For Johnnie

8/7/06	The vet treating Johnnie says that dogs with grade 2 mast cell tumors have a one-year survival rate of 65%. The two-year survival rate is somewhat less. A more detailed analysis of the biopsy tissue has been ordered to determine whether this is early grade 2 or advanced grade 2, which gives a better idea of how likely it was to have spread already. It takes about 2 weeks to get that report. Meanwhile, we are very encouraged that the radiation seems to be working and to see the tumor get smaller every day instead of bigger.
8/13/06	Johnnie has completed day 9 of the 18 day treatment. At the halfway mark, he remains mostly free of side effects. Johnnie still has a healthy appetite and is very energetic in the mornings. He slows down a bit later in the day. His muzzle was shaved Friday, so he looks a little different. I have enclosed pictures of the day before he started treatment and today. The reduction in the tumor may not be particularly evident in the pictures, but you can definitely see the difference in person! The girls have been working with him to refine his response to basic commands and teaching him some new tricks. He's settling in and seems much more relaxed in his new home than he was in the first week or two. So all is well at the moment, and we remain hopeful of a complete disappearance of the tumor over the remaining two weeks of treatments.
8/20/06	Johnnie is starting to show the effects of the radiation - a deep reddish rash on his muzzle and drooling. He takes 5 different medications and has a mouthwash and an ointment for his muzzle. He dislikes those! Johnnie has been keeping us up at night, panting, coughing, kind of gagging and whining now and then. We think one of the pain medications is not agreeing with him, so we stopped that today and he's acting much more normal. We also removed his big plastic head shield, which was making him very uncomfortable. Besides, those of you who know Johnnie know how he likes to lean his head up against you, and he can't get that closeness with the shield on. He has kept his paws away from his face - good dog! Only 4 more treatments to go. We think the tumor is continuing to shrink, though not as fast as initially. The radiation tech said that it may not go away until after the treatments are done - there's a delayed effect. He's in better shape today than he has been since we picked him up Thursday. We gave him a bath Saturday because he was stinky from the drool accumulating in his coat around his neck, and he's had a couple of long walks and play time with the girls, so he's just generally perked up. Depending on how he is, we may bring him out to HART's Dog Walk and Homecoming at Bull Run on the 10th. He's gotten very good at handshakes and high fives - it's very charming. We have also made progress at more consistent obedience to basic commands, with both voice and hand signals. He's very smart but needs motivation.
8/27/06	Discouraging news this week. The biopsy report came back and Johnnie's tumor is a more aggressive form of a grade 2 mast cell cancer. Last day of radiation therapy was Thursday. Unfortunately the tumor does not appear to be completely gone. It may still shrink, but there has been no apparent change since Thursday. The next decision is whether to try chemotherapy or not. Chemotherapy is good for destroying cells that have spread, not so good at eliminating localized tumors. The side effects of the radiation are probably at their worst right now. Johnnie is holding up OK, not the happiest dog you ever saw, but he still has a spring in his step when we're out walking. His appetite is good. We'll post another update after Johnnie's one-week checkup. Please keep us in your thoughts as we continue to evaluate how effective the radiation therapy has been.
9/8/06	Johnnie had his two-week checkup today and Dr. Gustafson thinks he is healing very well. There seems to be a bit of the tumor left behind on his nose; it changes all the time and looks different almost hour by hour. He had a bout of diarrhea for a few days last week, and then some vomiting, but we got prescriptions for both that worked well. This week he developed a bacterial skin infection so we have started him on antibiotics today. The predisone is probably behind both the infection and weight loss (he's getting quite thin), so we are cutting the predisone dosage in half. He will also gradually come off his pain medications over the next week. Johnnie looks worse than he is; he's getting past the worst of the side effects, but it will take a while for the skin and hair to renew itself. The coughing has stopped and the drooling has diminished. He is eating well, sleeping well, and can walk at a brisk pace for miles! Although the past two weeks have been a little daunting, it has not been as bad as you might think.
9/18/06	Johnnie has been noticeably better the last few days! The skin infection is clearing rapidly, he seems to be gaining a little weight, and his energy level is high. He's been waving his tail around like a flag, and it looks like his whiskers are starting to grow back. We decided to go ahead with chemotherapy, since the tumor was found to be closer to a grade 3 cancer. There's a little swelling just under his nose and it's a guess as to what that is and whether it poses any threat. If it is a residual malignancy, hopefully the chemotherapy will finish it off. Johnnie had his first injection of vinblastin on Friday and it did not appear to affect him at all. In other developments, he seems to have made friends with the pug and beagle next door, although they are still separated by a fence. Not so much with the squirrels ;-)
11/9/06	We just had another appointment with Dr. Gustafson today. Sorry to say that the tumor has come roaring back in the last month, bigger than ever right now and becoming more complex in its structure. We switched him from vinblastin to CCNU, and then today put him on a stronger dose of CCNU, which may tip his white cell count into the undesirable range. Since the chemo doesn't really seem to be working at all, this would be where it starts doing more harm than good, so if that happens, we will stop. Any treatment we do now is a delay, not a cure. His life expectancy can probably be measured in months now. However, this is more our problem than Johnnie's. Since dogs don't have a concept of the future, from his point of view, life is going great, he's just got a big bump on his nose. He has been acting completely normal and happy and has even regained a few pounds. His latest achievements have been learning to take food gently from your hands, always walking on your left, and reliably coming when called, even when there's something to distract him. And he has learned to like popcorn, although he's still not very good at catching it! There was a fox in our yard the other day and he got to watch it from the window, which was very exciting. All in all, Johnnie is still enjoying a very good period in his life indeed. While this may not end well, we're glad we have the time we've been given. He had a real shot at a cure and it'll always be comforting to know he got that chance.
2/21/07	We are sorry to say that Johnnie has passed away. He had been relatively well, and was active and happy in his last few months with us. Even as Johnnie's cancer progressed, he continued to learn new things, develop as a companion, and be a very cooperative patient. He even got a girlfriend named Cricket while being boarded over the holidays - I'm told they were quite compatible and enjoyed walks together! However, the cancer spread to his lymphatic system at the end of January. Once there, tumors began to spring up everywhere, and grew with truly astonishing speed. Although Johnnie's story does not have a happy ending, and we miss him, we are at peace with it. Johnnie provided an opportunity to practice compassion, probably an overlooked virtue in the overachieving, impatient culture of Fairfax County. We learned many things from this experience with Johnnie: Even if you are terminally ill, life can be pretty good and you can be happy. If you honestly need help and make your needs known, plenty of people do care and are eager to support you. Middle schoolers can be amazingly mature and responsible when it counts. A little dignity, patience, creativity and teamwork go a long way in turning big problems into minor inconveniences. Somehow, people can honestly still see you as handsome when you've got a big ugly lump on your face. There's still time to learn new tricks! Pretty good legacy for a dog to leave behind, don't you agree? Thanks to the staff at the Regional Veterinary Referral Center and the Pet Centre Animal Hospital for their professionalism and kindness. Thanks also to all the HART volunteers and donors who made a difference in Johnnie's life and ultimately, in ours.
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