Hi everybody! It has been a while since our last post, and some of you have asked for an update on how Sasha is doing. Well, I am happy to let you all know that, as I am writing this post, Sasha is chillin’ on her Big Shrimpy dog bed. And I say that quite literally; Sasha is stretched out on the bed, and we have a fan blowing directly on her. Cooler weather is on the way, but for now, Sasha needs fans to keep cool!
In our last post about Sasha, we wrote that she was feeling great, and we included a video of her playing with her ‘frisbee’. Since then, Sasha has gone through some ups and downs. She remained happy, healthy and active for a couple weeks after that post, but then there was a little incident.
Sasha started to show lameness in her arm. It seemed to start one day after she got down from our bed. We recently purchased a new mattress. We decided to do without a frame or a box spring so that it would be low for Sasha’s benefit. We also have two dog beds at the foot end of our bed that we keep partly under our mattress so that they are stable and do not move so as to make getting down easier for Sasha. Unfortunately, Sasha decided to get down onto another dog bed that we have next to our bed (Yes, we have many dog beds). That particular bed was not secured under our mattress, and it slid out as Sasha stepped onto it.
At first, we didn’t connect that incident with her new lameness. In fact, we thought that she was experiencing pain in her left leg. I suppose we automatically assumed the worst when we saw her stumbling around, and thought that the pain was coming from her leg or hip, where she has tumors. I’m sure that if she still had both arms, it would have been obvious what was going on, but with only one arm and a leg with cancer, we were fooled. I don’t remember exactly what Sasha did that finally made it clear that her arm is where the pain was. If I supported her front end, she would plant both rear feet firmly on the ground and support her rear without a problem. If I removed support from her front end, she would collapse.
Unfortunately, Sasha is now clearly showing that she is feeling pain in her rear. I babied her as much as I could once I realized that her arm was hurting her. I carried her everywhere, and used her Ruffwear harness to help her do her business outside. I figured that the cause of the pain that she was feeling in her arm was due to an injury from getting down off of our bed, and so by helping her to not use her arm, it might heal. The good news is that her arm is feeling much better. She is able to walk around now on her own, unassisted. There is more to tell about Sasha’s arm, and her health in general, but I will save that for another post.
– A couple days have passed since I wrote the above part of this post and the part below –
Sasha came home from NC State today. She had a bone scan performed on Tuesday, and she needed to spend the night at the hospital until she was no longer radioactive! I’ll write another post soon to update you all on her status. Thank you to all who read this blog. We appreciate the comments, e-mails and all the well wishes. Liliana and I pass on all of your love and caring to Sasha.
This past Saturday, Sasha woke up very happy and very spunky. She was being very vocal, and was acting super excited to go outside. After she had been outside for a few minutes, I asked her if she wanted her ‘frisbee’ (Kong Flying disk). Since her re-diagnosis, we have not been playing with her in ways that cause her to run for fear that her bones might fracture. That concern was still with us on Saturday, but Sasha’s enthusiasm won us over. We could not tell her, no.
I called the other dogs inside so as to prevent potential collisions in all the excitement. Argus got to stay out because three-legged Sasha is faster than he is and can maneuver more quickly than him, too. Check out this video…
Sasha continues to surprise and amaze us. I believe that one day, thanks to Dr. Mason, Sasha and the other dogs in the Mason Bone Cancer Study, lives will be improved.
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!
Sasha with Dr. Mason, her favorite vet.
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!
It is amazing. May 26th marked 3 months since we learned that Sasha had cancer, again. The day of the re-diagnosis, Dr. N apologized profusely because he was going to be out of town for the next few days, and going by what he saw on Sasha’s X-rays, he did not believe she would make it through the week.
The news was devastating. Our hearts were heavy, and many tears were shed in our home over the next few days. We could not believe that Sasha was going to be fighting cancer again. This was not supposed to happen!
