of protocols and prognoses and other similar unpleasantries. So while everything is going well, I thought I’d share some of the joyful moments.
Here are some recent pictures of Delilah having some fun.
A couple of posts ago, I detailed the differences between the available treatment protocols for Delilah; CHOP and COP. Since then, I received another bill which has basically made the difficult choice more straightforward – I cannot afford CHOP.
Initially, this pained me. The COP protocol effectively halves survival time. It felt like I was giving up, and letting money make all the wrong choices for me. But the costs and risks associated with the CHOP protocol make it far too expensive; financially and emotionally.
Basically, CHOP provides a longer life expectancy (10 months) with greater risk of side effects and the potential for compromised quality of life at a total cost of £10,000 ($15,000).
COP offers a shorter life expectancy (5 months) but with a lower risk of side effects and better quality of life at a cost of £2500 ($4000).
The chance of side effects is the clincher. As we’ve already experienced, negative reactions to chemo is incredibly difficult to manage. We can’t risk going through that again!
Remember that all of this is guesswork. Nobody can say with any certainty what Delilah’s quality of life will be or how likely the side effects are or really anything else! In the end, I’ve needed to make a decision.
I may be justifying a financial choice with abstract quality of life arguments that are impossible to make. But it makes me feel better.
I want to start by saying that the care Delilah has been receiving from her vets has been exceptional. They have cared for her as if she was their own and have gone beyond my expectations to support us through this difficult time.
Delilah is doing incredibly well. She is eating healthily, going for longer walks, playing with other dogs, and showing interest in everything around her. She has had several chemo treatments with each one causing her less distress. I even started to think that maybe her diagnosis was wrong and that she would make a full recovery!
With that said, I’m a little nonplused with recent developments.
There are 2 vets. One is the clinical director while the other was recently brought on to support a growing clientele. They don’t always see eye-to-eye, but they can always agree on what’s best for the animal they’re treating. They seem to have settled into two distinct roles; the compassionate caregiver and the realistic doctor. Both roles are appreciated and necessary, but they often provide diverging messages!
After starting chemotherapy, the realistic doctor left for a 2-week holiday. The compassionate caregiver was left to help me and Delilah through the variety of difficulties she initially went through. Drug after drug was prescribed to counteract the side effects, and fluid treatment was the norm for several days. She took up a daily position in the clinic and was pampered back to good health.
When the realistic doctor returned, Delilah was perceptively healthy and responding well to treatment. He said it wasn’t necessary to keep her in the clinic and that she needn’t be seen for a week. He also reduced the number of prescription drugs she was on, and suggested we only contact them if there were any problems with Delilah’s health. He then updated me on costs…
The compassionate caregiver had told me repeatedly that he was going to go through the previous invoices and identify places to reduce the £5000 ($7500) I owed them for diagnosis. Keep in mind I owe the specialist £1000 ($1500) for the bone marrow sample, so total cost of diagnosis was £6000 ($9000)!
I was quoted £400-1200 ($600-1800) per month for chemo costs, so imagine my surprise when the realistic doctor told me the chemo (and associated treatment) had already cost an additional £2500 ($4000)!!! For those of you that can’t be bothered to add, the grand total for diagnosis and 3 weeks of chemo is £8500 ($13,000)!!!
Let me say that again – £8500 ($13,000)!!!
Needless to say, this is not a sustainable course of action. I’ve been told that the exorbitant price for the past 2-3 weeks is primarily due to treating the ill-effects of chemo. I’ve also been told that I was not charged for hospitalisation nor nurse assistance, and half-charged for doctor care.
I am due an estimate for the next 3 months of chemotherapy, provided there are no more issues with side effects, later this week. I can then make the undesirable decision of how to proceed with care.
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Since Delilah started chemotherapy treatment, the only thing that I can say with confidence is that treating cancer is like magic. Something happens, you don’t know what, and to the untrained eye it seems incredible – but as you look behind the curtain you realize it’s all illusion.
Delilah is on a CHOP protocol. This involves a rotation of radiation treatments including cyclophosphamide, doxorubicin, vincristine, and prednisolone. The median survival time of dogs (with stage v lymphoma) undergoing CHOP is 10-12 months. I’m told that with Delilah, the prognosis is “much poorer” and to expect survival time to be a bit shorter than that.
If you’ve been following along you’ll remember how awful Delilah responded to treatment almost 2 weeks ago. This was after the doxorubicin treatment. It is considered to be the most toxic of drugs in the protocol, and works by inserting itself between DNA bases, damaging the DNA. Of the countless potential side effects, Delilah suffered through all of them! I expressed my concern with continuing on this aggressive protocol if she was going to suffer as much, and asked if there was something else we could try. The answer was COP.
The COP protocol is much like CHOP, but without the doxorubicin. The median survival time is about 6 months, but again Delilah’s prognosis is “much poorer” and translates to a mere 3-4 months…
The suggestion is to continue on with CHOP, but severely reducing the doxorubicin dose next time to see how she gets on. If she again goes through the torturous side effects, we will be forced to change to COP and accept the shortened life expectancy.
So she had the vrincristine on Tuesday and so far is doing very well. She’s still bright, interested and hungry. It’s so great to see her happily bound up/down the stairs and grabbing a toy to shake around. She’s a dog again!
I know that her days are numbered. This is the sad truth. My only hope (other than the Hand of God reaching down to rid her of this affliction) is that she has more good days than bad left, and that she stays comfortable without any suffering.
Saturday night not only saw a snowstorm in London, but it saw Delilah’s appetite, energy and interest return with a fury!
She was running & fetching like the old days. Her appetite was insatiable. She wanted to meet and play with other dogs and kids and anyone who would greet her!
