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Angel Loves Her Sister (And So Do I)!!!

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Hello! Meet Angel and Devil, my American Bulldog babies...sisters born on the day of the 2004 Indian Ocean earthquake and tsunami. Angel, my big sweetie with a golden "halo" on top of her head, was the third one out; Devil, with her little chola teardrop beside her right eye, was last and is the living runt of the litter (her brother with a cleft palate was her "fallen homie" out of eleven). And yes, their personalities do match their names...but it is all for show -- they are both angels and devils when they want to be. ;-) Like all sisters, they sometimes fight, but they are inseparable from each other...and from me.

Heartbreakingly, Devil was just diagnosed with stage III/possible stage IV lymphoma. This diagnosis follows her recent recovery from a $1200 surgery in January to remove two different and unrelated external masses that came with the joyous news of being noncancerous. Thanks to my invaluable best friend's affiliation with the university, I am still paying for this procedure through her payroll deduction, with approximately half the balance already paid. Since I did all of this in the hopes of saving her from cancer, this diagnosis was rather crushing indeed.

Lest anyone be understandably concerned that I might be allowing my highly sentimental attachment to these girls cloud my judgment in trying to pursue a course of treatment for her, I just want to share a little more about her and why we are so deeply bonded.

I understand Devil completely, because she is just like me. She is the most passionate, determined, emotive, expressive, and high-spirited dog I have ever met. Every day and night, she snuggles up to me and puts her paw on me in the most touching gestures of embrace. She has a way of kissing that closely resembles a rather startling game of "GOTCHERNOSE!!!" -- and another one just for getting rid of tears as quickly as caninely possible. On most mornings, she wakes up with a "good morning" expression so happy that it crinkles her eyes and face into a teeth-baring smile so wide and sweet that I (*not* being a morning person at all, the one difference between us, lol) cannot help but smile back...and completely mean it. She has a different, more sheepish, smile when she knows she's misbehaving, and she often accompanies this with a lot of very vocal sass...sometimes just bordering on a snarl, with head hung low, when she is being punished. There are no secrets about feelings between us; Devil *always* makes herself known.

And she is a survivor. When she was just four and a half years old, she suffered what I believe to have been a fibrocartilaginous embolism (FCE). Fifteen minutes after being let in from playing outside on a Sunday, she was dragging her paralyzed rear end down the hallway. I was unemployed at the time, with no money for the vet, and I begged my ex-husband for $50 to get her seen the next day and another $50 for a cortisone shot at the vet's suggestion. His diagnosis was degenerative disc disease, and the day after that he told me, "I strongly urge you to consider euthanasia." Had I listened to him, I would never have seen her regain the use of her back legs (to about 90-95%, with only a bit of a gimpy gait on the left as a reminder) or greet me with her morning smiles for the next five years. Doctors don't know everything. But even her oncologist, a self-described "practical man" who thoroughly advised me on all the odds, the expenses, and the lack of any guarantees, stated his belief that she would probably respond well to treatment, adding, "she's a tough little dog." That she is. And I would do anything for her.

However, I could never ask anyone to fund us without knowing everything that I know about it. Here are the treatment recommendations from her examination that explains lymphoma and gives a breakdown of the options, along with their costs and rates of success:

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Based on our exam findings today and the inhouse cytology performed, we highly suspect that Devil has a type of cancer called lymphoma. Lymphoma is a cancer that originates from a growth of malignant lymphocytes. These cells can move anywhere within the body. Breeds commonly affected include Golden Retrievers, boxers, German shepherds, and others but there has been no evidence for a genetic cause. Most dogs with lymphoma present feeling well with enlarged lymph nodes. Clinical signs may be variable and depend on the area of the body involved (such as vomiting due to gastrointestinal lymphoma).

Staging tests can be done to determine the extent of the lymphoma and in an attempt to identify prognostic factors. Blood work is done to evaluate organ function. Chest X-rays are performed to look for evidence of involvement of the lymph nodes inside the chest. Immunophenotyping (T vs. B cell origin) is a commonly performed staging test and can give a better idea of prognosis (long term survival and outcome) and how a patient will respond to therapy. Negative prognostic factors include: illness at diagnosis (substage b), location (intestinal), mediastinal involvement, T cell origin, and significant bone marrow involvement or leukemia. Immunophenotyping (T vs. B cell origin) is the only staging test that is strongly recommended before starting treatment. This test is one of the most reliable tests to give a good sense of longer term expectations.

The five stages of Lymphoma are:

Stage I= one enlarged lymph node
Stage II= enlargement of the lymph nodes above the diaphragm
Stage III= generalized lymph node enlargement
Stage IV= involvement of the spleen and liver
Stage V= involvement of the bone marrow or extranodal sites (ie, eye, CNS)

The two sub-stages of Lymphoma are:

sub-stage A= no clinical signs/symptoms
sub-stage B= clinical signs/symptoms


The recommended treatment for lymphoma is chemotherapy. Chemotherapy is meant to increase the quantity of life without decreasing the quality of life. Dogs usually tolerate chemotherapy well with minimal side effects which can include gastrointestinal upset (vomiting, nausea, diarrhea) and/or white blood cell suppression (increased risk of infection).

