Rolling Dog Farm Blog

Along with Aurora and Widget, I took Sunny to Peak in Burlington yesterday for an overall evaluation. For one thing, we wanted the surgeon there, Dr. Kurt Schulz, to look at Sunny's deformed front leg and help us decide what, if anything, to do about it. That's Kurt in the photo above with Sunny.  

We joke that Sunny's name should have been "Stormy" or "Cloudy With A Chance Of Showers," but Sunny was the name he arrived with, and his disposition has actually improved a lot since then. I was a bit concerned how he would do at the clinic, but he did fine. He was very shy and uncomfortable being handled, but he was a brave little guy about it. 

After examining the leg and watching Sunny walk down the hall and back, Kurt recommended holding off on removing the leg until we got more weight off Sunny. He is a plump character, and though he's been on a strict diet since he came, he still has quite a bit to lose. So we're going to wait a month and see how he does. We don't want to remove the leg if his overweight condition puts too much strain on his remaining legs.

And now that the snow is melting and bare ground is finally showing up once more, we're curious to see how well Sunny gets around on grass, and whether he will develop any sores on that foot once he becomes more active. At the moment he doesn't have any sores. It's not a real foot, of course, as the photos in this blog post show. Kurt explained which bones Sunny was missing in the foot, and how that affected his use of that limb.

There is a possibility we might just leave the limb alone, but watching him lurch as he walks really makes us think he would be a lot more comfortable without it. 

Our internal medicine specialist, Dr. Marielle Goossens, did a physical exam and took blood for a range of lab tests. Here she is with Sunny:

Marielle also had the radiologist do an abdominal ultrasound, which showed all of Sunny's organs looked good. The blood panels should be back today or tomorrow.

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Aurora is doing fine. No more pain episodes, which is great news. Marielle sent blood and urine samples out to various labs yesterday to find out to what extent Aurora's regimen of medications are reducing her risk of clotting. We should get those results coming back in over the next week.

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Yesterday Widget had her first round of chemotherapy under the third, and final, protocol we are going to try. We should know by next week whether this protocol is working. Alayne and I are on pins and needles at this point. If this protocol fails, then we are essentially out of options and can only let time, and cancer, run their course.

I didn't take any photos yesterday when I was at Peak in Burlington, so I thought I'd just go ahead and post this cute shot I took the other morning of Wilbur and Aurora in the living room. In a round-up of medical news from yesterday's trip, let's start with the good news:

— Darla's blind left eye had a pressure of 10, which means the fluids are no longer building up, the procedure worked, and her eye is now comfortable. Yay! I will post more on this particular procedure after some more time has gone by, but for right now I can say we are very glad we did the gentamicin injection.

Well, that was the good news. 

— On ultrasound,the clot in Aurora's leg has actually gotten larger, and it looks like a second, smaller clot has formed downstream of it. Fortunately, she is not painful now, which means that her body has compensated for the blockage by re-routing blood flow around it using different vessels. Unfortunately, it means that she is still too prone to clotting and her current medications are not sufficient. So our internal medicine specialist, Dr. Marielle Goossens, has added heparin to Aurora's protocol. We are now giving this to her three times a day via subQ (under the skin) injections. We will recheck her clotting factors next week.

And in the worst news…

— Widget's lymphoma has failed to respond to the first line "rescue" chemo drug called CCNU. Our next and perhaps last option is a different protocol called MOPP that we will begin next week. (Here's an interesting, brief paper on "Rescue Therapy for Canine Lymphoma.")  At this point — because she came out of remission so quickly, because returning to the original protocol did not work, and because she did not respond to the CCNU — the chances of it working in Widget are only about 50%, our oncologist told me yesterday. Thus the prognosis is not good. But we are not ready to throw in the towel.

Widget is still feeing too good, and she is so energetic and happy and active, that we don't want to concede defeat without at least one more try. If she were feeling poorly, and acting like she felt sick, we certainly wouldn't take this step. But no one could watch her march around the house, tail up and bobbing, wooing as she went, and think she could be weeks away from death. 

