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!