In the days between his diagnosis and his oncology consult, I went into denial. He’s been moving great and his appetite was coming back (it had diminished after his femur surgery). He seemed to be going in a positive direction and wasn’t showing the signs he should if he had cancer. At the same time, I was also depressed. I bailed out of work early and spent hours cuddled up bed with Gizmo (Colin had to lift him up there). Colin and I put him in the cart and walked him to the park every day and let him spend plenty of time there sniffing other dogs or just laying down getting cuddles and watching the world go by. Gizmo started catching on to the fact that I was becoming a huge sucker and would pet him every time he gave me a look or asked for attention, and he became a needier cuddle bug than ever if that’s even possible.
June 5, 2024 we had his consultation. My first question: we’re sure of the diagnosis, right? Yes, they were sure. We’re lucky that he feels great now and isn’t showing symptoms, but it could change quickly. We’d pretty much already decided that we were going to give chemo a shot, but we listened as the oncologist thoroughly explained the diagnosis and options. Lymphoma rapidly progresses. He can be fine one day and suddenly go downhill and be gone in a matter of weeks or even days.
On the scale from stage I to Stage V they expected Gizmo was IV or Va. Tests would determine whether the lymphoma had started to affect internal organs or was still contained to the lymph nodes to give a better sense of which.
Chemotherapy (the CHOP protocol) is the best option for treatment with 80-90% of dogs going into remission. Dogs handle chemotherapy better than humans with GI upset being the most common side effects, and they’d send some drugs home proactively in case that happened for Gizmo. However, he would lose muscle mass, which might exacerbate his orthopedic problems. We’d have to stop giving him his Galliprant and adjust his pain meds to compensate for taking out the anti-inflammatory. Also, we’d be suppressing his immune system and he has a history of infections with septic arthritis that could become major threats if contracted again. He’d have to go for treatment every week for 25 weeks (about 6 months) and it will be expensive, but we have pet insurance so that isn’t a main factor for our decision. His prognosis would depend on which type of lymphoma he has, should we choose to test it:
- T-cell lymphoma would mean chemo is likely to extend his life only 6-9 months. He’d likely be on the chemo for the rest of his life. If he doesn’t handle it well, it might not be a good life to live.
- B-cell lymphoma would mean chemo is likely to extend his life 14-16 months. He could have another good year and not be on the chemo the whole time so we might be able to tolerate a little more upset during treatment.
Foregoing chemo and just making sure he’s comfortable with steroids might give us another 6-8 good weeks. Doing nothing, we would be saying goodbye in about a month or less.
We decided to start the chemotherapy and test for the type of lymphoma. Armed with information about the type and seeing how he reacts in the first few treatments, we could decide whether or not to keep going at a later time. We were hopeful he’d handle the treatment well and we’d have more time with our baby bear.
Before we left, they did an exam and ultrasound, which showed that his internal organs were still okay. It was looking for like Stage IV. They took bloodwork and sent off a test to determine the type of lymphoma, gave us Prednisone to begin his steroid treatments. They also gave him an L-asparaginase injection to begin treatment. With the addition of this drug, it seems we’re going with the L-CHOP protocol. CHOP is a series of 4 drugs that work together to combat the lymphoma, and the L is basically just a 5th drug added into the rotation.
Gizmo didn’t like how long we had to spend in the hospital room and was a bit of a high puppy the rest of the day from being sedated, but we felt good about our choice and were hoping for the best.