The other complicating factor for her, besides her heart disease, is a recurring urinary bug that is now resistant to multiple antibiotics. Initially the pathology lab found it would respond to a single, rarely used antibiotic called chloramphenicol, which we needed to give her using surgical gloves. She's been on that for months. Two weeks ago another urine culture showed that chloramphenicol is not working any longer, so our oncologist switched Widget to another drug. Oddly, Widget shows no symptoms of urinary  or bladder problems, but if this bug gets out of control — easy to do in a body whose immune system is suppressed by chemotherapy — she could have a systemic crisis. 

So … continuing with chemo raises the risk for that, but giving up now on chemo brings death that much sooner. 

That's where we are. You can see why I thought a cute photo at the top of this post might help.

She may be blind in one eye now, and she may have had surgery on a knee to remove a tumor just two weeks ago, but Miss Darla is determined to show those two whippersnappers — Travis and Tanner — that she is still the Queen and this is her Palace. Entrance by invitation only.

After Alayne and I had brought in the dogs from their mid-day romp on Friday after lunch, we realized we were missing three dogs. Alayne looked out the storm door and saw Darla in the front yard, so she opened the door and called her. Darla ignored her. That's when Alayne noticed Travis frozen in place down by the spruce tree, and she realized Darla was in guard mode again. Alayne told me I'd need to call Darla in, so I went out and called to her. She turned her head slightly as if to acknowledge she heard me, but then stood her ground. I went to get the camera, then went back outside.

Travis saw me, figured it was a good time to advance towards the house, took several steps … and stopped. Darla was giving him the evil eye. She slowly walked a few steps towards him, head down, body language all about "don't mess with me, kid." That's what you see in the photo above. (Click on photos for larger images.)

Travis looked at me again, this time as if I was the lifeguard on the beach and he was the swimmer in trouble, but then decided I might not rescue him in time. Darla's few steps in his direction unnerved him. Just like a herding dog with sheep, Darla turned him and he reversed course:

That's when Tanner, who had been on the other side of the yard, thought he might get by the old gal. He started making his way over, as you can see above. Then the two-on-one stand-off resumed:

At that point I'd been calling Darla back to the house repeatedly, so Tanner decided to try the single-file technique and see if meekly following Darla back to the house might work. Darla reluctantly … finally! … turned around to walk towards the ramp, but she wasn't happy about being called off. She'd move forward a bit, then stop and turn her head in the whippersnappers' direction as if to remind them who's the boss. This would stop them in their tracks:

But having to listen to me and come inside drove her crazy — "I had them just where I wanted them!" — and even after she got to the ramp, she turned back around and stared them down one more time:

With one final summons from me, she turned once more and triumphantly dashed to the ramp and into the house. The boys, sheepishly (there's the word again) if happily followed.

Once inside, it's like nothing ever happened.

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A quick note on the Puppy Mill Survivors' photobook sale:  As luck would have it, the website that processes orders for Melissa McDaniel's photobooks stopped accepting credit card payments just as my blog post went up last Wednesday. For some reason it defaulted to only accepting PayPal. So if you tried to purchase a book and couldn't, Melissa says the website issue has been fixed.

 https://photobooks.myshopify.com

 

The photographer Melissa McDaniel emailed me this week to say she only has a couple hundred copies of her Puppy Mill Survivors book left, and she wanted to do another special discount sale for Rolling Dog Farm supporters.  

You may remember when I first posted this back in December that this stunning photo book includes two of our blind dogs, the beautiful Poodle sisters Molly and Priscilla, who we adopted out a few years ago.

Since the book came out, two dog magazines have featured it, and guess whose photos they chose to accompany their stories about the book?  Yes, each magazine independently selected one of the two Poodle girls!  Here's Bark magazine … Priscilla is second down on the right:

And here's Modern Dog with Molly:

You go, girls!

Back to the sale: 

I took Aurora, Darla and Widget back to Peak in Burlington last week. Our internist, Dr. Marielle Goossens, wanted the radiologist, Dr. Lynn Walker, to ultrasound Aurora's leg again to see what that clot in her artery was doing. That's Dr. Walker doing the imaging in the photo while vet tech Melissa holds Aurora. 

Dr. Walker graciously took quite a bit of time to show me what she found and explain to me what we were looking at on the monitor. Knowing I was going to post this on the blog, she also helpfully labeled the image for us:

(Click on photo for larger image.)

Unfortunately, the clot is larger and longer than it was a week earlier. That's because as it creates a dam in the artery, the blood flow slows down as it hits the clot and starts becoming turbulent; as it backs up and the rate of flow decreases, some of the blood begins clotting and adhering to the original clot. 

