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.
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.