Lucy - Cutaneous Lymphoma

Lucy as a puppy

Where to start?  I wasn’t sure if I should start at the beginning or the end.  After trying to write about Lucy for months I wasn’t even sure if I could write about her at all.  I decided to start at the end because that way I figured I could move on to sharing happier times.  We did have 18 and half years together.  Little Lucy always present, always there.  Towards the end I knew the time was coming but still I did everything to prevent it. Did I push her too far?  I’m not sure.  Two weeks prior to euthanizing Lucy, she was diagnosed with cutaneous lymphoma, which I knew in my heart she had but as a vet I needed confirmation. 

What is cutaneous lymphoma?

Many of you have probably heard of lymphoma which is a common cancer in dogs, the cutaneous form of lymphoma is very rare and only accounts for about 3-8% of all canine lymphomas.  It is usually seen in middle aged to older dogs and it is divided into two forms epitheliotropic and nonepitheliotropic. Lucy had the epitheliotropic form, which is also known as mycosis fungoides.  Clinical signs of early epitheliotropic lymphoma typically resemble that of inflammatory skin disease, which includes redness, scaling, itching, depigmentation, hair loss, ulceration, and crusting of the skin.  I first noticed depigmentation and redness with Lucy.  The skin lesions may be focal or generalized. Lucy’s skin lesions initially were focal around her mouth (which is a common location) and then spread to her nose and the skin around her eyes.  Like any cancer metastasis to lymph nodes and other organs can occur.  Nonepitheliotropic lymphoma is extremely rare in dogs but is the more common form in cats.  Clinical signs typically include multiple, ulcerated, skin nodules.

You can see the redness and the depigmentation around her muzzle, nose and eyes

The prognosis for both forms of cutaneous lymphoma is poor.  Recurrence is very common.  Generalized epitheliotropic lymphoma is often treated with chemotherapy as well as steroids.   Focal mycosis fungoides can be treated with surgery or radiation with or without chemotherapy.  Focal mycosis fungoides has a slightly better prognosis. (source http://www.vet.uga.edu/vpp/CLERK/Nesbit/)

Dreyfus took great care of her right up until the end

And she took great care of him!

Prior to her diagnosis I said I would never put her through chemotherapy or radiation.  After her diagnosis I did both.  Why?  Her cutaneous lymphoma was focal and I thought we could improve her quality of life as well as extend it.  Did she suffer through any of these treatments?  No, I was with her the whole time.  Quick note about chemotherapy in dogs and cats, they receive much lower doses than humans and therefore tolerate it much better and often have very few side effects.  When I realized that her condition wasn’t improving and she started eating less and less I knew it was time.  

Lucy was a Beagle through and through so eating was an easy way to measure her quality of life.  Her whole life, right up until the end, she ate her meals way too fast.  We had to put a tennis ball in the middle of her food bowl to slow her down.  For a few years of her life she lived in NYC.  She had all the doormen trained in our building to give her a treat when she left the building and when she came back in the building.  I still remember one year around Christmas we had just come back from a walk and we went through the service entrance of our building, which was full of deliverymen.  Lucy maneuvered her way through the deliverymen to our doorman where she proceeded to sit up perfectly and politely to ask for her treat.  The doorman stopped what he was doing, told the deliveryman to wait just a second and he gave her a treat.  She then turned around, walked back to me and we continued on our way.  

The last photo of Lucy

9/12/11 was the first day in her whole life that she didn't want to eat.  I knew it was time.  She passed away in my arms with her head on my heart.  To say I miss her is an understatement.  

Now on to the happier stories...