Sad news: my sick dogs

Cytology from a needle aspiration biopsy of a lymph node of a dog with lymphoma.

Not quite sure how to start this one, so I guess I’ll just jump in…. Laevatein has terminal cancer. Lymphoma.

She was just diagnosed, when a vet found somewhat-enlarged lymph nodes during a routine exam. “I have to mention the c-word,” she said, “but she really doesn’t present like a cancer dog.” Indeed not; Laev is 8, but she’s quite active (she spent about 4 hours Sunday night circling and jumping, trying to work out how to reach a critter in a tree) and looks sleek and shiny. We figured some sort of tick-borne disease was more likely and ordered panels to test.

But the biopsies came back as lymphoma. Two weeks later, her lymph nodes are already large enough to visibly distort her silhouette in front and rear. Monday we met with the oncologist, discussed options, got further tests (cancer has likely spread to spleen and lungs, but not liver), and started chemotherapy.

I’m fully of questions — how could my dog possibly get to Stage 4 of a 5-stage cancer without my notice? Am I the worst dog owner ever? — but there are a few things I know:

• Only about 20% of canine lymphoma patients have ill effects with chemotherapy, and even fewer have serious effects; quality of life is usually pretty good. So there’s little risk in trying treatment.
• Lymphoma doesn’t get cured, it just goes into remission. Median survival for Stages 3 and 4, substage A, dogs is a year. Which is way better than the mere weeks we’d have without treatment.
• Some of the chemo drugs are cardio-toxic, which is bad for a Doberman, but Laev’s heart is good now. And frankly, I’d love for her to live long enough to have a chance of heart disease, so we’ll risk it.
• Laev has done enthusiastic bitework with a broken tooth, qualified in obedience trials with a misaligned pelvis*, and acted normal with a closed pyometra ready to burst her uterus. She’s always been physically tough. Why not give her the chance to rise to this challenge, too?

It had never even occurred to me that Shakespeare might outlive Laev. If she gets an early remission, we can hope for a good prognosis and another year or so. If not, well, we’ll make a decision then.

* No, I didn’t know she’d broken a tooth, and no, I didn’t know she’d been knocked out of joint when she was jumping. Yes, I felt terrible afterward! But she volunteered those behaviors even in pain, she wasn’t coerced into them. She’s like that.

A Good Day at the Clinic

We couldn’t use treats for most of the visit, so I stopped at Goodwill and bought a stuffy surprise for Laev.

The oncology staff pleasantly surprised me. I’ve had two experiences with this particular specialist clinic, one bad and one very, very bad, so to be honest I really wasn’t happy about seeing an oncologist here. I wasn’t reassured when I pointed out to the receptionist that despite the sign, there were 2 wholly off-leash dogs in the waiting area and asked if we could wait in another space. She said no. A moment later, one of the off-leash dogs ran up on another leashed dog. A few moments after that, it ran up on Laev.

Laev handled the incident like a boss. A little bit of hackling, nothing else, and pretty much none of the snark which can come out when a strange dog pushes itself on her (especially in a stressful environment like a vet clinic). I wished so much that I could treat her, but we were on a fast before the ultrasound and x-rays, so I couldn’t do more than tell her how incredibly brilliant she was.

I asked the unleashed dog’s owner if she’d like to borrow a leash. She said no, she had one. /facepalm/ People, please!

Laev couldn’t take the toy, yet, but she put herself on the mat and started to relax herself.

But then it got better; a tech took us to the exam room, and Laev put herself into her relaxation protocol, lying down on her mat, putting her chin down, and breathing slowly. Good girl.

Dr. Rechner, our oncologist, listened to my concerns requests slightly-psychopathic-pleas and agreed to let me help with the handling for Laev’s tests. I was able to hold her during the ultrasound (during which she actually relaxed considerably — huzzah for Dead Bug training!) and then help to set her for the radiographs (though I couldn’t stay for the actual taking of pictures). I also was able to show our tech Michelle how to ask Laev for a chin target during the blood draw, so she could ask for and reward it during the chemo injection (OSHA forbids me from being present for that as well).

All that resulted in Laev being very much calmer than she would have been, with relatively quick recoveries (<30 seconds to normal, after the 2 exercises which left her a bit high). She stopped taking treats from Michelle during the injection, but she recovered quickly once back to me and left the building in a collected manner rather than frantic. And I’m totally counting that a win.

After a bit of settling, Laev was able to take the toy and fluff it into a soothing pacifier. Good girl!

Oh, and I did mention that she did almost all of this without treats? She was on a fast before radiographs and ultrasound, so she had nothing at all in the waiting or exam rooms, a single small lick of liver paste after the 5 minutes on her back for the ultrasound, and no treats until the end of the full set of x-rays in 2 rooms. And she stayed mostly calm, even without feedback or when she had no cues at all. Maybe that doesn’t sound like a big deal, if you don’t have that kind of dog, but trust me, it is. I am so proud of her.

Shakespeare’s Tooth

But Laev’s not the only patient in the house.

Shakespeare made it 13 years without any dental concerns. Seriously, he’s never even had a cleaning; a raw diet kept his teeth pretty pearly and white for the most part.

But recently he started to have dog breath for the first time, which caught my attention. I took him in, but we couldn’t identify exactly what the problem was, and I was reluctant to put a 13.5-year-old-dog under anesthesia, so we put him on a round of antibiotics and an oral rinse.

The dog breath went away, but now he’s developed a visible swelling in his lower jaw, near the back. Definitely some sort of infection or something going on, and probably the only way to treat it is to put him under for cleaning and/or extraction.

Shakespeare’s in great shape; he has arthritis and cataracts, sure, but he still patrols the yard and jumps on the couch and bullies our guests into cuddling him. He enjoys himself. Considering that most Dobermans his age have been dead for 4 years or so, he’s doing just fantastic.

But it’s still risky to put a dog this old under anesthesia, and so I’m faced with a decision: Leave the tooth alone, and let it develop into something which will degrade his quality of life? Or treat it, and risk his life over a non-lethal issue?

I have an appointment Tuesday to talk with the vet and make that decision. In case anyone wondered, no, it’s really not fun to be making life-or-death decisions for 2 dogs in 2 days.

So I’ll update when I know more. Thanks for listening.

Update: Shakespeare has cancer in his jawbone. Apparently very fast-moving, given how quickly the lump developed, and he might have as little as 3 weeks. Not more than 2 months with the very best outcome.

The bad breath was likely due to a secondary infection which we did clear up with the antibiotics and oral rinse, but we can’t treat the jaw cancer. Even if we tried surgery, we’d have to remove most of his lower jaw, we’re not sure how well he’d be able to eat, and I won’t do that to him.

So he has pain meds to keep him comfortable as it progresses, and at some point soon I’ll have to make a call when it starts affecting his ability to eat and enjoy himself.

Signing off for a bit….