Today, we feel very lucky that she is still with us, happy and full of life. There were a couple of weeks in March when we thought her time was up, but thank goodness we figured out what was going on (reaction to medication), because since then, Sasha’s light came back and she continues to be her spunky self 🙂
On Wednesday May 22nd, she received Palliative Radiation (posts on our experience with VSH Cary coming soon), and on Friday, May 25th, she received another dose of the vaccine (read about it here).
After everything this girl has gone through, she remains as happy as ever, and her spirit is unbroken. Sasha is a trooper and I am so proud of her.
Sasha went to North Carolina State’s veterinary school on Thursday (04/04/13) for her second round of palliative radiation, and her first round of Pamidronate. The last time I wrote about Sasha, I explained that her condition had quickly deteriorated, and we were hours from saying goodbye to her – forever. In an effort to dull her pain and make her more comfortable, we increased the dosage of Tramadol that we were giving her. She got worse. The pain was too great for the medications that we had on hand, and so our answer to this (supported by two veterinarians) was to increase the amount of Tramadol that we were giving Sasha. We didn’t know it at the time, but Sasha was not suffering from pain so much as she was experiencing extreme dysphoria from the Tramadol, and it only got worse as we increased the dosage. This mistake of ours almost cost Sasha her life.
After realizing that there was a correlation between when we gave Sasha her Tramadol, and when her suffering was at its worst (30 minutes after Tramadol, Sasha’s eyes were popping out of her head), we immediately reduced the dosage. Sasha improved dramatically over the course of the first day, and continued to get better the following day. It was at this time that we knew we needed to find an alternative method of managing Sasha’s pain.
Liliana and I spoke to Dr. Mason from the School of Veterinary Medicine at the University of Pennsylvania the day after we found out that Sasha’s cancer had come back. We talked about some of the options that were available to help Sasha cope with the pain that was sure to come. We had a similar conversation, more recently, with Dr. Hauck from the North Carolina State veterinary school. Both Dr. Mason and Dr. Hauck offered identical advice. They suggested to continue giving Sasha her oral pain medications (Carprofen, Gabapentin and Tramadol), and also explained the benefits of palliative radiation and Pamidronate. Unfortunately, it took us longer than it probably should have, but Liliana and I decided to go ahead with palliative radiation treatments as well as Pamidronate infusions.
The results thus far have been very good. Sasha is mostly back to her old self. She has enjoyed several outings where she excitedly tugged at her leash because Liliana and I were not walking fast enough for her liking. We have also taken her swimming at Lap it Up in Durham. When we first walked into the pool area, we waited with great anticipation, but also a certain amount apprehension and fear, to see if Sasha would get in the pool. She did! She swam the entire time we were there, and she did not want to leave when our time was up. We were so happy and proud of our girl!
If you look closely, you can see the blue target painted on Sasha’s shaven butt for her radiation treatment.
The best part is that the radiation and Pamidronate have not had time to take their full effect. Sasha will probably experience even more relief in the coming days and weeks! Liliana and I are fully aware that the cancer is back, and we are under no illusion that the long-term prognosis for Sasha is not good. That is why we are happy beyond words that Sasha is able to, not only stay with us for longer, but also enjoy herself. She currently has a very good quality of life, and she finds joy in all of the things in life that have always made her happy.
Laser focused and waiting for mom to throw her favorite toy in the pool.
When Sasha came home from her visit to NC State Friday of last week, she was clearly uncomfortable and in pain. During a previous visit to the vet school, Dr. Hauck had suggested that we increase the amount of Tramadol that we were giving Sasha in an effort to better manage her pain. At that time, we did not feel that increasing Sasha’s dosage of Tramadol was necessary, but after this last visit, we decided to give it a try. We started giving Sasha two Tramadol Pills with each meal, and then increased the dosage again to three pills. Sasha’s discomfort seemed to be getting worse and quickly. Carlos and I were so scared because Sasha’s health seemed to be deteriorating, and we feared that we were going to need to say goodbye to Sasha soon. We did everything that we could to comfort our girl, but nothing seemed to work. When things were really bad, Carlos called a 24hr emergency vet and asked if we could give Sasha four pills every six hours. The veterinarian told us, given Sasha’s condition and prognosis, “give your baby anything she needs to be comfortable”. This advice was echoed by another veterinarian that we had been in contact with. Giving so much Tramadol to a dog would usually never be recommended, but since Sasha’s condition was terminal, and the end seemed to be very near, there really wasn’t any concern about the damage that the Tramadol might cause. We understood that possible adverse side effects of Tramadol, especially at high dosages, but we agreed with the advice that we were given, and gave Sasha the four pills every six hours.
