Coby's first walk of the summer

Coby anxiously awaiting to go for a walk! A beautiful sunny day, mid 80's - the perfect evening to walk Coby to the lakefront, which is a good 3-4 mile walk there & back.
Coby enjoying being back home & able to relax & sleep. I think the walk knocked him out for the night. He has not moved for hours! LOL

Coby's first week home

I can't believe it's been only 1 week since Coby's been home from Boston - it seems like weeks ago since he was there. He has made significant improvement during this past week. He is full of energy & very feisty!! He has been playing with Olive all week - biting & pulling her tail, biting her head, rolling around on top of one another. Coby appears very happy & healthy. He's eating well & still loves to eat ice cubes. He now weighs 8 pounds, which is great since he was admitted to Angell's weighing only 6.6 pounds.


Ready to take another trip, but not back to Boston!!

One Year Later.....

On this day, May 24th of last year, Coby was officially diagnosed with GME. Now exactly 1 year later he is in remission, med free, has been off prednisone for 177 days & is doing great! It's been a year of hell for us - we've had many, many ups & downs, an incredible amount of money has been spent, but it's all been worth it! My little boy is a fighter!!

Coby had a CBC done yesterday. The results were better than I could have imagined. WBC 13.2 - normal; Neutrophils that were 3400 on Friday are NOW 10,164! They are normal. Platelets 196,000 - normal. Coby still has very mild anemia that is close to being resolved. Coby had his last dose of that liquid medication used to remove leflunomide from his body this afternoon. Now the only med he's on is Keppra three times daily! This is an anticonvulsant, but Dr. Sisson thinks it's possible we could eliminate this med in the future. He really doesn't think Coby needs it - he thinks the GME caused the seizures & that Coby probably has a 10-20% chance of having a seizure off the meds. We will wait & see.

Canine Swimmer

Vote for Coby at:

http://animal.discovery.com/the-spot/battle-breeds/canine-swimmers/

Coby had another CBC done this afternoon. We will find out the results tomorrow. I'm hoping for a neutrophil count of at least 5,000! Fingers & paws crossed!

Coby's first Saturday at home this month!!

FINALLY - after almost 2 weeks of hospitalizations this month & over $5000 spent, Coby is home!!!

Here is a brief summary of what happened from Thursday to today:
Thursday morning Coby had another CBC done. His neutrophils had increased to 1900 from Wednesday. He had a Neupogen injection both Wednesday & Thursday, but no more unless needed. I flew out to Boston & went to Angell Animal Medical Center to get Coby! I met with Dr. Sisson for some time to review Coby's medications & discharge instructions. Coby's meds included: Meropenem (injectable antibiotic), cholesttyramine (liquid used to remove all the leflunomide from his body) & Keppra (seizure medication) - all given 3 times a day. Dr. Sisson switched Coby's seizure medications - he really doesn't really thinks he needs an anticonvulsant because Coby has not once had a seizure since his intitial GME symptoms - the few he had were probably because of the GME/inflammation. I think we will taper the keprra down eventually & maybe d/c it all together. He thinks there is a 10-20% chance of him having a seizure without the meds, so he seems fairly confident Coby doesn't need that either! I was also given the vial of Neupogen just in case Coby needs another dose once we are back in Milwaukee. I was worried about taking all these meds & needles in the airport & thru security. Coby looked crazy with his legs & belly shaved, but he definitely looked much better than the day he was admitted. He was excited to see me & ready to get back home. After a 1 week stay at Angell, it cost $2000, plus an additional $600 for the airfare = $2600. (That does not include the weeks worth of hospital stays in Wisconsin the week prior). Below is a picture of Coby & Dr. Sisson. Friday morning we flew back to Milwaukee. No big problems at the airport, but my carry on bag did get carefully examined. As soon as we got home, Coby was playing with Olive (the cat). He was obviously feeling much better than the week prior. That afternoon Coby had another CBC done at our local vet. Coby did fine with the medications, he ate well & enjoyed sleeping in our bed again. This morning my local vet called with the CBC results. Coby's neutrophils are up to 3400!! The neutrophil response is very good. The platelets and anemia (red cells) are also slightly increased. We will do another CBC on Monday. Everything looks great for now. All 3 of his bone marrow lines seem to be recovering nicely according to Dr. Sisson. Coby appears to be back to his usual playful, yet aggressive self. It's so great to have him home & on the road to recovery. It's highly unlikely Coby was suffer a GME relapse at this point. His bone marrow is obviously damaged, but it is recovering right now - we don't know how long it will be for Coby to have a "normal" CBC, it could take weeks or months or years...but the bone marrow is recovering & Coby is doing great!!

