Cancer.

Such an ugly word.

Daisy.

She is not this.

She is my Daisy dog. Muffin of love. Angel pup. Baby dog.

This is Daisy.

– MARCH 1, 2007, JOURNAL ENTRY

The diagnosis was frightening, raw, overwhelming.

Lymphoma.

It was as if all knowledge fled as the words washed over me.

Then I heard “chemotherapy” and it echoed in my head.

But as I began to comprehend, I latched on to the thread running through it all.

A thread of hope.

It began a 48-hour stretch that was shocking because of the change it wrought in one very sick animal: my dog, Daisy.

The diagnosis

After nearly a month of conflicting test results and increasingly worrisome symptoms, Daisy’s regular veterinarian, Dr. Wendy Shepard of the Corinth Veterinary Clinic, set up a consultation with Dr. Chris Miles, then practicing at Kindred Spirits in Orrington, in an attempt to get a definitive diagnosis. Miles suggested taking several needle aspirations – a type of biopsy without the need for general anesthesia – of Daisy’s swollen lymph nodes. The results were expected to take two days, but she suggested Daisy go the next day to the Veazie Veterinary Clinic, where more tests could be performed.

There we met with Dr. Stephanie Monk, who in her six years at the clinic has pursued an interest in oncology. She outlined what tests were needed to determine Daisy’s situation and a short time later called with the details: An ultrasound showed an enlarged liver, problems with the spleen and fluid around her lungs. An X-ray showed spots around her lungs. She called it “a heavy tumor load.”

Monk then gave the options: Do nothing, knowing her prognosis was poor; start Prednisone, a steroid that might give her a few more weeks because it can knock lymphoma into remission, although usually short-lived; or begin chemotherapy.

Chemotherapy could extend her life. “The median survival time is around one year, with 25 percent or so going to two years,” Monk said in an interview for this story. “When you consider that quality of life within that time is generally very good, and without treatment most dogs will succumb within about six weeks, it becomes a nice option to have.”

On the afternoon of March 1, Daisy started chemotherapy.

The first 24 hours

Daisy’s first chemo drug was Elspar (common name L-asparaginase). She was on an intravenous drip to help keep her system in balance as the drug did its work killing the cancer cells and because she had an abdominal tap to drain some of the fluid that her organs could no longer process because the cancer was so far advanced.

She spent the night at Eastern Maine Emergency Veterinary Clinic in Brewer for monitoring and to keep the IV going. I went to see Daisy at about 10 p.m. and noticed she was breathing more easily. But something else seemed different. I felt the lymph nodes in her neck – Stephanie, as her chemo clients usually call her, had shown me what to look for – and they felt squishy, not hard. And then there was the little goose-egg lump under her right eye that had developed in December.

The journal entry I recorded said it all: “The weirdest thing is the bump/lump under her right eye. It has almost completely disappeared.”

The next morning, Daisy returned to Veazie where she began a dose of Prednisone, part of the first few weeks of the 26-week University of Wisconsin-Madison protocol, Monk’s preferred chemotherapy treatment plan “because it tends to provide remission times that are among the longest and is defined timewise. Some go on indefinitely.”

Daisy had another abdominal tap, and she started taking an antibiotic because she had some nasal discharge. She would stay another night in Brewer for monitoring.

And the results of the biopsies came in. It was lymphoma.

48 hours later

Saturday morning I arrived at the Veazie clinic to take Daisy home.

She was wiggling and wagging. Her nodes felt completely different. She seemed completely different.

Her body was no longer dying.

We went home with a bag full of medicine and plans to start weekly treatments the next Tuesday.

I walked with Daisy across our backyard, where new-fallen snow glittered in the March sunshine. My journal entry was succinct: “The new snow is fluffy – Daisy’s favorite. As we walked, I realized the d-o-g wasn’t beside me. I turned to see her take a header into the snowbank, rubbing and then rolling and kicking her feet in the air. She did it again on the way back to the house.”

It was less than 48 hours after she had received her first chemotherapy drug.

The treatments

The first weeks of chemotherapy had their difficulties. Daisy’s white blood cell count dipped one week, postponing treatment for a week until her body could build up its defenses again. She became mildly anemic for a while, a relatively common occurrence during chemotherapy. She had minor bouts with diarrhea as her system adjusted to eating again (we had to force-feed her at the height of her illness) and as a result of the antibiotics and possibly the chemo agents she had to take that first month.

But less than two weeks after her initial diagnosis, Monk did more tests and told me Daisy was in remission. That means, she said, “there’s no cancer detectable in the body.”

After about a month, the treatments were pretty much smooth sailing.

“When most people hear the word ‘chemotherapy,’ all they can think about are the horrible side effects like losing hair, feeling weak and sick all the time, wasting away,” Monk said. It is different with the pet population.

“Quality of life is of paramount importance,” she said. “We feel we’ve failed somewhere if a pet feels sick. We can’t explain to them that they’re going to feel icky for a while but the benefits will be worth it. Most patients really do cruise through.”

Daisy did and had a ball doing it, greeting every clinic worker with unabated joy during her weekly appointments. Her regular team included Darby Tarr, a licensed veterinary technician with a special interest in oncology, and Karen Golden, a veterinary assistant. Both would send her into bouncing delight every week, despite the fact that Darby was the person poking her with needles more than once every visit. Everyone else knew Daisy by name, too, and I found out she was making the rounds during her stays, getting “cookies” and visiting throughout the clinic.

The outlook

Daisy likely will relapse, although according to Monk, there are a few dogs that appear to be “cured.” If she comes out of remission, chemo remains an option, “but second and third remissions tend to be harder to achieve and don’t last as long,” she said.

Meanwhile, Daisy will visit Monk for monthly checkups. She already has breezed through two with no signs of any node trouble.

Her next visits, however, will be at the new Lucerne Veterinary Hospital on Route 1A in Dedham, which opened this week. The partners are Stephanie Monk and another of Daisy’s doctors, Chris Miles. And she’ll get to see Darby, too, who decided to join the LVH staff.

The final word

Daisy’s last treatment was Aug. 29.

It was then that Monk told me she initially didn’t think Daisy would make it through that first night if we had waited for the lab report results before moving forward with the chemotherapy.

In the interview for this story, I asked how she would describe Daisy’s situation for another owner contemplating chemotherapy. She said:

“Although she didn’t read the textbook, was as sick as sick gets with lymphoma and was standing just this side of the pearly gates, she’s a stunning example of how we just can’t predict which individual will pull back and go beautifully into complete remission. … The ones who feel sick at first tend to not respond as well overall, but she got one dose of Elspar and started trotting – no, sprinting – away from those gates. ‘Crazy Daisy’ doesn’t just describe her goofy personality, it summarizes her case pretty well, and highlights that with cancer, sometimes you just have to try. You may be surprised.”

What is lymphoma?

Lymphoma is a highly malignant tumor of the lymphatic system and is the most common form of cancer in humans and small animals, according to The Pet Health Library, part of the Veterinary Information Network. Lymphatic tissue is found in virtually every organ in the body.

Cancer occurs when a normal cell “goes wrong” and begins to divide rapidly and without control. When cells become cancerous within a lymph node, the node swells and hardens and malignant cells travel through the lymphatic system to other nodes. Soon, all of the nodes are enlarged.

“The most common presentation is that some or all of the peripheral lymph nodes – those you can feel during a physical exam – are larger than normal,” said Dr. Stephanie Monk. “Often, owners don’t even know anything is going on until they feel ‘lumps’ under their dog’s jaw.”

Janine Pineo’s e-mail address is jpineo@bangordailynews.net.