Canine Lymphoma | Apollo’s Experience

Hey dog people! Today we’re going to cover the heavier topic of canine lymphoma, in hopes that we can be a resource to other dog parents who (unfortunately) might experience what we have.

As most of y’all may know, Apollo was diagnosed with lymphoma a few months ago and we finally feel like we have a handle on just about everything that comes with that.

Now, this post is meant to help anyone who may be going or might go through this at some point. I will warn you: it’s long, emotional and informative. But, if it helps just one person then I don’t care if everyone else simply skims through and looks at the pictures.

WARNING: some of the images in this post might be uncomfortable to some people and feature needles, medication, etc.

Canine Lymphoma

Canine lymphoma accounts for 15-20% of new cancer diagnosis in dogs, generally affecting middle to elderly-aged dogs. But we never would’ve thought it would be affecting our otherwise healthy four-year-old Great Dane.

Diagnosis is generally easy — palpation of the lymph nodes can determine whether or not they are swollen, and fine-needle aspirates (FNA’s) can be done to draw a sample of the cell to send of for testing.

If there’s one thing you draw from this post is to please pay attention to your gut and be extra vigilant with your dogs. Only you know them best, so if you think something doesn’t feel right, a trip to the vet will help put everyone at ease and could potentially catch something so malignant as early as possible.

Lymphoma Diagnosis

Last November, my husband and I were on trip to Denver with Apollo when I noticed his lymph nodes were very swollen. I didn’t think much of it, he had just flown on a plane for the first time and I wasn’t even sure it was his lymph nodes and not his salivary glands. But I kept a close eye on him and his behavior to make sure nothing else weird was going on.

Aside from the swollen nodes, he was acting totally normal and was loving his time in the snow. Due to him being asymptomatic, I texted Dr. Lassin (our phenomenal vet) to get a second opinion. He said it was likely fine but to bring him in for an appointment when we got back if I was concerned.

But my gut was in knots. Something didn’t feel right. I made an appointment and drove straight from the Austin airport to Dr. Lassin, who confirmed our worries. It was, in fact, his lymph nodes that were swollen, and none of the reasons why were necessarily good.

After over six years of working as a veterinary technician, I was expecting something like this. But all of that experience never prepares you for when it’s your own dog. The word cancer is all you seem to hear.

We did FNA’s of both of his submandibular (under his jaw) lymph nodes to send off for testing, as well as bloodwork to ensure it wasn’t a tick-borne disease. And then it was just a waiting game.

It felt like years had gone by (it was less than 24-hours) when we got the call: Apollo had lymphoma. A progressive form of cancer that takes the lives of many pups. Our hearts broke into a million pieces.

Life After Diagnosis

I think I spent the first 48-hours crying. I couldn’t believe this was happening. How could it be happening? He was only four… we had so much left to do! I kept repeating “no, why” over and over to myself.

Thankfully we had such an amazing support system and I caught the swelling early enough, so we got started on treatment immediately. We set up an appointment with one of the best oncologists in town, Dr. Stein at Austin Veterinary Emergency and Specialty (AVES).

In the meantime, we took Apollo back to see Dr. Lassin, who had seen his share of canine lymphoma cases and began running some preventative tests:

• Radiographs of his whole body, to check that cancer hadn’t spread to any of his other organs.
• An ultrasound to do a finer check of his organs as well as monitor the swelling of the other, non-palpable lymph nodes.
• The PARR test, a pathology specifically meant to check the cell sample of the tumors and find out which type of cell it was: B-cell or T-Cell.

Dr. Lassin also recommended starting him on a low-carb, ketogenic diet and some Chinese herbals, both of which we began almost immediately. Thank dog for integrative medicine. More on that below.

B-Cell Lymphoma vs T-Cell Lymphoma

Let me start out by saying that while I had 6+ years of training, I am not a doctor. So please take everything I say with a grain of salt and know that should you, unfortunately, go through what we did, your veterinarian and oncologist will have all of the correct information to get you through this.

B-Cell lymphoma is what we were hoping for. It tends to have a much better prognosis than T-Cell and generally responds better to chemo. More on his prognosis below.

Initial Oncology Visit and Prognosis

Just two days after his diagnosis and five days after I initially noticed the swollen nodes, we were able to get in to see our oncologist. My advice? Go see a specialist as soon as possible. Lymphoma is fast-advancing cancer, so even if you’re not planning on doing chemo, the sooner you start any type of treatment the better their chance will be.

Our oncologist was very nice and straight to the point. Knowing I had an extensive veterinary background, he lost no time with formalities and went straight into what mattered: making sure our boy was happy and healthy for as long as possible.

