I know, it's been a very long time since I've sent any email out to this distribution list. Most of you have been "in the loop" anyway, and of course no news is good news. We just haven't had much to relay in the way of news.

However, last week that all changed. Harvey's appetite has been gradually diminishing, to the point where we now have to hand-feed him in order to get him to eat most of the time. Blood tests revealed last week that his hypercalcemia is back, and so over the past week we've been doing additional tests. We are still waiting to hear back on a blood test send out last week that is specific to a cancer-caused protein that mimics the hormone that controls calcium levels in the blood, but we already have the results from a fine-needle aspirate taken yesterday.

That FNA was drawn from a slightly enlarged lymph node on the left side of Harvey's neck, and it came back positive for malignant cells. It appears that Harvey's lymphoma is back.

The bad news: this is only treatable with chemotherapy.

The good news:

• We finally have a positive diagnosis. As you probably recall, because of the way Harvey's cancer had been treated the first time, we never were completely sure that he even had lymphoma. His exceptionally long remission even introduced doubt, since survival rates for lymphoma are almost never that good. Now, we can proceed with somewhat better confidence in what we're doing.
  
  
• Related to the positive diagnosis is the fact that Harvey's experience now has even more relevance to other dogs with lymphoma. We've always had to caveat any information we share with other people with the note that we were never sure of the diagnosis in the first place. Thanks to some clever detective work on the part of Dr. Melzer at WSU, we had a pretty high confidence, but we could never say for sure. Now, we can much more emphatically state that lymphoma is *not* necessarily the tragedy that it could be, and that our experience is every bit as applicable as one might hope.
  
  
• Statistically, each remission typically lasts 1/2 to 2/3 the length of the previous one. With nearly five years of remission for the first round, Harvey has a good chance of another two and a half years, or possibly even more. It is true that since Harvey's case has never been typical, it is somewhat "iffy" to rely on statistical data to predict the outcome. But we are hopeful that another series of chemo treatments will allow Harvey to have at least a couple more fulfilling years of life.
  
  
• We caught this relatively early. This may or may not affect the outcome of the chemo, but at the very least it means we have hopefully minimized any organ damage caused by the hypercalcemia. The first time around, we didn’t even know anything was wrong until the calcium level in Harvey's blood was higher than the vet's testing equipment could measure. This time, the calcium level has remained just slightly above normal, and the main indicators of kidney health -- creatinine and BUN -- have risen only slightly above what has been normal for Harvey the last year or so.
  
  
• Related to the above, Harvey is still in very good shape. There has been no precipitous weight loss as there was last time and the oncologist is suggesting that we stick with the dosages for the chemo we used last time, which were reduced as a result of his poor reaction to the higher dosages used initially. As a result, we are likely to be able to minimize the negative side-effects of the chemo. Obviously, no one can guarantee us that this will be true, but it's a likely outcome.

As you can see, there's only a little bit of bad news, and plenty of good news. :) Obviously, we would prefer that Harvey was just fine. We also have the complication that he's older now, and there are other things that might interfere with a good life over the next couple of years (arthritis being the big issue). But we are optimistic, and it seems that for a dog with lymphoma, Harvey's case is about as good as one could hope for. :)

So, what's next? We have an appointment at the oncologist today for Harvey's first chemo treatment. At this point, it appears we will be using the same protocols we used previously (COPA and a modified VOPP, if I recall correctly). Usually, there is a concern about drug resistance, which generally suggests slightly different drugs should be used. However, since the remission was so very long (reducing the chances of drug resistance) and since the remission was so very long (suggesting the protocols used before were very effective), it's likely we'll be sticking closely to the original protocol.

One exception to this may be the adriamycin (aka doxorubicin). That drug has a potential negative effect on the heart, and there is a general concept of a "lifetime maximum cumulative dose". Harvey has not reached that maximum (and because of the reduced dosages used during the first chemo series, isn't even close), but even so Harvey will be having his heart checked out before we use that drug. If there appears to be any sort of problem at all, obviously that drug will be eliminated from the protocol. I don't know at this time whether a substitute will be used or not in that case.

While we are optimistic and feel we're doing what's best for Harvey, your thoughts and prayers are always appreciated. Harvey's always had lots of friends, and it's nice to know during times like these that those friends are rooting for him. :) Thank you for your interest, and I hope to be able to provide reasonably regular updates on his condition, always with the best of news. :)

Pete

p.s. This email is being sent to the same distribution list I put together during Harvey's previous experience with chemotherapy. I've added a handful of addresses, people we've met since then who I think may have an interest in these email messages. I doubt that I've offended anyone by sending the email, but I do recognize that it's not necessarily true that every single person feels the need to be kept "in the loop". If you'd prefer that I remove your email address from my distribution list, please feel free to ask me and I will do so, no questions asked and no hard feelings.