When even this extremely high dosage of Tramadol was ineffective at helping Sasha, we knew it was time. Carlos called a mobile vet who provided in-home services, including euthanasia, in case Dr. Neuenschwander would not be available to come to our home when Sasha was ready. I took the day off from work to spend as much time with my baby as I could before saying goodbye to her.
Just as we were coming to terms with the inevitable, Carlos told me that he had an idea. He wanted to talk to me about an idea that he had that he felt might help Sasha, but there was some risk involved. His idea was to stop giving Sasha Tramadol altogether. The obvious risk was that Sasha would possibly be in severe pain as the last dosage of Tramadol wore off, but Carlos had noticed something. Almost like clockwork, Sasha seemed to feel the worst about 30-45 minutes after giving her Tramadol. It suddenly seemed clear that the Tamadol was the culprit in Sasha’s recent and ever worse suffering. Also, once he made that connection, Carlos also realized that Sasha’s suffering seemed more like anxiety and extreme restlessness rather than the effects of pain. After taking a high dose of Tramadol, Sasha would become very agitated and unable to find a comfortable position. She didn’t seem able to stay in one position for more than thirty seconds at a time. Her eyes were opened so wide that it seemed they would pop out of her head. We were mistaking this dysphoria as pain. It came on so quickly and seemed so bad that we were about to put Sasha ‘out of her misery’.
Sasha is doing much better now that we have decreased the amount of Tramadol we are giving her. No more dysphoria mistaken for pain, and no more tears being shed in our home for now. It looks like Sasha will be sticking around for a while. Now we need to figure out the best dosage of Tramadol for Sasha, and the best frequency to administer it. We are also inquiring about alternative pain meds that may not affect Sasha in the same way as Tramadol. Needless to say, Carlos and I are happy beyond words that we will have Sasha in our lives for more time.
Today marks one year since the amputation of Sasha’s right arm. Dr. Neuenschwander delivered the bad news of Sasha’s osteosarcoma diagnosis to Liliana and me on March 6, 2012, and eight days later, on March 14, Dr. Clary removed Sasha’s arm, up to and including her scapula. We brought her home on the 15th and spent the next few days by her side. I had read stories of other dogs that had limb amputations, and was hoping that, like many of those dogs, Sasha would not suffer terribly from the experience. Unfortunately for us, and much more so for Sasha, she did suffer quite badly during the first few days after returning home. I’ll never forget the confused eyes or the heartrending whimpering that was so uncharacteristic of my Sasha. I will also never forget that it was in my arms that Sasha seemed to find some assuagement from her suffering.
Sasha, day before the surgery
Sasha, day before surgery with mommy
Sasha with daddy, day after surgery
Happily, Sasha recovered quickly and was able to return to doing the things that she loved. I always like to tell the story of how Sasha was able to run and catch her Kong flying disk just three weeks after her surgery. She also enjoyed getting back into the water. She is the best swimmer in the house, even if with just three legs!
We do not celebrate the one year anniversary of Sasha’s amputation. It is, after all, not something that we ever imagined happening to our girl, and it is certainly not something that we wanted for her. Sasha’s one year ampuversary does, however, help us remember that she is beating the odds. Osteosarcoma is a terrible disease. Many dogs do not live more than two months after diagnosis, and the vast majority do not make it past the nine month mark. Sasha is still with us, and we are so grateful for the time that we have with her. Sasha, you go girl!!