The following is a list of treatments options that can be pursued to treat Devil's disease. They are listed based on longest median survival time to shortest median survival time. Devil's prognosis is dependent on stage, substage, grade, and most importantly, response to chemotherapy. Dogs that respond and stay in remission will live longer than those that do not respond or come out of remission earlier.

1. The Madison-Wisconsin (CHOP) chemotherapy protocol. This protocol has a combination of several chemotherapy agents administered subcutaneously, intravenously, or orally. Patients are given 16 treatments over 25 weeks, at which point therapy can either be stopped and go into a monitoring phase, or continued as maintenance chemotherapy where your pet would need to then come in every 3 weeks for several months, then every 4 weeks until the 2 year mark at which time chemotherapy could be discontinued. Approximately 90% of dogs will achieve a complete remission with this protocol. For dogs with B-cell lymphoma, median survival time for Lymphoma is one year, and 25% of dogs are alive at 2 years. For dogs with T-cell lymphoma, median survival times with this protocol are approximately 6 months. The estimated cost of this protocol is approximately $4500-5000. Each treatment costs approximately $200-300, with doxorubicin treatments being more expensive at ~$400-500 per treatment.

2. CHOP + half-body radiation therapy. This would would occur after the first month of treatment. It would involve cranial half body radiation therapy first followed by caudal half body radiation therapy 2 weeks later, then the CHOP chemotherapy protocol is continued per above. Median survival time with the addition of radiation therapy has been reported as approximately 2 years, with 44% of dogs still alive at 3 years. The estimated cost of radiation is $1000 per body half, or $2000 total.

3. Doxorubicin injectable chemotherapy. This would involve an intravenous infusion every three weeks for a total of 6 treatments. The median survival time for this protocol is 6-9 months. The estimated cost would be approximately $350-$500 per treatment. The unique side effect of doxorubicin is heart toxicity, which is usually a cumulative toxicity, but rarely can occur after 1-2 doses. Although this risk is small, an echocardiogram is recommended before giving doxorubicin to evaluate for underlying poor heart function.

4. Cyclophosphamide and prednisone. The prednisone will be given daily and the Cyclophosphamide is given 4 out of 7 days of the week, both in oral pill form. The median survival time for Lymphoma patients on this protocol is unknown, but our experience at UF would estimate a median survival time between 3-6 months. The estimated cost of this chemotherapy protocol would be approximately $200-300 per month. This estimate would include a recheck examination and blood work once a month.

5. Single agent Lomustine with prednisone. This is an oral pill that is given every 3 weeks. Median survival times for this protocol are 2-3 months. Approximate cost would be $200-300 per treatment.

6. The final option for chemotherapy is Prednisone by itself. Expected survival with prednisone alone is 4-6 weeks. Prednisone can build up resistance to other chemotherapy agents, so starting chemotherapy after a prolonged coarse of prednisone can caused decreased efficacy of chemotherapy and is not recommended.

Dogs on chemotherapy usually have a good quality of life and the chemotherapy is well tolerated in general. About 15% will experience a side effect. The most common side effects include gastrointestinal upset and a decrease in the white blood cell count that makes the patient at risk for infection. These signs are often mild and most can be managed at home with medications. Side effects of prednisone include excessive thirst, urination and hunger. It does not typically result in gastrointestinal upset and is not myelosuppressive (decreased bone marrow activity/production).
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There is no "cure" for this -- only the possibility of an extended remission. But it is my sincere hope that you now have enough familiarity with my beloved Devil and her disease to be able to make whatever small contribution that you are able so that we may try to enjoy another few years together even as we now embark on our fourth (and hopefully *last*) stressful household move in the last two years. Since I may eventually try to buy the home we are moving to, I would love nothing more than for both of my girls to be there for as long as I am able to have them. After all, they are my family. Peace, Love, Happiness...and Gratitude from ours to yours.

REWARD LEVELS:

So I was scratching my head about what I could offer to the kindest benefactors of our cause, and then I remembered...I'm an artist! (Lol...not a very productive one, but I do have a modicum of talent... ;-D) So this is a reward for everyone involved, because I can always use a good reason to create some art! And what better reason than immortalizing your furry loved ones?

I'm afraid that I don't have any pictures of my work to offer up as incentive, but my credentials include architectural and graphic design studies at the University of Florida, as well as photography studies there and professionally in the U.S. Navy. I also spent two years in the theming industry (theme parks, zoos, museums, etc.), so I've worked with a wide variety of media and materials. Most recently, I gained experience in wheel thrown ceramics, where I made a dimensional portait mug and illustrated nesting bowls. I would love to create a one-of-a-kind piece to thank you for helping me and my one-of-a-kind Devil! :-)

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Yer Asse
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Gainesville, FL

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