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!

Jul 302012
 

We’re back in Philly, well, Parkesburg, PA for the night, but Philadelphia tomorrow for Sasha’s second treatment in the Mason Bone Cancer Study at the University of Pennsylvania.  We drove up to Pennsylvania from Raleigh, NC today, and we are spending the night at my parent’s home.  We’ll head to UPenn tomorrow at about 7AM in hopes of getting there at 9AM to meet with Dr. Mason.

Sasha has been doing well; full of life and spunk.  She did great the last time she was in Dr. Mason’s care, and I expect everything to go well this time, too.  Dr. Mason is excited to see Sasha, and, apparently, so are some of the other staff at the UPenn Vet School.  It seems that Sasha has earned a bit of a celebrity status at the school.

Liliana and I are planning to visit the University of Pennsylvania Museum of Archaeology and Anthropology tomorrow after dropping Sasha off with Dr. Mason, but I’ll be sure to write an update on how our visit at UPenn goes, and I’ll also introduce you all to a beautiful dog named Dolly.  Dolly is scheduled to be the third dog to participate in the Mason Bone Cancer Study.

Jul 222012
 

About a week has passed since we returned to Raleigh from Philadelphia, where Sasha received her first treatment in the Mason Bone Cancer Study.  She is doing extremely well!  Take a look at this video:

We took Sasha to our local vet on Wednesday to have blood drawn and sent to Dr. Mason at UPenn.  During her stay in Philadelphia, Sasha’s liver enzymes rose to above normal levels.  Click here to read about Sasha’s first treatment at UPenn.  Dr. Mason was not too concerned about the elevated enzymes, as this reaction to the vaccine was reasonably expected.

Christina, a wonderful veterinary technician at Brentwood Animal Hospital, our local vet’s office, was tasked with drawing Sasha’s blood.  She is a bit of a phlebotomy hotshot with a knack for finding good veins quickly.  Unfortunately, this time Christina did have some difficulty guiding a syringe into Sasha’s vein.  She switched from Sasha’s leg to her arm and quickly found her mark.  Sasha was ready to leave after being poked, and Christina had all the blood she needed to send to Dr. Mason.

Sasha’s blood arrived at UPenn the next day.  Tests were run, and Dr. Mason let us know that all of Sasha’s numbers looked good.  Her red and white blood cells were normal, as were her platelets, and her liver enzymes were falling nicely, too.  Dr. Mason even sent us a graph where she plotted Sasha’s liver enzyme values so that we could see the downward trend, visually.

Liver Enzymes Graph, Mason Bone Cancer Study

Dr. Mason explained that the probable cause for Christina’s difficulty in finding a good vein to draw blood from in Sasha was that she may have been dehydrated.  She said that the sample of blood showed that her proteins were within normal parameters but at the top end of normal.  She also said that Sasha’s sodium level was a little high.  High blood proteins and high sodium levels are indicators of possible dehydration.  Another possibility is that sometimes the vessels where chemotherapy drugs are administered can become damaged, and are difficult to draw blood from.

Dr. Mason told us that the article on the study in the Philadelphia Inquirer brought several more dogs forward, and her team is currently screening their tumors for the Her2/neu expression.  There are currently 7 recruits and 3 or 4 being screened.  We hope these dogs make it into the study, and that they all do as well as Sasha has done so far!  Good luck to all!

Jul 152012
 

History was made on July, 10, 2012, when Sasha underwent her first round of treatment in the Mason Bone Cancer Study at the University of Pennsylvania School Of Veterinary Medicine.  The study takes a novel approach to fighting cancer using a recombinant L. monocytogenes vaccine to, hopefully,   cause anti-tumor activity of the body’s immune system.  Liliana and I drove to Pennsylvania with Sasha, Argus and Alli (the Three Musketeers) on Monday.  We are lucky that my parents still live in PA, so we had a place to lay our heads for the duration of Sasha’s stay at UPenn.

We met with Dr. Nicola Mason Tuesday morning.  I cannot say enough good things about Dr. Mason.  Entering Sasha into the first phase of a clinical trial was not an easy decision to make.  Allowing her to be exposed (intravenously) to Listeria monocytogenes bacterium and leaving her in the care of people that we do not know at a large University did not make the decision any easier, but Dr. Mason put our worries to rest and our minds at ease.  Whenever Liliana and I speak with Dr. Mason, we always feel that she genuinely cares about Sasha, and she makes a great effort to ensure that we understand everything that will happen during the trial.  She also called us several times each day while Sasha was in her care to give us updates about how our girl was doing.  We feel very fortunate to have been able to enroll Sasha in this innovative approach to treating bone cancer in dogs, humans, and other animals.