We were told that b-cell was the best-case scenario. That the average lifespan of a dog with b-cell lymphoma was around one year. While the average lifespan of a dog with t-cell lymphoma was only six months.

They gave us the chemotherapy options, the non-chemo options and everything in between. His treatment would largely depend on which type of lymphoma it was, and what we would be able to do financially. But we knew we would do whatever possible to help him.

Thankfully, both chemo options had the first initial treatment, so we started chemotherapy that same day, only two days after his diagnosis. It was probably the easiest decision we’ve made throughout this entire process.

About a week later, we received the PARR results with the news we were hoping: it was b-cell, large-grade lymphoma and we knew we were going to get him through this.

Chemotherapy

Now, let me start by answering the few questions you probably already have about chemo:

• No, they don’t lose their hair. Although a naked Apollo would be quite the sight to see. He is shedding quite a bit more now though.
• Dogs handle chemo sooo much better than humans do. They are so much stronger than we are.

Because of his PARR results, we opted for the CHOP chemotherapy plan. That essentially meant he would get one round of chemo each week for four weeks (with different drugs each week), a break in the fifth week, and then repeat that cycle three more times.

CHOP Protocol

Week 1: Vincristine

• They ran bloodwork to check his organ values and ensure he could handle the drugs.
• The drug was administered via IV by the technicians via catheter.
• It made his breath immediately smell funky and drug-like, something the technician had never heard of before. I was probably just hyper-sensitive.
• They also gave him an injectible anti-emetic to help with nausea, as well as sent us home with anti-nausea tablets and a medication to help with diarrhea, should it occur.
• They warned us that the chemotherapy would be leaving his system for the next 72-hours, so his urine, feces and any vomit would contain the drug. Because of that, they told us to wear latex gloves while cleaning any of those up, as well as to keep him away from playgrounds or areas with children.
• He was also started on a three-week course of Prednisone, a commonly prescribed steroid. Steroids normally make dogs very thirsty, causing them to need to urinate more frequently than normal. Steroids are known for increasing hunger and thirst, so we had to increase the amount of food we were giving him in order for him to maintain his weight. He was ravenous.
• Since this was our initial visit, we were in and out of the clinic in about an hour and 15 minutes.
• Side effects: lethargy for two days, loose stool for three days. 10lbs of weight loss.

Week 2: Cyclophosphamide

• They ran bloodwork to check his organ values.
• The drug was administered orally by an oncology technician.
• They also gave him a diuretic, since this drug targets the kidneys and can cause severe issues if urine sits in the bladder for too long.
• We did not have to give him any of the nausea or diarrhea meds.
• Side effects: none. But we made sure to take him on potty breaks every 3-4 hours.

Week 3: Vincristine (same as the first week)

• They ran bloodwork to check his organ values.
• A technician administers the drug via IV.
• We were able to get his weight back up to normal during the week!
• We were in and out of the clinic in 30-minutes.
• Side effects: lethargy for one day.

Week 4: Doxorubicin

• This is what they call the “hard-hitter”. It’s the strongest of the chemo drugs and generally has the most side effects.
• They ran bloodwork to check his organ values.
• A technician administers the drug via IV for an extended period of time.
• They also gave him the injectable anti-emetic to help with nausea.
• Our technician told us that symptoms are normally just intensified with this one, so to give him the nausea meds even if we didn’t think he needed them.
• We were in and out of the clinic in an hour.
• Side effects: lethargy for about three days, loose stool for about a week. 5lbs of weight loss.

Week 5: Break

• They still want you to go in to get bloodwork to check his organ values.
• This can be done at the specialty hospital or with your normal vet (which is usually cheaper).

Then, start the cycle all over again, three more times.

Overall, we’ve noticed some lethargy on the second and third days after treatment, and extra shedding. But he’s truly handling his treatment like a CHAMP.

Diet

Now we’re starting to get into the Eastern/integrative medicine aspect of things. I know not everyone “believes” in that, but come on. It’s not hocus pocus, it’s real-life medicine that doctors study in addition to basic medical training.

One of the first things Dr. Lassin recommended was for us to get him off his normal kibble and onto a low-carb diet. There are a few companies that prepare ketogenic food for dogs, but the amount of money it would’ve taken to buy enough food for Apollo would’ve bankrupted us. So, we opted to make his own food.

Ketogenic Diet

Why keto? I’ll put it in simple terms for you: carbs feed cancer. Think about it — when you eat carbs you feel bloated. If you feel bloated, it means your insides are inflamed. Cancer is inflammation. So by getting rid of excess inflammation in the body, you’re taking food away from the cancer.

Dr. Lassin provided us with a very clean, very simple recipe that we could make at home. It included equal parts of turmeric ground beef and cottage cheese, with flaxseed, super greens and a raw egg (shell included).