In the meantime, Marielle had also received the results of the tests she had run on Aurora, particularly the critical one checking her antithrombin value. As the Cornell lab report on Aurora's antithrombin value noted, "Antithrombin is the major naturally occurring inhibitor of blood coagulation." If you are deficient in it, you're at elevated risk of clotting. The normal range is 65-145%, and Aurora is at 49%.  

As it turns out, the underlying cause of Aurora's antithrombin deficiency is kidney disease. 

So … she is now on additional medications for clotting and for kidney disease. We'll also be transitioning her over to a special kidney diet.

Over the past several days, the pain Aurora was experiencing from the clot has subsided, and though she sometimes walks with a limp in that rear leg, overall she seems to be doing much better. Alayne is taking her to our local clinic this afternoon for some blood work to check her kidney values.

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In more depressing news, last week our oncologist, Dr. Kendra Knapik, determined that Widget is not responding to the vinblastine/Cytoxan protocol that we had resumed after she came out of remission. That is not what we wanted to hear, of course. Kendra started her on the first line "rescue" chemo drug called CCNU (Lomustine), which Widget has tolerated very well. Right now we are just keeping our fingers crossed.

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And also last week … Darla underwent the surgery on her mast cell tumor and the procedure on her now blind left eye. Instead of enucleating (removing) the eye, this time we elected to do an injection of gentamicin, which kills the cells that create the internal fluid that can no longer drain out adequately (thus causing glaucoma and then blindness). We have done this once before, more than a decade ago on a blind horse. Our view has been that if an eye is blind and chronically painful, it's better to get rid of the "hardware" once and for all. That way you avoid any future potential eye problems — trauma, corneal ulcers, entropian, etc.

After some lengthy and helpful discussions with our ophthalmologist, Dr. Sarah Hoy, on the pros and cons of each method, we chose the gentamicin procedure this time. In large part because Darla was already going to have surgery on her leg to remove the tumor, we thought it would be easier for her to not have an eye removed at the same time. And on a human emotional level, I wasn't ready to see her missing an eye yet. 

Sarah did her procedure first, and then our surgeon, Dr. Kurt Schulz, performed the leg surgery. Everything went well, and I was able to bring Darla and the other two girls home at the end of a very long day.

Here's Darla and Aurora the next morning:

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Yes, that's little one-eyed Aurora undergoing a CT scan on her neck last week at Peak in Burlington. We have a mystery here. As a result, this post might end up being the length of a mystery novel. Sorry!

Several weeks ago Aurora developed some neck pain, and responded quickly to prednisone. Once we tapered her off the pred, she remained pain free and became her normal self. But the week before last, she started yiking again and holding her head like her neck was painful. Pred initially helped, but we went ahead and scheduled her for a complete examination at Peak for last Tuesday. Clearly something was not right with her neck. It had been a year since she first came and had an ultrasound and echocardiogram, so she was due for a recheck anyway. 

Last weekend she became very painful — just crying out when moving — so I contacted our internal medicine specialist, Dr. Marielle Goossens, to find out what kind of pain medication we could start her on until we got her to the clinic. (Being on pred eliminates many choices, and one you can use while on pred — tramadol — Aurora can't tolerate.) We put her on buprenorphine, which really helped. 

On Tuesday, we began with Marielle doing her initial exam, followed by blood work and other tests:

Much to my total consternation, Aurora exhibited no pain whatsoever! That's a real obstacle, of course, because that makes it even more difficult to figure out where the problem is.

Here's the surgeon, Dr. Kurt Schulz, doing his physical exam and trying to pinpoint the source of her pain:

Kurt's vet tech Anthi is holding Aurora, while I'm looking through the camera lens in disbelief that no matter how Kurt moved her head or neck or other limbs, Aurora didn't yike at all! We had worried that the buprenorphine might mask the symptoms, but never to this degree.

This meant we really needed a CT scan to get an image of her neck for a detailed look. This is done under anesthesia, so first we needed her heart rechecked by the cardiologist at Peak, Dr. Don Brown:

On the left is vet tech Liz and on the right is the other doctor in the cardiology practice, Dr. Jenny Garber.