Administration of the Listeria monocytogenes vaccine began at about 2:00 PM on Tuesday and lasted approximately one hour.  The first sign of evidence that Sasha had been exposed to the ‘bug’ came a few hours later.  She developed a mild-to-moderate fever which peaked at 103.8 (normal temperature for dogs is 101.5) at around midnight.  The fever was easily kept under control with IV liquids and a fan blowing on Sasha.  The fever was a good sign, as it indicated that Sasha’s immune system recognized the Listeria, and was actively fighting it.

The idea behind the Mason Bone Cancer Study is to train Sasha’s immune system to find and attack cancer cells.   Normal cells divide by a process called mitosis.  Mitosis occurs at a regular rate, and each cell produces two identical daughter cells.  Cancer cells are essentially bad copies of parent cells.  The DNA of the parent cell is not replicated perfectly during mitosis, and mutant cells are born.  These mutant cells do not behave normally.  They do not die when they are supposed to – a process genetically hardwired into each normal cell called apoptosis.  Instead, cancer cells multiply, often at accelerated rates, and can form tumors.  Note: not all tumors are cancerous, and not all cancer cells form tumors, i.e. leukemia.  Unfortunately, the mutant cancer cells are not so different from normal cells that the body’s immune system recognizes them as a threat.

The Listeria bug used in the Mason Bone Cancer Study has been genetically modified to express a protein called, Her2/neu.  Sasha’s cancer cells also produce this same protein.  By injecting the Listeria into Sasha, the hope is to elicit an immune response.  Since the listeria used expresses the Her2/neu protein, Sasha’s immune system will become programmed to recognize the protein as a dangerous invader and attack it.  The hope is that her immune system will now also recognize any cancer cells in her body as dangerous invaders and attack them, as well.

The day after Sasha’s vaccination, bloodwork showed that she was mildly anemic and that her platelet count was lower than normal.  These counts returned to normal the following day.  Dr. Mason explained that the likely cause for the low platelet count was the vaccination caused her platelets to adhere to the lining of her blood vessels, thus removing them from the bloodstream, and causing the low reading from the collected blood.  The temporary low count of Sasha’s red blood cells (anemia) was probably due to her blood being diluted as a result of the intravenous fluids she received to keep her temperature in check the prior day.

More bloodwork was performed on July 12th.  The results showed that Sasha’s liver enzymes were on the rise.  Her elevated liver enzymes, ALT (Alanine transaminase) and AST (Aspartate transaminase), are likely elevated due to inflammation caused by the vaccine.  Similar findings were documented in human patients that received a comparable Listeria vaccination.  Dr. Mason told us that Sasha’s elevated liver enzymes were not something to be alarmed about but that they should be monitored.  She asked that we schedule an appointment with Sasha’s regular veterinarian, Dr. Neuenschwander, to do follow up bloodwork on Wednesday or Thursday of this week.

Dr. Mason said that Sasha was a trooper throughout her whole stay at UPenn, and took all of the poking and prodding in stride and without complaint.  The only sign that Sasha may have been feeling under the weather is that she did not seem to have much of an appetite.  Dr. Mason made several attempts to get Sasha to eat, including hand feeding her, but Sasha was not interested until she was presented with some yummy canned food.  Again, our gratitude to Dr. Mason for taking such good care of Sasha.

We are back home in Raleigh, NC now, and Sasha is doing great.  She is still being a little picky with her food; however, we believe that her appetite is fine.  Sasha is a smart girl, and she learned quickly that by turning her nose up to her regular kibble, she would be offered something tastier.   She retrieved her Kong flying disc several times this morning and was as fast as ever!  We hope to take her swimming sometime before the return trip to Philadelphia.

Thanks to everyone for reading about Sasha’s battle against cancer, and Dr. Mason’s innovative work.  Thanks to Dr. Mason and her team at UPenn School of Veterinary Medicine.  Thanks to my parents for providing me and  Liliana with food to eat and a place to sleep.  Thanks to Greg Goldberg (basically my brother-in-law) for staying at our home in Raleigh and taking care of our other dogs while we were away.

I will continue to chronicle Sasha’s progress here on Lili’s Notes.  Please come back to see how she’s doing!

PS.  I’m famous!  Check out this article about me and the Mason Bone Cancer Study in the Philadelphia Inquirer.

