Nov 262012
 

Monday, November 19, Sasha went in for her first bi-monthly post vaccine follow up at NC State Vet School.   Carlos and I were anxious to hear the results of Dr. Hauck’s evaluation of Sasha.  The last time Sasha was at NC State, radiographs of her chest revealed a nodule that was of some concern to us.  Dr. Hauck, the radiologists at NC State, and Dr. Mason at UPenn felt fairly confident that the white cloud that appeared in the radiograph a month ago did not represent metastatic disease.  The experts’ opinions helped put our minds at ease, but we were hoping for clear lungs this time round.

Sasha’s lungs are clear!

We got the news that we wanted.  Sasha’s lungs were clear!  There was no sign of metastasis!  Not even a single questionable cloud or mysterious nodule.  Dr. Hauck told us that Sasha checked out great, and that she appeared to be very happy and healthy.  Is Sasha an example of one of the very few dogs that might not have developed metastasis after amputation and chemotherapy, or do we have the Advaxis vaccine to thank for her continued good health?  I suspect we’ll never know the answer to that question.  The longer Sasha is healthy, and in fact lives, the more likely that the vaccine had a role to play in her extended time with us.  To be honest, there is a part of me that only cares about having Sasha with us for as long as possible regardless of the reason.  There is another part of me, however, that realizes the enormous significance of a vaccine that is effective at fighting osteosarcoma in dogs – and hopefully in people too.  Either way, Liliana and I were happy to receive the good news from Dr. Hauck.

Nov 012012
 

Sasha went back to NC State on October 15th for some follow-up radiographs, a month earlier than normally scheduled.  The reason for the early return to NC State was that another shadow appeared in the radiographs taken of her lungs back on September 18th.

We dropped Sasha off with Dr. Hauck in the morning, and would have to wait until 5pm for the results of her new radiographs.  We were a little anxious about what we would find out, of course, but we also were feeling positive.  Sasha had been acting completely normal; she was active and happy.  We even started taking her swimming at an indoor facility just for dogs.  Sasha loves swimming so much; she must have been a seal in a past life!

Liliana stopped by the house after work and picked me up so that we could pick up Sasha together.  It didn’t take long for Dr. Hauck to meet us in the waiting room area and bring us into an examination room.  She explained to Liliana and I that, once again, the blemish that appeared in last month’s radiographs of Sasha’s chest had disappeared.  Unfortunately, also like last time, a new white cloud was now visible.

Dr. Hauck explained that we should not be alarmed at the new finding.  It was very small, and like last time, no determination could be made as to what the cloud actually was.  In fact, it was her and the radiologist’s opinion that the new cloud was likely nothing more than the intersection of one of Sasha’s ribs, along with a vein and some other internal body.  Dr. Hauck showed the new radiographs to Liliana and me, and though we aren’t experts at reading radiographs, the intersection theory seemed like a fairly obvious conclusion.

So, we left NC State feeling good about Sasha’s current condition, and planed on carrying on as we had been doing.  Sasha would continue to go swimming at least once per week, her diet would stay the same (Orijen), and hugs, kisses, rubs, pats, and “good girls” would continue to be handed out liberally.  Sasha approves of this course of action!

Sasha is scheduled to go back to NC State on the 19th of November.  We will write again – hopefully in a timelier manner – about her checkup, and let everyone know how she is doing.  We would really like to travel to Philadelphia for Sasha’s January checkup.  I know Sasha would love to see Dr. Mason, and Liliana and I would enjoy the visit also.

Sep 182012
 

It was an overcast day.  The clouds were low and gray.  A few rays of sunlight found their way through the water-saturated air.  The light was the sort that makes photographers get excited.  The green trees, purple flowers and sandy ornamental grass seemed to glow with a vibrant saturation.  We expected Sasha to tremble in anticipation of the approaching storm, but she never did.  She wasn’t always scared of thunder, but something changed in her, and now the rumbles make her crumble.