Coby is Home

Coby is fnally back home with us in Milwaukee. I will update the blog tomorrow - I'm too exhausted right now, but wanted to give the good news.

Wednesday’s Update:

According to Dr. Sisson Coby looks great today! He is jumping around, wanting to play with people, pulling on the leash to go outside and trying to attack every dog he sees with his tail high up in the air. He is eating like crazy & up to 7.3 lbs. He was only 6.6 lbs. upon admission.

A CBC was done today & unfortunately it was not exactly what we had hoped for. Coby’s neutrophils have dropped from 1400 to 600. Coby had not been receiving the Neupogen for the past 3 days, so with this decrease in neutrophils it is apparent his bone marrow isn’t making enough cells on his own (or something like that – it is difficult to follow Dr. Sisson on the phone half of the time b/c he talks so fast & half of it I don’t understand). We will have to restart the Neupogen for an unknown period of time, but hopefully not too long b/c too much can cause even more & worse problems. He gave Coby a shot this morning & will repeat a CBC tomorrow. The good thing is Coby’s neutrophils did not plummet back to zero, so his body is doing something, but not as quick as we hoped.

Dr. Sisson said Coby is ready to come home despite what the CBC looks like. I will just need to give the Neupogen shot & repeat CBC’s over the next several weeks. Of course I wanted to make sure he didn’t need to stay there – I told him I’d come next week. He said not to waste the money on hospital bills when they are doing the exact same thing I can do here at home. Coby’s on antibiotics, his temp has been fine, his infection has cleared up, & he’s eating well. Coby is still getting a medication to remove some of the chemo that is left in his body & since Coby is no longer receiving chemo, he should not have GI problems & he should not get any infection. So…Dr. Sisson said Coby can come home!

Of course I am still nervous & worried especially with Dr. Sisson being so far away. Coby’s not out of the woods yet, so he still needs your positive support & prayers. The bone marrow will recover – it is just a matter of time. It could be years before Coby has a “normal” CBC, but Dr. Sisson thinks Coby will be just fine!!

I fly out tomorrow morning & will meet with Dr. Sisson at 6pm. At that time I will be able to get a better understanding of what’s going on & what my future rollercoaster ride will look like once back in MKE! Thankfully Kathy will help transport me & we can crash on her couch tomorrow night. Then we’ll be flying back to MKE bright & early at 6:30 am!! I am so excited to have Coby FINALLY coming home after almost an entire month of hospitalizations & sickness. Praying he only continues to get better & can life a happy, healthy normal doggie life!

Tuesday Update

This morning: According to Dr. Sisson Coby looks great. He has "definitely turned a corner". He ate all his food this AM & wanted more. He was barking at dogs that
walk by his cage & pawing at the bars for people to let him out. Coby is much
"livelier". He's interested in everything outside & has perked up. The CBC will
be tomorrow AM & Dr Sisson said he would "be surprised" if the CBC is not good.
Coby should be able to come home Thursday if it's normal.

This afternoon: He remains very active today and had a second full meal already eating everything right away. He is also barking and growling at other dogs on the leash now. "He is starting to become a little spitfire like you described" according to Dr. Sisson.