So this is where things got weird. Don discovered a growth of some sort flapping around in the mitral valve. It was attached to the valve wall with very thin fibers, and it floated around, buffeted by the blood flow. It was so large and recognizable that I could easily see it. He wasn't sure if this was tissue — an abnormally formed part of the valve wall she was born with, an oddly shaped blood clot somehow attached to the wall (but how?), or "vegetative" matter, the result of infection somewhere. 

Don turned to me at one point during the echo, pointed to that object in her mitral valve, and said, "Here's your worst case scenario. That thing could break off and disappear into her blood stream. If it did, I'd expect it to end up in her hindquarters somewhere."

I asked him if it was possible to surgically remove it before that happened, and he said no. Basically, that would be open-heart surgery and just not feasible.

After the echo, the action moved to the CT scan, which is what you see in the photo at the top of this post.  I took that photo just after they had finished imaging Aurora, and here she is coming out of the machine:

The back of her neck and skull is shaved because she had a myelogram done to inject a contrast dye into her spinal column for the CT imaging. The dye makes the spinal structure and surrounding tissue visible on the scan.

I was with the radiologist, Dr. Mark Saunders, when he read out the images alongside Marielle. While there were areas in her neck where some compression was noticeable in a few vertebrae, it wasn't significant, couldn't really explain the pain she was exhibiting, and wasn't surgically "fixable" in any case. In other words: We had hit a wall. The only test we were waiting on was an analysis of her cerebral spinal fluids, but it was unlikely to tell us much at this rate.

I brought Aurora home that evening, along with Darla and Widget. Marielle had equipped me with extra pain meds for Aurora, and our goal was to keep her comfortable and continue to monitor her.

And Then…

All was well until Friday morning. Aurora was standing at the front door, waiting to come in, and had been barking to get our attention. I opened the storm door, she came in, started walking … and suddenly screamed. And screamed. 

I looked down and saw she wasn't using her right rear leg. She was holding it up, whimpering and crying. She hopped, shuffled, and cried out. Alayne came running to see what was happening.

We took her into the living room and set her on the floor.  She continued to walk as if her rear leg was paralyzed. She was agitated, constantly trying to rustle up bedding, then lay down, get up, rustle the bedding, try walking on three legs, cry out, and start all over again. I took some quick video on my phone and sent it to Marielle. 

When I saw Aurora not able to use her back leg, and seeing the pain she was in, my first thought was what Don Brown, the cardiologist, had warned us about:  that thing in her mitral valve could break off and wash down her bloodstream, blocking blood flow to one or both hind legs. 

I bent down to feel her foot. Sure enough, it was cold. My heart sank. Alayne and I looked at each other with one thought:  Blood clot.  (We've been through this before, except with cats, in whom it is much more common.)  I texted Marielle and told her I thought Aurora had just thrown a clot.

Marielle called shortly thereafter, and I was soon on the way back to Burlington. She had alerted the cardiologist and the other radiologist on duty, Dr. Lynn Walker, that I was coming back with Aurora for an emergency. 

As soon as I arrived, Dr. Brown came out, felt Aurora's leg, and said "very weak pulse," meaning blood flow had indeed been cut off. A few minutes on the echocardiogram we learned what had happened: That chunk in her mitral valve had broken off and disappeared into her bloodstream. Whatever it was, it was gone.

And a few minutes after that, in a room down the hall, Dr. Walker found it while doing an ultrasound on Aurora's leg. It had plugged up the femoral artery in her right leg. Blood was still getting around it a little, but the artery above the clot was much larger than normal because of the dam in the bloodstream created by the blockage. This was painful, but there wasn't much to do other than keep Aurora doped up on pain meds. 

By the time I had arrived at Peak the warmth had already started returning to Aurora's leg. Puzzled by this, I asked Marielle how that could be. She said that the body almost immediately begins to compensate for the blocked artery by shifting blood flow to other vessels; it takes time, and occurred in Aurora faster than you might expect, but that's what was going on. 

Marielle said Aurora's body would very quickly begin breaking down that substance — clot, tissue, or vegetative matter — by sending out macrophages to digest it and clean it out. The process might take a few weeks.

A lot more happened that day, and this post is already too long, but in a nutshell we are waiting on a new batch of test results, including a blood culture that could tell us if Aurora had a blood infection that could have created "vegetative" matter. She is now also on blood thinners. I am taking her back on Wednesday this week for more tests.

