Archive for Canine Lymphoma
Results of the Bone Marrow Aspiration
I’d like to start with some nice “before and after†pictures…I think Sarge’s throat is less swollen just 24 hours after the first treatment!
Throat when first diagnosed
One day after 1st treatment
Dr. Hamilton had said there should be dramatic improvement initially, which is why he did not want to wait to start treatment. Yay for Sarge! Thank you, Dr. Hamilton!
Moving on to the more sobering part of the afternoon. Sobering but still hopeful.
Dr. Hamilton called this afternoon and said Sarge has very early signs of bone marrow involvement. Argh! Which officially makes him Stage 5. One hundred times arghhhhhhhhhhhhhh!
Dr. Hamilton, however, was not overly concerned about the bone marrow involvement because it is very slight. He also said staging was not prognostic with dogs and that it does not relate to how much time he has left.
Only 10 – 15% of dogs show bone marrow involvement.
Today he said 80 – 90% of dogs respond well to treatment, with 12 – 15 month survival time on average. A quarter of them make it to 2 years, and if they make it past 2 years, they are considered home-free!
So what are we going to do about this nasty cancer?
Dr. Hamilton plans to use the Wisconsin Protocol (which he also called a form of CHOP) to treat Sarge. Typically there will be 16 treatments over a 25-week period, with 3 drugs given over a 4 drug cycle (one is repeated) and a total of 4 cycles.
The vet’s office is going to give me a print-out of the treatment plan, but I found this online and it appears to be what they are recommending:
Week 1 – Asparaginase (which technically he got in Week 0, i.e., yesterday), Vincristine, Prednisone
Week 2 – Cytoxan, Prednisone
Week 3 – Vincristine, Prednisone
Week 4 – Adriamycin, Prednisone
Week 5 – Take a break from vet visits (although we continue with the Prednisone for one more week)
Week 6 – Vincristine
Week 7 – Cytoxan
Week 8 – Vincristine
Week 9 – Adriamycin
Week 10 – Take a break!
Week 11 – Vincristine (now we are on an every-other-week schedule)
Week 13 – Cytoxan
Week 15 – Vincristine
Week 17 – Adriamycin
Week 19 – Vincristine
Week 21 – Cytoxan
Week 23 – Vincristine
Week 25 – Adriamycin
Possible side effects by drug:
- Vincristine – no side effects; out-patient service.
- Cytoxan – 5% of dogs have blood in their urine. If I see this happening, I need to call Dr. Hamilton. Out-patient service.
- Adriamycin – 10 to 15% of dogs have side effects, which are usually GI in nature: loss of appetite, constipated diarrhea. Problems can show up 4 – 14 days after the treatment. Side effects can be minimized with Pepto Bismol. Sarge will need to be dropped off at the hospital for this drug treatment.
I asked Dr. Hamilton for the bottom line: besides the financial considerations, why would I not do this? He said if Sarge was his dog, he would do it in a heartbeat. Sounds like a plan to me.
But then there is the little factor of cost…for budgeting purposes…
After talking to Dr. Hamilton, the nurse called me and explained the protocol in more detail. What she explained seemed to match up pretty closely to the info I found online and posted above.
Cost-wise, she said the Vincristine will be $ 175 per treatment, the Cytoxan will be $ 195, and the Adriamycin (gulp) will be $ 400. There is some hope for relief on the Adriamycin cost if they eliminate the backorders that exist on the generic version of this drug. Apparently the problem is nation-wide, and it is affecting canines and humans who need it. Hopefully, by week 4, the generic will be back in supply. Surely by week 9! All costs include a full exam and a CBC test as well as the drug itself. If they decide not to proceed with a treatment one week, I will be charged for the cost of the exam and CBC only.
I asked the nurse how the treatment plan would change once they get the results of the PCR, which diagnoses B (Better) vs. T (Tougher) type of lymphoma. She said it would affect how aggressively they pursue the treatment schedule. If Sarge has type B (oh please, oh please, oh please) then they may be more willing to take a break from the plan if he shows signs of needing it (e.g., his blood count is not where it should be). If he has T type (Boo! Hiss!), then they might be more likely to stick to the schedule. The PCR results are due back 14 days from yesterday.
I also asked the nurse when I get my prescription for Valium. When does the owner get some prescription relief? 