Monday's Update

Here’s today’s scoop on Coby:
Dr. Sisson called this afternoon & apparently he did a CBC today on Coby (he was going to wait until Tuesday, so I’m not sure why he changed his mind). The WBC’s were normal & the neutrophils were up to 1,400 (600 more than yesterday). Coby can come home if they are over 1,000, but because we live so far away, Dr. Sisson wants to repeat a CBC on Wednesday. The neupogen was given for the past 3 days to help stimulate the production of neutrophils – Coby did not have any today & will not have any tomorrow. If the neutrophils are the same or increasing, Coby could possibly come home Thursday or Friday. However, if they are decreasing then Coby will receive more neupogen & continue his stay at Angell. Dr. Sisson stopped one of Coby’s antibiotics today – Coby is still on the clavamox & Meropenem (injectable antibiotic). Interestingly Coby’s platelets decreased & were low (mid-range of low value). Dr. Sisson believes the stress of the flight likely caused Coby’s spleen to contract & release stored platelets in response to temporary increases in blood epinephrine. The RBC’s are also low. Coby obviously has damaged bone marrow, scarring & may take months to fully recover. Bone marrow in animals always recovers if managed & support is being provided – thus, Coby’s will recover, it’s just a matter of time! So, it is a waiting game. Hopefully we get good news Wednesday morning so I can book a flight that night & pick him up Thursday. I’m missing my little boy so much, but I’m glad to hear he is getting the proper care he needs & getting better!

Sunday Update

After an entire day of waiting, I gave in & emailed Dr Sisson to see if he had any updates on Coby. I knew they were doing a CBC today, so I knew he would have an update eventually. About 5 minutes after my email he called.

Coby is doing very well. His neutrophils are up tp 800 & band neutrophils 200. Coby's temp was normal at 6am & this afternoon was actually slightly under the norm. So, obviously the new antibiotic & neupogen are working. Dr. Sisson said today will be the last day for the neupogen. He will repeat a CBC in about 2 days. The neutrophil goal is 3000 before sending Coby home. If I lived there, he'd probably send Coby home tomorrow, but he wants to make sure Coby is well before coming back to WI. Dr Sisson also plans to stop the metronidazole today since Coby has formed stool. He's not eating the best, but that is b/c he is picky. Dr Sisson hand feeds him (LOL) & Coby will eat just enough to get what he needs. Dr Sisson asked if Coby was a picky eater & I said of course, that is why I cook for him (I know he's a busy man & probably didn't remember). Hopefully the clavamox will be the next antibiotic d/c'd if Coby's temp remains normal. The goal is 3000+ neutrophils, no temperature & only 1 antibiotic needed (which are the injectable ones that were started when he arrived in Boston - I can't remember the name). Basically, I will have to give injectable antibiotics when Coby is home - not sure for how long. Dr Sisson hopes to have Coby ready to come home around Thursday - which is horrible looking at the price of airfare!!! LOL Friday is bad too. So, maybe if we get lucky or I can figure something out knowing he will for sure be ready Thursday, maybe I can fly in Wednesday which is much cheaper & leave Thursday or Friday at the latest. I may need some help again!!!

Chance of relapse are very low Dr Sisson stated...again. Coby's "allergies" are not evident to Dr Sisson right now while off the atopica, so we don't know if he will need that or not either. Hopefully not!!

In addition, Dr Sisson went on to discuss Coby & his behavior/temperment which I found astonishing. Dr Sisson said Coby has the personality of a "big dog" which he likes - very chill, not a snippy barky needy high strung "little dog". He said Coby is very smart, adapted & observant. Coby "goes with the flow" & understands the people there are helping him to get better. He's not mad, depressed or afraid. He is very obedient with Dr Sisson apparently. He recognizes him right away, will sit by his side & not leave him. Coby let a couple kids pet him & has acted fine around other dogs...which is NOT like Coby AT ALL. He is aggressive & will bite, but with Dr Sisson, he's a totally different dog. Dr Sisson is like the dog whisperer in Boston. LOL Dr Sisson said to me "someone MUST have trained this dog, he didn't learn this all on his own" - referring to just sitting at his side, going right into the kennel, etc. That was my husband's doing & Coby is much more obedient with him. Just the way Dr Sisson talked about Coby & his personality was amazing - Coby has adjusted fine, loves Dr Sisson & is being well behaved! I was impressed.

Update....where to begin.....

