As incredibly hard as this was to revisit and compile, I think it’s important to illustrate how aggressive and cruel a canine lymphoma diagnosis can be, especially for a senior dog like Tucker. I also think it’s important to share the treatment options we utilized for others on a similar path.
I know the overwhelm of the unknown and what it feels like to go frantically searching the internet looking for someone, anyone, who has navigated the heartbreaking journey you are on. I highly recommend joining one of the cancer specific cancer groups on Facebook. It is there that you will find “your people”. Those who get it, and those who understand your pain. I’m also going to share, in real time, Murphy’s prostate cancer treatment plan (yes, I’ve had a second dog diagnosed with cancer since losing my Tucker) so that the information regarding our experience with SRT (Stereotactic Radiation Therapy) is out there since everything surrounding his diagnosis and treatment is proving to be a bit rare.
It’s important to understand that YOU know your dog. Every single case will be different and will present unique challenges for you and your dog, regardless of what plan of action you choose regarding treatment. I’ll admit I clung tightly to Tucker. If you had told me I needed to move a mountain in order to save him, I would’ve turned myself into the incredible hulk and moved that mountain somehow. He was my once in a lifetime dog and I was never, ever going to be prepared to say goodbye.
We were able to get Tucker to his 13th birthday and even as I see dogs succumbing to cancer at half his age, I still feel robbed of my time with him after working SO hard to keep all his ailments under control. And even when my brain knew the time had come and he wasn’t going to beat lymphoma, I kept hoping for a miracle. Some will question why I put a senior dog through chemo to only get a couple of bonus months with him and I can only reiterate with you two important things our oncologist said to me:
1. “Don’t think about chemotherapy in terms of how it effects humans. The majority of dogs handle chemo with few side effects”
and most importantly,
2. “I think he still has in it him to rally”.
With cardiology and integrative medicine and our routine veterinarian onboard, that word, rally, became our mantra and now the foundation for this organization.
At a regularly scheduled acupuncture session at LSU, Integrative Medicine Veterinarian Dr. Hale notices that his lymph nodes in his neck region are slightly enlarged. Instructs us to get it looked at our routine veterinarian as it's likely an infection stemming from his dental disease. *It's important to note that Tucker had advanced MVD (Mitral Valve Disease- common for breed) and cardiology had not cleared him for a dental during his last echo.
We swing by our vet on way home and grab a round of antibiotics and agree to follow up in 2 weeks.
Tucker has an eye exam at Southern Veterinary Eye Clinic in Mandeville. Tucker had surgery on both eyes previously (pedicle graft procedure) and one of his grafts appeared irritated. We now know this was likely an immune response.
Dr. VanBrundt does not like how enlarged the lymph nodes are. Exasperatedly, I explain that my vet has retired (it was the shortest retirement ever, as she came back the next week), LSU can't get him in for another 2 weeks, the antibiotics didn't work, etc. He said something to me that I will forget, "I'm worried that if it's something like lymphoma, we have to move quickly". He, my ophthalmologist offers to take the FNA sample for us. I sob hysterically in gratitude. We begin prednisone that day to try to shrink the lymph nodes.
The lymph nodes are so enlarged that Tucker is struggling to breathe. His panting is uncontrollable and I'm worried about his heart. I call my vet (even if she were to retire, she had agreed to still see Tucker through this) to let her know we were headed to the ER at LSU. She tells me to meet her at the clinic instead. On a Sunday evening. She listens to his heart and while there's no indication of fluid, Tucker needs an oxygen cage ASAP. She instructs us to go ahead and bring him to New Orleans, not LSU, that way he can be overnighted and stabilized prior to his oncology appt the following morning. *The silver lining here is that MedVet is both an ER and specialty clinic.
X-rays and a battery of tests show that Tucker's heart is only mildly enlarged, but the lymph nodes are so enlarged that they are pressing on his windpipe. He is placed into the oxygen tank and I'll see him again in the morning for his 10:00am appt with oncology. Because Brian and I rode together, we have to both return to Baton Rouge. I debated sleeping in the cry room but would have no car so opted to go home.
I return to meet with oncology. Tucker is critical but his bloodwork looks good, his heart is stable, and he's bright and alert. The problem, she says bleakly "he's not eating, though". If there's one thing Tucker doesn't miss, it's his meals. Because of the swollen lymph nodes, he had developed an aversion to his bowl. I was hand feeding him on a paper plate. She has the tech bring him to me, with his food and a make shift plate, and he stomped it. Hallelujah.
We discuss moving forward and what our chemotherapy options look like. If Tucker hadn't shown such interest in his food the way he did, that day would've likely been our goodbye. He wasn't ready, however, and I'll stand by that to the day I die.
Because of the plethora of issues Tucker already going on along with his advanced age and failing heart plus Cushing's Disease, our chemo options were limited.
Tucker is given steroids, a long-acting antibiotic shot, an Elspar injection to shrink the lymph nodes and kick start the chemotherapy he would receive should he make it to a follow up oncology appt. Flow cytology is sent off. He is not stable enough to come home and will spend another night in the ICU.
