One evening this past January, we went to bed not knowing we would wake up to what would lead us to later “accidentally” discover that our Margarita has Lymphoma.

January 7, 2019

In the middle of the night, on January 7th, Margarita jumped-up out of a sound sleep and hopped off our bed.  She went to the bedroom door and proceeded to urinate on the floor.  This was not like her at all.  We questioned ourselves – “Did we forget to let her out before bed?” We took her out into the yard, and watched her urinate several times… “Must be a urinary tract infection!” we said.  We also observed that she seemed a bit out of sorts, and just stared off in to the empty yard.  The next morning though, she seemed fine, and was not urinating more than normal, so we did not think a call to our veterinarian was necessary.  The next night, we were woken up once again by the sound of Rita frantically jumping up and running for the bedroom door.  This time, she defecated on the floor!  We didn’t know WHAT to think at this point.  You may be reading this thinking – “What’s the big deal?” – dogs have accidents, end of story.  NOT this dog, and NOT in the middle of the night.  Rita lives for her beauty rest.  Rita does not EVER get up in the middle of the night, other than to switch sleeping positions.  By the end of the night on Tuesday, January 8 and into the morning on Wednesday, January 9, Margarita again began to urinate very frequently – much like the symptoms of a urinary infection.  She also seemed lethargic, and less interested in food (DEFINITELY not like Rita at all).  Wednesday morning we called our veterinarian, Dr. Campbell, and made an appointment for that night.

January 9, 2019

I drove Margarita to the vet on Wednesday evening expecting for a quick appointment with Dr. Campbell telling me that Rita had a urinary tract infection.  A urinalysis was conducted at the visit – and Rita did, in fact, have blood in her urine, and was given Cephalexin.  Margarita’s gums were also very pale and tacky, and her temperature was low.  Margarita was screened for tick-borne diseases, and this was negative. When I began describing other some of the other unusual-for Margarita-behaviors, Dr. Campbell asked if I would be OK with her doing a quick ultrasound on Rita.

When Dr. Campbell returned to the exam room with Rita, I could tell by her face I was not going to like the news of her findings. What was seen on the ultrasound was what looked to be a mass on her spleen.  A full panel of bloodwork was done on Rita.

• CBC / Blood Smear In-House
• IDEXX Total Health

The bloodwork results showed that her liver values were elevated, and that she was anemic.  Dr. Campbell immediately referred us to get an ultrasound with a specialist at Veterinary Specialty and Emergency Center (VSEC).

During this time, I had elected to put Margarita on “temporary retirement” from visiting my school as the District Therapy Dog.  I had not given any of the details to the students, but I did tell them she was not feeling well.  One of my very thoughtful students brought in a gift for her.  Inside the bag was a bone and sweet get-well note.

Margarita enjoyed her treat when I went home for lunch that day.

January 10, 2019

Rita was seen for the ultrasound at VSEC on January 10th, where a full abdominal ultrasound was done by Dr. Ana Caceres.  A splenic mass measuring approximately 2.5 cm in diameter was seen, but Dr. Caceres felt like the mass was unlikely to be the primary cause of Rita’s symptoms.  Dr. Caceres recommended that we pursue further evaluation regarding her urinary tract.  The following test were done in addition to the ultrasound:

• SNAP-4DX (Lyme/HW/Anaplasmosis/Ecanis)
• Sterile urine culture
• Urine protein / Creatinine ratio

Dr. Caceres referred to see an Internal Medicine doctor.

 

January 12, 2019

Dr. Campbell, our primary vet, did chest x-rays on Rita, which thankfully came back clear.

January 16, 2019

Margarita saw the head of the Internal Medicine Department at VSEC, Dr. Alan Klag. Dr. Klag did an exam and ran some blood work and took a sterile urine sample.  Although a recent urine culture taken at our primary veterinarian’s office was positive for Staphylococcus pseudintermedius, Dr. Klag did not expect that to cause the current clinical signs unless the infection was in her kidneys – but even then he would not expect the anemia, hypoalbuminemia, and increased  ALT that were present in her bloodwork.   Dr. Klag ran the following tests:

• PCV/TS
• Mini Liver Panel

Dr. Klag decided to treat the urinary tract infection with Enrofloxacin .  Dr. Klag suggested that considering the other symptoms we are observing, Rita could be experiencing some small repeated bleeding incidents from her splenic mass. It was suggested that we consult with a surgeon to discuss the biopsy of the splenic mass and/or a possible splenectomy.