It was amazing.
Catching a snowball!
She happily returned to the vet this morning. She spent the day with her new friends, and freely wandered around. I know she didn’t spend much time sleeping because she’s knackered right now! Her right leg has an abscess on it, which they cut open and drained. She’s taking it all in stride.
She’s due for a blood test tomorrow to see if she’s well enough to continue with chemo. On the one hand I hope she isn’t, because I fear how the chemo will make her feel. On the other, I hope she is, because that will mean her body is recovering!
I guess we’ll find out tomorrow either way! But for now, we’re just enjoying feeling well…
After all the promise of Delilah’s progress on Thursday, she took a turn for the worse after we returned home.
She was feeling so well that I had decided to walk her home (it’s about a mile). The vet encouraged this as a little bit of exercise can never do harm. Because she’s lost so much weight, they urged me to put a jacket on her – putting clothes on dogs is something I’m typically against, but it’s been so cold in London that I obliged.
As soon as we started on our walk home, she did a massive poo. This didn’t surprise me nor cause concern, as she had a healthy appetite that day and ate quite a bit (she had gained 2.5kg through the day!). The consistency wasn’t great, but it wasn’t cause for concern. Yet.
The walk was pleasant and she seemed to enjoy it. When we got home, she drank some water and ate a little more food. She laid down in her bed where I joined her for some much-deserved snuggling.
About 2 hours later, I smelled something foul and Delilah looked up from her slumber as if to accept blame for her gas. She looked at me, then toward the smell, at me again and then quickly sat up. She wanted to go out.
Immediately after we passed through the door, she went. The consistency was still better than earlier in the week, so I wasn’t terribly concerned, just a little…
We came back inside and she immediately returned to her bed and closed her eyes. I brought over water and she turned her nose at it. I again joined her on her bed, and whispered encouragement and approval while petting her.
About 2 hours later, the same thing happened; a smell, a look, and a rush through the door.
Throughout the night the same thing continued to happen every 2 hours. At 1a, 3a, 5a and 7a. A smell, a look, and a rush through the door. By 9a, we had returned to the vet where everyone immediately realized that it had not been a good night. Delilah was dehydrated and extremely tired. So was I! Frustrated, scared and concerned, I headed off to work.
At 1p I received a call from the vet. She had another 2 bouts with diarrhea and still refused to eat. They started her on antibiotics and she was on a drip and sleeping in a darkened room. When they were preparing her drip, Delilah disappeared! They found her in an office with the vet’s 3 dogs and she was laying between the 2 big ones, Condo & Zoe, hiding… She’s so clever!
At 5p I received another call from the vet. She had rejoined the dogs in the office and managed to eat some food. She seemed to feel a bit better and hadn’t had diarrhea since late morning. They spoke with the oncologist who agreed a break from chemo was warranted, and that she should have another blood test early next week to see how her white blood cell count is. They said I could bring her home if I wanted, provided I take her back in in the morning.
At 7p I arrived to collect her. When I walked in, Delilah saw me and she quickly sat up wagging her tail. It was such a relief to see her responsive. She had another poo at 6p that was much better, and she seemed a lot brighter. They wanted to keep the catheter in her left leg, because they were afraid that they wouldn’t be able to get it back in! Her right leg had started to bruise and swell so they didn’t want to take any chances. They wrapped it up so she wouldn’t be able to get to it (she loves pulling catheters out of her leg!) and I was given another bag of medicine to administer and we went went on our way…
She did well through the night. No diarrhea. She even ate some on her own. She did have an accident at midnight, but it was minor and inconsequential. We got up once at 4a to go for a quick walk – just in case – but she didn’t seem to need it. She ate a little more this morning, took her medicine, had a pleasant walk through the park and seemed to enjoy the taxi ride back to the vet.
Her favorite nurse answered the door at the vet and her little butt violently swayed back and forth straining to keep up with her tail! She burst inside and ran straight for “her” bed.
So from the high that was Thursday evening to the low that was Thursday night, Delilah’s state seems to swing wildly hour-by-hour. Everything is about maintaining an acceptable level of comfort for her and my assessment of that level is constantly changing. If you asked me 24 hours ago, I’d give a different response than I would right now. This is why it’s so difficult. She isn’t on a slide slowly getting worse, she’s on a roller coaster quickly speeding up and down and up and down. She isn’t all bad; there are moments where it seems like she can comfortably continue on for months. When she wants to play with her toys, and has an insatiable appetite and wants to investigate every corner of the park… But it’s the moments where it seems like she’s given up that confuse everything…
When I arrived to collect Delilah from the vet this evening, I was met by a happy and bouncing pup! She saw me approach the door, and as I walked in she sprinted toward me with a wagging tail and smile on her face. I’d almost forgotten what she looked like when happy, and I have to say… I missed it!
Her appetite picked up throughout the day, and had a few not-liquid poos. This is all good. She interacted more with the resident dogs, and regained her post as watchdog (every time the door buzzer rang, Delilah was the first to greet the visitor). She was alert and active all day – and even played with a ball!
It was a good day.
Now the bad. They took a blood test to determine whether she would be well enough to endure another round of chemo. Her white blood cell count is very low, as is red blood cell count & hemoglobin & several other counts. Her urea & creatine counts were high. This all adds up to being too unwell for continued treatment.
While the oncologist may have a different outlook (we find out in the morning), Delilah is going to take a break from chemo this week. She’s doing so well that another terrible week does not seem worth it right now. We can revisit treatment next week, giving her body time to rebound.
I don’t know what effect delaying treatment will have, but I’d prefer to give her a happy week than potentially subject her to the misery she’s just overcome.