Sasha Goes Back to UPenn

Liliana and I left Raleigh at around 10 PM on Thursday (May 24) and drove through the night with Sasha, Argus and Shelby to my parent’s home in Parkesburg, PA.  We were able to get in a couple hours of sleep before getting Sasha back in the Jeep, and heading to Philly to meet Dr. Mason at UPenn.  Traffic on the Schuylkill expressway was a bear, and it caused us to arrive at the hospital late.

After having the friendly people at the reception desk notify Dr. Mason of our arrival, Liliana, Sasha and I made our way to the seating area to wait for Sasha’s favorite doctor and friend.  It had been four months since our last time at UPenn, and I wondered how Sasha would be.  I wondered if she would be nervous and tremble with fear, as she does when visiting other veterinary hospitals.  I wondered how she would react to seeing Dr. Mason after so much time.  And I wondered if she would give a struggle to leave us behind when it came time for her to go off with the doctor.  I always worry that things will have changed since her last visit to PA, and Sasha might react in the same way that she does at other places.  Well, things have not changed!  Sasha was not trembling in the waiting area of UPenn, and she was ecstatic to see her special friend, Dr. Mason!  We have cellphone video to prove it!

Sasha’s return visit to UPenn is not part of the standard protocol for the Mason Bone Cancer Study.  Some evidence exists that suggests administering the genetically modified Listeria vaccine a couple days after palliative radiation may enhance the effects of the vaccine and cause strong anti-tumor activity from Sasha’s immune system.  Dr. Mason made us aware of this finding, and we all decided to give it a go with Sasha.

Sasha was the very first dog to receive the vaccine when the trial started, and she was given the lowest dose.  This time, Dr. Mason administered the highest dose to Sasha.  We weren’t 100% sure what to expect, but we assumed Sasha would react similarly to how she did last year.  IV fluids would be administered to keep her temperature down, and anti-emetics would help reduce nausea.  If the higher dose proved to be too much for Sasha, Dr. Mason would be able to keep things under control with antibiotics, but of course, that would defeat the purpose of what we were trying to achieve. 

Prior to receiving the vaccine, Sasha had blood drawn for a complete blood count, blood chemistry, and a coagulation panel.  The blood work showed that Sasha was very mildly anemic and her lymphocyte count was slightly lower than normal.  All other blood parameters were within normal limits.  Sasha also underwent a cardiac evaluation to ensure that her heart was healthy enough to proceed with the vaccination.  An electrocardiogram was performed to monitor Sasha’s heart for arrhythmias and a complete echocardiogram was performed to evaluate her heart’s ability to contract. The ECG showed that Sasha has a mild degeneration of her mitral, aortic and pulmonary valves.  These findings are associated with aging, and have nothing to do with the cancer, and they existed since the last time Sasha was at UPenn; there have been no appreciable changes since her last visit.  Dr. Mason explained that Sasha’s left ventricle was very mildly enlarged compared to her last evaluation but there was no associated changes that would suggest she has cardiac disease secondary to vaccination. None of the issues found with Sasha’s heart were considered significant enough to prevent her from being vaccinated. 

Thoracic radiographs were taken, and there was no evidence of metastasis to Sasha’s lungs.  A single radiograph was also taken of Sasha’s left femur and pelvis.  While the metastatic bone lesions at both sites were clear to see, there was no evidence that the disease had progressed since Sasha’s last radiographs that were taken by Dr. Neuenschwander at The Brentwood Animal Hospital. 

Dr. Mason gave Sasha an anti-emetic to prevent nausea, and then administered the vaccine at a little past 1:00PM on Friday.  Within a couple hours, Sasha had developed a fever.  Her temperature continued to rise until it peaked at 104.1 six hours post injection. Sasha vomited twice in quick succession while her temperature was at its highest.  Dr. Mason administered fluids via IV, and Sasha’s temperature began to fall.  It was back to within normal limits several hours later.  She also gave Sasha another anti-emetic for her upset stomach, and turned on a fan to help her be more comfortable.  Dr. Mason said that no other adverse events were noted during or after the infusion period, except that Sasha seemed lethargic and a little depressed. 

For the two days after Sasha received the vaccination, Dr. Mason wrote on Sasha’s discharge papers,

“On May 25th, Sasha seemed a little brighter. She ate canned dog food readily twice in the morning.  Repeat blood work was drawn to determine whether vaccination had caused any changes in her red and white blood cell count or changes in her blood biochemistry. The blood work showed that Sasha’s anemia was now more pronounced (PCR 25%) and she was moderately thrombocytopenic (low platelets). Her white blood cell count was unchanged. Her blood chemistry was normal. Sasha showed no clinical signs associated with these blood changes.”

We went back on Sunday for more blood work.  Dr. Mason wrote:

“On May 26th repeat blood work showed that Sasha’s red blood cell count was recovering (PCV 33%) and that her platelets were also coming back up to normal – although still below the normal range (87,000).  These changes were seen last time Sasha received her vaccines although this time, with the higher dose of vaccine, they were more marked. Repeat evaluation of Sasha’s blood chemistry on May 26th showed that Sasha’s liver enzymes were all within normal limits.”

We said our goodbyes to Dr. Mason and took a few photos of Sasha with her good friend.  The trip to PA from NC wasn’t an easy one for us, but we were happy to make it so that Sasha could receive the vaccine again.  We were also excited to see Dr. Mason again, and we know that Sasha was super happy about that, too.  Honestly, bringing Sasha to see Dr. Mason, treatment or no treatment, was worth the trip and any issues and minor hardships that it might cause.  I’m sure Sasha agrees, but she could probably do without all the poking and prodding!

A big thank you to Dr. Mason and to everyone else who helps care for Sasha during her stays at UPenn!  We will continue to take Sasha swimming, and exploring new places.  Check back for updates on Sasha’s progress and to see more photos of her enjoying life!