Dika's Lymphoma Treatment, Health, and Wellness

After Dika and I moved outside of San Antonio in April, we were walking around the horse stalls at my sister’s property and she yelped and lifted both of her back feet up. I looked for the cause of the sudden yelp and found nothing, but there are lots of scorpions and wasps out here so I thought she might’ve been stung. I examined her feet and didn’t see anything, but kept an eye on both of them just to be safe. She was licking her back left paw quite a bit through the rest of the day and night, but every time I examined and palpated it, she didn’t react like there was any pain.

The next day, her back left paw swelled up some. Not enough to make me feel like I needed to bring her to the vet, but it was noticeable to me, so I gave her some Benadryl and the swelling went away that same day.

Two days later, her popliteal lymph nodes (the ones behind her legs) had swelled to the point where I could see them sticking out when she was standing, and when I touched them, they were hard and just under the size of a ping pong ball. That alarmed me, and I immediately made the decision to take her to a local vet.

I brought her to a walk-in clinic in Floresville the next day, and it was while we were at the vet I discovered that it wasn’t just her popliteal nodes that were swollen; it was all of them. Every lymph node on her body was swollen. After spending just under $700 on various tests, including bloodwork, a test for Chagas disease, and aspiration of her lymph nodes to see if she had cancerous cells present in the lymph, the results I received that day were this: her bloodwork was normal, meaning no infection, and her lymph had only reactive cells, meaning likely no cancer, but that was only a maybe because lymphoma can be a tricky thing to diagnose in early stages. The vet was candid in her assumption that Dika may have lymphoma, because having all of her lymph nodes swell up at once is usually a clear sign that points to lymphoma.

I received the results of the Chagas disease test a few days later, and she was positive. But not in a normal, super obvious way; she was the lowest positive test the vet had ever seen, which led us to believe she may have contracted it when she was younger and had remained asymptomatic. What made me test for it was the presence of a heart murmur, but she’d had a heart murmur when we adopted her in 2017, so really I was just being safe.

Since none of this stuff was making much sense, the vet recommended I put her on some low-grade antibiotics that wouldn’t affect any further testing for lymphoma, should I choose to seek a referral to an oncologist, but would knock out any possible minor infection that might be lurking unseen in her system. They gave me a month supply, and told me that if her lymph nodes don’t shrink (or if they got bigger), I should call for the referral.

I decided to get an Embark DNA test with a health screening done, just out of curiosity mostly, but also because I thought there might be some kind of answer in her genes. It took awhile for the results to come back, and in the meantime I had her on the antibiotics. The first night was okay, but the second night scared the absolute shit out of me. I woke up around 1:30am to her shaking so hard I thought she was having a seizure. I had to lift her off the bed, and she was lethargic to the point of not being able to lift her head when she walked, and her walk was so slow I thought she might fall over. I almost had to carry her outside so she could go potty, and had to help hold her upright while she pooped (diarrhea). Her pulse was rapid, even when she had been lying down for a long period of time. Every time she’d start to doze off, she’d twitch awake and look confused. I kept thinking she was dying on me and silently cried while I held her paw. I did not go back to sleep.

That was the first night we stayed in the bathroom; she in her favorite cabinet space, me on the floor with a pallet of blankets beneath me.

I called the vet as soon as they opened, and they said it was a reaction to the antibiotics, but that I should keep giving them to her and her system would adjust. So I kept her on them, and over the next week, she adjusted as much as she could. She kept having diarrhea, and was vomiting quite a bit, but she kept eating, drinking, and enjoying her toys, so I did what the vet said and she stayed on the antibiotics.

Her lymph nodes stayed swollen.

Finally, the DNA results came in. She was at an increased risk for mast cell tumors. I looked up what those are, and was immediately concerned that the bumps every vet I’d ever brought her to told me were cysts, were actually mast cell tumors. The first and most prominent one to appear was on her head, clear as day, and changes size on a daily basis. I was afraid I’d left them unchecked for too long and they’d metastasized, spreading to her internal organs and lymphatic system, and that it was too late for me to help her.

I brought her back to the vet again, this time telling the vet I’d like her to aspirate the bump on her head and the one on her front left paw. She told me those bumps didn’t behave like tumors, and I told her I’d like to test them anyway, just to be safe. I ended up having to show her the DNA results to convince her. She aspirated the two bumps I’d asked her to, and then left the room to run the tests. Twenty minutes later, she came back in and said, “You were right, the one on her head IS a mast cell tumor; but I don’t believe that’s what’s causing her lymph nodes to swell, because there would have been cancerous cells in her lymph when we tested it on her first visit.”

Basically, back to square one.

I finally decided a referral to the oncologist was my only viable option, even though the lymph my vet had tested in house only showed reactive cells and no cancerous ones. She gave me the referral, and when the oncologist’s office called me, they requested that I take Dika back to my vet and have them do something called a flow cytometry test to confirm the diagnosis for lymphoma. I was UPSET. I wanted to know why my vet hadn’t done that test to begin with. By that point I’d spent well over $1500 just trying to figure out what the hell was happening to my girl, and all of that after leaving my husband and home in Houston, with no job, no car, and only money from clinical trials to fall back on. The oncologist was kind and patient with me, but said because they’re a cancer treatment center, they need a definitive diagnosis to take Dika in.