The phone rang at 1:48pm on February 26. It was Dr. Neuenschwander from Brentwood Animal Hospital. I had dropped Sasha off earlier in the day for a radiographic examination of her left leg and pelvic region. She had been in some pain that was causing her to avoid putting weight on her left leg. When we arrived at the veterinary office, Sasha was using her left leg primarily as a means of balancing herself. Her leg would tremble when she stood still, but that was attributed to being a product of the leg not bearing any weight. Liliana was no longer satisfied with the explanation that arthritis was the likely cause of Sasha’s symptoms, and that is why Sasha went in for X-rays, and that is what lead to our hopes being dashed and our fears being realized. The cancer had returned.
Dr. Neuenschwander explained that Sasha had tumors on her left femur and the left side of her pelvis. I couldn’t believe what I was hearing. I fully expected to hear that Sasha’s joints were deteriorating due to arthritis, but the thought of cancer returning to her body was not news that I was prepared to hear. The dog that I took to the vet’s office that morning was a happy, healthy animal with a sore leg. She was not a dog with cancer-riddled bones. Sasha was beating the odds! The cancer had been cut from her body, and any remnants were destroyed by chemotherapy treatments. Her immune system was trained via vaccine to seek out and destroy any rogue malignant cells that dared to take hold in her beautiful body. The cancer was not supposed to come back. Sasha was supposed to win the battle and the war!
Many tears were shed on the day that we found out the bad news. I think the pain that Liliana and I felt on that day was worse than what we felt when we learned of Sasha’s first diagnosis. The good news is that Sasha has no idea what is going on and she must have been thinking that her Mom and Dad were going loco with all the emotion going on.
Sasha has always been a stoic dog in the face of adversity, discomfort, and even pain. She represents her breed well as she embodies all the qualities of a good American bulldog. She stubbornly pursues tail-wagging fun, and avoids, just as stubbornly, things and activities that do not please her. Sasha is not one to lie down before the trials and tribulations of life, and so Liliana and I will try to be as tough as she is and help her continue her war against osteosarcoma.
Dr. Mason had already received the news about Sasha from Dr. Neuenschwander when Liliana and I called her the day after Sasha’s X-rays. We spoke with her on speaker-phone for forty-five minutes. Have I mentioned before that we love Dr. Mason? Well, we do. Anyway, part of what we talked about was, ‘what’s next for Sasha?’ We talked about several options, but the conversation centered mostly on Palladia. Palladia is an anti-cancer drug that works by blocking the signaling of several growth receptors and inhibits the growth of new blood vessels in tumors. A clinical trial using Palladia and Cyclophosphamide was running concurrently with the L. Monocytogenes vaccine trial at UPenn. The trial closed recently, so results are lacking, but hopes are high, and following its use in 2009 to treat dogs with a variety of cancers, evidence suggests that Palladia extended the lives of dogs with OSA longer than if they had only been treated with chemotherapy.
I called Dr. Hauck from NC State Veterinary Hospital the next day to see about getting Sasha started on Palladia. Dr. Hauck agreed that Palladia was a possible option for Sasha and asked to see her the next day for blood work and a urinalysis. Palladia has many possible side effects, some serious, and Dr. Hauck wanted to ensure that Sasha was healthy enough to begin the new treatment. When the lab was finished with Sasha’s blood and urine, the results were called, “beautiful”. Once again, Sasha had good blood and good pee. Sasha began taking Palladia that same day. She is to be given a 75mg dose once each Monday, Wednesday and Friday for two weeks to see how she tolerates the drug. If all goes well, more Palladia will be prescribed along with Cyclophosphamide. I’m happy to write that after three doses, Sasha appears to be 100% side-effect free! I’m sure that some side effects take longer to manifest, but I say this is a good start!
We will try to do a better job at keeping everyone up to date on how Sasha is doing. I’m sorry that the posts on Lili’s Notes have been few and far between. Liliana has been extremely busy in her new job, and I – well, I’ll just say that life can be difficult sometimes. I’m sure you’ve all heard the phrase, “when it rains, it pours”. I just wasn’t prepared for the buckets that have been crashing down on my and Liliana’s heads lately. Anyway, I’ll try harder to do a better job here. In the meantime, check out Sasha swimming at Lap it Up in Durham the day after we found out that the cancer had returned: