Bad News For Romie

[EllenEveBaz]

Romie perked up after a couple of weeks of tramadol for his arthritis pain, but then started acting quieter again. Saturday I could feel lumps in his neck. Vet today found swollen lymph glands all over. Took a fine needle aspirate to confirm -- results later this week. Probably multicentric lymphoma.

 

I'm starting to research the possibilities. Right now, he's eating fine; stools are a little on the soft side. I'm scared he'll suddenly nosedive, even before the aspirate results are back. Vet doesn't want to start with prednisone before results are back if we don't have to. I forget the reason -- I'm still a little shaky. Assuming he'll make it to the end of the week, I'm leaning toward either chemo with the Wisconsin-Madison/CHOP/whatever-it's-called protocol, or only palliative care. Cost and how Romie reacts will be the major factors. We live in a rural area, and there's not any vet oncologists closer than 60 miles.

 

I need to discuss cost with my vet, and ask OSU if the greyhound program is providing any lymphoma drugs (other GT'ers seem to have gotten both yes and no answers recently from OSU). But do people know of any possible cost reduction methods for the chemo protocol? The dogs get the medication through IV, right? So it has to be done at the vet's? I see there is an oral med, leukeran (sp?), but it doesn't seem to be as effective as the combo of drugs with Wisconsin-Madison?

 

Romie's "roman nose lite" profile:

[Batmom]

Hugs to both of you, and best thoughts for your boy.

 

Vet wouldn't want to start prednisone if Romie had something other than lymphoma (e.g., infection such as tick disease).

[grey14me]

[MP_the4pack]

[FiveRoooooers]

[robinw]

You are both in my thoughts

[fionasmom]

You might ask your vet about alternating prednisone with Lukeran. It will not cause a remission but will slow the advance of the lymphoma.

[Burpdog]

Sorry to hear the news Dr. Couto is doing consults with vets for a fee of $120. I think it's worth the money to make sure which way to go.

 

http://coutovetconsultants@gmail.com

[macoduck]

Ditto what Batmom said about not starting pred. This is what we just went through with Possum.

[LBass]

I'm so sorry your handsome boy may be facing such a serious illness.

[Charlies_Dad]

Not the news anyone of us want to hear. I am sorry about the diagnosis and will send good thoughts for both you and your boy.

[GreyPoopon]

No advice, just and .

[DesiRayMom]

Major bummer!!! Good thoughts & prayers on their way.....

[DaisyDoodle]

So sorry this is happening. Hugs to you and your pup.

 

Some of the chemo agents in the Wisconsin Protocol are IV, others are oral. IIRC (from 2003-2004 timeframe), our CoCo had to be sedated for the IV sessions, but this may have been because it was being done by our GP vet rather than by an oncology team.

 

CoCo received a Modified Wisconsin Protocol for a year (it was either 4 or 5 courses) until she maxed out on the one chemo agent that is cardiotoxic; then she received a "salvage" protocol (what is used after the first-line treatment can't be used any more) of CCNU (aka Loumoustime). CCNU is an oral medication and she did well on it.

 

There used to be a belief that chemo had to be started prior to prednisone for the chemo to be effective, but Dr. Couto found no difference. The one thing I will make a point to tell you, is that long-term use of prednisone has to be on an every-other-day schedule; otherwise, a dog will end up with iatrogenic Cushings (an adrenal-gland disorder).

 

Good luck.

[GreyTzu]

:grouphug

[Hubcitypam]

Ditto what Batmom said about not starting pred. This is what we just went through with Possum.

Buddy lasted 16 days from DX to the bridge on huge doses of pred. It was so not worth it. My old school vet told me they used try chemo both it was worthless in quality of life and he will no longer do it. Lymphoma is fast and furious. In retrospect if all the nodes are involved I'd never do pred again. Edited October 15, 2013 by Hubcitypam

[Remolacha]

[4My2Greys]

First of all I want to say how very sorry I am that you are probably dealing with lymphoma . Second, I would strongly recommend taking him to a veterinary oncologist if for nothing more than an initial consultation and to determine what stage you are dealing with. I so wish I had done this with Beanie. I feel very strongly that my first and biggest mistake I made was starting Beanie on prednisone prior to starting chemotherapy at my vet's suggestion. I had read that starting it prior to chemotherapy could result in the cancer cells developing a multidrug resistance. I believe this is why after an initial decrease in her lymph nodes that first month she went downhill after that and the cancer never seemed to respond anymore to the chemo from that point on. I don't blame my vet for this, he isn't an oncologist I blame myself for not listenening to my gut and waiting those few days to start the chemo first.

 

There is a paper on lymphoma by Dr. Couto called Lymphoma in the Dog: COP, CHOP or Something Else.

It is a pdf file so I am unable to link it, but you can google the title and you can download from the first result. In it he gives the different protocols for lymphoma.

 

Another good read is this link below.

 

http://www.vetcancerspecialists.com/resources/canine-lymphoma/

[45MPHK9]

No advice, but we will be thinking good thoughts for your sweet Romie.