So I scheduled the appointment with my vet for the flow cytometry test. The days before the appointment, the lymph nodes in her neck swelled up so much she was struggling to breathe while lying down, and she was having trouble eating and drinking. One of the nodes was the nearly the size of a baseball. She was having weird breathing episodes when we were laying in the bathroom at night, and I was terrified her airway was so obstructed she was going to suffocate. She was vomiting six or seven times a day, and at one point she inhaled some of her vomit during one of the breathing episodes and it got so bad her eyelids started to droop. I felt like I was watching her die every damn night.

The day before her appointment for the flow cytometry test, I couldn’t take it anymore. I wanted to know if I could get my vet to give her steroids to bring the swelling down before I brought her to the oncologist, so I called the oncologist. I explained what was happening, and she very seriously and cautiously said to me, “Cancel the appointment at your vet; we can get her in tomorrow.”

I did, and they saw us. They did bloodwork and an in-house test on her lymph, and the results were STILL INCONCLUSIVE. They sent the lymph off for a flow cytometry test, warning me that, while all the signs are pointing toward lymphoma, the flow cytometry results may still come back inconclusive. If that happened, there was one more test they could run without having to excise and biopsy a node, and there was a 95% chance that final test would give them the answer they were seeking. They recommended I keep her off steroids, because that could make her lymphoma resistant to treatment if the steroids were started too early. If they started chemo without having a confirmed diagnosis of lymphoma, and it turned out she DIDN’T have lymphoma but some kind of parasite or infectious disease, the chemo would knock out her immune system and the other thing(s) would wreak havoc and likely kill her.

The flow cytometry test DID come back mostly inconclusive, but with signs leaning toward lymphoma. The oncologist asked me if I wanted to do the PARR test she had told me about, and I said yes, so she let the lab in Colorado that had done the flow cytometry test know. She sent my pharmacy a prescription for ondansetron (anti-nausea), and told me if things got worse, I should call and have them send in a script for steroids anyway.

Things didn’t get worse, though. The swelling went down some and, with the help of the anti-nausea medicine, she was only vomiting a little bit, as opposed to many times a day. She was able to eat and drink. She was acting mostly normal; getting excited to see me, eating treats and playing with her toys, going on walks.

Finally, after another week and a half, I got the call on June 25th I’d been needing to start treatment. She has small B-cell lymphoma. The oncologist sent a script to my pharmacy for prednisone, which I was told to start her on immediately, and we scheduled an appointment to run pre-chemo bloodwork for yesterday. All of her bloodwork came back great, and I received the go-ahead to start as soon as the chemotherapy drugs arrive.

We’ll be starting her off with an oral chemo drug called chlorambucil, which I’ll be administering at home. If she handles it well, that’s what we’ll keep her on. It’s highly unlikely that the lymphoma will ever be “cured”, but we should be able to get it in remission, because the type she has responds well to treatment. She’s reacted really well to being on prednisone. She’s eating more, has more energy, and all of her lymph nodes AND the tumor on her head have shrunk. All I’m after is quality of life, and if I can give her a good quality of life for a year or two more, I’ll be okay with that. I love her more than I’ve ever loved anyone. She’s saved my life half a dozen times, and while I know now that I probably can’t save hers, I want to make what’s left of it good for her.

Along the vein of quality of life, before I received her lymphoma diagnosis, I decided I wanted to find a diet that would be best for dogs fighting cancer. I did some research and found that high protein, low carb is best, so I ordered some samples of different wet foods, supplements, and toppers to try out and see if she liked them, because she is THE PICKIEST DOG. I also got chicken hearts and beef liver, which I boiled for her and saved the broth to use with the supplements that required rehydrating. I’ve found a mix she likes and eats, and the oncologist approves of it, so I’m hoping I’ll be able to keep her on it.

Now that she's on prednisone, her usual incontinence, that was controlled by Proin, has increased tenfold. She has to wear diapers all day inside the house, and at night we sleep on a waterproof blanket with a bunch of towels and another super fluffy blanket on top. This is obviously the least of my worries, but I look forward to being able to get her off prednisone because she HATES wearing diapers, even though she looks adorable in them. On bad days, she has to have them changed four times. Sometimes, though, only once.

Since moving, I’ve been cleaning houses regularly, and participating in clinical trials, for money. I’ve spent just about $3,000 on figuring out a diagnosis. Treatment, plus her regular medications, and the diet I’ve got her on now aren’t going to be easy for me to keep up with financially, especially since I’m trying to save for a car and tiny house on a deadline. I’m still working on getting a job in the medical billing and coding field, and almost have my second certification, but in the meantime, I’m asking for help.

I want to help my girl live as happily and healthily for as long as I can. If you can donate or get stuff from her wishlist, anything is greatly appreciated. Prayers and good thoughts are most welcome, and if you want me to pass along some love to her, I’ll gladly do that too.