Lymphoma Options? Your Opinions Please

[Guest mmmberry]

This morning, my grey Speed Racer (racing name Tipp Josiah) was diagnosed with lymphoma. The vet called it high grade and gave me two options. Option one: We can make him comfortable for the next couple of months with prednisone. He may survive one or two months. Option two: We can treat aggressively with chemotherapy. She is referring me to an oncology specialist and let me know to expect ultrasounds, x-rays, and biopsies. Can you tell me your experience with these two options? My dog is 9 years old. I don't want to traumatize him if I'm only buying a few extra low-quality-of-life months with him. I don't want to be selfish. But if chemo will make him feel a lot better and gives him a significantly better quality of life, I am happy to spend the money. Thank you for your help.

[fionasmom]

There is actually a third option you can discuss with your vet. Alternate prednisone with lukeran (sp?). The lukeran is chemo drug administered orally; it will slow down the progression of the lymphoma but will not result in remission. I used this option with my grey Fiona. She was diagnosed in April and I lost her in October. Honestly, I do not know that I would do it again though, she had a gradual decline and was not the feisty alpha she had been before the diagnosis.

 

On the other hand I had a pointer I fostered who was diagnosed with lymphoma. We opted for just prednisone. The improvement was immediate and he was himself for a few months. When the prednisone stopped working it was immediately apparent and I knew it was time to let go.

 

There is no right answer. You know what your dog will tolerate. Fiona just was not a dog that liked her schedule changed or for strangers to touch her. Chemo treatments were not the right option for her.

[rycezmom]

http://greyhoundhealthinitiative.org/ Dr. Couto

[Guest mmmberry]

There is actually a third option you can discuss with your vet. Alternate prednisone with lukeran (sp?). The lukeran is chemo drug administered orally; it will slow down the progression of the lymphoma but will not result in remission. I used this option with my grey Fiona. She was diagnosed in April and I lost her in October. Honestly, I do not know that I would do it again though, she had a gradual decline and was not the feisty alpha she had been before the diagnosis.

 

On the other hand I had a pointer I fostered who was diagnosed with lymphoma. We opted for just prednisone. The improvement was immediate and he was himself for a few months. When the prednisone stopped working it was immediately apparent and I knew it was time to let go.

 

There is no right answer. You know what your dog will tolerate. Fiona just was not a dog that liked her schedule changed or for strangers to touch her. Chemo treatments were not the right option for her.

 

Thank you for this additional option and for sharing your experiences.

http://greyhoundhealthinitiative.org/ Dr. Couto

 

Thank you, I just emailed Dr. Couto. I read in another thread that he may or may not consult for lymphoma. It never hurts to ask, the worst he can say is no.

[krissy]

I always recommend that people go for the oncology referral. Have a consult and find out all of your options from the expert. Most general practice vets do not know all of the specifics regarding chemo because there are so many protocols that differ depending on cancer type, and even within it as for lymphoma (T-cell vs B-cell). Going for the consult does not commit you to doing chemo, it just gives you all of the information you need to make an informed decision. I've sent lots of clients for consults, many of whom opted just for prednisone, but all have been glad they went for the consult to find out their options and have any and all questions answered.

 

Best of luck; let us know what you decide to do.

[tbhounds]

I also recommend the consult and I would follow up with Dr Couto. Solely your baby is ill.

[EllenEveBaz]

Hugs to you and to Speed Racer.

 

I chose Option 4 with my Romie, also age 9. I had him euthanized right after confirmation of the lymphoma diagnosis. At first I was all geared up for chemo. He was eligible for free chemo through Ohio State . There would have been many other costs, of course, including our local vet's administration of the drugs. Then I rethought. Romie had absolutely no tolerance for discomfort, let alone pain. He hated the vet's and trembled and whined every time we turned into the parking lot, even though everyone there adored him. Our vet was supportive, but I could tell he was disappointed that we weren't going with chemo. He had good success with a non-greyhound of his own -- got a good year. But I was terrified of bad side effects from prednisone OR chemo. And, bluntly, afraid of the stress.

 

I wish Romie were still here, with every part of my being. But for him, and for me, I did the right thing.

 

A link to Romie's lymphoma thread: http://forum.greytalk.com/index.php/topic/302136-bad-news-for-romie/?hl= lymphoma romie

Edited May 20, 2016 by EllenEveBaz

[Hubcitypam]

With Buddy the vets said "he's got two weeks to two months", "I used to treat lympho aggressively with chemo but the time gained was never worth putting the dog through", and assorted other dismal answers. One vet looked into something about mast cell tumors that wasbeing used off label for lymphoma but the cost was prohibitive.

We did pred and he was gone in 16 days with all lymph nodes involved.

[PatricksMom]

I'm sorry, this diagnosis is such an awful one. With Murphy, for a variety of reasons we made the decision to forgo chemo and use prednisone and palliative care medications, he lived about 4 weeks post-diagnosis but it was a good four weeks and we were able to have him euthanized at home, before he started experiencing a lot of pain. For him, it was the right decision, I hope you and your family find the right path for you and your boy.