So now we are all wondering:  Was her original neck pain being caused by clots that were traveling to the other end of her body? We don't know at this point.

Please keep her in your thoughts. 

 

Darla's left eye going blind wasn't the only bad news last week. There was plenty. On Tuesday, I had taken Widget in for her post-chemo "re-staging" to see what the status of her lymphoma was. Since our oncologist, Dr. Kendra Knapik, had already determined Widget was in remission just a month ago, and since Widget just had her final chemotherapy treatment two weeks before, we weren't very concerned. She was her usual happy, active and bossy little self. The oncologist was out that day, so our internal medicine specialist, Dr. Marielle Goossens, did the tissue aspirates of her lymph nodes for pathology and supervised the rest of the tests performed by Kendra's team of vet techs.

On Wednesday afternoon, as that big snowstorm was roaring in, I was up at the hay barn feeding the goat bucks in their shed when Marielle called. She had just received the pathology report. Widget's lymphoma had returned. I was stunned. We had just finished the chemotherapy, Widget looked and acted like she was perfectly healthy, and we were expecting at least several months of smooth sailing ahead. It wasn't to be.

Kendra called later that night to review the findings and discuss our options. They ranged from putting Widget on a maintenance dose of prednisone, which might buy us weeks, to last-ditch "rescue" chemo drugs used in cases like this, to re-opening the original protocol and starting over.

What struck us as so strange is that Widget's remission had come in the wake of a steady treatment of the vinblastine/Cytoxan combination of drugs … but for the last several treatments, spanning about 6 weeks, she had been only on a single chemo drug called Mitoxantrone. I asked Kendra if it were possible that for whatever reason, the Mitoxantrone just wasn't as efffective in her as the vinblastine/Cytoxan combination. She said there was no way to know for sure, but it was possible. Clearly Widget had gone out of remission quite quickly, and the only thing that changed during that time was the drug.

We weren't about to give up. If you watched Widget march around the place, tail up, bossy as ever, you'd never know she had cancer. As I write this on Monday morning, I can hear her at the other end of the house in the dog room, wooing away, demanding one of us come down and offer her a snack of her choice.

We decided to re-open the protocol and resume the vinblastine/Cytoxan treatment. The goal will be to knock the lymphoma back into remission, and then see how she's doing.

Kendra wanted us to bring Widget in right away to start treatment again. That was a problem, with the worst of the snowstorm descending Wednesday night and Thursday. I had already plowed Wednesday to keep up with the snow, and Thursday morning I got on the tractor again to open the drive once more. Just before noon I bundled Widget into the front seat of the truck, put Darla in the back seat (more on that in a minute), set the truck in 4-wheel drive, and headed off to Burlington. It took well over three hours, including time to stop and assist briefly at a roll-over accident along the way, but eventually Widget, Darla and I made it to the clinic. 

While Widget was getting her vinblastine intravenously, I took Darla in to see our ophthalmologist, Dr. Sarah Hoy, again. I was still getting pressure spikes in her left eye in the morning, despite the additional glaucoma meds Darla was on. Sarah had hoped that after a few days Darla might regain a menace response, and thus vision, in that eye, but the pressure spikes I was registering before her morning eyedrops were troubling. It meant she was having significant spikes overnight.

Although her left eye looked much better than it did on Tuesday, it still didn't seem to have a menace response. Finally, Sarah taped a bandage over Darla's good right eye, put her on a leash, and walked out into the hallway with her. I could tell from how Darla was moving that she couldn't see. Her steps were tentative and her body language was fearful. My heart sank when I watched her walk into the wall. No, that left eye was blind and vision was not coming back.

Dang.

Now, instead of laser surgery to prevent glaucoma in that eye, we will be looking at removing that eye (enucleation) or doing an injection of Gentamicin, which "kills" the part of the eye that produces the fluid (called aqueous humor). It's the inability of the eye to adequately drain out this fluid that builds up the intraocular pressure, resulting in glaucoma and thus blindness. We haven't decided which option to take, but we'll make that decision by Wednesday, when we take her back to the clinic.

The (only) good news was that the three of us made it safely back to the farm Thursday evening. Widget has been getting her Cytoxan treatment here during the past few days (it's a pill we give her once a day). 

I think I hear Alayne heading back down the stairs to see what Widget wants now. Full-time concierge service, I suspect.