March 19, 2019

Margarita is a very special and complex case considering she has significant liver and intestinal diseases.  This does not allow us to deviate from her special diet, and limits some of our options. After much discussion with our primary veterinarian, Dr. Campbell, (who I would trust with my own life – they just don’t make women/people/doctors like her anymore!!) we have decided that Rita’s best chance of survival is to undergo at least one round of chemotherapy – IF her compromised system can handle the complete round.

We met Margarita’s oncologist, Dr. Rebecca Risbon, at Veterinary Specialty and Emergency Center (VSEC).

Based on the tests, Dr. Risbon explained that Margarita has been diagnosed with Stage IV A Lymphoma. Since her bone marrow was not tested, we are unsure if the cancer is present in her bone marrow. Chemotherapy is suggested because of this.  The staging chart is below, with Rita’s stages in bold.

Stages:

• Stage I:  Cancer involving one lymph node
• Stage II: Cancer involving more than one lymph node but on one side of the diaphragm
• Stage III: Generalized lymph node involvement
• Stage IV:  Spleen or liver involvement, with or without the previous stages
• Stage V:  Bone marrow involvement

Substages:

• Substage A: Absence of clinical signs of illness
• Substage B:  Presence of clinical signs of illness

The good news is that Rita has a couple of prognostic factors in her favor.

• Her cancer is B Cell (T Cell is even more aggressive than B Cell)
• She is not Stage V
• She is Substage A
• Her calcium is normal

Without further treatment beyond the Prednisone she was on, Rita’s survival time would be about 1-2 months.  If we began chemotherapy, Rita has a chance of surviving approximately 12-18 months.  There was no question that we were opting for the chemotherapy.

With Rita’s Stage of Lymphoma, research has determined that the best results have been achieved with protocols that combine the 4 most effective agents against lymphoma:  Vincristine, Cyclophosphamide, Doxorubicin (Adriamycin), and prednisone.  This is referred to as CHOP-based protocols).  In most cases, the CHOP-based protocol used on dogs with Stage IIIA or IVa Stage Lymphoma produces an 80-90% remission rate, an average disease-free interval (1st remission) of 9 months, a median survival rate of 12 months, and a 20-25% survival to 2 years.

Margarita’s chemotherapy plan is 16 weeks.  The hope is that her liver and intestinal issues are not going to hinder this plan’s completion.

She will be seen on a weekly basis so that she may be evaluated for improvement and toleration of the treatment itself.

Today Margarita received the following:

• L-asparaginase @ 400IU/kg
• Vincristine @0.5mg/m2 IV
• Prednisone @ 2mg/kg PO/day until next week’s visit

Due to Margarita’s other health issues, Dr. Risbon recommended keeping Rita on the prescription GI diet.  She also recommended to add fish oil back into her diet.  Dr. Risbon told us that fish oil as a supplement has been shown to improve survival times slightly in dogs with Lymphoma.

I promised Rita that we would do something special each week right before or right after her treatments.

This week she got to enjoy a couple of McDonald’s fries!

(Don’t worry – she only had a couple!)

Margarita is scheduled for her second visit with Dr. Risbon next week.

Thank you for joining Margarita in her journey to take a bite out Lymphoma.