[Guest mmmberry]

I always recommend that people go for the oncology referral. Have a consult and find out all of your options from the expert. Most general practice vets do not know all of the specifics regarding chemo because there are so many protocols that differ depending on cancer type, and even within it as for lymphoma (T-cell vs B-cell). Going for the consult does not commit you to doing chemo, it just gives you all of the information you need to make an informed decision. I've sent lots of clients for consults, many of whom opted just for prednisone, but all have been glad they went for the consult to find out their options and have any and all questions answered.

 

Best of luck; let us know what you decide to do.

 

Well we had our oncology consult on Friday and I am angry. I feel that I was pushed into going along with the testing just so the specialist could make $$$$. The x-rays and ultrasound were pointless because all that did was stress Speed out. He came out of that with cuts and bruises all over, and half his fur shaved off. Also he urinated all over himself. Probably from fright. The only remark was "x-rays and ultrasound are consistent with lymphoma" so that was a waste of time. I mean, DUH, we already knew he had lymphoma. We were not able to see the x-rays or ultrasounds so that made me mad too. With lack of sleep, I could not think straight. I feel taken.

 

I am glad he got the Elspar, but he didn't need additional testing to get it. Right now he's on prednisone and tramadol and appetite stimulant (can't remember what that is called). I gave him a nice bath. He's trotting around in the yard. I accept he's living on borrowed time.

[Hubcitypam]

Biggest ever to you and Speed. I am so sorry he was so stressed and you are too.

 

I totally feel you pain. When I took my Rex to the specialty center they said he either had GME or a Smore's nodule. We could find out which if he had an MRI and amazingly someone had just cancelled. They could do it right then for an exorbitant amount but if I passed on RIGHT NOW it might be many weeks until the could work him in.

I honestly felt like I was at a "we tote the note" used car dealer and felt like I needed a shower when we left. Told them I'd talk to my vet who said "Either of those two options have a bad prognosis - do you want to spend that much to see which one it is?"

 

Let me give you another . Lymphoma is just so horrid fast and furious. Buddy had to go when the ones in his throat got too big.

Edited May 23, 2016 by Hubcitypam

[tbhounds]

One thing I had hoped your Vet would have done was to test to see what type of lymphoma your dog is inflicted with-T-Cell or B-Cell.

There is a vaccine available that it showing incredible promise but, it's only effective against the B-Cell type. Your dog needs to be in remission ( which surprisingly can happen pretty quickly once starting treatment) and then would receive the vaccine (produced by Merial).

Of course another option is to start pred. Pred can usually cause remission but, as we all know it's full of side effects.

http://library.aratana.com/?media_dl=527

Edited May 23, 2016 by tbhounds

[Hubcitypam]

It all boils down to personal preferences and beliefs. My next door neighbor has been on chemo for over three years for colon cancer that has spread to his liver, lungs and lymph nodes. He has chemo every two weeks now and has maybe one good day a week. I'm seriously never going to go that route. I'd rather have a few good weeks as opposed to months of my body fighting the poison. It's easier to make the decision for yourself than your dogs.

[Guest budsmom]

I'm so sorry, this is an awful diagnosis. We think my Bud had lymphoma but is was so fast we didn't even have time to diagnose positively. I also lost my heart kitty to lymphoma, after going the chemo route. Lymphoma in dogs is not good, cats have much better results from treatment. Whatever you do will be right because it's done out of love.

[EllenEveBaz]

I'm sorry you and Speed had such a bad time at the specialist's. I hope he's out trotting in the yard in the sun.

 

Very interesting about the new vaccine.

[JJNg]

I'm sorry you had a bad experience with the oncology consult. My local referral center doesn't do a lot of tests without first having an in-depth discussion with the owner about options and prognosis. Some clients go in just for the consult to help them make a decision and elect not to do any further testing or treatment.

 

Also, a general comment on chemo in dogs. It in no way compares to chemo in humans. I've had a number of patients receive chemo, and most of them have few to no side effects. Chemo is dosed lower in dogs than in people because the focus is on quality of life, not trying to achieve a cure. In people, they use as high a dose of chemo as possible to increase the chances of getting rid of the cancer. In veterinary medicine, the goal is to slow down the cancer while maintaining the pet's quality of life. Because of this, most dogs will still die of their cancer, but you may be able to get some additional good quality time. This may only be 6 months or a year, compared to a few weeks with no treatment, so it becomes a very personal decision whether that's a route you'd want to go.

[Guest mmmberry]

I'm back with an update. We've been doing the lumostine with prednisone and he was going really well until this week. His lymph nodes started swelling up and getting hard, some of them were poking out of his skin. He had another dose of lumostine on Tuesday 8/16/16 and the oncologist said that it could go two ways: if he doesn't respond to it he can get Elspar on Friday 8/19/16 and if he does respond to it we can wait until next Tuesday 8/23/16 to give him the Elspar. I'm sure I misunderstood since this information was given to me third hand by my boyfriend. I left a message for the oncologist and I'm waiting for a call back.

