Stellaluna Starts Chemo Tomorrow, Final Update #41

[kudzu]

Made the decision yesterday to start chemo for Stellaluna this Wed. Her immunophenotype results will not even be in then but her condition is deteriorating. She's clearly uncomfortable & becoming more lethargic. It's either chemo or goodbye. The decision was very hard because her lymphoma seems quite rare & multiple signs point to a very poor prognosis even with chemo. I don't want to prolong discomfort nor risk making things even worse. However, after lots of discussion I've decided to try the first two chemo treatments to see if she improves. (They'll use Wisconsin protocol.) Am thinking of this as palliative. If she goes into remission, great. I'm not setting my sights that high yet. Right now I just want to take this one shot at getting her quality of life back. I'd like to see my Luna-tic again if only long enough for us to do a few fun things one last time. It's all happened too fast for me to process. It's only been 9 days since I found the first lump while she was still acting perfectly normal. Intellectually I know the realities but the rest of my psyche isn't up to speed on this. It seems unreal.

 

It still isn't decided if we will try pred or not. IM/onco vet feels it isn't worth the risk because of her history of adult onset demodecosis. Other vet feels it would be worth risk considering Luna's rapid deterioration. I am still on the fence but leaning toward trying it. Forgot to ask though if there was any conflict between chemo & using ivermectic should the demodex flare up.

 

So what sort of prep, mine & the vet's, will help Luna get through this with no or at least very minimal side effects?

- Should antinausea meds be given prophylactically? Or should I just ask to have some on hand in case she has problems?

- What about Big D? Anything in particular that might help?

- Is there anything I could give to help boost her immune system, something that doesn't conflict with chemo drugs? Her absolute lymphocyte count is down further as is the overall WBC. Am quite concerned about possible infection.

- Any other suggestions?

 

Thank you in advance on behalf of myself and The Monkey.

_____________

Trying to attach slideshow of what our Luna-tic was like until last week. Use this link if my attempt fails.

 

http://gallery.me.com/laurakbf81?fullscreen#100106&view=grid&bgcolor=black&sel=0&fullscreen=true&view=slideshow

Edited August 23, 2011 by kudzu

[Batmom]

Antinausea: I would ask to have some on hand.

 

Diarrhea: Here, chemical-caused diarrheas respond best to either metamucil wafers (not the powdered stuff) or Endosorb (ask your vet; there are some contraindications for this).

 

Immune: Really aren't any immune boosters (despite the many things that will turn up if you google). Best is to keep her out of vets' waiting rooms (if need be, stay in the car with the AC on until they're ready for you) and antibiotics if she needs them.

 

Hugs and best luck to you and your sweet, lovely girl.

[sabrina]

for you Stellaluna

[Guest goofydog]

Please give the Monkey an extra special kiss from me. I'm just a call away if you need anything

 

 

[Remolacha]

hoping for some more good days

[tbhounds]

If I'm not mistaken pred is given at the beginning of the Wisconsin protocol. I guess it might be optional. I would ask your vet if they will give your baby an ondansetron injection prior to the chemo drip -- it will help with the expected gi side effects. Did you contact OSU?

[kudzu]

Does ondansetron have any advantage over Cerenia? Just spoke to the vet & they plan to give her an injection of Cerenia. They are also going to give her Benadryl ahead of time.

 

We have decided to do the pred. My hope is that careful monitoring for hairloss or thinning, skin redness, etc. would happen early enough to let us wean her off before anything full blown could happen. Likely just wishful thinking but I'm in a wishing mood right now. Big wishes, actually, & lots of them. I'm scared to try the meds but too scared not to.

 

Antinausea: I would ask to have some on hand.

 

Diarrhea: Here, chemical-caused diarrheas respond best to either metamucil wafers (not the powdered stuff) or Endosorb (ask your vet; there are some contraindications for this).

 

Immune: Really aren't any immune boosters (despite the many things that will turn up if you google). Best is to keep her out of vets' waiting rooms (if need be, stay in the car with the AC on until they're ready for you) and antibiotics if she needs them.

