As veterinarians, we are often asked by clients struggling to make a decision regarding their pets care “What would you do if this was your pet?” This is a fair question – after all, not only are we veterinarians, we are pet owners and lovers as well. We know what it is like to have four legged family members who integrate themselves completely and inextricably into the fabric of our daily life. This is not to say that what we would do for our pet is always going to be the best course of action for you and your pet – there are so many other factors that come into play – but sometimes we might be able to offer a somewhat unique perspective based both on clinical and personal experience.
Because of this, we have decided to share a very personal story. As many clients know, our (Dr. Gary Palmer and Dr. Robin Lewis-Palmer) dog is Piper – a six year old half Australian Shepherd half Standard Poodle (an Aussiedoodle!). Pictures of her populate our waiting room, our website, our Facebook Page and Twitter. She is funny, affectionate and lovable – like living with an overgrown muppet or Sesame Street character – and she is very much a part of our family.
Several weeks ago, we started to notice some subtle changes in Piper. She seemed to lose interest in her breakfast of dog food. Initially, we were not overly concerned since she was otherwise acting normally. Then, we noticed a sudden and dramatic increase in the amount of water she was drinking and the amount she urinated – she even had a couple of accidents in the house. Blood and urine tests revealed that Piper had a high calcium level (hypercalcemia), a slightly low white blood cell count and very, very dilute urine. The high calcium level explained the increased thirst and urination but we were not certain what was causing it to be so high. Many things can cause a pet to have a high calcium level including toxins, endocrine or hormone problems, too much Vitamin D, some fungal infections and unfortunately, some forms of cancer (para neoplastic syndrome). To try and find the source of Piper’s high calcium levels, we began to systematically perform further blood tests, x-rays and ultrasound examinations – and while they showed persistent high calcium, low white blood cell count and dilute urine concentration the tests did not reveal a specific cause.
By this point, we were very concerned that Piper had something serious going on. Wemade the decision to take her to Michigan State University Veterinary Teaching Hospital in Lansing, Michigan to be assessed by an internal medicine specialist. Many Canadians are familiar with the University of Guelph Teaching Hospital – MSU VTH is an equivalent institution also staffed by a distinguished team of veterinary specialists and researchers. Both institutions have wonderful reputations for providing advanced diagnostics and care. We chose to go to MSU VTH simply because it is closer and easier to get to from Sault Ste. Marie.
At MSU VTH Piper was examined by a health care team including vet students, interns, residents and internal medicine and oncology (cancer) specialists. Further blood work and diagnostic tests were performed including ultrasound guided biopsies of lymph nodes, internal organs and a bone marrow aspirate. Samples were sent to Colorado State for even more advanced (PCR) testing. These further tests were able to give us an answer but the news unfortunately wasn’t good. Piper was diagnosed with T-Cell Lymphoma – our sweet girl has cancer.
Lymphoma is a type of blood cancer involving a type of white blood cell called lymphocytes that we see not uncommonly in pets. In Piper’s case it has spread to the bone marrow. It is not curable. Even with aggressive chemotherapy, Piper’s projected survival time is approximately six months.
In a word, it is heartbreaking. It is a devastating diagnosis for a relatively young dog (6yrs.) that up until this point has been very healthy. After discussing treatment options at length with the veterinary oncologist, we have decided to treat Piper with a chemotherapy regime that we are both familiar with and has been found to be well tolerated by patients (CHOP or Madison Wisconsin Protocol). We know this regime involving four different drugs will not cure Piper but we are optimistic we can make her feel good and put her into remission for a few months. In other words, we are trying to “buy” her some good quality time.
It has now been five weeks since Piper started her chemotherapy and she is doing very well. She actually feels good! Her appetite has returned (she will raid both the kitchen counter and the garbage can given the chance) and her white cell counts and calcium levels are normal – no more accidents in the house. She is happily soaking up extra attention and affection and she still insists on riding shotgun. To Piper’s delight, manners have becomes secondary. She now unapologetically begs for (and often gets) tidbits of table food and no one complains when she jumps on them in overly enthusiastic greeting. Realistically, we know this won’t last but as long as Piper is enjoying life, we will keep going with the treatment. We will make the most of each day we have together.
It’s time to go – Piper wants a belly rub 🙂
In “When the Vets Pet Gets Sick – Piper’s Journey” we shared the story of our own beloved dog Piper and her devastating diagnosis of Lymphoma.
It has now been two and a half months since her diagnosis and starting on an aggressive chemotherapy protocol and we are pleased to report that Piper is doing very well. She seems to feel really good! Her blood work is within normal range and her appetite is very good. She now weighs more than she ever has in her life – she actually has little tummy rolls. Her energy levels are very good – she still gives overly enthusiastic greetings to anyone stopping by, she tries to initiate play with the cats ( they are not always willing participants)and it is impossible to get out the door without her insisting on coming along to ride shotgun.
The one side effect of the chemotherapy that we have noticed is the dramatic change in her hair coat. Being half Australian shepherd and half poodle, she has always had a poodle type coat and has had long fluffy/curly hair that we have had to have regularly clipped. As a tiny puppy she had beautiful blue merle colouring but it faded out early on to a light grey/cream. As a result, she has always looked more like a poodle than like an Australian Shepherd. About a month ago, she started to lose the hair on her face, neck, lower back, abdomen and tail. What is interesting is the way her hair is growing back on her face – short and a lovely dark copper and blue merle. Finally, after six years, she is starting to look like an Australian Shepherd!