Sasha Update

 Posted by
Jun 202012
 

Several weeks have passed since I last posted here about my dog, Sasha.  My husband and I brought Sasha to our local veterinarian on March 6 because she was showing lameness in her right arm.  X-Rays revealed that Sasha had a growth on her humerus bone.  Our veterinarian explained to us that the growth  was a tumor and was the result of osteosarcoma.  Osteosarcoma is the most common and aggressive type of bone cancer seen in dogs.  The tumors usually occur in the limbs of large breed dogs.  The prognosis was not good.  We had three options (with slight variations of each) of how to proceed.  The first would be to do nothing.  Sasha would be in extreme pain for the rest of her time with us, and would likely not live beyond two months.  The second option would be to amputate her arm, which would provide her relief (after recovering from the surgery) from the pain caused by the osteosarcoma.  The positive thing about moving forward with the amputation, besides pain relief, would be that Sasha would be with us for longer.  The median survival time for dogs with osteosarcoma after limb amputation and no further treatment, is six months.  The reason for this is that once an osteosarcoma tumor has been found, the chances that the cancer has already metastasized to another part of the body – usually the lungs – are extremely high.  The third option would be to have the limb amputated, and then follow up with chemotherapy treatments.  Taking this option meant that we might have Sasha, pain free and happy, for 6 months to a year, or possibly longer if we are lucky.  We decided to go with option three.

Since we learned of Sasha’s diagnosis, we have been researching osteosarcoma, reading about experiences of others with dogs diagnosed with osteosarcoma, and exploring additional and alternative treatments that might help our beloved dog.  On May 8th, via the Facebook page, Chase Away K9 Cancer, I learned about a new vaccine available for bone cancer.  Since then, my husband and I have been looking into enrolling Sasha in the clinical trial in which the vaccine will be used for the very first time with dogs.

We spoke with Dr Mason, the doctor who is heading the trial, and a superbly nice person, and she explained to us that the patients would be injected with listeria bacteria.  It would be a very low-potency (for lack of better word) listeria bacteria, but the idea is that the listeria would hone in on a certain gene marker in Sasha’s tumors, and then her body’s natural defenses would attack the bacteria, and by association, the tumors.  It is a novel approach to treating osteosarcoma in dogs, but it has been used in mice and in humans with some remarkable success.

In order for Sasha to enroll for the trial, she would need to meet certain criteria:

  • She needed to be diagnosed with osteosarcoma, and the tumor site had to be one of her limbs.
  • Her affected limb had to be amputated
  • She needed to undergo four treatments of chemotherapy with carboplatin
  • She needed to have the her2/neu gene

Sasha met, or would soon meet, three of the criteria necessary to qualify her as a potential patient in the clinical trial.  The only thing that we needed to find out was whether Sasha’s tumor expressed the her2neu gene.  To find this out, we needed to contact the lab where Sasha’s tissue block had been sent off to for analysis.  Dr Mason had told me that for the sample to be viable, it needed to not have been decalcified.  I was so happy to hear that the lab still had her tissue block after over a month, but I was dismayed to learn that it had been decalcified.  Because of my high hopes for the clinical trial, I was very upset to hear that the tissue sample was no longer viable.  I sent Dr Mason an e-mail informing her of the bad news.  I was surprised when she responded, and said that she would be happy to test the sample, even though it had been decalcified, to see if she could determine if Sasha’s tumor sample expressed the her2/neu gene.

A few days later I received and e-mail from Dr Mason.  She explained that tests had been performed by multiple people, and they were all confident that Sasha’s tumor did, in fact, express the her2neu gene.  This was such happy news for us, as we felt very positive about the Mason bone cancer clinical trial.

It is now, June, 19, and Sasha completed her final carboplatin treatment on the Monday June 11.  We will need to take her to our local veterinarian’s office on the June 25th and again on July 2nd, to have blood drawn to make sure that her immune system is strong and ready for the listeria injection.  If all goes well, we expect to drive up to Philadelphia the second or third week of July.  Sasha will need to remain at the University of Pennsylvania, School of Veterinary Medicine, for three days.  There, she will be constantly monitored by Dr Mason and her team to ensure that everything goes well.  Dr Mason explained that she expects Sasha to feel flu-like symptoms and have an elevated temperature – similar to what people experienced who underwent this same treatment.  Her temperature should be back to normal levels by about the twelve hour mark after administration of listeria.

Thank you for reading this update on my dog, Sasha.  She is doing very well now; full of life and spunk!  Sasha still enjoys going to parks and running after her favorite toy, a red Kong frisbee.   She also loves to go swimming, and does just as well as she ever did in the water – no life vest required.

I will post again to keep you all abreast of Sasha’s progress.

Wish her luck!

 

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