We had planned on going back to Philadelphia for Sasha’s three week follow up on September,18, but Liliana just started a new job, and if we traveled to UPenn, she’d have to miss  at least one day of work.  Instead, we decided to take Sasha to the veterinary school at North Carolina State University which is about a 10 minute drive from our house.

Sasha was in good spirits when we arrived at the Oncology building of NC State Veterinary School.  Her good mood would not last long, though, for as soon as we walked up to the front desk, she began to shake.  Her demeanor here was very similar to how she is when we go to our local vet’s office, but a stark difference from how she is at UPenn.  I guess we will never understand what it is about UPenn that sits so well with Sasha.

Sasha, waiting at the lobby of NC State Vet School Oncology

After checking in, we sat down to wait for Dr. Hauck.  The waiting area is nice with comfortable seating, magazines for reading, Photo boards of surgical procedures that were performed at NC State, and photographs of cancer survivors.  There were also volunteer greeters working the area, and one of them came over to meet Sasha.  She sat down to speak with us for a while and also to give Sasha some attention.  She was very nice, and I think having her come over actually helped Sasha.  Usually when people come over to speak with us at vet’s offices or hospitals, those people poke Sasha with needles, stick foreign objects in her butt, or take her away from her mom and dad.  This lady was different, and Sasha appreciated that!

When Dr. Hauck came out into the waiting area, she quickly scanned the area with her eyes and locked onto us when she saw Sasha.  She came over, introduced herself and then sat down and spoke with us for a while about our girl.  Dr. Hauck is a very nice person, and we quickly felt comfortable with her taking care of Sasha.  After a few minutes, she led us into one of the examination rooms.  While there, she talked to us about what was going to happen with Sasha that day.

After helping the doctor get a weight reading on Sasha, we said our goodbyes, and watched as Dr. Hauck led Sasha down a hallway, away from us.  Now it was onto our normal day, minus Sasha, and we would wait until 5pm when we could return to pick up ol’ three legs.

When we arrived back at NC State, Sasha was very happy to see her mom and dad.  She had clearly warmed up to Dr. Hauck, but she was ready to go home. Before we could leave, we needed to speak with the doctor about the results of Sasha’s examination.  Her blood work came back completely normal, and so did her urinalysis.  We were happy about her good blood and pee-pee, but we were anxious about something else.  If you recall, a small cloud appeared in the last radiographs taken at UPenn when Sasha was there for her third and final treatment with the Advaxis Listeria Monocytogenes vaccine.  Today we would find out if that cloud was still present in Sasha’s new X-rays.  We did a lot of finger crossing, hoping and wishing, so we were extremely happy to find out that the cloud was gone!   But, there was something else.

The cloud that appeared in the last radiographs taken at UPenn disappeared, but there was now a new cloud in another area of Sasha’s chest.  Obviously, our hearts sank when we learned of the new cloud, but Dr. Hauck explained that we shouldn’t be alarmed.  The new spot was very similar to the first one.  It was small, and they were not able to determine what it was.  It might have even been an artifact in the radiograph.  On the other hand, the spot could, in fact, be cancer.  This sounds like a terrible thing, but Dr. Hauck gave us another way of looking at things.  If the first cloud (from the radiographs taken at UPenn) was cancer, but now is no longer visible, then perhaps the vaccine is doing exactly what it was developed to do.  Sasha returns to NC State on 10/15 to have more radiographs taken of her chest.  We will be waiting with abated breath for the results of the new radiographs.

Aug 282012
 

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.

Argus, Sasha and Alli on our way to Pennsylvania.

Sleeping the miles away to Pennsylvania.

Sasha resting before receiving her 3rd and last vaccine.

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!

Tuesday 8/21 at Penn Vet. Sasha waiting for 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.

Argus and Sasha sleeping on our way back to Raleigh.

Alli bored and tired on the long ride home.

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.