[4My2Greys]

Buddy lasted 16 days from DX to the bridge on huge doses of pred. It was so not worth it. My old school vet told me they used try chemo both it was worthless in quality of life and he will no longer do it. Lymphoma is fast and furious. In retrospect if all the nodes are involved I'd never do pred again.

This a thousand times over. This is one of the reasons I recommend seeing a veterinary oncologist to determine stage progression. Stage III (which is all lymph nodes involved with noticeable swelling) and higher respond poorly to treatment and if I had to do it over again would never put another dog through that.

[JJNg]

Sorry to hear about Romie's diagnosis. The decision regarding how to treat lymphoma is a personal one that involves a lot of different factors. There is no right or wrong choice. I would just encourage everyone facing this decision to research all the options, and ideally consult with an oncologist, as 4My2Greys also suggested, for the latest information so that you can make an informed decision.

 

Even though it's a bit of a drive, consider seeing the oncologist for a consultation before making a final decision. Depending on how experienced your vet is with administering chemo, the specialist may be able to work with your vet so that you can have some of the treatments, or at least the monitoring bloodwork, done at your regular clinic. Here are a couple good articles with general information about lymphoma:

http://www.veterinarypartner.com/Content.plx?P=A&A=592&S=0&EVetID=0

http://www.veterinarypartner.com/Content.plx?P=A&A=575

 

Buddy lasted 16 days from DX to the bridge on huge doses of pred. It was so not worth it. My old school vet told me they used try chemo both it was worthless in quality of life and he will no longer do it. Lymphoma is fast and furious. In retrospect if all the nodes are involved I'd never do pred again.

Every case is different. Not sure what doses of pred your vet used, but most oncologists recommend the usual anti-inflammatory dose of pred, and not 'huge doses'. I've had some dogs with all nodes involved that responded well to the pred (lymph nodes going down) and did well for 4-6 months. I've had others that didn't respond at all and were euthanized within a week or two, like Pam's Buddy. The average is probably around 1-2 months.

 

I would have to disagree that chemo is "worthless in quality of life". Lymphoma is one of the most common cancers in dogs, and it is also the one that responds best to chemo. The goals and doses of chemo used in veterinary medicine is very different from human medicine. Doses are kept lower with quality of life in mind. About half or more of dogs that get chemo have no obvious side effects. They feel fine and can go about enjoying their daily life like normal. Some have mild side effects like vomiting and diarrhea that can be managed with medication. Less than 10% get sick enough to need more aggressive medical treatment, and future chemo doses are adjusted to reduce or eliminate side effects.

 

One of the big considerations is that chemo is expensive and time-intensive. Because lower doses of the drugs are used to maintain quality of life, the goal is not to try to cure the cancer, but to slow down the progression and hopefully achieve a temporary remission. But you're just buying time, and the cancer will most likely return. With the typical case of lymphoma, even with aggressive chemo, the median survival time is only about 12-18 months. For some people, the chance to get this extra time is worth it. There's also a very small percentage of patients (less than 5%) that do well for more than 3 years. When I did my oncology rotation in vet school, I remember a couple lymphoma patients who were 3-4 years out.

 

Stage III (which is all lymph nodes involved with noticeable swelling) and higher respond poorly to treatment and if I had to do it over again would never put another dog through that.

Stage I and II are very rare in dogs, so the vast majority of lymphoma cases are Stage III or higher. So all the info above applies to Stage III or higher. I guess the definition of "respond poorly to treatment" is subjective, but I don't think that's true of most dogs with lymphoma that get chemo. The main factors that have been identified that predispose to a poorer response to treatment are substage b (meaning the dog is sick), Stage V (in the bone marrow), T-cell (vs B-cell), and the presence of an elevated blood calcium level. Here's a study that looked at these factors:

http://www.ncbi.nlm.nih.gov/pubmed/21320018

 

Again, I want to emphasize that there is no right or wrong choice. It may sound like I'm trying to encourage treatment with chemo, but I don't think there's anything wrong with just choosing palliative care with pred +/- Leukeran (which is very expensive, but less than chemo). I just want people to have an accurate understanding of what's involved and what can potentially be acheived with chemo before they dismiss that option.

[macoduck]

Here we had aspiration biopsies done twice (first set inconclusive) and they were conclusive. Pred dose set by my vet's call to the vet oncologist.

 

If I had known that Possum had only 13 days from lumps appearing to his goodbye day, I would rather have spent them cuddling and spoiling him.

[Guest LazyBlaze]

I'm sorry you're having to deal with this and hope it turns out not to be as bad as feared. Romie is beautiful. I'll be keeping my fingers crossed for you both.

[Hubcitypam]

Here we had aspiration biopsies done twice (first set inconclusive) and they were conclusive. Pred dose set by my vet's call to the vet oncologist.

 

If I had known that Possum had only 13 days from lumps appearing to his goodbye day, I would rather have spent them cuddling and spoiling him.

Amen Ducky. Buddy was on 40 mg of pred twice a day, It seemed like those two weeks were just a stressful pantingfest. I wouldn't do it again. Edited October 15, 2013 by Hubcitypam

[galgrey]