Having lost my Stella during an overnight ICU stay, I have severe PTSD about leaving dogs, so rather than driving back to Baton Rouge, I book a hotel room near the clinic so that if something goes wrong during the night, I'm in the same town and can get to the clinic quickly. Somehow, though I knew he wasn't ready, I also wasn't entirely convinced Tucker would pull through. Given that I was able to get him to eat, I also wanted to be there for his evening meal and the next round of visitation. My husband Brian got the honor of taking care of our other dogs for the night as I went shopping for overnight toiletries.
The ER treatment has helped stabilize Tucker's breathing and he is "cautiously" discharged and his follow up oncology appt for his first round of Tanovea is scheduled for Friday, April 29th.
Tucker's flow cytometry results came back consistent with B cell lymphoma. His chemotherapy treatment plan consists of 5 sessions of the chemotherapy drug, Tanovea via IV every 3 weeks. He receives his first dose and is sent home with a bandana with crawfish on it. Ironically, this day is also Tucker's Gotcha Day as 5 years prior was the day we signed his rescue adoption papers and made him ours!
We celebrate Tucker's 13th birthday/Gotcha Day with our birthday card backdrop. What a treasure those cards are as well as the opportunity to get to celebrate him. He received a blueberry swirl peanut butter honey cake. Sounds terrible and probably was, but antioxidants and honey for energy was our friend. He stomped it.
Since Tucker is no longer able to participate in his hydrotherapy sessions, we increase his acupuncture sessions. We make a review of his Chinese herbs given his chemotherapy treatment and addition of prednisone and try to stay hopeful that Tucker is going to continue to rally.
Tucker has his second round of chemo. So far, he is handling chemo like a champ. He is taking Cerenia with the Tanovea and we aren't seeing side effects though treatment day (and the day after) completely wipe him out. The lymph nodes are still not completely reduced though his CBC was adequate to continue with treatment. His appetite is still great, and he's sleeping and breathing more comfortably so we are taking our blessings as they come.
Dr. Hale sends Tucker home with his own aloe vera plant so we can continue to treat the paw pad.
The paw pad lesion is mostly healed and we learn it could potentially be a side effect of the Tanovea. Tucker gets an antibiotic shot to knock it out. Bloodwork is still looking good, but the prescapular lymph nodes are a bit larger and concerning. His CBC was adequate to receive his 3rd Tanovea injection. We discuss changing treatment if we can't get the lymph nodes back down.
You can't see it but on this day he goes home with a Louisiana hot sauce bandana.
For the first time, Tucker does not want to walk into the building and has to be carried. His panting is increased. I don't panic too much because a). he's about to see a specialist and b). it's summertime in Louisiana- I don't want to walk outside more than necessary either but I do make mental note of it. *He wears orthopedic boots for stability so it wasn't the hot concrete on his pads.
He is happy being held by the LSU student while Dr. Hale and I discuss our next steps.
Both lymph nodes are now enlarged. Chest radiographs still show no evidence of heart failure and CBC still looks ok. His liver values were high so he started a liver supplement.
We move forward with what oncologists refer to as "rescue protocol" which is quite scary to hear. Now, what could be considered routine treatment is "rescue" for Tucker. It basically refers to treatment that is implemented when another option has failed. We discuss the risk that Lomustine "may lower his white blood cell count and make him more susceptible to infections" therefore he also started antibiotics. We give this a whirl because we are out of options otherwise. We go home with with a patriotic bandana. Tucker isn't feeling great and I begin to understand that I need to make some hard decisions soon.
As cautioned, Tucker's white blood cell count has plummeted and the rescue protocol has only slightly decreased the lymph nodes. We are now 2/2 of failed treatments. We can try again in 2 weeks and see if the bloodwork has stabilized itself, but ultimately make the decision to stop the chemo, the poking and the prodding. He is declining rapidly and whether he is losing his eye sight entirely, or the results of the cognitive dysfunction wrecking havoc he is becoming disoriented and "stuck" in corners of the home. He is no longer able to lift himself up and has to have help being stabilized for potty breaks and eating.
He receives his final bandana (patriotic dogs!) and we enter palliative care with him. We know that our time is limited, but I hold out for a miracle.
As Tucker continued to decline, we realize what people mean when they say "better too early than a minute too late"...we almost waited too late to make the call that would allow us to say goodbye on our terms. I cleared my entire week and never left his side. Not even once. We went to Starbucks for one last pup cup, we took naps together, we sat in the sunshine, we baked treats for he and the rest of my crew, my husband and I took turns sleeping on the floor with him at night so he always had someone near and then on Saturday afternoon, following a living room massage session with his custom blend oils and as relaxation music played quietly and peacefully, we set my angelic Tucker bear free.
Grief is like the ocean; it comes on waves ebbing and flowing. Sometimes the water is calm, and sometimes it is overwhelming. All we can do is learn to swim.
-Vicki Harrison
