2 Month Follow Up Appointment

Hudson had his two month follow up appointment today.  I was very optimistic going into this check-up, which as anyone who reads this blog knows, is not common for me.  I tend to be a "the glass is bone dry" kind of girl.  I feel that it better prepares me to deal with the worst, if it comes.

We did the normal stuff, a CBC (normal,) a renal profile (normal,) a urinalysis (normal,) and chest x-rays.  As you may recall, there were three metastatic nodules (tumors) in Hudson's lungs at the last check up.  The big guy (previously walnut sized) is completely gone!  Of the smaller two, one has decreased in size marginally, and the other remained the same.  Obviously, this is great news as it means that Hudson's cancer is reacting well to the chemo and he's got partial remission in his lungs.  He's doing great...

Until they checked the bump on Hudson's shoulder for me.  I had convinced myself that it was a cyst, mostly because I really really wanted it to be a cyst.  It's not a cyst.  It's a metastatic osteosarcoma tumor.

Hudson is already on metronomic low dose chemotherapy that has been working in his lungs.  He receives Cyclophosphamide (Cytoxan,) Doxycycline, and Carprofen daily.  We are going to now add a fourth drug, Kinavet, to the mix in an attempt to treat the new resistant cells that have formed the mass on his shoulder.  He will begin receiving 13 mg of Cyclophosphamide every other day alternating with the Kinavet (675 mg.)

Kinavet is a slightly more aggressive drug, and has a higher likelihood of side effects, which can include nausea, vomiting, a marked decrease in appetite, blood in the stool, low white blood cell counts, and rarely kidney and liver dysfunction.  Hudson will need to return to see Dr. Janson two weeks after starting Kinavet.  At that time, we will do a CBC and measure the shoulder mass to see if there has been any effect.  He will return another 2 weeks after that for the same.  If the Kinavet does not work by that point, it won't ever and we will need to review further options.

Just as a comparison point, a one month supply of Kinavet costs approximately $450.  A one month supply of Cyclophosphamide is approximately $45.  A two week supply of Doxycycline is $16, and a one month supply of Carprofen costs approximately $36.

Prior to the introduction of Kinavet, our monthly med bill for Hudson was $113.00.  With Kinavet, it will be $563.00.  Tony and I discussed it, and despite our tight finances, we are proceeding with Kinavet treatment.

E-mail Update from Tony

As promised, here is Hudson's checkup summary....
 
Dr. Janson said he looked great! She said his weight looks very good and he has dropped 6.6 pounds. He is at 117.2. His white blood cell count is good. As far as the chest xray, she said the 2 little (1cm) nodes from last time have remained the same size, and the bigger one has shrunk considerably. It is now smaller than a walnut. His urinalysis and renal profile looks good with no concerns there. His heart and lungs auscult normally. She said he should remain on the same medicinal regiment he has been on with no changes. Because he is looking so good, she doesn't need to see him for 2 months. She just said to continue monitoring his urine for any signs of straining, and/or blood. She said he is in a "stable state" which means there is no concern at this time.

To Hudson's Patiently Awaiting Public....He's Back...and he peed on me

Dr. Janson officially lifted the "public" ban on Monday at Hudson's most recent oncology appointment.  His white cell count came back at a healthy enough level that he can return to visiting the dog parks, going to BDHPI events and peeing on stuff (and subsequently laughing when I have to buy aforementioned urine soaked items) at Petsmart. 


Speaking of urine soaked items, we were required to capture and deliver a urine sample to Dr. J and team.  I joked ahead of time with my co-workers that I was bound to get peed on.  I had initially planned on fashioning a pee collection implement by taping the sample cup to a pole, but decided against it.  With my luck, as I removed the implement, I'd tip it and the sample would spill out.  Instead, I decided to brave the rapids and go in myself.


Monday afternoon, I arrived home from work and let Porter and Lexi outside.  Hudson had to hold it a little longer while I got my pee catching instruments prepared.  I removed the sample cup from its plastic bag and slid bright blue latex gloves onto my hands.  I let Hudson out the door and then ran in pursuit.  He went to pee on the fence and I dove underneath to capture it.  He reared around to observe me with a look on his face that clearly indicated his doubts about my sanity.  As his stream began to peter out (please pardon the pun), it became less precise.  He managed to hit my right forearm from wrist to elbow, missing ENTIRELY THE BLUE GLOVES.  Not a drop landed on the gloves.  I feel that this was likely on purpose.


My sacrifice was not wasted, however.  Despite the disgustingness dripping down my arm, I managed to seal the sample cup and get it to his vet, after copious scrubbing of my arm.  Hudson's urinalysis came back good and we are cleared to continue oral chemo at his present dosage.


In four weeks, on February 13th, we go back for another urinalysis, blood test, and chest xrays.  Since I'm me, I'll be stressing that for the entirety of the next few weeks.  Even worse, I'm going to be out of the country for work when this happens.  I'll be scaring the crap out of myself in Poland as I wait to hear what shows up.  Tony is going to take Hudson to his appointment and has been instructed to record everything the doctor says on his iPhone and play it back for me.  His detail relay skills are not up to my exacting requirements.

Chest X-Rays and the Oral Chemo Choice

Hudson and I went to AHSC last night to get chest X-rays and a CBC.  It was very snowy, so it ended up taking us 1/2 an hour to get from our house to the office, which is normally a 10 minute drive.  Hudson was quite comfortable since he was wearing the coat his foster mom from RMGDRI made him over five years ago.

As usual, since I'm a worrier, I was stressed about the x-rays.  My stomach was in a knot all day.  I'm sure Hudson was feeling my concern, since he promptly peed on the floor at the Oncologist's upon our arrival.  He'd gone potty before we left home, so it's very likely it was a response to my stress. I try to maintain calm around him, but failed miserably this time.  (Then I start to worry that my worrying upsets him. It's a never ending cycle.)

If you will recall, at Hudson's initial time of diagnosis in June, he had zero visible tumors in his lungs on the first set of x-rays.  The 2nd set taken three months later in September, showed 7 tumors had grown in his lungs ranging in size from 0.5cm to 2.5cm.  The 3rd set, taken a month later, showed that 6 of his tumors had shrunk by 25-50% and that the biggest had disappeared all together from the x-ray.  Fast forward two months, to the chest x-rays taken yesterday.

The six remaining tumors have all decreased in mass.  Five are visibly gone (but likely not microscopically) and one was reduced by 75%.  Unfortunately, a new one has shown up.  It is approximately 4 cm (try looking at that on a ruler.  It almost stopped my heart.)  Fortunately, it's not in a bad location in the lungs and Hudson remains asymptomatic.  Our hope is that the new metronomic oral chemo protocol will either help to reduce the size, or at the least, prevent it from growing larger.

Our chemo meds are in the mail and will be taken daily.  (Previously, I had said that it would be every other day for the Metronomic Protocol, but recent findings show that daily meds are best.)  The most common side effect (30% likelihood) is bladder irritation, so we have to be certain to provide plenty of fresh, clean water.  We will also need to pay attention to how frequently he is urinating, as well as whether there is any blood in his urine.