Aug 162012
 

We took Sasha to our local vet on August 8, to have some blood drawn as per Dr. Mason’s request.  We took the same precautionary step a week after Sasha’s first visit to UPenn.  The vaccine (ADXS-HER2) causes an elevation of liver enzymes and also affects some other values that are of concern.  The blood sample arrived at UPenn on the 9th, and Dr. Mason informed us of the results on August 12.

Sasha’s red and white blood cells and platelets were all normal.  Her liver values were slightly elevated: ALT (180; normal=16-91), AST (87; normal=23-65), ALKP was normal.  Though these values are slightly high, they are far from being a cause for concern, and they are below where they were one week after the first treatment.  Dr. Mason is happy with the results of Sasha’s bloodwork, and so then, so are we.

Sasha goes back to UPenn for her third and final treatment the week of August 20.  We’ll keep everyone updated on how things go for our girl.  Wish her well!

Aug 062012
 

It’s a lazy Sunday (delayed post) here at the Ruano Ranch.  Our ride back to Raleigh from PA was mostly uneventful other than some heavy traffic between D.C. and Richmond, VA.  It’s a good thing I replaced the radiator cooling fan on the Jeep before we left for PA on Monday; things would have gotten a little steamy in all that stop-and-go.

  

Sasha did very well during her second treatment in the Mason Bone Cancer Study at The School of Veterinary Medicine at the University of Pennsylvania.  Shortly after arriving, a very nice gentleman named Alex (student/intern??) escorted us back to one of the examination rooms.  He gave Sasha a quick once over, and then went to get Dr. Mason.  When Dr. Mason walked into the room, it was like a reunion of old friends between her and Sasha.  Well, I guess that’s exactly what it was.  People say that dogs cannot be fooled with false expression of feelings – that they see past affectation and discern the truth behind the smile.  I believe this to be true, and that is how I know that Dr. Mason is as good a person as I think she is – Sasha tells me so.

Sasha reacted differently to the L. Monocytogenes vaccine the second time round.  She developed a fever during her first treatment, and we expected to see the same thing happen this time, but Sasha’s temperature stayed at normal levels for her entire stay at UPenn.  This was a little disappointing since a fever is a sure sign that Sasha’s immune system is reacting to the Listeria bacteria.  Dr. Mason explained to Liliana and me, however, that lack of a fever is not necessarily a sign of lack of efficacy of the vaccine.  Instead of developing a fever this time, Sasha became nauseous and vomited.  Although no one enjoys seeing Sasha suffer, her nausea was good evidence that the vaccine did have an effect.

Prior to administration of the vaccine, Dr. Mason had blood drawn from Sasha to evaluate her red and white blood cell counts, and her liver and kidney function values along with electrolytes and blood proteins.  Sasha’s blood work came back normal.  All of her numbers looked good, including her liver values which were of some concern after her first visit to UPenn.  Listeria is primarily sequestered in the liver and to a lesser extent, in the spleen.  It causes damage to the liver (reparable) and causes liver enzymes to rise.  We will be taking Sasha to our local veterinarian for bloodwork  on Wednesday to make sure that everything still looks good.  In the meantime, we will be giving Sasha Denosyl (prescribed by Dr. Mason) for her liver.  Denosyl contains Glutathione, a powerful antioxidant, which aids in liver detoxification by making toxins more soluble so that they can more easily be excreted from the body.

Sasha is relaxing beside me on her bed as I write this update.  She will go for a walk later, or maybe play with her Kong flying disk in the back yard.  Sometime during the next two weeks, we are planning on taking her swimming at a pond in Youngsville, NC.  It’s pretty cool because people can rent the entire pond by the half hour, and the cost is reasonable.  Swimming is one of Sasha’s favorite activities, so I have a feeling that we will be visiting the pond on a regular basis.

Thanks for reading about Sasha’s progress in the Mason Bone Cancer Study.  Be sure to come back for more updates on her and the other dogs in the study!

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