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 (Last Updated 7/26/10)
This is the story of Kaya, my 11 year old mixed breed dog who has leukemic lymphoma, a cancer of the white blood cells. I am happy to say that on
August 12, 2010, she will have survived 1 year from the date of her diagnosis. However, I am sad to say that the average survival of dogs with this disease, treated with chemotherapy is 10-12 months. I have no illusions that my dog is going to somehow dramatically outlive that, in fact with a recent relapse last month, I’m pretty sure she doesn’t have too much more time. But as of this morning, she is in remission, feeling good, and enjoying her life.
I felt compelled to write about this journey because its very near to a lot of pet owners hearts. If you have a pet, you’ll likely outlive it, and that is a painful experience anyway you slice it. But battling a diagnosis of cancer is a unique challenge, as we are often faced with the choice of putting our pets through a procedure, whether chemotherapy or surgery, in hopes of a longer and more fuller life. I am hoping Kaya’s story can help shine some perspective into this process for you.
I’ll be posting in chronological order, so scroll down for the most recent updates…
August 12, 2009:
I can still remember coming into work that morning and seeing Kaya’s labwork on my desk. I pulled blood on her the day before because she just hadn’t been herself lately. Overall, it looked good, except for a white blood cell count of 210,000 (normal 6.0-17.0). I called the lab to see if they had re-run it yet, because I was pretty sure it was just some odd lab mistake – no way was my dog walking around with a 210,000 white cell count. When I called the lab, they transferred me to the pathologist on duty who sadly informed me that she had already run it again and looked at the slides herself, and that my dog had advanced leukemia.
I had to run a few more tests, and eventually found that she actually had lymphoma – a cancer of the white blood cells in circulation, which had spread to the bone marrow causing leukemia as well. It was really all the same though, as the treatment and prognosis are identical – No treatment, 1 month survival. Oral steroids, 3 months survival. Full chemotherapy, 10-12 months survival. No cure. Rarely survivors at 2 years.
We decided to at least start chemotherapy and see if we could get her into remission and see how she would tolerate chemo. Both my wife and I have spent a lot of extra time training in oncology and are fully aware of the side effects of chemo. We did not intend to put her through a lot of illness just to extend her life, but knew that a lot of dogs can do quite well with chemo…we decided to give it a shot.
Sept, 2009 (…this initial entry is taken from my September 2009 Crozet Gazette Vet article):
There comes a time when we all will realize that our pets have gotten old. Sometimes, it’s a sudden and surprising catastrophe after seemingly endless years of perfect health. Other times, it’s just a matter of realizing that the gray around your dog’s muzzle is growing with each passing season.
This realization just hit me a few weeks ago when I diagnosed my own 10-year-old dog with leukemia. She has been in such good health her whole life that I figured she’d at least make it to 15 or 16—after all, she’s owned by not one, but two veterinarians! I always thought we’d somehow have more control over her health, and be able to diagnose and cure any condition quickly before it became too serious. But as a dog owner, I’m really not much different from the next.
It’s hard for anyone to separate what is normal “10-year-old dog” behavior from what is “maybe my dog is sick” behavior. For instance, over the past few months, she had gradually been sleeping more and more under the bed on my wife’s side. Ten-year-old dog, or sick? She had also been eating a bit slower, but usually still finishing all her food by the end of the day. Normal for an old girl … or is she ADR (ain’t doin’ right)? Also, I had clipped her coat pretty short about a month ago, and it was then that some of the glands under her jaw felt more prominent—not huge, just more prominent. Were they always like that?
And it’s hard to feel like there’s something wrong when your dog is so excited to see you whenever you come back home (even if you just checked the mailbox). Or when they would never turn down a treat or a walk, or still do those annoying but endearing “character traits” – like nudging your elbow when your cup of coffee is full.