January 25, 2019

Margarita had some more blood work done with Dr. Campbell to re-check her liver levels.

• IDEXX Catalyst Chem 10 CLIP
• PCV (Packed Cell Volume) / TS
• IDEXX CBC, Comprehensive

January 30, 2019

We were still observing a bloody discharge from Rita’s rear-end.  Because of this, several stool samples were sent out to Texas for a Fecal Alpha Proteinase Inhibitor test .  The concern was that Rita had a GI disease where proteins could be lost into the gastrointestinal lumen.  Gastrointestinal protein loss can be associated with a variety of gastrointestinal and systemic disorders such as:

• idiopathic inflammatory gastroenteropathies
• gastrointestinal neoplasia
• foreign bodies
• intussusceptions
• small intestinal bacterial overgrowth (SIBO)
• infectious enteritis
• immune-mediated diseases
• intestinal lymphangiectasia.

Margarita’s fecal tests came back negative.

February 14, 2019

Margarita was still exhibiting the same symptoms, and saw the surgeon on February 14th.  We met with Dr. Jennifer MacLeod to discuss Margarita’s case.  Dr. MacLeod felt that it was unlikely that the splenic mass was malignant. However, both benign and malignant splenic masses can appear identical on ultrasound, x-rays and even during surgery.  The only way to accurately diagnose the type of mass is with a biopsy.

Dr. MacLeod also felt as though there was a low chance of the mass rupturing, but because this can be very unpredictable, it should still be considered a risk. Both benign and malignant masses can rupture and bleed into the abdomen, which is a life-threatening condition that requires emergency surgery.

Margarita’s lethargy was still a bit of a mystery.  Dr. MacLeod felt that a liver biopsy may provide a cause for her increased liver enzymes, which could be related to her lethargy.

Due to the clinical changes and the splenic mass, Dr. MacLeod recommended exploratory surgery to remove the spleen, and do biopsies of Rita’s liver, and intestines in order to obtain a more definitive diagnosis.

February 21, 2019

Margarita had her surgery and biopsies.

The day Margarita went to the hospital for her surgery, a friend of ours sent her a Get-Well-Soon package from Chewy.com!

I could not believe this HUGE package of goodies for Rita!

Margarita had to stay the night at VSEC for monitoring, and was able to come home the next day.

February 22, 2019

On her way home from surgery:

Settling in at home after surgery:

Margarita had some difficulties the first few days, but overall, recovered well, and in about 2 weeks seemed more like herself again.

We set up a special “recovery room” so that our other fur-kids would not bother Rita while she was healing.

During her recovery she received gifts, flowers, and well wishes from so many people!

We were overwhelmed with the support, concern, and love our baby received.

Margarita with her card and gift from our neighbor:

Margarita’s “main-man” Mr. Spock the English Pointer sent her a beautiful bouquet of flowers:

 

February 27, 2019

On the morning of February 27th, we received the news that no one ever wants to hear.. there were malignant cells found in Rita’s spleen.  They were round cells, which indicated a type of Lymphoma. Additional tests would have to be run on the biopsies to identify what kind of Lymphoma it was.  But that wasn’t all.

Although malignant cells were not found in Margarita’s liver and intestines, she also had concerning diseases in both.  Her liver showed inflammation patterns that represented chronic hepatitis.  Despite her prior negative Fecal Alpha Proteinase Inhibitor test, her intestinal biopsy showed a severe degree of inflammatory bowel disease, causing the loss of proteins.  Without these two significant issues under control, Margarita would not be able to handle cancer treatment, if needed. Margarita was put on steroids, and her diet was changed to a GI-specific diet. The symptoms we had been seeing in Rita were not necessarily from the cancer itself – so we were very lucky in a way to have discovered ALL of this before it was too late.

We ordered the additional immunohistochemistry, for all previous biopsies, and anxiously awaited the results.

March 13, 2019

The detailed results and diagnosis came back to us in the afternoon on March 13th.  It was then that we found out Rita has Diffuse Large B Cell Lymphoma. We also learned her lymph node, liver, and intestinal biopsies thankfully did not show signs of the cancer spreading at this time to those areas specifically.  Unfortunately, even after malignant tissue is removed, the cancer may have already spread microscopically to other areas.  Since the cancer was detected in the spleen, which filters the blood, there is a concern that the cancer could now be present in her blood and bone marrow.

Dr. Campbell referred us to see the oncologist at VSEC.