We have an appointment for our first Vincristine injection next Wednesday, the 22nd. We should be in and out of there in 45 minutes. In the meantime, we are going to take it easy and hopefully, have some fun.
P.S. I must mention that the vet’s prediction of increased frequency of urination has come true. And not just frequency, but volume too. I took Sarge out to pee last night around 10 PM and when I woke up this morning a little after 7 AM, I found a puddle in the living room…mostly on the hardwoods (which was easy to clean) but a little on the Oriental rug. Oh well. I am so *over* worrying about the state of my carpeting! Sarge also had loose stools today (the late afternoon deposit had a little bit of blood too), but then Daphne’s stools were also a little loose today. (I won’t go into the state of mine.) I think we are all suffering the side effects of stress!
Sarge’s Tale
I’m compelled to start blogging again because my beloved greyhound, Sarge, has been diagnosed with lymphoma. I want to record all the details, which will help me to process the information. I also want to describe the roller coaster on which we are about to ride in case there are others out there who might benefit from reading a first-hand experience.
(I called this post “Sarge’s Tale†but I don’t want to forget my other sweet hound, Daphne. So, over the coming months, we will be covering some of Daphne’s escapades too.)
It started on Labor Day weekend 2010, when I noticed that Sarge’s throat was a little swollen. It looked like he had a goiter.
Sarge’s swollen throat
Luckily I noticed on Saturday morning so I could call my regular vet (Dr. Fowler) and make an appointment, the first available being Wednesday afternoon. He did a fine needle aspiration, and two days later, I got the bad news that it appeared to be lymphoma.
Dr. Fowler recommended that I take Sarge to see an oncologist named Dr. Hamilton, and within minutes I had made an appointment for Tuesday, the 14th (yesterday).
Unfortunately Dr. Hamilton said Sarge definitely has lymphoma. He could feel that all the lymph nodes near the outside of Sarge’s body are swollen (which must have developed since I saw my regular vet last Wednesday because he said only the lymph nodes in Sarge’s throat were swollen at that time). The oncologist also did an x-ray of Sarge’s chest and an ultrasound of his belly as well as another fine needle aspiration to figure out what type of lymphoma he has. The good news is that there were no signs that the lymphoma has spread to other organs, e.g., the lungs, liver, or spleen. The vet did see that some of the lymph nodes in Sarge’s stomach were mildly enlarged but overall it was relatively good news. He recommended that we come in the next day (today) for – it sends shivers down my spine – a bone marrow aspirate and Sarge’s first chemotherapy injection.
Even though a bone marrow sample is painful for a human, the vet says animals do not have the same reaction. Plus, he will be asleep while they are doing it, poor boy.
The oncologist will come up with a specific treatment plan after the results of all the tests are in but he wants to start the chemo tomorrow because this cancer can spread rapidly. He said 75 – 90% of dogs respond well to the chemo and that on average it can extend their life by 12 – 15 months; 25% make it to 2 years. Extended time with good quality of life and minor side effects from the chemo. Without chemo, Sarge would die in 1 – 2 months. 
I set 3 alarms this morning to make sure I got up in time to make Sarge’s “before 8 AM†drop-off time. Both he and Daphne were wondering what was going on since I tend to roll out of bed around 7:30 AM. (Waking up in the dark just doesn’t make sense to me.) So after showering, I came downstairs, and I was trying to figure out how I was going to feed Daphne without hurting Sarge’s feelings since he was – again! – not allowed any breakfast. They heard me rattling around in the kitchen and both of them came scampering in, Sarge with this big smile on his face. Time to eat! Poor boy. No food for you this morning.
We made it to the animal hospital in just over 30 minutes, which was pretty good for rush hour. After checking in, the tech came to take my boy away and I nearly lost it. I was just praying that everything would go perfectly today.
After many nervous hours at work, I got the call to come pickup Sarge. All had gone well!
So I brought my boy home, and he crashed on the floor after eating some pieces of chicken and a small snack of kibble. I also gave him his first dose of prednisone, which may increase his thirst, appetite, and need to pee. He doesn’t appear to be in any pain.
Sarge crashes at home after his first chemo treatment
Close-up of the bone marrow aspiration point
I’m hoping that Sarge beats all the odds and makes it beyond two years! In the meantime, we will be doing lots of fun things to keep his mind off our regular trips to the vet’s office.
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