This week marked the passing of a particularly special oncology patient, and I wanted to use this entry as a means to tell his story. It may sound cliché when we say each and every one of our patients is important to us, but it really is true. We do not discriminate, even when our patients literally try to kill us.
But some find a way to squirm their way into our hearts just a little deeper than others, and Bear was one such dog. I’m not sure if it was his incredibly fuzzy and untamable hairdo, or his propensity to bolt out of our chemotherapy room and race down the hallway if you left the door open just a split second too long, or the way he would always find a way to position himself for a nap just behind the wheels of my desk chair.
Maybe it was the fact that Bear had an outstanding appointment with our service pretty much 3-4 times a month over the past year or so for various issues and clinical signs that would probably have been better served by a psychologist than a veterinarian.
Bear was only 5 years old when he was diagnosed with lymphoma, a blood-borne cancer that occurs all too commonly in dogs. Bear’s case was quite unusual: He was initially seen by our emergency service for the acute onset of a severe nosebleed. Nosebleeds can occur in dogs as a result of several reasons, and although cancer would be one potential cause, for a young dog such as Bear, it would certainly not be the top concern.
Bear’s bleeding was so severe he needed to be hospitalized for several days. During this time, he underwent many different tests to try and investigate why it occurred, including blood work, blood pressure testing, a CT scan of his nose, and a procedure called rhinoscopy. This is where a small camera located on the end of a flexible tube is inserted into the nose so the sinuses can be visually examined and evaluated. During these latter procedures, we discovered a mass in the left side of Bear’s nasal cavity and a very enlarged left tonsil. Surgery was performed to remove as much of the mass as possible, and biopsies of the affected tissue showed lymphoma.
Soon after, Bear’s owner met with me to discuss treatment options for his disease. We performed further testing and found no evidence of lymphoma anywhere else in his body. I talked with his owner about how unusual Bear’s presentation was, and how I was always taught by my mentor that "weird lymphomas behave weirdly," which simply meant I wasn’t really sure how things were going to go for him. She elected to move forward with treatment, and Bear started on chemotherapy soon after.
Bear was a very quirky dog who liked to hide in corners, roll over for belly rubs, and refused to open his mouth for his exams, which was particularly irritating for me since I needed to pay close attention to his tonsils to monitor his disease state. He also loved to flop all 90-plus pounds of his body to the ground without warning, making it extremely difficult to perform basic tasks such as listening to his heart and lungs.
It was also extremely fun to watch him spring from recumbency the second I exited a 2 foot radius from his body. Bear hated confinement, and it would literally take three people to manipulate his oversized body into a cage. Once located safely behind the confines of the metal bars, however, he would immediately fall asleep, snoring loudly and peacefully in his slumber.
Bear was not a huge fan of other dogs, but for some reason they loved him and would constantly run up to greet him, while he patiently sat and stared at the ceiling. I swear if he could whistle a tune and tap his paw in complete denial, he would have.
Bear was treated with six months of chemotherapy. Towards the end of his protocol, he developed unusual wounds on his limbs, likely from an adverse reaction to medication. The wounds required regular care and monitoring, and through it all he never complained (other than the flopping). He spent his summer wearing decorated bandages and specialized braces for his front limbs.
This fall, during a routine "Bear checkup," I noticed his left tonsil was slightly enlarged. Since he was feeling great at home, we initially decided to monitor him, but it wasn't too long before he started showing signs of illness, and further testing confirmed relapse of his disease.
As an oncologist, I know this happens in 95% of dogs with lymphoma, and the timing for when it occurred was exactly when it would be expected. Still, I think for Bear’s case I was hoping the adage of "weird lymphomas behaving weirdly" would hold out in his favor.
Bear’s owner elected to try further chemotherapy for him, and we were able to successfully treat his disease. As with most cases, Bear’s second remission was shorter than his first remission, and a few months after starting treatment, I found his stubborn tonsil was enlarged again. Despite additional treatments and short-lived responses, ultimately his disease proved too aggressive. He crossed over the rainbow bridge this past weekend.
Bear wasn’t the most outgoing dog, or the smartest dog, or even the most attractive dog. He never performed tricks, he didn’t wag his tail, and I can’t recall him ever stooping so low as to lick a face or accept a treat. But he had so much personality and so many idiosyncratic behaviors, you couldn’t help but fall in love with him over and over again.
Probably what I admire most about him was his ability to undergo his treatments and visits with dignity and patience. I never had the impression that he was enduring things, but rather tolerating them. As if he possessed a greater understanding of what we were trying to do for him.
We will miss Bear a great deal, and I feel fortunate to have had the opportunity to know him and work with him and learn from him. And although he may be a good example of how weird lymphomas happen to weird dogs, he will remain a favorite in our hearts for many years to come.
Dr. Joanne Intile