sassy is relapsing.

[Sheena]

Alyssa – this disease turns us all towards the dark side of everything if we are not careful. For me, it was the breaking of my usual rule – surely it’s just anaemia, surely it can’t be IMHA, & for me, it can’t be even worse than that – bone marrow failure. It was. I think we are an exclusive club. BUT I try hard to keep us all (that includes ME!) on the straight & narrow – the most likely scenario really is the most likely!

It is hard to talk about my Mum in some ways, but she loved dogs so very much & would be willing me to share info like crazy. She instilled the dog & animal rescue & compassion in me, without doubt. She would love you for what you have done for Sassy a millionfold. So do I.

Oh, Mary – this must have been a terrible worry for you – it’s no fun being a nurse & having this – we are the worst for thinking the WORST about ourselves, but always being the most realistic & positive with everyone else! I think the saying is a little knowledge is a dangerous thing – your story says it all about us. I am so relieved all was well, thankfully.

Alyssa, our Uncle & Auntie adopted a rescue greyhound because they loved our two little monsters whilst looking after them for us – love breeds love, for sure. So I know he would also be on your side, Alyssa. 100%.

You know, we are probably the biggest worriers on earth now. We are entitled to be. But please, please don’t think the worst for now – Sassy is young, so that makes the worst scenario even more remote.

When are the results expected? I will be keeping a close watch for an update.

Sheena x

[alyssa]

So, the call came early – I was expecting it Monday. Results consistent with Lymphoma. :( I had the dr email the results to me, so I’ll post the comments below. Unless there can be any other reason for large lymphocytes making up 90% of the lymphocytes, it’s pretty conclusive. There shouldn’t be more than 20%. He told me there were things inconsistent with lymphoma as well, but I’m not sure what. I was starting to believe a little that it was allergy related, again going back to her ears. He has no idea why her ears are swollen, or what the other swelling is. It’s like her whole upper half. Lymph nodes are small compared to most lymphoma diagnosis. However this could be because she has been on prednisone.

I’m so angry. I just don’t know how to do this.

——

SOURCE/HISTORY

Right submandibular and left submandibular lymph nodes (2 slides
each). Currently on 60 mg prednisone and 75 mg azathioprine daily for
treatment of IMHA relapse. She relapsed January 1, 2016. Her IMHA is
controlled right now. Owner noticed submandibular and prescapular
lymphadenopathy 5 days ago. Rule out lymphoma.

MICROSCOPIC DESCRIPTION

These sites appear cytologically similar and will be described
together. The lymphoid population that is present is made up of
approximately 90% intermediate to large lymphocytes and 10% small
lymphocytes. The larger cells have a small amount of medium blue
cytoplasm, a round nucleus, stippled chromatin, and prominent
nucleoli. The nuclear diameter of most of the cells is approximately 2
to 3 times the diameter of an erythrocyte. Occasional atypical mitotic
figures are identified, and low numbers of nondegenerate neutrophils
and phagocytic macrophages are present. The background contains many
bare nuclei, moderate numbers of erythrocytes, many lymphoglandular
bodies, and thick, basophilic, proteinaceous material.

CYTOLOGICAL INTERPRETATION

Consistent with lymphoma. Please see comments.

COMMENTS

The predominance of larger lymphocytes is cytologically consistent
with lymphoma. However, if there are clinical features of the case
that are not consistent with lymphoma or if further characterization
is desired, excisional biopsy with histopathology of an affected lymph
node is recommended for assessment of tissue architecture and
definitive diagnosis. Immunophenotyping may be helpful to determine B
cell vs T cell origin and can be performed on tissue biopsy sections.
Immunocytochemical staining is also available at IDEXX via test code
8461. Five to eight additional unstained aspirates with intact cells
are required, and the turn around time is 7-10 working days.
Consultation with an oncologist regarding additional diagnostics as
well as treatment options may be of benefit in this case. Consultation
with an oncologist can be obtained by calling 1-888-433-9987.

For customers not currently viewing this pathology repor

[Sheena]

Alyssa, sorry dear friend, truly sorry – this is very worrying & not what you wanted to see/hear. But it’s NOT definitive, so I think you’ll have to go down the full biopsy path, or find & buy a test that gives you a yes or no answer – no choice.

One thing that sticks in my mind is that Mum’s lymphocytes were very high & I don’ t remember Sassy’s being high at all – but the immunosuppressants do keep them lower, so maybe a red herring in Sassy’s case. My knowledge is not great on this as far as bloodwork is concerned beyond my Mum – I need to do some homework for you. I would rather you conversed with your vet for now, goes withput saying. Have they said anything else after this report?

Need to think more for Sassy about this – sorry – we are in such different time zones. Be in touch tomorrow, I promise. Try to be philosophical – we can only do our best for our dogs, whatever that may be. You always have & you always will. You are the most wonderful & compassionate fur Mum.

Sheena x

[Vally]

Oh Alyssa, I’m so sorry. It’s not fair and of course you’re angry. I feel like screaming with you.

You mentioned the WBC was normal this time around when tested. Were lymphocytes tested?

As Sheena said, do the next test, although I know the time delay for results will be nothing short of an endless agony.

Big HUGE hugs Alyssa.