While we are very pleased with how Piper is doing, her quality of life is excellent; it unfortunately does not change her long term prognosis. The expected survival time with this form of cancer even with treatment is six months. Knowing this makes us cherish each day we have with her. We are all looking forward to Christmas together. Piper is all ready – sporting a bright red sweater and her Christmas bling collar 🙂
We are happy to report that Piper is still doing remarkably well with her chemo treatments. She is now into her 5th month of treatment for lymphosarcoma (cancer of the lymph nodes) and other than a dramatic change in her hair coat, you would never know there is anything going on. She is still very much herself and doing her normal things – eating well and leaving a trail of toys around the house. She weighs more than she ever has and her blood work is all within normal limits. She can still run like the wind and torments the cats on a daily basis. In other words, her quality of life is excellent so far and we are very glad we have made the decision to treat her. It is not a cure but it is giving us extra time (good quality time) with her that we otherwise would not have.
We are following a chemotherapy regime (modified Wisconsin CHOP protocol) that involves four different drugs given on a rotating basis. Initially, the treatments were once a week but now they are given once every two weeks. Piper is an excellent patient and is very co-operative – lots of tasty treats make the treatments a little more pleasant.
As mentioned, the biggest change we have noticed is in her coat. Being a “Doodle”, Piper has always had a very full light coloured poodle coat that gave her a teddy bear or muppet like appearance. Since starting chemotherapy however, Piper has lost most of her fuzzy coat and it has been replaced by shorter and much darker hair. You can now see her blue merle colouring – she actually looks like an Australian Shepherd! Because her new coat is so short, she does get cold – no problem though – she is acquiring a lovely collection of sweaters.
It has been over six months now since we (Dr. Gary Palmer and Dr. Robin Lewis-Palmer) diagnosed our own dog, Piper, a six year old Aussiedoodle, with lymphoma. Although it has been a devastating diagnosis with no cure, we have been treating her with chemotherapy to “buy” her as much good quality time with us as possible. Overall, other than the surprising change in hair coat colour and texture, she has tolerated chemotherapy remarkably well.
With the original chemotherapy protocol, we were successful in putting her into remission for six months and she has enjoyed an excellent quality of life throughout. A few weeks ago however, we started to notice Piper drinking more and her appetite was starting to decrease. Unfortunately, her blood work indicated that the chemotherapy was starting to lose effectiveness – she was no longer in remission.
After consulting with a veterinary oncologist, we stopped the series of weekly injections Piper was getting and started her on a different chemotherapy agent called Lomustine plus prednisone. Piper started to feel better almost immediately – and since this protocol just involves giving pills hidden in treats she is quite happy to get her treatments. She is back to her old self of tormenting the cats, stealing their food, riding shotgun in the car and asking for belly rubs 🙂
Once again, we know this is not a cure – but we take each day at a time and are grateful for every “good” day we have together.
With heavy hearts, we said goodbye to our much-loved Aussiedoodle, Piper, on Saturday, May 31/2014. We had diagnosed Piper with Lymphoma, a form of cancer of the white blood cells, in September 2013 and she had been on chemotherapy ever since. Piper tolerated the chemotherapy remarkably well and lived an excellent quality of life for the past several months. When the drugs stopped working and she came out of remission, the change for the worse was dramatic and undeniable within 48 hrs. By this point, we had exhausted all reasonable treatment options and it was clear that euthanasia was the kindest thing we could do for her. As difficult as it was to actually do, we knew it was the right thing.
Last fall, we were devastated by her diagnosis – she was only six years old and it seemed so unfair that such a good dog could be cut down in the prime of her life like that. We are grateful however, for the chemotherapy protocols that gave us a wonderful extra eight months with her. We knew from the beginning that it would not cure her but that it could Piper April 2014 webprovide her with good quality time and it really was ‘good quality time’. Within days of starting the treatment protocol her appetite and energy levels improved significantly. The biggest side effect we saw overall was that she lost most of her light grey hair coat – but it grew back in a pretty dark tan and steel grey and for the first time in her life she looked more Australian Shepherd than poodle. She acted so energetic and happy that it was hard to believe she was sick – she certainly didn’t seem to think she was! We feel very good about having made the decision to pursue chemotherapy for her.
As the days pass, the reality of her being gone is slowly starting to sink in. The house seems empty without her enthusiastic greetings or the gentle thump, thump of her tail letting us know where she was. She approached everything with enthusiasm and made the most mundane daily tasks seem like fun. She loved people, never even remotely considering the possibility that she might not be included in whatever activity was taking place or that someone might not be as absolutely thrilled to see her as she was to see them. We had a magnet on our door that said “Beware of the Aussiedoodle” and friends and relatives came to know that a visit to our house or a ride in our car likely meant having Piper plastered to their side or demanding belly rubs – fortunately most didn’t seem to mind. She also provided tremendous comic relief – you just couldn’t look at that face and stay sad or angry. She tried very hard to ‘talk’ to us with various barks, woofs, rumbles and comical sounds – we always thought someday we would figure out what she was trying to say 🙂 Piper was a unique, lovable, huggable character and she was very much a part of our family. She will be missed more than words can say.
R.I.P. Doodlebug ♥