What a busy & exhausting week we've had....I don't know where to begin! So much has happened since I last posted. Let's see...my last post was Wednesday & Coby was back in the hospital. That day they informed me they no longer wanted to manage Coby's case & he should be seen by a "primary" vet (such as their oncologist). To make a long story short, I ended up transferring him to another ER Wednesday afternoon. The "new" ER had agreed to work with Dr. Sisson regarding Coby's care. Coby stayed there Wednesday night. Due to disagreements between vets, a lot of back & forth, inconsistency in care...I decided to take Coby to Boston to see Dr. Sisson. Thursday morning I took Coby out of the 2nd ER here in Milwaukee & hopped a flight to Boston. I went to Angell Animal Medical Center, met with Dr. Sisson & admitted Coby to the hospital so he could be cared for by the expert Dr. Sisson. I then flew back to Milwaukee Friday early morning. So...Coby is currently in Boston & I am in Milwaukee. Coby's neutrophils are totally depleted, so he is now getting Neuprogen daily to hopefully stimulate the bone marrow. His RBC's & platelets are normal which is a good sign. Unfortunately there are many detailed medical updates I have not posted because it's been a rollercoaster for about 2 weeks now. All I can say is Coby is in the best place he can be for recovery. I don't know how long he will be at Angell's...hopefully not too long. Financially this has been one rough month! The upside to all of this is once Coby's recovered, he will no longer be receiving ANY chemo & it is highly unlikely he will have a GME relapse.

There are a lot more updates on Coby's facebook page - Care for Coby.

Quick Update

Due to my physical & emotional exhaustion from this week's events, I will keep this short. Coby was discharged from the hospital Monday night, but we had to return last night b/c his fever came back. He will receive another stronger antibiotic, more IV fluids, an abdominal ultrasound & hopefully he will be home by the weekend. Will post more at a later time. :-(

Saturday Night Visit

We went to visit Coby Saturday, which was his 4th day being in the hospital. He still remains in the same condition, running a fever, but is bright, alert & responsive. He was excited to see us, as we were also excited to see him! No lab work had been drawn, we are holding drawing a CBC until Monday (unless they feel it's absolutely necessary to draw one before then).

Saturday Morning Update

Coby has remained stable overnight. Nothing new has happened, he has not gotten any worse. His temperature is still elevated, bouncing back & forth between 103.0-104.2 degrees. He remains bright & alert. He ate a little bit of dry & canned food this morning - not exactly sure how much, but knowing Coby it was probably not much considering he is such a picky eater & prefers his homemade food. He will continue on IV antibiotics & fluids. No blood work will be checked today unless it looks like there are problems or Coby's condition declines. They will plan on rechecking a CBC on Monday. Coby will indeed be in the hospital throughout the weekend. Hopefully this weekend he will recover, beat this infection & be able to come home Monday! We are going to visit him later today!

Update on Coby & his current hospitalization

Here are some details of what has been going on with Coby this past week:

Friday 4/22/11 - Coby went to the ER for his regular pre-lomustine CBC check (Yes, I take him to the ER for blood draws now).
The results came back a little low.
WBC 3.6 (normal value 4.0-18.2)
Seg Neutrophil 2.05 (normal value 2.5-15.7)
Platelets 116 (normal value 140-540)
RBC, Hgb, Hct were all in normal range
I was nervous to give the lomustine (chemo pill) on the 26th because of the low values noted above, but I did anyways - I was told it was ok to give & we've had no problems with the lomustine prior to this.

Thursday 4/28/11 - Coby was not acting like himself, he was lethargic, had thrown up a couple times & started to have some diarrhea, so I took him to the ER. When we arrived Coby had a mild fever but recheck temps were normal. We had determined it was high when we arrived because of anxiety and excitement. Coby did have fluid administered under the skin to keep him hydrated and another CBC was drawn. This is now 2 days after the lomustine (but these symptoms could not have occured this quickly from the chemo). We were also instructed to hold the Atopica (allergy med) until Coby's GI symptoms resolved (Atopica can cause GI problems). We also were instructed to hold the daily leflunomide.
CBC results from this visit:
WBC 3.3 (normal value 4.0-18.2)
Seg Neutrophil 2.18 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC, Hgb, Hct were all in normal range

Friday & Saturday 4/29-4/30 - Coby was eating ok, more active, seemed more "himself".

Sunday 5/1/11 - Coby started to appear not himself again, was a little lethargic, threw up breakfast and lunch. He ate dinner without vomiting.