 

Hugs and best luck to you and your sweet, lovely girl.

Thank you. Just spoke to them about the nausea issue. I'll stop off tonight & find the Metamucil wafers. She is loving the canned food I have started adding to her meals. That should make a good mixer for crushed wafers should it be necessary. She & I would both be happy to wait in the van rather than in the waiting room.

[Guest budsmom]

I'm not sure if dogs have the same side effects as cats, but I'm going through this exact thing with my 14 yr old Maine Coon cat right now. He's due for chemo #3 this Friday - we're on the Madison protocol also. His tumor is in a different spot, and we couldn't find any other signs of it internally before we started chemo, but you never really know. Anyway, I don't mean to scare you, but be prepared for a roller coaster ride. Along with that have appetite stimulants on hand when you bring her home. That has been the biggest problem I've had so far. Everyone says and you read that animals really tolerate chemo very well, not like humans, but I think that's not accurate. I consider loss of appetite a huge side effect. I'm using mirtazapine to stimulate appetite, I know dogs can take it. Another drug is cyproheptadine - not sure if dogs can have that, but ask your vet. Also, have a big selection of different food ready to try. I'm hoping that finally today we found the "magic" food for my kitty, otherwise the vet wants to put a feeding tube in when he goes in on Friday. Try anything and whatever she'll eat, feed her until she stops, but don't be surprised if she won't eat it the next time you try. Might want to ask the vet for some A/D food to have on hand, also. It's prescription only and meant to stimulate appetite. A cerenia shot just in case might not be a bad idea. Also, I've read that it is really important to keep them well hydrated, both for the chemo and to help their appetite. I don't know if it would make a difference, but cats take prednisolone, not prednisone. Cats can't metabolize regular prednisone into prednisolone like humans and dogs, you might ask if that would be any easier on her.

 

I am so very sorry you're facing this. I wouldn't wish this disease on my worst enemy. Please let me know if you want/need to talk, I can totally relate to your situation. I hope everything goes perfect for you with treatment, you and Luna will be in my prayers.

[robinw]

best of luck tomorrow!

[DesiRayMom]

We'll be thinking of you!! Hope all goes well.

 

Kathy, Desi, Skeeter

[Guest greyhoundgirl1]

My greyhound, Zevon, had lymphoma and was on the CHOP protocol. You should definitely contact Dr. Cuoto at OSU. He was very helpful. Zevon did not have many adverse reactions to the chemo. He would just prance in and out. I hope Stellaluna will do well. Hopefully they will find the cure for this.

[tbhounds]

Cerenia is great drug, however, the injection stings/burns like crazy. There is an oral form too which I assume you would give at home directly prior to the chemo treatment.

The nice thing about the ondansetron (Zofran) is it can be given iv via the catheter just prior to the chemo drip.

 

I wanted to add that the Ondansetron should allow her to maintain her appetite. Also wanted to mention which I'm sure this is something your already aware of-- don't forget to use carafate and a medication like pepcid or prilosec while using pred.

Edited August 10, 2011 by tbhounds

[mychip1]

Many well wishes and prayers for Stellaluna.

Edited August 10, 2011 by mychip1

[JJNg]

Best wishes for Luna that the chemo gives the best result possible. Our local oncologist says roughly half of her chemo patients don't have any side effects at all, so I'm hoping Luna falls in that category. I think the Cerenia is a good idea. From a pharmacological standpoint, Cerenia potentially has many other benefits besides the labeled use as an antiemetic, including treating other GI disturbances, so it may actually help with diarrhea too.

 

As tbhounds mentioned, it can sting on injection, but keeping it refrigerated and giving the SC injection cold cuts down on the stinging considerably. Since we learned that trick, I almost never have dogs react to the shot. You might want to ask if the oncology office does that. Cerenia lasts 24 hours, so will they send you home with the oral form to continue after giving her the injection the day of the chemo?

 

Don't have much experience in this area, but I know our local oncologist uses metronidazole to treat chemo-induced diarrhea. I wonder if it would be a good idea to use a probiotic in conjunction with the Metamucil to try to reduce/prevent diarrhea?

