Sasha’s back home from The University of Pennsylvania’s School of Veterinary Medicine after her third and final administration of ADXS-HER2 vaccine in the Mason Bone Cancer Study.
Liliana and I drove up to my parent’s home in Parkesburg, PA from Raleigh, NC on Monday, August 20 (Liliana’s birthday). Many thanks to my mom and dad for helping us out with a place to stay and food to eat during our multiple stays in PA. My parents have also welcomed two of our other dogs, Argus and Alli, into their home each time that we’ve made this journey. The drive from our home in Raleigh to my parent’s home in Parkesburg takes about seven hours. It isn’t all that bad, but after making the trip several times in the span of a couple months, each landmark becomes a familiar reminder of how much further we still have to go before reaching our destination. It’s Ok, though, I travel with good company, and as long as I have coffee to drink and something to chew on occasionally, the trip is easily bearable.
We headed to Philadelphia at around 7:30AM on Tuesday to ensure that we would arrive at UPenn by our 9AM scheduled appointment with Dr. Mason. Anna, a fourth year student, greeted us and brought us back to an examination room. During Anna’s examination of Sasha, Dr. Mason arrived. She peeked into the room through the glass panel on the door. Sasha noticed the Dr. through the glass and perked up. I’ll never forget Sasha’s reaction to Dr. Mason entering the room. She jumped up and darted toward Dr. Mason. Her tail was wagging in a fashion reserved only for very special people. I’m sorry to go on, each time I write, about the Dr’s. and Sasha’s relationship, but I cannot get over how well they get along, and how much Sasha loves Dr. Mason!
Sasha’s clinical examination was unremarkable. She was bright and alert, her temperature was normal at 101.5⁰F, and her vital parameters were all within normal limits. Sasha does have a small lesion on her right foot, second digit, and a small area of dermatitis between the digits of the same foot. Dr. Mason had seen the lesion on her toe during her last visit. We all agree that the probable cause of this lesion is that the adjacent toe nail is splintered and rough, and rubs the other toe as Sasha walks and runs. The dermatitis is new, but of little concern.
Prior to administering the final dose of the vaccine, Sasha’s blood was drawn, and a chemistry screen was performed. Her white blood cells were just low of normal, but her red blood cells and platelets were within normal parameters. A repeat cardiac examination was performed using an echocardiogram and an EKG. The examination revealed no significant changes from previous visits.
On 8/21, administration of the listeria vaccine began at 12:20PM and lasted for 30 minutes. Within a few hours, the effect of the vaccine on Sasha was apparent. She appeared to be feeling ill and a bit depressed. At about 3:45PM, Sasha vomited, but her vital parameters remained within normal limits. Her temperature peaked at 102.6⁰F at about 5:00PM. This is not high enough to be considered a fever.
We all hoped, as perverse as it may seem, that Sasha would develop a fever as a result of receiving the vaccine. A fever is a sure indicator that her immune system recognizes the listeria as an unwanted intruder in her body, and mounts an attack against it. Such a response from her immune system would suggest that her body’s defenses might also recognize any cancer cells in her body as agents of nefarious character, since both the listeria in the vaccine, and the cancer cells that caused Sasha all her grief to begin with, both carry the HER2 genetic marker. Dr. Mason made it clear, however, that a fever is not unequivocal proof of efficacy; nor is lack of a fever proof of ineffectiveness.
8/22/12 – Sasha remained stable with her vital parameters within normal limits. She was not interested in her usual food that we feed her at home, but this has become normal for her while at UPenn. She seems to have figured out that by turning her nose up at her Wellness Core and Orijen food, she will be given something different (canned chicken and rice) by Dr. Mason. She seemed slightly depressed and lethargic prior to eating, but then perked up after her meal. Bloodwork on this day showed mild anemia and lower platelet count (from 278,000 to 109,000). Something I found funny: In Dr. Mason’s remarks about an orthopedic evaluation performed on Sasha, she noted, “She had no neurological deficits but resented her right foot being pinched”. It’s funny, because I think I might resent that too! Actually, the reason Dr. Mason made that comment is because Sasha showed a little extra sensitivity on her right foot, but that is likely explainable by the dermatitis that she had between her toes during this visit.
8/23/12 – Sasha’s hematocrit level was back to normal and her platelet count rose to 141,000 (still slightly below normal). Her serum biochemistry panel showed no elevations in liver enzymes.
During Sasha’s initial examination on Tuesday, we told Dr. Mason that Sasha seemed to be feeling a little lethargic. She needed a little extra coaxing to get up and go outside for bathroom breaks, and she just seemed, overall, a little less active than usual. This had been going on for about a week previous to our arrival in Philly. As a result of our observation of Sasha’s lack of energy, Dr. Mason decided to take some thoracic radiographs. They revealed a 6.5mm soft tissue opacity in her right cranial lobe. As you can imagine, Liliana’s and my heart stopped for a moment when we heard that news. Radiographs taken during our first trip to UPenn were clean. Dr. Mason explained to us that we should not be alarmed at the finding. It is unclear what is showing up in the radiographs, and it could be any number of things. More radiographs will be taken during her “re-stage” exam in three weeks, and we will have a better idea of what is going on. Till then, we will cross our fingers and hope that a fly landed on her chest and went unnoticed as the film was exposed, or something else equally innocuous!
As we were walking out of the hospital, Dr. Mason led the way, but when she turned right and we continued straight ahead for the exit doors, Sasha came to an abrupt stop. She looked at Dr. Mason as to say, “Aren’t you coming with us?” She would not budge an inch until Dr. Mason told her, “Go ahead, you can go home now.” Sasha knows the phrases, “go ahead” and “go home”. This was just another example of the closeness that Sasha feels to Dr. Mason. Sasha only behaves with Liliana and me, the way that she does with Dr. Mason.
Now that we are all back home, Liliana and I need to decide whether we will bring Sasha back to Philadelphia for her 3-week follow up, or if we will bring her to see Dr. Hauck at North Carolina State University. Sasha made her vote very clear; she wants to see Dr. Mason! Liliana is starting a new job (Congratulations!), though, and the trip to PA is wearing on all of us a little. Sasha will need to go in for bimonthly checkups after this first three week post treatment checkup, so we will definitely be going up North for many of those. We’ll let you know what we decide. Until then, thanks for reading, and be sure to come back. We’ll be posting more updates on Sasha and the other dogs enrolled in the trial.