Ultimately, nobody knows your pets like you do. With more prodding from my wife than from me, I took our former Roanoke SPCA mutt (priceless now, of course) in to work with me, only to find out that her white blood count was twenty times the normal range—consistent with leukemia. In one day I was saddened and surprised that my girl had somehow gotten old on me.
My point is to say that if you feel like your older dog or cat is just not right, get them checked out. Hopefully, they’re just getting older. But dogs and cats are very talented at hiding signs of serious diseases. It’s just not in their nature to advertise that they’re sick. Survival of the fittest is a tough world.
I want to talk about chemotherapy for cancer treatment in dogs and cats. Many people may feel that only crazy people would do such a thing, or that it’s unfair to the pets, or that you’re simply beating a dead horse. But let me just say that our old girl is feeling pretty good and has a totally normal white blood cell count after just two weeks of pretty reasonable chemotherapy.
Still, whether to do chemotherapy in a pet with cancer is a complicated decision with lots of uncertainties. First, many cancers are simply not responsive to chemotherapy at all. Many that are, are only responsive for a short period of time. In fact, in the majority of cases where we are use chemotherapy in pets, we are not curing their disease, but rather trying to prolong their quality of life. So it’s not always an easy call.
Second, there is the possibility for significant side effects. Chemo-therapy, simply, attacks rapidly dividing cells–—i.e., the cancer cells. But the cells in the intestinal tract and the bone marrow are also rapidly dividing, hence the chance for side effects such as vomiting, diarrhea, anemia, and a weakened immune system. However, chemotherapy protocols in dogs at least, are generally well-tolerated. They are designed to get as much control of the disease as possible, without making your pet miserably sick for extended periods of time. But tell that to the person whose dog spent the weekend in the emergency hospital because of fever and severe diarrhea a few days after their last chemo treatment.
Lastly, chemotherapy is expensive and becomes more expensive the longer they live. Not only are the drugs expensive, but they often have to be given in the hospital through IV catheters, and weekly blood tests are required to make sure the chemo is not wiping out the bone marrow.
Cost is a deal breaker for a lot of people, but nothing to be ashamed about. Who can argue with someone choosing to spend limited income on getting their child braces instead of trying to keep their 14-year-old dog going for another 6 months? These are tough decisions and take a lot of thought and understanding.
In the end, chemotherapy is not done commonly. But it’s worth a discussion if you find that your old companion has been diagnosed with cancer. For some folks, four to six months of happy mornings and nudged elbows are worth it.
Cost is a deal breaker for a lot of people, but nothing to be ashamed about. Who can argue with someone choosing to spend limited income on getting their child braces instead of trying to keep their 14-year-old dog going for another 6 months? These are tough decisions and take a lot of thought and understanding.
In the end, chemotherapy is not done commonly. But it’s worth a discussion if you find that your old companion has been diagnosed with cancer. For some folks, four to six months of happy mornings and nudged elbows are worth it.
 October 2009:
Kaya is a tough old girl! To update, she is in complete remission and is actually tolerating the chemo without incident! She has had a few days of a less than usual appetite, but no other signs and is really back to her old self in terms of activity and energy.
She comes into the office with me every Wednesday for treatment. Thank God she is such a good dog, she sits perfectly still while we give her the IV injections she needs. She gets lots of treats from the staff, and the way I see it – she can get a little spoiled and chubby in her last year.
November 2009:
Kaya continues to do great! Her cell counts are normal, just a little anemia from the chemo. She still is feeling pretty normal, maybe sleeping a little more. She has had a few bouts of diarrhea post-chemo, but really nothing bad. We do have to entice her to eat a bit more as well, but I think we’ve also spoiled her so that regular dry dog food is no longer acceptable! Oh well, we are happy with the progress so far…
December 23rd, 2009:
Well, I think we’ve reached the end of chemotherapy. Kaya got incredibly sick last week’s chemo. She received 2 drugs, cytoxan and vincristine, both of which she has had before. But this time it made her very ill. She didn’t eat for 4 days and had terrible vomiting and diarrhea a few days ago all over the house. My poor wife who had to come home to that with our 4 year old son! She even peed in the house that day which she never does. She kept enough energy in her though to greet me when I came home, poor thing.
