Dena had cancer
I got a call from our vet yesterday afternoon. He got back the pathology report, and it turns out that she had lymphoma. He didn't check her brain or bone marrow, but it didn't matter, there was enough information from her organs. There were no signs that she was sick up until 4 weeks ago, but apparently she had been, we have no idea how long. There were small tumors in her liver, her lungs and her kidneys. At the end she developed DIC, disseminated intravascular coagulation, a clotting disorder that is a complication of some cancers, infection, liver disease, and even blood transfusions, causing internal or external bleeding. Her heart had hemorrhaged, which is what probably finally killed her.
On an earlier visit, cancer was mentioned as a possibility – he said it’s always on the list, but it was low on the list because we had all these other symptoms that led in a different direction. And potentially obvious signs, such as enlarged lymph nodes, were not apparent. Her white cell count was on the low end of the normal range, as were her lymphocytes. He believes whatever she ate caused an insult to the digestive tract and all these other symptoms – the fever, the diarrhea, the autoimmune anemia, and because she was already sick, it overwhelmed her system. But she would have died young in any case.
Having answers is always better than no answers, and it does help to the extent that I can let go of the regrets that we didn't do enough - more tests, more treatments, none of it would have made a difference, she was not going to recover from this. I did some reading about lymphoma last night, and although I haven't discussed it with the vet yet, it seems like it was a catch 22 situation. You need to boost the immune system to fight lymphoma, but her immune system was killing her red blood cells and platelets. You need to suppress the immune system to reverse that process, but then the lymphoma is unchecked. I don't know if that's exactly what happened, but it seems like treating one problem would hasten the progression of the other, no matter which problem we treated.
If she hadn't gotten sick a few weeks ago, her lymphoma may have been undiagnosed awhile longer, until she started showing symptoms. Untreated, dogs typically last 4-6 weeks after diagnosis. With treatment they can go into remission for 6 months, a year, a year and a half, but most do not last much longer than that. I would have gladly taken that extra time with her, but it wasn't in the cards.
Dr. Schuchman has spoken to an oncologist, and is waiting to hear back from another specialist. I know he wanted to save her, and is trying to find out what happened, if there was anything that he missed that should have led him in that direction. He's doing this on his own, we had actually decided not to request a necropsy, partly due to the expense - it's one thing to spend thousands of dollars to make your dog better, but another thing entirely to spend thousands of dollars only to lose her, and then spend more, but also I was afraid to find out that a decision that we made may have caused her death. So it's comforting to know that there wasn't anything more we could have done, but it makes me incredibly sad to know that she was always doomed to live such a short life.
We need to go back to settle the bill, (although I have a feeling we won't be charged for a lot of stuff), and to pick up her bed, so I'm going to make sure that we go when Dr. Schuchman is there so we can talk with him and ask more questions. I'd like him to go over it with Tom there too because I know I missed a bunch of stuff the doctor said. I tried to take notes, but there were medical terms I'm not familiar with, and I think he'll want to ask questions of his own.
Keefer 8/25/05-4/24/19 ~ The sweetest boy
Halo 11/9/08-6/17/18 ~ You left pawprints on our hearts
Dena 9/12/04-10/4/08 ~ Forever would have been too short