 

Btw, I loved the photos! Beautiful girl - she was still a puppy the last time I saw her!

Edited August 10, 2011 by jjng

[Guest IrskasMom]

No Advice just Hugs and good Wishes , that all goes well . I will be thinking of you and Stellaluna

[EllenEveBaz]

Adding our very best wishes for the beautiful Stellaluna.

[45MPHK9]

Thinking good thoughts for Stellaluna.

[JJNg]

How is Luna doing? Hope everything went well yesterday.

[RedSquare]

Sending good thoughts and hopes for some more good time.

[kudzu]

Thank you, everyone. As of last night there was no apparent change in Luna. She was lethargic. Wanted to do things, had the will but just didn't have the energy. Her stools were soft & of course she's urinating more than usual. We did go for a brief stroll in the pasture, where she found a toad & followed him for a little while. Here appetite was very good. During the night she had to go out to potty twice. Her stools were quite loose & she appeared more uncomfortable.

 

This morning though it has changed dramatically. She is even more lethargic with no appetite at all. The big D has started though in minimal amnt. However, nearly all the lumps are GONE. Just like that. A few are can still be felt but are much smaller. WTH? The scariest part is gone but my baby feels worse. Is she feeling worse from whatever disease this is or is it from the chemo?

 

OK, now for the really bad part. The immunophenotype report came back inconclusive. There were neither B nor T cells. In fact they are questioning whether this is even lymphoma. Here is part of what the pathologist wrote:

"The cytologic findings are consistent with malignant round cell neoplasia, with differentials including anaplastic lymphoma and

histiocytic saroma"

"While it is possible these represent poorly differentiated lymphoma, the degree of nuclear pleomorphism and finding of binucleate and trinucleate cells is concerning for a disorder such as histiocytic sarcoma. Anaplastic plasma cell neoplasia is also possible. A second and third opinion were obtained for this case and the consensus was that while lymphoma cannot be excluded cytologically."

 

The specialist who ordered the tests spoke to the pathologist. She said they did have three different pathologists go over this. Also, when the flow cytometry didn't yield expected results they did "immunocytochemical staining". In other words, it's malignant. They don't know what it really is but apparently it is even worse than T cell lymphoma. Discussed this with both the specialist and my regular vet, it was decided that the prognosis is very poor indeed. IF we were to continue chemo she recommended we switch protocol to Lomustine.

 

After this I drove home yesterday planning to let Luna go today though I think my vet was trying to convince me to wait. When I got home, despite her lethargy, I could see that Luna was clearly not ready to go. I don't want to say goodbye. She's much too young. My terror though is not in letting her go too soon. It is waiting too long & putting her through unnecessary suffering.

 

Now though I just don't know what the next step is. Did do the consult form for OSU. Do have another call in to my regular vet & am about to call the specialist. Outlook is grim. Luna is worse. Yet the lumps are gone. I'm a wreck, totally lost & confused.

 

ETA: If anyone wants to see the reports just PM me. I can give you the link to the files & how to access them.

Edited August 12, 2011 by kudzu

[Guest goofydog]

Damnit. I was so hoping for better news for both of you. Please give here extra special kisses from Get Em and me. If you think a visit from her boyfriend might brighten her day just give a shout and we'll be right over.

[Batmom]

This website may be of some use to you: http://www.histiocytosis.ucdavis.edu/

 

I'm sorry she isn't feeling better .

[sweetdogs]

I don't have anything to offer but . I do think I would wait for a while to see how everything goes. There are too many unknowns right now & you just started treatment. She has her youth on her side & OSU has yet to weigh in. I know it's so hard to see her sick especially if she won't eat but I would want to have as much info as possible before I let her go. My very best wishes to you both.

[Remolacha]

so frustrating when you don't have clear answers! no advice, just

[tbhounds]

Give OSU a call and ask to speak to either Dr Couto or Dr Marin- explain the importance of the call. I believe Dr Couto will be out next week.

Fingers crossed for you both.