Because of the different nutrition in his new diet, it took a bit of finagling to ensure he was intaking the right amount of calories. After that, we got in the habit of pre-making his food twice a week and pre-packaging it so that it was easier for us to feed him.

Tips:

• Buy the ingredients in bulk from Costco or Sams. It’ll save you money and help you make larger batches.
• Buy (and reuse) Tupperware containers so that you can package their individual meals, saving time in the mornings and at night.
• Crush the eggshell and mix it into their food, the shells have so many more nutrients and minerals than the egg itself.
• If you are having trouble consistently making food, try substituting some of the meals with Bones & Co patties.

Disclaimer: AGAIN, please consult your veterinarian before changing your pet’s diet. Just because this works for Apollo doesn’t mean it’ll work for your dog.

So, Now What?

The first few weeks after his diagnosis are honestly kind of a blur. However, what I do remember were the extensive conversations my husband and I had regarding Apollo. Not the fact that he had cancer, but that our goal was to keep him happy and healthy for as long as he had left.

So, we decided it was best to live one day at a time and simply do whatever possible to ensure he has the best life ever. Whether that’s a few weeks, months, or (hopefully) years.

If you’re going through this, here are a few tips that helped keep us positive:

• Make a “bucket list”, but don’t think about how long you’ll have to help them complete it.
  • Our list includes going back to the snow, going to the beach (check), going on more weekly walks, visiting as many dog-friendly spots as possible, evenings at Zilker Park, a flower-crown session with ZilkerBark and much more. Include things that you and your pup enjoy doing, and just go after it.
• Reach out to someone who has gone through the same thing.
  • One of the first things I did was reach out to a few Instagram acquaintances that I knew had experienced lymphoma with their pups. Speaking to someone that had been in my shoes really helped me stay calm and begin healing. You can always reach out to me.
• Do. Your. Research.
  • Hopefully, this post will help, but try to do as much research as possible about the kind of cancer your pet has. Research gave me a purpose since I was on a mission to find the best treatment option for him.
• Give yourself a few days to mourn, but then pick yourself up and move forward.
  • I know that might sound harsh and a lot harder to say than do, but your dog can sense when you’re upset. I could feel my worried and sad energy pass on to Apollo on those days when I just couldn’t stop crying.

One of the hardest things for me to deal with were the inevitable comments we got from strangers when they saw Apollo. None of them clearly knew that he had just been diagnosed with cancer. So they would come up to us and say “omg, Great Danes die young don’t they?” or “I’ve heard they often have health issues, is that true?”. And while the questions were harmless, it was hard for me to not burst into tears every time I heard that.

Before the diagnosis, I used to love telling people how Great Danes actually have longer lifespans now than they did years ago, mainly from the progression of medicine and the better understanding of the breed. Now, I just simply force a smile and mumble a quick answer to get them out of there as fast as possible.

So, lastly, I’d like to leave some tips for the friends and family of those who may be dealing with a cancer diagnosis of their beloved pet:

• Instead of asking “are you ok?” ask them how you can help or offer to take them out to dinner.
  • Thinking about the fact that Apollo had cancer was when I had my weakest moments. When someone would ask me if I was okay, I nearly burst into tears. Staying busy helped me focus on the greater thing: his happiness.
• Offer to go with them to those first few appointments.
  • I was lucky enough to have my mom and my husband by my side, with my best friend just a phone call away if I needed her. They asked the questions I hadn’t thought of, and together we all left feeling well-informed on how to get Apollo the treatment he needed.
• Offer to have a food making party.
  • I cannot tell you how great it would’ve been to be able to make the first few weeks of his food in one big batch, freeze it, and not have to worry about it. If you can get a few people together to help make, mix and prepackage the food, it’ll take a huge strain off of those initial weeks.
• Stay strong, even if you are heartbroken inside.
  • This may sound selfish, but the last thing I needed was to console other people when I myself was broken. I had a family member call me sobbing when they heart about Apollo, and while I was touched that they loved him so much, the last thing I needed was someone else crying in my ear. If you’re upset, save the phone calls for when you know you can hold it together. You need to be strong for them.
• Do not question their choices.
  • It doesn’t matter if you don’t agree with them. It’s their dog, not yours. I had a few people on Instagram belittle me for putting Apollo through chemo, saying it was cruel. Ultimately, it is their decision on what they do or don’t do, can or can’t do for their pups.

If you’re going or have gone through this, my heart is with you. Dogs are such an unbelievable light in our lives, it’s such a shame that their time on Earth is shorter than ours. But, know that you are not alone — if you ever need to talk, please don’t hesitate to reach out.

With love,
Melanie, GGW Momma