As is the life of a dog owned by two veterinarians, we put an IV into her that night at home, hung a bag of fluids by the nightstand, and “doctor’d her up”. Along with the fluids, we gave her some meds for the vomiting and diarrhea and she was much perkier the next morning. As of today, she still hasn’t recovered her appetite and her poop is still pretty loose.
We’ve decided that we’re just going to stop chemo now. We had another 6 weeks to go to finish the course of drugs that is associated with the 10-12 month survival, but that will just have to do. It was getting pretty hard on me anyway taking her into the office every week. She eventually started to tremble when I pulled up to the clinic, which she never used to do. She also would tremble the whole time she got her treatments, and wouldn’t even take treats from us (she used to eat them by the handfuls during treatment!). I think it would be easier if I wasn’t the one administering it – again its this balance of knowing its going to make her a little (or a lot) ill, but also knowing that it is to make her life longer. She doesn’t know that though, all she knows is that she feels sick. Anyway, she had done really well, it was only this last bout that was bad, but that’s enough. I hope she can stay in remission for a while.
January, 2010:
So far so good! Kaya remains in remission and is feeling great. Still not back to her old appetite, but she’s been happy and getting to enjoy all this crazy snow!! It was nice to have her for another Christmas and snowstorm.
March, 2010:
Spring is here and Kaya continues to do exceedingly well. She really is back to her normal self, eating dry dog food alone (of course getting a lot more scraps and treats these days though!). We keep checking her labwork periodically and its great so far. We both agree the chemo was well worth it and its been 3 months without it!
May 12, 2010:
I knew it couldn’t last forever. We had felt like her lymph nodes had been getting a little more prominent lately and she seemed a little down last week. So we ran a CBC (complete blood cell count), and her leukemia is back. Her lymphocyte count is 12,000, so not nearly the elevation as at her initial diagnosis, but it’ll get there if we let it.
I think I’m more upset about this relapse than the initial diagnosis. With the initial diagnosis, it was a lot of shock, but also I knew a lot of dogs respond well to chemo, so kind of like procrastinating…we treated her and got to “put off the inevitable” until later. Now I’m faced with the reality that its not going to be too much longer before we lose her. The fact is that it’s a lot harder to get them back into remission the second time, if you are able to at all.
We decided to give it a try though. She really did well with chemo except for that one treatment, and we just don’t want to lose her. One of my good friends from my internship after school is now an oncologist and has been an invaluable resource, helping us tremendously with treatment protocols and decision making. He decided trying the same protocol we used the first time, since she really responded well to it…so I took her in today and started with Vincristine and prednisone. The only other thing we’ve agreed on is to be super proactive on antivomiting/diarrhea medication. She was pretty good today, not a lot of trembling at the office…
May 20th, 2010:
Repeat labwork shows her lymphocytes still elevated, but better at 8,480. It has me worried because they went down dramatically after just one treatment back in August. But also, one of the chemo drugs Elspar, is on backorder and is unavailable…grunt. Gave second dose chemo today, so far so good.
May 26th, 2010:
Slightly lethargic this week post-chemo, but no vomiting or diarrhea. Unfortunately, her lymphocyte count has gone up, its at 20,000. Worried, but am going to stay the course for now. Gave another dose of vincristine today.
Kaya now has another grave challenge. His name is Boone, an 8 week old male yellow
Labrador retriever…This is a mixed blessing…we are truly excited to have a puppy. We really weren’t planning on this, but actually had discussed it before Kaya relapsed – we really wanted her to “train” a young dog in her incredible ways. Also, our son has some allergy issues, and we really didn’t want a time without a dog in the house. Our friend Kim Maddox who raises labs that the local Virginia Service Dogs people use, has 16 puppies, and we decided it would be a good time…just before Kaya relapsed.