Vally
xxx

[Brigitte]

Dear Alyssa,
What can I say? Everybody was hoping for better results, everybody had that glimmer of hope. You have been Sassy’s advocate, her partner in this fight and her best friend. She in turn will love you until her last breath, when ever that may come. In one of your earlier posts you describe how Sassy loves her food and she is acting pretty happy. You have to remember, she does not think about what tomorrow may bring, all that matters to her is today and how she can make you happy and how she can get some tasty food! Try and just stay in the moment with her and take it one day at a time.
Thinking of you with lots of love,
Brigitte

[Sheena]

Morning Alyssa

Been thinking about you & Sassy a lot. I imagine you are worrying yourself crazy – I would be too. Brigitte & Vally are right – Sassy is happy, hungry & doesn’t know anything is wrong. Cherish her.

Found this very positive article on the website we both have mentioned before – it shows lymphoma is treatable, absolutely, and like IMHA, there is remission & life can be good:
http://www.caninelymphoma.com/canine-lymphoma-life-expectancy/

You can look up all sorts of things on this site – it’s very nicely explained.

How quickly can your vet do the next tests? Do you have any bloodwork you can send us? You know I’m always happy to take a look at anything for you. Going to get my (very expensive) books out & have a read later. But I do think this is going to be a bit of an oncologist/haematologist puzzle because of the IMHA & the drugs as well.

Love & hugs
Sheena x

[alyssa]

Hi everyone, thank you for the support.

About doing chemo – I honestly would do it, if I thought it would work, but I just don’t think it’s going to be very successful:( I’ve been told by both her vets that she really isn’t a candidate for chemo do to long term prednisone useage. She likely won’t respond to treatment, we won’t be able to stage or correctly or determine the best drugs to try. pred triggers drug resistance before drugs are even introduced – which is eventually why dogs getting chemo still die from lymphoma. eventually it becomes resistant to all the drugs. So to go into it with those things already in place, I don’t think is something we will be doing :(

http://www.dogcancerblog.com/blog/common-cancer-mistake-starting-your-dog-with-lymphoma-on-prednisone-too-soon/

There is a good article on it & there are many others.

I questioned both of her vets separately about it… and they said they treat a lot of lymphoma dogs. and a lot of owners decide not to do chemo and go the pred route. Then, when they see the dog responding so well they decide they want to start chemo. And nearly it always fails to work. It’s a very bad situation. And that is just from a dog being on it for a few weeks. Sassy has been on such a high dose, for so long.

I don’t want to give up – it’s SO hard – I can’t even think straight. I want to give her every possible chance, I want to have her even if it’s another year… but we can’t stop her pred for months and months away. I have to ask myself very hard questions I’ve avoided until this point because there was always that ray of hope and certainty eventually that she would get better. I threw money at her to the tune of 13,000 in her two AIHA episodes. I’ve got a few credit card debts.. I simply don’t think I have the funds to do 5-7,000 to attempt a treatment that, in her specific case, will have a very high chance of failure or only gaining a month or two. If I was told differently? And that pred wasn’t an issue, and there was a great chance she’d be with me another year? I likely wouldn’t be able to control myself and spend that 7,000 I don’t have. But it’s just not so.

At this point I’m trying to come to terms with myself, I am having a real difficult time even feeling sad. I’m feeling numb and furious. With bouts of extreme depression. It just feels so unfair. I’m trying to tell myself, God just wants her back. He’s wanted her back for a long time now. And so he’s finally put something in front of me I couldn’t stand up against so that I will stop. :(

[Sheena]

Hi Alyssa

Your head must be all over the place – this is a real quandry for you & feeling hurt & angry is normal in the circumstances.

Done some homework now. I totally understand where you & your vets are coming from on this. I am not even going to discuss all the possibilities. I can only say what I would do, and why I would do it, depending on the results of the biopsy/tests & determining of the staging of the suspected lymphoma. But you must make up your own mind. Whatever you decide, we are right beside you through this with any support we can give. And we still don’t know 100% what you are dealing with here – so hoping it isn’t lymphoma until you hear otherwise.

Sassy is acting fine, eating well & enjoying life – so why not give her more time, even if it is not “long”. Their lives are sadly much shorter than ours anyway, so the chances are that we outlive them. A few extra months, even a year, is a long time in dog world. As long as the quality of life is good, it is worth having. The emphasis is quality for me, beyond doubt. If Sassy was not feeling good, I would not be saying this to you. So, if it was Worzel & he was acting really well, I would try the vincristine (mentioned as one of several available drugs in my animal haematology book) & pred for sure – purely because she is so well, she deserves a chance of some more quality time. We know that drug is used in IMHA treatment, so would not compromise that side of things either.

Can you remind me of what drugs exactly Sassy is on at the moment & the doses?

One last thing – how about contacting Dr Dodds? I would guarantee she has seen this before many times & may give you a different perspective on things. Plus she knows sooooo much. Remember all the negativity we have all heard about IMHA recovery – figures on some sites are rubbish & made people think you couldn’t overcome this horrible disease. We know that is NOT true.

If you think Sassy is not happy in any way, I know you will do the right thing. But for now, that is not an issue. Play it day by day, dear Alyssa.

Sheena x