Cassie, a beautiful golden retriever
, was first referred to my cancer care service in June 1993, when she was five. Her regular veterinarian found enlarged lymph glands that contained cancer. Lymphoma (cancer of the lymph glands) is one of the more treatable varieties of cancer.
After consulting with me, Cassie's family decided to start treatments, despite the fact that the biopsy report said "prognosis: guarded to poor."
As part of my consult, I wanted Cassie's family to know that most biopsy reports don't mention that dogs do well with treatment, and that lymphoma often responds to chemotherapy. They were happy to learn that Cassie wouldn't lose her beautiful coat in the same way humans may lose their hair with chemotherapy.
Cassie came into our clinic always holding her leash in her mouth and was a delightful, happy patient. I especially loved treating her because she was the first life we saved with Neupogen, a new white blood cell growth factor. Neupogen stimulates the white blood cells to increase in number. Made by Amgen, Neupogen is highly valued as a miraculous recovery agent. It's used if the white blood cell count drops dangerously low (less than 1,000) from the effects of chemotherapy.
Typically, lymphoma goes into remission when a series of maintenance treatments are administered, but the remission is not permanent. Surprisingly, Cassie never came out of remission, even when Cassie's family decided to discontinue her maintenance treatments!Cassie Wins Her Second Battle
In July 1998, five years after she won her battle against lymphoma, Cassie was referred for a second time with a new cancer. This time, the cancer was from cells of the connective tissue (fibrosarcoma) located in the muscle and skin of her hind leg about 2 inches above her right hock (ankle). Sarcomas are a difficult variety of cancer that will come back if not removed entirely with an extra inch of normal tissue as a safety margin.
It was impossible to remove Cassie's fibrosarcoma entirely without amputation of her leg, which her owners declined. We discussed options to save her leg. We offered a special procedure at surgery, which involves injecting chemotherapy into the tumor bed, followed by radiation into the open tumor bed (intraoperative radiation). Two weeks after the surgery, Cassie started follow-up radiation for 10 more treatments. She had some trouble with seromas (pockets of fluid), but she was cured and always had full use of her leg. That was another celebration!Cancer Finally Takes Over
One year later, Cassie came in to see me again. She had a poor appetite and had been listless for two weeks. She also seemed to have a big belly and appeared to have gained weight. On exam, she was pale (as evidenced by her gums, and the skin on her ears and abdomen) and had a distended abdomen with an enlarged spleen, which we presumed had ruptured. We took her immediately into our ultrasound room and found that she had a belly full of fluid (ascites) and a huge mass in her spleen.
This mass had the classic appearance of malignant hemagiosarcoma, a cancer of the cells that create blood vessel walls. Fine-needle aspirations (extracting fluid from the abdomen through the use of a needle and syringe) identified blood in the abdomen, but failed to show malignant sarcoma cells from the spleen to confirm the diagnosis.
During this consultation, I explained to Cassie's owners that one in five (20 percent) of big dogs with Cassie's problem don't have cancer. If she was lucky, this would be the result of a big blood sac (hematoma) from a ruptured benign tumor on the spleen. The odds were against Cassie because 80 percent of the time, the spleen has cancer and it spreads to the lungs and liver in four to six months.
In Cassie's case, we recommended surgery. She was a good candidate because the ultrasound showed no lesions in her liver, her chest X-ray was normal, and her blood tests were all within normal limits except for a mild anemia. I also told her owners that we would ultrasound Cassie's heart before surgery to make sure that there were no heart tumors or fluid around her heart.
Cassie's tearful family declined surgery. They wanted to take Cassie home and let nature take its course. We set up a special "hospice" for Cassie's end-of-life care. We sent her home on a special herb called Yunnan Paio that some veterinarians believe helps the clotting process. Sweet Cassie kept her good cheer and her belly even seemed to shrink. Then after one week at home, she became weaker and wouldn't eat.
Cassie's mom called me early one morning to tell me it was time. We gathered in our clinic on Cassie's favorite travel blanket early in the morning, and bade her a gentle farewell. We read poems from Angel Pawprints, a book by Laurel Hunt that reflects on loving and losing a canine companion. Her family was consoled and they began their grieving process in peace, knowing in their hearts that they'd done what was best for their beloved pet.