The Diagnosis
In October of 2017 our worst fears for Yuki came true when he was diagnosed with Lymphoma.
Yuki had been fighting some kind of sinus infection (again) when one of his bottom lips became very inflamed. This had happened once just after we adopted him (the inflamed lip) so between the two problems it was time to take him to the vet again.
As was likely to happen in the past, we expected a vet visit, followed by pill prescriptions, some words of comfort from the vet (if you actually get to speak with her) and then come home. Yuki had just been there the week before for a required checkup needed for his painkiller prescription (hips) to be renewed, so no reason to worry. We, as is probably the case with a lot of pet owners, were not expecting the diagnosis we ended up with.
When the vet called to talk to us about Yuki, she was very concerned. She had given him a once-over and found his lymph nodes to be overly swollen, the ones in his neck and the ones near his back legs. She asked our permission to do a cytology of his lymph nodes and we, of course, agreed. Especially after she explained what it could possibly find. The vet got the samples and we took Yuki home. Needless to say, “Dr. Google” got quite the workout that night as we both did our own research in what Yuki was likely facing. It didn’t read well.
Canine Lymphoma is a rapid killer if untreated. It comes on fast, and the dog is usually deceased in a month. The cancer utilizes the lymphatic (immune) system as an expressway to spread throughout the body. When the vet did the cytology there just happened to be an ultrasound tech at the office that day, so they shaved Yuki’s belly and did an ultrasound of his mid-section. The result suggested that most of his organs were involved, but his lungs looked and sounded clear.
It turned out the cytology results were inconclusive due to some mishandling along the way and we had to bring Yuki back for a second collection, however, the case was still pretty strong that Lymphoma was the diagnosis. His lymph nodes under his jaw were like two hockey pucks floating under the skin.
With as fast as the Lymphoma spreads (the vet put Yuki at “stage four”), time is of the essence if you decide to treat the cancer. With a referral from the vet, we made our appointment with an Oncologist. We surprisingly got in the next day mostly because, as was explained to us later, a dog with Lymphoma is accepted ASAP and other appointments are re-arranged in order to get the dog in. “We treat is as an emergency situation.” a nurse told us.
That Wednesday Yuki met his Oncologist and we were being briefed on the process Yuki would endure for the next 20 weeks. After going over the possible treatment options, and there are a few, we decided to go with the full Madison Wisconsin protocol. This treatment would take the longest, cost the most (of course) but had the best chance of success (remission for a year or two) and 50/50 chance of cure.
But how did we come to this decision? I will admit that the decision to put Yuki through chemotherapy is mostly a selfish one, at least on my part. Mom may have the same, or other reasons, but I’m simply not ready to let Yuki go. Sure, he’s a dog. He won’t know either way. We could put him to sleep now, or later. So there has to be something deeper.
Speaking for myself and aside from the selfish reason mentioned previously, trying to save Yuki’s life feels, to me, like a part of the responsibility we take on when deciding to adopt and care for a living thing. I know, he’s a dog not a child, but I feel a responsibility for him, regardless. He can’t care for himself; we are smart and caring people, so we can help this life fight to live. As someone once told me, when some rabbits they were caring for froze one winter, they were crushed and felt a greater sense of shame and failure for carelessly allowing the rabbits to die in the cold. I felt the same way after the death of my dog Archie. The second guessing, the missed signs and portents disregarded as “old age”. Nights spent awake in fits of self-accusal (I know, not a word) for not doing enough to save him and choosing to put him to sleep. Was it the right decision? I’ll never know.
Is this the right decision for Yuki? We will know the answer to that question eventually. One way, or the other.
This chemotherapy regimen (CHOP or L-CHOP) is also very close to the therapy given humans with similar cancers but with one difference. In humans, this protocol is aggressive and, most times, extremely unpleasant. A human can suffer through pain, hair loss and other discomforts, knowing that the result they are striving for makes it worth the suffering. A dog doesn’t, and one can’t expect to make one suffer through such side effects. The dog won’t understand the greater goal of the treatments and will simply be miserable and most likely associate the treatments with punishment. Try getting the dog in the car when they know such unpleasantness is coming.
The Madison Wisconsin protocol, for animals, is slightly different. As with anything dealing with animal end-of-life issues, quality of life becomes a phrase one will begin to hear…a lot. Everything you do for that animal, medically speaking, will be weighed on the quality of life scales. Will “A” improve their quality of life, or will “B”? In the case of the chemotherapy the dosages are such as to fight the cancer as best one can without disrupting the dog’s quality of life. One can fight the cancer to a point, but if you’re making the dog’s life miserable by doing so, then what’s the point?
These ideas aided in our decision. As long as Yuki was not suffering, or in pain from either the chemotherapy or the cancer, we could do this. Yes, there will be some side effects: nausea, diarrhea, vomiting, etc., but these are treatable with medications that will make these symptoms milder or vanish completely. No matter how much I/we want Yuki to stay, he is too happy and carefree of a dog to make miserable. Yuki is a dog, as compared to say, Pecos, that has never known a day of hardship. Ever. He went from birth to a loving owner, to loving foster Mom and then to us. He never saw the inside of an animal shelter, has never been on the streets or abused. Because of this he is the happiest, most well-adjusted dog I’ve seen (except when there’s thunder), and I don’t want to be the one that introduces him to an unhappy life of pain an misery. We’ll do the chemotherapy and hope for remission. If he’s not improving and heads into untreatable suffering, then the quality of life scales suggest it’s time to let him go.
As mentioned previously, we chose the full 20-week chemotherapy regimen. The Wisconsin Madison (Adriamycin) protocol, as they described it to us. The basic plan is this: they start week “0”, if you will, with an injection of L-Asparaginase (“Lspar” for short), which is, as the nurse put it, “The magic drug.” This one dose almost immediately (24-48 hours) took the wind out of the Lymphoma’s sails. Yuki’s lymph nodes were huge, as I said, but within 24 hours of the “Lspar” injection the lymph nodes shrank back to their normal size. It is simply amazing to observe. As the Dr. described, this drug would stop the cancer spread, then the chemotherapy would keep knocking it back from different vectors of attack until it goes into remission (undetectable by any known means).
Week “1” is a dose of Vincristine, week “2” is Cytoxan, week “3” is Vincristine again and week “4” is Adriamycin. Week “5” is a rest week for Yuki where they’ll do a CBC on him and make sure no damage is being done to his organs by the treatments. After week “5” we start all over again with weeks 1-5’s treatments again. This process goes 4 times, or 20 weeks. This is the plan, anyway. The Dr. says things may change along the way if Yuki has a bad reaction to a particular treatment or other complications arise.
For now, at the end of week “0”, things look great. Yuki’s lymph node swelling has vanished, the Prednisone he’s also on is making his old body feel young again, and, on top of all that, his sinus infection appears to be gone, so he’s sleeping, and breathing well, at night. All good things. All good quality of life things.