Monday 5/2/11 - Took Coby to the ER for another CBC since it was now 6 days after the lomustine.
CBC results from this visit:
WBC 2.5 (normal value 4.0-18.2)
Seg Neutrophil 1.50 (normal value 2.5-15.7)
Platelets estimated 108 (normal value 140-540)
RBC, Hgb, Hct were all in normal range
Despite the low values, we thought they would start increasing now that Coby had reached the low part of the lomustine (where it was the strongest - the nadir). The plan was to have another CBC drawn in one week to determine if we could restart the leflunomide. It was decided Coby would have no more cytarabine injections - he completed 10 rounds of the injections & the lomustine would also be stopped - he completed 9 rounds of this.

Tuesday 5/3/11 - Coby started having diarrhea & was not eating very well. The diarrhea persisted throughout the entire day. I bought some special food for him, which he ate. He felt very hot when laying on my lap, but I did not check his temperature - I just wrapped him in a cold wet towel. I was hoping the next morning he would be better......

Wednesday 5/4 - Coby continued to have diarrhea & didn't eat breakfast so I decided to check his temperature - it was sky high at 104.9. I wrapped him in a cold wet towel & rushed him back to the ER. Coby was admitted for severe leukopenia and pyrexia with a concern for sepsis given the bloodwork. He was bright, alert & responding. IV fluids & IV antibiotics were started.

Thursday 5/5 - Coby continued to be bright and alert. His temperature had improved to a high normal range. He ate ok and had no vomiting or diarrhea.

A CBC was drawn again. The values were all low:
WBC 2.0 (normal value 4.0-18.2)
Seg Neutrophil 1.00 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC 4.07 (normal value 4.48-8.53)
Hemoglobin 9.0 (normal value 10.5-20.1)
Hematocrit 29.1 (normal value 33.0-58.7)

I went out to visit Coby. He was happy & excited to see me, but eventually calmed down & just slept on my lap. He is very skinny. Because of his neutropenic condition I had to wear gloves while I visited.

Friday 5/6 - Coby's fever returned overnight & was running 103.5-104.0.
Another CBC was drawn and the numbers continue to decrease.
WBC 2.1 (normal value 4.0-18.2)
Seg Neutrophil 0.84 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC 3.19 (normal value 4.48-8.53)
Hemoglobin 7.3 (normal value 10.5-20.1)
Hematocrit 22.7 (normal value 33.0-58.7)

This is what our neuro says is happening: Coby's bone marrow has cumulative injury from months of chemotherapy and is not going to recover quickly. This white blood cells will likely stay low for several days, weeks to even months. This is actually ok as long as the lining of his GI tract comes back which will be much faster. He had some very close to liquid brown diarrhea this AM. He is barking, active and strong. He has had no vomiting and eating a little, but not as much this morning as last night. They have replaced the IV ampicillin with IV Unasyn - this has a broader spectrum of activity & hopefully will take care of whatever infection Coby has going on. As soon as the diarrhea resolves and he is eating better, he should do well. It will just take time. I anticipate Coby being hospitalized over the entire weekend. :-(

Coby's Hospitalized Again

Just a quick note, Coby was admitted to the hospital yesterday morning. He had a fever, low WBC count, low neutrophils - basically the same stuff he went thru in December. I just pray he can make it thru again......

Chemo Free

Coby is officially chemo free!! The Cytarabine injections & Lomustine have both been stopped. Coby's bone marrow has reached the point in which it is slower to recover from the chemotherapy than in the past. The "goal" of the chemotherapy was to complete 12 rounds of each - Coby has completed 10 Cytarabine injections & 9 Lomustine pills. Coby had been lethargic last week & vomiting, so I took him to the ER. We've had 3 CBC's drawn throughout this past week. Unfortunately we also had to stop the Atopica & Leflunomide due to the GI upset. The combination of all these medications did a number on Coby this past week, so everything is on hold or stopped. We will restart the Atopica in about 3 days only if he continues to eat well and not vomit. As soon as his CBC is normal again the Leflunomide will be restarted. We will have another CBC drawn in one week. As of last night Coby has been eating well without problems. However, he has lost weight & weighs about 7lbs right now - he should be around 8-8.5lbs. Fingers & paws crossed he can resume the Atopica & Leflunomide within the next 1-2 weeks, but more importantly.....there is NO relapse!

Here are pictures of Coby last week when he wasn't feeling well!