But we are committed and so far so good. He is a sweet pup, pretty harmless so far.
June 1st, 2010:
Feeling pretty stressed. Despite 3 rounds of chemo, Kaya’s WBC has risen, her lymphocyte count is now at 27,000 and she’s clearly not feeling well. We’re feeling a bit of despair at the moment and still no Elspar, which might help. Today I’ll be giving doxorubicin, perhaps our last hope. She hasn’t had this since her relapse, and it’s a pretty potent chemo drug. Its nickname is “red death” because of its red color and it has to be give via an IV drip…just looks very menacing going into your dogs vein. Has to be given via a central line catheter – Kaya is still so good, just sits there as we place this huge catheter into her vein.
June 8th, 2010:
The Doxorubicin is working! Lymph count has gone down to 8322, still well above normal, but 1/3rd of what it was last week. That is really a relief, I was getting pretty down on the whole scenario. Spoke with my oncologist buddy who recommended pounding her with that for a while, every 2 weeks (normally given every 3 weeks by itself), so as long as she feels ok, game on. Seems to be tolerating it so far.
We’ve got a chemo survival pack at home now. Filled with bottles of anti-nausea meds, anti-diarrhea meds, antibiotics, steroids, and canned food…we take it with us when we travel and keep it in our pantry. Seems like I’m getting stuff out of it daily. She’s been having some diarrhea and a poor appetite, but I can tell she’s actually feeling a bit better.
June 16th, 2010:
Repeated Doxorubicin again today. Kaya is definitely better and her lymph nodes seem normal. Poor thing is just having to deal with the puppy - she is his one desire, he wants to play and bite her constantly, and she is just not into it. Appetite is steadily increasing, I’m sure that’ll go back down after todays treatment, but it still seems worth it.
June 22nd, 2010:
I’m just so impressed with our dog. She is back in complete remission and feeling great. She’s actually playing with the puppy and feels like her old self. She had a few bad days after the last treatment, but predictably rallied.
July 14th, 2010:
Giving Kaya her last dose of Doxorubicin today. “The red death” can be toxic to the heart, so you’re supposed to limit it to 6 cumulative doses – today is number 6. She had a pretty rough week after the last dose, didn’t eat for 2 days, loose stool…but again rallied. Heading out of town with her this weekend, so we’ll bring her feel good drugs and hope she does ok.
We’re not exactly sure where to go from here. She’s done so well, and we can continue with some different drugs in the same class, but I also can’t help but second guess at what point is it too much. Just gonna see how she does this time and watch her white cell count…we’re thrilled she’s back in remission, but again are faced with the reality that this remission won’t be as long as the previous, and I’m just not sure I’ll try and rescue her out of another. Her rear leg veins are pretty shot, she’s got permanent shaved spots on all four legs (hair isn’t regrowing very well from her catheters)…
But we noticed she was biting at our puppy’s heels today. My wife pointed out that she used to do that when she was a young dog whenever she’d play with dogs off leash, like a herding dog. I had totally forgotten about that. Simple detail, but a refreshing blast from the past.
July 26, 2010:
Its amazing to realize that we're only a few weeks away from Kaya living a year since her diagnosis and treatment began. Its been a long time, it really puts in perspective for me when we tell people "average survival with chemo is 10-12 months", how long a time that is. Life becomes routine at times, its not all spoiling and cherishing every moment...there are plenty of times of scalding, depriving of treats, continued training...times I tell her "you're driving me crazy!...Outside!". There's been a lot of emotional times too when she has been feeling sick. Still have to figure out where to go from here, we'll probably start a new drug next week with an every 3 week schedule and see how that goes.
It has brought our family much joy to see her live long enough to help raise our new puppy Boone. He is now 4 months old and just loves Kaya. My wife and I are chopped liver. It still if funny to refer to my "dogs", plural. Went on a nice long walk with both of them last night, it was a good walk.
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