 

Does this make sense to anyone? I'm pushing my boyfriend to get the Elspar sooner but he's deluding himself into thinking Speed is improving. I know the Elspar is a last-ditch effort so I don't know what difference a few days delay would do. I want Speed to be comfortable and I've prepaid for his euthanasia, we are doing it at home. I was fully expecting to have to put him down before the end of the month. It's already been over two months since he was diagnosed. I have said my goodbyes.

 

This brings me to another problem: boyfriend and I are not on the same page. He keeps crying and saying he doesn't want Speed to die. Speed has to die at some point, let's be real. I'm not happy about it but I'm not going to torture my dog. Today is not the day, but I know it's coming soon. How do I get boyfriend to understand that he needs to prepare himself without sounding cold-hearted? I'm tired of comforting him because no one is comforting me. I keep asking him if he's said goodbye to Speed. I think boyfriend is starting to have magical thinking. Today he accused me of wanting to kill Speed and of being heartless.

 

Speed is having a little trouble standing up when he's lying down, and vice versa. This morning he wanted to go for a walk but didn't make it past the driveway before turning around and walking back into the house. His abdomen is bulging out a lot, so much so that he doesn't have a tuck anymore. I think it's because his spleen is swollen? He has two bleeding/oozing open wounds on his back that I'm cleaning. Also one eye is bulging out and oozing. The other eye is oozing a little bit but it's not bulging out. He has a good appetite and actually gained three or four pounds in the last month.

 

All advice and sympathy is appreciated!

[tbhounds]

Oh my--I'm sorry. Its time to release him from his ailing body. Personally, I would not pursue any further treatment--just because we could doesn't mean we should. What I would do is see if your vet can make a home euthanasia visit. If your vet can't then , I would ask for a referral for another clinic that could. Having him home in his own bed without stress without fear will allow his passing a much more peaceful one. I'm sorry that your boyfriend is fighting the painful truth but, allowing your boy to cross will be the most loving thing you can do for him. Doesn't he deserve that? Sadly, when we sign up as adopters we all will need to part with our beloved friend--your boys time has come. I wish you strength and courage.

Edited August 18, 2016 by tbhounds

[Hubcitypam]

Oh my--I'm sorry. Its time to release him from his ailing body. Personally, I would not pursue any further treatment--just because we could doesn't mean we should. What I would do is see if your vet can make a home euthanasia visit. If your vet can't then , I would ask for a referral for another clinic that could. Having him home in his own bed without stress without fear will allow his passing a much more peaceful one. I'm sorry that your boyfriend is fighting the painful truth but, allowing your boy to cross will be the most loving thing you can do for him. Doesn't he deserve that? Sadly, when we sign up as adopters we all will need to part with our beloved friend--your boys time has come. I wish you strength and courage.

Very well stated. Buddy made it easy for me as the nodes in his throat started shutting off his breathing. It was time. I am a big believer a day too early than a day too late.

[Neighsayer]

Hugs to you! His body is saying that he has run out of time. Please don't continue with additional treatments. Read what you wrote. Bleeding wounds. Bulging, oozing eye. Bulging abdomen. Trouble getting up and down. Wouldn't go for a walk. Why would you want to prolong this? It is Sooo hard to do the right thing, but it is time! Make the call out of love for him!

[45MPHK9]

Oh my--I'm sorry. Its time to release him from his ailing body. Personally, I would not pursue any further treatment--just because we could doesn't mean we should. What I would do is see if your vet can make a home euthanasia visit. If your vet can't then , I would ask for a referral for another clinic that could. Having him home in his own bed without stress without fear will allow his passing a much more peaceful one. I'm sorry that your boyfriend is fighting the painful truth but, allowing your boy to cross will be the most loving thing you can do for him. Doesn't he deserve that? Sadly, when we sign up as adopters we all will need to part with our beloved friend--your boys time has come. I wish you strength and courage.

Yes, yes.

 

I'm so sorry for what you're going through.

[robinw]

I'm so sorry that this is happening. It really sucks.

[PatricksMom]

I'm so sorry, so sorry, it really does sound like it's time to let Speed go, but I think you know that. I'm sorry that your BF can't be supportive.

[NeylasMom]

I'm sorry. I'm wrestling with the same decisions and it's a double-edged sword either way - I am single so my decisions do t have to take anyone else's feelings into account, but that means I do all of the second-guessing, carry all of the guilt and take on all of the stress and work by myself. But honestly, I can't imagine watching my dog suffer because my partner wasn't ready to let him go so I guess I will take alone. In any event, I'm very sorry you're in this tough place and that your boyfriend seems to be dealing with his own grief by being insensitive to you. I hope you can find a common ground.

 

No advice on the treatment aspect except to say that in the many threads I've seen on this site dealing with end of life decisions I've rarely seen such emphatic recommendations to one end. Maybe sharing the responses with your boyfriend would help him come to terms?

Edited August 19, 2016 by NeylasMom

[MP_the4pack]

His weight gain is ascites. Fluid in the belly.

 

I'm so sorry. I have 7 at the Bridge and it never gets easier.